HIV Plus Issue 120 September/October 2017

BECAUSE YOU’RE MORE THAN YOUR STATUS

REALITY STAR KARAMO BROWN WANTS TO CHANGE HOW WE TALK ABOUT HIV & GAY BLACK MEN

ARE GAY MEN LITERALLY STARVING FOR LOVE ?

SEPTEMBER/OCTOBER 2017 www.hivplusmag.com

YOU MATTER AND SO DOES YOUR HEALTH That’s why starting and staying on HIV-1 treatment is so important.

WHAT IS DESCOVY®?

DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection.

DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.

DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. 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 DESCOVY? DESCOVY may cause serious side effects: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to monitor your health.

What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: • 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 DESCOVY. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being

more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

• 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 DESCOVY 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 DESCOVY? • 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 over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY 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 DESCOVY with all of your other medicines.

• If you are pregnant or plan to become pregnant.

It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. • 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 DESCOVY, including important warnings, on the following page.

Ask your healthcare provider if an HIV-1 treatment that contains DESCOVY® is right for you.

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

(des-KOH-vee) MOST IMPORTANT INFORMATION ABOUT DESCOVY

POSSIBLE SIDE EFFECTS OF DESCOVY

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

DESCOVY can cause serious side effects, including: • Those in the “Most Important Information About DESCOVY” section.

• Changes in your immune system.

• New or worse kidney problems, including kidney failure.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

• Bone problems.

The most common side effect of DESCOVY is nausea.

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

ABOUT DESCOVY • DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years of age and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection.

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

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

• Have any other medical condition.

• Are pregnant or plan to become pregnant.

• 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 DESCOVY.

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

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

HOW TO TAKE DESCOVY • DESCOVY is a one pill, once a day HIV-1 medicine that is taken with other HIV-1 medicines.

• Take DESCOVY with or without food.

DESCOVY, the DESCOVY Logo, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: April 2017 © 2017 Gilead Sciences, Inc. All rights reserved. DVYC0057 05/17

IN THIS ISSUE SEPTEMBER/OCTOBER 2017

ON THE COVER 20 Karamo Gets Real

KARAMO BROWN is hosting & starring on multiple TV shows, but still makes time for 6in10, his HIV organization helping gay and bi black men.

FEATURES

24 Poz Organs Are Saving Lives

HIV-positive people can finally receive organ transplants from HIV-positive donors! We talk to surgeons, recipients, and those still waiting.

34 What’s Eating Us?

Queer men (and trans women) are disproportionately impacted by eating disorders. Can we feed what ails us?

36 Cracking Wise

Meet TV’s newest funny man, JACK MILLER—and he’s poz too!

41 Resistance Warrior

JOSHUA THOMAS overcame drug resistance to become a warrior for youth. His journey is inspiring.

COVER AND THIS PAGE: KARAMO BROWN PHOTOGRAPHER: PHILIPPE BERTRAND OF B&P STUDIO STYLISTS: KWAME WATERS AND NADIA DURHAM

HIVPLUSMAG.COM

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editor in chief DIANE ANDERSON-MINSHALL • svp, group publisher JOE VALENTINO

art director RAINE BASCOS senior editor JACOB ANDERSON-MINSHALL managing editor SAVAS ABADSIDIS editors at large TYLER CURRY, KATIE PEOPLES associate editor DAVID ARTAVIA assistant editor DESIREE GUERRERO contributing editors KHAFRE ABIF, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writers DR. EVAN GOLDSTEIN, CHARLES STEPHENS creative director, digital media DAVE JOHNSON interactive art director CHRISTOPHER HARRITY online photo and graphics producer MICHAEL LUONG front end developer MAYRA URRUTIA senior drupal developer NICHOLAS ALIPAZ, SR. traffic manager KEVIN BISSADA manager, digital media LAURA VILLELA director of integrated marketing BRANDON GRANT senior manager, integrated marketing JAMIE TREDWELL managers, integrated marketing GRETA LIBBEY, CASEY NOBLE, RYAN WEAVER events manager JOHN O’MALLEY junior designer TEDDY SHAFFER senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director of social and branded content LEVI CHAMBERS branded content producer LENNY GERARD editor, social media DANIEL REYNOLDS senior fulfillment manager ARGUS GALINDO operations director KIRK PACHECO office manager HEIDI MEDINA production services GVM MEDIA SOLUTIONS, LLC

HERE MEDIA chairman STEPHEN P. JARCHOW ceo PAUL COLICHMAN cfo/coo TONY SHYNGLE managing directors LUCAS GRINDLEY, JOHN MONGIARDO executive vice presidents JOE LANDRY, BERNARD ROOK senior vice presidents GREG BROSSIA, CHRISTIN DENNIS, JOE VALENTINO vice president ERIC BUI ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 209-5174 • Subscriptions Fax (212) 242-8338 LOS ANGELES EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES 43430 E. Florida Ave. #F PMB 330, Hemet, CA 92544 • Phone (951) 927-8727 • Email support@retrogradecommunications.com or editor@HIVPlusMag.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.

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SEPTEMBER / OCTOBER 2017

50 years

on of award-winning HIV coverage.

IN THIS ISSUE SEPTEMBER/OCTOBER 2017

BUZZWORTHY

7 Tetris Tops PTSD

Is this old school video game the key to ending PTSD?

8 Activists Descend

HIV activists lobbied legislators in D.C. at AIDSWatch 2017.

10 License to Discriminate

Mississippi law allows discrimination against LGBT & poz people in the name of religion.

11 Hornet’s Poz PSA

The gay dating app’s new ad with poz users is adorable.

12 A Speedo and a Smile

Instagram star Kevin Carnell takes on AIDS/ LifeCycle in a Speedo.

13 Burning Books

This is the best reading material you’re likely to find this year.

CHILL

14 Bottoms Up

Dr. Evan Goldstein offers tips for healthy sex. Are you ready?

CORY DECAREAUX (KEVIN CARNELL); SHUTTERSTOCK (TETRIS)

15 The Gym is a Killer

Tyler Curry explains why your obsession with perfection will put you six feet under.

DAILY DOSE

31 Afraid You’ll Lose Your Meds? Fear not.

Benjamin M. Adams says there are more options than you think.

TREATMENT/TASP 43 50+ New HIV Drugs

New therapies are in development to prevent, treat, or cure HIV. Are they for you?

44 Could This Plant Treat HIV?

A plant used in traditional Indian & Chinese medicine is more effective than some HIV meds.

45 A Cheaper PrEP?

A Truvada generic has gotten FDA approval.

46 Mumps on Parade

An outbreak of mumps hits gay and bisexual men in Los Angeles.

47 Cures All Around New curative treatments for hep C work on all genotypes.

BACK TALK

48 Preaching Social Justice

Rev. William Francis on how the black church should address the rising HIV rates in gay and bi black men.

EDITOR’S LETTER WHEN WE STARTED

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

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SEPTEMBER / OCTOBER 2017

The Real World: Philadelphia’s Karamo Brown was the first out gay black man on reality television, and has since blossomed into an HIV activist and TV host.

The Real World: San Francisco’s Pedro Zamora was the first reality star who was out about his HIV-positive status.

TONY DONALDSON (DIANE); KEN PROBST (PEDRO); PHILIPPE BERTRAND OF B&P STUDIO (KARAMO)

planning this cover story on Karamo Brown, it dawned on me what a role MTV has played in both the fight against HIV and the struggle for visibility by those living with it. While our cover star Karamo Brown isn’t HIV-positive, he has teamed up with someone who is (radio host and minister Donta Morrison) to create an organization aimed squarely at changing the future of gay, bi, and same-gender loving black men.

Their organization, 6in10, hopes to combat the disproportionate impact that HIV has on black gay/bi/SGL men—by removing stigma, urging men to talk about healthy sexuality and HIV, and supporting those who are already living with the virus.

A lot of the attention 6in10 has gained is due to Brown’s fame, which in part is courtesy of MTV, the first network to feature a reality TV star who was an out HIVpositive gay man of color. On The Real World’s third season (set in San Francisco), Cuban-American Pedro Zamora became a fan favorite and used his time on the show to educate others about HIV while also changing the face of AIDS to one that young people loved and understood. That was 1994, and Zamora died soon after the final episode aired.

Fast forward a decade (and 12 seasons) later to The Real World: Philadelphia, where Brown had his own groundbreaking stint as the first out gay black man on reality TV. Brown didn’t handle the fame well at the time, and subsequently fell away from the spotlight. During his time back in the actual “real world,” he became a social worker, and unexpectedly, a father. Eventually, Brown came back to television in full force in 2014 and has been going nonstop since.

Brown is now on multiple channels, but he owes his start to MTV, and therefore his HIV-related work as well. We also have MTV to thank for Zamora, who brought HIV visibility to young people and helped millions of Americans feel like they had been personally touched by AIDS. MTV has a charitable arm now, the Staying Alive Foundation, which raises money for youth-led, grassroots HIV education and prevention projects (they’ve given out 7 million condoms in the last 12 years alone).

I’m old enough to remember when MTV was all about music videos (hell, I remember when The Buggles produced the first music video back in 1981), but I’m glad the network has continued to give an audience and voice to guys like Brown and Zamora, and the many others who’ve come through reality programming. At the moment, the future of The Real World is still uncertain, but regardless of whether or not there is a 33rd season, we look forward to future MTV programming. And we hope tomorrow’s reality stars will want to change the world as much as Brown does—and Zamora did.

buzzworthy TETRIS PREVENTS PTSD? YEP, THE DECADES-OLD ARCADE GAME BLOCKS TRAUMA.

A

Those given the game played for 20 minutes within six hours of the traumatic event and ended up with 62 percent fewer intrusive memories, compared with the control group.

Researchers believe that Tetris works by disrupting “the consolidation of sensory elements of trauma memory, preventing these vivid memories from reoccurring.” The findings are particularly hopeful because they show a mental health professional doesn’t need to be involved, and as little as 20 minutes of game playing could have a dramatic effect.

“This brief ‘therapist-free’ technological intervention was found to be feasible and acceptable,” the researchers reported in Molecular Psychiatry, “with 48 percent of patients approached agreeing to participate (compared with 10 percent in a psychotherapy trial and 8 percent in a pharmacological trial, both also in the emergency department), and with intervention completion at 97 percent.”

Gamers, including Nikolai Veselov, from the free gaming website MyRealGames.com, hailed the study for showing, “Beyond being great fun, [games] certainly test and stimulate the mind in complex ways that, if utilized, could be put to good use. The therapeutic aspect of playing these family-friendly games should never be underestimated.”

—JACOB ANDERSON-MINSHALL

SHUTTERSTOCK

new study suggests the classic arcade game Tetris could help people avoid developing post-traumatic stress disorder. According to a report published in Molecular Psychiatry, the game might help the brain reset and disrupt intrusive visual memories that plague people suffering from the emotional aftermath of a traumatic event. And since intrusive memories are essential elements of the disorder, keeping them from forming could also prevent the trauma from lingering.

Researchers from the United Kingdom, Germany, and Switzerland first subjected volunteers to “an experimental analogue of a traumatic event” through disturbing film footage, followed by exposure to a variety of cognitive tasks to see if they would reduce the development of intrusive memories. Scientists chose Tetris for its “high visuospatial demands,” or complex patterning, but also tried “some verbal tasks,” including backwards counting and the verbal computer game, Pub Quiz. The verbal tasks didn’t prevent intrusive thoughts. In fact, some of them even increased “intrusions,” indicating “possible harmful effects.”

Tetris, however, seemed to have a positive impact.

Next, researchers recruited real life survivors of trauma from emergency rooms and had half of them play Tetris while the other half did not.

HIVPLUSMAG.COM

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buzzworthy Left: The kick-ass ladies of AIDSWatch (from left): Estrella Sanchez, Kiara St. James, Jada Mercedes Cardona, Cecilia Chung, Nala Simone, Jazielle Noelle Triplett, and Arianna Lint.

Bottom (right): Jesse Milan, Jr. (in suit), the CEO and president of AIDS United, rallies the crowd. He’s been living with HIV for over 30 years.

Bottom (left): Staying cool required patience—and a colorful umbrella.

THE #RESISTANCE CONTINUES AIDSWATCH WAS CHARGED UP LIKE NEVER BEFORE.

Washington, D.C., and Puerto Rico gathered in the nation’s capital earlier this year for AIDSWatch 2017. Now in its 26th year, AIDSWatch is an annual event in which activists try to meet members of Congress and push them for change and greater dialogue about HIV. This year, activists contacted all members of the House and Senate and coordinated in-person meetings with over 260 legislators.

