HIV Plus Issue 109 November/December 2015 by Pride Media

WORLD AIDS DAY 2015

BECAUSE YOU’RE MORE THAN YOUR STATUS

CONTROVERSIAL RAPPER & ARTIST

MYKKI BLANCO COMES OUT AS POZ

NOVEMBER / DECEMBER 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 can also 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 whose healthcare provider determines that they meet certain other requirements. 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? STRIBILD 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 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. • 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, carbamazepine, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, phenobarbital, phenytoin, rifampin or the herbal supplement 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? Serious side effects of STRIBILD may also include: • 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. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones. • Changes in body fat can happen in people taking HIV-1 medicines. • Changes in your immune system. Your immune system may get stronger and begin to fight infections.

Tell your healthcare provider if you have any new symptoms after you start taking STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking STRIBILD? • All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, bone, or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking STRIBILD without first talking with your healthcare provider. • If you take hormone-based birth control (pills, patches, rings, shots, etc). • If you take antacids. Take antacids at least 2 hours before or after you take STRIBILD. • If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in STRIBILD can pass into breast milk, and it is not known if this can harm the baby. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Brief Summary of full Prescribing Information with important warnings on the following pages. *STRIBILD is a combination of the medicines TRUVADA (emtricitabine and tenofovir disoproxil fumarate), TYBOST (cobicistat), and VITEKTA (elvitegravir).

STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD can also 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 whose healthcare provider determines that they meet certain other requirements. STRIBILD does not cure HIV-1 or AIDS.

I started my personal revolution Talk to your healthcare provider about HIV-1 treatment. STRIBILD is a complete HIV-1 treatment in 1 pill, once a day that combines the medicines in TRUVADA + TYBOST + VITEKTA.* Ask if itâ&#x20AC;&#x2122;s right for you.

www.STRIBILD.com

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:

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®) • carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®) • cisapride (Propulsid®, Propulsid Quicksolv®)

• have trouble breathing

• 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®)

• have stomach pain with nausea or vomiting

• lovastatin (Advicor®, Altoprev®, Mevacor®)

• feel cold, especially in your arms and legs

• midazolam, when taken by mouth

• feel dizzy or lightheaded

• phenobarbital (Luminal®)

• have a fast or irregular heartbeat

• phenytoin (Dilantin®, Phenytek®)

• feel very weak or tired • have unusual (not normal) muscle pain

What should I tell my healthcare provider before taking STRIBILD?

• 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. 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:

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.

• See “What is the most important information I should know about STRIBILD?”

• If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take 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.

- You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

• 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.

- 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: • Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Some medicines may interact with STRIBILD. Do not start any new medicines while you are taking STRIBILD without first talking with your healthcare provider. • Do not take STRIBILD with any products that contain the herbal supplement St. John’s wort. • If you take a medicine for indigestion (antacid) that contains aluminum and magnesium hydroxide or calcium carbonate, take it at least 2 hours before or after you take STRIBILD. 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: July 2015

GILEAD, the GILEAD Logo, HEPSERA, STRIBILD, and the STRIBILD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. © 2015 Gilead Sciences, Inc. All rights reserved. STBC0195 08/15

editor in chief DIANE ANDERSON-MINSHALL SVP, group publisher JOE VALENTINO art director BONNIE BARRETT copy chief TRUDY RING contributing editors NEAL BROVERMAN, KATIE PEOPLES, MARK S. KING, SUNNIVIE BRYDUM, JACOB ANDERSON-MINSHALL, DAWN ENNIS 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 VINCENT CARTE front end developer MAYRA URRUTIA drupal developer KEN MERRIMAN traffic manager KEVIN BISSADA 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 programmatic & yield managerADRIAN GRAHAM sr. director, audience development & consumer marketing ROBERT HEBERT director of social media LEVI CHAMBERS associate social media editor DANIEL REYNOLDS circulation director JEFF LETTIERE fulfillment manager ARGUS GALINDO operations director KIRK PACHECO los angeles office manager HEIDI MEDINA production services GVM MEDIA SOLUTIONS, LLC 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 ADVERTISING & SUBSCRIPTIONS OFFICES 120 West 45th Street, Suite 3800, New York, New York 10036-4041 Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 209-5174 • Subscriptions Fax (212) 242-8338 EDITORIAL OFFICES 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, California 90024 Phone (310) 806-4288 • Fax (310) 806-4268 • Email mail@HIVPlusMag.com DISTRIBUTE HIV PLUS FOR FREE AT YOUR OFFICE OR FACILITY HIV/AIDS service organizations, community-based groups, pharmacies, physicians’ offices, and other qualifying agencies can request bulk copies for free distribution at your office or facility. Log on to HIVPlusMag.com and select “organization copies” on the “subscribe” link at the top of the page to download a copy request form. There is a 10-copy minimum. FREE INDIVIDUAL SUBSCRIPTIONS Plus magazine is now available FREE to individual subscribers. Subscribe and get a digital copy of each magazine delivered to the privacy of your computer six times per year. We require only your email address to initiate delivery. You may also share your copies with friends. To sign up, just log on to HIVPlusMag.com and select “digital edition” on the “subscribe” link at the top of the page. NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, just email our circulation department at Jeff.Lettiere@HereMedia.com. Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. Plus is a registered trademark of Here Media Inc. Entire contents © 2015 by Here Publishing Inc. All rights reserved. Printed in the USA. WHAT’S YOUR STORY? We want to hear from you: Email us at editor@HIVPlusMag.com or write us at Plus, 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. FOLLOW US ON FACEBOOK AND TWITTER

november / december 2015

BUZZWORTHY 8 Undetectable Gets a Boost

NOVEMBER | DECEMBER 2015

A new study shows zero transmissions.

9 Put Me in, Coach!

Sometimes you need more than a cheerleader.

11 Shark Attack and Pirate Raids

One guy’s mission to raise awareness.

11 Obama’s PrEP Talk

The new White House plan to stop HIV.

16 Best Song You Missed This Year Here’s why Rachel Garlin rocks.

17 Hit the Books

Books that go from high fashion to real intimacy.

IN EVERY ISSUE 41 Barbershop Diaries

Five guys give advice to their younger selves.

44 Daily Dose: Paul Thorn

This British author explains his “HIV Happy” theory.

TREATMENT CHRONICLES 45 Will I Ever Stop Wishing for a Cure?

Our mental health editor tackles the ultimate question.

46 Just Diagnosed? How to Understand Lab Tests Definitions of CD4 and T cells, viral loads, and more.

48 Curing Hep C Gets Even Easier

Gilead’s Harvoni becomes even more popular than Sovaldi.

FEATURES 18 ON THE COVER: Magic Mykki Blanco

No man has raised more awareness about HIV in music this year than rapper Mykki Blanco, who came out about being poz in a provocative Facebook post. In our exclusive interview, the artist gets emotional talking about keeping a secret for two years, the power of being yourself, and what it means to be a musician today.

24 World AIDS Day Special: Our HIV Year in Review

A look at the year’s hottest news in HIV brings you the most up-to-date info on possible vaccines, treatments, and a potential cure.

PHOTO: JACK MANNIX COVER: PHOTO BY NATALIE WEISS

hivplusmag.com

EDITOR’S LETTER

I Want to Thank the Academy…

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

november / december 2015

The Wheaties Box We Deserve

We can’t take all the credit, but we posted this photo of Olympic diver Greg Louganis on the Wheaties box, and then a social media campaign and a Change.org petition turned our art into a movement. We spoke with Louganis after watching HBO’s Back on Board: Greg Louganis and like many were saddened to think of all the endorsements (like Wheaties) he lost out on by being a gay, HIV-positive athlete. Numerous organizations, including the Elizabeth Taylor AIDS Foundation and GLAAD, banded together to encourage General Mills to put Louganis on the Wheaties box he never received even though he broke (and still holds) many world diving records. There’s still time to protest if you’re just hearing about this: Tweet @GeneralMills with the #GetGregWheaties hashtag or switch your Facebook profile picture to his Wheaties box. The good news? Louganis has just signed with Creative Artists Agency for representation, so this may be the tide turning. Thanks for helping to #EndStigma with @greglouganis.

BRADFORD ROGNE (DIANE), TEXELART (TROPHIES)

Every World AIDS Day we come together to celebrate innovations in medicine that have advanced treatment of HIV and lowered the number of related deaths worldwide, to mourn those we’ve lost to complications of the disease, and to project what we need to do in the coming year to make real progress in the fight against HIV and AIDS. As important as the fight against HIV is the fight for people living with it—to end the stigma and misinformation they live with every single day. A 2014 study from MAC AIDS Fund of American youth ages 12-17 found that 33 percent did not know HIV is a sexually transmitted disease but half of the participants reported being more afraid of getting HIV than cancer. Only half of the teens say they’d treat a friend with HIV “normally” and 13 percent wouldn’t touch them. A 2012 Kaiser Family Foundation study found that 27 percent of Americans thought you could acquire HIV by sharing a drinking glass with someone who is positive; 17 percent thought you could catch HIV from a toilet seat; and a remarkable 11 percent still thought they could get the virus by sharing a swimming pool. That jibes with stories I heard all week at the U.S. Conference on AIDS, about folks in Mississippi, Alabama, hell, even New York City, whose families refused to eat on the same dishes or to let their children touch their poz aunties and uncles. It’s sad and alarming. We need to change that. HIV is easier to treat—and prevent—than at any other time in history, but stigma keeps people from treatment. In 2016, Plus is going to look harder at the issues that are keeping so many poz people out of treatment. And we’re going to bring you voices of people living with HIV, who are combating stigma their way. So go out, observe World AIDS Day your way, and start thinking about what we need to do in 2016 to knock stigma out!

It’s been a phenomenal year for Plus magazine and our sister brand The Advocate, with a number of awards piling up. The latest: Josh Robbins— who launched his digital series, HIV Video Minute on our website in 2014 and took it wide on his own blog, I’m Still Josh—just won the ADAP Advocacy Association’s Leadership Award for Best Social Media Campaign.” (You can find his videos at HIVPlusMag.com/hiv-plus-video-minute.) Even more exciting: The Marguerite Casey Foundation has announced the recipients of the 2015 Equal Voice Fellowship, which goes to journalists who are investigating and reporting on critical poverty issues in underserved communities, and we were on the list! Plus contributing editor Jacob Anderson-Minshall beat out dozens of other journalists for his upcoming series examining the intersection between poverty, race, sexual orientation, gender identity, and HIV. The fellowship is small, but it’ll fund his travel to meet with interviewees and his research needed to focus on the criminalization of HIV, the role incarceration plays in HIV transmission, the link between depression and HIV, and trans women with HIV. His work will appear in the March/April 2016 issue of Plus and on our website as well, so stay tuned!

