WORLD AIDS DAY 2017 IS A CURE IN SIGHT? BECAUSE YOU’RE MORE THAN YOUR STATUS
RESISTANCE WARRIORS ONGINA GETS REAL NEW TREATMENTS
AMERICA’S SWEETHEART Stylist turned TV star Eric Leonardos is more than just a poz Prince Charming
NOVEMBER/DECEMBER 2017 www.hivplusmag.com
YOU MATTER AND SO DOES YOUR HEALTH That’s why starting and staying on HIV-1 treatment is so important. WHAT IS DESCOVYŽ? DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.
DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance QH UGZWCN EQPVCEV YKVJ DQF[ ĆƒWKFU 0GXGT TGWUG QT UJCTG PGGFNGU QT QVJGT KVGOU VJCV JCXG DQF[ ĆƒWKFU QP VJGO
IMPORTANT SAFETY INFORMATION What is the most important information I should know about DESCOVY? DESCOVY may cause serious side effects: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY YKVJQWV ƂTUV VCNMKPI VQ [QWT JGCNVJECTG RTQXKFGT CU they will need to monitor your health. What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: • Changes in your immune system. Your immune U[UVGO OC[ IGV UVTQPIGT CPF DGIKP VQ ƂIJV KPHGEVKQPU Tell your healthcare provider if you have any new symptoms after you start taking DESCOVY. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems. • Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being
more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. • Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-coloredâ€? urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. • Bone problems, such as bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones. The most common side effect of DESCOVY is nausea. Tell your healthcare provider if you have any side effects that bother you or don’t go away. What should I tell my healthcare provider before taking DESCOVY? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take DESCOVY with all of your other medicines. • If you are pregnant or plan to become pregnant. It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Important Facts about DESCOVY, including important warnings, on the following page.
Ask your healthcare provider if an HIV-1 treatment that contains DESCOVYÂŽ is right for you.
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IMPORTANT FACTS ;OPZ PZ VUS` H IYPLM Z\TTHY` VM PTWVY[HU[ PUMVYTH[PVU HIV\[ DESCOVY HUK KVLZ UV[ YLWSHJL [HSRPUN [V `V\Y OLHS[OJHYL WYV]PKLY HIV\[ `V\Y JVUKP[PVU HUK `V\Y [YLH[TLU[ ®
KLZ 26/ ]LL MOST IMPORTANT INFORMATION ABOUT DESCOVY
POSSIBLE SIDE EFFECTS OF DESCOVY
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ABOUT DESCOVY ₔ +,:*6=@ PZ H WYLZJYPW[PVU TLKPJPUL [OH[ PZ \ZLK [VNL[OLY ^P[O V[OLY /0= TLKPJPULZ [V [YLH[ /0= PU people 12 years of age and older. DESCOVY is UV[ for \ZL [V OLSW YLK\JL [OL YPZR VM NL[[PUN /0= PUMLJ[PVU ₔ +,:*6=@ KVLZ UV[ J\YL /0= VY (0+: (ZR `V\Y OLHS[OJHYL WYV]PKLY HIV\[ OV^ [V WYL]LU[ WHZZPUN /0= [V V[OLYZ
BEFORE TAKING DESCOVY ;LSS `V\Y OLHS[OJHYL WYV]PKLY PM `V\! ₔ /H]L VY OHK HU` RPKUL` IVUL VY SP]LY WYVISLTZ PUJS\KPUN OLWH[P[PZ PUMLJ[PVU ₔ Have any other medical condition. ₔ (YL WYLNUHU[ VY WSHU [V ILJVTL WYLNUHU[ ₔ (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` ;LSS `V\Y OLHS[OJHYL WYV]PKLY HIV\[ HSS [OL TLKPJPULZ `V\ [HRL! ₔ 2LLW H SPZ[ [OH[ PUJS\KLZ HSS WYLZJYPW[PVU HUK V]LY [OL JV\U[LY TLKPJPULZ ]P[HTPUZ HUK OLYIHS Z\WWSLTLU[Z HUK ZOV^ P[ [V `V\Y OLHS[OJHYL WYV]PKLY HUK WOHYTHJPZ[ ₔ (ZR `V\Y OLHS[OJHYL WYV]PKLY VY WOHYTHJPZ[ HIV\[ TLKPJPULZ [OH[ ZOV\SK UV[ IL [HRLU ^P[O +,:*6=@
GET MORE INFORMATION ₔ ;OPZ PZ VUS` H IYPLM Z\TTHY` VM PTWVY[HU[ PUMVYTH[PVU HIV\[ +,:*6=@ ;HSR [V `V\Y OLHS[OJHYL WYV]PKLY VY pharmacist to learn more. ₔ .V [V +,:*6=@ JVT VY JHSS .03,(+ ₔ 0M `V\ ULLK OLSW WH`PUN MVY `V\Y TLKPJPUL ]PZP[ DESCOVY.com for program information.
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DESCOVY, the DESCOVY Logo, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: April 2017 © 2017 Gilead Sciences, Inc. All rights reserved. DVYC0057 05/17
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BECAUSE YOU’RE MORE THAN YOUR STATUS
RESISTANCE WARRIORS A Trans Latina Leader Prince Charming & An Activist Turned Actor
WORLD AIDS DAY 2017
GETTING TO ZERO
RUPAUL’S LADYBOY IS POZ & PROUD Drag Race star Ongina on marriage, trans rights, epic voices, and living with HIV
NOVEMBER/DECEMBER 2017 www.hivplusmag.com
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IN THIS ISSUE
NOVEMBER/DECEMBER 2017
28 26
42 ON THE COVER Eric Leonardos came out poz on gay reality dating show Finding Prince Charming and won our hearts—and the competition. Now he’s using his fame to help HIV-positive women and other people living with HIV.
FEATURES
22 Count Down to a Cure?
For World AIDS Day 2017 we look at whether we’re on the verge of a cure, a vaccine, or the end of AIDS.
26 Not So Preachy
A preacher’s poz son learns his father was also living in the closet. How did coming out transform their family and their church?
36 The Most Marginalized
Why must poz trans women (like Bamby Salcedo), aging Latinos, Asian-Americans, and Pacific Islanders fight such battles to get resources?
42 Like a Lady
RuPaul’s Drag Race star Ongina takes on stigma as part of the Epic Voices program.
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JON DEAN (MEREDITH); GETTY IMAGES (ONGINA)
28 The Hunk Next Door
MARCH / APRIL 2017
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IN THIS ISSUE NOVEMBER/DECEMBER 2017
BUZZWORTHY 7 Don’t Fear the Reaper Can death be stopped? Two women find out. 8 Dark Arts Immersive theater that shares the black gay HIV experience. . 9 Prison Break Fewer positive people behind bars than ever before. 14 Cattle Drive Could cows be the key to an HIV vaccine? Maybe so.
TREATMENT/TASP 16 Eating Ghosts Gene editing attacks HIV like a ghost-gobbling Pac-Man. 17 Is His Semen Safe? Reports that HIV can hide in semen raise fears. Bruce Richman busts the myths. 18 Liver Lovers Live Longer Switching meds could save your liver—and prevent early death. 19 Report Roundup New findings on cutting fat and building muscles, fighting drug resistance, and ending the epidemic.
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CHILL 20 Sex Crime? Having an STI shouldn’t be a crime.
RESISTANCE 27 Empowered Advocate Drug resistant from day one, this warrior never stopped helping others, but now he’s advocating for himself too.
SHUTTERSTOCK (BAR); COURTESY ANDREW SHAYDE (COMIC)
DAILY DOSE 47 Drunk Dating Drowning my sorrows in alcohol and men drove me to HIV. But I've learned.
48
BACK TALK 48 Monsters Among Us Andrew Shayde of Amazing Race fame fights AIDS and uses comic books to talk about life in Trump's America.
COVER AND OPPOSITE PAGE (LEFT): ERIC LEONARDOS PHOTOGRAPHED BY LENNY GERARD. RIGHT (TOP) MICAH MEREDITH AND HIS MOM LYDIA AND (ON BOTTOM) ONGINA FROM RUPAUL’S DRAG RACE.
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EDITOR’S LETTER
DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM
Contributing editor Khafre Abif (left) and I working at USCA. His new book, Sistah’s Speak, is a collection of works by women living with HIV.
CORRECTIONS: Our “5th Annual HIV Treatment Guide” (July/August 2017) included a few errors we need to correct Edurant (Rilpivirine): H2-receptor antagonists should only be administered at least 12 hours before or at least 4 hours after Edurant. Antacids should only be administered either at least 2 hours before or at least 4 hours after Edurant. Vfend taken orally was mistakenly included in the drugs that should be used with caution with Edurant. There are no reported drug interactions with Edurant and boosted-protease inhibitors, which we had also mistakenly listed. Intelence (Etravirine): Caution is only recommended when using the oral (systemic) formulation of ketoconazole. The topical formulation of ketoconazole does not have reported drug interactions with Intelence. Olysio (Simeprevir): Olysio can be used with Sovaldi, and cimetidine and grapefruit juice were also mistakenly listed as interactors. In addition to the interactors we listed, Olysio is not recommendefor use with cyclosporine, ledipasvir, NNRTIs, Priftin, Ketek, and cisapride. Prezcobix (Darunavir & Cobicistat/Tybost): Proper dosing is one tablet of Prezcobix (800 mg of darunavir and 150 mg of cobicistat) taken once daily with food. Embolex was mistakenly included list of interactors, but it has no reported drug interactions with Prezcobix. Prezista (Darunavir): Victrelis and Embolex were mistakenly included in the drugs that shouldn’t be taken with Prezista, but they have no reported drug interactions with Prezista. Sporanox (Itraconazole): Both capsules and the oral solution of Sporanox have this warning on packaging: Do not take capsules if you have or had congestive heart failure. New Warning Issued for Hep C Drugs: The Federal Drug Administration recently issued a new box warning added for all hepatitis C (HCV) directacting antivirals (DAAs): “Risk of hepatitis B virus (HBV), reactivation in patients connected with HCV and HBV has been reported, in some cases resulting in fulminant hepatitis, hepatic failure, and death.”This warning applies to Epclusa (sofosbuvir, velpatasvir), Zepatier (elbasvir, grazoprevir), Daklinza (daclatasvir), Technivie (ombitasvir, paritaprevir, ritonavir), Viekira Pak (Ombitasvir, paritaprevir, and ritonavir packaged with dasabuvir), Harvoni, (ledipasvir, sofosbuvir), Sovaldi (sofosbuvir), and Olysio (simeprevir).
6
We couldn’t help fight winter blues with two of our sunniest covers ever: reality TV stars Eric Leonardos (on front), and Ongina (née Ryan Ong Palao) on page three. Eric’s boy-nextdoor charm made him a fan favorite on Finding Prince Charming (which he won after coming out poz!) while Ongina, from RuPaul’s Drag Race, was so popular he’s became a RuPaul regular. I love O’s glam shots (the perfect yin to Eric’s yang), but I’ve got to admit it’s the photos of Eric kicking back, cracking up, and hamming it up for photographer Lenny Gerard that really made me smile this issue. I wish we could print them all!
We launched a new video series, I Am A Warrior, in which six HIV-positive people talk about dealing with drug resistance, switching meds, and what other qualities make each person a warrior. Bamby Salcedo, the founder of Los Angeles-based TransLatina Coalition, is so amazing it’s hard to believe filmmaker Tony Donaldson could narrow it down to just a few minutes. Salcedo, who went from abuse in Guadalajara, Mexico, to the street economy and drug addiction in the U.S., is a true long-term survivor story. You can read about three of these warriors in this issue and watch the videos as they roll out on ww.HIVPlusMag.com/I-am-Warrior.
TONY DONALDSON (DIANE; BAMBY);LENNY GERARD (ERIC);
R E C E N T LY, T H E U. S . has survived two devastating hurricanes, with people in the South (primarily Texas, Louisiana, and Florida) most impacted. That’s the same region with the highest rates of new HIV cases.As thousands in those states lost homes, I was reminded of the spirit of generosity that happens during emergencies, the ability to cross political boundaries to help each other. It also underscores the great vulnerability of people living with HIV, for whom even a short treatment interruption can be dangerous. As Irma hit Florida and the Caribbean, I was at NMAC’s U.S. Conference on AIDS with numerous people from those regions who had nowhere to go as the conference ended and no idea how their homes (and sometimes families) had weathered the storm. That’s when NMAC, AIDS United, and Gilead all stepped up to help them. Gilead gave $1 million gift to HIV capacity building organizations that were impacted by both Hurricane Harvey (in Texas and Louisiana) and Irma. AIDS United is administering the fund. Meanwhile, in the Caribbean, where islands were devastated Alturi teamed with The Rustin Fund for Global Equality, which links U.S. based foundations and people to help LGBTI people in low and middle income countries (that “I” is for intersex, by the way) to get funds to the Caribbean Vulnerable Communities Coalition (which works with Caribbean populations who are especially vulnerable to HIV). Charlie Rounds, program director of Mossier Social Action & Innovation Center, tells us that CVC’s work is crucial for gay and bi men and trans people in the area, because fundamentalist religious groups often blame natural disasters on queer and trans folks (just like in the 2008 Haiti earthquake) and they can be denied food and water because their households don’t include cisgender females or children. Marginalized people become even more vulnerable during disasters so it’s on those of us who can help to do so. Here’s info: Alturi.org/Rebuild_Caribbean. And please tell anyone who’ll listen about your own needs so they are addressed. As we head into the holidays, let’s remember we are all one people and are responsible for each other.
NOVEMBER / DECEMBER 2017
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editor in chief DIANE ANDERSON-MINSHALL • svp, group publisher JOE VALENTINO
50 years
on of award-winning HIV coverage.
art director RAINE BASCOS senior editor JACOB ANDERSON-MINSHALL managing editor SAVAS ABADSIDIS editors at large TYLER CURRY, KATIE PEOPLES associate editor DAVID ARTAVIA assistant editor DESIREE GUERRERO contributing editors KHAFRE ABIF, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writers DR. EVAN GOLDSTEIN, CHARLES STEPHENS creative director, digital media DAVE JOHNSON interactive art director CHRISTOPHER HARRITY online photo and graphics producer MICHAEL LUONG, JAGO SORIA front end developer MAYRA URRUTIA senior drupal developer NICHOLAS ALIPAZ, SR. traffic manager KEVIN BISSADA manager, digital media LAURA VILLELA director of integrated marketing BRANDON GRANT senior manager, integrated marketing JAMIE TREDWELL managers, integrated marketing GRETA LIBBEY, CASEY NOBLE events manager JOHN O’MALLEY junior designer TEDDY SHAFFER senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director of social and branded content LEVI CHAMBERS 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
PRIDE MEDIA president LUCAS GRINDLEY executive vice presidents JOE LANDRY, BERNARD ROOK senior vice presidents GREG BROSSIA, CHRISTIN DENNIS, JOE VALENTINO vice president ERIC BUI ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 209-5174 • Subscriptions Fax (212) 242-8338 LOS ANGELES EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES 43430 E. Florida Ave. #F PMB 330, Hemet, CA 92544 • Phone (951) 927-8727 Email support@retrogradecommunications.com or editor@HIVPlusMag.com FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To 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@heremedia.com. Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc. Plus is a registered trademark of Here Publishing Inc. Entire contents © 2017 by Here Publishing Inc. All rights reserved. Printed in the USA.
