Issue 99, March-April 2014 by Pride Media

HIV 101

TRE ATMENT+HE ALTH+RE SE ARCH

just diagnosed? + find the right doctor + understanding meds + what to do first + how to disclose + affording it all

Carlton wilborn

MADONNAâ&#x20AC;&#x2122;S HIV+ FORMER DANCER HAS THE ANSWERS FOR SURVIVING AND THRIVING

March/april 2014

www.hivplusmag.com

What is STRIBILD? STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. It combines 4 medicines into 1 pill to be taken once a day with food. STRIBILD is a complete single-tablet regimen and should not be used with other HIV-1 medicines. STRIBILD does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking STRIBILD. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about STRIBILD? STRIBILD can cause serious side effects: t Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. t Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. t You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.

t Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking STRIBILD, your hepatitis may suddenly get worse. Do not stop taking STRIBILD without first talking to your healthcare provider, as they will need to monitor your health. STRIBILD is not approved for the treatment of HBV. Who should not take STRIBILD? Do not take STRIBILD if you: t Take a medicine that contains: alfuzosin, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, rifampin or the herb St. John’s wort. t For a list of brand names for these medicines, please see the Brief Summary on the following pages. t Take any other medicines to treat HIV-1 infection, or the medicine adefovir (Hepsera®). What are the other possible side effects of STRIBILD? Serious side effects of STRIBILD may also include: t New or worse kidney problems, including kidney failure. Your healthcare provider should do regular blood and urine tests to check your kidneys before and during treatment with STRIBILD. If you develop kidney problems, your healthcare provider may tell you to stop taking STRIBILD. t Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones. t Changes in body fat can happen in people taking HIV-1 medicines. t Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

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

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

I started my personal revolution Talk to your healthcare provider about starting treatment. STRIBILD is a complete HIV-1 treatment in 1 pill, once a day.

Ask if itâ&#x20AC;&#x2122;s right for you.

Patient Information STRIBILDTM (STRY-bild) (elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg) tablets #SJFG TVNNBSZ PG GVMM 1SFTDSJCJOH *OGPSNBUJPO 'PS NPSF JOGPSNBUJPO QMFBTF TFF UIF GVMM 1SFTDSJCJOH *OGPSNBUJPO JODMVEJOH 1BUJFOU *OGPSNBUJPO What is STRIBILD? t STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. 453*#*-% JT B DPNQMFUF SFHJNFO BOE TIPVME OPU CF VTFE XJUI PUIFS )*7 NFEJDJOFT t STRIBILD does not cure HIV-1 or AIDS. :PV NVTU TUBZ PO DPOUJOVPVT )*7 UIFSBQZ UP DPOUSPM )*7 JOGFDUJPO BOE EFDSFBTF )*7 SFMBUFE JMMOFTTFT t Ask your healthcare provider about how to prevent passing HIV-1 to others. %P OPU TIBSF PS SFVTF OFFEMFT JOKFDUJPO FRVJQNFOU PS QFSTPOBM JUFNT UIBU DBO IBWF CMPPE PS CPEZ þ VJET PO UIFN %P OPU IBWF TFY XJUIPVU QSPUFDUJPO "MXBZT QSBDUJDF TBGFS TFY CZ VTJOH B MBUFY PS QPMZVSFUIBOF DPOEPN UP MPXFS UIF DIBODF PG TFYVBM DPOUBDU XJUI TFNFO WBHJOBM TFDSFUJPOT PS CMPPE

t %P OPU TUPQ UBLJOH 453*#*-% XJUIPVU ý STU UBMLJOH UP ZPVS IFBMUIDBSF QSPWJEFS t *G ZPV TUPQ UBLJOH 453*#*-% ZPVS IFBMUIDBSF QSPWJEFS XJMM OFFE UP DIFDL ZPVS IFBMUI PGUFO BOE EP CMPPE UFTUT SFHVMBSMZ GPS TFWFSBM NPOUIT UP DIFDL ZPVS )#7 JOGFDUJPO 5FMM ZPVS IFBMUIDBSF QSPWJEFS BCPVU BOZ OFX PS VOVTVBM TZNQUPNT ZPV NBZ IBWF BGUFS ZPV TUPQ UBLJOH 453*#*-% Who should not take STRIBILD? Do not take STRIBILD if you also take a medicine that contains: t BEFGPWJS )FQTFSB®

t BMGV[PTJO IZESPDIMPSJEF 6SPYBUSBM®

t DJTBQSJEF 1SPQVMTJE® 1SPQVMTJE 2VJDLTPMW®

t FSHPU DPOUBJOJOH NFEJDJOFT JODMVEJOH EJIZESPFSHPUBNJOF NFTZMBUF % ) & ® .JHSBOBM® FSHPUBNJOF UBSUSBUF $BGFSHPU® .JHFSHPU® &SHPTUBU® .FEJIBMFS &SHPUBNJOF® 8JHSBJOF® 8JHSFUUFT® BOE NFUIZMFSHPOPWJOF NBMFBUF &SHPUSBUF® .FUIFSHJOF®

t MPWBTUBUJO "EWJDPS® "MUPQSFW® .FWBDPS®

t PSBM NJEB[PMBN

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

t QJNP[JEF 0SBQ®

STRIBILD can cause serious side effects, including: 1. Build-up of lactic acid in your blood (lactic acidosis). -BDUJD BDJEPTJT DBO IBQQFO JO TPNF QFPQMF XIP UBLF 453*#*-% PS TJNJMBS OVDMFPTJEF BOBMPHT NFEJDJOFT -BDUJD BDJEPTJT JT B TFSJPVT NFEJDBM FNFSHFODZ UIBU DBO MFBE UP EFBUI -BDUJD BDJEPTJT DBO CF IBSE UP JEFOUJGZ FBSMZ CFDBVTF UIF TZNQUPNT DPVME TFFN MJLF TZNQUPNT PG PUIFS IFBMUI QSPCMFNT Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: t GFFM WFSZ XFBL PS UJSFE t IBWF VOVTVBM OPU OPSNBM NVTDMF QBJO t IBWF USPVCMF CSFBUIJOH t IBWF TUPNBDI QBJO XJUI OBVTFB PS WPNJUJOH t GFFM DPME FTQFDJBMMZ JO ZPVS BSNT BOE MFHT t GFFM EJ[[Z PS MJHIUIFBEFE t IBWF B GBTU PS JSSFHVMBS IFBSUCFBU 2. Severe liver problems. 4FWFSF MJWFS QSPCMFNT DBO IBQQFO JO QFPQMF XIP UBLF 453*#*-% *O TPNF DBTFT UIFTF MJWFS QSPCMFNT DBO MFBE UP EFBUI :PVS MJWFS NBZ CFDPNF MBSHF IFQBUPNFHBMZ BOE ZPV NBZ EFWFMPQ GBU JO ZPVS MJWFS TUFBUPTJT Call your healthcare provider right away if you get any of the following symptoms of liver problems: t ZPVS TLJO PS UIF XIJUF QBSU PG ZPVS FZFT UVSOT ZFMMPX KBVOEJDF

t EBSL iUFB DPMPSFEw VSJOF t MJHIU DPMPSFE CPXFM NPWFNFOUT TUPPMT t MPTT PG BQQFUJUF GPS TFWFSBM EBZT PS MPOHFS t OBVTFB t TUPNBDI QBJO You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time. 3. Worsening of Hepatitis B infection. *G ZPV IBWF IFQBUJUJT # WJSVT )#7 JOGFDUJPO BOE UBLF 453*#*-% ZPVS )#7 NBZ HFU XPSTF þ BSF VQ JG ZPV TUPQ UBLJOH 453*#*-% " iþ BSF VQw JT XIFO ZPVS )#7 JOGFDUJPO TVEEFOMZ SFUVSOT JO B XPSTF XBZ UIBO CFGPSF t %P OPU SVO PVU PG 453*#*-% 3Fý MM ZPVS QSFTDSJQUJPO PS UBML UP ZPVS IFBMUIDBSF QSPWJEFS CFGPSF ZPVS 453*#*-% JT BMM HPOF

t TJMEFOBý M 3FWBUJP® XIFO VTFE GPS USFBUJOH MVOH QSPCMFNT

t SJGBNQJO 3JGBEJO® 3JGBNBUF® 3JGBUFS® 3JNBDUBOF®

t TJNWBTUBUJO 4JNDPS® 7ZUPSJO® ;PDPS®

t USJB[PMBN )BMDJPO®

t UIF IFSC 4U +PIO T XPSU Do not take STRIBILD if you also take any other HIV-1 medicines, including: t 0UIFS NFEJDJOFT UIBU DPOUBJO UFOPGPWJS "USJQMB® $PNQMFSB® 7JSFBE® 5SVWBEB®

t 0UIFS NFEJDJOFT UIBU DPOUBJO FNUSJDJUBCJOF MBNJWVEJOF PS SJUPOBWJS $PNCJWJS® &NUSJWB® &QJWJS® PS &QJWJS )#7® &Q[JDPN® ,BMFUSB® /PSWJS® 5SJ[JWJS®

STRIBILD is not for use in people who are less than 18 years old. What are the possible side effects of STRIBILD? STRIBILD may cause the following serious side effects: t 4FF i8IBU JT UIF NPTU JNQPSUBOU JOGPSNBUJPO * TIPVME LOPX about STRIBILD?” t /FX PS XPSTF LJEOFZ QSPCMFNT JODMVEJOH LJEOFZ GBJMVSF :PVS IFBMUIDBSF QSPWJEFS TIPVME EP CMPPE BOE VSJOF UFTUT UP DIFDL ZPVS LJEOFZT CFGPSF ZPV TUBSU BOE XIJMF ZPV BSF UBLJOH 453*#*-% :PVS IFBMUIDBSF QSPWJEFS NBZ UFMM ZPV UP TUPQ UBLJOH 453*#*-% JG ZPV EFWFMPQ OFX PS XPSTF LJEOFZ QSPCMFNT t #POF QSPCMFNT DBO IBQQFO JO TPNF QFPQMF XIP UBLF 453*#*-% #POF QSPCMFNT JODMVEF CPOF QBJO TPGUFOJOH PS UIJOOJOH XIJDI NBZ MFBE UP GSBDUVSFT :PVS IFBMUIDBSF QSPWJEFS NBZ OFFE UP EP UFTUT UP DIFDL ZPVS CPOFT t Changes in body fat DBO IBQQFO JO QFPQMF XIP UBLF )*7 NFEJDJOF 5IFTF DIBOHFT NBZ JODMVEF JODSFBTFE BNPVOU PG GBU JO UIF VQQFS CBDL BOE OFDL iCVGGBMP IVNQw CSFBTU BOE BSPVOE UIF NJEEMF PG ZPVS CPEZ USVOL -PTT PG GBU GSPN UIF MFHT BSNT BOE GBDF NBZ BMTP IBQQFO 5IF FYBDU DBVTF BOE MPOH UFSN IFBMUI FGGFDUT PG UIFTF DPOEJUJPOT BSF OPU LOPXO t Changes in your immune system *NNVOF 3FDPOTUJUVUJPO 4ZOESPNF DBO IBQQFO XIFO ZPV TUBSU UBLJOH )*7 NFEJDJOFT :PVS JNNVOF TZTUFN NBZ HFU TUSPOHFS BOE CFHJO UP ý HIU JOGFDUJPOT UIBU IBWF CFFO IJEEFO JO ZPVS CPEZ GPS B MPOH UJNF 5FMM ZPVS IFBMUIDBSF QSPWJEFS SJHIU BXBZ JG ZPV TUBSU IBWJOH BOZ OFX TZNQUPNT BGUFS TUBSUJOH ZPVS )*7 NFEJDJOF

The most common side effects of STRIBILD include: t /BVTFB t %JBSSIFB Tell your healthcare provider if you have any side effect that bothers you or that does not go away. t 5IFTF BSF OPU BMM UIF QPTTJCMF TJEF FGGFDUT PG 453*#*-% 'PS NPSF JOGPSNBUJPO BTL ZPVS IFBMUIDBSF QSPWJEFS t $BMM ZPVS IFBMUIDBSF QSPWJEFS GPS NFEJDBM BEWJDF BCPVU TJEF FGGFDUT :PV NBZ SFQPSU TJEF FGGFDUT UP '%" BU '%"

EJHPYJO -BOPYJOÂ®

EJTPQZSBNJEF /PSQBDFÂ®

FTUB[PMBN FUIPTVYJNJEF ;BSPOUJOÂ®

Ã¾ FDBJOJEF 5BNCPDPSÂ® Ã¾ VSB[FQBN Ã¾ VUJDBTPOF 'MPWFOUÂ® 'MPOBTFÂ® 'MPWFOUÂ® %JTLVT 'MPWFOUÂ® )'" 7FSBNZTUÂ®

JUSBDPOB[PMF 4QPSBOPYÂ®

What should I tell my healthcare provider before taking STRIBILD? LFUPDPOB[PMF /J[PSBMÂ®

MJEPDBJOF 9ZMPDBJOFÂ®

Tell your healthcare provider about all your medical conditions, including: NFYJMFUJOF t *G ZPV IBWF PS IBE BOZ LJEOFZ CPOF PS MJWFS QSPCMFNT JODMVEJOH PYDBSCB[FQJOF 5SJMFQUBMÂ®

IFQBUJUJT # JOGFDUJPO QFSQIFOB[JOF t *G ZPV BSF QSFHOBOU PS QMBO UP CFDPNF QSFHOBOU *U JT OPU LOPXO JG Â® 453*#*-% DBO IBSN ZPVS VOCPSO CBCZ 5FMM ZPVS IFBMUIDBSF QSPWJEFS QIFOPCBSCJUBM -VNJOBM

JG ZPV CFDPNF QSFHOBOU XIJMF UBLJOH 453*#*-% QIFOZUPJO %JMBOUJOÂ® 1IFOZUFLÂ®

o 5IFSF JT B QSFHOBODZ SFHJTUSZ GPS XPNFO XIP UBLF BOUJWJSBM QSPQBGFOPOF 3ZUINPMÂ® NFEJDJOFT EVSJOH QSFHOBODZ 5IF QVSQPTF PG UIJT SFHJTUSZ JT UP RVJOJEJOF /FVEFYUBÂ® DPMMFDU JOGPSNBUJPO BCPVU UIF IFBMUI PG ZPV BOE ZPVS CBCZ 5BML SJGBCVUJO .ZDPCVUJOÂ®

