HIV Plus Magazine #86

Black HIV/AIDS Awareness Special Edition + Two and a Half Men Star Holland Taylor

ne w y ear new lo o k !

H E A L T H + S P I R I

10 Ways to Look Sexy Feeling and looking great doesn’t end when you’ve got HIV

Testing for Teens What age is too young to get screened?

T + C U L T U R E + L I F E

100?

CAN YOU LIVE TO

Expert advice that’ll help you live a long, happy life

our dreamgirl

SHERYL LEE RALPH

january/february 2012 www.hivplusmag.com

From Good Times to Moesha to Barbershop, this Hollywood mainstay still leads the way as an activist and fund-raiser for HIV causes

The

one

for me

Patient model. Pill shown is not actual size.

INDICATION COMPLERA (emtricitabine 200 mg/rilpivirine 25 mg/tenofovir disoproxil fumarate 300 mg) is a prescription HIV medicine that contains 3 medicines, EMTRIVA® (emtricitabine), EDURANT™ (rilpivirine), and VIREAD® (tenofovir disoproxil fumarate) combined in one pill. COMPLERA is used as a complete single-tablet regimen to treat HIV-1 infection in adults (age 18 and older) who have never taken HIV medicines before. ®

COMPLERA does not cure HIV and has not been shown to prevent passing HIV to others. It is important to always practice safer sex, use latex or polyurethane condoms to lower the chance of sexual contact with any body fluids, and to never re-use or share needles. Do not stop taking COMPLERA unless directed by your healthcare provider. See your healthcare provider regularly.

IMPORTANT SAFETY INFORMATION Contact your healthcare provider right away if you get the following side effects or conditions while taking COMPLERA: • Nausea, vomiting, unusual muscle pain, and/or weakness. These may be signs of a buildup of acid in the blood (lactic acidosis), which is a serious medical condition • Light-colored stools, dark-colored urine, and/or if your skin or the whites of your eyes turn yellow. These may be signs of serious liver problems (hepatotoxicity), with liver enlargement (hepatomegaly), and fat in the liver (steatosis) • If you have HIV-1 and hepatitis B virus (HBV), your liver disease may suddenly get worse if you stop taking COMPLERA. Do not stop taking COMPLERA without first talking to your healthcare provider. Your healthcare provider will monitor your condition COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works, and may cause serious side effects.

Do not take COMPLERA if you are taking the following medicines: • other HIV medicines (COMPLERA provides a complete treatment for HIV infection.)

• the anti-seizure medicines carbamazepine (Carbatrol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®, Epitol®), oxcarbazepine (Trileptal®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®) • the anti-tuberculosis medicines rifabutin (Mycobutin), rifampin (Rifater®, Rifamate®, Rimactane®, Rifadin®) and rifapentine (Priftin®) • a proton pump inhibitor medicine for certain stomach or intestinal problems, including esomeprazole (Nexium®, Vimovo®), lansoprazole (Prevacid®), omeprazole (Prilosec®), pantoprazole sodium (Protonix®), rabeprazole (Aciphex®) • more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate • St. John’s wort (Hypericum perforatum) • other medicines that contain tenofovir (VIREAD®, TRUVADA®, ATRIPLA®) • other medicines that contain emtricitabine or lamivudine (EMTRIVA®, Combivir®, Epivir® or Epivir-HBV®, Epzicom®, Trizivir®) • rilpivirine (Edurant™) • adefovir (HEPSERA®) In addition, also tell your healthcare provider if you take: • an antacid medicine that contains aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA • a histamine-2 blocker medicine, including famotidine (Pepcid®), cimetidine (Tagamet®), nizatidine (Axid®), or ranitidine hydrochloride (Zantac®). Take these medicines at least 12 hours before or at least 4 hours after you take COMPLERA • the antibiotic medicines clarithromycin (Biaxin®), erythromycin (E-Mycin®, Eryc®, Ery-Tab®, PCE®, Pediazole®, Ilosone®), and troleandomycin (TAO®) • an antifungal medicine by mouth, including fluconazole (Diflucan®), itraconazole (Sporanox®), ketoconazole (Nizoral®), posaconazole (Noxafil®), voriconazole (Vfend®) • methadone (Dolophine®) This list of medicines is not complete. Discuss with your healthcare provider all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take.

COMPLERA is a prescription medicine used as a complete single-tablet regimen to treat HIV-1 in adults who have never taken HIV medicines before. COMPLERA does not cure HIV or AIDS or help prevent passing HIV to others.

New COMPLERA A complete HIV treatment in only 1 pill a day.

Ask your healthcare provider if it’s the one for you.

Before taking COMPLERA, tell your healthcare provider if you: • have liver problems, including hepatitis B or C virus infection • have kidney problems • have ever had a mental health problem • have bone problems • are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child • are breastfeeding; women with HIV should not breast-feed because they can pass HIV through their milk to the baby Contact your healthcare provider right away if you experience any of the following serious or common side effects: Serious side effects associated with COMPLERA: • New or worse kidney problems can happen in some people who take COMPLERA. If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA • Depression or mood changes can happen in some people who take COMPLERA. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, or if you have thoughts of hurting yourself (suicide) or have tried to hurt yourself • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones • Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long-term health effect of these conditions are not known • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting your HIV medicine

Common side effects associated with COMPLERA: • trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression Other side effects associated with COMPLERA: • vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles),

and pain Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of COMPLERA. For more information, ask your healthcare provider or pharmacist. Call your healthcare provider for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Take COMPLERA exactly as your healthcare provider tells you to take it • Always take COMPLERA with a meal. Taking COMPLERA with a meal is important to

help get the right amount of medicine in your body. A protein drink does not replace a meal • Stay under the care of your healthcare provider during treatment with COMPLERA and see your healthcare provider regularly

Please see Patient Information for COMPLERA on the following pages.

Learn more at www.COMPLERA.com

FDA-Approved Patient Labeling Patient Information COMPLERA® (kom-PLEH-rah) (emtricitabine, rilpivirine and tenofovir disoproxil fumarate) Tablets

COMPLERA may help: • Reduce the amount of HIV in your blood. This is called your “viral load”.

• Increase the number of white blood cells called CD4+ (T) cells that help fight off other infections.

Important: Ask your doctor or pharmacist about medicines that should not be taken with COMPLERA. For more information, see the section “What should I tell my healthcare provider before taking COMPLERA?”

Reducing the amount of HIV and increasing the CD4+ (T) cell count may improve your immune system. This may reduce your risk of death or infections that can happen when your immune system is weak (opportunistic infections).

Read this Patient Information before you start taking COMPLERA and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.

What is the most important information I should know about COMPLERA?

COMPLERA does not cure HIV infections or AIDS. • Always practice safer sex.

• Use latex or polyurethane condoms to lower the chance of sexual contact with any body fluids such as semen, vaginal secretions, or blood.

• Never re-use or share needles.

Ask your healthcare provider if you have any questions about how to prevent passing COMPLERA can cause serious side effects, including: 1. Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in HIV to other people. some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic Who should not take COMPLERA? acidosis is a serious medical emergency that can lead to death.

• Do not take COMPLERA if your HIV infection has been previously treated with Lactic acidosis can be hard to identify early, because the symptoms could seem like HIV medicines. symptoms of other health problems. Call your healthcare provider right away if you • Do not take COMPLERA if you are taking certain other medicines. For more get any of the following symptoms which could be signs of lactic acidosis: information about medicines that must not be taken with COMPLERA, see “What • feeling very weak or tired should I tell my healthcare provider before taking COMPLERA?” • have unusual (not normal) muscle pain • have trouble breathing What should I tell my healthcare provider before taking COMPLERA? • have stomach pain with Before you take COMPLERA, tell your healthcare provider if you: - nausea (feel sick to your stomach) • have liver problems, including hepatitis B or C virus infection - vomiting • have kidney problems • feel cold, especially in your arms and legs • have ever had a mental health problem • feel dizzy or lightheaded • have bone problems • have a fast or irregular heartbeat • are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child Pregnancy Registry. There is a pregnancy registry for women who take antiviral medicines during pregnancy. Its purpose is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry.

Call your healthcare provider right away if you have any of the following symptoms • are breast-feeding or plan to breast-feed. The Centers for Disease Control and of liver problems: Prevention recommends that mothers with HIV not breastfeed because they can pass • your skin or the white part of your eyes turns yellow (jaundice). the HIV through their milk to the baby. It is not known if COMPLERA can pass through • dark “tea-colored” urine your breast milk and harm your baby. Talk to your healthcare provider about the best • light-colored bowel movements (stools) way to feed your baby.

• loss of appetite for several days or longer Tell your healthcare provider about all the medicines you take, including prescription • nausea and nonprescription medicines, vitamins, and herbal supplements.

• stomach pain 2. Severe liver problems. Severe liver problems can happen in people who take COMPLERA or similar medicines. In some cases these liver problems can lead to death.

Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis) when you take COMPLERA.

You may be more likely to get lactic acidosis or severe liver problems if you are COMPLERA may affect the way other medicines work, and other medicines may female, very overweight (obese), or have been taking COMPLERA or a similar affect how COMPLERA works, and may cause serious side effects. If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and medicine containing nucleoside analogs for a long time. it may not work to help control your HIV infection. The HIV virus in your body may become 3. Worsening of Hepatitis B infection. If you also have hepatitis B virus (HBV) infection resistant to COMPLERA or other HIV medicines that are like it. and you stop taking COMPLERA, your HBV infection may become worse (flare-up). A “flare-up” is when your HBV infection suddenly returns in a worse way than before. Do not take COMPLERA if you also take these medicines: COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV • COMPLERA provides a complete treatment for HIV infection. Do not take other HIV medicines with COMPLERA. therapy with your healthcare provider.

• the anti-seizure medicines carbamazepine (CARBATROL®, EQUETRO®, TEGRETOL®, • Do not let your COMPLERA run out. Refill your prescription or talk to your healthcare TEGRETOL-XR®, TERIL®, EPITOL®), oxcarbazepine (TRILEPTAL®), phenobarbital provider before your COMPLERA is all gone.

(LUMINAL®), phenytoin (DILANTIN®, DILANTIN-125®, PHENYTEK®) • Do not stop taking COMPLERA without first talking to your healthcare provider. ® ® • If you stop taking COMPLERA, your healthcare provider will need to check your health • the anti-tuberculosis medicines rifabutin (MYCOBUTIN ), rifampin (RIFATER , ® ® ® ® RIFAMATE , RIMACTANE , RIFADIN ) and rifapentine (PRIFTIN ) often and do regular blood tests to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking • a proton pump inhibitor medicine for certain stomach or intestinal problems, including esomeprazole (NEXIUM®, VIMOVO®), lansoprazole (PREVACID®), omeprazole COMPLERA. (PRILOSEC®), pantoprazole sodium (PROTONIX®), rabeprazole (ACIPHEX®) • more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium What is COMPLERA? COMPLERA is a prescription HIV (Human Immunodeficiency Virus) medicine that: phosphate • is used to treat HIV-1 in adults who have never taken HIV medicines before. HIV is the • St. John’s wort (Hypericum perforatum) virus that causes AIDS (Acquired Immunodeficiency Syndrome).

If you are taking COMPLERA, you should not take: • contains 3 medicines, (rilpivirine, emtricitabine, tenofovir disoproxil fumarate) • other medicines that contain tenofovir (VIREAD®, TRUVADA®, ATRIPLA®) combined in one tablet. EMTRIVA and VIREAD are HIV-1 (human immunodeficiency • other medicines that contain emtricitabine or lamivudine (EMTRIVA®, COMBIVIR®, virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and EDURANT is an EPIVIR® or EPIVIR-HBV®, EPZICOM®, TRIZIVIR®) HIV-1 non-nucleoside analog reverse transcriptase inhibitor (NNRTI).

• rilpivirine (EDURANT™) It is not known if COMPLERA is safe and effective in children under the age of 18 years. • adefovir (HEPSERA®)

Also tell your healthcare provider if you take: The most common side effects of COMPLERA include: • an antacid medicine that contains aluminum, magnesium hydroxide, or calcium • trouble sleeping (insomnia) carbonate. Take antacids at least 2 hours before or at least 4 hours after you take • abnormal dreams COMPLERA. • headache • a histamine-2 blocker medicine, including famotidine (PEPCID®), cimetidine • dizziness (TAGAMET®), nizatidine (AXID®), or ranitidine hydrochloride (ZANTAC®). Take these • diarrhea medicines at least 12 hours before or at least 4 hours after you take COMPLERA. • nausea ® ® ® • the antibiotic medicines clarithromycin (BIAXIN ), erythromycin (E-MYCIN , ERYC , • rash ERY-TAB®, PCE®, PEDIAZOLE®, ILOSONE®), and troleandomycin (TAO®) • tiredness • an antifungal medicine by mouth, including fluconazole (DIFLUCAN®), itraconazole ® ® ® (SPORANOX ), ketoconazole (NIZORAL ), posaconazole (NOXAFIL ), voriconazole • depression (VFEND®) Additional common side effects include: • methadone (DOLOPHINE®) • vomiting Ask your healthcare provider or pharmacist if you are not sure if your medicine is • stomach pain or discomfort • skin discoloration (small spots or freckles) one that is listed above.