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BUZZWORTHY
DEATH BECOMES HER
You can’t die in their town without these women knowing why.
BY JACOB ANDERSON-MINSHALL
S
For example, Schwarcz explains, “if someone with HIV dies from a heart attack, the underlying cause of death is heart disease. HIV may be listed on the death certificate as a condition present at death, and if so, HIV would be listed as a cause of death but not as the single underlying cause.” Schwarcz, who is overseeing a pilot project diving even deeper into the data around deaths of those with HIV, adds “there are known inconsistencies in how death certificates are completed and the coding of causes of death are based only on information from the death certificate,” which is not always completed by the person’s primary health care provider. “To obtain a better understanding of the documentation of causes of death on death certificates,” Schwarcz says, “this project includes an
CONTINUED ON PAGE
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SHUTTERSTOCK
an Francisco’s Susan Buchbinder and Sandy Schwarcz are obsessed with death. In fact, they’re so familiar with the Grim Reaper that no one dies in their city without them knowing about it. And when someone does die, they want know why—and if they could have stopped it. These two San Francisco Department of Public Health employees are less fascinated with death than they are determined to prevent it. Like ever-vigilant superheroes, they feel every death in their city as though it is some kind of personal failure. Buchbinder and Schwarcz pour over death certificates, and reams of data—including statistics about illnesses and diseases (particularly HIV), and their symptoms and side effects—in order to understand why someone has died. They cross-reference death certificates with the national database of death records from each state’s vital statistics office. “We get the death certificates… and then we do matches with the National Death Index that records everyone’s death. So, we get the underlying cause of death and we also get multiple causes of death.”
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Scenes from As Much as I Can, the immersive show about the experiences of newly poz black gay men.
Immersed in Blackness
COURTESY HARLEY & CO.
Groundbreaking theater gives a voice to black gay and poz men. As Much as I Can astonished audiences earlier this year, giving voice to black gay men who bear a disproportionate brunt of HIV. The groundbreaking production came about as a collaboration between creative agency Harley & Co. and ViiV Healthcare’s ACCELERATE! Initiative, a four-year, $10 million investment in outreach, education, and support for those living with HIV—particularly in Baltimore, Md., and Jackson, Miss., two cities with the highest rates of new HIV cases. Exploring themes of faith, family, community, friends, and self-acceptance, As Much as I Can takes audiences on an immersive experience through the lives of four men impacted by HIV diagnoses. Director James Walsh tells Plus, “I lived through the AIDS crisis in the 1980s. I lost loved ones, survived, and lived to share the stories [of those] who weren’t as fortunate as the young gay men profiled in the piece. I have never considered myself much of an activist, but this piece has enlightened me about the possibilities of theater as an activist mode of expression.”
Written by Sarah Hall (with original content by Harrison David Rivers) and informed by the stories of numerous black gay men, the immersive project “was designed to help audiences build a bridge to empathy with the notion that it would fuel them to leave the experience and take action in their communities,” says executive producer Alexandra Hall. “It is the most important project I have worked on in my career,” Hall adds. “I believe that we must surface the important narratives of the struggles and triumphs of black gay men if we are going to create change.” Based on more than 100 interviews from men in Baltimore and Jackson, the goal of As Much as I Can is to have people walk away feeling empowered to take action. It has moved not only audiences, but the production’s actors too, including New York City-based Brent Whiteside who says, “We have opened the door to having tough conversations—with no judgment or limitations. I am forever changed.” —DAVID ARTAVIA
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IMPORTANT FACTS (cont’d)
MEDICINES THAT MIGHT INTERACT WITH TRIUMEQ • antacids, laxatives, or other medicines that contain aluminum, magnesium, sucralfate (Carafate®), or buffered medicines. TRIUMEQ should be taken at least 2 hours before or 6 hours after you take these medicines. • iron or calcium supplements taken by mouth may be taken at the same time with TRIUMEQ if taken with food. Otherwise, TRIUMEQ should be taken at least 2 hours before or 6 hours after you take these medicines. • anti-seizure medicines: oxcarbazepine ( Trileptal ® ), phenytoin (Dilantin®, Dilantin® -125, Phenytek ®), phenobarbital, carbamazepine (Carbatrol®, Equetro ®, Tegretol®, Tegretol® -XR, Teril®, Epitol®). • any other medicine to treat HIV-1, medicines used to treat hepatitis virus infections (such as interferon or ribavirin), a medicine that contains metformin, methadone, rifampin (Rifater ®, Rifamate ®, Rimactane ®, Rifadin®), St. John’s wort (Hypericum perforatum).
TRIUMEQ can cause serious side effects including: • See “What is the most important information about TRIUMEQ?” section • Changes in liver tests • Changes in your immune system • Changes in body fat distribution • Some HIV-1 medicines including TRIUMEQ may increase your risk of heart attack. (cont’d)
• Talk to your healthcare provider or pharmacist. • Go to TRIUMEQ.com or call 1-877-844-8872, where you can also get FDA-approved product labeling. COMBIVIR, EPIVIR, EPZICOM, TIVICAY, TRIUMEQ, TRIZIVIR, and ZIAGEN are registered trademarks of the ViiV Healthcare group of companies.
The other brands listed are trademarks of their respective owners and are not trademarks of the ViiV Healthcare group of companies. The makers of these brands are not affiliated with and do not endorse the ViiV Healthcare group of companies or its products. ©2017, ViiV Healthcare group of companies. All rights reserved. April 2017 TRM:5MG
8
WHERE ART independent review of the circumstances surrounding death— THOU, V? as percent obtained through the Fifty of men (and nearly asmedical many women) chart physicians don’t knowreviews—by where the vagina actually is. who provide care to persons with HIV.
BY DEwill S IR ÉE GUER R the EROinformation We compare
on causes of death as determined by
these physicians to owners the information BAD NEWS FOR vagina and visitors
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EPIVIR-HBV is a registered trademark of the GSK group of companies.
POSSIBLE SIDE EFFECTS OF TRIUMEQ
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The most common side effects of TRIUMEQ are: trouble sleeping, headache, and tiredness. These are not all the possible side effects of TRIUMEQ. Tell your healthcare provider right away if you have any new symptoms while taking TRIUMEQ. Your healthcare provider will need to do tests to monitor your health before and during treatment with TRIUMEQ. You may report side effects to FDA at 1-800-FDA-1088.
from the death half certificates.” alike: Approximately of the 2,000 is the director menBuchbinder—who who participated in a recent British of Bridge HIV, to San Francisco survey were unable identify the vagina inCounty’s a diagram of the female reproductive HIV prevention research anatomy. Not onlyatisHIV-related this discouraging, it’s unit—looks also downright in terms ofthem. sexual deaths anddangerous how to prevent health for women and many trans men. “We’re trying to identify, first and The survey, conducted by London-based foremost, how do we prevent HIVgynecological cancer research charity, The associated deaths? But secondly, Eve Appeal, also found that over half the men how do we prevent preventable were uncomfortable discussing gynecological death?” health with their partners, and only 20 percent Youfelt read that enough correctly: San a said they confident to mention Francisco Public Health wants change in their partner’s vagina. Furthermore, 83to percent of the men surveyed saiddeaths, they didn’t eliminate preventable fully understand thekind vaginaof really works.” almost like “how some futuristic But we’re notdepartment trying to pick onbent the guys— pre-crime on orpreventing Brits for that matter. After all, American murder. studies have yielded similar results, and in a “We are collecting information previous survey conducted by The Eve Appeal, regarding possible risk factors nearly the same amount of women (44 associated death,” Schwarcz percent) couldn’twith identify the vagina either. says. “Such as inconsistent primary The latter survey also found that 15
care, poor medication adherence, inadequately treated mental illness, etc., as well as more detailed information concerning the circumstances of death.” “Here in San Francisco,” Schwarcz adds, “we have seen that despite the widespread prescription of antiretroviral therapy, persons with HIV [or] AIDS continue to experience premature death. Our data indicate that although deaths have declined, we continue to have about 200 deaths every year in persons who were reported with HIV in San Francisco. We know as well that about 40 percent of these deaths are attributed to HIV and that the most frequent nonHIV related underlying cause of death has been due to non-AIDS related cancers, heart disease, [and] percent of women wouldn’t see aoverdoses.” doctor if accidents—mostly drug they found a vaginal or growth, and 50 “We’ve seen lump an uptick in the percent wouldn’t seek medical attention if number of drug overdoses of people they experienced persistent bloating. living with HIV,” Buchbinder says. The Eve Appeal’s CEO, Athena Lamnisos, That bothers her because “that told Forbes magazine that the findings were should beattempt a completely preventable released in an to increase awareness cause of death.health And issues, we’velike seen a about gynecological
small increase in the number of suicides. So, we are looking at this as both HIV-associated causes of death, but we’re also looking at preventable causes of death.” As part of that quest to preempt preventable deaths, Buchbinder has begun looking for cases where, “for instance, if someone who’s pretty young—under 40 or under 50— dies of something that we think generally should kill someone who would be much older? Well, we’re also looking at those cases to see if that’s HIV-associated or not.” That’s because studies have suggested some aging is happening faster for people who are on antiretroviral therapy. Ultimately, Buchbinder says, “We’re trying to do a deep dive into the causes of death and do as symptoms of uterine, vulvar, much as we cancervical, to do vaginal, a structural andautopsy ovarian cancer—which sexual partners of each person—as we get a canreport help identify. of death—to figure out how So, whether you have a vagina or love did the system fail this person? And someone who does, you’d better hit the is there some way that we could books to make sure you’re fluent in human have intervened have kept this anatomy. Better yet, whyto not try some personal alive?” hands-on exploration? HIVPLUSMAG.COM19 13
DECEMBER 2017 / JANUARY 2018 THE ADVOCATE
BUZZWORTHY BY T H E N U M B E RS
Great News! 49%
of Americans living with HIV are virally suppressed.
53%
of all people with HIV globally have access to treatment.
Fewer poz folks are now in prison than ever before.
The estimated number of state and federal prisoners known to be HIV-positive is at its lowest since 1991, according to a report by the U.S. Bureau of Justice Statistics released this August. The report shows that in 1991—the first year it began keeping records—17,680 prisoners were known to be HIVpositive. That number peaked in 1998, when 25,980 inmates were living with HIV. As of 2015, those numbers have dropped back to 17,140, down an additional 600 from the year before. Between 2010 and 2015, the number of HIV-positive men behind bars declined by 14 percent, while the number of women locked up with HIV declined by 31 percent. The number of AIDS-related deaths have also decreased significantly—from 73 deaths in 2010 to 45 deaths in 2015, according to data from BSJ’s Deaths in Custody Reporting Program. This could well be the impact of the Obama administration’s efforts to send nonviolent drug offenders to rehab instead of prison, and the Fair Sentencing Act of 2010 that reduced sentences for some drug offenses. It’s also likely that prison populations are benefiting from the same thing the population at large is: the success of treatment as prevention (TasP) and PrEP. As treatment has become more available, more people with HIV are reaching undetectable viral loads and therefore cannot transmit the virus to sexual partners. Meanwhile, more people are taking PrEP to prevent contracting the virus.—DA 14
of those accessing treatment are virally suppressed worldwide.
Since 2010: AIDS-related deaths have declined by
42%
New HIV diagnoses have declined by
29%
And among children, the drop in new HIV transmissions was
56% Source: UNAIDS and Centers for Disease Control & Prevention, 2017
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New research suggests old Bessie’s immune system might hold the key to preventing HIV.
One of the biggest challenges in combating HIV is its ability to mutate frequently, which has made it incredibly difficult to find a long-term vaccine. Typically, a vaccine would involve giving someone a small amount of the virus, so their immune system can build antibodies to fight it. However, the way HIV hijacks the immune system prevents it from building these antibodies. But research conducted by the International AIDS Vaccine Initiative and the Scripps Research Institute tested an HIV vaccine on cows, and it’s showing surprising results. “From the early days of the epidemic, we have recognized that HIV is very good at evading immunity, so exceptional immune systems that naturally produce broadly neutralizing antibodies to HIV are of great interest—whether they
belong to humans or cattle,” Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, recently told BBC News, in response to the study. Researchers previously discovered that a very small number of people living with the virus may eventually develop “broadly neutralizing antibodies” themselves, which attack parts of the virus that cannot mutate. These “elite controllers” represent only one percent of those living with HIV—generally those of European decent. But for the general population, a vaccine would need to provide the antibodies itself or somehow induce the immune system to manufacture them. Given that no prior study has been able to “reliably elicit” broadly neutralizing antibodies to HIV in humans or animal models, the cow study represents a significant step forward. “This is really important because we hadn’t been able to do it, period,” said Dr. Devin Sok from the Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery at The Scripps Research Institute in La Jolla, California. “Who would have thought cow biology was making a significant contribution to HIV?” Researchers found that not only were the cows able to produce the antibodies, but they did so quite rapidly. “The response blew our minds,” said Sok, who was also one of the lead authors on the study, published in the journal Nature. “It was just insane how good it [worked]. In humans it takes three to five years to develop the antibodies we’re talking about.” That reliable speed would be necessary to mass produce any HIV vaccine. It is believed that cows evolved particularly robust immune systems due to their complex, bacteria-packed, fourstomach digestive system. Researchers also found that these cow antibodies neutralized 20 percent of HIV strains within 42 days and by day 381, they had neutralized 96 percent of the strains tested in the lab. “The potent responses in this study are remarkable,” said Dr. Dennis Burton, another Scripps researcher on the project. “Unlike human antibodies, cattle antibodies are more likely to bear unique features and gain an edge over HIV.” That unique feature is apparently the antibodies’ “long and loopy structure,” according to the BBC. The U.S. National Institutes of Health was quoted in BBC coverage as calling the findings of “great interest.” While vaccines are typically used solely to prevent the transmission of a virus, in the case of HIV, researchers are also investigating their use in treating those already living with the virus. Only time will tell whether cows will become essential to an HIV vaccine’s success. —DESIREE GUERRERO
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TECH THAT EATS HIV LIKE PAC-MAN EATS GHOSTS
Technology moves fast. Last year, we reported on the potential of CRISPR for editing DNA sequences in mice with the possibility of eradicating HIV. CRISPR’s capabilities have exploded exponentially since. As Wired magazine reports, not only is CRISPR able to “kill and eat HIV and Zika like Pac-Man” eats ghosts, but it’s also got cancer in its cross hairs.