NOW SHOWING AT

WWW.HIVPLUSMAG.COM

YURIY VLASENKO (PLAY BUTTON)

Check out one of these awesome videos online this month

What happens when a poz man asks for a hug? Possibly the most moving video we’ve seen all year. Grab a hanky and go to http://bit.ly/1GIVPKM

A musical comedy for anyone who is gay and poz Like Kimmy Schmidt? You’ll like Merce, about a middle-aged HIV-positive guy in New York City. Watch now at http://bit.ly/1LrB90V

Stag Condoms’ hilarious new ad for its gay condom had us smiling all day. Never leave your backdoor unprotected. Check it out at http://bit.ly/1J1LGQJ

A Madonna parody about condoms? Hell yes! It’s smart, sexy, and inclusive with lyrics that proclaim whether you’re poz or not, “We’re all clean!” Watch now at http://bit.ly/1hbwJ2y

OOPS! In our September/October issue a couple of people in our article “The Missing Generation” were misidentified. In the second photo, that’s actually Ron Swada on the right, an activist in Washington, D.C., who has lived with HIV for over 30 years. And in the third photo that’s actually Javon Egyptt, a longtime trans activist who spoke from her hometown of New York City. Sorry!

hivplusmag.com

B UZZWORTHY

Undetectable From Treatment = Zero Transmissions

Research shows probability of HIV transmission is zero if you’re suppressed on antiretroviral treatment A groundbreaking study on antiretroviral treatment has shown that the drugs can disable HIV and stop sexual transmission. The randomized study of 1,700 couples, conducted by the University of North Carolina-Chapel Hill, confirmed findings released in 2011 that indicated treatment could prevent transmission of HIV if it is taken reliably. When medications can suppress HIV to the point that it is undetectable, it can prevent transmission to a sexual partner. The catch, though, is patients must adhere to treatment, as going off antiretrovirals will cause the virus to reemerge. In the U.S., there are 1.2 million people living with HIV, but only 37 percent of them are on antiretroviral therapy, a.k.a. ART. “If people are taking their pills reliably and they’re taking them for some period of time, the probability of transmission in this study is actually zero,” Myron Cohen, chief of the Institute of Global Health and Infectious Diseases at UNC, told Raleigh’s News & Observer. “Let me say it another way: We never saw a case of HIV transmission in a person who is stably suppressed on ART.” —Katie Peoples

Texas Tragedy Since his early 20s, Jesse Jacobs suffered from debilitating panic attacks, depression, and general anxiety disorder. To treat his severe mental health issues, his psychiatrist prescribed him several medications, including Xanax. The cocktail of meds helped Jacobs throughout his 20s, enabling him to eventually graduate college and begin a career. But when the 32-year-old gay man turned himself in to Texas’s Galveston County Jail earlier this year to serve a two-week sentence for driving while under the influence, he wasn’t allowed his prescription Xanax. Even after he showed severe symptoms of withdrawal from the drug—for which he had a prescription from his psychiatrist— he still didn’t get his meds. Shortly after entering the jail, Jacobs began suffering seizures. In six days, he was dead. Jacobs’s parents now want answers and are preparing to file a lawsuit against jail officials, and mental health experts are advocating for reform. Jacobs’s psychiatrist

november / december 2015

confirmed to the Houston Press that abruptly cutting off a Xanax regimen could result in deadly seizures. After his first convulsion, jail nurses did not send Jacobs to a doctor; instead they gave him liquids and ammonia capsules. He was taken to a medical clinic after another seizure, then returned to the jail. After a third seizure he was taken to a hospital, where he died. There are conflicting reports surrounding Jacobs’s condition right before his death, as police have given different versions. Some say medical personnel found him in his cell, unresponsive; another says he collapsed when he was being administered medication, though it was not his Xanax. There is no disagreement that Jacobs was denied Xanax, but Galveston jail officials say the young man died of a non-drug-related seizure disorder, even though Jacobs himself told a nurse that he had no history of seizures before arriving at the jail.

“Most county jails have a formulary that they use to prescribe drugs, and almost [all] of them do not include Xanax,” Matt Simpson of the American Civil Liberties Union’s Texas affiliate told About magazine. “Jails often fail to identify with withdrawal symptoms, and it can be deadly. The sheriff has every right to intervene when there is a medical condition, and he should have before this young man’s cardiac arrest occurred.” The Galveston County Jail was cited six years ago for “not dispensing medications as ordered by a doctor.” —Neal Broverman

SHUT TERSTOCK/HALIMQ(BOT TOM PILL); SHUT TERSTOCK/PANICAT TACK (TOP TEXTURE)

A young gay man was denied his medications in jail and paid the ultimate price

Breaking Free When you have HIV, you may need more than a cheerleader. You need a coach

To some, the phrase “life coach” evokes images of affluent people frivolously spending money on a yes-man to tell them what they want to hear—validation for those who can afford it. But Christian Hutchinson is seeking to change that notion. The HIV-positive, Orlando, Fla.–based life coach helps other poz people, especially those who are newly diagnosed, navigate through the all negativity in their lives. “The reality is there are many circumstances in life we can’t change or control,” says Hutchinson, who has lived with HIV for over 20 years. “The one thing we can control is how we respond to them.” He says that life’s biggest challenges often offer up the opportunity to redefine our priorities and get clear on how we want to spend our time and who we want to spend it with. “But if we are stressed by our circumstances or we’re living by old priorities, it can be very difficult to move forward,” Hutchinson adds. Coaches help people with HIV navigate through all this efficiently and make sustainable changes in how they approach life. He works with clients to help them understand the impact their thoughts have and “how to break away from those that drain their energy and know how to focus on the ones that help them to design the life they want and be their own source of positivity instead of relying on outside sources for that feeling,” he says. But don’t be fooled into thinking life coaching is just talking about feelings. According to Hutchinson, the secret to his particular brand of coaching HIV-positive clients all starts with the awareness of the impact of choices, actions, and thoughts. “We identify what it is the client wants and the obstacles, both internal and external, that are holding them back. From there, we use a variety of approaches and accountability to overcome those obstacles,” he says. “With HIV, as with any chronic illness, people are often faced with making different lifestyle choices they need to implement. This requires behavior change. The greatest challenge to implementing new behaviors is stress. It messes with the wiring of the brain and impacts our ability to create sustainable changes. The sooner we can start reducing the stress and overwhelm, the more ability clients have to make the changes that will support their well-being.” And through his work, Hutchinson not only helps others but learns a lot about himself. The coach says that each client he helps also expands his own way of thinking about all aspects of living. “Coaching helps me to be stronger in my own values and purpose in life,” he says. “It reminds me that my journey may not be the same as my neighbors’ and to be OK with this truth.” Still, it’s his partner of 27 years, Tim, who is his “inspiration and my unspoken hero,” he says. “He has stood with me for nearly 27 years, with 20 of those years living courageously as a partner to someone living with HIV. He remains HIV-negative to this day.” —Raffy Ermac

Rapper Mykki Blanco’s unapologetic declaration that he is HIV-positive continues a tradition of black LGBT artists challenging stigma, says Charles Stephens (left), founder of the Counter Narrative Project, a black gay advocacy group. “Much of the history of HIV activism is also the history of artists. They were able to create the messages, imagine the tactics, and in many ways provide the poetry for the movement,” he told The Daily Beast. Stephens added that Blanco’s attitude reminds him of black gay activist Craig G. Harris’s 1991 essay “I’m Going Out Like a Fucking Meteor,” which concludes, “I want to live the rest of my life with an energy that ignites and irritates, burns and bubbles, soothes and inspires until it bursts from this atmosphere, dissipating into the cosmos.”

The World Health Organization has released the results of a meta-analysis of data from 15 different countries showing that transgender women were nearly 49 times more likely to have HIV than the general population. Transgender women who were also sex workers were also nine times more likely to have HIV than trans women who were not sex workers, making them the most likely group to have HIV in the world. JoAnne Keatley, a transgender woman who works at the Center for Excellence for Transgender Health at University of California, San Francisco, told NPR that trans women had shockingly high risk of HIV because of discrimination and lack of health care. “We see this repeated all over the world,” Keatley said. “Transphobia is alive and well in many societies around the globe. And we see it play out in terms of verbal and physical violence as well as denial of employment or education or familial support, or all kinds of ways in which transgender people are marginalized.” —Katie Peoples

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SHUT TERSTOCK/OLLYY (WOMAN); DONALD AGARRAT (STEPHENS)

Transgender Women 49 Times More Likely to Contract HIV

Shark Attack, Pirate Raid, and HIV Awareness? Victor Mooney’s nearly 5,000-mile rowing trek A New York man has made it back home after months rowing a one-man boat from Africa to the U.S. in order to raise HIV awareness. Victor Mooney had made three earlier attempts to cover the 5,000 miles between Africa and New York. His first attempt, in 2006, ended with his homemade boat sinking; the second, in 2009, had to be aborted when his fresh water system failed; in 2011 he ended up spending 10 days in a lifeboat after the main vessel took on water. His effort, known as the Goree Challenge (GoreeChallenge.com), is a project of South African Arts International, whose mission is to promote multimedia events, facilitate worldwide cultural understanding, and to increase awareness of the global pandemic of HIV and AIDS. His latest attempt began in February 2014. Mooney began his journey off the coast of Africa in the Canary Islands and did not have an easy trip. During more than 100 days at

sea, Mooney has endured a shark attack, being raided by Haitian pirates, and losing close to 100 pounds. “I never gave up,” Mooney told a North Carolina TV station during a stop off the coast of that state over the summer. “With the Heavenly Father with me, I’m just asking for continued permission to continue this row.” Mooney has had two brothers who are HIV-positive. One died of AIDS-related complications in 1983. His other brother has been living with HIV for 20 years now. “This is a mission that I’ve embraced,” Mooney told the station, WCTI. Mooney remains focused on the reason for his voyage: raising awareness (and money) for an HIV cure. So far his efforts have garnered international attention and the support of numerous corporate sponsors, including Energizer, FIFA, Right Guard, and FedEx. — Jacob Anderson-Minshall

PrEP Talk

GE T T Y/CHRISTIAN DRAGHICI (MOONEY); GE T T Y/SEYLLOU (FIST)

Obama’s ambitious plan to fight HIV has raised eyebrows The next stage of the Obama administration’s 10-year plan to treat and prevent HIV in the United States calls for “full access to pre-exposure prophylaxis services.” Both the Centers for Disease Control and Prevention and World Health Organization recently came out with recommendations for the widespread use of PrEP among certain at-risk groups, so a White House mandate could go far in promoting it. But what exactly is meant by “full access?” Will the federal government start funding PrEP nationwide? Sources within the White House tell Plus the answer is categorically no. The administration has no plans to guarantee or in any way fund full access to PrEP, but officials do want to make access to the prevention strategy over the next five years a “clear priority” for both federal and local governments and organizations. An administration official clarified that the president’s updated strategy is for PrEP to be made readily available to every patient fitting the guidelines issued by the CDC. Yet even in the clarification, officials were short on exactly how that would happen—and who would fund it. “This call for full access to comprehensive PrEP services encompasses more than just access to the daily pill,” says the official, “but also includes important components such as access to regular med-

ical visits—including HIV and STI screening—as well as wraparound services that help with treatment adherence.” Truvada, a drug also used in HIV treatment, is the only drug approved to date for use as PrEP. The problems, say health advocates, are multiple. Many of those at risk for HIV complain they are not being offered PrEP by their medical providers, feel too stigmatized to request it, or are denied it even if they do. More important, the cost of PrEP can be prohibitive for those without insurance or whose insurers either don’t cover Truvada for PrEP or have extremely high co-pays. Douglas M. Brooks, director of the Office of National AIDS Policy, says HIV “remains a major health crisis for the United States” and that President Obama’s HIV strategy for the next five years will continue what the administration has already done, not just at the federal level but nationwide, with state, local and private organizations. Among its goals: widespread PrEP access, earlier and more widespread HIV testing, expanded treatment in the hard-hit South, and viral suppression for those who are poz. The cost? Obama has asked Congress for a $1.2 billion increase over last year’s budget, for a total of $25.3 billion in domestic HIV spending. How much of that will fund PrEP access, after Congress has signed off on the cash? No comment. —Dawn Ennis hivplusmag.com

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SERIES

PEOPLE YOU KNOW

Most Overlooked Song About a Poz Person This Year After coming of age during the height of the AIDS crisis and losing three of her beloved teachers to the disease, San Francisco folk-rock storyteller Rachel Garlin pays musical tribute to famed artist Keith Haring, who died of AIDS-related complications in 1990, with her sweet, folksy, guitar-filled tune, “Hey Keith Haring” on her new album, Wink at July. Now a teacher herself and a touring musician, Garlin (who is raising two kids with her wife) lets her voice do as much talking as the lyrics, which strike a chord, especially for people who grew up at a time when little was known about the disease. —R.E.