Sean Black, a professor, photographer, and senior editor of A&U Magazine, attended the event and shared some of his favorite shots from the days of activism.

“I am happy and honored to contribute… in our shared mission of ending AIDS, dispelling stigma, and especially fighting against the unthinkable violence towards our trans family members,” Black says. His images capture the resilience, tenacity, and in some cases, joy of the activists banging on the doors of Congress.

One of the main focuses of AIDS Watch 2017 was on overturning the draconian HIV criminalization laws that still land countless HIVpositive people in prison. Currently, there are well over 30 states in the nation with laws that discriminate against people living with the virus.

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SEPTEMBER / OCTOBER 2017

“The trans community, women, people of color, these people—particularly in California, women in California—are being marginalized and criminalized to an even greater degree and I don’t think people have any idea that this is going on,” says Laela Wilding, Elizabeth Taylor’s eldest granddaughter and ambassador to the Elizabeth Taylor AIDS Foundation, which sponsors AIDSWatch. “Once we hear about it, we get fired up. We think, Why is our government spending money criminalizing these people? We need to protect them, and support them in the right ways. That would reduce the transmission of HIV, which is the point.”

AIDS United organizes AIDSWatch each year. AU president and CEO, Jessie Milan, Jr., said that this year’s AIDSWatch, “channeled our movement’s powerful legacy of grassroots advocacy to make Congress understand that the needs of people living with and at risk for HIV cannot be ignored. With continued federal funding and strong health care policy, we can end the epidemic in this country.”—DAVID ARTAVIA

PHOTOGRAPHY BY SEAN BLACK/@SEANBLACKPHOTO

OVER 650 ADVOCATES from 34 states,

HIV TREATMENT CAN GET YOUR VIRAL LOAD SO LOW, IT’S UNDETECTABLE. GO FOR UNDETECTABLE.

There is no cure for HIV, but being undetectable helps protect your health. See how. Watch “The Goal of Undetectable” at HelpStopTheVirus.com © 2015 Gilead Sciences, Inc. All rights reserved. UNBC1853 03/15

MISSISSIPPI BURNING

A new draconian “license to discriminate” law targets LGBT folks.

M

ississippi’s draconian “license to discriminate” law, allowing widespread discrimination against LGBT people and others—and making it harder to fight the HIV epidemic in the state—is now in effect, thanks to a federal appeals court ruling.

A lower court last year issued an injunction preventing the law from taking effect, but in early July a three-judge panel of the U.S. Court of Appeals for the Fifth Circuit lifted it, saying those who sued to block the law lacked the standing to do so, reports The Clarion-Ledger of Jackson, Miss. The Fifth Circuit did not rule on the merits of the law.

Mississippi’s House Bill 1523, signed into law by Republican Gov. Phil Bryant last year, allows businesses, individuals, and religiously affiliated organizations to deny service to LGBT people, single mothers, and others who somehow offend an individual’s “sincerely held religious belief.” It also directly targets transgender residents, effectively claiming that one’s sex assigned at birth is immutable, and will be the only gender legally recognized by the state.

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SEPTEMBER / OCTOBER 2017

Titled the Protecting Freedom of Conscience from Government Discrimination Act, it states that the government cannot penalize an individual, organization, or business for acting in accordance with their “sincerely held religious beliefs or moral convictions.” But also that “marriage is, or should be, recognized as the union of one man and one woman;” that “sexual relations are properly reserved to such a marriage;” and that “male (man) or female (woman) refer to an individual’s immutable biological sex as objectively determined by anatomy and genetics at time of birth.” While the legislation was being considered, there were numerous protests at the Mississippi capitol and throughout the state.

A suit brought by the Campaign for Southern Equality against the law had been consolidated with another brought by Mississippi civil rights attorney Robert McDuff and the Mississippi Center for Justice, and joined by Lambda Legal. Just before it was set to go into effect last July, U.S. District Judge Carlton Reeves blocked the law as unconstitutional. Now that Reeves’s ruling was overturned, the plaintiffs plan to appeal, asking for the full Fifth Circuit to review the panel’s ruling. The American Civil Liberties Union will continue to pursue a separate suit that it filed.

The law will also undermine efforts to fight HIV and AIDS in Mississippi by further driving people into the closet, activists said.

The state has been hit particularly hard by the epidemic—the capital city, Jackson, has the fourth-highest rate of HIV infection in the nation. Four in 10 gay and bi men in Jackson have HIV, according to an Emory University study. Numbers are not available for transgender women, but it’s generally acknowledged that they are at high risk for HIV, and the gender identity provision of the law could lead to them being denied health care.

“At the heart of the escalating HIV/AIDS crisis in the U.S. South is stigma and discrimination,” said a statement released by Elton John and David Furnish, founder and chairman, respectively, of the Elton John AIDS Foundation. “Yet in that context, Mississippi lawmakers have decided to enact this hurtful, discriminatory law. This so-called ‘religious freedom’ law is nothing more than an attack on the

SHUTTERSTOCK

buzzworthy

dignity and rights of LGBT people in Mississippi and serves only to discriminate against us for being who we are. Laws like this further the stigma that prevents LGBT people from living safely and openly, and, ultimately, contribute to the HIV/AIDS crisis by driving people into the shadows and away from the treatment and care they need.”

The EJAF has made grants to My Brother’s Keeper, a nonprofit that operates a clinic and provides HIV education, testing, and treatment in the state. “In the last few months, too many of Mississippi’s teenagers have come to the clinic and faced the new reality of being HIV-positive in the midst of homelessness, poverty, and lack of health insurance,” said June Gipson, president and CEO of My Brother’s Keeper. “The HIV/AIDS epidemic is far from over, but instead of investing in education and resources needed to help highrisk communities, lawmakers in Mississippi have chosen to legislate in support of discrimination. This law hurts Mississippi’s growing LGBT community and furthers a health crisis that we at Open Arms Healthcare Center are working tirelessly to stop.”

EJAF and My Brother’s Keeper intend to keep fighting the law, as do several other LGBT rights groups.

“This decision is not only deeply upsetting for the rights of LGBT individuals living in Mississippi, but also for the protection of religious liberty in our

country,” said Roberta Kaplan, lead counsel for the plaintiffs in the Campaign for Southern Equality suit, in a press release.

“Our clients have already suffered enough. The state communicated a message loudly and clearly with the passage of HB 1523: only certain, anti-LGBT beliefs will get the protection and endorsement of the state.

Under the logic of this opinion, it would be constitutional for the state of Mississippi to pass a law establishing Southern Baptist as the official state religion. We plan to seek an en banc review of the decision by the Fifth Circuit.”

ACLU of Mississippi executive director Jennifer Riley Collins issued this statement: “We are ready to move forward with our case filed on behalf of ACLU members Nykolas Alford and Stephen Thomas, who are planning to marry in Mississippi in the near future. That case was put on hold until the court of appeals ruled. We will continue to proceed on behalf of Nykolas and Stephen to protect them, and other same-sex couples from this harmful and discriminatory law.”

Rob Hill, Mississippi state director for the Human Rights Campaign called the law “the most discriminatory, anti-LGBTQ state law in the country,” and added, “We will continue to fight tooth and nail against HB 1523 until it no longer threatens our community.” —TRUDY RING

Coming Out in Resistance Meet the nation’s first out HIV-positive university president.

Dr. Raymond E. Crossman, president of Adler University, publicly disclosed his HIV-positive status in Salon to share what he learned as an AIDS activist. Already out as gay, Crossman may be the first university president to come out HIV-positive.

“I was certain—as were many gay men— that few cared if we all died, because we heard those words often and from many,” wrote Crossman, who has been living with HIV for 30 years. “Today, I wonder whether many immigrants—and many people who might look like immigrants—feel now how I felt in the 1980s. I can imagine that many people… feel as abandoned by the state as I felt then.

“I find myself back in the 1980s as I listen to President Trump,” Crossman added, writing that he’s now sharing lessons he learned “from the successes and failures of the 1980s—lessons about leadership, strategy, and focus of advocacy and political action. I know how to fight for my life and an oppressed community and how to win.”—DA

The Buzz on Hornet’s New PSA CHARLIE SIMOKAITIS (CROSSMAN), HORNET (TEXTING)

App Connects Poz Users in Hornet Video

This summer, gay dating app Hornet released an adorable public education video in which a newly diagnosed HIV-positive man confides in another Hornet user, who is also HIV-positive. Their shared status jumpstarts a deeper conversation and ultimately leads to a friendship. The experienced poz guy even offers support when the other guy admits he’s nervous about disclosing his status on a date. The goal of the video is to encourage Hornet users to get tested and learn their status.

(Don’t take our word for it, check it for yourself at bit.ly/HrntHIVApp.)—DA HIVPLUSMAG.COM

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buzzworthy

GOOD IN A SPEEDO LEVERAGING SOCIAL MEDIA

FOR PEOPLE LIVING WITH HIV.

SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION, 2017

—DAVID ARTAVIA 12

SEPTEMBER / OCTOBER 2017

DAVID SIMMONS (CARNELL), CDC (CHART)

I

nstagram star Kevin Carnell is more than his nearly 80,000 followers. The 25-year old activist has been dedicated to raising awareness for HIV and body positivity for years now by taking part of the AIDS/LifeCycle—wearing only a Speedo and a smile.

In 2015 and 2016, Carnell raised $10,000 for people living with HIV. And while it might seem like a lot of money for most people, for him it’s a small dent in what he feels is a greater calling.

“I am so grateful to have discovered the wonderful organization that is AIDS/ LifeCycle,” Carnell says. “I came across the ride when I moved to New York City in 2014.

I had a few friends at the time who had just completed it and I remember thinking these guys are so brave and incredibly selfless. It was inspiring to see the amount of money they’d raised and how much good they were providing to our community.”

Carnell decided to do the ride himself in 2015 and, he says, it was one of the “best decisions” he’d ever made. His cyclist representative, Jacob Ittycheria, was also supportive and proved to be a mentor at a time when Carnell was facing his own difficulties living in the city.

“I didn’t know if I could do it,” Carnell reflects. “If I could leverage my following on social media to donate, or if I could subject myself to the questioning that doing a ride like this brings about.”

Carnell admits, “When you do AIDS/ LifeCycle and publicly promote the cause, you’re faced with the question of ‘When did you become positive?’ or ‘Is that why you’re riding?’ I am not positive, and if I were, there is nothing wrong with that. I have done this ride because I believe in the assistance this organization has provided and will continue to provide for those who need it most. I felt a sense of pride advocating for this organization because I wanted to be a part of the change. I wanted to say that I used my platform to impact my community.”

After competing in 2015 and 2016, Carnell made the decision not to ride in 2017 to focus on the next chapter of his busy life.

However, he is “eyeing a return for 2018.”

No doubt, this year’s onlookers missed his smile—not to mention that Speedo!

BOOKSHELF

Don’t Call Us Dead, by black queer, HIV-positive poet Danez Smith, is the author’s highly anticipated second collection. Smith, who uses the pronoun they, won a Lambda Literary Award for their first book [insert] boy. Don’t Call Us Dead is equally compelling. It begins with the devastating poem “summer, somewhere,” imagining an afterlife where black boys who were killed by police receive the love, health, security, and abundance they deserved on earth. When not addressing HIV issues (testing, seroconversion, criminalization), the remaining poems rebuke white America, gay dating apps, and Donald Trump.

(GraywolfPress.org)—DA

Your Body’s Brilliant Design: A Revolutionary Approach to Relieving Chronic Pain is a master guidebook to author Karen M. Gabler’s pioneering approach in rediscovering the body’s natural architecture in order to live painfree. Gabler is an expert on fascia (the web of connective tissue that runs through our bodies) and why it’s the cause of so much pain.

(SkyhorsePublishing.com)—DAM

Trunky: Transgender Junky is Samuel Peterson’s gritty, brutally honest, yet still hilarious memoir of his time spent in a Southern rehab facility. Struggling with a gender transition, he had fallen into the depths of depression and relapsed after 10 years of sobreity. During a life changing 21 days, Peterson is surrounded by a diverse group of men—thugs, white supremacists, professional athletes, and business men—all fearful of the truths that lie at the core of their addictions. As Peterson navigates his perilous journey to sobriety, he also finds himself—through newfound courage and naked vulnerability—on an unexpected journey into the depths of the human soul.

(TransgressPress.org)—DG

Together, Closer is Giovanni Frazzetto’s attempt to use neuroscience to answer the question of who we decide to get close to. Subtitled “The Art and Science of Intimacy in Friendship, Love, and Family,” the book offers stories of, among others, a woman with an entirely fictional boyfriend and a gay couple in a cycle of rejection and attraction.