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CRISPR, ACCORDING TO
Dr. Chris Blazier, a researcher at Texas A&M University, “stands for centered regularly interspaced short palindromic repeat. [It’s] part of the bacterial immune system that allows bacteria to remember viruses that have previously attacked them.” Scientists have used CRISPR to target and remove the viral genes, sort of cut-and-pasting their way to healthy DNA. As Time magazine explained, “CRISPR’s power lies in the fact that its precise enough to find and cut out just the viral genes, leaving the animals’ own DNA intact.” So far, removing HIV has only been done with transgenic animals, which are lab animals whose DNA has been modified by scientists. (In this case, the lab rats had to be modified to even get HIV because they aren’t naturally susceptible to it.) Human trials could still be far off, but as Dr. Keith R. Jerome, head of Vaccine and Infectious Diseases at the University of Washington, noted in a press release, “This is an important study that marks the next step toward using HIV DNA excision from the host genome as part of a curative strategy.” Since then, it’s been discovered that CRISPR “has another trick up its sleeve. The system that sparked a revolution in gene editing can
also be used in fast and cheap tests for pathogens.” More importantly, “a tool based on CRISPR has been shown to detect the Zika virus in blood, urine, and saliva.” It was developed by researchers at the Broad Institute of MIT and Harvard in Cambridge, Massachusetts, who call it SHERLOCK—for “Specific High-sensitivity Enzymatic Reporter unLOCKing.” CRISPR was discovered in E. coli, which uses it to recognize the genetic material of viruses and destroy it—much like Pac-Man eats ghosts. Another study by the University of California, Berkeley found, “10 new CRISPR enzymes that, once activated, are said to ‘behave like Pac-Man’ to chew through RNA in a way that could be used as sensitive detectors of infectious viruses.” Furthermore, according to Wired, “These new enzymes are variants of a CRISPR protein, Cas13a, which, the UC Berkeley researchers reported last September in Nature, could be used to detect specific sequences of RNA, such as from a virus. The team showed that once CRISPR-Cas13a binds to its target RNA, it begins to indiscriminately cut up all RNA making it ‘glow’ to allow signal detection.” Doctors could pick up that signal and pinpoint the cancer cells. It goes without saying: We can’t wait to learn what CRISPR can do next.
—SAVAS ABADSIDIS
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PUTTING THE FEAR OF SEMEN TO BED Despite what several misleading reports suggest, the semen of undetectable men is safe. I KNOW THAT a person living with HIV who is on treatment and has an undetectable viral load cannot sexually transmit HIV. So, I’m frustrated by a recent study that suggests people still need to worry about HIV transmission between serodiscordant couples. The study, presented at the American Urological Association Annual Meeting, showed that there can still be detectable viral RNA and DNA in the semen of a person with HIV, even though their viral load is undetectable in blood tests. Although this information has actually been known for a fairly long time, the report made it sound like the findings were new, shocking—and revolutionary. The researcher made it sound like it was something that people living with HIV and their partners needed to be concerned about. But I’m here to assure you that you don’t need to worry. It is true that HIV RNA or DNA may be present in semen, especially in the first year that someone is on treatment. But HIV RNA and DNA aren’t infectious. They’re just genetic material, and not the whole virus. You need the whole virus in order for HIV to be viable and able to infect a living cell. It’s like finding a human leg on the ground and thinking it can walk. You need the whole body, not just a leg to walk. “We have known for decades that HIV genetic material exists in bodily fluids of those living with HIV who are virally suppressed,” Dr. Carl W. Dieffenbach, Director
of the Division of AIDS at the National Institute of Allergy and Infectious D i s e a s e s , re i te rate d recently on ImStillJosh. com. “On its own, HIV genetic material, RNA or DNA, is not infectious. It is not ‘whole virus,’ which is needed for HIV to infect a living cell.” Another s t u d y, published in Clinical Infectious Disease, was reported on in Infectious Disease Advisor with the sensational headline, “HIV RNA Replication in Semen Occurs During Antiretroviral Therapy.” The suggestion that HIV replication occurs in semen, even when the person with HIV is in treatment also sounds like new and frightening findings; scary information for people living with HIV and their intimate partners. But don’t worry. The headline is misleading. The study was not about viral replication in semen. Instead, it was an important study looking at the time it takes for people to reach undetectable viral loads using different types of treatment. The study looks at HIV RNA in the testes, which shows evidence of the virus. But, again, HIV RNA is not infectious. If your HIV is undetectable and you stay on your meds, you don’t need to worry about HIV in your semen. So, do whatever you’d like with your—or your undetectable partner’s—semen. It’s safe. And so is your undetectable partner. —BRUCE RICHMAN
Bruce Richman is the founder of Prevention Access Campaign and the Undetectable = Untransmittable campaign, which educates the public on the scientific consensus that people living with HIV who have an undetectable viral loads cannot transmit HIV to others.
Eat Up
SHUTTERSTCK (COUPLE & PIZZA BOY)
Finally, getting the munchies is a good thing. The first and only Food Drug and Administration-approved cannabinoid is now available for prescription, to treat anorexia (a lack or loss of appetite, not to be confused with the disease anorexia nervosa) and nausea. Syndros is a liquid formulation of dronabinol, a synthetic form of THC. Produced by Insys Therapeutics, Inc., the oral solution is an alternative for those who prefer liquid medication over capsules, or whose physicians suggest liquid titration and delivery for more flexible dosing. Dronabinol treats the loss of appetite and weight loss faced by 7 to 8 percent of HIV-positive people, and the nausea and vomiting associated with chemotherapy. Over 15 million people are living with cancer in the United States and 70 to 80 percent of those experience chemotherapy-induced nausea and vomiting. Syndros is available to wholesalers for regular pharmacies and through the Insys Specialty Pharmacy Network. The company (Syndros.com) also offers financial assistance to those who can’t afford the prescription. —DAVID ARTAVIA HIVPLUSMAG.COM
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LOVE YOUR LIVER? Switching from efavirenz can reduce serious risks.
The U.S. National Library of Medicine flags efavirenz, an antiretroviral drug typically used in combination with other ARTs, as having an “uncommon but well established cause of clinically apparent acute liver injury.” Switching from efavirenz to raltegravir as a replacement significantly decreases chances of developing fatty liver disease, suggests a Spanish study in Oxford’s Clinical Infectious Diseases, which observed HIV-positive people—as well as those who are both poz and living with hepatitis C. Of 39 people with suppressed viral loads and hepatic steatosis (fatty liver disease), 19 were switched to raltegravir, and the other 20 continued to take efavirenz. After 48 weeks, those who switched meds showed fewer hepatic steatosis symptoms. “HIV-infected individuals switching efavirenz to raltegravir showed decreases in the degree of hepatic steatosis... compared with those continuing with efavirenz,” researchers concluded. “In addition, the proportion of patients without significant hepatic steatosis after 48 weeks was 18
greater for those who switched.” The participants’s livers were assessed using a Fibroscan, which measures liver stiffness and the accumulation of fat. It takes one to eight weeks for symptoms of liver hepatotoxicity to appear, which often includes a rash or a fever. A separate study points to doravine as another alternative to efavirenz, showing that people taking doravine experienced fewer neuropsychiatric events. In addition to liver and cholesterol problems, the evidence has shown that efavirenz can cause profound hallucinations, mood swings, suicidal thoughts and, as one study published in the journal Neuropsychopharmacology found, “LSD-like properties.” Despite those dangers, the drug is quite popular worldwide. Switching to raltegravir reduces the risks, though you will pay a pretty penny for the less-toxic qualities. The monthly cost of efavirenz is $1,010 compared to $1,713 a month for raltegravir. In the United States, efavirenz is often sold individually as Sustiva, raltegravir as Isentress. No doubt, raltegravir will surely grow in popularity as a less toxic alternative. Efavirenz is also used as one of the three drugs in the tablet Atripla, a common once-a-day HIV regimen—becoming one of the best-known drugs to pass the bloodbrain barrier.
Mylan Pharmaceuticals got the green light to launch a generic version of Atripla containing efavirenz in Canada. Avonza, a very similar generic drug containing efavirenz, was launched in India in August. Avonza is lower than half the price of first-line antiretrovirals. The Indian company produces 4 billion antiretroviral tablets per year. In Costa Rica, efavirenz was so popular that authorities announced an inventory crisis in August. Because of its psychotropic properties, it is reportedly (and foolishly) being used recreationally in South Africa, where HIV drugs can be found relatively easy on the black market. Modern drugs are an improvement from older generation drugs like AZT, but HIV-positive people have enough to worry about without having to be concerned with hallucinations, suicidal thoughts, or the inability to think clearly. There are safer alternative drug regimens out there. Stribild and Genvoya, for instance, are efavirenz-free and potentially less risky drug regimens compared to Atripla, and chances are your out-of-pocket premium will stay the same. Doctors will rarely inform you on their own about the latest drugs that are available, so be sure to ask yours about treatment alternatives. —BENJAMIN M. ADAMS
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(BELLY) FAT TO FIT
And other news from this year’s International AIDS Society Conference. EARLIER THIS YEAR, the International AIDS Society’s 2017 Conference on HIV Science in Paris provided numerous new insights into HIV-related treatment. The three-day annual conference focused on scientific advancements made in treatment and prevention of the virus. Here’s a round-up of the top findings.
Can Egrifta Also Make You Buff? Egrifta (tesamorelin) may not only reduce fat deposits but could also build muscle as well. Analysis of data from two randomized placebo-controlled trials of Egrifta among HIV-positive people with lipodystrophy—a redistribution of fat that impacts up to 50 percent of those living with HIV and is responsible for wasting, buffalo humps, and other fat changes—showed that, as fat in trunk muscles decreased, muscle area increased. In the study participants not only lost excess visceral adipose tissue (a.k.a. abdominal fat) when taking the drug from Theratechnologies, they also saw muscle growth. The amount of muscle growth wasn’t tied to the amount of abdominal fat lost. “This is the first study to evaluate changes in trunk muscle fat—both abdominal and spine musculature—in HIV patients who have responded to tesamorelin,” said Kristine Erlandson, assistant professor of medicine, Divisions of Infectious Disease and Geriatric Medicine, University of Colorado. More Evidence New Drugs Are Better Than Tivicay Two Phase III studies (1489 and 1490) by Gilead Sciences continue to support substituting bictegravir-based regimens for commonly prescribed dolutegravir-based regimens. Though dolutegravir (Tivicay) is effective, it has been vulnerable to the development of drug resistance, while bictegravir (a new investigational drug of the integrase inhibitor class) appears to avoid that issue. According to Dr. Joseph Custodio from Gilead, bictegravir is less likely
to become drug resistant, is useful in treating both non-mutated and drug-resistant HIV, and has low risk of drug interactions. The new studies concluded that the bictegravir containing regimen is as effective as regimens containing dolutegravir, and has “low rates of discontinuations due to adverse events, a high barrier to resistance and few drug interactions,” according to Dr. Joel Gallant, medical director of specialty services at Southwest CARE Center in Santa Fe, N.M. and lead author of Study 1489. Dr. Paul Sax, professor of medicine at Harvard Medical School and lead author of Study 1490 said the meds will “be appropriate for a broad range of HIV patients, including those with mild to moderate renal impairment (kidney damage).” Forthcoming Drug Successfully Treats Multidrug Resistance Given concerns about drug resistance, the Phase II data for ibalizumab was welcome news. The long-acting antibody from Theratechnologies has already been submitted to the Food and Drug Administration for approval (under the fasttrack Biologics License Application program). Ibalizumab continues to prove effective in treating HIV strains resistant to other antiretroviral drugs, a problem for many long-term survivors. In other words, ibalizumab is effective even for those with multidrug resistances, a great advantage to people who’ve developed resistance to multiple classes of anti-HIV drugs, including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors (as well as those resistant to enfuvirtide or maraviroc).
“HIV drug resistance is a key topic at the IAS conference this year, and these findings are particularly important as they suggest that ibalizumab is equally active against HIV, whether it is resistant or responsive to approved antiretroviral agents,” said Steve Weinheimer, vice president of biological sciences at TaiMed Biologics USA, which is collaborating with Theratechnologies to distribute the drug. “On the heels of the BLA acceptance for priority review, these data provide additional support for ibalizumab as a potential tool for the treatment of multidrug resistant HIV-1.” Researchers Fear a New HIV Pandemic The threat of a new worldwide AIDS pandemic was a frequent topic at the conference, with a sober evaluation of the current epidemic and grim predictions that—if certain conditions remain unchanged—the global fight against HIV could be facing disaster. The depressing reality? We may go from closing in on “the end of AIDS” to a new global pandemic. Core issues that experts say could cause a massive second wave of AIDS-related deaths are: Drug-Resistance: Many HIV strains are drug-resistant. The longer people are on treatment, the more likely drug resistance will develop. In some countries, as much as 10 percent of the people who start treatment are already resistant to entire classes of treatment. Manufacturing Limits: Paul Stoffels, the chief scientific officer for Johnson & Johnson, warns that the world’s manufacturers simply cannot sustain 40 or 50 years of manufacturing enough anti-HIV drugs to keep the tens of millions of people living with the virus alive for their lifetimes. —Research by Plus editors HIVPLUSMAG.COM
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HAVING AN STI SHOULD NOT MAKE YOU A CRIMINAL THE RECENT CASE THAT ACCUSES USHER OF TRANSMITTING HERPES SHOULD OPEN A DIALOGUE ABOUT HIV CRIMINALIZATION. LET’S START NOW. 20
WHILE THE RECENT gossip headlines alleging that at least one woman has acquired herpes from sexual contact with R&B crooner Usher Raymond make for social media gold—celebrity, scandal, and sex—it also provides the perfect foil to discuss how the legal system criminalizes those living with HIV, and the role that has in perpetuating stigma. At the root of this policing is the need to have control over social conduct, especially sexual conduct. This predilection for regulating sexual behavior through criminal and civil law is long documented in anti-sodomy laws that targeted gay men; anti-miscegenation laws that sought to prohibit interracial marriage; and sterilization laws that took reproductive and sexual health out of the hands of individuals. Women’s reproductive conduct has also been targeted through criminal laws and policies, stripping them of reproductive rights, including access to abortions. Like these other examples, HIV criminalization is based almost entirely on stigma and plays into stereotypes. It frames people who live with HIV as sexual deviants and imagines their bodies as lethal weapons.