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HERETV.COM

KEITH HARING POLAROID BY ANDY WARHOL VIA WIKIMEDIA COMMONS

NEW SERIES

Reading Rainbow Three new books offer inspired reads

Alexander McQueen: Blood Beneath the Skin by Andrew Wilson Although he is remembered the world over as one of the most brilliant minds in fashion, Alexander McQueen was also a man living with HIV, a topic discussed in-depth in award-winning journalist Andrew Wilson’s new biography of the late artist, Alexander McQueen: Blood Beneath the Skin. Wilson’s volume, published by Scribner, has already been met with plenty of accolades in the U.K. and explores the inner workings of McQueen’s career and personal life through his relationships with loved ones and the power of the women in his life. With details collected from interviews with McQueen’s surviving family members, Blood Beneath the Skin gives readers an unprecedented look into the life and times of one of fashion’s most complicated figures and all the events that led to his tragic suicide in February 2010. Wilson portrays McQueen as not only a genius but also a human being grappling with HIV, a history of abuse, and the same complicated emotions we all feel from time to time.

If You Feel Too Much by Jamie Tworkowski While too many self-help books offer vague and useless advice that leaves readers feeling confused, If You Feel Too Much serves up real-world anecdotes that make you realize struggle is part of the universal human experience. The debut effort by Jamie Tworkowski, founder of the famed suicide-prevention organization To Write Love on Her Arms, If You Feel Too Much is a collection of essays delving deep into many emotions that we regularly feel but too often ignore. Whether you’re dealing with a major loss or searching for inspiration, there is definitely an entry in Tworkowski’s book that will tug at your heartstrings (in a good way). The most notable of these entries is the 2006 essay “To Write Love on Her Arms,” which inspired the founding of his organization. At age 35, Tworkowski exudes wisdom beyond his years, and If You Feel Too Much is proof of that.

Love Together: Longtime Male Couples on Healthy Intimacy and Communication by Tim Clausen One of the biggest challenges many couples—gay or straight—face when they first get married is how to keep their relationship healthy and thriving for many years down the road. While there is obviously no single answer, Tim Clausen’s newest book seeks to help answer a question that plagues so many men who date men: How do we stay together over the long term? Featuring real-life success stories of male couples who have been together for 20, 30, and more than 40 years, Love Together gives readers an honest look at what it’s really like to be (and stay) in a monogamous relationship. In an age of rapidly increasing separation and divorce rates, keeping the intimacy and communication going in your love life is critical, and Love Together can help show you how. —Raffy Ermac

Visual AIDS’ Day With(out) Art Day With(out) Art began December 1, 1989, as a national day of action and mourning in response to the AIDS crisis. To make the public aware that AIDS can touch everyone, and inspire positive action, some 800 U.S. art and AIDS groups participated in the first Day Without Art, shutting down museums, sending staff to volunteer at AIDS service organizations, or sponsoring special exhibitions of work about AIDS. Since then, Day With(out) Art has grown into a collaborative project in which an estimated 8,000 national and international museums, galleries, art centers, HIV service organizations, libraries, high schools, and colleges take part. VisualAIDS.org hivplusmag.com

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ykki Blanco is a rapper and performance artist who is known to his thousands of fans as a gender-bending rebel, someone who is unafraid to be himself and push boundaries in an industry that often demands conformity. A music video for one of his early songs, “Wavvy,” went viral, racking up over 1.5 million views to date, because it exemplifies this ethos. In the 2012 clip, Blanco raps as two different characters: the first, a shirtless thug trying to evade police capture; the second, a fabulous wigged and lipsticked entertainer singing in a posh nightclub. “Oh this fag can rap? Yeah, they saying that. They listening,” Blanco lyricized about his entrée into a music scene known for its homophobia. But unbeknownst to his fans, who praised him for being “brave” and having the “makings of a gay icon,” Blanco, whose birth name is Michael David Quattlebaum Jr., was living a different double life from the one depicted in his videos and concerts. For years, Blanco was closeted about being HIV-positive. The coming-out process is difficult for any HIV-positive person. Many feel shame and fear the reactions of friends, family, acquaintances, possible romantic partners, and society, which still stigmatizes those who have contracted the virus. For public figures, particularly those in the music industry, these problems are amplified. Coming out as positive becomes public record and a feature of news coverage. Attacks rooted in stigma can come from all angles, particularly in a world with social media, where anyone can post or tweet a hateful remark. In addition to harassment, there’s also the financial threat of the loss of a fan base and, ultimately, one’s livelihood. For these reasons, hardly any living musicians are out as HIVpositive. There are exceptions—British New Wave artists Holly Johnson (Frankie Goes to Hollywood) and Andy Bell (Erasure), indie singer-songwriters John Grant and Byron Keith, and Styx bassist Chuck Panozzo. But all of these performers are white rockers and, for the most part, came out after having achieved success in their field. Although he has achieved success—eight music videos, three EPs, three world tours, and the opportunity to open for A-list talent like Björk—Blanco feels like he is still in many ways just getting started. And the path ahead is uncharted. There are no major rappers or hip-hop performers who are out as HIV-positive. One of the most prominent to have lived with the virus, Eazy-E, whose story is depicted in the new film Straight Outta Compton, died of AIDS-related complications a month after his diagnosis. Before his death, Eazy-E, who identified as straight, came out to his fans in a letter in order to raise awareness about HIV and how it is spread. He sought, in his own words, “to turn my own problem into something good that will reach out to all my homeboys and their kin, because I want to save their asses before it’s too late.… I have learned in the last week that this thing is real, and it doesn’t discriminate.” Eazy-E died in 1995. Twenty years later, and there are still no black musicians who speak publicly about having HIV. Except for Blanco. He came out on Facebook this year during Pride season, a time when the LGBT community celebrates its identity. “I’ve been HIV-Positive since 2011, my entire career. Fuck stigma and hiding in the dark, this is my real life. I’m healthy I’ve toured the world 3 times but I’ve been living in the dark, it’s time

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to actually be as punk as I say I am,” Blanco wrote, and followed it with another comment: “No more living a lie. HAPPY PRIDE.” When Blanco posted this note, he did not anticipate the reaction he would receive. Over 12,000 people liked the post, and over 700 shared it. News of it went viral, and the story was covered both in LGBT media outlets, including The Advocate, and mainstream media, such as Time. “I did it on this whole emotional whim,” Blanco says of his coming-out. “But I think afterwards, when Newsweek and Time magazine—who have never heard of me before—are writing about it, I’m like, ‘Oh, wait, maybe it’s been a while since someone’s done this.’ ” When he’s asked how it feels to have such a secret off his chest, Blanco’s voice, which had previously been upbeat and energetic, becomes thick with emotion. “I actually feel like a good person. And I don’t think I had felt like a good person in a really long time,” he says, before breaking down in tears. Although the 29-year-old performer had come out as HIVpositive on a “whim,” Blanco admits he had been struggling with the emotional burden of his silence for years. He remembers how bleak his outlook was when he first received his diagnosis. “I thought the world was over,” he recalls. However, he says, “I was not entirely surprised because I knew what I was doing in that period of my life—it was a very dark period—and I knew what I was doing to contribute to the high-risk behavior that led to it happening.” Blanco, a survivor of child abuse, now understands that the cruelty he experienced then led to his taking actions that endangered his physical health, such as having risky sex with multiple partners. At the time, he suffered from “feelings of low self-worth,” of “never being good enough,” and a “sense of abandonment,” and he sought “emotional love through physical love.” He describes his mind-set at the time as “obliviousness, when you want to be loved so bad that you start taking careless risks.” For a year after learning he was positive, Blanco was afraid to have romantic partners, and he kept the news of his status to himself. “The best way to keep a secret is to tell no one,” he says. His mantra was a lesson learned from his childhood in the gossipfueled South, specifically North Carolina, where he lived until he was 16. It took two years before Blanco told his mother, who had raised him single-handedly, and he did it in “the worst possible way… [during] a heated argument.” “The reason I didn’t tell my mother for so long is because I didn’t think she’d be able to handle it,” says Blanco, who remembered her warnings about HIV and the importance of safe sex. “I think that for a lot of mothers who end up having gay sons, that is a fear.” However, he found the reverse to be true. Although there were tears and an initial period of uncertainty, Blanco’s mother called him about a week later with a reassuring message. “I’ve been doing a lot of reading. I’ve been doing a lot of praying. You’re gonna be OK,” Blanco recalls his mom telling him. And she made sure of it. She took charge of his health care and treatment, ensuring he made all of his medical appointments, which he admits he had been inconsistent in keeping before her support. “I’m so glad I told her,” he says. But even with support from his family, Blanco lived in a state of anxiety about his status and the social stigma attached to it.

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He worried that those he had sex with and disclosed his status to might tell the world he is HIV-positive and ruin his music career. As a result, he sketched plans in his head—he would be closeted about it until he was 40 years old, he reasoned, or at least until he made a certain amount of money (the roving dollar figure somewhere in the millions). Depressed, he would sometimes tweet to his fans that he was considering leaving the entertainment world for, say, a career in journalism, a field away from the limelight where he could use his skills as a writer and activist. As time went on, however, he realized that he could no longer keep a secret that he felt contradicted the punk ethos for which he publicly stood. To the world and to his fans, Mykki Blanco was a queer pioneer who was unafraid of challenging gender norms and defying conventions. Blanco had never had to come out about his sexual orientation. “Everyone always knew I was gay. My father told me he knew I was gay when I was 3 years old,” he says. After a lifetime of transparency, the thought of staying in a closet about his HIV status, when he was perceived as so out and proud, was untenable. Moreover, he felt like it violated a trust with his fans. “How shitty and how deceived would they feel if, 20 years from now, they found out I was HIV-positive but I was too afraid of the stigma to come out about it?” he asks. “What kind of fraud would I have been to all the people that supported me? All the people that are trans and positive? Who are gay and positive? Who have supported me and bought my music and come to my shows? I couldn’t be honest with myself enough, to love myself enough, [so] that self-love could then be encouragement or inspiration to them? No, no, no. Honestly, truthfully, I think I have too much integrity for that.” Beyond his career, his relationship with his fans, and his public life, however, there was another factor that propelled Blanco to come out as HIV-positive. “I did it for love. I did it for myself,” he asserts. “At a certain point, my real life has to be more important than this career. And at a certain point, my own happiness and my own loneliness, it overcame me.” He’s looking for the same thing we all are. “I want real love in my life. I don’t want love at 3 a.m.,” he says, pointing to lonely, late-night searches for romantic connections on hookup apps like Grindr. “I want someone who knows. I want positive guys who are positive to know that I am positive, so that they can approach me and that we can talk and there can be no awkwardness. I want negative guys to know so that I don’t have to have that awkward conversation with them anymore. Or if they

really do like me, they know what they’re getting into.” It also means setting new boundaries at home and while on tour. “I had made this rule for myself: I can’t hook up with groupies on tour,” he says. “But then I found myself in Berlin or in different countries or in bathhouses or part of a culture that I don’t condemn, but…that is not healthy for me. And so, I was like, You know what? I don’t want to be this person anymore.” In addition, Blanco’s decision to come out came from a place of defiance against a world that told him from the onset that as “a gay black cross-dresser from a single-parent home, that I was not going to be able to be shit.” Bracing for “another wave of stigmas,” he made the following resolution: “Guess I’m gonna have to do what I do best, which is challenging people’s expectations of what my limitations are going to be.” Surprisingly, a source of strength for Blanco was the Kardashians, the ubiquitous reality TV family who have built a media empire through living their lives openly. In particular, Caitlyn Jenner—the former Olympian who came out as transgender earlier this year to much fanfare—became a “symbol of hope” to Blanco. “Good God. That took so much courage,” Blanco says of Jenner’s decision to come out at the age of 65. Although he worries about Jenner’s impact on public perceptions of transgender people—as a wealthy conservative, she is the farthest thing from typical trans women, who face economic discrimination, violence, and an HIV rate nearly 50 times higher than that of the general population—he says that witnessing someone tell the story of decades suffering in the closet “gave me the push to come out.” Throughout his journey, Blanco has also heeded the wisdom of the matriarch of the Kardashians, Kris Jenner, who as a mother cried after learning of her daughter’s sex tape in 2007, and as her manager realized, “All I knew was that I had to make some lemonade out of these lemons fast. Real fast,” as she would later tell the tabloid press. There have been more than a few sour notes in the public reaction to Blanco’s coming-out. He speaks with exasperation of the “click-bait” headlines wondering if his fans will turn on him, a pair of comedians speculating on YouTube if his coming-out was a publicity stunt, and his frustration knowing that thousands of people who had never heard his music or understood his art were now judging, commenting on, and spreading misinformation about him. But he’s learned to take it with a grain of salt. “I realize now that as my profile raises, I am going to start to have to understand that people will say ugly things, and that I’m not just in my little artsy community of people that understand what I’m doing, or in the indie world,” he says. His profile has indeed risen in 2015. For the first time in his hivplusmag.com

