Plus 125 July August 2018

2018 TREATMENT GUIDE

BECAUSE YOU’RE MORE THAN YOUR STATUS

THE CURIOUS CASE OF TV’S KARL SCHMID YES, COMING OUT POZ HAS MADE THIS ABC REPORTER EVEN HOTTER

00_PLUS125_Cover_FINAL_rev.indd 1

JULY/AUGUST 2018 www.hivplusmag.com

5/16/18 8:08 AM

What is BIKTARVY®?

BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements.

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about BIKTARVY? BIKTARVY may cause serious side effects: ` Worsening of hepatitis B (HBV) infection.

If you have both HIV-1 and HBV and stop taking BIKTARVY, your HBV may suddenly get worse. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to monitor your health.

Who should not take BIKTARVY? Do not take BIKTARVY if you take: ` dofetilide ` rifampin ` any other medicines to treat HIV-1

What are the other possible side effects of BIKTARVY? Serious side effects of BIKTARVY may also include: ` Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY. ` Kidney problems, including kidney failure.

Your healthcare provider should do blood and urine tests to check your kidneys.

If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY. ` Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death.

Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. ` Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (5%), and headache (5%). 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 BIKTARVY? ` All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection. ` All the medicines you take, including prescription and over-the-counter medicines, antacids, laxatives, vitamins, and herbal supplements. BIKTARVY and other medicines may affect each other. Keep a list of all your medicines and show it to your healthcare provider and pharmacist, and ask if it is safe to take BIKTARVY with all of your other medicines. ` If you are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY. ` If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

B

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.

Ask your healthcare provider if BIKTARVY is right for you.

Please see Important Facts about BIKTARVY, including important warnings, on the following page.

GILC0396_BIKTARVY_A_7-875x10-5_Plus_KeepShining_r1v1jl.indd 2-3 18650 Biktarvy Plus 125 spread.indd 2

5/8/18 4:34 PM

Get HIV support by downloading a free app at MyDailyCharge.com

KEEP SHINING. Because HIV doesn’t change who you are.

BIKTARVY is a 1-pill, once-a-day complete HIV-1 treatment for adults who are either new to treatment or whose healthcare provider determines they can replace their current HIV-1 medicines with BIKTARVY.

BIKTARVY does not cure HIV-1 or AIDS.

BIKTARVY.COM

18650 Biktarvy Plus 125 spread.indd 3

5/7/18 11:47 AM 5/8/18 4:34 PM

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

(bik-TAR-vee) MOST IMPORTANT INFORMATION ABOUT BIKTARVY BIKTARVY may cause serious side L LJ[Z PUJS\KPUN! ₔ Worsening of hepatitis B (HBV) infection. 0M `V\ OH]L IV[O /0= HUK /)= `V\Y /)= TH` Z\KKLUS` NL[ ^VYZL PM `V\ Z[VW [HRPUN )02;(9=@ +V UV[ Z[VW [HRPUN )02;(9=@ ^P[OV\[ ÄYZ[ [HSRPUN [V `V\Y OLHS[OJHYL WYV]PKLY HZ [OL` ^PSS ULLK [V JOLJR `V\Y OLHS[O YLN\SHYS` MVY ZL]LYHS TVU[OZ

ABOUT BIKTARVY )02;(9=@ PZ H JVTWSL[L WPSS VUJL H KH` WYLZJYPW[PVU TLKPJPUL \ZLK [V [YLH[ /0= PU HK\S[Z 0[ JHU LP[OLY IL \ZLK PU WLVWSL ^OV OH]L UL]LY [HRLU /0= TLKPJPULZ ILMVYL VY WLVWSL ^OV HYL YLWSHJPUN [OLPY J\YYLU[ /0= TLKPJPULZ HUK ^OVZL OLHS[OJHYL WYV]PKLY KL[LYTPULZ [OL` TLL[ JLY[HPU YLX\PYLTLU[Z BIKTARVY does not cure HIV-1 or AIDS. /0= PZ [OL ]PY\Z [OH[ JH\ZLZ (0+: Do NOT take BIKTARVY if you also take a medicine [OH[ JVU[HPUZ! â‚” KVML[PSPKL â‚” YPMHTWPU â‚” HU` V[OLY TLKPJPULZ [V [YLH[ /0=

BEFORE TAKING BIKTARVY Tell your healthcare provider all your medical JVUKP[PVUZ PUJS\KPUN PM `V\! â‚” /H]L VY OH]L OHK HU` RPKUL` VY SP]LY WYVISLTZ PUJS\KPUN OLWH[P[PZ PUMLJ[PVU â‚” (YL WYLNUHU[ VY WSHU [V ILJVTL WYLNUHU[ â‚” (YL IYLHZ[MLLKPUN U\YZPUN VY WSHU [V IYLHZ[MLLK +V UV[ IYLHZ[MLLK PM `V\ OH]L /0= ILJH\ZL VM [OL YPZR VM WHZZPUN /0= [V `V\Y IHI` Tell your healthcare provider about all the TLKPJPULZ `V\ [HRL! â‚” 2LLW H SPZ[ [OH[ PUJS\KLZ HSS WYLZJYPW[PVU HUK V]LY [OL JV\U[LY TLKPJPULZ HU[HJPKZ SH_H[P]LZ ]P[HTPUZ HUK OLYIHS Z\WWSLTLU[Z HUK ZOV^ P[ [V `V\Y OLHS[OJHYL WYV]PKLY HUK WOHYTHJPZ[ â‚” (ZR `V\Y OLHS[OJHYL WYV]PKLY VY WOHYTHJPZ[ HIV\[ TLKPJPULZ [OH[ PU[LYHJ[ ^P[O )02;(9=@

POSSIBLE SIDE EFFECTS OF BIKTARVY BIKTARVY can cause serious side L LJ[Z PUJS\KPUN! ₔ ;OVZL PU [OL ¸4VZ[ 0TWVY[HU[ 0UMVYTH[PVU (IV\[ )02;(9=@¹ ZLJ[PVU ₔ *OHUNLZ PU `V\Y PTT\UL Z`Z[LT ₔ 5L^ VY ^VYZL RPKUL` WYVISLTZ PUJS\KPUN RPKUL` MHPS\YL ₔ ;VV T\JO SHJ[PJ HJPK PU `V\Y ISVVK SHJ[PJ HJPKVZPZ ^OPJO PZ H ZLYPV\Z I\[ YHYL TLKPJHS LTLYNLUJ` [OH[ JHU SLHK [V KLH[O ;LSS `V\Y OLHS[OJHYL WYV]PKLY YPNO[ H^H` PM `V\ NL[ [OLZL Z`TW[VTZ! ^LHRULZZ VY ILPUN TVYL [PYLK [OHU \Z\HS \U\Z\HS T\ZJSL WHPU ILPUN ZOVY[ VM IYLH[O VY MHZ[ IYLH[OPUN Z[VTHJO WHPU ^P[O UH\ZLH HUK ]VTP[PUN JVSK VY IS\L OHUKZ HUK MLL[ MLLS KPaa` VY SPNO[OLHKLK VY H MHZ[ VY HIUVYTHS OLHY[ILH[ ₔ :L]LYL SP]LY WYVISLTZ ^OPJO PU YHYL JHZLZ JHU SLHK [V KLH[O ;LSS `V\Y OLHS[OJHYL WYV]PKLY YPNO[ H^H` PM `V\ NL[ [OLZL Z`TW[VTZ! ZRPU VY [OL ^OP[L WHY[ VM `V\Y L`LZ [\YUZ `LSSV^ KHYR ¸[LH JVSVYLK¹ \YPUL SPNO[ JVSVYLK Z[VVSZ SVZZ VM HWWL[P[L MVY ZL]LYHS KH`Z VY SVUNLY UH\ZLH VY Z[VTHJO HYLH WHPU ₔ ;OL TVZ[ JVTTVU ZPKL L LJ[Z VM )02;(9=@ PU JSPUPJHS Z[\KPLZ ^LYL KPHYYOLH UH\ZLH

HUK OLHKHJOL

;OLZL HYL UV[ HSS [OL WVZZPISL ZPKL L LJ[Z VM )02;(9=@ ;LSS `V\Y OLHS[OJHYL WYV]PKLY YPNO[ H^H` PM `V\ OH]L HU` UL^ Z`TW[VTZ ^OPSL [HRPUN )02;(9=@ Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.

HOW TO TAKE BIKTARVY ;HRL )02;(9=@ [PTL LHJO KH` ^P[O VY ^P[OV\[ MVVK

GET MORE INFORMATION â‚” ;OPZ PZ VUS` H IYPLM Z\TTHY` VM PTWVY[HU[ PUMVYTH[PVU HIV\[ )02;(9=@ ;HSR [V `V\Y OLHS[OJHYL WYV]PKLY VY WOHYTHJPZ[ [V SLHYU TVYL â‚” .V [V )02;(9=@ JVT VY JHSS .03,(+ â‚” 0M `V\ ULLK OLSW WH`PUN MVY `V\Y TLKPJPUL ]PZP[ )02;(9=@ JVT MVY WYVNYHT PUMVYTH[PVU

)02;(9=@ [OL )02;(9=@ 3VNV +(03@ */(9., [OL +(03@ */(9., 3VNV 36=, >/(;»: 05:0+, .03,(+ HUK [OL .03,(+ 3VNV HYL [YHKLTHYRZ VM .PSLHK :JPLUJLZ 0UJ VY P[Z YLSH[LK JVTWHUPLZ =LYZPVU KH[L! -LIY\HY` .PSLHK :JPLUJLZ 0UJ (SS YPNO[Z YLZLY]LK .03*

GILC0396_BIKTARVY_A_7-875x10-5_Plus_KeepShining_r1v1jl.indd 4 18651 Biktarvy Plus 125 PI.indd 1

5/7/18 11:47 AM 5/8/18 4:34 PM

IN THIS ISSUE JULY/AUGUST 2018

28 26

30 LUKE FONTANA (SCHMID); TIM DANIELS (ABIF); COURTESY OF JACK MACKENROTH (MACKENROTH)

ON THE COVER

30 MAD ABOUT SCHMID ABC reporter and former cohost of Logo's Operation Vacation, Karl Schmid came out HIV-positive on social media, breaking the mold of what it means to be poz, out, and proud.

OUR ANNUAL TREATMENT GUIDE 36 KNOW YOUR MEDS Consider yourself informed on the most commonly prescribed, FDA-approved drugs on the market for HIV and associated conditions.

40 CLASSY The types of HIV drugs explained.

43 THE FRESHMEN Newly approved HIV meds.

46 FUTURAMA Sneak a peek at breakthrough drugs currently in the works.

48 TALK THERAPY How to talk to your doc about antidepressants.

OTHER FEATURES 16

BROTHER TO BROTHER Peer-to-peer HIV prevention works, in the U.S. and Russia.

20 SWEET HOME ALABAMA Fighting HIV stigma and providing care in the rural South.

26 MACK DADDY Jack Mackenroth bares all.

28

ACT UP Khafre Abif says you too can create change. Here's how

Cover and above left: Karl Schmid photographed by Luke Fontana. Activists (above right, from top): Khafre Abif and Jack Mackenroth.

HIVPLUSMAG.COM

03-07_PLUS125_TOC_FINAL.indd 3

3

5/16/18 8:27 AM

Your pharmacist can make a

real difference People may know their neighborhood pharmacist as someone in a white coat who fills pill bottles.

In reality, pharmacists can also be great sources of personal support and medication guidance. They are close by and able to answer questions without an appointment. Whether you are newly diagnosed or have been living with HIV for years, he or she can help you manage, afford and get the most from your medications.

Helping you stay on track Taking your medications on time, in the correct dose and in the right way can be big factors in making sure they stay effective.

Your pharmacist can help you identify any barriers that may keep you from staying on track.

Walgreens has convenient digital tools that can help, such as pill reminders and the ability to set up refills by email or text.*

Helping you afford your medications

Helping you manage multiple medications

Many medications, including those for HIV, can be costly with high copays, which can make it hard to stay on your treatment plan. The good news is that there are copay assistance sources and even manufacturer programs that can help bring costs down.

Ask your Walgreens pharmacist about these programs. He or she can help you find them and even help you apply.

Pharmacists can help you manage medications for all health conditions, and can even work with you to arrange a same-day refill so you can pick up all your medications at the same time.

To learn more about Walgreens HIV services, visit HIV.Walgreens.com.

*Message and data rates may apply. Ongoing texts may be sent using an automatic telephone dialing system when prescriptions are ready for pickup and refill. Consent not required for purchase.

Reply STOP to cancel or HELP for help. ©2018 Walgreen Co. All rights reserved.

18580 Wallgreens Advertorial.indd 1

657159-197

0218

3/8/18 2:56 PM

Let their courage encourage you Let’s Grow Old Together Your status is part of your story, but you are much more than your diagnosis.

Watch how others found the strength to share their HIV diagnosis at Walgreens.com/LetsGrowOldTogether.

Š2018 Walgreen Co. All rights reserved.

18652 walgreens PLUS 125.indd 1

698805-843

5/8/18 4:44 PM

Look Who’s Wearing That AIDS Memorial Tee

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

creative director RAINE BASCOS associate art director PATRICK MADISON deputy editor JACOB ANDERSON-MINSHALL senior editor SAVAS ABADSIDIS managing editor DAVID ARTAVIA associate editor DESIRÉE GUERRERO assistant to the editor DONALD PADGETT contributing editors KHAFRE ABIF, TYLER CURRY, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writers JACOB OGLES, BORIS ABRAMS, BENJAMIN M. ADAMS, ALEXANDER CHEVES creative director, digital media DAVE JOHNSON interactive art director CHRISTOPHER HARRITY online photo and graphics producer MICHAEL LUONG, TEVY KHOU front end developer MAYRA URRUTIA senior drupal developer NICHOLAS ALIPAZ, SR. traffic manager KEVIN BISSADA manager, digital media LAURA VILLELA svp, publishing, integrated partnerships GREG BROSSIA senior director, integrated partnerships STUART BROCKINGTON directors, integrated partnerships TARA DABUNI, ADAM GOLDBERG, NOREEN MURRAY director, integrated marketing BRANDON GRANT associate directors, integrated marketing JAMIE TREDWELL, ANDREW PARK senior manager, integrated marketing ERIC JAMES managers, integrated marketing GRETA LIBBEY, CASEY NOBLE associate director, events JOHN O’MALLEY designer, integrated marketing MICHAEL LOMBARDO coordinator, integrated sales & marketing HAYLEY YATES senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director of social and branded content LEVI CHAMBERS editor, social media DANIEL REYNOLDS branded content producer LENNY GERARD branded content writer IAN MARTELLA senior fulfillment manager ARGUS GALINDO operations director KIRK PACHECO office manager HEIDI MEDINA print production director JOHN LEWIS

6

ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions Fax (212) 242-8338 LOS ANGELES EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES Retrograde Communications • Phone (951) 927-8727 Email editor@HIVPlusMag.com FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To subscribe, visit HIVPlusMag.com/signup.

There is a 10-copy minimum.

