HIV Plus Issue 105 March/April 2015

The HIV Answers Issue

RIHANNA TO THE RESCUE 20 Amazing Poz Women Plus: Herpes & Hep C Testosterone Loss Medical Marijuana TREATMENTS

TESTING

STIGMA

THE CURE

PREVENTION MARCH / APRIL 2015 www.hivplusmag.com

What is STRIBILD? STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. It combines 4 medicines into 1 pill to be taken once a day with food. STRIBILD is a complete single-tablet regimen and should not be used with other HIV-1 medicines.

STRIBILD does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking STRIBILD. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids.

Never reuse or share needles or other items that have body fluids on them.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about STRIBILD?

• Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking STRIBILD, your hepatitis may suddenly get worse. Do not stop taking STRIBILD without first talking to your healthcare provider, as they will need to monitor your health. STRIBILD is not approved for the treatment of HBV.

Who should not take STRIBILD? Do not take STRIBILD if you: • Take a medicine that contains: alfuzosin, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, rifampin or the herb St. John’s wort.

• For a list of brand names for these medicines, please see the Brief Summary on the following pages.

• Take any other medicines to treat HIV-1 infection, or the medicine adefovir (Hepsera®).

What are the other possible side effects of STRIBILD?

STRIBILD can cause serious side effects:

Serious side effects of STRIBILD may also include:

• Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

• New or worse kidney problems, including kidney failure. Your healthcare provider should do regular blood and urine tests to check your kidneys before and during treatment with STRIBILD. If you develop kidney problems, your healthcare provider may tell you to stop taking STRIBILD.

• Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain.

• You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.

• Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

• Changes in body fat can happen in people taking HIV-1 medicines.

• Changes in your immune system.

Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea.

Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking STRIBILD? • All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, bone, or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking STRIBILD without first talking with your healthcare provider.

• If you take hormone-based birth control (pills, patches, rings, shots, etc).

• If you take antacids. Take antacids at least 2 hours before or after you take STRIBILD. • If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in STRIBILD can pass into breast milk, and it is not known if this can harm the baby.

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 Brief Summary of full Prescribing Information with important warnings on the following pages.

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

I started my personal revolution Talk to your healthcare provider about starting treatment.

STRIBILD is a complete HIV-1 treatment in 1 pill, once a day.

Ask if it’s right for you.

Patient Information STRIBILD® (STRY-bild) (elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information.

What is STRIBILD? • STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD is a complete regimen and should not be used with other HIV-1 medicines.

• STRIBILD does not cure HIV-1 or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses.

• Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or reuse needles, injection equipment, or personal items that can have blood or body fluids on them. Do not have sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood.

What is the most important information I should know about STRIBILD? STRIBILD can cause serious side effects, including: 1. Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take STRIBILD or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: • feel very weak or tired • have unusual (not normal) muscle pain • have trouble breathing • have stomach pain with nausea or vomiting • feel cold, especially in your arms and legs • feel dizzy or lightheaded • have a fast or irregular heartbeat 2. Severe liver problems. Severe liver problems can happen in people who take STRIBILD. 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). Call your healthcare provider right away if you get any of the following symptoms of liver problems: • your skin or the white part of your eyes turns yellow (jaundice) • dark “tea-colored” urine • light-colored bowel movements (stools) • loss of appetite for several days or longer • nausea • stomach pain You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time.

3. Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take STRIBILD, your HBV may get worse (flare-up) if you stop taking STRIBILD. A “flare-up” is when your HBV infection suddenly returns in a worse way than before.

• Do not run out of STRIBILD. Refill your prescription or talk to your healthcare provider before your STRIBILD is all gone

• Do not stop taking STRIBILD without first talking to your healthcare provider • If you stop taking STRIBILD, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking STRIBILD Who should not take STRIBILD? Do not take STRIBILD if you also take a medicine that contains: • adefovir (Hepsera®) • alfuzosin hydrochloride (Uroxatral®) • cisapride (Propulsid®, Propulsid Quicksolv®) • ergot-containing medicines, including: dihydroergotamine mesylate (D.H.E. 45®, Migranal®), ergotamine tartrate (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), and methylergonovine maleate (Ergotrate®, Methergine®) • lovastatin (Advicor®, Altoprev®, Mevacor®) • oral midazolam • pimozide (Orap®) • rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • sildenafil (Revatio®), when used for treating lung problems • simvastatin (Simcor®, Vytorin®, Zocor®) • triazolam (Halcion®) • the herb St. John’s wort Do not take STRIBILD if you also take any other HIV-1 medicines, including: • Other medicines that contain tenofovir (Atripla®, Complera®, Viread®, Truvada®) • Other medicines that contain emtricitabine, lamivudine, or ritonavir (Atripla®, Combivir®, Complera®, Emtriva®, Epivir® or Epivir-HBV®, Epzicom®, Kaletra®, Norvir®, Trizivir®, Truvada®) STRIBILD is not for use in people who are less than 18 years old.

What are the possible side effects of STRIBILD? STRIBILD may cause the following serious side effects: • See “What is the most important information I should know about STRIBILD?” • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking STRIBILD. Your healthcare provider may tell you to stop taking STRIBILD if you develop new or worse kidney problems.

• Bone problems can happen in some people who take STRIBILD. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones.

• Changes in body fat can happen in people who take HIV-1 medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the middle of your body (trunk). Loss of fat from the legs, arms and face may also happen. The exact cause and long-term health effects of these conditions are not known.

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 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 right away if you start having any new symptoms after starting your HIV-1 medicine.

The most common side effects of STRIBILD include: • Nausea • Diarrhea 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 STRIBILD. For more information, ask your healthcare provider.

• Call your healthcare provider for medical advice about side effects.

You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my healthcare provider before taking STRIBILD? Tell your healthcare provider about all your medical conditions, including: • If you have or had any kidney, bone, or liver problems, including hepatitis B infection • If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. - There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk with your healthcare provider about how you can take part in this registry.

• If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take STRIBILD. - You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

- Two of the medicines in STRIBILD can pass to your baby in your breast milk. It is not known if the other medicines in STRIBILD can pass into your breast milk.

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

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements: • STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works.

• Be sure to tell your healthcare provider if you take any of the following medicines: - Hormone-based birth control (pills, patches, rings, shots, etc) - Antacid medicines that contain aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or after you take STRIBILD - Medicines to treat depression, organ transplant rejection, or high blood pressure - amiodarone (Cordarone®, Pacerone®) - atorvastatin (Lipitor®, Caduet®) - bepridil hydrochloride (Vascor®, Bepadin®) - bosentan (Tracleer®) - buspirone - carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®) - clarithromycin (Biaxin®, Prevpac®) - clonazepam (Klonopin®) - clorazepate (Gen-xene®, Tranxene®) - colchicine (Colcrys®) - medicines that contain dexamethasone - diazepam (Valium®)

- digoxin (Lanoxin®) - disopyramide (Norpace®) - estazolam - ethosuximide (Zarontin®) - flecainide (Tambocor®) - flurazepam - fluticasone (Flovent®, Flonase®, Flovent® Diskus®, Flovent® HFA, Veramyst®) - itraconazole (Sporanox®) - ketoconazole (Nizoral®) - lidocaine (Xylocaine®) - mexiletine - oxcarbazepine (Trileptal®) - perphenazine - phenobarbital (Luminal®) - phenytoin (Dilantin®, Phenytek®) - propafenone (Rythmol®) - quinidine (Neudexta®) - rifabutin (Mycobutin®) - rifapentine (Priftin®) - risperidone (Risperdal®, Risperdal Consta®) - salmeterol (Serevent®) or salmeterol when taken in combination with fluticasone (Advair Diskus®, Advair HFA®) - sildenafil (Viagra®), tadalafil (Cialis®) or vardenafil (Levitra®, Staxyn®), for the treatment of erectile dysfunction (ED). If you get dizzy or faint (low blood pressure), have vision changes or have an erection that last longer than 4 hours, call your healthcare provider or get medical help right away.

- tadalafil (Adcirca®), for the treatment of pulmonary arterial hypertension - telithromycin (Ketek®) - thioridazine - voriconazole (Vfend®) - warfarin (Coumadin®, Jantoven®) - zolpidem (Ambien®, Edlular®, Intermezzo®, Zolpimist®) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking STRIBILD without first talking with your healthcare provider.

Keep STRIBILD and all medicines out of reach of children.

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

Issued: October 2013

COMPLERA, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, the STRIBILD Logo, TRUVADA, and VIREAD are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. © 2014 Gilead Sciences, Inc. All rights reserved. STBC0096 10/14

EDITOR’S LETTER

WE TOOK SHOWER SELFIES. DID YOU? OUR TEAM JOINED HUNDREDS OF OTHERS WHO SCRUBBED UP FOR THE #WEAREALLCLEAN SOCIAL MEDIA CAMPAIGN TO INCREASE POZ VISIBILITY AND RAISE MONEY FOR HIV.

DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM

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BRADFORD ROGNE (TOP)

I was in high school when Rock Hudson got HIV (and back then, that led immediately to AIDS) and I quickly became an activist for people living with the disease. But at that time celebrities who supported us—and my dying brothers—were really rare until Elizabeth Taylor stepped up, joining the fight against this virus and embracing the people who had it. She fought hard both to raise money for a cure, treatments, and medical care and to battle the stigma against people who had HIV or AIDS. We take a look at Taylor’s legacy (not just the organizations she helped found but also the many members of her family who took up her activist mantle) on page 16.

Now, as some cities make plans to keep their poz residents healthy, seeking to reduce the number of AIDS cases to under 700 or so, you can’t help but notice that HIV transmission itself is still rising, especially among people 13 to 24. Which is why it’s heartening to see so many young celebrities take up Taylor’s mantle as well, many of whom weren’t even born when Taylor first defended her friend Rock Hudson. As the MAC AIDS Fund named Miley Cyrus its spokeswoman for Viva Glam this year, we caught up with superstar singer Rihanna (last year’s spokeswoman). She’s still bringing her star power to HIV causes, raising money for charity and promoting visibility for people with the virus—and most importantly, she’s talking to young people about both preventing transmission and living with HIV. There are plenty of people ready to talk about HIV now. Here’s hoping we can get people to listen!

IN THIS ISSUE

march | april 2015

IN EVERY ISSUE

FEATURES

7 Buzzworthy

18 R ihanna to the Rescue

Francisco Ibáñez-Carrasco’s “raw” talk, where sex is a crime, and stopping self-destruction.

36 Daily Dose

Gay men say building support networks doesn’t have to be a drag (unless you want it to be).

55 Barbershop Diaries

Atlanta’s Khafre Abif talks cornbread and collard greens.

TREATMENT CHRONICLES

51

Can cannabis treat HIV? How to stop obsessing over your HIV diagnosis. Do you need a testosterone shot? As syphilis rates skyrocket, will a new rapid test help get it under control? How to get (or stay) fit when you have a chronic condition.

18

COVER: P HOTO BY IMEH AKPANUDOSEN/GETTY IMAGES THIS PAGE: PHOTO BY JP YIM/GETTY IMAGES (RIHANNA); THINKSTOCK/DIGITAL VISION (GUYS)

The superstar joins other millennial celebs in using social media to get the word out about HIV.

21 Twenty Most Amazing

HIV-Positive Women of 2015

From presidential advisers to rural working moms agitating for change, these 20 powerful women show just how much impact women can have—even when living with a chronic condition!

40 The Answers Issue

We’ve got some expert advice on the many questions you’ve sent us this year, from side effects of meds to where we are with a cure and whether you can ever ditch your condoms.

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editor in chief DIANE ANDERSON-MINSHALL art director BONNIE BARRETT copy chief TRUDY RING contributing editors NEAL BROVERMAN, KATIE PEOPLES, MARK S. KING, SUNNIVIE BRYDUM, TODD HEYWOOD, MICHELLE GARCIA assistant editor DANIEL REYNOLDS wellness editor SAM PAGE mental health editor GARY MCCLAIN video correspondent JOSH ROBBINS creative director, digital media DAVE JOHNSON director, digital media SCOTT RAGAN interactive art director CHRISTOPHER HARRITY online photo and graphics producers YANNICK DELVA, MICHAEL LUONG manager, application development ALEX LIM Program Manager VICTOR CARTE

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SVP, group publisher JOE VALENTINO VP, integrated marketing AMANDA JOHNSON senior manager, integrated marketing STEVEN O’BRIEN manager, integrated marketing LAUREN THOMAS coordinator, advertising PAIGE POPDAN coordinator, integrated marketing JOHN MCCOURT art director, integrated marketing CHARLIE FLAUMER senior director, media strategy STEWART NACHT circulation director JEFF LETTIERE fulfillment manager ARGUS GALINDO production services GVM MEDIA SOLUTIONS, LLC advertising production manager HEIDI MEDINA front end developer MAYRA URRUTIA traffic manager KEVIN BISSADA

HERE MEDIA chairman STEPHEN P. JARCHOW ceo PAUL COLICHMAN cfo/coo TONY SHYNGLE executive vice presidents BERNARD ROOK, JOE LANDRY VP, editorial director LUCAS GRINDLEY

senior vice presidents CHRISTIN DENNIS, JOHN MONGIARDO, JOE VALENTINO vice presidents GREG BROSSIA, ERIC BUI, STEVEN CAPONE, JUSTIN GARRETT, LUCAS GRINDLEY, AMANDA JOHNSON

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HIV Plus is a registered trademark of Here Media Inc. Entire contents © 2015 by Here Publishing Inc. All rights reserved. Printed in the USA.

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BUZZWORTH Y

BRIAN LYNCH (GMHC); KEITH HARING DESIGN COURTESY OF THE KEITH HARING FOUNDATION

STEP ASIDE, MAD MEN, THESE ARE THE COOLEST NEW ADS GMHC’s new “I Love My Boo” campaign showed up in 260 New York City subway stations, speaking to and celebrating gay men of color by highlighting their strength and resilience, rather than only sexualizing gay relationships with chiseled bodies and glossy imagery. “While one campaign can’t solve the race issues in our city or country, I believe this campaign directly challenges homophobia and racism by demonstrating the fundamental belief that all lives, regardless of the color of your skin or whether you are gay or straight, matter, period,” says GMHC CEO Kelsey Louie.

“Art & AIDS: Amor y Pasión” at the Leslie-Lohman Museum of Gay and Lesbian Art spotlighted artists living with HIV or AIDS. The exhibition, curated by Osvaldo Perdomo and David Livingston, came out of weekly therapeutic art classes run by GMHC’s Volunteer, Work, and Wellness Center. And the poster? Well, that’s just hot.

Astroglide gave us a woody through its partnership with the forward-thinking advertising agency Experiences for Mankind, which created a series of intimate moments enjoyed by intentionally sexually ambiguous wooden art mannequins, affectionately known as “The Pleasure People.”

“This ambiguity allows the campaign to focus on intimacy,

leaving audiences open to interpret the scene while thinking about lube and its possibilities for their own sex lives,” says Experiences for Mankind senior account manager Morgan Graham. The whole series is fun, inclusive, and sexier than we imagined wood could be.

MAKE THAT STARBUCKS RUN

Results of a study published in Hepatology show that people who drank three or more cups a coffee a day, even decaf, had lower levels of various liver enzymes than those who drank none, indicating that chemical compounds in coffee other than caffeine may help protect the liver. Previous studies found that coffee consumption may help lower the risk of developing diabetes, cardiovascular disease, nonalcoholic fatty liver disease, cirrhosis, and liver cancer. hivplusmag.com

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B UZZWORTHY

THE RAW STORY HIV educator and author Francisco Ibáñez-Carrasco’s witty, gritty new memoir, Giving It Raw: Nearly 30 Years of AIDS, is, he says, a part of contemporary overshare culture in all the best ways.

The book has the kind of “TMI”— too much information—that every reader seeks in a satisfying read: Raw sex, raw sadness, and raw fun. Visceral and brutally honest, at turns slapstick and erudite, and redolent of sweat, lube, and leather, the book offers the highlights (and lowlights) of the 52-year-old writer’s nearly three decades of living first with HIV, and then AIDS. A native of Santiago, Chile, Ibáñez-Carrasco immigrated to Canada as a young man, where he received both an institutional education in social science and an in-the-streets-and-bathhouses education on how to live shamelessly as a queer man.

Both voices come through in Giving It Raw (Transgress Press), his first—and, he says, most self-searchingly difficult to write—piece of nonfiction since his novel Flesh Wounds and Purple Flowers and story collection Killing Me Softly/Morir Amando.

Giving It Raw’s title is as in-your-face and darkly humorous as the writing. How did you develop your unique approach to telling your life’s story?

My life has been tragicomic, laugh and tears, and affluence, illness, and wellness. My inyour-face is part defense mechanism and part low tolerance for bullshit. To tell a nobody’s memoir, you got to find a firm, proud voice or be swallowed by torrents of media barf… and, trust me, I do have a very ebullient, coy, strategic, filtered, and sexy side to me.

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“Nobody’s” memoir?

In the ever-stretching constellation of autobiographic, memorializing, autopathographic writing, celebrities and victims and heroes reign, but a new type of memoir—one from the everyday person—has emerged proudly. Mine is one of them. I might be known in my scientist circle or maybe even wider, but I am no Bill Clinton talking about AIDS or Greg Louganis or [Sean] Strub or [Michael] Callen, etc.

Mine is a nobody’s memoir for the everyday person. march / april 2015

So, what will the everyday person gain from reading your not-so-average story?

To learn that we all have the wherewithal, hope, and motives to get up in the morning and live our lives and transform our worlds. Yup, very Miss Universe interview response, I know, but I stand by it.

My memoirs will tell anyone, “You are in this crazy world and you matter!” And, “Get noticed. If one person pays attention, you won’t have lived in vain.” I also expect a diverse audience to get a rich, if not always expected, understanding of the everyday life of a person living with HIV. The amazing, the horrific, and the quirky.

Amazing? Horrific? Quirky? Go! Amazing? What humans and gay men do to fight nature, to stretch skin and bones, to stretch the boundaries of relationships.

Horrific? The microaggressions we store for each other, the ways in which we mystify HIV and we forget our other ailments and resilience and assets. Online, for example, we ask about HIV only, but we are willing to meet cheating hetero husbands, bulimic gym types, gorgeous bipolar dudes. A microaggression is how we are subtly and not so subtly unsupportive and unloving to transgender [men], saying implicitly, “You are not a real man and you will never be.”

Quirky? Our queer sensibility mixed with individuality, the way we organize our jack-offs, our sex with others, our open, semidetached, or monogamous—yeah, right!—relationships.

The way we wrap HIV risk in sexy Mylar.

I’m struck, when I read Giving It Raw, by this brash, almost antiauthoritarian stance you have toward living shamelessly with HIV, yet you’ve also spent your career working within institutions for HIV prevention. What do you make of this tension?