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career, he signed with a label this year, !K7 Records, which will give his music an international reach. Blanco has even launched his own imprint on the label, Dogfood Music Group, which seeks to “disrupt” the “singular image of ‘African-American music’” in media, according to its mission statement. His decision to come out as HIV-positive also earned him the admiration of !K7’s CEO, Horst Weidenmuller, who lost his brother to an AIDS-related illness in the 1980s. “Mykki, you’re making such a political statement,” he told Blanco, though the rapper downplays his own impact still. An assertion that Blanco is saving lives by coming out elicits nervous laughter from the artist. “You think so?” he says. “I don’t know about that. I don’t think I can take that on yet.” But in many ways, he has already taken on that fight. Although Blanco initially feared becoming the “new poster child” for HIV, with requisite tours, lectures, and visits to hospitals, the process of coming out has enlightened him to the power of his voice and his visibility. “It’s felt so liberating,” he remarks. “I find myself wanting to talk about it in a way that I never did.” For Blanco, social media—the space where he came out— remains an essential forum for education and tearing down stigmas that surround those who live with the virus. It has been a learning experience for him as well. He recalls one instance where he temporarily fell into “a K-hole of insecurity” over whether or not to post a sexy picture of himself online, in part because he feared the judgments of those who would see it as perpetuating the behavior that led to his infection. After an hour, he brushed these concerns aside. He posted the image along with an empowering message to others. “Being HIV-positive doesn’t mean you don’t get to feel sexy or free or liberated,” he wrote. “It doesn’t silence you from talking about sex or having sex. Be safe. Be conscious. Be aware. But don’t let society make you feel like you can’t be sexy, or ashamed for being sexual. Stay safe. Stay free.” Societal stigma toward HIV-positive people is one of Blanco’s greatest sources of outrage. “35 million people” is a phrase he repeats throughout his interview with Plus, a number that refers to the number of people living with HIV worldwide, as estimated in 2013 by the World Health Organization. “Thirty-five million people? I hate to say it, but that’s enough to have it almost be normal,” he says. “I think 35 million people deserve to be treated with a sense of normalcy. I think 35 million people deserve to live in a world where they’re not fearmongered. I think 35 million people deserve to have the stigma lifted from their lives. I think 35 million people deserve to live in a country—to

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live in a world—where HIV-negative people don’t think they can turn their fucking nose up at us because we’re positive. Thirty-five million people is a lot of people.” So why does stigma continue to exist, particularly in at-risk groups like African-Americans, in which women contract HIV at 20 times the rate of white women, and 60 percent of men who have sex with men will test positive by the time they turn 40? “Because no one talks about it,” Blanco says point-blank, and that’s a problem that he is already striving to correct. Without naming the rapper, he also references the problem with hip-hop lyrics that glorify misogyny and unprotected sex. Blanco quotes the following lyrics, which a Google search reveals belong to ASAP Ferg, in his song “Shabba.” “Run up in this shit raw, I got a girl,” Ferg sings. “I ain’t never got no fuckin’ condoms.” Words like these have the unfortunate power to influence cultural norms and behaviors, and fuel misinformation about how HIV is spread. To counter this, Blanco says lyrics to his future songs will address HIV, as he believes that musicians and other influencers have a responsibility regarding the health of those who listen. His experience of coming out as HIV-positive has particularly awakened him to this duty. “I know that when I talk about sexual things in my songs now, I’m going to have to. And to be honest, I’m not begrudged about that,” he says. Even the more liberal-minded hipsters—whom he identifies as more of his audience than typical hip-hop fans— need to take responsibility, Blanco maintains, as he observes how straight people in this group are also negligent in safe-sex practices. “If everyone wants to be so politically open, then they need to start being socially aware. And they need to start being health-conscious,” he says. Despite press speculation that Blanco might lose his fans over the revelation of his diagnosis—and thus his ability to influence them about anything, much less health practices—the rapper insists that the opposite has already occurred. His bond with his listeners has never been stronger. “The music industry has never given me anything,” he says. “I’ve always had to fight for it. I’ve always had to get it myself. And I’ve always had to get it organically. So if anything, this revelation has made my relationship with my fans closer.” Though he hates to bring them up, Blanco again references the selfie-loving Kardashians as offering yet another guiding light in his journey toward honesty with himself and the world.

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“We’re living in the age of transparency,” he says. “We’re living in a time where people kind of want to know all your business. To a lot of my fans, they actually feel like they know me now—or they know me better.” Though Blanco acknowledges that he will make mistakes on the road ahead, he takes comfort in being as honest as he can be—with the world and with himself. The fears that plagued him before have lifted. And the future is bright with possibilities. “I’m no saint. I’m no perfect person. I’m sure that something will happen or I’ll do something imperfect,” he concludes. “But right now I literally have nothing to hide. And it feels so amazing.” ✜

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Images: unless otherwise credited, all photos Shutterstock

In 2016 we observe the 35th anniversary of the diagnosis of the first cases of AIDS. Of course, we now know that HIV didn’t suddenly appear in 1981. There were a handful of cases of what we now recognize as AIDS-related illnesses in the decades prior to 1980. But 1981 is when people in the U.S. first recognized symptoms of AIDS, which was attacking mostly gay men. Here’s a look at just how far we’ve come since then...

1982 In March The Advocate publishes its first major article on AIDS, asking, “Is the Urban Gay Male Lifestyle Hazardous to Your Health?”

Image: public domain - wikipedia commons

1981

Image: Courtesy of The Advocate Magazine

In June the Centers for Disease Control and Prevention reports five Los Angeles men diagnosed with Pneumocystis pneumonia—later determined to be the first publicized cases of AIDS.

1983 French researchers isolate the human immunodeficiency virus and determine it is the primary cause of AIDS. American scientists report a similar discovery the following year.

Declares the first World AIDS Day.

1988

1984 Seen as hotbeds of unsafe sex and HIV transmission, San Francisco’s gay bathhouses are officially shut down, with similar efforts in other major metropolitan areas.

Image: By National Institutes of Health - wikipedia commons

AZT becomes the first antiretroviral drug approved by the FDA. The recommended dose is initially 100mg capsule every four hours, 24 hours a day. Image: By Deutsche Fotothek - wikipedia commons

1986 Image: Wildhartlivie - wikipedia

1985

Image: White House photo office wikipedia commons

The U.S. surgeon general publishes a report on AIDS, the government’s first major statement on what the nation should do to prevent the spread of HIV.

Cleve Jones and several associates launch the NAMES Project AIDS Memorial Quilt, which memorializes those who died of AIDS-related illnesses.

Indiana teenager Ryan White is barred from school after contracting HIV from a blood transfusion. Hollywood star Rock Hudson announces he’s “dying of AIDS.”

Image: By National Institutes of Health - wikipedia commons

Image: U.S. National Library of Medicine

1987

1989 At the urging of activists, the National Institute of Allergy and Infectious Diseases endorses a “parallel track” so that people living with HIV who don’t qualify for clinical trials can still access experimental treatments. The process starts the following year.

Image: Wendy Chen from Rockefeller University - wikipedia commons

1997 FDA approves the first multiple-drug tablet, Combivir, which contains Retrovir and Epivir.

Time magazine names HIV researcher David Ho as Man of the Year for his work in the creation of lifesaving combination therapy.

1996

Image: By The U.S. Food and Drug Administration

1995 Gay Olympic diver Greg Louganis reveals that he has HIV. Image: public domain - wikipedia commons

1990 Ryan White dies of AIDS complications at age 18. Ronald Reagan apologizes for his neglect of the AIDS crisis during his presidency. Congress passes the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act to provide federal assistance to low-income and uninsured people with HIV.

The first protease inhibitor (Saquinavir, Invirase) and a nucleoside reverse transcriptase inhibitor (3TC, lamivudine; Epivir) are approved by the FDA.

Image: Herb Rittis

Image: unknown - wikipedia commons

1993 Tom Hanks wins Oscar for his role in Philadelphia as a gay lawyer suing over being fired for having HIV.

Pedro Zamora stars on MTV’s reality series The Real World: San Francisco — an out gay man who is also HIV-positive. Image: Alan Light - wikipedia

1992 Image: By World Economic Forum from Cologny, SUI - wikipedia commons

Image: unknown - wikipedia commons

1991 Basketball legend Magic Johnson reveals he is HIV-positive.

AIDS-related illnesses become the number 1 cause of death for men in the U.S. between ages 25 and 44.

A black woman, Dr. Helene Gayle, is named the director of the newly created National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention.

1994

Image: Courtesy of GMHC

1998 HIV Plus magazine is founded, an outgrowth of an HIV supplement that previously ran in OUT magazine.

2007 First integrase inhibitor, Isentress (raltgravir), approved by FDA. The agency also approves its first entry inhibitor, the CCR5 blocker Selzentry (maraviroc).

2006 Image: Courtesy of OUT Magazine

Dr. Marjorie J. Hill becomes the first black woman to head the Gay Menâ&#x20AC;&#x2122;s Health Crisis.

Image: By Damien Persohn - wikipedia

1999 Phill Wilson founds the Africa-American AIDS Policy and Training Institute, which eventually becomes the Black AIDS Institute.

2005 Image: Courtesy of The Black Aids Institute

CDC releases guidelines for post-exposure prophylaxis, or PEP.

2000

2004

2003

First annual

First saliva-based HIV test is approved.

First annual

2001

2002

In just 20 years, HIV has infected 60 million people, killed 22 million, and achieved the status of the most devastating epidemic in human history.

FDA approves OraQuick, the first rapid HIV test.

INFECTED

KILLED

MILLION

MOST

DEVASTATING

MILLION

Image: By Marcello Casal JR/ABr - wikipedia

2008

2015

PEPFAR (Presidentâ&#x20AC;&#x2122;s Emergency Plan for AIDS Relief) is reauthorized for another five years.

A groundbreaking study at San Franciscoâ&#x20AC;&#x2122;s Kaiser Permanente Medical Center follows 600 people on a PrEP regimen of daily Truvada for 32 months and finds no participants became HIV-positive.

2009

2014

Greater Than AIDS campaign is started to get prevention info to black Americans.

The CDC estimates that in 30 years, 70% of 20-year-old black gay men will have HIV.

Image: By Alun McDonald/Oxfam East Africa - wikipedia

2010 The White House unveils the first National HIV/AIDS Strategy. The Affordable Care Act passes; it will broaden coverage for those with HIV/AIDS and provide many uninsured people with the ability to have coverage for the first time.

Image: By dbking - wikipedia

Image: By Pete Souza - wikipedia

2011 Secretary of State Hillary Clinton issues call to action to create an AIDS-free generation.

2012 Image: public domain - wikipedia commons

The FDA approves Truvada as PrEP. Truvada becomes the first drug approved to reduce the risk of acquiring HIV.