(PenguinRandomHouse.com)—DAM

Taking Turns: Stories from HIV/ AIDS Care Unit 371. Among the takeaways one has after reading MK Czerwiec’s graphic novel Taking Turns is that even in the form of sequential art, the story of the early days of the HIV epidemic is a visceral and heart wrenching experience. In 1994, at the height of the epidemic, Czerwiec took her first nursing job at Illinois Masonic Medical Center in Chicago. She was part of the staff of HIV/AIDS Care Unit 371, a community for thousands of patients with HIV or AIDS and their caregivers. Taking Turns combines Czerwiec’s memories with the oral histories of patients, family members, and staff, going back and forth in time, revisiting life and death in the ward and how it affected and informed those who passed through it. HIV deaths in the Midwest peaked in 1995 and declined drastically with the advent of better meds, which led to a decline in patient populations (and ultimately Unit 371’s closure). Czerwiec’s illustrations are as friendly and inviting as a children’s book, yet they stir up tremendous emotions as a person, an institution, and a community respond to the HIV epidemic. (PSUPress.org)—SAVAS ABADSIDIS

The Life and Death of ACT UP/LA, a detailed chronology told through a feminist lens, this book explores the history of how AIDS Coalition to Unleash Power’s Los Angeles division battled the governmental, medical, and institutional neglect that characterized the early days of the epidemic. While shining a light on another important chapter of ACT UP (New York generally gets the most ink in history books), author Bennita Roth exposes the intersectionality inherent in the group’s grassroots activism, how local politics shaped the organization, and the social and gender inequalities that existed within ACT UP/LA itself. Roth’s book seems particularly relevant as healthcare has become part of multi-issue activism in 2017.

(Cambridge.org)—DA

The Cancer-Fighting Kitchen: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery is the new and revised edition from chef Rebecca Katz and co-author Mat Edelson. A scrumptuous collection of recipes designed to help patients thrive while going through any sort of cancer treatment is great for anyone dealing with immune system issues. The best part, though, is that while it’s filled with foods that are rich in nutrients, minerals, and phytochemicals that are good for you, these recipes are tasty, too. I can’t get enough of the simple but delish Thai It Up Chicken Soup that graces the cover. And if you don’t cook, there’s a list of good foods to add to your diet. (TenSpeed.com) —DAM

HIVPLUSMAG.COM

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CHILL

BOTTOMS UP! SHAME-FREE TIPS ON INCREASING YOUR SEXUAL HEALTH AND PLEASURE.

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SEPTEMBER / OCTOBER 2017

WHILE THIS IS advice for those who identify as “bottoms,” anyone who has anal sex should have an understanding of the process involved in successful bottoming. It will help you be a better “top” and positively affect your sexual experiences.

The act of bottoming is a true art, and whether it’s your first attempt or you’ve been experimenting with it for quite some time, analyzing your readiness and the proper techniques not only allows you to reach heightened sexual pleasure, but also enables safe and enduring practices.

If you’ve never tried bottoming, but you’re curious, you shouldn’t just dive in without preparation.

Successful and pleasurable

bottoming takes time and practice, through dilation exercises, training of your selfawareness, and control of the pelvic floor.

The good news? Bottoming shouldn’t hurt. Of course, it may be uncomfortable at first and you might initially question how there could ever be pleasure in it—something that happens with vaginal sex the first time as well.

It takes practice, patience, and following a few simple guidelines to enhance this sexual practice.

I often tell patients that great bottoms have been doing it for quite some time, with many first experiencing it in their youth.

Unfortunately, no one showed us the right way to bottom in our high school sex ed classes. Still,

SHUTTERSTOCK

B Y D R . E VA N G O L D S T E I N

it’s never too late to learn so you can enjoy new and positive sexual experiences.

Here’s my 101 guide to bottoming:

BEGIN WITH DILATION

Get yourself an anal trainer kit, and start training for dilation two to three times a week (for as little as five minutes each time). Use a water-based lubricant and start with the smallest plug. Insert just to the point of pressure. Hold it there for a few seconds, then try to engage the muscles. Allow yourself to relax before removing the plug, then re-lubricate and re-insert to the point of pressure. Repeating this process will prove successful over time, so don’t get discouraged if the first time you only get a small portion of the tip in. Repeat the process three to five times. The key is to remember there are three sets of muscles that need to relax for a successful entry. Think of it as a tunnel, and the entire tunnel needs to be a well-lubed cylinder.

We don’t advise inserting the entire length of the plug and leaving it in on the first try, because removal may be difficult, which could cause tearing. If after four to five sessions you can insert that size without any issues, you’re ready to graduate to the next size. Don’t forget to enjoy it. If you become stimulated during the process, go for it! Not only is it a pleasurable side effect to your dilation training, but you can start to channel your orgasm anally and begin to gain control over time.

SHUTTERSTOCK

READY FOR THE REAL THING

When you’ve successfully mastered a medium size plug, you’re ready to graduate to the real thing. Congratulations! It’s always best to start off with you in total control and a partner you trust to be patient in letting you decide the level you’re comfortable with. Some people use dilators first, either with or without a sexual partner, to “warm up” and remind themselves of the practiced techniques. Once the engines have been started, the bottom needs to sit on the tip of the penis, allowing control of entry. Use plenty of lubricant and remember the different sets of muscles that need to be released to continued on page

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Dear Gay Men: That Gym Body Might Kill You Every year, thousands of gay men vow to transform whatever version of themselves they see staring from the mirror into the body of their dreams. Yet the goals we place on ourselves are often too radical to achieve and we inevitably end up failing.

This perpetual loathing of our bodies is because our goal is to never just be fit, but to get that “gym body.”

Quite simply, the difference between a fit and healthy body and a gym body is that the former is achievable by anyone, no matter their genetic disposition, and the latter is an utter fallacy. No matter how buff, no matter how lean, the “gym body” is a never-ending work in progress.

And just like anything else that you want so badly but can never attain, the quest for chiseled abs and massive muscles can leave you absolutely miserable.

We’re not all meant to look the same and striving for that look has us trying to cram into boxes we’ll never fit in.

Let’s face it, there is a very small window of variety when it comes to what most people view as the perfect body. But the truth is, the only people who seem to personify the Adonis that many try to be only look that way because of genetics— either that, or they take drastic measures and risk their health (and their hard-on) by using steroids.

Yes, for some, the price of using steroids to be the hottest boy in a tank top comes at a very steep price. For those who aren’t genetically predetermined to have washboard abs or gigantic pecs, the cost for these things may include blurred vision, cataracts or glaucoma, high blood pressure, increase in body hair, breast tissue, osteoporosis, liver cancer, heart attacks, and on and on. Did I mention it could also deform your face?

For those living with HIV, the pressure to work out, build muscles—and avoid any suggestion of the wasting that was once a characteristic sign of AIDS—can be even more intense; and even more dangerous.

But when so many of these side effects happen years later, and the pool party is next week, it’s tempting to live for the moment. As a former bodyobsessed, gay 20-something, I know all too well how the quest for a perfect body can leave you worse for wear. In my early 20s, I exercised constantly but could never quite get to the size or the shape I wanted. Although I didn’t use steroids, I did use incredibly dangerous over-the-counter prohormones. These pills did exactly what I wanted to do.

My muscles grew, my six-pack popped out, and I finally had that “look.” This, however, started the chase of the dragon.

No matter how I looked, it was never enough. I was never finished, never enough, and never, ever happy.

My story is a common one. It’s the silent epidemic among gay men, who are six times more likely than straight men to use steroids, abuse testosterone supplements, or locate a doctor who will find the smallest reason to diagnose them with “low T.” Simply put, my genetics told me I was to look a certain way, and I said, “screw that.” Doing so screwed me up in the process. Five years later, I’m finally getting back to good.

Gay men are stereotyped for our bodies and held to an impossible standard of perfection, second only to women. And just like a healthy, inclusive version of beauty is a part of the foundation of women’s rights, a body-positive image of what gay men look like needs to be a part of gay rights.

So what is a fit body, then? It’s hard to define because it is what you look like when you are living a healthy life. It is exactly not what the man across the gym looks like, because you can never look like him. In fact, it isn’t a look at all, but a feeling. A fit body can change, but that change is only the benefit of a healthy mind.

The journey to a fit body and a fit mind never has a stopping point, either. But unlike the journey to the gym body, each day of healthy living can feel like a success all on its own.

It’s time to make every day a victory. Quit worrying about everyone else’s hot ass, and find a way to worship your own.

—TYLER CURRY

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we stay Sure HIV treatment = Prevention #PlaySure

BE Sure, Play Sure, Stay Sure.

If you’re HIV positive, starting and staying on treatment can keep your viral load undetectable. Treatment keeps you healthy and makes it nearly impossible to pass HIV to your partner. Condoms offer additional protection against HIV and other STIs.

STAY SURE: Call 311 or visit nyc.gov/health/staysure to learn more about services that can help you get and stay on treatment.

continued from page

15

allow access. Start off using the same technique of inserting until you feel pressure, hold it there, pull out, re-lubricate, and repeat. The three to five-time rule applies here as well.

Being on top of the penis really allows for you to determine your level of comfort. If pain occurs, you can stop, call it a day, and try again another time. It’s not worth causing pain or a potential injury.

COURTESY DR. GOLDSTEIN

GRADUATING TO NEW POSITIONS Once you have fully received the penis, the last hurdle is to add new positions into the mix, like doggy-style. Now, be sure to take this easy to begin with—it’s an intense position and tops can get a little eager. Make sure you have mastered receiving to minimize any injury and maximize pleasure. Start with you receiving on top and gaining control of your muscles before moving around to new positons.

INJURY HAPPENS TO THE BEST OF US Proper techniques are obviously a must, but even brand-new cars can break down. The most common issue related to anal sex trauma are tears, also known as anal fissures. If this happens, take a break but don’t get discouraged.

Most anal fissures will heal themselves with

proper care, but fissures that become chronic will require surgical intervention. If an injury happens, it’s best to analyze why it did so you can plan to avoid reoccurrence in the future.

BE HONEST WITH YOUR BODY Small, petite frames and pelvises just may not be able to accept those of the more wellendowed variety. Be realistic with your goals, and realize that you may need to work up to this over several months.

USE IT OR LOSE IT The key to continued ease of bottoming is to be consistent in using the above dilation methods, even throughout sexual dry spells. We all have them so don’t fret, but just remember if you don’t use it, you lose it. Keep at it so the next experience is a pleasurable one.

ENGAGE A SPECIALIST The process to becoming a pro at bottoming can be daunting, but it is totally achievable if you follow the above process. If all else fails, see a specialist in gay sexual health and wellness, who can provide both medical—such as personalized dilation and Botox—and surgical options (including anal restoration) to help improve results and assist in relaxation of the muscles.

D R . E VA N G O L DST E I N ,

founder of Bespoke Surgical (with offices in New York and Beverly Hills), has extensive experience educating gay and bi men on health care issues, including: anatomical and mental sexual dysfunction; different same-sex relationship types and their evolving dynamics; HPV prevention, management, and treatment; anal Pap smears and cancer prevention; sexual education (i.e., proper techniques to minimize injury and enhance overall sexual experience); and how medical advances have revolutionized the way that gay men have sex.

HIVPLUSMAG.COM

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THE FUTURE’S SO BRIGHT, HE’S GOT TO #UNSHADE

After a decade away from Hollywood, The Real World star Karamo Brown is back on MTV (hosting Are You the One: Second Chances) and the History Channel (The Unexplained). He talks about his accidental fatherhood, getting off drugs, and best of all, how he is using his newfound visibility to lead the call around HIV. With Brown’s leadership, the nonprofit organization, 6in10—which he founded in 2015 alongside HIV-positive minister, radio host, and educator Donta Morrison—is ready to take on the high rates of HIV in the black community.

BY JACOB ANDERSON-MINSHALL PHOTOGR APHY BY PHILIPPE BERTR AND OF B&P STUDIO

karamo

Brown made history as the first out gay black man on reality TV when he appeared on 2004’s The Real World: Philadelphia. He instantly became a role model, simply for providing visibility to gay and bi black men.

Brown, who was a licensed social worker for nearly a decade after The Real World, has always wanted to help others, “especially men of color who didn’t have anyone.” Now that he’s back on TV (hosting shows like Are You the One: Second Chances), he considers his work as part and parcel of that because of the visibility it brings.

“I hate the term role model,” Brown says, choosing not to use the phrase about himself. But he hopes to be someone that other guys can look to and think, “Oh, if he did it, I can do it too.”

