HIV Plus Issue 106 May/June 2015 by Pride Media

32 Things You Need to Know When You Find Out You Have HIV

BECAUSE YOU’RE MORE THAN YOUR STATUS

POW!

ACTOR MEL ENGLAND

TREATMENTS

TESTING

STIGMA

KNOCKS OUT FANS & TALKS STRAIGHT ABOUT BEING POZ THE CURE

COMORBIDITIES MAY / JUNE 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. STRIBILD 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 breast-feed. 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 itâ&#x20AC;&#x2122;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 can also be used to replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL of virus in their blood), and have been on the same HIV-1 medicines for at least 6 months and have never failed past HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements. • STRIBILD is a complete HIV-1 medicine and should not be used with any 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®) • midazolam, when taken by mouth • 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 elvitegravir, cobicistat, emtricitabine, or tenofovir (Atripla®, Complera®, Emtriva®, Truvada®, Tybost®, Viread®, Vitekta®) • Other medicines that contain lamivudine or ritonavir (Combivir®, Epivir® or Epivir-HBV®, Epzicom®, Kaletra®, Norvir®, Triumeq®, Trizivir®) 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 doctor 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 over-the-counter 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 - 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: December 2014

COMPLERA, EMTRIVA, GILEAD, the GILEAD 7Logo, GSI, HEPSERA, STRIBILD, the STRIBILD Logo, TRUVADA, TYBOST, VIREAD, and VITEKTA 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. © 2015 Gilead Sciences, Inc. All rights reserved. STBC0171 03/15

EDITOR’S LETTER

IT WAS OLD HOME WEEK AT PLUS,

where one of my favorite photographers, Tony Donaldson, teamed with art director Bonnie Barrett to create this knock out cover of actor Mel England. I couldn’t decide which I liked more. What’s your vote? It’s hard to believe that I’ve worked with both Tony and Bonnie off and on for 20 years! Tony shoots a lot of Olympic and pro athletes, so he brings out the sporty side of every celebrity, but I loved this shot of Mel camping it up with his lil’ fur babe most of all. Just Diagnosed? 32 Urgent Questions Answered

Just Diagnosed? 32 Urgent Questions Answered

When HIV Plus magazine was founded in the 1990s, AIDS was at pandemic levels, HIV was a virus that researchers knew little about, and few people with HIV were expecting to live long, healthy lives. Today, as we publish issue 106, the landscape has changed and so have people living with or affected by HIV. Now the virus is like other manageable chronic conditions that require daily medications, much like diabetes, and people with it are living as long as their HIV-negative peers. They are often dealing with coinfections, like hepatitis C, and social stigma more troubling than the actual virus. That’s why it’s time for HIV Plus to rebrand itself as Plus, eliminating the stigmatizing language that leads with the virus, and recognizing and telling our readers we get it: You’re you, plus a little something more. Sometimes that’s HIV, hep C, another viral condition or STI, any one of those comorbidities, which you can now read about in Plus without having to worry about whether carrying the magazine on the subway, reading it in your cubicle, or leaving it on your coffee table will automatically get you branded with the term HIV at first glance. We’ll still emphasize HIV in our content (that’s our primary mission, after all) and our website and mobile app will remain the same. But by losing those three little letters in our magazine’s title, we both open ourselves up for people to feel free to read us anywhere and we invite in readers for whom stigma has directly affected access to treatment, testing, and overall health care. We care about everyone impacted by this virus and its complications as well as other viral infections (from Ebola to HCV), which is why we are America’s number 1 magazine for people with HIV.

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

may / june 2015

Over the next year we’re compiling the first of what we hope will be our annual list of the Best Places to Work for People with HIV. It’s a big undertaking so we can use all the help we can get. Got ideas, suggestions, or time on your hands? Drop me a note at editor@hivplusmag.com. In the meantime, check out this year’s features on working while poz on page 26. READ OR DOWNLOAD ISSUES OF PLUS FREE AT HIVPLUSMAG.COM

POW!

ACTOR MEL ENGLAND

KNOCKS OUT AUDIENCES & TALKS STRAIGHT ABOUT HAVING HIV

TREATMENTS

TESTING

STIGMA

THE CURE

PREVENTION

KNOCKS OUT AUDIENCES & TALKS STRAIGHT ABOUT HAVING HIV

TREATMENTS

TESTING

STIGMA

THE CURE

MAY / JUNE 2015 www.hivplusmag.com

PREVENTION MAY / JUNE 2015 www.hivplusmag.com

GET OUR HIV PLUS TREATMENT GUIDE MOBILE APP AT ITUNES OR GOOGLE PLAY

CHECK OUT OUR NEW FAVORITE MUSIC VIDEO ABOUT HIV FROM NICO & VINZ

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WE WANT TO HEAR FROM YOU LIKE US! FACEBOOK.COM/HIVPLUSMAG TWEET US! TWITTER.COM/HIVPLUSMAG EMAIL THE EDITORS! EDITOR@HIVPLUSMAG.COM

BRADFORD ROGNE (TOP); SARA MCCOLGAN (NICO & VINZ) ; TONY DONALDSON (MEL ENGLAND)

BEST COMPANIES IN 2016?

may | june 2015 IN EVERY ISSUE

7 Buzzworthy

Luring HIV to its death, new programs for women, and a photographer’s journey through the virus.

36 Daily Dose

It’s time to have the conversations about sex and viruses.

40 Treatment Chronicles

Hepatitis B, oral cancer from STDs, new combo meds, and a study that asks if herpes causes Alzheimer’s.

48 Barbershop Diaries

Latino firebrand Freddy Ceja has educated politicians.

SPECIAL SECTION: JUST DIAGNOSED?

FEATURES

15 Cover: The Resurrection of Actor Mel England

The star of Best Day Ever took a Hollywood hiatus, but now he’s back on top. The actor talks family, selfesteem, and living and working with HIV.

26 Your Career Isn’t Over

In this special section we look at best places to work;; employee programs helping poz workers stay on the job; what Levi’s is doing right; and how to fight discrimination based on your health or disabilities.

38 Love, Babies, and HIV

One serodiscordant couple uses treatment as prevention to have a child without transmitting HIV.

20 Tyler Curry and the Plus editors answer your

most pressing (and sometimes embarrassing) questions.

15 9

MARVELL L. TERRY COURTESY FACEBOOK; MEL ENGLAND BY TONY DONALDSON

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, JACOB ANDERSONMINSHALL, MICHELLE GARCIA assistant editor RAFFY ERMAC wellness editor SAM PAGE mental health editor GARY MCCLAIN 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 SVP, group publisher JOE VALENTINO VP, integrated marketing AMANDA JOHNSON managers, integrated marketing LAUREN THOMAS, JOHN MCCOURT integrated sales/marketing and ad production manager PAIGE POPDAN art director, integrated marketing CHARLIE PFLAUMER junior designer COURTNEY RHODES senior director, media strategy STEWART NACHT circulation director JEFF LETTIERE fulfillment manager ARGUS GALINDO production services GVM MEDIA SOLUTIONS, LLC 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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may / june 2015

BUZZWORTH Y

See You See Me

German photographer and visual artist Dirk H. Wilms has been taking self-portraits since he learned he was HIV-positive 14 years ago. He was used to lazy days photographing nature and the beaches of the North Sea (“It was a perfect life, it was my perfect life, and it should never end,” he recalls thinking), but his diagnosis changed that. He says he lost many friends who were afraid of the virus, his work assignments dried up, and for the next four years he stayed home, hidden from a stigmatizing world. Then, he says, “I decided to start documenting my life, my fears, and my physical decline as an art form in itself. Photography helps me to make my fears, my depressions and my nightmares visible to those who care to see. So I began shooting myself.” Because the first traces left by this virus were seen in his face, Wilms first covered it (and often still does). But he says today, “when I take my images I forget the time of day and all of my problems. It is as if I’m in another dimension, as if I’m back by the sea, running barefoot through the sand and catching moods with my camera. The difference is that I do not photograph beach scenes but my body, as it is today.”

CREDIT

VISIT HIVPLUSMAG.COM TO SEE A SLIDESHOW OF WILMS’S AMAZING IMAGES

Reporting by Daniel Reynolds, Michelle Garcia, Sunnivie Brydum, Denise Hernandez, and Jacob Anderson-Minshall hivplusmag.com

B UZZWORTHY

CAN WE LURE DORMANT HIV TO ITS DEATH? After years of trying to determine how to eradicate every trace of HIV, a team of researchers led by Dr. Carl Siliciano at Johns Hopkins University School of Medicine may have found a critical key. Even for people with undetectable viral loads and those on aggressive treatment regimens, HIV maintains the ability to hide inside cells, creating what scientists call “HIV latent reservoirs.” These reservoirs—literally collections of HIVinfected CD4+ T cells that cannot be reached by antiretroviral treatment—can slowly “leak” HIV-positive cells that can attack cells that are otherwise healthy. When an HIV-positive person’s immune system is further compromised—by a lapse in treatment, for example—the floodgates on those reservoirs open, unleashing a new round of viral infection that can rapidly spread to healthy cells. What’s more, the infected cells in the reservoir have often mutated from their original form, meaning they cannot be detected by the human immune system, even as they attack healthy cells. “In order to achieve HIV-free for an infected individual, we have to eradicate dormant HIV,” explains Kai Deng, a postdoctoral fellow in Siliciano’s lab at the Howard Hughes Medical Institute at Johns Hopkins. Deng is the lead author of a paper published in January in the online edition of the journal Nature, which chronicles the groundbreaking success the Johns Hopkins–led team had not only in finding these latent HIV reservoirs but also training cells to use their own defense mechanisms to destroy the dormant virus. Using a complex genetic process known as “deep sequencing” on blood samples from HIV-positive people, the researchers were able to train existing T cells to become “killer T cells,” essentially attacking dormant HIV where it is hiding. Through deep sequencing, T cells can be trained to detect latently infected cells. The process of drawing out the dormant virus is still a challenge needing a more perfect solution, the researchers tell Plus, but the Johns Hopkins study provides what could be an important step toward ultimately eradicating HIV.

Before T cells can be trained to become “killer” and detect infected cells that are usually hidden, the person’s HIV must be well managed, the researchers caution. A key factor in achieving such management is early treatment, both Deng and Siliciano stress. “Early treatment is very important,” Deng says. “When the treatment was initiated early, the latent HIV largely remained unchanged, which is easier for killer T cells to recognize and kill. Early treatment has [also] been shown to limit the size of viral latent reservoir in infected patients, which is considered beneficial for eradication.” While latent reservoirs exist in HIV-positive people regardless of what, if any, treatment they are receiving, those who obtained treatment early had the greatest levels of HIV cells existing in their original, unmutated state. The longer an HIV-positive person goes without treatment, the more opportunities the virus has to mutate, making it harder to detect and even harder for the “killer T cells” to attack. Therefore, samples from those who received treatment early—within three months of infection—saw the most success with “killer T cells” able to destroy the HIV in infected cells.

Sisters Are Doing It for Themselves

20%

OF THE POPULATION IS RESPONSIBLE FOR THE TRANSMISSION OF

OF INFECTIOUS DISEASES

SOURCE: THE WALL STREET JOURNAL, 2014

8 | may / june 2015

Young people have been disproportionately affected by sexually transmitted infections, including HIV, in recent years. In Chicago, people ages 13 to 24 accounted for 71 percent of all STI diagnoses in 2012, and of the women who tested positive for STIs, a full 95 percent were African-American or Hispanic. That led the AIDS Foundation of Chicago to partner with other health organizations to help reduce the rate of sexually transmitted infections among young women of color. Project Elevate, funded by the Centers for Disease Control and Prevention, will use social media to educate this at-risk group about STI prevention as well as making testing and treatment resources available to them. The program is particularly reaching out to transgender women, a group often neglected by health care workers, and it will be run by women of color.

BUZZWORTH Y

AN EASIER WAY TO ACCESS MEDS

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CRIME AND (EXTRA) PUNISHMENT

An HIV-positive Toronto man is suing the superjail where he was held in solitary confinement for a total of three months after other inmates objected to him being jailed with the general population. Jamie Simpson is seeking $200,000 for the alleged mistreatment, saying he endured “deplorable and filthy conditions” in solitary confinement, The Toronto Star reports. Simpson was arrested in February 2014, charged with theft, breaking and entering, mischief, and breach of probation. Simpson spent three months at the Toronto West Detention Centre, and then transferred to the superjail, the Toronto South Detention Centre, where he was to remain until his trial. He told the Star that an inmate declared he and other men did not want him there because he was “sick.” Soon after, an officer told him he would be placed in solitary confinement overnight. His stay there ended up lasting about 75 consecutive nights. Ontario law states that an inmate’s placement in solitary confinement must be reviewed by a superintendent every five days. Simpson says he consistently asked guards when he would be released, but he was given no solid answers. He was locked in his cell for up to 24 hours a day, he told the Star, and denied access to basic hygiene, such as showering. He attempted to transfer to a medical unit, but the state-of-the-art Etobicoke jail infirmary had been closed, which has led to multiple sick inmates being placed in solitary confinement instead. After he was found guilty of the charges he faced, Simpson learned he would likely be sentenced to another 60 days at Central North Correctional Centre in Penetanguishene, where he had previously served and had been abused and harassed by fellow inmates because of his HIV status. He wrote a request to the Toronto South superintendent asking not to be sent to Penetanguishene, but the letter went unanswered. He was told he would indeed be sent to Penetanguishene, and when he complained, he was taken to solitary confinement at Toronto South yet again. Simpson said he was subjected to additional harsh conditions, including his mattress being taken away for day-long periods and not being able to shower for days at a time, leading to him to developing a staph infection. Eventually, his mother orchestrated a transfer to St. Joseph’s Health Centre, where his infection was treated. He spent a week in the hospital, and then requested to be sent to an infirmary at another institution. His request was denied, and he spent the remaining eight days of his sentence in solitary at Toronto South.

