BECAUSE YOU’RE MORE THAN YOUR STATUS
WORLD AIDS DAY: THE BEST & WORST OF 2018
10 AWESOME HOLIDAY GIFTS TACKLING TREATMENT FOR NATIVE AMERICANS AND LATINOS FORMER PRESIDENT BILL CLINTON IS STILL FIGHTING HIV
A “HILLBILLY” IN HOLLYWOOD, POSE’S PIONEERING WRITER & PRODUCER OUR LADY J IS ALSO A TRANSGENDER WOMAN LIVING WITH HIV
00_PLUS127_Cover_Lady J_FINAL.indd 1
NOVEMBER/DECEMEBER 2018 www.hivplusmag.com
9/27/18 7:52 AM
IN THIS ISSUE NOVEMBER/DECEMBER 2018
16 26
20
ON THE COVER
34 LADY BIRD Our Lady J, writer and producer for FX's Pose and Amazon's Transparent, vows to educate the world about undetectability, trans lives, and HIV stigma.
FEATURES 16
GIFT GUIDE Holiday swag fit for anyone on your list.
20 THE BILL IS DUE Former U.S. President Bill Clinton says this is a critical moment in the global fight to end HIV.
26 THE CASTAWAYS Native Americans, Latinos, sex workers, and disabled people are often missed by HIV services. Some of the difficulties these folks face—and what can be done in response. 38
On the cover: Pose writer and producer Our Lady J photographed by Matthew Simmons/FilmMagic.
4
DOUBT Can we still trust the CDC in the hands of the Trump administration?
MEDIAPUNCH/IPX (20); COURTESY APLA/RED CIRCLE PROJECT (26); COURTESY CORC YOGA (16); MAXWELL POTH (34)
34
NOVEMBER / DECEMBER 2018
04-05_PLUS127_TOC_FINAL_REVISED_JAM.indd 4
9/27/18 4:57 PM
15 11
24
46
NINA PROMMER/BOOM EVENTS (11); COURTESY TYLER CURRY-MCGRATH (15); LOUIS KENGI CARR (24); SHUTTERSTOCK (44)
BUZZWORTHY 8
LOST BOYS Young gay and bi men aren't getting on PrEP.
8
MILKSHAKE A delicious lovefest.
9
WHOLE HOGG #MarchForOurLives founder David Hogg takes on HIV and violence against trans women.
9
EASY RIDERS Celebs motor over the Alps to end HIV.
10
BY GEORGE Prince Harry sings lines attributed to his ancestor, Hamilton's George III, for charity.
10
ROCK OUT A School Of Rock star comes out poz.
11
STARS SHINE Celebs dress up to support HIV org DIFFA.
DAILY DOSE 15
MY GENERATION Living with HIV today is completely different from what it was.
TREATMENT 45 FIRST TIMERS Two new drugs give those just starting treatment
24 THE 2018 WORLD AIDS DAY SPECIAL SECTION LEADERS OF TOMORROW Meet the AIDS Memorial Grove's Pedro Zamora scholars who are taking on HIV in their own ways. YEAR OF THE DOG There were some great HIV advancements, but 2018 also bit back at times.
additional options. 46 KEYMASTERS Could these poz folks—whose viral loads rebound slowly after treatment interruption—be the key to a cure? 48 MUSCLE UN-BOUND Older HIV-positive people are at risk of frailty. HIVPLUSMAG.COM
5
editor in chief DIANE ANDERSON-MINSHALL • svp, group publisher JOE VALENTINO creative director RAINE BASCOS • associate publisher PAIGE POPDAN
deputy editor JACOB ANDERSON-MINSHALL senior editor SAVAS ABADSIDIS managing editor DAVID ARTAVIA associate editor DESIRÉE GUERRERO associate art director PATRICK MADISON editor at large TYLER CURRY-MCGRATH contributing editors KHAFRE ABIF, MARK S. KING, ZACHARY ZANE assistant to the editor DONALD PADGETT editorial intern ASHLEY SCHEIBELHUT mental health editor GARY MCCLAIN contributing writer BENJAMIN M. ADAMS creative director, digital media DAVE JOHNSON interactive art director CHRISTOPHER HARRITY online photo and graphics producers MICHAEL LUONG, TEVY KHOU front end developer MAYRA URRUTIA senior drupal developer NICHOLAS ALIPAZ, SR. traffic manager KEVIN BISSADA manager, digital media LAURA VILLELA svp, publishing, integrated partnerships GREG BROSSIA senior director, integrated partnerships STUART BROCKINGTON director, integrated partnerships ADAM GOLDBERG director, integrated marketing BRANDON GRANT associate directors, integrated marketing JAMIE TREDWELL, ANDREW PARK senior manager, integrated marketing ERIC JAMES manager, integrated marketing CASEY NOBLE associate director, events JOHN O’MALLEY designer, integrated marketing MICHAEL LOMBARDO coordinator, integrated sales & marketing MICHAEL TIGHE senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN 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 chief executive officer NATHAN COYLE executive vice presidents JOE LANDRY, BERNARD ROOK senior vice presidents GREG BROSSIA, JOE VALENTINO vice president ERIC BUI human resources ANTIOUSE BOARDRAYE ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions Fax (212) 242-8338 LOS ANGELES EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES Retrograde Communications • Phone (951) 927-8727 Email editor@HIVPlusMag.com FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To subscribe, visit HIVPlusMag.com/signup. There is a 10-copy minimum. FREE DIGITAL SUBSCRIPTIONS Plus magazine is available free to individual subscribers—a digital copy of each issue can be delivered to the privacy of your computer or reader six times per year. We require only your email address to initiate delivery. You may also share your digital copies with friends. To subscribe, visit HIVPlusMag.com/signup. NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, please email our circulation department at Argus.Galindo@pridemedia.com. Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc. Plus is a registered trademark of Here Publishing Inc. Entire contents © 2018 by Here Publishing Inc. All rights reserved. Printed in the USA. FOLLOW US ON FACEBOOK AND TWITTER
Facebook.com/ HIVPlusMag
6
Twitter.com/ HIVPlusMag
NOVEMBER / DECEMBER 2018
06_PLUS127_Masthead_FINAL_REVISED.indd 6
9/27/18 4:57 PM
EDITOR’S LETTER Theatre, and Mark Morris Dance Group), Lady J transitioned to scriptwriting on the Golden Globe- and Emmy-winning series Transparent, where the out poz trans woman infused the show with authenticy. Lady J holds the honor of being the first out trans woman to perform at Carnegie Hall, as well as the first out transgender writer to be hired for a television writers room. She was awarded a Peabody Award for her work on Transparent, and has been nominated for two Writers Guild Awards and an NAACP Image Award. It’s fitting, too, that we began the year with a double cover (actor Todrick Hall on one side, and two stars of Transparent—Alexandra Billings and Trace Lysette on the other) and we’re ending the year with a woman who helped make that show great, and is now bringing another groundbreaking series to millions of American TV-viewing households. That’s particularly important on Pose, a show that features more trans actors as regulars than any other in history—one that revolves around queer and trans people of color facing the early, brutal days of the AIDS epidemic, with resilience and grace. Sure, this year had its problems, but as former president Bill Clinton (see page 20) likes to say, “Don’t worry about yesterday, embrace tomorrow.” I can’t wait to see what news (and amazing poz newsmakers) 2019 brings.