XJUI ZPVS IFBMUIDBSF QSPWJEFS BCPVU IPX ZPV DBO UBLF QBSU JO UIJT SFHJTUSZ SJGBQFOUJOF 1SJGUJOÂ®

t *G ZPV BSF CSFBTUGFFEJOH OVSTJOH PS QMBO UP CSFBTUGFFE %P OPU SJTQFSJEPOF 3JTQFSEBMÂ® 3JTQFSEBM $POTUBÂ®

CSFBTUGFFE JG ZPV UBLF 453*#*-% TBMNFUFSPM 4FSFWFOUÂ® PS TBMNFUFSPM XIFO UBLFO JO DPNCJOBUJPO :PV TIPVME OPU CSFBTUGFFE JG ZPV IBWF )*7 CFDBVTF PG UIF SJTL PG XJUI Ã¾ VUJDBTPOF "EWBJS %JTLVTÂ® "EWBJS )'"Â®

QBTTJOH )*7 UP ZPVS CBCZ TJMEFOBÃ½ M 7JBHSBÂ® UBEBMBÃ½ M $JBMJTÂ® PS WBSEFOBÃ½ M -FWJUSBÂ® 5XP PG UIF NFEJDJOFT JO 453*#*-% DBO QBTT UP ZPVS CBCZ JO ZPVS 4UBYZOÂ® GPS UIF USFBUNFOU PG FSFDUJMF EZTGVODUJPO &% *G ZPV HFU CSFBTU NJML *U JT OPU LOPXO JG UIF PUIFS NFEJDJOFT JO 453*#*-% DBO EJ[[Z PS GBJOU MPX CMPPE QSFTTVSF IBWF WJTJPO DIBOHFT PS IBWF QBTT JOUP ZPVS CSFBTU NJML BO FSFDUJPO UIBU MBTU MPOHFS UIBO IPVST DBMM ZPVS IFBMUIDBSF 5BML XJUI ZPVS IFBMUIDBSF QSPWJEFS BCPVU UIF CFTU XBZ UP GFFE QSPWJEFS PS HFU NFEJDBM IFMQ SJHIU BXBZ ZPVS CBCZ UBEBMBÃ½ M "EDJSDBÂ® GPS UIF USFBUNFOU PG QVMNPOBSZ BSUFSJBM Tell your healthcare provider about all the medicines you take, IZQFSUFOTJPO including prescription and nonprescription medicines, vitamins, UFMJUISPNZDJO ,FUFLÂ®

and herbal supplements: UIJPSJEB[JOF t 453*#*-% NBZ BGGFDU UIF XBZ PUIFS NFEJDJOFT XPSL BOE PUIFS WPSJDPOB[PMF 7GFOEÂ®

NFEJDJOFT NBZ BGGFDU IPX 453*#*-% XPSLT XBSGBSJO $PVNBEJOÂ® +BOUPWFOÂ®

t #F TVSF UP UFMM ZPVS IFBMUIDBSF QSPWJEFS JG ZPV UBLF BOZ PG UIF GPMMPXJOH NFEJDJOFT [PMQJEFN "NCJFOÂ® &EMVMBSÂ® *OUFSNF[[PÂ® ;PMQJNJTUÂ®

)PSNPOF CBTFE CJSUI DPOUSPM QJMMT QBUDIFT SJOHT TIPUT FUD Know the medicines you take. ,FFQ B MJTU PG BMM ZPVS NFEJDJOFT BOE TIPX JU UP ZPVS IFBMUIDBSF QSPWJEFS BOE QIBSNBDJTU XIFO ZPV HFU B "OUBDJE NFEJDJOFT UIBU DPOUBJOT BMVNJOVN NBHOFTJVN OFX NFEJDJOF %P OPU TUBSU BOZ OFX NFEJDJOFT XIJMF ZPV BSF UBLJOH IZESPYJEF PS DBMDJVN DBSCPOBUF 5BLF BOUBDJET BU MFBTU IPVST 453*#*-% XJUIPVU Ã½ STU UBMLJOH XJUI ZPVS IFBMUIDBSF QSPWJEFS CFGPSF PS BGUFS ZPV UBLF 453*#*-% .FEJDJOFT UP USFBU EFQSFTTJPO PSHBO USBOTQMBOU SFKFDUJPO PS IJHI Keep STRIBILD and all medicines out of reach of children. CMPPE QSFTTVSF 5IJT #SJFG 4VNNBSZ TVNNBSJ[FT UIF NPTU JNQPSUBOU JOGPSNBUJPO BNJPEBSPOF $PSEBSPOFÂ® 1BDFSPOFÂ® BCPVU 453*#*-% *G ZPV XPVME MJLF NPSF JOGPSNBUJPO UBML XJUI ZPVS IFBMUIDBSF QSPWJEFS :PV DBO BMTP BTL ZPVS IFBMUIDBSF QSPWJEFS PS BUPSWBTUBUJO -JQJUPSÂ® $BEVFUÂ®

QIBSNBDJTU GPS JOGPSNBUJPO BCPVU 453*#*-% UIBU JT XSJUUFO GPS IFBMUI CFQSJEJM IZESPDIMPSJD 7BTDPSÂ® #FQBEJOÂ®

QSPGFTTJPOBMT PS DBMM PS HP UP XXX 453*#*-% DPN CPTFOUBO 5SBDMFFSÂ®

*TTVFE "VHVTU CVTQJSPOF DBSCBNB[FQJOF $BSCBUSPMÂ® &QJUPMÂ® &RVFUSPÂ® 5FHSFUPÂ® DMBSJUISPNZDJO #JBYJOÂ® 1SFWQBDÂ®

DMPOB[FQBN ,MPOPQJOÂ®

DMPSB[FQBUF (FO YFOFÂ® 5SBOYFOFÂ®

$0.1-&3" &.53*7" (*-&"% UIF (*-&"% -PHP (4* )&14&3" 453*#*-% UIF 453*#*-% -PHP 5367"%" BOE 7*3&"% BSF USBEFNBSLT PG (JMFBE 4DJFODFT *OD PS JUT SFMBUFE DPNQBOJFT "53*1-" DPMDIJDJOF $PMDSZTÂ®

JT B USBEFNBSL PG #SJTUPM .ZFST 4RVJCC (JMFBE 4DJFODFT --$ "MM PUIFS NBSLT SFGFSFODFE IFSFJO BSF UIF QSPQFSUZ PG UIFJS SFTQFDUJWF PXOFST NFEJDJOFT UIBU DPOUBJO EFYBNFUIBTPOF EJB[FQBN 7BMJVNÂ®

Âª (JMFBE 4DJFODFT *OD "MM SJHIUT SFTFSWFE 2$

back talk

Editor in chief

Diane Anderson-Minshall ART DIRECTOR Boo Jarchow copy chief Trudy Ring

Svp, group publisher

E Joe Valentino

Stephen Murray Amanda Johnson creative director, integrated marketing Robert Hébert associate Editors Daniel Reynolds, Sunnivie Brydum senior manager, integr ated marketing Steven O’Brien art director, integr ated marketing Kristi Wisner editorial interns Michael Regula, Nicholas Cimarusti Coordinator, advertising Paige Popdan coordinators, Integr ated marketing creative director, digital media Dave Johnson Vineet Sathe, John McCourt director, digital media Scott Ragan senior director, media str ategy Stewart Nacht senior online producer Christopher Harrity circulation Director Jeff Lettiere manager, application development Alex Lim fulfillment manager Argus Galindo front end developer Mayra Urrutia Production director John Lewis tr affic manager Kevin Bissada Advertising Production Manager Heidi Medina senior VP, marketing & Br and str ategy

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IN THIS ISSUE

MARCH/APRIL 2014

buzzworthy

The AIDS Generation Perry Halkitis’s new book shares survival stories from the ‘80s generation.

10 TV Stars Who’ve Got Your Back These celebs are using their fame for good.

Can yoga help with HIV?

10 why do natives keep dying? Native Americans’ HIV rate isn’t the highest, but their death rate is. Why?

you 2.0

TV stars who are AIDS activists

Carlton Wilborn once danced with Madonna in front of tens of thousands of fans around the globe, but coming out as HIV-positive has helped him achieve an even richer kind of fame.

11 new year, new you

Viral mindfulness, online dating, and yoga to the rescue.

TREATMENT CHRONICLES

20 how to afford your meds

There’s real help if you know where to look. Plus: Understanding lab tests. more

18 We Are the champions UFC Hall of Famer Forrest Griffin aims to knock out HIV .

48 Is it getting real in here? Self-acceptance means facing what it’s actually like to live with HIV.

56 vaccine watch Rare antibodies hold great potential for a vaccine, says a top Israeli HIV scientist.

From top left: courtesy subjec t; ge t t y images; michael higgins

HIV 101: just diagnosed ISSUE

30 + 38 + 40 + 42 + 45 29

HIV 101: Just Diagnosed

Have lots of questions about what comes next now that you’re HIV-positive? Here’s our easy guide. Get straightforward answers to your FAQs (page 30); figure out how to tell people you’re poz (page 40); find the right doctor and see what Obamacare means for you (page 38); learn what the heck “superinfection” is (page 44); find out how to keep your sex life happy and healthy (page 42).

Carlton Wilborn

The dancer turned author, actor, producer, and motivational speaker thinks he finally knows what it takes to thrive while HIV-positive.

Justice Isn’t Blind

A shocking number of transgender women fear HIV criminalization laws, which is probably making HIV rates rise even faster.

On the cover (and above): Carlton Wilborn photographed by Michael Higgins

think i ' m like

a lot of people when it comes to all things health and fitness. I have my goals (resistance bands every day!) and the things that make me feel good (massages, lots of them), but then life intrudes in one way or another and it's easy to see that commitment fall away. A resolution like "Get to the gym five days a week" becomes three days after a while and then dwindles to "Well, at least I walked the dogs and took my medicine this morning." But it's so critical to take care of your health these days, especially now that preventive care is easily accessible (under the Affordable Care Act, insurers are required to cover it) and can help us live longer and healthier lives, regardless of what chronic conditions we may be in treatment for. That's one reason I'm so stoked about our new HIV Plus Treatment Guide Mobile App. It's the first mobile app I've launched (so you know it's good, right?) and our Here Media engineering team (especially Bernard Rook and Eric Bui) has spent months working on it. So why should you care? Because, I hope, it's going to change your life. I know that's a lofty goal, but this isn't just any other app. This one, which you can get in the Google Play store or on iTunes (it works on virtually any platform), shows a photo and lists information (side effects, dosage, warnings, recommendations, generic names) for every single medication used to treat HIV or AIDS or complications from one of those. With a little bit of programming you can set it up to notify you when it's time to take a pill, go to the doctor, or even recertify for your ADAP coverage. If you aren't in your neighborhood or are traveling or you just don't have a pharmacy yet, the app has a built-in GPS that will help you find a pharmacy and pinpoint it on a map, and it includes only those with pharmacists who have been trained to deal with the needs of people with HIV. It's even got articles from HIV Plus's Daily Dose section, a list of current clinical trials, and a rundown of complementary therapies. (Is acupuncture good for poz folks? What about colloidal silver? Hint: One is, one isn't.) Best of all? It's free. Go to HIVPlusMag.com/TreatmentGuide to check it out and link to iTunes or Google to download it, then tell me what you think. After all, this is our beta test where we work out all the kinks. I've raved so much about the app that I may have neglected to tell you enough about the current issue in your hands, so let me tell you the main points: We've got a couple of pretty great dudes (cover guy Carlton Wilborn might look familiar, as he's been in everything from Truth or Dare to NCIS, and so might our Ask & Tell subject, MMA fighter Forrest Griffin). While Wilborn, a former backup dancer for Madonna, has a hugely fascinating personal story, I think our Just Diagnosed section is what I'm most proud of. As soon as you hear that word ("positive"), you have a load of questions you need answered. It's my hope that we've done that for you with this issue. But if we didn't, please let me know what we missed and what else you want to read about in 2014. I'll get right on it. Happy reading!

Diane Anderson-Minshall Editor in Chief | Editor@HIVPlusMag.com

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d Downloivaplus h the freeent guide treatmile app mob hivplusmag.com/treatmentguide

The most trusted brand in HIV news today has launched a free mobile app that's a super easy way to get information wherever you are. Don't have a phone? You can get it on your computer too. Available on all mobile platforms.

bradford rogne

Editor's Letter

Buzzworthy

We Will Survive A new book chronicles the journeys of gay and bi men who’ve lived with HIV for decades

By Nicholas Cimarusti

etting older isn’t easy, but the addition of HIV to the aging process is uncharted territory, both medically and psychologically. Perry N. Halkitis, a New York University professor of applied psychology and public health, explores the topic in his new book, The AIDS Generation: Stories of Survival and Resilience. The book contains interviews Halkitis recently conducted with 15 gay men who contracted HIV before 1996, a time when most people died within a few years of their diagnosis. Each man tells his story of survival during the 1980s and early ’90s and what his life following that harrowing period has been like. Perry talks to us about aging in a youth-obsessed culture, the missing mental health link, and why “survivors’ guilt” is overstated but mental health counseling is crucial for people with HIV. Why is the subject of aging HIV-positive people so important? First of all, you have this aging of America, and in this aging there are a lot of LGBT folk. We know very, very little about Baby Boomers in general and very little about those who are LGBT and almost nothing about those who are LGBT and HIV-positive. Gay culture is known to emphasize youth. How does that affect older HIV-positive gay and bi men? I’m a 50-year-old gay man myself, so I feel [the youth obsession]. I’m not going to just point the finger at the gay community, because I think [society in general] is youth-obsessed. However, it seems more pronounced in the gay community. So for those men, many of whom have felt rejected and invisible anyway because of their HIV status, there is this double invisibility. Does HIV stigma affect longtime survivors and the recently diagnosed the same way? The stigma is still there. This notion that it somehow disappeared over the course of the last 32 years is ridiculous. Here’s what I really think has changed: We know how this virus operates and we have effective treatments that, if properly administered, can handle it. It’s like we’ve moved forward in so many ways with this epidemic, but it’s like we’re reacting to it emotionally like we did in the ’80s. We hear a lot of stories about men who become positive while using recreational drugs. What’s the most important link between HIV and drug use? It’s not just HIV and drug use, I think it’s HIV, drug use, and mental health. I say this all the time to my students: “Show me a drug problem and I’ll show you a mental health problem and I’ll show you sex risk.” They fuel each other. Tell us your feelings on HIV survivors’ guilt. I don’t believe in this notion of survivors’ guilt. I think it is an overstated psychopathology. There is limited research to support that

it actually exists. Absolutely, the men in my generation, including myself, have feelings of sorrow. When I was writing the book I thought I had very easily put all of these emotions away, but as I was writing they all came forward. But I don’t feel guilty that I’m alive. I feel happy that I’m alive. You don’t like the label “men who have sex with men.” Why? Gay is a sexual orientation, and being gay is associated with a certain community and a way of understanding oneself. MSM is a term the Centers for Disease Control developed in the early ’90s as a way of categorizing people who got HIV transmitted to them through sex with another man. They did that because there were a handful of these men who did not identify as gay. They were closeted; they were married. But the vast proportions of men who have sex with men are gay, and to deny their sexual orientation and to deny our sexual orientation is disrespectful. I want to be labeled as a person whose sexual orientation and sexual identity is that of a gay man. And the way you would provide services for a gay man is very different from the way you provide services for a man who is married to a woman and who has sex with men. Were there certain men you interviewed whose stories really resonated with you? Kerry, who I’ve gotten to know a lot better since the book, his life became derailed because of this epidemic. His career became undermined and he struggles so much and speaks so eloquently about his ability to not really remember and think clearly. He sticks out really, really clearly in my mind. And then there’s Richard, the musician, who talks about how he finally went up to the piano and how he felt the energy coming back into his body after he was almost dead. During the interview process, what was the most surprising thing that you discovered? How every single one of those men, regardless of when they found out about their status, were convinced they’d be dead in two years. Eventually all of these 15 guys were able to not only tend to their physical health but to their emotional and social well-being. And the role of mental health counseling was so crucial.

