HIV Plus Issue 112 May/June 2016

BECAUSE YOU’RE MORE THAN YOUR STATUS

J UST DIAG NOS E D? WE HAVE TH E AN SWE R S WHY TR E ATM E NT I S TH E B E ST PR E VE NTION

CARMEN CARRERA O N H I V, LOS I N G A DA D TO A I DS , A N D B E I N G A TR A N S S U P E R M O D E L

MAY/JUNE 2016 www.hivplusmag.com

WHAT IS GENVOYA®?

GENVOYA is a 1-pill, once-a-day prescription medicine used to treat HIV-1 in people 12 years and older. It can either be used in people who are starting HIV-1 treatment and have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. These include having an undetectable viral load (less than 50 copies/mL) for 6 months or more on their current HIV-1 treatment. GENVOYA combines 4 medicines into 1 pill taken once a day with food.

GENVOYA is a complete HIV-1 treatment and should not be used with other HIV-1 medicines.

GENVOYA does not cure HIV-1 or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking GENVOYA. 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 GENVOYA? GENVOYA may 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 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 and fatty. Symptoms of liver problems include your skin or the white part of your eyes turning yellow (jaundice), dark “teacolored” 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, or have been taking GENVOYA for a long time. In some cases, lactic acidosis and serious liver problems have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.

• Worsening of hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking GENVOYA, your HBV may suddenly get worse.

Do not stop taking GENVOYA without first talking to your healthcare provider, as they will need to monitor your health.

Who should not take GENVOYA? Do not take GENVOYA if you take: • Certain prescription medicines for other conditions. It is important to ask your healthcare provider or pharmacist about

medicines that should not be taken with GENVOYA. Do not start a new medicine without telling your healthcare provider.

• The herbal supplement St. John’s wort.

• Any other medicines to treat HIV-1 infection.

What are the other possible side effects of GENVOYA? Serious side effects of GENVOYA may also include: • Changes in body fat, which 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 GENVOYA. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys.

If you develop new or worse kidney problems, they may tell you to stop taking GENVOYA. • Bone problems, such as bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

The most common side effect of GENVOYA is nausea. 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 GENVOYA? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and overthe-counter medicines, vitamins, and herbal supplements.

Other medicines may affect how GENVOYA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take GENVOYA with all of your other medicines.

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

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 Important Facts about GENVOYA including important warnings on the following page.

Ask your healthcare provider if GENVOYA is right for you, and visit GENVOYA.com to learn more.

GENVOYA does not cure HIV-1 or AIDS.

SHOW YOUR

POWER

Take care of what matters most—you. GENVOYA is a 1-pill, once-a-day complete HIV-1 treatment for people who are either new to treatment or people whose healthcare provider determines they can replace their current HIV-1 medicines with GENVOYA.

IMPORTANT FACTS This is only a brief summary of important information about GENVOYA and does not replace talking to your healthcare provider about your condition and your treatment.

(jen-VOY-uh) MOST IMPORTANT INFORMATION ABOUT GENVOYA

POSSIBLE SIDE EFFECTS OF GENVOYA

Genvoya® may cause serious side effects, including:

GENVOYA can cause serious side effects, including:

• Build-up of lactic acid in your blood (lactic acidosis), which is a serious medical emergency that can lead to death. Call your healthcare provider right away if you have any of these symptoms: feeling very weak or tired, unusual 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.

• Severe liver problems, which in some cases can lead to death.

Call your healthcare provider right away if you have any of these symptoms: 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.

• Worsening of Hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking GENVOYA. Do not stop taking GENVOYA without first talking to your healthcare provider, as they will need to check your health regularly for several months.

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

• Those in the “Most Important Information About GENVOYA” section.

• Changes in body fat.

• Changes in your immune system.

• New or worse kidney problems, including kidney failure.

• Bone problems.

The most common side effect of GENVOYA is nausea.

These are not all the possible side effects of GENVOYA. Tell your healthcare provider right away if you have any new symptoms while taking GENVOYA. Your healthcare provider will need to do tests to monitor your health before and during treatment with GENVOYA.

BEFORE TAKING GENVOYA Tell your healthcare provider if you: • Have or had any kidney, bone, or liver problems, including hepatitis infection.

• Have any other medical condition.

ABOUT GENVOYA

• Are pregnant or plan to become pregnant.

• GENVOYA is a prescription medicine used to treat HIV-1 in people 12 years of age and older who have never taken HIV-1 medicines before. GENVOYA can also be used to replace current HIV-1 medicines for some people 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 HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements.

• GENVOYA does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.

Do NOT take GENVOYA if you: • Take a medicine that contains: alfuzosin (Uroxatral®), carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), cisapride (Propulsid®, Propulsid Quicksolv®), dihydroergotamine (D.H.E. 45®, Migranal®), ergotamine (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), lovastatin (Advicor®, Altoprev®, Mevacor®), methylergonovine (Ergotrate®, Methergine®), midazolam (when taken by mouth), phenobarbital (Luminal®), phenytoin (Dilantin®, Phenytek®), pimozide (Orap®), rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®), sildenafil when used for lung problems (Revatio®), simvastatin (Simcor®, Vytorin®, Zocor®), or triazolam (Halcion®).

• Take the herbal supplement St. John’s wort.

• Take any other HIV-1 medicines at the same time.

• Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

• Ask your healthcare provider or pharmacist about medicines that should not be taken with GENVOYA.

HOW TO TAKE GENVOYA • GENVOYA is a complete one pill, once a day HIV-1 medicine.

• Take GENVOYA with food.

GET MORE INFORMATION • This is only a brief summary of important information about GENVOYA. Talk to your healthcare provider or pharmacist to learn more.

• Go to GENVOYA.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit GENVOYA.com for program information.

GENVOYA, the GENVOYA Logo, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks are the property of their respective owners.

Version date: November 2015 © 2016 Gilead Sciences, Inc. All rights reserved. GENC0020 03/16

BECAUSE YOU’RE MORE THAN YOUR STATUS

WHY TACKLING HIV AMONG TRANS WOMEN MEANS LISTENING TO THEM FIRST

I DON’T WANT TO BE SOMEONE WHO IS JUST ABOUT GLAMOUR AND FAME, AND NOT DEAL WITH THE REAL ISSUES. I FEEL A RESPONSIBILITY. — CARMEN CARRERA

MAY/JUNE 2016 www.hivplusmag.com

EDITOR’S LETTER

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

4 | MAY / JUNE 2016

BECAUSE YOU’RE MORE THAN YOUR STATUS

J UST DIAG NOS E D? WE HAVE TH E AN SWE R S WHY TR E ATM E NT I S TH E B E ST PR E VE NTION

CARMEN CARRERA O N H IV, LOS I N G A DA D TO A I DS , A N D B E I N G A TR A N S S U P E R M O D E L

MAY/JUNE 2016 www.hivplusmag.com

BECAUSE YOU’RE MORE THAN YOUR STATUS

WHY TACKLING HIV AMONG TRANS WOMEN MEANS LISTENING TO THEM FIRST

I DON’T WANT TO BE SOMEONE WHO IS JUST ABOUT GLAMOUR AND FAME, AND NOT DEAL WITH THE REAL ISSUES. I FEEL A RESPONSIBILITY. — CARMEN CARRERA

MAY/JUNE 2016 www.hivplusmag.com

WHICH IS YOUR FAVORITE COVER? Tell us and win a free book!

When you have a supermodel on your cover, you’ve got to know the options will be endless. After a rousing debate, we chose the tough leather jacketclad glam shot you saw on the front of the magazine. But, this one, offering a sweeter, softer side of Carmen Carrera (love the braid!)was a close second favorite.

Which is your favorite cover? Vote now at Facebook.com/ HIVPlusMag and a random winner will win your choice of books— either Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery or A Woman’s Guide to Living With HIV Infection.*

*See what our editors thought about the books at HIVPlusMag.com

BRADFORD ROGNE

I’ve known since middle school that I was going to be a journalist when I grew up. In fact, I was already writing a column for our local newspaper (we only had 2,000 readers, but that was half the population of our whole town). I was high on the prestige, but when I closed my eyes at night I dreamt of being a supermodel: having the whole world know my name, walking the Paris runway wearing haute couture from designers whose clothes weren’t even sold within 300 miles of my tiny Idaho hometown. Alas, I was a short, mixed-race, fat chick with a giant nose, who had to settle for living vicariously and plastering my walls with photos of Cindy Crawford, Gia, and Iman.

I’m telling you this to explain that I sturggled not to totally nerd out about fashion while talking with Carmen Carrera, one of the most beautiful souls to ever walk a runway. Carmen may not be poz, but she has quite literally become the face of HIV in an ad campaign gracing New York City buses and subways.

But she’s not just another model pegged for a public awareness campaign, she’s an eager participant in an action that honors the father she lost to AIDS complications.

Carmen remains committed to that campaign despite being advised against it; against aligning herself with this cause, lest others assume she’s poz herself. After all, she’s been told, no one wants a Sports Illustrated swimsuit model associated with HIV. Unwilling to give up—either her support for people living with HIV or her career dreams—Carmen tells me she doesn’t want to be “all smoke and mirrors,” someone too glamorous to tackle the real issues facing men and women with HIV—especially women who are transgender like her.

This issue also features our special three-month investigation into what it’s like to have HIV behind bars. That might seem a heavy subject for springtime, especially since it deals with the intersections of race, poverty, violence, and HIV. But with the Sero Project battling HIV criminalization laws and other groups working on getting former prisoners connected to care outside, it’s a hopeful one too.

Our annual Just Diagnosed segment reflects optimism as well. Learning you’re HIV-positive is no longer the devestating news it once was. Sure, it means new challenges, but we’re here to guide you through some of the hardest parts, begninning with disclosure—coming out to friends and family, talking to your kids, broaching with your sexual partner the changes s/he might want to make. We also offer advice on picking the right medications, and even explain how many doctors and exes (or hookups) you’ll want to call and why.

Take your meds, take care of yourself, and don’t let anyone throw shade your way.

Happy Spring!

editor in chief DIANE ANDERSON-MINSHALL SVP, group publisher JOE VALENTINO art director RAINE BASCOS senior editor JACOB ANDERSON-MINSHALL managing editor TYLER CURRY copy editor ELAINE MENDUS contributing editor KATIE PEOPLES, MARK S. KING mental health editor GARY MCCLAIN creative director, digital media & integrated marketing 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 traffic manager KEVIN BISSADA VP, integrated marketing AMANDA JOHNSON senior manager, integrated marketing JOHN MCCOURT manager, integrated marketing JAMIE TREDWELL multiplatform advertising solutions manager PAIGE POPDAN jr. designer, integrated marketing PETER OLSON coordinator, integrated ad sales/marketing, CASEY NOBLE senior director, media strategy STEWART NACHT 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, 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 LOS ANGELES EDITORIAL OFFICES 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, California 90024 Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES Retrograde Communications, 43430 E. Florida Ave. Ste. F PMB 330, Hemet, CA 92544 Phone (951) 927-8727 • Email support@retrogradecommunications.com FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility.

To sign up, just log on to HIVPlusMag.com/signup to subscribe. There is a 10-copy minimum.

FREE DIGITAL SUBSCRIPTIONS Plus magazine is now available free to individual subscribers—a digital copy of each issue can be delivered to the privacy of your computer or reader six times per year. We require only your email address to initiate delivery. You may also share your digital copies with friends. To sign up, just log on to HIVPlusMag.com/signup and give us your email address.

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 Ste., Los Angeles, CA 90024. Plus is a registered trademark of Here Media Inc. Entire contents © 2016

by Here Publishing Inc. All rights reserved. Printed in the USA. FOLLOW US ON FACEBOOK AND TWITTER

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|5

ON THE COVER 18 Supermodel Alert!

Transgender model Carmen Carrera tackles HIV stigma.

JUST DIAGNOSED 32 The 6 Biggest Questions What we get asked at Plus.

34 How to Disclose Your Status What and how to tell family and friends.

39 Here's Why Treatment is the Best HIV Prevention

It can save your life and prevents transmission.

40 How Do I Tell My Kids?

Professionals offer advice.

OUR SPECIAL INVESTIGATIONS 42 We Don’t Need Another Hero Working with street educated trans women changes a girl.

Is society throwing away the key on prisoners with HIV?

6 | MAY / JUNE 2016

COURTESY OF VH1

24 Locked Up & Lost

New Odefsey is now available Actual Size (15.4 mm x 7.3 mm)

One small pill contains rilpivirine, emtricitabine, and tenofovir alafenamide (TAF).

Ask your healthcare provider if ODEFSEY is right for you.

To learn more visit ODEFSEY.com

Please see Brief Summary of Patient Information with important warnings on the adjacent pages.

Brief Summary of Patient Information about ODEFSEY ODEFSEY (oh-DEF-see) (emtricitabine, rilpivirine and tenofovir alafenamide) tablets Important: Ask your healthcare provider or pharmacist about medicines that should not be taken with ODEFSEY. There may be new information about ODEFSEY. This information is only a summary and does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is the most important information I should know about ODEFSEY? ODEFSEY can cause serious side effects, including: • Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis may happen in some people who take ODEFSEY or similar medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems.

Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – have stomach pain with nausea or vomiting – feel cold, especially in your arms and legs – feel dizzy or lightheaded – have a fast or irregular heartbeat • Severe liver problems. Severe liver problems may happen in people who take ODEFSEY. In some cases, these liver problems can lead to death. Your liver may become large and you may develop fat in your liver.

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 – nausea – pain, aching, or tenderness on the right side of your stomach area • You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking ODEFSEY or a similar medicine for a long time.

• Worsening of Hepatitis B virus (HBV) infection. ODEFSEY is not approved to treat HBV. If you have HBV and take ODEFSEY, your HBV may get worse (flare-up) if you stop taking ODEFSEY. A “flare-up” is when your HBV infection suddenly returns in a worse way than before.

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

– Do not stop taking ODEFSEY without first talking to your healthcare provider.

– If you stop taking ODEFSEY, 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 ODEFSEY.

What is ODEFSEY? ODEFSEY is a prescription medicine that is used to treat HIV-1 in people 12 years of age and older: • who have not received HIV-1 medicines in the past and have an amount of HIV-1 in their blood (“viral load”) that is no more than 100,000 copies/mL, or • to replace their current HIV-1 medicines in people who have been on the same HIV-1 medicines for at least 6 months, have a viral load that is less than 50 copies/mL, and have never failed past HIV-1 treatment.

It is not known if ODEFSEY is safe and effective in children under 12 years of age or who weigh less than 77 lb (35 kg).

When used to treat HIV-1 infection, ODEFSEY may help: • Reduce the amount of HIV-1 in your blood. This is called “viral load”.

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

Reducing the amount of HIV-1 and increasing the CD4+ (T) cells in your blood may help improve your immune system. This may reduce your risk of death or getting infections that can happen when your immune system is weak (opportunistic infections).

ODEFSEY does not cure HIV-1 infection or AIDS. You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses.

Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or re-use 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.

Who should not take ODEFSEY? Do not take ODEFSEY if you also take a medicine that contains: • carbamazepine (Carbatrol®, Epitol®, Equetro ®, Tegretol®, Tegretol-XR®, Teril®) • dexamethasone (Ozurdex®, Maxidex®, Decadron®, BaycadronTM) • dexlansoprazole (Dexilant®) • esomeprazole (Nexium®, Vimovo ®) • lansoprazole (Prevacid®) • omeprazole (Prilosec ®, Zegerid®) • oxcarbazepine (Trileptal®) • pantoprazole sodium (Protonix®) • phenobarbital (Luminal®) • phenytoin (Dilantin®, Dilantin-125 ®, Phenytek®) • rabeprazole (Aciphex®) • rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • rifapentine (Priftin®) • the herb St. John’s wort or a product that contains St. John’s wort

What should I tell my healthcare provider before taking ODEFSEY? Before taking ODEFSEY, tell your healthcare provider if you: • have liver problems including hepatitis B or C virus infection • have kidney and bone problems • have had depression or suicidal thoughts • have any other medical conditions • are pregnant or plan to become pregnant. It is not known if ODEFSEY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking ODEFSEY.

Pregnancy registry: there is a pregnancy registry for women who take HIV-1 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.

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

– At least one of the medicines in ODEFSEY can pass to your baby in your breast milk. It is not known if the other medicines in ODEFSEY 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.

Some medicines may interact with ODEFSEY. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.

• You can ask your healthcare provider or pharmacist for a list of medicines that interact with ODEFSEY. • Do not start a new medicine without telling your healthcare provider.

Your healthcare provider can tell you if it is safe to take ODEFSEY with other medicines.

How should I take ODEFSEY? • Take ODEFSEY exactly as your healthcare provider tells you to take

• •

• • •

it. ODEFSEY is taken by itself (not with other HIV-1 medicines) to treat HIV-1 infection.

Take ODEFSEY 1 time each day with a meal.

Do not change your dose or stop taking ODEFSEY without first talking with your healthcare provider. Stay under a healthcare provider’s care when taking ODEFSEY. Do not miss a dose of ODEFSEY. If you take too much ODEFSEY, call your healthcare provider or go to the nearest hospital emergency room right away.

When your ODEFSEY supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to ODEFSEY and become harder to treat.