Good question. I work as a scientist and teacher who is connected with organizations, work, and persons I often criticize,

but whose help we need very much in order to succeed. They all do good, ethical, and thorough work, if not always prompt and lucid. However, research is its own convoluted métier and so are the arts. I am one of the few persons I know who tiptoes in both fields of creativity, methods, and practice. (You see, your question has made my prose prickly right off the bat.) I live with the ambivalence and tension between producing data and producing art the same way I live other ambivalence in my life.

This is a productive uncertainty and tension because it makes me think everything twice, nothing is easy—and that is a good way to live.

What else have your life’s uncertainties produced?

Living long with HIV creates great uncertainty, but like any other force in life, you ride it or it rides you hard. I am guarded and distrustful due to this uncertainty, but it also makes me hopeful (paradoxically) and ambitious and risky. What do I have to lose? Yes, I’m uncertain about people, their motives, their egos, but I either crawl into a bad hole or I ride the waves and pangs and spasms of uncertainty.

I think you capture this flux of emotions really well in Giving It Raw. What else do you think readers will get from this book that possibly hasn’t been touched on elsewhere in the AIDS memoir genre?

The joy of sex and eroticism that scents everything in our lives—whatever your medical or body ability is. It is in the way we eat, in our emotional despair, in the urban traffic and spaces. The fact that HIV is an environmental disaster like global warming and wars, that the band plays on, and we, the people, must ponder and be tactful, but we must also create carnival and drama with it. It is the contradictory stuff of the human condition.—Mitch Kellaway

BUZZWORTH Y

SE’S L E E N O E M O S T 5 WAYS TO SPO S R O I V A H E B E V I CT

THINKSTOCK

SELF-DESTRU

Self-destructive behaviors can manifest in many ways. At times they are noticeable on the body, particularly if someone has an eating disorder that causes significant weight gain or loss, cuts or burns the body in obvious places, or appears to be openly under the influence of drugs or alcohol. At other times the behaviors are less obvious. In these cases, there are useful “red flags” that one can use to assess for the possibility that a loved one is engaging in self-harm.

Secrecy: Despite a strong desire to stop, until a person learns new ways to cope, they typically return to the immediate sense of relief or numbing that self-harm achieves. However, the conflict between doing or not doing the behavior often leads to intense feelings of guilt and shame. As a result, acts of self-harm are often done secretly. A person who isolates more than usual, regularly declines social invitations, and seems to be spending more time by themselves may be using that solitude to secretly engage in their self-destructive acts.

Untreated Depression or Anxiety: These conditions can leave a person overwhelmed by negative thoughts and feelings that evoke helplessness, hopelessness, inability to have fun, lethargy, loss of concentration, excessive worry, panic, or unbearable tension. If a loved one manifests any of these symptoms and they don’t have healthy tools to manage and navigate these experiences, they are vulnerable to using self-harm in an attempt to cope and selfmedicate.

History of Unresolved Trauma: In some cases, self-harm is the reenactment of prior modeling that normalized abusing or neglecting the body. Oftentimes, it’s a way for people to creatively communicate that unspeakable things were done to their bodies in the past. If no one was available in childhood to protect or comfort them, they may be lacking in the fundamental skills of self-care and have no healthy resources to manage stress. People who

have not processed or resolved their trauma in therapy are more vulnerable to turning toward acts of self-harm both in adolescence and adulthood.

Frequent Zoning Out: In order to engage in acts of self-harm, especially ones that physically hurt the body, one has to be in a detached state. People who frequently appear to be “spacey” and describe the sensation of being disconnected from their bodies and their environment are more easily able to hurt themselves.

The person who self-harms uses zoning out as a way to cope with situations that trigger or overwhelm them. Rather than responding in proactive ways, they tend to “freeze” or shut down. In a more frozen state they are able to hurt themselves without feeling the full extent of their injuries.

Prior History of Self-Harm: People who engage in self-injury often have more than one method. They might abuse substances in social situations and then engage in acts of self-mutilation when they’re alone. Without healthy tools to address negative thoughts, emotions, and upsetting social triggers, other forms of self-harm will be adopted when difficult situations arise. However, true healing can be achieved when a person learns new ways to communicate their pain, short-circuit overwhelming experiences, and turn to safer forms of self-care. —Lisa Ferentz A nationally recognized psychotherapist, clinical consultant, and educator, Lisa Ferentz specializes in the treatment of adolescent and adult trauma, abuse, and neglect. She is the founder and president of the Institute for Advanced Psychotherapy Training and Education Inc. She is the author of Treating Self-Destructive Behaviors in Trauma Survivors: A Clinician’s Guide, now in its second edition, and Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing. For more information visit LisaFerentz.com. hivplusmag.com

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BAD NEWS FOR GRINDR, GOOD NEWS FOR BAREBACKRT After a California man was charged with knowingly infecting another man with HIV late last year, the judge in the case ordered him to stay off Grindr (where he met his alleged victim) and other Internet hookup sites. We couldn’t help but think that if he’d gone first to a dating site aimed at HIV-positive folks, like Volttage or PozSingles, this would all be for naught. And then there’s BarebackRT, the world’s largest online hookup site for gay men who prefer not to use condoms, many of the members are HIV-positive. The site was founded 11 years ago by an HIVpositive guy (he remains anonymous but goes by the moniker Pigmaster) who wanted a place for poz guys to be out and open about both their status and their sexual desires. He told Positive Lite last year that he “started the site out of frustration that when dealing with other websites when you filled in your status as HIV, people were freaked out, even the people who were HIV-positive. People who were

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HIV-positive still wouldn’t talk to you because they didn’t want you to know their status. It just got very frustrating.”

In the beginning, BarebackRT “was mainly for positive people to meet other positive people; in the positive community there is a lot of barebacking; there are negative people too, though, who do come to the website—we have some that put down that they use condoms but they just like our website,” he said. Now the mix of members is changing, with negative men on PrEP and more poz guys on treatment that has given them an undetectable viral load and therefore little chance of transmitting the virus.

“The negative people actually have a more informed choice because there is no guessing,” Pigmaster said. “They would like to meet people who are undetectable.”

A bonus: The dating site has a social mission—in 2013 it donated almost $60,000 to HIV and LGBT equality causes. —Jacob Anderson-Minshall

BUZZWORTH Y

When Sex Is a Crime

Just having sex can be a crime in Florida, depending on the kind of sex being had

T:4.5”

WHERE SEX IS A CRIME IN THE U.S. HIV-SPECIFIC STATUTE, AT LEAST ONE PROSECUTION IN PAST TWO YEARS HIV-SPECIFIC STATUTE, NO RECENT REPORTED PROSECUTIONS HIV-RELATED PROSECUTIONS, THOUGH NO HIV-SPECIFIC STATUTE PUNISHMENT INCLUDES SEX OFFENDER REGISTRATION

Map courtesy HIV Law and Policy, based on data from 2008-2013

After a flurry of legal filings, a complicated case pending before the Florida Supreme Court could have a major impact on laws that are used, in part, to criminalize sex involving HIV-positive people, though any ruling would not address the criminalization law itself.

Initially, in 2011, a state-level court dismissed a charge that Florida resident Gary Debaun had “uninformed HIV-infected sexual intercourse” with his former partner Charles Marlin. But an appeals court disagreed on the definition of “intercourse,” and now the state’s Supreme Court will weigh in on the case.

Marlin had alleged that Debaun lied to him about his HIV status, going so far as to falsify lab reports and forge a doctor’s note saying Debaun was HIV-negative. After engaging in several sex acts, including oral and anal sex, Marlin said he learned that Debaun was HIV-positive, and the state subsequently charged Debaun under a Florida law that makes it a crime to not inform a potential partner of one’s HIV-positive status.

In 1986, Florida was among four states that became the first to enact laws requiring HIV-positive individuals to disclose their status and seek consent before engaging in “sexual intercourse” with a partner. Violation of the law originally brought a misdemeanor charge, but in 1993 it became a third-degree felony.

The trial court that first heard Debaun’s case dismissed the charge, relying on a similar earlier case involving two women in which it was determined that the Florida law, as written, applied only to sex that involves a penis entering a vagina. Thus, the court reasoned, any sex act between two men could not meet the statutory definition of “sexual intercourse” required for prosecution under the law. But the state appealed that decision, and in October 2013, Florida’s Third District Court of Appeal overturned it. The intention of the law, the appeals court reasoned, was to criminalize anyone who purposefully hid his or her positive status from a potential partner, regardless of gender or type of sex act.

“We need not determine whether the term ‘sexual intercourse’… encompasses any and all forms of sexual activities,” the Third District wrote in its decision. “We do find that the term encompasses more than just penetration of the female sex organ by the male sex organ and includes the acts at issue here (fellatio and penile-anal penetration).”

The appeals court cited the definition of “sexual intercourse” employed by Merriam-Webster’s Third New International

Dictionary, which included not only penis-in-vagina sex but also “intercourse involving genital contact between individuals other than the penetration of the vagina by the penis.”

Attorneys representing Debaun then appealed that court’s decision, prompting a flurry of legal filings from both sides debating the precise meaning of the statute under which Debaun was charged. Early in 2014 the Florida Supreme Court agreed to consider the case, though a series of extensions means the state’s high court has not yet heard arguments in the case. (At press time, oral arguments were scheduled for February 4, though there’s no set timeline for a decision.)

However the case is decided, it could have a lasting impact on who can be charged under Florida’s HIV criminalization laws, experts say. In effect, the decision could “redefine how Floridians legally define sexual intercourse,” notes The Citizen, a Key West newspaper. If the state’s high court determines that “sexual intercourse” involves any type of sexual act between individuals, including oral sex, any HIV-positive person could face criminal charges if it’s alleged they did not disclose their status prior to sex.

On the other hand, if the Supreme Court decides to side with the trial court and interpret the phrase in its most limited sense, Debaun’s case could set a precedent that would make it much harder to charge HIV-positive people who have anal or oral sex, whether with a partner of the same or different sex. Alternately, the court could arrive at a novel definition of “sexual intercourse” that includes some sex acts but not all. Regardless of what the court decides, the decision will be legally binding statewide.

Florida is just one of 34 states and territories that still have HIV-specific laws on the books. (Some that don’t, such as Texas, have still prosecuted people with HIV under more general laws.)

Like Florida’s, most of these state laws make it a crime to have sex without disclosing your positive status to your partner, even if you use a condom, have low- or no-risk activity, or have an undetectable viral load and are therefore unlikely to transmit HIV. Most scientists, researchers, and health care workers have come out against such laws in recent years, and Iowa became the first state to undo its own law last summer.

Unfortunately, however, none of the lengthy and involved legal proceedings in the Debaun case have sought to dismantle Florida’s HIV criminalization law. —Sunnivie Brydum hivplusmag.com

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BUZZWORTHY

Elizabeth Taylor’s Legacy of Philanthropy The Hollywood starlet turned film legend left another legacy of equal importance: She founded or benefited a number of AIDS organizations, inspired generations of people with HIV, moved policy and politicians, and left behind a family tree of people who continue to work on HIV and AIDS causes. Here’s what she begot.

Organizations Taylor Founded National AIDS Research Foundation: In Los Angeles in 1985, Taylor and Dr. Michael Gottlieb cofounded the National AIDS Research Foundation to research, find a cure and help people living with AIDS. At the same, Dr. Mathilde Krim established the AIDS Medical Research Foundation. These two merged to become…amfAR, cofounded by Krim and Gottlieb with Taylor as its international founding chairperson. With the success of amfAR and people with HIV beginning to live longer, Taylor established the Elizabeth Taylor AIDS Foundation in 1991 to focus specifically on funding organizations that cared for individuals with HIV or AIDS.

When Taylor was alive, she was completely hands-on with her HIV work and her family was supportive and proud. As a way to honor her legacy, many of her family members are now stepping forward as ETAF ambassadors, lending their own talent or craft to help the foundation, representing ETAF at events, or even volunteering at local AIDS service organizations in their own community. Here’s how Taylor’s children, grandchildren, and other family members are involved today.

Taylor sold her wedding photos to People for $1 million and used the money in its entirety to open the doors of ETAF. To date, more than 650 organizations in 33 countries have been helped through ETAF’s funding efforts.

Taylor’s Leadership Impacted These Groups Taylor organized the first Hollywood fundraiser benefiting HIV and AIDS in September of 1985, for AIDS Project Los Angeles. Taylor called all her friends within the entertainment industry and was able to wrangle some the biggest names in Hollywood and elsewhere, including Madonna, Warren Beatty, and Betty Ford. In 1986, Taylor was honored at the group’s second Commitment to Life.

The ETAF provided its first major grant to Project Angel Food, a lifeline for those diagnosed with serious ailments. Taylor was a trustee until her death. In 2014, on the 25th anniversary of Project Angel Food, the organization presented Taylor’s former daughter-in-law, Aileen Getty, with the newly created Elizabeth Taylor Legacy Award.

Grandson

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Naomi Wilding

organized an art auction in 2014 to benefit ETAF and represented it at several events: Macy’s Passport, Project Angel Food, and Camp Hollywood Heart/One Heartland.

represented ETAF at Macy’s Passport, Project Angel Food, and Camp Hollywood Heart/One Heartland.

Son Chris

Wilding

serves as a trustee of ETAF.

Stepdaughter Kate Burton introduced the Elizabeth Taylor Leadership Award at the 25th Project Angel Food event attended by many family members.

The Taylor Timeline of Major Milestones 1986: Elizabeth Taylor testified before Congress on the need to fund emergency AIDS care, with legislation known as the Ryan White bill. Taylor returned to Congress in 1990 with Ryan’s mother, Jeanie White, to help pass a more comprehensive AIDS resources bill.

Granddaughter

Caleb Wilding has

1987: Elizabeth Taylor made a personal plea to President Reagan to discuss HIV and AIDS in the public sphere, after he had been silent so long. She successfully persuaded him to finally give his first speech on the AIDS epidemic at a dinner honoring his surgeon general, C. Everett Koop,

Grandson Tarquin Wilding has

represented ETAF at Macy’s Passport, Project Angel Food, and Camp Hollywood Heart/ One Heartland.

who also sent a pamphlet to every home dispelling the myths of AIDS, the first time a nationwide mailing was done in the U.S. to inform people about an epidemic.

President Reagan declared, “There is no reason for those who carry the AIDS virus to wear a scarlet A.”

BUZZWORTH Y The first AIDS organization in the state of Arizona, Arizona AIDS Trust got the Hollywood treatment in 1986 when Elizabeth Taylor brought Bob Hope to take part in its Gift of Life event.

Arizona AIDS Trust board member Kirk Baxter recalls, “It brought Hollywood glamour to the Valley of the Sun and, more importantly, a renewed chance for life for so many.”

Visual AIDS created the now-ubiquitous red ribbon for the 1991 Tony Awards as a symbol of support and compassion for those living with HIV. Executive director Nelson Santos says, “When Elizabeth Taylor pinned one on, it became an internationally renowned symbol of AIDS awareness. Ms. Taylor was rarely seen without a red ribbon.”

Taylor attended the opening of the Elizabeth Taylor Medical Clinic at Whitman-Walker, established in her name, in Washington, D.C., in 1993. (The clinic currently provides free HIV testing and medical services.) In 2005, when the Elizabeth Taylor Endowment Fund was established for Clinical AIDS Research and Education at the University of California, Los Angeles (UCLA CARE Center), Taylor was there for the ribbon-cutting ceremony.

Playing a major role in the unfurling of the Names Project Quilt’s 1996 display in D.C., Taylor led a candlelight vigil and gave a rousing call to action on the steps of the Lincoln Memorial. For many Americans it was the first they had heard of the Quilt.

Grandson Quinn Tivey did a photojournalism project on Wattpad and for People exploring agencies helped by ETAF. He has spoken at the FACE AIDS Conference on behalf of ETAF. Quinn is also a leader of amfAR’s GenCure.

Granddaughter Laela Wilding is a board member

for Our House in Portland, Ore., which provides housing, food, and medical services to people with HIV. She also hosts an annual screening of an Elizabeth Taylor classic movie as a benefit for Our House and Cascade AIDS Project. She has also spoken at other HIV benefits.

Taylor became the founding chair of Macy’s Passport in 1987 when the five-year-old event first expanded to Los Angeles. Passport began in 1982 as an awareness-raising fashion show in the Macy’s employee cafeteria. It has since grown into one of the largest and longest-running HIV fundraising events of its kind and, along with Macy’s Foundation, has donated more than $31 million to HIV and AIDS services, prevention, education, and research.

In the aftermath of Hurricane Katrina, ETAF created a mobile medical clinic to help people with HIV or AIDS receive proper care and medications. Impacted by the reverberations of the hurricane, Taylor recognized that in Third World countries, including many in Africa, poor access to health care is a reality daily, not just after a natural disaster. In 2008, Taylor reached out to the Global AIDS Interfaith Alliance to discuss a method to properly service locations in Africa with the greatest distance to health care and the highest prevalence of HIV and AIDS. As a result of the partnership, the Elizabeth Taylor Mobile Medical Clinics were created and have now become GAIA’s largest medical assistance program. Today, there are seven mobile clinics in Malawi, five of which are in the Mulanje region, where on weekdays no one has to walk more than an hour to get to proper health care. HIV has since decreased by 50 percent in that region.

Granddaughter

Eliza Carson has represented ETAF at ACRIA, GAIA, and an amfAR screening of The Battle of amfAR at the United Nations.

Grandson Rhys Tivey, a jazz trumpeter, performed at the ETAF auction organized by his cousin Naomi Wilding. He has represented ETAF at ACRIA, GAIA, and amfAR events.

Former daughter-in-law Aileen Getty received the inaugural Elizabeth Taylor Leadership Award from Project Angel Food. Last year she matched donations at ETAF’s art auction event. She joined many other ETAF ambassadors at Camp Hollywood Heart/One Heartland and founded both the Aileen Getty Foundation and Gettlove, a progressive group that gets homeless people into housing; both groups benefit people with HIV and AIDS.

• Grandson Lowell Wilding (not pictured) has recently joined the ETAF ambassadors and represented ETAF at Project Angel Food’s Angel Awards.

1987: Yet another unwavering moment in her fight against HIV and AIDS, Taylor spoke to the National Press Club and outwardly criticized laws that prohibited needle exchanges as “murder.” People were shocked to see a glamorous movie star take on this topic.

1992: Elizabeth Taylor stirred controversy when she posed for the cover of Vanity Fair

holding a condom. Photographer Firooz Zahedi recalls, “When the editor at Vanity Fair requested that Elizabeth hold up a condom for the cover, I thought it may come across as tasteless and was sure that she would decline. I was wrong. Elizabeth was determined to do whatever it took to bring attention to the need to curb the spread of AIDS and promote safe sex. The

final result is amazingly beautiful, classy and to the point.”