Know the medicines you take. Keep a list of your medicines and show it to your • pain healthcare provider and pharmacist when you get a new medicine. Your healthcare provider and your pharmacist can tell you if you can take these medicines with COMPLERA. Do not start any new medicines while you are taking COMPLERA without first talking with your healthcare provider or pharmacist. You can ask your healthcare provider or pharmacist for a list of medicines that can interact with COMPLERA. How should I take COMPLERA? • Stay under the care of your healthcare provider during treatment with COMPLERA. • Take COMPLERA exactly as your healthcare provider tells you to take it.

• Always take COMPLERA with a meal. Taking COMPLERA with a meal is important to help get the right amount of medicine in your body. A protein drink does not replace a meal.

• Do not change your dose or stop taking COMPLERA without first talking with your healthcare provider. See your healthcare provider regularly while taking COMPLERA. • If you miss a dose of COMPLERA within 12 hours of the time you usually take it, take your dose of COMPLERA with a meal as soon as possible. Then, take your next dose of COMPLERA at the regularly scheduled time. If you miss a dose of COMPLERA by more than 12 hours of the time you usually take it, wait and then take the next dose of COMPLERA at the regularly scheduled time.

• Do not take more than your prescribed dose to make up for a missed dose.

• When your COMPLERA supply starts to run low, get more from your healthcare provider or pharmacy. It is very important not to run out of COMPLERA. The amount of virus in your blood may increase if the medicine is stopped for even a short time.

• If you take too much COMPLERA, contact your local poison control center or go to the nearest hospital emergency room right away.

What are the possible side effects of COMPLERA? COMPLERA may cause the following serious side effects, including: • See “What is the most important information I should know about COMPLERA?” • New or worse kidney problems can happen in some people who take COMPLERA. If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA. • Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: - feeling sad or hopeless - feeling anxious or restless - have thoughts of hurting yourself (suicide) or have tried to hurt yourself • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones.

• Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known.

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time.

Tell your healthcare provider if you start having new symptoms after starting your HIV medicine.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of COMPLERA. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 (1-800-332-1088).

How do I store COMPLERA? • Store COMPLERA at room temperature 77 °F (25 °C).

• Keep COMPLERA in its original container and keep the container tightly closed.

• Do not use COMPLERA if the seal over the bottle opening is broken or missing.

Keep COMPLERA and all other medicines out of reach of children.

General information about COMPLERA: Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use COMPLERA for a condition for which it was not prescribed. Do not give COMPLERA to other people, even if they have the same symptoms you have. It may harm them.

This leaflet summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals. For more information, call (1-800-445-3235) or go to www.COMPLERA.com.

What are the ingredients of COMPLERA? Active ingredients: emtricitabine, rilpivirine hydrochloride, and tenofovir disoproxil fumarate Inactive ingredients: pregelatinized starch, lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, magnesium stearate, povidone, polysorbate 20. The tablet film coating contains polyethylene glycol, hypromellose, lactose monohydrate, triacetin, titanium dioxide, iron oxide red, FD&C Blue #2 aluminum lake, FD&C Yellow #6 aluminum lake.

This Patient Information has been approved by the U.S. Food and Drug Administration Manufactured and distributed by: Gilead Sciences, Inc. Foster City, CA 94404 Issued: August 2011 COMPLERA, the COMPLERA Logo, EMTRIVA, HEPSERA, TRUVADA, VIREAD, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc. or its related companies.

ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other trademarks referenced herein are the property of their respective owners. © 2011 Gilead Sciences, Inc. All rights reserved.

202123-GS-000 02AUG2011 CON11218 11/11

in this issue

January+February 2012

36

status symbols 6 THINKING OUTSIDE THE BOX A North Carolina group uses Craigslist to overcome fear.

8 Settling For Life Helping a friend with AIDS turned into a real business.

8 GAY PANIC A new study suggests that gay HIVers face a heightened risk of domestic abuse.

9 Open and Shut While new HIV care facilities open, other centers close their doors.

around the globe 13 ONE LIFE U2’s Bono fights poverty and preventable disease by raising public awareness.

haart beats

40 Testing for Teens?

The age at which a person should first be tested for HIV depends on whom you ask.

42 Booze Bust Three new studies aim to find out how harmful alcohol is to people with HIV.

43 Pregnancy SCARE Does a popular contraceptive contribute to the spread of HIV?

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Scientists test a skin patch that may be the best way for you to take your HIV meds.

36 Diva Does Good

Sheryl Lee Ralph fights to end stigma and raise money for HIV prevention.

24 Money Changes Everything

columns 44 MIND + MOOD The end of a year is the perfect time to check in on your goals—just remember to reflect, not critique.

46 MESSAGE IN A BOTTLE For HIVers, menopause should be a real celebration—despite the hot flashes.

ALSO 48 ASK & TELL: Holland Taylor

The world’s top thinkers consider a shift in priorities on HIV spending in the world’s hardest-hit areas.

31 15 Ways to Live to Be 100

People with HIV can live well into their golden years. Here are 15 key ways to promote long life.

26 African-Americans Talk About HIV

Every nine and a half minutes, somewhere in America, someone is infected with HIV. Half are them are black. These are their stories.

22 You Look Marvelous!

You’re beautiful on the inside—make yourself just as stunning on the outside.

clock wise from top: courtesy diva foundation; photos.com; courtesy alfa

43 A Whole New Kind of Patch

Now on

HIVPlusMag.com Editor in chief

Diane Anderson-Minshall

managing Editor Winston

Gieseke Scott McPherson Senior Editor Neal Broverman digital Editor Michelle Garcia contributing editor Michael Matson editorial intern Ivan Villanueva creative director

manager, editorial and marketing operations

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Trudy Ring

HERE MEDIA

Stephen P. Jarchow ceo Paul Colichman cfo Tony Shyngle cPo Robert Ames executive vice president Stephen Macias senior vice president & group publisher Joe Landry advocate group editorial director Matthew Breen senior vice presidents Christin Dennis, Alex Paul, Bernard Rook, Josh Rosenzweig vice presidents John Knoebel, Joe Valentino chairman

Publisher

Joe Valentino

senior director, client services

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Magic Johnson: HIV’s MVP

Twenty years ago Earvin "Magic" Johnson shocked the world when he announced he had HIV and was retiring from the NBA. After initially enduring an uphill battle with the virus, Johnson is healthier than ever. He's not only a symbol of living well with HIV, he has also utilized his celebrity to bring economic ventures to low-income communities. The basketball legend tells us about his diagnosis and discusses his regrets about retiring at age 32, the disproportionate effect HIV has on African-Americans, and his feelings on the disease two decades after his announcement.

Follow us on Facebook and Twitter Find daily news, features, guest commentaries, and more on Facebook and Twitter.

If you have any questions or problems with your bulk or individual magazine delivery, just email our circulation department at Jeff.Lettiere@HereMedia.com. what’s your story?

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Do you have an interesting story about yourself or someone you know that you want to share? You might be a candidate for a profile in one of our departments or another section. We want to hear from you, and we want to know what you’ve been up to. So email us at mail@HIVPlusMag.com or write us at HIV Plus, 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. We’ll even take faxes at (310) 806-4268.

HIV Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. HIV Plus is a registered trademark of Here Media Inc. Entire contents © 2012 by Here Publishing Inc. All rights reserved. Printed in the USA.

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• j a n u a r y/ f e b r u a r y 2 0 1 2

Thinking Outside the Box

ALFA’s David Zealy (left), Rodney Tucker

courtesy alfa

In one of the most conservative corners of America, an AIDS service organization uses gay hookup app Grindr to overcome fear hiv stigma is so intense in the Appalachian foothills of western North Carolina that many people walk into the offices of the AIDS Leadership Foothills-Area Alliance having progressed to AIDS. “When we look at our new clients from last year, 90% came in with an AIDS diagnosis,” ALFA executive director Rodney Tucker tells HIV Plus from his office in Hickory, N.C. “They’ve been positive for a long time and they’re coming in through the emergency room—they’re coming in very sick.”

ALFA, which provides outreach, education, counseling, testing, and referrals though state, federal, and private funding, has a client base that is mostly Caucasian men, many of whom have sex with other men but don’t identify as gay. Many of these men, often married to women, are driven to extremely risky behavior because of internalized homophobia and shame, according to surveys conducted by ALFA. “It reminds me of what was happening in the ’80s [in other areas],” Tucker says. “A lot of park hookups. Sex in the saunas, the gyms, on Blue Ridge Parkway. While they’re having all this risky behavior, they’re not getting tested.”

These men would rarely talk to their primary care physician about HIV concerns, Tucker says. And when considering visiting a clinic like ALFA, their fears about their reputation often outweigh their health worries.

“Many men are afraid to come into our office because they think if anyone sees them coming to an AIDS service organization, they’re already tagged as being gay or

positive,” Tucker says.

To reach these men before they’re sick, Tucker, along with ALFA’s director of education, David Zealy, recently came up with some novel approaches. Using Tucker and Zealy’s own pictures, the men, both gay themselves, created profiles on the menseeking-men section of Craigslist and through the gay hookup smart phone app Grindr. When people click on their profiles or ads, they see friendly messages about testing and where to go if they have health questions.

“Most people have a blank screen as a profile,” Tucker says, describing the agency’s patients. “The last two that came in were married and had been having sex with men for the majority of their lives. One was 50, another in his 30s.”

Many of those reached through Grindr and Craigslist are out of work and have ample time to cruise for unsafe sex.

“Most people are very poor and unemployed,” Tucker says. “Hitting Craigslist gives them something to do during the day.”

Tucker and Zealy’s unusual gambit is working—on the fall day that Tucker spoke to HIV Plus, three people contacted them through Grindr. Tucker and Zealy tell some of the more skittish men that ALFA representatives can come to their homes to provide testing and services in private.

Seeing success in their approach, Tucker and Zealy hope to expand their outreach to other gay-popular sites. Their innovative method uncovered “an invisible population that we didn’t know how to find otherwise,” Tucker says. —Neal Broverman

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STATUS SYMBOLS status symbols

Shocking Stats on Partner Abuse

Two decades ago the AIDS epidemic inspired a secondary market for unwanted or unneeded life insurance policies that help people in need when they need it in the late 1980s a close friend of Wm. Scott Page was diagnosed with HIV, which soon progressed to AIDS. With his funds deteriorating as quickly as his health, it became apparent that the friend—whose only remaining asset was a life insurance policy he couldn’t afford to maintain—was no longer able to provide for himself.

It was then that Page came up with an idea: to offer his friend’s insurance policy to someone who could provide an immediate lump sum of cash in exchange for the benefit it would eventually pay out. Unfortunately, most financial institutions found the plan to be too risky at the time. But seeing an important opportunity to provide a service for those in need, Scott took on the business himself, and, in 1989, he formed the Lifeline Program (TheLifeline.com).

At the time Page had no idea that his devotion to his friend and other people with AIDS would boom into a billiondollar industry that would allow people with unneeded life insurance to enjoy the benefits

A Sexy Calendar for the Cure

of that money during their lifetime.

Today, the Tucker, Ga.–based Lifeline Program is a leader in what has become known as the life settlement industry. In 2005 actress Betty White (seen most recently in Hot in Cleveland) signed on as the company’s first celebrity spokesperson.

“Betty White is one of America’s most recognizable and beloved faces,” says Page, now Lifeline’s president and CEO, “particularly when it comes to seniors. She will help us to teach thousands of seniors how to uncover hidden wealth by selling their life insurance policies.”

While each person choosing a life settlement has a unique reason for doing so—some need additional funds to pay for alternative medical treatment, while others want to take that once-in-a-lifetime vacation or help pay for their grandchildren’s education—the Lifeline Program and other life settlement providers assist people in finding the resources they need to accomplish their goals, whatever they may be.—Winston Gieseke

Want to help raise money and support a fellow HIVer? Get your friends a copy of Jack Mackenroth’s 2012 Calendar for the Cure and 100% of all profits will go directly to amfAR, the Foundation for AIDS Research.

Mackenroth, who came out as HIV-positive on season 4 of Project Runway in 2007, was voted one of the sexiest men alive for 2011 by Australian magazine DNA (along with Ryan Reynolds and Ricky Martin).