What are the possible side effects of ODEFSEY? ODEFSEY may cause serious side effects, including: • See “What is the most important information I should know about ODEFSEY?” • Severe skin rash and allergic reactions. Skin rash is a common side effect of ODEFSEY. Rash can be serious. Call your healthcare provider right away if you get a rash. In some cases, rash and allergic reaction may need to be treated in a hospital. If you get a rash with any of the following symptoms, stop taking ODEFSEY and call your healthcare provider right away: – fever – skin blisters – mouth sores – redness or swelling of the eyes (conjunctivitis) – swelling of the face, lips, mouth or throat – trouble breathing or swallowing – pain on the right side of the stomach (abdominal) area – dark “tea-colored” urine

• Depression or mood changes. Tell your healthcare provider right

away if you have any of the following symptoms: – feel sad or hopeless – feel 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 ODEFSEY. Liver problems can also happen during treatment with ODEFSEY 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 ODEFSEY. • 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.

• 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 ODEFSEY. Your healthcare provider may tell you to stop taking ODEFSEY if you develop new or worse kidney problems.

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

The most common side effects of rilpivirine, one of the medicines in ODEFSEY, are depression, trouble sleeping (insomnia), and headache.

The most common side effect of emtricitabine and tenofovir alafenamide, two of the medicines in ODEFSEY, is nausea.

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 ODEFSEY. For more information, ask your healthcare provider or pharmacist.

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

This Brief Summary summarizes the most important information about ODEFSEY. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ODEFSEY that is written for health professionals.

For more information, call 1-800-445-3235 or go to www.ODEFSEY.com.

Keep ODEFSEY and all medicines out of reach of children.

Issued: March 2016

ODEFSEY, the ODEFSEY logo, EMTRIVA, GILEAD, the GILEAD Logo, and GSI are trademarks of Gilead Sciences, Inc., or its related companies. All other trademarks referenced herein are the property of their respective owners. © 2016 Gilead Sciences, Inc. All rights reserved. GILC0216 03/16

MAY | JUNE 2016 COVER: Carmen Carrera photographed by Alex Evans; BACK COVER: Shutterstock; INSERT COVER: Carmen Carrera photographed by Melina Varela

BUZZWORTHY 11 Spin Class Proposal A serodiscordant love story is a viral sensation.

12 Goodbye, Gluten!

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12 Positive Transplants New rules pave way for organ recipients.

13 Coffee RX

7 Ways to get a caffine fix.

14 The Cocktail Cure Drink to your health.

14 Safer Than You Think People in treatment are less infectious than they think.

15

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51 First PrEP to Poz Case

Rare drug resistant HIV strain was immune to PrEP.

52 Do You Need a Meningitis Vaccine?

Some people are particularly vulnerable to the deadly disease.

53 Put a Ring on It

This insertable vaginal ring could prevent HIV in women.

53 Sex & Meth

The dangers of mixing the two.

10 | MAY / JUNE 2016

THE BEST OF THE REST 48 I Love Your Microbiome New research suggests we actually fall in love with each other’s stomach bugs.

54 Might Be Time to Switch Meds

Sleep weird hours? Take pills without food? An expert’s guide to which meds are right for your lifestyle.

SPECIAL INSERT Poz Hollywood

The HIV-positive actors, creators, and subjects of 3 new projects: Unsure/Positive, Guys Reading Poems, and D-Man.

SHUTTERSTOCK

TREATMENT CHRONICLES 50 Salute This

BUZZWORTHY Keller (center) and Marinelli (right) with family and friends.

MIXED-STATUS COUPLE BECOMES SOCIAL MEDIA SENSATION Unless you have been living under a social media rock, chances are you have seen the spin class flash mob proposal that took the Internet by storm. In less than 24 hours, the marriage proposal of Adam Keller and Jared Marinelli, now known as #TeamJadam, racked up over 3 million views. Their engagement, however, was not the only source of inspiration to come out of the spin class couple, because Keller and Marinelli are also a public example of a mixed HIV-status relationship.

On Valentine's Day, JoyRide spin instructor Keller surprised his boyfriend and fellow JoyRide instructor, Marinelli, when Marinelli’s class burst out into a top-secret, choreographed wedding proposal. With Keller on a bike front and center, everyone appeared to be cycling as usual.

But, when Marinelli began the warm-up, the music suddenly changed and the cyclists stepped off their bikes and started to move in formation. Soon enough, Marinelli’s family and friends began to fill the room and he started connecting the dots. With not a dry eye in the room, Keller finally broke from the crowd and approached Marinelli. Keller was equal parts emotional and out-of-breath, but he managed to eventually find the words and ask the big question.

Marinelli, while laughing and crying, emphatically said yes. #TeamJadam became a certified overnight sensation.

Just days later, the two decided to do something useful

with the spotlight by revealing to Plus that they are in serodiscordant couple. The pair had asked their friend to write about how they became a couple, including the point when Marinelli was crushing on Keller but afraid to reveal his HIV-positive status.

The story goes like this. Keller came into JoyRide looking for a job and Marinelli was instantly smitten. Marinelli gushed over the new instructor to his friend, HIV-positive artist Jonathan Joseph Ganjian, but also sharing his reservations about revealing his own status. Ganjian assured Marinelli that if Keller was the right guy, he would not be deterred by something like HIV. Keller was not only receptive to dating a person with HIV; he also began actively seeking out information and advice; which ultimately led him to begin taking PrEP. In fact, it was Keller’s idea to become a more vocal supporter of his HIV-positive fiancé and to speak out against the HIV stigma that he has noticed in the LGBT community.

“PrEP lifted a huge weight off our shoulders as far as making sure we’re doing everything we can to protect ourselves—I want to share that too,” Keller said. “I think we’re just two guys in love who won’t let something like status stand in the way.” #TeamJadam is now planning their spring or fall 2017 wedding in Connecticut.

—T Y L E R C U R RY

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BUZZWORTHY

DO I NEED TO GO GLUTEN-FREE? For people who need it, the glutenfree movement is far more than the latest fad. When people with gluten intolerance or celiac disease, remove gluten (a protein found in wheat, rye and barley) from their diet it has a range of benefits from decreasing stomach pain, bloating, and gas to reducing more serious symptoms like joint pain, skin rashes, and anemia. For those who don’t, it’s just money down the drain.

How do I know if I'm gluten sensitive?

A new blood test called Array 3, from Cyrex Labratories identifies gluten reactivity more accurately than earlier tests. It's the the most comprehensive analysis available for determining gluten sensitivity, according to Dr. Chad Larson, an advisor on the clinical consulting team for Cyrex (JoinCyrex. com), “because it accurately identifies gluten reactivity and measures antibody production against 8 wheat proteins and peptides, three essential enzymes (transglutaminase-2, transglutaminase-3 and transglutaminase-6), and the gliadin transglutaminase complex.”

That’s a lot of science-y words. So who should take it?

Larson tells us that the test isn’t for everyone. Array 3 is only recommended “for people who have non-responsive gastrointestinal symptoms present with multiple-symptom complaints—including joint pain, fatigue, muscle pain, brain fog, hormone imbalances, and chronic inflammation—or suffer from depression or neurodegenerative symptoms like peripheral neuropathy, Alzheimer’s disease, or multiple sclerosis,” says Dr. Larson.

And if you have those symptoms?

Ask your doctor about the Array 3 blood test. Results are reported in about two weeks. “Patients can then work with their physician to develop an appropriate treatment plan that may or may not include the elimination of gluten from their diet,” Dr. Larson adds.— DA M

For the first time, HIV-positive individuals may now receive organs from HIV-positive donors in the United States, opening up a new pipeline of treatment, according to advocates.

Johns Hopkins University School of Medicine recently received approval from the United Network for Organ Sharing to perform two transplants between HIV-positive patients: one kidney and one liver. It’s the first and only medical center approved for such an operation. The number of HIV-positive donors is estimated between 500 and 600, according to The New York Times. Those donors could save nearly 1,000 people a year.

The new policy will give HIV-positive patients with end-stage organ diseases a “new chance at life,” says Dr. Dorry Segev, associate professor of surgery at Johns Hopkins, and an advocate for the HIV Organ Policy Equity Act. For many years, HIV-positive patients weren’t considered good candidates for organ donations, as they were not expected to live long.

Though they were not forbidden from receiving donor organs from HIVnegative patients, transplants—or even the study of transplants—between two HIV-positive people had been illegal since 1988. But with the onset of better medications and longer, healthier, lifespans for people with HIV,

12 | M AY / J U N E 2 0 1 6

new possibilities opened up. In 2013, President Obama signed the HIV Organ Policy Equity Act, which legalized transplants between poz patients. The new law seems to be a win-win, as HIV-positive patients will have more potential donors while HIV-negative patients might move up the organ donor lists.

“Organ transplantation is actually even more important for patients with HIV, since they die on the waiting list even faster than their HIVnegative counterparts,” said Segev. “We are very thankful to Congress, Obama, and the entire transplant community for letting us use organs from HIV-positive patients to save lives, instead of throwing them away, as we had to do for so many years.”

Segev warned The New York Times reporter Daniel Victor that it will be slow at first to begin positive-to-positive organ transplants, as these transplants were illegal for decades, and most medical centers aren’t yet equipped to perform them. In addition, organs will only be taken from deceased donors for now until it is established that it safe for living HIV-positive persons to donate.— KAT I E P E O P L E S

SHUTTERSTOCK

The First HIV-Positive Organ Transplant

SUPPORT HIV & LGBT CAUSES

REASONS TO GET YOU DRINKING COFFEE

Science is on your side.

Turns out you should absolutely be drinking coffee. A meta-analysis of studies proved that drinking two cups of coffee a day lowers your risk of developing liver cirrhosis by 44 percent and other recent studies have shown that coffee may help you stave off diabetes, Parkinson’s, dementia, and Alzheimer’s disease. One cup revs your metabolism, increases your energy by 16 percent, and makes you more productive. A French study proved that drinking three cups a day increased treatment success by 80 percent and reduced side-effects by more than 80 percent for people living with hepatitis C and HIV. So we’ve got some fun ways to get your coffee RX.

At Rainbow Brew Coffee you’ll find scrumptiously unique blends with funny gay (and bi) descriptions, but this Minneapolis-based roaster— which offers one of the largest selections of organic coffee in the country—means business.

Certified fair trade, they also use solar panels to power the three Primo roasters. Even better, in their CaffeinatedFor-A-Cause shop, for every pound sold, $1 is donated to the non-profit of your choice including these worthy HIV groups: Minnesota AIDS Project, Clare House, Triangle of Hope, or Red Ribbon Ride. $13, RainbowBrew.com

GO AU NATUREL

Dancing Moon’s premium all-natural antioxidant coffee is roasted in small batches, high in antioxidants, fair trade certified, organic, and mold-free. And they focus on coffee beans from the world’s best single source plantations. Even better, besides the taste, is the fact that 5 percent of all profits are donated to Semper Fi Fund and go to help wounded and critically ill members of the armed forces. Try the Full Moon Gourmet Blend or the Ethiopian Yirgacheffe. $12.95 and up, DancingMoonCoffee.com

CHEW ON THIS

Don’t think you have to drink to get coffee goodness. The delicious il Morso Coffee Bars are the perfect all-natural, organic, and fair trade energy food that are literally tiny squares of coffee and other sweets without the cup. Each il Morso bar has only 1 gram of sugar, 2.5 grams of fat, and 15 to 25 calories, but the caffeine kick of a shot of espresso. My faves—Mocha, Americano, and Coffee & Cream—offer the highest caffeine quotients. $59 for a box of 40, ilMorso.com

—DIANE ANDERSON-MINSHALL

THE ONLY BREWER YOU'LL EVER NEED

I “went Keurig” three years ago and have never regretted it. I love its ability to make both single serve and larger pots of coffee or tea with the simple touch of a screen.

You can use one of 500 different pre-made pods (love the salted caramel macchiato), fill a reusable pod with your favorites (Café Du Monde!), or make your own tea. Keurig stays on trend with a new brewer in the Pantone Color of the Year. Pantone anointed two colors this year—cool blue Serenity and warm Rose Quartz—meant to express the new gender blur and "societal movements toward gender equality and fluidity.” Coffee activism? Now I can't wait to get the new Keurig K250 brewing system in Serenity and their new double-walled ceramic travel mug in Rose Quartz before they sell out. Brewer: $129.99; Mug: $16.99, exclusively at keurig.com/pantonecolor-of-year

MOCHA MOSES All hail the Chosen Bean: this punny artisan roasted specialty coffee that is “Biblicallyinspired” is a great fun for Christians and atheists alike.

Try the Abraham Mocha Java, the Forbidden Dark Rose, or the light Moses Blend, which is earthy, chocolaty, and yummy. $6.95 and up, TheChosenBean.com

COFFEE ON THE CHEAP

On a tight budget? Café Valet’s Starter Combo includes the Signature Single-Serve Brewer and a 10-count pack of coffee for a mere $25. It brews a hot, fresh cup in just minutes with the touch of a button and it’s tiny enough to easily fit on a desk or in a dorm room, weighs only 1.9 pounds, and can be transported back and forth easily. $25, CafeValet.com

AND, THE NON-EDIBLE BONUS…

Pacific Shaving Company Caffeinated Shaving Cream and Aftershave combines an espresso worth of caffeine with organic aloe and spearmint to offer a shave (and healthy skin) that'll help get you going. Bonus: every purchase leads to planting of a tree, and there’s never any animal testing of these safe, natural, vegan, paraben- and sulfate-free, eco-friendly ingredients. $7.99 each or $15.75 set, PacificShaving.com

H I V PLU SM AG . C OM

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BUZZWORTHY

THE COCKTAIL CURE Want a drink that doesn’t set your health back? If you’re in New York City, SushiSamba’s new culinary cocktails menu might be the answer. Developed by Richard Woods, winner of U.K.’s “Most Imaginative Bartender Award,” SushiSamba's new drinks let you socialize, drink your food, and have a healthy (even a post-workout) cocktail you won’t feel guilty about tomorrow. Our

faves: the vibrant green Avocado Batida (creamy, colorful twist on a classic Brazilian favorite with fresh avocado purée swizzled through crushed ice with cachaça, almond syrup, and cacao and served with an accompanying cone of maiz cancha, an Andean snack like corn nuts), the Coco Ceviche (Bombay Dry gin swizzled through crushed ice with yuzu, passion fruit, and a dark chocolate liqueur with a “shot” of ceviche with a tamarind ponzu), or the Tom Yam (a fresh, fiery, cooling Asian combination of coriander, ginger, lime leaf, and chili spiked with vodka and served with nigiri sushi). But if you’re booze-free or in recovery (congrats!), just ask for a Lychee Cooler without the Grey Goose and St. Germain—still yummy. — DA M

I Think I Can?

A recent study of people on antiretrovirals showed the disconnect between a person’s viral load and their view of their likelihood of transmitting HIV.

52%

thought they were highly or somewhat infectious after 3 years of treatment.

90%

were wrong—they were actually undetectable, meaning their risk of transmission was actually close to zero.

10%

still had detectable viral loads and were infectious.

But, at the beginning of the 3-year study…

16%

thought they had low (or no) risk of transmitting HIV.

100% of those people were wrong.

Source: Landovitz/UCLA, CROI 2016

Got Food?

SHUTTERSTOCK

ANTIDEPRESSANT MAY IMPROVE COGNITIVE DAMAGE IN HIV-POSITIVE PEOPLE You can live a long and healthy life with HIV, but many still can experience complications like cognitive damage and chronic inflammation.

Studies have shown that HIVassociated brain disorders can have a serious health impact, accelerating the aging process and increasing death rates. Meanwhile, increased inflammation is linked to cancer, heart disease, kidney failure, dementia, and autoimmune diseases.

Fortunately, researchers from John Hopkins University School of Medicine recently discovered that an existing antidepressant may be able to ameliorate these health concerns and improve the quality of life for those aging with HIV. In a small, controlled study, the antidepressant drug paroxetine (Paxil) boosted mental functions related to cognitive damage and suppressed inflammation for patients with HIV. The drug improved reaction time and decision-making and moderately suppressed inflammation in patients known to have HIV-associated neurocognitive disorders (HAND).

“Over a period of 20 years and after 10 clinical trials, this is the first time we have been able to clearly demonstrate benefit…of cognitive performance for patients with HIV-associated neurocognitive disorders,” said lead author Ned Sacktor, a neurology professor at Johns Hopkins University, noting the groundbreaking nature of the findings.

Even when virally suppressed, people living with HIV can still experience inflammation, which in the brain causes damage to nerve cells. People who suffer from HAND can often experience difficulty with learning, decision-making, motor function, and memory.

Paroxetine seems capable of stopping mental decline and reversing earlier damage. In a 2014 study, those who took paroxetine saw significant improvement in decision-making and reaction time. Since Paroxetine is currently approved for mental health disorders, nothing should delay FDAapproval, which could dramatically reduce the time before the treatment is available to consumers.—TC

In order to stay healthy we try to remember to take our meds and use apps and activity trackers to keep us fit, but when we’re too busy to eat, what happens?