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So, what do we mean when we say HIV criminalization? According to AIDS United, “HIV criminalization refers to the overly broad use of criminal laws to penalize alleged, perceived or potential HIV exposure; alleged nondisclosure of a known HIVpositive status prior to sexual contact (including acts that do not risk HIV transmission); or nonintentional HIV transmission.” Under these laws, people living with HIV can face unjustly long jail sentences for allegedly exposing a partner to HIV—regardless of transmission or ability to transmit. The legal obligation to disclose can be traced back to the 1990 Ryan White CARE Act, which premised funding for HIV on the creation of legislation requiring states to demonstrate a willingness to prosecute “intentional” HIV exposure. At the time, it was thought that exposure to HIV, or having sex with someone who was living with the virus, meant certain death. The requirement was dropped from Ryan White legislation in 2000, but state criminalization statutes remain. Criminalization under HIVexposure laws is a relic from an earlier time and flies in the face of the science about how HIV is transmitted. These laws perpetuate stigma. Once you know your status, you can be jailed just for having consensual sex, sometimes even if you are using condoms or are on medications that all but eliminate the chance of transmission. As of 2014, 34 states had laws that specifically criminalized HIV exposure (not transmission) through consensual sex. The Obama Justice Department issued guidelines suggesting elimination of HIVspecific criminal laws, except in a few particular situations. In addition to HIV-specific criminal laws, people can be prosecuted under general applicable criminal laws such as reckless endangerment,
HIV CRIMINALIZATION IS BASED ALMOST ENTIRELY ON STIGMA AND PLAYS INTO STEREOTYPES. aggravated assault and attempted murder. While Usher is not being criminally prosecuted for his alleged transmission of herpes, many states do have laws that criminalize “willful” or “knowing” exposure or transmission of sexually transmitted infections beyond HIV. Those in favor of STI criminalization often position women as helpless pawns in need of protection, as if they are too feebleminded to have agency over their sexual health. As feminist scholar Evelynn M. Hammonds notes, “in the HIV/AIDS discourse, AfricanAmerican women are constantly represented as the victims that are the ‘other’ of the ‘other,’ the deviants of the deviants, irrespective of their sexual identities or practices.” It is also important to acknowledge that the language used often invokes a narrative of black men as hypersexual and predatory, and in doing so, robs them of their ability to be seen as sexually vulnerable. This framework masks the victimization of black men by assuming that only women can be victims. The accuser in the Usher case says that, despite seeing a “greenish discharge” coming from his penis, she decided—against her better judgment—to have unprotected sex with the singer. It is the responsibility of all parties involved to care for their own sexual actions and sexual health. It’s also important to note that “greenish discharge from the penis” is not a symptom of herpes. It can be a symptom of a different STI, but
when you’re being sued or criminally charged with transmission of an STI, parsing symptoms like this becomes necessary. And it feels necessary to mention that the description doesn’t support the health condition she alleges—another example of how murky it is for the government to legislate sex acts. The decision to engage in sex rests in the hands of both participants in this case. As such, all of the responsibility, as well as the burdens that accompany the act of having consensual sex, also lie in the hands of the people engaging in it. Exempting one party from personal responsibility is inconsistent with the public health message that the prevention of sexually transmitted diseases is a shared obligation. These laws are not good for public health. They force people to fear disclosure (and knowing one’s status), yet there is no evidence that these laws actually reduce new transmissions. They also give police, judges, and prosecutors far too much control over our sex lives. Most critically, people should not be forced to disclose their health status, and such laws try to take away one’s right to disclose their health status on their own terms. Herpes, like HIV, is treatable. They are both manageable chronic conditions. When we treat them instead like deadily diseases, we reinforce stigma, which ultimately harms prevention efforts. In many ways, Usher is fortunate. His accuser is only seeking restitution, which means that—unlike those accussed of transmitting HIV—the only thing he has to lose is money, not his freedom. Eric T. Paulk is an advocate working at the intersections of law, policy, race, and sexuality. His specific areas of interest deal with the impact of HIV criminalization laws on black queer communities, as well as the impact of the school-to-prison pipeline on black LGBT youth. HIVPLUSMAG.COM
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cusp of a by d
on the
id r
i
cure ince the first cases of what would become known as AIDS were reported in June 1981, nearly 700,000 Americans have died due to complications from the disease. Though they might not physically remain with us, their spirits continue to inspire our stories and progress us towards an HIV-free generation. In the last couple of decades, science has discovered HIV began much earlier than the 1980s, too. Researchers have delivered medications able to suppress the virus to undetectable levels (ultimately saving millions of lives), and has edged closer to finding a cure. But, even as technology becomes more sophisticated, researchers have also discovered that curing—or even stopping—the virus is far more complicated than they had anticipated. HIV can now be suppressed to such low levels that it becomes impossible to transmit to others. With the right combination of antiretroviral drugs, HIV-positive people can keep the virus at bay—allowing them to live long and healthy lives without the fear of death looming over them. But it wasn’t always this way…
THE FIRST ANTI-HIV DRUG It took the U.S. Food and Drug Administration seven years to approve the first anti-HIV drug, and tens of thousands died in the interim. To combat the rising death rates, public health officials were pressured to give something—anything—to treat those living with HIV. They found it in azidothymidine, also known as AZT, a drug originally developed to fight cancer by inserting itself into the DNA of a cancer cell to stop it from replicating. When the AIDS crisis was at its height, the pharmaceutical company Burroughs Wellcome found a version of AZT that appeared to block HIV activity in animal cells. A clinical trial of 300 people diagnosed with AIDS compared AZT to a sugar pill. After four months, many of the participants on the sugar pill had died, but AZT helped stabilize those with HIV, and on March 19, 1987, the FDA approved it as the first AIDS medication. Dr. Anthony Fauci, who has been the director of the National Institute of Allergy and Infectious Diseases since 1984, has played a leading role in the fight against HIV since day one. “For the years… ‘85, ‘86, it was frustrating, but AZT changed things,” he recalls. “There was a degree of optimism when we showed that AZT prolonged the lives of individuals. That optimism was quickly dampened by the fact that, in many of the patients who were treated with AZT—that’s the only drug we had—after a finite period of time, the virus developed resistance against it.” There are several classes of HIV drugs today, and AZT is still included in many antiretroviral regimens at very low doses. But at the levels it was first prescribed, AZT ate away at a person’s immune system like rat poison. Still, for nearly a decade it was
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AFTER NEARLY 0 YEARS OF HIV RESEARCH, IS TOTAL ERADICATION EDGING CLOSER TO REALITY
the best option available, as virtually every other additional medication developed to treat HIV proved disappointing.
1996, THE GREAT SUPPRESSION Protease inhibitors were the second class of antiretroviral drugs developed— with saquinavir and ritonavir approved by the FDA in 1996. Within a couple years, the Centers for Disease Control and Prevention reported that annual AIDS-related deaths plummeted from 50,000 to 18,000 in the United States. These miracle drugs were proven to prevent viral replication, and when combined with AZT (and later other drugs), were less prone to the development of drug resistance. Fauci remembers the development of highly active antiretroviral therapy as “about as transforming a moment as when we first discovered the virus back in 1983.” HIV RESERVOIRS, THE GREAT BARRIER As our ability to suppress viral replication with antiretroviral treatment increased—especially now that people on treatment are achieving undetectable viral loads—it has enabled those living with HIV to have long and healthy lives, as well as prevent transmission. Still, people around the world dream of a cure, or the complete eradication of HIV from a person’s body. By far, the greatest barrier to reaching that goal is the existence of viral reservoirs where HIV lies dormant, ready to come roaring back and begin replicating again when someone goes off ART or develops drug resistance. Of course, scientists have tried to outsmart these reservoirs by conceiving new strategies—particularly one called “kick and kill,” in which latency reversing agents “wake” the inactive virus, and antiretroviral medications kill it on the spot. But Fauci worries it isn’t enough. “Decreasing the size of the reservoir doesn’t really get you much,” he explains, because “when you stop therapy… they almost invariably bounce back.” IS A CURE EVEN POSSIBLE? In the last decade, reports of people being “cured” of HIV or experiencing years-long viral suppression without medications have captivated the imaginations of both researchers and those living with the virus. The most important of these cases involves Timothy Ray Brown—dubbed the “Berlin Patient”—who was cured after being treated for leukemia with a bone-marrowsupplied stem cell transplant in 2011. It was later discovered that his donor happened to be part of the one percent of European descendants who appear immune to HIV (likely as a result of their ancestors having survived the Bubonic Plague). Unfortunately, later efforts to replicate Brown’s results via stem cell transplants have failed. And, as Dr. Warner Greene, director of Gladstone Institute of Virology and Immunology HIVPLUSMAG.COM
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points out, “doing stem cell transplants puts patients at considerable risk.” Although Timothy Brown remains HIV-negative, David Margolis, the head of Collaboratory of AIDS Researchers for Eradication, has argued, “there are close to 80 million people that have been infected around the globe over the last century. So, one in 80 million [cured] is not great odds.” Those odds were raised slightly with the announcement at this year’s International AIDS Society conference that a 9-year-old HIV-positive girl has remained undetectable for eight years, after only receiving 40 weeks of antiretroviral treatment. More good news from South Africa came last year when Science Translation Medicine reported on a group of HIV-positive children with high viral loads who have no symptoms. Greene believes he has found one way someone could be asymptomatic despite high viral loads. It involves keeping the immune system’s CD4 T cells from killing themselves, which they do in a vain attempt to stop the spread of the virus. These cell deaths trigger the immune system to send even more CD4 T cells, which end up repeating the deadly cycle. But, if you could stop the T cells from committing suicide—even if you didn’t attack the virus itself—Greene believes you could eliminate most of the symptoms of HIV. Greene has found that the cellular death spiral can be broken by inhibiting an enzyme known as Caspase-1. One highly potent Caspase-1 inhibitor already exists but was sold to a company that appears to have no interest in developing it for HIV treatments. Greene says, because of this, “we have had to revert to creating our own [drug]… at considerable cost, which has slowed [research].” Other researchers have turned to the promise in gene editing, but Fauci fears that idea may end up being more science fiction than science fact. “From a concept standpoint, gene editing is interesting and can work, but it may not work unless you do other interventions that are going to be dangerous for the patient,” Fauci says. “Just editing a gene without necessarily ablating the rest of the T cells in the body, may not work. It may protect those cells that were edited, but it’s not going to protect those other cells.” Still, he admits, “I like the idea about pursuing research on gene editing.” But if curing millions of HIV-positive people isn’t possible, what is?
MEDICATION-FREE REMISSION “We’ve not given up entirely on the notion of eradication,” Greene argues, “but I think where the successes and the gains are being made is around the area of being able to reduce and control the virus.” Fauci goes one step further, suggesting we need to give up on the old notion of an HIV “cure,” and embrace what he calls “ART-free remission.” 24
“In other words, getting people to the point where you can give them either sustained time off ART or intermittently be able to get them off ART for months, maybe even years at a time,” Fauci says. Even getting a few months of a medication vacation—without the long-term impacts that currently come from treatment interruption—would be a great advantage. But suppressing HIV for years without additional treatment is the ultimate goal. “That’s where a lot of work is going on.” Whether you call it antiretroviral-free remission or a functional cure, a number of recent findings suggest we could be on the cusp of much longeracting treatments. As Fauci’s team at Emory University reported last year in Science, a drug used to treat gut inflammation (Entyvio) produced long-lasting viral remission in monkeys. “When the animals were released from antiretroviral therapy, they didn’t rebound,” Greene explains. “Actually, they rebounded and then they reestablished a control. Amazing. The Alpha 4 Beta 7 antibody… seems to be somehow arming an immune defense against the virus that keeps it controlled,” even after ART stopped. Human trials with the antibody have already begun. Earlier this year at the Conference on Retroviruses and Opportunistic Infections, Fauci said the antibody therapy may “teach the immune system to recognize HIV in a way it doesn’t recognize it if it just sees HIV alone. Our job now is to find out just what the nature of that immune response is.” Understanding that could be a game changer—because the difficultly in training the immune system to respond to HIV has hindered both treatment and vaccine efforts.
ALL EYES ON A VACCINE For decades, researchers have been seeking another holy grail: an HIV vaccine. But like those searching for a cure, they quickly discovered creating one wouldn’t be easy. Usually vaccines involve introducing small amounts of a virus to our immune system, which develops antibodies to it. But when our immune system encounters even a small amount of HIV, it kicks into the suicidal-death spiral that Greene uncovered. Still, a vaccine is seen as essential to ending the global HIV epidemic, and several perspective vaccines are currently in clinical trials. They aren’t all aimed at keeping HIV-negative people negative either. Some are evaluating the possibility of utilizing a vaccine to achieve a functional cure. In a study published in Nature last year, Dr. Hanneke Schuitemaker from Janssen Vaccines reported that when her team combined an investigational vaccine (which was a combo of two other vaccines) with an immune booster and used it to treat HIV-positive monkeys, they not only reached undetectable viral loads, but also saw reduced viral reservoirs and achieved long-term viral remission. To do that, Schuitemaker explains, “You need to further educate the immune system through vaccination and if you then wake up the latent virus… [it] can be taken out by the immune system.” In collaboration with Dr. Dan Barouch of Beth Israel Deaconess Medical Center, Schuitemaker’s team found that one-third of their test subjects remained virally suppressed for years after the discontinuation of treatment. The treatment is now being studied on newly HIV-positive people in Phase I/II clinical trials, but Schuitemaker acknowledges they’ll probably end up needing to add additional drugs to the treatment regimen to increase its effectiveness. That fits with what Greene imagines: “some type of cocktail approach, just like we use with therapy, is probably going to wind up being important for the ultimate functional cure or eradication of the virus and of the latent reservoir as well.” Schuitemaker and Greene also share ethical concerns, pointing out that any potential cure, even one that is just a temporary remission, must be worth the risk of removing people from antiretroviral treatments known to be working. “We have to have a safe and effective therapy… for subjects that are doing well on antiretroviral therapy,” Greene says. “We can’t put them at high risk to achieve a cure.”
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WORLD AIDS DAY 2017
50+ years of HIV
by PLUS edi ors
FIVE DECADES SINCE HIV HIT THE U.S., WE’RE CLOSER THAN EVER TO ENDING AIDS. As we now know, HIV didn’t arrive with the AIDS epidemic of the early 1980s, and we haven’t eliminated it yet. But the end of AIDS is in sight as treatment as prevention and PrEP dramatically slow the epidemic in many countries—and researchers close in on both a vaccine and a functional cure. In celebration of World AIDS Day, here are some of the most significant moments in the past five decades. The FDA approves the first HIV antibody test. Elizabeth Taylor (left) co-founds American Foundation for AIDS Research (amfAR). President Ronald Reagan mentions AIDS for the first time, and the federal government commits $100 million to developing HIV medications. The first minority-focused AIDS organizations are founded, including Bebashi, Black and White Men Together, Minority AIDS Project, and the National Minority AIDS Council (NMAC).
1960-1980
Samples from numerous individuals who die during these two decades are later identified as HIV-positive, including several in the U.S.—like St. Louis teenager, Robert Rayford, who dies in 1969 and San Francisco resident Ken Horne, who dies in 1980.
1981-1984
The Centers for Disease Control and Prevention reports on the first cases that will later be determined to be AIDS-related. Researchers isolate the human immunodeficiency virus as the cause of AIDS. As thousands of gay men fall ill and die, the LGBT community responds, forming organizations like New York City’s Gay Men’s Health Crisis (GMHC), established by Nathan Fain, Larry Kramer, Lawrence D. Mass, Paul Popham, Paul Rapoport, and Edmund White. People living with AIDS (above) issue “The Denver Principles,” demanding their right to be at the table when decisions about their care and HIV policy are made.