Mackenroth’s new calendar features sexy images of the fitness model, designer, and champion swimmer by various photographers. Mackenroth assembled the calendar to recognize the 30-year anniversary of the AIDS epidemic—and show that people with HIV (he’s been positive since 1990) can be healthy, fit, attractive, and vibrant. JackMackenroth.com/2012calendar

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clock wise from top: photos.com (2); carsten fleck

Settling for Life

It’s long been acknowledged that in addition to the physical complications of HIV, people with the virus face emotional and social problems, such as depression, stigma, and discrimination. Now a new study suggests that gay HIVers face a heightened risk of yet another societal malady—domestic abuse.

Researchers from Boston and Seattle looked at a sample of 168 HIVpositive gay men and found that half had experienced psychological abuse by a partner in the previous year. Physical and sexual abuse were also fairly common, with rates either comparable to or higher than those reported in recent studies of HIV-positive women and older studies of HIV-positive gay and bisexual men.

“The high prevalence of partner abuse we discovered…indicates the importance of systematic screening for all patients in HIV care settings—including men— despite common perceptions that only women are victims [of abuse] and men are perpetrators,” wrote the researchers, who published their study in the journal AIDS and Behavior.

They noted that their outpatient-based sample was relatively small, and they called for more research on the subject.

Still, it is urgent to deal with the problem, they said, as men who reported being physically abused also reported higher rates of depression, feelings of stigma, and suicidal thoughts than those who did not suffer abuse.

Abused men did not appear to have a problem with taking their medications as directed or managing other aspects of their HIV treatment, but nonetheless the investigators recommended that doctors and other care providers routinely assess whether their clients are experiencing any form of partner abuse.

“Collaborative efforts with clients, providers, and public health officials will be needed to address partner abuse in a comprehensive manner,” they wrote.

“Given the extent of partner abuse and its deleterious effects, work on such interventions cannot begin too soon.”

Open and Shut

While new HIV care facilities open, including New York’s West 17th Street Clinic, other centers close their doors

from top: courtesy here! entertainment; photos.com

over a year after the closing of St. Vincent’s Hospital Manhattan, which had long served HIVers in New York’s West Village, the Center for Comprehensive Care—a program of St. Luke’s–Roosevelt Hospital Center, and New York State’s largest provider of HIV care—has opened a new facility in the neighborhood, the West 17th Street Clinic, which is expected to serve around 1,600 HIV patients.

The new clinic’s staff will include some of the same HIV experts who worked at St. Vincent’s. CCC director Victoria Sharp, MD, said this is important to patients because it “has been critical to continuity of care for many of them.”

The West 17th Street Clinic joins two other CCC locations: the Samuels Clinic at St. Luke’s Hospital in midtown Manhattan and the Morningside Clinic at Roosevelt Hospital in Harlem. Together, the three divisions provide HIV services to more than 5,000 patients.

Elsewhere in the nation, some HIV service providers have struggled financially, while others have been able to expand their offerings. Money problems led Chicago’s Better Existence With HIV, which offered case management, testing, and other services, to close early in 2011 after more than two decades of operation; the poor economy had caused private donations to shrink, and officials said federal funding was inadequate. Bienestar, which targets education, prevention, and support services to Latinos in Southern California, closed its 10-year-old San

Diego branch in September, also due to lack of funds. AIDS Resources of Rural Texas, which provided primary medical care and other assistance to more than 400 clients in Weatherford and Abilene, shut down in the fall as well, another casualty of fiscal troubles.

Yet some AIDS service organizations have added facilities and services. In the past year Philadelphia FIGHT saw the opening of the first of several computer centers it will manage, making Internet access and computer training available to HIVers and others in need. FIGHT provides HIV education and outreach services to about 10,000 clients annually and medical care to 1,300 people with HIV at its Jonathan Lax Treatment Center. In Connecticut, AIDS Project New Haven and MOMS Pharmacy joined forces to open the New Haven Access Center in September, allowing HIVers to pick up medications and see a case manager in the same visit. Last spring in Greensboro, N.C., the Moses Cone Health System and three other agencies opened a Regional Center for Infectious Diseases to improve delivery of treatment for HIV and other infectious diseases. And the Southwest Center for HIV/AIDS and its community health partner, McDowell Healthcare Center, have begun thorough renovation of a 50,000-square-foot building in downtown Phoenix that will house both beginning next fall. It will be Arizona’s largest HIV primary care and support services facility. —Ivan Villanueva

AIDS, Unscripted

Three documentaries tackle AIDS in the U.S. and abroad 30 Years From Here (shown above), which debuts on here! TV in November and plays through the end of the year on this premium subscription channel (owned by Here Media Inc., the parent company of HIV Plus), examines the AIDS pandemic over the past 30 years, with activists and medical experts sharing personal stories. Interviewees include playwright Terrence McNally, ACT UP instigator Larry Kramer, and Marjorie Hill (above), CEO of Gay Men’s Health Crisis, among others. HereTV.com/30_Years_ From_Here/About Endgame: AIDS in Black America is an upcoming 90-minute doc from producers of the PBS series The Age of AIDS. Filmmaker Renata Simone wrote, directed, and produced this film, which reveals the untold story of how AIDS in black America became the crisis it is today. Along the way we meet inspiring people living with HIV, their loved ones, and people fighting the disease on all fronts. The film presents some alarming numbers (every nine and a half minutes in America, someone is infected with HIV; half of all new diagnoses are among blacks; among women, six of 10 new cases are black women). But the story here is about identifiable people like Magic Johnson as well as Tom and Keith—HIV-positive teens born with the disease. Frontline.org The Carrier is a riveting first-person account of 28-year-old Mutinta, whose hopes and dreams aren’t much different from those of many other young women.

But her soft-spoken husband came with two other wives—in their Zambian village, polygamy is still the norm—and soon HIV is devastating her community. Maggie Betts’s film is a stunning portrait of both a family and a community caught in a desperate struggle to emancipate their next generation from AIDS. When Mutinta learns she is pregnant with another child, she begins to recognize that saving her baby from AIDS could be her family’s last hope for redemption. TheCarrierFilm.com

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Model

INDICATIONS ISENTRESS is a medicine used to treat the human immunodeficiency virus (HIV). ISENTRESS must be taken with other HIV medicines to improve your chances of fighting the virus. You must remain under your doctor’s care.

ISENTRESS has not been studied in children.

ISENTRESS will not cure HIV or reduce your chances of passing it on to others.

IMPORTANT RISK INFORMATION A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when anti-HIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to treat the HIV infection and strengthen the immune system.

Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS. Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions muscle problems can be serious and can lead to kidney damage.

When ISENTRESS has been given with other anti-HIV drugs, side effects included nausea, headache, tiredness, weakness, trouble sleeping, stomach pain, dizziness, depression, and suicidal thoughts and actions.

Mild rash occurred more often in patients taking ISENTRESS plus Prezista than with either drug alone.

You are special, unique, and different from anyone else.

And so is your path to managing HIV. When you’re ready to start HIV therapy, talk to your doctor about a medication that may fit your needs and lifestyle.

In clinical studies lasting 96 weeks, patients being treated with HIV medication for the first time who took ISENTRESS plus Truvada: Had a low rate of side effects — The most common side effect of moderate to severe intensity (that interfered with or kept patients from performing daily activities) was trouble sleeping — This side effect occurred more often in patients taking ISENTRESS plus Truvada (4%) versus Sustiva plus Truvada (3%) Experienced less effect on LDL cholesterol (“bad” cholesterol) — Cholesterol increased an average of 7 mg/dL with ISENTRESS plus Truvada versus 21 mg/dL with Sustiva plus Truvada — When they began the study, the average LDL cholesterol of patients on ISENTRESS plus Truvada was 96 mg/dL versus 93 mg/dL for those on Sustiva plus Truvada

Ask your doctor about ISENTRESS. Not sure where to start? Visit isentress.com/questions People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection.

Tell your doctor about all of your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breast-feeding or plan to breast-feed. ISENTRESS is not recommended for use during pregnancy. Women with HIV should not breast-feed because their babies could be infected with HIV through their breast milk.

Tell your doctor about all the medicines you take, including prescription medicines like rifampin (a medicine used to treat infections such as tuberculosis), non-prescription medicines, vitamins, and herbal supplements.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

For more information about ISENTRESS, please read the Patient Information on the following page.

Need help paying for ISENTRESS? Call 1-866-350-9232 Copyright © 2011 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

INFC-1011810-0000 09/11(112) Sustiva is a registered trademark of Bristol-Myers Squibb Truvada is a registered trademark of Gilead Sciences, Inc. Prezista is a registered trademark of Tibotec, Inc.

Patient Information ISENTRESS ® (eye sen tris) (raltegravir) Tablets Read the patient information that comes with ISENTRESS1 before you start taking it and each time you get a refill. There may be new information. This leaflet is a summary of the information for patients. Your doctor or pharmacist can give you additional information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment.

What is ISENTRESS? • ISENTRESS is an anti-HIV (antiretroviral) medicine used for the treatment of HIV. The term HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). ISENTRESS is used along with other anti-HIV medicines. ISENTRESS will NOT cure HIV infection.

• People taking ISENTRESS may still develop infections, including

opportunistic infections or other conditions that happen with HIV infection.

• Stay under the care of your doctor during treatment with ISENTRESS. • The safety and effectiveness of ISENTRESS in children has not been studied.

ISENTRESS must be used with other anti-HIV medicines.

How does ISENTRESS work?

• ISENTRESS blocks an enzyme which the virus (HIV) needs in order to make more virus. The enzyme that ISENTRESS blocks is called HIV integrase.

• When used with other anti-HIV medicines, ISENTRESS may do two things:

1. Reduce the amount of HIV in your blood. This is called your “viral load”.

2. Increase the number of white blood cells called CD4 (T) cells.

• ISENTRESS may not have these effects in all patients.

Does ISENTRESS lower the chance of passing HIV to other people?

No. ISENTRESS does not reduce the chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood.

• Continue to practice safer sex.

• Use latex or polyurethane condoms or other barrier methods to lower the chance of sexual contact with any body fluids. This includes semen from a man, vaginal secretions from a woman, or blood.

• Never re-use or share needles.

Ask your doctor if you have any questions about safer sex or how to prevent passing HIV to other people.

What should I tell my doctor before and during treatment with ISENTRESS? Tell your doctor about all of your medical conditions. Include any of the following that applies to you: • You have any allergies.

• You are pregnant or plan to become pregnant.

- ISENTRESS is not recommended for use during pregnancy.

ISENTRESS has not been studied in pregnant women. If you take

ISENTRESS while you are pregnant, talk to your doctor about how

you can be included in the Antiretroviral Pregnancy Registry.

• You are breast-feeding or plan to breast-feed.

- It is recommended that HIV-infected women should not breast-feed

their infants. This is because their babies could be infected with HIV through their breast milk.

- Talk with your doctor about the best way to feed your baby.

Tell your doctor about all the medicines you take. Include the following: • prescription medicines, including rifampin (a medicine used to treat some infections such as tuberculosis) • non-prescription medicines • vitamins • herbal supplements Know the medicines you take.

• Keep a list of your medicines. Show the list to your doctor and pharmacist when you get a new medicine.

How should I take ISENTRESS? Take ISENTRESS exactly as your doctor has prescribed. The recommended dose is as follows: • Take only one 400-mg tablet at a time.

• Take it twice a day.

• Take it by mouth.

• Take it with or without food.

Do not change your dose or stop taking ISENTRESS or your other anti-HIV medicines without first talking with your doctor.

If you fail to take ISENTRESS the way you should, here’s what to do: • If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do NOT take two tablets of ISENTRESS at the same time. In other words, do NOT take a double dose.

• If you take too much ISENTRESS, call your doctor or local Poison Control Center.

Be sure to keep a supply of your anti-HIV medicines.

• When your ISENTRESS supply starts to run low, get more from your doctor or pharmacy.

• Do not wait until your medicine runs out to get more.

What are the possible side effects of ISENTRESS? When ISENTRESS has been given with other anti-HIV drugs, side effects included: • nausea • headache • tiredness • weakness • trouble sleeping • stomach pain • dizziness • depression • suicidal thoughts and actions Other side effects include: rash, severe skin reactions, feeling anxious, paranoia, low blood platelet count, diarrhea, liver failure.

A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when combination antiretroviral treatment is started. Signs and symptoms of inflammation from opportunistic infections that a person has or had may occur as the medicines work to treat the HIV infection and help to strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS with other anti-HIV medicines.

Contact your doctor promptly if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions, muscle problems can be serious and can lead to kidney damage.

Rash occurred more often in patients taking ISENTRESS and darunavir together than with either drug separately, but was generally mild.

Tell your doctor if you have any side effects that bother you.

These are not all the side effects of ISENTRESS. For more information, ask your doctor or pharmacist.

How should I store ISENTRESS? • Store ISENTRESS at room temperature (68 to 77°F).