We either skip the meal altogether or end up holding a greasy bag of fast food on our way to tick off another to-do list item. Here’s a better option: 100%FOOD, a nutritionally complete meal replacement smoothie that provides all the nutrients— including golden flaxseed, hemp, sesame seeds, and rice flour, as well as vitamins and Omega oils—that your body needs to stay healthy. It’s vegan and contains no geneticallymodified ingredients, and comes in two flavors, the lightly malted chocolate flavor, Choco, and Raw, which is a vanilla similar to many protein powders. Even better: it comes with an app that allows you to simply drag and drop suggested fruits and vegetables (even energy boosters) into the onscreen simulated blender and note the changes in nutrient levels. Once you’ve hit 100%, you are good to go.— DA M

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D A I LY D O S E J . H O LT

WITHOUT A DATE AT 67, I’M CLOSER TO DEATH FROM OLD AGE THAN FROM AIDS COMPLICATIONS. M Y N A M E A N D birthdate are engraved on a grey, granite headstone in Woodlawn Cemetery. At Dad’s death, Mom thought it best if all our names were carved on the headstone.

It was cheaper. I have a constant reminder of my immortality, as if I needed it.

I’ve been at the threshold of death since age 40 when I left a California testing center holding a piece of a paper that said HIVpositive. My life, and my friends instantly became like batteries, forever viewed as positive or negative. That day I felt fine. There was no diarrhea, no night sweats, no neuropathy, and no pill box. At that moment, I would have been content to be Lot’s wife, a pillar of salt caught in the moment, never to change, looking like a graceful palm tree outside the testing center. The only future I saw was disability, suffering, and death. So why not end it now? That day, was a safe haven away from a perceived empty future.

16 | MAY / JUNE 2016

Then, as time wore on, I became the aftermath of a plague, archeological dust—unwanted and sifted out, a broken vessel.

I saw my parents’ names engraved on that headstone. Other headstones and other names were added, ending with Aunt Mary, the last of my parents’ generation. I’m now the elder, and I never prepared for this rank.

Though I often surrendered myself to the inevitability of death, night’s dark comfort, for 30 years, my mortality escaped daily with the stars into the brightness of day. Trouble is, when you’re not dead you’d like to talk to someone about being a survivor. I want to tell someone my thoughts, my concerns, my preoccupation with death, but anyone who might care stopped listening long ago. They’re weary of the same, old survivor story. Conversations and tears are reserved for those who died.

Those who listen do so out of kindness, willing themselves to hear only words, their meaning floating up and away unnoticed, like smoke from the morning fire.

Occasionally an unfamiliar person at the local coffee shop will engage me in polite conversation. They inquire about the nature of my day, and I want to tell them my day always starts with the thought of death. They find this bizarre. Why not think of life if you’re up and walking?

When she was young enough to still ride in the child’s seat of the grocery cart, my boisterous, redheaded daughter would often say, “Daddy, I said hello to that woman and she won’t talk to me.”

I responded, “Honey, people don’t always want to talk.” She couldn’t comprehend why, and I couldn’t understand why she kept asking. Now I am the one wanting to know why people don’t want to talk. Of course, I’m not as cute or as innocent as a 3-year-old redhead.

But I’d still like to talk to someone about surviving AIDS. I don’t want casual conversations about lives lost. The number of panels on the AIDS Quilt is well known to me. I’ve seen them displayed in the engine room of the Queen Mary in Long Beach and on the mall in Washington D.C., and I have a patchwork quilt of my own, pictures of my friends who died and visions of those I never knew. Problem is, I ached to be a panel on that quilt, not look at others. And I wonder if anyone’s memory can be reduced to a square of fabric.

So at 67, where does this leave me? I still have an uncertain future, but I am much closer to death from old age than AIDS complications.

Looking at a chasm in my sexual history, friends who have died. Anxious about long-term effects of HIV and the drugs used to treat it. Still hearing voices of damnation: “Gay is evil, AIDS is God’s punishment.”

Most of all though, glad I did not become that pillar of salt. I would have missed a lot of life. I would have missed telling my story.

Doctor Holt, a retired physician, 30-year survivor, and award-winning author of Square Affair (TimmHolt.com), lives with his partner in Chicago.

SHUTTERSTOCK

BY TIMMOTHY

BY DI ANE AND E RSO N -M IN S H ALL

CALL ME

CARMEN M I L L I O N S O F P E O P L E H AV E seen actress and model Carmen Carrera become the woman she is today—quite literally. On RuPaul’s Drag Race, MTV viewers watched Carrera—then identifying publicly as a gay man—pull off some of the fiercest femme drag ever seen on TV. Except it wasn’t drag, not for Carrera.

That was the real her, the woman Carrera had dreamed of being since she was a precocious toddler trying on maxi pads— because she’d seen her mom using them.

The transgender model now says she was living “between genders” while filming Drag Race; feeling like she was in boy drag during the day and her real self at night. Carrera didn’t know how to tell her husband Adrian Torres the truth, so she didn’t say anything. She just began taking hormones and eventually her body said everything for her: when she grew breasts, Torres figured it out.

Fans of VH1’s Couples Therapy know all about that—and the transition, their infidelities, the immense pressure Carrera feels being one of the most high-profile transgender models in the world (signed

by Elite). The couple appeared on the sixth season of the reality show, the first trans-inclusive couple to spill their guts to Dr. Jenn Mann and the viewing public.

By showing the ordinary challenges trans (Carrera) and pansexual (Torres) individuals face, it became groundbreaking, culminating in Carrera becoming the first transgender person to wed on cable TV.

18 | MAY / JUNE 2016

“It definitely made us stronger and closer as far as seeing each other’s points of view…to have an understanding of each other [with] fewer expectations,” says Carrera. “But going through the process on television and letting everyone in was a little scary at first.”

Carrera, an HIV and LGBT activist in her own right, says she and her quiet, press-shy husband decided being on the show was “a great opportunity” for trans visibility. “I wasn’t going to do it right away, because who wants to put their personal business out there? I did it anyway, because it was going to be valuable to my community, and to the acceptance of us.

I wanted to drive home that me and Adrian are just a boy and a girl trying to figure it out.”

Her initial qualms were eased after she watched previous episodes. “Couple’s Therapy is not the kind of show that’s sensationalized drama.” But, she admits, “the experience was very intense,” and she worried about “the judgment of other people, the people that are watching and the people that I’m opening up to—and how I’m going to be perceived. But there was a part of me that was comforted by the idea that I was doing something for my community—and it was good therapy.”

Overall Carrera feels she “was pretty successful,” in reaching her goals and says, “I’m happy that I did it.”

The model, who has been featured in W, Elle, Glamour and a big Orbitz campaign, stands out on screen and in magazines as well as she does in person, coming across as relatable and approaching others as though the “majority of people” aren’t transphobic, they just need to be given real information in, well, a relatable way.

“If I’m trying to educate them, it’s not going to work,” she says. “I knew that I had to make it a casual conversation. I had my boundaries, but tried not to be overly Laverne Cox about the situation, because it wouldn’t sink in.”

In addition to Couples Therapy, Carrera had a role last year in the film Ricki and the Flash and she was photographed by the legendary David LaChapelle (whose runway show she M

BRENDAN FORBES

SHE’S A MOM, A WIFE, AND A GIRL WHO LOST HER FATHER TO AIDS COMPLICATIONS. NOW CARMEN CARRERA, AMERICA’S FIRST TRANSGENDER SUPERMODEL, IS USING HER CELEBRITY TO FIGHT HIV AND ITS STIGMA.

PHOTO CREDIT

HIVPLUSMAG.COM

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20 | MAY / JUNE 2016

SHUTTERSTOCK (PG 32)

Carrera and Torres, who starred on Couples Therapy, have been together nearly a decade.

COURTESY VH1

walked), Mark Seliger, and Steven Meisel to name a few. NARS, a luxury makeup brand, recently named a lipstick after Carrera as part of its new Audacious Lipstick Collection. But closer to her heart is a project many advised her against: representing New York City’s new HIV prevention campaign in a safer sex ad called “Play Sure.” Her face now graces the sides of buses and greets subway riders as they travel through the veins of our nation’s busiest city.

HIV has been a personal cause for Carrera ever since she learned her father, a former injection drug user, died of complications from AIDS. “My mom told me that he had died from an epileptic seizure,” she recalls. “He did suffer from epilepsy, and that was actually the second cause of death. My mom dealt with a lot of the judgment [my father experienced]. He was sick for about a year. I was 2 when he passed away. She had to take him to the clinic, because his family wasn’t around. He was living on his own. She was trying to take care of me, have a career, and take care of him—and keep him off of the streets and out of doing drugs.”

Her mother felt all the stigma attached to an AIDS diagnosis and was “freaked out at the time, because it was so new. They didn’t know how to treat it. My mom carried a lot of that with her after he passed away.”

Fearing what Carrera might say to others, or that she would “think that my dad was a bad person,” her mother never shared his HIV status. But the modelto-be was tenacious. “I started investigating when I was 16. That’s when I found out.”

Later, she also met her father’s family. “I got to meet them while I was transitioning, so, it was a lot to take in. It was really weird, but they were very accepting. I still have a relationship with them to this day. I have two aunts and I have a bunch of cousins…they treat me with a lot of love.”

Her father’s memory may have helped fuel her HIV activism, but Carrera says, as a trans woman of color, she’s also painfully aware of how disproportionately HIV impacts her community. Trans women of color have the highest HIV rates in the country and little is being done to change that.

“So many of my friends from the club scene would like get [HIV] and not take care of themselves, and it was so sad to see these things happen right before my eyes—and there was nothing I could do because they wouldn’t want to listen. They didn’t want to care about themselves anymore, as though [they thought] their life was over.”

She says now that marriage equality is the law of the land, the LGBT community should turn its attention back to HIV and AIDS. “If we take control of it, we can really end AIDS sooner,” she argues. “If we take the treatment serious; if we take our [medication]; if we talk about it so it’s not so taboo. It’s not something to fear. That’s part of the reason why I decided to work with New York City Department of Health and to target the nightlife scene, because

I DON’T WANT TO BE SOMEONE WHO IS SMOKE AND MIRRORS, AND JUST ABOUT GLAMOUR AND FAME, AND NOT DEAL WITH THE REAL ISSUES, BECAUSE I’M GOING TO FEEL SOME KIND OF RESPONSIBILITY ABOUT IT.

I experienced it first hand. ... [there is] a “don’t ask, don’t tell” around HIV status. Nobody talks about it. It took me to educate myself, and I learned it first hand to be able to speak back to my community.”

There are other topics she thinks we need to talk more about too, like sex work and the high percentage of trans women of color who are forced into survival sex when other economic avenues are closed.

Or about trans women who seek love at all costs, even if it means not requesting to use a condom or questioning their partner’s status.

“The majority, maybe all, of my friends who influenced me to make some decisions as far as my transition goes…my support group, really, they were all sex workers,” says Carrera. “That’s what they did. I’m not surprised to hear that these numbers are so high, because I definitely can understand that completely.

You just want that love. You want to feel that intimacy…a part of you that wants to feel like you are completely desirable.”

What she doesn’t understand is why she gets “a lot of flak from the trans community for doing HIV stuff. A lot of trans women…have reached out to me and said, ‘Oh, people are going to think that you have HIV,’ or ‘People are going to think that being intimate with trans women means you have a higher risk of getting HIV.’ ‘You have a mainstream platform like VH1, you have a lot of heterosexual people that are learning from you, and the first thing you want to talk about is HIV stuff ? It’s not a good look.’”

In an effort to counter the myth that all trans women are sex workers, Carrera fears activists have left behind the women who are. “The way I look at it is, facts are facts,” Carrera insists. “And in order for us to be above it, to actually be in control, is to talk about it and to not be afraid of it. Because, these are the facts. It is what it is. I don’t want to be someone who is smoke and mirrors, and just about glamour and fame, and not deal with the real issues, because I’m going to feel some kind of responsibility about it. AIDS doesn’t just affect gay people or trans people—it affects the human race. Period.”

Of course she still recognizes the weighty impact HIV has on transgender women, in particular, and she sees a unique way to engage trans people HIVPLUSMAG.COM

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around that: recognizing healthcare as part of transitioning and embracing their true selves. “We have to keep ourselves healthy. We need to be able to live a full, fulfilling life after the transition and how are we going to do that if we’re not taking care of ourselves? …if you keep avoiding it, you’re just cutting your life shorter. What’s the point, if you’re going to live your life unhealthy, in going through this transition? To just not take care of yourself after that is foolish.”

She sees unhealthy people as being “examples for the younger generation to not make these decisions, and to not choose to avoid dealing with things. Some people will last longer than others, and it’s something that’s sad to say, but it’s honest, and it’s something that maybe people do need to hear.”

Carrera believes HIV-positive trans people have worked too hard to become their true selves to just throw it away by not getting treatment. But Carrera also sees how “you can get lost in your transition sometimes. I’ve seen it with my friends, girls who are solely focused on looking 100 percent biological and [not trans]. Everything else goes out the window, and they triple up on their estrogen, or they triple up on their testosterone blockers, or whatever they need to do to look the way they need to look so that they can go out and have interactions with people that don’t know they’re trans—just to feel better, just to fit in. But it’s delusional. It’s not

22 | MAY / JUNE 2016

really dealing with the truth, and not really creating stability for yourself as a trans person.”

As a model, taking care of her own body is among Carrera’s top priorities. It needs to be, especially if she hopes to reach her goal of appearing in Sports Illustrated or becoming a Victoria’s Secret model.

Her fans certainly want that; around 50,000 signed a petition urging Victoria’s Secret to hire her. Carrera makes that goal seem plausible. You get the feeling she’s on the cusp of even bigger acclaim.

Her HIV campaign is certainly putting her on the map. “Every single day,” Carrera says, “I get a tweet or two: ‘Oh, you’re on the bus!’ or ‘Sit on the bus with Carmen!’ There was a huge billboard somewhere in Chelsea, somebody sent me a picture of it. I think it’s great. I’m so happy that they used me for it. People want to take photos, want to tweet it out, and want to like it, share it, and stuff like that, just because it’s me, which gets the message out even more. When I see that, I feel proud of myself.”

Does she wonder how her father—the man she never knew and who never had a chance to live a healthy life with HIV—would feel about what she’s done?

“Oh, my dad would be so proud of me,” she gushes. “My mom tells me every day that my dad is smiling down from heaven. I had one experience: I went to an HIV/AIDS rally in Brooklyn and an older gentleman just happened to be standing right next to me…and you can tell that he had to muster up whatever energy he had just to get out of bed and go and be there. I got the feeling that if my dad had been alive, I would have probably been going with him to these rallies. I just kind of felt like, ‘I would’ve been there with him’ and for a second I kind of felt that he was there with me.

That made me feel like he’s definitely watching me, he’s really proud of me, and if he would’ve stuck around, we would’ve been going through it together.”

Today Carrera has her own family: Adrian Torres and her two stepdaughters she helps raise, sharing custody with his ex, Stephanie. “[We’re] about the whole family unit. To be able to come home and function as a stepmom and as a wife, is amazing. It definitely gives me strength. We have an 11-year-old and a 7-year-old who are going through their changes and coming into awareness of who they are, and I feel so great to have a hand in that. I’m a very active [parent], because their mom goes to school and works full-time, so I have the kids a lot of the time. I have a different style of parenting that is different from Adrian’s and different from Stephanie’s, and I love it. Their support also helps me immensely.”

SETH WENIG/ASSOCIATED PRESS

Carmen Carrera models a dress featuring characters by the artist Keith Haring during an event on World AIDS Day at the Apollo Theater in New York. The state of New York will dedicate $200 million more to its $2.5 billion effort to end the AIDS epidemic by 2020. It’s already reporting significant milestones: for the first time since the epidemic began, no new cases of mother-to-child transmission were reported in the past year.

Carrera along with genderqueer and trans luminaries (from left) Jacob Tobia, Geena Rocero, Isis King, Laverne Cox, and Mila Jam at the premier of the MTV/ Logo documentary Laverne Cox Presents: The T Word in 2014.

I HAD MY BOUNDARIES, BUT I TRIED NOT TO BE OVERLY LAVERNE COX ABOUT THE SITUATION,

SCOTT ROTH/INVISION/ASSOCIATED PRESS

BECAUSE IT WOULDN’T SINK IN. The girls, Stephanie, and a plethora of friends, family, and fans watched her walk down the aisle last year on Couples Therapy. After nearly a decade together, this wasn’t her and Torres’s first wedding, but it was the first since Carrera came out to the world as a woman. On that day, she was just a girl, marrying a boy, in the dress of her dreams.

“I felt like I was a born again virgin walking down the aisle. That’s how I felt. Even though we had done it right before, there was something about this experience that was way more special to me, and real, and valuable. Before when we got married, the love was real, but everything else was kind of in disarray. Now, it just feels so much more real, and I value that experience so much.”

The wedding episode aired last December, a cap to a phenomenal year in which Carrera seemed to be everywhere. But she says, she couldn’t have gotten there without her husband’s support.

“He gives me the validation that a lot of trans women look for in a relationship,” she says. “And I

feel humble because he’s known me for so long. He’s my rock. I think that having someone by my side that has been there for the journey, and has been able to stick around to want to see me succeed gives me that validation and gives me that sense of love. I think that is so priceless to have. With him I can just be myself. He doesn’t love me just because I’m an actress, just because I model, just because I do this.

He loves me because he knows me as a person that wants to make things better.”