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

NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, please email our circulation department at Argus.Galindo@pridemedia.com.

Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc. Plus is a registered trademark of Here Publishing Inc.

Entire contents © 2018 by Here Publishing Inc. All rights reserved. Printed in the USA. FOLLOW US ON FACEBOOK AND TWITTER

Facebook.com/ HIVPlusMag

Twitter.com/ HIVPlusMag

COURTESY SUBJECT/FACEBOOK

Check out our cover star, Karl Schmid (top) looking especially hunky in an AIDS Memorial T-shirt. The TV reporter posted the photo on Facebook along with a caption revealing he is HIVpositive and it soon went viral. The all-queer cast (bottom) of Broadway’s The Boys in the Band—which includes Matt Bomer, Zachary Quinto, and Jim Parsons—were also seen sporting the tee and supporting the cause in an Instagram post. The T-shirt itself is the funding vehicle for a collaborative campaign between The AIDS Memorial Project (@TheAIDSMemorialTshirt) and artist Zach Grear (@ZachGrearArt) and sales benefit Housing Works (HousingWorks.org), an organization focused on addressing the issue of homelessness and HIV.

PRIDE MEDIA chief executive officer NATHAN COYLE president LUCAS GRINDLEY executive vice presidents JOE LANDRY, BERNARD ROOK senior vice presidents GREG BROSSIA, JOE VALENTINO vice president ERIC BUI human resources ANTIOUSE BOARDRAYE

JULY / AUGUST 2018

06_PLUS125_Masthead_FINAL.indd 6

5/15/18 8:41 AM

IN THIS ISSUE JULY/AUGUST 2018

56

11

SHUTTERSTOCK (11, 15); AP PHOTO/ARIANA CUBILLOS (10)

10

BUZZWORTHY

BACK TALK

10 TRIBE IN TROUBLE As Venezuela's crisis deepens, a deadly AIDS crisis puts the country's indigenous population at risk.

15 FLASHBACK TO THE '80S In her new film, 1985, Virginia Madsen plays a mother whose son is dying of AIDS complications. In real life, her uncle did as well.

11 CHEERLEADERS Celebrities show their appreciation for funding to fight HIV in the South.

DAILY DOSE

56 TRUTH OF MY YOUTH Tyler Curry finds coming out stops bullies—in high school and much, much later.

FAMILY

52 TIMES SQUARE How a weekend with mom inspired one AIDS Walk participant.

RESISTANCE

54 POSITIVE THINKER Even being kept from his HIV meds didn't break his positive point of view.

Above (from left): Kandi Burruss; refusing to listen; and AIDS in Venezuela.

HIVPLUSMAG.COM

03-07_PLUS125_TOC_FINAL.indd 7

7

5/24/18 3:24 PM

EDITOR’S LETTER

athlete, or other notable figure comes out about living with HIV, there’s a spike in visibility. Public awareness goes up, and so does the number of people getting tested and treated for HIV. It’s been this way since the beginning.

From Magic Johnson (in 1991) to Charlie Sheen (in 2015), each new celebrity (voluntarily) coming out has helped move public understanding and empathy a bit farther along. In

OUR ANNUAL HIV TREATMENT GUIDE

BECAUSE YOU’RE MORE THAN YOUR STATUS

TV’S CAPTIVATING KARL SCHMID

BECAUSE YOU’RE MORE THAN YOUR STATUS

YOUR ANNUAL TREATMENT GUIDE IS HERE

TOO SEXY FOR THIS SUIT

COMING OUT POZ MADE THIS RED CARPET REPORTER EVEN SEXIER

BECAUSE YOU’RE MORE THAN YOUR STATUS

BACKTALK FROM JACK MACKENROTH VIRGINIA MADSEN ANNUAL HIV TREATMENT GUIDE

CAN WE TALK?

COMING OUT POZ MADE TV REPORTER KARL SCHMID EVEN HOTTER

TV REPORTER KARL SCHMID IS OUT, PROUD, AND LIVING WITH HIV

JULY/AUGUST 2018 www.hivplusmag.com

JULY/AUGUST 2018 www.hivplusmag.com

WHICH COVER IS YOUR FAVORITE? 8

JULY/AUGUST 2018 www.hivplusmag.com

children’s TV shows in the region, What Now? His first taste of fame was appearing on Neighbours, the long-running Australian soap that also produced Kylie Minogue, Russell Crowe, and Guy Pierce. The Aussie show was so big in the U.K. during the ‘80s, that the entire cast was flown in to perform for the Queen.

Today, covering the glamour of Hollywood, Schmid is a far cry from the kid who’d pretend to be a TV host—practicing saying, “Goodnight, Australia”—each night before bed.

He’s hearing from fans worldwide that were inspired by him coming out poz. Still, Schmid can hardly believe a picture of him in an AIDS Memorial T-shirt had such an impact.

“Honestly, part of me is flattered and I am proud, but I’m also sorry,” he told Plus. “Sorry that in this day and age, this is still such a big deal.

We are not doing enough and haven’t come far enough to fight the stigma around HIV.” Hear, hear! Glad to have this hunky activist publicly joining the fight against stigma and shame.

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

Every time photographer Luke Fontana shoots our cover, I end up playing a fashion face-off akin to the “Who Wore it Better?” other mags run. I’m not comparing different people, though, but multiple shots of our cover star wearing various outfits. With our resident stylist Aisha Rae (and her assistant Angel Cross) on set, there’s always bitchin’ outfits to choose from. Eventually, after a round of debates, there’s usually an Aha! moment, and I know which photo to pick as the cover.

This issue, however, was a tough call. As we head to press, I’m still not sure. What do you think?

Contact Editor@HIVPlusMag.com or @HIVPlusMag on social media and tell us your fave!

TONY DONALDSON (ANDERSON-MINSHALL); LUKE FONTANA (SCHMID)

EVERY TIME AN actor, politician,

this issue we talk to one of the earliest reality stars to come out poz as well as the latest TV star (well, reporter) to come out, too.

Insta hunk Jack Mackenroth, who came out on Bravo’s Project Runway in 2008 (the first out poz designer on the show), revisits his last decade of HIV activism in our interview on page 26. The designer, model, and champion swimmer is also an actor (he played hot guy number 17 in the Sex and the City movie), and an activist (creating HIV Equal and the HIV “Shower Selfie” Challenge). But as he inches towards 50, he says he’s moving away from his earlier work.

Meanwhile, our equally handsome cover star, Karl Schmid, is just coming out—jumping into activism and advocacy in a brand new way (check out our interview with him on page 30). You might have already seen Schmid, a TV reporter for ABC in Los Angeles, chatting with celebs on the red carpet. In the 10 years that Mackenroth has been an activist, Schmid has been toying with the idea of coming out—generally with industry insiders warning him not to. When he chose to come out in a simple Facebook post, the photo went viral in part because of timing, but also because Schmid was born to be in front of the camera.

As a child actor in Australia, Fiji, and New Zealand, Schmid starred as host of one of the top live-action

JULY / AUGUST 2018

08_PLUS125_EdLetter_FINAL_REVISED.indd 8

5/16/18 9:01 AM

we Play Sure PP ep ep + + Condoms Condoms #PlaySure #PlaySure

BE HIV & STI Sure BE HIV & STI Sure If you are HIV negative, PrEP is a daily pill that protects you from HIV. Condoms add If youprotection are HIV negative, is a help dailyprevent pill thatother protects you from HIV. Condoms add more againstPrEP HIV and Sexually Transmitted Infections. more protection against HIV healthy and helpand prevent other Infections.

Combine these tools to stay prevent theSexually spread ofTransmitted HIV and other STIs. Combine these tools to stay healthy and prevent the spread of HIV and other STIs. PLAY SURE: Call 311 or visit nyc.gov/health to design the right PLAY SURE: 311 or visit nyc.gov/health to design the right HIV and STI Call prevention combination for you.

HIV and STI prevention combination for you.

Bill de Blasio Mayor Bill deT.Blasio Mary Bassett, MD, MPH Mayor Commissioner Mary T. Bassett, MD, MPH Commissioner

BUZZWORTHY

AIDS THREATENS VENEZUELA’S INDIGENOUS POPULATION

W

hile HIV rates continue to decline in many parts of the world, Venezuela’s are climbing, due to unprecedented political instability. The indigenous Warao people who live near the Orinoco Delta are among those struggling to locate the most basic HIV medicine and care, and it’s putting Venezuela’s ancient indigenous culture at risk.

Starting in 2013, under the regime of President Nicolás Maduro, the nation’s economy plummeted and doctors began to flee for better lives elsewhere— leaving Venezuela’s once worldclass health care system in shambles. The nation’s indigenous peoples are left experiencing the brunt of this collapse.

Warao community leaders say the Venezuelan government 10

is completely ignoring the HIV epidemic they are facing.

Previously, the community received a minimal number of free condoms from the government, but even that limited support has ended. Venezuelan HIV activists say that diagnosis rates have skyrocketed, but state-approved HIV announcements—which are sporadic and often misleading— claim otherwise.

“If there’s no intervention, it’s going to affect the existence of the Warao,” Dr. Jacobus de Waard, an expert in infectious diseases at the Central University of Venezuela told The New York Times. “A part of the population is going to disappear.”

There is no way of sugar-coating the situation the Warao currently face. A 2013 study published in the journal AIDS indicated that nearly 10 percent of

the Warao adults living in eight villages in the Orinoco River delta are HIV-positive, a dramatic departure from the relatively low prevalence in other South American communities. Jobure de Guayo is one of the villages most impacted, said Rafael Pequeño, a nurse who helped treat the Warao two years ago. He’s familiar with the declining availability of HIV treatment—and its ramifications.

When he recently returned to Jobure de Guayo, 20 percent of the villagers living with HIV had succumbed to AIDS complications.

According to the Times, a criminal organization has taken control over the region’s gasoline flow, further limiting access to HIV medicine.

Not too long ago, Venezuela’s health care system was world class, before the true impact of Hugo Chávez’s mismanagement of

AP PHOTO/ARIANA CUBILLOS

An entire culture is at risk due to failing government programs.

JULY / AUGUST 2018

10-11_PLUS125_Buzzworthy_FINAL.indd 10

5/15/18 3:41 PM

nation’s oil reserves became apparent. Since his death, Venezuela’s economy has crumbled, causing crippling shortages of HIV medications. The ramifications of disrupting access to antiretrovirals is that more and more poz Venezuelans are seeing their HIV progress to stage 3 (AIDS). The more remote people are, the more difficult it is for them to access appropriate care.

The situation is dire, and goes well beyond HIV. In fact, there are shortages for up to 80 to 95 percent of all medications in Venezuela. The country is seeing HIV rates it hasn’t had since the 1980s, during

the peak of the epidemic—and before modern antiretrovirals were available to control the virus.

StopVIH is one of the few organizations still operating in Venezuela dedicated to controlling HIV. It provides reliable and unbiased news about positive and negative developments regarding HIV in Venezuela, and is covering the situation in indigenous communities. Until someone steps in to address these problems, the Warao people will continue lacking medication they need to ensure their culture’s health and safety.—BENJAMIN M. ADAMS

Waiting at the Doctor’s Office?

SHUTTERSTOCK (CELEBS AND GRAPHIC)

More Than Selfies, Celebs take to social media to boost an HIV cause.

The news that 12 organizations in the South will receive $625,000 in an effort to address the disproportionate impact of the HIV epidemic on young people and communities of color, sent celebs to Twitter to celebrate. The series of grants are a collaboration of The Elton John AIDS Foundation, The Elizabeth Taylor AIDS Foundation, and the Aileen Getty Foundation.

It’s the largest philanthropic partnership addressing HIV in the Southern United States.

“By bringing particular focus on the needs and aspirations of young people and communities of color, and by delivering support to communityrooted organizations that have been engaging the epidemic for years, this partnership has incredible potential to reduce transmissions, improve quality of life, and speed the South’s progress toward an AIDS-free generation,” says EJAF Chairman David Furnish. After the announcement, these celebs tweeted out their excitement.

—DAVID ARTAVIA

30%

1

Of people have walked out of a doctor’s office, missing their appointment, due to long wait times.

1 in 5

3 2

People have changed doctors because of long wait times.

4

5

18 minutes Average doctor visit wait time.

Source: Vitals Physician Wait Time Report, 2018.

1. Paul Janeway, @StP_BrokenBones 2. Ellen DeGeneres, @TheEllenShow 3. Brittany Howard, @Alabama_Shakes 4. Kristin Chenoweth, @KChenoweth 5. Kandi Burruss, @Kandi

HIVPLUSMAG.COM

10-11_PLUS125_Buzzworthy_FINAL.indd 11

11

5/15/18 3:42 PM

How long will it take for the world to be fully educated on HIV? 16

SHUTTERSTOCK

THE FUTURE OF HIV PREVENTION

T H E R O O M W A S filled with a group of charismatic men, all warm, funny, wellliked, and well-connected in Milwaukee’s LGBT community. While they were already influential in their respective social circles, together they would become the lynchpin in an HIV intervention project led by the Center for AIDS Intervention Research (CAIR) at the Medical College of Wisconsin.

The recent project included about 600 gay or bisexual black men in Milwaukee and Cleveland. “One of the challenges is how do you reach people who are hidden in the community with prevention messages and interventions, especially when they want to stay hidden,”

JULY / AUGUST 2018

16-19_PLUS125_FEA_HIV Prevention_FINAL.indd 16

5/15/18 8:54 AM

intervention reduced participants’ risk behaviors and rates of syphilis—the latter is important because syphilis can make a person living with HIV more likely to transmit the virus to someone else.

“People like to see they’re part of the solution,” Kelly explains. “There’s a lot of power if you tap into people’s desire to help.”

notes Jeffrey Kelly, PhD, a MCW professor of psychiatry and behavioral medicine and the director of CAIR. The answer is through friends. CAIR first reached out to dozens of gay and bisexual black men who were well-known and trusted in their social circles. The message was simple: “We want to save lives, and you can help.”

Armed with brochures on HIV prevention and advice on how to talk to one another about the issue, the men then recruited their friends, and those men subsequently brought in others.

Eventually, the peer-to-peer project reached hundreds of people almost entirely through social networking. Researchers found that this

LIFE-SAVING RESEARCH That project is just one example of how CAIR’s work is having an impact on HIV and AIDS in Wisconsin and around the world. With partner programs in Russia, the Ukraine, Hungary, Bulgaria, and El Salvador, CAIR has designed and tested interventions to prevent new HIV diagnoses, increase treatment rates for those already diagnosed, and share the latest insights from prevention research with HIV service providers on the front lines.

CAIR is one of just a few federally-funded centers focused on behavioral interventions to stop the spread of HIV, and it’s the only one not located on one of America’s coasts. Over the past 23 years, the CAIR team has brought in more than $150 million in funding and published over a thousand research papers. The center’s 12 full-time faculty members are engaged in approximately 20 projects at any given time, involving participants who range from adolescents to senior citizens.