Since the beginning of the epidemic, almost 78 million people have been infected with HIV and about 39 million people have died of its complications.

2013

STARTING STARTINGHIV HIVTREATMENT TREATMENT HELPS HELPSPROTECT PROTECTYOUR YOURHEALTH. HEALTH. There Thereisisno nocure curefor forHIV, HIV,but buttreatment treatmentcan canstop stopthe the virus virusininyour yourbody bodyand andthe thedamage damageHIV HIVcauses. causes.

Treatment Treatmentalso alsohelps helpsmake makeitit possible possibletotolive liveaahealthy healthylife. life.

STAYING ON TREATMENT HELPS LOWER THE AMOUNT OF VIRUS IN YOUR BLOOD. The amount can get so low, it cannot be measured by a test. This is called being undetectable and it means you are taking care of your health. It also lowers the chance of passing HIV on to others.

TALKING ABOUT HIV TREATMENT An open conversation with your healthcare provider can help put you on the path to a long and healthy life. When you work together, it helps your healthcare provider find the treatment that is right for you.

HelpStopTheVirus.com

STARTING HIV TREATMENT IS A HEALTHY STEP. Here are two resources that can help.

Watch videos, share information, and see how we can all help stop the virus. www.HelpStopTheVirus.com

Get the answers you need, privately, on your phone. www.HIVanswers.com/app

ONE OUT OF 80 MILLION? Timothy Brown may have been cured, but one out of 80 million isn’t great odds. That’s what Dr. David Margolis, head of the Collaboratory of AIDS Researchers for Eradication told the audience attending this summer’s HIV Cure Conference, which was hosted by CARE and the University of California, San Diego’s AntiViral Research Center. “A cure is feasible,” Margolis added. “But I want to manage expectations and convey the reality about this whole cure expedition and that is, it ain’t gonna happen fast.” Margolis sees the biggest hurdle to a cure being the way HIV can hide out of sight, becoming undetectable in the bloodstream, and yet rebounding later. SHUT TERSTOCK/WHITEHOUNE

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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 that combines the medicines in TRUVADA + EDURANT in only 1 pill a day.*

Ask your healthcare provider if COMPLERA may be the one for you. *COMPLERA is a combination of the medicines in TRUVADA (emtricitabine and tenofovir disoproxil fumarate) and EDURANT (rilpivirine).

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 (Epivir-HBV), carbamazepine (Carbatrol, Equetro, Tegretol, TegretolXR, 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: • Severe skin rash and allergic reactions. Call your doctor right away if you get a rash. Some rashes and allergic reactions may need to be treated in a hospital. Stop taking COMPLERA and get medical help right away if you get a rash with any of the following symptoms: severe allergic reactions causing a swollen face, lips, mouth, tongue or throat which may lead to difficulty swallowing or breathing; mouth sores or blisters on your body; inflamed eye (conjunctivitis); fever, dark urine or pain on the right side of the stomach-area (abdominal pain). • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood tests to check your kidneys before starting treatment with COMPLERA. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may also check your kidneys during treatment with COMPLERA.

Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself. • Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may do tests to check your liver enzymes before and during treatment with COMPLERA. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones. • Changes in body fat can happen in people taking HIV-1 medicines. • Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking COMPLERA. •

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

What should I tell my healthcare provider before taking COMPLERA?

All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, mental health, bone, or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking COMPLERA without first talking with your healthcare provider. • If you take rifabutin (Mycobutin). Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take. • If you take antacids. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. • If you take stomach acid blockers. Take acid blockers at least 12 hours before or at least 4 hours after you take COMPLERA. Ask your healthcare provider if your acid blocker is okay to take, as some acid blockers should never be taken with COMPLERA. • If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking COMPLERA. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in COMPLERA can pass into breast milk, and it is not known if this can harm the baby. •

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

Brief Summary of full Prescribing Information COMPLERA® (kom-PLEH-rah) (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information. What is COMPLERA? • COMPLERA is a prescription medicine used as a complete HIV-1 treatment in one pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood (this is called ‘viral load’). Complera can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements. • COMPLERA is a complete HIV-1 medicine and should not be used with any other HIV-1 medicines. • COMPLERA should always be taken with food. A protein drink does not replace food. • 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 emtricitabine or tenofovir (ATRIPLA, EMTRIVA, STRIBILD, TRUVADA, VIREAD) • Other medicines that contain lamivudine (Combivir, Epivir, Epzicom, Triumeq, Trizivir) • 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?” • Severe skin rash and allergic reactions. Skin rash is a common side effect of COMPLERA but it can also be serious. Call your doctor right away if you get a rash. In some cases, rash and allergic reaction may need to be treated in a hospital. Stop taking COMPLERA and call your doctor or get medical help right away if you get a rash with any of the following symptoms: – severe allergic reactions causing a swollen face, lips, mouth, tongue or throat, which may cause difficulty swallowing or breathing – mouth sores or blisters on your body – inflamed eye (conjunctivitis) – fever, dark urine or pain on the right side of the stomach-area (abdominal pain) • 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 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 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 over-the-counter 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. 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. Revised: May 2015

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.

COULD THE IMMUNE SYSTEM TURN ASSASSIN? Luring dormant HIV out of hidden reservoirs with bryologs or some other method is just the first step, say researchers at Johns Hopkins University School of Medicine. “Our results suggest that luring HIV out of hiding is winning only half the battle,” said senior investigator Robert Siliciano earlier this year. “We found that these pools of dormant virus carry mutations that render HIV invisible to the very immune cells capable of disarming it, so even when the virus comes out of hiding, it continues to evade immune detection.” In the lab, Siliciano’s team successfully trained immune sentinel cells known as “killer T cells” to spot and eliminate mutated strains of HIV. These T cells found and killed 61 percent of the HIV-infected cells.

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TOP: WIKIPEDIA; BACKGROUND: SHUT TERSTOCK/WATCHARA

WAKING DORMANT HIV ESSENTIAL TO A CURE Reservoirs of HIV are a major barrier to any cure because the current medications can’t find and treat the virus in those reservoirs, so many researchers are working on finding a way to activate and eliminate HIV reservoirs. Using synthesized compounds called “bryologs,” researchers have figured out how to wake up HIV in the lab and make it detectable “at least for a short time,” according to a study led by Jerry Zack of the David Geffen School of Medicine at the University of California, Los Angeles, and Paul Wender at Stanford University. But they still don’t know if they can clear the newly detectable virus and whether they have reached every cell that is infected.

TOP: SHUT TERSTOCK/ULKASTUDIO; BOT TOM: CDC

HOW TO STOP MUTANTS That same John Hopkins study also discovered that patients who began antiretroviral therapy within a few weeks or months of infection harbored largely nonmutated HIV. Starting therapy early appeared to have halted the mutation process, freezing the virus more or less in its original state. By contrast, more than 98 percent of the virus in the latent reservoirs of late-treated patients was mutated. Treating— and eventually curing—HIV is much more difficult with mutated strains. IS THIS HIV KRYPTONITE? Canadian researchers have discovered another method for destroying once-dormant HIV after it has been awakened. They discovered a molecule, JP-III-48, that they dubbed the “can opener,” which tricks HIV into opening itself up to attack from antibodies that could kill the virus. The study, published in Proceedings of the National Academy of Sciences, builds on earlier findings in which cells infected with HIV-1 (the most common strain of HIV) were more easily eliminated when two HIV-specific proteins were deactivated. Because these two proteins protect HIV from attack, eliminating or deactivating them could leave the virus vulnerable and exposed. The JP-III-48 molecule mimics the CD4 protein, so HIV opens itself up, expecting the CD4 protein to enter. In doing so, it becomes vulnerable to immune system attacks. Then antibodies that are naturally present in people with HIV can target those infected cells. The Canadian researchers see the molecule playing a part in a “shock and kill” approach to eliminating HIV reservoirs. “We have to reactivate HIV reservoirs to force the virus out of its hiding place,” said Dr. Andrés Finzi, the study’s author. “Then kill the infected cells with this molecule and the already present antibodies.” hivplusmag.com

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SUGAR AND SPICE, ANYTHING BUT NICE A new study indicated that HIV has a voracious sweet tooth, which can be used against it. When the virus enters an activated immune cell, it needs energy to replicate, which it gets from sugar and other nutrients. Cut off the supply of sugar, the theory goes, and HIV can’t replicate in the cell. Researchers at Northwestern Medicine and Vanderbilt University say they’ve found a way to cut off the sugar pipeline and starve the virus. This novel approach, which could also work on cancer (another disease with a powerful sweet tooth), has several benefits, including the reduction in organ damage in people with HIV. The virus causes an abnormal proliferation of immune cells, which can lead to inflammation and damage to organs over time, even in patients who are on antiretroviral treatment. “This discovery opens new avenues for further research to solve today’s persisting problems in treating HIV infection: avoiding virus resistance to medicines, decreasing the inflammation that leads to premature aging, and maybe even one day being able to cure HIV infection,” said Richard D’Aquila, director of Northwestern’s HIV Translational Research Center.

SHUT TERSTOCK/HOPEFUL.YA

ALREADY SAFE FOR HUMANS At this year’s Cure Conference, scientists reported that HIV is actually “a disease of the lymphoid tissue.” In other words, only 1 percent of a person’s T cells are located in the bloodstream, while 98 percent of CD4 T cells reside in lymphoid tissues, where HIV behaves differently than in the blood. Dr. Warner Greene has discovered that T cells in lymphoid tissue launch an attack not on the virus itself but on pieces of human DNA that are discarded as HIV replicates. In doing so, the T cells release inflammation, which draws more T cells to the spot, where they also die. The cells essentially commit suicide in a vain attempt to protect the larger host. Ending that deadly cycle, Greene believes, could reduce HIV’s impact on a person’s health, basically making their viral load irrelevant to their condition. His team has already discovered what will stop this cycle: caspase-1 inhibitors, caspases being substances that play an important role in cell death. Already in clinical trials for other applications, a caspase-1 inhibitor called VX -765 has proved safe in humans, but it would need Food and Drug Administration approval before it could be prescribed to treat people with HIV.

DO ELITE CONTROLLERS HOLD THE KEY? The aforementioned study isn’t the only one looking at the possibility that elite controllers could hold the key to an HIV vaccine or cure. For example, University of California, Davis, researchers are studying 61-year-old Californian Loreen Willenberg, who has been HIV-positive for more than two decades, has never taken HIV medications, and yet remains symptom-free. In fewer than 1 percent of those who are HIV-positive, the immune system seems capable of controlling the virus and preventing it from damaging cells, Dr. Richard Pollard of UC Davis told a Sacramento TV station. There are reportedly only 500 of these elite controllers in the world. “Their body has such an effective way of reacting to the virus that it’s hard to even detect that they’re virus-positive,” said Pollard. In most cases, once HIV has entered a person’s bloodstream it attacks the white blood cells known as CD4 T cells. HIV kills T cells and replicates itself, while also fighting off immune system responses, including those from healthy CD8 cells that usually combat viral infections. In people like Willenberg, however, CD8 cells remain strong and regulate infected CD4 cells, which keeps HIV from replicating. Finding a way to harness what makes her and other elite controllers special may well help researchers develop a vaccine or a cure.