LUKE FONTANA (ANDERSON-MINSHALL); BEN MARGOT/AP PHOTO (CLINTON)
I N S O M E WAYS , it’s an amazing time for
people living with HIV. Yes, politics haven’t favored HIV funding this year, but science has had some remarkable breakthroughs. Two years after scientists put out a consensus statement about U=U (undetectable equals untransmittable), people, organizations, and media outlets are finally sharing the groundswell of research proving that when a person living with HIV is on effective treatment, it can reduce the level of HIV in their blood to undetectable levels, which protects their health and makes it virtually impossible to transmit the virus to sexual partners. Years after the Prevention Access Campaign started their education initiative to “end the dual epidemics of HIV and HIV-related stigma by empowering people with, and vulnerable to, HIV with accurate and meaningful information about their social, sexual, and reproductive health,” that message is finally being heard. Even better: new drugs made specifically for long-term survivors, for those with multidrug resistance, and for those newly diagnosed, have hit the shelves this year; so finding an effective form of treatment to get to U=U is easier than ever. (And for HIV-negative people in serodiscordant relationships with poz partners, PrEP has become more accessible as well, even if the uptick is still too slow). People living with HIV have become more visible than ever with more actors, journalists, and TV stars coming out in 2018. Others have stepped up their visibility after doing so (like cover stars Karl Schmid and Mark Malkin). This now includes our newest cover star, Our Lady J, who is a writer and producer on Ryan Murphy’s breakout FX series, Pose. After a career of making music in both the pop and classical worlds (for Sia, American Ballet
DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM
HIVPLUSMAG.COM
07_PLUS127_Ed Letter_FINAL.indd 7
7
9/27/18 7:52 AM
BUZZWORTHY
THIS MILKSHAKE BROUGHT EVERYONE TO THE YARD
HIV activists rocked the all-inclusive Amsterdam fest.
GENERATION GAP
New study suggests an alarming chasm in HIV knowledge among younger gay and bi men.
8
T
his summer, the Milkshake Festival (MilkshakeFestival.com) in Amsterdam welcomed “all who love” to their annual multi-stage concert, which features DJs, drag acts, and performance artists. Over 20 singers and electronic dance music (EDM) DJs from around the world rocked this party that embraces people of all sexualities, genders, races, and bodies (even providing space for those with physical or intellectual disabilities). This year’s fest coincided with AIDS 2018, the International AIDS Conference. Activists from around the globe descended on Milkshake with gusto. A gay-led community initiative called PrEPnu (PrEPnu.nl) was a sponsor of this year’s festival and their PrEP workshop, which provided information about the HIV-prevention strategy, was a big hit. —PLUS EDITORS
SHUTTERSTOCK (FACE); SAVAS ABADSIDIS (MILKSHAKE)
New research shows that one in four young, sexually active gay or bisexual men have never been tested for HIV. The study, conducted by the Williams Institute at the University of California, Los Angeles School of Law, also found that only 4 percent of sexually active gay and bi men in the United States use PrEP, a prevention strategy that when practiced makes it virtually impossible to contract HIV. “Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV,” said the study’s principal investigator, Dr. Ilan H. Meyer. “It is alarming that high-risk populations of men who are sexually active with same-sex partners are not being tested or taking advantage of treatment advances to prevent the spread of HIV.” Researchers looked at gay and bisexual men from three age groups—young (18-25 years old), middle-aged (34-41), and older (5259)—and found that only 4 percent overall used PrEP. Those who had visited an LGBTQ health clinic and searched online for LGBTQ resources were associated with greater likelihood of PrEP use. Only about half (52 percent) of young, sexually active gay and bi men were even familiar with PrEP as an HIV-prevention method, compared with 79 percent of men ages 34 to 41. Bisexual and non-urban men were less familiar with PrEP compared with gayidentified and urban men. Another alarming finding was that one quarter (25 percent) of young gay and bisexual men had never been tested for HIV, compared to approximately only 8 percent of middle-aged and older groups of men combined. Black gay and bisexual men were more likely than white men to get tested, which may reflect recent community efforts targeting them. “The extremely low rate of PrEP use, while not surprising given barriers to access in various parts of the country, is disappointing,” says lead author Dr. Phillip L. Hammack. “I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did. The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”—DESIRÉE GUERRERO NOVEMBER / DECEMBER 2018
08-11_PLUS127_Buzzworthy_FINAL_REVISED_JAM.indd 8
9/27/18 4:57 PM
I AM A SURVIVOR #MarchForOurLives founder David Hogg helps give voice to trans people and those living with HIV. BY SAVAS ABADSIDIS
MICHAEL EMANUEL RAJNER (HOGG); LENNART PREISS/GETTY IMAGES (LIFE BALL/EPIC RIDE)
H O L D I N G A FA N emblazoned
with the colors of the trans pride flag and the words: “End Trans Gun Violence,” Parkland massacre survivor and #MarchForOurLives founder David Hogg took the stage at the opening of the United States Conference on AIDS in Orlando, Fla., this September. The renowned anti-gun violence activist now attracts concert-
sized crowds when he speaks in venues around the country. “We’re more upset about a pair of shoes than gun violence... or HIV and AIDS,” said Hogg. His speech came just days after a conservative backlash over Nike’s new Colin Kaepernick ad. But it’s a reminder of how Hogg draws the connection to his own trauma—almost all of the murders of trans women over the last few years have been by gun fire. In the wake of the deadly school shooting, Hogg has also used his platform and significant social media following to bring attention to the HIV crisis. Another Parkland survivor, Cameron Kasky, recently joined amfAR, The Foundation for AIDS Research, in its mission to end the global epidemic through its #BeEpic campaign, which raises money for the cause.
Hogg is keenly aware of the way his particular talents mesh with how his generation thinks. New York magazine recently stated of the young activist, “A lot of what has catapulted Hogg to this elevated and precarious place is his wonkishness: his dexterity on social media and cable news, his appetite for the nitty-gritty of policy disputes.” At the March For Our Lives, Hogg hung an orange sales tag stamped “$1.05” around the microphone—the price Parkland students calculated that their senator, Marco Rubio, put on each of their lives, given the donations he’d accepted from the NRA. (At graduation, he attached it to his mortarboard like a tassel.) Hogg’s Twitter feed is a study in narrative discipline. It has a relentless focus on the politicians who accept gun-lobby money twinned with exhortations to his nearly 900,000 followers to vote. “People call us snowflakes,” he tweeted earlier this year. “What happens when all the snowflakes vote? That’s called an avalanche.”