Brown took a more proactive step in 2015 by cofounding the organization 6in10, with HIV-positive minister Donta Morrison, to address the high rates of HIV in the black community. The name reflects the Centers for Disease Control and Prevention’s prediction that six in 10 gay and bisexual black men will contract HIV before they turn 40.

The non-profit organization partners with the CDC and creates viral campaigns, like its #UNSHADE effort calling on the African-American LGBT HIVPLUSMAG.COM

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community to stop stigmatizing HIV. The clarion call from 6in10: “By eradicating the HIV shaming and shade that occurs within the black LGBT community, we can begin to change the six in 10 statistic.”

Although Brown isn’t poz himself, he says, “The HIV epidemic has always been on my mind, it’s always been something I’ve spoken—and speak—about, because it affects us [so much].”

The group 6in10 was launched in part when Brown’s appearance on a radio show was abruptly canceled.“I was supposed to be talking about HIV/AIDS awareness in the black community,” Brown says, “And I got canceled.” The producer reportedly explained it was “because the host ‘did not care about the topic,’” Brown recalls. “I thought, You don’t care about black people? LGBT people? HIV? Because either way I’m going to be pissed off!”

Brown says it was this anger that “propelled me into making sure… we were telling our own story, sharing our narratives.” In particular, 6in10 focuses on improving the mental health and self-esteem of gay black and bisexual men. “At the core,” the former social worker says, “If you can’t change your mind, you can’t change your heart, you can’t change yourself, you can’t change the way you’re living your life.”

“As African-Americans,” he continues, “we don’t focus enough on mental health. Your self-esteem and the way you see yourself in this world is the reason you react the way you do. If you don’t value your life, then, ‘Why would I put on a condom? Why… [avoid] risk?’ We focus 22

SEPTEMBER / OCTOBER 2017

right there, so that way we can start at your heart and your core, and then everything else can move forward.”

In addressing self-esteem, Brown isn’t just focused on encouraging individuals to fight stigma or proudly share their poz stories—he also wants to transform the black community so it’s less hostile to its LGBT members. “We have to start making sure that churches start to talk about… black queerness in a way that’s affirming,” Brown says, “because a lot of young black men are in the church. And that’s where they start to learn this self-hate behavior.”

6in10 also targets parents by speaking to parent/teacher associations and other groups to help them “understand how they can support their children… [especially if they] identify as gay or bisexual, or trans, or queer, or gender non-conforming. How do you have those conversations [on HIV] in a positive and healthy way, so that way they don’t put themselves at risk.”

To better assess how to position their appeals to parents and black churches, 6in10 is currently doing market research in 12 schools and four churches.

Aware that PrEP uptake hasn’t been as widespread among black gay men as among their white counterparts, Brown blames marketing (including public education campaigns) and access (including “perceived access,” since he says many people mistakenly believe the HIV prevention strategy is only available to white guys or those with money).

“I get so tired of people trying to market to African-American gay men—or AfricanAmericans period—in the club,” he adds.

“Nobody in that club is going over to your table to get a condom or get a pamphlet. It’s just not happening. So, take your condom table… out of the club,” he argues.

Instead, Brown recommends that organizations recruit DJs as partners in sharing the message. “Make sure your DJ says every five songs, ‘Hey make sure if you go home with somebody, love yourself, protect yourself,’” he suggests. “Do things that are more creative, get out of the box.

Encourage them to say, ‘Hey, see your doctor, get PrEP.’ Let [people] know that it’s available to them, you know, with or without insurance.”

There also needs to be more messaging in the black community about embracing medical care. “I never saw my father go to the doctor,” Brown says. “It took me until I was probably like 26, or 27, to get a primary care physician.

In my mind, unless I’m like coughing up a lung, why do I need to go to the doctor? And I think those types of stereotypes still permeate the black community. We feel like that’s not for us, we don’t have access to that.”

Brown thinks that’s one of the reasons African-Americans living with HIV don’t always get the care that they need, while studies show white HIVpositive people seek care and reach undetectable levels at higher rates.

“Also,” Brown adds, “I think there’s a lot of stigma when it comes to gay black people, trans people—we just don’t want to go to the doctor and be judged. It’s very hard to sit in front of a doctor or a physician, who’s supposed to be caring and understanding, and tell them, ‘I think I might have an STD.’ People are embarrassed.

And part of that embarrassment goes back to their self-esteem and mental health, of like, well, taking care of yourself—you should never be embarrassed about that.”

As 6in10 gets off the ground, Brown’s television career is also taking off. But the truth is that both his advocacy work and TV career almost didn’t happen.

In the wake of The Real World, Brown admits, “I got addicted to drugs, to cocaine, and was like partying every night, wasting away, killing myself, basically, because I didn’t know how to deal with this sort of new reality fame.

I was getting messages that I loved

from people saying, ‘Oh my gosh, you stopped me from killing myself,’ but I didn’t… know how to respond [or] what to do. [It was] a lot of pressure.”

Then something happened that snapped Brown out of his addiction and forced him to grow up fast: he discovered he was someone’s father.

His son, Jason, was already 10-yearsold when Brown first met him, and, a short time later (in 2007), gained full custody of the pre-teen.

“It’s the greatest gift ever,” Brown says now. “You know, being an openly gay man, I didn’t ever think that fatherhood was a possibility.

Obviously, I was scared, I was terrified… but luckily, I grew up in a family that embraced being together and taught me… you have to step up. And it was the best decision ever.”

Brown put aside dreams of becoming a TV star and buckled down into the social work career he’d prepared for in college. He also ended up adopting a second son, who would later give Brown another life changing gift.

“He was writing a paper on living your dreams,” Brown recalls. “And he asked me if being a social worker was my dream. …I could say ‘Yes,’ which was a lie. I said ‘No.’ He said, ‘Well why

don’t you go after your dreams?’ I quit my job, maybe two months later.”

He was hired by Oprah Winfrey to host #OWNSHOW on Oprah.com, then recruited to be a panelist on Dr. Drew on Call, in part because of his social worker background. He filmed 54 episodes on Dr. Drew, between 2014 and 2016.

Last year, Carlos King, a producer known for his work on Real Housewives and Hollywood Divas offered Brown a spot on The Next 15 with other former reality stars like Tiffany Pollard (I Love New York) and Claudia Jordan (Real Housewives of Atlanta). In addition to hosting both Are You the One: Second Chances on MTV and a new History Channel show, The Unexplained, Brown is getting into producing and has been filming a show he developed. Details are still under wraps, but it should premiere in early 2018.

“This has been a three-year journey since I got back in the entertainment industry,” Brown says. “I would just tell people to watch out because I’m about to be a force to be reckoned with.”

Find out more at 6in10.org.

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This Article Could Save Your Life BUT ONLY IF THE RIGHT PERSON READS IT.

SHUTTERSTOCK

BY JACOB ANDERSON-MINSHALL

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SEPTEMBER / OCTOBER 2017

HIVPLUSMAG.COM

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SEPTEMBER / OCTOBER 2017

“There continues to be a supply and demand problem where we have more people in need of a kidney than we have kidneys available,” acknowledges Dr. Jayme Locke, surgical director of UAB’s HIV Transplant Program, where Williams’s transplant was performed.

That’s why HIV-positive people continue to die waiting for kidneys.

According to HIV.gov, up to 30 percent of those living with HIV suffer from abnormal kidney function issues, which, left untreated, could turn deadly. While the disease itself can cause kidney damage, those on treatment are more at risk of nephrotoxicity, which is “toxicity or injury to the kidneys.” It can be a side effect of some HIV meds, including protease inhibitors and nucleoside reverse transcriptase inhibitors. Long-term survivors are particularly susceptible to this kind of kidney damage because of the length of time they’ve been on antiretroviral meds.

In addition, a number of comorbidities common in those living with HIV also increase the risks of kidney damage, including high blood pressure (which HIV-positive people are three times more likely to develop), diabetes (which poz folks are four times more likely to develop), and hepatitis C (which approximately one out of every four people with HIV also have). Poz people suffering from these other diseases further add to the number who experience renal failure, have issues on dialysis, and spend their remaining years on a transplant waiting list.

Mary Smith* was already aware she might need a transplant at some point when she discovered she had gotten HIV from her husband. “When I became HIV-positive, I was, ‘Oh god, what about if I need a transplant?’ I’m going back to 1990,” Smith recalls. “That always scared me, that I would never be able to get a transplant, because, at the time, no one even thought about it.” Indeed, since the height of the AIDS epidemic in the 1980s, HIV-positive individuals have been legally prohibited from donating organs, and doctors have been prohibited from transplanting HIV-positive organs into another person—regardless of the recipient’s status.

Because of the way HIV can attack the immune system, people living with the virus were once considered too high risk to even receive organ transplants. But in the 1990s, the federal government granted a few research facilities the opportunity to study the impact of organ transplants on people living with HIV. Dr. Sander Florman, director of Mount Sinai’s Recanati/Miller Transplantation Institute, says his hospital was one of the first “committed to the transplantation of people with HIV since way before it was ever anywhere near popular.

I think the first HIV-positive transplant was done in 1998 here. And that was at a different time when people were very scared of HIV.” Florman explains further: “Mount Sinai found many of our anti-rejection medicines actually work synergistically with the HIV medicines to prevent the virus. And that’s part of the secret to why

COURTESY THE MOUNT SINAI HOSPITAL (BOTH PAGES)

I N 2 015, J O E WILLIAM S,* a gay man from Mississippi, experienced HIV-related renal failure. As his kidneys shut down, his ankles and feet became swollen and painful.

Still, it was the extreme fatigue that really got him down. He’s in his 30s.

Williams promised himself a long time ago never to let HIV run his life, but it became increasingly difficult for him to pursue his dream of becoming an educator.

He’d go to classes for his teaching credentials in between dialysis treatments, but it was a constant struggle. And, like many living with HIV, he wasn’t doing well on dialysis.

New Yorker Ken Teasley (right), a gay man from the Bronx, also ended up on dialysis.

Teasley was a typical healthy high school student, who “drove a school bus and had a second job, ran long distance track, co-editor of my school newspaper, played cello—you know, normal stuff,” he says, sounding more accomplished than most teens.

Teasley was diagnosed with high blood pressure at 17, but still managed to pass an Army physical two years later. He moved to New York after getting out of the military and did what gay men are supposed to, he says, by getting tested for HIV “every six months until my first relationship.”

Teasley was 27 when he learned he was not only HIV-positive, but “only had 23 percent kidney function and, at some point, would require dialysis.” To prolong the inevitable, he made numerous lifestyle changes to lower his blood pressure and stop taking pain medication for the gout he experienced as a side effect of the kidney failure.

“I finally got off blood pressue meds, but the damage was already done,” Teasley says. In 2002, a doctor recommended he check out The Mount Sinai Hospital’s organ transplant program. It was one of only a handful of medical centers in the U.S. doing transplants into HIV-positive patients. But Teasley wasn’t ready.

“I didn’t want a transplant,” he admits, “until I started dialysis.”

HIV-positive individuals “on dialysis are twice as likely to die as compared to their [HIV-negative] counterparts,” says Dr. Shikha Mehta, medical director of the University of Alabama Birmingham’s HIV Transplant Program. “Research has shown that kidney transplantation reduces this risk of death by 80 percent as compared to staying on dialysis.”

Neither Williams’s nor Teasley’s living relatives were found to be matches, so they were each placed on the organ transplant waiting list. While Teasley was told he might have to wait seven or eight years before getting a donated kidney, Williams’s type O blood would make finding a match even more difficult. He might have to wait up to a decade for a kidney—if he lived that long.

HAPPY DAYS (left): Kenneth Teasley, the first recipient of an HIV-positive organ transplant at The Mount Sinai Hospital.

SAVING LIVES: The transplant team in the operating room at Mount Sinai with surgeon Sander S. Florman (bottom, right).

people with HIV can have successful organ transplants, which was heresy 10 years ago.”

Alabama-based Locke has also conducted research showing that HIV-positive individuals who receive kidney transplants can have “excellent long-term outcomes.” Locke says her subsequent study that came out last year “also demonstrated a significant survival benefit.”

“No one had ever really shown that,” Locke explains. “They’d shown good outcomes after transplant, but no one had ever been able to quantify the survival benefit that an HIV-positive person receives by getting a kidney versus waiting on dialysis. We were able to demonstrate that as well, providing even more evidence that this is the right thing to do for this vulnerable population.”

In 2012, Teasley was feeling particularly vulnerable himself when he was diagnosed with kidney cancer.

“My mother, sister, and I were [all] diagnosed with cancer within six months of each other,” he recalls. That’s when Teasley discovered that having a cancer diagnosis made him “inactive” on the organ transplant list.