• Keep ISENTRESS and all medicines out of the reach of children.

General information about the use of ISENTRESS Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets.

• Do not use ISENTRESS for a condition for which it was not prescribed.

• Do not give ISENTRESS to other people, even if they have the same symptoms you have. It may harm them.

This leaflet gives you the most important information about ISENTRESS. • If you would like to know more, talk with your doctor.

• You can ask your doctor or pharmacist for additional information about ISENTRESS that is written for health professionals.

• For more information go to www.ISENTRESS.com or call 1-800-622-4477.

What are the ingredients in ISENTRESS? Active ingredient: Each film-coated tablet contains 400 mg of raltegravir.

Inactive ingredients: Microcrystalline cellulose, lactose monohydrate, calcium phosphate dibasic anhydrous, hypromellose 2208, poloxamer 407 (contains 0.01% butylated hydroxytoluene as antioxidant), sodium stearyl fumarate, magnesium stearate. In addition, the film coating contains the following inactive ingredients: polyvinyl alcohol, titanium dioxide, polyethylene glycol 3350, talc, red iron oxide and black iron oxide.

IMPORTANT: Take ISENTRESS exactly as your doctor prescribed and at the right times of day because if you don’t: • The amount of virus (HIV) in your blood may increase if the medicine is stopped for even a short period of time.

• The virus may develop resistance to ISENTRESS and become harder to treat.

• Your medicines may stop working to fight HIV. • The activity of ISENTRESS may be reduced (due to resistance).

Distributed by: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Whitehouse Station, NJ 08889, USA

Registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Copyright © 2007, 2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

Revised February 2011 9795112 U.S. Patent Nos. US 7,169,780 INFC-1011810-0000 09/11(112)

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around the globe

DIPTENDU DUT TA/AFP/Gett y Images

Siliguri, India An artist paints during an awareness campaign for HIV/AIDS on November 18. Some 20 artists from north Bengal took part in an art exhihibition organized by the West Bengal Voluntary Health Association to raise funds for HIV-affected patients.

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STATUS SYMBOLS around the globe

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clock wise from left: Joe Scarnici/Ge t t y Images for amfAR, alexander joe/afp/ge t t y images

 Cape Town, South Africa (top) A model displays clothing from the new 46664 brand September 25, during South Africa Fashion Week. The 46664 line, which was launched to raise money for Nelson Mandela’s AIDS charity, made its runway debut with couture influenced by the vivid shirts he often wore as president.

West Hollywood (above) Actress Jenifer Lewis, from Tyler Perry’s Meet the Browns, attends

the 27th Annual AIDS Walk Los Angeles October 16.

 Paris U2’s Bono, cofounder of the organization One, at a meeting focused on G20 and foreign aid October 19 at One’s headquarters. One fights poverty and preventable disease, particularly in Africa, by raising public awareness and pressing political leaders to address the issues. j a n u a r y/ f e b r u a r y 2 0 1 2 •

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Eric Charbonneau/WireImage

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from top: SAMUEL KUBANI/AFP/Ge t t y Images; SERGEI SUPINSKY/AFP/Ge t t y Images

 Bratislava, Slovakia (top) Slovakian tennis player Daniela Hantuchova, photographer Lukas Kimlicka (right), and stylist Jan Molnar (left) pose with their 2012 charity calendar during its presentation November 11. Proceeds from the calendar will go to Cambodian orphans with HIV.

Kiev, Ukraine (above) Elton John stands next to a placard bearing a picture of a woman diagnosed with HIV, prior to a

press conference held by the Elton John AIDS Foundation and Ukrainian businesswoman Elena Pinchuk’s ANTIAIDS Foundation November 9.  West Hollywood Sinéad O’Connor (left) and Deborah Harry at the Inspiration Gala, benefiting amfAR, the

Foundation for AIDS Research, October 27 at Chateau Marmont.

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Eric Charbonneau/WireImage

STATUS SYMBOLS around the globe

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clock wise: Chip Somodevilla/Ge t t y Images; HEIKKI SAUKKOMAA/AFP/Ge t t y Images; JOHAN ORDONEZ/AFP/Ge t t y Images)

from top: SAMUEL KUBANI/AFP/Ge t t y Images; SERGEI SUPINSKY/AFP/Ge t t y Images

W O R L D

A I D S

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 Washington D.C. U.S. President Barack Obama delivers remarks during a World AIDS Day event at the Jack Morton Auditorium on the campus of George Washington University December 1, 2011. Focusing on ‘the beginning of the end of AIDS,’ the event was sponsored by HIV/AIDS awareness organizations The ONE Campaign and (RED). Speakers also included former Presidents George W. Bush and Bill Clinton (via satellite link), Sen. Marco Rubio (R-FL), Rep. Barbara Lee (R-CA), Tanzanian President Jakaya Mrisho Kikwete (via satellite from Tanzania), and music artists Bono and Alicia Keys.  Guatemala City (above) A transvestite participates on December 1, 2011 in Guatemala City in the commemoration of the World AIDS Day.  Helsinki, Finland

Finnish Parliament on December 1.

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A I D S

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opposite page (from top): THOMAS NSAMA/AFP/Ge t t y Images)

; sTAN HONDA/AFP/Ge t t y Images;

this page: Photo by Foto24/Gallo Images/Ge t t y Images

W O R L D

 Johannesburg, South Africa A woman wearing a t-shirt with slogans attend a city march to mark the

23rd commemoration of World Aids Day on December 1, 2011 in Johannesburg, South Africa.

 Lusaka, Zambia Former US President George Bush, his daughter Jenna and his wife Laura listen to Peace Corps volunteer Raekenya Walker in Lusaka on December 3, 2011. Bush is on a five-day African tour with his family to promote efforts to fight diseases like cancer, AIDS and malaria.  New York City Kirven James Boyd and the Alvin Ailey American Dance Theater during dress rehearsal

for the world premiere of ‘Home’ by Rennie Harris December 1, 2011. The work, inspired by people living with HIV, premiered on World AIDS Day and the day company founder Alvin Ailey died from the disease in 1989.

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YOU LOOK

You’re beautiful on the inside—now it’s time to make yourself just as stunning on the outside.

Marvelous!

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By Diane Anderson-Minshall

!

Once upon a time obvious physical symptoms were common among HIVers, from wasting to Kaposi’s sarcoma lesions. Thankfully, improved treatments have made most visible signs of the disease a thing of the past. But that doesn’t mean you don’t have to do some extra work to stay sexy, as immune-compromised folks often have specific issues to watch out for.

Here are a few tips:

1. Keep your pucker ready for kissing.

Thrush (caused by a common fungus called Candida that can occur in HIVpositive people with relatively high CD4 counts) and canker sores can both cause an icky-looking tongue and white spots in the mouth. The best thing you can do is brush your teeth after every meal, floss, gargle with antiseptic mouthwash like Listerine, see your dentist every six months, and cut back on booze (but eat more yogurt—it helps fight Candida). If you get thrush, talk to your doctor. There are topical meds and medicated throat lozenges that can help.

2. Don’t give up on those six-pack abs.

The best strategy for keeping fit is following a low-fat diet and exercising 30 to 60 minutes a day. Hate both? Try jumpstarting your routine by reading Working Out Sucks! (And Why It Doesn’t Have To), Chuck Runyon’s 21-day fitness kickoff program, or Colleen Patrick-Goudreau’s The 30-Day Vegan Challenge. The latter may sound drastic (no steak?) but a vegan diet actually reduces risk of diabetes, cardiovascular disease, and several forms of cancer. Munch on that.

3. Get MORE help when your body won’t cooperate.

Even if you’re working out and eating right, HIVers can sometimes get lipodystrophy, a fat redistribution syndrome that can give you a fat abdomen, a “buffalo hump” on your back, and sunken cheeks or other facial features. Don’t fret. Some protease inhibitors are common causes of lipodystrophy, so talk with the doc about perhaps switching antiHIV meds or treating your lipodystrophy

with other medications. If all else fails, cheek implants and other forms of plastic surgery to correct fat distribution are increasingly common for HIVers.

you to over-the-counter treatments (like face cream with alpha hydroxy acids) or prescription treatments (like Retin-A products).

4. Keep having sex.

7. Drink lots of fluids.

Researchers at Wilkes University in Wilkes-Barre, Pa., discovered that having sex once or twice a week was linked with higher levels of immunoglobulin A, an antibody that provides protection against colds and other infections. Sadly, one of the top reasons some men stop taking their anti-HIV meds is erectile dysfunction. Don’t stop your meds. But do get treatment for ED, which can involve switching or adding medications, or boosting testosterone levels. For women, sexual dysfunction is a bit more complicated but no less treatable, so don’t be ashamed to talk to your doctor as well.

Having (safe) sex is crucial to feeling good and looking good.

You’ve heard this before; it’s true for anyone hoping to look good. (And no, margaritas do not count.)

5. Think squeaky-clean.

You may think acne is just for teens, but when an HIVer gets a zit, well, it can take eons to go away. Also, folliculitis, an inflammation of hair follicles that can cause clogged, inflamed, pus-filled pores, often occurs in places where you shave—yes, even down there. To avoid both, experts say to use soap and water frequently, switch to electric razors, ditch those skintight jeans, and, if necessary, see your doc for antibiotics.

8. Get a mani-pedi.

Very few people dislike having someone pamper their tootsies, and these days even dudes are getting their fingernails cleaned and buffed professionally. But if anything looks red or swollen, see a doctor instead. HIVers are susceptible to paronychia, a soft-tissue infection around nails. Soaking your nails in warm water a few times a day can help alleviate symptoms, but if the swelling persists for a few days, skip the over-the-counter treatments, as research indicates they don’t work on paronychia. Instead, ask your doctor about antibiotics.

9. Take your vitamins.

Make sure you’re getting enough vitamin D. Most Americans don’t get enough of this sunshine drug, but it’s one of the best ways to stay alert and prevent a host of diseases. And have an orange too: Vitamin C is thought to counteract skin damage caused by aging.

6. Don’t be rash.

10. Remember what we said about sex?

Everyone gets ’em, but people with HIV are more susceptible to rashes and skin hyperpigmentation—dark patches of skin caused by increased melanin. See a dermatologist so she can rule out other conditions (such as rosacea) and can direct

Orgasms make you sleep better, lower your prostate cancer risk, reduce pain (thanks to a surge in oxytocin), and even burn calories. Maintaining a healthy sex life—even if it’s with yourself—keeps you looking and feeling great year-round. ✜

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Money

y

Changes Everything

B

The world’s top thinkers consider a shift in priorities on HIV spending in the world’s hardest-hit areas

jorn lomborg, a Danish activist, writer, and researcher, wants governments and health experts to think big when it comes to HIV—real big. Lomborg’s think tank, the Copenhagen Consensus Center, recently launched an ambitious project, RethinkHIV, to explore how AIDS money is spent in sub-Saharan Africa, where 70% of all HIVpositive people live and where over 80% of all AIDS deaths occur. Experts looked at whether the billions of dollars being spent there can be better utilized—many suggested shifting dollars from short-term efforts, like hiring more health workers, to long-term strategies like vaccine research.

“A billion dollars spent on one set of approaches can’t be spent elsewhere,” Lomborg wrote in Slate last fall. That central question was the basis for RethinkHIV: Where should money go? “So where is it best to spend more first? Often, this simple question is not asked, because doing so means choosing between many popular strategies, each with its own base of enthusiastic supporters.”

The Copenhagen Consensus Center teamed with the HIV think tank the Rush Foundation to create RethinkHIV, with the hope of starting a dialogue that could lead to policy changes in Africa and possibly around the world. RethinkHIV gathered

By Neal Broverman

some of the world’s top economists, population experts, and public health authorities and asked them to write 18 research papers on HIV spending in sub-Saharan Africa.

They specifically wanted those leaders to talk about how a relatively small increase in funds ($10 billion over the next five years) could best be used. The research covered six major areas—health systems, social policy, treatment, vaccine research, sexual transmission, and nonsexual transmission—and three authors (or sets of coauthors) spoke to each topic, so the work represents a diversity of opinion.

Those RethinkHIV papers then became the subject of three panel discussions last fall at Washington, D.C.’s Georgetown University. Using the RethinkHIV reports as background, participants that included students, health experts, and leaders at HIV organizations ranked their spending priorities. Organizers found that there were more similarities than differences. Near or at the top of all lists was providing male circumcision services and preventing motherto-child transmission by putting money toward top-notch treatment of HIV-positive pregnant women. Economist Lori Bollinger believes mother-to-child transmissions in sub-Saharan Africa could be practically wiped out by 2015 with additional expenditures of only $140 million a year.

While efforts like abstinence programs were seen as a bad investment, there was strong support for making blood transfu-

sions safer as well as for increased vaccine studies. Researchers Dean Jamison and Robert Hecht believe that at current funding levels a vaccine could become widely available in two decades. Adding $100 million a year to spending could significantly shorten that timetable.