But the center’s biggest impact is more difficult to measure. “CAIR is a crown jewel,” says Jon Lehrmann, MD, the Charles E. Kubly professor and chair in MCW’s Department of Psychiatry and Behavioral Medicine. “They do incredible work. They probably have saved more lives than anybody here.”

Kelly’s work in the field began in the mid-1980s when the HIV epidemic was still relatively new. “This was the era when the very first AIDS cases were starting to appear and people that I knew, or knew of, were developing this disease and dying,” he recalls. “Then it became clear after a year or two, that it was sexually transmitted and that there might be ways to get people to change their risk behaviors.”

As a clinical psychologist, he was intrigued. “I’m an impatient type,” he admits. “At the time the research was mostly in epidemiology—basically body counting, trying to figure out who’s dying—whereas my interest was to figure out what kind of interventions could change the risk.”

In 1989, Kelly published the first paper in this field. It focused on the results of an AIDS intervention with gay and bisexual men in the Deep South. A year later, he joined the MCW faculty and founded what would become CAIR. In Wisconsin, like other parts of the country, most HIV diagnoses are among gay and bisexual men, particularly black men. A much smaller percentage of HIV cases are among women and those who use injection drugs. Kelly says, “That has been true always, but we’re seeing trends where HIV [diagnoses] are decreasing in other populations, so that makes the health disparity even more significant.”

According to a December 2015 report by the Wisconsin Department of Health Services, an estimated 7,900 people in the state have HIV, and nearly half of them live in Milwaukee County. HIV rates are not as high in Wisconsin as some other parts of the country and new diagnoses have decreased in recent years. Still, Kelly and his colleagues are determined to HIVPLUSMAG.COM

16-19_PLUS125_FEA_HIV Prevention_FINAL.indd 17

17

5/15/18 8:54 AM

Dr. Jeffrey Kelly (second from right) with colleagues at the Medical College of Wisconsin

reduce the numbers even further. In 2016, the Shepherd Express honored Kelly with their LGBTQ Progress Award for Health and HIV Awareness, in recognition of his work’s impact on the community.

INTERNATIONAL IMPACT CAIR’s researchers moved into international work around 2000. “We started thinking: 96 percent of HIV [diagnoses] occur outside North America, and don’t we have an obligation to bring our models to other places of great need?” Kelly explains. “Maybe we can learn things from other countries that would benefit them and also us here in the United States.”

At the time, the HIV epidemic in Russia was not widely studied. “The country moved from having 6,000 HIV [diagnoses] in the mid-to-late ‘90s to now having more than 1.5 million. It has been a huge, explosive increase,” says Kelly, who visits CAIR’s partners in Russia and Bulgaria about eight times each year. “Initially it was because of injection drug use.

In the era after the Soviet Union fell apart, vast numbers of young people were injecting drugs.”

Today, about 40 percent of CAIR’s research is international, and the researchers have found that different countries require different prevention approaches. In the U.S., HIV primarily affects men who have sex with men, while in Africa it affects mostly heterosexuals. Both drug use and condomless sex are major drivers of the spread of HIV in Eastern Europe.

One of the things that Kelly is most proud of is putting CAIR’s research into action. “Very often the people who really need our research, who are leading frontline programs in Russia or Guatemala or Tanzania, don’t read our research journals, and they don’t have nearly enough information to carry out our interventions,” he says. “So how can you take our research findings and put them in the hands of community leaders around the world?”

In 2001, Kelly and his colleagues designed a project to do just that. They identified the main HIV service providers in 78 countries around the world, from Africa to Latin America to Central Asia. The goal was to share with those agencies the characteristics of effective HIV prevention programs.

“We were trying to bring together the science of HIV prevention with the service of HIV prevention,” Kelly explains. “The question was: Could this package of programs help organizations who are on the front lines in faraway countries, with little resources, benefit from the science we’re doing?”

In short: Yes. CAIR researchers offered detailed manuals and ongoing distance education in English, French, Spanish, and Russian to all 78 countries. Those who were familiar with each region provided ongoing consultation and worked with local program leaders to tailor the interventions to their region’s needs.

“It was probably the most ambitious thing we’ve ever done. People were working all night because of the time differences,” Kelly says. The majority of service providers adopted the science-based programs as a result, and the findings were published in Science in 2004.

NEW DIRECTIONS FOR PREVENTION The focus of HIV prevention is currently undergoing a massive evolution.

“The whole field of HIV prevention has changed dramatically in the last five years,” Kelly explains. “Prior to that, the focus was on reducing risk behaviors.

Now if someone is HIV-positive and gets quickly diagnosed and starts taking 18

HIV medications, they’re going to live a very long time, and their viral load declines markedly and is much less likely to transmit to someone else. So now prevention means a lot more than condoms.

It means getting people who have HIV quickly into care so the virus is suppressed and they’re less likely to transmit [it].”

Another new development is the medication called pre-exposure prophylaxis, or PrEP, which can protect people who are at high risk from contracting HIV. PrEP is much more commonly used on the coasts than in the Midwest, so one of CAIR’s current research goals is increasing awareness of PrEP in middle America.

JULY / AUGUST 2018

16-19_PLUS125_FEA_HIV Prevention_FINAL.indd 18

5/15/18 8:54 AM

COURTESY MEDICAL COLLEGE OF WISCONSIN

Increasing rates of medical treatment is also a focus of CAIR’s international work. In St. Petersburg, Russia, CAIR researcher Yuri Amirkhanian, PhD, professor of psychiatry and behavioral medicine, recently tested a social network-based intervention with people who are HIV-positive but not presently receiving medical care. Similar to the recent project in Milwaukee and Cleveland, the peer-to-peer program in Russia emphasized reasons to get medical care and take medications.

“What we’re finding is that it helps people get care more quickly,” Kelly says. “It’s not just a way to reach people; these kinds of interventions are more effective. People pay

attention to their friends, and these kinds of social norms can influence behaviors.”

Kelly is excited to continue the peer-topeer approach with future interventions.

“Something that surprises me is that ordinary people are willing to do extraordinary things to prevent HIV, if we only ask,” he says. “If we ask people who have had a lot of challenges in their lives and affirm that they are good, that they have an important role to play and they can play it better than anyone else, then people want to be part of the solution. What we have to do is develop interventions that tap into the altruism. The fact that it works so well is heartening to see.”

This article is courtesy of the Medical College of Wisconsin.

HIVPLUSMAG.COM

16-19_PLUS125_FEA_HIV Prevention_FINAL.indd 19

19

5/15/18 8:54 AM

20

JULY / AUGUST 2018

20-25_PLUS125_FEA_MAO_FINAL.indd 20

5/15/18 3:37 PM

BY DesirÉe Guerrer o

SOUTHERN HOSPITALITY

SHUTTERSTOCK

For over three decades, this nonprofit has been fighting stigma and taking HIV services to rural Southerners who need it most.

If any organization understands the needs of rural Southerners—who represent one of the most underserved populations in the United States, particularly when it comes to people living with HIV—it’s Medical Advocacy and Outreach. It has diligently and humbly served poz people in rural Alabama for more than 30 years, and much like the epidemic it’s dedicated to combatting, the organization has undergone immense change since its beginnings.

First known as Montgomery AIDS Outreach, MAO made the conscious decision to officially drop AIDS from its name in honor of its 30th anniversary, and in response to changing needs.

These days, people living with HIV are much less at risk of developing the opportunistic illnesses that define an AIDS diagnosis.

Furthermore, stigma still reigns supreme in the South, and the outdated term—referenced now as stage 3 HIV—only fuels fear and dissuades people from seeking help at “AIDS” clinics.

Thomas Stephens, MAO’s media relations specialist, tells Plus the biggest barriers to providing services to rural clients “continue to be stigma, cost, and geography.”

“Removing the stigma of HIV [and] AIDS and other illnesses requires ongoing strategy changes while maintaining procedures that offer protection for those seeking information and care,” Stephens continues. “Even after more than 30 years of growing public knowledge, many patients coming to MAO maintain concerns stemming from a fear that a member

of their church or community might see them.

Phrases like ‘my church’ or ‘my community’— that usually translate to feelings of support and hope for many—translate to fear for people living with HIV.” Especially in small towns, where everyone knows each other’s business, and ostracization can have life-altering ramifications, “public education needs to be loud and as frequent as resources permit.”

Fighting stigma wasn’t the only reason for MAO’s name change. “The new name reflects our expansion of quality services to new healthcare issues facing rural Alabama,” says Michael Murphree, MAO’s chief executive officer. In addition to its commitment to serving those living with HIV, MAO now routinely helps those impacted by hepatitis C, diabetes, and behavioral issues. They also offer preventive care like PrEP, and free rapid HIV and hep C testing, with results in just 20 minutes. MAO even recently added enhanced case management and transportation services, a mother and infant program, and a dental clinic. Despite the expansion, Murphree says the group is dedicated to “the same missiondriven quality care that MAO has always been known to provide.”

But how is it possible to bring this type of care to those who need it most, in these remote and rural areas of Alabama—many miles from major cities and often without urban conveniences CONTINUED ON PAGE 25 HIVPLUSMAG.COM

20-25_PLUS125_FEA_MAO_FINAL_REVISED.indd 21

21

5/16/18 9:06 AM

CHILL CHILL

URBAN DICTIONARY DEF: COOL, TIGHT, WICKED, SICK, SWEET, NICE, EASY GOING, SEX URBAN DICTIONARY DEF: COOL, TIGHT, WICKED, SICK, URBAN DEF: COOL, TIGHT, WICKED, OUR DEF: DICTIONARY A NEW MEN’S MAG THAT’S ALL SEX THAT ANDSICK, MORE SWEET, NICE, EASY GOING, SWEET, NICE, EASY GOING, SEX PREMIERING A P R I L / M AY 2018 OUR OUR DEF: DEF: A A NEW NEW MEN’S MEN’S MAG MAG THAT’S THAT’S ALL ALL THAT THAT AND AND MORE MORE CHILL.US P R E M I E R I N G A P R I L / M AY 2 0 1 8 CHILL.US CHILL.US

CHILL_MODEL_012918_text.indd 18566 Chill AD.indd 11 2 Chill_Ad_Plus.indd

1/29/18 3:51 2/20/18 4:29 PM 2:23 3/20/18

CONTINUED FROM PAGE 21 Left: MAO’s CEO, Michael Murphree, has dedicated his career to providing care to rural Alabamans.

COURTESY OF MAO

Below: Murphree and MAO health educator, Doug McCloud, take a breather at MAO’s annual Tread Red Walk & Fun Run, which raises community support for its programs and services.

like electricity, phone, or cable lines? The answer, ironically, is cutting-edge technology.

“Much of South Alabama, for example, represents the most rural of areas,” says Stephens, “requiring residents to cover vast distances to obtain routine care.”

MAO reaches its clients through its growing network of satellite clinics sprinkled throughout the most rural and off-the-grid communities in the state. These telemedicine clinics were branded as Alabama e-Health, allowing care to be delivered with less stigma than clinics with names derived from references to HIV or sexual health.

Thanks in part to a grant from AIDS United, MAO established the first Alabama e-Health telemedicine clinic in Selma in 2011. Its

telemedicine network has since expanded to cover 12 counties throughout rural Alabama— and garnered the attention of the Obama administration as a viable and cost-effective means of reaching rural HIV-positive people. An Alabama governor even turned to MAO for advice on addressing health disparities in the state and nominated Murphree to the Alabama Health Care Improvement Task Force.

Murphree, who has advocated for policies to bolster rural healthcare capabilities at the White House on three separate occasions, sums up why the organization has been so successful in reaching this often ignored demographic: “The MAO team does not just see health conditions, we see human beings in need.”

HIVPLUSMAG.COM

20-25_PLUS125_FEA_MAO_FINAL_REVISED.indd 25

25

5/16/18 9:06 AM

COURTESY JACK MACKENROTH

26

JULY / AUGUST 2018

26-28_PLUS125_FEA_Jack Mackenroth_FINAL.indd 26

5/15/18 9:08 AM

YOU DON’T KNOW JACK Why model, fitness inspo, and former Project Runway star JACK MACKENROTH—one of the most visible HIV activists of the last decade—is taking a step back.

By Z ach ary Zane

“I don’t mind being a poster boy for HIV,” Jack Mackenroth says, sitting in a midtown burger joint. “I was very cognizant of what I was doing when I came out on national TV a decade ago, because the HIV conversation had virtually disappeared from mainstream television.”

The model and fashion designer came out as HIV-positive in 2008 while a contestant on season four of Project Runway Runway. Since then, his life has been all about activism. He spent two years working for the Global Forum on MSM & HIV, and five years collaborating with Merck on the HIV awareness campaign, Living Positive

by Design, before raising a record-breaking $52,000 for the Braking AIDS Ride.

The Instagram hunk also launched widely successful campaigns to reduce HIV stigma, including HIV Equal and the HIV “Shower Selfie” Challenge. But now, Mackenroth says, he’s “moving away from the nonprofit sector.”

“The issue with nonprofit stuff is that you are overworked and underpaid,” he explains.

“Like teachers, people expect that we should basically volunteer our services because we are doing important work. I’m getting really close to 50, and I can’t be hoofing it all the time. It’s [also] relatively thankless work. I’m not doing it for accolades, but everyone likes... to feel like something beneficial is coming from your job.”

He needs to think about his future and eventually retiring—something he didn’t even consider when he was first diagnosed with HIV at 19, nearly 30 years ago.

“I thought I was going to die at 25,” he recalls. “My boyfriend died at 27. Until my mid-30s, I was like: ‘Why should I have a 401k?’ I wasn’t planning ahead. It’s been over the past decade, where I’m like, ‘I’m going to live. I need to plan for the future.’” That’s why he returned to school to get a second bachelor’s degree (in nursing).

But in some ways, Mackenroth acknowledges he’ll always be an HIV activist, especially on social media. “Even when I’m not working in a HIV-specific arena, because I’m so public about my status, I get two to three Instagram messages a day from someone in a foreign country who just found out [they’re HIV-positive].”

The activist often Facetimes with these people, too. “And even though it’s a different time, people, especially in lesser developed countries, freak out the same way [I did when I was diagnosed]. When there are different opinions on homosexuality in their home country, it’s even worse. It can be very isolating.”

No matter who he is speaking with, Mackenroth is vocal in promoting the message that undetectable equals untransmittable (U=U). In October of last year, the Centers for Disease Control and Prevention endorsed this message, officially confirming that HIV-positive people whose viral loads are suppressed to the point that they are undetectable cannot transmit HIV to sexual partners.

“It’s really empowering to lots of people.”

Mackenroth says of that new message. He says HIVPLUSMAG.COM

26-28_PLUS125_FEA_Jack Mackenroth_FINAL.indd 27

27

5/15/18 9:08 AM

How to Become an Activist

By Khafre Abif

As the original ACT UP generation ages out of street activism (marching for hours is a young person’s game), it’s good to remember that everyone can be an HIV activist in one way or another. Even you. Here’s how: 1.

Educate Yourself. You need to learn enough that you can debunk myths and speak the truth about HIV and what the epidemic looks like.

2.