Gay Men’s Health Crisis and Walgreens have collaborated to launch a new HIV-specialized pharmacy. The new facility, which is located in GHMC’s David Geffen Center for HIV Prevention and Health Education on 29th Street in New York City, opened last October. The pharmacy offers confidential care, medications, and consultations to visitors to GMHC, which annually serves 9,000 people affected by HIV. A pharmacist trained in HIV services will be available at the other GMHC office, on 33rd Street. To date, Walgreens has equipped over 700 HIV-specialized pharmacies across the country with expert pharmacists and personalized counseling, though this is the first to actually reside inside an AIDS service organization.

“This work is personal for me. I don’t only work hard for those who are infected with HIV like myself that feel they don’t have a voice, but I also work for the millions of young people born into a world where we still have to aggressively fight HIV. I do this for my nieces and nephew and the next generation.” —Marvell L. Terry, II, the HIVpositive founder and executive director of the Red Door Foundation, a Memphis, Tenn.-based organization that provides health services to gay and bisexual black men, who has just been named the Human Rights Campaign Foundation’s HIV/AIDS Project Fellow. He’ll work with atrisk communities in the South, with funding provided by the Elton John AIDS Foundation.

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“Because of poor access to HIV testing and health care, many people living with HIV in the U.S. South enter into treatment when their HIV disease is much more advanced,” says David Furnish, chairman of the Elton John AIDS Foundation, “and [they] find it difficult to remain on treatment. As a result, the U.S. South has the lowest rates of successful HIV treatment in the country. This is particularly true for LGBTQ individuals and black Americans living in the Southern states. We are therefore profoundly grateful to the Elizabeth Taylor AIDS Foundation for joining with us to fund the innovative work of these grantees.”

Two major foundations are working together to fight HIV and AIDS in the American South. The Elton John AIDS Foundation and the Elizabeth Taylor AIDS Foundation have joined forces— and funds—to award more than $300,000 in grants to local HIV groups below the Mason-Dixon line. The grants will help fund six groups: LGBT centers in Virginia and Alabama, programs dedicated to addressing HIV among young black men in Georgia and Mississippi, a program for gay and bisexual men in rural Oklahoma, and an Atlanta organization that helps transgender people of color and seeks to end policies that criminalize HIV. The goal of the grant partnership is to help provide HIV services like testing, education, and treatment in one of the most underserved but hardest-hit areas of the country, particularly to at-risk groups.

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Number of those who were gay or bi men

Number of those who were HIV-positive Number of people in every million who usually get ocular syphilis each year. (That’s 10 percent of people with syphilis.)

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HIV IN THE SOUTH

Number of people in Washington State infected with ocular syphilis in late 2014

Styling by Anton Khachaturian (AntonKMakeup.com) using MAC Cosmetics and Kevin Murphy Hair Care. Suit by Calvin Klein. Location: Studio M Productions in Culver City, Calif.

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uring his early days of dealing with his HIV-positive diagnosis over 20 years ago, actor Mel England woke up every morning to a white piece of notebook paper taped above his bed with a simple Deepak Chopra quote: “I’m an infinite field of potentiality.” “I would bicycle up the side of that mountain in Boulder chanting, ‘I’m gonna live, I’m gonna live, I’m gonna live,’ ” he says. England’s life with HIV has been a turbulent one. Diagnosed in the late 1980s, the actor lived through the loss of friends and stigma of being positive. “As a friend of mine puts it, it was like living in wartime,” recalls England. “We were surrounded by death.” He was only 19 years old when he was diagnosed. At the time, England was beginning his life as an actor, attending New York University on a full-ride scholarship and working with Marlon Brando’s acting teacher. It had seemed like a dream come true for the Texas native, whose parents recognized his “demonstrative” traits and enrolled him in acting lessons at the Dallas Theater Center at age 5. He grew up in the theater, began working in professional theater in sixth grade, and attended a performing arts high school. But after his diagnosis, England was a bit lost. He felt his dreams of becoming a working actor were dead, and the message he got from everyone—the government, the doctors, his family, the media—was that he was going to die. He ditched the big-city life for health-crazed Boulder, Colo., on a recommendation from his friend. Forgoing AZT, the only anti-HIV medication available at the time, England focused instead on alternative treatments like homeopathy and nutrition, and coped through using alcohol and marijuana. “I know I had made a decision to live then, I just didn’t know how to, and I was trying everything I could,” England says of his time in Boulder. It wasn’t until he had progressed to AIDS that England had an epiphany about how to go about living. He had been suspicious of government recommendations to take AZT, because, as he put it, he “had no reason to believe these people had my best interest at heart.” But lying in a hospital bed with his mother by his side, England looked around and realized everyone there, including his mother and the doctors and nurses, was trying to help him get better. “I had to realize in my head these people are trying to help me, these people are trying to save my life,” the actor recalls. He agreed to go on treatment, got sober, and moved back to New York City. The antiretroviral treatment made England confront the seriousness of HIV but also gave him a way to live life he didn’t have before. After years of stage acting, England moved to Los Angeles a decade ago to launch his film career. Also, in 2009 he channeled his experience as a survivor into his critically acclaimed one-man, off-Broadway show, Swimming With the Polar Bears, as part of a benefit for the nonprofit organization the Climate Project. He took the solo show on a worldwide tour, with stops in Washington, D.C., for Earth Day and at the United Nations’ Climate Change Summit in Copenhagen. (The posters for the show were signed by his best-known supporter, Al Gore.) Today, the 40-something actor is making a name for himself on the indie film circuit. His film Ron and Laura Take Back America has garnered awards at several festivals (including Best Comedy at the New York City International Film Festival). hivplusmag.com

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Written and directed by England and actress Janice Markham, the film is a mockumentary satire about American politics, religion, Hollywood, gays, health-food nuts, and reality TV, and it features actors Irene Bedard and Jim J. Bullock as well as a cameo by the legendary Sally Kirkland. England has already starred in a string of indie hits—Little Big Top, Highlights, Archeology of a Woman, and Persona Au Gratin (which won Best Comedy at Indie Fest USA)—and has appeared on a few TV series, notably the crime shows Murder and Unusual Suspects. His latest film, Best Day Ever, won the prize as Best LGBT Feature Film at Indie Fest 2014. In that buzzworthy film, England plays a 50-year-old gay filmmaker going through a midlife crisis in Hollywood who unexpectedly finds love with a much younger man from Iowa. The irony of a healthy, HIV-positive man now playing a middle-aged character is not lost on England. A survivor of both AIDS and cancer, England was able to relate to the crisis of his character, though he jokes that like a lot of gay men of his generation who witnessed the AIDS epidemic firsthand, he went through his midlife crisis in his 20s rather than his 40s. Now England can reflect on his life and the massive changes he’s seen in such a short time. “I’m so excited for the kids these days,” he says about the change in acceptance of LGBT people. “We were so used to living trauma from AIDS. We were so used to living in the closet. It was like living in a prison—and we had to decorate it, make it look pretty.” He laughs.

“Leave it to a gay man to talk about decorating, but whatever.” However, England says there’s still more work that needs to be done to destigmatize being HIV-positive. He hopes that by being open about his status and living a life without shame, he can show that it shouldn’t matter so much. “Why would I be ashamed of this? It’s my biggest accomplishment,” he says. “It’s just not a big deal. I don’t think it should be a big deal.” He notes that HIV treatment has come so far since the early AIDS crisis that HIV today is not much different from other chronic illnesses. “It’s like diabetes now,” he says with a slight chuckle at his own hyperbole. “So why are we treating it like the bubonic plague?” England gets serious reflecting on his younger self, and there is a long pause. What would he tell his younger self ? “Oh, wow,” he says, “Beyond anything, I’d tell myself, don’t be afraid, that it’s OK to hope and it’s OK to dream.” There is a second long pause. England explains that he’d grown up in a time and place where it wasn’t OK to be gay. “It’s like you weren’t allowed to breathe, much less have an erection.” It has been quite a journey for England from his home in Texas to his diagnosis in New York to his years in Colorado and finally back to life as an actor in Hollywood. It’s this journey that has made him what he is today, he says. Would he change any of it? “Would I wish I didn’t have HIV? I don’t know—it would be like saying, ‘Would I wish I wasn’t me?’ ” he says. “It’s such a part of my life.” ✜ hivplusmag.com

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ART WORK BY CLARIONE GUTIERREZ

he moments after learning you’re HIV-positive can seem like a free fall. In a matter of seconds, you are sent into a tailspin of whatif scenarios, and your vision fills with horrific images from a bad movie montage. Your mind races, then stalls completely, working in frantic fits and spurts and grasping onto bits of information you can remember about what it is to be HIV-positive today. The nurse tells you that you are going to be just fine and that HIV is now a manageable disease. The doctor tells you that if you take care of yourself, you can expect to live just as long as you would have if HIV-negative. Still, there is an inescapable fear of the unknown. What does it mean to live with HIV? What is going to have to change in your life, and more importantly, what can you expect to remain the same? You aren’t alone. There are so many who have gone through the exact same thing and have already asked all these burning questions. Below are some quick answers.

What do I do now?

Can I only have sex with other people who are also HIV-positive?

Of course not! Today, there are multiple ways to have safe sex, and believe it or not, most of us are knowledgeable enough to know that informed sex is the safest sex of all, regardless of status. Again, staying compliant with your meds and maintaining an undetectable viral load is one of the best ways to ensure that you never transmit the virus (this is called “treatment as prevention”). This method of prevention is for your protection just as much as it is for your partner.

How will I tell my friends and family?

First off, you don’t have to tell anyone except your future sexual partners. But talking about your status may be the best way for you to feel like yourself again. There are probably other people around you who are either HIV-positive or have been affected by HIV in one way or another. The first time you tell someone may be scary, but it gets easier every time. The first step is to just say the three little letters out loud. Start there. (Check our mental health editor’s guide—http://bit.ly/1E4JnJs—for 10 steps to make the process easier.)

The first thing to do is to stop panicking. You are the same person who walked into the clinic before receiving your test results. It may seem like everything has changed, but it hasn’t. Still, there What does it mean to manage my are some things you can do to ease your mind and virus? The American find your way back to being OK. Find a doctor For most people who are diagnosed today, manAcademy of who is highly knowledgeable aging your virus simply HIV Medicine about HIV and is the right means being compliant with fit for you. You might be sura one-pill-a-day regimen. (AAHIVM.org) prised about how uneducated Once you find a doctor, start has a database of doctors and medical your average family doctor is medication, and achieve an services nationwide, allowing you to search about HIV and how to treat it. undetectable viral load, you The last thing you need is to be will just need to have your for an HIV-knowledgeable doctor in your treated by a doctor who has just lab work done every four hometown. They’ll also match you with as many questions as you have. months or so to make sure doctors who focus on specialized HIV care There are many HIV specialists that everything is all right. who know exactly how to treat in areas such you, and that includes how to Am I going to die? as nutrition, ease your concerns. These docHere’s the deal. A person dental care, tors can also act as your primary physician, who diagnosed today has roughly the same life expecwill keep your HIV diagnosis in mind when minor tancy as a person who is HIV-negative. Howevor access to health issues arise along the way. er, your virus does make you more susceptible clinical trials. to several other health problems that you need I found a doctor. Now what? to be aware of. Some of these are cardiovascular During your first appointment, your doctor will disease, kidney problems, and bone density loss. do your initial lab work. This is to see what your CD4 count and But before you start to panic again, know that these can be previral load is. Your CD4 count is the number of disease-fightvented with the proper care. Being knowledgeable about what ing white blood cells you have in your body, and your viral load to look out for is the best way to ensure a long and healthy life. is the number of copies of HIV that are in your system. Your doctor will also determine whether the virus you have is resisAm I going to get AIDS? tant to any medications, which is unlikely. This sounds scary, but The term AIDS does seem scarier than HIV, doesn’t it? The truth is, it doesn’t have to be. No matter what your CD4 count may be, many people who are living with HIV will never be diagnosed with most people can bring their count up by simply taking a sinAIDS. HIV is a virus; AIDS is a diagnosis that a person receives gle-pill regimen. The same medication can also help reduce your once the virus reaches a certain point. When your CD4 count dips viral load to an undetectable level, which would make it highbelow 200 and your immune system is so damaged that common ly unlikely for you to transmit the virus to someone else. Most illnesses can be life-threatening, then your disease is classified as likely, this will be the extent of managing your virus, along with AIDS. As long as you stay on your medication and keep a healthy regular checkups with your doctor to make sure that your body is body and mind, you can keep your CD4 count in the healthy zone healthy and that your medication is working. The key to staying and far away from the level of AIDS. And if your CD4 count is healthy and keeping an undetectable viral load is to never miss a already in the danger zone, the correct medication can bring you dose—just as you should with medication for any other ailment. back up to healthy levels. ✜

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When your initial test comes back positive (unless you’ve done the athome test) you should be offered a confirmatory test, basically a second test to make sure you’re HIV-positive. The likelihood of two false positives is extremely rare. If you took the at-home test, it’s a good idea to go to a doctor or clinic to do the second test. Sadly, false-negative test results can happen too, so if you come up positive and your partner comes up negative, be cautious and have your partner retest. According to AIDS.gov, the likelihood of a false negative depends on when you might have been exposed to HIV and when you took the test: “It takes time for seroconversion to occur. This is when your body begins to produce the antibodies an HIV test is looking for—anywhere from two weeks to six months after infection. So if you have an HIV test with a negative result within three months of your last possible exposure to HIV, the CDC recommends that you be retested three months after that first screening test. A negative result is only accurate if you haven’t had any risks for HIV infection in the last six months—and a negative result is only good for past exposure.”