BAES & BIKERS
Actors JR Bourne (Falling Water), Adrien Brody (Peaky Blinders), Charlize Theron (Tully), and Gilles Marini (Days of our Lives) pose with Life Ball organizer Gery Keszler and activist Dick Huisman. Theron flew to Vienna to accept an award on behalf of her Africa Outreach Project and celebrated the collective efforts of Life Ball, which has raised $6 million for HIV. The others pictured (and Longmire’s Katee Sackhoff ) rode motorcycles 700 miles over the Alps to Austria in amfAR’s Epic Ride to Life Ball. The star-studded motorcycle rally is part of the 25th Anniversary celebration of the world-renowned Life Ball, Europe’s largest HIV fundraising event. Paris Jackson, Kelly Osbourne, and Caitlyn Jenner also flew in to celebrate.—DIANE ANDERSON-MINSHALL HIVPLUSMAG.COM
08-11_PLUS127_Buzzworthy_FINAL.indd 9
9
9/27/18 8:02 AM
BUZZWORTHY
HARRY AND THE HAMILTONS
Prince Harry and Meghan, Duchess of Sussex meet the Hamilton cast after a gala London performance supporting an HIV charity.
Prince Harry joined the Hamilton cast to help children affected by HIV
This August, at a special charity performance of the enormously popular Broadway hit Hamilton in London’s West End, the audience was wowed by a surprise guest star. Breaking into song during the show’s finale—to a tune sung by the George III character—was none other than George’s real-life, great-great-great-great-greatgreat-grandson, England’s Prince Harry himself.
The event benefited the Prince’s HIV charity, Sentebale, supporting mental health and wellbeing of children and young people affected by HIV in the African nations of Lesotho and Botswana. Harry watched most of the production with his wife, Meghan Markle, the Duchess of Sussex, and Hamilton’s creator, LinManuel Miranda. The play tells the story of American founding father
Alexander Hamilton and his rise from poverty to power against the backdrop of the American Revolutionary War (with Britian). Ahead of the show, Miranda had commented it would be “fun and surreal” to see the royal couple watch the performance of King George III—but the outspoken Royal took it one step further, joining the cast onstage at the end of the show. —SA
WHERE THE LIGHTS ARE BRIGHT...
B R OA DWAY STA R H E R N A N D O Umana chose to begin a
recent life-changing Instagram post with the phrase “takes deep breath.” He did so in order to illustrate the gravity of what he was about to reveal. The talented Broadway actor—who’s performed onstage in Kinky Boots and the U.S. tour of School of Rock— continued, “This is by far the most important, scary, liberating post of my life. Here we go—10 years ago, at a young, young age of 20, I was diagnosed with HIV.” His August 20 post featured a photo of himself holding a sign: “Living with HIV.” “I’ll never forget the moment they told me,” Umana recalled. “It wasn’t possible—I had only slept with three people in my life! This can’t be true. The first words out of my mouth were ‘how long do I have to live?’ That’s how uneducated I was about it. It had been drilled in my head that gay people get HIV because of wrong doings and they deservingly die from it. Well I’m here to shut that shit down. There is nothing wrong with me and I am healthier than I’ve ever been.” Umana says he proudly “stands on the shoulders” of the millions of “men and woman who fought and died to get to where we’re at now—to take a pill at night and never have to worry about dying. To get the disease to a point where it is impossible to transmit— undetectable.* How can I be ashamed of this? I honor their legacy by telling my story.” He concluded, “I, Hernando Umana, am a proud gay man living with HIV. Fuck that feels good to say.”—SA
*Editor’s note: When your viral load is undectable (under 200/ml) your HIV cannot be transmitted to another person. Undetectable = Untransmittable. 10
DAN CHARITY/THE SUN POOL/AP (ROYALS); KEVIN THOMAS GARCIA (UMANA)
Out of the closet to fight stigma.
NOVEMBER / DECEMBER 2018
08-11_PLUS127_Buzzworthy_FINAL.indd 10
9/27/18 8:02 AM
VOGUEING FOR A CAUSE
The cast of Pose joins others to raise money for HIV charity. 10
This August, Grammy- and Tony Award-winning actor Billy Porter (Pose, American Horror Story: Apocalypse) hosted the Diversity x Design Emmyseason soirée celebrating diversity, inclusion, and representation on television. The cocktail party, held at Bolon and Louis Poulsen showrooms at Helms Design Center in Culver City, Calif., raised money for Design Industries Foundation Fighting AIDS (DIFFA.org). —SA
13 3
Among the guests at the DIFFA event: former Plus cover star Trace Lysette (1) of Transparent; Billy Porter (2), Hailie Sahar (3), and Johnny Sibilly (4) of Pose; Jeffrey Bowyer-Chapman (5) and Ash Santos (6) of American Horror Story: Apocalypse; Dara Renee (7) of Freaky Friday; Isis King (8) of America’s Next Top Model; Mary Chieffo (9) of Star Trek: Discovery; Rushi Kota (10) of Grey’s Anatomy; Abraham Lim (11) of The Fix; Carla Jeffery and Emilia McCarthy (12) of Disney’s Zombies; and Kathryn Gallagher (13) of Lifetime’s You.
1 5
6 4 2
NINA PROMMER/BOOM EVENTS (ALL)
12
7
11
8 9 HIVPLUSMAG.COM
08-11_PLUS127_Buzzworthy_FINAL.indd 11
11
9/27/18 8:02 AM
What is BIKTARVY®? BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS.
IMPORTANT SAFETY INFORMATION What is the most important information I should know about BIKTARVY? BIKTARVY may cause serious side effects: ` Worsening of hepatitis B (HBV) infection. If you have both HIV-1 and HBV and stop taking BIKTARVY, your HBV may suddenly get worse. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to monitor your health.
Who should not take BIKTARVY? Do not take BIKTARVY if you take: ` dofetilide ` rifampin ` any other medicines to treat HIV-1
What are the other possible side effects of BIKTARVY? Serious side effects of BIKTARVY may also include: ` Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY. ` Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY. ` Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death.
Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. ` Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (5%), and headache (5%). Tell your healthcare provider if you have any side effects that bother you or don’t go away.
What should I tell my healthcare provider before taking BIKTARVY? ` All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection. ` All the medicines you take, including prescription and over-the-counter medicines, antacids, laxatives, vitamins, and herbal supplements. BIKTARVY and other medicines may affect each other. Keep a list of all your medicines and show it to your healthcare provider and pharmacist, and ask if it is safe to take BIKTARVY with all of your other medicines. ` If you are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY. ` If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.
B
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Ask your healthcare provider if BIKTARVY is right for you.
Please see Important Facts about BIKTARVY, including important warnings, on the following page.