“We see RethinkHIV as opening a new dialogue and discussion among researchers, donors, governments, and civil society,” Lomborg tells HIV Plus. “In coming months and years, we expect to see this significant first effort responded to and built upon by researchers from many fields.”

RethinkHIV suggestions will be brought to more organizations and universities as a way to continue the discussion. Rethinkrelated panels, many focusing on youth issues, were organized at November’s International Conference on AIDS and STIs in Africa in Addis Ababa, Ethiopia.

But what about America? While needs here are not as dire as in Africa, HIV rates are on the rise among gay men, while treatment funds remain scarce, as evidenced by the struggling AIDS Drug Assistance Program. The RethinkHIV papers are applicable only to Africa, Lomborg says, but the methods in which they were assembled could be used for a similar American study.

“The framework itself [of RethinkHIV]— of utilizing cost-benefit analysis to find out which actions are most valuable to society compared to their societal costs—could be applied to an American context,” he says. ✜

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ecause of that mindset, I never got tested. I figured if I didn’t educate mys ctor and he told me I already had AIDS. My T-cells were under 200. Once my mother and not dealing with my diagnosis. I willed myself to die. In nd my lungs were set to collapse. I went through every dime I had. I final me on a respirator and medication. Things started turning around. It too my T-cells are at about 500. The fear and anger have subsided. I’m able to m red but when I do, I catch myself and rest both my mind and body. I was osis, I educated myself—the more I did that, the better I felt. It took quite losing because I learned I was willing to accept it. I built up the courage t able to give me more insight into what I was dealing with. If wasn’t for th was diagnosed as a non-progressor, so as long I keep my CD-4 count and —that’s a real blessing. I know that day is going to come but I want it furth e nursing field, so she knows exactly what it takes for us to be healthier. E sed with AIDS in 1988; Dionne and I had been together three years at tha ough God’s grace, Dionne and my son remain negative. Dionne: I never th e others just like me—mothers, fathers, brothers, and sisters affected—an rogram, HIV Anonymous (HIVAnonymous.com), which speaks to those i nnermost feelings. People often talk about HIV being a physical illness, disease. The mood swings, the highs and the lows, it’s harder to deal with up, like AA or NA. It allows us to create an atmosphere conducive to heal paign GreaterThan.org/DecidingMoments), which has been a real blessing Every nine happy and healthy with HIV—is what people need to see. I had the wron and a half problem.

That was my downfall, my precursor for becoming positive. Bac ate myselfminutes, about it, I wouldn’t get it. The day I buried my mother, I went to Once Isomewhere was diagnosed, I went through depression. I was already in mourn n July 2008, I went down to three T-cells; I had three infections, pneumon in America, y drove to the hospital, got to the door, and collapsed. In the hospital, the someone about two years from that for me to start climbing out of that abyss. Now infected ke betterischoices when it comes to finances. I’m able to rest. I still get real withinHIV. s diagnosed November 1998 through heterosexual contact. After the d a while accept and disclose. My [HIV] advocacy work had a lot to do w Fiftytopercent to tellof mythem family. areI started with my mother, who’s in the nursing field, so r the compassion from my family, my diagnosis would have been a lot mo black. unt and viralThese load undetectable I don’t have to worry about medication at aredown their t it further the road. I recently got married and my wife is negative healthier.stories.

Everything is great. I found happiness. I have love in my life. R e years at that time. We got tested because we got pregnant—mine came onne: I never thought about leaving. God told me he chose me for this jou ters affected—and I had to speak out and say a positive diagnosis doesn’t

In Our

own words

self about it, I wouldn’t get it. The day I buried my ce I was diagnosed, I went through depression. I was July 2008, I went down to three T-cells; I had three A week doesn’t go by without another news report about HIV’s disproportionate lly drove to the hospital, got to the door, and collapsed. effect on African-Americans, but what’s often missing from those stories is the fact ok aboutthat two years from that to start climbing these are real people, notfor justme nameless, faceless statistics. We asked four people affected by HIV to tell us about their lives, their moments of discovery, and make betterhow choices when it comes to finances. I’m able they’ve changed since HIV became a part of their existence. s diagnosed in November 1998 through heterosexual a while to accept and disclose. My HIV advocacy work to tell my family. I started with my mother, who’s in the he compassion from my family, my diagnosis would have d viral load undetectable I don’t have to worry about her down the road. I recently got married and my wife is Everything is great. I found happiness. I have love in my at time. We got tested because we got pregnant—mine hought about leaving. God told me he chose me for this nd I had to speak out and say a positive diagnosis doesn’t Atlanta Curtis Montgomery, Chicago and Dionne Smith, Atlanta infectedTommie and Jackson, affected.

That program helped us getReggie free.

Reggie: I was diagnosed with I was diagnosed in November I had the wrong mind-set but no one really taps into the AIDS in 1988; Dionne and I had 1998 [as having contracted HIV] about HIV from the beginning, been together three years at that through heterosexual contact. I I never thoughtHIV it was my h on problem. because your own.

Anonymous That was my downfall, my precur- was involved with drugs and alcohol at that time. We got tested because we got preging. We’re also involved with Than nant—mine came back positive. Through time ofthe my life; Greater I was also homeless.

So I was AIDS sor for becoming positive.

Back in 2001, because of that mind-set, I a part of all the avenues of high-risk behav- God’s grace, Dionne and my son remain g. The imagery that we project asdiagnosis an African-American ior. After the I took it upon myself negative. never got tested. I figured if I didn’t educate to learn what I was dealing with. The more I myself about it, I wouldn’t get it.

The day I ng mindset about HIV from the beginning, because II never thought about leaving. God Dionne: buried my mother, I went to the doctor and educated myself, the better I felt. told me he chose me for this journey because It took quite a while to accept andgot dis- tested. told me I already had AIDS. of My Tthat cells ck inhe2001, because mindset, I never there are others just like me—mothers, were under 200. Once I was diagnosed, I close. My [HIV] advocacy work had a lot to fathers, brothers, and sisters affected—and I o thewent doctor and he toldinme I already had AIDS. My do with disclosing, because I learned I was through depression.

I was already had to speak out and say a positive diagnosis mourning for my mother and not dealing willing to accept it. I built up the courage doesn’t mean death. We run a program, HIV ning for my mother and dealing with diagnosis. to tell my family. I started with my my mother, with my diagnosis.

I willed myself to die. not Anonymous (HIVAnonymous.com), which in the nursing field, so she was able In July 2008, I went down to threeset T who’s nia, and my lungs were to collapse.

I went through speaks to those infected and affected. That cells; I had three infections, pneumonia, to give me even more insight. I have three program helped us get free. We began to other brothers, and I explained itThings to them. my lungs to collapse. I went and ey gotandme onwereasetrespirator medication. started share our innermost feelings. People often through every dime I had. I finally drove to If wasn’t for the compassion from my famtalk about w, my theT-cells at and about anger haveHIV being a physical illness, but ily, my The diagnosisfear would and have been a lot hospital, got are to the door, collapsed. 500. no one really taps into the emotional aspect In the hospital they got me on a respirator more tragic. of the disease. lly tired but when I do, I catch myself restso both I was diagnosed as a and nonprogressor, and medication. Things started turning CD-4 count [up] and viral Reggie: The mood swings, the highs and around. It Itook about two years from that as long I keep my diagnosis, educated myself—the more I did that, the for me to start climbing out of that abyss. load undetectable, I don’t have to worry the lows, it’s harder to deal with on your about medication this time—that’s a real to own.accept HIV Anonymous is a 12-step support my T cells are at about 500. with Now disclosing because I learned I atwas willing The fear and anger have subsided. I’m blessing. I know that day is going to come, group, like AA or NA. It allows us to creshe was able give me insight I was but I want it further downinto the road.what ate an atmosphere conducive to healing. able to make betterto choices when it comesmore I recently got married, and my wife is We’re also involved with the Greater Than to finances. I’m able to rest. I still get really ore tragic.

I was diagnosed as a non-progressor, so as tired, but when I do, I catch myself and rest negative. She’s also in the nursing field, so AIDS Deciding Moments campaign (Greashe knows exactly what it takes for us to be terThan.org/DecidingMoments), which has my mind and body. this both time—that’s a real blessing.

I know that day is I’ve since become a public speaker and healthier. Everything is great. I found hap- been a real blessing. The imagery that we I haveso love she in my life. project as an African-American couple— community speaking out, I hope piness. e. She’s alsoactivist. in Bythe nursing field, knows exactly that you can be happy and healthy with to help others make better choices.

Reggie: I was diagnosed with AIDS in 1988; Dionne HIV—isand what people need to see. back positive. Through God’s grace, Dionne and my urney because there are others just like me—mothers, plus mean death. We run a program, HIV Anonymous READ MORE stories

at HIVPlusmag.com

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www.egrifta.com

Actual patient living with HIV since 2000

YOU HAVE YOUR HIV UNDER CONTROL. NOW, ON TO

HIV-RELATED EXCESS BELLY FAT. In two separate clinical trials of HIV-infected people with lipodystrophy, each lasting 6 months, EGRIFTA® reduced HIV-related excess belly fat by an average of 18% in the first trial, and 14% in the second trial.

This reduction in excess belly fat resulted in an approximate 1-inch reduction in waist size. Individual results may vary.

On average, patients on EGRIFTA® did not lose weight.

Like HIV, HIV-related excess belly fat is a chronic condition. In clinical studies: • People who used EGRIFTA® continuously for 1 year maintained their results over this time period • People who stopped taking EGRIFTA® after 6 months had their HIV-related excess belly fat come back EGRIFTA® is believed to work with your own body to produce natural growth hormone to reduce your excess belly fat.

Indication: EGRIFTA® is a daily injectable prescription medicine to reduce the excess abdominal fat in HIV-infected patients with lipodystrophy.

Limitations of use: • The impact and safety of EGRIFTA® on cardiovascular health has not been studied • EGRIFTA® is not indicated for weight-loss management • It’s not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications • EGRIFTA® is not recommended to be used in children Important Risk Information: Do not use EGRIFTA® if you: • Have pituitary gland tumor, pituitary gland surgery or other problems related to your pituitary gland • Have or had a history of active cancer (either newly diagnosed or recurrent) • Are allergic to tesamorelin or any of the ingredients in EGRIFTA®, including mannitol or sterile water • Are pregnant or become pregnant Before using EGRIFTA®, tell your healthcare provider if you: • Have or have had cancer • Have diabetes • Are breastfeeding or plan to breastfeed • Have kidney or liver problems • Have any other medical condition • Take prescription or non-prescription medicines, vitamins, or herbal supplements EGRIFTA® may cause serious side effects, including: • Serious allergic reaction. Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: rash over your body, hives, swelling of your face or throat, shortness of breath or trouble breathing, fast heartbeat, feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome) • Increase in glucose (blood sugar) intolerance and diabetes 111115-163708 11/11

• Injection-site reactions, such as redness, itching, pain, irritation, bleeding, rash, and swelling. Change (rotate) your injection site to help lower your risk for injection-site reactions The most common side effects of EGRIFTA® include: • numbness and pricking • joint pain • nausea • pain in legs and arms • vomiting • swelling in your legs • rash • muscle soreness • itching • tingling EGRIFTA® will NOT cure HIV or lower your chance of passing HIV to others.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see Consumer Brief Summary of EGRIFTA® on adjacent page.

Ask your healthcare provider if EGRIFTA®, the first and only FDA-approved medicine for HIV-related excess belly fat, may be right for you.

For more information, visit www.egrifta.com or call the AXIS Center at 1-877-714-AXIS (2947).

S:6.625 in

Consumer Brief Summary for EGRIFTA® (tesamorelin for injection)

Keep EGRIFTA® and all medicines out of the reach of children.

General information about the safe and effective use of EGRIFTA®: Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use EGRIFTA® for a condition for which it was not prescribed.

Do not give EGRIFTA® to other people, even if they have the same symptoms you have. It may harm them.

Do not share your EGRIFTA® syringe with another person, even if the needle is changed. Do not share your EGRIFTA® needles with another person.

This Patient Information leaflet summarizes the most important information about EGRIFTA®. If you would like more information, talk with your healthcare provider.

You can ask your healthcare provider or pharmacist for information about EGRIFTA® that is written for healthcare professionals.

For more information about EGRIFTA®, go to www.EGRIFTA.com or contact the AXIS Center toll-free at 1-877-714-2947.

What are the ingredients in EGRIFTA®?

Active ingredient: tesamorelin Inactive ingredients: mannitol and Sterile Water for Injection

©2011 EMD Serono, Inc. 110815-130056 8/11 All rights reserved.

EGRIFTA® is a registered trademark of Theratechnologies Inc.