1993: Taylor created Cinema Against AIDS to fundraise for amfAR at the Cannes Film Festival, believing Cannes was the ideal location for a large global fundraiser. This annual event, which is still going strong, raised a record $35 million in 2014 alone.

ELIZABE TH TAYLOR, K ATE BURTON (WIKIPEDIA); RHYS TIVEY, LAELA WILDING, CALEB WILDING, CHRIS WILDING, NAOMI WILDING (FRAZER HARRISON); ELIZA CARSON (ROBIN MARCHANT); AILEEN GE T T Y (MIKE WINDLE); TARQUIN WILDING (MICHAEL KOVAC); QUINN TIVEY (ALBERTO E. RODRIGUEZ)

hivplusmag.com

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RIHANNA

?

TO THE RESCUE Rihanna is sending out an “SOS” about HIV to her fans. Last year the “Umbrella” singer partnered with MAC Cosmetics in an awareness campaign that is designed to educate young people about the virus.

As part of this campaign, Rihanna walked the red carpet at a recent Hollywood screening of It’s Not Over, a new documentary

by Andrew Jenks about three young people affected by HIV in different areas of the world, which is now streaming on Netflix.

The film centers on Paige, an American teenage girl born with the virus who raises awareness of HIV issues in schools throughout the country; Sarang, a gay playwright from India who is staging a production in support of same-sex marriage; and Lucky, an educator from South Africa who is trying to prevent youths from making poor life decisions.

After standing alongside these extraordinary people at the premiere, Rihanna revealed to Plus that it was the statistics about HIV infection that shocked her into participating: People age 13 to 24 accounted for 26 percent of new infections in the U.S. in 2010, according to the Centers for Disease Control and Prevention. Globally, that number is nearly 40 percent.

“That’s younger than I am!” the 26-year-old singer exclaims,

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by Daniel Reynolds

looking both professional and chic in a pink gingham blazer and skirt designed by Altuzarra. “That’s how real that is. And people don’t know that, especially young people. It changes all the time, and I think the only way to stop it is to have people know what’s going on.”

Rihanna has tweeted a message to her fans to help educate them on this issue. “Check out #ItsNotOver, a film from @MACAIDSFund about young people affected by #HIV,” she wrote, along with a shareable graphic that stated, “90 percent of U.S. teens don’t think they’re at risk for contracting HIV.” The post, which was broadcast to her nearly 39 million followers, has been shared 4,500 times and favorited 4,800 times. This proves that a tweet from the right account can translate to major real-world benefits. And by educating influencers of young people, organizations like the MAC AIDS Fund have found an ideal way to pass this lifesaving information on to this group.

“I am very close with my fans, and when MAC approached me about this, I got a whole lot of information [and] a lot of heartbreaking real statistics that I didn’t know,” Rihanna says. “They were very shocking for me, and it’s something that I felt was important for me to get the word out, to spread the word, to educate

GE T T Y: JASON KEMPIN / STAFF

The pop superstar is joining other 20-something celebrities using star power and massive social media followings to get young people talking about HIV young people, educate my fans on a matter that’s really killing us and killing the youth.”

Rihanna says she jumped into HIV activism with a real concern for young people, those who are poz and those who are at risk of contracting the virus. In addition to promoting the film, the pop icon also partnered with MAC Cosmetics to be the face of the Viva Glam makeup line, from which 100 percent of sales goes to the MAC AIDS Fund, helping people affected by HIV. The founders of MAC, Frank Angelo and Frank Toskan, started the MAC AIDS Fund in 1994 with Viva Glam lipstick, which the fund’s website dubs “the first lipstick created to directly confront and raise money and awareness for AIDS at a time when the pandemic dramatically affected the fashion makeup communities, and was greatly stigmatized as a gay disease.” Since then, spokespeople have included RuPaul, Miley Cyrus, Eve, Mary J. Blige, Lady Gaga, Ricky Martin, and Elton John.

Last year the fund, which is fully supported by Viva Glam sales, made a $2 million grant to the Joint United Nations Programme on HIV/AIDS, which will help provide testing and treatment to millions of young people around the world as part of its UNAIDS’ Treatment 2015 initiative.

John Demsey, group president of the Estée Lauder Companies, MAC’s parent firm, praised Rihanna’s work to raise awareness and money for such an essential cause.

“MAC Cosmetics has a long history of engaging the right star power to motivate our customers and make an impact on this important cause,” he said in announcing the grant. “With UNAIDS’ resources and strategic thinking and Rihanna’s passionate support, we’re helping save lives one lipstick at a time.”

The “Diamonds” singer is following in the footsteps of one of her role models: the late actress Elizabeth Taylor, who cofounded amfAR and set up the Elizabeth Taylor AIDS Foundation, and was one of the first celebrities to support people with HIV. In fact, at the 2014 amfAR Inspiration Gala in Los Angeles, Rihanna paid $100,000 for a print of the Who’s Afraid of Virginia Woolf ? actress, which was signed by artist Willy Rizzo.

“Everybody loves Elizabeth Taylor!” Rihanna says. “She’s very glamorous. She’s the best that’s ever done it. But it was for a good cause. I didn’t mind spending every penny on it, because it all went to charity.”

Carrying on the torch of the late public health champion, Rihanna is in the vanguard of a group of young celebrities who are hivplusmag.com

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herself from people with HIV, and months later she happily took on the MAC AIDS Fund role with Viva Glam.

Both Cyrus and Rihanna walked the red carpet at the Los Angeles amfAR Inspiration Gala last fall, and both ended up contributing a ton of money to the HIV organization. In addition to bidding on and winning the Elizabeth Taylor print, Rihanna put down a winning $35,000 bid for diamond earrings designed by Harry Winston. Cyrus, who along with boyfriend Patrick Schwarzenegger was also among the attendees at the It’s Not Over screening, spent even more than the Barbadian-born singer. She bid $300,000 on a photograph shot by Ryan McGinley and then gave another $200,000 to amfAR to help support the organization’s search for a cure.

But these young stars are doing more than donating money; they’re opening the eyes of their fans to an epidemic that, as the documentary’s title states, is not over. Their participation is essential to get people caring, talking, and tweeting about a disease that affects us all, regardless of age, sexual orientation, or nationality, a virus that millions more young people are learning to manage and live with than ever before. And words from a renowned singer like Rihanna go a long way toward helping those who don’t have a voice of their own.

“I want to help reach as many young people around the world as I can,” Rihanna said in a statement released by UNAIDS and the MAC AIDS Fund last year. “While we need to begin with education, we also need to deliver HIV testing and treatment to the millions of young people who need our help, which is exactly what we plan to do.” ✜

GE T T Y: CRAIG BARRIT T

raising awareness of HIV for the millennial generation, which is an at-risk group for infection. Alicia Keys, the 15-time Grammy Award–winning musician, has become one of the most visible celebrity HIV activists of her generation and has been instrumental in championing Greater Than AIDS, which runs campaigns aimed at raising awareness, fighting stigma, and encouraging prevention.

Last year’s campaign, “Empowered,” had Keys trumpeting the power of women—as mothers, daughters, sisters, friends, partners, and people living with HIV—to change the course of HIV and AIDS through everyday actions. Keys stumped for the cause at festivals and events, made hearthside videos with HIV-positive women, and used her great social media outreach to get women, both poz and not, to talk about HIV. Other world-renowned artists, such as Christina Aguilera and Nicki Minaj, have spoken out about HIV as models for the Viva Glam campaign in prior years, and superstar Miley Cyrus has taken on the role in 2015. The “Wrecking Ball” singer has become a strong LGBT supporter in recent years, so many fans hope she’ll be just as outspoken for reducing stigma around people with HIV. In 2013, Cyrus was the subject of a social media hoax that went viral, alleging she had found out she was HIV-positive and including the hashtag #CureForMiley. Fans—those who weren’t in on the “joke”—reacted with support and concern rather than prejudice, and the singer didn’t react to the hoax with hostility. In fact, both then and when it happened again in 2014, after Cyrus was hospitalized with an allergic reaction to a flu medication, the singer didn’t react publicly at all. She felt no need to defend or distance

THE

20 MOST AMAZING HIV-POSITIVE WOMEN OF

MEN

2015

MAY GET MORE ATTENTION BUT THESE FINALISTS ,

WHITTLED DOWN FROM OVER

100

NOMINEES , PROVE

WOMEN HAVE BEEN AT THE FOREFRONT OF THE FIGHT AGAINST Tami Haught

HIV

An Iowa farm girl at heart, Tami Haught, who still lives in a small rural community, recalls lying about the cause of her husband’s death. Positive since 1993, she just couldn’t admit that her husband had died of AIDS complications. For six years, Haught continued to lie, living “in silence” and hiding her own positive status from family and friends. When she finally came out as HIV-positive, Haught says, she felt “a burden lifted off my shoulders.”

Today, Haught is not only out and proud, she’s become a leading organizer and champion of anticriminalization efforts for people with HIV, and what Poz called a “mama bear” to many living with HIV. She’s been a Sero Project board member, a member of the United States People Living With HIV Caucus Steering Committee, a GNP+NA board member, and president of Positive Iowans Taking Charge, an educational, emotional and social support group. Haught was also the Sero Project criminalization conference coordinator, helping organize the first HIV Is Not a Crime conference, held last year.

Her work around HIV criminalization has gained her the greatest accolades. As community organizer for Community HIV/Hepatitis Advocates of Iowa Network, Haught led the group’s education and mobilization campaign to repeal and replace Iowa’s HIV criminalization statute, making the state the first in the nation to do so.

“Tami is an unstoppable force,” says Terry Lowman, who launched the advocacy group Iowa Unitarian Universalist Witness Advocacy

FOR DECADES .

Network and worked with Haught in the effort to replace Iowa’s outdated law with a statute that reflects current knowledge about the virus and transmission routes. “After two years of lobbying, she knew all 150 Iowa Senate and House members. Legislators passed Iowa’s reformed HIV law because she took the time and effort to get to know each and every one of them. It became personal. They passed the law because they couldn’t let Tami down.”

When she received a 2014 Annual Friends of Iowa Civil Rights Award, Haught told friends it didn’t “seem right to be honored for something that was a labor of love. Love for the advocacy work that I thoroughly enjoy doing and love for everyone in Iowa who modernizing this law helps; along with justice and peace for myself.”

She was equally gracious about being the most nominated woman for this list too. “I am very honored,” she says. “There are so many incredible women living with HIV who are leading to make change in HIV criminalization, stigma, violence, etc., against people living with HIV. There are so many who deserve recognition. When women come together, change happens. I have met so many incredible people who are infected or affected by HIV. It is my honor to work beside them to fight the stigma, criminalization, and discrimination. We become a family that works together for better treatment of us all.”

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Naina Khanna

The executive director of Positive Women’s Network-USA, a national organization that prepares women living with HIV for leadership roles and supports their involvement in all levels of decision-making, Naina Khanna is a leader of leaders. A member of the steering committee for the 30 for 30 Campaign, this powerhouse sits on the board of trustees for AIDS United and is a member of the U.S. People Living With HIV Caucus. For four years, she also served on the Presidential Advisory Council on HIV/AIDS. “Naina leads by example,” says Haught. “She is an inspiration, making change and advocating for women living with HIV/AIDS. Naina is dedicated to keeping women living with HIV/ AIDS included in every aspect of care, treatment, and programming… she is ensuring women are not forgotten in these efforts.”

Khanna leads PWN-USA to fight for a world where, she says, women living with HIV “can live long, healthy, dignified, and productive lives, free from stigma and discrimination.” Last year the group organized the first-ever National Leadership Summit for Women With HIV, focused on timely and critical issues and bringing together more than 200 women living with HIV from across the U.S. Haught says, “Bringing that many women together was an incredible opportunity. Having been a woman who for years did not know any other women living with HIV, it is wonderful to have the opportunity to be in a room full of women who can understand what it is like to live with HIV.” Khanna was also moved. “All around the country, women with HIV are standing up and fighting for our rights,” she says, “and I’m proud to be a part of that movement with so many other women who inspire me every day.” hivplusmag.com

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Cecilia Chung

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CECILIA CHUNG (FACEBOOK)

Patricia Clark

Patricia Clark was 31 years old and living in a small town in Michigan when her boyfriend called from prison and told her that she needed to be tested for HIV. It was 1991, and Clark didn’t know a single person with HIV. When she tested positive, Clark was certain she was going to die, especially because she didn’t even have health insurance. But unlike many who are paralyzed by fear at the discovery, Clark immediately applied for services, going straight from the testing center to apply for Medicaid the same day. From the beginning, Clark had turned to her local HIV and AIDS service organization, CARES, for support—and when her boyfriend was released from prison she got him hooked up with the organization too.

Then Clark inherited a 6-year-old girl from family members who were unable to care for her—and everything changed. “Within two weeks,” Clark told The Body, “I could see that either I was going to invest in having this child and raising her—and if I did that, I wouldn’t stay with this man [who’d been in jail] because the chaos for her would not be healthy. If it had just been me, I would have probably still been there, but because it was her, I was able to disengage from him.”

She immediately began volunteering at CARES and soon afterward started working there part-time. That’s when Kelly Doyle, director of client services at CARES, met her. “Pat started working for CARES 10 years ago as an administrative assistant,” Doyle tells Plus. “Then [she] moved on to being a prevention specialist and then a case manager.”

Doyle is amazed at her colleague’s ability to be so open about her HIV. “In the time that I have known her, [Pat] has been an outspoken advocate for HIV and openly discussed her own journey with HIV in our small community,” Doyle says. “She has grown up in a small town and with her family all around her, she has been brave to come out to them about living with HIV.” At CARES, Clark “has fought for her clients and gone above and beyond to make sure the message of HIV was out in the community,” says Doyle, talking about Clark’s willingness to do presentations, be on television, and even share her story in a United Way ad. “Pat has facilitated every program at CARES and has consistently advocated for clients to be a part of conferences in Michigan, even driving them herself across the state.”

Now the team leader for CARES’ case management team in Kalamazoo, Clark is also the cochair of the Positive Women’s Network Michigan chapter and involved with a coalition in Michigan working on HIV criminalization laws. “Pat is an inspiration to everyone here at CARES and in our community due to her strong voice, her advocacy for those living with HIV, and her resourceful nature,” Doyle raves.

“She is one of those people, if you want something done, you go to her and she will figure it out.”

To call her the most visible HIV-positive transgender woman in the U.S. would embarrass her, but Cecilia Chung, who serves on the Presidential Advisory Council on HIV/AIDS, has earned every ounce of that national recognition for her advocacy on behalf of human rights, social justice, health equity, and LGBT equality.

“Cecilia is a fierce advocate for social justice, working in the intersecting fields of HIV, transgender rights, and health care,” says Christopher Roebuck, a medical anthropologist who teaches at Haverford College. “Her list of accomplishments are vast and growing. She has this unique and inspiring ability to link both local and global concerns in her work, both broadening and refining all our approaches to confronting HIV crises. She’s a fierce leader, inspiring role model, and powerful community organizer.”

Mark Misrok, president of the board of directors for National Working Positive Coalition, praises Chung for advocating on behalf of trans people, women, people living with HIV, sex workers, and those who have been victims of sexual and other violence while incarcerated. “Cecilia has been an indefatigable leader across communities,” he notes.

Chung is a San Francisco health commissioner (the first transgender woman appointed to the post), a senior strategist at the Transgender Law Center, and a past chair of the San Francisco Human Rights Commission, where she was the first openly HIV-positive person and first trans woman and to hold that post. “[Chung] developed a pioneering study of economic and employment status of transgender women of color in the San Francisco Bay area,” says Misrok, “and succeeded in following up on it to obtain funding to launch San Francisco’s groundbreaking transgender employment program.”

She’s equally committed to helping trans women fight HIV. “Cecilia has fought relentlessly to keep transgender women at the center of national and local HIV prevention and care strategies,” says the Sero Project’s Reed Vreeland. One such effort was her role as a consultant to the 2014 International AIDS Conference, for which Chung organized a satellite conference on transgender issues.

“What launched my own advocacy path was my desire to survive as a trans woman, an immigrant, and a person of color living with HIV,” Chung says. “I’m heartened to see the progress in HIV prevention and treatment but concerned that many inequities that make us vulnerable to HIV still exist today. Next time when you see or hear me, please keep in mind that there are hundreds and thousands of stories from other HIV-positive women waiting to be heard.”

Tommy Luckett

TOMMY LUCKETT (FACEBOOK); WAHEEDAH SHABAZZ-EL (FACEBOOK); LAUREL SPRAGUE (FACEBOOK)

One of those women Chung wants you to keep in mind is Tommy Luckett. “In the HIV sphere, where voices of trans women living with HIV are most underrepresented, I am inspired by emerging leaders like Tommy,” Chung says. “She brings a trans woman of color perspective from the southern states and a personal story that reflect the current landscape of the epidemic.”

“My role can best be described as an agitator,” Luckett told My Fabulous Disease blogger Mark S. King, who chose Luckett for his “15 HIV Advocates to Watch in 2015” list. She’s shaking up Arkansas, where Luckett sits on the board of the Arkansas Transgender Equality Coalition and the state health department’s Quality Care Advisory Board.

“I was in a relationship when I contracted HIV from my partner,” Luckett told King, hoping to dispel the common misconception that all trans women with HIV got the virus from risky behaviors like sex work.

Still, she acknowledged sex work and HIV are risks for trans women.

“In order to have shelter, some trans women are forced into sex work.

Being caught with a certain number of condoms is against the law in some states. In essence, the laws are contributing to the spike of HIV cases in the transgender community.”

Luckett’s influence has grown as she’s made her voice heard: at the Presidential Advisory Council on HIV/AIDS; at the HIV Is Not a Crime Conference; at AIDS Watch 2014 in Washington, D.C.; at the National Leadership Summit for Women Living with HIV; as keynote speaker at the first LGBT Summit in Fayetteville, Ark.; and on the U.S. People Living With HIV Caucus Steering Committee.

“Tommy is a powerful and effective transgender woman demonstrating courage and leadership in Arkansas, with a nationwide reach inspiring and educating others,” says Misrok.

Waheedah Shabazz-El

“Waheedah is a fierce advocate for women living with HIV,” says the Sero Project’s Reed Vreeland. “And for the experiences of women of color, sex workers, and women who are currently or have been incarcerated.” Indeed. Waheedah Shabazz-El describes herself as a 50-plus African-American Muslim woman and retired U.S. postal worker who was diagnosed with AIDS in 2003. “I am a native Philadelphia resident, a retired postal worker and a kick-ass AIDS activist,” she said in

an interview with the HIV Philly blog. “That’s what my friends tell me.”

Shabazz-El is a founding and advisory member of Positive Women’s Network-USA and coordinator of PWN-Philly. By day she works as an HIV counselor and tester at Philadelphia Fight, but her résumé of extracurriculars is packed: She’s a steering committee member for the HIV Prevention Justice Alliance and chair of the community advisory board at the University of Pennsylvania’s Center for AIDS Research.