2. How did I get HIV?

This is a question you’ll get asked exhaustively, but right now you’re probably just asking yourself. The bottom line is that the main risk is having unprotected anal sex or (for women) vaginal sex or sharing needles with an infected person. It’s possible but quite a bit less likely that you got it from oral sex. The CDC says it’s also possible to acquire HIV through exposure to infected blood, transfusions of infected blood, blood products, or organ transplantation, “though this risk is extremely remote due to rigorous testing of the U.S. blood supply and donated organs.”

3. Can “tops” get HIV?

Actually, there’s some truth to the assumption that male “tops” (insertive partners in anal sex) get HIV less. The insertive partner in both anal and vaginal sex is less likely to contract HIV—in the case of anal

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sex, tops have 86 percent reduction in transmission, according to a 2012 study—but that still means tops can get HIV from sex.

4. Does being HIV-positive mean I also have AIDS?

Absolutely not. In the U.S., the majority of people living with HIV will never develop AIDS, the most advanced stage of HIV disease. HIV is the virus that causes AIDS, but for most people, proper treatment and regular medical care to keep your immune system strong will prevent you from ever developing AIDS. Remember, an HIV-positive test result means only that: You have HIV.

5. Am I going to die?

No, probably not anytime soon. There can always be complications, just as there are with any chronic condition (like diabetes, for example), but generally, with current medications, people with HIV are living near-normal lifespans. You will be susceptible to the same medical conditions that affect all people as they age, and some experts say that people with HIV will experience some of these conditions associated with aging (like osteoporosis) sooner because of the lifesaving antiretroviral drugs you need to take.

6. What do I tell people about how HIV is transmitted?

Let’s start with how it is not transmitted. Since the virus cannot survive outside the body, you cannot get it from toilet seats or shared cups or utensils. You can’t get it from kissing or from spit, since it’s not transmitted in your saliva. It is also not transmitted in sweat or urine. You can’t get it from a swimming pool, hot tub, sauna, mosquito or rodent bites, tattoos, or ear/body piercings. Only four bodily fluids are known to carry HIV in quantities concentrated enough to infect another person: blood, semen, vaginal fluids, and breast milk. According to the Centers for Disease Control and Prevention, it is one of these fluids from an HIV-positive person that has to come in contact with a mucous membrane or damaged tissue, or be directly injected into the bloodstream (from a needle or syringe) for HIV transmission to possibly occur.

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1. Is it possible I got a false positive on my HIV test?

7. Who is at higher risk of HIV infection?

10. What is “Treatment as Prevention?”

8. Does this mean I have to stop having sex?

11. What is PrEP?

Across all ethnicities, in the U.S. the group most affected by HIV infection is gay and bisexual men and other men who have anal sex with men (but for some reason don’t identify as gay or bi, dubbed MSM). Transgender women, especially women of color, are at a significantly higher risk as well, though exact numbers aren’t known because in many studies they are included, erroneously, in the MSM category. Black and Latino men and women and injection drug users have higher risk rates, but of course anyone (straight, gay, black, white, whatever) who has unprotected anal or vaginal sex is at risk. No, not unless you want to. But we encourage you not to stop. Orgasms can be wonder drugs in themselves: They help you sleep, boost your immunoglobulin levels (which fight infections), and reduce stress, loneliness, and depression. There are ways to protect yourself and your partner, however, including consistent condom use, PrEP, serosorting, and keeping your viral load undetectable. One tip: If you use lube during vaginal or anal sex, avoid two ingredients: polyquaternium and polyquaternium-15, both types of polymers, which may increase the possibility of HIV transmission.

9. What about oral sex?

It is far less common but possible to transmit HIV through oral sex, especially if you are a man and you ejaculate into someone else’s mouth. If you have HIV and your partner performs fellatio on you but you do not ejaculate in that person’s mouth, you have an extremely low chance of passing HIV to them. HIV transmission through “fellatio without ejaculation can happen, but it is exceedingly rare,” says Thomas Coates, Ph.D., a professor of medicine and director of the University of California, San Francisco, AIDS Research Institute and the Center for AIDS Prevention Studies. “It’s not ‘no risk,’ but it’s relatively low-risk.” When ejaculation occurs during fellatio, the risk of HIV transmission rises; researchers debate what the rate of transmission is but most estimates are between 1 and 10 percent, but you lower that to almost no risk if you pull out for the money shot. And if you are a woman, having someone perform cunnilingus on you is extremely low-risk as long as you are not menstruating.

A couple of large-scale studies, on both gay and straight couples in which one was HIV-positive, showed that a person taking medication that reduces the amount of virus in their blood (that’s their “viral load”) to an undetectable level has only a 4 percent chance of passing HIV along to their partner, even if they do not use condoms. Any poz person will tell you one of the most frightening parts of being poz is the concern about infecting others; if you get yourself healthy enough and stay that way with an undetectable viral load, you actually make yourself safer to your partners than if you use only condoms. Right now PrEP refers to Truvada, a combo pill that’s given in one particular configuration to people with HIV and in another configuration to people trying to prevent HIV. In the latter, it’s taken daily to prevent infection and has been approved for use in anyone at high risk (your partner would be considered high-risk now that you are poz). PrEP is extremely effective when taken correctly, but doctors still recommend you use condoms for added protection. (And make no mistake here: no, your partner cannot just take your Truvada if that’s what you’re prescribed; the different combination in your pill’s formulation won’t work and could do them great harm.)

12. Can I still have kids?

Yes. If you’re a woman who is positive, medications can make it so you have less than a 1 percent chance of transmitting HIV to your unborn child. If you’re a man, your sperm will need to be “washed” of HIV and then inseminated into your partner, wife, or surrogate. The main difference for couples is that you’ll need a specialist who deals with HIV, fertility, and insemination. PrEP has also recently been prescribed by doctors off-label to prevent transmission during intercourse when couples are trying to conceive as well. If you want to adopt or foster parent, there are some new protections for HIV-positive parents-to-be that ensure you can’t be discriminated against.

13. I already have kids. How do I tell them?

Many parents worry that telling their kids might place a 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 (if there are medicine containers all around, kids will ask about them), how discreet you need to be (asking kids to keep your status a secret is a heavy burden), and how strong you can be for them (some kids will be angry or overly clingy, worried you’ll be dying). For most people, telling their children is the right thing to do. Before you do, learn everything you can about HIV. Your kids have been perfecting the “why” questions since they were 2 years old; this is a moment when there will be a lot of whys and hows. Your doctor or counselor might have ideas about groups or advocates for children, who can also talk to the kids or be a support team for you and the offspring as you go through the coming-out process. Then, says Mark Cichocki, a nurse educator at the University of Michigan’s HIV/AIDS Treatment Program and the author of Living With HIV: A Patient’s Guide, talk in a quiet space, be honest, trust your kids to handle it, and let them express their emotions fully (remember, kids can experience a range of feelings, including guilt, fear, rage, and rejection). This process may take hivplusmag.com

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more than one day—it’s the beginning of a conversation in which you should be honest, age-appropriate, and willing to offer both answers and assurances. Kids can impress us with their ability to understand and assimilate information; you just need to have it ready for them. After the crying and talking is done, take them out for ice cream so they remember that this is just another thing that your family will tackle together.

14. What is a serodiscordant couple?

Serodiscordant simply means one of you has HIV and one of you doesn’t. Some gay couples use the term “magnetic couples” to mean the same thing. There’s very little research on how successfully serodiscordant, or mixed, couples cope with the complications of HIV. According to TheBody.com, an online HIV resource guide, “research of this nature tends to measure the most negative aspects of positive/negative couplings, telling us primarily how HIV complicates our lives. It tells us very little about the rewards, the discovery of inner strengths, the emotional ties, the opportunities for developing better communication skills, or the joy generated when a mixed-status couple does create a happy, strong, fulfilling relationship.”

15. So how do we handle being a serodiscordant couple?

What you need to know if you’re a mixed couple is that you can have a happy and healthy relationship, but like all relationships, it requires work and commitment, because love does not conquer all. The HIV-negative partner may want to talk to his or her physician about PrEP; you should talk with yours about achieving an undetectable viral load. Both reduce the likelihood of you transmitting the virus to your partner. Couples might also want to see a counselor who specializes in coping with HIV. Many HIV-positive people fear spreading the disease to their partners, making sex fraught with tension. Many HIV-negative partners encounter disrespect from friends and family members when the other partner’s status is revealed. A counselor can help you work through those kinds of issues and communicate to each other your anxieties, fears, and needs.

16. How many of my previous sexual partners do I need to tell about my diagnosis?

This is kind of a murky area, with debate between activists and public policy experts. You will be asked to notify, or have the health department notify, anyone you have had sex with or shared needles with since your last negative HIV test or, if you’ve never had one, the most recent sex partners (say, in the last year). Your partner(s) will need to be tested now and, if the test is negative, again in three months (the window period between infection and when it actually shows up on a test). According to the New York Department of Health, how far back in time known partners should be reported is determined on a case-by-case basis depending on such factors as the approximate dates when you believe you were exposed and became infected and how willing (or able) you are to dig up those names and contact info, with the priority on current and recent partners. The federal Ryan White Care Act requires states to make a good-faith effort at notifying current spouses and anyone who

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has been the HIV-positive person’s spouse within the last 10 years. Therefore, spouses within the last 10 years, if known, should be notified, unless you’ve had a negative HIV test result since then. Do know that public health departments and clinics are not supposed to pressure you for this information and they cannot withhold your test results or penalize you in any way for not divulging this info.

17. How much do I need to tell my dentist and other health care workers oﬀering me nonsurgical treatment?

All health care professionals use “universal precautions” to prevent the transmission of blood-borne diseases like HIV and hep C to and from patients, according to Robert J. Frascino, MD, of the Robert James Frascino AIDS Foundation. An expert for TheBody.com, Frascino says he’d recommend disclosing your status to your dentist, though, so that he or she could be on the lookout for HIV-specific problems in the mouth. “Health care professionals, including dentists, are trained to look for certain conditions more closely if they know you have an underlying medical problem, be that diabetes, cancer, HIV or whatever,” he writes. “Why would you not advise your dentist of your HIV status? If you feel that dentist would discriminate against you for being HIV-positive, that’s not the office you want to be treated in anyway, right? Being HIV-positive is not something to be ashamed of. It’s a viral illness.” The same is true for other health care providers: You don’t have to tell them, but it’s in your best interest and best health to do so.

18. What will change for me in my everyday life now that I’m positive?

With proper treatment, being HIV-positive is a manageable, chronic condition like lupus, diabetes, or asthma. But it’s a chronic condition nonetheless. Unless you had other health conditions prior to diagnosis, you’ll likely see a physician more than you did before because it’s vital that you monitor your health closely. Regular visits with your HIV health care provider will keep you up to date on everything concerning your health. Speak with your doctor about changes that need to be made to your diet, exercise regimen, and use of alcohol, prescription medicines, and recreational drugs. If drugs were a factor in your transmission (there’s a link between crystal meth use and HIV transmission, for example), your doctor might recommend rehab. You may tire more easily, be more prone to infections, have medical side effects you didn’t have before. But hands down, the biggest change in your daily routine will be taking medication, if you and your doctor decide this is the best treatment option for you. HIV medication requires strict adherence to the prescribed daily dosage, and the drugs often have side effects. Open communication with your doctor will ensure that you are fully equipped to handle the changes in your life.

19. Will being HIV-positive aﬀect my ability to have gender conﬁrmation surgery, plastic surgery, or gastric bypass surgery? What about hormone treatments?

Short answer: No. There was thought to be heightened risk from surgery, but a study published in 2006 in The Journal of the American Medical Association compared surgery data for both HIV-positive and HIV-negative patients and found that the two groups had the same level of complications from surgery. Moreover, medical workers are better educated about HIV than they once were, and the fear of positive patients has eroded. But you may still have to work harder to find a surgeon who has worked with HIV-positive patients, or if you’re transgender, a doctor who can work with both your HIV specialist and your reassignment surgeon.

20. Do I need a special doctor for my HIV-related issues?

Yes. It is important to find a health care provider who specializes in HIV medical service right away. Sometimes your HIV testing center will recommend someone, or you can also ask your primary health care provider. Finding an HIV specialist who fits your needs is a huge first step after being diagnosed as positive. That person will literally be your lifesaver.