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Buzzworthy

10 TV Stars Who Are HIV Activists Television actors such as Oscar-winner Jessica Lange and Covert Affairs’s Hill Harper are lending their voices to raise awareness for causes related to HIV and AIDS. We’ve listed 10 of our favorite “supporting” actors below By Daniel Reynolds

At 64, Jessica Lange is one of the most accomplished talents in Hollywood. Currently, the Academy Award–winning actress wows fans with her portrayal of the witch Fiona on American Horror Story: Coven. But her work doesn’t end there. Lange has long been a goodwill ambassador for UNICEF, working to raise awareness of HIV and AIDS in Russia and the Democratic Republic of the Congo.

Jessica L ange

As a singer, actor, and activist, Naturi Naughton is a triple threat to HIV. The Client List star is a Greater Than Aids ambassador who has also lent her singing voice to the annual HIV and AIDS benefit concert DIVAS Simply Singing!

American Horror Story: Coven

Naturi Naughton The Client List

Lea Michele Glee

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Comedian Kathy Griffin knows that HIV is no joke. The host of the Kathy talk show is a regular speaker and emcee at events for HIV and AIDS organizations including amfAR, the Foundation for AIDS Research, which supports scientific research and political advocacy.

Kathy Griffin Kathy

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She may be best known as the powerhouse singer Rachel Berry on Glee, but Lea Michele has also used her talents to benefit HIV- and AIDS-related causes through Broadway Cares/ Equity Fights AIDS, an organization that brings together Broadway’s best for a variety of events that raise funds for AIDS service organizations.

It has been a breakthrough year for Jonathan Groff, a leading voice actor in the film Frozen as well as the lead of the new HBO series Looking. But Groff’s most challenging work yet may be his role in the upcoming film The Normal Heart, based on author-activist Larry Kramer’s semiautobiographical play about the early years of the AIDS crisis in New York City.

Jonathan Groff

Yvette Nicole Brown, who stars as Shirley Bennett on NBC’s Community, may be celibate, but she chose to be tested for HIV in 2004 at a Black AIDS Institute event to raise awareness among African-Americans. Recently Brown became a Greater Than Aids ambassador to further promote her message of self-empowerment through testing to women and girls.

Looking

Yvette Nicole Brown Community

Hill Harper is a smart man. In addition to playing HIV-positive characters in the movie The Visit and TV series Soul Food, the Harvard Law School graduate and former CSI: NY star has also written several books, including Letters to a Young Brother and The Conversation, that educate young people about HIV and AIDS. One of the most visible black HIV activists in Hollywood, he has also been a featured spokesman for National Black HIV/AIDS Awareness Day.

Covert Affairs

Tamala Jones Castle

D.C. Diagnosis From 2007 to 2011, Washington, D.C., saw a 46% drop in newly diagnosed HIV cases and 47% decrease in newly diagnosed AIDS cases.

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Source: D.C. Department of Health, 2012 District of Columbia HIV/AIDS, Hepatitis, STD and TB Epidemiology Annual Report

Hill Harper

As a spokeswoman for Greater Than AIDS, Tamala Jones is no stranger to activism. The Castle star has appeared in numerous public service announcements on HIV testing, stigma, and research, including a video for National Women and Girls HIV/AIDS Awareness Day (which happens March 10).

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Buzzworthy

As a Greater Than AIDS ambassador, Jason George is seeking to raise awareness of HIV and AIDS among African-Americans. The busy actor and activist portrays Dr. Ben Warren on Grey’s Anatomy and Adam Noble on Witches of East End, but his most significant role is pushing for visibility around HIV.

Another Glee star, Darren Criss (who plays Blaine), is an avid supporter of HIV and AIDS causes as well as LGBT rights. The “Teenage Dream” singer has crooned his support at fundraisers for groups such as AIDS Project Los Angeles and the Elton John AIDS Foundation.

Jason George

Darren Criss

Grey’s Anatomy, Witches of East End

Glee

Stacked Odds Why are Native Americans dying from HIV and AIDS at higher rates than other Americans?

he most recent studies of HIV among Native Americans living on the Navajo reservation in New Mexico found alarming numbers, with infections up 20 percent from 2011 to 2012. The results, reported in The New York Times, included another disturbing but little-discussed statistic: Native Americans with HIV and AIDS have lower survival rates than any other racial group. Statistics covering 1998 to 2005 indicate HIV rates among Native Americans were slightly higher than but comparable to those of Caucasians, but lower than those of African-Americans and Latinos. The problem is that testing, treatment,

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and care are not reaching Native Americans the same way they’re reaching other Americans. There are a variety of reasons for that, says Lisa Neel, program analyst at the HIV Program for the Indian Health Service, the federal government health program for American Indians and Alaska Natives. Poverty, which limits access to doctors and can put health concerns on the back burner for those struggling to feed themselves, is an all too common problem for Native Americans. Neel says that compared with other racial and ethnic groups, American Indians and Alaska Natives have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage. This often translates into people not getting tested and, in effect, many being unaware they’re HIV-positive. At the end of 2009, 18 percent of all Americans with HIV were unaware of their

have never been tested for HIV. On the eighth annual National Native HIV/AIDS Awareness Day, March 20, encourage your friends to get tested and get involved by checking AIDS.gov for a list of events or for ideas on how your social media account can make a difference.

infection, while 25 percent of American Indians and Alaska Natives with HIV did not know they had the disease. It’s likely that some HIV-positive people in these groups are not getting on treatment until their HIV progresses to the point that they experience symptoms. Cultural stigma faced by some gay and bisexual Native American men could also be discouraging testing and treatment, Neel worries. She also points to higher rates of alcohol and drug use among all American Indians and Alaska Natives. “Although alcohol and substance abuse does not cause HIV infection,” Neel says, “it is an associated risk factor because of its ability to reduce inhibitions and impair judgment. Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age, use them more often, and in higher quantities, and experience more negative consequences from them.” —Neal Broverman

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YOU 2.0

Alexander Smith

Fitness

Viral Mindfulness Alexander Smith explains how doing yoga’s corpse pose helped him appreciate his own life

ifficult poses (asana) are expected in life and on the yoga mat. Hatha yoga is a style of yoga common in the West that focuses on poses and breathing. As we pose, we learn to sit with the pain and discomfort that arises in our bodies, and we become aware of the suffering in our minds that is attached to our thoughts and story. In a place of discomfort, we often let go of the breath (pranayama), which is there to strengthen and sustain us. It is taught that shavasana—best known as the corpse pose or dead man’s pose—is the most difficult of all the poses. To assume the posture, lie down on your back, allow your feet to fall outward, rest your arms at your sides with palms facing upward, and let your breath follow its inherent inhaling and exhaling pattern. At the end of our practice we traditionally assume this pose. In the giant metaphor of sitting like a corpse, we have an empty space to release all effort in mind and body. Do nothing. Completely surrender. And experience the sweet spot of shavasana. Yoga, meditation, and mindfulness drive us toward a strength that rises when we surrender everything. It reminds us that the happiness we seek is already here. At the end of summer a couple of years ago I posed in my own version of a dead man. Facing the fact that my strain of HIV had mutated and developed a resistance to my current cocktail of antiretrovirals, I stood at a crossroads. After a decade I could stop taking pills and lean toward my own corpse pose. Set down the worry and frustration and struggle I experience in posing with this virus. Develop AIDS, catch an opportunistic infection or two, and be dead within a year. As I surrendered in this pose I noticed that by focusing so much on my death I had distracted myself from stories of life. In a place of complete honesty and reproach, I made a decision to build me a life. I recommitted myself to regular practice of meditation and yoga—with compassion—and I started by cleaning my entire house, doing the laundry and dishes, feeding my body, and taking my medications. When I checked the online schedule of yoga classes I saw a picture of a beautiful man and yogi. Posing. I recognized him from years earlier. We had shared a neutral greeting when I attended a class at his studio in Laguna Beach, Calif. I was super excited to think he would be teaching class that day. Perhaps he is my future husband, I thought hopefully. When I looked deeper for class details I realized the picture was in honor and memory of his life. My future husband was dead, but somehow I found comfort in the eerie coincidence—and I marveled at the beauty and strength in his pose. I had suddenly convinced myself that he had died of AIDS complications. So I turned to Google and started to search. I learned that he had achieved levels in pose few have done. He was a renowned Bikram teacher. I smiled at my attempt to distract myself from my life and yoga class while hunting for details concerning a dead man’s pose. As I looked at his picture in a spirit of kinship, there was nothing that separated us. No one person is more worthy, sacred, loved, or valuable than another. No one person is more unworthy, profane,

despised, and infected than another. No one’s pose is better or worse than another’s. In kinship there is no darkness, light, or letters that separate us. I felt inspired and challenged to strengthen my pose. And found something to live for that day. At my next class I sat quietly afterward in a state of appreciation and reproach. The studio was quiet and I sat alone on a bench. Nearly naked and recuperating from 90 minutes of Bikram yoga, I felt deeply connected. It was not long before the nearest yogi and I began to converse about Jason Alexander Winn—my mysterious yogi, the dead man who had shown up in my world as I reached for a deeper connection with my own life. He died of an AIDS-related illness, pneumonia. He had stopped taking medications and attempted alternative means of sustaining his immune system. His family did not want stories of HIV and AIDS to be discussed. Many in the yoga community wanted to pay tribute and offer funding to fight HIV and AIDS, but the family wanted to keep their secret and grieve with shame and stigma. The stigma. Why? Why can we not talk about HIV and AIDS like we do cancer or a heart attack? The family’s choice is “right” for them, and my choice to continue with an aspiration to deconstruct shame, stigma, and secrets is “right” for me. With strength and awe, I felt honored and not at all surprised that “the dead” and I were communing in a conversation about living and dying around HIV. Earlier this evening I took a yoga break. The room was packed full of yogis. Sweat, breath, heat, and unique poses sustained us in a rich connection of community. I traveled to dead man’s pose and paused. With my eyes open, I saw a beam of light from the setting sun make its way through a corner window and across the ceiling. I thought of Jason Alexander Winn. It felt as if he were there, with us, in the studio, reminding me that outside poses, viruses, letters, status, life, and death, we are all deeply connected to each other. I only wish we could have shared a glass of wine before he left.

Alexander Smith is an MSW, LCSW, and HIV-positive life coach and storyteller, spreading poz-ivity, presence, playfulness, and permission. Follow and subscribe to Alexander TV and Viral Mindfulness at BlessYourVirus.com.

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you 2 .0

Health swag in the mail

Dating

Online Dating for Positive Singles Looking for love online? Look no further

Women who love cosmetics have beauty boxes, those little monthly subscription-only swag bags that come in the mail filled with samples, but what about us health buffs? Bulu Box is the newest way to discover health, nutrition, and weight-loss products, all without leaving the house. For $10 a month, you get a box containing four or five samples including a variety of vitamins, weight-loss products, energy and protein supplements, and sleep aids, plus lifestyle extras like gym gift cards or DVDs from time to time. BuluBox.com lets you try out new products so you don’t invest in a fullsize bottle of something you end up hating. —Michael Regula

Yoga Can Relieve Your Pain The title speaks for itself. In Yoga to the Rescue for Pain-Free Back, Neck, and Shoulders, instructor Desirée Rumbaugh demonstrates how yoga can both relieve and prevent pain in the upper body. Ideal for beginners, this two-DVD set provides a yoga tutorial with a regimen of exercises that specifically targets discomfort in the back, neck, and shoulders. Rumbaugh, an internationally renowned teacher with more than 25 years of experience, leads the viewer through each move, providing tips on positioning and alignment that will also improve strength, posture, and flexibility. All you’ll need is a TV, a mat, and a can-do attitude. —Daniel Reynolds

hile many dating sites and apps, like the massive Gay.com, offer a chance to join an HIV-positive (or supportive) community, a handful of boutique websites cater exclusively to people who are HIV-positive and those who want to date them, with options for straight, gay, and bisexual singles. Here are some faves:

Volttage

For: Gay and bi men Website: Volttage.com Price: Free Members: 11,000 Fashion designer and model Jack Mackenroth, who rose to fame as the first openly HIV-positive contestant on Project Runway (and appeared on the cover of HIV Plus in 2013), launched Volttage in October 2012. Unlike some other gay matchmaking portals, Volttage does not ask its members, over 11,000 and growing, to disclose their status; the assumption is that everyone is either positive or positive-friendly. Since the minimum age requirement is 21, users do have the option to reveal height, weight, and “other” measurements through photographs. In addition, a feature called Volttage Buzz provides users with news related to HIV activism, health, politics, and more. There will eventually be a mobile version, Mackenroth says.

Positive Singles

For: Anyone Website: PositiveSingles.com Price: Basic is free; Gold is $15.95 a month or $95.95 for six months Members: 700,000 Positive Singles is an online dating and support community open to straight and gay singles living with any sexually transmitted disease, including herpes, HPV, and HIV. This website allows users to tailor their search for men or women with more traditional search criteria, such as age, income, political beliefs, religion, and even astrological sign. While browsing is available to all users, gold membership unlocks the ability to search specifically for positive users.