As a member of the National HIV/AIDS Strategy Working Group, Shabazz-El has visited the White House, and on behalf of PWN she delivered the closing address at the XVIII International AIDS Conference in Vienna. She wants to make sure women are “counted in,” having their voices heard when it comes to planning and prevention efforts, policy decisions, and HIV leadership.

“In the U.S., women make up nearly a third of all new infections,” she told HIV Philly. “[We need to] prioritize women in a risk category of their own. Not women in jail or women who do drugs or even women with children. Count all women in. Whether they are of childbearing age or experiencing menopause. Women’s risks for acquiring HIV have not been clearly defined.”

Laurel Sprague

As a leader of the U.S. implementation of the People Living With HIV Stigma Index, research director for the Sero Project, and regional coordinator of GNP+NA, the North American affiliate of the Global Network of People Living With HIV, Laurel Sprague is “a research powerhouse who has moved community-based research and PLHIV leadership forward,” says Vreeland.

When she was diagnosed in 1991, she was 20 years old. “I became ill very quickly and many of the friends who became my support system were dying too,” she says. “What I really cared about was my son, who was an infant, and how I could possibly give him what he needed to be OK without me…a group of gay men with HIV in southeastern Michigan, my first support group, helped me. Between them, they taught me a kind of endurance, generosity, graciousness. In retrospect, it feels like the work I do just happened, but I think it started in those fragile friendships. We couldn’t do anything to stop what was happening, but we could do a lot to be there for each other.”

Ask anyone and they’ll tell you Sprague, who works with grassroots organizations to support participatory, community-based research projects, is there for anyone who asks. She has provided technical assistance to local, national, and global organizations and to networks of people living with HIV throughout North America as well as sub-Saharan Africa, Central and Eastern Europe, and Central Asia. She coordinates the research work of GNP+NA and the Sero Project. Sprague teaches political science at Eastern Michigan University and is a Ph.D. candidate at Wayne State University in Detroit. Her research focuses on the resiliency and capability of people, particularly when faced with stigma and discrimination, criminalization, and human rights abuses.

Since 2009 she has provided worldwide technical assistance on the development and implementation of the Stigma Index, which Sprague described as “a research action tool for communities living with HIV to be able to document our lived experiences of HIV-related hivplusmag.com

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Linda Scruggs

Linda Scruggs was 25 years old and 13 weeks pregnant when she tested positive for HIV in 1990. “They told me that I had the option of terminating the pregnancy to prolong my health, and they offered me, with the termination, five years to live,” Scruggs told CNN in 2011. “If I did not terminate this baby, probably me and the baby both would be dead within three years.”

Refusing to give up her child, Scruggs settled for her three-year expiration date, which came and went. (And the child, Isaiah, was born HIV-negative.)

Over two decades later, Scruggs, now 50, has become not only a success story but an HIV activist, coordinating programs to spread awareness and fight the stigma that remains after all these years.

For 10 years, Scruggs was the director of programs for the AIDS Alliance for Children, Youth, and Families in Washington, D.C., and since then she’s spoken about HIV in front of heads of state (including former president Bill Clinton), been honored by President Obama, and traveled to remote villages in South Africa to talk about HIV, and she was a much-lauded plenary speaker at the 2012 International AIDS Conference in Washington, D.C., where she spoke about the importance of women and girls in turning the tide against HIV. She is a founding member of the Positive Women’s Network-USA and the National Black Woman HIV Network. Scruggs decided in 2006 to pursue higher education, and in 2010 she received bachelor’s and master’s degrees in human services.

Scruggs cofounded the Ribbon Consulting Group with another woman on this list, Vanessa Johnson. Together they have a combined 50 years of experience dealing with HIV and other health issues. Along with their members, Scruggs and Johnson provide consulting services to help organizations, health departments, and hospitals increase their ability to support and promote healthy communities through collaborative partnerships and community engagements.

Oh, and that single mom with the death sentence in 1991? She eventually married an HIV-positive man, Nathaniel, and the two have a blended family that includes her son Isaiah, Nathaniel’s two children, and another son, Lawrence, whom Scruggs adopted in 1997, when he was 9 years old.

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Dawn Averitt

Dawn Averitt was just 19 when she was diagnosed with HIV in 1988. Since then, she has become a respected speaker, writer, and advocate around women’s health issues and HIV. In 2002, Averitt and her brother Richard launched the Well Project, a nonprofit organization aimed at improving the lives of women living with HIV and AIDS, providing accurate and current information on women and girls and HIV, and changing the course of the pandemic through treatment and prevention efforts focused on women. The Well Project’s award-winning Web portal now attracts more than 1.3 million unique visitors each year, operating as a global hub of resources that help women and girls overcome the inequalities, barriers, and stigma that contribute to the epidemic among women.

Averitt also founded the Women’s Research Initiative on HIV/ AIDS, a program of the Well Project, which has helped shift the research paradigm to include more women and people of color. In 2007 she received a Women Leading Global Change Award from the World YWCA for her leadership in the HIV and AIDS pandemic. She’s served on numerous boards and panels, including a Food and Drug Administration advisory panel, several National Institutes of Health working groups, and the Perinatal HIV Guidelines Working Group.

In 2010 she was named to the Presidential Advisory Committee on HIV/AIDS. Today, Averitt is a member of the Office of AIDS Research Advisory Council and has helped organize several important scientific conferences, such as the Conference on Retroviruses and Opportunistic Infections and the National Women and HIV Conference.

She also makes time to serve on advisory boards for major pharmaceutical companies producing HIV medications.

Krista Martel, executive director of the Well Project, says she’s always been impressed by “Dawn’s unequivocal focus on ensuring women are included at every level of the HIV research process.”

Martel says Averitt’s work has a “far-reaching impact beyond what we can measure.”

Michelle Anderson

When she entered the 2011 Miss Plus America beauty pageant— the premier national pageant competition for plus-size women of every age—Michelle Anderson became the first out HIV-positive

LINDA SCRUGGS (FACEBOOK); MICHELLE ANDERSON (FACEBOOK)

stigma and discrimination, and to then use the results as evidence for advocacy work on our own behalf,” in an interview with the Stigma Action Network’s blog. Now she’s leading the U.S. implementation of a tool that’s meant to both “address stigma relating to HIV while also advocating on the key barriers and issues perpetuating stigma—a key obstacle to HIV treatment, prevention, care and support.”

Since the project began in 2008, more than 50 countries have completed the study. More than 1,300 people living with HIV have been trained as interviewers and 50,000 have been interviewed. The Stigma Index questionnaire has been translated into 54 languages.

woman to compete for a national pageant title. And when she walked away with a crown, she became the world’s reigning HIV-positive beauty queen.

A survivor of childhood sexual abuse, Anderson was pregnant at 15 and by her 20s a suicidal drug user who lost custody of her two children and ended up in rehab, where she was offered an HIV test. She decided to get the test, as she “thought HIV was a gay white man’s disease and black women didn’t get it,” she told HIV Positive magazine.

Although she learned then that she was HIV-positive, she didn’t seek treatment until her own daughter gave birth. Having a grandchild was the impetus Anderson needed to turn her life around.

She entered the 2010 and 2011 Miss Texas Plus America pageants, competing as an openly HIV-positive contestant, then won at the national level in Miss Plus America, receiving the Ms. Plus America title, one of several the pageant bestows.

“I just didn’t win that night,” Anderson has often said. “Every HIV-positive woman won that night!”

Anderson has used her title to raise awareness about HIV and the stigma around it, especially among women of color, as part of the CDC’s “Let’s Stop HIV Together” campaign. Working at the Afiya Center in Dallas, Anderson is also cochair of the Campaign to End AIDS Texas, a board member for the ADAP Advocacy Association, and a member of the Ryan White Consumer Council Committee.

MONIQUE HOWELL-MOREE (FACEBOOK); GINA BROWN (FACEBOOK); MARY BOWMAN (MAGAZINE CUT/FACEBOOK); VALERIE REYES–JIMENEZ (FACEBOOK)

Monique Howell-Moree

The author of the 2010 memoir Living Inside My Skin of Silence, Monique Howell-Moree is the founder and CEO of Monique’s Hope for Cure Outreach Services in Holly Hill, S.C., which aims to increase awareness of HIV and combat stigma and health disparities in rural South Carolina.

“I contracted HIV in 2005 while pregnant with my third son,” Howell-Moree, a married mother of three, wrote in a blog post for A Girl Like Me, “and this disease changed my life in so many ways; most of all it gave me the strength to endure any obstacle that I may have in my life. Every day is not easy for me, but every day is worth it, because I still have one more day to live.”

An administrative clerk in the U.S. Army when she discovered she had HIV, Howell-Moree later had a relationship with another soldier and was prosecuted for nondisclosure by the military, even though she had him use a condom and he never contracted HIV. That led to activism around anticriminalization efforts. Since then Moore has spoken twice on Capitol Hill, in addition to speaking at colleges, schools, conferences, and churches nationwide. She has received several awards for her work, and she’s also highly active with the church founded by her father, Bishop Donald C. Howell, Solid Rock International Outreach Ministries. Moore says today she still wants other women to know that they are not alone, and anyone who knows her is familiar with her signature advice, “You have to first love yourself.”

Gina Brown

Gina Brown provides medical services to HIV-positive men and women as a medical case manager at Priority Health Care Inc., a nonprofit in the New Orleans area that provides care and seeks to empower underserved populations. Poz for two decades, Brown has been working in the HIV field for a dozen years and has become a valued advocate and speaker. A board member for PWN-US, she’s also been involved with the Women’s Research Initiative; the AIDS Alliance for Children, Youth, and Families board of directors; Until It’s Over Inc.; the Louisiana AIDS Advocacy Network; Positive Leaders Uplifting Sistas; and Camp ACE. “Gina is an extraordinary advocate and activist, as well as a social worker, through her excellent skills as a public speaker, fighting HIV stigma, and working to improve representation of women living with HIV, increase understanding of their unique issues and the response to their needs,” says Misrok.

Mary Bowman

She was 20 years old when she took the stage at a SpitDat open mike night in Washington, D.C., ready to reveal a secret her family had kept since she was a child: Mary Bowman is HIV-positive and has been since she was born to a poz drug addict who died when Bowman was still a toddler. You could have heard a pin drop when she spoke, but after hearing Bowman ourselves, we can surely say that deafening silence was probably sheer amazement. Her words and her delivery of her spoken-word performances today are riveting reminders of the universality of experience, but that day it helped Bowman first realize she was not alone. She’s brought tears to the eyes of people at performances nationwide and has become the voice of a poz generation. But it’s her policy and advocacy work at the Women’s Collective in D.C., often helping save women like her mother, that brings it all together. “She is amazing,” says Carrie E. Foote, an HIV activist and a sociology professor at Indiana University-Purdue University Indianapolis. hivplusmag.com

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Valerie Reyes–Jimenez

Vanessa Johnson

A pioneering leader in HIV policy and programs for many years, Vanessa Johnson has served on or worked with perhaps a dozen organizations, including the National Association of People With AIDS, National Black Women’s HIV/AIDS Network, and National Women and AIDS Collective. She’s currently the national training and leadership director for the Positive Women’s Network-USA. (She’s also a cofounder and board member—and has a law degree.) She initiated the founding of the U.S. People Living With HIV Caucus, and she serves as a board member for the National Working Positive Coalition.

Years before Johnson cofounded the Ribbon Consulting Group with Linda Scruggs, she helped form the Capital District African-American Coalition on AIDS, a nonprofit organization in Albany, N.Y., where she served as deputy executive director. She found out she was HIV-positive in 1990, and she’s spent the decades since developing and providing capacity-building assistance in the area of HIV with a special emphasis on women living with HIV. One of the most laudable contributions: launching Common Threads, a microenterprise project for positive African-American women, in which they come together to explore the common threads in their lives that led to HIV (such as childhood trauma) and then learn to become advocates and entrepreneurs through a shared jewelry-making venture. The women often come together to sell their wares and share their skills at AIDS events around the country. The training sessions for the program are part healing, part business boot camp, but from a black poz women’s perspective.

Kia Michelle Benbow (a.k.a. Kia Labeija)

“A wonderful artist and activist, Kia Benbow is not shy about being a young positive woman living with HIV,” says Vreeland. “Her energy and activism shines a light on those around her.”

Benbow (a.k.a. Kia Labeija) has been HIV-positive for 25 years; she was born with the virus.

“I lost my mom when I was 14,” Benbow told audiences at (Re) Presenting AIDS: Culture and Accountability, a 2013 forum in New York created by Visual AIDS, the Pop Up Museum of Queer History, and the Center for Lesbian and Gay Studies. “And since then I have been trying to piece together how to help the younger generation deal with this.”

The artist felt that children born to poz parents weren’t given much visibility and their issues were rarely explored. “I think that is a big issue,” she said. “A lot of us born to positive parents, we lose our parents, and we lose that kind of guidance of how we relate to the world, being positive, being young, being sexual, being all these kinds of things.”

Benbow, who cofounded the artists’ collective #GrenAIDS to utilize art to connect with the younger generation and popular culture, wants to see an artistic revival in which the reflection of HIV and AIDS is not about fear and death (present in much good AIDS art in the 1980s and ’90s) but celebration of life. Her work reminds us that HIV and AIDS aren’t over, but neither are the people living with the virus. For young people like her, HIV isn’t “sad,” it’s merely a part of their lives, tied up with feelings about youth and vitality and sexuality in a way we’ve never really seen expressed before.

Today, the multidisciplinary artist, an alumna of the Juilliard School and the Ailey School, works in photography, performance, and installation and is a member of the Iconic House of Labeija, “a platform in which she uses to continue her love of the intersections of performance, fantasy, nightlife, and community,” according to her website.

And the messages from #GrenAIDS are fast becoming pop artifacts of modern perspectives on HIV and AIDS, including tees that read, “AIDS isn’t racist. But you are.”

Maria Mejia

Miami’s sassiest HIV activist is clearly Maria Mejia, a 40-year-old lesbian Latina who found out she was positive at age 18 during a routine Job Corps screening. A fixture on the podium at both Latino and HIV-specific events, Mejia

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VANESSA JOHNSON (FACEBOOK); KIA MICHELLE BENBOW AKA KIA LABEIJA; MARIA ME JIA (FACEBOOK)

Through having served on President Clinton’s Advisory Council on HIV and AIDS, working as an organizer for Housing Works, and sitting on the board of Praxis Housing Initiatives (New York City’s largest provider of transitional housing to homeless people with HIV),Valerie Reyes-Jimenez has become an expert in the intersection of HIV and homelessness. And she got there from the inside, as a onetime client of Housing Works, whose mission is to “end the dual crises of homelessness and AIDS through relentless advocacy, the provision of lifesaving services, and entrepreneurial businesses that sustain our efforts.”

“Valerie Reyes-Jimenez is an incredible woman who’s been a grassroots advocate for people living with HIV or AIDS for decades,” says HIV Law Project attorney Alison Yager.

She’s been helping people dealing with HIV as well as homelessness or addiction all the while becoming a pro at advocacy, public policy, grassroots organizing, and lobbying.

is one of the few people in the nation reminding others that, despite the stats, there are lesbians living with HIV. An activist, a peer educator, and a caregiver in a city with one of the country’s highest per capita rates of HIV infections, Mejia spoke at the U.S. Conference on AIDS last fall, works with the Well Project, serves on the digital advisory council for Janssen, and starred in the CDC’s “Let’s Stop AIDS Together” campaign with her wife, Lisa. A native of Colombia, she’s worked with the Red Cross and other groups in educating Latino and immigrant communities about HIV, urging testing, providing counseling, and telling everyone who will listen that “being HIV positive is nothing to be ashamed about.… We will take away all the stigma, slowly but [first] we have to open up.”

Perhaps her biggest impact is on social media, where she provides a forum for others to talk, via her bilingual YouTube channel (Mariasjournal) and two of the largest Facebook groups, one in English (Mariahiv), one in Spanish (Mariahiv1111), for people with HIV. That’s tens of thousands who come together to talk about everything from dating advice to coming out to your parents about being poz.

Jacqueline Williams

Too often in honoring “amazing” people (the top 10s, the 40 under 40) media honors the power players, the executive directors, those media-friendly agitators. But that underestimates the impact a person in a support position can have on those around them. So is the case with Jacqueline Williams, a receptionist at New York’s Gay Men’s Health Crisis, one of the world’s largest organizations providing prevention, care, and advocacy for people with HIV. “I can honestly say that she has been the most inspiring woman in my life since the first day that I met her!” says her colleague Mariah Burnett, an HIV testing counselor at GMHC’s David Geffen Center for HIV Prevention and Health Education. Williams has been HIV-positive for nearly 20 years and has been an inspiration for other women, poz or not, for equally long—both at church and at work.

“From sharing her testimony at church and to mentoring the young women around her, she has taught myself and plenty of others what an amazing woman is,” Burnett says, adding that she and the women around her have learned from Williams self-respect and “how to have dignity in any and everything that I put my mind to. She is a very wise and carefree woman who spreads nothing but love and elated energy when she is in your presence. She is truly the definition of an amazing woman…she is the most beautiful person I ever met, seriously.”

LISA TIGER (FACEBOOK); JESSICA WHITBREAD (FACEBOOK)

Lisa Tiger

Her name is appropriate, say her friends and followers: Lisa Tiger is a force of nature. A member of the Muscogee Nation and of Creek, Seminole, Cherokee, and Irish descent, Tiger has had HIV since the late 1980s and has been doing AIDS education nearly as long. She’s raised four kids, dealt with Parkinson’s disease, and advocated both for crime victims (after her brother was shot and killed in 1990) and for people with HIV and AIDS. Tiger has spoken nationwide, and she has received the Woman of Courage award from the National Organization for Women as well as honors from amfAR, the Foundation for AIDS Research, making her perhaps the most visible HIV-positive Native American woman in the U.S. But it is her talks to other Native Americans that are the most notable. When Wilma Mankiller, the pioneering chief of the Cherokee Nation, asked her to speak at the Oklahoma reservation, she accepted gladly. “There is such a need for education,” Tiger told Positively Aware in 2009. “And people weren’t paying attention to the Red Cross coming in with their classes. They needed to hear from one of their own.”

Tiger has spoken about why every facet of dealing with HIV, including testing, treatment, and prevention, needs to be more culturally based in order to work in Native communities, often arguing that a return to traditional Native values could battle some of the biggest health threats facing Native Americans today, including AIDS, addiction, suicide, and violence. She knows these well, having lost a brother and daughter to murder, her father to an accidental self-inflicted gunshot, and a fiancé to alcoholism. She maintains a stoic sense of humor, though. “You gotta go through the manure to get to the magic,” she told Positively Aware.