21. In between doctor visits, are there symptoms I should be on the lookout for?

Regular appointments with your HIV specialist are absolutely necessary. It is also necessary that you monitor your body on your own. There are certain signs and symptoms to look out for and a few health factors that should be constantly monitored. According to Rose Farnan, RN, and Maithe Enriquez, RN, authors of What Nurses Know… HIV/AIDS, you should pay special attention to certain symptoms: diarrhea, weight loss or loss of appetite, trouble or pain when swallowing, white patches or sores in or around your mouth, long-lasting fever, a new cough, shortness of breath, headaches, dizziness, blurred vision, or difficulty remembering things. It can be hard to distinguish whether these symptoms are just passing or a more serious issue, but keeping track of your body’s patterns will greatly benefit your health. Farnan and Enriquez suggest keeping written records of weight and other factors that can change over time. Also, do know that medications affect each person differently. While side effects are rarely severe, if you have any side effect longer than a few weeks, don’t just assume you have to just put up with it; ask your doctor about it.

THINKSTOCK

22. How do I prevent myself from getting sick?

Because your immune system’s strength will fluctuate, it is even more important to always keep clean. It sounds basic, but it’s a big help if you simply wash your hands and encourage others around you to do the same, especially before and after you eat, after using the toilet, and if someone around you is sick. Maintain healthy eating habits (there are HIV specialist nutritionists, and your doctor can refer you to them

if needed) and start or keep up a regular exercise routine as well (even if it’s just walking 30 minutes a day). Smoking, drinking, and recreational drug use all compromise your immune system, so find ways to cut back on (or ideally, stop) these activities. Don’t forget to keep tabs on your emotions, because mental health is as crucial as physical health. HIV is a chronic condition that comes with a lot of baggage because of cultural stigma. You’ll feel it, and it’ll take a while to get used to it. An HIV-friendly therapist can help you build resiliency at this difficult time. You’ll need a strong support system that can include your doctor, friends, and family, plus new friends you meet in your support groups along the way. But do not hesitate to reach out, because a positive outlook will be one of your greatest allies.

23. If for some reason I’m bleeding, do I need to worry about people who are helping me?

This probably depends on the situation, but often the answer is no. HIV is rarely transmitted in a household between family members (outside of sex and IV drug use, of course). And, if, for example, you got hurt playing football or duking it out at the gym, it’s “highly unlikely that HIV transmission could occur in this manner,” according to the University of Rochester Medical Center. “The external contact with blood that might occur in a sports injury is very different from direct entry of blood into the bloodstream which occurs from sharing needles or works.” The same goes for blood on a Band-Aid or a nosebleed or a cut finger, says Lisa B. Hightow-Weidman, MD, MPH, an associate professor of medicine in the Department of Infectious Diseases, University of North Carolina-Chapel Hill, and an expert for TheBody. com. “There is no risk of getting HIV from blood that has been sitting outside of a human body. Even if the [person bleeding] was infected, HIV begins to die once it leaves the body and becomes unable to infect anyone else.” One caveat: If you’ve been in a serious auto or other accident, the emergency medical techs who are helping you should be using universal precautions, but it’s always good for your own health to tell them you’re HIV-positive (it’s illegal for health workers to refuse you care based on your status, per the federal Americans With Disabilities Act).

24. Do I have to tell my boss I have HIV, and can I be ﬁred if my boss ﬁnds out I have HIV?

You absolutely do not need to tell your boss you have HIV. And you can’t legally be fired unless you have limitations on what you can do and your employer has made every effort to accommodate them. The Americans With Disabilities Act requires employers to make “reasonable accommodation” to the known physical or mental limitations of employees with disabilities (including HIV infection/illness). That doesn’t mean all employers understand the ADA; violations happen all the time, but if you do get fired, you have legal recourse. And certainly, if you have no symptoms that require you to have accommodations, then you can’t be let go because of your status. And under federal nondiscrimination laws your boss or prospective employer cannot require you to take an HIV test either.

25. How do I ﬁnd support centers or support groups near me?

Each state has its own toll-free HIV and AIDS hotline, and Project Inform has the full list at ProjectInform.org/hotlines. If you call Project Inform’s HIV Health InfoLine, which is (800) 822-7422, you can talk to nonjudgmental people (in English and Spanish) who will listen to you, share their experiences, offer you accurate information about HIV, and help you navigate health care obstacles and talk to doctors about your concerns. ✜ hivplusmag.com

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Working Nine to Five

It’s a brave new world for workers with HIV By Diane Anderson-Minshall

In 2012, for example, Microsoft’s Texas Diversity Leadership ndrew Johnson* knows all about the now-25-year-old Team donated money and staffing, and hosted the opening and Americans With Disabilities Act, the historic civil rights legislaclosing ceremonies, for the Lone Star Ride Fighting AIDS, an antion that, as President Obama said in his famous 22nd anniversary nual cycling event that raises money for three North Texas HIV and address, “affirmed Americans with disabilities are Americans first.” AIDS service organizations. As part of the challenge to get riders to Obama said that when many “wrongfully doubted that people raise $100,000, Microsoft even gave copies of company software to with disabilities could participate in our society, contribute to our anyone who raised $1,000 or more. economy, or support their families, the ADA asserted that they Of course, sponsoring AIDS rides (and walks, runs, swims, and could.… America became the first nation to comprehensively deother such events) is common corporate charity these days—the clare equality for its citizens with disabilities—an accomplishment Texas ride had support from insurance companies, big pharma, that continues to guide our country toward fulfilling its most esrental agencies, tech, and more. Macy’s, in an industry once heavily sential promises not just for some, but for all.” impacted by AIDS, now runs a huge annual charity fashion event, Andrew knows the ADA is supposed to protect HIV-positive Glamorama, which has raised $51 million to combat HIV, cancer, workers like himself, who can’t legally be denied jobs or be fired for and childhood illnesses. having HIV or for requesting reasonable accommodations needed Sometimes this charity translates to a better workplace for poz to do their jobs and stay healthy. Andrew thought the ADA would workers, and sometimes it doesn’t. Anecdotally, HIV-positive emprotect him when approaching his human resources rep and asking ployees of Macy’s and Bloomingdale’s—owned by for those “reasonable accommodations,” he recalls. “They the same parent corporation—have reported then asked for it in writing along with a supporting high satisfaction with their workplace, but letter from my doctor. Once they had proof of so far no national organization ranks my status, I was terminated.” DiversityInc’s companies on how they treat their He went to an employment lawyer poz workers. We hope to change after he was canned; the attorney told Top 10 Companies for that in 2016, with your help him “that my workplace knew that People With Disabilities (see page 4 for more info). they were breaking the law, but Each year DiversityInc that it would be easy to break 1. EY (Ernst & Young) ranks the Top 10 Comthe law and settle with me af2. Procter & Gamble panies for People With terwards. I wish I could tell 3. Boehringer Ingelheim Disabilities (see its 2014 you that I was working for a list below) and while that conservative organization in a 4. IBM doesn’t say anything spesmall town, but that is not the 5. General Motors cific about poz workers, it case—quite the opposite.” does point out some great For Andrew, the takeaway 6. Wyndham Worldwide companies generally, and was that he’ll never feel safe 7. WellPoint it uses measurements that disclosing in another workplace. 8. The Hartford Financial Services Group could help you determine if a “Sadly, it is still quite dangerous,” company would be a good fit he says, for poz workers to come 9. BASF for you. For example, Diversityout. Andrew is right. In some places, 10. AT&T Inc researchers consider whether at some companies, coming out about Source: DiversityInc.com certain benefits are available and being positive can be a one-way ticket to utilized, including telecommuting and the unemployment line—even though that’s alternative career tracks for those with a violation of federal law. long-term family-care issues; whether a compaMany companies are woefully ignorant about the ny tracks the number of people with disabilities in the ADA’s protections; others find ways to fight claims by saying workforce; and the role employee resource groups for people with the accommodations requested weren’t reasonable. Still, there’s disabilities plays in creating an inclusive workplace. Yes, for some good news: Today many companies are learning to embrace their companies, “workers with disabilities” is often simply translated as poz workers, to incorporate people living with HIV not just into “workers in wheelchairs,” but savvy organizations know that’s not their workplace but into the culture of their companies. Living the totality of a diverse workforce. with HIV is a lot like living—and working and loving and having a family—with any other disability or chronic illness, and some comContinued on page 37 panies are taking extra strides to support people living with HIV.

26 | may / june 2015

Yes, There Is a Job for You By Diane Anderson-Minshall

The National Working Positive Coalition knows where the gaps in HIV treatment and prevention come from: employment and economic security

THINKSTOCK

hile headlines about HIV tout long-shot but possible cures and very real pharmaceutical treatments, there’s something missing when experts talk about that so-called treatment cascade. It’s something critical to treating HIV, says Mark Misrok, president of the board of directors for the National Working Positive Coalition, and it’s not something a doctor can give you. It’s a job. “In developing effective treatments for HIV, we’ve found that what was most effective was combination therapy and not monotherapy,” says Misrok. “The same applies to improving HIV health outcomes and to reducing health disparities and new infections. Medically focused interventions alone will not achieve our treatment and prevention goals. Employment plays a powerful role in the social and economic lives of almost everyone. Addressing employment needs of people living with HIV is essential to our success in facing down HIV now in the U.S.” Misrok’s group hears from people all over the country who have “a desperate need for help and information to get or keep a job” as well as service providers trying to help poz clients with their employment needs. The NWPC was started in 2003 by people living with HIV and committed allies to connect “the few but passionate HIV employment service providers, researchers, educators, and advocates in the U.S.” The group advocates at all levels of government for measures that would expand opportunities for employment and access to employment services for people living with HIV, and it also seeks to link poz people with existing vocational rehab and “transition-to-work” programs. “This has long been an underdeveloped and underexplored area of service for the needs of people living with and at greatest risk of HIV,” he says. “Pharmaceuticals are capable of profound benefits in HIV care and prevention, but key social and economic determinants of health—including poverty, unemployment, and underemployment—present equally powerful barriers to optimal engagement in care and adherence to treatment and prevention medications.” NWPC, he says, has also built alliances with advocates for populations “disproportionately struggling for stable, healthy, living-wage employment, all of which include people living with HIV. Structural barriers and discrimination in employment intersect with challenges

to staying HIV-negative and achieving viral suppression for people living with HIV, including inequities based on race, sex, sexual orientation, gender identity, disability, poverty, mass incarceration, immigration status, religion and geographic location. In our social and economic contexts, many of us need help to approach leveling the playing field related to employment.” Employment is a “major challenge for so many of us,” Misrok says, “yet it’s one that can be addressed.” While some areas have HIV-specific employment services available, like New York City, HIV service organizations are often unaware of what local employment programs are available to their clients. This has led many people with HIV to feel like they have to drop out of the workforce, further jeopardizing their health and economic future. “What we regularly hear from people living with HIV is how much they need and want to work…and [inquiring] where to get the information, training, and employment assistance needed to get the jobs they need,” he says. Often folks don’t even realize the range of jobs they could do, careers they could have even with their disability. With some help from high up, NWPC is seeing positive change, both with providers seeking information and with policy leaders deciding to “address employment needs as a social and economic determinant of health.” Douglas Brooks, director of the White House Office of National AIDS Policy, has recently said that expanding access to employment and employment services for people living with HIV is among the top priorities for achieving the goals of the National HIV/AIDS Strategy. Brooks and Misrok, with the help of other HIV organizations such as the Positive Women’s Network and National Minority AIDS Council, have been working with leaders at the U.S. Departments of Labor, Education, and Housing and Urban Development as well as other federal and state agencies to focus resources on the employment needs of people living with HIV. “There’s simply never been a priority on ensuring that fundamental information about existing employment assistance programs or the ‘transition-to-work’ policies of SSI/SSDI, Medicaid/Medicare, HOPWA, and Section 8 are made accessible, either to people living with HIV or to their service providers,” Misrok says. But if his group has a say, all that is going to change. ✜ hivplusmag.com

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Here’s Why Levi Strauss and Co. May Just Be the Best Place in America to Work if You’re HIV-Positive For decades, the company built on ethical treatment of workers has oﬀered a lesson on how to support poz employees THINKSTOCK