SHUT TERSTOCK/ZEBER

KICK AND KILL, BUT NOT FOR A DECADE Research published in Clinical Infectious Diseases in May introduced what an international team has called the “kick and kill” strategy—a different way of saying “shock and kill”—for eliminating HIV. Researchers from England’s University of Oxford, the University of North Carolina at Chapel Hill, and the University College London Hospitals NHS Foundation Trust (a collection of eight hospitals that are part of England’s National Health Service) believe it’s possible to use an HIV vaccine as a stepping-stone to an HIV cure. Their strategy would first use a vaccine to stimulate the immune system; then the HIV lying dormant in hidden reservoirs would be reawakened with a chemical “kick.” Although promising, this group’s research on “kick and kill” revolves around the experience of a single subject, an “elite controller”—someone whose immune system can control HIV for an extended period without treatment. The immune system of the study’s subject was able to subdue HIV as well as antiretroviral medication would. Scientists hope to develop a vaccine from elite controllers. Study coauthor Dr. Ravi Gupta cautions, “Drugs to stimulate reactivation of dormant HIV are still imperfect, and we do not know if they would be able to flush out all of the HIV from the body. Likewise, it remains to be seen whether a vaccine could enable a normal HIV patient’s immune system to kill HIV with the full strength of an elite controller. Our study is a proof of principle and the results are promising, but it is unlikely to lead to a cure for at least a decade.”

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…OR A VACCINE Dr. Michael Farzan also thinks CCR5 is the answer. The Harvard University professor is famous for discovering the benefits of the CCR5 mutation 16 years ago. He recently told The Guardian he’s close to developing an HIV vaccine based on this same genetic immunity. Farzan said his potential vaccine would bind to HIV and prevent it from invading white blood cells. “This isn’t a cure,” Farzan was quick to explain. “A cure would remove all evidence of the virus from the body, and we don’t have that ability.” Still, Farzan hasn’t written off those who are already poz; in fact, he said his vaccine could provide people with HIV what he calls a “biologic remission, which means they can live without drugs.” While some of the other efforts to develop an HIV vaccine focus on stimulating (and sometimes enhancing) the body’s natural immune response, Farzan’s approach is to block cell receptors that the virus can attach to, thus preventing it from latching on and replicating. Farzan acknowledged that some strains of HIV are capable of simply finding other receptors to attach to, but he said, “Those strains of HIV are extremely rare, so if it moves away from the common receptors, this will come with what we call a fitness cost for the virus. Because there are fewer strains, they are less replicative and transmissible.” …OR EVEN JUST RESISTANCE TO INFECTION University of Minnesota scientist Reuben Harris is studying serodiscordant couples who’ve retained their mixed HIV status without medication, despite many opportunities for the virus to be transmitted to the negative partner. Harris believes the answer lies with a family of genes called APOBEC3, which produce antiretroviral enzymes. Harris discovered that a specific variation to the gene APOBEC3H produces stronger and more stable antiretroviral enzymes, which appear to impede the replication of HIV. Those with the gene variation aren’t totally immune, but they are less likely to contract the virus. Harris told The Guardian that gene therapy based on the APOBEC3H variant could help make certain populations less susceptible to HIV. In this case, studies show that few Caucasians naturally have the optimal version of the gene, so they could benefit from this therapy. “These enzymes are really powerful virus inhibitors,” Harris said. “And it may be possible to suppress infection completely by unleashing them to a greater extent.… There are probably lots of different ways that people can resist infection. I guess it’s a perfect example of why we don’t want homogeneity in the human race. If we were all the same, then it would be too easy for a supervirus to sweep through and wipe us all out.”

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TINKERING WITH GENES COULD LEAD TO A ONE-SHOT CURE Genetic variations that provide natural resistance to HIV (like the ones that elite controllers have) are central to some researchers’ efforts to develop a cure. One of the doctors responsible for curing Timothy Ray Brown, the so-called Berlin patient, is focusing on gene therapy based on a genetic variation and believes he’s closing in on a one-shot HIV cure. “I believe it’s possible to develop a massmarket single-shot treatment for HIV,” Dr. Gero Hütter told U.K. newspaper The Guardian. “If we can overcome a few problems, our approach is closer to a complete cure than anything in the last 30 years.” Brown was cured with a bone marrow transplant from a donor who had a natural immunity to HIV. About 1 percent of the population has that donor’s rare gene mutation, which prevents HIV from binding to white blood cells by disabling its typical receptor target, CCR5. So far all efforts to replicate the Brown results have failed—aside from the Barcelona patient who was reportedly cured for several years before dying of cancer—but Hütter still believes that CCR5 holds the key.

TOP: SHUT TERSTOCK/STEPHEN COBURN RIGHT: SHUT TERSTOCK/S_BUKLEY

MONKEY SEE, MONKEY DO—ER, DON’T We reported last April on a monkey vaccine that blocked simian immunodeficiency virus (SIV, HIV’s primate relative) and quickly suppressed the viral loads of monkeys. Researchers hoped that the monkey vaccine could be the first step to creating a human vaccine for HIV, but findings of a new study show the monkey vaccine to be less effective than previously thought, calling into question a central assumption in how a human vaccine might work. Previously, researchers had thought that an HIV vaccine could protect people from getting the virus by stimulating moderate levels of antibodies to neutralize it. But these scientists found that SIV still managed to infect monkeys that had been vaccinated, even though potent neutralizing antibodies were found in the monkeys’ blood. The scientists had expected that any virus that could infect a vaccinated monkey must have mutated to develop a resistance to the vaccine. But that’s not what happened. The study, published August 10 in Proceedings of the National Academy of Sciences, revealed that the vaccinated monkeys were exposed only to the same strain they’d been vaccinated against. The researchers said the vaccine protected some monkeys from SIV infection, but it was not foolproof and may not remain effective through multiple exposures. More research is needed to fully explain the failure, but in the meantime scientists can’t proceed to human trials as quickly as they’d hoped. DON’T LET JENNY MCCARTHY HEAR THIS Three new studies demonstrate how a series of vaccinations could “prime” the immune system in anticipation of attacking HIV. Each vaccination would build on the other, as many childhood vaccines do, preparing the immune system so it can make antibodies that neutralize an entire spectrum of HIV strains. If HIV later enters the body, the immune system is able to fight off the infection. Scientists at the Scripps Research Institute set out to mimic the antibodies produced by elite controllers and use them to protect HIV-negative individuals from contracting the disease. The first step is to stimulate the immune system to make more of a subtype of B cells that can produce these broadly neutralizing antibodies. They created two engineered molecules that trigger the production of increasingly mature antibodies (one was, according to Science, shown to be an effective HIV vaccine in rabbits). HIV is covered in proteins that confuse the immune system, which attacks them instead of noticing the more vulnerable regions. By mimicking the receptors that HIV usually attaches to, the molecules trick the virus into attaching to them, thus rendering it incapable of replicating. hivplusmag.com

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THE REAL COCK BLOCK Researchers say a newly discovered tweezer-shaped molecule delivers a two-pronged attack on HIV in semen and may also be effective against hepatitis C, herpes, the flu, and Ebola. The molecule, CLR01, has shown positive results in laboratory tests, leading an international team of scientists at the University of Pennsylvania and Germany’s Ulm University to suggest the molecule could effectively prevent HIV transmission as a vaginal or anal gel. “We think that CLR01 could be more effective than other microbicides that are in development because of its dual action, its safety in terms of side effects and its potential broad application,” noted James Shorter, coauthor of the study, published in the journal eLife.

TOP: SHUT TERSTOCK/VIENNE T TA; BOT TOM: SHUT TERSTOCK/TOEY TOEY & CUREALZ.ORG

HEADS OR TAILS? A promising new treatment could prevent HIV without the need for a vaccine, and so far in monkey trials it has appeared to be effective even against the most virulent and treatmentresistant strains of HIV. Published in Nature, the findings indicate that a particular compound, a protein dubbed eCD4Ig, which resembles normal antibodies but has both a head and a tail, can block two receptors at once. If HIV can’t attach to either receptor, it cannot infect the cell and is rendered harmless. So far the research has been very limited and exclusively on monkeys, but four monkeys given the compound remained HIV-free despite repeated attempts to infect them over a 12-month period.

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LEFT: SHUT TERSTOCK/CARLOS YUDICA; RIGHT: SHUT TERSTOCK//DIMA SOBKO

LESS IS MORE? Studies in France and the United Kingdom have shown that Truvada, the only drug currently approved for the prevention of HIV, continues to work even when the dose is lowered. While it’s successful at preventing HIV transmission nearly 96 percent of the time when taken daily, tests showed that when taken less frequently but at particular key times, Truvada as pre-exposure prophylaxis, or PrEP, still lowered HIV risk by 86 percent. Patients are urged not to increase their risks by breaking with their daily regimen, though. The Food and Drug Administration has only approved a daily dosage for PrEP, and there’s more testing to be done to see if these results can be repeated. “We don’t want people to potentially put their lives at risk from taking the wrong kind of PrEP regimen,” said Jennifer Horvath, deputy director of news media at the Centers for Disease Control and Prevention.

A NEW KIND OF MONTHLY A new implanted device could revolutionize HIV treatment by making it so people with HIV don’t have to take another pill, making it so more people would adhere to treatment. The matchstick-size device is designed to be implanted under the skin, where it can automatically deliver carefully measured doses of antiretroviral drugs. The device has undergone animal trials, and the findings, published in Antimicrobial Agents and Chemotherapy, showed it successfully delivered a controlled, sustained release of antiretroviral drugs for up to 40 days. Adherence has been shown in clinical trials to be one of the most significant factors in determining successful HIV outcomes, and it is widely viewed as one of the most critical elements in the fight against HIV. Some patients struggle with adherence, especially if they are prescribed numerous drugs—whether to enhance drug effectiveness, provide cheaper treatment options, fight multiple HIV strains, or prevent the virus from becoming drug-resistant. “This novel device will revolutionize how we treat or prevent HIV/AIDS,” said Dr. Marc Baum of California’s Oak Crest Institute of Science, which developed the device. “It delivers powerful HIV-stopping drugs and eliminates one of the key obstacles in HIV/AIDS prevention— adherence to proper dosing regimens.” Moving forward with plans for human trials, the institute is also working to extend the effectiveness of the implant: Researchers hope eventually to have one that can remain effective for an entire year.

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WHO NEEDS AQUAMAN? A marine sponge may hold the key to reducing HIV hiding in reservoirs in the body, say scientists at the Florida campus of the Scripps Research Institute in a study published in the journal mBio. Unlike traditional antiretrovirals, the natural compound Cortistatin A reduces residual levels of HIV from these infected dormant cells, establishing a near-permanent state of latency and greatly diminishing the virus’s capacity for reactivation, they say. Cortistatin A was isolated from a marine sponge, Corticium simplex, in 2006, and in 2008, Scripps chemist Phil Baran was the first scientist in the world to synthesize the compound. HIVpositive people given the compound saw viral reactivation a reduced by an average of 92.3 percent. “Our results highlight an alternative approach to current anti-HIV strategies,” said Susana Valente, the Scripps associate professor who led the study. “Prior treatment with Cortistatin A significantly inhibits and delays viral rebound in the absence of any drug. Our results suggest current antiretroviral regimens could be supplemented with a Tat inhibitor [Tat is a protein that helps the virus reproduce] such as Cortistatin A to achieve a functional HIV-1 cure, reducing levels of the virus, and preventing reactivation from latent reservoirs.”

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THE STRAIN(S) A study published in PLOS Medicine suggests that only a handful of mutations are responsible for the majority of drug-resistant HIV strains. Researchers at Stanford University School of Medicine focused specifically on medications used to treat infections in resource-limited settings (particularly nonnucleoside reverse transcriptase inhibitors) and discovered that a limited number of mutations are behind most cases of transmitted drug-resistant HIV around the world. Like other viruses, HIV has the ability to mutate in response to environmental factors, including the presence of antiviral drugs, and those mutations can then be transmitted from one person to another. The Stanford study is the largest of its kind, examining 50,000 patients in 111 countries. The fact that a small group of mutations accounted for a majority of the cases of transmissionrelated drug-resistance suggests that the number of these drugresistant strains has not increased dramatically, as was previously feared.