Be at Home in Your Own Skin. You need to be comfortable enough in yourself to be able to stand in your own shoes.

3.

Be Bold. As activists, we have to be willing to be brave enough to speak about HIV in our communities, in our social networks, in our churches, and in the institutions we’re in and around.

4.

Find Your Own Voice. There are many forms of advocacy, so everyone can find their own lane. Mine is being out front, being vocal, being seen. Other people’s advocacy might be making a phone call, writing a letter, or sending information to their local legislator. There are different ways to be an advocate.

5.

Be Authentic. At all times, stand in your own truth.

Contributing editor KHAFRE K. ABIF is a bisexual HIV-positive activist, who works with the Southern AIDS Coalition, and also serves as contributing editor of the new men’s magazine, Chill.

28

COURTESY JACK MACKENROTH (MACKENROTH); TIM DANIELS (ABIF); SHUTTERSTOCK (PROTEST)

people who are newly diagnosed still often feel like, “‘I can never have sex again. I’m going to [transmit to] my partner.’ But honey, get on your meds, get undetectable, and you—and everyone else—will be fine!”

While Mackenroth has moved away from working directly with HIV nonprofit organizations, he says he can “still make sure to help. I still respond to nearly everyone who reaches out.” He’s also found that some of the more unlikely social platforms have been great venues for educating others about HIV and helping calm the fears of men recently diagnosed. “Believe it or not, Scruff is a great tutorial platform,” Mackenroth says. “I link to PrEPster.info and PreventionAccess.org—which is the U=U campaign. Often when I’m on Scruff I’m talking to people about HIV.” Recently, Mackenroth began an OnlyFans.com account, where he posts more explicit material. Unfortunately, this also opened the door to harassment from trolls who call him an “AIDS-faced meathead,” and much worse. Some of the site’s commenters also ridicule him and other adult performers for not using condoms. Mackenroth sees this as a teachable moment, an opportunity to let others know about PrEP and the power of being undetectable. “Men with HIV are allowed to have sex. We’re even allowed to have sex without condoms, like other gay men.” In the era of PrEP and U =U, he adds, “we can have sex safely” even without condoms.

As he steps away from more formal forms of activism, simply being out, visible, and available, has allowed Mackenroth to continue to make a difference. After all, “I’m always available to talk,” he says. “I’m very accessible.

[People can] message me on Twitter or Instagram.” (@JackMackenroth) Through those platforms he’s able to reach poz men around the world who are struggling to accept their HIV status—which may even be more beneficial than his work in the past. Thanks to social media, Mackenroth is also back where he belongs: in the spotlight.

JULY / AUGUST 2018

26-28_PLUS125_FEA_Jack Mackenroth_FINAL.indd 28

5/15/18 9:08 AM

In adults with HIV on ART who have diarrhea not caused by an infection

IMPORTANT PATIENT INFORMATION This is only a summary. See complete Prescribing Information at Mytesi.com or by calling 1-844-722-8256. This does not take the place of talking with your doctor about your medical condition or treatment.

What Is Mytesi?

Mytesi is a prescription medicine used to improve symptoms of noninfectious diarrhea (diarrhea not caused by a bacterial, viral, or parasitic infection) in adults living with HIV/AIDS on ART. Do Not Take Mytesi if you have diarrhea caused by an infection. Before you start Mytesi, your doctor and you should make sure your diarrhea is not caused by an infection (such as bacteria, virus, or parasite).

Possible Side Effects of Mytesi Include:

Tired of planning your life around diarrhea?

Enough is Enough Get relief. Pure and simple. Ask your doctor about Mytesi.

Mytesi (crofelemer): • Is the only medicine FDA-approved to relieve diarrhea in people with HIV • Treats diarrhea differently by normalizing the flow of water in the GI tract • Has the same or fewer side effects as placebo in clinical studies • Comes from a tree sustainably harvested in the Amazon Rainforest What is Mytesi?

Mytesi is a prescription medicine that helps relieve symptoms of diarrhea not caused by an infection (noninfectious) in adults living with HIV/AIDS on antiretroviral therapy (ART).

Important Safety Information Mytesi is not approved to treat infectious diarrhea (diarrhea caused by bacteria, a virus, or a parasite). Before starting you on Mytesi, your healthcare provider will first be sure that you do not have infectious diarrhea. Otherwise, there is a risk you would not receive the right medicine and your infection could get worse. In clinical studies, the most common side effects that occurred more often than with placebo were upper respiratory tract (sinus, nose, and throat) infection (5.7%), bronchitis (3.9%), cough (3.5%), flatulence (3.1%), and increased bilirubin (3.1%).

For Copay Savings Card and Patient Assistance, see Mytesi.com

Please see complete Prescribing Information at Mytesi.com.

• Upper respiratory tract infection (sinus, nose, and throat infection) • Bronchitis (swelling in the tubes that carry air to and from your lungs) • Cough • Flatulence (gas) • Increased bilirubin (a waste product when red blood cells break down) For a full list of side effects, please talk to your doctor.

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

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Should I Take Mytesi If I Am: Pregnant or Planning to Become Pregnant?

• Studies in animals show that Mytesi could harm an unborn baby or affect the ability to become pregnant • There are no studies in pregnant women taking Mytesi • This drug should only be used during pregnancy if clearly needed A Nursing Mother?

• It is not known whether Mytesi is passed through human breast milk • If you are nursing, you should tell your doctor before starting Mytesi • Your doctor will help you to decide whether to stop nursing or to stop taking Mytesi Under 18 or Over 65 Years of Age? • Mytesi has not been studied in children under 18 years of age • Mytesi studies did not include many people over the age of 65. So it is not clear if this age group will respond differently. Talk to your doctor to find out if Mytesi is right for you

What Should I Know About Taking Mytesi With Other Medicines?

If you are taking any prescription or over-the-counter medicine, herbal supplements, or vitamins, tell your doctor before starting Mytesi.

What If I Have More Questions About Mytesi?

For more information, please see the full Prescribing Information at Mytesi.com or speak to your doctor or pharmacist.

To report side effects or make a product complaint or for additional information, call 1-844-722-8256.

Rx Only Manufactured by Patheon, Inc. for Napo Pharmaceuticals, Inc. San Francisco, CA 94105 Copyright © Napo Pharmaceuticals, Inc.

RELIEF, PURE AND SIMPLE

Mytesi comes from the Croton lechleri tree harvested in South America.

NP-390-34

000_Mytesi_18436.indd 1

9/6/17 11:31 AM

Looking good in a T-shirt led ABC entertainment reporter KARL SCHMID to come out HIV-positive in a social media post that went viral. Now, we’re all mad about the guy.

By S avas Ab adsidis / Ph o to graph y by Luke Fo ntana S t y li s t: Ai sha R ae / Assistant sty list: Angel C ro ss Gro o min g: C a lvin Sco tt

30

JULY / AUGUST 2018

30-35_PLUS125_FEA_Cover_Karl Schmid_FINAL.indd 30

5/15/18 10:08 AM

SUIT BY KLEIN EPSTEIN & PARKER @KEPREBELS WHITE BUTTONUP SHIRT BY DOM BAGNATO @DOMBAGNATO SHOES BY COLE HAAN @COLEHAAN

30-35_PLUS125_FEA_Cover_Karl Schmid_FINAL.indd 31

HIVPLUSMAG.COM

31

5/15/18 10:08 AM

THE CIRCUMSTANCES LEADING hunky ABC reporter Karl Schmid to come out as poz were refreshingly nonchalant.

There was no vicious ex threatening to out him, nor were there signs of reporters planning on breaking a story.

Instead, he chose to come out by posting a now-famous photo wearing an AIDS Memorial T-shirt on Facebook.

“Honestly, I just thought I looked cute in that picture,” admits the Australian native, an on-camera reporter for ABC in Los Angeles and the former cohost of Logo’s Operation: Vacation. “I was going out to happy hour with some friends, so I threw it on. And while out I said, ‘Will you do me a favor—can you get a picture of me in this thing? Because at some point I want a post wearing it.’”

It’s the sincere authenticity of the post that made it go viral.

“Hi. I’m a 37-year-old HIV-positive man who has been poz for almost 10 years,” he wrote. “I work in television.

And on the side of the camera where, for better or worse it’s considered ‘taboo’ for people ‘like me’ to be ‘like me.’ For 10 years I’ve struggled with ‘Do I or don’t I?’ For 10 years the stigma and industry professionals have said, ‘Don’t! It’ll ruin you.’”

The off-hand nature of Schmid’s coming out doesn’t reveal the details of those 10 years of handwringing and uncertainty underlying the potentially career-damning decision of a TV personality—who happens to be viewed in 350,000 homes

32

a night—to come out HIV-positive. That underscores the profundity behind his choice and what was at stake for him to become an advocate for other people living with HIV, too.

Schmid’s Facebook post concluded, “But, for anyone who has ever doubted themselves because of those scary three letters and one symbol, let me tell you this: You are somebody who matters. Your feelings, your thoughts, your emotions count. And don’t let anybody tell you otherwise.

I’m Karl Schmid, and I’m an HIV-positive man!”

For Schmid, coming out as poz was his way of controlling the narrative and taking agency over his life. “I made it about me,” he says. “I had been sort of on and off about it. I thought, you know, one day I would like to be able to be more public about this so I could get passionate about this stigma thing and fighting it.”

The intensity of the public’s response took Schmid by surprise, he says, because “my status prior to that didn’t come up much. I would take one pill in the morning with my multivitamin and whatever else, and that’s it.”

Touched by the outpouring of love that he’s received, Schmid says, “Honestly, part of me is flattered and I am proud, but I’m also sorry. Sorry that in this day and age this is still such a big deal.”

In the United States, he argues, “We are not doing enough and haven’t come far enough to fight the stigma around HIV.

JULY / AUGUST 2018

30-35_PLUS125_FEA_Cover_Karl Schmid_FINAL.indd 32

5/15/18 10:08 AM

We’ve seen things like PrEP, but there are a lot of people my age who still think of this as a death sentence.”

Just as his Facebook post was going supernova, Schmid headed to India for a family vacation, the timing of which he says made one response to his post particularly moving.

“This guy said, ‘All I want to do is be a flight attendant.

That’s my passion. But I can’t because I have to take an HIV test.’ He wanted to fly with a Middle Eastern airline and unfortunately, with this particular airline, being HIV-positive precludes you from working for them.”

It reminded Schmid that even in America as recently as 2009, “you had to declare on an immigration form that you were HIV-positive, because it is considered a communicable disease.” Indeed, Immigration Equality, the nation’s leading LGBT immigrant rights organization, reports that “from 1993 until January 4, 2010, HIV was considered a ground of inadmissibility, meaning that HIV-positive foreign nationals could be denied short-term visas or applications for lawful permanent residence simply because of their HIV status.”

Schmid himself is an immigrant—or a child of the world.

Born in Australia, Schmid’s family moved around a lot due to his father’s job in the garment industry. Schmid’s acting career was the one constant, following him from Australia to Fiji, to New Zealand. There, from the ages of 13 to 18, he

starred as the host of one of country’s top live-action children’s TV shows, What Now? He got that gig after producers saw him on TV New Zealand’s drama, Mel’s Amazing Movies (about a group of friends who embark on wild adventures making home movies).

Schmid’s life suggests he was destined to be a TV star. His first brush with fame was on TV in his native Australia, when he appeared on the long-running soap opera Neighbours.

Schmid’s brother was one of its stars. Kylie Minogue also came from Neighbours, as did Russell Crowe and Guy Pierce.

Back in the ‘80s, it was the biggest thing on TV in Australia and the United Kingdom.

Schmid always loved “the world of make believe, of being on a TV show and it was exciting, and I remember—as embarrassing as it is to say—I would play TV host in my head. I used to pretend to the point of even saying ‘Goodnight Australia,’ every night before I went to bed.”

At 19, he started working in event management and it was there that Schmid got interested in being on the production side of the camera. It’s also been a successful path for him.

“I like that I’m able to be on camera as a presenter or host, but at ABC I also produce and write,” Schmid says.

“I’m equally happy behind the camera as I am on camera. I just finished a show for the Game Show Network and I just produced a one-hour documentary on Meghan Markle.”

HIVPLUSMAG.COM

30-35_PLUS125_FEA_Cover_Karl Schmid_FINAL_REVISED.indd 33

33

5/16/18 9:02 AM

Beyond concerns over whether coming out would impact his career, Schmid says disclosing his status while dating has been “the hardest thing for me personally living with HIV. The stigma.

I’ve had someone throw a drink in my face, I’ve had someone tell me, ‘Well there’s no point in us carrying on with this dinner’ and these are from other gay men: the one part of the community you think would be more understanding.”

(Or at least more educated.)

Schmid believes things are finally starting to change. “I think the younger generations—people in their teens and 20s—are much more up to speed with things versus people my age group and older.”

Now in his mid-30s, Schmid says, “I think that’s because they weren’t around when the epidemic really hit the fan, and so they didn’t see people dying.”

But he remembers. As a kid, Schmid says, “I grew up with the most horrendous TV ad campaigns designed to place the fear of God in people about HIV [and] AIDS.” The ad Schmid refers to is the notorious Grim Reaper television ad that ran in Australia for nine weeks in 1987 before it was pulled from the air over public outrage. The commercial, filmed in black-and-white, features the Grim Reaper in a smoky bowling alley where the pins are people, including children and a woman holding a baby.

The Grim Reaper bowls, and knocks all but the mother to the ground. She looks panicked, ready to run, when she is picked off by the Grim Reaper and the baby falls from her arms.

Schmid says he was about 7 when he saw it and remembers “watching this terrifying ad and—look, scare tactics had to be used because no one knew what this thing was or how to stop it, so I get the ‘why’—but the negative effect of that ad is that if it’s still engrained in my head I know it’s engrained in other peoples’ as well. That fear is still very real to me.”

34

Schmid has friends in their 40s who have said to him, “‘You know, considering everything I did in the ‘90s, I should have HIV. But I just don’t want to know because if I do it’ll destroy me.’ And I just want to scream!

Don’t they know that’s the kind of ignorance that keeps HIV going?”

He’s an advocate and educator, but Schmid is also giving Ryan Seacrest a run for his money in the hosting, red carpet, entertainment world.

Schmid deflects questions about being a journalist, at a time when the news is under attack, by arguing “mostly what I do is entertainment reporting or lifestyle-related stuff. I consider journalists people who really get out there and put it all on the line.”

He adds, “I can’t speak on behalf of ABC—I don’t think that’s right—but I think the truth now is more important than ever. Certainly, I know within an organization like ABC, our journalists and news teams take what they do very seriously, and they are all very passionate about it, especially when they’re being called ‘fake news’ all the

time. I think it really fires up the news team, to prove the point that now more than ever the media’s role is important!”

Schmid points to the recent Netflix My Next Guest Needs No Introduction with David Letterman episode with Jay-Z as an example of what he means.

“Jay-Z made a really good point about what’s going on politically in this country at the moment,” Schmid recalls.

“We have elected someone who is very polarizing and it is forcing people to have conversations that needed to be had.