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1987-1990
Frustrated activists become more demanding. ACT UP (AIDS Coalition to Unleash Power) is founded; the NAMES Project Memorial Quilt (above), honoring those who’ve died, is unveiled in Washington, D.C. The first HIV drug, AZT, is approved by the Federal Drug Administration. Surgeon General Koop distributes “Understanding AIDS” pamphlet, the only publication—besides tax or census forms—to be mailed to all 107 million homes in America. Congress passes $800 million AIDS research package. Dr. Anthony Fauci, head of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, endorses giving HIVpositive people who don’t qualify for clinical trials access to experimental treatments. The World Health Organization declares the first World AIDS Day.
SHUTTERSTOCK (1960S-1980S & TAYLOR); COURTESY OF NATIONAL INSTITUTES OF HEALTH (DENVER PRINCIPLES FOUNDERS & AIDS QUILT)
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START HIV TREATMENT. HELP PROTECT YOUR HEALTH.
There is no cure for HIV, but find out how treatment helps make it possible to live a healthy life. See Inside
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A HEALTHIER LIFE CAN START WITH HIV TREATMENT. Starting HIV treatment right after diagnosis can help stop the virus in your body. Because treatment helps lower the damage HIV causes to your immune system. Plus, doctors and scientists have found that it can help lower the risk of heart disease and certain cancers.
TREATMENT ALSO HELPS YOU PROTECT OTHERS. HIV treatment can help lower the amount of virus in your body. It can get so low, it can’t be measured by a test. It’s called being undetectable. And it helps lower the chance of passing HIV on to others by more than 90%.
TALK TO YOUR HEALTHCARE PROVIDER. Have an open conversation. When you work together it helps your healthcare provider find the treatment that’s right for you.
Watch HIV: “Treat 2 Prevent” See how staying on treatment can help protect you and the people you care about. YouTube.com/HelpStopTheVirus
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STOPPING THE VIRUS CAN START WITH YOU. Here are two resources that can help.
Watch videos, share information, and see how we can all help stop the virus. HelpStopTheVirus.com YouTube.com/HelpStopTheVirus
Get the answers you need, privately, on your phone. HIVanswers.com/app
© 2016 Gilead Sciences, Inc. All rights reserved. UNBC3477 07/16
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1996-1999
Everything changes with the advent of highly active antiretroviral therapy. Time magazine names researcher David Ho (left) 1996’s Man of the Year for creating the new generation of combination therapies. Those drugs, and Ho’s efforts promoting earlier treatment interventions, leads AIDS-related deaths to decline by 47 percent in a single year. Reflecting the new reality, ER has a regular character become HIV-positive—and she doesn’t die. Congress funds the Minority AIDS Initiative, investing $156 million to prevent and treat HIV among communities of color. The Supreme Court rules the American Disabilities Act covers people living with HIV. UNAIDS launches. President Clinton (below) calls finding an effective vaccine for HIV in 10 years a national priority.
Finally addressing the needs of those with HIV, Congress passes both the Ryan White Comprehensive AIDS Resources Emergency Act and the Housing Opportunities for People with AIDS (HOPWA) Act, providing federal assistance to low-income and uninsured people living with HIV. New HIV organizations include the Latino Commission on AIDS, the Elizabeth Taylor AIDS Foundation, and the Elton John AIDS Foundation. Visual AIDS launches the Red Ribbon Project, and NMAC holds the first of what will become the United States Conference on AIDS. Longtime Companion, one of the first U.S. films to focus on the early AIDS epidemic is released. Basketball star Magic Johnson (above), comes out HIV-positive.
1993-1996
Visibility for people living with HIV increases dramatically with pop cultural representation like Tom Hanks (who wins an Oscar for his role) in Philadelphia, as a gay lawyer suing over getting fired for being HIV-positive; Tony Kushner’s Angels in America, which wins a Pulitzer Prize; and Pedro Zamora, a poz gay man starring on Real World: San Francisco. Olympic diver Greg Louganis (above) reveals that he has HIV. The first annual “AIDS Watch” draws hundreds to D.C. to lobby Congress for increased funding. President Clinton establishes the Presidential Advisory Council on HIV/AIDS.
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1999-2002 African-Americans get more attention as Phill Wilson founds what becomes Black AIDS Institute and the first annual National Black HIV/AIDS Awareness Day is celebrated. The CDC announces a new HIV Prevention Strategic Plan to cut annual HIV infections in the U.S. by half within five years. The Clinton administration declares HIV a threat to national security. 2002-2005 The FDA approves the first rapid HIV test. The Global Fund to Fight AIDS, Tuberculosis and Malaria is founded and offers $600 million in grants. The first annual National Latino HIV/AIDS Awareness Day is celebrated. President Bush launches PEPFAR (President’s Emergency Plan for AIDS Relief), a $15 billion, 5-year plan to combat AIDS. The Bill and Melinda Gates (right) Foundation donates $50 million to Global Fund and $60 million to the International Partnership for Microbicides (for HIV microbicides).
SHUTTERSTOCK (MAGIC & CLINTON); AP PHOTO/GEORGE BRICH (LOUGANIS); COURTESY DAVID HO (HO); KJETIL REE (GATES)
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2008-2011 The “Berlin patient,” Timothy Brown, is cured of HIV through a bone marrow transplant, becoming the first person to be cured of HIV—he remains virally suppressed. Positive Women’s Network-USA is founded. Greater Than AIDS campaign launches to boost prevention among black Americans. The Obama White House unveils the first National HIV/AIDS Strategy. The Affordable Care Act greatly broadens the number of people who have access to HIV care. Project Runway star Mondo Guerra reveals he’s HIV-positive. Studies confirm PrEP (pre-exposure prophylaxis) works. In fact, it’s up to 99 percent effective in preventing the transmission of HIV.
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2011-2014 The journal Science declares the HPTN 052 clinical trial their Breakthrough of the Year: the study proves that when someone is virally suppressed to undetectable levels, they are no longer able to transmit the virus to sexual partners. Annual HIV diagnoses in the U.S. fall 19 percent between 2005-2014. Obama signs the HIV Organ Policy Equity Act, allowing HIV-positive people to donate and receive HIV-positive organs. Larry Kramer’s autobiographical play The Normal Heart (written in 1985) opens on Broadway; in 2014 it becomes a hit HBO movie. Actors Matthew McConaughey and Jared Leto (above) win Academy Awards for their portrayals of HIV-positive characters in Dallas Buyers Club. The FDA approves Truvada as PrEP, the first protocol approved for the prevention of HIV. 2014-2017 The PARTNER study confirms undetectable equals untransmittable. To date, zero transmissions have occurred between serodiscordant partners when the HIV-positive one is undetectable. Bruce Richman founds Prevention Action Campaign to promote “U=U.” Transgender Law Center’s Cecilia Chung (left, with Ivory Aquino, who portrayed her in ABC’s When We Rise) launches Positively Trans and the first National Transgender HIV Testing Day is celebrated. Hollywood star Charlie Sheen comes out HIVpositive, sparking a huge increase in the number of people getting tested; amfAR announces a $100 million investment in cure research as researchers inch closer to a functional cure.
NORTHERN TERRITORY AIDS & HEPATITIS COUNCIL INC (PEP POSTER); SHUTTERSTOCK (DALLAS BUYERS CAST); COURTESY DINING OUT FOR LIFE (MONDO); COURTESY OF CECILIA CHUNG (CHUNG AND AQUINO)
2005-2008 The FDA approves the first once-a-day singletablet regimen for HIV, greatly reducing the number of pills most poz folks have to take. The CDC releases guidelines for PEP (post-exposure prophylaxis). The first annual National HIV/ AIDS Awareness Days for Asian and Pacific Islanders, Women and Girls, and Native Americans are celebrated.
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13 aids
we have years to end or, enneth cole s end aids coalition warns, we ll face a new andemic of deaths.
ARTHUR MOLA/AP IMAGES (KENNETH COLE)
by s
s b dsidis
Earlier this year, out fashion designer Kenneth Cole launched an effort to end the epidemic: the End AIDS Coalition, which will be run by Tom LaSalvia, who formerly served on the President’s Emergency Plan for AIDS Relief under President Obama. La Salvia’s passion for HIV activism was born when he was in his 20s, fueled by the memory of those he loved and lost to AIDS complications. LaSalvia recalls “the political and social environment of the epidemic in the ‘80s and early ‘90s, when our political and social leaders were unresponsive at best. Stigma and discrimination against people with AIDS or at risk of HIV infection—as I was—was rampant. Those were horrible times.” Now he’s applying that same passion to the End AIDS Coalition, which is part of a growing effort to prevent new AIDS diagnoses around the globe by 2030. Last year, the United Nations General Assembly adopted, by consensus, the “Political Declaration on the Fast-Track to End AIDS.” Reaching that goal requires the world to acheive specific targets by 2020, and the statement sets out time-bound goals and actions member states agree to attain. The End AIDS Coalition was founded to support that declaration, LaSalvia says, and to “hold countries and the global and regional AIDS organizations charged with meeting these targets accountable.” “Time is of the essence,” LaSalvia reiterates. “We must get ahead of the epidemic in the next three to five years before a new and larger adolescent population becomes atrisk of infection.”
He fears if we miss those targets and fail to prevent people with HIV from entering the endstage of the disease, we’ll instead see a new pandemic of AIDSrelated deaths. “If we don’t make it by 2030,” he says, “we may be looking at a global epidemic far beyond the one we witnessed in the ‘80s and ‘90s.” At least, LaSalvia argues, the landscape has changed dramatically since those early days. “Patient activism… was born out of the inaction and lack of compassion in the ‘80s. People from all walks of life demanded access to, and input on, decisions related to patient care as well as the fundamental research and scientific discovery process. AIDS activism became a model for patient and community input.” LaSalvia says we “have the end of the epidemic within sight— an incredible accomplishment given where we started.” New discoveries are continuing, “at a pace we never thought possible,” he adds. “The fact that a preventive vaccine and a functional cure may be on the near horizon makes it even more important that we stay focused on the critical path to ending the epidemic.” Ultimately, LaSalvia argues, we’re at a crossroads: Either we’ll end AIDS or a new wave of AIDS-related deaths will rock the globe. Which will it be? La Silvia knows which future he hopes wins out. “As a father,” he says, “I am passionate about ending this epidemic in our lifetime and protecting and saving our children and their parents around the world. Over two million people [contract] HIV every year and over a million people still die of AIDS, despite the fact that we have the tools and medicines to prevent this. I’m passionate about ending this epidemic because, working together, and in new ways, we can.” HIVPLUSMAG.COM
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son of a
preacher man i a i , whose mom l dia enned the gay preacher’s wife, grew u ga and came out hiv ositive in his closeted reacher father s church.
by desiree guerrero
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Micah Meredith and his author mom
in kindergarten. I was rather fond of my best friend, Andrew,” he jokes. But he learned early on it wasn’t okay to express his feelings (or gender differences). “There were incidents when I was shamed for non-typical boy behavior, such as wearing my towel like a female when I got out the shower, or my speech, or being made fun of for being too sensitive.” Meredith says this type of negative reinforcement held him back from talking to his parents: “I already knew I embarrassed them. Confiding in them would have made it too real. I wanted them to be proud of me.” His mother Lydia admits her part in perpetuating what she now calls the “toxic theology” that preaches against homosexuality. “He didn’t feel safe to tell us,” she says, and remembers telling him as a young child “not to act like a girl,” because people would tease him. “I wish I knew then… how to be a better, stronger parent and how to be an advocate for my child.” By the time Meredith came out to his parents in college, they were deep in their own struggles—dealing with his father’s closeted sexuality and their crumbling marriage. But at least the subject of gayness was no longer taboo. Their “immediate acceptance... surprised me. I think they saw it coming.” Despite the pain that religion inflicted upon them as a family, the Merediths have all found their own ways to stay connected to faith. Meredith’s father, Dennis, is still a pastor but is now open and comfortable with who he is, and preaches at a LGBT-friendly church. In an interview with Rolling Out, Dennis said he consented to his ex-wife publishing her book because, although he doesn’t agree with everything in it, “I felt it would start a conversation that was necessary in the faith community [and] just to people in general.” “Jesus doesn’t say anything about LGBT people—not one thing,” Lydia declares with a joyful confidence. “Jesus only taught love and tolerance. God is a God of diversity.” As for the preacher’s son, Meredith says he believes that “religion is a helpful reminder that life is bigger and more important than our perceived shortcomings… I let go of [the] faith that oppressed me and reconstructed my faith to benefit my own esteem.”
PHOTOGRAPHED BY JON DEAN STYLING BY KIMBERLY COULTON
fter surviving a childhood of secrets, shame, and lies, truth is very important to Micah Meredith. “Be truthful and honest, for the truth will indeed set you free,” says the easy-going, confident young man with a warm smile. He speaks from experience. Meredith’s father, a charismatic pastor, hid his homosexuality from his son and congregation but later came out and left Meredith’s mother for another man. Lydia Meredith chronicled that experience in her book, The Gay Preacher’s Wife. Meredith also came out gay—and HIVpositive. Looking back, the preacher’s son says, “My advice is, the sooner you learn how to articulate who you are, the better.” Meredith says that being honest and letting go of fear is especially important to those who are poz. “HIV-positive men have a tendency to live in the shadows from fear of their truth,” he says. His advice? “Flip your perspective. Negative thoughts will come, but rage against them. Surround yourself with positive energy.” Meredith says that he’s proud to be someone who has “perseverance, even when the odds are against me,” and says being HIV-positive has made him brave. “Ironically,” he says, “it’s the truth that one must run to—call it out, get comfortable saying it, and [talk] about it. Once exposed, the shame will have no more power over you, and what once was your prison becomes your playground.” Reaching this place of truth wasn’t easy, nor was growing up in an environment where gay men were forced into the closet, in fear of being “discovered.” Yet, despite its demonization of homosexuality, and the fact that he was sexually abused by a prominent member of his church, Meredith says it was the place he felt most comfortable as a child. “Because I was so gifted at music, church was one of the few places I could be celebrated,” he explains. “Most of my suffering was derived from TV comedy that made fun of homosexual lifestyles, school playground bullying, radio slander of gay men, and negative comments made by family and friends about my demeanor. However, when I matured as a man, I began to realize religion was the sole reason. My parents would not have done this to me if the church hadn’t educated them to be prejudiced.” Meredith says he knew he was gay “when I was N0VEMBER / DECEMBER 2017
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R E S I S TA N C E WA R R I O R BY JACOB ANDERSON-MINSHALL
IN THE DRIVER’S SEAT OPENING UP TO HIS DOCTOR EMPOWERED THIS ADVOCATE IN OTHER AREAS OF HIS LIFE.