BVYC0047_BIKTARVY_A_7-875x10-5_Plus_KeepAspiring_r1v1jl.indd 2-3 18740 Biktarvy Plus 127 spread.indd 2
9/5/18 9:13 PM
Get HIV support by downloading a free app at MyDailyCharge.com
KEEP ASPIRING. Because HIV doesn’t change who you are. BIKTARVY is a 1-pill, once-a-day complete HIV-1 treatment for adults who are either new to treatment or whose healthcare provider determines they can replace their current HIV-1 medicines with BIKTARVY.
BIKTARVY does not cure HIV-1 or AIDS.
BIKTARVY.COM
18740 Biktarvy Plus 127 spread.indd 3
8/31/18 2:33 PM 9/5/18 9:13 PM
IMPORTANT FACTS This is only a brief summary of important information about BIKTARVY® and does not replace talking to your healthcare provider about your condition and your treatment.
(bik-TAR-vee) MOST IMPORTANT INFORMATION ABOUT BIKTARVY BIKTARVY may cause serious side L LJ[Z PUJS\KPUN! ₔ Worsening of hepatitis B (HBV) infection. 0M `V\ OH]L IV[O /0= HUK /)= `V\Y /)= TH` Z\KKLUS` NL[ ^VYZL PM `V\ Z[VW [HRPUN )02;(9=@ +V UV[ Z[VW [HRPUN )02;(9=@ ^P[OV\[ ÄYZ[ [HSRPUN [V `V\Y OLHS[OJHYL WYV]PKLY HZ [OL` ^PSS ULLK [V JOLJR `V\Y OLHS[O YLN\SHYS` MVY ZL]LYHS TVU[OZ
ABOUT BIKTARVY )02;(9=@ PZ H JVTWSL[L WPSS VUJL H KH` WYLZJYPW[PVU TLKPJPUL \ZLK [V [YLH[ /0= PU HK\S[Z 0[ JHU LP[OLY IL \ZLK PU WLVWSL ^OV OH]L UL]LY [HRLU /0= TLKPJPULZ ILMVYL VY WLVWSL ^OV HYL YLWSHJPUN [OLPY J\YYLU[ /0= TLKPJPULZ HUK ^OVZL OLHS[OJHYL WYV]PKLY KL[LYTPULZ [OL` TLL[ JLY[HPU YLX\PYLTLU[Z BIKTARVY does not cure HIV-1 or AIDS. /0= PZ [OL ]PY\Z [OH[ JH\ZLZ (0+: Do NOT take BIKTARVY if you also take a medicine [OH[ JVU[HPUZ! â‚” KVML[PSPKL â‚” YPMHTWPU â‚” HU` V[OLY TLKPJPULZ [V [YLH[ /0=
BEFORE TAKING BIKTARVY Tell your healthcare provider all your medical JVUKP[PVUZ PUJS\KPUN PM `V\! â‚” /H]L VY OH]L OHK HU` RPKUL` VY SP]LY WYVISLTZ PUJS\KPUN OLWH[P[PZ PUMLJ[PVU â‚” (YL WYLNUHU[ VY WSHU [V ILJVTL WYLNUHU[ â‚” (YL IYLHZ[MLLKPUN U\YZPUN VY WSHU [V IYLHZ[MLLK +V UV[ IYLHZ[MLLK PM `V\ OH]L /0= ILJH\ZL VM [OL YPZR VM WHZZPUN /0= [V `V\Y IHI` Tell your healthcare provider about all the TLKPJPULZ `V\ [HRL! â‚” 2LLW H SPZ[ [OH[ PUJS\KLZ HSS WYLZJYPW[PVU HUK V]LY [OL JV\U[LY TLKPJPULZ HU[HJPKZ SH_H[P]LZ ]P[HTPUZ HUK OLYIHS Z\WWSLTLU[Z HUK ZOV^ P[ [V `V\Y OLHS[OJHYL WYV]PKLY HUK WOHYTHJPZ[ â‚” (ZR `V\Y OLHS[OJHYL WYV]PKLY VY WOHYTHJPZ[ HIV\[ TLKPJPULZ [OH[ PU[LYHJ[ ^P[O )02;(9=@
POSSIBLE SIDE EFFECTS OF BIKTARVY BIKTARVY can cause serious side L LJ[Z PUJS\KPUN! ₔ ;OVZL PU [OL ¸4VZ[ 0TWVY[HU[ 0UMVYTH[PVU (IV\[ )02;(9=@¹ ZLJ[PVU ₔ *OHUNLZ PU `V\Y PTT\UL Z`Z[LT ₔ 5L^ VY ^VYZL RPKUL` WYVISLTZ PUJS\KPUN RPKUL` MHPS\YL ₔ ;VV T\JO SHJ[PJ HJPK PU `V\Y ISVVK SHJ[PJ HJPKVZPZ ^OPJO PZ H ZLYPV\Z I\[ YHYL TLKPJHS LTLYNLUJ` [OH[ JHU SLHK [V KLH[O ;LSS `V\Y OLHS[OJHYL WYV]PKLY YPNO[ H^H` PM `V\ NL[ [OLZL Z`TW[VTZ! ^LHRULZZ VY ILPUN TVYL [PYLK [OHU \Z\HS \U\Z\HS T\ZJSL WHPU ILPUN ZOVY[ VM IYLH[O VY MHZ[ IYLH[OPUN Z[VTHJO WHPU ^P[O UH\ZLH HUK ]VTP[PUN JVSK VY IS\L OHUKZ HUK MLL[ MLLS KPaa` VY SPNO[OLHKLK VY H MHZ[ VY HIUVYTHS OLHY[ILH[ ₔ :L]LYL SP]LY WYVISLTZ ^OPJO PU YHYL JHZLZ JHU SLHK [V KLH[O ;LSS `V\Y OLHS[OJHYL WYV]PKLY YPNO[ H^H` PM `V\ NL[ [OLZL Z`TW[VTZ! ZRPU VY [OL ^OP[L WHY[ VM `V\Y L`LZ [\YUZ `LSSV^ KHYR ¸[LH JVSVYLK¹ \YPUL SPNO[ JVSVYLK Z[VVSZ SVZZ VM HWWL[P[L MVY ZL]LYHS KH`Z VY SVUNLY UH\ZLH VY Z[VTHJO HYLH WHPU ₔ ;OL TVZ[ JVTTVU ZPKL L LJ[Z VM )02;(9=@ PU JSPUPJHS Z[\KPLZ ^LYL KPHYYOLH UH\ZLH HUK OLHKHJOL ;OLZL HYL UV[ HSS [OL WVZZPISL ZPKL L LJ[Z VM )02;(9=@ ;LSS `V\Y OLHS[OJHYL WYV]PKLY YPNO[ H^H` PM `V\ OH]L HU` UL^ Z`TW[VTZ ^OPSL [HRPUN )02;(9=@ Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.