PozMatch

For: Anyone Website: PozMatch.com Price: Basic is free; Premium is $14.95 a month or $59.99 a year Membership: Thousands Though its numbers may be small in comparison to some sites, PozMatch is one of the largest that caters exclusively to HIV-positive singles, regardless of sexual orientation. To start, you’ll fill out four pages of information to describe your interests and physical appearance as well as those of your ideal mate. Even the free basic membership allows a broad range of services; you can send a virtual kiss or a message, or instantly chat with members around the world. There’s even a live video option.—Daniel Reynolds

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ask & t e l l

fighting champ

Forrest Griffin combats complacency

The UFC Hall of Famer talks about adding his muscle to the fights against HIV and homophobia in sports

courtesy protec t yourself campaign

By JASE PEEPLES

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he ultimate Fighting Championship may be best known for takedowns, tapouts, and technical knockouts, but the mixed martial arts organization is working hard to become a heavy hitter in the world of HIV education as well. Last fall the UFC partnered with the Gay and Lesbian Community Center of Southern Nevada for a new HIV awareness campaign titled Protect Yourself at All Times. The campaign, designed to specifically raise awareness of the virus among people under 30, rolled out in the weeks leading up to World AIDS Day. UFC Hall of Famer Forrest Griffin says that when he first heard about the campaign he wanted to get involved, but he became further motivated after learning about high HIV infection rates among young people. “I grew up in a different era,” Griffin says. “People were definitely afraid of HIV back then, but education also helped change the way we thought about the disease. That education helped my generation make smarter choices about the way we protected ourselves. I was surprised to learn HIV infection rates were on the rise in young people, and I wanted to help change that.” Griffin, who is one of the spokesmen for the campaign, says complacency about HIV is an undeniable contributor to the rise in infections among young Americans. “People don’t talk about HIV like they used to,” he says. “Because fear of the disease has lapsed, we’ve sort of forgotten about it. But HIV is still out there, and we’ve got to instill the importance of protecting yourself in a generation who didn’t see the terrible effects of the disease in the ’80s and ’90s.” As a part of the Protect Yourself at All Times campaign, several UFC athletes and personalities have flexed their advocacy muscles by visiting centers around the nation that offer free HIV tests and educational initiatives. Public service announcements across a variety of media are also in the works, and the UFC will fully support the Nevada center’s LGBTQ+ program, which offers free HIV tests in and around Las Vegas. In addition to pushing HIV awareness, Griffin also views the UFC’s partnership with an LGBT organization as an opportunity to fight homophobia in sports. “I think any place people can be themselves is a good thing,” Griffin says. “I went to the groundbreaking of the center years ago, and I’ve been the UFC’s representative at many events there. I’ve met so many cool people at the center over the years, and if my involvement in this can help open people’s mind, even better.”

Though the partnership is the first of its kind for the UFC, the MMA organization has already been actively working toward leveling the field for LGBT athletes and fans. The sport embraced lesbian fighter Liz Carmouche after she came out in 2012 (fans have since playfully nicknamed themselves “Lizbos” in a show of support) and (albeit to a lesser extent) transgender athlete Fallon Fox (after her 2013 coming-out). The UFC has also suspended fighters for the use of antigay and antitrans slurs, and UFC president Dana White has encouraged gay fighters to come out. “It’s a continuation of something that started a long time ago,” says Griffin. “Gay, straight, whatever—none of that actually matters when you’re fighting someone. Not what you have in your bank account, what you drive, what sex you are, none of it. I think that’s the message the UFC has been trying to push.” Griffin says he’s proud to be a part of an organization that’s attempting to make positive change in sports, but he’s aware there is a lot of work ahead before homophobia is a distant memory. “It’s long been a problem,” he admits. “But I’m not just talking about the UFC—I mean homophobia in sports in general. And athletes sometimes say really stupid things. That’s why I think it’s great to see there are even commercials being played during the Super Bowl educating people about saying ‘that’s gay’ and how it can be offensive to gay people. When I was younger it was something we never thought about, and I’d like to think that most people who’ve said that kind of stuff don’t hate gay people, it was just a term that was in use. But it’s only by hearing how it can affect people that we realize how those things can really cause a lot of hurt.” Throughout his career, Griffin has also been a coach and mentor to many aspiring UFC fighters, and while the sport has yet to gain its first out gay male mixed martial artist, he expects the UFC will greatly benefit from any athlete who is brave enough to be the first. “I know not everyone would receive him well, but I think it would be best if some male fighter did come out,” Griffin says, adding some words of encouragement for anyone who may be contemplating opening up publicly about being gay. “Of course, like anything else, it’s going to be hard to be the first to do something, to be in that category by yourself. But that being said, others will follow later. Whoever that person ends up being, they are going to be a mentor to a lot of other people by setting an example. And my thing is, nobody should have to hide who they are. If you have to lie about yourself to anyone, they aren’t worth having in your life.” ✜

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Treatment chronicles

doctor figure out why you might be experiencing abnormal levels of fatigue, weakness, bruising, or bleeding.

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

Lipids/Cholesterol

Understanding Your Lab Tests

Blood tests are a routine part of an HIV-positive person’s life. But what do they all mean?

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

CD4/T-cell Count This is one of the most common and helpful tests for figuring out how your body is reacting to the virus and to treatment. Knowing the number of CD4 cells, also known as T cells, in your blood allows your doctor to have a general overview of your immune system’s health. Because T cells send signals to activate your immune system when it’s exposed to a virus, it’s important to keep your count in the normal ranges. According to the Centers for Disease Control and Prevention, a healthy CD4 count ranges from 500 to 1,000 cells per cubic millimeter of blood. The CDC recommends that anyone with a T-cell count below 350 cells per cubic millimeter should seek treatment,

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but your doctor might start you on treatment before your T cells drop to that level.

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

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

Complete Blood Count This routine test measures the number of white blood cells, which fight infections; red blood cells, which carry oxygen throughout the body; and platelets, which make blood clot. Because of white blood cells’ role in fighting disease, keeping track of them can help your doctor diagnose opportunistic infections. Since both HIV and antiretroviral therapy can affect your white and red blood cell and platelet counts, a blood count can also help your

This lab test measures liver and kidney function in addition to assessing the levels of glucose, proteins, and electrolytes in your blood. A comprehensive metabolic panel tells doctors how well your kidneys and liver are filtering waste produced by your body, plus it measures your blood sugar levels and checks how well your cells are producing calcium, sodium, potassium, and other electrolytes needed for healthy organ function, in addition to carbon dioxide. Many HIV treatment regimens affect the liver and kidneys, so this is an important test for any HIV-positive person, but it’s especially critical for those who also have hepatitis B or C, since those conditions can have a severe impact on liver and kidney function.

Drug Resistance Tests This test will let your doctor know if your particular virus is resistant—or unresponsive—to any type of antiretroviral drug. It can help your doctor determine which treatment regimen is best for you. If you’ve begun treatment and it isn’t lowering your viral load sufficiently, this test can help your doctor figure out why. —Sunnivie Brydum

How to Afford Your Meds Don’t let the steep costs of HIV drugs prevent you from receiving the medication you need

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s of 2012, an estimated one third of people with HIV in the United States were not on any sort of drug treatment, a situation that can rob them of healthy, long lives. Yes, HIV medication can be pricey, especially if you have to pay out of pocket. (In some cases, HIV treatment regimens may cost up to $5,000 per month.) But that doesn’t mean you’ll have to pay for it alone. There are a few ways to ease the cost of HIV drugs—and in some cases get your prescriptions covered entirely.

First Try ADAP The AIDS Drug Assistance Program is a state-run system that helps people under a certain income level obtain their

medications. Each state has its own set of guidelines to calculate who qualifies. Your state health department’s website should have information about how to apply for ADAP. At this point, there is no waiting list to get on the program, so you shouldn’t have to wait for coverage. Don’t Worry if You Don’t Qualify for ADAP People who can’t qualify for ADAP, Medicare, or Medicaid may be able to take advantage of Patient Assistance Programs, which provide free HIV medication. They are offered by drugmakers, and eligibility is based on a multiple of the federal poverty level. Participating companies include Merck, Bristol-Myers Squibb, Gilead,

and ViiV Healthcare, and a standardized application for each of them is available though the U.S. Department of Health and Human Services Administration’s HIV/AIDS Programs. If All Else Fails Most of the major HIV drug manufactures have a program to help you with copays for their medications. Atripla and Reyataz maker Bristol-Myers Squibb, AbbVie (which makes Kaletra and Norvir), and Gilead (the maker of Stribild and Truvada, among others) are just some of the drug companies that offer co-pay assistance. Check the websites of the individual companies for the terms of the programs, since the payment setup tends to vary. —Michelle Garcia

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THE TRUTH

Carlton Wilborn once danced with Madonna in front of tens of thousands of fans around the globe, but learning to come out—about being gay, about having HIV, about surviving sex abuse—helped him achieve an even richer kind of fame

By diane anderson-minshall

tanding in front of 140,000 fans at London’s Wembley Stadium, performing with the woman who is arguably among the most iconic and successful pop stars of the 20th century, should have been a pinnacle of Carlton Wilborn’s professional life. He was Madonna’s lead dancer for The Girlie Show and Blond Ambition, two of her biggest concert tours, and two of the biggest tours overall of the 1990s. Rolling Stone called Blond Ambition a “sexually provocative extravaganza” and “the best tour of 1990.” Blond Ambition wasn’t just a tour, though. It was a spectacle that, after it was filmed, became the most watched TV special to date for HBO (with 4.3 million households viewing), and it spawned the 1991 documentary Truth or Dare, which became not just a mainstream success (it grossed $29 million, making it one of the highest-grossing documentaries ever) but a bona fide gay hit. Two of her male dancers kiss, the troupe attends an LGBT pride parade, and Madonna pays tribute to her friend Keith Haring, who had died of AIDS complications in 1990. It is a very gay film that was as huge culturally as the concert series. And Wilborn was there in the midst of it all, in the film, performing onstage. He had it all, but there was something off. Something not quite right. Perhaps because he was keeping a secret. “I’d get these grand opportunities—and now I’m touring the world and now I’m at Wembley Stadium with Madonna and we’re doing these grand things—and I had this huge secret that nobody knew about,” he recalls. “I don’t feel it so much now, but there was a somewhat recent feeling of sadness about that time for me in reflection, in that, man I was really not able to ever sit in the glory that my life was having because there was this on-the-down-low truth going on that was [stopping me from] feeling amazing and being really excited about what I had.” One of the highlights of Wilborn’s professional experiences came during the Girlie Show tour. “Madonna created an eightminute number that was exclusively a highlighted moment for me,” he says. “She was not on the stage. It was a piece that was set completely around me. I was the leader of the thing, and I had eight minutes to entertain 120,000 people.” But like all moments during those years—after Wilborn discovered he’s HIV-positive but before he told anyone—it was tempered. “Because as excited as I was, it’s 10:30 at night and the sound is booming and the audience is screaming for us, and I’m also aware that it’s 10:30 at night and we’re in a city or a country where it’s cool outside and all I have on is briefs, and God forbid I should be cold or get a chill. I’m fucked.” An actor and dancer in his youth, now an actor, producer, writer, and motivational guru, Wilborn was diagnosed with HIV in 1985, at the height of AIDS hysteria, a time when even the president wouldn’t utter the term “AIDS” because it supposedly didn’t apply to good, decent people. “For me, it was a crazy living nightmare, in a weird way,” admits Wilborn. “Again, I was diagnosed when it first landed in the consciousness of America, and it was fire and brimstone.” He got the news while in Hawaii on tour with Hubbard Street Dance Chicago. “I had been feeling a little uncomfortable and had gone to the doctor in Chicago,” he recalls. “Just, you know, saying, ‘I have a cold or the flu, I’m not quite sure.’ Then I go on tour and I’m in Hawaii and I check in with the doctor and his first thing he said is, ‘You should have a seat.’ And he said what he ...Continued on page 27

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said, and I don’t know what he said after that; my brain literally went blank.” He was shocked, but after the tour ended and he returned to Chicago, Wilborn says, he was in the dance studio warming up for the class and “I just had this resolve that said, This thing is not going to take me down. And it literally ended up being—even to this day—one of the best dance classes I’ve ever had. This other force was alive in me.” Part of that force, Wilborn says now, is the relationship he has built with God. In 2000, still not out about his HIV status, he saw his life “really hit its serious rock bottom.” Work had dried up, so he got a job on a cruise ship as the dance captain and a performer. During the cruise, he bought a cross on a chain in Nassau, the Bahamas, because the kids were wearing them in hip-hop videos on MTV. Then a few months later he questioned the meaning of the cross. At the same time his sister sent him his childhood Bible, a relic he’d forgotten. A year later, Wilborn had developed a “real concentrated relationship with God,” and in 2004, he says, he was saved. (“What that means, to be saved,” he says, “is to accept and declare that Jesus Christ, for laymen’s term, is your template, is your model for how you go after life, and you surrender your life to this higher force that can take care of you better than you can take care of yourself.”) That moment began his “concentrated time with God that has turned my life into all that my life is now— and I love my life.” Today Wilborn is still a dancer, though he’s known equally well for his other work in entertainment. He won the best actor

award in 2013 for his new film, The Boarder, at the New York Los Angeles International Film Festival. (The film is now touring the festival circuit prior to DVD release.) The Boarder tackles reactive attachment disorder, a mental health issue that affects children who’ve experienced trauma of some sort. “What’s been so amazing about this opportunity is we’re getting to shine a light on a condition that’s been really misdiagnosed for a lot of families and for a long time,” he says. He’s also producing and starring in a film he wrote called Breakout, which he calls “my main baby right now.” The film is in pre-production, but the trailer, which screened at a handful of film festivals last summer, was nominated for best action sequence and best short film at the Action on Film International Film Festival. And he’s got a couple of scripted things in development and, of course, he’s still showing up on television from time to time, most recently as Marine Master Sgt. Charles Garrett on a January episode of NCIS. When Wilborn first began acting, he was closeted about being gay. He landed his first role in a series (as one of the leads) with L.A. Firefighters on Fox, on which he played a very masculine, and straight, fireman. “I was making 15 grand a week and that was all fantastic, but the thing I was most excited about was that he was a butch dude and that I could now get everybody to think I was a straight guy,” Wilborn admits. His first day of filming caught him off guard, though. “Here’s gay Carlton on the DL doing his thing,” he says, chuckling. “I’m going to show up and I’m going to be Mr. Flirty with all of the girls. There was an actress who was cast as

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one of the series regulars as well, and we’ve now got this energy that we’re doing all day long and we’re wearing it strong.” After a day of filming, they went to a bar and had a drink. “And some part of the mask is not wearing well for either one of us. I’m the first to be honest and say that I’m actually gay. And turns out she’s actually a lesbian. We frickin’ laughed about that so hard in that bar.” (That woman, by the way, was actress, later photographer, Alexandra Hedison, who would eventually come to fame as the woman Ellen DeGeneres left for Portia de Rossi.) One of his 2012 performances, as a transgender woman named Glenda on The Mentalist, won Wilborn accolades from the LGBT community, and the episode was nominated for a GLAAD Media Award. “I noticed every time that God really, really wants to take me to another level, he activates me through work, through a work opportunity,” Wilborn says. “So, you know, I’ve been gay, I’ve been with men, I’ve been with women, I like to be with women—but I’ve had my issues around [accepting cross-dressers and trans women] even though I’m kind of turned on by them. So here’s what’s interesting. I had a call from my manager saying there’s an opportunity to do this role and I’m like, ‘Oh, lord, are you kidding me?’ I breathe into it, I have my conversation with God and he’s like, Go for it. Women have always been my strongest allies. I thought, Carlton if you’re going to do this and you’re going to step into this female persona, you’ve got to do justice for the female race and for the trans race. And really honor it—don’t let it be something that’s caricatured.” At his first costume fitting, Wilborn says, he discovered “a part of me that is a flamboyant man. I love my maleness. I’m very good in my man, but there’s a side of me that is very tuned in to his female.” But fear of being stigmatized as feminine, as queeny or flamboyant, and his own internalized phobia, “the part of me that’s still battling with ‘I don’t really want to be fully known as this thing,’ ” he says, “is doing all this extra conversation in the wardrobe room and, oh, my God, it’s so overwhelming.… It was such bullshit, it was so funny.” He took the high heels home to break them in and learn to walk in them, and it helped him face his own homophobia, Wilborn says. “All these years what I’ve been petrified of is the pointing finger going, ‘He’s a faggot, he’s one of them.’ So I’m like, OK, dude, you got to face this—and this person you’re about to step into has no shame on the game at all.” So the 6-foot, 2-inch Wilborn headed to Larchmont, an affluent area of Los Angeles filled with high-end boutiques and cafés, and put on those super-high heels and trotted around, to see what it felt like to at least walk in Glenda’s shoes. Wilborn says it was the beginning of “me getting right with my sexuality” and “coming around to fully embrace, to love all that I am.”