We thought we had progressed a great deal with having had a black president, while the reality is, we are unfortunately learning that maybe that’s not the case.

It’s like someone lifted the veil on a dirty dark secret in this country, and while it’s uncomfortable, I think it is necessary, because it is forcing us to have these uncomfortable conversations—whether it be about race, sexual harassment, and #MeToo, or, in my case, HIV stigma. We have to talk about things. If you don’t have a dialogue, you don’t get anywhere.”

Schmid is hopeful that this will ultimately be a cathartic moment in

JULY / AUGUST 2018

30-35_PLUS125_FEA_Cover_Karl Schmid_FINAL.indd 34

5/15/18 10:08 AM

DENIM JEANS BY DIESEL @DIESEL SHORT SLEEVE BUTTONUP SHIRT BY RAGA MAN @THERAGAMAN BLACK BOOTS BY GRAND VOYAGE @THEGRANDVOYAGE

American history. “I like to think of it that way,” he says.

Though he’s poz and proud, Schmid doesn’t let HIV define him.

“I don’t walk around going ‘I’m HIVpositive!’ I just don’t. I’ve lived with it for 10 years. I’m perfectly healthy and a mostly moderately sane person, so when it came to that moment on that Friday evening [when he came out publicly]—I don’t want to come across as sounding douchey—but I was comfortable in that moment.

I thought it was a nice photo, and it was my way of putting my story link in with The AIDS Memorial and promoting that T-shirt. That was it.

I went to bed that night and didn’t think about it. When I woke up the next morning I noticed it had a bit of traction, and then by 10 A.M. on Saturday morning my Twitter blew up, and then Instagram. You know prior, I’m a nobody with like 2,000 followers, and then the numbers are going up. Then I get an alert about The Wrap writing this up and it’s all going crazy.”

Schmid has come to understand how and why what he did on an impulse affected so many people so profoundly. HIV visibility is so low that when a celebrity or public figure like Schmid comes out, it inspires pride in many people who are still burdened by stigma.

It makes Schmid reflect on the dual and often contradictory impulses the United States inspires, and it reminds him of an anecdote he learned while working many years ago in London for Dame Edna (née comedian Barry Humphries).

“Edna used to have a line in the show when we were touring the U.S. about how she’s Australian and how she would rather be from a country that was settled by convicts instead of Puritans.”

HIVPLUSMAG.COM

30-35_PLUS125_FEA_Cover_Karl Schmid_FINAL_REVISED.indd 35

35

5/16/18 9:02 AM

OUR 6TH ANNUAL HIV TREATMENT GUIDE

FOR 2018, PLUS HAS SHAKEN THINGS UP, FOCUSING OUR GUIDE ON THE INFORMATION YOU ARE MOST LIKELY LOOKING FOR. HERE ARE THE MOST COMMON MEDICATIONS APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION FOR THE TREATMENT OF HIV AND OPPORTUNISTIC INFECTIONS.

Editor’s note: This info was culled from the National Institutes of Health’s drug database, the FDA, and individual pharmaceutical companies.

36

PHOTO BY JOSHUA COLEMAN ON UNSPLASH

RESEARCH BY JACOB ANDERSON-MINSHALL, TRUDY RING, DESIRÉE GUERRERO, DAVID ARTAVIA, AND MARY R. LADD

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 36

5/16/18 8:33 AM

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 37

37

5/16/18 8:33 AM

Unless otherwise noted, all dosages are traditional adult dose.

ATRIPLA generic name: efavirenz, emtricitabine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults and children 12 years and older weighing at least 40 kg as an initial regimen. Should not be used for those with moderate or severe kidney or liver impairment, those with neuropsychiatric issues, or women who are pregnant or may become pregnant. traditional dosage One tablet once daily. Tablet contains 600 mg efavirenz (Sustiva, a NNRTI), 200 mg emtricitabine (Emtriva, a NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, a NRTI).

BIKTARVY

NEW

generic name: bictegravir, emtricitabine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults who have no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (less than 50 copies per mL) on a stable antiretroviral regimen for at least three months with no history of treatment failure and no known resistance to the components of Biktarvy.

Not recommended for those with creatinine clearance below 30 mL per minute, those with hepatitis B, or those with severe liver impairment. traditional dosage One tablet once daily. Tablet 38

includes 50 mg of bictegravir (an INSTI), 200 mg of emtricitabine (Emtriva, a NRTI), and 25 mg of tenofovir alafenamide (a NRTI). Doesn’t need to be taken with other HIV drugs.

COMPLERA

generic name: emtricitabine, rilpivirine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 and older who are new to antiretroviral drugs who have viral loads of 100,000 copies/ ml or less; or as a replacement regimen for individuals with a viral load of 50 copies/ml or less and no resistance to any components. Use caution if also positive for hepatitis B. traditional dosage One tablet once daily. Tablet includes 25 mg rilpivirine (Edurant, an NNRTI), 200 mg emtricitabine (Emtriva, a NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, a NRTI).

EDURANT

EMTRIVA

generic name: emtricitabine class of drug: nucleoside reverse transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children as component of initial regimen. Dosing needs to be adjusted for those with decreased kidney function.

Use caution if also positive for hepatitis B. traditional dosage One 200 mg capsule once daily.

EPIVIR

generic name: lamivudine or 3TC class of drug: nucleoside reverse transcriptase inhibitor maker: ViiV Healthcare who is it for? For adults and children at least 3 months old, as component of initial regimen. Dosing needs to be adjusted for those with decreased kidney function. traditional dosage One 300 mg tablet once daily, or one 150 mg tablet twice daily.

EPZICOM generic name: rilpivirine class of drug: nonnucleoside reverse transcriptase inhibitor maker: Janssen who is it for? For treatment of HIV-1 in adults and children 12 and older weighing at least 35 kg who haven’t previously taken antiretroviral drugs and have a viral load of 100,000 copies per milliliter of blood or less. traditional dosage One 25 mg tablet once daily with meal. It is always taken with other antiretrovirals, and is a component in single-tablet regimens Complera, Odefsey, and Juluca.

generic name: abacavir sulfate and lamivudine class of drug: nucleoside reverse transcriptase inhibitor maker: ViiV Healthcare who is it for? For adults and children weighing 25 kg or more as component of initial regimen. Not recommended for those with decreased kidney function. traditional dosage One tablet once daily.

Tablet contains 600 mg abacavir sulfate and 300 mg lamivudine, both NRTIs.

EVOTAZ generic name: atazanavir and cobicistat class of drug: protease inhibitor and booster maker: Bristol-Myers Squibb who is it for? For those initiating treatment as a component of a regimen. Not recommended for those with liver impairment. Use with caution if you have heart or kidney problems; diabetes; hemophilia; or are pregnant, plan to become pregnant, or are using hormonal birth control. Do not breastfeed. traditional dosage One tablet once daily, in combination with other antiretroviral drugs. Tablet includs 300 mg atazanavir (Reyataz, a PI) and 150 mg cobicistat (Tybost, a PKE).

INTELENCE generic name: etravirine class of drug: nonnucleoside reverse transcriptase inhibitor maker: Janssen who is it for? For treatment-experienced HIV-1 patients with viral strains resistant to an NNRTI and other antiretroviral agents.

For adults, children 6 years or older weighing at least 16 kg. traditional dosage One 200 mg tablet (or two 100 mg tablets) twice daily following meal. Pediatric patients (6-18 years old) should be dosed by medical professionals based on body weight.

ISENTRESS generic name: raltegravir class of drug: integrase inhibitor maker: Merck who is it for? For those

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_REVISED2.indd 38

5/17/18 11:04 AM

new to treatment or treatment experienced, as a component of a regimen. For adults and children weighing at least 2 kg. Tell your doctor if you have tuberculosis, or liver problems or phenylketonuria. traditional dosage One 400 mg tablet twice daily for those with treatment experience. Those new to treatment or with undetectable viral loads may either take one 400 mg tablet twice daily or two 600 mg tablets once daily.

GENVOYA generic name: elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older who weigh at least 35 kg and are new to antiretroviral therapy; or as replacement therapy for those virologically suppressed for at least six months, with no previous virologic failure, and no drug resistance to the components of Genvoya. Not recommended if you have a creatinine clearance below 30 ml/minute. traditional dosage One tablet once daily. Tablet contains 150 mg of elvitegravir (an INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, a NRTI), and 10 mg tenofovir alafenamide (a NRTI).

NORVIR generic name: ritonavir class of drug: protease inhibitor maker: AbbVie who is it for? Used only in combination with other antiretrovirals, recommended as component of initial

regimen for adults and children. Reduced dosage recommended for people taking other protease inhibitors. traditional dosage Six 100 mg tablets taken twice daily.

traditional dosage One tablet once daily with food.

Tablet contains 800 mg of darunavir (Prezista, a PI) and 150 mg of cobicistat (Tybost, a boosting agent).

PREZISTA

ODEFSEY generic name: emtricitabine, rilpivirine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults and children 12 years and older weighing at least 35 kg who are new to antiretroviral drugs, who have a viral load of 100,000 copies/ml or less; or can be used as a replacement regimen for individuals with a viral load of 50 copies/ ml or less, who have been virologically-suppressed for at least six months. traditional dosage One tablet once daily.

Tablet conains 200 mg of emtricitabine (Emtriva, a NRTI), 25 mg of rilpivirine (Edurant, a NNRTI), and 25 mg of tenofovir alafenamide (a NRTI).

PREZCOBIX generic name: darunavir and cobicistat class of drug: protease inhibitor and a boosting agent maker: Janssen who is it for? For both treatment naive and treatment-experienced adults with no darunavir-related resistance. Should be used in combination with other antiretroviral medicines. Use with caution if you have liver or kidney problems; or if you are pregnant, breastfeeding, or plan to become pregnant.

generic name: darunavir class of drug: protease inhibitor maker: Janssen who is it for? For treatment of HIV-1 both those initiating treatment and those who have previously been on antiretroviral therapy, including those with some drug resistance to PIs. For adults and children 3 years or older weighing at least 10 kg.

May reduce effectiveness of birth control pills. traditional dosage One 800 mg tablet once daily with 100 mg Norvir or 150 mg Tybost for those without resistance. One 600 mg tablet with 100 mg Norvir taken twice daily for pregnant women and those with Prezista-related resistance. Must be taken with a booster like Norvir or Tybost. Pediatric patients (3 years to less than 18 years old and weighing at least 10 kg) should be dosed by a medical professional based on body weight. Should always be taken with food.

REYATAZ generic name: atazanavir class of drug: protease inhibitor maker: Bristol-Myers Squibb who is it for? For both treatment naive and treatment-experienced individuals. traditional dosage 300 mg capsule, taken with 100 mg of Norvir or 150 mg Tybost, once daily.

SELZENTRY generic name: maraviroc class of drug: entry inhibitor maker: ViiV Healthcare who is it for? Not recommended as a component of an initial regimen. For the treatment of only CCR5-tropic HIV-1 infection in adults and children 2 years or older, weighing at least 10 kg, and having a creatinine clearance of at least 30mL/minute.Tell your doctor if you have heart or kidney problems, or if you have low blood pressure or take medication to lower it. traditional dosage 300 mg twice daily; or 150 mg twice daily if taken with CYP3A inhibitors; or 600 mg twice daily if taken with CYP3A inducers.

STRIBILD generic name: elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older, who weigh at least 35 kg, and are new to antiretroviral therapy; or as a replacment regimen for those virologically suppressed on their current regimen for at least six months, who have no previous virologic failures, and no drug resistance to Stribild components. Not recommended for those with a creatinine clearance below 70 ml/minute or for those with severe liver problems, or during pregnancy. traditional dosage One tablet once daily. Tablet contains 150 mg of elvitegravir (a INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, a NRTI), and 300 mg tenofovir HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_REVISED2.indd 39

39

5/17/18 11:04 AM

SUSTIVA generic name: efavirenz class of drug: nonnucleoside reverse transcriptase inhibitor maker: Bristol-Myers Squibb who is it for? For adults and children 3 months and older weighing at least 3.5 kg as a component of initial regimen. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures. traditional dosage One tablet of 600 mg once daily.

It is a component in the single-tablet regimen Atripla.

TIVICAY generic name: dolutegravir class of drug: integrase inhibitor maker: GlaxoSmithKline who is it for? For both those new to treatment and those who have taken integrase inhibitors previously and may have resistance to such drugs. For adults and children at least 30 kg. Take during pregnancy only if potential benefits outweigh risk. traditional dosage One 50 mg tablet, once daily for those new to antiretrovirals; twice daily for those who take certain other antiretrovirals or have taken integrase inhibitors and may have resistance.

TRIUMEQ generic name: abacavir sulfate, dolutegravir, and lamivudine 40

class of drug: singletablet regimen maker: ViiV Healthcare who is it for? For adults and children weighing at least 40 kg as initial regimen.

Not recommended for those with a creatinine clearance below 50 ml/minute or those with liver impairment. traditional dosage One tablet once daily. Tablet contains 600 mg abacavir sulfate (Ziagen, a NRTI), 50 mg dolutegravir (Tivicay, an INSTI), and 300 mg lamivudine (Epivir, a NRTI).

TROGARZO

NEW

generic name: ibalizumab class of drug: postattachment inhibitor maker: Theratechnologies who is it for? For heavily treatment-experienced adults with multidrug resistant HIV-1 infection who are failing their current antiretroviral regimen, as a component of a regimen. traditional dosage A loading dose of 2,000 mg, administered as an injection, followed by a maintenance dose of 800 mg every two weeks.

TRUVADA generic name: emtricitabine and tenofovir disoproxil fumarate class of drug: nucleoside reverse transcriptase inhibitor maker: Gilead Sciences who is it for? For those with HIV or at high risk of becoming HIV-positive.

As treatment for HIV, for adults and children weighing at least 17 kg. As HIV prevention, for adults and and adolescents 15 or older weighing at least 35 kg. Dosing adjustments necessary for those with

decreased kidney function. for hiv treatment: One tablet once daily, in combination with other HIV medications. Tablet includes 200 mg emtricitabine (a NTRI) and 300 mg tenofovir disoproxil fumarat (a NRTI). for hiv prevention: One tablet once daily. Must be paired with regular HIV tests and safer sex practices.

VIREAD generic name: tenofovir disoproxil fumarate class of drug: nucleoside reverse transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children at least 2 years old and weighing at least 10 kg, used in combination with other antivirals to treat HIV-1 infection. Dosage adjustments recommended for those with kidney problems. traditional dosage One 300 mg tablet once daily.

ZIAGEN generic name: abacavir maker: GlaxoSmithKline who is it for? For adults and children at least 3 months old, as a component of initial regimen. Dosage adjustments not needed for those with kidney problems. traditional dosage One 300 mg twice daily or two 300 mg once daily.

Individuals with mild liver impairment should take 200 mg twice daily.

MEDS 101 DRUG CLASSES COMBAT HIV IN DIFFERENT WAYS. HERE’S HOW.