TONY DONALDSON
CHRIS WILSON-SMITH IS A FIGHTER,
and he knows it. “I am a resistance warrior,” the 31-year-old explains. “I am an L.A. warrior. I’m a public health warrior. I’m a capacity-building warrior. I’m a husband warrior. I’m a godddad warrior. I’m a son warrior. I’m just a warrior.” Wilson-Smith has been an advocate from the moment he discovered he was HIV-positive a decade ago, shortly after he turned 21. Within days,he was speaking about being poz on an HIV prevention panel. He hadn’t even come out to his parents yet, but says, “I just kind of went full speed ahead with trying to help other people and trying to talk about my experience as much as I could.” But he wasn’t always as good about advocating for himself. In the beginning, Wilson-Smith admits, “I really didn’t understand [HIV] medication. I also didn’t understand why you’d have to take certain medications and couldn’t take others. I was prescribed Truvada, Norvir, and Prezista. I didn’t know [then] that I had a resistance to Atripla and other things, because the person who [I contracted HIV from] was already on medication. I didn’t understand that for years.” In fact, it took him becoming a case manager and having to answer his own clients’s questions before he became educated on genotypes and drug resistance. “Talking to other people has helped me,” he says now. “I mean, I have a therapist, so I got a lot out that way, but I also think that watching those fuses connect in people’s brains, or when they go from not really caring about their health to caring about their health, that piece is amazing.” Wilson-Smith went to school to become a social worker, but says he “kind of fell into HIV prevention, which was like the best decision I could have made. I didn’t grow up around gay people. I grew up in the church, so just being around gay people all the time, and then more specifically, HIV stuff, was just really exciting. I shared a lived experience with people, so that was something that drew me even closer and made me work harder.” Already working in the HIV field when he became positive, Wilson-Smith acknowledges he was a little embarrassed “because there are things that I know—like
I know about condoms.” And he was “a little resistant” to being open with his doctor too, because she “worked across the street from where I worked. I would see her at lunch. She knew a lot of my personal information… In the beginning, I didn’t talk to her about everything. Now I just tell her everything.” That kind of no-holding-back communication is important, Wilson-Smith says, “because you do yourself a huge disservice when you’re not forthcoming with your physician. It also allows them to either recommend the best avenue for treatment, or just make recommendations on what you should and shouldn’t do.” He continues: “I’d say people of color, we’re not taught to really advocate for our health. So, like in the beginning of my journey of being poz, I was recommended medication and asked no questions. I think when I started to ask questions, I started to advocate for myself on a medical level, but also in very different areas of my life. I was able to negotiate what type of sex I wanted to have, or what I was willing to do, what I wasn’t going to do, if I was using condoms or not. It just empowered me in a very, very different way. I found that advocating, or talking to my doctor, and being forthcoming and just honest, has been one of the best things. It’s been amazing.” Wilson-Smith is now a capacity builder, doing trainings for the Centers for Disease Control and Prevention, and training organizations on “how to actually work with people who are HIV-positive, who are gay-identified, and a lot of organization development stuff to make sure that orgs
are sustainable… make it through the current political climate, but also, just always improve their services and get better.” Wilson-Smith recently disrupted his treatment on purpose, choosing to switch drugs again. He’s long disliked the number and size of the drugs he was taking, and says that was ultimately why he decided to change. “I just really wanted a simpler regimen. I need to be able to put it in a smaller pill case, just because I’m private. The number of pills is still around the same, it’s just a smaller pill.” But it’s also come with some unexpected side effects: “I’ve had allergies that I’ve never had, I’ve had stomach issues that I’ve never had. Now I have night sweats, and I have all of these things that I’ve never experienced, and I wish I was better prepared for that.” A year ago, Wilson-Smith also embraced a vegan lifestyle, which he says, “kind of just changed my whole life. I started to look different and feel different.” As he moves into his 30s, Wilson-Smith says he wants to continue to prove “that being HIVpositive, or being poz, you can [be] ‘normal.’ You can work out, you can have a great quality of life, you can have a good job, and live in a great place, and just have a regular life. It doesn’t really change much.” Going forward, he’s hoping to get into acting— another desire he’s embracing. In talking to his parents about the decision, WilsonSmith says, “I’m like, ‘I did what I was supposed to do. I went to college. I have a job, I have a career. Now I’m doing what I wanted to do.’” No doubt, as an actor who is out about his HIV status (one of the few actors who are), Wilson-Smith will continue to serve as a guide for other poz folks, just as he does now. HIVPLUSMAG.COM
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america’s
sweetheart this te as red o ne t door won a ga realit dating com etition and the devotion of fans coming out as hiv ositive. now he s a ing it forward in erson, and on camera, in the new i a a warri r cam aign.
by desiree guerrero o ogr y by e y ger rd
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ith piercing blue eyes, a perfect pearly white smile, and great hair (of course), ERIC LEONARDOS is every bit the image of the all-American boy next door. But the dimple-chinned dreamboat is much more than a handsome face. For many, he’s a hero. The Los Angeles-based celebrity hairstylist and makeup artist gained fame last year when he appeared on Logo’s Finding Prince Charming, a reality competition where gay men vied to win the heart of bachelor Robert Sepulveda Jr. Leonardos won, and—more importantly— came out publicly as HIV-positive while taping the show. Ultimately, the couple’s romance didn’t last, but the impact of Leonardos’s revelation continues to be felt as he joins the small handful of reality stars who have opened up about their poz status—from Pedro Zamora of MTV’s Real World, to stars of RuPaul’s Drag Race, Project Runway, and Big Brother. While reality TV fame was never on his radar, Leonardos’s career as a hairstylist in Los Angeles gives him a fair dose of Hollywood exposure. He’s capitalized on his own celebrity by helping others and trying to reduce the stigma around HIV. Since his appearance on Prince Charming, he’s spent much of his time sharing his story and contributing his talents to worthy causes, like the Design Industries Foundation Fighting AIDS and Project Angel Food. He stars in the new Plus and Prezcobix-powered I Am a Warrior campaign, talking on camera about his battles with HIV drug resistance. He’s also developing his own nonprofit called Beauty Allies. Leonardos says he was inspired to start his own organization (which is still in its beginning stages) after teaming up with MAC Cosmetics at a makeover event earlier this year that benefited formerly homeless women. Admittedly, he was also feeling a bit helpless and defeated after the 2016 presidential election. “I think that young people out there are wanting to do something, to take action, and they’re looking for those opportunities,” Leonardos says. Since his vision for Beauty Allies is primarily giving makeovers to deserving individuals, all donors need to contribute is their time, skills, or space in order to make a difference. Leonardos feels a strong connection to women and women’s causes, which he says need and deserve more attention. “Of course for me, some of my main objectives for this organization that are important to me are people living with HIV,” he adds. “Particularly 30
right now, I want to bring a lot of focus and attention to women living with HIV.” “I cannot tell you how much this event means to our clients,” Terry Goddard II, executive director of Alliance for Housing and Healing, said of the MAC event. “Their joy and gratitude are immeasurable. This kind of activity helps to build self-esteem and pride. When our clients look in the mirror, they see themselves in a whole new and wonderful light.”
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Leonardos says in this appearance-obsessed world, he wants to focus on inner beauty and strength in his organization, hoping that the momentary sprucing up will bring a lasting boost of self-esteem and self-worth. “We already know these people are beautiful, but we want to make sure they know it,” says Leonardos. “The look on their face as they spin around in the chair to look at themselves in the mirror for the first time is so special to me—the confidence they walk away with is priceless.” Leonardos’s sweet and upbeat personality is both refreshing and endearing. And despite his fresh-off-the-farm good looks, the Texas native possesses wisdom and calmness that seem beyond his years, which might partly be due to the fact that, at 36, Leonardos still looks in his early-20s. But this Prince Charming’s journey hasn’t always been a fairy tale, and some of the wisdom and zest for life he possesses today comes from surviving dark and difficult times. In a moving speech he delivered at DIFFADallas’s Dining by Design fundraising event this past June, Leonardos opened up about his past to the sold out crowd of 1,600 design VIPs. “I definitely [told] my story in a way that has not been public yet,” he says.
The eldest of three boys, Leonardos was born and raised in the Bible belt of Houston, Texas, by “sweet, loving, caring parents who are still married and in love after 38 years.” After coming out to them at 18, Leonardos was given a choice: go to gay conversion therapy or move out. Being fresh out of high school with no means to support himself, he initially opted for the latter, but only lasted a few sessions “with a ‘counselor’ who was about as ex-gay as RuPaul …let’s just say I made a life choice to stop going.” So, at 18 years old, he found himself alone, broke, ostracized, and depressed. Leonardos says he only survived these times due to the help of caring strangers—and by utilizing the types of community programs and services he generously gives back to today. “Very early on, I sought out mental health services knowing that I had some de-programming to do,” says Leonardos. “News alert: when you’ve been trying to pray the gay away, and you’ve been thrown out of the house, and you’re gay in Texas in 1999 just in general, you get some issues that require a professional’s intervention,” he explains. “Also, I needed my regular STI test every three to six months, which wouldn’t have been possible without these types of organizations.” A couple years later, Leonardos moved to the gay-friendlier and progressive Texas city of Austin, with big dreams of making it “to New York City, where I would one day become a famous makeup artist or hairdresser.” The future was indeed looking bright for Leonardos, who quickly found work at an upscale salon after completing beauty school—that is until an unexpected discovery derailed him from his dreams, and once again sent him into darkness. In 2006, two months before his 25th birthday, Leonardos was excitedly focused on an important presentation he was giving at the salon that day. On his way to work, he stopped in for what he thought CONTINUED ON PAGE 35 HIVPLUSMAG.COM
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was just another routine STI test. But while the doctor continued to speak, Leonardos says he heard nothing after she told him his rapid HIV test had come back positive. “I entered a dark vacuum, her voice distant and garbled, like someone talking to you underwater,” he recalls. “In that one moment, I felt all of my dreams die. This was 2006 and a positive diagnosis felt like a very different animal than it does today. I wouldn’t go to New York and work fashion week. I wouldn’t have love in my life. I’d never have a husband. I wouldn’t be happy. I wouldn’t be able to afford treatment. I may not even live. These thoughts are irrational of
course—we all know that or we wouldn’t be here. But I cannot tell you how convinced I was, in a split second, that this was going to be my future.” After feeling shamed by the first doctor he saw after his diagnosis, he fortunately decided to find a new one—and ultimately met the woman who would help him reverse his hopeless and dreary outlook, Dr. Cynthia Brinson. “This woman changed my life. She immediately helped me get on a pharmaceutical study she was administering on her off-hours at a nonprofit treatment center,” says Leonardos. “She assured me that I would be okay, that I would live a normal life…. She said, ‘Eric, keep living your dreams.’” Leonardos has surely had his ups and downs with treating his HIV. The first regimen he was put on in the study gave him “crazy, vivid dreams” and a “loopy, stoned kind of feeling.” Then Leonardos moved to Atripla, which he was on for about 10 years, until his doctor convinced him to switch to Complera, which was then a newer drug with fewer side effects. Like many people on successful treatment, he was hesitant at first to make any changes despite the side effects. Leonardos admits he is now glad he eventually did make the switch in meds, because it had less psychotropic side effects, though he did experience mood changes and depression for a while. “This is something that is not well known,” Leonardos says of the adjustment period that can happen after a medication switch. As an activist, he wants people to know the experience is normal, urging switchers to “hang in there.” He ended up making one more switch to Odefsey, which is an updated version of Complera with even less toxicity and fewer side effects. Leonardos says even though it can be a bit of a nuisance and disruption to your life, making occasional changes to your drug regimen is necessary because “treatment for HIV is improving every single day.” Ultimately, Leonardos says, “I’m just a normal person, living with HIV… who just happened to end up on a reality television show,” he says with a laugh. “The real story is that I’m a hairdresser [who works] right out of West Hollywood. This is my real story.” These days, life is but a dream for Leonardos, who now has a great relationship with his parents. “Today, I am closer to my parents than I’ve ever been,” he says. “My parents have become advocates. [They] changed churches, changed themselves, and their lives.” Oh, and by the way, last year he ended up fulfilling his dream of styling hair at New York Fashion Week. Take that, universe! (@EricJLeo) HIVPLUSMAG.COM
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miracle
worker this advocate roc star is dedicated to hel ing other transgender latina immigrants.
amby Salcedo is truly a miracle—and she knows it. “I always say… ‘Yo soy milagro,’” says the founder of the Los Angeles-based TransLatina Coalition, “which means that ‘I am a miracle.’ In some ways, I definitely [am].” As a trans woman—who survived childhood sexual abuse, the rough streets of Guadalajara, Mexico, drug addiction, immigration to America, and a stint in a U.S. prison—Salcedo sees her very survival as a miracle. She knows firsthand the hardships trans women of color face because she has walked in their shoes. Salcedo has survived, overcome, and persevered, when others didn’t, galvanizing her to use her position as a community leader to provide safety, services, and support for other transgender Latina immigrants. Salcedo founded the TransLatina Coalition in 2009, and initially conceived of it as “a national advocacy organization with this idea of changing the structures that continue to marginalize our community, specifically focused on addressing the needs and issues of trans Latina immigrant[s].” By 2015, the organization had representation in 10 states and was soon expanding beyond advocacy to provide social services, with the help of a federal grant. Today, TransLatina has a staff of five and a drop-in center (established “for violence prevention”) that provides daily lunches and more. “We are an organization now that has two arms,” Salcedo says. “The advocacy and organizing piece of it, but also direct service provision.” TransLatina has developed programs to address the specific issues that trans Latina immigrant women face, such as escaping violence or abuse, dealing with the legal system and immigration (often without documentation), and finding permanent housing and steady employment. Towards the latter goal, TransLatina has received funding from the California Workforce Development Board to support their partnership with TransCanWork, a trans hiring program developed by the CEO of one of the largest El Pollo Loco franchise chains—who also happens to be transgender. Michaela Mendelsohn says she started TransCanWork five 36
years ago to create “positive workplaces for transgender people.” Walker,* a young trans employee, adds, “Working somewhere like El Pollo Loco—where I’m employed by a trans woman, [and] my coworkers are trans—is really empowering.” TransLatina can also provide clients their own caseworker and accompany women to court appearances or doctor’s appointments. “We can walk with you through whatever processes that you may be going through,” Salcedo says. But perhaps the most important thing they offer “for those individuals who are undocumented and who are HIV-positive, and if you are trans, [is] to really acknowledge that you are a valuable person, that your life really matters, and that your health matters. Because we do acknowledge you, and we love you, and we value your existence in this world.” A long-term survivor of HIV, Salcedo found out she was poz in the early ‘90s. “The very first medication that I started taking was AZT,” Salcedo recalls. “I was involved in the street economy and using drugs. Because of that, I was obviously not able to take care of my health as I should have… I had to constantly switch medications.” Salcedo says that because of the abuse and trauma she has endured throughout her life, “My emotional being obviously was all screwed up. Luckily… I was able to reform my life. I have had people who have been there for me, who have affirmed my existence here in the world. That obviously has helped me, for my emotional being, to continue to be at a place that I should be.” And with that support and emotional work, Salcedo continues, “I have learned that taking care of myself, it’s important. Not only my physical health but also my emotional health, my spiritual health. All of those things that make me whole and make me a healthy person.” Salcedo says that because she has “survived and experienced many different challenges, I have been able to turn those challenges into opportunities. For me, I would say it’s not that the past has led me to really think of [myself ] as a victim, but rather for me to think as a warrior—and that’s what I am doing now.” *Last name withheld for privacy
TONY DONALDSON
by desiree guerrero
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seeking
simpatia
by d
id r
i
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aging hiv ositive latinos face constant discrimination and invisi le stigma, et their stories are never told until now.