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A month and a half later, Wilborn, now a life coach and motivational speaker as well as the author of the memoir Front & Center: How I Learned to Live There and the workbook I Am Empowered, got a text from his own life coach: In TV Guide, Mentalist executive producer Daniel Cerone, who also wrote the episode, “did this three-quarters page ad with three paragraphs speaking full on my behalf with every single kind of wordage that one would pay for as an endorsement. You know, ‘We needed a force of nature and after a long search we got lucky and found Carlton Wilborn.’ ” Today Wilborn says those days of hiding his HIV status are long gone, and so are fears that standing in the cold in his underwear in front of hundreds of thousands of fans will send him into an immune spiral. “My health is absolutely fantastic,” he says. “My health is solidly strong. I mean, I’m on a cocktail and have been since around 2004. After a round of scrambling to find the right mix to keep me balanced, we happened upon this particular cocktail, and it has me undetected since 2004. Honestly, if I did not have to take meds every day, there is nothing to my physical being or my moods or anything that represents that I’m HIVpositive. I would not know that I’m HIV-positive.” Wilborn is now all about living with love and courage and spirituality, examining the infinite possibilities that he never thought possible when he was a street-tough kid in Chicago giving disco lessons to the uptown kids and later as a young, sexually abused man, re-creating self-destructive patterns—including addictions to drugs and sex—instead of dealing with the ramifications of his abuse, which he talks about in Front & Center. He and the director of The Boarder are developing a scripted project inspired by his life story, and he’s starting a foundation this year called the We Are Gifts Foundation (GoFundMe.com/WeAreGifts), meant to empower sexually abused and HIV-positive youth. He hopes this year to mount the first full-day camp day, in which the kids will “use the different modalities of creativity to hone their voice.” They will act, dance, sing, write, all the things that helped Wilborn “free myself and find my voice.” That’s what saved him, and maybe now it can do the same for others. “The trauma lasted as long as it did because I kept my story dormant. So what I want to do is give children and youth an opportunity to celebrate their truth, to bring it to the light so that they can get freer sooner.” Would he be where he is today—happy, healthy, and selfaware—had the virus not come into his life? Could it be that HIV not only didn’t end his life, but in fact saved it? “I have come to the reality that I am actually grateful that HIV showed up in my space because it did add velocity to my character work,” says the empowerment expert. “Don’t think I would be as clean about myself…about how I want to deal with people, as clean about how I can perceive life, honestly, if HIV had not shown up, because I would be off and running. I probably would not honestly be here. I have really come to believe that all of my journey, the HIV, the angst, the issues, the cravings, the addictions, me being on the other side of that is so that I can have a voice that can speak to somebody else who is still stuck or still trying to unravel that part of their life. I didn’t make it just so I could celebrate and go, ‘Carlton’s now fabulous and look at how healthy I am’—it was never about that. My life is fantastic. I get to do all the things that I want to do, honestly. HIV helped me wake up and embrace love—love for myself, love for others.” ✜

HIV 101 a manual for living for anyone who has just been diagnosed as hiv-positive

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No matter where you get the test or how supportive your environment is, the day you find out you have HIV is an overwhelming one. For some, a mix of emotions comes flooding in, from fear to shame to anger to embarrassment. We live in a culture that has been dealing with HIV and AIDS for less than 50 years, so ignorance and stigma still surround the virus (compare that to obesity, which has been around since the dawn of time and is still quite stigmatized). Many Americans don’t know the facts about HIV; medical facilities still haven’t begun to provide education about it; and the rare media appearances of HIV-positive people (thank you, Project Runway) don’t offer opportunity for the kind of complex and nuanced discussions that are lacking in the national sphere. The bottom line: After finding out you are HIV-positive, you’ll have a lot of basic questions and you’ll need some straightforward answers to help you move forward with what will be a long, healthy, happy life. We hope this special section of HIV Plus offers all that and more.

24 things

you need to know

about hiv

Everyone has questions when they find out they are positive. Here are several of the most common, plus straightforward answers to help you navigate this new life of yours

By Nicholas Cimarusti & Diane Anderson-Minshall

Does being HIV-positive mean I also have AIDS? Absolutely not. In the U.S., the majority of people living with HIV will never develop AIDS, the most advanced stage of HIV disease. HIV is the virus that causes AIDS, but for most people, proper treatment and regular medical care to keep your immune system strong will prevent you from ever developing AIDS. Remember, an HIV-positive test result means only that: You have HIV. Am I going to die? No, probably not anytime soon. There can always be complications, just as there are with any chronic condition (like diabetes, for example), but generally, with current medications, people with HIV are living near-normal life spans. You will be susceptible to the same medical conditions that affect all people as they age, and some experts say that people with HIV will experience some of these conditions associated with aging (like osteoporosis) sooner because of the lifesaving antiretroviral drugs you need to take. How is it transmitted? Let’s start with how it is not transmitted. Since the virus cannot survive outside the body, you cannot get it from toilet seats or shared cups or utensils. You can’t get it from kissing or from spit, since it’s not transmitted in your saliva. It is also not transmitted in sweat or urine. You can’t get it from a swimming pool, hot tub, sauna, mosquito or rodent bites, tattoos, or ear/body piercings. Only four bodily fluids are known to carry HIV in quantities concentrated enough to infect another person: blood, semen, vaginal fluids, and breast milk. According to the Centers for Disease Control and Prevention, it is one of these fluids from an HIV-positive person that has to come in contact with a mucous membrane or damaged tissue, or be directly injected into the bloodstream (from a needle or syringe), for HIV transmission to possibly occur.

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How did I get HIV? This is a question you’ll get asked exhaustively (see page 40 for advice on how to deal with it), but right now you’re probably just asking yourself. The bottom line is that the main risk is having unprotected anal sex or (for women) vaginal sex or sharing needles with an infected person. It’s possible, but quite a bit less likely, that you got it from oral sex. The CDC says it’s also possible to acquire HIV through exposure to infected blood, transfusions of infected blood, blood products, or organ transplantation, “though this risk is extremely remote due to rigorous testing of the U.S. blood supply and donated organs.” Wait, but I’m a top... Actually, there’s some truth to the assumption that “tops” (insertive partners in anal sex) get HIV less. The insertive partner in both anal and vaginal sex is less likely to contract HIV—in the case of anal sex, “tops” have 86 percent reduction in transmission, according to a 2012 study—but that still means tops can get HIV from sex. (Read more on page 42.) Who is at higher risk of HIV infection? Across all ethnicities, in the U.S. the group most affected by HIV infection is gay and bisexual men and other men who have anal sex with men (but for some reason don’t identify as gay or bi, dubbed MSM). Transgender women, especially women of color, are at a significantly higher risk as well, though exact numbers aren’t known because in many studies they are included, erroneously, in the MSM category. Black and Latino men and women and injection drug users have higher risk rates, but of course anyone (straight, gay, black, white, whatever) who has unprotected anal or vaginal sex is at risk. Can I still have kids? Yes. If you’re a woman who is positive, medications can make it so

you have less than a 1 percent chance of transmitting HIV to your unborn child. If you’re a man, your sperm will need to be “washed” of HIV and then inseminated into your partner, wife, or surrogate. The main difference for couples is that you’ll need a specialist who deals with HIV, fertility, and insemination. If you want to adopt, there are some new protections for HIV-positive parents-to-be that ensure you can’t be discriminated against. Does this mean I have to stop having sex? No, not unless you want to. But we encourage you not to stop. Orgasms can be wonder drugs in themselves: They help you sleep, boost your immunoglobulin levels (which fight infections), and reduce stress and depression. There are ways to protect yourself and your partner, including consistent condom use, PrEP, serosorting, and keeping your viral load undetectable. (Get the deets for gay and bi men on page 42; for women, many of these stats still apply.) One tip: If you use lube during vaginal or anal sex, avoid two ingredients: polyquaternium and polyquaternium-15, both types of polymers, which may increase the possibility of HIV transmission.

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What about oral sex? It is far less common, but possible, to transmit HIV through oral sex, especially if you are a man and you ejaculate into someone else’s mouth. If you have HIV and your partner performs fellatio on you but you do not ejaculate in that person’s mouth, you have an extremely low chance of passing HIV to them. HIV transmission through “fellatio without ejaculation can happen, but it is exceedingly rare,” says Thomas Coates, Ph.D., a professor of medicine and director of the University of California, San Francisco, AIDS Research Institute and the Center for AIDS Prevention Studies. “It’s not ‘no risk,’ but it’s relatively low risk.” When ejaculation occurs during fellatio, the risk of HIV transmission rises; researchers debate what the rate of transmission is but most estimates are between 1 and 10 percent. If you are a woman, having someone perform cunnilingus on you is extremely low risk as well, as long as you are not menstruating. What is a serodiscordant couple? Serodiscordant simply means one of you has HIV and one of you doesn’t. Some gay couples use the term “magnetic couples” to mean the same thing. There’s very little research on how successfully serodiscordant, or mixed, couples cope with the complications of HIV. According to TheBody.com, an online HIV resource guide, “research of this nature tends to measure the most negative aspects of positive/negative couplings, telling us primarily how HIV complicates our lives. It tells us very little about the rewards, the discovery of inner strengths, the emotional ties, the opportunities for developing better communication skills, or the joy generated when a mixed-status couple does create a happy, strong, fulfilling relationship.” how do we handle being a serodiscordant couple? What you need to know if you’re a mixed couple is that you can

have a happy and healthy relationship, but like all relationships, it requires work and commitment, because love does not conquer all. The HIV-negative partner may want talk to his or her physician about pre-exposure prophylaxis, or PrEP; research has shown that the anti-HIV drug Truvada reduces the risk of HIV infection in the negative partners of HIV-positive gay men. While some doctors warn that PrEP shouldn’t be the first line of defense against HIV infection, instead recommending regular condom use, many experts recognize that condoms are rarely utilized 100 percent of the time in a relationship. Also, many HIV experts now say that when the HIV-positive partner has an undetectable viral load (which happens with early and consistent drug treatment; see page 38 on finding a doctor) the likelihood of transmitting the virus to a partner is significantly reduced or eliminated. Couples might also want to see a counselor who specializes in coping with HIV. Many HIV-positive people fear spreading the disease to their partners, making sex fraught with tension. Many HIV-negative partners encounter disrespect from friends and family members when the other partner’s status is revealed. A counselor can help you work through those kinds of issues and communicate to each other your anxieties, fears, and needs. How many of my previous sexual partners do I need to tell about my diagnosis? This is kind of a murky area, with debate between activists and public policy experts. You will be asked to notify, or have the health department notify, anyone you have had sex with or shared needles with since your last negative HIV test or, if you’ve never had one, the most recent sex partners (say, in the last year). Your partner(s) will need to be tested now and, if the test is negative, again in three months (the window period between infection and when it actually shows up on a test). According to the New York Department of Health, how far back in time known partners should be reported is determined on a case-by-case basis depending on such factors as the approximate dates when you believe you were exposed and became infected and how willing (or able) you are to dig up those names and contact info, with the priority on current and recent partners. The federal Ryan White Care Act requires states to make a good-faith effort to notify current spouses and anyone who has been the HIVpositive person’s spouse within the last 10 years. Therefore, spouses within the last 10 years, if known, should be notified, unless you’ve had a negative HIV test result since then. Do know that public health departments and clinics are not supposed to pressure you for this information and they cannot withhold your test results or penalize you in any way for not divulging this info. How much do I need to tell my dentist and other health care workers offering me nonsurgical treatment? All health care professionals use “universal precautions” to prevent the transmission of blood-borne diseases like HIV and hep C to and from patients, according to Robert J. Frascino, MD, of the Robert James Frascino AIDS Foundation. An expert for TheBody.com, Frascino says he’d recommend disclosing your status to your dentist, though, so that he or she could be on the lookout for HIV-specific problems in the mouth. “Health

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care professionals, including dentists, are trained to look for certain conditions more closely if they know you have an underlying medical problem, be that diabetes, cancer, HIV or whatever,” he writes. “Why would you not advise your dentist of your HIV status? If you feel that dentist would discriminate against you for being HIV positive, that’s not the office you want to be treated in anyway, right? Being HIV-positive is not something to be ashamed of. It’s a viral illness.” The same is true for other health care providers: You don’t have to tell them, but it’s in your best interest and best health to do so. Is it possible I got a false positive on my HIV test? When your initial test comes back positive (unless you’ve done the at-home test) you should be offered a confirmatory test, basically a second test to make sure you’re HIV-positive. The likelihood of two false positives is extremely rare. If you took the at-home test, it’s a good idea to go to a doctor or clinic to do the second test. Sadly, false-negative test results can happen too, so if you come up positive and your partner comes up negative, be cautious. According to AIDS.gov, the likelihood of a false negative depends on when you might have been exposed to HIV and when you took the test. “It takes time for seroconversion to occur. This is when your body begins to produce the antibodies an HIV test is looking for—anywhere from two weeks to six months after infection. So if you have an HIV test with a negative result within three months of your last possible exposure to HIV, the CDC recommends that you be retested three months after that first screening test. A negative result is only accurate if you haven’t had any risks for HIV infection in the last six months—and a negative result is only good for past exposure.” What will change for me in my everyday life now that I’m positive? With proper treatment, being HIV-positive is a manageable, chronic condition like lupus, diabetes, or asthma. You might need to exercise caution with some of your regular activities. Unless you had other health conditions prior to diagnosis, you’ll likely see a physician more than you did before because it’s vital that you monitor your health closely. Regular visits with your HIV health care provider will keep you up to date on everything concerning your health. Speak with your doctor about changes that need to be made to your diet, exercise regimen, and use of alcohol, prescription medicines, and recreational drugs. If drugs were a factor in your transmission (there’s a link between crystal meth use and HIV transmission, for example), your doctor might recommend rehab. You may tire more easily, be more prone to infections, have medical side effects you didn’t have before. But hands down, the biggest change in your daily routine will be taking medication, if you and your doctor decide this is the best treatment option for you. HIV medication requires strict adherence to the prescribed daily dosage, and the drugs often have side effects. Open communication with your doctor will ensure that you are fully equipped to handle the changes in your life.