T:9.75 in

– hives – swelling of your face or throat – shortness of breath or trouble breathing – fast heartbeat – feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome) • Increase in glucose (blood sugar) intolerance and diabetes. Your healthcare provider will measure your blood sugar periodically • Injection-site reactions. Change (rotate) your injection site to help lower your risk for injection-site reactions. Call your healthcare provider for medical advice if you have the following symptoms around the area of the injection site: – redness – bleeding – rash – itching – swelling – pain – irritation The most common side effects of EGRIFTA® include: – nausea – joint pain – vomiting – pain in legs and arms – rash – swelling in your legs – itching – muscle soreness – tingling, numbness, and pricking Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of EGRIFTA®. For more information, ask your healthcare provider or pharmacist.

Call your healthcare provider for medical advice about side effects. To report side effects, contact EMD Serono toll-free at 1-800-283-8088, ext. 5563. You may report side effects to the FDA at 1-800-FDA-1088.

S:9.375 in

EGRIFTA® (eh-GRIF-tuh) (tesamorelin for injection) for subcutaneous use Read the Patient Information that comes with EGRIFTA® before you start to take it and each time you get a refill. There may be new information. This leaflet does not take the place of talking to your healthcare provider about your medical condition or your treatment.

What is EGRIFTA®?

• EGRIFTA® is an injectable prescription medicine to reduce the excess in abdominal fat in HIV-infected patients with lipodystrophy. EGRIFTA® contains a growth hormonereleasing factor (GRF) • The impact and safety of EGRIFTA® on cardiovascular health has not been studied • EGRIFTA® is not indicated for weight-loss management • It is not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications • It is not known if EGRIFTA® is safe and effective in children. EGRIFTA® is not recommended to be used in children Who should not use EGRIFTA®?

Do not use EGRIFTA® if you: • have pituitary gland tumor, pituitary gland surgery, or other problems related to your pituitary gland • have or have had a history of active cancer (either newly diagnosed or recurrent) • are allergic to tesamorelin or any of the ingredients in EGRIFTA®. See the end of this leaflet for a complete list of ingredients in EGRIFTA® • are pregnant or become pregnant. If you become pregnant, stop using EGRIFTA® and talk with your healthcare provider. See “What should I tell my healthcare provider before using EGRIFTA®?”

What should I tell my healthcare provider before using EGRIFTA®?

Before using EGRIFTA®, tell your healthcare provider if you: • have or have had cancer • have diabetes • are breastfeeding or plan to breastfeed. It is not known if EGRIFTA® passes into your breast milk. The Centers for Disease Control and Prevention (CDC) recommends that HIV-infected mothers not breastfeed to avoid the risk of passing HIV infection to your baby. Talk with your healthcare provider about the best way to feed your baby if you are taking EGRIFTA® • have kidney or liver problems • have any other medical condition Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. EGRIFTA® may affect the way other medicines work, and other medicines may affect how EGRIFTA® works.

Know the medicines you take. Keep a list with you to show your healthcare provider and pharmacist when you get a new medicine.

How should I use EGRIFTA®?

• Read the detailed “Instructions for Use” that comes with EGRIFTA® before you start using EGRIFTA®. Your healthcare provider will show you how to inject EGRIFTA® • Use EGRIFTA® exactly as prescribed by your healthcare provider • Inject EGRIFTA® under the skin (subcutaneously) of your stomach area (abdomen) • Change (rotate) the injection site on your stomach area (abdomen) with each dose.

Do not inject EGRIFTA® into scar tissue, bruises, or your navel • Do not share needles or syringes with other people. Sharing of needles can result in the transmission of infectious diseases, such as HIV What are the possible side effects of EGRIFTA®?

EGRIFTA® may cause serious side effects including: • Serious allergic reaction. Some people taking EGRIFTA® may have an allergic reaction.

Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: – a rash over your body

100 pier/ge t t y images

15 Ways to Live to be

People with HIV can live well into their golden years. Here are 15 key ways to promote long life by MICHELLE GARCIA

H

IV diagnoses were once death sentences, but that is no longer the case for those of us who stay healthy. In fact, the average HIVer is expected to live to be about 78, which is roughly on par with the general population. Meanwhile, more and more people are reaching the century mark. Here are a few things you can do—besides adhering to your medication regimen—to help ensure a long, healthy life.

1. Keep Your Head in the Game Depression, stress, and anxiety are tough for people to overcome, but these conditions can also harm your immune system. Psychotherapist Melissa Lopez works with her HIV-positive patients to develop a plan once their moods start to sour. “When you’re already working with a compromised immune system, pre-depression or anxiety can bring on a lack of motivation,” she says, which can lead to people slacking on their meds. Lopez suggests finding a professional counselor, especially when you’re first diagnosed with HIV, to form a plan to deal with anxiety, depression, or other negative feelings. “Know the symptoms of depression, know the symptoms of anxiety, so you know what’s happening to you,” she says. “You have to be proactive to prevent another, deeper cycle of depression.”

50% more likely to die in the research’s follow-up period—an average of 7.5 years—than their peers with strong social bonds. To fight feelings of loneliness, Lopez encourages joining support groups for people with HIV or finding dependable friends or family members to whom you can vent every once in a while. “Do not isolate yourself, and don’t make [HIV] a secret,” Lopez says. “I always think that clients, no matter how long they’ve been living with HIV, should find other people to talk to.”

4. Shake Your Groove Thing Exercise helps control your weight, fights cardiovascular disease, and lets you look fantastic in an old pair of jeans, but it can also help boost your T cells.

Brian Risley, the manager for treatment education at AIDS Project Los Angeles, says some studies have shown that moderate activity, even in short bursts, spurs an uptick in T-cell counts, even when it doesn’t have a serious effect on viral load. Exercise can also help you feel better between your ears. Says Lopez: “Exercise is beneficial because we produce hormones that help calm us down when we exercise.” According to the Mayo Clinic, most people should aim for at least 30 minutes of physical activity each day. “Walk, go to the gym, dance around your house,” Lopez adds. “Anything is good, as long as it makes you feel good.”

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2. Beat Back the Blues Even when things don’t seem like they’re going your way, looking at life with a positive attitude may be enough to help you get through a tough situation and even live longer. One study indicated that people in their 20s who used mostly positive, affirmative words to describe themselves were more likely to live into their 80s than those with negative outlooks.

Additionally, people with a more positive view of life tend to have fewer strokes, coronary problems, injuries, and colds—and positive-thinking women have healthier pregnancies.

3. Make Friends—Not Just the Online Kind Having strong relationships with other people can be a matter of life or death. A joint review by Brigham Young University and the University of North Carolina at Chapel Hill of existing research on the topic found that people with weak social connections were j a n u a r y/ f e b r u a r y 2 0 1 2 •

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5. Listen to Your Inner Music Loss of brain function is often a difficult side effect of both HIV and aging. Galina Mindlin, MD, coauthor of Your Playlist Can Change Your Life, has created Brain Music Therapy, a method of converting a person’s brain waves into music to help them concentrate, sleep, and deal with stress or depression. But, says Mindlin, your medulla oblongata doesn’t need to be the next Mozart to benefit from music. Any song from your playlist that calms you—it can be Kanye West, Ozzy Osbourne, or Native American flute solos—can help you rewire your brain and change your behavior in as little as two weeks if you play it twice a day for five minutes.

6. Get It On Orgasms can be wonder drugs in themselves: They help you sleep, boost your immunoglobulin levels (which fight infections), and reduce stress and depression.

So get it on once or twice a week, but don’t forget to play safe.

7. Have a Little Faith No matter if you worship in a cathedral, in a temple, or on the sofa, most physicians believe that some form of spirituality can help people better cope with their health problems. Religion can also help you build your social circle and feel generally more positive.

8. Nurture Your Gut The lymphoid tissues in a person’s stomach are filled with T cells. Because HIV affects T cells, many people with the virus have gastrointestinal problems, but a healthy GI tract is crucial to proper absorption of antiretroviral medication. Some anti-HIV meds need to be taken with food to assure this absorption and avoid potential side effects such as diarrhea. Many HIVers could also benefit from probiotics and a high-fiber diet, APLA’s expert Brian Risley says.

9. Kick the Habit for Good It’s common knowledge that cigarettes are bad for everyone, but an estimated 60% of HIVers still smoke.

“In the beginning, when people had an AIDS diagnosis and they were given eight to 16 months to live, we overlooked their smoking,” Risley says. As people are living longer, it’s impor34

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tant to remember that smoking may cause mitochondrial infections—mitochondria are an energy-producing feature of human cells. Also, some people with HIV have a heightened susceptibility to cardiovascular disease, and smoking compounds that risk.

Plus, of course, there’s smoking’s association with lung cancer and emphysema.

10. Take Your Vitamins Many doctors recommend that their patients take a general multivitamin to supplement their diet, but HIVers can also benefit from supplements like selenium, which has been shown to boost immunity in HIV patients while suppressing the level of virus in the body. Other helpful supplements include vitamin D and calcium for bone health, and

iron to fight anemia, especially for menstruating women. Still, people with HIV should also be wary of some supplements that might interact badly with antiretroviral treatment. Risley says Saint-John’s-wort, for example, does not mix well with antiretrovirals or some other drugs, like statins, which lower one’s cholesterol. Talk with your doctor, then take your Flintstones.

11. Get Testy People tend to experience a drop in testosterone levels once they advance past the age of 50, but HIV can also lead to a sharper drop in the hormone. Constant fatigue can be an indication that the virus is affecting your testosterone. While some doctors may write you off as just being tired from hav-

ing HIV, Risley says both men and women should insist on being tested for chronic testosterone loss if fatigue is a persistent problem. If your levels are low, you and your doctor may want to consider testosterone replacement therapy to help you stay alert.

12. Skip the Sushi When your T-cell count goes below 200, you become more susceptible to bacterial infections. Risley suggests avoiding raw foods like sushi or oysters, which may contain fungi or bacteria. You should also avoid soft cheeses made from unpasteurized milk (Brie, Camembert) and any with mold (Roquefort or other blue cheeses). All meats should be well cooked, and leftovers should be refrigerated immediately or tossed out. Risley also suggests the same cooking method for HIVers who use medicinal marijuana. “I’ve heard a few doctors who tell their patients who smoke marijuana to nuke it in the microwave for 30 seconds,” he says. “That kills a lot of the trace bacteria or fungus that may remain on the plant.”

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13. Hose Down Your Veggies Even if thinking about all the hands that have touched your produce from the farm to your table doesn’t give you the willies, Risley suggests using a fruit- and vegetable-specific spray to clean raw produce. Even better, you can make your own veggie wash, one part vinegar to three parts water. Wash, rinse, eat—what could be simpler?

14. Build Your Own Dream Team Not everyone can afford a team of celebrity doctors, personal chefs, and expensive therapists, but most HIVers have access to qualified professionals at local HIV clinics and organizations. Consider talking to a nutritionist to find out which foods are right for your needs as well as seeing a qualified counselor to determine a plan to strengthen your mental health. While professionals at private practices may be unaffordable for some people, many offer a sliding fee scale, with the fee based on what you can afford to pay. Don’t be afraid to ask. Lopez also suggests doing some research to assure that a potential therapist has some understanding of HIV/AIDS in addition to any community or culture that you may identify with,

such as Asian, African-American, Latino, or LGBT.

15. Consider Personalized Meds One of the burgeoning medical trends is personalized medicine for a patient based on their demographic information and genes.

“We’re going to have a lot more genetic tests for people to specifically tailor medication,” Risley says. “We just assume that if you take this one particular medication, your body will absorb it, but not everyone has the same absorption capabilities.” While genetically tailored treatment is not widespread, it may be soon. Talk to your doctor about developments regarding ailments such as depression, colorectal cancer, and chronic obstructive pulmonary disease. ✜ j a n u a r y/ f e b r u a r y 2 0 1 2 •

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DIVA opposite page: pier/ge t t y images; this page: photos.com

DOES GOOD

Just as AIDS began to ravage New York City in 1981, Sheryl Lee Ralph starred in the original production of the Broadway smash Dreamgirls.

That time in her life would be formative, and it would turn Ralph into one of the world’s preeminent AIDS activists. After many years of fundraising and speaking out, her fight to end stigma and raise money for treatment and prevention of HIV continues

By Neal Broverman j a n u a r y/ f e b r u a r y 2 0 1 2 •

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acts the part, dresses the part, and talks the part. Discussing her most recent Divas Simply Singing fundraising spectacular a few days before the curtain rose on the October event in Los Angeles, Ralph spoke loudly and clearly—like she was back on Broadway getting ready to belt out her hit song “One Night Only.”

“It’s hard to see that here we are, going into the 31st year of AIDS in January 2012, and people still don’t want to know about a disease that is all around them,” Ralph says.