Jessica Whitbread

An impressive artist and social media agitator, Jessica Whitbread is also global chair of the International Community of Women Living with HIV, the youngest and first queer woman to be elected. She’s also the founder of the first International Chapter of Young Women, Adolescents, and Girls living with HIV, a steering committee member for AIDS Action Now, a consultant for the Canadian HIV/AIDS Legal Network in Toronto, and an organizer of Carlton University’s AIDS Activism History Project. But it’s her community art—merging activism, commentary, and artistry—that deserves equal accolades. She uses her own body as the site of her work, making for often-uncomfortable epiphanies around our interpretations of sexuality and desire and the intersection with HIV. She also sponsors “tea parties” (yes, those old icons of domesticity) but uses them to share stories and discuss real issues around women and health, HIV and sexuality, and social change.

During her residency last year at North Carolina’s McColl Center for Art and Innovation, Whitbread extended that conversation beyond HIV to include long-term psychological effects associated with trauma.

How do these events show up later in life and how do they inform the navigation of relationships? Through a series of open forums, both at the center and in the community, Whitbread led discussions and story-sharing opportunities aimed at healing. hivplusmag.com

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COMPLERA is a prescription medicine for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood. COMPLERA can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements. COMPLERA combines 3 medicines into 1 pill to be taken once a day with food. COMPLERA should not be used with other HIV-1 medicines.

Just the

one

for me

COMPLERA is a complete HIV-1 treatment in only 1 pill a day.

Ask your healthcare provider if COMPLERA may be the one for you.

Pill shown is not actual size.

COMPLERA does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids.

Never reuse or share needles or other items that have body fluids on them.

It is not known if COMPLERA is safe and effective in children under 18 years old.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

• Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain.

• You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.

• Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking COMPLERA, your hepatitis may suddenly get worse. Do not stop taking COMPLERA without first talking to your healthcare provider, as they will need to monitor your health. COMPLERA is not approved for the treatment of HBV.

Who should not take COMPLERA? Do not take COMPLERA if you: • Take a medicine that contains: adefovir (Hepsera), lamivudine (EpivirHBV), carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol), oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek), rifampin (Rifater, Rifamate, Rimactane, Rifadin), rifapentine (Priftin), dexlansoprazole (Dexilant), esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole sodium (Protonix), rabeprazole (Aciphex), more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate, or the herbal supplement St. John’s wort.

• Take any other medicines to treat HIV-1 infection, unless recommended by your healthcare provider.

What are the other possible side effects of COMPLERA? Serious side effects of COMPLERA may also include: • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood tests to check your kidneys before starting treatment with COMPLERA. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may also check your kidneys during 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.

Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may do tests to check your liver enzymes before and during treatment with COMPLERA. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

• Changes in body fat can happen in people taking HIV-1 medicines.

• Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking COMPLERA. •

The most common side effects of COMPLERA include trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Other common side effects include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), and pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

What should I tell my healthcare provider before taking COMPLERA? All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, mental health, bone, or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking COMPLERA without first talking with your healthcare provider.

• If you take rifabutin (Mycobutin). Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take.

• If you take antacids. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. • If you take stomach acid blockers. Take acid blockers at least 12 hours before or at least 4 hours after you take COMPLERA. Ask your healthcare provider if your acid blocker is okay to take, as some acid blockers should never be taken with COMPLERA. • If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking COMPLERA. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in COMPLERA can pass into breast milk, and it is not known if this can harm the baby.

•

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 Brief Summary of full Prescribing Information with important warnings on the following pages.

Brief Summary of full Prescribing Information COMPLERA® (kom-PLEH-rah) (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information.

What is COMPLERA? • COMPLERA is a prescription medicine used as a complete HIV-1 treatment in one pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood (this is called ‘viral load’). Complera can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements.

• COMPLERA is a complete regimen and should not be used with other HIV-1 medicines. HIV-1 is the virus that causes AIDS. When used properly, COMPLERA may reduce the amount of HIV-1 virus in your blood and increase the amount of CD4 T-cells, which may help improve your immune system. This may reduce your risk of death or getting infections that can happen when your immune system is weak.

• COMPLERA does not cure HIV-1 or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses.

• Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or reuse needles, injection equipment, or personal items that can have blood or body fluids on them. Do not have sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood.

What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects, including: • Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – having stomach pain with nausea or vomiting – feel cold, especially in your arms and legs – feel dizzy or lightheaded – have a fast or irregular heartbeat • Severe liver problems. Severe liver problems can happen in people who take COMPLERA. 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). Call your healthcare provider right away if you get any of the following symptoms of liver problems: – your skin or the white part of your eyes turns yellow (jaundice) – dark “tea-colored” urine – light-colored bowel movements (stools) – loss of appetite for several days or longer – nausea – stomach pain

• You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time.

• Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider.

– Do not run out of COMPLERA. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone.

– 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 often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA. Who should not take COMPLERA? Do not take COMPLERA if you also take any of the following medicines: • Medicines used for seizures: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) • Medicines used for tuberculosis: rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) • Certain medicines used to block stomach acid called proton pump inhibitors (PPIs): dexlansoprazole (Dexilant); esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) • Certain steroid medicines: More than 1 dose of dexamethasone or dexamethasone sodium phosphate • Certain herbal supplements: St. John’s wort • Certain hepatitis medicines: adefovir (Hepsera), lamivudine (Epivir-HBV) Do not take COMPLERA if you also take any other HIV-1 medicines, including: • Other medicines that contain tenofovir (ATRIPLA, STRIBILD, TRUVADA, VIREAD) • Other medicines that contain emtricitabine or lamivudine (ATRIPLA, Combivir, EMTRIVA, Epivir, Epzicom, STRIBILD, Trizivir, TRUVADA) • rilpivirine (Edurant), unless you are also taking rifabutin (Mycobutin) COMPLERA is not for use in people who are less than 18 years old.

What are the possible side effects of COMPLERA? COMPLERA may cause the following serious side effects: • See “What is the most important information I should know about COMPLERA?” • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking COMPLERA. If you have had kidney problems in the past or need to take another medicine 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 • Change in liver enzymes. People with a history of hepatitis B or C virus infection or who have certain liver enzyme changes may have an

increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease.

Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA. • 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 tests to check your bones.

• Changes in body fat can happen in people taking HIV-1 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-1 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 any new symptoms after starting your HIV-1 medicine.

The most common side effects of COMPLERA include: • Trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, depression Additional common side effects include: • Vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), 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.

• Call your healthcare provider for medical advice about side effects.

You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my healthcare provider before taking COMPLERA? Tell your healthcare provider about all your medical conditions, including: • If you have or had any kidney, mental health, bone, or liver problems, including hepatitis B or C infection.

• If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child.

– There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry 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.

• If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take COMPLERA. – You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

– Two of the medicines in COMPLERA can pass to your baby in your breast milk. It is not known if this could harm your baby.

– Talk to your healthcare provider about the best way to feed your baby.

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements: • COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works.

• If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help control your HIV-1 infection. The HIV-1 virus in your body may become resistant to COMPLERA or other HIV-1 medicines that are like it.

• Be sure to tell your healthcare provider if you take any of the following medicines: – Rifabutin (Mycobutin), a medicine to treat some bacterial infections.

Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take.

– Antacid medicines that contain aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. – Certain medicines to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). Take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA. Some acid blocking medicines should never be taken with COMPLERA (see “Who should not take COMPLERA?” for a list of these medicines).

– Medicines that can affect how your kidneys work, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte).

– clarithromycin (Biaxin) – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) – fluconazole (Diflucan) – itraconazole (Sporanox) – ketoconazole (Nizoral) – methadone (Dolophine) – posaconazole (Noxafil) – telithromycin (Ketek) – voriconazole (Vfend) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking COMPLERA without first talking with your healthcare provider.

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 food. Taking COMPLERA with food is important to help get the right amount of medicine in your body. A protein drink is not a substitute for food. If your healthcare provider decides to stop COMPLERA and you are switched to new medicines to treat HIV-1 that includes rilpivirine tablets, the rilpivirine tablets should be taken only with a meal.

Keep COMPLERA and all medicines out of reach of children.

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

Issued: June 2014

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. ©2014 Gilead Sciences, Inc. All rights reserved. CPAC0115 08/14

DAILY DOSE

BUILDING BROTHERHOOD Why we have to create our own support networks sometimes

“So, what is it that’s bullying, breaking, shaking, scaring, scarring, stimulating, exciting, inspiring, and firing you up today?”

That is how I start each of my 50-minute therapeutic sessions.

I know it may sound overwhelming, having your therapist ask you nine conflicting questions the very moment you sit down in the chair—but that’s exactly the point. Life itself is overwhelming on a regular basis, and where else better to discuss this crazy, clashing world in which we live than in one’s individual therapy sessions?

As a psychotherapy trainee with specializations in gayaffirmative and HIV-positive therapy, I have come to learn that the weekly sessions I spend with my clients are not only meant to delve into the muck and mire of our problem-saturated lives.

We must also come together to celebrate even the most seemingly mundane of milestones, breakthroughs, and accomplishments.

The importance of operating with this sort of therapeutic duality has never been better affirmed than in my current work at Being Alive. Opened in 1986 by three friends living with AIDS, Los Angeles’s first peer-led HIV agency began as a “dying with dignity” grassroots initiative. However, as treatment options have improved over the past 30 years—greatly lengthening and improving the quality of life for those who are HIV-positive—

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march / april 2015

the organization has morphed into a beacon of support and empowerment for thousands of gay, bisexual, and queer-identified men within the community. Each day, as I bustle through the halls of Being Alive, I see us celebrating just that, not only surviving but thriving—and being alive!

My individual clientele has proved to be extremely diverse, ranging from members of the Hollywood elite to well-known LGBTQ activists to those struggling with basic needs. Within the quiet, confidential walls of therapy room number 7, I define the psychological work we do as a brave and bold coauthorship.

When my clients cry, I cry; when they rejoice, I fill with joy. And when they explode with hurt and rage, I do my best to hold a safe space for a corrective experience that makes way for future healing. I’ve seen addicts get sober, shut-ins step out into the world, and those who proclaim to be lost pave a fulfilling future for themselves. Yet there is one problem that many of my clients cannot seem to shake: the feeling of isolation.

As a gay man myself, I must admit that my own lived-in experiences within the West Hollywood community have been Continued on page 39

THINKSTOCK/DIGITAL VISION

by Michael Anthony-Nalepa

If you’re on HIV meds, Fulyzaq may help you...

Is diarrhea holding you back? If you are on HIV medications, Fulyzaq is a plant-based, FDA-approved prescription medication that may help manage your diarrhea.

Fulyzaq may help manage your diarrhea over time by making your bowel movements less frequent and loose. Fulyzaq works by normalizing the flow of water in your gut. Fulyzaq did not interfere with commonly used HIV medications, and did not affect CD4 count or viral load in a 4-week study.

It’s time to stop dealing with diarrhea and ‘Start the Conversation’ about Fulyzaq today.

Indication FULYZAQ ® (crofelemer) is an antidiarrheal indicated for the symptomatic relief of noninfectious diarrhea in adult patients with HIV/AIDS on antiretroviral therapy.

Important Safety Information about FULYZAQ FULYZAQ® (crofelemer) delayed-release tablets should not be used for the treatment of infectious diarrhea. It is important that your healthcare provider considers infectious causes of diarrhea before you start taking FULYZAQ. If infectious causes are not considered, and you begin taking FULYZAQ based on a probable diagnosis of noninfectious diarrhea, there is a risk that you will not receive the appropriate treatments, and your disease may worsen.

• FULYZAQ tablets should be swallowed whole. FULYZAQ tablets should not be crushed or chewed. You may take FULYZAQ with or without food. You should follow the instructions of your healthcare provider. • If you are pregnant, or planning to become pregnant, talk to your healthcare provider before taking FULYZAQ. The safety and effectiveness of FULYZAQ have not been established in people younger than 18 years of age. • In clinical studies, the most common adverse reactions associated with FULYZAQ – occurring in at least 3% of patients taking FULYZAQ – were upper respiratory tract infection, bronchitis (inflammation of the lining of the tubes which carry air to and from your lungs), cough, flatulence (intestinal gas passed through your rectum), and increased bilirubin (a waste product of the breakdown of red blood cells). • 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 following page for brief summary of Prescribing Information for FULYZAQ. Snap a picture of our logo and show your doctor to ‘Start the Conversation’

IMPORTANT PATIENT INFORMATION

Under 18 or Over 65 Years of Age?

The following is a brief summary only. See complete Prescribing Information at Fulyzaq.com or request complete Prescribing Information by calling 1-800-508-0024. This information does not take the place of talking with your doctor about your medical condition or your treatment.

• FULYZAQ has not been studied in children under 18 years of age

WHAT IS FULYZAQ?

Talk to your doctor to find out if FULYZAQ is right for you.

FULYZAQ is a prescription medication used to improve symptoms of noninfectious diarrhea (diarrhea not caused by a bacterial, viral, or parasitic infection) in adult patients with HIV/AIDS who take HIV medication.

• FULYZAQ studies did not contain a large number of patients over the age of 65; therefore, it is unclear if this age group will respond differently

HOW SHOULD I TAKE FULYZAQ? • FULYZAQ should be taken orally, by mouth 2 times per day • FULYZAQ tablets may be taken with or without food

WHO SHOULD NOT TAKE FULYZAQ?

• FULYZAQ tablets should not be crushed or chewed

• FULYZAQ should not be taken if you have diarrhea caused by an infection

• FULYZAQ tablets should be swallowed whole

• Your doctor and you should make sure your diarrhea is not caused by an infection (such as bacteria, virus, or parasite) before you start taking FULYZAQ

WHAT ARE THE POSSIBLE SIDE EFFECTS OF FULYZAQ? • Upper respiratory tract infection (nasal or sinus infection) • Bronchitis (inflammation of the lining of the tubes which carry air to and from your lungs) • Cough • Flatulence (intestinal gas passed through your rectum) • Increased bilirubin (a waste product of the breakdown of red blood cells) For a full list of side effects, please talk to your doctor.

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

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.

SHOULD I TAKE FULYZAQ IF I AM: Pregnant or Planning to Become Pregnant?

• Studies in animals show that FULYZAQ could cause harm to an unborn baby or affect the ability to become pregnant • There are no studies in pregnant women taking FULYZAQ

WHAT SHOULD I KNOW ABOUT TAKING FULYZAQ WITH OTHER MEDICATIONS? • If you are taking any prescription or over-the-counter (OTC) medications, or herbal supplements or vitamins, tell your doctor before starting FULYZAQ

WHAT IF I HAVE MORE QUESTIONS ABOUT FULYZAQ? • For more information, please see the full Prescribing Information at Fulyzaq.com or speak to your doctor or pharmacist To report side effects, a product complaint, or for additional information, call: 1-800-508-0024.

Rx Only Manufactured by Patheon, Inc. for Salix Pharmaceuticals, Inc. 8510 Colonnade Center Drive, Raleigh, NC 27615 www.salix.com Copyright © Salix Pharmaceuticals, Inc. US Patent Nos. 7,341,744 and 7,323,195.

FUL-RALAB49-062014 Fulyzaq is manufactured for Salix Pharmaceuticals, Inc. by Patheon, Inc. and distributed under license from Napo Pharmaceuticals, Inc. ©2014 Salix Pharmaceuticals, Inc. All rights reserved. Printed in USA. FUL50-0614

• This drug should only be used during pregnancy if clearly needed

A Nursing Mother?

• It is not known whether FULYZAQ is passed through human breast milk • If you are nursing, you should tell your doctor before starting FULYZAQ • Your doctor will help you to make a decision whether to stop nursing or to stop taking FULYZAQ

The botanical drug substance of FULYZAQ is extracted from Croton lechleri (the botanical raw material) that is harvested from the wild in South America.

DAILY DOSE Building Brotherhood… continued from page 36 colored with similar shades of loneliness. How many times have I stood in a crowded gay bar and yet felt totally isolated? A lot.

How often have I walked through the gym locker room and felt insidiously inadequate? Many. And how regularly do I walk down Santa Monica Boulevard and make eye contact with men I’ve seen a million times, only to be ignored once again? Trust me, it happens daily.

In my one-on-one conversations with clients, I have found that their WeHo experiences are no different. And when one adds serophobia—the manifestation of fear, aversion, exclusion, and discrimination toward those living with HIV or AIDS—to the mix, the results prove psychologically devastating. In my professional opinion, we do not discuss this enough, the veiled but deep-seated anxiety many HIV-negative men feel toward their HIV-positive counterparts. As one of my clients put it, “There is a poz panic in the gay community, but we’ve gotten too PC to talk about it!”

I have witnessed firsthand how years—and in some cases, even decades—of this unspoken panic have led to deep depression, bankrupt self-esteem, and long stretches of often self-imposed isolation. Too many times I’ve seen my most dynamic clients sitting silently in the Being Alive lobby; although surrounded by a dozen men who are also HIV-positive, they are too afraid to engage them.

Why is that? It is because society has conditioned many of my clients to believe that being rejected by another man—whether HIV-positive or not—is not only a possibility but a probability.

And it is that internalized schema that raises the question—what can we, as mental health professionals, do for our most marginalized clients? While individual therapy holds the space for the building of vital ego-strengthening, what good are those psychological coping skills it if they don’t translate into the real world?

A long discussion with my fellow trainees birthed the idea that I should start a support group to address the issue of alienation for our positive clientele; and while it seemed like a logical solution, I must admit the idea did not wholly thrill me. I have participated in traditional group work as a patient, and my experience mirrored what you often see in cliché Hollywood movies—men sitting in a circle, crying about how life has wronged them, all the while binging on cheap coffee during multiple smoking breaks.

I had to wonder, when did gay-affirmative group therapy work lose its fabulousness—the laughter, the fun, the flirtation? We are a resilient population with a unique spirit, eros, and essence—why wasn’t that incredible awesomeness the primary driver of group gatherings? Was it ever? And if not, why shouldn’t we, as the next generation of mental health professionals, begin such a trend?

And thus Building Brotherhood was born. I pitched it to my supervisor as “a gathering for HIV-positive men that gives voice to our unique stories, while offering witness from those that have experienced similar discrimination, trauma, hardships, successes, and victories. Through psychoeducation, art, gay mythology, interactive activities, sharing circles, and role-play, we will aim to build lasting connections and affirm the fact that we are not alone; even in our darkest moments, we are never alone.”

I envisioned our weekly two and a half hours together as a “reeducation in fabulousity and friendship.” Sex and queer culture would be celebrated; Broadway and Beyoncé’s attempt at bangs would be debated. But most importantly, we would talk less and do more; and by doing rather than talking, I quite literally mean that we would be up on our feet and engaging in hands-on,

interactive tasks that challenged the problems that HIV-positive individuals wrestle with on a regular basis.