Drugs that treat HIV, known as antiretroviral medications, are grouped in various classes based on the methods the drug uses to attack the virus. HIV treatment regimens include drugs from multiple classes, to improve their combined effectiveness and help prevent the development of drug resistance. Here are brief descriptions of the classes and how they work.

ENTRY AND FUSION INHIBITORS (EIs) Drugs in this class help block HIV from binding, fusing, and entering T cells. They are always taken with other HIV medications.

INTEGRASE STRAND TRANSFER INHIBITORS (INSTIs) Drugs in this class block integrase, an enzyme HIV needs in order to reproduce. HIV uses integrase to insert its viral DNA into the DNA of T cells. Blocking the

SHUTTERSTOCK

disoproxil fumarate (Viread, a NRTI).

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_REVISED3.indd 40

5/17/18 12:34 PM

integration process prevents HIV from replicating. They are always taken with other HIV medications.

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs, also known as nukes) Drugs in this class block reverse transcriptase, an enzyme that HIV needs in order to reproduce. HIV uses reverse transcriptase to convert its RNA into DNA, blocking the reverse transcription process prevents HIV from replicating. They are always taken with other HIV medications.

NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs, also known as non-nukes) Drugs in this class also block reverse transcriptase, as NRTIs do, but in a different way. They are always taken with other HIV medications.

PHARMACOKINETIC ENHANCER/ CYP3A INHIBITORS (PKEs, also known as boosters) Drugs in this class boost the effectiveness of another antiretroviral medication. When the two are taken together, the pharmacokinetic enhancer slows the breakdown of the other drug, which allows the drug to remain in the body longer at a higher concentration. They are always taken with other HIV medications.

POST-ATTACHMENT INHIBITORS (PAIs) Drugs in this class bind to CD4 cells after HIV has attached to them, but still inhibit the HIV virus from successfully infecting those cells.

They are always taken with other HIV medications.

SHUTTERSTOCK

PROTEASE INHIBITORS (PIs) Drugs in this class block activation of protease, an enzyme HIV needs to develop. Blocking protease prevents immature forms of HIV from becoming a mature virus capable of infecting other T cells.

They are always taken with other HIV medications.

SINGLE-TABLET REGIMENS (STRs) These are fixed-dose pills that combine multiple anti-HIV medications (often three or more) from more than one class of drug into a single tablet, which is usually taken just once a day. They do not need to be taken with other HIV medications.

SOME OTHER DRUGS YOU NEED TO KNOW

THESE TREAT HIVRELATED CONDITIONS. ANDROGEL, FORTESTA, TESTIM

generic name: testosterone gel makers: AbbVie, Endo Pharmaceuticals cautions: For men’s use only. Women and children should avoid skin-to-skin contact with application area. Tell your doctor about all your health conditions, especially if you have breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea.

traditional dosage Amount and frequency determined by physician.

Applied topically. what it treats Treats low testosterone, which can be a complication of HIV, especially for men over 50.

EGRIFTA

generic name: tesamorelin maker: Theratechnologies cautions: Do not take if you have or had pituitary gland issues, if you have active cancer, or if you are pregnant or breastfeeding. traditional dosage 2 mg injected subcutaneously (just below the skin), once daily. what it treats Reduces HIV-related excess belly fat by encouraging the body to produce natural growth hormones.

ERAXIS

generic name: anidulafungin maker: Pfizer cautions: Effects on women who are pregnant or breastfeeding have not been studied, discuss possibility of pregnancy with your doctor.

CONTINUED ON NEXT PAGE

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_REVISED.indd 41

41

5/16/18 9:56 PM

CONTINUED FROM PAGE 41

traditional dosage For esophageal candidiasis 100 mg by injection the first day, followed by 50 mg daily dose thereafter for 14 days; for candidemia and Candida infections, 200 mg by injection first day, followed by 100 mg daily. what it treats Treats esophageal candidiasis, candidemia, and other Candida infections.

CAN’T AFFORD YOUR MEDS? HELP IS ON THE WAY

BY DAVID ARTAVIA If you find yourself struggling to make ends meet, finding affordable HIV treatment may seem nearly impossible.

But the AIDS Drug Assistance Program (ADAP) provides financial assistance to nearly half a million people in the U.S. who aren’t able to afford their meds.

Now, with the ADAP Directory online, finding help has never been easier.

ADAP.Directory (yes, that’s the actual website) is a one-stop online resource for the latest info, linking HIVpositive people to treatment assistance programs within their state fitting their needs. While the ADAP program is federally funded, the directory is made possible by grants from Walgreens and pharma companies, including AbbVie, Gilead Sciences, Janssen Therapeutics, Merck & Co., and ViiV Healthcare.

Each state has its own Maximum Qualifying Income, which is the most you can make and still qualify for ADAP. Some states start at the poverty level (around $12,000 a year—plus $4,200 for each additional family member).

But, in higher income states that number goes way up. (in California, for example, you can make over $60,000 and still qualify for assistance.)

To find out if you qualify, visit ADAP.Directory/About and fill in the ADAP Income Eligibility Calculator.

42

MARINOL

generic name: dronabinol maker: AbbVie cautions: Do not use if you have a psychiatric history, are pregnant or may become pregnant. Use caution if you experience seizures or have a cardiac disorder. traditional dosage One 2.5 mg capsule taken twice daily. what it treats A man-made form of cannabis, it is used to stimulate the appetite of people living with HIV.

MEGACE ES, MEGACE ORAL SUSPENSION

generic name: megestrol acetate maker: Strativa, Bristol-Myers Squibb cautions: Do not use if you are pregnant. If you have a history of blood clots, check with your doctor before taking. traditional dosage 625 mg (one teaspoon), once daily. what it treats Treats appetite loss, severe malnutrition, or unexplained, significant weight loss.

(lipoatrophy) and stimulates the body’s collagen production to combat HIV-related facial wasting.

SCULPTRA

generic name: injectable poly-L-lactic acid maker: Dermik Laboratories who is it for? If you have an active skin infection or inflammation in or near the treatment area, do not use until this condition is under control. traditional dosage Amount and frequency varies by patient; delivered by subcutaneous injection. what it treats Helps restore or correct signs of facial fat loss (lipoatrophy).

SEROSTIM

generic name: somatropin maker: EMD Serono cautions: Do not use if you are critically ill, following surgery, have serious injuries, or a severe breathing problem, or have cancer. Do not use if you have eye problems caused by diabetes. traditional dosage 0.1 mg per kg of body weight daily (up to 6 mg), injected subcutaneously at bedtime. what it treats Treats wasting (HIVrelated weight loss).

SPORANOX

generic name: crofelemer maker: Napo cautions: Get tested to make sure your diarrhea is not caused by an infection. traditional dosage One 125 mg delayed-release tablet, twice daily. what it treats Formerly named Fulyzaq. Relieves HIVrelated diarrhea that is a side effect of many antiretroviral drugs

generic name: itraconazole maker: Janssen cautions: Use caution if you have heart, lung, or kidney disease, or take certain antiretrovirals. Do not take capsules if you have or had congestive heart failure. traditional dosage 200 mg daily, in oral solution, without food (if possible) for 1 to 2 weeks for oral candidiasis; 200 mg daily in capsule form, for other fungal infections. what it treats Treats fungal infections.

The oral solution only treats the fungal infections of oral candidiasis (thrush) and esophageal candidiasis. Sporanox capsules are a different preperation than Sporanox Oral Solution and should not be used interchangeably.

RADIESSE

VFEND

MYTESI

generic name: calcium hydroxylapatite maker: Merz Aesthetics cautions: Users of blood thinners or aspirin may have bleeding or bruising at the injection site. traditional dosage Single-use vial injected into the skin. what it treats Treats facial fat loss

generic name: voriconazole maker: Pfizer cautions: Use with caution if you have a heart arrhythmia. traditional dosage 200 mg in tablets or oral solution, every 12 hours. what it treats Treats fungal infections, such as esophageal candidiasis.

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_REVISED2.indd 42

5/17/18 11:04 AM

THE NEWEST KIDS ON THE BLOCK

THE RUN DOWN ON THE LATEST FDA-APPROVED HIV MEDS.

BY PLUS EDITORS

SHUTTERSTOCK (ILLUSTRATION) JOSHUA COLEMAN ON UNSPLASH (PILL BOTTLES)

BIKTARVY

CERTAINLY ONE OF the most exciting advances in HIV treatment this year is the U.S. Food and Drug Administration’s approval of the once-daily, singletablet regimen, Biktarvy. The drug demonstrated high efficacy, few drug interactions, and a high barrier to resistance in extensive clinical trials. In April, the Committee for Medicinal Products for Human Use of the European Medicines Agency recommended the new treatment be granted authorization for marketing in Europe. If approved, Biktarvy will be available in all 28 countries of the European Union, Norway, Iceland, and Liechtenstein.

The smallest single-pill, INSTI-based triple therapy regimen available on the market, Biktarvy combines the novel, unboosted integrase strand transfer inhibitor (INSTI) bictegravir with a backbone of Descovy (emtricitabine and tenofovir alafenamide), Gilead’s dual nucleoside reverse transcriptase inhibitor (NRTIs).

“In clinical trials through 48 weeks, no patients taking the regimen of bictegravir plus FTC/TAF developed treatment-emergent resistance, results that were observed both in people new to therapy and those who were virologically suppressed and chose to switch regimens,” said Paul Sax, MD, professor of medicine at Harvard Medical School and a lead clinical trial investigator. “In addition, the clinical data show that the regimen’s antiviral efficacy, tolerability profile, and limited drug interactions offer an effective new treatment option for a range of people living with HIV.” Biktarvy is a complete regimen for the treatment of HIV in adults who have either never been on antiretroviral treatment, or who are virally suppressed

and looking to simplify or replace their current regimen.

You should only switch to Biktarvy if you have been on a stable antiretroviral regimen for at least three months with no history of treatment failure and no known resistance issues associated with its individual components.

Since Biktarvy does not contain the drug abacavir, it does not require an HLA-B*5701 test (which checks for a hypersensitivity to abacavir), has no food intake requirements, and has no baseline viral load or CD4 count restrictions. As long as your kidneys are functioning healthily (your estimated creatinine clearance must be greater than or equal to 30 mL/ minute), no dosage adjustment is required.

According to Biktarvy’s prescribing information, healthcare providers should test for hepatitis B and renal function prior to initiating treatment, and appropriately monitor renal function during therapy. Throughout the clinical trials, none of the participants developed virologic resistance or discontinued Biktarvy due to adverse renal events. The most common side effects were diarrhea, nausea, and headache.

“Gilead is committed to improving care and simplifying therapy for people living with HIV,” said John F. Milligan, PhD, Gilead’s president and CEO. “We are pleased to offer Biktarvy, our latest triple-therapy treatment, which brings together the potency of an integrase inhibitor with the most-prescribed dual-NRTI backbone in a once-daily single-tablet regimen.”

Additional clinical trials of Biktarvy are ongoing, including new studies dedicated to women, adolescents, and children living with HIV—which Gilead plans to present data from at future scientific conferences.

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 43

43

5/16/18 8:33 AM

JULUCA

IN THE EARLY days of the epidemic, the first treatment options for HIV were so harsh on the body (due to high levels of toxicity) that the side effects were nearly worse than the immune system damage of the virus itself. Fortunately, since breakthroughs made with antiretroviral therapy in the 1990s, researchers have remained dedicated to developing treatment regimens that require less medication and fewer pills, and offer lower toxicity. Now, ViiV Healthcare has created Juluca, the first single-pill, two-drug regimen.

“Juluca, our new two-drug regimen, once-daily, single pill, now provides people living with HIV who are virologically suppressed the option to reduce the number of antiretrovirals they take, while maintaining the efficacy of a traditional three-drug regimen,” John C. Pottage, Jr., MD, the chief scientific and medical officer at ViiV Healthcare, told reporters in November 2017, when Juluca was FDA-approved. Pottage said the new regimen was developed “based on the fundamental principle that no one should have to take more medicines than necessary.”

To use Juluca—the first two-drug regimen comprising the integrase strand transfer inhibitor, dolutegravir (a product of ViiV Healthcare), and the non-nucleoside reverse transcriptase inhibitor, rilpivirine (developed by Janssen Therapeutics)—you must already be virologically suppressed. According to a statement by ViiV Healthcare, the FDA-approved Juluca can be used “as a complete regimen for the maintenance treatment of HIV-1 infection in adults who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable antiretroviral (ART) regimen for at least six months with no history of treatment failure and no known substitutions associated with resistance to the individual components of Juluca.”

In clinical trials, very few side effects were reported.

The main serious adverse reactions to Juluca are severe skin rash, depression, and liver problems. You should contact your health care provider right away if you develop a skin rash or major changes in mood (feelings of sadness or hopelessness, lack of motivation).

People with a history of hepatitis B or C, or who have elevated results on liver function tests, may have an increased risk of developing new or worsening liver problems while taking Juluca. Liver problems have also occurred in people taking it who have no history of liver problems. Depending on your specific health history, your doctor may want to test your liver function before starting Juluca, and may continue to monitor it while on treatment.

Deborah Waterhouse, ViiV Healthcare’s CEO, told reporters, “The FDA approval of Juluca marks an important milestone in our commitment to deliver innovative advances in HIV care by providing new treatment options that challenge the traditional approach to care. This is the start of a new era in HIV treatment. We are delighted to be able to provide the first two-drug regimen to physicians and people living with HIV in the U.S., to support the reduction of longterm ART exposure as they receive life-long treatment for their chronic condition.”

ViiV Healthcare is also exploring the potential of other two-drug therapies (both in phase 3 44

development), a once-daily, single pill containing dolutegravir/lamivudine for treatment-naïve patients, as well as a cabotegravir/rilpivirine long-acting injectable for treatment-experienced and naïve patients. Thanks to ViiV Healthcare and other drug developers focused on simplified treatment options, the quality of life continues to improve for those living with HIV.

CIMDUO

CIMDUO IS A once-daily combination of two nucleoside reverse transcriptase inhibitors—lamivudine and tenofovir disoproxil fumarate—and is indicated in combination for the treatment of HIV in adults and children weighing at least 35 kg. Cimduo is not a complete treatment regimen and is meant to be prescribed with other antiretroviral agents to complete therapy. It was developed to simplify treatment for those who are taking these two meds with the option of combining them into a single pill, which essentially allows many folks to drop from a three-pill to twopill regimen—and fewer pills usually translates to greater adherence.

Like most HIV medicines, Cimduo may cause some bothersome but manageable side effects, such as nausea or occasional dizziness. More serious adverse reactions that can be caused by Cimduo include a buildup of lactic acid in the blood (lactic acidosis), severe liver problems, and new or worse kidney problems.

If you have both HIV and hepatitis B and take Cimduo, your HBV infection may flare up if you stop taking Cimduo. To help avoid this, take Cimduo exactly as prescribed and don’t stop taking it without talking to your doctor first.

A worsening of liver disease has occurred in people being treated for hepatitis C and taking HIV medicines and interferon alfa (with or without ribavirin). If you are taking Cimduo and interferon alfa, and you have any new symptoms, tell your health care provider right away. Others taking Cimduo also have developed new or worse kidney problems, including kidney failure.