s people living with HIV continue to live longer and healthier lives, a new conundrum is beginning to emerge within the community: managing the virus alongside comorbidities that come with age, like osteoporosis, heart disease, vision problems, and diabetes (the latter effects one in every 10 HIV-positive people). In 2013, nearly 42 percent of HIV-positive people in America were 50 and older. These issues are compounded for poz people who trace their heritage to Latin America (which includes Portuguese speakers from Brazil), Mexico, Cuba, the Caribbean, or other Spanish-speaking countries. Yet, there have been few studies focusing primarily on their specific needs. As a result, healthcare professionals are often clueless, which in turn makes this community less likely to discuss sexual practices with their doctors and less aware of HIV risks overall. Olvidados (or “Forgotten Ones”), a new report by the Latino Commission on AIDS (in partnership with the Hispanic Health Network) seeks to explain the social and health challenges faced by Latino and Hispanic people 50 and older who are living with HIV in the U.S. Over the course of a year, researchers
collaborated with communitybased organizations and clinics in various American cities, eventually speaking with 157 HIV-positive respondents—61 percent of whom identified as male, 36 percent as female, and three percent as transgender. Representing 18 percent of the U.S. population, Hispanics and Latinos are the nation’s fastest growing minority and ethnic groups, as well as the fastest growing aging population. They also account for 24 percent of HIV diagnoses, the study points out. As a matter of fact, in 2015, Latinos aged 50 to 54 had an HIV transmission rate more than twice that of white HIVPLUSMAG.COM
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non-Hispanics, reports the Centers for Disease Control and Prevention. Lead researchers of the new report, David Garcia and Gabriela Betancourt confirmed that, while most respondents reported being insured and having undetectable viral loads, about 25 percent of all respondents said they were “less than satisfied” with some aspect of their provider’s care. According to Garcia, that might be due to a lack of respect from doctors themselves. “Developing a genuine relationship with their provider was important for continued engagement in their care,” Garcia explains to Plus. “This included liking one’s provider, having a provider that takes time to talk or is available,
In 2015, Latinos aged 50 to 54 had an HIV transmission rate more than twice that of white non-Hispanics. and a provider that is respectful of their needs and culture. [Respondents] also noted that providers who take a ‘team approach’ to care were helpful. Providers are often rushed and do not give their patients the attention they need.” A lack of trust might also explain the near 60 percent of respondents who were not counseled during medical visits about relevant health concerns, screenings, and comorbidity risks. This could also explain why one in three participants indicated some level of difficulty adhering to proper treatment. Another unfortunate discovery was that over half of respondents had clinical depression and daily stress, which in turn compromises the immune system. According to focus groups lead by researchers, common struggles included fear and mistrust, a lack of understanding on how HIV could impact other illnesses, and the social challenges relating to access to care—not to mention, language barriers. As these issues continue to pile on, more and more older HIVpositive Latinos are choosing to live a life of isolation. And they’re not alone. Nearly one-third of older adults living outside nursing homes or hospitals live alone, according to the Institute of Aging. Another study published in CMAJ Open, an online open-access medical journal from Canada, showed that over the course of a decade, more than eight percent of poz deaths were caused by suicide. Garcia adds that language barriers, poverty, and low education levels are associated with inadequate knowledge about HIV and lower HIV testing rates, “therefore, we need to better learn how these factors vary among those who are foreign born and those who are more acculturated versus those who are U.S. born.” 38
Garcia’s study also points out the significance of cultural values within Latino communities, known as “simpatia, respeto, familismo,” referring to sympathy, respect, and family. Because of these traditional value systems, many older HIVpositive Latinos avoid coming out poz for fear of causing pain or distress to loved ones. But being in the closet ultimately leads people to feel isolated and ashamed. The study further shows that older Latinos have significantly lower levels of education than the general population, with 38 percent having less than a high school education compared to 17 percent of African-Americans and 7 percent of non-whites. It should also be noted that 18 percent of older Latinos also live below the poverty line, with 70 percent receiving lower social security payments. Affordable housing is another challenge, and it has an even bigger impact on those with chronic health problems. “All of these issues need to be taken into consideration to meet the needs of our diverse Latino communities,” Garcia says. “The more we learn about [stigma], the better we can tailor our services so that it can bring wider access to care. Larger social messaging campaigns are needed to address cultural issues that perpetuate stigma in Hispanic/Latino communities to impact their use of HIV testing and prevention services, including biomedical interventions. Anti-stigma campaigns must effectively address discrimination and violence due to homophobia, transphobia, and misogyny, as well as race and ethnicity, to be successful.” Garcia explains that while religion might also play a role in HIV and LGBT stigma among Latino communities, stigma is a “learned behavior.” He cites the Latino Commission on AIDS as a great example for anti-stigma initiatives. “The Commission runs one of the oldest Latino religious leadership projects, where we train and enlist leaders from religious congregations to deliver health education messages, including anti-stigma education to each participating congregation in order to reach Latinos in New York City in a meaningful way that resonates with these underserved communities,” he says. “Replicating this type of program at a national level would greatly impact our Latino community and work to demystify and combat stigma.” It is time to address the invisible voices in the community. The needs of Latinos and Hispanics must not be ignored while we discuss growing concerns around HIV and aging—and the only way to do that is by educating ourselves, and our healthcare providers, on the social, political, and economic conditions these groups face. When it comes to treating aging HIV-positive Latinos, Garcia says healthcare providers “need to establish a genuine relationship with enhanced rapport-building strategies that work to allow that patient to trust them and open up about their concerns.”
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do API
lives matter rates of hiv among asian americans and acific islanders um ed ercent. so, where s the u roar or the funding ob
derso
i s
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Meanwhile, as of 2014, Native Hawaiians and other Pacific Islanders have HIV rates nearly twice that of the white population in the U.S., according to the federal government’s Office of Minority Health Resource Center. Despite these disconcerting statistics, those providing HIV services for the AANHPI community are reportedly struggling for resources and have become “endangered species.” At a USCA conference panel, “Novel Approaches in an Era of Resource Scarcity,” moderator Jacob Smith Yang of Asian & Pacific Islander American Health Forum reported that in 2010, there were 55 organizations providing HIV services to the AANHPI community. In the past seven years, that number has plummeted to only 12. Yang believes the sharp decline is a direct result of losing federal funds after the National HIV Strategy directed agencies to focus on AfricanAmerican and Latino communities, which have the highest rates of HIV in the country. Native Americans and AANHPIs weren’t even mentioned in the 2010 strategy, Yang says. Five years later, the strategy offered a slight improvement, noting, “Although it is vital to focus national efforts in communities with the highest burden, HIV prevention must continue to be supported in localities with concentrations of groups such as Asian-Americans and Pacific Islanders, and American Indian/Alaska Natives.” Henry Ocampo of the Office of Minority Health Resource Center announced while speaking at the panel, “We are in a crisis, in regards to basic funding and assistance,” noting that only 0.3 percent of the $260 million the CDC spends on HIV is currently directed to the AANHPI community.
SHUTTERSTOCK
uring the final plenary on the last day of the 2017 United States Conference on AIDS, half a dozen women took the stage. Due to the protest-friendly nature of the conference, they didn’t need to storm up the stairs, or forcibly grab microphones from the women of color seated there. Instead, they were simply invited to speak. Why was it, they asked, that so few of their kind had been invited to speak at the conference? More so, why didn’t this last plenary—“The Power of Women & the Future of Leadership for Women of Color”—include a single AsianAmerican, Native Hawaiian, Pacific Islander, or Native American woman? It was a good point. Although AsianAmerican, Native Hawaiian, and Pacific Islanders (AANHPI) accounted for less than six percent of the U.S. population in 2015 (according to the Census Bureau), their population is growing faster than any other racial group in the country. They represent Americans with heritage from the most populated countries of the world— including China (1.41 billion people) and India (1.34 billion) who together reflect 37 percent of the world population, according to the U.N. The Centers for Disease Control and Prevention reports that “between 2010 and 2014, the Asian population in the United States grew around 11 percent, more than three times as fast as the total U.S. population. During the same period, the number of Asians receiving an HIVpositive diagnosis increased by 36 percent, driven primarily by an increase in HIV diagnoses among Asian gay and bisexual men.” N0VEMBER / DECEMBER 2017
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Numerous AANHPI organizations have merged or simply faded away, advocates say. Other providers, like API Wellness—which has served the Asian and Pacific Islander American community in San Francisco for decades—are dropping references to APIs from their names and expanding their focus. Nikki Calma, a trans woman who has worked for API Wellness for over 20 years, told USCA attendees that the organization has been “afraid San Francisco AIDS Foundation would absorb us.” Instead, the Tenderloin-based API Wellness, which has long served the broader LGBT community (in particular their 400-plus trans clients), will become more multicultural. Even their monthly “Joy Luck Club” will open to the entire community. Calma adds that the changes ahead are necessary to survive, insisting that while their name is changing in January, they will still serve the API community and “keep our values going.” In the future, Calma says, the organization may not look the same, “but our history will not be erased.” Kunane Dreier of Life Foundation in Hawaii said it’s not just his organization—which has been around since the 1980s—that has felt the brunt of new federal funding priorities. The entire state was reportedly cut off when Hawaii was “designated a low incident state” and no longer qualified for HIV prevention funds from the CDC. With a fraction of their old staff, Life Foundation has tried to increase collaborations and rely more on the local community. Dreier said they find ways to offer their clients other services—including transgender health care, smoking cessation programs, and needle exchanges—all of which have other, non-HIV-specific funding sources. AANHPI organizations are having to think outside the box to survive, says Jimmy Sianipar of the Asian Pacific AIDS Intervention Team (APAIT) in Los Angeles. His organization kept running up against funding constraints because their HIV prevention efforts were limited to a brick and mortar location. They raised their own money and bought a mobile testing facility, which has enabled them to do testing at bathhouses, clubs, and recurring gay parties like Gameboy that are frequented by API gay men. APAIT also sends staff to walk the streets of Hollywood (after midnight, three nights a week) to provide outreach, hand out water, and offer free HIV testing. And the group recently opened a threebed shelter where clients can have a hot shower, something to eat, and have a nap. The absence of funding is being experienced in other ways as well. For example, Ben Cabangun of APIA Health Forum, argued that “a decade ago” there was a core group of researchers focusing on HIV in the AANHPI community. Now, he says, “they have moved on, to where there’s funding” and their current research revolves around trans women and other gay and bi men of color. Jimmy Quach, from HealthRight 360 and AA Recovery Services in the San Francisco Bay
Area, said most of their funding comes from the Office of Minority Health and the Science and Management of Addictions Foundation (SAMA). He sees the idea of Asian-Americans being a “model minority” as a major barrier to funding. “Positive stereotypes can also harm us,” he said, including myths that Asian-Americans are all
In Chinese-American communities, sexual education is underemphasized since STDs are related to four taboo subjects: sex, homosexuality, disease, and death. wealthy and don’t need financial support, Asians don’t use drugs, and Asians don’t have unsafe sex. Cabangun argued the latter myth is furthered by the “reticence to talk about sex and sexuality in our community.” A policy paper written by Stanford student Siyou Song seems to agree, noting that in “Chinese-American communities, sexual education is underemphasized since STDs are related to four taboo subjects: sex, homosexuality, disease, and death. In these communities, condoms are also associated with promiscuity and are, therefore, used less frequently for fear of being perceived as salacious.” Another issue is that data about AsianAmericans is limited and confounded by researcher’s penchant of lumping all Asians together, regardless of whether their ancestors hailed from China; other Asian nations like Japan, Korea, Vietnam; or the Indian subcontinent. “It’s important for us to collect our own data,” Sianipar said. “We ask more questions than the county wants us to ask.” Different Asian communities have different sexual practices or other differences that could impact HIV prevention and treatment efforts. “We’re sharing data everywhere we can,” Quach noted, saying that speaking at conferences like USCA is part of the effort to increase awareness of the need for HIV services—and funding—in the AANHPI community. Many of the panelists worried about the future, wondering how the Trump administration will impact funding priorities. “The Secretary’s Minority AIDS Initiative [Fund] is keeping us afloat,” Quach noted, yet, “This administration wanted to eliminate [the entire fund].” Fortunately, there’s been pushback from the Senate. But no one really knows what the final budget will look like and that worries Quach. He believes the AANHPI community needs to become more vocal about its needs and the lack of funds for services, posing the rhetorical question, “Where is the uproar?” HIVPLUSMAG.COM
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by desireé guerrero
it
takes a
ladyboy a fierce and fearless queen, ongina delivers a message to the world via lashes and heels.
ute but fierce. Chic and unique. Sassy yet sweet. These are just a few terms that come to mind when trying to describe the big-hearted, bald-headed, bubbly ball of light that is Ongina—a fan favorite from the nowhistorical fledgling season of RuPaul’s Drag Race. Ryan Palao, the Filipino-American performer behind Ongina’s polished persona, says that because he is “a very feminine male,” Ongina is not just a character, but an inseparable part of his identity. “Ongina is a part of me… wholeheartedly. And there is definitely a part of Ryan that crosses over to Ongina,” he explains. In fact, Palao, who inspired RuPaul’s hit single, “Ladyboy,” is so naturally feminine that he even thought at one point he might be transgender. “I knew at a young age that I was different,” he says of growing up in the Philippines, one of the most gay and trans tolerant countries in Southeast Asia. Palao says, “I was never told I couldn’t act the way that I did. My family really supported my individuality and… who I am as a person.” But Palao says all that changed when his family relocated to a small town in the U.S., where “being gay was something I obviously had to hold back on—being feminine was something I had to change,” he recalls. Despite his isolating 42
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Opposite page: Ongina, photographed by Davide Laffe. This page: Ongina takes glam to the streets at amfAR’s Countdown to the Cure event (photo by Getty Images).
environment, Palao came out during his junior year in high school because “hiding who I’ve always been allowed to be growing up in the Philippines, and then not becoming that person growing up in your teenage life, was really hard.” And then came drag: Palao first dressed in drag on his 21st birthday, but didn’t start performing until several years later. “I started out very, like, club kid,” Palao recalls of his early days in drag. One can still see the club kid influence in Ongina’s edgy yet sophisticated style—preferring a bald head and coquettish hats to wigs, and having been known to sport black pleather eyebrows. But beneath the glitz and glamour is a courageous and caring heart, which has transformed the petite diva into a powerful advocate and activist. Palao famously opened up about being HIV-positive on an episode of 2009’s RuPaul’s Drag Race, after winning a challenge related to the cause. He says “coming out publicly about my HIV status wasn’t because I had a plan for it. It was because I won a challenge that was so close to my heart.” Palao says the tearful revelation “burst out, out of emotion,” but he “never really imagined the impact that it would have, and how it would change my life forever.” This brave act made Palao one of the first people to come out as HIV-positive on reality television since pioneering activist Pedro Zamora (MTV’s Real World) did so in 1994. Not only did that “emotional and organic” moment affect and inspire thousands, it was the birth of Palao’s new life as an HIV activist. In continuing this commitment, the host of Logo’s 2010 talk show, HIV+Me, recently teamed up with the Foundation for AIDS Research to spread messages of awareness, hope, and positivity about HIV through an online video series called Epic Voices. And he firmly believes that he can deliver those messages more effectively in “a pair of really large eyelashes and four inches of makeup.” “We can get away with so much shit being in drag, versus if I was just Ryan, because of that fascination with the drag culture,” explains Palao. “I think that drag... is a bigger voice, and people really tend to listen,” he says. “Especially being associated with RuPaul’s Drag Race, it’s such a huge, huge, huge community… and a lot of the fans are also the new and younger generation,” which is exactly the demographic the campaign is hoping to reach. “At one point, I was really ashamed of being HIV-positive,” Palao admits.