She’s living the dream—balancing love, family, career—but unwilling to rest on her laurels.

“I would love to be a triple threat,” she admits. “But it’s way too soon. I’m still pretty young, and I still have a long way to go. If J. Lo is a triple threat at 47 years old, well, I have about 17 years to go! But I’ll get there.”

Some day down the line she wants to do a showgirlesque Cirque du Solei type of acrobatic show, with Dita Von Teese influences. That’s long term, she says, because “there is something about the stage and live shows that, for me, is still my first love.”

For now, pursuing those dreams means a lot of hours at the gym so she can “blow it out the water with modeling” in an industry with high standards. “I am trying my best to match them,” she says. “It’s kind of like running a marathon. I’m so in beast mode, training right now. [Audiences] have seen me as a drag performer, they’ve seen me as a showgirl…now it’s the model that needs to emerge.

I’m just focused on training and leaning out my body, bringing the supermodel to realization, and then blowing people away. So they’re like, ‘Wow, she looks amazing—she is a supermodel!’”

Not satisfied with being a celebrity because of her visibility as a trans woman, Carrera dreams of becoming “so qualified that people are excited to have me work with them. I’m very hopeful right now. Because I feel like everything is there, and now I just need to put in my effort, and take all of my creative juices, and all of my experience that I’ve picked up going through…my transition and show them something that’s really new, and innovative, and amazing. So, yeah, I’m working on it. It’s all a work in progress.”

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LOCKED UP IS SOCIETY THROWING AWAY THE KEY ON PRISONERS WITH HIV?

B Y JAC OB A N DE R S ON - M I N SHA L L

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PHOTO CREDIT

S

pend a little time talking with Bryan C. Jones and you’ll have a hard time thinking of him as average. But, like far too many black men, the 55-year-old from Ohio has spent time locked up.

When Jones was released from an Ohio State penitentiary in 2008 he recalls that a social worker attempted to link him with care, providing him with directions to HIV service providers and giving him a bottle of antiretroviral medication to bridge the gap.

The college-educated, world traveler—who’d been HIV-positive, and in care, for decades—probably seemed like a perfect candidate for the reentry program. But, like thousands of other HIV-positive former inmates, Jones never showed up at the addresses he’d been given.

“I’m not going there,” he decided.

Worse, he discarded the pills he’d been given.

“They handed me two weeks’ worth of medication,” he remembers. “And most people probably did just like me—I left them at the bus station. I was like, ‘Well I’ve got two weeks’ worth, but what the hell am I to do after that?’” M

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His behavior may seem shocking, but it reflects a startling reality: 90 percent of HIV-positive prisoners experience interruptions in their treatment upon their release from prison.

Treatment interruptions can have long-term, negative impacts on the health of those living with HIV. The longer the interruption, the more time the virus remains unfettered, the more damage it can inflict and the greater reservoirs it can establish. More than 60 percent of former inmates report experiencing treatment interruptions lasting two months or more.

Jones, who was also featured in Plus magazine’s special investigation on depression, is an activist, peer educator, and performer with the unique ability to bring people to tears—from laughing so hard—even when talking about seriously depressing shit.

He grew up in poverty in “the heart of the ghetto,” where he was a victim of child sexual abuse. After growing up and coming out gay, Jones moved to Atlan-

most 40 percent of the total prison and jail population in 2011. African-Americans are incarcerated at five times the rate of whites. The probability that a young black man will go to prison is tripled if he doesn’t finish high school.

The decades-long war on drugs—which Benjamin calls “a war on people”—and mandatory sentencing laws, have filled prisons to capacity. They also disproportionately criminalize people of color, Benjamin explains, by enforcing laws that penalize African-Americans more harshly. For example, he says the punishment for possession of crack cocaine was “100 times stricter than for powder cocaine, the latter of which was favored by whites.”

Black gay and bisexual men are also disproportionality impacted by mass incarceration, according to a 2014 Louisiana Public Health Institute report. The study’s author, Russel Brewer, director of the Institute’s HIV/STI program, tells Plus, “I think what was

ta where he was later diagnosed with AIDS. That was in 1984, and Jones was told he had six months to live.

Outliving that prediction—“for whatever reason, I’m still trying to figure it out”—Jones has had the un-enviable luck of watching others fade away. “Everyone else just died,” he reflects now. “Most of my friends…60, 70 people in the span of a few years.”

Nearly 20 years after his HIV diagnosis, Jones was back in Ohio and still struggling when, he admits, “my depression led me to prison.” Jones may have depression to blame, but far too often what leads those with HIV to prison seems to be the color of their skin.

The mass incarceration of African-Americans has become commonplace in the United States, both a result of and contributor to enormous racial and economic disparities in employment, education, healthcare, poverty, and even mortality. For guys like Jones, this stacked deck begins early and casts a long shadow.

“Inadequate prenatal care, childhood exposure to lead and other toxins in the home, poverty, and other early childhood trauma all predispose underserved children to poor performance in school,” argues Georges Benjamin, the executive director of the American Public Health Association. “Minor behavior patterns—especially among kids of color—can result in school suspensions as early as preschool. This practice starts the school-to-prison pipeline.”

More than 2 million people in the United States are incarcerated in federal, state, and local correctional facilities on any given day. Despite representing only 13.5 percent of the U.S. population, blacks accounted for al-

26 | MAY / JUNE 2016

surprising was that there was such a high prevalence of incarceration history among the black, gay [and] bisexual men in this study. About 60 percent of the men—I think it was over 15,000 men enrolled in the study—had a history of incarceration.”

Pulling disproportionately from disadvantaged communities with higher risks for HIV, correctional facilities have long reported much higher rates of HIV than external communities. In 2010, the rate of diagnosed HIV infection among inmates in state and federal prisons was more than five times greater than the rate among the general public.

But in the last two decades, institutions have also benefitted from outside HIV prevention efforts and wider access to antiretroviral medications. The number of AIDS-related deaths in prisons overall plummeted 77 percent between 2001-2010. In the same period, the estimated number of inmates with HIV also declined, although by a much smaller amount, just 16 percent.

Still, people living with HIV appear to be at an increased risk of being incarcerated, and studies show 20 to 26 percent—that’s nearly one in four—of all Americans living with HIV are incarcerated at some point each year.

Though HIV rates among black women are down overall, African-American women remain particularly vulnerable to being HIV-positive and imprisoned. In fact, prisons are the only setting in the U.S. where HIV prevalence is higher among women than men, with approximately 2.6 percent of female and 1.8 percent of male state prison inmates known to be HIV-positive.

SHUTTERSTOCK (PG 24)

NEARLY ONE IN FOUR AMERICANS LIVING WITH HIV WILL BE INCARCERATED AT SOME POINT THIS YEAR

Further, African-Americans make up two-thirds of all newly reported HIV cases among women and 34 percent of female inmates.

Despite widespread concern that mass incarceration of African-American men has fueled the HIV epidemic in the black community, most experts, including those at the Centers for Disease Control and Prevention (CDC), insist that the majority of those locked up with HIV were positive prior to their incarceration.

It’s also a misconception that gay and bisexual men spread HIV in prison through sexual contact; several studies have shown that men who had anal sex with other men were far less likely to report this activity while they were locked up than prior to and after their incarceration.

“The research is really saying that folks are already living with HIV before they enter prison, or jail,” Brewer confirms. “And they just don’t necessarily know their status.”

One of the biggest barriers to that knowledge is the fact that there are no universal protocols on testing inmates for HIV. While some facilities mandate HIV testing for all incoming inmates, most rely on various voluntary options. Some facilities offer testing during an inmate’s intake while others only test inmates upon release. Very few prisons test both incoming and exiting prisoners for HIV. Brewer, whose home state of Louisiana “has the highest incarceration rate in the U.S.,” says his agency is trying to expand HIV testing in the state’s correctional facilities, “so that upon entry, folks know their status so that they can get the care that they need while they’re there.” Unfortunately, most people incarcerated in the United States actually serve their time in jail cells rather than prisons. Jails are short-term facilities typically run by the county, while state and federal prisons are where time is served after sentencing. Some jail systems are enormous and dwarf many prisons. For example, Los Angeles has the largest jail system in the country, with approximately 18,000 inmates at any given time.

The transient nature of the jail population makes HIV testing even more difficult. In fact, nine out of 10 jail inmates are released in under 72 hours, generally not long enough for a lab to process the test and notify the individual before they are released—let alone for providers to link the HIV-positive to care.

A 2010 study of New York City jails found that 28 percent of inmates with HIV hadn’t been diagnosed at the time of their admission. Furthermore, researchers concluded, “Despite a four-fold increase in jail testing, most undiagnosed infections still are not identified through routine, voluntary jail testing, largely because of the low acceptance of HIV testing.”

There is also no denying that HIV can spread behind bars. Despite legal prohibitions, inmates continue to have sex and inject drugs. Prison tats had long been thought to spread HIV between inmates but several studies ruled tattooing out as an HIV vector. One CDC examination of seroconverters in Georgia state M

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prisons created genetic fingerprints for the prison’s various HIV strains, and then followed them back to determine how each inmate was exposed. Those who initially insisted their only risk-factor was tattooing, later admitted to having sex with other prisoners prior to testing positive.

Efforts at preventing the spread of HIV inside prisons face more hurdles than those outside and the services provided aren’t consistent throughout the correctional system. Some, but hardly all, institutions offer educational materials, instructor-led trainings, peer-to-peer programs, and prevention case management. Although other countries have successfully integrated harm reduction options for inmates who use injection drugs, no American facility has yet to authorize a needle exchange program.

The World Health Organization and CDC both recommend the distribution of condoms in prisons, but in 2014, California became only the second state—after Vermont—to do so.

“That condoms work is not a mystery,” Los Angeles jail epidemiologist Garrett Cox told Al Jazeera after the law passed in California. Unfortunately, even inmates who are aware of their HIV status and/or want to practice safer sex rarely have access to condoms. Instead they employ creative solutions like using plastic wrap, latex gloves, or plastic grocery bags secured with rubber bands.

Other inmates may not understand risks associated with sex or drug use. Or they just may not care. The Georgia prison study found that of those who seroconverted in prison, 44 percent had been previously incarcerated, 86 percent had committed a violent offense, and 34 percent were serving life sentences. While some of these men may not have understood their risks, others may have felt they had nothing to lose or that the risk

from disadvantaged communities with limited resources, the healthcare correctional institutions provide may be the first such care an inmate has ever received.

“Unfortunately the economic downturn and resulting healthcare cuts have dramatically impacted the jail, making it the provider of first resort for any number of health problems, HIV included,” the Cook County, Illinois, sheriff ’s office said in a statement to Chicago’s Windy City Times. “We are working to better identify those with medical and behavioral healthcare needs, including HIV, and developing better transitions to care in the community with the hope that people will continue to access that care rather than cycling through the jail for care.”

Medical care of prisoners may be constitutionally required but there are no guarantees about the quality and inclusivity of that care. Many prison systems outsource their medical care to other providers and not all of them are equal. In fact, several have been sued for allegedly denying HIV care.

While researching her report, HIV Treatment in U.S. Jails and Prisons, Mary Sylla, founder and director of Policy & Advocacy for the Center for Health Justice, discovered that only 43 percent of surveyed correctional care providers reported that an HIV specialist was “often” available to see patients at their facility. More disturbingly, 38 percent reported that an HIV specialist was “never” available.

Kerry Thomas isn’t surprised.

“Although the medical contract reads like a medical plan comparable, if not better than, a private plan in the community,” says Thomas, “in application it is difficult to get the services we need at times.”

Thomas, a straight black man, is serving a 30-year sentence in an Idaho prison for not disclosing his status to a woman he had sex with—even though he used

PRISONS ARE THE ONLY PLACE IN THE U.S. WHERE HIV PREVALENCE IS HIGHER AMONG WOMEN THAN MEN of HIV was worth the high or sexual contact.

Jones, the one-time Ohio prisoner, recalls that for those facing long prison sentences, “people just did what they did.” Even knowing someone had HIV wouldn’t necessarily stop someone else from having sex (or sharing a needle) with them. (Interestingly, that Georgia study did confirm that—as in the general population—those who find out they are HIV-positive while in prison do alter their risk taking behavior afterwards and thereby decrease their likelihood of transmitting HIV to others.)

As prison populations swell, correctional facilities increasingly find themselves serving as primary health care providers. Considering that those serving time often hail

condoms, had an undetectable viral load, and did not transmit HIV. As a person living with HIV, Thomas is a part of his prison’s Chronic Care Clinic, where he says he sees a provider three to four times a year—just not the same provider.

“It has been my experience that the person I’ve seen is unfamiliar with my case,” he admits. “On one occasion the provider thought I was there for hep C follow up. Although the contract says that counseling and education is offered, it is not at this facility.”

Although he is able to see his doctor from the outside community once a year, Thomas says getting his antiretroviral prescriptions filled isn’t a breeze. “I have CO N T I N U E D A F T E R I N S E RT

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BOYS & POETRY

An HIV-positive actor helps make an incomparible neo-noir feature film.

JASON FRACARO (GUYS IN TIES); MICHAEL MARIUS PESSAH (DANIEL); SEAN PAUL FRANGET (HUNTER)

BY DIANE ANDERSON-MINSHALL

When it premiered at the the 21st Palm Beach International Film Festival, the ingenious film, Guys Reading Poems, broke all the rules by integrating visual poetry with traditional narrative, in black-and-white (shot on the new Red Epic monochrome camera). The film follows a resourceful child who uses poetry to survive when his disturbed avant garde painter mom locks him in a puppet box and builds an art installation around his imprisonment.

While there are celebs among the cast (The Last Kingdom’s Alexander Dreymon; Young & Hungry’s Rex Lee), director/producer/writer Hunter Lee Hughes also defied Hollywood expectations by casting Daniel Berilla, an HIV-positive actor. “I believe in Daniel,” says Hughes. “He’s has a lot to offer as an actor and human being.”

Here the guys chat about poetry, film, and HIV. DANIEL BERILLA, ACTOR & ASSOCIATE PRODUCER You’ve appeared in a few films and had a memorable spot on It’s Always Sunny in Philadelphia, but this project was different.

What drew me to Guys Reading Poems first was my friendship with the director. Hunter's been gracious enough to include me in his projects and he showed me the script for this film and you’re right, it was

very different, very unique. And it just sounded like I’d be able to explore a new side of myself in a movie that is super creative.

What’s Hunter like as filmmaker?

As a filmmaker, Hunter is very intuitive. He listens to people’s opinions and takes them seriously. As an actor, that makes it easier to have confidence in what I’m doing.

Will audiences “get” this film or is it too avant garde?

This film does speak to a niche audience, to be honest, but it’s also going to create a whole new genre of film. I hope it’s the start of something new and innovative.

Has making this movie changed you in any way?

As associate producer, I’ve been able to experience a whole new side of this business… and without this experience I might not have [known] what I was capable of. And as an actor, I learned I look pretty damn fetch in black-and-white.

You’re one of the few actors who is out about being HIV-positive.

Yeah, I am, and proud to be. Back in 2009 when I was diagnosed, I, like anyone else in the world, was frightened, scared of what my friends and family would think. I felt lost. I knew I had a choice to make when it came to what I moved out here to do: act and be gay. So I looked deep down inside myself and thought for days on end. Should I tell anyone? The answer was “yes” and, to my astonishment, I received a resounding acceptance from friends and the people I like to call my family in L.A. I’ve never looked back or regretted the decision to tell the truth because I knew there are many people my age…that need to know that you can still chase your dreams and live a healthy life, all while being HIV-positive.

Has that impacted your career in any way?

Yes, it honestly has, but not to the point to where it’s ruined my career. I’ve always looked young, and I always wanted to do Disney and Nickelodeon shows, especially when I first moved here. But I was diagnosed less than a year after my move and I told myself, to stop pursuing those shows"… because I honestly believed Middle America wouldn’t want their sons or daughters to Google me and find out that their favorite “character” was positive. The good thing that came out of my situation was my involvement in gay charities, becoming a speaker for the LGBT Center in L.A., being in a national commercial that still airs today about being positive, being in multiple gay-themed movies…and still living my life to the fullest.

I realized that trying to make a difference in the world was just as important as being on Disney.

Do you think we’ll see a day when being HIV-positive is treated as commonly as say asthma?

We can already see a change happening. Society has already begun to accept, support, and try to change how HIV is perceived.The fact that HIV is a sexually transmitted disease, means it will always have [some] opposition.

more about my grandmother, since she had underlined key phrases, starred certain titles, even made notes in the margins. The poems became like psychological puzzle pieces that helped me figure out a fuller picture of who my grandmother was. It was just a matter of time before I found a way to try to use poetry as cinematic puzzle pieces in a film.

What about A-list performers coming out as poz?

It just happened—look at Charlie Sheen! Charlie is one of the most relevant people working in entertainment today, and he took the risk to put his career, his family, his life on the line because I believe deep down that he was trying to make a difference as well. He was accepted by most, but not everyone.

Are audiences ready for this type of storytelling?

At my local ice cream place here in L.A., they’re now selling a flavor called Strawberry Honey Balsamic with Black Pepper.

So yeah, I think we can handle a poetry neo-noir feature film.