HOW TO TAKE BIKTARVY ;HRL )02;(9=@ [PTL LHJO KH` ^P[O VY ^P[OV\[ MVVK
GET MORE INFORMATION â‚” ;OPZ PZ VUS` H IYPLM Z\TTHY` VM PTWVY[HU[ PUMVYTH[PVU HIV\[ )02;(9=@ ;HSR [V `V\Y OLHS[OJHYL WYV]PKLY VY WOHYTHJPZ[ [V SLHYU TVYL â‚” .V [V )02;(9=@ JVT VY JHSS .03,(+ â‚” 0M `V\ ULLK OLSW WH`PUN MVY `V\Y TLKPJPUL ]PZP[ )02;(9=@ JVT MVY WYVNYHT PUMVYTH[PVU
)02;(9=@ [OL )02;(9=@ 3VNV +(03@ */(9., [OL +(03@ */(9., 3VNV 36=, >/(;»: 05:0+, .03,(+ HUK [OL .03,(+ 3VNV HYL [YHKLTHYRZ VM .PSLHK :JPLUJLZ 0UJ VY P[Z YLSH[LK JVTWHUPLZ =LYZPVU KH[L! -LIY\HY` .PSLHK :JPLUJLZ 0UJ (SS YPNO[Z YLZLY]LK )=@*
BVYC0047_BIKTARVY_A_7-875x10-5_Plus_KeepAspiring_r1v1jl.indd 4 18741 Biktarvy Plus 127 PI.indd 1
8/31/18 2:33 PM 9/5/18 9:13 PM
D A I LY D O S E
B Y T Y L E R C U R R Y- M C G R AT H
HIV:
YOU’RE HISTORY!
COURTESY TYLER CURRY-MCGRATH.(ALL)
THE MODERN EXPERIENCE OF BEING POZ IS NOTHING LIKE IT WAS THREE DECADES AGO. IN MY LINE OF WORK , I often find myself conversing about what it means to be HIV-positive today. Whether it be in professional settings or at casual get togethers, discussions about testing, treatment, and prevention are a daily occurrence for me. As an HIV-positive man in 2018, my experience isn’t one that is commonly showcased on television or in movies, so even though the LGBTQ community is almost hyper-aware of the HIV epidemic, many still have no clue what it means to be living with HIV today. Instead, people like to talk about what they know, or in this instance, who they knew with HIV. And before you know it, a discussion about the modern HIV experience turns into an unbearably sad walk down memory lane. Now, I’m not trying to discount the experience of anyone who lived through the early years of the epidemic or lost people to AIDS complications. I know I
have only been living with HIV for six years. When someone who is a long-term survivor shares their story, I listen with the utmost respect and admiration for their struggle. But it’s not my struggle. That’s the point of this essay. At some point, we as a community must create a demarcation clearly separating the history of the HIV epidemic and the legacy of long-term survivors from the current and future experiences of being HIV-positive now. It is my belief that if we continue to attach the history of HIV to the current HIV experience, we will never be able to truly eliminate stigma and allow people to move beyond their status. For our community to continue to move in healthy directions, we must allow HIV to simply be what it is today: a highly manageable chronic condition that doesn’t have to take away anything from the person living with it if they have access to care. That’s what it is—but what it used to be is another subject entirely. For some of you, this might seem flippant, or even disrespectful of those who did not—or do not—have it so easy, or of your friends and family who may have lost their lives. I can’t pretend to understand the immense pain you’ve felt, because I am a part of a different generation, one that was spared the horror and heartache of the worst of it. I understand, of course, that my generation was spared because of the sacrifices of the generations before me. I think it is essential to preserve the legacy of our community and honor those who did suffer tremendous struggles and loss. I believe the only true way to honor those who lost their lives is to ensure that any LGBTQ person, HIV-positive or otherwise, doesn’t waste a single moment of their lives living in unnecessary fear. It has been almost 40 years since HIV first became a global crisis. In that time, the virus has gone from being quite literally a plague to becoming the sexually transmitted version of a chronic condition like high blood pressure or diabetes. Yes it is still potentially deadly, but so are many other chronic conditions if left untreated or unchecked. The reasons why HIV continues to go untreated or unchecked deserve our attention. The uneven level of risk among gay and bisexual men of color needs to be a focus. These are the real issues that people with HIV face today, and they are enough to tackle without losing focus and going down a wormhole of what used to be.
The author, Tyler Curry-McGrath (above), doesn’t let HIV slow him down.
Editor at large Tyler Curry-McGrath is also a contributing editor at The Advocate magazine and the author of A Peacock Among Pigeons. (@IamTylerCurry)
HIVPLUSMAG.COM
15_PLUS127_Daily Dose_FINAL.indd 15
15
9/27/18 8:02 AM
OUR SUPER HANDY HOLIDAY GIFT GUIDE WORLD PEACE WOULD BE NICE, BUT HERE ARE GIFTS YOU HAVE A CHANCE OF ACTUALLY GETTING. CURATED BY DIANE ANDERSON-MINSHALL AND DESIRÉE GUERRERO
STAND IN YOUR LIGHT SNEAKERS
ALL PHOTOS COURTESY OF MAKER
We are agog over artist and designer Chelsea Leifken’s new limited edition “Stand in Your Light” white leather sneaker via Josefinas, creating a fashion statement that celebrates unconditional self-love and empowerment. “Stand in Your Light,” Leifken says, means to "unapologetically be your true self and consciously own your unique power—to know you are indeed the light and can illuminate the world when you decide to authentically shine." ($299, Josefinas.com)
16
NOVEMBER / DECEMBER 2018
16-19_PLUS127_Gift Guide_FINAL.indd 16
9/27/18 8:02 AM
HOLIDAY GIFT GUIDE
SOUL EMOTION WIRELESS EARBUDS These wireless earbuds not only offer excellent sound quality, but are also lightweight and decently priced. Includes auto-Bluetooth connectivity, built-in microphone, and up to six hours of playtime. ($50, SoulElectronics.com)
AQUIO BOTTLE SPEAKER What if that ubiquitous water bottle you carry was was also a speaker? This BPA-free, double-walled steel bottle has a removable high-quality iHome music system. Keeps liquids hot for up to 14 hours, or cold for up to 24. The waterproof and sandproof speaker is great, and there’s also a digital echo cancellation for speakerphone use and audio caller ID. ($70, AquioBottles.com)
CORC YOGA MAT Sustainably-harvested Portugal cork provides beautiful, comfortable, and chemicalfree yoga mats—and supports organizations working to solve the country’s mental health crisis. ($119, CorcYoga.com) HIVPLUSMAG.COM
16-19_PLUS127_Gift Guide_FINAL.indd 17
17
9/27/18 8:02 AM
DELALLO GOURMET GIFT COLLECTIONS Everyone likes yummy food, right? From judgy in-laws to the hard-to-impress boss, DeLallo's gourmet charcuterie and cheeseboards take the guesswork out of gift-buying. (Buy one for your self and you’ll be even more appreciative.) Brimming with colorful combinations of fine Italian meats, cheeses, olives, antipasti, spreads, desserts, and more, DeLallo’s gift collections start at only $35. And if you have to play host, they also offer readyto-serve charcuterie boards with hand-selected, vacuum-sealed items already artfully arranged on a slate serving tray, leaving you more time to enjoy the party! ($35 to $230, DeLallo.com)
LIVE HAPPY SOCKS The folks behind the Live Happy podcast now have cheerful stocking stuffers. These happy socks include our favorite slogans like, “Don’t Be Moody, Shake Your Booties.” ($15, Store.LiveHappy.com)
NOD POD WEIGHTED SLEEP THERAPY
ALL PHOTOS COURTESY OF MAKER
The reason hugs feel good and babies like to be swaddled is because our body responds positively to gentle, constant pressure, and this microbead-filled easyto-wash sleeping mask does just that. It also blocks light from all sides because it’s extra long so you can wear it tucked in or loose, too. ($25, NodPod.com)