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How do I tell my kids I have HIV? Many parents worry that telling their kids might place a burden on the children. Mental health professionals say the decision about whether to tell your kids depends on many factors, including how perceptive they are (if there are medicine containers all around, kids will ask about them), how discreet you need to be (asking kids to keep your status a secret is a heavy burden), and how strong you can be for them (some kids will be angry or overly clingy, worried you’ll be dying). For most people, telling their children is the right thing to do. Before you do, learn everything you can about HIV. Your kids have been perfecting the “why” questions since they were 2 years old; this is a moment when there will be a lot of whys and hows. Your doctor or counselor might have ideas about groups or advocates for children, who can also talk to the kids or be a support team for you and the offspring as you go through the coming-out process. Then, says Mark Cichocki, a nurse educator at the University of Michigan’s HIV/AIDS Treatment Program and the author of Living With HIV: A Patient’s Guide, talk in a quiet space, be honest, trust your kids to handle it, and let them express their emotions fully (remember, kids can experience a range of feelings, including guilt, fear, rage, and rejection). This process may take more than one day—it’s the beginning of a conversation in which you should be honest, age-appropriate, and willing to offer both answers and assurances. Kids can impress us with their ability to understand and assimilate information; you just need to have it ready for them. After the crying and talking is done, take them out for ice cream so they remember that this is just another thing that your family will tackle together. Will being HIV-positive affect my ability to have gender confirmation surgery, plastic surgery, or gastric bypass surgery? What about hormone treatments? Short answer: No. There was thought to be heightened risk from surgery, but a study published in 2006 in The Journal of the American Medical Association compared surgery data for both HIV-positive and HIV-negative patients and found that the two groups had the same level of complications from surgery. Moreover, medical workers are better educated about HIV than they once were, and the fear of positive patients has eroded. But you may still have to work harder to find a surgeon who has worked with HIV-positive patients, or if you’re transgender, a doctor who can work with both your HIV specialist and your reassignment surgeon. do I need a special doctor for my HIV-related issues? Yes. It is important to find a health care provider who specializes in HIV medical service right away. Sometimes your HIV testing center will recommend someone, or you can also ask your primary health care provider. Finding an HIV specialist who fits your needs is a huge first step after being diagnosed as positive. That person will literally be your lifesaver. In between doctor visits, are there symptoms I should be on the lookout for? Regular appointments with your HIV specialist are absolutely

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

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How do I prevent myself from getting sick? Because your immune system’s strength will fluctuate, it is even more important to always keep clean. It sounds basic, but it’s a big help if you simply wash your hands and encourage others around you to do the same, especially before and after you eat, after using the toilet, and if someone around you is sick. Maintain healthy eating habits (there are HIV specialist nutritionists, and your doctor can refer you to them if needed) and start or keep up a regular exercise routine as well (even if it’s just walking 30 minutes a day). Smoking, drinking, and recreational drug use all compromise your immune system, so find ways to cut back on (or ideally, stop) these activities. Don’t forget to keep tabs on your emotions, because mental health is as crucial as physical health. HIV is a chronic condition that comes with a lot of baggage because of cultural stigma. You’ll feel it, and it’ll take a while to get used to it. You’ll need a strong support system that can include your doctor, friends, and family, plus new friends you meet in your support groups along the way. But do not hesitate to reach out, because a positive outlook will be one of your greatest allies. If for some reason I’m bleeding, do I need to worry about people who are helping me? This probably depends on the situation, but often the answer is no. HIV is rarely transmitted in a household between family members (outside of sex and IV drug use, of course). And, if, for example, you got hurt playing football or duking it out at the gym, it’s “highly unlikely that HIV transmission could occur in this manner,” according to the University of Rochester Medical Center’s website. “The external contact with blood that might occur in a sports injury is very different from direct entry of blood into the bloodstream which occurs from sharing needles.” The same goes for blood on a Band-Aid or a nosebleed or a cut finger, says Lisa B. Hightow-Weidman, MD, MPH, an associate professor of medicine in the Department of Infectious Diseases, University of North Carolina-Chapel Hill, and an expert for TheBody.com. “There is no risk of getting HIV from blood that has been sitting outside of

a human body. Even if the [person bleeding] was infected, HIV begins to die once it leaves the body and becomes unable to infect anyone else.” One caveat: If you’ve been in a serious auto or other accident, the emergency medical techs who are helping you should be using universal precautions, but it’s always good for your own health to tell them you’re HIV-positive. (It’s illegal for health workers to refuse you care based on your status, per the federal Americans With Disabilities Act.) Can I be fired if my boss finds out I have HIV? Not legally, unless you have limitations on what you can do and your employer has made every effort to accommodate them. The ADA require employers to make “reasonable accommodation” to the known physical or mental limitations of employees with disabilities (including HIV infection/illness). That doesn’t mean all employers understand the ADA; violations happen all the time, but if you get fired, you have legal recourse. And certainly, if you have no symptoms that require you to have accommodations, then you can’t be let go because of your status. Can my boss or prospective employer require me to take an HIV test? No, not under federal nondiscrimination laws. How do I find support centers or support groups near me? Each state has its own toll-free HIV and AIDS hotline, and Project Inform has the full list at ProjectInform.org/hotlines. If you call Project Inform’s HIV Health InfoLine, which is (800) 822-7422, you can talk to nonjudgmental people (in English and Spanish) who will listen to you, share their experiences, offer you accurate information about HIV, and help you navigate health care obstacles and talk to doctors about your concerns. There are a myriad of support groups, and trying to choose the right one can feel overwhelming. There are more than enough options out there—clinic-based support groups, faith-based support groups, private support groups, online support groups—so you can find one made up of people who share your values, needs, or communication styles. On About.com, HIV specialist Dennis Sifris, MD, and HIV educator James Myhre suggest you consider five things in your search for an HIV support group: • Is this group able to provide the confidentiality I need to express myself fully and freely? • Can I speak to this group without fear of embarrassment or judgment? • Do I require a certain expertise or advice, and, if so, can this group provide me that? • Does this group provide the kind of support I need to deal with my immediate issues? • What about the other group members? What has the group experience done for them? ✜

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paging dr. right When you’re HIV-positive, it’s crucial to track down the right doctor to fit your needs. Here’s how to find that special someone—with an MD By sunnivie brydum and michelle garcia

ask around Sometimes getting other people’s recommendations is the best way to find someone you’ll like. Ask for referrals from your local HIV resource center, your current general practitioner, or other HIV-positive people you know. Using the dating analogy, remember you aren’t looking for a one-night stand; you’re seeking a long-term partnership, so anyone who can be vouched for is worth consideration.

get online The American Academy of HIV Medicine (AAHIVM.org) and the HIV Medicine Association (HIVMA.org) both offer a database of doctors and medical services nationwide, allowing you to search for an HIV-knowledgeable doctor in your hometown. Both websites can help you find the right person to handle most of your HIV-related needs, but AAHIVM will also match you with doctors who focus on specialized HIV care in areas such as nutrition, dental services, or access to clinical trials.

Scan the ratings After you find a couple of promising doctors in your area, you may want to check reviews on websites RateMDs, ZocDoc, HealthGrades, or Angie’s List for any red flags. More information on a particular doctor you are interested in may be available through your insurance provider. And if you want to be really investigative, the Federation of State Medical Boards (FSMB.org) can give you a report on any physician’s license, medical education, any sanctions or disciplines, and location history.

Talk It Out  Don’t hesitate to consult with your prospective doctor before you dive into his or her client pool. Good doctors will make time to speak with you before it’s time to put on the examination gown. Find out if you have a compatible philosophy about your HIV treatment: Do you want cutting-edge methods or consistent, conservative care? Do you like to supplement your health care with alternative therapies such as massage and acupuncture? Would you rather collaborate on your treatment plan with your doctor or have him or her take the wheel? Now’s the time to bring up anything that might be contentious. If you use marijuana daily, for instance, find out how the doc feels about drug use so you don’t ever feel like you have to hide anything from your doctor.

Pass It On  When you’re ready to become a patient, make sure your new doctor has as much of your medical history as possible to determine the right care plan. Transferring medical records is often as easy as calling your previous medical provider. When you talk to your doctor, try to be as honest as possible. At this point, you probably already know their philosophy on common sticking points, so you should feel comfortable talking about your sexual history, sleep patterns, and substance use. Always remember, he or she is a doctor, not your parents, and you pay him or her for services, so tell the truth and get your money’s worth in a lifetime of great care. ✜

NEW HELP WITH HEALTH CARE Obamacare will improve health care coverage for people with HIV, but it may not meet all your needs

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By Trudy ring As the Affordable Care Act—the health insurance reform law backed by President Obama—goes into full effect this year, it brings changes designed to improve coverage for people living with HIV. Still, there are fears that some plans offered on insurance exchanges will provide inadequate coverage for, say, prescription drugs. And it won’t be entirely clear how well “Obamacare” works until the public has more experience with it. The law does bring some important new protections to Americans with HIV. Beginning this year, insurers will no longer be able to deny coverage to anyone because of a preexisting condition, nor will they be able to put lifetime caps on benefits. Both of these are particularly important for people with HIV or AIDS, who have often been denied insurance policies or run up bills that max out their benefits. It mandates that individual and small-group plans offer coverage similar to that found in most employer-provided plans, including prescription drugs, preventive care, and chronic-disease management. The ACA also broadens eligibility for Medicaid, the insurance program for low-income people that’s jointly funded by the federal and state governments. As of this year, states have the option of offering Medicaid to people with income below 133 percent of the federal poverty level (the level is $11,490 for an individual and $23,550 for a family of four in the lower 48 states and D.C., slightly higher in Alaska and Hawaii), including childless adults, who were previously not generally eligible for Medicaid. Because of this, in many states, people with HIV who meet this income threshold will be able to receive Medicaid; previously, you had to have an AIDS diagnosis in order to qualify. The Kaiser Family Foundation, which analyzes health care policy, estimates that 70,000 uninsured people with HIV who are currently receiving care will gain coverage through the law—47,000 through Medicaid, if every state expands it, and 23,000 through the insurance marketplaces set up under Obamacare. So far 26 states and the District of Columbia were planning Medicaid expansion this year, and two more after 2014, according to the foundation; for a full list, see KFF.org. (Among those not in care, another 124,000 could gain coverage through the ACA.) The Department of Health and Human Services recommends that even if your state isn’t among those planning to expand, go ahead and apply for Medicaid, as your state may have a provision that lets you qualify. You can find out more at HealthCare.gov. Also, a new consumer Web portal to assist people with HIV in navigating the new options is available from Greater Than AIDS at GreaterThan.org. The ACA further promises that people with HIV who are on the Medicare Part D prescription drug plan will move more quickly through what’s known as the “donut hole,” a temporary gap in coverage. If you get medications through state AIDS Drug Assistance Programs, these benefits will be considered contributions to Part D’s out-of-pocket spending limit, which will help you meet that limit and get out of the

coverage gap faster. And the ACA gradually closes the gap until it is eliminated in 2020. Other promising aspects of the ACA include an emphasis on preventive and coordinated care, with most insurance plans required to provide HIV screening and counseling at no cost to the patient. The act also offers training to help health professionals improve their service to people with HIV and requires insurers to explain coverage in easily understood language. Toward the end of last year, as people began signing up for plans through the health insurance exchanges, several reported plans that weren’t covering important HIV medications or were requiring patients to pay up to half of the prescription cost. But most plans now provide front-line HIV meds, says John Peller, vice president of policy for the AIDS Foundation of Chicago. “The vast majority of plans look pretty good,” he says. He credits news coverage about the problem for the change. Also, a coalition of HIV organizations, the HIV Health Care Access Working Group (of which the AIDS Foundation is a member), urged HHS secretary Kathleen Sebelius to make sure all plans cover key HIV drugs. Some problems do remain, with certain plans charging very high co-pays for medications. The working group recommends that if you have problems getting your meds covered, see if help is available from your state ADAP; your pharmacy, doctor, or case manager; or assistance programs run by drugmakers (see p. 21 for details). Above all, plan ahead and research your insurance options thoroughly before signing up. Most plans, Peller adds, have an “exceptions” process through which you can apply to have a drug covered that wasn’t before. The coalition offers more advice at its website, HIVHealthReform.org, where you can also report any issues you have with prescription coverage. ✜

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g n i s o l c dis o t w Ho Hereâ&#x20AC;&#x2122;s d e t r a t S t e G B y G a ry M

ccl ain

ne of the milestones on your living with HIV journey is learning how to disclose your status to friends, family members, potential romantic partners, and other people in your life whom you want or need to know. In a way, disclosing is an endless series of milestones, because each disclosure is a unique experience. Because of that, it’s hard not to get caught up in asking yourself questions like: How will they react? Will they be supportive? Try to micromanage my life? Reject me? Some will take the news in stride, as you expected them to. Others won’t, as you might also have expected. And some could surprise you, for better or worse. Talk about uncertainty! A lot to think about, right? Here are some strategies to help you get started: Take a “need to know” approach

Decide ahead of time what you want to tell your friend or family member about your diagnosis and how much beyond the diagnosis you want to disclose. Most likely, you will feel comfortable giving some people specific information, such as how you were infected. Ask yourself, What do I need them to know? What do we not need to discuss? You’re in control here.

If you sense they are uncomfortable with this conversation—and looking for an exit—that’s a sign they may not want to go any further. Respond with “It looks like you aren’t comfortable talking about this.” And then wait for them to let you know whether they can have this discussion. It may take some time to process the news, and so this may be an ongoing discussion.