Maybe not everybody, but enough people are buying Strawberry Honey Balsamic with Black Pepper to keep it on the menu. So I don’t see why Guys Reading Poems can’t find its audience, too.

There’s an online list of cutest men of 2015 and you’re sandwiched between Josh Hutcherson and Tyson Beckford. How does that feel?

I’m sandwiched between them? That’s not my preferable position, but…I’m actually honored and very surprised that I’m on a list with people of that stature. So thank you, America!

HUNTER LEE HUGHES, DIRECTOR, PRODUCER & WRITER What led you to create Guys Reading Poems?

After my grandmother passed away, my mother, brother, and I had to walk through her house and decide what we might like to keep. I decided to take her poetry collection. I came to learn a lot

Unsure/Positive The Series Creator Talks About Silence, Meth Use, and the Power of Post-Its.

BY TYLER CURRY

What led you to cast Daniel?

He’s a charmer, but even more of a fighter than a charmer and I like that about him. He and Patricia [Velasquez], and Rex do have a lot in common because all three of them were friends of mine before we shot. I love working with actors I already know. So much of our work is about whether or not the actors trust me enough to take risks and touch an uncomfortable or tender part of themselves.

He’s one of the very few actors who is out about living with HIV. Does that anything to the project?

One beautiful part of being an actor is that even challenging moments in your life can be used for creative fuel… if you’re

For the new hit web series Unsure/Positive, creator and star Christian Kiley (left) drew inspiration from his personal seroconversion. After premiering online, the series— which follows Kieran from the moment of his HIV-positive diagnosis—hit Boston’s International Film Festival and Wicked Queer, the city’s LGBT film fest.

The project began as just a few pages of dialogue Kiley wrote for his graduate film program at Emerson College.

His fellow classmates didn’t know that Kiley was pulling from his own experiences as an HIV-positive man learning to deal with a new diagnosis.

Soon, Kiley began working on the script outside of class and his assignment quickly turned into a passion project.

“I remember very specifically a conversation, over drinks, with my close friend Jacqui,” he recalls. “We were talking about the value of serialized storytelling in media, specifically on TV, and the idea of

CO N T I N U E D O N PAG E 4 6

following characters through multiple episodes—letting them act and react against a constantly changing backdrop.”

During that conversation, Kiley says, “things crystallized.

I was going to write a serialized narrative about a character like myself.”

He admits that HIV-positive people have been “pigeonholed or simply not represented in the mainstream media since the epidemic began,” something he wants to change. For Unsure/ Positive, Kiley took inspiration from other serialized shows that resonated with him (Nurse Jackie, Louie, and Breaking Bad to name a few), shows that helped him realize what was missing.

“Protagonists whose imperfections were their defining aspects,” he says.

"I think this trend is actually a vector for creators who are making shows that are more true to their central characters. Shows like that can tell stories that… run the gamut in terms of emoCO N T I N U E D O N PAG E 4 6

STARTING HIV TREATMENT STARTINGHIVHIVTREATMENT TREATMENT STARTING HELPS PROTECT YOUR HEALTH. HELPSPROTECT PROTECTYOUR YOURHEALTH. HEALTH. HELPS There is no cure for HIV, but treatment can stop the There isno nocure cure for HIV, but treatment can stop virus inisyour body and the damage HIVcan causes.

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Treatment also helps make it Treatmentalso also helps make it Treatment make possible to live a helps healthy life.it possibletotolive livea ahealthy healthy life. possible life.

STAYING ON TREATMENT HELPS LOWER STAYING ON TREATMENT HELPS LOWER THE AMOUNT OF VIRUS IN YOUR BLOOD. THE AMOUNT OF VIRUS IN YOUR BLOOD.

The amount can get so low, it cannot be measured by a test. This is being and it means you areby taking care ofisyour Thecalled amount canundetectable get so low, it cannot be measured a test.

This It also lowersand the itchance passing HIV care on toofothers. calledhealth. being undetectable meansof you are taking your health. It also lowers the chance of passing HIV on to others.

TALKING ABOUT HIV TREATMENT TALKING ABOUT HIV TREATMENT

An open conversation with your healthcare provider can help you on the pathwith to a your long healthcare and healthyprovider life. When Anput open conversation canyou helpwork together, it to helps your healthcare provider the put you on the path a long and healthy life.

When find you work treatment that is right for you. together, it helps your healthcare provider find the treatment that is right for you.

HelpStopTheVirus.com HelpStopTheVirus.com

H I V P LU S M AG . CO M

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

Š 2015 Gilead Sciences, Inc. All rights reserved. UNBC1771 03/15

BY TYLER CURRY Bill T. Jones/Arnie Zane Dance Company and teaches dance at Loyola Marymount University. She's looking to fans to help bring the heartfelt documentary to life.

“The only obstacle to making this film is financial,” LeBlanc says. “Everyone who has seen the footage has rallied around it. It is a high caliber production. It is being made thoughtfully and well. People want to see this film get made. People need this film to get made.”

Although LeBlanc’s team has only reached the halfway mark in their goal to raise more than $500,000 for the production, filming has already begun. The documentary starts in a dance studio in 2015, where LeBlanc is teaching “D-Man in the Waters” to nine of her most skilled students from LMU. As the dancers are put through their paces, we understand their inquiries into the history of the dance. We see their difficulties, and later how their understanding deepens.

D-Man, LeBlanc says, is not “about” AIDS. “It was the glorious alchemy that resulted when a dance company committed to to putting one foot in front of the other while an epidemic raged in and around them. The virus hasn’t been eradicated—the face of AIDS has changed, and the location of the epidemic has…shifted, but it is still here.”

LeBlanc wanted to explore the tragic backstory that led Jones to create the dance. In doing so she uncovers the stories of risk, sacrifice, love, loss, and resurrection that were embedded in the choreography over two decades ago. In the film, Jones and seven of his former dancers recall reeling from the 1988 loss of co-director, Arnie Zane, to AIDS complications. Only weeks into rehearsals for their More than two decades later, a new film new dance called “Waters,” a beloved member revisits the backstory with a millennial touch. of the company, Demian “D-Man” Acquavella, was also diagnosed with AIDS. Over the next six months, Jones created his seminal dance even as Acquavella’s health deteriorated. What In 1989, the award-winning choreograstarted as a lighthearted ballet about the movement of water pher, artistic director, and dancer Bill T. transformed into a penetrating look at love and survival during a Jones (pictured above) gifted the world plague. Renamed, "D-Man in the Waters" in honor of Acquavela, with his explosive tour-de-force, “D-Man the dance brought the audience inside the heartbreaking strugin the Waters,” an emotional dance pergle of love and ultimate loss that the AIDS epidemic represents. formance and tribute to dancer Demian Jones, still an active choreographer, director, and dancer has Acquavella and others who died from earned numerous accolades, including Kennedy Center Honors, a AIDS-related complications during the MacArthur “Genius Grant," Tony Awards, and the National Medal height of the epidemic. More than 25 of Arts. The National Young Arts Foundation honored him for years later, the documentary D-Man gives having a “significant influence on the development of young audiences a chance to revisit the heartAmerican artists,” and that influence is reflected in the ages of breaking time that led Jones—now 64 and those supporting the making of D-Man (D-ManDocumentary. living with HIV—to create his bittersweet com). Perhaps that’s a reminder that those with the most to learn celebration of life. about the impact of the epidemic are those too young to have The film's co-director/producer, lived through it.

Rosalynde LeBlanc, performed with the

MARK ELIAS/ASSOCIATED PRESS

THE MAKING OF AN AIDS-INSPIRED DANCE MASTERPIECE

K E R RY T H O M A S

SERO PROJECT

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to stay on top of the pharmacy to make sure there isn’t a delay,” one that could seriously impact his health.

With so many inmates either learning for the first time they have HIV, or finally having access to health care in prison, it’s not surprising that studies show 75 percent of HIV-positive inmates receive their first antiretroviral treatment while incarcerated.

Living with HIV while locked up adds a layer of complication to what can already be a stressful and life-altering chronic illness.

“In terms of confidentiality,” Jones says, “in prison, it’s not something that exists.”

First, he says, inmates cue up in the “pill line” to get their medication and “everyone else can see what you’re getting. You can’t take a handful of pills without other people looking, so everyone knows.”

In the Ohio facility where Jones served his time, inmates with HIV saw a specialist via telemedicine, rather than in person. “You would talk to a doctor on a TV,” he recalls.

“They would call you out during count time. I’m up there with five other people and we’re all in this room to talk to this particular doctor. So it doesn’t take a lot for other people to realize we all must be positive.”

In prison culture, where any sign of weakness—or isolation—can open an inmate up to violence and victimization, having other people know your HIV status isn’t something to be taken lightly. “You might be harmed,” Jones admits. “You could be harassed in a lot of ways. You could be ostracized.”

Lara Strick of the Washington-based Northwest AIDS Education and Training Center, encouraged prison administrators and health care providers attending the 2014 Oregon Corrections Conference to seriously consider side effects when choosing which HIV meds to give inmates.

For example, Strick noted that jaundice could broadcast one’s ill health to other prisoners, drowsiness could impact both alertness and a prisoner’s ability to respond to a threat, and one of the biggest side effects of ART, diarrhea, is “a big deal in prison” because inmates don’t have free access to a bathroom. M

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For Jones, his time in prison—and his health—were further complicated when he was diagnosed with terminal cancer. The creator of the one-man show about his experience, “And I Die Slowly,” jokes about it now. “Having stage four cancer, with one leg chained to a bed while being depressed? It’s not something you want to experience.”

His cancer added to the many reasons Jones says having “a good relationship with the nurses [makes] all the difference in the world.” A good provider can help you get the right meds, deal with side effects, access facilities, and feel like a human being instead of an “offender.”

“We are called, ‘offenders,’” Thomas says. “I’m not a big fan of that term. I was charged with an offense, men here

All released inmates—not just those with HIV—experience social and economic barriers to their efforts to reestablish connections with friends and family, secure housing and employment, and deal with untreated substance use issues and mental health disorders.

Having served time can bar a person from receiving public assistance and forever alter one’s legal rights.

“Upon release, bans on welfare, public housing, educational aid, employment, and voting make it virtually impossible for ex-offenders to have a real chance at life,” notes Brewer in one of his studies. Thus, “almost guaranteeing recidivism.”

Having HIV chips away at even those slim chances of success, particularly because health outcomes for poz

ONLY 5% OF HIV-POSITIVE INMATES FILLED A PRESCRIPTION FOR TREATMENT WITHIN 10 DAYS AFTER THEIR RELEASE may have even offended, but to me the term ‘offender’ implies that a certain behavior is ongoing. I believe that a behavior or crime is what a person did, not who they are.”

The people who see inmates only as “offenders” rarely see the value in providing HIV prevention (especially condoms or needle exchanges) and sometimes even HIV treatment (especially when it comes with a hefty price tag). But prison administrators and public health advocates are starting to see common ground.

Condom distribution has not only reduced transmission inside the L.A. jail system, but has also had a ripple effect on public health in outside communities.

“More than 95 percent of prison inmates will be released at some point during their lifetime,” adds Nina Harawa, who previously worked in Los Angeles County Department of Public Health’s HIV Epidemiology Program. Now a professor at Charles Drew University and the University of California Los Angeles (UCLA), Harawa has launched a number of innovative and successful programs for African-Americans living with or at risk of HIV. The concern over prison inmates going out into the larger community is what really fuels HIV prevention and treatment efforts inside. Talk about releasing people with undiagnosed or untreated HIV back into a community and suddenly even the most pro-law enforcement public officials may discover the political will— and funding—to preempt a public health nightmare.

Add to that the potential that those prisoners may be taking drug-resistant strains back to their home communities and suddenly controlling HIV in prisons sounds like a taxpayer bargain. The Georgia HIV study proved exactly that, that many of the HIV strains in the prison system were drug-resistant and could further compromise efforts to treat the chronic condition, inside and outside prison walls.

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people generally plummet post-incarceration. While the majority of HIV-positive inmates respond well to antiretroviral medication during their prison sentence, most discontinued their treatment following release from prison.

In fact, national studies show only 5 percent of inmates receiving antiretroviral medications in prison filled a prescription for the drugs within 10 days after their release and only 18 percent filled one within 30 days. As few as 20 percent were successfully linked to any type of HIV-related care within a month after their release.

A 2010 review of Texas’s attempts to connect recently released HIV-positive inmates to care found that 90 percent of the time there were treatment interruptions; in more than 70 percent of the cases, that interruption lasted at least a month. Over 60 percent of the former inmates experienced treatment interruptions lasting two months or more.

University of Texas researchers followed HIV-positive “repeat offenders,” inmates who were reincarcerated after being provided discharge planning services like a 10-day supply of antiretroviral medications and assistance applying for AIDS Drug Assistance Program (ADAP) funding for a 30-day supply of meds. One striking finding was that “between the time of release from prison and reincarceration,” inmates experienced dramatic decreases in their CD4 lymphocyte counts and simultaneous increases in their viral loads.

Bottom line: the health of inmates with HIV deteriorated after they were released from prison. These findings aren’t that surprising, given the known negative health outcomes associated with interrupted or discontinued antiretroviral therapy. These interruptions have also been associated with the development and transmission of drug-resistant HIV strains.

Formerly incarcerated people with HIV who had undetectable viral loads at the time of their release were more likely to fill their prescriptions within the first ten days, though, as were those who received assistance completing a Texas ADAP application.

“It really is difficult to find employment, find housing, or other services that you might need,” Brewer says, repeating what he’s heard from former inmates and trying to explain why people are getting lost after they get out of prison. “So, forget care. You’ve got to worry about other stuff; your immediate needs. You can’t be focusing on going to the doctor yet. You’ve got to take care of your other business.”

When it comes to “transitioning HIV care after release,” Thomas says he’s heard that “there are issues in Idaho in this area.” But his personal experience—he’s been in and out several times while living in the same Idaho city where he was incarcerated—has been consistency in care. In fact, he says, his HIV provider is with the same clinic that serves the prison system. “Therefore I have had the same doctors since 1988 and before my release in 2003 a case manager came out to the prison to determine which services I needed.”

When Jones was released he was given those two weeks of medication he left at the bus station, an action that stuns Harawa. As someone who helped establish similar programs in Los Angeles, Harawa is shocked

by Jones’s admission that he discarded expensive antiretroviral drugs in a public venue.

“But,” she stammers, “He was on medication in the jail! Why did he not know what to do with it?” She also worries about the person who stumbled upon the medication after that. “What are they doing?”

Despite Jones’s experience, Harawa still believes in providing people getting out of prison with a starter supply of antiretroviral meds. In the state of California, she says, HIV-positive inmates are “supposed to get 30 days of release meds, and generally people were getting that, and that helped. It might take that long for somebody to reestablish their care, but they were generally able to do so, especially if they already had a care provider before they went to prison.”

Jones says the Department of Corrections in Ohio sends somebody from the health department to visit poz prisoners “maybe 30 days before your release date.”

“But they need to start that process a lot earlier,” Jones explains. “So I’ve been trying to propose to our Department of Corrections a peer program. To have a positive person that’s been incarcerated…so positive inmates can [listen] to another positive person saying, ‘I’ve been in and this is what I did. If necessary give me a call when you get out, I can go with you to a doctor’s appointment.’

A lot of people don’t even want to go into a hospital, because that’s where infectious diseases breed.”

That’s where a peer can intervene, Jones says. He now runs a pre-release support group for HIV-positive inmates closing in on their exit dates.

“It’s important to me to make sure that people who are coming out of prison are linked to care,” he explains,

proud that the program has gotten a positive response.

“I was surprised that people would attend these, that they were bold enough to attend. It’s amazing to me that [it] went so well.”

DeAnn Gruber, STD/HIV Program Director at Louisiana’s Department of Health and Hospitals, agrees that pre-release interactions need to start earlier. Louisiana launches its program 180 days before the client’s release date in order to complete the requisite paperwork and applications for post-release HIV medical care, case management, and ADAP enrollment. Finding that the traditional system offered “a limited focus and little opportunity for dialogue,” Gruber’s department launched a video conferencing program (funded by Special Projects of National Significance) to encourage more backand-forth communications and hopefully increase the likelihood that HIV-positive prisoners will link to care within 90 days of their release.

Los Angeles has started a “peer navigator” program, doing much of the same things that Jones hopes to see in Ohio. “There is transitional case management that goes on in our jails,” Harawa acknowledges. “But you know, it often, like beautiful plans, fell apart quickly after people [left jail].”

So William Cunningham, a professor at UCLA, launched LINK LA, a first-of-its-kind program and clinical study that employs people who share backgrounds with those coming out of jail to meet them at the gate upon release, help them access HIV services, and reintegrate into the community.

“The jail system represents an important aspect of the epidemic that hasn’t been addressed sufficiently,” Cunningham explained when the program began. “Recidivism rates for HIV-positive men are extremely high— it’s like a revolving door between the community and the jail.”

If Link LA, a randomized controlled trial funded by the National Institutes of Health, succeeds in slowing that revolving door, it could end up serving as a model for other correctional facilities—and the communities those released inmates return to.

Post-release programs are making an impact.

“Those who are getting social services, support, case management, and other services, seem to do better,” Harawa concludes. “And that has a positive effect.”

But, she admits, they still aren’t reaching everyone.