18
NOVEMBER / DECEMBER 2018
16-19_PLUS127_Gift Guide_FINAL.indd 18
9/27/18 8:02 AM
HOLIDAY GIFT GUIDE TONAL Imagine having an intelligent in-home gym that takes up the space of a big flat screen TV. Tonal is the world’s first machine learning-powered strength training system. It’s a wall-mounted, space-saving digital weight system (powered by an electromagnetic resistance engine rather than clunky metal plates). The machine is combined with a subscription service that provides interactive, ondemand, full-body workouts as well as expert videos and personalized coaching. ($2,995 or $199/month, Tonal.com)
ROBOCALL BLOCKER If you still have a landline, you know spam calls are never ending. But this machine prevents your phone from even ringing thanks to the pre-installed database of 5,000 numbers of the most notorious telemarketers and spam callers. If a nuisance caller who’s not on the list gets through, the device has a red “Block Now” button that automatically ends the call and adds the number to its database of blocked callers. ($80, Hammacher.com)
SLEEP CROWN A yoga teacher developed this cozy curved over-the-eyes-and-ears pillow that is designed to block light, apply a calming pressure to your crown, and muffle sound without blocking your airway. ($168, SleepCrown.com)
THE DREAMPAD Hate earphones but need sound to fall asleep without waking your partner? Get this Shark Tank-approved pillow, which plays music and ambient sounds only you can hear. Once your head’s on the Dreampad, the music travels internally and signals your body’s natural relaxation response so you can go the fuck to sleep. The app controls songs, volume, and length of play. And your bedmate won’t hear a thing. ($129 and up, DreamPadSleep.com) HIVPLUSMAG.COM
16-19_PLUS127_Gift Guide_FINAL.indd 19
19
9/27/18 8:02 AM
“If you don’t do anything else, I’d say, don’t let anybody get complacent.” 20
PHOTO CREDIT
(T
NOVEMBER / DECEMBER 2018
20-23_PLUS127_FEA_Clinton_FINAL.indd 20
9/27/18 8:02 AM
DON’T Stop
(Thinking About
Tomorrow) Former President Bill Clinton may no longer be in office, but he still oversees a platform to rid the world of HIV. And he’s not quitting anytime soon.
MPI01/MEDIAPUNCH INC/IPX
BY SAVAS ABADSIDIS
FORMER U.S. PRESIDENT BILL CLINTON SPEAKS AT THE 2018 INTERNATIONAL AIDS CONFERENCE DURING A PANEL HOSTED BY THE CLINTON FOUNDATION
y the time former president Bill Clinton took the stage at the closing ceremony for the International AIDS Conference in Amsterdam this summer, he was already following a heavy roster. International leaders, businessmen, and celebrities including Bono, Bill and Melinda Gates, Prince Harry, Elton John, South African president Cyril Ramaphosa, and actress Charlize Theron had all spoken of their passion for ending the fight against HIV. It was early afternoon on the final day of a wee long conference when Clinton stepped onstage. It had been a week characterized by daily protests over the International AIDS Society’s decision to hold the next conference in the San Francisco Bay Area in 2020. And some of the more zealous protesters interrupted President Clinton’s speech multiple times. As did some sex workers, heckling Clinton—whose presidency was marred by a sex scandal—with refrains of “We know you love sex workers!” linton, who li ely couldn’t hear the specific content of the catcalls due to the acoustics of the room, commended the conference on allowing all people “who come here with a grievance or a concern the right to be heard.” “Not everybody can be,” he added to applause. “And I appreciate it.” HIVPLUSMAG.COM
20-23_PLUS127_FEA_Clinton_FINAL.indd 21
21
9/27/18 8:02 AM
22
Protests against holding the next conference in the U.S. have arisen from many fronts, including opposition to Trump and the fact that many of the delegates invited to the conference might not even be allowed into the country because of new customs and immigration rules. The cost of traveling to the U.S. has also been raised, as it may be prohibitive to disadvantaged groups like trans women, sex workers, and injection drug users, who are most impacted by the HIV epidemic globally. Clinton seemed to be responding to some of the anger around the setting, by contextualizing San Francisco as an epicenter of the American epidemic, a research hub central to our understanding of HIV, and “a sacred place.” any people died, and all the first battles were fought, and many more died,” he explained. I’ll never forget in , when a distinguished American diplomat sneeringly referred to my party as the San Francisco Democrats, because we cared about HIV and AIDS. So, you’ll be glad when we get there—glad that we held the conference in San Francisco.” It was refreshing to see the older Clinton still masterfully navigate issues around HIV, as he has done since founding the Clinton Foundation in
ABOVE FORMER PRESIDENT BILL CLINTON DELIVERS THE KEYNOTE ADDRESS AT THE NATIONAL AIDS MEMORIAL ON WORLD AIDS DAY LAST YEAR ACROSS CLINTON WITH SINGER ELTON JOHN, FOUNDER OF ELTON JOHN AIDS FOUNDATION, AT 2013’S LIFE BALL
BEN MARGOT/AP PHOTO
Still, the jeers continued until security escorted protesters out. It was hard to watch the former president—once admired as much for his ability to connect with 20-something voters as for his ability to converse on wonky policy questions— struggling to communicate with that same demographic, not to mention protesters with whom Clinton mostly agreed. But true to form, the 72-year-old wielded his public speaking skills (and considerable charisma), eventually mastering the crowd. Clinton lauded his friend Eric Goosby, the famed HIV researcher and Clinton Foundation board member who served the Clinton administration, first as director of the yan hite HIV/AIDS Program, and later as deputy director of the hite House ational I olicy ce and director of the ce of HIV I olicy. I first heard about him in the s when he was running an AIDS clinic in San Francisco,” Clinton told the crowd. In an aside, he conceded, “I know San Francisco is in the United States, and I know a lot of you disagree with our government on a thing or two.” The audience roared with laughter, as Clinton continued. “Put me down in that category.” ventually they settled and gave him the oor. NOVEMBER / DECEMBER 2018
20-23_PLUS127_FEA_Clinton_FINAL.indd 22
9/27/18 8:02 AM
HANS PUNZ/AP PHOTO