Your health care provider may do blood and urine tests to check your kidneys before and during treatment with Cimduo.

“Mylan has been on the forefront of bringing innovative delivery and dosage forms of ARVs to millions of patients in the developing world,” said Mylan president, Rajiv Malik. “We’ve already extended our reach to people in the U.S. living with HIV with the introduction of Symfi Lo and Cimduo.” The company also added Symfi and Symfi Lo to their portfolio of FDAapproved drugs (see below).

Mylan is the world’s largest supplier by volume of HIV therapies—more than 40 percent of the 20 million people on treatment worldwide depend on a Mylan product.

SYMFI AND SYMFI LO

THIS SPRING , GLOBAL pharmaceutical company Mylan announced that the FDA approved their new single-tablet, once-daily regimens Symfi, and Symfi Lo. Symfi contains three different medicines combined into one pill that is a complete regimen: the non-nucleoside reverse transcriptase inhibitor, efavirenz; and two nucleoside reverse transcriptase inhibitors, lamivudine and tenofovir disoproxil fumarate.

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 44

5/16/18 8:33 AM

SHUTTERSTOCK

Symfi and Symfi Lo both include this same triple combination of molecules—the only difference being that Symfi Lo features a reduced dose of efavirenz, while Symfi uses a dosing similar to other efavirenz products already on the market. The combination represented by Symfi is the most widely taken antiretroviral regimen outside the United States, with more than seven million users worldwide in 2016, according to Mylan.

Symfi is indicated as a complete regimen for the treatment of HIV in adults and children weighing at least 40 kg.

Not many side effects were reported, though some adverse reactions can be very serious.

Though not specifically related to Symfi use, lactic acidosis and hepatomegaly with steatosis (including fatal cases) have been reported with the use of nucleoside combos that include lamivudine and tenofovir disoproxil fumarate. Some people with hepatitis B also reported severe acute exacerbations of the condition, and had to discontinue regimens with these components.

“As the largest supplier of antiretrovirals by volume in the world, Mylan has a longstanding commitment to expanding affordable access to treatments for people living with HIV,” said Mylan’s chief executive officer, Heather Bresch. “As we continue to grow our U.S. portfolio of ARV products, now including Symfi Lo, Symfi, and Cimduo, we are providing access to patients and empowering them to choose the lower-cost ARV treatment option that is right for them.”

HELLO, HOT SHOT MULTIDRUG-RESISTANT HIV ISN’T A DEATH SENTENCE ANYMORE.

BY BENJAMIN M. ADAMS AND JACOB ANDERSON-MINSHALL

he U.S. Food and Drug Administration has approved a years-indevelopment, first-of-its-kind treatment that could be a lifesaver for those resistant to most or all available HIV meds.

The long-acting injectable ibalizumab (brand name Trogarzo) is the first non-oral therapy of its kind, and one specifically aimed at fighting multi-drug resistant strains of HIV. Ibalizumab concluded its phase 3 trials over a year ago, and since then researchers have recruited participants for an expanded access study that gives needy patients (who didn’t qualify for the CONTINUED ON PAGE 51

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 45

45

5/16/18 8:33 AM

SHUTTERSTOCK

46

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 46

5/16/18 8:33 AM

ON THE HORIZON

THESE INVESTIGATIONAL HIV DRUGS ARE EITHER EXPECTING FDA APPROVAL OR ARE CURRENTLY IN LATE STAGE TRIALS. REMEMBER THEIR NAMES.

BY DAVID ARTAVIA

There are always new drugs being investigated in clinical trials around the globe, or awaiting FDA approval. Here are the most promising:

COMING IN 2018

DORAVIRINE/TENOFOVIR DF/LAMIVUDINE (BRAND NAME TO BE DETERMINED): Expected to be FDA-approved this October, DOR/ TDF/3TC is a single-tablet regimen with a non-nucleoside reverse transcriptase inhibitor, which can benefit those who have developed resistance to other non-nukes.

FOSTEMSAVIR (NAME TBD): ViiV Healthcare’s latest drug is expected be FDA-approved this year following a successful phase 3 trial. A gp120 attachment inhibitor, fostemsavir works by attaching to the gp120 protein on the outer surface of HIV, blocking the virus from getting into and corrupting immune cells.

SYMTUZA (DARUNAVIR/COBICISTAT/EMTRICITABINE/TENOFOVIR ALAFENAMIDE): This single-tablet regime was approved for use in Europe last September, and is expected to be approved by the FDA this summer. Developed by Janssen Inc., DRV/COBI/FTC/TAF would be the first single-tablet regimen containing a protease inhibitor. Single tablets could mean a lesser chance of missing doses.

COMING IN 2019

CABOTEGRAVIR/RILPIVIRINE LONG-ACTING INJECTABLE (NAME TBD): Consisting of ViiV Healthcare’s integrase inhibitor cabotegravir and Janssen’s NNRTI rilpivirine, this long-acting injectable is administered once every four to eight weeks. During trials, 90 percent of participants remained undetectable during 96 weeks of studies. It’s expected to be FDA-approved sometime in 2019.

DOLUTEGRAVIR/LAMIVUDINE (NAME TBD): Earlier this year, ViiV Healthcare began a phase 3 study (TANGO) to see if folks on a three-drug regimen can maintain viral suppression upon switching to this two-drug therapy, DTG/3TC. The two-drug combo is expected to be approved in 2019.

2020 AND BEYOND:

VACCINES: Although no HIV vaccines exist yet, researchers are studying investigational preventive vaccines and treatment vaccines. Therapeutic vaccines are designed to slow the progression of HIV and to delay the onset of stage 3 HIV, or AIDS. Research is well underway and from the looks of it, we’re likely to see more advancement with these: VAC-3S: Currently in phase 2a trial, VAC-3S is made up of an HIV peptide (a piece of HIV protein), used to help the body generate an immune response against HIV. The goal is for VAC-3S to slow down the progression of HIV and to eliminate the need for ART while still remaining undetectable. Researchers hope it will help eliminate all HIV from the body as part of a combination strategy.

VRC DNA-HIV: Currently in phase 2 development, VRC DNA-HIV is a DNA vaccine made up of parts of HIV’s genetic information, which is meant to produce an immune response against HIV in the body. It may also act as an HIV prevention tool. When combined with other vaccines, it may reduce the amount of inactive HIV in the body.

VRC RAD5: Currently in phase 2 development, VRC rAd5 is a viral vector vaccine, which means it delivers pieces of HIV’s genetic blueprint into the body’s cells. From there, the body uses the genetic information to produce a response from the immune system that can fight the virus. VRC rAd5 may also act as an HIV prevention tool, though its main focus right now is as a therapeutic vaccine.

LATENCY-REVERSING AGENTS: The goal of latency-reversing agents is to reactivate latent HIV hiding within resting T cells so that their home cell can be killed off by the body’s immune system. This remains one of the main obstacles to curing HIV, given that the virus can remain inactive inside certain cells (referred to as HIV reservoirs) for many months or even years.

DISULFIRAM: Currently FDA-approved for helping in the management of alcoholism, Disulfiram is now in phase 1/2 development as a latency-reversing agent for HIV as a type of agent called a phosphatase and tensin homolog (PTEN) inhibitor. Its involvement is in the regulation of the cell cycle, preventing cells from growing and dividing too rapidly.

It’s also a target of many cancer drugs.

LEFITOLIMOD: Currently in phase 1b/2a development as an HIV therapeutic, lefitolimod is a type of latency-reversing agent called a toll-like receptor agonist.

Researchers believe it may also improve the body’s immune response to HIV in addition to its effectiveness on latent virus cells.

Researchers in Denmark put lefitolimod to test in the TEACH study, which showed it to be safe in early phase trials.

CD4 ATTACHMENT INHIBITOR: CD4 attachment inhibitors work by attaching to a protein on the surface of the immune cells.

As a result, it keeps HIV from attaching and entering the healthy cell. This prevents HIV from multiplying and can reduce the amount of HIV in the body.

UB-421: Currently entering a phase 3 clinical trial, UB-421 saw safety and effectiveness in lowering one’s viral load in phase 2 and phase 2a trials in Taiwan sponsored by United Biomedical.

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_REVISED2.indd 47

47

5/17/18 11:04 AM

PHOTO CREDIT

48

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 48

5/16/18 8:33 AM

THAT’S NOT CRAZY TALK

WHETHER YOU BRING UP THE TOPIC OF ANTIDEPRESSANTS OR ANTIANXIETY MEDICATION—OR YOUR DOCTOR DOES—IT CAN BE THE START OF AN AWKWARD CONVERSATION. HERE’S HELP.

SHUTTERSTOCK (ACROSS)

BY GARY MCCLAIN, PHD,

of my therapy clients have been prescribed medication for depression or anxiety by their primary care physicians. Some of them initiated these discussions with physicians following a conversation we had about trying medication. Others have had this discussion with their doctors before finding their way to me.

Still other clients have told me their doctor suggested they consider medication after they’ve received a medical diagnosis—including learning they are HIV-positive—that their doctor worried would impact them emotionally.

I always appreciate when physicians have concern for the emotional states of their patients, but I also hear from clients that conversations with their primary care physicians about depression or anxiety medication are rarely easy. People don’t always know how to bring up mental health issues with their doctor. Or they may have concerns about what they should know before consenting to begin medication.

I like to present the discussion about such medications as an opportunity for clients to team up with their doctors in their health care. Here are some guidelines to help you have this conversation: If you are requesting the medication, be direct and specific.

Let your doctor know that you are concerned about your mental health and why. Say something like, “I think I may be experiencing depression. Over the last (be specific about the timeframe), I have been feeling (briefly list your symptoms).” If you have talked this over with a therapist, make sure your doctor is aware of that as well. If your doctor recommends medication, ask them to be specific about what they are recommending and why.

Alternately, your doctor may initiate the conversation, by asking you some questions about your mental health, and then suggesting medication. If so, ask them to explain what they heard you say, or what they observed, that led them to diagnose you with depression or anxiety and why they recommend a pharmaceutical solution.

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 49

49

5/16/18 8:33 AM

Ask why a specific drug is being recommended. Your physician may have specific reasons why one medication is being recommended over another. Or the medication being recommended may be your physician’s standard “go to,” which they generally recommends for patients who have symptoms similar to yours. If you have questions about how well it’s working, later on, or want to talk about it with another physician, this will be important information.

And ask if there are other options. Not only other medications, but also therapy.

Get fully informed on your physician’s thinking behind their recommendation.

You may want to research some of these alternatives on your own to help you to make the medication decision. Asking these

you’re at it, also ask if there any side effects that, if experienced, should be reported immediately, or that might be dangerous.

Keep in mind that individuals vary in terms of whether they experience side effects and how pronounced those side effects are. Getting clear with your doctor on potential side effects—both common and rare—will help to set your expectations for how you might be impacted. This will help you decide if this is the right path for you.

Don’t start until you are ready. The decision to go on medication for depression or anxiety is a big one. You may not be ready to give the go ahead after a brief discussion with your doctor. You may want to say something like, “I need some time to digest all of this, and do some of my own research. I will get back to you soon.”

questions will also help you to feel confident about your physician’s level of experience in treating depression or anxiety.

Understand how the medication should benefit you, and how soon. I often hear from my clients that they have no idea how their medication should make them feel, if they should feel better, or just not feel worse. Some people do notice a shift in their mood as a result of medication. Or, your medication may put a “floor” under your depression, so you don’t sink any lower, or a “ceiling” over your anxiety so you don’t experience anxious episodes or panic. Ask your physician to let you know what you should expect in terms of any symptom relief or prevention. And ask how soon you should expect to experience the benefits. This will help you to determine if the medication is helping or not. Ask your doctor if they can give you a sense of how long they think you might need the medication. Is this to help get you through a rough spot or something you might have to take indefinitely?

It’s also important to get an idea of potential side effects of any medication your doctor recommends. Some medications have quite pronounced side effects, such as weight gain or changes in libido, while others have relatively few side effects. So ask your doctor to give you an idea of what you might expect. While 50

And then do your own due diligence by researching the recommendation and your options. You may then want to schedule another appointment to talk about what you learned.

Consider a second opinion from a psychiatrist. Many primary care physicians have been prescribing psychiatric medications for years, and are very competent. But still, consider this: If you had a serious skin condition, you would probably want to consult with a dermatologist. If you had eye trouble, you would probably go to an ophthalmologist.

So if you are experiencing depression or anxiety or another mental health issue that may require medication, you might also want to seek the opinion of a psychiatrist. I specifically recommend seeing a psychiatrist in this context rather than a psychologist, counselor, or other mental health professional because only psychiatrists can prescribe medication.

Don’t hesitate to be high maintenance.

Keep your doctor abreast of how you’re feeling. Raise any concerns you have about how the medication may, or may not, be affecting you. Your doctor can’t help you if you don’t keep them in the loop.

To reiterate: Ask questions. Express your concerns. Do your own research. That way, if you take the big step of starting medication, you’ll do it with confidence!

Gary McClain, PhD, is a therapist, patient advocate, and author in New York City, who specializes in working with individuals diagnosed with chronic and catastrophic medical conditions, their caregivers, and professionals.

(JustGotDiagnosed.com)

MAXIMILIAN IMAGING (MCCLAIN)

Get fully informed on your physician’s thinking behind their recommendation.

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 50

5/16/18 8:33 AM

CONTINUED FROM PAGE 45

SHUTTERSTOCK

The long-acting injectable Trogarzo is the first non-oral therapy of its kind.

clinical trial) access to the new drug while awaiting official FDA approval. That program was possible because the FDA had already declared ibalizumab a “breakthrough therapy.”

“It has been more than a decade since ibalizumab moved to phase 2b development,” said Edwin DeJesus, M.D., medical director for the Orlando Immunology Center and an ibalizumab clinical trial investigator. “Early on, we knew the potential of this agent. However, I believe this long developmental process has served everyone well, especially in our ability to understand where this drug, which is the first drug to be administered intravenously for the treatment of [HIV], can best fit in our [medical armory].

Although we have waited a long time, ibalizumab now becomes available perhaps at a point in which it is most needed.”

Ibalizumab was developed by Theratechnologies Inc. and showed to be effective in clinical trials, significantly decreased viral loads in participants after just a few weeks of treatment. Those results continued—and even improved—over the course of the study.

Forty people with multi-drug resistant strains of HIV participated in the study, where they were either given injections of 2,000 mg of ibalizumab in addition to their (failing) antiretroviral therapies, or ibalizumab with no additional antiretrovirals.

Like other antiretrovirals, ibalizumab’s success rate wasn’t high enough to justify it as a stand-alone drug but it will improve the effectiveness of combination therapy (all currently approved HIV regimens include multiple drugs). The new drug is particularly designed for people living with multidrug-resistant HIV whose current antiretroviral regimens are failing to keep them undetectable.

In addition to being the first long-acting therapy, ibalizumab is the first HIV therapy with a new mechanism of action approved in a decade. It is in a new class of post-attachment inhibitors (PAIs), which bind to CD4 cells after HIV has attached to them, and inhibits the HIV virus from successfully corrupting the cells.