By Katie Peoples

28 | may / june 2015

high prevalence, such as South Africa, programs also must work hat began as a grassroots campaign among Levi Strauss harder to focus on testing and encouraging treatment as well as and Co. employees in the early 1980s to raise awareness of HIV fighting stigma. and AIDS among their San Francisco colleagues has blossomed In other countries, like Russia, Levi’s may reach out to help orinto a program largely unparalleled in corporate America today. ganizations working in public health or with women in particular, For over 30 years, the clothing manufacturer has taken positive along with educating employees on their legal rights and dispelling steps to address the epidemic inside and outside the company. In myths about transmission. addition to Levi’s Worldwide HIV/AIDS Workplace Policy—a The company’s commitment to fighting the HIV epidemic corporate policy that not only welcomes and supports HIV-posdrives it to address these issues even in countries where HIV is not itive employees but also actively fights for their rights—its global highly prevalent, Walker says. In those areas, she says, it’s still imEmployee HIV/AIDS Program helps employees and their families portant to raise awareness about discrimination and let employees by providing HIV education, combating stigma and discrimination know about their rights and how to access care. on the job, and offering a free 24/7 HIV information and resource In addition, the company lobbies on behalf of HIV-positive telephone line for employees and their families in the U.S. workers. In 2012, Levi’s president and CEO Chip Bergh joined Even better: Levi’s reimburses employees for the cost of HIV with over 20 other CEOs in signing a pledge to urge countries testing, and in places where treatment is not covered by health into repeal laws that prevent HIV-positive people from traveling surance providers, it covers 100 percent of the cost of HIV treatfreely. The pledge was an initiative of UNAIDS, Levi Strauss, and ment, including medications. GBCHealth, a coalition of companies working on global health Though it started in the ’80s, this employee program became issues. The effort has seen success, negotiating the end of waiting more focused in 2006 as part of a response to the Clinton Global periods in Hong Kong and Mexico, and removing a preexisting Initiative, with a larger official global company policy and program condition exclusion in Taiwan. coming into play. The company has also given over $60 million in grants to HIV “This is really, truly a comprehensive program,” says Anna Walkand AIDS organizations through the Levi Strauss Foundation, er, head of public policy and government affairs at Levi’s. The prowhich, Walker says, works “hand in glove” with the company’s gram works on several levels. First, the policy makes sure that Levi’s global employee policy. employees have access to care and treatment and that the cost is “One of the pillars of [the foundation’s] giving is around HIV covered, either through insurance or the company’s own funds. and AIDS, so there’s a certain level of coordination of what we’re Second, the policy addresses stigma and discrimination by educatdoing internally with employees, and the giving [the foundation] ing its employees through HIV and AIDS awareness workshops, is doing,” she says. “So, making sure grants are being given to orwhich are followed up with surveys to tell if the workshops are ganizations in those countries where we need to do more to tackle improving work environments for poz workers. The company also those misunderstandings, those misperceptions, and follows a strict nondiscrimination policy—in evthose prejudices.” ery one of the 110 countries where it The company takes its policy seriously, operates—that lets managers know but its employees are just as active in efforts that any kind of discrimination to improve the lives of people living with against employees with HIV will HIV. Employees volunteer in Community not be tolerated. In areas where Involvement Teams to organize volunteer The company also addresses days and fundraisers. One of the largest the needs of the comtreatment is not covered teams is the AIDS Action Group, and munities where by health insurance it’s these employees who help organize it operates by providers, Levi’s pays 100 participation in the AIDS Walk. working with loWalker credits the early leadership cal AIDS service orpercent of its employees’ of Bob Haas, Levi’s former chairman— ganizations. Levi’s has HIV treatment and and great-great-great grandnephew of the worked to increase awaremedications founder—who came out in support of those ness among its employees dealing with AIDS in the earliest days of and to address HIV issues the epidemic. Haas is widely credited in globally by adapting its policy business circles for creating an ethical workand goals to local culture, says place where employees are paid well and treated Walker. Employee education has been a fairly. It was the extension of tradition at Levi’s, a huge success internally, as the number of emcompany that integrated its factories in the Deep South during ployees who said in surveys they felt understood the era of segregation and refused to lay off workers during the and supported in their work environments doubled Great Depression. after HIV awareness training. But credit also goes to the grassroots efforts of employees to “Is it education? Is it prevention? Is it providing care and treatspread empathy and understanding among the employee base in ment?” she posits of the company’s success with helping HIV-posSan Francisco. What began as a small group to address discriminaitive workers. “In some countries there’s really a low level of awaretion and misunderstandings around a disease yet to be named has ness [of HIV] and certain stigma attached to it, which still needs to transformed into a global leader of employee support and commube overcome…less so with our San Francisco population.” nity outreach around HIV and AIDS. Levi’s program, she says, is about “recognizing not one size fits “It became just a part of what the company was doing since the all when you’re talking about a truly global initiative.” For example, very beginning,” says Walker. ✜ while prevention is still part of the program in countries with a hivplusmag.com

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Getting Back To Work

Longer lives with HIV mean a reinvigorated workforce. This NYC group is out to help ast fall the ﬁrst generation of people to become infected with HIV hit retirement age. While that is a positive indicator of the health and longevity of people living with the virus, it’s also a reminder that more people with HIV are going to need steady income to support themselves into their later years. Queens, N.Y.–based Elmcor is one of the growing number of organizations across the country helping people with HIV gain steady employment. Joey Betancourt, an administrative data specialist for Elmcor’s Positive Ventures Program, says clients have a range of work experience and education levels, and are guided through résumé development, career counseling, and job applications. “We try to meet the clients where they’re at and take them where they’re going,” says Betancourt, who emphasizes that the group works with everyone from entry-level employees to those with college degrees. For many, he adds, “we try to set them up with

vocational training or [retraining in] an area they’re interested in.” Many of Elmcor’s clients have been placed with local employers, including JFK and LaGuardia airports, and in a range of workplaces—offices, restaurants, and more. In any case, clients would not be placed in any sort of work that would compromise the client’s immune system or overall health, says Elmcor program director Janice Teague. The next step is to get more people to use Elmcor’s resources in the Corona section of Queens, which may seem far away for someone in, say, the Canarsie neighborhood of Brooklyn. But Teague says there’s a fix in the works. “It’s not easy to get to Corona, so we recently made an adjustment to the program where we will outstation our intake and orientation,” she says. “We’re taking it on the road. I want folks to know we can come to them, so they can know what we’re getting involved in before they take the trek.” ✜

Visit Elmcor.org for info on Positive Ventures. WorkingPositive.net also has a list of 23 HIV and AIDS service providers that oﬀer employment and training services. If there isn’t one listed in your state, try asking your local AIDS organization or social worker for poz employee assistance programs.

30 | may / june 2015

THINKSTOCK

By Michelle Garcia

Taking on a Banking Giant

A major civil rights group represents an HIV-positive man in his discrimination case against JPMorgan Chase By Trudy Ring

sources department, but Chase still did not make the accommodations, according to the suit, which says he was forced to resign in August 2012. The relevant Chase officials were aware of Leon’s HIV status, the suit states, and he was “at all times…fully qualified for his position and was performing his job duties well.” This is not the first HIV discrimination case handled by MALDEF. In 2013 it reached an out-of-court settlement in a case involving an HIV-positive employee who lost his job at the Ivy, an upscale restaurant in Los Angeles, Saenz says. “Our mission includes fighting against discrimination experienced by the Latino community, including multiple-basis discrimination, intersectional discrimination,” says Thomas A. Saenz, president and general counsel for MALDEF, adding that the group is “on the lookout” for more cases of multiple-basis discrimination. Simply put, multiple-basis or intersectional discrimination recognizes that we all have many intersecting identities that make up who we are; they can include gender, race, ethnic origin, sexual orientation, and yes, health factors. And any or all of these identities can be the basis for discrimination. “Our concern is that the Latino community, more than most, could be hurt by this multiple-basis discrimination,” says Saenz. While one characteristic could be the basis for overt discrimination, it’s also possible that others play into it; for instance, most employers these days would be careful to avoid any appearance of racial discrimination, he notes.

The suit seeks a trial by jury and punitive, compensatory, and other damages, plus reimbursement of legal costs. It was filed in Los Angeles County Superior Court, but has been moved to a federal venue, the U.S. District Court for the Central District of California, at JPMorgan Chase’s request, Saenz notes. The banking company has yet to make any public comment on the suit. Leon, meanwhile, has found other employment in the industry, Saenz says. ✜

Being Discriminated Against at Work?

If you think you’ve been discriminated against because of health factors or any other characteristic, it’s important to consult a lawyer if you can, says Thomas A. Saenz, president and general counsel for MALDEF. If you’re worried about the cost, many nonproﬁt organizations (such as MALDEF, Lambda Legal, the American Civil Liberties Union) and legal aid clinics take on discrimination cases at little or no cost to the client. It’s also important to document when discrimination occurs— and if the discrimination involves a health condition, such as HIV, that’s covered under disability law, to document that your employer knew of your condition and the fact that you required accommodation on the job. Saenz suggests creating and keeping an email that documents all this and the dates involved.

THINKSTOCK

leading Latino civil rights organization has sued banking giant JPMorgan Chase, alleging that the company discriminated against an employee because he’s HIV-positive—an example of how activist groups are increasingly recognizing “intersectional” discrimination. The Mexican American Legal Defense and Educational Fund brought the suit on behalf of former JPMorgan Chase employee Jesus Leon in January, alleging that the company failed to make reasonable accommodations for Leon’s health, as required by the federal Americans With Disabilities Act and the California Fair Employment and Housing Act. Eventually, according to the suit, Leon was forced to resign. Leon, who was diagnosed as HIV-positive in 2004, began working for the company in June 2010 in Florida as vice president of global philanthropy, according to MALDEF, and in January 2012 he moved to Los Angeles to take a new position on Chase’s community development banking team. In July of that year, Leon’s doctor recommended that because of his health, he should work no more than 40 hours per week, and submitted a note to Chase officials to this effect. However, the company continued to require him to work more than this, and at one point he experienced complications that led a fellow employee to call an ambulance for him, the suit states. Soon afterward, he submitted a complaint to the human re-

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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. •

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

SAY SOMETHING We’re still too reluctant to talk about HIV By Dontá Morrison

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discussion, or should it only be brought up when sex is a possibility? There’s no definite answer, but I would say this to my friends, and anyone else: Say something. Start the conversation, even if it sounds awkward, even if you think he might not like it. As gay men, we are bombarded with HIV statistics, messages, and images. The constant reminders to “be safe” and “use condoms”—or now maybe how we might take the little blue pill called PrEP— are a looming presence some of us would like to escape, especially when we’re just trying to get to know someone. You would think this constant messaging would make conversations about HIV easier, but fear and resistance are still present, especially during the early stages of dating. Those of us who are actively dating are weary of trying to figure out how to incorporate HIV, PrEP, condoms, or anything else associated with the responsibilities of gay sex into our conversations with other men. These can be taxing topics, especially for those on the disclosing end. Yet we know that it’s necessary. Maybe if HIV became a normal, “by the way” conversation, people wouldn’t be so resistant to having it. Maybe if we were taught that sex should be a positive, connecting experience with another person, this would feel as easy as asking a man his sign. It all boils down to communication. Whether we are disclosing our HIV status or other need-to-know information, we should be willing the have these exchanges if healthy and honest relationships are what we truly desire. Talking is a way to overcome fear—to make a real connection—and to show that guy you meet what makes you stand apart from others. If you want that Greek wedding, what are you going to say? ✜ Dontá Morrison is an HIV advocate, a blogger, and the host of the online radio show Diggin Deep With Dontá. He is a program coordinator at APLA Health & Wellness’s Gleicher / Chen Health Center in Los Angeles, where he oversees the R3VNG campaign, an HIV awareness initiative for young gay men of color. This article originally appeared in The Advocate magazine. Reprinted with permission.

ILLUSTRATION BY CRUMB

ou are out on the town and a handsome man catches your eye. He is breathtaking, and in your heart you pray that his conversational skills match his physique. Your heart skips a beat when he is able to complete a full sentence, and your mind instantly conjures images of your wedding on an island in Greece: cobalt blue waters, warm breezes, and white doves released in celebration of your union. You’ll be enjoying a long life together filled with happiness, love, and sexual satisfaction. That fantasy, however, can never be reality without first talking about sex, condoms, HIV, sexually transmitted diseases, and more. Isn’t that a mood killer? Why do we always have to talk about this stuff ? And when are we supposed to? During the first conversation? There are many reasons why people—even in this day of instant communication—still have a hard time verbally expressing themselves. If a man is living with HIV, he may think, If I tell too soon, this person I just met may share my business with the world. That is definitely reason for hesitancy, but it doesn’t negate the fact that the talk needs to occur. It is also safe to assume that no one wants to be rejected for something so common within the gay community. Amazingly enough, however, there are many gay men who will have anonymous sex with men whose status they do not know, but then vehemently refuse to date or be in a relationship with people who are openly living with HIV, regardless of whether they’re in care or not. That speaks volumes about HIV-related stigma and why so many men refuse to disclose. It also says a lot about the kinds of conversations we have, and the ones we don’t. Dating can be a complex and draining experience, especially for people who are intent on finding Mr. Right. Quite often, I hear friends boast with glee about their new suitors and wonder whether the only questions they asked the guys were: “What’s your sign? What do you do for fun? Are you full vegetarian or pescatarian?” I know that during the get-to-know-you phase, people usually steer away from the real get-to-know-you questions that may shatter the dream of a beautiful courtship. Questions about sexual history, HIV, STDs, past relationships, and more are not easy to have in the beginning, but when exactly should they begin? Is it a second-date

Positive Careers… continued from page 31 Another tell of whether your company supports poz workers: Whether its CEO joined in a call to end HIV travel restrictions, calling them “bad for business.” More than 20 CEOs signed an unprecedented pledge urging the repeal of laws and policies in 46 countries that still deport, detain, or deny entry to people solely because they are living with HIV. They represented companies including Johnson & Johnson, Coca-Cola, Pfizer, Heineken, Merck, Gilead, Virgin, Kenneth Cole, OraSure, Aetna, and the NBA. “HIV travel restrictions are discriminatory and bad for business,” said Chip Bergh, president and CEO of Levi Strauss and Co., who launched the CEO petition along with the Joint United Nations Programme on HIV/AIDS and GBCHealth, a coalition of companies that address global health challenges. “Global business leaders are coming together to make sure we end these unreasonable restrictions.” Bergh and others argued that HIV travel restrictions are a hindrance in today’s globalized economy because companies must be able to send their employees and best talent overseas, regardless of their HIV status. “Travel restrictions on individuals with HIV are unnecessary and hinder the ability for individuals and companies to operate in a truly global workforce,” said Mark Bertolini, chairman, CEO, and president of Aetna. Of course, none of this helped Andrew at his old company, nor Noah Crawford, who said he wasn’t hired by Popeye’s Chicken & Biscuits in Longview, Texas, despite his many qualifications, because he was poz. Then again, Crawford got $25,000 from that company in a settlement of his lawsuit, and a taxi driver in Florida is getting a fat check from the biggest taxi company that serves Disney World (details of the settlement weren’t disclosed). So as smart companies court people with HIV and stupid ones get fined for discrimination, perhaps we can build a world where HIV-positive workers aren’t just tolerated but celebrated for their unique contributions to the workplace. ✜

THINKSTOCK

Take This to Your Boss I’m letting you know you have an HIV-positive employee. Most employees with HIV continue working their normal jobs with little change. But HIV is a disability covered under the Americans With Disabilities Act, which means you are required to provide that employee with reasonable accommodations if necessary for him or her to complete their job. Customer or coworker attitudes are not relevant factors in determining an undue hardship; the potential loss of customers or coworkers because an employee has HIV does not constitute an undue hardship. Employers cannot fire an employee now because they fear the employee will become too ill to work in the future, or because they’re worried about higher medical insurance costs, workers’ compensation costs, or the threat of passing HIV to others. It is medically established that HIV can only be transmitted by sexual contact with an infected individual, exposure to infected blood or blood products, or perinatally from an infected mother to infant during pregnancy, birth, or breast-feeding. HIV cannot be transmitted by casual contact. Thus, there is little possibility that HIV could ever be transmitted in the workplace. You are legally forbidden from telling anyone else about your HIV-positive employee’s health status. Any medical information you have on that employee must not be put in their standard personnel file so as to protect that employee’s privacy. Your employee may also be eligible for leave time under the Family and Medical Leave Act; if so, you must provide them with up to 12 weeks of unpaid leave. If you violate this law, you may receive a civil penalty from the U.S. Department of Justice of up to $75,000 for your first offense; after that it can go up to $150,000. For more info, visit ADA.gov/AIDS.