“The people who really seemed to struggle in our study,” Harawa says, “were those who found out [they were HIV-positive] when they got to prison, or maybe they’d only first gotten care in prison. When they got out, they were just—pretty lost. And, unless they found a really good social service provider, or a friend support network who could help them along the way, they seemed to stay pretty lost.”

This article was produced as part of a 2015 Equal Voice Fellowship awarded Jacob Anderson-Minshall by a partnership of New American Media and the Marguerite Casey Foundation.

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JUST DIAGNOSED

The 6 Top Questions People Ask Us About HIV

BY D I A N E A N D E RS O N - M I N S H A L L , E D I TO R I N C H I E F O F P L U S M AG A Z I N E

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THE THINGS THE NEWLY DIAGNOSED ASK US ABOUT BEING POZ MIGHT SURPRISE YOU.

IS IT POSSIBLE I GOT A FALSE POSITIVE?

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

HOW MANY FORMER SEX PARTNERS DO I HAVE TO TELL?

This is kind of a murky area, with debate between activists and public policy experts. You will be asked to notify, or have the health department notify, anyone you have had sex with or shared needles with since your last negative HIV test or, if this was your first one, your recent sex partners (say, in the last year). Your partner(s) will need to be tested now and, if their test is negative, again in three months.

According to the New York Department of Health, how far back in time known partners should be reported is determined on a case-by-case basis depending on such factors as the approximate dates when you believe you were exposed and how willing (or able) you are to dig up those names and contact info. The federal Ryan White HIV/AIDS Program requires states to make a good-faith effort to notify current spouses and anyone who has been the HIV-positive person’s spouse within the last 10 years. However, public health departments and clinics aren't supposed to pressure you for this information and they cannot withhold your test results or penalize you in any way for not divulging.

WHAT WILL CHANGE NOW THAT I'M POZ?

With proper treatment, being HIV-positive is a manageable, chronic condition like lupus, diabetes, or asthma. You might need to exercise caution with some of your regular activities. Unless you had other health conditions prior to diagnosis, you’ll likely see a physician more than you did before because it’s vital that you monitor your health closely. Regular visits with your HIV health care provider will keep you up to date. Speak with

your doctor about changes that need to be made to your diet, exercise regimen, and use of alcohol, prescription medicines, and recreational drugs. If drugs were a factor in your transmission (there’s a link between crystal meth use and HIV transmission, for example), your doctor may recommend rehab. You may tire more easily, be more prone to infections, or have medical side effects you didn’t have before. But hands down, the biggest change in your daily routine will be taking medication. HIV medication requires strict adherence to the prescribed daily dosage, and the drugs often have (mostly minor) side effects. Open communication with your doctor will ensure that you are fully equipped to handle the changes in your life.

CAN I TRANSMIT HIV THROUGH ORAL SEX?

Because you can’t transmit HIV through saliva, you cannot pass HIV to your partner if you perform oral sex on them. Period.

With blow jobs, it is technically possible, but extremely rare, to transmit HIV to your partner if you ejaculate into their mouth. Years ago, a study by Eric Vittinghoff, a professor at University of California San Francisco’s Center School of Medicine’s Department of Epidemiology and Biostatistics, looked at oral transmission among men who had sex with men. He determined the rate of HIV transmission via oral sex was about four one-hundredths of one percent (0.0004). In fact, by the early 2000s—decades after the start of the AIDS epidemic, with more than 36 million people infected by the virus world wide—fewer than 40 cases of possible oral transmission had been reported in medical literature. “HIV acquisition by receptive oral sex without ejaculation is so unlikely, that we don’t have any firm evidence even to show that it actually occurs,” said Dr. Laurence Peiperl, former director of UCSF Center for HIV Information, at a roundtable on the subject. So it’s a biological possibility but it’s exceedingly rare and here’s why: As an HIV-positive man, even if you ejaculate into someone else’s mouth, they need to have open wounds in the mucous membranes in their mouth in order for the virus to penetrate them. Swallowing semen or pre-cum is not a risk because stomach acid and other enzymes kill HIV. And if you are a woman with HIV, having someone perform cunnilingus on you is also extremely low risk, especially if you’re not menstruating and your partner doesn't have open sores in her or his mouth (even then the risk is low).

Although the risk of HIV transmission is exceedingly low, you can still get other sexually transmitted diseases, including gonorrhea, via oral sex.

ARE THERE SYMPTOMS I SHOULD WATCH OUT FOR NOW?

There are certain signs and symptoms to look out for and a few health factors that should be constantly monitored. According to Rose Farnan, RN, and Maithe Enriquez, RN, authors of What Nurses Know About HIV/AIDS, you should pay special attention to particular symptoms: diarrhea, weight loss or loss of appetite, trouble or pain when swallowing, white patches or sores in or around your mouth, long-lasting fever, new cough, shortness of breath, headaches, dizziness, blurred vision, or difficulty remembering things. It can be hard to distinguish whether these symptoms are just passing or sign of a more serious issue, but keeping track of your body’s patterns will greatly benefit your health.

Farnan and Enriquez suggest keeping written records of weight and other factors that can change over time.

DO I NEED TO STOP HAVING SEX?

No! In fact, we encourage you not to. Orgasms help you sleep, boost your immunoglobulin levels (which fight infections), and reduce stress and depression.

There are ways to protect yourself and your partner, including condom use, PrEP (for an HIV-negative partner), serosorting, and Treatment as Prevention (see page 39) .

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JUST DIAGNOSED

HOW TO DISCLOSE YOUR HIV STATUS TO YOUR FAMILY AND FRIENDS Your First Step Is Making Sure You’re Not Alone In This.

BY TY L E R C U R RY

W HEN YOU FIR ST LE AR N T H AT you are HIV-positive, one of the immediate, dreaded thoughts that can come to mind is this: How will I ever tell my family and friends that I’m positive? What will they think of me?

What usually follows is a barrage of what-if scenarios of rejection and shame that flood your headspace, all before you utter those three little letters out loud. The trauma caused by these theoretical nightmares is often enough to keep you second-guessing who to tell and who to keep quiet around for far longer than it should.

The best way to stay healthy and manage your virus well is to create a support system of people who you love and trust. In order to do that, you need to get over your hang-ups and come out about your status to those who are important in your life. To help you get there, here are a few ways to make the process easier.

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TALK TO OTHER HIV-POSITIVE PEOPLE It’s always better to crawl before you walk, and walk before your run. If you can, it helps to get advice from a person who has personal experience. Reach out to someone in your life who you know is HIV-positive. If nobody comes to mind, talk with someone you know who has at least dated someone with HIV. Seek out online support groups and look for a new friend who can give you good advice. Gaining a real life perspective can easily assuage any stress or apprehension you may have.

ARM YOURSELF WITH THE FACTS Just like when you first found out, chances are the people you disclose your status to will have quite a few questions. Prepare yourself with some of the facts and figures about the state of HIV treatment to put their mind at ease. Once you allay their concerns about your health, you can graduate to deeper discussions. But make sure you get your facts straight by only using reputable sources: search topics on

HIVPlusMag.com, the Center for Disease Control and Prevention’s HIV site, and AIDSMap to start.

TAKE IT ONE PERSON AT A TIME Don’t worry about how everyone in your life will handle the news. Start with the person you're closest with, someone who supports you no matter what.

After you've told the people in your inner circle, you can decide how to approach the rest of the world. Every time you say "HIV" out loud, it will get easier and easier.

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BE PATIENT It’s more than likely that your family and friends won’t know the most up-to-date information about HIV, and they may have stigmatizing beliefs about HIV-positive people. They may initially mistake your new HIV status as a terminal one, rather than the manageable chronic condition it is. Give them time to learn and process the information. Support them through this and they will

likely return the favor. Remember, people who love you will probably be very concerned and upset at first. That’s because they are worried about you. It’s a natural reaction, just like the one you probably had when you first learned of your status. Be patient. In a month or two, you will be discussing your lab results and your T-cells in the same way you talk about your job and your love life.

BE BRAVE Discussing HIV with someone who you care about is never easy. Then again, nothing worthwhile ever is. Be brave and believe that you’re worthy of love and support—because you are.

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5 Reasons Why TasP Is the Best HIV Prevention

WHY THE MOST UNDERRATED AND LEAST TALKED ABOUT FORM OF SAFER SEX MIGHT JUST BE THE BEST.

BY TY L E R C U R RY

ALTHOUGH THE USE of Truvada as pre-exposure prophylaxis (PrEP) continues to make headlines, the use of treatment as prevention (dubbed TasP) is one of the most underrated yet most effective ways to prevent the spread of HIV.

JUST DIAGNOSED

WHAT IS TASP?

TasP is when someone who is HIVpositive achieves an undetectable viral load through the use of consistent antiretroviral medication. When a person with HIV has a viral load that is suppressed to undetectable levels, they reduce their risk of transmitting the disease by 96 percent.

To date, there has not been one confirmed case of someone with a suppressed viral load who has transmitted HIV. Study after study, TasP has been proven to work. When evaluated with the added benefits associated with antiretroviral meds, it’s simply the best HIV prevention methods out there. Here's why: IT CAN HAVE A BIG IMPACT.

An estimated 1.2 million people in the U.S. are living with HIV and 50,000 new infections occur annually. Currently, only 30 percent of people living with HIV are utilizing TasP by being on and adhering to their treatment to maintain a suppressed viral load. TasP users represent a more targeted, at-risk audience who have a greater reason to use this prevention method.

ISTOCK

IT SAVES LIVES.

Not only is TasP on of the most effective and under-utilized form of HIV prevention,

but—unlike PrEP, PEP, or even condoms—the use of TasP to prevent HIV has the added benefit of saving an HIV-positive person’s life. Whereas an HIV-negative person doesn't have to take PrEP, a person living with HIV must stay on treatment to remain healthy.

IT EMPOWERS HIV-POSITIVE PEOPLE.

Unfortunately, the majority of people with HIV aren't in treatment or taking advantage of TasP, due to numerous reasons, including not knowing their status or having access to care. There's also no denying the disempowerment people feel when they are first diagnosed. Promoting the effectiveness and benefits of TasP can show those living with HIV that their treatment is empowering, not just a symbol of stigma.

IT REDUCES HIV STIGMA AND PROMOTES HEALTHY CONVERSATION.

It’s difficult to talk about PrEP without getting bogged down into anecdotal discussions about worst-case scenarios and slut-shaming rhetoric. That's because HIV stigma still very much exists. When it comes to PrEP and TasP, one is not better or worse than the other. But when it comes to advocating for PrEP, the inclusion of TasP removes the barrier between HIV-positive and negative people and encourages conversation about shared interests in preventing HIV. The use of TasP, and more importantly, the conversation about TasP can greatly reduce the stigma of living with HIV and promote healthy discussion between sexual partners.

IT WORKS. IT REALLY WORKS.

TasP doesn’t work only in conjunction with PrEP. It doesn’t work only in conjunction with condoms. It just works. Period. On its own. An HIV-positive person who is using TasP as their HIV prevention method has virtually no risk of transmitting HIV. TasP is the best way for anyone with HIV to protect themselves from transmitting HIV and still have a healthy sex life. Like PrEP, TasP doesn't prevent other STIs . Couples can choose and use whatever additional protective methods they deem necessary. But make no mistake, TasP works. No disclaimers needed.

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Finding out you’re positive is tough; figuring out how to tell your children is even harder. A noted child therapist talks to several experts about doing it right.

40 | MAY / JUNE 2016

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JUST DIAGNOSED

DO I HAVE TO TELL THEM? Probably. “Ninety-eight percent of the time, unless it’s a highly unusual circumstance, telling your child is best,” says Christa Peterson, PsyD, and a certified child life specialist at Seattle Children’s Hospital.

Often, the child already senses something is wrong. And even very young children intuitively know when a parent is lying, warns Bernard Douglas, a psychotherapist in private practice.

Older children may figure out the parent has HIV on their own, by going through the parent’s medicine cabinet, says Ken Howard, founder of Gay Therapy LA. This can spark feelings of betrayal.

“The child wonders, ‘What else haven’t they told me? Am I not part of this family?

Do they not feel I can handle it?’ They can start to question their own abilities,” says Rebecca Hobbs-Lawrence, Pathways Program and Grief Services Coordinator at The Dougy Center. A child who feels betrayed that you didn’t tell them, can lose confidence in you, says Douglas.

AM I READY TO SHARE? Don’t rush home from learning about a HIV diagnosis and tell your child immediately. Sit down with your medical team first and hear about your treatment options, advises Peterson. Put a plan in place. You want to be able to tell them some concrete details, like, “This is the name of my medication.” You’ll also want to think about your goals for sharing this with your children, says Douglas.

“Make a list of your goals, and a list of your fears—what your children could experience that you don’t want,” he says. You want to be able to temper your expectations for how your children should react.

HOW DO I DO THIS? You want to use age-appropriate language, which means using simple terms for young children, and more details for teens or young adults. Hobbs-Lawrence says you can try something gentle but clear, like: “This is hard for me to tell you. I haven’t been feeling well. The doctors ran some tests, and they found out what I have. It’s something called Human Immunodeficiency Virus. Some people call it HIV.”

You can assure them that—unlike years ago—there are now medicines that help people with HIV live long, healthy lives. Or, if your diagnosis has a more serious prognosis because of comorbidities or AIDS complications, explain, “I have some other health conditions that means this is very serious.” Peterson suggests acknowledging if your prognosis is serious, by saying, “This is very distressing, and we’re going to have some really hard days,” but also make it clear that “not every day is going to be hard.”

WHAT SHOULDN’T I SAY? What can you leave out of this initial conversation? You don’t need to share how you got HIV, says Steve Lapuk, a psychotherapist in private practice.

“Allow the child to have the choice [whether or not] to ask that question,” says Douglas. But be prepared if they do. This conversation is also not a time to bring up safer sex.Yes, you want to educate your child, but do it at another time.

WHAT ABOUT PRIVACY? “The smallest children, will say, ‘My mommy’s sick’ but generally won’t use the word ‘HIV,’” says Hobbs-Lawrence. With a younger child, Douglas says parents need to ask themselves how being open about their diagnosis could impact their child’s invitations to sleepovers, sporting events, and other activities with their peers.

“Parents may think, ‘I’m going to stand up to the stigma,’” Douglas says, “but if their child will be excluded, that has to be considered.”

For older kids, you can ask your teenager, “What do you want to do with this information?” Douglas says.Talk about possible consequences. Give them power by including them in that decision-making process. It’s one thing to deal with ignorance, he says, but it’s another thing entirely to have had absolutely no say about it.

Hobbs-Lawrence offers another option: “You can tell your teen, ‘My preference is that the whole school won’t know.You need someone to talk to—who would you pick? A best friend, teachers, a therapist? We’ll make sure they have accurate info.’” That ensures your child is not “keeper of the secret,” which can be a huge burden. Be sure to add that “’if it does get around, it’s not anyone’s fault. We’ll handle it.’”

AFTER YOU COME OUT TO YOUR KIDS Your first conversation will be the beginning of a continuous conversation with your family. Tell your child you want to hear their questions. Ask how they want to share information. “Say, ‘Do we want to share one-on-one?'” says Hobbs-Lawrence. “‘Maybe we want a rule that anyone can call a family meeting? Maybe a Q&A box?’”

Families that focus on problem solving do best, says Peterson. Children feel protected when they hear, “We’re a team, we’ll face this together. No one is going to be left alone in this,” adds Hobbs-Lawrence.

Athena Brewer, MA, LMFT, is an expert in the treatment of angry and high-intensity children. She has a private practice in Seattle, and welcomes your feedback at athena@athenabrewer.com.

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42 | MAY / JUNE 2016

We Don’t Need Another Hero Working with street educated trans women around HIV and health issues taught me more about life, survival, and feminism than my entire college degree. by elaine r. mendus

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I M OV E D T O N E W YO R K C I T Y after college graduation to get out of rural America for good. BOOM! Health, a Bronxbased provider that integrates HIV, housing, legal, and advocacy services for disadvantaged communities, was the first place to give me a desperately needed reprieve from unemployment alley and the chance to wet my feet in social work as a peer mentor. As my grant-funded position was set to end, Eriká, a transgender colleague, approached me with another opportunity. She had developed a class to teach other trans women about health issues and wanted me to become her co-facilitator. M

Editor’s Note: Erika’s name has been changed to protect her privacy.

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44 | MAY / JUNE 2016

topics that might have been familiar to others but were quite new to me. I wanted to make sure I understood them all before the training began. I needed to impress Eriká and others at BOOM!, especially those making permanent hiring decisions.

I wanted to hit a home run and use this as a springboard to a full-time position.

Sure, I was thinking about future paychecks, but I also had people to save. I planned to introduce a segment on intimate partner and sexual violence. I knew trans women were often victimized by such violence, especially since some of our students would be coming from sex work backgrounds. As a liberated young trans millennial with a college degree and tons of earnestness, I just knew I would be able to save women who hadn’t had the education and enlightenment I had.

My first day would show me just how wrong I was.

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Not only was it a reprieve from my pending joblessness, I was honored to be wanted. I happily accepted the offer and on the subway ride home, I couldn’t get over the fact that I had garnered the respect of someone I’d never even worked with. I didn’t know Eriká well, but I respected her for her brash, outspoken attitude. I was thrilled that she was taking me on to assist in this endeavor.