1997, without even glancing at his notes. The elder statesman’s speech was a stark reminder of how far American political discourse has fallen. Can anyone imagine Trump talking about an issue like HIV so knowledgably? On e issue Clinton focused on was UNAIDS’s 90-90-90 goal: to have 90 percent of people know their status, 90 percent of those diagnosed on treatment, and 90 percent of those in treatment undetectable, all by the year 2020. He warned the crowd that in many respects, the world has gone off track in reaching those goals. By doing so, Clinton echoed what the United Kingdom’s StopAIDS campaign (StopAIDS.org.uk) stated earlier in the week at another protest. StopAIDS is a network of U.K. agencies working to ensure an effective global response to HIV. t the protest, the organizations’ spokesperson, Alysa Remtulla said, “New HIV infections are declining too slowly, with 1.8 million people newly acquiring HIV in 2017. New infections have declined by only 18 percent since 2011. In some regions, including Eastern Europe and Central Asia, the rate of new infections is actually increasing. Nearly one million people died of AIDS-related causes in 2017 compared to the target of reducing deaths to below 500,000 per year by 2020. Just over half of people living with HIV currently have access to treatment with 15 million people still waiting for access to treatment.” Like Clinton, Remtulla stressed, “We’re at a critical moment in the global HIV response right now. We have the knowledge and the tools we need to end the AIDS epidemic, yet there’s overwhelming evidence coming out of UNAIDS that we are off trac to meet the targets on reducing new HIV infections and AIDS-related deaths. If we miss these targets we risk also missing the Sustainable Development Goal of ending AIDS by 2030.” We’re already facing “an annual funding gap of $6 billion,” Remtulla said. And, unfortunately, at this critical moment, the U.S. and other countries are actually reducing their funding for the global fight, with eight out of donor governments reducing funding for the global HIV response in 2017,” according to Remtulla. She argued, “AIDS is not over, but it can be. With just two years to reach the 2020 targets, the leading donors in the global HIV response must reverse current trends and increase political and financial commitment to achieve them. Clinton underscored this, saying, “There is no Brexit in the war against HIV and AIDS.” Referring to the fact that none of the Clinton Foundation’s work could have been done without the support of others, Clinton praised the late South African president Nelson Mandela; the governments of Sweden, Norway, and Ireland; The Gates Foundation; Warren and
Susan Buffet; Elton John; “and so many others.” Clinton continued, “I say this to make a larger point: the fight against AIDS worldwide and against tuberculosis, the current effort to reconcile the need to deal with noncommunicable diseases without abandoning our efforts, all of these things re present remarkable partnerships.” Clinton warned that through the combination of complacency and active hostility to global multinational cooperative efforts, there is a serious risk people will lose the sense of urgency that we once had around ending AIDS. They may quit funding the effort altogether, cut bac on funding, or transfer their focus to combatting other diseases or health issues (like cancer, heart disease, or obesity). here is always a reason to abandon or reduce your efforts in a call in which you have been involved in, which total victory has not been achieved,” he explained. But Clinton argued, “That would be calamitous. As all of you know, there’s been a significant statistically significant anyway increase in the new infections.” “So, what are we supposed to do?” he asked rhetorically. “If you don’t do anything else, I’d say don’t let anybody get complacent. Don’t let anybody think that we don’t have to increase our efforts. on’t let anybody believe that the only way to deal with non-communicable diseases in di cult settings is to cut back on what we are doing with HIV [and] AIDS, and tuberculosis, in particular. This is just something that we have to face.” Clinton solemnly reminded the audience that while we have made great strides in reaching our goals around HIV, we can’t become complacent especially considering the headwinds we face against the Trump administration. He recalled speaking with former president George W. Bush immediately after Trump’s electoral win (over Clinton’s own wife, Hillary). He warned Bush that the new administration would be gunning for PEPFAR (The United States President’s Relief Fund for AIDS Relief). Bush and Clinton reportedly strategized together to ensure Trump couldn’t dismantle the program. n that note, linton reminded everyone that the fight against HIV is in the “possibility business” considering we have already accomplished things that people originally claimed were impossible, particularly before the development of and global distribution of antiretrovirals. Clinton concluded his remarks, by arguing that holding the 2020 conference in the United States, in the midst of a new presidential election cycle would literally bring its message home in a more potent and profound way than if it were held elsewhere. Many of his supporters agree. HIVPLUSMAG.COM
20-23_PLUS127_FEA_Clinton_FINAL.indd 23
23
9/27/18 8:02 AM
WORLD AIDS DAY 2018
Pedro Zamora’s life was cut short when he died of AIDS complications at 22 in 1994. The first HIV-positive person on reality television, Zamora starred on The Real World: San Francisco. Now the activist and educator is posthumously honored by the Pedro Zamora Young Leaders Scholarship. Created by the National AIDS
24
By: Desirée Guerrero
Memorial Grove, the Zamora scholarship spotlights young activists as they pick up his mantle in fighting the HIV epidemic. The Memorial Grove, which became a federally-designated national memorial in 1996 thanks to Congressional legislation signed by then-President Bill Clinton, receives major funding from
Wells Fargo and Gilead Sciences for the scholarship program. Since 2009, it has awarded a total of $200,000 in college scholarships to nearly 60 young leaders working in the fight against HIV—many who are living with HIV themselves. Meet four of them:
Kelly Gluckman Granada Hills, Calif.
Nestor Rogel South Central Los Angeles
Alexander Pacach Los Angeles, Calif.
Antwan Matthews Meridian, Miss.
At 23, Kelly Gluckman was in a monogamous relationship—until she found out she was poz. “It was shocking and devastating.” She recalls demanding, “Who are you having sex with?” Eventually she realized, “I can sit here and place blame... but at the end of the day, I knew that my sexual health was my responsibility.” Gluckman was raised by “very liberal” parents
“I’m straight by the way,” Nestor Rogel quips, knowing if you’re Latino, and poz, people assume you must be gay or bi. His wit hides past struggles. Born with HIV, Rogel discovered his status at 13 after a caseworker clumsily disclosed, thinking he already knew. “It was heartbreaking,” he recalls, “I straight up stopped thinking I was a person anymore... I really thought I was a monster.”
Being disowned by his family for being pansexual turned HIVnegative Alexander “Xander” Pacach into an activist. “As someone who has experienced family rejection and homelessness—factors that could lead to sexual behaviors that carry the highest risk of HIV transmission, I knew it was important to get involved in my community and support those who have
After a conversation with a former partner gave him a feeling he might be poz, Antwan Matthews went in for a test, just days before his 20th birthday. It wasn’t his first time at a clinic: Matthews says his parents had been very proactive when it came to sexual health and they routinely took him and his siblings for STI screenings. By the time his test came back positive, Matthews had already decided not to
COURTESY KELLY GLUCKMAN (GLUCKMAN); LOUIS KENGI CARR (ROGEL); ALEXANDER PACACH (PACACH); ANTWAN MATTHEWS (MATTHEWS)
We Are The Future
These Pedro Zamora Young Leaders are as inspiring as the man behind the scholarship’s name.