Having a different mechanism of action is essential for those who’ve developed drug resistance, since becoming resistant to a class of

drugs often renders every drug in that class useless.

Study participants weren’t solely resistant to a single HIV therapy, but showed resistance to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors. More than 60 percent also had resistance to at least one integrase inhibitor. Some had become resistant to all the drug classes on the market. For those people, ibalizumab could literally be lifesaving.

“We are at a crossroads,” DeJesus reiterated, “where we have developed great ARV therapies to treat our newly diagnosed HIV patients, and those who have failed, or poorly tolerated their second or third ARV regimen. For patients with no treatment options to build a potent new ARV regimen, this multidrug resistance can become a life or death situation. But even before that point is reached, this multi-drug resistance, and the inability to control the HIV [virus], can significantly reduce patient’s quality of life and promote the development of significant morbidities; something that we also need to avoid.”

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 51

51

5/16/18 8:33 AM

ACTIVISM

SHUTTERSTOCK

BY ALEXANDER CHEVES

52

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 52

5/16/18 8:33 AM

TIMES QUEER

RECALLING A MAGICAL NIGHT IN NEW YORK INSPIRED ME TO JOIN AIDS WALK.

HERE’S MY FAVORITE childhood memory.

I was about 10 years old. My mother and I were in New York City to see The Lion King on Broadway. I’m sure the show was fantastic, but I remember my mother more than the play.

She transformed on the streets of New York before my eyes.

It’s remarkable when you realize your parents have separate lives, or separate identities, and are not a unit of one. My father was a dogmatic presence. He judged the world by a rigorous ethic: Excess is a sign of

the statue behind us. My mother hailed taxis like she had done it a hundred times. She was a bohemian businesswoman enjoying Central Park with her son, and I followed behind her in awe.

For two days, the city was freezing but it refused to snow. On our last night, as we walked out of the play, a light snowfall started in Times Square. The city went silent. There was no one around. We tiptoed through the snow, past the illuminated billboards, unable to speak. In that moment it was my mother and me. There was no one else in the world.

Two days ago, my mother donated $100 to my fundraising efforts for AIDS Walk New York. This will be my first AIDS Walk.

I moved to Manhattan one month ago and wanted to show my love to the greatest city in the world. My parents helped me move, but on the trip I watched my father intently.

He had softened in my years away from home. Where had that gray hair come from?

And my mother, huddled against the cold of the street, near tears as I waved goodbye.

I remember when I told her I had HIV. I called her from Los Angeles to tell her I was going public with a secret I had kept from her and everyone else in my family for three years. “I’m fine,” I assured her. “I’m on meds and taking care of myself. I just wanted you to know.”

COURTESY ALEXANDER CHEVES

“IT’S OK, MOM,” I TOLD HER. “I MADE IT. IT’S OK.” liberal, secular decadence. He practiced an uncompromising religiosity, refused to eat at “white tablecloth restaurants,” fixed his own farm equipment, and distrusted people with expensive cars and stylish clothes. He was hottempered and rough.

My mother, I always believed, was his sidekick—the softness to balance his hardness and the adjacent bolster to his furor. But over two days in New York City, she became something else. She wore a coat I have never seen her wear before or since. It was wool, calf-length, with a Native American pattern on it, dashes of crimson, brown, and olive running down the back.

I followed her through the glass city. She knew where to go. We walked up escalators and down stone steps through clothing stores and halls of perfume. Gone was the woman I knew before. This one was regal and confident. We went to the Statue of Liberty and took pictures of ourselves at the tip of the ferry, waving back at home with

She called me later that same day to tell me she was sorry—sorry that she hadn’t been supportive when she needed to be, sorry I had felt unable to tell her when I first tested positive. I needed to hear it. I was standing in the parking lot of a movie theater listening to my mother tell me she wished she had been there to help me get through those first years. I wished she had, too. “It’s OK, Mom,” I told her. “I made it. It’s OK.” The AIDS Walk is for many people. It’s for the queer men and women who’ve fallen to this unimaginable and relentless disease, for the many more who will die before we find a cure; and for the trans, brown, black, undocumented, genderqueer, and non-binary people still under attack, still underserved and unreached in their battle against HIV and AIDS. It’s for the many mothers whose sons never told them, “I’m going to be fine.” How many more do we need to lose? In a different decade, my mother would have lost me. But I live, and I run for her.

Alexander Cheves is a New York-based writer and author of The Beastly Ex-Boyfriend blog. (@BadAlexCheves)

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 53

53

5/16/18 8:33 AM

R E S I S TA N C E

COURTESY TOMMY BROWN

B Y D AV I D A R TAV I A

54

JULY / AUGUST 2018

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 54

5/16/18 8:33 AM

RELENTLESSLY POSITIVE THIS POZ WARRIOR SEES EVERY CHALLENGE AS AN EXCUSE TO EDUCATE OTHERS, AND HE’S GONE THROUGH PLENTY OF THEM. TOMMY BROWN IS positive in every sense of the word. Diagnosed with HIV at 22, the now-30-year-old producer and activist has made it his life’s mission to not only tell his story, but to give others courage to tell theirs, and to “no matter what, never give up” living life to the fullest.

A Jackson, Miss. native, Brown has chosen to live blessing to blessing, rather than letting HIV stigma rule his life. A former project coordinator for Mississippi’s healthcare organization My Brother’s Keeper, his new production company, PrinceT Productions, is continuing to build up steam.

In addition to being chosen by the Centers for Disease Control and Prevention to be part of its HIV Treatment Works campaign, Brown continues to serve his local community by taking part in discussions relating to HIV and mentorship. But uncovering his own status was anything but easy.

“My mom called to say I had received a letter from the health department stating they wanted me to come in for more testing because my recent test was inconclusive,” he told Plus last year. “Within that year they ran several tests: The first was positive, the second was negative, the third was positive, and the last test, which was sent to D.C., was negative. They ended up sending me away with a ‘clean bill of health.’ It wasn’t until 2013 I found out I was actually HIV-positive.”

The experience proved to be a valuable lesson for Brown, who had always been adherent with doctor visits and treatment

regimens. That would be put to the test two years later when he ended up in the county jail awaiting trial and the institution withheld his HIV medication for “one month, two weeks, and five days,” he says.

“I was falsely jailed because of someone else, and in that time I informed the center that I was HIV-positive and that I had to take my meds every day,” Brown shares. He was allegedly told at the time that it cost the prison too much money for the medication.

As a result, Brown, who says he was undetectable upon entering the jail, was unable to get proper treatment to remain so. Once released, he returned to his proper regimen but due to the emotional stress in the following weeks, he admits he would sometimes skip meals while taking his pills. As people with HIV quickly learn, many antiretroviral medications must be taken with food in order for them to properly metabolize. Not eating the right foods at the right times can make the drugs less effective.

According to his doctor, because Brown had been living a healthy life and was extremely adherent to his meds before he went to jail, his viral load didn’t actually increase to the point of making his HIV detectable again (a rare scenario, which is why it’s always recommended to never skip treatment). However, Brown’s doctor did notice his T cells were lower than usual.

“He basically informed me that since I wasn’t getting proper foods [required] with my medication that he wanted to switch me over to [a drug] that doesn’t require me to intake food with the medication,” Brown says. “That way, I can maintain my daily life and my undetectable viral load.”

The experience led Brown to speak on behalf of the importance of adherence, especially for those who are newly diagnosed and are unclear how HIV treatment works. Where he’s from in the South, sharing that kind of information is especially important. Jackson, Miss., has the nation’s highest rates of gay and bisexual men who are HIV-positive: 40 percent.

Columbia, S.C.; El Paso, Texas; Augusta, Ga.; and Baton Rouge, La., follow quickly behind, according to a report by The New York Times.

These days, Brown hopes his story inspires other poz folks to be vigilant about treatment, resistance, and the need to occassionaly switch medications.

“If that particular medication isn’t working for you, don’t give up and don’t give in,” he says. “There are several ways to get you undetectable and keep you undetectable.

After all, that is the ultimate goal here.”

HIVPLUSMAG.COM

36-55_PLUS125_FEA_Treatment Guide_FINAL.indd 55

55

5/16/18 8:33 AM

B AC K TA L K

TIME TRAVELER

IN HER LATEST FILM, VIRGINIA MADSEN PLAYS A MOTHER WHOSE CLOSETED GAY SON COMES HOME TO LET THE FAMILY KNOW HE’S DYING FROM AIDS COMPLICATIONS. enjoyed a recent surge in relevance, from the spectacle of Ready Player One to the nostalgia of Stranger Things. But the era remains one marked in sadness in the history of HIV, a time when the stillmisunderstood virus claimed countless lives.

Actress Virginia Madsen launched to stardom in the mid-‘80s thanks to roles in Dune and Modern Girls, becoming one of Hollywood’s sexiest stars. Even as her fame rose, she was well aware of the growing tragedy. Now, as she promotes her new film, the nostalgic AIDS drama 1985, Madsen remembers the loss of life, telling press and film festival audiences about the deaths of close friends— and an uncle she never got to truly know.

“It was talked about in hushed tones,” she recalls.

“People were trying to hide when they were terribly ill. If somebody developed a bad respiratory infection, people wanted to move away. Nobody knew anything. They

THE 1980S HAVE

56

JULY / AUGUST 2018

wondered, could you get it from touching or from tears?”

Families, including her own, suffered irreparable ruptures. She recalls her uncle Chicky, who moved away from the family’s small Illinois community while Madsen was just a child.

“I didn’t know him well, but remember him as a little kid because he was extraordinarily beautiful,” Madsen says. “But he had to leave and move to San Francisco. I was robbed of knowing him because no one could accept who he was in our community.”

Chicky died in 1989, and Madsen learned about her uncle from a long-time partner who stayed at his side as his health declined.

Friends would officially announce “cancer” as the cause of death, but it fell on Madsen to share the truth with Chicky’s mother.

“Nobody wanted to talk because nobody knew what to say,” Madsen recalls. “My father said, ‘You probably know what this is all about, so would you talk to her?’ She didn’t know. She wondered, ‘Did I do something wrong?’ I just talked to her a long time and told her what I knew.”

Madsen knew too much. By that point, she was living in Los Angeles, and had seen other friends succumb to AIDS complications.

“People aren’t supposed to die in their 20s, and the first of my friends who did, it was the same thing,” she says. “His family said he died from a rare form of leukemia. He was only 23 or 24, and he didn’t want anybody to know he was sick. It was this horrible secrecy, an isolation that went on with the people who got it, that ‘gay cancer.’”

Even as supposed cures surfaced, and the effective drug cocktails in the late ‘90s came into development, hopes often faded. “I had a close friend of mine, and it didn’t work for him for one reason or another,” she says of the antiretroviral therapy of the time. “So you’d watch your friend wither away and start wasting, and you could just see the life ebbing away.”

In 1985, Madsen plays a mother whose closeted gay son comes home to let the family know he’s dying. The son, played by Cory Michael Smith, lived in a time when the telltale marks on the skin (Kaposi sarcoma) associated with AIDS served as an impending death notice.

But as Madsen visits film festivals—the movie premiered at SXSW before heading to the Sarasota Film Festival and the Dallas International Film Festival— she hopes young people today know that while HIV is now treatable, it remains no small concern. At some screenings, filmmakers handed out condoms.

“There’s a lot of parental common sense things I can pontificate about, but people need to know it’s not over and you can still get sick.”

Medical advances—everything from treatment as prevention to PrEP—at least erase much of the terror and fear around HIV discussions, Madsen says.

“We are being nostalgic and looking back at a story like this, but I want to make sure people understand it’s current. People need to be safe and take care of their partners at the same time.”

NICK HOLMES

BY JACOB OGLES

D A I LY D O S E

BY TYLER CURRY

A LIFE OUT LOUD LIVING YOUR TRUTH TAKES THE POWER AWAY FROM BULLIES. Texas as a gay boy in the 1990s, you can’t imagine how incessant the teasing, taunting, and bullying was. After years of being called every gay slur in the book, and changing schools twice, I eventually came out of the closet at the beginning of my junior year. I braced myself for more torment, but something strange happened. Things got better. I owned my story, and it took all of the power and impact away from the insults. What was the point of them calling me gay when I was already admitting I liked guys? I was allowed to enjoy my remaining years of high school in a relative peace.

The lesson of owning my truth would serve me well in the future.

When I tested positive for HIV 14 years after high school, I was far removed from the experiences of being bullied and suppressing my truth.

My 20-something reality was quite the opposite—a life of late nights and boozy brunches chatting about who slept with who and when the next pool party would be.

SHUTTERSTOCK (ILLUSTRATION); COURTESY TYLER CURRY (CURRY)

GROWING UP IN

For a lot of gay men, your 20s and 30s is a second chance to be the popular girl at school. It was for me, and I’m not proud of the way I acted because of it. After grad school, what I looked like and with whom I partied took precedence over my career interests and my integrity. Then I suddenly found myself with a new secret that could potentially burst my superficial bubble.

On the outside, I kept up appearances. On the inside, I vacillated from petrified to numb.

However, I did start to reveal my HIV status to a few key people I thought I could trust. It started with my sister, then a close friend, and person-byperson the new reality of living with HIV began to come into focus. Just like high school, however, tell the wrong person your secret and it won’t be a secret for long.

One of the few folks I disclosed to also struggled with the need to be validated by men. His need to be wanted ran so deep that nothing was off limits if it meant he would get attention from whichever conquest was currently in his sights. In order to eliminate me as a competitor, he began revealing my HIV status to people. It got nastier than just sharing my business, quite frankly, but I don’t want to waste any more words on him. Suffice it to say, people who I didn’t want to know my status found out. I was that gay kid in high school all over again.

Naturally, I struggled with all of the fears and trepidations one does before coming out with something as stigmatizing as HIV. From my family and friends to my professional peers, I worried about being judged for my status and the varied ramifications.

Then, I realized these concerns mirrored my fears of coming out of the closet 14 years earlier. I remembered how much better life was after coming out and taking back the power people had over me.

Unlike being gay, living with HIV was something I had the ability to conceal. In many ways, I think this made the process harder. Coming out about being poz felt like more of a choice than coming out gay. The truth is I am more thankful for the second experience. I had to come out HIVpositive and stand with my truth in the same place. Finding the strength to be confident in myself helped me become a more fully realized person.

Living out loud with your truth might not get you a seat at the popular table, but it can take the power away from your bullies—and save you the struggle that comes when you live with secrets.

Editor at large Tyler Curry is also a contributing editor at The Advocate magazine and the author of A Peacock Among Pigeons. (@IamTylerCurry)

HOW DO WE HELP STOP HIV? A. PREVENT IT. B. TEST FOR IT. C. TREAT IT. D. ALL OF THE ABOVE. Learn how it all works together at HelpStopTheVirus.com © 2015 Gilead Sciences, Inc. All rights reserved. UNBC1856 03/15

18642 gilead bonus plus red.indd 1

5/1/18 12:12 PM