Teasley eventually had his cancerous left kidney removed and says his family all survived and all three remain cancer-free today. Still, he was told post-surgery he’d have to wait an additional two years before his transplant listing was active again. He was looking at 2019 or 2020 before a kidney would become available.

Things weren’t looking good for Smith, either. The polycystic kidney disease she’s had since 1986 had “just gotten worse” over the decades. One of the hurdles Smith faced was financial. She’s on Social Security disability, but to get Medicaid insurance coverage, she’d have to pay. Not wanting to spend any of her meager income, Smith put it off until last year. But she “was getting weaker and sicker,” so she decided it was time to try for a transplant, and to do so she “had to pay six months up front in order for them to start the ball going. That’s how I ended up on the regular list; I got moved up to be officially on the list.”

After that Smith says, “My daughter and my sister both tried to be organ donors for me, but we didn’t match. Then I realized I could do a swap. So, my daughter is in the process of that.”

A swap (or chain) happens when a donor isn’t a match for their planned recipient.

“About half of the people who come forward to be living donors are going to be found not matched with their intended recipient,” explains Locke, whose lab has the “longest”

kidney chain in history. “What a chain does, it takes an individual who wants to be a living kidney donor but doesn’t know anybody who needs a kidney. They are matched to a person who has a donor, but their donor doesn’t match them. So that altruistic donor gives to that recipient, then that recipient’s original donor gives to the next incompatible pair, and so on. It’s like a domino reaction. It creates a bunch of compatible transplants that otherwise would not have occurred.”

Having a donor willing to donate can certainly speed up the chances of you getting an organ, but still, the wait can drag on. And, especially for people with HIV, waiting can be deadly.

That’s why after years of lobbying by the United Network for Organ Sharing, HIV activists were thrilled when the federal government finally reversed their policy with 2013’s HIV Organ Policy Equity Act. The HOPE Act, which went into effect in late 2015, authorized the use of organs from HIV-positive donors for transplantation into HIV-positive recipients.

“I found out about the HOPE Act, which I think is fabulous!”

Smith says. “I don’t know why it took so long, you know, when so many people could’ve been saved. So, I said, ‘Well, go ahead and put me on that [list], too!’”

Doctors believe those who are already HIV-positive can safely receive organs from another poz person, and in doing so, free up organs for those who aren’t HIV-positive. “So, it’s a net gain for the system,” Locke says.

“To my surprise,” Teasley recalls, in 2016, “I was asked to participate in this new protocol involving an HIV-positive transplant.” continued on page

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27

WHAT IS GENVOYA®?

GENVOYA is a 1-pill, once-a-day prescription medicine used to treat HIV-1 in people 12 years and older who weigh at least 77 pounds. 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 infection 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: • 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 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. • Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

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 or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and over-the-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.

GENVOYA.com

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 WHAT IS GENVOYA®? ( jen-VOY-uh ) MOST IMPORTANT INFORMATION ABOUT GENVOYA GENVOYA may cause serious side effects, including: •

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.

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.

•POSSIBLE SIDE EFFECTS OF GENVOYA GENVOYA can cause serious side effects, including: •

• •

• • Too much lactic acid in your blood (lactic acidosis), which

is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

GENVOYA does not cure HIV-1 infection or AIDS. ABOUT GENVOYA GENVOYA is a prescription medicine used to treat HIV-1 in people 12 years of age and older who weigh at least 77 pounds and 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 IMPORTANT SAFETY INFORMATION HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements.

What is the most important information I should

•

•know GENVOYA does not cure HIV-1 or AIDS. Ask your healthcare about GENVOYA?

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 ), lurasidone (Latuda®), methylergonovine Who should not take GENVOYA? (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.

•

What are the other possible side effects GET MORE INFORMATION of GENVOYA? •

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.

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

Changes in your immune system.

New or worse kidney problems, including kidney failure.

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

Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, What I tell my healthcare provider before darkshould “tea-colored” urine, light-colored stools, loss of appetite taking GENVOYA? for several days or longer, nausea, or stomach-area pain.

•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 have had any kidney or liver problems, including

• hepatitis infection.

Have any other medical condition.

Are pregnant or plan to become pregnant.

• • 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-thecounter 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.

Ask your healthcare provider if GENVOYA is right for you.

• Take GENVOYA with food.

GENVOYA.com

GENVOYA, the GENVOYA Logo, LOVE WHAT’S INSIDE, SHOW YOUR POWER, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: April 2017 © 2017 Gilead Sciences, Inc. All rights reserved. GENC0141 04/17

D A I LY D O S E

BY BENJAMIN M. ADAMS

THERE’S NOTHING SCARIER THAN LOSING ACCESS TO YOUR MEDS

SHUTTERSTOCK

LOSING COVERAGE FOR HIV MEDICATION CAN BE NERVE-RACKING. TAKE OUR WORD FOR IT. I LOST COVERAGE for my HIV medication for 64 days, and it was one of the single most frightening episodes of my life. But the conundrum of losing access to your medication can be better solved if you remain calm in the face of danger. You’ll be much healthier if you can take control of that which is controllable, but push aside the worry and fear over the things you can’t change.

Not long ago, I moved from Los Angeles County to Riverside County, Calif. Putting together the paperwork for my primary and secondary insurance was confusing, but I’ve always considered myself generally responsible about taking the necessary steps to ensure my paperwork was in order.

Changing counties meant I had to update my information for Covered California, the California marketplace for insurance providers under the Affordable Care Act. It also meant I had to update the information for the assistance I need to cover the soaring cost of insurance premiums and copays.

A series of miscommunications led to missing paperwork, which led to missing deadlines and caused me to lose my prescription assistance.

Fixing the issue didn’t happen nearly as quickly: By the time I was able to resolve it and get my prescriptions refilled, I had gone 64 days without HIV treatment. It was utterly terrifying.

The success of Stribild, the daily pill I was taking, hinges upon the strict daily adherence to a person’s drug regimen. HIV-positive people are told not to skip a single day of Stribild or the other daily pill regimens because of the risk of developing drug resistance. HIV’s unique ability to mutate and adapt to drugs is one of the reasons why the United States and other

nations failed to develop effective HIV medicine for many years.

Knowing this, I was overwhelmed with stress as I slowly realized I wasn’t going to be able to get a refill.

I had used up a 30-day emergency assistance cushion from a wonderful service that helps HIV patients get their medicine if all else fails. But it would take another two months before I was able to get the necessary documents together.

The case worker who took my case interrogated me as though I was trying to take advantage of government handouts. There was nothing I could do to get the documents I needed faxed to where they needed to go. Later, I found out that unnecessary holds had been placed on my account because of that particular case worker (who no longer works there). I scoured the area for HIV resources and I had applied (or tried to apply) at five or six.

Rashes appeared on my elbows, and I convinced myself it was an indication that the virus was progressing and that my health was plummeting. I couldn’t acquire my primary insurance—let alone my copay coverage.

Months later, when I finally got coverage and a refill, I told my doctor what had happened. He checked my

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D A I LY D O S E

BY BENJAMIN M. ADAMS

32

SEPTEMBER / OCTOBER 2017

the incomprehensible five-figure annual medication costs. It’s part of a 30-yearold system designed to keep HIV-positive people from losing medication.

In 1987, people couldn’t afford to pay for their AZT just as many can’t afford their medication now. Are we repeating history?

Many of these problems wouldn’t exist if HIV medication costs weren’t inflated by pharmaceutical greed. Raising HIV drug prices up to 5,000 percent is the new normal. With the push to repeal the ACA, it seems obvious that major changes in the American healthcare system are headed our way. The chances of getting cut off from HIV drugs are higher than ever before.

Healthcare “reform” will inevitably cause some people living with the virus to have gaps in their drug coverage.

Fortunately, the actual impact of losing my HIV drug assistance was nowhere near as life threatening as I had imagined. If you find yourself in a similar situation, where you temporarily lose your coverage, relax.

You’re going to be alright.

B E N JA M I N M . A DA M S is a journalist and advocate for HIV,

medical cannabis, & LGBT rights. He writes for HuffPost, Vice, Reset. me, MerryJane.com, Treating Yourself, and Culture.

SHUTTERSTOCK

blood work and my T cell count was still in the 700s. I had not developed a resistance to Stribild. In fact, none of my fears were realized. The rashes that developed on my elbows were probably a result of stress.

Recently in Los Angeles, HIV-positive people have been turned away from pharmacies or dropped from assistance programs altogether because of a change of contract in a state-run AIDS assistance program.

California’s AIDS Drug Assistance Program, which pays for medication costs for over 30,000 low-income HIV patients, switched pharmacy and enrollment contractors. This caused a chain reaction of complications for many patients. A report by Kaiser Health News indicates that patients weren’t able to get their medication in a timely manner. In March, the contractor responsible for enrolling people into California’s ADAP program was fired for putting thousands at risk. It was the third major contract reversal in two years.

My message to all people living with HIV who temporarily lose insurance coverage or drug assistance is this: Keep calm. You’re not going to die. Not in this day and age.

Government programs like ADAP save lives for those who can’t afford to fork over

continued from page

27

Last summer, just two months after signing the paperwork, Teasley became one of the first people to receive a kidney from an HIV-positive donor. “I still have to pinch myself,” Teasley says. “My health is back on track. And by back on track,” he jokes, “I mean, I developed diabetes at two months post-transplant because of the steroids [given to prevent organ rejection].”

Florman performed Teasley’s historic transplant surgery, which was “the first time that we’ve been legally allowed to use HIVpositive organs” at Mount Sinai. Even in the best of situations, getting an organ can take years. “There are over 90,000 people listed that are waiting for a kidney transplant,” Florman says. “And there are 58 organ procurement organizations, and yet only a small handful have produced HIV-positive organs.”

The HOPE Act also included the caveat that transplants only occur “under approved research protocols designed to evaluate the feasibility, effectiveness, and safety of such organ transplants.”

Florman says that’s a smart move because, “We don’t know the answer to what will happen when we give an HIVpositive patient an organ from somebody with HIV. Could there be another strain of the virus that overtakes their strain? What if we gave them an organ with a strain of HIV that wasn’t able to be controlled?

Could we potentially make their HIV worse and even… trigger something that would lead to AIDS?” These are the questions that concern Smith too. “I have my HIV under control,” she says. “Murphy’s law: [what if] I catch a disease that I can’t treat?”

Whether that’s possible still isn’t clear.

“There’s no guarantee that when you transplant you would transmit HIV,” says Florman. “You’re not getting blood, you’re getting a kidney that has been washed out with our preservative solution. We do have some loose data from some older studies that show there probably is detectable virus in the kidney itself, but whether or not that would transmit [HIV], into the recipient is not clearly known.”

Researchers want to assess these concerns before making transplant surgeries widely available.

One discovery Florman made after completing just eight kidney transplants was a pleasant surprise for both surgeon and organ recipients: “Half of those kidneys have been in people where the test was a false positive,” which means the donor wasn’t actually HIV-positive at all, and 50 percent of Florman’s transplant patients received healthy kidneys. “The screening test for HIV in donors is not very sensitive,”

he explains. “As a screening test, you want it not to miss any cases.

Those organs, by law, prior to the HOPE Act… had to be discarded.

We weren’t legally allowed to procure them. But now that we have the HOPE Act, we can still offer those organs only to people with HIV.” Unfortunately, for all the insight the HOPE Act’s research caveat may provide, it also limits the number of facilities authorized to undertake such transplants. The United Network for Organ Sharing reports 13 hospitals have enrolled with the Organ Procurement Transplantation Network to participate in research studies.

“Only a dozen programs or so have agreed to transplant these organs,” Florman confirms. “And only two or three programs that have actually transplanted these organs, when there are 250 or 300 transplant programs out there.”

State laws also hamper the pace of adoption, so activists like Rick Zbur of Equality California have pushed for laws authorizing the surgeries (California’s Governor Brown signed such a bill in 2016).

Florman says another barrier is the fear surgeons have of acquiring HIV. Although the fear is overblown, Florman does acknowledge there is risk to the surgeons doing the procurement. “These organs don’t just appear,” he explains. “We have to go to other hospitals… we’re flying off to other parts of the country… [having] to go actually operate in another hospital with a team [we]’re not used to.”

Worse, deceased donors can’t share their medical histories (like which strain of HIV they have and if they are resistant to drugs) and may have been diagnosed as HIV-positive for the first time when they were brought in to the hospital. “We don’t know their history… or even if we do, they often may have viral loads that are detectable,” which is different from the recipients—who must have their HIV suppressed to undetectable levels before the procedure can proceed.