“[After being diagnosed], I didn’t want to have a sexual relationship, I didn’t want to talk about it. I was in denial, I was depressed.” And then Palao says that “something in my system just switched and said, ‘You know what? I can’t be like this anymore. I’m not this person!’” Palao is passionate about many issues in addition to helping those living with HIV— especially the treatment of transgender people. “I think trans rights, it’s just part of human rights,” he says. “I have family… you know, chosen family, that are trans, women and men. I may not know the struggles a hundred percent of what they’re going through, but I think I can empathize with them because I am also a person that is different in a lot of people’s eyes.” And with the Trump administration now in power, Palao says it is more important than ever to be vocal and vigilant about these issues, and to continue fighting ignorance and bigotry. “You see more of the hatred that was once a little bit more suppressed… now come into light because they have a leader who is encouraging this,” says Palao. Of meeting his husband on Facebook, Palao quips, “It’s like the new Cinderella story,” and says that he has matured a lot since getting married in 2011. “It’s given me a lot of patience—or has taught me a lot of patience,” Palao adds with a laugh. Despite his full plate, Palao has also managed to find time to start penning a “one-womanshow”—the working title: The Ongina Monologues: A Timepiece, Not a Masterpiece. (@Ongina) HIVPLUSMAG.COM
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WHAT IS GENVOYAÂŽ? GENVOYA is a 1-pill, once-a-day prescription medicine used to treat HIV-1 in people 12 years and older who weigh at least 77 pounds. It can either be used in people who are starting HIV-1 treatment and have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. These include having an undetectable viral load (less than 50 copies/mL) for 6 months or more on their current HIV-1 treatment. GENVOYA combines 4 medicines into 1 pill taken once a day with food. GENVOYA is a complete HIV-1 treatment and should not be used with other HIV-1 medicines. GENVOYA does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking GENVOYA. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance QH UGZWCN EQPVCEV YKVJ DQF[ Ćƒ WKFU 0GXGT TGWUG QT UJCTG PGGFNGU QT QVJGT KVGOU VJCV JCXG DQF[ Ćƒ WKFU QP VJGO
IMPORTANT SAFETY INFORMATION What is the most important information I should know about GENVOYA? GENVOYA may cause serious side effects: • Worsening of hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking GENVOYA, your HBV may suddenly get worse. Do not stop taking GENVOYA YKVJQWV Ƃ TUV VCNMKPI VQ [QWT JGCNVJECTG RTQXKFGT CU VJG[ will need to monitor your health. Who should not take GENVOYA? Do not take GENVOYA if you take: • Certain prescription medicines for other conditions. It is important to ask your healthcare provider or pharmacist about medicines that should not be taken with GENVOYA. Do not start a new medicine without telling your healthcare provider. • The herbal supplement St. John’s wort. • Any other medicines to treat HIV-1 infection. What are the other possible side effects of GENVOYA? Serious side effects of GENVOYA may also include: • Changes in your immune system. Your immune U[UVGO OC[ IGV UVTQPIGT CPF DGIKP VQ Ƃ IJV KPHGEVKQPU Tell your healthcare provider if you have any new symptoms after you start taking GENVOYA.
• Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking GENVOYA. • Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. • Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-coloredâ€? urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. The most common side effect of GENVOYA is nausea. Tell your healthcare provider if you have any side effects that bother you or don’t go away. What should I tell my healthcare provider before taking GENVOYA? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how GENVOYA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take GENVOYA with all of your other medicines. • If you take antacids. Take antacids at least 2 hours before or after you take GENVOYA. • If you are pregnant or plan to become pregnant. It is not known if GENVOYA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking GENVOYA. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Important Facts about GENVOYA, including important warnings, on the following page.
Ask your healthcare provider if GENVOYA is right for you.
GENVOYA.com
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GENVOYA does not cure HIV-1 or AIDS.
SHOW YOUR
POWER Take care of what matters most—you. GENVOYA is a 1-pill, once-a-day complete HIV-1 treatment for people who are either new to treatment or people whose healthcare provider determines they can replace their current HIV-1 medicines with GENVOYA.
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IMPORTANT FACTS This is only a brief summary of important information about GENVOYA® and does not replace talking to your healthcare provider about your condition and your treatment.
( jen-VOY-uh ) MOST IMPORTANT INFORMATION ABOUT GENVOYA
POSSIBLE SIDE EFFECTS OF GENVOYA
GENVOYA may cause serious side effects, including:
GENVOYA can cause serious side effects, including:
•
Worsening of hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking GENVOYA. Do not stop taking GENVOYA without first talking to your healthcare provider, as they will need to check your health regularly for several months.
•
• • •
ABOUT GENVOYA •
•
GENVOYA is a prescription medicine used to treat HIV-1 in people 12 years of age and older who weigh at least 77 pounds and have never taken HIV-1 medicines before. GENVOYA can also be used to replace current HIV-1 medicines for some people who have an undetectable viral load (less than 50 copies/mL of virus in their blood), and have been on the same HIV-1 medicines for at least 6 months and have never failed HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements. GENVOYA does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.
Do NOT take GENVOYA if you: • Take a medicine that contains: alfuzosin (Uroxatral®), carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), cisapride (Propulsid®, Propulsid Quicksolv®), dihydroergotamine (D.H.E. 45®, Migranal®), ergotamine (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), lovastatin (Advicor®, Altoprev®, Mevacor®), lurasidone (Latuda®), methylergonovine (Ergotrate®, Methergine®), midazolam (when taken by mouth), phenobarbital (Luminal®), phenytoin (Dilantin®, Phenytek®), pimozide (Orap®), rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®), sildenafil when used for lung problems (Revatio®), simvastatin (Simcor®, Vytorin®, Zocor®), or triazolam (Halcion®). •
Take the herbal supplement St. John’s wort.
•
Take any other HIV-1 medicines at the same time.
GET MORE INFORMATION •
• •
This is only a brief summary of important information about GENVOYA. Talk to your healthcare provider or pharmacist to learn more. Go to GENVOYA.com or call 1-800-GILEAD-5 If you need help paying for your medicine, visit GENVOYA. com for program information.
Those in the “Most Important Information About GENVOYA” section. Changes in your immune system. New or worse kidney problems, including kidney failure. Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. The most common side effect of GENVOYA is nausea. These are not all the possible side effects of GENVOYA. Tell your healthcare provider right away if you have any new symptoms while taking GENVOYA. Your healthcare provider will need to do tests to monitor your health before and during treatment with GENVOYA. •
BEFORE TAKING GENVOYA Tell your healthcare provider if you: • Have or have had any kidney or liver problems, including hepatitis infection. • Have any other medical condition. • Are pregnant or plan to become pregnant. • Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-thecounter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. • Ask your healthcare provider or pharmacist about medicines that should not be taken with GENVOYA.
HOW TO TAKE GENVOYA • •
GENVOYA is a complete one pill, once a day HIV-1 medicine. Take GENVOYA with food.
GENVOYA, the GENVOYA Logo, LOVE WHAT’S INSIDE, SHOW YOUR POWER, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: April 2017 © 2017 Gilead Sciences, Inc. All rights reserved. GENC0141 04/17
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D A I LY D O S E
BY TYLER CURRY
HEARTBREAK AND ALCOHOL LED ME TO HIV
SHUTTERSTOCK; SCOTT KINSFATHER (CURRY)
MY ROMANCE CRUMBLED IN SOUTH KOREA AND DROWNING MY SORROWS STATESIDE PUT ME AT RISK. IT WAS 2009 and I had just finished graduate school. As I donned my cap and gown, the U.S. market was nearing the bottom of the drain in the midst of the Great Recession. I moved home, started bartending, and waited for my luck to change. Six miserable months later, a friend introduced me to someone she thought I’d have fun with. He was kind of geeky, very handsome, and just aloof enough to steal my heart. The romance was fast and furious. It was the hardest I had ever fallen for someone. It was a fairytale. I had decided to capitalize on the recession by applying to spend a year teaching abroad in South Korea. When my prince said he wanted to go with me, my imagination ran wild with thoughts of exciting travels and intimate moments in foreign locales. Soon I was living in a shoebox, waiting for his plane and for our journey to begin—but culture shock does strange things to people. Three months into our Korean adventure, my Prince Charming morphed into a villain this princess was no match for. He could barely look at me, and when he did it was in disappointment or disgust. Back home, I was surrounded by friends, but alone in this foreign land I desperately tried to get him to see me the way he had when the alphabet was still familiar, and I didn’t live above a fish house. Six more excruciating months dragged by before I fled—quite literally—back to the states. I took a department store job in Austin, Texas, just to have a place to land. I was home, in a sense, but my head and my heart were stuck in a spin cycle over the nightmare that was supposed to have been a dream. I did what I thought any 20-something with a broken heart would do: I found new friends and hit the bars—hard. Alcohol tasted like medicine; the induced frivolity it invoked was the closest I’d felt to happy in a long, long time. In the midst of drunk and numb nights, I remembered what it was like to feel OK. But every morning when the buzz wore off, everything would come rushing back. Days were unbearable and I lived for the night, the alcohol, and all that came with it—including sex. I just wanted to feel something, anything, other than the way he’d made me feel. I was desperate for intimacy, as though it would fill
the hole in my heart. While dating, I would invariably rush the moment where we were comfortable enough to discard the condoms; as though that meant I was in something meaningful and finally over my ex. It meant no such thing: I was continuously placing myself at risk over a lie. Alcohol is an incredibly dangerous drug because it’s legal, and marketed in a way that promotes abuse. What do the heartbroken do in the movies? They drink. And they drink to get drunk, and to forget. I followed cues from my favorite rom-coms and was drunk for nearly a year. For the record, I don’t blame anyone else for my contracting HIV. I was 27-years-old and I knew exactly what I was doing, even when I didn’t remember all the details. Far too often we look at other people and proclaim that we would never do what they have done. We take them at their worst and compare them to our best. It has been almost seven years since I returned from South Korea. In retrospect, I am incredibly thankful for the experience. It’s the same with HIV. I would rather be HIVnegative, but life doesn’t operate in retrograde and there’s no point pining over what could have been. We are a collection of choices. After being diagnosed with HIV, I decided I’d only be defined by the choices I made from that point on—what I choose today—and by the life I want to lead tomorrow.
Editor at large TYLER CURRY is author of A Peacock Among Pigeons and a contributing editor at The Advocate magazine. He currently lives in Austin, Texas, with his fiancé and two dogs. (@IAmTylerCurry)
HIVPLUSMAG.COM
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B AC K TA L K B Y S AVA S A B A D S I D I S
HE HEARTS MONSTERS AMAZING RACE STAR AND HIV ACTIVIST ANDREW SHAYDE TAKES ON TRUMP’S AMERICA. Andrew Shayde appeared on The Amazing Race, he became an HIV activist. After a young friend’s death from AIDS complications galvanized him to become involved, Shayde began focusing on HIV-prevention education and testing. Seven years later, the emotional toll of the work had worn him down. “Giving positive [HIV test] results, while harder on the recipient, also caught up with me, and my own burnout began,” he says. “Luckily, I was asked to move into development planning for all of the fundraising events for Cascade AIDS Project. So, over the last six or so years, I’ve worked with a tiny team, raising over six million bucks through our annual events, like an art auction; a queer softball tournament, Bat ‘n Rouge; and AIDS Walk Portland.” At Cascade AIDS Project, Shayde has watched HIV funding decrease over the years. “Federal funds have fairly flatlined and the public seems to think AIDS is gone. It’s so frustrating, I’ve wanted to throw red ribbons at people’s faces.” Opening a competent health care clinic for the LGBT community made sense, and still “connected with HIV in a strong way.” So, following similar moves by AIDS organizations in other states, CAP decided to expand its mission. “We worked at CAP to open Prism, an LGBTQ-plus health center. Folks can see a doc that ‘gets it,’ whether it’s [for] hormone therapy, strep throat, or an STI scan.” Shayde points out that, “I have seen a friend’s medical record from a standard physician’s office that read ‘homosexual’ under the label ‘chronic conditions.’ Some smart doctors are very stupid.” Now, Shayde is breaking into the world of comics, with the Monsters Among Us 48
series about legendary beasts like Bigfoot, chupacabra, and Mothman. He sees the comic books as a way to tell “real life stories” about fictional characters. Writing for HIV-positive comic book publisher Darren Davis—who penned Lost Raven, one of the first comic books with an HIV-positive protagonist—at Tidal Wave Productions, he admits, “is a freaking blessing because I’m not chained up to write comics that appeal to 4-year-olds. I hit heavier themes.” Indeed, Shayde builds references to the current political environment into his stories. “Monsters Among Us is such a clear [allegory] of these alt-right, KKK, Nazi-esque psychopaths literally hunting down anyone they deem unworthy. You could read it and simply say ‘Bigfoot Lives Matter,’ but know that as a writer I am very much slapping you in the face that it is Black Lives Matter. My characters represent minorities just trying to survive.” Shayde pauses, adding, “I love writing, I get to play make-believe as an adult. But I’m also currently a pissed off American. And as sure as fuck, you’re going to see it in my writing.”
COURTESY ANDREW SHAYDE
TWO YEARS AFTER
NOVEMBER / DECEMBER 2017
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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.
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The weight of my diagnosis only made me stronger.
Let’s Grow Old Together See what life with HIV looks like from diagnosis through grandkids with a little help from Walgreens. Explore Jack’s HIV journey at Walgreens.com/LetsGrowOldTogether. ©2017 Walgreen Co. All rights reserved.
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