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iPrEx study, and the PARTNER PrEP study between straight couples. It would be three years before either study published results. She also mentioned timed intercourse without PrEP. The Hartmanns couldn’t believe it. Finally, someone was talking to them about their choices—all their choices. Cohan spoke without giving any method a moral weight. In other words, said Susan, “She talked to us like adults.” The Hartmanns left with some serious thinking to do. Though Cohan was dispassionate in her recitation of options, their conversation confirmed what Susan had always suspected: She might be able to have sex with her husband, have a baby, and not contract HIV or pass it on to her child. “When we picked our jaws up off the ground about how high the pregnancy success rate was and how low the risk of transmission was, we started to think,” Dan said. “Suddenly we were armed with some data, coming from a more reliable source than a blog from somewhere,” said Susan. “And we started to have a serious conversation about, ‘Why don’t we just…? Can we just…?’ ” Even on the Hartmanns’ honeymoon in January of 2009, they didn’t leave the condoms behind. But now it was February, they

THINKSTOCK

t was late 2007 when Susan Slingluff Hartmann and Dan Hartmann finally found a doctor who was willing to have a conversation with the couple about HIV, emerging science, sex, and pregnancy—a conversation they’d been trying to have for nearly seven years. It happened at a Mexican restaurant in Berkeley, Calif., and Dr. Deborah Cohan, a Harvard-trained medical director of UC San Francisco’s Bay Area Perinatal AIDS Center and an associate clinical professor of obstetrics, gynecology, and reproductive sciences at UCSF, was the expert they’d been looking for. Over their meals, Cohan, who herself was well into her second pregnancy at the time, laid out for the couple the pregnancy options no one had shared with the Hartmanns before. She detailed the work Pietro Vernazza was doing in Switzerland, prescribing HIV medicines to HIV-negative women interested in having babies with their HIV-positive husbands, using a then-experimental approach called pre-exposure prophylaxis (PrEP). She talked about preliminary results from small studies underway in Africa. PrEP could be a good option, she remembered telling them, but, to be sure, they should watch for the data from two ongoing studies—“Pre-exposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex With Men and Transgender Women,” also known as the

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were home, and they were ready to make a decision. Or at least Susan was. “We should do this,” she told her husband. “I’m OK with it.” Dan hedged; from his perspective, the risk was hers. “If we were going to talk about unprotected sex, Susan needed to be completely comfortable and committed to it before I could make a decision,” he recalls. The couple started to talk through all the possibilities. Sometimes, the conversations were brutal. Did they really want to have a baby with the risk that Dan could become ill and pass away while their child was young? What would it mean if Susan contracted the virus? How would that affect their marriage? What if their baby had HIV? What if Susan changed her mind about unprotected sex? What if she changed her mind in the middle of sex? What if Dan changed his mind? What would they do to ensure that he had as undetectable a viral load as possible? In the end, they settled on a kind of pilot program for sex. They would have unprotected sex only when Susan was ovulating, and then only a few times per cycle, to reduce the risk of transmission. If they didn’t get pregnant in six months, they would reassess. Susan was, she said, “empowered with the right of refusal at all times.” If at any point she became uncomfortable, they were done. They wouldn’t be using PrEP—just the power of Dan’s treatment—to protect Susan from contracting the virus “There would not be a lot of just having fun,” Susan remembered thinking. “We can’t do that. We’re going to be responsible around our risk-taking.” So it was that, after years of faithful, vigilant condom use, Susan and Dan Hartmann were about to go “a little wild.” For the record, the Hartmanns’ “wild” would, to any HIV-negative couple, look more like a highly structured, forced march to conception. Susan joked that she turned into “a crazy wanting-toget-pregnant lady.” The research skills she’d developed during her years of trying to figure out how to have a baby translated seamlessly to the science of careful conception; in no time, she was elbow-deep

in ovulation-testing kits and meticulously kept calendars. Then the time for calendars and tests was gone and it was just the two of them—the proverbial man and woman who loved each other very much. It was still a little fraught. Dan still worried that his wife would get the virus; Susan couldn’t get the always-use-condoms voice out of the back of her mind, even in the midst of things. Still, it was “sort of, a little fun,” she says in a high, sweet voice. Finally, they’d given themselves permission for a little well-structured wildness. They stuck to the schedule they’d concocted, and, two months later, when the pregnancy test came back positive, they were ecstatic—and a little disappointed to go back to the condoms. “Part of me thought, ‘It happened so fast! We couldn’t ask for anything better!’” Susan admitted in an awed voice. “But then, the second thought was, ‘Oh. It happened so fast.’ ” Their wildness was over. The couple went back to condoms right away, they said. But would the baby—and Susan—be HIV-negative at the end of this? In September, Susan was in her doctor’s office’s lab, having blood drawn to find out. Her pregnancy was six months along, and this was the second time she’d been tested for the virus. The first test, at nine weeks, had been negative. But the standard of care for HIV detection was to check at six months to give her immune system time to generate antibodies that can be detected in tests. A few weeks later, she got the verdict: still negative. The chances of the fetus having the virus were negligible, but Susan would be tested once more, just before the birth, to make sure they didn’t have to alter delivery plans. They didn’t: both she and their daughter, Ryan Nicole, are HIV-negative today. “But I’ll be honest, [the risk of transmission] is always there,” she said. “It will continue to be there. We were just safe enough. And honestly, I hold nothing against the doctors who tried to dissuade us. It’s their job to try to prevent an epidemic.” ✜ Positively Negative is now available at https://positively-negative. squarespace.com

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MANY WITH HEPATITIS B VIRUS LEARN TOO LATE FOR TREATMENT People who are infected with the hepatitis B virus early in life can eventually develop serious health problems, but a new study indicates that most infected people don’t even learn they have the virus until it’s already too late for effective treatment. The World Health Organization calls hepatitis B, which affects more than 240 million people worldwide and kills 780,000 people every year, “a potentially life-threatening liver infection…[that] can cause chronic liver disease and chronic infection and puts people at high risk of death from cirrhosis of the liver and liver cancer.” One of the things that makes hep B so hard to fight is the fact that the virus frequently lies in a somewhat dormant state for years, giving a person what is known as “chronic hepatitis B.” The stealth virus often causes no symptoms to alert an individual to its arrival. When symptoms do occur, the Centers for Disease Control and Prevention says, they can appear any time between six weeks and six months after exposure and include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. “The HBV is regarded as a stealth virus, in part, due to its ability to subvert innate immune responses,” writes Dr. Peter Revill of the Victorian Infectious Diseases Reference Laboratory in Melbourne, Australia, in a study published in the journal Gut. Able to effectively hide from the immune system, the hepatitis B virus can continue to replicate, produce viral proteins, and damage the body. Even worse, another new study reports that if a person’s immune system is weakened, as with HIV, the dormant hep B virus can spontaneously reactivate. —Jacob Anderson-Minshall

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Early HIV Treatment Advantage Lost If Treatment Interrupted Experts want to connect people with HIV with care as quickly as possible, especially since early treatment has been shown to provide long-term advantages. But a new French study indicates that any immune recovery benefits gained by starting antiretroviral medications may be lost if treatment is interrupted. In fact, the study found little or no difference in terms of immune reconstitution between those who had started treatment immediately and later stopped for a time and those who didn’t start treatment until their CD4 cell counts fell below a certain figure. The findings, published in the journal AIDS, suggest that only combining early treatment with continuous lifetime adherence gives patients the best hope of reaching a near-normal CD4-toCD8 ratio. CD4 cells, also known as “T-helper” cells, play a key role in launching the body’s immune response to an infection. In contrast, CD8 cells, or “T-suppressor” cells, help kill off infected cells. Healthy HIV-negative people tend to have more CD4s than CD8s, meaning their CD4-to-CD8 ratio is greater than 1.0, while those with HIV typically have ratios below 1.0. The researchers looked at HIV-positive people who were part of the PRIMO cohort study and were receiving treatment at the time. The patients in the study fell into three groups: • 34 percent (244 people) started treatment, on average, less than two months after infection. More than half of those had only one treatment interruption, while 47 percent had more than one. • 30 percent (218 people) did not start taking antiretroviral medications until an average of two and a half years after infection. • 36 percent (265 people) started treatment shortly after contracting HIV and remained on it continuously. The study found that those who began treatment quickly and remained on it continuously had an average CD4 count of 731 cells, 125 cells more than those in the deferred treatment group and 106 more than those who started treatment early but interrupted it. Those who received treatment early and stayed on it continuously also had higher CD4-to-CD8 ratios than those in either of the two other groups. A full 64 percent of them had a ratio greater than 1.0, in contrast to 40 percent of those who deferred treatment and 36 percent of those who interrupted it. These results held true even after controlling for factors including treatment duration, sex, and age. “While most people prescribed [antiretroviral therapy] eventually develop a near-normal CD4 count, only those who started treatment soon after infection, who have continued it ever since and remained undetectable stand a more-than-even chance of achieving an immune system where the balance of T-lymphocytes resembles that of a person without HIV in terms of their CD4:CD8 ratio,” notes AIDSMap. The researchers say their study’s results underline the critical need to get into treatment early and to adhere to medication in order to limit cumulative HIV viremia (the amount of HIV in the bloodstream) and achieve the best possible degree of immunesystem recovery, notably the CD4-to-CD8 ratio. But this does not mean that there is no point in starting treatment early or in returning to it after going off. While continuous treatment is better, this study’s findings reiterate that antiretroviral treatment is key to the immune system’s health. —J.A.M.

THINKSTOCK

T REATMENT CHRONICLES

TREATMENT CHRONICLE S

EVER GIVE A BJ? THEN YOU’RE AT RISK FOR ORAL CANCER A very common virus can lead to some serious cancers A few weeks ago, one of my patients saw me for a sore throat. The pain was isolated to the left side of the throat and the patient is a former smoker, so I was immediately concerned. I saw a rather large but otherwise normal-appearing tonsil on the left side and sent the patient to an ear, nose, and throat colleague to assist me. My patient underwent a biopsy and the result, tonsillar cancer, did not surprise me. However, learning that the cancer was due to human papillomavirus did.

have an even slightly higher risk. While Pap smears can detect the presence of HPV and early precancerous cells, making it easier to treat cervical and rectal cancers in the earliest stages, there is no similar test to detect HPV-associated oral cancers. HPV tends to cause cancers in the back of the mouth, primarily at the base of the tongue and in the tonsils. Tell your doctor if you have symptoms that could indicate oral cancer, like difficulty chewing or swallowing, or hoarseness. There is some good news: You are more Human papillomavirus, or HPV, is the most likely to survive oral cancer caused by HPV common sexually transmitted infection in than oral cancer caused by another risk the U.S. Current estimates suggest that factor, such as smoking. HPV vaccines up to 79 percent of sexually active men are approved for use in both men and and women will become infected with women up to the age of 26 and are HPV at some point during their lives. designed to protect against the types HPV transmission may occur during If you test of HPV that most commonly lead to positive for HPV, vaginal, rectal, and oral intercourse cancer. The vaccine, three doses over there is no sure way to even without symptoms or a visible know when you were infected a period of six months, may be up growth. There currently is no with HPV or who gave it to you. A to 99 percent effective at preventing approved test to screen whether person can have HPV for many years, these types of HPV. Check with you’ve been exposed to HPV even decades, before it is detected your insurance to make sure it will The older you are and the more or it develops into something serious pay for the vaccine, as it may cost sexual partners you have, the greater like a cancer. Testing positive for an you up to $500 out of pocket. your risk for HPV infection. HIVHPV infection does not mean that you Hopefully in the future, we’ll infected men and women are also or your partner is having sex outside have a better approach to screening more likely to become infected of your relationship. It is believed to and early detection for the presence have long periods of inactivity or with HPV and more likely to have of oral HPV. Until then, it’s important dormancy that may even cover persistent infections. Most often, your decades; these are periods to know your risk, modify behaviors that body will clear HPV infection on its of time that you will test may increase your risk for oral cancer (e.g. own. Persistent HPV infection, though, negative for it. stopping smoking), and consider vaccination may lead to cancer including cervical, against HPV. anorectal, and, increasingly, oral cancer. A study published in the Journal of Clinical Oncology estimated that the annual incidence of HPV-associated oral cancers will surpass that of HPV-associated cervical cancers by 2020. Condoms can lower your risk both for getting and transmitting HPV. However, very few gay and bi men use condoms for oral sex. Unlike with HIV, it is very easy to get HPV from oral sex. Men who have sex with men are at higher risk for developing HPV-associated oral cancers, and among this population, African-American men

Plus’s wellness editor, Joseph Arcuri Jr., MD, has a private practice in internal medicine in New York City’s Chelsea neighborhood, with a focus on preventive medicine, men’s health, and HIV care. He’s also an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai. + Visit HIVPlusMag.com for a list of oral cancer signs and symptoms.