Later that night, I started imagining all the good I could do in this new role. I could really teach these women something. Hell, maybe I could even save a life. My inner Wonder Woman bursting to the surface, I fell asleep with a smile. Only my roommates were happier than I was because this new position meant the rent would be on time.

I spent time studying a course outline Eriká provided. I read up on hepatitis c, silicon pumping, needle sharing, and other

I came in early. I was decked out in black dress pants, a mint green blouse, and black Doc Martins. A long, black trench coat protected me on the way up from the subway. When I stepped into the office-space-turned-lounge, Eriká greeted me with a smile.

She wore leggings, a red tracksuit top, and bright red sneakers.

Her long and perfectly manicured nails clicked when she touched pretty much anything. The other girls were also dressed more casually than I. As we waited for everyone to arrive and sorted out lunch, the girls chatted. Words flew back and forth, and I didn’t really pay attention, at least not until one sentence hit me like a freight train.

“She looks cunt!”

My mom would have backhanded me for saying the c-word at home.

Now these women were throwing it around like it was just another word. Yet it didn’t seem like they were using it to offend or cut each other down. This was a safe space, but shade was everywhere. Girls had no problem with calling each other a “man” or saying that somebody else “looked like a man” in jest, or to be shady, suggesting a trans woman didn’t pass. But their use of the c-word didn’t sound like shade.

Cunt couldn’t be a compliment, could it?

I had come to teach these women, but I was quickly getting an education. It turned out that cunt—like fish—was a hell of a compliment to these women. It implied that a girl was born female. It was sort of like the more politically correct term “passing,” only with a little more chutzpah.

I held my tongue and listened to how the girls talked that day.

It was a gateway to a whole new world. The women I was here to “educate” exuded that infamous New Yorker attitude, and it was delightful, even if it seemed strange and unfamiliar to me. They seemed isolated from, and outside of the transgender community that I was familiar with, the one that had blossomed on the Internet and come of age in college gender studies classes.

Teaching these women actually turned into an education for me. I learned just how asinine my savior approach had been.

These women may have lacked degrees—some hadn’t even graduated from high school—but they had the street smarts to make it through the tumultuous times before Laverne Cox was a TV star, before Janet Mock was Redefining Realness, before Jazz Jennings, Carmen Carrera, and legions of trans resources existed on the Internet.

Some of these women were engaged in sex work, but instead of the exploited and trafficked women I had imagined, they exuded power. They had survival skills. They didn’t need saving. You can’t save those who are already saving themselves. They were already being their true selves. These girls had let nothing stop their transition in an era where it was still dangerous to even be gay, much less trans, and yet they had survived.

There was something tangible about them. They seemed far more real to me than the trans women I encountered complaining on social media sites, or even the middle class activists who showed up at protests and Pride parades. To put it another way, these girls

simply weren’t camera-friendly enough to even appear in a public service announcement and the only way they would be in the media spotlight was as some kind of cautionary tale—and yet they had a lot to teach me.

In the college educated, social justice world, black and brown trans women have become a little like unicorns, nearly mythical beasts that everyone wants to study— and to help save.

Rather, I was quickly learning that these women were totally real, and they weren’t about to be taught (or saved) by a light-skinned Puerto Rican girl who thought she was better than them. They wouldn’t be caught in a classroom discussing abstract gender studies, nor did they need to. They didn’t need lectures on why “cunt” was an offensive term. They wouldn’t have known what it meant if I’d called the c-word “a trigger.”

What I learned they did—and do— need are opportunities from a society too often closed to them. And they need their voices heard. Black and Latina transgender women have some of the highest rates of HIV, of death from AIDS complications, of death from violence. These women receive a lot of love and “rest in power” comments when they are dead, but it’s time we started paying these women attention while they are still alive. Black and brown trans women are real people.

Not sacred idols, or people we should only evoke once a year on Transgender Day of Remembrance.

The wisdom and courage of those women at BOOM! has continued to inspire me more than any protest or radical activism I’ve witnessed since. Let’s stop talking about how “precious” or “important” the lives of black and Latina trans women are and start listening to them.

Let them speak and you’ll discover that many already know what they need—we just have to get out of their way. Bring trans women of color to the front and let them lead for a while. Maybe then we can stop turning dead trans women of color into “rest in peace and in power” protest memes.

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UNSURE/POZ HOLLYWOOD CONTINUED FROM INSERT

tions and reactions: from affection to disgust, and back again. That’s where Kieran comes from. In Irish, the name Kieran means ‘little dark one,’ and that seemed perfect.”

Reactions from viewers have run a similar gamut, Kiley admits.

“My father-in-law—who I admire greatly—saw…a few seconds from the scene where my character, Kieran, relapses with three other guys in a sexually suggestive montage. He was so dismayed. I think he’s still on the fence about watching the show.”

That’s not the only scene viewers have reacted to. “One of the most hopeful and upbeat moments of the show,” Kiley says, has “drawn out a bit of controversy. I’d talk about that more, but I’m only allowed one spoiler.”

There’s also a fairly intense episode in which Kieran uses meth.

“I consider that high praise!” he says. “We aimed to shoot the scene so that the adrenaline rush that one might experience before deciding to relapse was something tangible, palpable. Casting that scene was one of the longest processes in the production. We needed our actors to fully commit to the specifics of what that world is like. It paid off though, because everyone involved understood… [it] was crucial in getting things right. So I have to give props to my crew and cast for maintaining a completely professional set while we shot this difficult scene.”

Kiley says the realism paid off, perhaps too well. “On a personal level, I had to compartmentalize the relapse scene very carefully.

My husband, who was my fiancé at the time, did not like that scene. We

had to discuss it a lot, and I would remind him over and over that we were just acting out a situation, that this wasn’t reality. His worry was that the scene might act as a trigger for me, which was a very legitimate concern. But in the end, I think acting out that whole scene, explaining to my very talented cast members what this situation was really like from my own past experience, was in some way a turning point for me and my struggle with past meth use.”

Kiley felt it was necessary to include the scene, in part, because Kieran’s story is derived from his own personal history and because “it’s something that people don’t like to talk about. Sometimes when a subject like crystal meth use comes up, people instinctively try to change the subject. I think the problem of meth use in the gay community is that it’s treated as a taboo subject, which just creates stigma around those who use it.

The only way to make progress on that front is to actually engage in fruitful discourse around the subject. There was a time when talking about interracial marriage was similarly taboo. I’m all about moving the discussion forward.”

With season two on the horizon, he says “everyone is very excited to do it and part of the reason for that is, with the world of the show now established, we’re looking forward to delving into some of the characters lives in more detail. Allie, played

by Amy DePaola, and Paula, played

by Maureen Kieller, are characters that we really want to explore— not to mention Ottavio, played by Ken Breese, the weird roommate.”

He says that Kieran’s story, which has really just begun with season one, is important for a few reasons.

“Most importantly, there needs to

POETRY/POZ HOLLYWOOD CONTINUED FROM INSERT

as open, vulnerable, and talented as Daniel. His living with HIV provides a whole range of new experiences to bring to the table. And it deepens his work, too.

Will we see a day when HIV is treated like other medical issues?

I hope so. Here in Hollywood, especially with male actors, there’s an illusion of perfection

46 | MAY / JUNE 2016

be an HIV-positive character, who is relatable, accessible to a mainstream audience, giving voice to the scores of young people who are newly infected and living with HIV now.”

Kiley admits it’s a completely different thing to receive an positive diagnosis today than it was 20 years ago, but the media hasn’t caught up. “When I was first diagnosed, [if] there had been a series about a character who was dealing with post-diagnosis depression, along with life—which goes on for us poz folks these days—I might have felt more empowered to reach out to friends and loved ones and ask for the help I needed. Unfortunately, I had no model for that, so Kieran’s three months of silence is actually nothing compared to the nearly five years of isolation I experienced after my diagnosis.”

Unsure/Positive is filling that gap, and dozens of viewers have thanked him “for offering a perspective that they hadn’t ever considered,” he says. “Some of them are HIV-positive long-term survivors; some of them simply have never really felt affected by the epidemic. Maybe, now, they feel as though they know someone who is HIV-positive.”

Despite the high praise (or perhaps because of it), viewers shouldn’t expect controversy to go away next season.

“A second season will also allow us to contribute to the discourse around life with HIV and all that goes with it— PreP comes to mind, and so do other topics, like having an undetectable viral load, the perspective of long-term survivors, and the people who love them. There’s a lot to work with, and if you walk into my apartment, that fact manifests itself physically—as lots of Post-it notes, lots and lots of color coded Post-its. They really are a miracle.”

that the studios and actors themselves sometimes strive to create. That’s why I’m so proud of casting four openly gay actors in the film, between Patricia, Rex, Daniel, and myself. There’s a psychological cost to pay for denying your truth and, sadly, many artists do pay it.

What poem really sticks with you?

I was really so moved by Steven Reigns poem, “Recipe Box,” that I had to put it in our film. It takes place just after the period when so many succumbed to AIDS and the author recounts all his friends who died. He decides to sort the names of his friends into categories in the same way that recipe boxes are organized…hors d’oeuvres, entrees, desserts. There’s a reason I chose “Recipe Box” as the final poem of the film.

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

Starting treatment means you’re protecting your health. Find out why it’s so important at HelpStopTheVirus.com © 2015 Gilead Sciences, Inc. All rights reserved. UNBC1857 03/15

BY WILLIAM B. MILLER, JR. M.D.

I LOVE YOU…ACTUALLY I LOVE YOUR MICROBIOME YOU MAY NEED REAL CHEMICAL ATTRACTION TO FIND A MATE. W H AT D E T E R M I N E S C H E M I S T R Y

between two people? Who has not said, “They have good chemistry together?” We hear it so often that it seems trite. Typically, we direct that remark towards a couple that looks mismatched to our judgment. We ask ourselves, “What do they see in each other?” Our usual answer is that their “chemistry” is just right.

This is often our only way of reconciling the force of attraction between these two opposites.

However, what if the concept of chemical attraction has a direct biological basis? New research is revealing that it does and many of the reasons why.

It’s becoming increasingly apparent that our microbiome has a tremendous influence upon us. The microbiome represents all the microorganisms that are in us and on us.

Astoundingly, these are so numerous that they outnumber our own innate cells by a factor of ten to one or more. The current estimate is that we harbor 100 trillion cells that we would not think of as our own.

Importantly, our relationship with our microbial companions is essential to our well being. Their influence is a crucial element of metabolic pathways. They are critical participants in glucose regulation, the mediation of our immune systems, and they even partially regulate our emotional responses to stress.

Our relationships with these obligatory microbial partners are intimate. We cannot survive without them and they cannot exist without us. It should not be totally surprising then that they can affect our social choices and even our love life.

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How could germs influence our sexual choices? Those factors had remained hidden from our appraisal until recently. We simply did not have the technological means to assess them.

Now we do and current research has found that the amount of microbial life in our mouths is startling and the transfer between kissing partners is extensive. However, the particular surprise is that although frequent intimate kissing between partners does correspond to the composition of the microbes that are shared between each, there is more afoot. It seems that there is a shared linkage in microbial composition in the mouths of sexual partners that operates regardless of kissing frequency. The implication is that there is a background connection with the microbial realm that might influence our initial choices of sexual partners.

For example, the microbiota on the back of the tongue is more similar between kissing partners than unrelated individuals, but that identity does not clearly correlate to any kissing behavior or frequency. Nor does it appear to be due to specifically shared environmental factors. Something extends beyond that.

COULD IT MEAN THAT WE ARE ATTRACTED TO ONE ANOTHER ON THE BASIS OF FORCES THAT ARE UNAPPARENT TO OUR TYPICAL SENSES? There is evidence to suggest that this the case—and that it is based on our immunological status, which we depend on for our survival. So it should not be shocking that our immunological status might affect our choice of mates. Afterall, we exist on a planet also inhabited by aggressive bacteria and other microorganisms.

How might any organism cope? Our evolutionary path, and that of all other complex organisms includes mechanisms directed towards protecting our offspring as much as possible. This biological imperative significantly influences how we select mates. As part of this process, we each have a group of genes crucial to immunological defenses. Experiments have shown that we are unconsciously attracted to other partners whose immunological background is complementary to our own.

In order to best protect our children against an intrusive and agitating microbial realm, we tend to seek to mate with those that differ from ourselves on an immunological basis. Although this may seem odd on first consideration, it actually makes sense from an evolutionary perspective.

The combining of the immunological capacities of healthy mates that are

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different confers better protection to the next generation.

There are research studies that reinforce this finding.

Experiments have demonstrated that sexual partners are attracted to certain body odors. Microbes play a part in creating those human aromas. However, in a crucial evolutionary twist, that odor attraction is not for similarity but for opposite types. In the aggregate as a species, we seem to search for sexual partners that are not our match immunologically.

What might underlie this instinct?

The answer lies within both our own personal genes and our particular microbial complement. On an evolutionary basis, our species is best protected by the mixing of opposing genes and microbes. Successful mating proceeds for many reasons, but there is an important one that has been previously obscure.

That additional reason is our critical association with a vast microbial partnership that is crucial to our immunological balance. When contrasting individuals both mix genes and share microbes, the next generation gets a boost.

Even more astoundingly, the influence of the microbial sphere extends well beyond these factors. Research has demonstrated that infection with certain parasites can overtly guide sexual choice. Such an example is a parasite

called Toxoplasmosis. Cats serve as an intermediate host but it also frequently infects humans. Although it rarely causes illness in those with healthy immune systems, it can lead to an infection of the brain among people living with HIV. Surprisingly, the parasite has also been shown to affect human behavior, physiology, and even physical appearance.

As strange as it may seem, in carefully controlled experiments, human females perceive infected males as more dominant and more masculine than uninfected males.

What should we make of all this? The next time you gaze lovingly at your favorite other, tip your hat mentally to your hidden microbial partners. In truth, your microbiome might have made you do it.

Dr. William B. Miller has been a physician in academic and private practice for over 30 years. He is the author of The Microcosm Within: Evolution and Extinction in the Hologenome (themicrocosmwithin.com). He currently serves as a scientific advisor to OmniBiome Therapeutics, a pioneering company in discovering and developing solutions to problems in human fertility and health through management of the human microbiome.

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TREATMENT

VETERANS CAN NOW GET THE HEP C TREATMENT THEY NEED

Treatment for hepatitis C has dramatically improved in recent years, with the development of new curative therapies like Gilead’s Sovaldi. But, with costs for the three-month regimen running close to $80,000, Veterans Affairs Hospitals had limited treatment to those who were severely ill.

That led to more than 180,000 veterans being outsourced for their HCV therapy last year. Now, thanks to an increase in funding and a decrease in drug prices, all veterans will be able to receive HCV treatment through the VA regardless of the stage of their liver disease.

“We’re honored to be able to expand treatment for veterans who are afflicted with hepatitis C,” VA Under Secretary for Health Dr. David Shulkin said in a statement. “To manage limited resources, previously we established treatment priority for the sickest patients.”

Veterans Affairs spent $696 million—or 17 percent of their total annual pharmacy budget—on HCV medication in 2015. This year, it has dedicated nearly a billion, which it hopes to increase to $1.5 billion in 2017.

According to recent studies, one out of 10 U.S. veterans are living with HCV, a rate five times higher than the average population. Veterans of the Vietnam War are considered to be at particular risk due to blood transfusions and blood contact during warfare.

With the increase in the budget for HVC treatment, the VA is encouraging veterans living with the disease to take advantage of the life-saving treatment. —TYLER CURRY

50 | MAY / JUNE 2016

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After outsourcing treatment last year, the VA increases funding to cover more veterans living with hepatitis C.

FIRST MAN TO BECOME HIV-POSITIVE WHILE ON PREP IS RARE EXCEPTION

AP/ JEFF CHIU

After tens of thousands of PrEP successes, the first documented case of someone becoming poz involves rare multiclass drug resistance.

It’s been nearly two years since the Centers for Disease Control and Prevention issued historic guidelines recommending that thousands of Americans—particularly gay and bi men, transgender women, injection drug users, and partners of HIV-positive individuals—start taking Truvada as pre-exposure prophylaxis (or PrEP) to prevent HIV infection.

PrEP has proven to be around 99 percent effective at preventing HIV transmission among those who take it daily as prescribed. As was reported at the Conference on Retroviruses and Opportunistic Infections (CROI), PrEP is still 86 percent effective even among those using it “on demand” (which is technically one dose two to 24 hours before sex, and then twice more the two days following sex).

Sure, Truvada as PrEP has had its critics, most notably Michael Weinstein, the head of AIDS Healthcare Foundation, who has led what some activists call a moral crusade against the drug. However, far more scientists, doctors, public health experts, and activists have heralded the prevention method as a game changer. In fact, a new CDC study shows PrEP has the potential to reduce new HIV infections by at least 70 percent if adopted across the country.

Still, naysayers recently got the tiniest bit of ammunition for their culture war over PrEP, with the first documented case of HIV infection in a PrEP user. The 43-yearold Canadian man appears to have been using PrEP as prescribed. The report was presented at CROI by Dr. David C. Knox, a physician at Toronto’s Maple Leaf Medical Clinic, who noted that “clinical and pharmacokinetic data” backed up the patient’s claims that he seroconverted despite having adhered to his treatment.