“That’s why we continue to do Divas Simply Singing. As long as people will come in and pay their money to see a diva strut with her big hair, wild wardrobe, outsize attitude, and the simple gift of song—if that’s what it takes to get people’s attention focused on HIV—that’s what we have to do.”

Ralph originated the famed role of Deena Jones in Dreamgirls, and she’s starred in several hit TV shows and films, including Moesha, Barbershop, and To Sleep With Anger. But when it comes to stars putting their necks out for people with HIV, especially African-Americans with the disease, Ralph is in a class all her own. Divas Simply Singing is part of Ralph’s nonprofit organization, the DIVA Foundation (TheDivaFoundation.org), which has just entered its third decade of raising money for HIV causes. The shows have delivered hundreds of thousands of dollars for organizations like Women Alive, Caring for Babies With AIDS, Minority AIDS Project, AIDS Healthcare Foundation, and the Black AIDS Institute. At the most recent Simply Singing event, the 21st annual one, stars including Reno 911! actress Niecy Nash, Glee’s Amber Riley, singer Bonnie Pointer, and Ralph’s Dreamgirls costars Loretta Devine and Jennifer Holliday performed—making not only money, but also bringing needed media attention to the cause.

“It’s amazing how deep the silence is, and how the silence seems to be killing folks quicker than the disease,” Ralph says. “I was talking with folks at the AIDS [Memorial Quilt] project and they said to me, ‘The 38

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AIDS quilt is 50 miles long, and only half a mile is people of color. Because people of color don’t even want to admit or acknowledge they’ve lost their loved ones.’ We’ve got to stop that.”

Ralph’s introduction to AIDS started early on. The year that the first AIDS case was diagnosed, 1981, was the year Dreamgirls began wowing audiences, and Ralph found herself in New York starring in a hit show as the disease was ravaging the city, especially Broadway performers and creative personnel, many of whom were gay.

“People found it easy to turn their backs on gay people because of what they thought about ‘those people,’ ” Ralph remembers of that time. “Now, 30 years later, we are all ‘those people.’ And people are still dying under shame, stigma, and silence. I remember my friends, I remember what they looked like, I remember how they lived, I

remember how they died.”

Ralph started the DIVA (Divinely Inspired Victoriously Aware) Foundation in 1990 to honor those friends. The work of the organization extends beyond the Simply Singing fund-raiser—it’s involved with prevention seminars, testing events, and distributing free health care materials.

The DIVA Foundation hosted 2008’s Sisters Circle, a four-day summit in South Africa that brought together infected and affected women, including Ralph. In 2009, Ralph toured this country with her one-woman show, Sometimes I Cry, which tells the stories of women with HIV, and raised money for the foundation.

Last fall Ralph joined Dionne Warwick and other black leaders at a town hall meeting in Harlem that drew 200 people to discuss HIV’s effect on black America— recent numbers from the CDC show that

previous spread: courtesy diva foundation

diva? Sheryl Lee Ralph

“It’s amazing how deep the silence is, and how the silence seems to be killing folks quicker than the disease. I was talking with folks at the AIDS quilt project and they said to me, ‘The AIDS quilt is 50 miles long and only half a mile is people of color.

Because people of color don’t even want to admit or acknowledge they’ve lost their loved ones.’ We’ve got to stop that.”

clock wise from left: ge t t y images (2); ebony magazine; courtesy diva foundation

Clockwise from left: Sheryl Lee Ralph performs at the 18th Annual Divas Simply Singing at the Wilshire Theater in 2008 in Beverly Hills; with singer-actress Brandy (center) and her Moesha castmates celebrating the 100th episode of the comedy series; the May 1982 cover of Ebony magazine; the diva herself.

while African-Americans compose 14% of the population, they make up nearly half of all people in the U.S. with HIV, and they’ll account for half of all new HIV infections this year. Infections among young black men who have sex with men increased 48% between 2006 and 2009.

“The message imparted at the town hall was, number 1, we were in the middle of Harlem and we know the rate of HIV infection there is high. We also know that room wasn’t as full as it should have been,” Ralph says, even though nearly 200 people attended the event at the Harlem United Community AIDS Center. “What I’ve noticed from all my travels across the country is that anytime I go to a place that has a problem and folks don’t show up, the problem is usually bigger than we thought. That was very hard to see. It was hard to see people still not wanting to grasp that a way to contract HIV

is through heterosexual sex. It was hard to see people not able to grasp that there are intravenous drug users who have to be dealt with and needle-exchange programs are not programs from hell.”

The latest philanthropic project for Ralph, who was honored for her contributions with the United Nations’ Red Ribbon Leadership Award in 2005, is serving as the spokeswoman for Bristol-Myers Squibb’s Fight HIV Your Way contest. Now in its third year, Fight HIV Your Way asks people living with HIV to document their lives through photo essays. In previous years the most powerful testimonies were featured in public spaces in New York and San Francisco, but this year 10 winners will find their stories interpreted through dance by the prestigious Alvin Ailey American Dance Theater. Artistic director Robert Battle worked with renowned hip-hop choreographer Rennie Harris to

create the new work, titled Home. The world premiere took place on World AIDS Day, December 1, in New York City, and there will be select performances of Home across the nation in 2012. (Go to FightHIVYourWay. com for additional information and to read the winners’ stories.)

“This contest is a wonderful effort to bring the arts to the fight against HIV and AIDS,” Ralph says. “To be able to have people’s own HIV/AIDS stories put to music, put to dance, set up on the stage as a thing of beauty to be shared with other people, is really thinking outside of the box.”

The mission of the DIVA Foundation is similar, Ralph says: using song, dance, and joy to remind people that HIV is still a big deal.

“Everybody seems to have the feeling that, I’ll just pop a pill. It’s just a disability; it’s not the disease it used to be,” Ralph says.

“A young man called me up yesterday to say, ‘Miss Ralph, you told me to take the test…and I’m positive.’ That call has never changed over 30 years—the same fear, the same apprehension, the same not knowing is still the same as it was 30 years ago, except now people are thinking, Now what do I do? because they know they have something to do. It may not be the death sentence it was 30 years ago, but it certainly remains a life-altering existence.” ✜

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Testing for Teens?

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The age at which a person should first be tested for HIV depends on whom you ask

parents may think 16 is too early to have to deal with the harsh realities of HIV, but the American Academy of Pediatrics says it’s just the right age for people to start getting tested. In a new report released last October, the AAP recommended that all sexually active teenagers and anyone else over the age of 16 who resides in areas with high infection rates get tested for the virus.

“Forty-eight percent of the youth who are infected don’t know they are infected,” said Jaime Martinez, MD, of the University of Illinois at Chicago. “It’s important to realize that those who don’t know they are infected drive the epidemic.”

Currently, 55,000 Americans between the ages of 13 and 24 have HIV, reports Reuters Health. Early diagnosis not only helps prevent teens and young adults from infecting others but can lead to earlier treatment with medications that keep the virus from proceeding to AIDS. According to Martinez, who helped author the AAP report last fall, more than 60% of high school seniors say they are sexually active—and many of those admit to having had sex while under the influence of drugs or alcohol.

Some organizations call for even earlier— and more widespread—testing. The U.S. Centers for Disease Control and Prevention, for example, has been recommending since 2006 that everyone between the ages of 13 and 64 be screened for HIV, regardless of their risk factors. This recommendation is bolstered by the CDC’s estimate that approximately 39% of new HIV infections diagnosed in 2009 occurred among people aged 13 to 29.

The startling nature of this statistic is indicative of the need for earlier testing: It’s believed that many adolescents don’t get

tested simply because they’re unaware or don’t believe that they’re at risk for contracting the virus. Some may not even understand how HIV is transmitted or what they can do to protect themselves. Advocates for early testing believe the procedure can help plant the seed about risk factors and the necessity of safer sex.

But not all experts agree with the suggestions of the AAP and the CDC. The results of a sizable French study, also released in October, showed that in that country—where rates of HIV are low—finding just one new infection would require the testing of over 1,000 adults. This study and the similarly low yields from other studies have led the U.S. Preventive Services Task Force, which is backed by the United States government, to avoid providing a recommendation about the age at which HIV screening should begin and how frequently it should be performed. The task force does, however, suggest regular testing for those in high-risk groups. Critics go back to the issue of cost-effectiveness.

Among those who want more details on how AAP’s new testing recommendation will be funded is Jason Haukoos, MD, of the Denver Health Medical Center.

“There is reasonable evidence to support screening, but it is not clear what the best approach is,” he told Reuters Health. “I think the policy statement is a reasonable statement, but I say that recognizing that they don’t take it far enough in terms of how this should be done.”

What’s missing from the report, he says, are considerations of consent and disclosure in regard to testing children and who should be responsible for funding the procedures.

“The big issue here is, we don’t know if it’s cost-effective,” he said. —Winston Gieseke

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Sweet Relief

People dealing with one of the most common side effects of HIV may finally feel relief with the help of an existing natural remedy People with the skin affliction shingles have long suffered pain, stiffness, burning sensations, and numbness even after the rash has healed, but a patch called Qutenza has been helping ease post-shingles pain since 2010. Now HIVers with similar symptoms (all bundled under the diagnosis of HIV-related peripheral neuropathy) might be able to get the same relief. NeurogesX Inc., the maker of the patch, has asked the U.S. Food and Drug Administration to approve the patch’s use to treat HIV-related pain.

The move would be important, says David Simpson, MD, the director of neurology at the Mount Sinai School of Medicine, because there are no FDA-approved drugs to treat HIV-related peripheral neuropathy, one of the most common complications of the virus.

Patches to release drugs or natural remedies have been used in a variety of ways—Ortho Evra delivers birth control, and NicoDerm helps smokers quit. Qutenza contains a high dose of capsaicin, the same element that gives spicy food its zest. The patch rests on the skin for an hour, and then the pain-fighting formula stays effective for about three months.

Simpson says an added benefit of Qutenza is that it would not introduce yet another drug to HIVers’ regimens, as capsaicin is a natural ingredient. This is particularly significant for people with HIV in poor or developing countries, who generally have access only to older, more toxic medications to treat their HIV—with Qutenza, they would not add another on top of those. Also, the topical treatment targets the specific areas of pain, allowing minimal contact with the nervous system and less negative impact on a patient’s overall health.

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Booze Bust

While doctors have long thought that alcohol consumption can be harmful to people with HIV, three new studies aim to find out just how much toasting the new year with alcohol might be commonplace, but mixing booze with HIV might not be the best way to start 2012. Robert Cook, MD, the lead investigator in a new study, says that’s because there are many risk factors involved when alcohol is combined with HIV, from poor decision-making and an inability to take medications on schedule to more direct and harmful effects on the immune system, including higher viral loads and more rapid disease progression.

The University of Florida, where Cook is a professor of epidemiology and medicine, received a $2.7 million grant from the National Institute on Alcohol Abuse and Alcoholism in October for a study researchers hope will determine whether a common medication can help women with HIV reduce the amount of alcohol they drink.

“It is the same with any chronic disease, such as diabetes,” says Cook. “Our goals are to identify simple and acceptable treatment options that can help reduce these harmful effects.”

Cook’s previous study of the alcohol habits of women with HIV found that between 14% and 24% of those surveyed admitted to hazardous drinking—having more than

three drinks a day or more than six drinks in a given week—during the previous year.

The new study will explore whether the prescription medication naltrexone, which is marketed under the brand name ReVia, is effective in reducing hazardous drinking in women with HIV. The drug, which blocks the pleasure-feeling parts of the brain that are stimulated by alcohol, has been found to decrease men’s alcohol consumption but has never been tested exclusively on women or in conjunction with HIV infection. Researchers also plan to examine more clinical topics, such as the effects of alcohol on the taking of HIV medications and its relationship with white blood cell counts and sexual behavior.

Cook’s study, which also involves researchers from Florida International University and the University of Miami, is one of three Florida-based surveys involving alcohol and women with HIV. Another will examine the link between alcohol intake, cholesterol, and long-term effects on health, while the third will focus specifically on the effects that alcohol has on the immune system over time. The National Institute on Alcohol Abuse and Alcoholism has provided a total of $5 million in funding for the research. —Winston Gieseke

Pregnancy Prevention’s HIV Connection A study links HIV risk—both contracting it and spreading it— to a popular contraceptive

qutenza: courtesy neurogesx; photos.com (3)

when the results of a new study released late last year showed that women using the popular injectable contraceptive Depo-Provera faced double the risk of contracting and transmitting HIV, there was a collective shudder among family planning experts, HIV health workers, and young women.

Conducted by researchers from the University of Washington in Seattle, the study looked at nearly 4,000 heterosexual, serodiscordant African couples and found that injecting Depo-Provera put the HIVnegative women at twice the risk for HIV and it also doubled the chance that positive women would transmit the virus to their boyfriends or husbands.