Take, for example, week 5: the Oppression Olympics. Imagine, rather than sitting in a circle and discussing heteronormatively entrenched societal phobias, we play an interactive fantasy game.

Think Survivor meets Big Brother with political twists and turns.

Picture men divided into teams, clandestinely hiding in therapy rooms, building alliances, and debating whether they should share resources with the opposing teams or crush them for personal gain.

They are forced to decide whether they, as the oppressed, become the oppressors or unite and buck the system.

Envision week 7: Speed Friending. Tonight there’s no focus on love, dating, or happily ever after, but rather how you convey your inner essence, those things that make you uniquely you, to another man in no more than three minutes? And go!

Picture week 3: Tell Off Theater. You select a family member, an ex-boyfriend, or someone else from the past who has rejected you.

Then you pick a fellow group member to role-play that person.

Together you enact the most dramatic soap opera imaginable, and you verbally unload all of those zingers and stingers you wished you’d said. (We might even try it with costumes!)

Imagine participating in these therapeutically based activities with a queer twist, while we facilitators also hold a space for our brothers to step into the room and say, unabashedly and without shame, “I am lonely.” “I haven’t left my house in six days.” “I’m feeling weaker, not healthier.” “I am lost.” “I need help.” Visualize what gay-affirmative and HIV-positive group therapy would look like if the process championed resiliency as much as oppression, focused on affirmation rather than frailty, and reframed feelings of alienation not as a problem but as the first steps on a journey to building lasting friendships.

My cofacilitator, Colin Stack-Troost, and I launched Building Brotherhood last October; 10 intrigued men signed on to give our “reeducation in fabulosity and friendship” a try— and the results have inspired me deeply, both personally and professionally. It’s not my place to relay what goes on within the confidential space that we hold in the Being Alive green room; however, I can tell you that the desserts we bake for each other are delicious, the opinions we voice are fierce, and the uncensored conversations we have about life and love would surely put any Sex and the City episode to shame. We’ve become a queer family of sorts, a fellowship that reaffirms the best parts of each other.

I think one of our participants put it best during our checkout; when asked how he was feeling in one word, he said, “It’s not really a feeling and it’s not one word, but the truth is, I finally feel like I matter.”

And for me, as both a clinician and a brother, that’s the sole measure of therapeutic success. Because the truth is that living with HIV will bully, break, shake, scare, and scar our clients on a regular basis. The question is—what do we, as mental health professionals, do about it? I encourage us to stop talking, start doing, and celebrate fabulousness by building brotherhood. Only then will our clients truly understand that they are not alone; even in their darkest moments, they are never alone—and sometimes that’s all they need to know.

For info on Michael Anthony-Nalepa’s therapeutic work, visit IAmAnonymoUS.org or contact him directly at MNalepa@antioch. edu. For more on Building Brotherhood program, contact Being Alive at (323) 874-4322 or info@beingalivela.org. hivplusmag.com

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The Answers Issue

You asked us a dozen different questions about HIV, so we tracked down some answers for you. Here they are in no specific order.

What are the most common side effects of HIV meds and how many people have them?

There are actually side effects to almost all new medications, so it’s not uncommon to feel aches and pains, headaches, stomachaches, or fatigue for a few days (up to a maximum of a month). Anything beyond that and you should tell your doctor. One 2008 study showed that 60 percent of people on antiretrovirals had diarrhea, but that was before the Food and Drug Administration approved Fulyzaq, the first antidiarrheal drug for people with HIV.

Side effects to HIV meds used to be brutal—if you lived through the last few decades, you probably remember—but with newer medications on the market, the majority of people will not experience any serious side effects. If you do, your doctor should help you find a treatment that works for you without them. AIDS.gov has a list of the most common long-term effects of HIV meds on some users, which include lipodystrophy (fat redistribution); insulin resistance (which can lead to blood sugar level abnormalities and, possibly, diabetes); increases in cholesterol or triglycerides (which affects 3-5 percent of certain medication users); decreases in bone density (which can increase your risk of fractures), and lactic acidosis (which can lead to everything from muscle aches to liver failure). Also, the U.K.

And we can think of a couple of really funny HIV-positive comedians who did make jokes about HIV. Mike DeStefano did a great show called Drugs, Disease and Death: A Comedy that touched on some serious stuff: battling heroin addiction, being HIV-positive, and losing his wife to AIDS complications. Steve Moore—who along with his lesbian green-card wife (former Roseanne writer Lois Bromfield) was Pauly Shore’s guardian while he was in high school—joked often about coming out and living with HIV (and going onstage sweating bullets after a bout of diarrhea). In his famous comedy show about life with HIV, Drop Dead Gorgeous, he even joked about his mother buying him a cemetery plot for Christmas. “And the saddest thing—it’s the only piece of land I’ve ever owned,” he deadpanned. The next Christmas she told him she didn’t buy him anything because he “didn’t use what we gave you last year.” Ba-da-bump!

Both men made HIV and AIDS funny by recounting their own experiences, never making light of the virus or other people who had lived with it. We wanted to ask these two brilliant guys if it was ever OK to joke about HIV, but Moore died last May, DeStefano in 2011.

So we offer this advice: If you’re joking about your own life as a way to cope with your status, medical symptoms, or social stigma you encounter and can do so without mocking anyone else, go for it. But beware, you may make some people around you really uncomfortable, no matter how PC you think you are. Oh, and if you are HIVnegative, do not even try this. Just don’t go there. —D.A.M.

Can an HIV-positive person ever have sex without a condom again?

HIV group Avert points out that not all drugs have the same side effects so “for example, efavirenz is the drug most associated with psychiatric symptoms, while protease inhibitors are more likely to raise levels of cholesterol and triglycerides.” So what works for one person might make the other person sick, and if there are other existing health issues like high blood pressure, diabetes, anxiety disorders, or hepatitis, those can increase the risk of certain side effects. Bottom line: They are rarely severe, but if you have any side effect longer than a few weeks, don’t just assume that’s life; ask your doctor about it. —Diane Anderson-Minshall

The answer is yes, but with a very large asterisk, says Dr. Gary Cohan. With better antiretroviral treatment and PrEP, it is possible to conceive of a situation where couples could have sex without a condom with a small risk of transmission. In the PARTNER study of serodiscordant couples, preliminary results show that among more than 700 couples, that no HIV-positive person with a viral load of less than 200 copies per milliliter of blood transmitted the virus to their uninfected partner. But these results come two years into a five-year study. Cohan cautions to follow the Centers for Disease Control and Prevention guidelines for using preexposure prophylaxis, or PrEP, which emphasizes using condoms in conjunction because they prevent not only the spread of HIV but also other sexually transmitted infections.

“Many HIV-positive people have falsely conflated the term ‘undetectable’ with ‘noninfectious,’” says Cohan (although some other

Here’s our thinking on this. Artists will tell you nothing is off limits, and some comics, like Louis C.K., Chris Rock, and Whitney Cummings, have paid dearly for bucking censorship and daring to tackle real-world issues like race, politics, or sexuality.

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ALL IMAGES: THINKSTOCK

Is it ever OK to joke about HIV or AIDS?

doctors, like Robert Grant, below, do use such terminology). “This is not yet proven to be true and has created lots of confusion and risk taking by sexually active people.” “Undetectable” means that a person’s viral load is below a quantifiable level, but it is not the same as HIV having been completely eliminated. “Many HIV-negative patients have shared with me situations in which HIV-positive people have stated to them, ‘I’m positive but undetectable, so you can’t get HIV from me.’ Simply not unequivocally proven—yet,” Cohan says.

The researchers also stressed that because of the relatively small number of anal sex acts reported, it is not yet possible to be certain about the risks for HIV-negative men who engage in receptive anal sex with undetectable HIV-positive men. PARTNER continues to recruit gay couples and will release more definitive results in 2017.

In conclusion, the risk of contracting HIV from an undetectable

So can a person with HIV ever have sex without a condom again? “[It] completely depends on each sex partner’s appetite for risk— risk of HIV transmission to the negative partner, whether the HIVpositive person is on effective antiviral therapy (i.e. ‘undetectable’ viral load), whether the negative partner is on daily PrEP, and whether everyone understands the risk of acquiring and transmitting HIV and other STDs like syphilis, gonorrhea, chlamydia, herpes, hepatitis C, etc.,” says Cohan. —Daniel Reynolds

Which theory on the origin of HIV seems the most viable?

HIV has had some crazy origin stories, from CIA conspiracies to God’s judgment, but the most likely origin of HIV is simian. The strains HIV-1 and HIV-2 have much in common with the simian immunodeficiency virus (SIV), and researchers estimate that the virus made eight leaps before becoming the HIV we know today. A recent study from Oxford University’s Zoology Department makes a very compelling case that the ancestor of HIV emerged in 1920 in what is now the Democratic Republic of Congo. Several factors, including a population boom, new transportation networks (HIV grew along with train routes), changing practices of sex workers, decolonization, and growth of using injectable medicine (and reuse of the needles) all contributed to the spread into the larger population during the 1960s. —Katie Peoples

What is the risk of spreading HIV if I am undetectable?

The ongoing PARTNER study, which is seeking a definitive answer to this question, has so far found zero transmissions from an HIVpositive person who has an undetectable viral load (one who is receiving antiretroviral therapy and has a viral load under 200 copies per milliliter of blood) to his or her HIV-negative partner, which is great news. The study to date has covered more than 40,000 sex acts of over 700 mixed (or serodiscordant) couples, of which about 40 percent are same-sex. These couples, spread across 75 locations in Europe, have engaged in vaginal and/or anal sex that was at least occasionally condomless. The negative partners included in the analysis did not use prevention strategies involving HIV drugs, such as pre- or post-exposure prophylaxis, during this time.

However, zero transmissions does not mean a zero percent chance of transmission. At a conference in early 2014, study researchers reported a 95 percent confidence rate in these results due to the limited size and length of time of the study. Because of this uncertainty, researchers still estimate that one in 10 negative partners have a maximum 5 percent risk of contracting HIV over the course of 10 years. This puts the risk of HIV infection from vaginal sex with ejaculation at 2 percent per year; receptive anal sex at 2.5 percent per year; and receptive anal sex with ejaculation at 4 percent per year. But these are worst-case scenarios. Researchers may find these rates to be much lower as more data becomes available.

partner is extremely low. Wearing a condom will lower this risk even further and will protect against other sexually transmitted infections.

But it’s not 100 percent certain that there is no risk. —D.R.

What has been the closest science has gotten to a cure?

We may be the closest to a cure right now with current treatment of HIV. Many people forget how far we’ve progressed since the outbreak of HIV and AIDS in the 1980s, but with proper treatment, HIV-positive people can live long and generally healthy lives.

“I would emphasize that with early use of antiretroviral therapy, people’s life span is normal or near normal,” says Dr. Robert Grant, chief medical officer of the San Francisco AIDS Foundation. Even those who do not find out their positive status until years after infection can live long lives with treatment.

“I think the therapies are more safe, more convenient than they’ve ever been in the past. I think that they do prolong life, they render people uninfectious…. And in some ways I think it’s better than a cure,” Grant says, noting that so far only one person, Timothy Brown (dubbed the “Berlin patient” by researchers) has been cured of HIV. In other cases where patients were thought to be cured, the virus came back without warning.

“I think we have to ask ourselves what would we rather be, on therapy and confident that we are doing what we can to restore our immune system and render ourselves uninfectious so that we’re safe for our partners, or do we want to attempt a cure and then stop therapy but then never really know how long we’re going to last until the virus comes back?” Grant says.

We should not give up on cure research, he says. There have been many advances toward antibody injections and other therapies that may lead to a cure or a vaccine. In addition to treatments, condoms and PrEP can be used to prevent the spread of HIV. And several organizations and civic leaders are pushing either for a cure or vaccine (like amfAR’s Countdown to a Cure, which aims for a cure by 2020) and a reduction of AIDS cases to less than 1,000 (leaders in New York and San Francisco).

“So there’s just a lot of ways to prevent HIV, and I think that everyone can find something attractive for them to use,” says Grant. hivplusmag.com

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While a cure and vaccine are worthwhile goals and would be huge improvements, experts note that we should be very encouraged by the progress made so far in just treating the disease. “I think sometimes we lose track of what we can do waiting for that next finding around the corner [when] we can end this epidemic now,” says Grant. “The other thing I would say is we have not found a cure for is HIV stigma. That requires some concerted action and some novel ideas.” —K.P.

How to Avoid Jail for Having Sex While HIV-Positive In many states, if someone alleges you had sex with them without disclosing your positive status it could lead to arrest, a lengthy legal battle, a prison sentence, and a lifetime of public embarrassment and stigma— and worse—after being placed on a sex offender registry. Here’s how to cut through the red tape, still have sex, and keep yourself safe.

Thirty-four U.S. states and territories have laws criminalizing the behavior of those living with HIV, and others have prosecuted them under more general laws. These laws vary from state to state (and whether or not someone is in the military) and most are convoluted and out of step with current medical knowledge about HIV and its transmission.

For example, current Department of Defense policies exclude military service members living with HIV from enlistment or deployment. Under the Uniform Code of Military Justice, service members who know they are HIV-positive can face criminal prosecution for violating “safe sex orders,” which limit the allowable sexual activities (including some with virtually no risk of transmission).

Depending on where you live you may receive harsher sentences for crimes like assault or prostitution if you are HIV-positive. You may also be prohibited from donating blood or tissue, sharing needles, exposing someone else to bodily fluids (including saliva), or simply having sex—consensual or not, with or without a condom, and regardless of your viral load—if it’s alleged you have not disclosed your positive status to your partner.

“In some places it’s just vaginal and anal sex [that’s prohibited]; other places it includes oral sex,” says Lambda Legal HIV Project director Scott Schoettes. “Other places, like Michigan—it’s crazy— it includes any sexual penetration, even with an object.” —Jacob Anderson-Minshall

So how do you avoid prosecution for having sex while HIV-positive?

First, you need to learn what the HIV criminalization statutes say in your state (check out the comprehensive data at LawAtlas.org or bit.ly/1xSSAPA) and what, if any, federal policies apply to you.

Second, you must tell all your sexual partners—before you have sex—that you are HIV-positive.

“I get the reasons people choose not to disclose their status,” says Schoettes, who is himself HIV-positive. “It’s hard to do. It’s hard to face possible rejection…it’s scary to put that information out there to someone who really has no legal obligation to maintain confidentiality.” Do it anyway.

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While so many of the HIV criminalization prosecutions hinge on the issue of disclosure, you can’t avoid prosecution without disclosing, but, Schoettes adds, disclosure itself is not enough.

“You have to be able to prove it,” Schoettes explains. “You need to somehow document that disclosure with an email, a text message, a message on an app.”

The Sero Project, an organization focused on ending inappropriate criminal prosecutions of people with HIV, suggests you keep a journal and write down dates when you’ve talked about your status with your partner; videotaping you and your partner talking about your having HIV; and leaving evidence of your status (like your prescription bottles or copies of Plus magazine) in plain sight and taking photos. At SeroProject.org (or bit.ly/1xTyub6) you’ll also find a blank HIV disclosure acknowledgment form that you can ask your partner to sign before engaging in sexual activity.

Involving a third person as a witnesses can provide even more “proof ” if you later have to convince a judge or jury that your partner knew your status before having sex. The ideal, Schoettes says, would be “to bring along your potential sexual partner to a doctor’s appointment” and discuss your status in front of the doctor. Still, Schoettes acknowledges, while videotaping and doctor visits may play well in a courtroom, they are “not very practical.” (That’s especially true for hookups and other casual sex, unlike real relationships, in which your partner going to the doctor with you would be more appropriate.)

The Positive Justice Project of the Center for HIV Law and Policy also recommends that you ask your medical provider to note in your records that you disclose your status prior to sex but still tell your doctor to never discuss your medical records with anyone, not even the police, without a court order (which differs from a subpoena).

There are also a few things you should avoid doing: Don’t write, email, or leave in voice messages anything that suggests you are hesitant about sharing your status; this can be used against you.

And, Schoettes adds, “never say that you are hoping or intend to infect another person with HIV through spitting or biting or any of those things.” That’s true, even if you are joking or are hoping it will stop someone from hitting or attacking you.

“First of all,” he points out, “HIV is not transmitted that way.”

Secondly, he says, such statements can open you up to prosecution and be used against you to suggest you were trying to intentionally infect someone else—even though it’s not possible to do so in that manner.

Criminalization experts don’t want to scare you; they want to arm you with knowledge so you know your state laws, disclose to every sexual partner and, at the very least, confirm your HIV status via email, text, Facebook, or instant messaging (and make sure you save a copy where it won’t be deleted).

If you do get arrested, contact Lambda Legal’s help line (866-5428336) or Sero Project for a referral (info@seroproject.com). And a final word of advice that Schoettes and other legal experts agree on: Never talk to the police about your status or consent to a blood test. If you haven’t been arrested, you aren’t legally compelled to answer their questions. If you have been arrested, you should say nothing except “I want a lawyer.” —J.A.M.

But what if I’m in the military?

Current Department of Defense policies exclude service members living with HIV from enlistment—or deployment if they become HIV-positive while in the service—and threatens those who engage

ALL IMAGES: THINKSTOCK

“So I wouldn’t stay in bed waiting for a vaccine or something. There’s something that everyone can do now—they have just have to choose which way to prevent, to keep themselves free of HIV.”

in consensual sexual relations with dishonorable discharge and criminal prosecution.

Under the Uniform Code of Military Justice, crimes that would be minor for civilians are more serious for men and women in military service. “If you [even] get a traffic violation on a military installation, it is prosecuted as a federal misdemeanor,” an elevated charge, says Kenneth Pinkela, military policy director for the Sero Project.

That can also ruin the lives of HIV-positive service members if

Reviewing Pinkela’s sex orders, you might imagine that he violated them by having consensual sex with another man. Instead, he says, “there was no sex” at all. “My case has no sexual acts in the record of trial. So there was no means for any bodily fluid exposure, and yet I am a convicted felon for aggravated assault—with HIV as the aggravation.”

While civilian cases often hinge on the defendant’s ability to prove his sexual partner was aware of his HIV status, in Pinkela’s case that was never a question. “My accuser testified on multiple occasions to knowing my HIV status before ever being introduced to me,” Pinkela tells Plus. “He says he knew I was HIV-positive, but yet can’t describe what type of sex we had to have exposed him to HIV.”

Pinkela says his accuser, who remains anonymous until the appeals process is over, is apparently the son of two high-ranking Army officials. He says the “facts” of the case were never documented. It was several years after the alleged incident before the accuser came forward, and even then there was no investigation, so all that’s left is a he-said/he-said that left Pinkela’s career in ruins.