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STICK TO IT, MISTER Early HIV treatment has already been shown to provide long-term advantages, but a new French study reports that any immune recovery benefits gained by starting antiretroviral medications early may be lost if treatment is later interrupted. 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 ratio of CD4 to CD8 cells, which combine to do the work of fighting the virus. â&#x20AC;&#x153;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,â&#x20AC;? reported AIDSMap.

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status. Several municipalities put big money into PrEP education and outreach (San Francisco, New York) in attempts to connect residents to funding sources like Medicare, while Washington State began paying for PrEP in full for residents who are aren’t insured and covering insurance co-pays for those who are. And back on the cure front, pharma giant GlaxoSmithKline, maker of HIV meds such as Tivicay, dedicated $20 million to establish a research center with the University of North Carolina at Chapel Hill dedicated solely to finding a cure for HIV. One of its primary focuses will be on the “shock and kill” approach. “The ‘shock and kill’ approach has shown significant promise in early translational research on humans and has been the focus of research for the last several years,” said Dr. David Margolis, the professor of medicine at UNC-Chapel Hill who also heads CARE, at that San Diego HIV Cure conference. He is one of the first researchers to come up with the “shock and kill” proposal: to reactivate the dormant virus and make it visible to be attacked by the body’s immune system. In 2012, Margolis published promising results from a clinical trial that used the drug vorinostat (originally developed for blood cancers of T cells) to shock the HIV awake.

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MAKE IT RAIN More money was funneled into HIV research in 2015 than ever before, with amfAR, the Foundation for AIDS Research, creating a $100 million investment strategy in support of its Countdown to a Cure for AIDS initiative, launched last year with the goal of coming up with a functional cure by 2020. The establishment of the amfAR Institute for HIV Cure Research within a major academic research institution with a grant of $20 million is the centerpiece of the investment strategy, which Kevin Robert Frost, amfAR’s chief executive officer, called “the greatest expansion of amfAR’s grantmaking in the 30-year history of the foundation.” The institute, he said, brings cure researchers under one roof to “facilitate the rapid sharing of knowledge and ideas and create the kind of synergy needed to accelerate the search for a cure.” Meanwhile, the Centers for Disease Control and Prevention announced it is investing $216 million in new funding to strengthen HIV prevention efforts throughout the country. ViiV Healthcare put $3 million into a program called Positive Action, aimed at lowering HIV’s impact on gay and bi men and transgender people around the world by tackling discrimination and stigma based on sexual orientation, gender identity, and HIV

SIX HIV-POSITIVE MEN GIVE ADVICE TO THEIR FORMER SELVES Here are words of wisdom on surviving and thriving for those newly diagnosed with HIV By Tyler Curry Imagine all the worries, questions, and concerns that would race through your mind on the day you were diagnosed with HIV. The endless barrage of worst-case scenarios runs on a loop as you try to gather yourself and somehow make it to a safe place to sort it all out. In this moment, the world probably seems as if it will never be the same again as you vacillate from feelings of numbness to restless panic. And even though you think time has stopped, soon it has been a week, then a month, and then years since that day in the clinic when you thought your life was over. It wasn’t. Life goes on, and sometimes it can even get better post–HIV diagnosis if you have the right medical and emotional support. Sure, things might be a little more complicated, but it is by navigating those complications that you get to know yourself and find the strength that you might not have known you had. In an effort to help those new to their diagnosis, we asked six HIV-positive guys what advice they would give their former selves on that fateful day.

DUANE CRAMER

Khafre K. Abif

Khafre K. Abif is a master librarian, writer, editor, blogger, and artist who’s been living with HIV for 25 years. The founder and executive director of Cycle for Freedom, he’s been a full-time activist for the last decade. He’s the editor of several upcoming anthologies as well as the 2013 collection Cornbread, Fish and Collard Greens: Prayers, Poems & Affirmations for People Living With HIV/AIDS (AuthorHouse). “As I look back on the early years of living with HIV and what I would share with my younger self, I would start by sharing I could have combated the isolation and loneliness by trusting that my mother, or as I call her, MaDear, would love me unconditionally. Waiting more than five years after my diagnosis to share with MaDear was one of the biggest mistakes I made. I allowed my fear and internalized stigma and even homophobia to mask and hide from telling the one person who had always been my biggest cheerleader. Instead I withdrew and created a distance between us. I told myself I did not want to be a burden on MaDear’s heart because she was still healing from the sudden death of my father, her husband. I should have known the power of a mother’s prayer and allowed myself to be wrapped in her arms and endless love, regardless of the fact that we have never had a discussion about my sexuality. I should have found a way to push past my own shame in order to be covered by MaDear’s prayers and love.”

Find a way to push past your own shame in order to be covered by your mother’s prayers and love. hivplusmag.com

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David Duran

Greg Revenj

You’re much more than a diagnosis.

Reach out to loved ones for support. Greg Revenj wasted no time when it came to overcoming the stigma he felt after being diagnosed with HIV in early 2014. He is now the host of the forum Talk Posi+ively and is an outspoken HIV activist who was on the cover of Plus magazine’s 20 Amazing HIV-Positive Gay Men issue. “Sitting in this doctor’s office, I know you can’t hear a thing. Everything has faded to a blur. HIV has just become a reality for you. You feel like your life is over, like you’ve come to the end. “You’ve felt like an outcast your entire life, but now it feels like that mentality has been reaffirmed. You want to run away, for good this time. You’re going to cut all of your family and friends off, and in the process lose a few of them. Don’t. This is the one time you need family and friends. Little do you know this diagnosis is going to be the best thing that has ever happened to you. You’ll find your community. You’ll find love. Even more, you’ll find yourself and you’ll find purpose. This isn’t the end. It’s the beginning.”

David Duran is an accomplished journalist who travels the world writing for a variety of publications. To say he was taken by surprise when he tested positive for HIV in 2009 would be putting it mildly. “The day I was diagnosed, I was actually helping a friend during his HIV scare and opted to get tested as well, as a sign of solidarity and support. I remember being prepared with words of advice and encouragement, just in case his test came out to be positive. It turned out I was the one with the positive results, and I wish I had taken the time to tell myself what I was prepared to tell my friend that day. The reality is, it’s not easy, but it’s also not hard. At least, it’s not if you make an effort to take care of yourself and give yourself the proper amount of time to grieve the news, and then move on to living your daily life with this new bit of yourself that doesn’t define who you are, but instead is just a tiny piece of what makes you, you. Your life is what you make of it. If you let this one little piece of you take over and dominate you with sadness, regret, and anger, you’re doing yourself a disservice, because there’s more to you than a diagnosis.”

Eric Woodring You don’t owe anyone an explanation. Eric Woodring remembers the exact date and time of his diagnosis, as many often do. It was not too long ago, a blistering, wintry Saturday afternoon, January 3, 2014. And even though it was just a short time ago, his family and friends say that he has tackled HIV like anything else. “The biggest advice I would give my slightly younger self is: Don’t feel like you need to explain, justify, or convince anyone of anything. It’s a life lesson, really, but I find it particularly suited to learning to love yourself post-diagnosis. There will be people in your life—some friends, some family, some strangers that you meet. They will ask you how you contracted the virus, and some of the more brazenly ignorant individuals will even try to get you to admit a flaw in your character or cast judgments about your sexual behaviors. You owe them nothing. You will quickly realize that you are entrenched in a community that is defined by more than their viral count, and that everyone deserves to be treated with the same dignity and respect, regardless of how they came to be poz. You aren’t ‘less than’ and you don’t need to convince others that you’re better or different than anyone else carrying this virus.”

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Mark S. King Hang on. You will survive this.

JEREMIAH JOHNSON; SEAN BLACK : A&U

Mark S. King is a longtime HIV activist and the brilliant and irreverent man behind the popular blog My Fabulous Disease. He admits that his take on things looking back is a little dark, but in his own words, “Those were some dark times.” “Hang on, Mark. Just hold on tight and know that this nightmare will fade and things will get better. But not for a very long time. You just tested HIVpositive and it is the dark, early days of 1985. Even now, I’m not sure how to comfort you. You’re going to survive this, that’s the honest truth, but during your traumatic walk through this catastrophe you are going to have to step over a lot of dead bodies. You know and love a lot of them. You must not turn your eyes away from their ordeal. Try to stay present, because you must remember this time in all its heartbreaking detail. You will revisit and repeat this story for the rest of your life. That is the price of survival. Many years from now, you will understand the tragic beauty of demonstrating compassion when it felt like the world was ending. But for now, just hang on. Please. Just hang on.”

What’s Your Advice? Tell us what you’d tell your younger self editor@hivplusmag.com. Please include your name, age, location, photo, and a bit about yourself.

Jeremiah Johnson You will find love and romance, and continue to have mind-blowing sex. Jeremiah Johnson was in the Peace Corps when he found out about his positive status, and he was subsequently kicked out because of it. Since then, he has gone on to become one of the biggest emerging voices in HIV activism as the HIV research and policy coordinator at the Treatment Action Group. But he hasn’t forgotten the day that would change his trajectory forever. “You are not alone, and you do not have to be alone. When I was first diagnosed with HIV, one of my greatest fears was that I would never feel romantically or sexually connected to anyone ever again. Those fears have proven to be unfounded; if anything, my dedication to taking care of myself physically, spiritually, and mentally since my diagnosis has led to even more fulfilling connections. There is simply no reason to allow HIV to become a barrier to human contact, especially now that studies have shown that HIV-positive people who are successfully on treatment will not pass HIV on to their partners. Take the time to take care of yourself, find the support you need, and then, when you are ready, restart your love life without fear. HIV makes us no less worthy of romance, attraction, and mind-blowing sex.”

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DAILY DOSE

Thinking Positively One British author passes on the baton of knowledge By Raff y Ermac

hile inspirational books saturate the self-help market, none delves into the issues of living a positive, fruitful life quite like U.K. author Paul Thorn’s newest release, HIV Happy. Using what he calls the “Five Pillars,” Thorn describes the simple ways in which both people newly diagnosed with HIV and those who have been living with the virus for a while can take negative thinking and self-image and turn them into positivity in their everyday lives. “I was inspired to write HIV Happy after seeing an advertising campaign trying to get people to test for HIV,” Thorn says. “The slogan was ‘Take the test—take control.’ It got me thinking, How do people actually take control of their lives once they discover they have the virus? Personally, I think the mind-set of many people I meet living with HIV doesn’t always correlate with the success of treatment. It’s all too easy to believe we are victims and our own propaganda.” But what exactly does it mean to be “HIV Happy”? According to Thorn and his new book, it’s about living a life where your diagnosis doesn’t define you. “Being ‘HIV Happy’ is about living in a way where having the virus has a minimal impact on my well-being, in every sense: physically, mentally, emotionally, and spiritually,” he says. “It’s about harmonious coexistence with the virus in the absence of a cure.” Thorn also knows that adopting this mentality is not an overnight process, and taking the steps necessary to feel better about yourself and your life isn’t always the simplest thing to do—especially when you first get diagnosed. “Life hasn’t always been easy, but the alternative to not pushing through wasn’t an attractive option either,” he admits. “Of course, there were times when I wanted to give up, but we are only on this planet for a very short time. The way I got through the darkest days was to see life purely in the nature of an experiment. I wanted to know what happened and how far I could go.” Thorn says he “learned more about living with the virus— especially before [I was on] effective treatment to manage it—from other people in the same situation. If I do not share what I learned, then the newly diagnosed won’t also benefit from their wisdom. I am merely passing on this baton of knowledge.” His new radio chat show, HIV Happy Hour, is very much in the upbeat vein of the book. “The beauty of this show is that anyone in the world can listen to it,” Thorn says of the inspirational poz program that’s the only one of its kind in the U.K. It will be broadcast on Radio Reverb’s 97.2 FM in the U.K. and streamed live on the Radio Reverb website, www.radioreverb.com. It will also be available on iTunes and for podcast. Thorn wants HIV Happy Hour and HIV Happy to be real-world guides to poz life.