FDA Approves Two New HIV Combo Pills

EMPR.COM; RXLIST.COM; THINKSTOCK

The U.S. Food and Drug Administration has approved two oncedaily, fixed-dose combination pills for HIV that use previously approved single drugs: Prezcobix and Evotaz. Janssen’s Prezcobix is a combination of the protease inhibitor darunavir and boosting agent cobicistat. It’s useful for patients new to treatment and those who haven’t developed a resistance to darunavir, which is marketed under the brand name Prezista as an individual antiretroviral. Cobicistat (brand name Tybost) raises the level of other antiretroviral drugs.

“This approval gives physicians the option of a darunavir-based fixed-dose combination tablet to treat adults living with the HIV-1 infection, which can help reduce the number of pills in their overall treatment regimen,” said Karen Tashima, a professor of medicine in the division of infectious diseases at Brown University and a lead investigator in the study that led to Prezcobix’s approval. “Additional options remain an important medical priority to meet the diverse needs of those living with and managing this disease.” Bristol-Myers Squibb’s Evotaz combines cobicistat and the protease inhibitor atazanavir (brand name Reyataz). BMS officials said Evotaz performed well in a 602-patient clinical trial compared with ritonavirboosted atazanavir, with sustained effectiveness and safety through 48 weeks. Some 85 percent of those taking the cobicistat combination and 87 percent of those on the ritonavir regimen achieved HIV levels of below 50 copies per milliliter of blood. —J.A.M. hivplusmag.com

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CORNER

My girlfriend told me she wants to go on PrEP. I’m OK with condoms and she said she is too; she just wants extra protection. I have a lot of feelings coming up about my status, like I’m damaged goods or something. I’m afraid she’s going to talk herself out of wanting to stay with me. PrEP has been a game changer in a lot of ways, including helping to lower the risk of HIV infection for individuals in serodiscordant relationships, like yours. But the PrEP decision can conjure up some ghosts from the past, as you are experiencing, and some insecurities about the future. Serodiscordant couples have a couple of extra hurdles when it comes to sex. First, there’s the importance of negotiating safe sex and having a routine in place in terms of what you can do, can’t do, and need condoms for. That’s pretty straightforward. But what is not so simple is the feelings that come up in a serodiscordant relationship, like fear and insecurity on both sides. I have often had serodiscordant couples tell me how hard it can be to talk about sex. HIVpositive partners may think of themselves in terms like “damaged goods” early on in the relationship and fear that their partners may think of them that way as well. They have fears of passing the virus to their HIV-negative partners. And they may feel insecure about whether their partners will want to be with them in the long term. Of course, their partners also have some fears around the possibility of becoming exposed to the virus. As you said, you and your girlfriend have worked out these concerns over time. As in most serodiscordant couples, condoms have become routine with you. It sounds like you two have adjusted just fine—or so you thought. Now, about your reaction to your girlfriend’s decision to go on PrEP. It’s only human for you to experience this decision as a blast from the past, calling up insecurity about how your status might affect your relationship going forward, along with those fears about being damaged goods. But that’s only one way to view it. Let’s look at her decision from another angle. While comfortable with using condoms, your girlfriend may have had some lingering concerns about her chances of becoming infected, e.g. if a condom broke. Even if your viral load is undetectable. So for her, PrEP use may be a way of putting those concerns to rest. Or your girlfriend may simply see PrEP as an opportunity for an added layer of protection. It’s available, so why not take advantage of it? And consider this: Chances are, your girlfriend is considering PrEP because she loves you and wants to build a future with you. While we’re shifting perspectives on this decision, how about also taking a look at the potential benefit of PrEP on your relationship? If your girlfriend is feeling all that more confident and secure, that can only strengthen the connection the two of you have with each other. Here we are, you and I, trying to read your girlfriend’s mind. Productive only up to a point. Maybe it’s time to sit down with her and have a conversation about PrEP? Or maybe another conversation, with less defensiveness on your part and on hers. I hope I have helped to “prep” you to have this talk. Be ready to listen with an open mind. Take ownership of your feelings. And don’t assume the worst. Team up with your girlfriend. Make the PrEP decision a relationship builder! 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.

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may / june 2015

TEST YOUR VITAMIN D LEVELS AT HOME If you were chased indoors by crappy weather or have traded outdoor sunbathing for the non-cancer-causing convenience of a spray tan, you might be one of the 40 percent to 75 percent of Americans with a vitamin D deficiency—and at an increased risk of developing Alzheimer’s, cancer, or cardiovascular and autoimmune diseases. Now you can find out, in the comfort of your own home, with a DIY vitamin D test kit available from the Vitamin D Council, a nonprofit public education organization. Maintaining proper levels of vitamin D is essential to keeping your bones and all your organs healthy. Symptoms of vitamin D deficiency include bone pain, muscle weakness, chronic fatigue, and impaired balance, but doctors say you don’t have to have symptoms for such a deficiency to pose health risks. At $50, the new test kit is the most affordable available in the United States. A drop or two of blood is all that’s needed by Heartland Assays—the lab partnering with the Vitamin D Council—to determine levels. After you send in the card provided, Heartland Assays uploads results in one to two weeks to a secure Web page where you can access the information privately. —J.A.M.

Inflammation May Lead to Diabetes for Those on HIV Meds A new study has identified lowgrade systemic inflammation as an underlying factor in the development of type 2 diabetes among HIV-positive people on antiretroviral medications. Researchers who published their findings in the Journal of Acquired Immune Deficiency Syndromes examined the relationship between the preexistence of inflammatory markers and new type 2 diabetes diagnoses among approximately 3,700 people in the Strategies for Management of Antiretroviral Therapy and ESPRIT HIV treatment studies. The study subjects were all taking antiretrovirals continuously without additional adjunct therapy. Those who developed diabetes had significantly higher baseline levels of two inflammatory markers (including high-sensitivity C-reactive protein) than those who did not develop the disease. In addition, those who had higher body mass indexes, were older, had coinfections with hepatitis B or hepatitis C, or used lipidlowering medication also had higher overall rates of diabetes diagnoses. —J.A.M.

THINKSTOCK

THERAPY

TREATMENT CHRONICLE S

Studies Show Citrus Extract Reduces Risk of Heart Disease and Diabetes Several recent studies suggest that extracts from the bergamot citrus (an Italian orange-like citrus that is best known as the aromatic ingredient in Earl Grey tea) may be as effective as statin drugs in reducing the risk of heart disease, stroke, and diabetes associated with metabolic syndrome. Metabolic syndrome, reportedly affecting 35 percent of Americans, is characterized by high blood pressure, elevated blood sugar, excess body fat around the waist, and abnormal cholesterol levels. That a natural supplement has been found effective in treating these conditions is particularly important for HIV patients, who may have been taken off statins because of the risk of significant side effects such as neurological disorders, liver damage, and digestive issues. Recent research published in the International Journal of Cardiology and the Journal of Metabolic Syndrome found that by adding bergamot derivatives to patients’ treatments, doctors were able to reduce the dose of statin drugs and yet achieve greater success in lowering cholesterol levels and improving metabolic health. The studies were supported in part by Australia’s Nathealth Solutions and utilized the bergamot formulation available under that company’s brand name, BergaMet (38 percent bergamot polyphenol fraction/ BPF). Other dosages and strengths may not be as effective. At the 2014 annual meeting of the American College of Gastroenterologists, another researcher, Dr. James Ehrlich, presented data (published in Advances in Biological Chemistry) that showed BergaMet effective in improving liver structure and function in patients with both metabolic syndrome and fatty liver disease. “BergaMet’s effect on this potentially dangerous liver condition is unmatched by any drug or supplement,” said Ehrlich, who serves on Nathealth Solutions’ medical advisory board. “Since there are no drugs approved for the epidemic of nonalcoholic fatty liver disease and our results with BergaMet are so important, we are planning to proceed through rigorous FDA trials to create a drug from our patented extract of bergamot.” Capitalizing on the results of these studies, expect to see numerous supplements flood the market featuring bergamot alone or with other ingredients. For example, Bergamot Cholesterol Support, a new product from Reserveage Nutrition LLC of Gainesville, Fla., “combines the citrus extract with resveratrol, an antioxidant derived from grapes and Japanese knotweed,” The Wall Street Journal reports. “The company hasn’t studied the combination, but ‘logically it would make sense’ that the two would work well together, says Rob Maru, the company’s chief innovation officer.” Keep in mind, though, as David Frid, a staff physician in the section of preventive cardiology at the Cleveland Clinic told the Journal: “If you want to try it, you need to be aware that we don’t really know its side effects.” —J.A.M.

Does Herpes Cause Alzheimer’s? Two Swedish studies published in Alzheimer’s & Dementia have found evidence that the herpes simplex virus—the virus that causes common cold sores— doubles the risk of developing Alzheimer’s disease. In one study, researchers followed nearly 3,500 people over an average period of 11 years and found that the presence of certain antibodies to herpes seems to double the likelihood of the infected person developing the neurological disorder. In the second study, blood samples from 360 Alzheimer’s patients indicated a link between herpes and Alzheimer’s. “Herpes virus causes a significant proportion of all cases of AD—about 40 to 50 percent—according to our data,” lead researcher Hugo Lovheim, an associate professor in the department of community medicine and rehabilitation at Umea University in Sweden, told website Psych Central. Other specialists, including Greg Cole, the associate director of the Geriatric Research and Clinical Center at the University of California, Los Angeles, Alzheimer Disease Research Center, aren’t convinced about the link, as the herpes simplex virus is so common. “More than 90 percent of the population has antibodies to herpes,” Cole told the site. “They are not all destined to develop Alzheimer’s disease.” The oral herpes virus infects epithelial cells found in the mouth. Once a person is infected, the virus replicates and uses nerve pathways to travel to the brain, where it establishes a latent infection. Cold sores occur when the virus periodically travels back to the original site of infection. Reactivated and traveling in the nervous system, the virus may cause acute neurological disorders such as encephalitis and low-grade, asymptomatic infections, or it might establish lifelong latent infections, which could launch the progression of Alzheimer’s toward dementia. “The identification of a treatable cause of the most common dementia disorder is a breakthrough,” Lovheim said. “Whether treatment of herpes infection with antiviral drugs may slow the Alzheimer’s progression is not known, but is certainly worth investigating in clinical studies.” —J.A.M. hivplusmag.com

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WHAT IS PREZCOBIX™ ?

• It is not known if PREZCOBIX™ is safe and effective in children under 18 years of age. • When used with other antiretroviral medicines to treat HIV-1 infection, PREZCOBIX™ may help:

Medihaler,® Migergot,® Wigraine,® Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev,® Advicor,® Mevacor ®), lurasidone (Latuda®), oral midazolam (Versed®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin,® Rifater,® Rifamate,® Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor,® Vytorin,® Zocor ®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®).

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

• Serious problems can happen if you take any of these medicines with PREZCOBIX.™

○ increase the number of CD4+ (T) cells in your blood that help fight off other infections.

What should I tell my healthcare provider before taking PREZCOBIX™ ?

• PREZCOBIX™ is always taken in combination with other HIV medications for the treatment of HIV-1 infection in adults. PREZCOBIX™ should be taken once daily with food. • PREZCOBIX™ does not cure HIV-1 infection or AIDS, and you may still experience illnesses associated with HIV-1 infection. You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses. • Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people. • Please read the Important Safety Information below and talk to your healthcare provider to learn if PREZCOBIX™ is right for you.

• About all health problems. Tell your healthcare provider if you have liver problems, including hepatitis B or hepatitis C, have kidney problems, are allergic to sulfa (sulfonamide), have diabetes, have hemophilia, or have any other medical condition, are pregnant, breastfeeding, or plan to become pregnant or breastfeed. Tell your healthcare provider if you become pregnant while taking PREZCOBIX.™ • About all medicines you take. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with PREZCOBIX.™ Keep a list of your medicines to show your healthcare provider and pharmacist. Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take PREZCOBIX™ with other medicines.

IMPORTANT SAFETY INFORMATION

What are the possible side effects of PREZCOBIX™ ?