This much isn’t disputed: The two men met when a Marine Corps officer and common acquaintance asked Pinkela to mentor the younger serviceman. He agreed and they reportedly had a short, platonic relationship, which ended.

they are accused of violating “safe sex orders,” which define which sexual activities are allowable for them.

That’s what Pinkela learned in 2008 when he was convicted, dismissed from the Army, and sent to the Fort Leavenworth prison for 272 days. Then a lieutenant colonel in the U.S. Army, he was charged with aggravated assault “solely because of an accusation that I exposed someone to HIV,” he says.

The military HIV prosecutions are based on the code’s safe sex orders. Not following them to the letter can open service members to charges of failure to follow a lawful order. Pinkela says these sex orders typically do not differentiate between types of sex; instead, if you have HIV, any type of sexual contact, with or without condoms, consent, and disclosure, is prohibited. And even with those three things covered, you may still be in trouble.

There is not a standard language across the military branches, Pinkela says; each service has a different order and language. “The Navy is the most progressive,” he says. “They were the first to drop the threat of prosecution and write a more public health–based order for sailors.”

Pinkela’s own safe sex order from 2008 included orders to:

• “verbally advise all prospective sexual partners of your diagnosis prior to engaging in any sexual intercourse.”

• “use latex condoms”

• “not engage in unprotected sexual relations (including but not limited to: sexual intercourse, oral-genital, or anal-genital contact) with persons other than your spouse, or with your spouse unless the spouse freely and knowingly consents to such relations after having been informed of your current medical status.”

It was the latter command that Pinkela and others find most confusing. “It sounds like [you just need] consent, right? Not!” he says sarcastically. Instead, he says, the Army meant that all sex was forbidden outside of a marriage. But back in 2008, the idea of having a same-sex yet federally recognized “spouse” was a pipe dream.

Several years later, after the younger man was diagnosed as HIVpositive, he accused Pinkela of exposing him to the virus. After not seeing each other for months, the younger man claimed the two had consensual sex during the holidays.

Pinkela says the sex never happened and that he now believes the other man orchestrated their meeting in order to have someone to “blame” for his own HIV infection.

But Pinkela wasn’t allowed to argue that or even have the representation of a lawyer for more then a year in the military courtmartial proceedings, and when he did receive counsel the military judge denied a simple 30-day delay request to prepare his defense.

In a statement delivered to the Presidential Advisory Council on HIV/AIDS in 2013, Pinkela reported, “The prosecution’s case was focused almost solely on proving that I had HIV. I am quoting directly here, ‘Where there is smoke there is fire…you are HIVpositive, so it must have been you.’ ” Pinkela’s conviction and imprisonment cost him far more than time. “Now I am a convicted felon and registered sex offender,” he said in that statement. “My 26-year career of service and sacrifice to my nation, including a stint as the Army’s legislative liaison to the U.S. House of Representatives, all retirement benefits, including medical care, are gone.”

Pinkela has continued to fight his conviction and the criminalization of HIV through his work at the Sero Project and supporting legislation like the amendment to the National Defense Authorization Act that requires the Department of Defense to review its policies and criminal prosecutions of military members living with HIV. The act passed with the amendment in 2013, and President Obama signed it into law.

Pinkela called the amendment “powerful” and told The American Independent in 2013, “These prosecutions show the insanity of how we are treating people with HIV.” —J.A.M.

Why isn’t there a cure yet?

Dr. Rowena Johnston, vice president and director of research at amfAR, has the answer: hivplusmag.com

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There has been only one known case of cure of HIV, namely the “Berlin patient.” It would be hard to overstate how important this case has been in terms of spurring optimism that a cure for HIV can be found, in the scientific community as well as other stakeholders (i.e., infected people). Of course, the drawbacks are that the procedures done on him cannot be replicated on an expanded scale.

In fact, many doctors around the world have tried, and there has not yet been one instance where this cure has been replicated.

There is a group of patients in France, known as the VISCONTI cohort, who started taking antiretroviral therapy within weeks of infection, then eventually stopped taking the drugs. These people have been able to maintain low but detectable levels of the virus.

The mechanism whereby they can keep their virus in check is not understood. Certainly, nobody recommends that patients stop taking their drugs; in almost all cases, the virus returns to very high levels. If some way could be found to safely withdraw patients from their antiretrovirals, this would be a great step forward, even though patients would still be infected. It is unknown whether the VISCONTI patients can still transmit their virus to others.

The major objectives of amfAR’s research road map address the four remaining roadblocks to curing HIV. These are all related to reservoirs, pockets of virus that persist in the DNA of infected cells.

Antiretroviral therapy targets and helps contain any new viruses that these infected cells produce, but the blueprint for making those viruses remains within the cells’ DNA. If treatment is stopped, there is nothing to prevent that DNA blueprint from making new copies of the virus, which are able to spread unchecked.

Therefore, in order to cure HIV, we need to tackle these four challenges: • Chart the precise locations of viral reservoirs.

Locating all the places where HIV is hiding in the body is a bit like finding a needle in a haystack. A particular body part—such as the brain or the gut— can harbor a reservoir of HIV. Particular cell types, including immune cells that are found throughout the body and are not limited to one place, can also be reservoir sites. We will not be able to eradicate or neutralize this latent virus unless we know exactly where all of it is.

• Understand how HIV persists in the reservoirs. Although scientists know that HIV hides in various reservoirs throughout the body and in different types of cells, many questions remain about why it persists in particular places and how it behaves.

• Record how much virus is in the reservoirs. When testing potential cure strategies, it is important to be able to assess whether the amount of virus in the body is diminishing. This will require highly sensitive measurement tools—tests that are capable of recording even a single particle of virus.

• Eliminate the reservoirs—via pharmacotherapy, immunotherapy, or cell therapy.

This shouldn’t be a zero-sum game. Many areas of HIV research continue to be important, including improving treatment, finding a preventive vaccine, and curing the infection. The scientific community can learn a lot about how HIV persists, and some circumstances under which it can be reduced or removed, via transplants. Many think that transplantation will not ultimately be a realistic way to

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cure millions of people. It’s difficult to know that in advance; perhaps if transplants could cure a lot of people, someone would work out how to provide transplants, or some cure intervention based on what we learn from transplants, to all the people who need to be cured.

Dr. Rowena Johnston, vice president and director of research at amfAR, is responsible for overseeing the foundation’s pioneering research program, targeting work directed at improving HIV prevention and treatment interventions, supporting the career development of young HIV and AIDS researchers, and aggressively pursuing a cure for HIV. In 2010 she was instrumental in forming the amfAR Research Consortium on HIV Eradication (ARCHE).

Can I conceive if I have HIV? Yes. First consult with a medical professional who is knowledgeable about the use of HIV medications in pregnancy. You need to do this before you become pregnant to prevent you from transmitting HIV to your child. With proper care, you can reduce the risk of transmitting HIV to your baby to less than 1 percent. If possible, take advantage of specialists like those at Johns Hopkins HIV Women’s Health Program, who are experienced in the use of such meds in pregnancy. The program also provides comprehensive social services and referrals to pediatricians. You’re likely to find similar programs at other large health care organizations.

If you are a woman with a male partner who is also HIV-positive, you may be tempted to get pregnant the old-fashioned way: through unprotected sex.

However, doing so puts you at risk of reinfection or superinfection, even if both of you have a low or undetectable viral load—although new research on treatment as prevention (TasP; see below) may change some of the recommendations involving that. But it’s safest to utilize the procedure known as “sperm washing,” which can literally wash the HIV from sperm, so you can be inseminated without fear of reinfection or superinfection.

If your baby-daddy is HIV-negative, you may be able to conceive through sexual intercourse if he’s being treated with pre-exposure prophylaxis (PrEP). Sure, it’s not very romantic imagining your doctor involved in your conception process, but the trade-off is having a healthy, HIV-negative baby. —D.A.M.

What if my husband, boyfriend, or male partner has HIV, but I’m negative?

Yes, you absolutely can conceive, and in fact, recent research on PrEP and TasP indicate that it’s generally much safer and easier than if your situation were reversed. You’ll still want to have an HIV specialist doctor involved, or at least one who has dealt with using HIV medications and conception before. Your doctor will likely prescribe you PrEP, which when taken appropriately prevents HIV transmission in the majority of cases. You’ll take medication— Truvada, the only drug so far approved by the FDA for PrEP— during the duration of your attempts at old-fashioned procreation.

The doctor will also make sure your husband is on treatment and maintaining an “undetectable” viral load (that’s the TasP) and thus has a significantly lowered chance of passing HIV along to you. The new book Positively Negative chronicles two couples utilizing PrEP and/or TasP to conceive this way; you may want to read it. —D.A.M.

Can I adopt if I have HIV?

How do I tell my kids I have HIV?

Yes. The federal Americans With Disabilities Act makes it illegal for adoption services to disqualify prospective adopters solely for an HIV diagnosis. Do know that with all chronic conditions, having a doctor who says you are healthy and can take care of a child will be an important factor in your approval process, but adoption workers should view HIV much like diabetes, arthritis, lupus, and dozens of other manageable medical conditions. Having a chronic condition is no longer seen as an impediment to raising a child, as it once was. But you may encounter stigma from some agencies, and if you do, you may want to have an attorney remind them of your rights.

Also, many AIDS service organizations and LGBT organizations have resources to help you find a friendly adoption agency used to dealing with HIV-positive parents. —D.A.M.

Many parents worry that telling their children about their positive status might place an undue burden on the children. Mental health professionals say the decision about whether to tell your kids depends on many factors, including how perceptive they are (have they asked about your medicines?), how discreet you need to be (asking kids to keep a secret can create a heavy burden), and how strong you can be for them (some kids will be angry, overly clingy, or terrified you’re dying).

Can I become a foster parent if I have HIV? Yes. Having HIV isn’t a sufficient reason to prevent someone from becoming licensed as a foster parent.

However, the ACLU’s “Know Your Rights: HIV Parenting” brochure notes that if your health is compromised to the point that you cannot adequately care for a child, you probably won’t get licensed. (As is the case with adoption, all prospective foster parents have to share their medical history and have a doctor’s go-ahead before they are certified.) As the AIDS Beacon reiterates, agencies are “allowed to reject the applicant if other factors exist that determine the prospective parents are unqualified.” Again, utilize your local AIDS service organization or LGBT center (even if you are in an opposite-sex couple) to find poz-friendly agencies that work with the foster care system. Most major cities have such agencies. —D.A.M.

Kids can understand and assimilate information; you just need to have it ready for them. So, for most parents, telling their children will be the right choice. Before you do, though, make sure you are prepared for their questions about HIV. Your kids have been perfecting the “why” questions since they were 2 years old, and you don’t want to be in a situation where you don’t know the answer.

Living With HIV: A Patient’s Guide author Mark Cichocki, a nurse educator at the University of Michigan’s HIV/AIDS Treatment Program, recommends selecting a quiet place for the conversation, being honest, trusting your kids to handle the news, and letting them express their emotions fully. Kids can experience a range of feelings, including guilt, fear, rage, and rejection—all normal reactions.

There are support groups and advocates for your kids to lean on in the coming-out process. And it is a process, so don’t expect it to be done the moment you share your status. That’s just the beginning. A good second step: After the crying and talking is done, take them out for ice cream.

Then resume your normal activities so they see this is just another situation your family will tackle together. —D.A.M.

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TREATMENT CHRONICLE S

COULD CANNABIS TREAT HIV? More and more studies are surfacing that show just how important cannabis may be for the treatment of HIV

By stimulating activation of CB2 with cannabinoid receptor antagonists, Mount Sinai researchers decreased the ability of HIV to infect cells that utilize CXCR4, reducing the frequency of infected cells by 30 to 60 percent.

Cannabinoids may help prevent Support for medicinal marijuana has reached neurocognitive disorders an all-time high in the United States. with over 70 percent of Americans in favor of Research conducted at Temple University School the use of cannabis to lessen the effects of a of Medicine and published in the Journal of Leukocyte large number of chronic medical conditions.

Biology suggests that compounds that stimulate CB2 People with HIV have long realized on macrophages may weaken HIV infection. CB2 is that cannabis can ease many HIV-related the binding site for cannabinoids on macrophages, and conditions, including nausea, loss of appetite, stimulation of these receptors, unlike CB1, does not produce depression, weight loss, and neuropathic pain. the euphoric effects associated with cannabis use.

In addition to treating common symptoms of HIV Neurocognitive disorders are common in people and side effects of antiretroviral drugs, research with HIV even in the presence of a strong indicates that cannabis may help fight HIV Cannabis has been immune response and suppressed viral itself. used for centuries for the load. The virus establishes itself in the An increasing number of scientific treatment of a wide range of central nervous system early on in HIV studies, conducted at well-known illnesses. The potential medical utility infection and maintains a stronghold institutions and published in of cannabis is much greater than the use throughout the course of disease. prominent medical journals, are of cannabis to alleviate symptoms. Despite Most antiretroviral medications are revealing antiviral effects of cannabis evidence that cannabinoids may be potential unable to cross the blood-brain against HIV. These studies detail treatments for many diseases, cannabis’s current barrier and thus cannot decrease the diverse approaches in measuring designation by the federal government as a level of HIV in the brain, allowing favorable effects that cannabis Schedule I substance—that is, a dangerous drug for cognitive damage to continue. may have in slowing HIV disease with no legitimate medical use and great potential Macrophages are long-lived cells progression. for addiction and abuse—is preventing academic that are targeted by HIV and exist THC in monkeys may lessen HIV’s damage in the gut

centers and life science companies from throughout the body. Macrophages conducting research and development are present in the blood and all organs, of cannabinoids for the treatment of including in the brain. Some researchers devastating diseases hypothesize that these cells may be key to such as HIV. ongoing replication that creates inflammation,

During primary infection HIV attacks the gut-associated lymphoid tissue (GALT), where a substantial amount of the immune system is located, hitting CD4 cells hard and early during this process. The initial damage done to GALT is believed to be essential to the progression of HIV disease.

A study funded by the National Institutes of Health and the National Institute on Drug Abuse and published in AIDS Research and Human Retroviruses in 2014 found that THC, the best-known component of cannabis, had a positive effect on GALT in rhesus monkeys that were infected with SIV, the simian version of HIV, after 17 months of receiving THC. Checking the monkeys five months later, researchers from the Louisiana State University Health Sciences Center found that THC produced a generalized decrease in viral load and tissue inflammation and increased production of disease-fighting CD4 and CD8 central memory T cells in GALT. Blocking HIV’s entry The effects of cannabis are a result of interactions between cannabinoids and receptors located on many cells, including macrophages (a tissue cell of the immune system) and CD4 cells called cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). Researchers at New York City’s Mount Sinai School of Medicine published data in 2012 demonstrating that stimulation of CB2 with compounds called cannabinoid receptor agonists can block the signaling process between HIV and CXCR4, one of the main types of receptors that allow HIV to enter and infect a cell.

CXCR4 is used by HIV during advanced disease and allows for faster disease progression.

a damaging effect of overstimulation of the immune system. Inflammation can greatly contribute to many non-AIDS-related illnesses, such as neurocognitive disorders, cardiovascular disease, bone disease, and some forms of cancer. The study authors found that anti-inflammatory compounds related to THC bind to CB2, effectively reducing viral replication and inflammation in the brain.

The future of cannabis in HIV Although Big Pharma is yet to make a serious commitment to the study of cannabis for the treatment of disease, many universities and a small number of biotech companies are investing in the research and development of cannabinoid-based medications. One such company has taken an interest in cannabis and HIV. Cannabis Science is exploring the use of cannabinoids to treat Kaposi’s sarcoma in people with HIV as well as a potential therapy directed at inhibiting the HIV protein Tat, which is key for viral replication and modulates the expression of genes that regulate a variety of cellular activities. This would be revolutionary for people living with HIV, as chemotherapy, a primary treatment for Kaposi’s sarcoma, is largely unavailable in Africa, which has the highest burden of the disease. A cannabinoid-based antiviral would be cheaper than currently available drugs, greatly decreasing the cost of treating HIV and allowing for increased access to treatment for the nearly 7 million HIV patients around the world who need antiretroviral drugs but do not currently have access to them. —Jeannie Wraight and Mariel Selbovitz hivplusmag.com

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T REATMENT CHRONICLES

Ask & Tell

I can’t stop obsessing about the guy who gave me HIV. What can I do to move on?

Being newly diagnosed with HIV brings up a lot of questions. The first one is “Why me?” And that often leads to “How did this happen?” or “Why did I let it happen?”

Some of my clients have no idea how they became HIV-positive. They find themselves going back over past sexual encounters and trying to figure out when and from whom they acquired the virus.

Others know exactly who passed HIV on to them. And they find themselves going back over that specific encounter and obsessing, as you may be, which is a normal reaction.

To be honest, I am not sure which obsession is hardest to deal with, but I see the results of both. A lot of self-criticism, along with feelings of anger, regret, and shame. Those are also normal, especially when someone is new to being HIVpositive. But those emotions are keeping you stuck. My clients who share youra

aaexperience often talk about wanting to understand how this person could have been unaware of his or her HIV status.

And if they were aware, why they would make the choice not to disclose their status.

They tell me about how they search their memory to recall if there were any signs along the way, something that was said or done that they might have missed, along with asking themselves what they could have done to prevent this from happening.

Our minds want answers. How? Why? And a big part of all that obsessing is trying to get those answers. In the absence of real information, our minds are all too willing to create stories. And our minds tell us that if we keep mulling over these stories, we can get some kind of resolution.

But for what purpose?

Some of my clients have gone back and confronted the person who infected them.

Or they have warned others about them.

Others have not been able to contact them again, because they couldn’t locate them or because they couldn’t bring themselves to initiate any more contact.

I don’t know what your plans are. But I can say that the majority of the time, the only closure is to not have closure.

In other words, the resolution may be to accept that you may never know exactly why the guy who infected you placed you

IT’S NOT ABOUT SEX, IT’S ABOUT CANCER The Food and Drug Administration has approved Merck Pharmaceuticals’ Gardasil 9 vaccine to prevent nine strains of human papillomavirus, more than any previous vaccine.

HPV is the most common sexually transmitted infection, which nearly every sexually active person will get in their lifetime. HPV can infect the mouth, throat, and genitals and is the leading cause of a number of cancers, including cervical, anal, and throat. In fact, the Centers for Disease Control and Prevention reports that HPV is to blame for 95 percent of anal cancers, 35 percent of penile cancers, 65 percent of vaginal cancers, 60 percent of all cancers of the throat, tongue, and tonsils, and nearly all cases of cervical cancer.

In clinical trials the new Gardasil 9 vaccine was 97 percent effective in preventing vaginal, vulvar, and cervical cancers associated with HPV and 79 percent effective in preventing anal cancer. The most common side effects were headaches and pain, redness, and swelling at the injection site. The FDA has approved the vaccine for females aged 9 to 26 and males 9 to 15; because the vaccine prevents but does not treat HPV, it must be taken before people become sexually active. —Jacob Anderson-Minshall

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in this situation. You may never get the apology you want. You may never have the opportunity to hurt him back. And if any of these scenarios came about, all those feelings wouldn’t magically disappear.