Offer to answer questions

Say something like “Thanks for listening. Do you have any questions you want to ask?” Keep in mind that you don’t have to answer any questions you aren’t comfortable with or that you don’t think are relevant. It’s as simple as saying “I’m not ready to talk about that” or “I am not sure how to answer.”

Educate them

You may want to provide some information to the person you disclose to. This might be a pamphlet or a link to a website they might benefit from. You’ll get an idea of how educated they are by how they respond to your news.

Don’t assume you have to defend yourself

Choose a moment when the two of you can share some quiet time. Think about the setting that will be comfortable for you as well as the other person. At your home? In a public setting? It’s up to you.

Again, you’re in control of the message here. You don’t have to apologize or make excuses for your HIV status. Keep the conversation focused on moving forward in your relationship. Respond to judgmental reactions with “I’m all about the present and the future, not the past. I would like to count on you to be there for me!” End of story.

Be clear about your intentions

Be ready to offer support—within limits

State the facts

And keep your expectations realistic

Decide when the time and place is right

Are you looking for support? A deeper relationship? Is this a person you want to have sex with? This can be as simple as “I wanted to tell you something about myself. The reason I want to tell you is .” This will help your friend or family member understand what you are expecting—and not expecting—from them. And hopefully, it will help them listen with an open mind.

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Be sensitive to how they are reacting

Once you say “HIV,” the other person might have trouble hearing whatever comes next, at least when you first tell them. You may want to start with a simple disclosure along with a brief overview of how you’re doing and—equally important—what you’re doing: “I just learned that I am HIV-positive” or “I am living with HIV,” followed by “I am taking really good care of myself, physically and emotionally. And an important part of taking care of myself is disclosing my HIV status to people I care about and trust.”

Most likely, some of the people you disclose to are going to say “I just feel terrible” or even use terms like “devastated.” That can be your cue to remind them that you’re taking responsibility for managing your HIV. You can be supportive without being pulled into someone else’s outof-control emotions. Be gentle but firm. They’re feeling helpless. You’re not. Sure, it’s disappointing if someone you feel close to isn’t able to have this conversation, is judgmental, or is otherwise unsupportive. But here’s where you aren’t calling all the shots. You don’t have control over how someone else chooses to think, feel, or behave. And for those who won’t deal, it’s their limitation, not yours. Disclosure is a step toward sharing more of your life with people you care about. Support is power. ✜

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Condoms

aren’t the only

answer By todd heyw

o od

HIV prevention has become a twisted mire of ideas and science. But most gay and bi men have heard only one clear message about preventing HIV: Use a condom, correctly and consistently, every time you have sex. But new prevention tools and technology as well as techniques are here. In order to discuss them, we need a common language. Here is an explanation of various risk reduction technologies and their effectiveness.

Drug Interventions

Tools and Technology

Treatment as prevention: Following a large-scale study of heterosexual couples in Africa where one partner was HIVpositive and the other was not, there was a 96 percent reduction in transmission of HIV when a medication regimen had successfully suppressed the viral load—the measure of virus in the blood. As a result the federal government has been scaling up treatment for people living with HIV who are aware of their status as a prevention tool.

Rectal microbicides: Scientists are working feverishly to develop drug-related interventions that can be applied in the anus and prevent infection. Some trials have proven of interest, but nothing has been approved.

PrEP: This is the use of Truvada, a combination pill of two powerful anti-HIV drugs, taken daily to prevent infection in HIVnegative persons. It has been approved for use in men who have sex with men, as well as intravenous drug users and women at high risk. It has proven to be as much as 72.8 percent effective in preventing infection when taken more than 90 percent of the time. PEP: This intervention is the use of three or more anti-HIV drugs taken for 28 days following an exposure to HIV. The regimen must be initiated within 72 hours of the exposure to be successful. No studies provide solid answers on the effectiveness of this intervention, but it is estimated to be 81 percent effective in preventing infection.

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Female condoms: This is a condom that is inserted in either the anus or the vagina. It is large and loose-fitting, and looks like a pocket. Ironically, this was originally designed specifically for anal sex; however, the FDA declined to approve it for that use. Instead makers repurposed the product as a vaginal insert and it was approved. This is currently an off-label use, although several pocket or pouch condoms specifically for anal sex are working their way through the FDA approval process. Rapid HIV testing: Those who are infected but unaware of the infection are significantly more likely to transmit their infection to another. As a result, testing for HIV antibodies is a key tool in preventing HIV. The Centers for Disease Control and Prevention recommends that men who have sex with men be tested every three months for HIV. Knowing one’s status, whether positive or negative, is key in preventing transmission and creating prevention options for people.

pushing past the fear With an undetectable viral load, I have virtually no chance I could transmit HIV to you. But that still remains my greatest worry By BRENDEN SHUCART Risk Reduction Serosorting: This is where a person says he or she will only engage in sexual activity, whether condomless or not, with a person of the same HIV status. In theory this should be effective in preventing new transmissions; however, with the low testing rates and knowledge of actual HIV status in the MSM community, it is not very effective. A study released in 2012 at the 19th Annual Conference on Retroviruses and Opportunistic Infections found this option had only a 51 percent reduction in HIV infections. Either no anal sex at all or 100% condom use: This category was found to be 74 percent effective in reducing HIV infections in the 2012 study. However, a 2013 study from CROI found that condoms are only 70 percent effective in preventing HIV infections, and only if used every time. Inconsistent condom use had no prevention effect.

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Seropositioning: In this risk reduction option, a man who has sex with men determines whether to be top or bottom based on the HIV status of his partner. The person using seropositioning will opt to top for those who are HIV-positive or whose HIV status is unknown or whose test is out of date. It was found in the 2012 study to be 75 percent effective in reducing infections. Top-only: Those who are tops-only during anal sex have an 86 percent reduction in transmission, according to the 2012 CROI study. This may have something to do with the already low risk of insertive anal sex—estimated at .065 percent for a single sexual episode for a top by the CDC. ✜ This article originally appeared in the print and online editions of Between the Lines, Michigan’s LGBT newsweekly, and is available at Pridesource.com.

It happens like this: We’ll meet at a bar or a party, or—just for the sake of argument since I haven’t seen the inside of one in almost five years—at the gym. We will smile and flirt and do our best to charm one another as we share some beers or a few shots, or—again, for the sake of argument—a delicious and healthy fruit smoothie. We will exchange numbers and make plans for later in the week. And when we meet up, we will have a lovely time. The conversation will be easy and free-flowing, the chemistry will be palpable, and at some point—maybe while we are sharing an after-dinner glass of wine, or perhaps during a post-movie moonlit stroll—I will find a way to work into the conversation the fact that I am HIV-positive, and you will come to a full stop. Your eyes will widen slightly and your face will go completely blank as you begin to do a kind of subtle calculus in your head, weighing your culturally ingrained, almost instinctual fear of contracting HIV against your—hopefully considerable—attraction to me. And let me tell you, this moment is just as uncomfortable for me as it is for you—though not for the reasons you might suspect. Because, you see, this isn’t really about the fear that you’ll reject me. The interaction that you and I just participated in—the beers, the moonlit walk, the wide eyes and blank face, all of it—is something you’ve maybe experienced once or twice in your life, if at all. I, on the other hand, have danced this particular dance dozens, if not hundreds, of times since learning in the spring of 2005 that I am living with HIV. And though getting rejected for being HIV-positive never starts being fun at any point, like most things, it gets easier with practice. In some ways, getting rejected by you is the easier course. Whether you politely tell me that you just aren’t comfortable dating a guy with HIV, or excuse yourself to use the bathroom and never come back, after we part ways it’s over, and I never have to think about you again. It is when your mental math ends in a smile and a willingness to take things further that it starts to get complicated. Complicated because at this point you and I have shared some awesome times, and you have proven yourself to be either well-educated or brave enough to see past my serostatus and take a chance on a guy living with HIV. Complicated because I have a thing for interesting, brave, well-educated guys who like beer and moonlit walks, and by now I’m probably starting to crush on you. Complicated because at some point in the near future, you and I are going to be naked together and I am going to come face-to-face with my greatest fear. (No, not clowns, you kinkster.) My greatest fear is that I am going to give you HIV. In fact, I am just as afraid of passing along my virus as you are of contracting it. And that is true for most of the HIV-positive guys I know. It doesn’t matter that, arguably, the safest sex you can have is protected sex—either by PrEP or with condoms—with a guy who is HIV-positive and on meds, and that there is almost no chance that I could transmit the virus to you; I’ve been on antiretroviral medication since 2006, and I’ve maintained an undetectable viral load ever since. My fear is irrational, but there it is. That doesn’t mean that this hypothetical relationship isn’t worth pursuing— all of my serious relationships since seroconverting have been with guys who are HIV-negative. It just means that if you meet me or one of my HIV-positive brothers, be patient with us. And know that when it comes to keeping you HIVnegative, we’re in this together.

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Should I worry about superinfections? Doctors say that even if both partners have HIV, you still need to use condoms during sex to prevent superinfection. Some experts disagree. Robert M. Grant, MD, and J. Jeff McConnell, MA, from the Center for AIDS Prevention Studies at the University of California, San Francisco, help demystify the situation for us.

what we know about hiv superinfection

Why does superinfection matter? Superinfection is a concern because it may be a way for you to acquire drug resistance, and it may lead to more rapid disease progression. People who are HIV-positive and have HIV-positive partners often ask about superinfection. Public health officials need more information, though, in order to craft messages that help explain the risks of unprotected sex among HIV-positive persons, without creating undue anxiety that could undermine rewarding relationships and disclosure of HIV status with prospective new partners. Research on when superinfection may or may not occur could also identify types of immune responses that may protect against infection. This could guide the development of HIV vaccines. Does superinfection really occur? Many scientists believe that superinfection can occur. Research in monkeys has indicated that superinfection with viruses like

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HIV is possible. Scientific literature has so far examined 16 people with SEDI (apparent superinfection), including injection drug users in Asia, women in Africa, and men in Europe and the U.S. Laboratory analysis in some of these reports suggested that the second virus that appeared in these individuals was not present earlier, which suggests superinfection. The sensitivity of these laboratory assays is limited, though, and source partners have not been identified, so there is no way to know for sure when the second virus was acquired. Who is at highest risk? Ninety-five percent of apparent superinfection cases have occurred during the first three years of infection. Studies have found evidence of superinfection in 2 to 5 percent of persons in the first year of infection. Intermittent treatment in acute cases or for those just diagnosed may prolong their susceptibility to superinfection. In contrast, studies of those with longer-term infection have found no evidence of superinfection. One study found no cases after a combined 1,072 years’ worth of observation of its participants. Another found none after 215 person-years of observation among intravenous drug users. A third found none after 233 person-years and 20,859 exposures through unprotected sex. It is possible that having a very low viral load in your blood makes you more susceptible to superinfection. Low viral load can occur during combination antiretroviral therapy or in “healthy nonprogressors.” Antiviral immune responses and viral interference is lower for these people, so superinfection may occur more

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What is dual infection, coinfection, superinfection? Dual infection is when a person is infected with two or more strains of HIV. That person may have acquired both strains simultaneously from a dually infected partner or from multiple partners. A different strain of the virus is one that can be genetically distinguished from the first in a “family,” or phylogenetic tree. Acquisition of HIV strains from multiple partners is often called coinfection if all the strains were acquired prior to your seroconversion, that is, very early before any HIV infection is recognized. Acquisition of different HIV strains from multiple partners is called superinfection if the second virus is acquired after seroconversion. By the way, superinfection and reinfection mean the same thing.

When justice isnâ&#x20AC;&#x2122;t blind Is it any surprise that a majority of HIV-positive transgender people fear criminalization laws? Some startling stats show just what that means for everyone

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By katie peoples

eel like “the man” is out

to get you for being poz? You’re not alone, especially if you’re transgender or third sex. A recent survey revealed that a majority of transgender people are so fearful of criminalization laws that it makes them avoid HIV testing, treatment, and sometimes even disclosure of their positive status to sex partners. The National HIV Criminalization Survey, conducted by the Sero Project, found 58 percent of HIV-positive transgender and third-sex people say it is reasonable to avoid testing for fear of prosecution, compared with 49 percent of cisgender (nontrans) men and 47 percent of cisgender women. The survey also showed that 61 percent of transgender people living with HIV said it was acceptable to avoid disclosure of their status to sex partners, and 48 percent found it reasonable to avoid treatment out of fear of legal penalties. “These findings don’t surprise us,” says Cecilia Chung, senior strategist at the Oakland, Calif.–based Transgender Law Center, in a prepared statement. “The data speaks to the long-standing history of stigmatization and discrimination of trans people, especially trans people of color, by the criminal justice system, because of either their race or their gender identity.” Current law in many states allows for HIV-positive people to be tried as criminals if they keep their status from their sex partners. Because of these laws, many people are hesitant to get tested. Trans respondents were the least likely

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to support criminal penalties for nondisclosure, the survey found. And when deciding if disclosure is warranted, they were most likely to say, “It depends on the circumstances.” In addition, 25 percent of HIV-positive respondents said they knew at least one person who avoided testing for fear of being prosecuted, and 57 percent of HIV-positive transgender and third-sex respondents feared false accusations. Conversely, 74 percent of cisgender women said they “never” worried about that. Pessimism extends even to the judicial system, with fewer than 15 percent of the trans respondents believing that a person with HIV could get a fair trial in a U.S. court. One of the anonymous HIV-positive trans respondents called it “doubtful that I would be given a fair hearing in any court of law.” Another respondent added, “There is so much stigma and miseducation that I feel the bad publicity would unfairly influence the process.” Principal investigator Laurel Sprague says the study shows that when transgender people interact with law enforcement, they expect prosecution rather than protection. The open-ended section of the survey found a number of trans respondents indicating that bias against them, bias against racial minorities, and bias against people living with HIV “all intersected to create a system that would not give them a fair chance at justice,” Sprague says. She notes that the proportion of transgender and third-sex respondents in this study was small—only about 2 percent of the 3,034 surveys—but still very revealing.