Floorman says, “because the organ procurement agencies share these same type of sentiments,” few have begun accepting HIVpositive organs even though it’s now legal for HIV-positive folks to donate. “I don’t think they mean any ill will,” he adds. “I think there’s [just] a lot of fear.”

In the first 12 months after the federal law went into effect, facilities like Mount Sinai and UAB performed 19 transplants (13 kidney and six liver transplants—some to the same recipient). At least 80 people living with HIV signed onto the waiting list for poz organs the first year, providing a sense of how much need currently outpaces supply. Even if donor matches were immediately found and made available at the speed of current HIV-positive transplant surgeries, it could take another four years to get all 80 off of dialysis.

When every year could be your last, four can seem like a lifetime.

There are simply not enough HIV-positive donors to go around.

Although Smith is still waiting, Williams was one of the lucky ones. He was matched with a donor and became the eighth person in the U.S. to receive a poz kidney, through UAB. “The very disease most people consider a death sentence is the same disease that has now given me a second chance at life,” Williams said several weeks after the surgery. “I am truly grateful.”

Teasley is more than thrilled to have received a kidney. “I get to keep my promise to myself to serve the community,” he says. “What better way to serve my community and other communities of color than to help provide much needed data to help future generations bridge the disparity gap, dispel some stigmas, and to provide hope to those afflicted around the globe? All the research that I and my fellow HOPE transplantees provide can potentially help countless people all over the globe.”

Locke hopes to get the word out to people living with HIV that they can now be organ donors. “They can be a part of the solution,” she says. “HIV-positive individuals can give back to other HIVpositive individuals.”

Smith doesn’t care who donates her organ. “I don’t look at it as whose [organ], just something that’s healthy [so] I can feel normal again.” *Name changed for privacy, upon request.

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Gay and bi men, bi women, and trans people all have higher rates of eating disorders. How do we stop that? by david artavia 34

SEPTEMBER / OCTOBER 2017

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STARVING FOR LOVE

t’s hard to admit, but there was a time in my life when I felt I needed permission to look in the mirror. As a young adult, I never allowed myself to like what I saw because I didn’t look like a porn star. And when you’re a young gay man living in Los Angeles, that’s the basic beauty standard.

It took a while before I was able to look past the mirror and see my real reflection—one that wasn’t etched around an idea of perfection. Turns out, once I discovered there is no such thing as perfection, I was able to back away from my compulsion to emulate the porn stars.

The truth is perfection is a marketing strategy used to convince us that no matter how good we look now, we could always look better. Of course, in order to do so we must buy another product or undergo another procedure.

If we still can’t live up to our unattainable image, we are further victimized by a marketing campaign lining someone else’s pocket. We’re all victims of self-esteem sucking consumer capitalism, even when it’s wrapped in a sexy package. Unfortunately, the journey towards that impossible-to-reach land of perfection has unforeseen consequences— and it’s disproportionately impacting the LGBT community.

A 2007 study from Columbia University’s Mailman School of Public Health (published in the International Journal of Eating Disorders) showed that 42 percent of men who have eating disorders identify as gay or bi. In fact, cisgender gay and bisexual men are seven times more likely to binge, and 12 times more likely to purge than cisgender straight men.

Additionally, the study showed over 15 percent of gay and bisexual men had, at some time, suffered from anorexia, bulimia, or binge eating disorders, compared to 5 percent of straight men.

Researchers compared the ratio of eating disorders among gay and bisexual men who stated they were part of the gay community versus those gay and bi men who said they weren’t. Turns out, there was hardly a difference, which suggests eating disorders aren’t propagated by the social pressure of the gay community’s beauty standards alone.

Transgender people also have high rates of eating disorder symptoms. One 2015 study, published in The Journal of Adolescent Health, showed that nearly 16 percent of trans college students had been diagnosed with or treated for anorexia or bulimia in the previous year. Trans students also reported much higher rates (13.5 percent) of using diet pills in the previous month compared to cisgender straight men (less than 2 percent) and cisgender straight women (4 percent).

Bisexual young women and those unsure of their sexual orientation were found to have the highest rates of eating disorders among women in researcher Annie Shearer’s 2016 Drexel University study published in Eating Behaviors. Lesbians, overall, have been found to have higher levels of self-esteem and lower instances of internalized

cultural standards about sexual attractiveness, which has led to lower rates of disordered eating among lesbian women.

Both the 1999 study, “Lesbians, bisexual women, and body image: an investigation of gender roles and social group affiliation,” published in the International Journal of Eating Disorders, and “Differences Between Lesbians and Heterosexual Women in Disordered Eating and Related Attitudes,” a 2002 study in the Journal of Homosexuality, indicate that masculine, androgynous, or butch-identifying lesbians are “more experienced at accepting themselves as being different from societal and mediarepresented norms.” Furthermore, the highest levels of body satisfaction (and thus lower eating disorders) are found among lesbian women who have mostly lesbian and bisexual friends.

It’s not all rosy though: A 2006 study in the International Journal of Eating Disorders found that for both men and women, “any same-sex sexual experience, no matter how infrequent, is predictive of bulimic symptoms.”

What was once thought of as merely a “young, white girl issue” thanks to film and TV, is now anything but. The landmark 2007 study showed that black and Latinx cisgender lesbians, gays, and bisexuals have at least as high a prevalence of eating disorders as white people in the same category.

(Trans people were not included in the study.)

So why do gay, bi, and trans men as well as bi and trans women face higher rates of eating disorders than cisgender straight people? According to Tyler Wooten, medical director of Eating Recovery Center in Dallas, Texas, the reason might be rooted in internalized transphobia and homophobia.

“There’s a lot of messaging all over the world that [homosexuality] is a problem that’s unacceptable; it’s a disease, or it needs to be fixed.” Wooten tells Plus. As a result, this type of negativity can drive queer men to reflect a masculine ideal, leading to efforts to improve their physical value in an unconscious desire to please the world.

“The eating disorder brainwashes the individual,” Wooten adds. “I’ve had many patients say ‘I am my eating disorder, it’s part of who I am, my personality.’ It actually does help them. It makes them feel more self-assured, it improves their self-esteem a bit—until it starts to unravel.”

At the end of the day, trying to reach perfection is a losing battle. Like a poison, it infects our psyche to such a degree that we eventually let it invade and take over.

But instead of allowing ourselves to get eaten by the game, why not force ourselves to see the truth: there is no such thing as perfection. And because there’s no such thing as perfection, there’s no such thing as a flaw.

“As a society we should be watching the children,” Wooten concludes. “If they’re getting sicker and sicker, that should teach us the messaging that’s being taught is sick. We have to do a global change.”

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BY

NE DIA

AND

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ALL

ure. t u f e of th hump. r a t s ged ffalo a u b e l a dd have e mi o h t t s t Mee ppen a h t s He ju

CAEZMON DEGRACE (JACK MILLER)

W H E N AC TO R J AC K R . M I L L E R first

found out he was living with HIV, he was young enough to start treatment through the risk reduction program at Children’s Hospital in Los Angeles. He officially “graduated” the program at 25 (in 1995) and “I’m still living today!”

Born and bred in New York, Miller, now “44 years young,” divides his time between Los Angeles and New York City. With guest stints on Unbreakable Kimmy Schmidt, The Good Wife, Guy Code, and even Sesame Street, Miller’s been busy making a name for himself as an actor. All that despite the fact that he’s only been in the game a few years.

“I started acting five years ago,” Miller recalls. “I enjoy making people laugh and being comical. I was cast in a few TV or film projects and I received my union status.” In that half decade he’s seen the entertainment industry change a great deal. To take advantage of that, he has embraced the financial-core or Fi-Core option, in which he pays nonmember fees with SAG-AFTRA, the union that represents actors in film and TV, but remains able to work nonunion jobs as well.

“Now I can both do nonunion and union work, which helps me in the long run because there is so much more nonunion work in the industry nowadays,” Miller admits.

With guest spots on hot series like Unbreakable Kimmy Schmidt, Miller may be on the cusp of, well, if not stardom, then at least some greater fame to come. But does he feel it?

“Well, I’m over 40, so it’s hard to tell with Hollywood these days. I think my big break may come some day, but I’m just glad to be a working actor in New York and L.A.” That he’s gotten this far may surprise some, especially since his initial diagnosis in 1995 wasn’t just HIV-positive.

“Well, yes, back in 1995, my diagnosis was AIDS,” Miller admits, “because my CD-4 count was less than 200. It was 189, so I was

considered AIDS-defined due to the U.S. government not establishing the viral load testing. I’m proud to say today my viral load is [undetectable] and my current CD-4 is over 600.”

While many long-term survivors find it hard to work, Miller graduated from vocational school in 2008, which he calls “a great accomplishment.”

Now he’s plugging away at a pretty demanding career for his second act.

But Miller says it took time and treatment to get where he is. “For many years, I was living on government assistance programs like food stamps, Section 8 housing, and Social Security. I really never planned a career because I didn’t see hope in living a healthy life with HIV/AIDS. Now look, it’s been over 20 years and I’m starting life over again!”

Even with his busy schedule, Miller isn’t worried about medication adherence these days. But it was a different story a decade ago: “I wasn’t adherent at all,” he admits. “I missed many, many doses, especially when I first started out with the virus. I didn’t see the importance of taking the medication because the [expected] life span was so short. That’s why I’m resistant to all classes of antiviral therapy today and I’m on my last leg of medications. The doctors I had along the way just kept changing and adding new medications, so I didn’t worry about the future back then.”

Miller has also persevered through his fair share of other problems.

“Oh my god,” he says, beginning a litany of ailments but still managing to sound like a guy who’d fit right in on Brooklyn Nine Nine (as opposed to, say, The Wire). Perhaps his sense of humor is what got him through it all.

“The side effects were horrible at first,” Miller recalls, “with night sweats, uncontrollable diarrhea, skin rashes, bloating, gas, wild dreams, bodily disfigurement. Today, one of my antivirals causes me to have a buffalo hump in my back. And when I was taking Fuzeon, I got scars from injection site reactions. I’m proud to say now that I can maintain a pretty vibrant lifestyle and not get worn out by side effects. I just have to watch what I eat and take my medication as prescribed.”

As a big guy, Miller has had to become comfortable with his body in order to embrace life as a performer. One of his best friends could not do so. “He committed suicide due to the side effects [that had] disfigured his body,” Miller recalls. “It was so sad.”

Miller is strict with his own adherence now, too. It’s even gotten easier.

“My acting gigs come in spurts so my schedule isn’t that busy until I hit it big time,” he jokes, laughing both at Hollywood and at aging. “But when taking pills on set, I’m embarrassed at times or try to hide them from people asking questions. But as I got older, everyone has some form of ailment or a pill to take here and there.”

Miller wants others who are newly diagnosed to see in his example that “there is hope out there if you stay strong and maintain a dramafree, stress-free, and harmful-drug-free lifestyle, you can live a long and productive [life].” He wants to be “continuously sharing my knowledge and stories with the HIV/AIDS community and helping [mentor] LGBT communities of color.”

He dreams of moving to L.A. full time, “to see if I can make that big break in a movie or sitcom. I would love to buy a tiny house and travel the coast and do my acting career and enjoy life to the fullest.”

What else does a full life include for Miller? Playing the penny slots at the casinos, hitting up nude beaches, checking off those bucket list items, continuing a healthy and drama-free life.

Could the actor have imagined 20 years ago when first diagnosed just where he’d be today?

“Sometimes I feel like I’m in a very long dream and I’m trying to wake up. I had no clue that I would be still here today. My mom died of breast cancer over 10 years ago and I’m still living with AIDS. I had no idea the medication would sustain me this long! Sometimes I do get survivor’s guilt, but I must say that God, I guess, wanted me here for a reason, season, or lifetime—as the saying goes.”

HIVPLUSMAG.COM

37

WHAT IS PREZCOBIX®?

• It is not known if PREZCOBIX® is safe and effective in children under 18 years of age.

• When used with other antiretroviral medicines to treat HIV-1 infection, PREZCOBIX® may help: ○ 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.

• PREZCOBIX® is always taken in combination with other HIV medications for the treatment of HIV-1 infection in adults.

PREZCOBIX® should be taken once daily with food.

• PREZCOBIX® does not cure HIV-1 infection or AIDS, and you may still experience illnesses associated with HIV-1 infection.

You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses.

• Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people.

• Please read the Important Safety Information below and talk to your healthcare provider to learn if PREZCOBIX® is right for you.