In the meantime, keeping that person front and center is also causing you to suffer. So a question for you: What if you moved on? I am not saying the two of you need to sing “Kumbaya” and hug it out.

But on the other hand, unless he is sending you a fat rent check every month, he is also occupying a big chunk of prime real estate in your brain that could be better used.

So what can you do? I encourage you to gradually fill up that space with what’s really important. The people you care about. Your health. Your job. The things you enjoy doing. Your community. Your future. This might be a great time to add to your life—new interests, new people.

I’m not saying success is the best revenge, because this is not about getting revenge.

But I am saying it’s time to push that old tenant out into the street. Choose to make your life about what’s inspiring, what’s exciting, and what’s next.

Mental health editor Gary McClain, Ph.D. ( JustGotDiagnosed.com), is the coauthor of several books, including The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life with Joy.

Complex Plumbing

The female reproductive tract is highly susceptible to HIV, according to a new study published in PLoS Pathogens, which may change the way scientists approach studying HIV transmission in women.

Researchers have primarily examined how HIV is transmitted to women by examining only the cervix and not the other parts of the female reproductive system. To determine whether HIV actually is more or less potent in other areas, scientists at Northwestern University conducted a study of female rhesus macaques and how susceptible their reproductive tract is to the simian immunodeficiency virus (the primate version of HIV).

The scientists created an artificial version of SIV that infects cells the same way HIV does. They found that the virus is able to quickly spread and can infect other parts of the female reproductive tract, from the vagina to the ovaries and everything in between. In fact, the trial showed that the virus entered multiple parts of the reproductive system.

Based on their findings, the researchers say the entire female reproductive tract “should be considered as potentially susceptible to HIV infection.” They also recommend that any mechanisms created to prevent HIV infection in women should take the entire reproductive system into account to truly protect against the virus. —Michelle Garcia

TREATMENT CHRONICLE S

WILL A NEW RAPID SYPHILIS TEST GET IT UNDER CONTROL?

DO YOU NEED MORE TESTOSTERONE? Sure, low T can cause complications in men with HIV, especially as they age, but there’s no simple “yes” or “no” answer to that question.

ALL IMAGES: THINKSTOCK

We’ve all seen the commercials: attractive middle-aged men who’ve slowed down a bit due to low testosterone, using hormone replacement products to get their groove back. What they generally don’t mention is that low testosterone is a concern for people with HIV—not as much as it once was, but definitely for a certain growing subset of the population.

Before the advent of protease inhibitors and other highly effective HIV treatments, beginning in the mid-1990s, some people with the virus experienced severely reduced testosterone levels, says Octavio Vallejo, MD, MPH, who works in the treatment education department at AIDS Project Los Angeles.

This is less common now, he says, due to the newer drugs and the fact that people are often beginning treatment immediately after diagnosis, before the virus has had a chance to do much damage to the immune system and other components of the body.

But by prolonging lives, the drugs have resulted in an aging HIV-positive population, and low T is a common problem for those over 50, Vallejo notes. The data on how many people are affected vary from study to study, but, for instance, an Italian study of 1,325 HIV-positive men published in 2012 found that 11 percent of participants in their 30s had testosterone deficiencies, 15 percent of those in their 40s, and 24 percent of those in their 50s. In contrast, only about

6 percent of HIV-negative men in their 40s and 50s have low T, the researchers reported.

Some loss of testosterone is common as men age, and replacement therapy isn’t indicated for everyone, Vallejo says, but he recommends that men experiencing certain complications—low sex drive, depression, fatigue, loss of bone density, or loss of muscle mass—have T levels tested and consider treatment. Testosterone gels and patches are widely available (by prescription), providing an easier means than injection for delivering the hormone.

There are potential complications. Some studies have shown increased risk of stroke or heart attack in men taking testosterone replacement therapy. There is some concern about a link to prostate cancer, but scientists say more research is needed on this. And a new study published in January by Italian scientists sees a link between low T and “frailty” in poz men but notes that this could be the body’s way of making HIVpositive people conserve their energy.

Although most people think of testosterone as a male hormone, women have testosterone too, and they can see similar complications from decreases in the hormone. Some researchers say testosterone replacement can benefit women as well as men, but the general feeling is that more study is needed. In 2013, the HIV Medicine Association of the Infectious Diseases Society of America recommended that even monitoring testosterone levels in HIV-positive women be done only in research settings.

Bottom line: If you have any of the symptoms associated with low T, talk frankly with your doctor to see if testing and replacement are warranted. —Trudy Ring

At the end of 2014 the Centers for Disease Control and Prevention released its sexually transmitted disease surveillance data for the previous year, 2013, showing the rates for primary and secondary syphilis, which is the most infectious stage of syphilis, increased by an alarming 10 percent.

“This second year of double-digit increases of syphilis rates is completely unacceptable and also significantly intersects with our HIV epidemic,” says William Smith, executive director of the National Coalition of STD Directors.

“This continues to affect populations already disproportionately impacted by all STDs, including HIV, most notably gay men and other men who have sex with men (MSM).”

The coalition notes that the rate of syphilis in 2013 was the highest recorded since 1996. That 10 percent increase in syphilis rates in 2013 was almost entirely increases in men, mainly gay and bi men; no overall increase was seen in women that year. Smith also reports that syphilis and HIV coinfection among gay and bi men is so common that over half (52 percent) of MSM with primary and secondary syphilis also have HIV and that MSM account for 75 percent of the primary and secondary syphilis cases reported to the CDC. There is good news on the horizon, though. The Food and Drug Administration has just approved Syphilis Health Check, the first rapid syphilis test to receive a waiver for use outside of traditional laboratory settings, which Smith calls a “game-changer in syphilis testing and prevention, allowing for a much quicker response, similar to what was previously available for HIV testing for over a decade.”

Dr. Susan Philip, immediate past chair of the coalition’s board of directors and STD controller for San Francisco, says that in outreach settings with highrisk populations, “every rapid HIV test being run should have a rapid syphilis test run concurrently.”

Test results are available in 12 minutes, and the tests can now be run in STD clinics, ERs, jails, and HIV testing centers, among other places.

—Denise Hernandez hivplusmag.com

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T REATMENT CHRONICLES

How to Stay Fit if You Have Health Issues

My doctor has told me that I’m at risk for high blood pressure and placed me on blood-pressure medication. What’s the best way to augment my workout routine in this situation?

Yoga improves immune function, high blood pressure, anxiety, depression—even irritable bowel syndrome. It’s accessible and inexpensive, with many community classes free of charge. The benefits of yoga become evident only if you do it regularly. Above all, listen to your body and don’t force yourself into any exercise situation where you don’t feel comfortable. Take breaks, drink water, and breathe. If you’re an animal lover and have room to adopt, dogs are proven to reduce blood pressure too.

I’ve been lifting weights five or six days a week for the past year, but I haven’t really been able to put on much weight. I’m feeling tired and unmotivated all the time. Is it possible for someone with HIV to work out too much?

You’re probably lifting weights too frequently and inadvertently hampering your muscle growth. It’s called “overtraining” (training too hard and too often without giving the body enough time to rest in between workouts). The effects of overtraining usually show up as fatigue and extreme muscle soreness. Sometimes, as in your case, the signs are even more serious: depression, low energy, insomnia, loss of appetite, and worst of all, loss of lean body mass. With plenty of rest you can turn this around. Cut back on your training and make sure you’re getting adequate rest between workouts. Find a trainer to explain how to schedule your workouts. Take a hard look at what you’re eating (or not eating) and figure out if you’re getting enough macronutrients (carbs, fat, protein).

I’ve heard that taking glutamine and creatine can have positive effects in people who are HIV-positive. Do these sports supplements have any potential interactions with antiretroviral therapy?

When it comes to sports supplements and their potential interactions with HIV meds, research is scant and inconclusive. But an ounce of prevention is worth a pound of cure, so supplementing with L-glutamine is a smart way to keep your lean body mass up. While no adverse effects have been reported with glutamine use, other supplements such as SaintJohn’s-wort (which has significant interactions with some HIV meds) have illustrated the complexity of adding “natural” substances to an antiretroviral regimen. Creatine may also have a place at the table, but your doctor can help you balance the benefits of these sports supplements with your overall treatment regimen. It’s best to avoid products that have documented interactions and to communicate with your doctors about all the supplements you’re using. That way, they can take them into account if you develop any side effects or if your viral load response is not appropriate.

While the primary touchstone for people with HIV is weight training, cardiovascular exercise is probably the best natural medicine for depression, and regular cardio results in feelings of self-mastery and accomplishment. My own free fitness training app, PocketSAM (Pocket-sam.com), also contains workouts specifically to address targeting the glutes.

I was recently diagnosed with peripheral neuropathy. I still have feeling in my fingers, but I’ve lost most of the feeling in my toes. Do you have any advice on ways I can manage this condition through exercise or supplementation?

Resistance training is a great way to improve overall muscle strength, especially for people with neuropathy. One study found that people who walked four days a week for one hour slowed down the worsening of their neuropathy. Seated resistance exercises are an excellent choice, as are swimming, rowing, and pretty much any upper-body exercise. But avoid high-impact exercises like running on a treadmill or jumping up and down, as this can result in foot injuries.

I’m finding it hard to go to the gym. Between my job and my family and trying to take care of my elderly dad, I just don’t have the time. I’ve also been depressed about having HIV and worrying that people think I’ve lost weight because I’m positive. How can I break this cycle?

When you’re under a lot of stress, the best thing you can do for your physical and mental health is to stake out some “me” time and recommit to a more active lifestyle. The mood-enhancing benefits of exercise and its effects on the immune system are well documented and more durable than once thought, lasting up to 12 hours after the workout is over. Unfortunately, stopping exercise only enhances feelings of isolation, anxiety, and depression. Don’t let the gym scene drag you down any longer. Get outside. Change your environment.

Go for a brisk walk around the neighborhood, swim at a local pool, hike a new trail, take a self-defense class, join a team, or sign up for an AIDS walk. Many AIDS walks (or bike rides) have pre-walk trainings where groups get together and walk (or bike) increasing amounts of distance each weekend, working up to the big day.

My trainer told me that doctors sometimes prescribe testosterone for people with HIV. Would it help me beef up?

Yes, supraphysiological levels of testosterone (and growth hormone) will increase lean body mass, reduce fat, and improve well-being, but the long-term effects are largely unknown. I’d make an appointment with your doctor for blood work. Meanwhile, do everything you can to enhance your natural levels of testosterone—eat a balanced diet, take a multivitamin, get enough sleep, and avoid excessive caffeine, alcohol, and nicotine. Ask your trainer for more multiple joint exercises (e.g., lunge, bench press, deadlift, clean, squat, pull-up) as these exercises can play a role in higher levels of post-workout testosterone. If after you’re tested, your natural level of testosterone is below the normal range, have a robust conversation with your doctor that covers all the options, including testosterone patches, gels, creams, injections—even implants.

Wellness editor Sam Page is a fitness trainer and lifestyle expert in Los Angeles. @SamPageFitness SamPageLA THINKSTOCK

I’m worried about the possibility of wasting and body-fat redistribution. I currently lift weights but can’t do exercises for my glutes like squats because I have arthritis and degenerating discs in my spine. Is there

something else I can do to keep my body, especially my butt, in shape?

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THE BARBERSHOP DIARIE S

His boys are already in college, but this busy dad is still giving voice to youth—and other people with HIV

DUANE CRAMER

E

very week Khafre Abif is at the barbershop getting his mustache and beard trimmed—and sometimes talking about HIV. “I often talk about HIV and other health disparities in the barbershop,” says Abif, an activist, author, and the editor of Cornbread, Fish and Collard Greens: Prayers, Poems & Affirmations for People Living With HIV/AIDS. “My barber knows I am positive because I am asked what I do and because I share the articles in which I am featured. I have shown a copy of [the book] to my barber, and he has in turn shared it with the other barbers. Now I get questions from barbers and clients when I am at the barbershop about HIV, prostate cancer, and many other health issues.”

It’s not a surprising story. Black-owned barbershops have always been a community hub, one in which some guys are more willing to shoot the breeze about health issues than in a clinical medial setting. But it wasn’t always the case for Abif.

Abif was diagnosed with HIV in 1991, and he didn’t tell his mother that he was positive until five years later. She hugged him, they prayed, and she cooked—hence the title of Cornbread, Fish and Collard Greens. “She put her arms around me; she prayed for me and prayed over my life. And then she went downstairs to the kitchen and pulled out a cast iron skillet and started cooking cornbread—she wanted to fatten me up, I guess.”

He still had to find his voice as a poz man, though. Abif was an HIV and AIDS activist on behalf of other people, with work centered around his local Ryan White CARE Act Planning Council, statewide community planning, and other forums where he kept his status confidential. He had a voice, he says, but his advocacy focused on the needs of children, youth, and families, particularly black families, he says.

In 2005 he left his career as a librarian and returned home to Pittsburgh “to care for my MaDear [mother], who had cancer for the second time. While caring for

her, she spoke with me about my calling/ assignment and my need to step out of whatever was holding me back from walking into what God has for me to do.

It was like she was freeing me from the shame, stigma, and fear by letting me know how proud she is of me and the fact that, at the end, what matters most is what I have done for the Kingdom of God. It was then I began to speak and share openly, publicly, about my status and sexuality. My activism came out into the public.”

Abif was able to speak openly about being bisexual and HIV-positive and to gather 125 authors and poets (some famous, many not) to offer their words about HIV for a book that’s now available worldwide in several languages, including English, Spanish, French, Xhosa, and Zulu. “We wanted to create a quilt of words to wrap around people to combat the negative words we living with HIV often hear from family, community and just the media,” says Abif.

It still hasn’t reached as many people as he’d like—though it’s used in support groups and by several organizations—but readers who’ve reached out to him via social media have been demonstrably impacted. One message read, “When I ordered my copy via Amazon it arrived on the fifth anniversary of my partner’s death.

I began reading Cornbread and I needed to reach out and share with you how it is the medicine I so desperately needed today.”

He started the book after launching his pet project, Cycle for Freedom, which he began working on five years ago when “two very dear friend and warriors in this fight against HIV made their transition,” he recalls. “They were both long-term survivors. I sat in quiet contemplation asked God, ‘Why am I still here?’ I began to receive the answer.”

Abif envisioned Cycle for Freedom as a national mobilizing campaign meant to reduce the spread of HIV among African-Americans and Latinos by confronting the three critical issues that fuel the HIV pandemic: HIV-related

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stigma, homophobia, and lack of education.

Participants will do so over 75 days this year on a bike trip along what they call the Underground Railroad Bicycle Route, with working groups in 14 cities to offer rapid HIV testing and counseling and an antistigma component specifically tailored to meet the needs of the populations who bear the brunt of stigma in the host cities.

Of course, it’s not all activism for Abif.

He’s raised two sons, both college students and, he brags, both on full scholarship.

“My oldest is 6 foot 8 and on the men’s basketball team at Drexel University, while my other son is studying neuroscience at Georgia State University with a 3.85 cumulative GPA,” he says. “I have always wanted to be a father, and I have been blessed in that regard.”

This busy dad works as a parent liaison for Atlanta Public Schools, leads an HIV support group weekly, is a fiber artist (“I made quilts and have made several for the Names Project”) and wicked cook (“I love to cook and folks love what I cook”), and a man of faith (“I love the support I give and receive from my church home”).

But at the end of the day he’s a storyteller or, rather, a story sharer. He’s got plans to curate and edit five more collections of stories by LGBT people or people with HIV (one for women, another for straight men with HIV, whose voices are rarely heard), and there’s a memoir in the mix too. It’s all a wonderful mash-up of community, church, and family. And don’t forget, love. The once-divorced author-activist-leader and his partner, his youngest son’s mother, have been together nearly 15 years now—and, he reminds us, “she remains HIV-negative.” —D.A.M hivplusmag.com

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WHOLE YOU

Did you know that approximately 90% of people living with HIV/AIDS have at least one other health condition that needs ongoing care?1 The most common are high blood pressure, high cholesterol and heart disease.2 And as therapies improve and people living with HIV/AIDS live long lives, other health concerns associated with aging will occur.

So, while it’s important to find a pharmacy with HIV/AIDS expertise, you should also consider a pharmacy that cares for the whole you, for the long term. For instance, pharmacies that offer services such as:

And the pharmacists at more than 700 Walgreens HIV-specialized pharmacies are trained on HIV/AIDS plus other health conditions such as diabetes, high cholesterol and high blood pressure.

A broad range of immunizations—People living with HIV/AIDS can be at risk for more serious complications from illnesses like the flu, pneumonia, hepatitis, chicken pox and others, so it’s important to protect yourself with vaccinations.3

No matter which Walgreens you choose, you can count on confidential, one-on-one medication counseling on any health concern you have. To learn more and find a Walgreens HIV-specialized pharmacy near you, just go to HIV.Walgreens.com.n

Health testing—A pharmacy that offers convenient health test services can make it easy to find out if you have high blood pressure, high cholesterol or elevated blood glucose. And once you know, you can take advantage of ongoing testing to manage your condition.* There is a pharmacy that offers the whole-person care you can count on now and down the road.

More than 8,000 Walgreens locations nationwide provide CDC-recommended immunizations and a range of health tests, including ones for cholesterol and blood glucose.†

See how Walgreens pharmacists help support people living with HIV/AIDS with the HIV Plus Ask the Expert video series at HIVPlusMag.com.

* Test results are not for diagnostic or treatment purposes and are not conclusive as to the absence or presence of any health condition. Recipients are encouraged to report test results to their primary care physician. Pharmacist consultation with patient does not constitute medical advice. †Vaccines subject to availability. State-, age- and health-related restrictions may apply.

1. Magalhaes MG, Greenberg B, Hansen H, Glick M. Comorbidities in older patients with HIV: a retrospective study. J Am Dent Assoc. 2007;138(11):1468-1475.

2. Weiss JJ, Osorio G, Ryan E, Marcus SM, Fishbein DA. Prevalence and patient awareness of medical comorbidities in an urban AIDS clinic. AIDS Patient Care STDs. 2010;24(1):39-48.

3. Vaccines you need if you have HIV or AIDS. WebMD Web site. http://www.webmd.com/vaccines/aids-hiv-immunizations. Reviewed February 27, 2014.

Accessed November 3, 2014. ©2015 Walgreen Co. All rights reserved.

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We understand that living with HIV/AIDS can make a busy life even more complex. That’s why your Walgreens HIV-specialized pharmacy offers services that can help make your overall care easier, such as: • Prescription alignment that makes it easy to fill all your medications on the same date.

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To learn more, visit HIV.Walgreens.com.

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