“Even with a small sample size, the results from transgender and third-sex respondents are striking in the way they consistently indicate a sense of greater vulnerability to the legal system and less faith in the legal system to treat them fairly,” Sprague says. While many HIV criminalization laws were passed (often decades ago) ostensibly to protect people, most experts today agree they are based on inaccurate or outdated science. For example, in some areas an HIV-positive person could be prosecuted for knowingly infecting a person even if they merely kiss, even though research shows contact with saliva isn’t enough to transmit HIV. The laws also fail to make exceptions for HIVpositive people who use condoms or other safe-sex practices or have undetectable viral loads. The results of the survey should raise alarms for policy makers and public health workers, as the findings show that these laws increase barriers to HIV testing and treatment, not to mention the feelings of vulnerability that transgender people live with. For Bamby Salcedo, coordinator of the HIV Prevention Services Project with Children’s Hospital Los Angeles, the results weren’t surprising. “HIV is one of the things that affects the trans community the most, but it’s really not understood in the judicial system,” she says. Salcedo is herself both trans and HIV-positive, and is the subject of Dante Alencastre’s 2013 documentary Transvisible: The Bamby Salcedo Story. Salcedo says that because HIV is such a widespread problem among transgender people and because so many trans people also work in the sex industry, there is a combination of stigmas that prevents people from getting tested and disclosing their status. For sex workers in particular, disclosure could mean a loss of income. They also face assumptions and discrimination from law enforcement. “I know a couple of people who have had issues with law enforcement,” Salcedo says. “Because HIV and sex work are very prevalent in the trans commu-

nity, law enforcement officers automatically assume that a trans person may be infected, and so one of the first questions that I know they ask trans women is if they are HIV-positive.” The survey also shows the need for access to legal education and services as well as more support for people living with HIV, regardless of their gender and orientation. Salcedo says there are a couple more things that need to be done: train service providers specifically about HIV and the trans population and allocate funding to empower trans people to be open about themselves and obtain services. Policy makers and service providers, she says, really need to be aware of and understand the issues of trans people related to HIV and how serious the problem is in this population. Others point out inequities as well. “We live in a society that is profoundly unjust, with mass incarceration and widespread economic injustice,” says Sean Strub, executive director of the Sero Project, author of Body Counts and founder of Poz magazine. “There are new ways society collectively, through the state, is dividing us, like criminalizing health conditions and finding ways to manipulate and exploit parts of the population.” The findings in the study, according to Strub, show the “tremendous distrust of the criminal justice system” and “should be a wake-up call” because they indicate something is wrong. Strub said it’s obvious that transgender people and their concerns are getting more attention and are benefiting from broader LGBT advocacy, but a long road remains ahead. “Campaigning for justice and equality isn’t a matter of clicking off one box after another; it is a never-ending struggle, requiring constant vigilance as well as an evolving understanding of how we discriminate and oppress parts of our society,” he says. “We need to see a fight for justice as not unique to one part of the population but something that must become part of the lives of everyone.” ✜

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“HIV is one of the things that affects the trans community the most, but it’s really not understood in the judicial system,” Salcedo says.

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OPINION

The Truth About HIV Happy, shiny messages are nice, but they’re not reflective of what it’s like to be positive By DAVID DURAN

David Duran is a Brooklyn-based freelance journalist who focuses his writing on travel, entertainment, LGBT, and HIV topics.

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he truth? It fucking sucks. That’s the deepest and most honest answer someone who is HIVpositive can tell you about living with the disease. Is it manageable and tolerable? Yes, of course. With advancement in treatments, living with HIV does not have to be burdensome, but no one-a-day pill will ever take away the real truth that there is a deep pain felt inside those of us who are positive. I personally know how easy it is to trivialize what it’s truly like to live with HIV. But are we spending too much time glorifying the ease of medication and treatment? Are we convincing others and ourselves that HIV is not as big a deal as it really is? “Get tested.” “Know your status.” “You can take one pill a day.” “Undetectable makes it safe.” These are the phrases that we are pouring over gay youth while “educating” them. Is HIV going to kill you? No, most likely not. Can you live with it, and live a normal life? With treatment adherence, most can. I’m all about showing the world that I am just another person, living a normal life, while also being an HIV-positive man. I feel that I am doing just that. But what I’m guilty of not doing is talking about something that needs to be discussed more by others who are also HIVpositive: the reality that life will never be the same and the mental and social ramifications of having HIV are heartbreaking. Imagine if advocates actually told the truth about how they feel instead of masking their feelings with encouraging anecdotes. If they admitted that self-acceptance comes with a long and dark journey. That disclosing your positive status is one of the most gut-wrenching processes that you will have to repeatedly go through, and it won’t ever get easier. That figuring out how to strategically hide your medicine

bottle so that your friends, neighbors, repair people, and airport security guards don’t see it will become routine. That not knowing the long-term consequences of taking HIV medication will keep you up at night. For me, self-acceptance came after two years of denial, heavy drinking, and abundant anger, shame, and embarrassment. I was a volunteer at an HIV/AIDS organization, so when my status changed overnight, I felt as if I was living a lie and I couldn’t be honest with anyone aside from a few close friends. Being a single man, disclosure is still incredibly difficult. Sometimes it’s just easier to not meet that person or to end an online conversation instead of uttering those three letters. I’d like to say that I no longer feel any shame, but I think there will always be an underlying layer of shame that will remain with me. I’m not a gloomy person. Quite the contrary—I’m generally an outspoken, vibrant, overly happy guy. But I am human, and I have my moments of sadness and depression. And those moments are elevated when the reality of my status makes itself present in my life. Does it hurt? Obviously it does. I put on a brave face and do what I can to help comfort newly diagnosed folks. Listen, it does get better, and the intense mental anguish won’t be forever or as frequent. There’s not much more I can do than just be a resource to those who are new to the club. But when preaching prevention, I’m ready to change my tactics, and I truly hope others are as well. Why not speak about what we are truly feeling? Why not tell our stories of hope and encouragement but also tell the truths of the mental pain HIV causes? Maybe then, those who are fortunate enough to be HIVnegative will take HIV more seriously and stop taking their negative status for granted. ✜

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DA ILY DO SE

putting disappointment behind you Disillusionment and regret are anchors weighing good people down. Here’s how to cut them loose By Gary Mcclain

why keep asking, right? Well, because it’s only human to ask why and to take a look at your life and what living with HIV means. For that reason, asking “Why me?” is a milestone along the road to acceptance. Recognize the blame game. Disappointment usually lays the blame on something outside yourself. Regret lays the blame on your own doorstep. Either way, blame is a losing proposition, because you spin the same story over and over, trying to explain the unexplainable. In the meantime, life is happening all around you. Think of acceptance as “Here I am. Now what can I do?” This is going with the flow instead of struggling against the tide. Decide to focus on what’s possible in your life, beginning with what you can do right now to have a better day. Start each day with gratitude. One of the best antidotes to negative feelings is reminding yourself of what’s good. Focusing on the positive can “rewire” your brain to see the big picture.

Let yourself just feel. When phrases like “if only” and “I never thought” creep into your thoughts and speech, don’t judge yourself for not having the “right” attitude—or hold it all in and hope the disappointment or regret will go away on its own. Talk with someone who won’t judge you.

Be compassionate to yourself. Give yourself credit for having challenges and doing the best you can. Give yourself a break. And remember, you’ve got too much going on to spend time on disappointment and regret.

Don’t avoid the “Why me?” question. Disappointment and regret often lead to the ultimate question: “Why me?” That can be a scary question because it brings up painful feelings. Most likely, you will find the answer is that there isn’t an answer. So

Gary McClain, Ph.D., is a counselor in New York City with a specialty in coping with chronic health conditions. His books include The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy.

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“I

never thought this would happen to me. I didn’t think life would turn out this way. If only I hadn’t [fill in the blank].” These are words of disappointment and regret I hear from clients. I don’t know any person who doesn’t use those phrases from time to time. Life happens, and generally not the way we planned or hoped. Nobody knows this better than someone living with HIV. The disease can bring up all kinds of thoughts and feelings about what you thought your life would be. Disappointment is the perception that you didn’t get what you wanted and the wish that things had turned out differently. Regret is wishing you had made different choices. Disappointment can leave you feeling your life is out of control. With regret, you give yourself the power but also the blame. Either way, disappointment and regret leave you wishing your life were anything but what it is. They go hand in hand with anger, sadness, and guilt. It’s important to remember that disappointment and regret are stops along the road when living with HIV, not places you want to stay. Here’s what to do when you feel disappointment and regret closing in on you:

Continued from page 44 frequently. More research is needed to know for sure.

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Is it bad to have more than one virus? Dual infection can have a harmful effect on your health. Superinfected individuals may have higher viral loads and lower CD4 counts, which causes more rapid disease progression. And the disease’s progression can accelerate after a second virus appears. Superinfection may also affect treatment of HIV, as it increases the likelihood of drug resistance, and you may not respond as well to available antiretroviral medication due to resistant strains. What don’t we know? There is a lot we still do not know about superinfection. First of all, we need to be more sure about whether superinfection actually occurs between HIV-positive persons. A definitive case of superinfection has not been documented, which would require that the timing of the second infection be traced to a relationship with a new sexual partner. Second, we need to understand how and when superinfection occurs. Among researchers some consensus is developing about the idea that HIVpositive persons in early infection—and particularly the first year of infection—may be at higher risk for superinfection than others. We also should determine whether people with suppressed viral load on treatment are more susceptible to superinfection. Third, we need to know how to protect against superinfection. If superinfection is rare, or if it only happens in recent infection, it is important to determine what makes an HIV-positive person immune to acquiring a second virus. It would be important to know, for example, if exposure to dif-

ferent viral strains may provide protective immunity against superinfection. Lastly, we must continue to provide up-to-date scientific data on superinfection, its causes and consequences to HIV-positive people and health care professionals who work with them. What do you recommend right now? Counseling about superinfection should be based on understanding an individual’s sexual relationships. Before providing advice about superinfection, a counselor should know whether you are in a continuing relationship with another HIV-positive partner, whether you routinely seek out other HIV-positive partners for unprotected sex, and whether there is disclosure of HIV status with prospective partners. This background should inform the discussion about the risks and benefits of sex among HIV-positive partners. If the counselor does not have time to consider these personal issues, it would probably be best to simply say, “There is not enough information available about superinfection. If superinfection occurs at all, it probably occurs in the first few years after infection. After that, it may be rare.” Even less is known about superinfection as a result of sharing needles, although it is reasonable to expect the same pattern of initial high risk followed by low risk during chronic infection. However, because intravenous drug users are at high risk of hepatitis C infections from sharing needles, efforts to obtain clean needles through needle exchange should always be emphasized. People with multiple sexual partners, or partners with multiple partners, should be counseled regarding the risks of other sexually transmitted infections. Vaccination for hepatitis B and periodic testing for syphilis is warranted. ✜

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The Search for a Vaccine The work of top Israeli HIV researcher Ron Diskin looks at rare antibodies that could treat or prevent HIV and is proceeding at a swift pace By trudy ring

he search for a cure or vaccine for HIV hasn’t always inspired optimism—but hopes are buoyed now by recent advances, including a new understanding about how certain rare antibodies can fight the virus. “There has been a substantial amount of research that has already been done” since scientists isolated some such antibodies in 2009 and 2010, says Ron Diskin, a biomedical researcher at the Weizmann Institute of Science in Rehovot, Israel, who recently visited the U.S. to share some of his findings and participate in a variety of HIV awareness efforts with the Consulate General of Israel in Los Angeles. These antibodies, which occur in roughly 10 percent to 20 percent of people with HIV, are able to block many strains of the virus, which mutates rapidly and can therefore resist other antibodies produced by the human immune system. This special class of antibodies is therefore known as broadly neutralizing antibodies. Researchers have known for some time that a small number of people with HIV produced broadly neutralizing antibodies, usually long after they were infected, even though these antibodies did not always prevent their disease from progressing. Scientists believe, though, that broadly neutralizing antibodies could be used in a vaccine to prevent HIV from taking hold in the first place. Some, including Diskin, think it could also eventually be used in treatment, replacing antiretroviral medications. Or, perhaps, human

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cells could be reprogrammed to produce the antibodies, he says. Scientists isolated several new broadly neutralizing antibodies in 2009 and 2010, including one that can block more than 90 percent of the strains of the virus. Since then, researchers have been analyzing these agents to find out how they work—how they recognize and neutralize HIV, how the body produces them, and even how they can be made stronger. In 2011, while doing postdoctoral research at the California Institute of Technology, Diskin was part of a team that modified an antibody called NIH45-46 to make it more effective in stopping HIV from entering cells. “We took something that was already extremely good and made it better,” he says. Others pursuing research on broadly neutralizing antibodies include Rockefeller University, a partner with the Weizmann Institute; the National Institutes of Health; and the Scripps Research Institute, which has a partnership with the International AIDS Vaccine Initiative. Diskin emphasizes that what he is doing is “basic research” into the antibodies’ properties; it will be up to others to develop them into products that can then be tested, eventually, on humans. But that’s not necessarily far off, he says. “In maybe three to five years we will have our first clinical data,” he predicts. And there is precedent—there are numerous antibody-based treatments for other diseases, primarily cancer, that are already in use. And various other types of basic

research done by the Weizmann Institute have led to the production of many prescription drugs, such as Copaxone, used to treat multiple sclerosis. Indeed, the institute’s research has formed the basis for seven of the 25 most-prescribed drugs in the world, according to Weizmann officials. At other institutions, recent advances in HIV antibody research include an NIH-funded study at Duke University that tracked how the virus and the strong antibody response evolved together in one HIV-infected person. This knowledge, according to the NIH, will help scientists in an effort to develop a vaccine that mimics the virus to generate broadly neutralizing antibodies, first in uninfected animals and then in uninfected people. Whatever type of vaccine is developed, Diskin says, it may turn out that one dose is not enough to keep HIV at bay; “booster shots” may be needed. He also thinks antibody-based treatment might be able to replace antiretroviral drugs in suppressing the virus, not for all patients, but perhaps for some. “That’s a very interesting possibility,” he says. Diskin, a native of Jerusalem, has been involved in HIV antibody research since 2010, having entered the effort at Caltech before joining the Weizmann Institute in September 2012. He had not thought of going into the field, he says, until Caltech biology professor Pamela Bjorkman asked him to join her lab’s effort. “I realized that would be a perfect project for me,” he says, as it’s culturally relevant and has the potential to make a significant impact. Before visiting Los Angeles, Diskin attended the AIDS Vaccine Conference in Barcelona, Spain, where he was encouraged to see so much research being pursued so enthusiastically. “I’m overwhelmed with the amount of research that was done and the achievements that have been made,” he says. One highlight of the conference was a report on a trial of a vaccine called RV144, which showed at least a modest degree of success in preventing HIV infection. This vaccine uses ordinary antibodies, not broadly neutralizing ones. What’s more, he says, it was obvious that much research into broadly neutralizing antibodies was going on. Diskin says the effort involves both collaboration and cooperation among scientific institutions. “There is a lot of cooperation because the magnitude of the task is enormous,” he says. “There is a lot of competition, also. Competition is not necessarily a bad thing—it stimulates the field and forces people to be efficient.” And he’s optimistic that the work will be productive. “We’re talking about a lot of time and a lot of effort,” he says, “but at least it seems we’re heading the right way.” ✜

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