More than 12 million women in sub-Saharan Africa use injectable contraceptives. Low-cost injectables are not just for convenience’s sake—in parts of Africa, such as rural Ethiopia, women die in childbirth at 50 times the rate American women do. Since injectables are given every few months, they are easier for women to keep up than many other methods.

American women are also big consumers of Depo-Provera. Many users in the U.S. are low-income and people of color, according to Betsy Hartmann and Aline Gubrium, professors at Hampshire

College and the University of Massachusetts, Amherst, respectively.

“Depo-Provera has other serious risks and adverse effects, including loss of bone density in young women, significant weight gain, and increased depression,” warned Hartmann and Gubrium in a letter to The New York Times in October.

After news broke of the Depo-Provera study, others took a different tack.

Caitlin Gerdts and Divya Vohra of the School of Public Health at the University of California, Berkeley, wrote in The Daily Beast that the African study was inherently flawed because it wasn’t specifically looking at the connection between HIV and Depo-Provera—rather, it was studying whether herpes medication could help prevent HIV transmission. The Depo-Provera findings were coincidental.

Because the study was not designed to look at the links between Depo-Provera and HIV, Gerdts and Vohra wrote, “the researchers could not account for all the factors that might be different about women who use contraception and those who do not.”

There is one thing all the experts do agree on: the need for a study that looks specifically at injectable contraceptives and their connections to HIV. —Neal Broverman

A Whole New Kind of Patch

Scientists are now testing a skin patch that may be the best way for you to take your HIV meds One of the toughest aspects of getting medications to work perfectly is the fact that we humans must administer them. Remembering to take pills at the right time each day can be difficult, even when it’s as simple as one pill per day.

However, a skin patch, similar to NicoDerm (which helps you kick a smoking habit), is being examined as a possible way to administer a consistent dose of HIV medication.

Additionally, in the strategy known as pre-exposure prophylaxis (PrEP), drugs could be administered to HIV-negative people through the patch to help prevent them from contracting the virus.

“The huge potential advantage of a patch…is the ability to maintain the right level of the drug without the fluctuations observed when adherence to pills is less than perfect,” Rowena Johnston, the director of research for amfAR, the Foundation for AIDS Research, told Health Day. The patch is still in early stages of development. As of November it had yet to even be tested on animals, and the actual medication mixture that’s being transmitted through the new patch is not yet available to the public. Still, the tests that have been done—using simulated human skin—by scientists at ImQuest BioSciences showed that 96% of the medication was transmitted from the patch to the skin. Fingers are crossed that follow-up tests have similar results. —Michelle Garcia

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STATUS SYMBOLS mind+mood

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Gary McClain, Ph.D.

Sizing Up 2011

The end of one year and the start of another is the perfect time to check in on your goals—just remember to reflect, not critique

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so here we are at the beginning of 2012. Yes, it’s that time of year when we’re hit with those “best of the year” and “worst of the year” lists as everyone looks back on the year we just finished. It’s a good time to do your own year-end review, thinking about what happened and what didn’t happen, what you accomplished and what you didn’t. How do you think you did?

I know, this may be a sensitive topic—at least it has been for a lot of the people who pass through my office. Here’s what I heard from clients I’ll call Deb and Carlos.

Deb came in with a pretty bleak attitude about 2011: “The new year just reminds me of what I haven’t accomplished yet. Looking back, I feel like I let myself down. What do I have to show for this year?”

Carlos also decided that 2011 was a bust and predicted more of the same for 2012: “I didn’t get anything I wanted in 2011. I have to ask myself what I have to look forward to in 2012. After all, I’m still going to be in charge, right?”

Let’s go back to that question of how you did last year and ask it one more time but change the emphasis. How do you think you did? It’s important to emphasize the word think because that’s where you can get yourself in trouble when you’re doing your annual review. Here’s why.

Who’s doing the judging here? As you evaluate the past year, whose voice are you really hearing in your head? Is it a realistic, encouraging voice or one that can only point out

what’s missing and what could have been better last year? Or, worse, is yours a voice that flat-out screams what a loser you are? If so, it might be time to fire that little Simon Cowell holding court in your head and see if Oprah can fill in instead.

Don’t give in to all-or-nothing thinking. It’s easy to fall into that “if I didn’t accomplish this one thing, then I didn’t do anything” trap. So 2011 didn’t look like you expected it to. Take a step back and ask yourself, “What’s good in my life?” I suspect there was more to the year than you are giving yourself credit for. Make a list of 2011’s achievements, no matter how small you think they are.

If you are comparing yourself to others, you’re only going to come up short. You don’t have to prove yourself to anyone else. Instead, acknowledge that each of us is on our own unique path—we have strengths, weaknesses, joys, and challenges. Let go of the shoulda-coulda-woulda and accept where you are at this particular moment in time. Ease up on the self-criticism.

Focus on the bigger picture. Life is an ongoing process of growing, developing, learning, caring, and being cared for. Life may seem to go better—fewer challenges, more successes—some years, and not so great others. But the point is that your life isn’t about only one year, but the years that you have lived and the years that you have ahead of you. So don’t lose your perspective.

Give in to the possibility of change.

While you’re looking at the bigger picture, ask yourself, “Is 2012 a year for new directions?” The only thing we can really count on is that things change. You’ve already seen it in your own life, with the changes that your HIV diagnosis introduced. The more flexible you can be—ready, willing, and able to shift your priorities and change your routine—the easier it is to live with uncertainty. Open yourself up to the unexpected.

Make realistic priorities for 2012.

Think about where you want to focus your efforts this year. Be honest about what you want in your life and set realistic goals that will get you there.

Make “take better care of myself” the top priority. Think about what you need to do to strengthen your foundation: Give more attention to your physical well-being by creating an exercise plan? Sign up for that dance class you keep putting off? Read in bed each night, take up a hobby, or spend more time with friends? Figure it out and do it first.

Celebrate the close of 2011 by celebrating your future. Remember that 2012 is a year of even more opportunities for personal growth. Make 2012 the best year yet…at least until 2013.

Gary McClain is a counselor in New York City with a specialty in coping with chronic health conditions. His books include The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy.

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River Huston

Change of Life For HIVers, reaching menopause should be a celebration— once you deal with the hot flashes

i recently attended a women’s conference on HIV—or, I should say, another women’s conference on HIV. Having been positive for over two decades, I have attended more conferences on women and HIV than I can count. But this experience was different.

There attendees included a small percentage of recently diagnosed women, but the majority were old-timers, in more ways than one.

There was the telltale ripping off of outerwear, a lot of fans waving, and the occasional outburst of “Is it hot in here, or is it me?”

It seems a lot us living with HIV are now in the midst of full-blown menopause.

I started this journey over 10 years ago, and I remember the first symptoms were startling. I had no idea what was going on. Living long enough to watch my body change from the normal wear and tear of life plus loss of hormones has been an adventure.

I read that women with HIV sometimes enter menopausal stages as early as their mid 30s, but I had other things on my mind back then—like surviving. With the gift of surviving, I found my lady parts dehydrating like a sand trap on the 17th hole of a golf course, then went through hot flashes, night sweats, lack of libido, moodiness, dry skin and hair, and a general feeling that I was no longer a desirable woman.

Sometimes when I spoke I would bring it up, but the audiences were usually not receptive to the topic— especially if the majority were men, or even young women.

I recall speaking at a dinner for women with HIV, and the woman who spoke before me was Native American. She was the first person in an HIV setting I heard talk about the change of life in nonmedical terms.

She spoke of it as a journey and something to both embrace and celebrate.

I sat at my table muttering under my breath, “Yeah, right,” as I felt my skin heat up to lava proportions. Afterward I asked how she could possibly embrace this.

She said, “Menopause is the passing from one stage of your life to another. It is a time to celebrate, not to mourn.” In her culture, women who have gone through menopause are wise women or matrons and are recognized for their life experiences. Nothing could be further from reality in our youth-obsessed culture, I thought.

Yet I was curious to see if I would find a revered wise woman within myself.

As with everything else in life, it’s all in the attitude. As I went on my speaking and performing journey, I started to talk about menopause—regardless of the response I was expecting to get. I gave it a comical twist, followed by discussion of the need to honor who we are as women rather than buy into the messages that we’re invisible or no longer vibrant. HIV tried its best to extinguish my inner goddess, and I was not going to let some hormonal fluctuations finish the job.

The more I started to focus on this thought pattern, the better I felt about myself. I noted that with aging came knowledge of myself and what

was important to me. I recognize now that crossing over into my 50s was a bridge to a new, stripped-down version of who I am, which forced me to let go of the neurotic thinking about who I should be, what I should look like, or what I should do. I was allowed to take up as much space with girth and voice as I wanted—simple concepts, but surprisingly difficult for many people.

As I stood in front of the audience on a beautiful fall day in Detroit, I tried to convey these ideas to the sea of women holding programs doubling as fans. I heard my own former cynicism from the crowd but hoped I was able to plant some seeds that menopause is not a horror show, a punishment, or the end of our existence as sexy women. I did see smiles when I told them researchers have found that daily masturbation will help stop the thinning of walls of the vagina, keeping it more lubricated, but you need to do it every day to keep everything in working condition. It will also put a little lift in your step. OK, technically, that was not in the research, but my experience bears it out. Doctors offer the usual advice on how to weather the storm—exercise, herbs, rest—but from a scientific perspective, so far masturbation beats them all.

With the advent of HIV treatment I could go another 25 years, and I want it to be glorious—not some horrible consolation prize for surviving. I want to celebrate every wrinkle, stretch mark, and personal heat wave.

So pass the word: If you survived long enough to reach menopause, it is a new beginning, a new freedom to just be. ✜

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“ Not only was it terrifying and heartbreaking all around, but there was this added stigma that one’s personal friends faced, and the rage, the increasing rage at the government. ” Not until 1987, near the end of his second term, and after over 20,000 Americans had died. I remember just

politically, not only was it terrifying and heartbreaking all around, but there was this added stigma that one’s personal friends faced, and the rage, the increasing rage at the government. I don’t remember what year Larry Kramer’s play was [1985’s The Normal Heart]…but I remember staggering out of the theater with relief that it had been expressed, that something had been told so truly. It was just a searing event emotionally as well as marvelous theater.

Tell us about the A Faire of the Heart gala, where you received the Aid for AIDS Celebrity Trailblazer Award. I

she’s been in show business longer than her TV costars, but Holland Taylor, who plays Evelyn on the CBS comedy Two and a Half Men, isn’t afraid to show her sexy side. A fixture in Hollywood—with films like Legally Blonde and Emmy Award–winning roles on shows like The Practice—the 69-year-old has never been a mere Tinseltown bombshell. Currently touring in Ann: An Affectionate Portrait of Ann Richards, her onewoman show about the former Texas governor, Taylor was recently honored with the Aid for AIDS Celebrity Trailblazer Award. —Diane Anderson-Minshall You’ve been a longtime supporter of HIV causes and specifically Aid for AIDS [AidForAIDS.net]. What attracted you to that charity? They are tremendously

efficient in getting the money directly to clients, and they’re not an office-heavy organization. When you get great huge charities, depending on their leadership, they can develop enormous overhead expenses.

I remember my mother worked for an arts organization that was letting go of all their part-time workers because they just couldn’t afford them, and yet they redid their lobby with marble. Leadership is just terribly

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important in these organizations, and I think the Aid for AIDS leadership is great.

When did HIV and AIDS first become part of your world? I’ve always been in

theater, and I was in New York in those [early years of AIDS] and it was so shocking. These deaths came like hammer blows then. People got this mysterious illness and could be gone in two weeks. Then, of course, we went through a period in which a lot of work was being done, even though President Reagan never mentioned AIDS. I’m not sure if he ever mentioned AIDS.

Aid for AIDS’s largest fund-raiser is its Best in Drag Show. Are there Holland Taylor drag queens out there? I never

thought of that until this moment. [Gasps] That’s pretty scary. Actually, what they do at that particular show is so exaggerated that you just fall down laughing, because it’s meant to be comical. There are serious drag queens who really do an extraordinary [version of] Judy Garland and Barbra Streisand, and there are people who are so brilliant as mimics…that’s not what this is.

This is highly exaggerated, with extremely comical costumes. One of my favorites was Jeff Sumner... he plays a wonderful Indian belly-dancer type in a sari named Bindi Dundat, which is about the funniest name.

Of course, every single instant of this show is politically incorrect to such a degree that you’re just falling out of your chair. You don’t want to take just anybody to that show. ✜

courtesy cbs television

Taylor Made

still can’t believe that I said I would accept, because to be honored just for giving a tiny bit of time and money is just—well, it’s just the nature of how money is raised these days.

But the fact is, the people who work to put on that evening, who donated their time and effort to do that, gave more than I did. So they are the ones that should be honored.

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