What is the most important information I should know about PREZCOBIX™ ?

• The most common side effects of darunavir, one of the medicines in PREZCOBIX,™ include diarrhea, nausea, rash, headache, stomach area (abdominal) pain, and vomiting.

• PREZCOBIX™ may cause liver problems. Some people taking PREZCOBIX™ may develop liver problems which may be life-threatening. Your healthcare provider should do blood tests before and during your treatment with PREZCOBIX.™ ○ Chronic hepatitis B or C infection may increase your chance of developing liver problems. Your healthcare provider should check your blood tests more often. ○ Signs and symptoms of liver problems include dark (tea-colored) urine, yellowing of your skin or whites of your eyes, pale-colored stools (bowel movements), nausea, vomiting, pain or tenderness on your right side below your ribs, or loss of appetite. Tell your healthcare provider if you develop any of these symptoms. • PREZCOBIX™ may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. Call your healthcare provider right away if you develop a rash. ○ Stop taking PREZCOBIX™ and call your healthcare provider right away if you develop any skin changes with symptoms such as fever, tiredness, muscle or joint pain, blisters or skin lesions, mouth sores or ulcers, red or inflamed eyes like “pink eye” (conjunctivitis). • PREZCOBIX,™ when taken with certain other medicines, can cause new or worse kidney problems, including kidney failure. Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX.™ Who should not take PREZCOBIX™ ? • Do not take PREZCOBIX™ with any of the following medicines: alfuzosin (Uroxatral®), cisapride (Propulsid,® Propulsid® Quicksolv), colchicine (Colcrys,® Mitigare,® if you have liver or kidney problems), dronedarone (Multaq®), dihydroergotamine (D.H.E.45®, Embolex ,® Migranal®), ergotamine tartrate (Cafergot ,® Ergomar ®, Ergostat ,®

• Other possible side effects include: ○ High blood sugar, diabetes or worsening diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZCOBIX.™ ○ Changes in body fat can happen in people who take HIV-1 medicines. The exact cause and long-term health effects of these changes are not known. ○ Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. These are not all of the possible side effects of PREZCOBIX.™ For more information, ask your healthcare provider. Tell your healthcare provider if you have any side effect that bothers you or that 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. Please see accompanying full Product Information for more details. Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2015 01/15 008417-140113

027409-150108

• PREZCOBIX™ is a prescription HIV-1 (Human Immunodeficiency Virus 1) medicine used with other antiretroviral medicines to treat HIV-1 infection in adults. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). PREZCOBIX™ contains the prescription medicines PREZISTA® (darunavir) and TYBOST® (cobicistat).

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Wisdom inspired by real people

B:10.75 in

T:10.5 in

S:9.875 in

DISCOVER YOUR WISDOM WITHIN

Visit PREZCOBIX.com to hear wisdom inspired by experts and people like you living with HIV. Ask your provider if Once-Daily* PREZCOBIX™ is right for you.

PREZCOBIX.com *PREZCOBIX™ is taken in combination with other HIV medications for the treatment of HIV-1 infection in adults.

IMPORTANT PATIENT INFORMATION PATIENT INFORMATION PREZCOBIX (prez-koe-bix) (darunavir and cobicistat) tablets Please read this information before you start taking PREZCOBIX and each time you get a refill. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or treatment. What is the most important information I should know about PREZCOBIX? • PREZCOBIX may cause liver problems. Some people taking PREZCOBIX may develop liver problems which may be lifethreatening. Your healthcare provider should do blood tests before and during your treatment with PREZCOBIX. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems. Tell your healthcare provider if you have any of the below signs and symptoms of liver problems. • dark (tea colored) urine • yellowing of your skin or whites of your eyes • pale colored stools (bowel movements) • nausea • vomiting • pain or tenderness on your right side below your ribs • loss of appetite • PREZCOBIX may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. Call your healthcare provider right away if you develop a rash. Stop taking PREZCOBIX and call your healthcare provider right away if you develop any skin changes with symptoms below: • fever • tiredness • muscle or joint pain • blisters or skin lesions • mouth sores or ulcers • red or inflamed eyes, like “pink eye” (conjunctivitis) • PREZCOBIX when taken with certain other medicines can cause new or worse kidney problems, including kidney failure. Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX. See “What are the possible side effects of PREZCOBIX?” for more information about side effects. What is PREZCOBIX? PREZCOBIX is a prescription HIV-1 (Human Immunodeficiency Virus 1) medicine used with other antiretroviral medicines to treat HIV-1 infection in adults. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). PREZCOBIX contains the prescription medicines PREZISTA (darunavir) and TYBOST (cobicistat). It is not known if PREZCOBIX is safe and effective in children under 18 years of age. When used with other antiretroviral medicines to treat HIV-1 infection, PREZCOBIX may help: • reduce the amount of HIV-1 in your blood. This is called “viral load”.

• i ncrease the number of CD4+ (T) cells in your blood that help fight off other infections. Reducing the amount of HIV-1 and increasing the CD4+ (T) cells in your blood 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 (opportunistic infections). PREZCOBIX does not cure HIV-1 infection or AIDS. You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses. Avoid doing things that can spread HIV-1 infection to others. • Do not share or re-use needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. • Do not have any kind of sex without protection. Always practice safe sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people. Who should not take PREZCOBIX? Do not take PREZCOBIX with any of the following medicines: • alfuzosin (Uroxatral®) • cisapride (Propulside®, Propulsid® Quicksolv) • colchicine (Colcrys®, Mitigare®), if you have liver or kidney problems • dronedarone (Multaq®) • ergot-containing medicines: • dihydroergotamine (D.H.E. 45®, Embolex®, Migranal®) • ergotamine tartrate (Cafergot®, Ergomar®, Ergostat®, Medihaler®, Migergot®, Wigraine®, Wigrettes®) • methylergonovine (Methergine®) • lovastatin or a product that contains lovastatin (Altoprev®, Advicor®, Mevacor®) • lurasidone (Latuda®) • midazolam (Versed®), when taken by mouth • pimozide (Orap®) • ranolazine (Ranexa®) • rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®) • sildenafil (Revatio®), when used for the treatment of pulmonary arterial hypertension (PAH) • simvastatin or a product that contains simvastatin (Simcor®, Vytorin®, Zocor®) • St. John’s Wort (Hypericum perforatum), or a product that contains St. John’s Wort • triazolam (Halcion®) Serious problems can happen if you take any of these medicines with PREZCOBIX. What should I tell my healthcare provider before taking PREZCOBIX? Before taking PREZCOBIX, tell your healthcare provider if you: • have liver problems, including hepatitis B or hepatitis C • have kidney problems • are allergic to sulfa (sulfonamide) • have diabetes • have hemophilia • have any other medical condition

IMPORTANT PATIENT INFORMATION • a re pregnant or plan to become pregnant. It is not known if PREZCOBIX will harm your unborn baby. Tell your healthcare provider if you become pregnant while taking PREZCOBIX. • Pregnancy Registry: There is a pregnancy registry for women who take antiretroviral medicines during pregnancy. The purpose of the 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. • are breastfeeding or plan to breastfeed. Do not breastfeed if you take PREZCOBIX. • You should not breastfeed if you have HIV-1 because of the risk of passing HIV to your baby. • It is not known if PREZCOBIX can pass into your breast milk. • 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 over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with PREZCOBIX. Keep a list of your medicines to show your healthcare provider and pharmacist. • You can ask your healthcare provider or pharmacist for a list of medicines that interact with PREZCOBIX. • Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take PREZCOBIX with other medicines. How should I take PREZCOBIX? • Take PREZCOBIX exactly as your healthcare provider tells you. • Do not change your dose or stop taking PREZCOBIX without talking to your healthcare provider. • Take PREZCOBIX 1 time a day with food. • If you miss a dose of PREZCOBIX by less than 12 hours, take your missed dose of PREZCOBIX right away. Then take your next dose of PREZCOBIX at your regularly scheduled time. • If you miss a dose of PREZCOBIX by more than 12 hours, wait and then take the next dose of PREZCOBIX at your regularly scheduled time. • If a dose of PREZCOBIX is skipped, do not double the next dose. Do not take more or less than your prescribed dose of PREZCOBIX at any one time. • If you take too much PREZCOBIX, call your healthcare provider or go to the nearest hospital emergency room right away. What are the possible side effects of PREZCOBIX? PREZCOBIX may cause serious side effects including: • See “What is the most important information I should know about PREZCOBIX?” • Diabetes and high blood sugar (hyperglycemia). Some people who take protease inhibitors including PREZCOBIX can get high blood sugar, develop diabetes, or your diabetes can get worse. Tell your healthcare provider if you notice an increase in thirst or urinate often while taking PREZCOBIX. • Changes in body fat can happen in people who take HIV-1 medications. The changes may include an 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 new symptoms after starting your HIV-1 medicine. • Increased bleeding for hemophiliacs. Some people with hemophilia have increased bleeding with protease inhibitors including PREZCOBIX. The most common side effects of darunavir, one of the medicines in PREZCOBIX, include: • diarrhea • nausea • rash • headache • stomach area (abdominal) pain • vomiting Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all of the possible side effects of PREZCOBIX. For more information, ask your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store PREZCOBIX? • Store PREZCOBIX tablets at room temperature between 68°F to 77°F (20°C to 25°C). Keep PREZCOBIX and all medicines out of reach of children. General information about PREZCOBIX Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use PREZCOBIX for a condition for which it was not prescribed. Do not give PREZCOBIX to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about PREZCOBIX that is written for health professionals. For more information call 1-800-526-7736. What are the ingredients in PREZCOBIX? Active ingredients: darunavir and cobicistat Inactive ingredients: colloidal silicon dioxide, crospovidone, hypromellose, magnesium stearate, and silicified microcrystalline cellulose. The tablets are film-coated with a coating material containing iron oxide black, iron oxide red, polyethylene glycol, polyvinyl alcohol (partially hydrolyzed), talc, and titanium dioxide. Manufactured by: Janssen Ortho LLC, Gurabo, PR 00778 Manufactured for: Janssen Therapeutics, Division of Janssen Products, LP, Titusville NJ 08560 Issued: January 2015 © Janssen Pharmaceuticals, Inc. 2015 027415-150108

THE BARBERSHOP DIARIES

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A DIAGNOSIS BECOMES A RALLYING CALL Fredy Ceja has advocated tirelessly for those with HIV. Now he’s expanding his reach

hen Fredy Ceja tested positive for HIV nine years ago, he didn’t run away from his diagnosis; in fact, he did the opposite. A Los Angeles native, Ceja dove head first into activism. He got a job at Bienestar, an organization that assists Latinos affected by HIV and AIDS. In 2009, Ceja was featured in the Soy/I Am video campaign, a partnership between the Kaiser Family Foundation and Univision aimed at reducing HIV stigma among Latinos and putting a face on the disease. He also served on the California HIV/ AIDS Planning Group, the Latino advisory board to the California Office of AIDS, the Los Angeles County HIV Commission, and the boards of the Wall Las Memorias Project and the Latino Equality Alliance, advocating for Latino LGBT rights. Raised in a single-parent household with six siblings, Ceja earned enough money selling churros during lunch as part of a high school leadership club to visit Washington, D.C. That visit to “what seemed a foreign land” jump-started his love of politics. Soon afterward, he became the first person in his family to attend college, eventually graduating from California State University, Los Angeles. He was hired as a senior field deputy for California Assembly member Gilbert Cedillo and served in the position until Cedillo was term-limited out of office at the end of 2012. The next year, Ceja went to work as a consultant to California State Senate President Pro Tempore Darrell Steinberg. He was open about his HIV status early on, but it raised eyebrows in political circles, he admits. “People were respectful of the fact that I was open about it,” he recalls. “Even if they didn’t want to know about it, they had a minor understanding of HIV.” It’s a bit different now. In part because, among other duties, he promotes HIV services, his status doesn’t raise any eyebrows among his coworkers. Today, Ceja’s mission is focused entirely

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on health, though it’s broadened beyond HIV. As the director of public affairs for St. John’s Well Child and Family Center, a nonprofit community health center serving low-income Los Angeles residents, Ceja deals with everything from diabetes to transgender health issues. His job is both “making sure people know what [St. John’s is]…and building capacity within the community for people to advocate for their own health.” A typical day for Ceja now involves “a lot of meetings,” he says with a sigh and a laugh. His demanding job doesn’t leave much time for other pursuits, though Ceja is active with his Cal State alumni group and remains in a leadership position at the nonprofit cultural organization Plaza de la Raza, helping oversee services for needy preschool children. Although Ceja works with children in this capacity as well as at St. John’s, he doesn’t—yet—have any of his own. “I have 23 nieces and nephews, so I’m busy in that regard,” the 35-year-old says. “I think my mom’s waiting for me to knock out a few kids.” And as a busy professional, this public affairs director still finds time to talk about HIV, whether it’s at work, at Cal State events, or even at the barbershop. He admits that before he received his diagnosis, he too was ignorant about the realities of life with HIV. Now, so clearly focused on the present, Ceja marvels a bit recalling his reaction to finding out he was positive nearly a decade ago. “[Before being positive] I didn’t even want to deal with the issue. When I became positive, it was just a complete 180-degree change,” he says. “I had to become a voice for people in my situation. I had to discuss what was going on in my community. I’m actually glad it happened because I felt so disconnected from my community. Now I choose to give back.” ✜

COURTESY CE JA

By Neal Broverman

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