The man’s virus was found to have an uncommon resistance to multiple drugs, including emtricitabine and tenofovir, the two main ingredients in Truvada.

Researchers from several other facilities, including Toronto’s St. Michael’s Hospital, the British Columbia Centre for Excellence in M HIVPLUSMAG.COM

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TREATMENT

52 | MAY / JUNE 2016

DO YOU NEED A MENINGITIS VACCINE? If you have HIV, yes, you do.

“Meningitis is a highly-contagious, fast-moving disease that leads to death in 20 percent of cases,” says Anthony Hayes, Public Affairs and Policy Vice President at Gay Men’s Health Crisis.

Meningitis is a serious infection of the brain and spinal cord that can lead to death—even with treatment.

“People living with HIV and AIDS,” Hayes adds, “are at greater risk than the general population of acquiring the infection.”

HIV-positive people aren’t just more susceptible to the disease; they are also more likely to die if infected. In fact, the New York City Department of Health and Mental Hygiene reports that over half (55 percent) of bacterial meningitis infections that occurred in the city from August 2010 to March 2013 were among people with HIV. A greater proportion of deaths also occurred among those who were HIV-positive (32 percent) than those who were HIV-negative (20 percent).

That is one of the reasons GMHC has prioritized fighting the disease. The organization led public education, outreach, and vaccination efforts to help end a meningitis outbreak in 2012. Not content in simply making the vaccine available at GMHC’s clinic, the organization went beyond their doors to stem the New York outbreak. Dr. Demetre Daskalakis and Dr. Frank Spinnelli, two doctors on GMHC’s board, provided over 2,600 vaccinations in bars and clubs in the city as well as on Fire Island.

Since then, GMC has lobbied tirelessly for legislation requiring meningitis vaccinations for children. The HIV organization also teamed-up with dozens of other groups, local politicians, and even family members of those who’ve died of the disease—like Kevin Cummines, whose fiancee, Kyle Spidle, was one of the first HIV-positive gay men to die in the 2012 outbreak.

Last year, GMHC’s pressure helped push a meningitis vaccine bill through the New York State Legislature. With the new law, New York has become the 29th state to require meningitis vaccinations for youth in public schools, as recommended by the Centers for Disease Control and Prevention. Previously, New York State only required colleges and universities to provide education about meningitis and offer the vaccine to incoming students.

“Meningitis is a silent killer,” GMHC CEO Kelsey Louie said in a written statement announcing the passage of the New York law. “But gratefully there is a vaccine that is safe, effective, and life-saving.”

“We urge [everyone], including those living with HIV and AIDS, to get vaccinated and protect themselves,” Hayes concludes now.—DAM

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HIV/AIDS, and the University of Colorado ran a battery of tests. Completing standard and deep sequencing of the virus revealed CCR5-tropic clade B HIV-1 with mutations that were resistant to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase (NNRTI), and integrase inhibitors.

In other words, the strain is resistant to many of the medications most commonly used to treat HIV, including Isentress (raltegravir), Vitekta (elvitegravir), Tivicay (dolutegravir), Ziagen (abacavir), Viread (tenofovir), Epivir (lamivudine), and Emtriva (emtricitabine). Fortunately, Poz’s Benjamin Ryan reports that “despite all these resistance mutations, the man in the case study is currently on successful HIV treatment, with a fully suppressed viral load. He is taking Tivicay (dolutegravir), Prezcobix (darunavir/cobicistat), and Edurant (rilpivirine).”

Phylogenetic analysis of the man’s HIV strain revealed a very narrow range of sequence diversity, consistent with infection from a single source, leading researchers to conclude that the virus acquired the drug resistance prior to being transmitted to the man.

How can researchers be certain the man was really adherent to PrEP? They reviewed his pharmacy records, which showed consistent prescription refills. Liquid chromatography–mass spectrometry “was performed on the untimed plasma sample from day zero” to determine the quantities of each medication in his system. Dried blood spot testing collected on day 16 showed consistent dose-taking in the preceding one to two months, thus overlapping with the time period when he would have seroconverted to HIV-positive.

In addition, standard population sequencing and deep sequencing to 2 percent of the viral population was completed on day 7, as was phenotypic testing for resistance to integrase inhibitors, and “phylogenetic analysis of the V3 loop of envelope protein gp120” to characterize the “founder virus.”

That’s a lot of scientific jargon, but it boils down to laboratory confirmation that the man was following PrEP guidelines, making him, “the first reported case of breakthrough HIV infection with evidence of long-term adherence to [Truvada as PrEP],” according to Knox.

After the litany of tests the newly-poz man has already undergone, further analysis seems unwarranted. Moreover, considering PrEP is 99 (not 100) percent effective, this case may indeed reflect that one percent failure rate. While none of the nearly 10,000 people in the famed iPrEx study of PrEP among gay and bi men and trans women acquired HIV—and a mutation like this wasn’t seen among the participants— scientists have always cautioned that the possibility existed.

While resistance to tenofovir is cited as a main concern among people living with HIV who are resistant to treatment worldwide, tenofovir-resistant strains of HIV only account for about one percent of all cases. Resistance to Truvada’s other active ingredient, emtricitabine, is more common, but the strain that managed to bypass the safety of PrEP for the man in this study involved a mutation that was resistant to both medications, an exceedingly rare occurrence.

This case reiterates that there is no 100 percent guarantee of prevention—not even with PrEP. But, most experts, including those in this study, say that cases like this will likely remain rare.—DIANE ANDERSON-MINSHALL

3 THINGS TO KNOW ABOUT METH AND SEX The expert-author of Lust, Men, and Meth: A Gay Man’s Guide to Recovery gives us the lowdown on a drug up to 30 percent of young gay and bi men have used.

PUT A RING ON IT

Study suggests that use of an insertable vaginal ring can prevent HIV infection for some women.

New England Journal of Medicine reports that a ring filled with the antiretroviral drug dapivirine and inserted within the vagina provided extended protection against HIV— at least for older women. Now the National Institute of Allergy and Infectious Diseases has announced it will fund follow-up research to determine why the ring wasn’t as effective for younger women.

Two large studies—the Ring Study and ASPIRE (“A Study to Prevent Infection with a Ring for Extended Use”)—conducted in Africa among sexually active, but not pregnant, women 18-45 years old found the ring was only 27 percent effective. That success rate rose to 37 percent when scientists removed data from locations where “it was apparent early on that many women were not returning for study visits or using the ring consistently.”

Results were remarkably different when it came to women 25 and older, for whom the ring lowered the rate of HIV infection by 61 percent. Based upon the amount of dapivirine in the younger women’s blood streams, the scientists determined that

the disparity existed because the younger women weren’t using the ring consistently. “If you could get a 61 percent efficacy in the older group, that means there is something about this that works,” Dr. Anthony Fauci, NIAID director said in a statement.

“The real question is, in the real world, why is it not working in the younger group?”

The research was conducted in SubSaharan Africa, home to 80 percent of the world’s women living with HIV. HIV transmitted through rape is also a major issue in the region, where a 2011 United Nations study found frequent conflicts serve as harbingers of sexual violence against women.

The ring isn’t nearly as effective as PrEP, but many women in SubSaharan Africa have little chance of accessing that preventative protocol.

The ring, which is still at least a year from market, would offer women a form of HIV prevention that is under their control and doesn’t rely on the use of condoms by sexual partners; which makes it a life saving device in a region wracked by sexual violence.

— E L A I N E R I TA M E N D U S

Methamphetamine use in the gay community has reached epidemic proportions, taking a terrible toll on users. Most gay and bi men know of the drug’s power to intensify sexual experience, but few realize its devastating impact on sex and intimacy. Here are three crucial things to know.

1. METH INCREASES SEXUAL DYSFUNCTION

Sure, meth reduces inhibitions, but it increases a false sense of confidence, and sends sexual compulsion into overdrive. Users spend sleep-deprived days immersed in the pursuit of—and then the painful recovery from— high-risk sexual encounters. But while meth stokes the brain’s ravenous hunger for sex, it ironically also causes erectile dysfunction, and the constant barrage of sexual thoughts and images eventually dulls one’s ability to actually achieve sexual arousal.

2. METH ESCALATES HIGH-RISK SEXUAL BEHAVIOR Meth destroys the brain’s dopamine

receptors, the so-called pleasure centers. The first exhilarating high is therefore not obtainable again. Consequently, meth users turn to darker, rougher, and generally unprotected sexual behavior—placing them at risk—in an attempt to recapture the initial intoxication.

3. METH CREATES SEXUAL AND INTIMACY PROBLEMS Meth and sex quickly “fuse” in

the minds and bodies of users. They simply can’t have one without the other. This results in persistent sexual dysfunction. Disconnecting meth from sexuality is crucial for recovery, and requires time, patience, and therapeutic support—but it is wholly possible.—DAVID

FAWCETT, PHD Nationally-recognized psychotherapist Dr. David Fawcett provides a roadmap to recovery in Lust, Men, and Meth. Learn more at David-Fawcett.com.

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BY TYLER CURRY

ARE YOU ON THE RIGHT MEDS? WHEN IT COMES TO YOUR HIV TREATMENT, NOT ALL PILLS ARE CREATED EQUALLY. in best cases, can be relatively easy to manage, you might think that there isn’t much difference when it comes to selecting your antiretroviral medication. However, it’s crucial for a person living with HIV to consider a variety of factors in order to get the maximum outcome with the minimal amount of unnecessary side-effects. Unfortunately, if you don’t know the right questions to ask, your doctor could make the wrong decision for you.

To help figure out what meds will work best for you, we asked nurse practitioner Eric Klappolz, an HIV specialist in Dallas, Texas, who treats a variety of people living with HIV. “Most people might just buy into the one-pill once-a-day and that is it, but there are plenty of factors that someone should consider when choosing their HIV medication,” says Klappholz. “Your job, your schedule, you lifestyle, these all factor into determining which medication will work best.”

Klappholz says that he regularly treats new patients who elect to switch meds because they didn’t know enough when they first started taking treatment. New patients can often be so fixated on their diagnosis that they do not think to ask their doctor the right questions. Not only that, but patients can be reticent to share some of their behaviors that could help their doctor make the right choice. Once a person with HIV has successfully achieved viral suppression and the emotional component of treatment has subsided, he or she is in a place where they can better assess if there is a better

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medication to fit his or her needs.

Klappholz tells us which medications would correspond best with several common lifestyle factors.

IF YOU HAVE AN UNUSUAL SCHEDULE

Maybe you travel to different time zones often or, you work alternating or swing shifts. An unusual schedule can make it difficult to comply with a strict dosage schedule. For some medications, missing even a dose or two here and there can be quite the problem. “I would typically prescribe Prezcobix and Truvada for this patient, just because the Prezcobix is the most forgiving if you are likely to miss dosages. The chances of building a resistance is low, and even if you do, it doesn’t eliminate a lot of other options later on,” says Klappholz.

IF YOU’RE “OTHERWISE HEALTHY”

If you are not dealing with any coinfections, you don’t smoke or drink heavily, and you aren’t overweight, you may be considered what doctors call “otherwise healthy.” This just means that you aren’t at any significant risk for cardiovascular disease, which makes you the perfect candidate for Triumeq.

“Right now, I am putting my new patients on Triumeq when I can, because there is no other interactions with other medications and it just seems to me to be the best thing out there.”

IF YOU CAN BE CONSIDERED “OVERWEIGHT”

Although Triumeq is an excellent drug choice for some, it does come with certain cardiovascular risks. Therefore,

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N OW T H AT H I V has become a chronic disease that,

Klappholz doesn’t recommend that patients who are overweight take this drug. Instead, he says a Tenofivir-based medication, such as Stribild or Genvoya, is the best choice.

IF YOU ALSO HAVE HEPATITIS C

More than 20 percent of people living with HIV are also living with hepatitis C. An HIV/HCV comorbidity more than triples a person’s risk for multiple liver issues, so it is important to select the right medication to best treat both diseases while minimizing any unnecessary risks. New medications are making hep C easier to treat, as well. “If one of my patients also has HCV, Complera is the safest bet during the duration of the person’s HCV treatment. Once he or she is determined to be HCV-negative, a patient can then re-evaluate their HIV medication about three to six months afterwards.

TYLER CURRY

IF YOU’RE A HEAVY DRINKER OR RECREATIONAL DRUG USER

Much like people with unusual schedules, a person who engages in heavy alcohol or recreational drug use runs the risk of missing their daily dose by time specified or altogether. Likewise, the same suggestion of Prescobix and Truvada is recommended because, once again, it is the

most forgiving when it comes to drug resistance for patients who might miss doses.

IF YOU’RE A LONG-TIME USER OF ATRIPLA

Atripla was once the go-to for people with HIV, but the arrival of new medications such as Stribild, Complera, Truimeq, and Genvoya has knocked the popular drug down a notch. Now that Atripla is no longer a first-line medication, Klappholz recommends that his patients switch to a newer medication that provides all of the benefits with fewer side-effects. “I will often hear, ‘But it’s working and I don’t have any bad side-effects, so why change?’” Klappolz says. “But even patients who claim to no longer have side-effects from Atripla usually come back in a month or two saying that they are so happy with the switch.”

Our new expert on-call is nurse practitioner Eric Klappholz, an HIV specialist in Dallas, Texas, who treats people living with HIV.

IF YOU SMOKE

A person who smokes should avoid Triumeq in order to avoid any additional increase in cardiovascular risks. Unfortunately, many patients will try and minimize their tobacco use when speaking with their doctor. Even if you smoke occasionally, let your doctor know. If you have yet to completely give up smoking, Klappholz says that Stribild or Genvoya are most likely the best options for you.

HIVPLUSMAG.COM

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A GENETIC MUTATION THAT BLOCKS HIV MAY HOLD THE KEY TO FUTURE TREATMENT AND, PERHAPS, A CURE E V E N T H E M O S T careful individuals can find themselves with a positive HIV diagnosis, while others couldn’t get the disease if they tried. Researchers trying to find out why discovered some people carry a genetic mutation that makes them highly resistant to HIV infection. This mutation, called Delta32, keeps a protein called CCR5 from rising to the surface of the immune system’s T cells. When CCR5 is on the surface of the cell, HIV is able to latch on to it and infect the cell; when it is not, the cell’s “door” is effectively closed to HIV. Very few people have this genetic variation, which some scientists think has been inherited from ancestors who survived the massive bubonic plague in Europe centuries ago. About 1 percent of Caucasians have it, and it is even rarer in Native Americans, Asians, and Africans. A 2005 report indicated that 1 percent of people descended from Northern Europe are virtually immune to AIDS. Those lucky enough to be resistant must inherit the HIV-shielding genes from both parents, though having only one parent with the mutation still leaves a child better prepared to defend HIV than having none. At least one genetic testing company, 23AndMe.com still does the HIV immunity test (among their battery of tests, not as a stand alone), though many companies that once catered specifically to gay men for the HIV immunity test have closed down.

In the case of Timothy Ray Brown, the so-called “Berlin Patient” cleared of HIV after receiving stem cell transplants to treat his leukemia, there was great difficulty finding a donor who not only had this mutation, but matched other components of Brown’s immune system closely enough that his body would not reject the cells. Researchers are now focusing on the possibility of introducing the rare genetic mutation into a patient’s body, infusing T-cells that have been modified so as to have the CCR5 variation.

Under the sponsorship of the National Institutes of Health, researchers at the University of Pennsylvania Perelman School of Medicine in Philadelphia, the Fred Hutchinson

56 | MAY / JUNE 2016

Cancer Research Center in Seattle, and other institutions and biomedical companies are conducting research on this process, first to assess its safety, then its effectiveness. The latter will involve stopping study participants’ anti-HIV medications to see if their immune systems continue to suppress the virus.

Joining in such research will be the Timothy Ray Brown Foundation, which Brown has formed in partnership with the World AIDS Institute.

“The Timothy Ray Brown Foundation will be solely dedicated to finding a cure for AIDS,” Brown said at the U.N. AIDS conference in July.

Brown is now a vocal advocate for bringing a cure to others living with HIV. However, a recent interview with Brown, and the doctor who cured him, has served to underscore how much luck played a role in Brown’s own cure.

His doctor, Gero Hütter, pointed out that Brown was in the “right place at the right time.” In fact, later efforts by doctors to successfully cure other patients using Hütter’s treatment method have all failed, with patients dying from the stem cell transplant itself, or other complications before it could be determined if HIV had been removed from their bodies.

That said, the groundwork laid down by Hütter in curing Brown of his HIV is now viewed as one blueprint for creating a cure to HIV. The consortium of academic and private sector research institutions of defeatHIV —a Delaney Cell and Genome Engineering Initiative—are hoping to use stem cells from HIV-positive individuals to mimic the genetics of humans immune to HIV. Clinical trials are now opening up within the consortium for patients who meet multiple eligibility factors.

It may be a while until we can find a cure to HIV, but, it seems that there is real possibility following the path of the Berlin Patient. That possibility is enough to excite researchers into seriously pursuing further results, and their enthusiasm should excite those who live with HIV. There might, indeed, be a light at the end of the tunnel. How soon they can find it, though, is still very much up in the air.

SHUTTERSTOCK

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MAY / JUNE 2016 www.hivplusmag.com