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

• PREZCOBIX may cause liver problems. Some people taking PREZCOBIX® may develop liver problems which may be life-threatening. Your healthcare provider should do blood tests before and during your treatment with PREZCOBIX.® ○ Chronic hepatitis B or C infection may increase your chance of developing liver problems. Your healthcare provider should check your blood tests more often. ○ Signs and symptoms of liver problems include dark (tea-colored) urine, yellowing of your skin or whites of your eyes, pale-colored stools (bowel movements), nausea, vomiting, pain or tenderness on your right side below your ribs, or loss of appetite. Tell your healthcare provider if you develop any of these symptoms.

• PREZCOBIX® may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital.

Call your healthcare provider right away if you develop a rash. ○ Stop taking PREZCOBIX® and call your healthcare provider right away if you develop any skin changes with symptoms such as fever, tiredness, muscle or joint pain, blisters or skin lesions, mouth sores or ulcers, red or inflamed eyes like “pink eye” (conjunctivitis). ®

• PREZCOBIX, when taken with certain other medicines, can cause new or worse kidney problems, including kidney failure.

Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX.® ®

Who should not take PREZCOBIX ?

• Do not take PREZCOBIX® with any of the following medicines: alfuzosin (Uroxatral®), carbamazepine (Carbatrol® Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®) cisapride (Propulsid®), colchicine (Colcrys®, Mitigare®, if you have liver or kidney problems), dronedarone (Multaq®), elbasvir and grazoprevir (Zepatier®), dihydroergotamine (D.H.E.45®, Migranal®), ergotamine tartrate (Cafergot®, Ergomar®,

Ergostat®, Medihaler®, Migergot®, Wigraine®, Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev®, Advicor®, Mevacor®), lurasidone (Latuda®), oral midazolam (Versed®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor®, Vytorin®, Zocor®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®).

• Serious problems can happen if you take any of these medicines with PREZCOBIX.® What should I tell my healthcare provider before taking PREZCOBIX®?

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

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

What are the possible side effects of PREZCOBIX®?

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

• Other possible side effects include: ○ High blood sugar, diabetes or worsening diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZCOBIX.® ○ Changes in body fat can happen in people who take HIV-1 medicines. The exact cause and long-term health effects of these changes are not known. ○ Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines.

Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time.

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

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

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to Janssen Products, LP at 1-800-JANSSEN (1-800-526-7736).

Please read accompanying Important Brief Summary for PREZCOBIX®.

Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2017 07/17 068105-170627

061037-161017

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

“RESISTANCE IS A RISK I TAKE SERIOUSLY.” Everyone is at risk of developing drug resistance. So when deciding on an HIV treatment, think long-term.

Once-Daily* PREZCOBIX® has a high genetic barrier to resistance, which may help. *

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

Wisdom inspired by real people

ASK YOUR DOCTOR ABOUT DRUG RESISTANCE AND ONCE-DAILY

*

PREZCOBIX.com

}

WHAT IS PREZCOBIX®?

• It is not known if PREZCOBIX® is safe and effective in children under 18 years of age.

• When used with other antiretroviral medicines to treat HIV-1 infection, PREZCOBIX® may help: ○ 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.

• PREZCOBIX® is always taken in combination with other HIV medications for the treatment of HIV-1 infection in adults.

PREZCOBIX® should be taken once daily with food.

• PREZCOBIX® does not cure HIV-1 infection or AIDS, and you may still experience illnesses associated with HIV-1 infection.

You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses.

• Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people.

• Please read the Important Safety Information below and talk to your healthcare provider to learn if PREZCOBIX® is right for you.

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

• PREZCOBIX may cause liver problems. Some people taking PREZCOBIX® may develop liver problems which may be life-threatening. Your healthcare provider should do blood tests before and during your treatment with PREZCOBIX.® ○ Chronic hepatitis B or C infection may increase your chance of developing liver problems. Your healthcare provider should check your blood tests more often. ○ Signs and symptoms of liver problems include dark (tea-colored) urine, yellowing of your skin or whites of your eyes, pale-colored stools (bowel movements), nausea, vomiting, pain or tenderness on your right side below your ribs, or loss of appetite. Tell your healthcare provider if you develop any of these symptoms.

• PREZCOBIX® may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital.

Call your healthcare provider right away if you develop a rash. ○ Stop taking PREZCOBIX® and call your healthcare provider right away if you develop any skin changes with symptoms such as fever, tiredness, muscle or joint pain, blisters or skin lesions, mouth sores or ulcers, red or inflamed eyes like “pink eye” (conjunctivitis). ®

• PREZCOBIX, when taken with certain other medicines, can cause new or worse kidney problems, including kidney failure.

Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX.® ®

Who should not take PREZCOBIX ?

• Do not take PREZCOBIX® with any of the following medicines: alfuzosin (Uroxatral®), carbamazepine (Carbatrol® Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®) cisapride (Propulsid®), colchicine (Colcrys®, Mitigare®, if you have liver or kidney problems), dronedarone (Multaq®), elbasvir and grazoprevir (Zepatier®), dihydroergotamine (D.H.E.45®, Migranal®), ergotamine tartrate (Cafergot®, Ergomar®,

Ergostat®, Medihaler®, Migergot®, Wigraine®, Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev®, Advicor®, Mevacor®), lurasidone (Latuda®), oral midazolam (Versed®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor®, Vytorin®, Zocor®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®).

• Serious problems can happen if you take any of these medicines with PREZCOBIX.® What should I tell my healthcare provider before taking PREZCOBIX®?

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

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

What are the possible side effects of PREZCOBIX®?

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

• Other possible side effects include: ○ High blood sugar, diabetes or worsening diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZCOBIX.® ○ Changes in body fat can happen in people who take HIV-1 medicines. The exact cause and long-term health effects of these changes are not known. ○ Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines.

Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time.

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

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

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to Janssen Products, LP at 1-800-JANSSEN (1-800-526-7736).

Please read accompanying Important Brief Summary for PREZCOBIX®.

Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2017 07/17 068105-170627

061037-161017

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

R E S I S TA N C E WA R R I O R

BY DESIREÉ GUERRERO

THIS HIV PREVENTION WARRIOR HELPS KIDS

SIDE EFFECTS CAUSED JOSHUA THOMAS TO STOP TAKING HIS MEDS, UNTIL HE REALIZED THERE WERE OTHER OPTIONS. discovered he was HIV-positive in 2009, he thought the most difficult part of his journey would be coming out to his family.

“At that time,” Thomas recalls, “I wasn’t even out to them as being gay, and so I had that to deal with. Then I got diagnosed, and it wasn’t until a year and a half later that I finally told my mom. Since then, everyone’s been super supportive. I had nothing to worry about.” Close friends have also been a huge help. As he says, “They’ve been there through everything.”

But despite being surrounded by love and support, Thomas began to experience serious side effects from his medication regimen. He started antiretrovirals nine months after being diagnosed, when his T cell count hovered around 250.

“The first medication I started on was Atripla,” Thomas says, explaining that the side effects began soon afterward, “There was nausea, and then just a constant fog throughout the day, a haze,” he remembers. “As the time went on, I stopped taking my meds because of the side effects, but didn’t really realize that was the reason. It was just this whole mental thing.”

Looking back, Thomas acknowledges he should have talked to his doctor about these issues sooner. Like most people, he was hesitant to report unhealthy behaviors or habits to his health provider. So for some time he held back the fact that he had not been adherent. Now he advises others who are experiencing negative side effects to talk to their doctor right away, because there are more HIV treatment options than ever before.

“I waited a really long time to bring it up to my doctor,” Thomas says. “I’d say just do it sooner because in that

TONY DONALDSON

WHEN JOSHUA THOMAS

relationship, they’re the medical professional, and most likely they’re on your side. You can always try out the new meds and if they work, continue on that path. If not, see what else is out there and hopefully you can figure one out that doesn’t give you any side effects.”

Making the change was easy, says Thomas, and afterwards everything fell into place for him. “We made the switch [to Complera] and the medication kept working and my side effects went away completely. My numbers have gone up and up… my T cell count is at over 850, so I’m doing great and I’m undetectable.”

With the right treatment therapy in place, Thomas was able to focus on his life, career, and passions with a clear mind and positive outlook. He left an unfulfilling job at an accounting firm to go into nonprofit work.

Since high school, Thomas says he knew he wanted to help others. He now works for an organization that helps children, and volunteers his time talking to young people about HIV prevention.

“I knew that I needed to speak out about it, to make sure other people didn’t end up in my shoes… I got to go out to different high schools and colleges throughout the year and speak to the kids and share my story in hopes that they learn from it,” explains Thomas. He says this makes him feel like a warrior in the fight against HIV: “Just giving back to the community, that’s my passion.”

Thomas hopes to eventually shift his work with nonprofits toward helping LGBT people and those living with and affected by HIV, but for now he’s content with where he is. Aside from surrounding himself with a strong support system—of friends, family, and a good doctor—and trying to a live a healthy lifestyle, Thomas says he also takes time every day for fun recreational activities to keep himself happy and healthy.

“I do enjoy running sometimes, getting out with my dogs, gardening,” he says. While he’s “not like a professional dancer or anything,” Thomas indulges in a daily one-hour dance session in his living room. “I just love music, I love dancing,” he says. “I don’t even need to shut the blinds!”

HIVPLUSMAG.COM

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PROGRESS IN THE FIGHT AGAINST HIV/ V/AIDS V/ /AIDS IS IN DANGER. JOIN US IN DC TO PROTECT IT. THE UNITED STATES CONFERENCE ON AIDS

presented by

www.2017USCA.org

A PIPELINE WE DO WANT

SHUTTERSTOCK

Dozens of new medications are in development for the treatment or prevention of HIV. IN THE THREE decades since HIV was first identified in the United States, activists, providers, researchers, government agencies, and the pharmaceutical industry have all played a part in the quest to expand prevention and treatment options.

New scientific breakthroughs have reignited the hope of stopping not only transmission of the virus, but also its impact on the quality of life for HIVpositive people across the nation. In fact, 2017 is proving to be a springboard towards innovation, progress, and optimism. Over 52 medicines and vaccines for HIV are currently in development, according to 2017 HIV/AIDS Medicines in Development, and The Pharmaceutical Research and Manufacturers of America, an industry public relations and lobbying organization.

Overall, 32 medications on the list are antiretrovirals and antivirals, 16 are vaccines, and four are cell therapies, including a “potential first-in-class medicine intended to prevent HIV from attaching to new cells and breaking through the cell membrane.” All are either in clinical trials or awaiting review by the U.S. Food and Drug Administration.

According to findings published in the journal The Lancet Infectious Diseases, the number of people with HIV who are showing resistance to their drugs is increasing.

For HIV-positive people with resistance to both newer and older drugs, the development of manageable therapies could be a game changer. According to a 2012 Centers for Disease Control and Prevention report, two out of every 10 new HIV cases involve strains with at least partial resistance to one or more antiretroviral medications.

Less than one percent of new HIV diagnoses in the United States have a strain resistant to all classes of antiretroviral drugs, but that still represents hundreds of people each year who are resistant to all currently available therapies. These new drugs could offer those people a lifeline.

In conjunction with the release of the PhRMA report, American biopharmaceutical companies unveiled a new ad campaign, “Together,” featuring an HIV-positive person and

a researcher developing new treatments (including vaccines and treatments to overcome drug resistance).

Since the first AIDS cases were reported in 1981, the FDA has approved over 40 medications for HIV, according to PhRMA. The biggest pharmaceutical breakthrough came in the 1990s with highly active antiretroviral therapies that led AIDS-related deaths to plummet.

The next major innovation could be a cure, a vaccine, or simply a significant improvement in the long-term health of those living with HIV. Only time will tell whether that revolutionary treatment is on this list; but with more treatments in development now than have ever been approved, the odds are certainly good!

—DAVID ARTAVIA

Additional research

by Desireé Guerrero.

HIVPLUSMAG.COM

43

TREATMENT / TASP

COULD THIS PLANT TREAT HIV?

A plant used in traditional Chinese and Indian medicines may inhibit HIV replication better than some existing HIV drugs.

Products shows that a plant compound could be more effective at suppressing HIV than azidothymidine.

Although AZT (also called zidovudine, and sold under the brand name Retrovir) is no longer the go-to treatment it once was, it is still used as an ingredient in some combination therapies (Combivir, Trizivir), as well as for poz folks fighting resistance to other HIV meds, and in some lowincome nations.

AZT was the first drug approved to treat HIV in the early days of the AIDS epidemic. It works by inhibiting an enzyme HIV needs to “invade” a cell (a process called reverse transcriptase). At the high levels it was initially prescribed, AZT was eventually shown to be extremely toxic. But at much lower doses it has been an essential element of many combination therapies.

The World Health Organization now recommends doctors first prescribe combination therapies using other drugs, but still recommends AZT in cases where other nucleoside reverse transcriptase inhibitors (NRTIs) are “contraindicated or not available.”