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“In the past, my own negative thinking and internalized stigma was preventing me from living a happier life,” he says. “My thinking needed to change. Having worked through my feelings over many years, I wanted to share my simple philosophy with

other positive people so that they too can make the most of the second chance that treatment affords to them. I want to save them time so they can get on with it and enjoy their lives to the fullest.”

TREATMENT CHRONICLE S

Will I Ever Stop Wishing for a Cure?

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Doing so may just leave you focusing on what you don’t have in your life By Gary McClain “I wake up every day wishing there was a cure for HIV. Will this ever go away?” You ask a really great question. Let me begin by saying that if you are wishing every day that a cure for HIV will emerge, you are in good company. It’s a wish that I hear often from my clients. Each and every person who has been touched by HIV in any way is wishing that someday soon HIV will be curable. I can hear the pain behind your question, along with some frustration. An HIV diagnosis brings new responsibilities and challenges to your life. In that way, it’s like an uninvited houseguest who’s moved in and wants lots of attention. You’re taking over my bedroom and you expect breakfast every morning? Really? HIV demands your attention every single day of your life. So it’s not surprising that you would wake up every day wishing it would just move on. I get the feeling you think you shouldn’t be waking up with that wish. Maybe because you’re concerned about wishing and not facing reality, or maybe because having that wish makes you feel more sad and frustrated. In other words, it sounds as if you think wishing for a cure is not such a good thing. So here’s my question: What if you looked at your morning wish from another perspective?

What I am saying here is that there are two ways to view the wish you wake up with every day. When we wish for something, we are coming from a place of not having. I don’t have this; I wish I had that. Or, I don’t want this; I wish that I had that instead. The flip side of wishing is focusing on what’s missing in your life. Wishing can leave you feeling stuck in what you don’t have in your life. But here’s an alternative way to view your morning wish. Let’s rephrase it a little bit by replacing the word “wish” with a new word: “hope.” How about if you made the conscious decision to wake up every morning with an attitude of hope? And the next question: How do you get your hopefulness on track every morning? Here’s how: Start with an attitude of gratitude. As part of your morning ritual, first identify something in your life that you’re grateful for. It can be something as simple as a sunny day, a great cup of coffee, your job, a few minutes on the phone with a friend. Remember: attitude of gratitude. Follow this with reviewing what makes you feel hopeful. Hope for a cure, sure. We’ve come a long way in treating HIV and we’re all hopeful about the future. But you should also feel hopeful because of the foundation you’ve created

for yourself: Your commitment to taking the best possible care of yourself. Your inner resilience that has helped you to accept your HIV status and move forward in life. Your health care team that is watching over you and helping you to maintain your health. And your support network of caring people who always have your back. Take a look at your foundation, what you need to do to keep it rock solid. That’s how you’ll cope with whatever the future does or doesn’t bring. And that’s a lot to feel hopeful about. You might want to take a moment when you first wake up to jot down what you’re grateful for on a piece of paper and stick it in your pocket. Or record it on your smartphone. This will help you stay focused on what’s working in your life. Review it as needed throughout your day. Take good care of yourself. Stay hopeful. About the future. About your ability to handle the curveballs that might get lobbed in your direction. About the people in your life who are there to support you. Every morning. Every day. 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. hivplusmag.com

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Just Diagnosed? Here’s How to Understand All Those New Lab Tests Blood tests are a routine part of an HIV-positive person’s life. But what do they all mean? By Sunnivie Brydum

CD4/T-cell Count This is one of the most common and helpful tests for figuring out how your body is reacting to the virus and to treatment. Knowing the number of CD4 cells, also known as T cells, in your blood allows your doctor to have a general overview of your immune system’s health. Because T cells send signals to activate your immune system when it’s exposed to a virus, it’s important to keep your count in the normal ranges. According to the Centers for Disease Control and Prevention, a healthy CD4 count is at least 500 cells per cubic millimeter of blood. The CDC once recommended that anyone with a T-cell count below 500 cells per cubic millimeter should seek treatment but now advises beginning treatment immediately after an HIV diagnosis.

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HIV Viral Load This checks the amount of active HIV in your blood and can help determine how well your body is responding to treatment. Depending on your viral load—the number of HIV particles, or “copies,” in your blood—your doctor might change your antiretroviral therapy, especially if your viral load tops 200 HIV copies per millileter of blood. The goal is to have as few copies as possible, known as an “undetectable” viral load, generally considered to be between 40 and 75 HIV copies per milliliter, depending on the type of test administered, according to AIDS.gov.

TOP: SHUT TERSTOCK/SOMSAK SUWANPUT; LEFT: SHUT TERSTOCK/SCIENCE PHOTO; RIGHT: SHUT TERSTOCK/XRENDER

So you’ve just been diagnosed with HIV. You’ve found the right doctor and you’re ready to take control of your health, but how do you figure out what tools your body needs to stay at its peak? Your doctor will perform numerous tests to assess your needs, but these are some of the ones doctors use frequently to gauge how your body is dealing with HIV. Get to know them, because most of these tests will be performed whenever you visit your doctor, or at least every three months.

Lipids/Cholesterol This test measures the amount of fat, also called lipids, being carried through the blood. It’s important to note that lipids include both the “good” cholesterol (HDL) and “bad” cholesterol (LDL), and that protease inhibitors and other drugs used in highly active antiretroviral therapy (HAART) can have an impact on lipid levels. Regular lipids tests can help your doctor determine if you should go on cholesterol-lowering drugs or change your diet. Smoking also increases the risk of elevated lipid levels.

TOP: SHUT TERSTOCK/ANUKOOL MANOTON; CENTER LEFT: SHUT TERSTOCK/PIT TAWUT; CENTER RIGHT: SHUT TERSTOCK/SCIENCE PHOTO ; BOT TOM: SHUT TERSTOCK/ BIOMEDICAL

Complete Blood Count This routine test measures the number of white blood cells, which fight infections; red blood cells, which carry oxygen throughout the body; and platelets, which make blood clot. Because of white blood cells’ role in fighting disease, keeping track of them can help your doctor diagnose opportunistic infections. Since both HIV and antiretroviral therapy can affect your white and red blood cell and platelet counts, a blood count can also help your doctor figure out why you might be experiencing abnormal levels of fatigue, weakness, bruising, or bleeding.

Blood Sugar/Glucose This test measures the amount of glucose in your blood, also known as blood sugar. Since HIV-positive people are at an increased risk for diabetes, and because some HIV treatments can affect the amount of glucose your body absorbs, it’s important to be screened for diabetes before starting any new treatment. Regularly monitoring your blood sugar levels also helps detect any early signs of insulin resistance, which can lead to diabetes.

Comprehensive Metabolic Panel This lab test measures liver and kidney function in addition to assessing the levels of glucose, proteins, and electrolytes in your blood. A comprehensive metabolic panel tells doctors how well your kidneys and liver are filtering waste produced by your body, plus it measures your blood sugar levels and checks how well your cells are producing calcium, sodium, potassium, and other electrolytes needed for healthy organ function, in addition to carbon dioxide. Many HIV treatment regimens affect the liver and kidneys, so this is an important test for any HIV-positive person, but it’s especially critical for those who also have hepatitis B or C, since those conditions can have a severe impact on liver and kidney function. Drug Resistance Tests This test will let your doctor know if your particular virus is resistant—or unresponsive—to any type of antiretroviral drug. It can help your doctor determine which treatment regimen is best for you. If you’ve begun treatment and it isn’t lowering your viral load sufficiently, this test can help your doctor figure out why.

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Curing Hep C Gets Easier But More Expensive Harvoni is this year’s marquee drug for treating hepatitis C, but it’s a costly one

For people with the hepatitis C virus—many of whom have HIV as well—it’s been a year of change and challenge, with a new breakthrough drug pushing a previous one out of the headlines, but bringing with it issues of how to pay for the treatment. Harvoni, a combination med from Gilead Sciences, is this year’s big news on the HCV front. It’s become more popular than Gilead’s Sovaldi, hailed last year as a groundbreaking new treatment for the virus, but it’s even more expensive. Harvoni, approved by the Food and Drug Administration in October 2014, combines Sovaldi (generic name sofosbuvir) with another drug, ledispavir. Unlike Sovaldi and other HCV meds, it does not have to be taken with other drugs, such as ribivarin or peginterferon alfa. That makes Harvoni a super simple treatment, just one pill a day, and in studies it’s shown a 95 percent cure rate, even better than Sovaldi’s 90 percent. The combination of simplicity and efficacy has led to great demand. “People are coming in who never wanted to be treated before,” Dr. Douglas Dieterich, director of outpatient liver disease treatment at Mount Sinai Hospital in New York City, told the Associated Press. “When I started in 1989, I used to have a 3 percent cure rate. Now I have a 3 percent failure rate.” That’s great news for people with HCV. An estimated one-quarter of all people with HIV also have HCV, as do more than half of injection drug users who are HIV-positive. A person can carry HCV for years without symptoms, but if untreated it can cause cirrhosis of the liver, cancer, and other life-threatening complications. Today it’s the leading chronic viral infection leading to death in the United States, overtaking HIV in 2007 for that distinction. Patients and doctors quickly embraced Harvoni; in the first quarter of 2015, it made up three-fourths of the prescriptions filled for HCV drugs, according to IMS Health, a company that tracks prescription drug sales. Its sales surged as Sovaldi’s dropped. Another new, equally effective HCV treatment is AbbVie’s Viekira Pak—ombitasvir, paritaprevir, and ritonavir tablets pack-

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aged with dasabuvir tablets. It was also approved by the FDA in late 2014; it has been gaining in popularity, according to news reports, although this is hard to quantify as the drugmaker didn’t divulge Viekira Pak sales to IMS. The fact that it’s not a single-tablet regimen may cut into its popularity. Both Harvoni and Viekira Pak come highly recommended by professional associations. The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America issued joint guidelines for HCV treatment this year, saying all patients should receive one of these two new drugs, with older ones “not medically recommended.” But cost is an issue. Before discounts, Harvoni retails for about $94,000 for a 12-week regimen (compared with $84,000 for Sovaldi) and Viekira Pak about $83,000. Many patients are cleared of the virus in 12 weeks, although some require 24 weeks of treatment. The price has some insurers and government officials alarmed, but state Medicaid programs are entitled to deep discounts, and some private insurers have negotiated them as well. Also, drugmakers say the price will drop as pent-up demand for effective HCV treatment is met, and note that HCV, unlike HIV, doesn’t require lifelong treatment. Still, the cost has led some states to establish guidelines for who gets treated; for instance, California’s Medi-Cal program, for low-income people without private insurance, will offer treatment only if a test shows heightened scarring of the liver. Some doctors say delaying treatment this long won’t increase the chance of illness or death. But waiting until there are more serious complications is not recommended. Ultimately, some health care activists say, the federal government may need to regulate drug prices. “As a society we need a way of determining what is a reasonable price at the time of introduction of a new drug,” Stephen Schondelmeyer, a University of Minnesota professor focusing on pharmaceutical economics, told the AP. “We have expanded coverage, but we haven’t done anything to control costs on the pricing side.”

SHUT TERSTOCK/BIOMEDICAL

By Trudy Ring

WE KNOW HIV/AIDS medication therapy

But we also know you want a pharmacy that cares for you and the community. From participating in AIDS walks to offering education and free HIV testing in select stores nationwide, Walgreens is committed to giving back to the local groups and organizations that bring people together and bring us closer to new treatments, avenues of supportâ&#x20AC;&#x201D; and a cure.

To learn more, visit HIV.Walgreens.com.

14CS0017-A-0814

YOU CAN LIVE A HEALTHY LIFE WITH HIV. TREATMENT HELPS MAKE IT POSSIBLE.