This makes the discovery of a plant that delivers similar effects without the damaging side effects a significant finding. The study was led by Lijun Rong, professor of microbiology and immunology at the University of Illinois College of Medicine.

Rong discovered that a chemical compound called “Patentiflorin A,” derived from the willow-leaved justicia (Justicia gendarussa), an evergreen plant widely used in Indian and Chinese traditional medicines, “was able to inhibit the action of reverse transcriptase much more effectively than AZT, and was able to do this both in the earliest stages of HIV infection when the virus enters macrophage cells, and alter infection when it is present in T cells of the immune system,” noted Rong in the Journal of Natural Products.

The team ran tests related to “tropism,” which refers to the kind of virus Patentiflorin A can invade: M-tropism for macrophages, and T-tropism for T cells. Both macrophages and T cells are white blood cells that play key roles in the immune system.

Rong also noted in the study that “if we can make the drug in the lab, we don’t need to establish farms to grow and harvest the plant, which requires significant financial investment, not to mention it has an environmental impact.” But, “Patentiflorin A represents a novel anti-HIV agent that can be added to the current anti-HIV drug cocktail regimens to increase suppression of the virus and prevention of AIDS.”—DA

44

SEPTEMBER / OCTOBER 2017

SHUTTERSTOCK

NEW RESEARCH PUBLISHED in the Journal of Natural

FDA APPROVES GENERIC VERSION OF TRUVADA The availability of a generic version likely means a cheaper PrEP. THE COST OF

PrEP may soon go down. The Food and Drug Administration has approved a generic version of Truvada, the only drug currently approved for use as preexposure prophylaxis, aimed at preventing the transmission of HIV. Truvada, also used in HIV treatment in combination with other medications, is a mix of emtricitabine and tenofovir disoproxil fumarate.

The generic will be made by Teva Pharmaceutical Industries (an Israeli company whose U.S. headquarters are in North Wales, Pa.). Brandname Truvada is a product of Gilead Sciences of Foster City, Calif.

Generic drugs are generally far cheaper than brand-name ones.

Medscape reports that the price for the one-pilldaily dose of Truvada for PrEP is about $1,500 a month, or $18,000 a year, with insurers and patient assistance programs covering much of the cost. The price of the generic hasn’t been

announced, but Mitchell Warren, executive director of the HIV prevention organization AVAC, told Medscape that a generic drug will likely reduce the cost of PrEP by 80 percent. Generic versions of Truvada sold overseas have a price tag as low as $70 a year, according to Warren.

However, it’s uncertain when the generic will be available. In an email response, a Teva spokesperson said the company had no further comment. Gilead issued a statement to Poz asserting that the generic medication won’t be on the market right away because the patents Gilead holds on Truvada’s components are still in effect.

But FDA official Jeffrey Murray told Poz the generic drug

“will now be available in the U.S.” Tim Horn of Treatment Action Group told Poz, “Approval of a generic product doesn’t necessarily mean that product launch is imminent. … It’s not uncommon in patent settlement agreements for generics to negotiate language permitting full approvals months and years in advance of the settlement license date.

Regardless, now is the time to start thinking seriously about the advantages as well as the drawbacks of generic products to prevent and treat HIV.” In any case, the approval is welcome news, Warren told Medscape. “This is an exciting day,” he said.

“We’ve seen momentum for PrEP programs and policies. Having a lower-cost alternative will only increase that momentum.” He said he expects other companies to launch generic versions of Truvada as well.

Activists expressed hope that Teva will offer patient assistance programs for the generic, as Gilead does with Truvada. “Gilead’s patient and co-pay assistance programs have become central pillars in patient access,” veteran activist Peter Staley told Poz. “They must maintain these programs, and Teva must establish equivalent or better assistance programs for their generic version.”

SHUTTERSTOCK

—TRUDY RING

HIVPLUSMAG.COM

45

treatment / tasp This summer, Los Angeles County health officials confirmed at least 42 cases of the mumps among people living in west L.A., most of whom are gay or bisexual, according to the Los Angeles Times.

The Los Angeles County Department of Public Health had previously issued an alert stating that the “majority of these cases are among men who have sex with men, but some are women and heterosexual men with social connections to MSM cases. Most transmissions appear to have occurred at large venues such as athletic clubs, bars, theaters and nightclubs.”

According to the Centers for Disease Control and Prevention, over 3,500 mumps cases in 44 states had been reported in the first half of 2017 (through June 17). Last year’s 5,833 cases were the highest number reported nationwide in the past ten years.

Many who contracted mumps had no symptoms, others experienced flu-like symptoms along with swelling of their salivary glands.

Some of the people who contracted the disease in L.A. had been previously vaccinated, according to Dr. Franklin Pratt, medical director of the immunization program at the L.A. County Department of Public Health.

In fact, most U.S. children get vaccinated for mumps, measles, and rubella via the MMR vaccine that was introduced in 1967. The vaccine reduced cases by nearly 100 percent, so officials are concerned about this new outbreak among adults.

According to Pratt, the vaccination’s immunity might have decreased over time or current strains of mumps may be particularly strong. “Across the country, we’re seeing mumps kind of get strength again,” Pratt told L.A. Times, adding that the county usually only sees 13 cases per year.

“This is clearly a blip.”

Prat advised people to wash their hands frequently, and avoid sharing drinks, especially from someone who isn’t feeling well. If you have symptoms that line up with mumps, you should see a doctor immediately.

According to the L.A. County Department of Public Health, mumps typically begins with a few days of fever, headache, myalgia (muscle pain), fatigue, and loss of appetite; followed by development of salivary gland swelling, pain, and tenderness. Gland swelling usually results in the visibly swollen cheek and neck areas, which the virus is known for.

In vaccinated patients, symptoms may be non-specific. In rare cases, if untreated, mumps can lead to sterility in men.

Vaccines are available for adults, and, according to HIV InSite, “The CDC recommends MMR vaccination for all HIV-infected adults with CD4 counts of >200 cells/µL who lack evidence of [vaccination or] immunity.”—DA

DOWN IN THE MUMPS

SHUTTERSTOCK

AN OUTBREAK STRIKES LOS ANGELES’ GAY AND BI MEN.

46

SEPTEMBER / OCTOBER 2017

NEW HEP C CURES COVER ALL GENOTYPES Two new drug combinations may

SHUTTERSTOCK

soon receive approval in Europe and the U.S.

THE EUROPEAN MEDICINES Agency’s Committee for Medicinal Products for Human Use—similar to the U.S. Food and Drug Administration—is pushing for two new antiviral drug combinations to be approved by the European Commission. The decision, which is expected later this year will likely be followed by requests for FDA approval as well.

These two combinations are curative treatments considered “pangenotypic drugs,” which means they work on all genotypes of hepatitis C. There are six or seven known genotypes and the Centers for Disease Control and Prevention reports “more than 50 subtypes of HCV.” Genotype 1 is most common in the U.S., accounting for 74 percent of hep C diagnoses. According to hep magazine, only four people around the world have been identified with genotype 7, while genotypes 4, 5, and 6 account for less than 1 percent of those living with hep C. That leaves 25 percent represented by genotypes 2 and 3. It is also possible to have a superinfection with multiple genotypes of the virus.

While pangenotypic antivirals work against every genotype, they are often more effective on particular ones. In combinations, these drugs can be highly effective in combating hep C across all types, and these new drugs have had particular success in that regard.

According to the CDC, viral genotyping is necessary in treating hep C because of the number of different genotypes, but

advocates argue the success of pangenotypic meds may remove the need for genotype testing. That could simplify diagnosis and speed up the time needed to get those with hep C into care and cured of the disease.

The two pangenotypic treatments seeking approval as curative treatment for hepatitis C genotypes 1 through 6 are Maviret and Vosevi, both once-daily medications. Manufactured by AbbVie, Maviret is a combination of the NS3/4A protease inhibitor glecaprevir and the NS5A inhibitor pibrentasvir.

Clinical trials of glecaprevir/pibrentasvir showed very high rates of sustained virologic response with 97.5 percent cured across genotypes 1 through 6, including for those harder to treat—those with genotype 3, severe kidney disease, or compensated cirrhosis.

Manufactured by Gilead Sciences, the second product, Vosevi, is a combination of the NS5B polymerase inhibitor sofosbuvir, the NS5A inhibitor velpatasvir, and the NS3/NS4 protease inhibitor voxilaprevir.

Sofosbuvir and velpatasvir are already approved as a combination product, Epclusa (also manufactured by Gilead), for the treatment of genotypes 1 through 6.

Clinical trials of Vosevi showed that the combination cured 95 percent of people with and without cirrhosis, and lead to continued viral suppression in 96 percent of people with genotype 3 infection and cirrhosis (one of the hardest groups to cure). —DESIREÉ GUERRERO HIVPLUSMAG.COM

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B AC K TA L K

KEEPING THE FAITH REV. WILLIAM FRANCIS WANTS BLACK CHURCHES TO THINK OF HIV AS A SOCIAL JUSTICE ISSUE. AN INITIATIVE CALLED The

Black Church & HIV is offering church leaders a new strategy on how to handle the disproportionate number of HIV cases in the black community: turning the conversation into a social justice issue.

The Black Church & HIV—a partnership between the National Association for the Advancement of Colored People (NAACP), Gilead Sciences, and the Clinton Global Initiative—recently updated The Pastoral Brief and Activity Manual (both previously published in 2012) aiming to inspire church leaders to preach about HIV by giving detailed information on the virus as well as specific recommendations on activities to combat stigma.

“The church is a staple of the black community. It’s always been a cornerstone,” Reverend William

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Francis (pictured above), an ambassador for the initiative, tells Plus. “One thing we wanted to do was to engage faith leaders to preach from the pulpit messages that would reduce stigma and discrimination, and reduce the fear of being tested and [accessing] care. Then we wanted to get them involved in testing, we wanted to get them involved in linkage.”

In 2015, African-Americans accounted for 45 percent of HIV diagnoses despite blacks only accounting for 12 percent of the United States population, according to the Centers for Disease Control and Prevention.

More than half of AfricanAmericans diagnosed with HIV were gay or bisexual men—38 percent of whom were between the ages 13 and 24.

Still, despite efforts to manage the disproportionate rates of HIV in the black community, many black leaders continue to assess the virus as a gay issue.

According to Francis, if we truly want to destigmatize the virus and help reduce cases of HIV, it needs to start on the pulpit.

“I am a pastor, so I know just speaking with colleagues [that] HIV was looked at as a gay disease, or a moral issue, or as some kind of punishment from God; and that made theology very difficult for several pastors,” Francis explains. “But using the social justice framework, it takes all of that off the table and makes you focus on humanity. And once you start focusing on humanity, then we can go ahead and get to work to reduce HIV.” The Black Church & HIV’s resources offer current statistics and positions on HIV, as well as first-hand stories of how church leaders can preach about the virus being a social justice issue. Since launching the program in 2013, Francis and his colleagues have traveled to nearly 30 cities, speaking with church and community leaders to better understand how they can work together.

“Every church is not going to do testing and condom distribution, but we can do testing at your homeless event with a partnership—say, with a community-based organization or board of health. That reduces HIV, creating safe spaces for those who may have already been diagnosed with HIV, or those newly diagnosed with HIV,” Francis explains.

“It creates that sanctuary where they can come for prayer, for support, spiritual care, [and] counseling.”

Perhaps one of the greatest benefits of turning HIV into a social justice issue, says Francis, is that it brings us all to the roots of the problem: poverty and a lack of access to care. “Social justice means for all and not for some,” he says.

After coming out as HIV-positive to members of his church, Francis says many in his congregation turned their backs on him. Admittedly, such experiences drive his passion for creating a wider conversation.

“Fast forward eight years later,” Francis says, “and I’m now pastor in the church and doing a lot within the community, providing help and healing across all of the things that I learned, getting involved in this initiative—doing things in housing, doing things in the public health sector, doing things, you know, to alleviate poverty.” Francis asks and answers the age-old question: “What can one person do? We have to be the change we want to see. So if [change] is not going to [come from church leaders], we have to remember that we are the church and the power of one is great.”

To learn more about the initiative, visit TheBlackChurchAndHIV.org.

COURTESY OF REVEREND WILLIAM FRANCIS

B Y D AV I D A R TAV I A

The weight of my diagnosis only made me stronger.

Let’s Grow Old Together See what life with HIV looks like from diagnosis through grandkids with a little help from Walgreens. Explore Jack’s HIV journey at Walgreens.com/LetsGrowOldTogether. ©2017 Walgreen Co. All rights reserved.

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