NOVEMBER / DECEMBER 2018
24-25_PLUS127_World Aids Day_FINAL_REVISED2_JAM.indd 24
9/27/18 6:53 PM
WORLD AIDS DAY 2018
#LetsEndIt
THE
HIGHs OF HIV NEWS
AND
LOWs
THIS YEAR
Compiled by Jacob Anderson-Minshall
00_PLUS127_Gilead_FINAL.indd 1
SHUTTERSTOCK
Climbing mountains, then falling off the other side: This year’s efforts in the fight against HIV saw victories and defeats.
9/27/18 7:52 AM
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 healthier life.
See Inside
18744 Gilead HSTV Gatefold Plus 127.indd 2
9/7/18 2:00 PM
WORLD AIDS DAY 2018
#LetsEndIt
THE GOOD. A small but exciting study published in Cancer Immunology Research found that two-thirds of HIV-positive participants with Karposi sarcoma who were treated with immunotherapy experienced partial or complete remission. Although it is rare, KS can persist or develop in those taking antiretroviral therapy. In fact, all nine men in the study were on ART and seven had undetectable viral loads. The usual treatment for KS, chemotherapy, can cause immune suppression and involves troubling side effects. One person saw a complete remission of his KS, with partial remission observed in five other participants, and three remaining stable.
NEW HOPE FOR THOSE WITH DRUG RESISTANCE This year saw the approval of one new HIV drug, and phase three results on a second, for those who struggle with multidrug resistance. Ibalizumab (brand name Trogarzo) by Theratechnologies is the first drug in the new class called monoclonal antibodies. Designed specifically for those who are suffering
00_PLUS127_Gilead_FINAL_revised.indd 5
through multidrug resistance, it’s a long-acting injectable given every two weeks. ViiV Healthcare’s new drug fostemsavir, an attachment inhibitor, is still in the pipeline but showing success with people facing extensive drug resistance, as well.
SWITCHING WHILE UNDETECTABLE GETS EASIER
Studies show it’s safe to switch meds even while undetectable, and two newly approved HIV drugs provide good options for those who hope to reduce side effects or the number of medicines they take. ViiV Healthcare’s Juluca is the first two-drug regimen on the market and first not to include a nucleoside reverse transcriptase inhibitor (NRTI). Juluca combines the integrase strand transfer inhibitor dolutegravir and the non-nucleoside reverse transcriptase inhibitor rilpivirine. Gilead’s Biktarvy is also a single-table regimen combining the novel, unboosted integrase strand transfer inhibitor (INSTI) bictegravir, with Descovy (FTC/ TAF), a two nucleoside reverse transcriptase inhibitors (NRTIs). Biktarvy is approved for both those new to treatment and those who are undetectable and looking to replace their current antiretroviral regimen.
DNA SEQUENCING REVEALS NETWORKS DNA sequencing is helping researchers identify HIV clusters, transmission networks, and hotspots. Some findings this year: Transgender women in Los Angeles are more likely than any other risk group to be in genetically-connected clusters— probably due to a shared pool of sexual partners. A University of Edinburgh analysis of 14,405 people living with HIV in the U.K. discovered something similar about men who have sex with men but don’t identify as gay or bisexual. They’re passing HIV to each other, but not to gay men or straight women. In this issue (page 28), we look at what some clusters are revealing about HIV rates among young, queer Latino men.
ADDICTION DRUGS LOWER VIRAL LOADS The drug methadone, used to help addicts break chemical dependency also helps lower their viral loads. Earlier this year, the Journal of Acquired Immune Deficiency Syndromes found that poz people taking extendedrelease naxeltrone, a drug that treats alcohol use disorder, were more likely to maintain or reduce their viral loads as well.
SHUTTERSTOCK (ALL)
BREAKTHROUGH FOR KARPOSI SARCOMA SUFFERERS
10/1/18 3:49 PM
A HEALTHIER LIFE CAN START WITH HIV TREATMENT. Starting HIV treatment as soon as possible helps stop the damage HIV causes to your body. Plus, doctors and scientists have found that it can help reduce the risk of some infections, certain cancers, and even AIDS.
TREATMENT HELPS PREVENT THE SPREAD OF HIV. Starting and sticking to HIV treatment can lower the amount of virus in the body so much, it can’t be measured by a test. It’s called being undetectable. According to current research, sticking to daily treatment and staying undetectable means there’s basically no risk of spreading HIV through sex. HIV is still in the body, and being undetectable doesn’t prevent other STIs. So use condoms and practice safer sex.
TALK TO YOUR HEALTHCARE PROVIDER. Have an open conversation. There’s no cure for HIV, but 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.
e
YouTube.com/HelpStopTheVirus
18744 Gilead HSTV Gatefold Plus 127.indd 3
9/7/18 2:00 PM
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 HelpStopTheVirus.Tumblr.com
.
e
Get the answers you need, privately, on your phone. HIVanswers.com/app
HIV ANSWERS, the HIV ANSWERS Logo, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc. All other marks are the property of their respective owners. © 2018 Gilead Sciences, Inc. All rights reserved. UNBC5788 06/18
G04_18744 18744 Gilead Gilead HSTV HSTV Gatefold Gatefold PlusPlus 127.indd 127.indd 4 1
9/7/18 9/28/182:00 9:13 PM AM
WORLD AIDS DAY 2018
#LetsEndIt
THE BAD. ALL KICK NO KILL
At the 9th International Workshop on HIV and Aging, researchers revealed 39 percent of poz people 50 or older and 49 percent of those under 50 have hepatic steatosis (aka fatty liver disease). Those aged 50-plus with the comorbidity were more likely to be women (43 percent versus 29 percent), have hep C, and be long-term survivors who had been on antiretroviral medications for more than a decade. The researchers noted that obesity is also a major factor.
KIDNEY DISEASE RATES RISING FOR 60+ POZ FOLKS?
At the International AIDS Conference, U.K. researchers revealed that diagnoses of kidney disease and osteopenia or osteoporosis rose for HIV-positive people aged 60 and older at one London clinic. Between 2010 and 2017, the proportion of 60 and older poz folks also more than doubled. Researchers found as of 2017, 99.7 percent of the clinic’s over-60 clients were on ART, and 95.3 percent were virally suppressed. But they were also increasingly likely to have multiple comorbidities, be on numerous (nonantiretroviral) medications, and have stage-three kidney disease—the latter was particularly common among those who had taken the HIV drug tenofovir disoproxil fumarate.
00_PLUS127_Gilead_FINAL.indd 6
HIV is able to lie dormant in hidden reservoirs where it avoids detection and treatment but can quickly rebound if someone goes off antiretrovirals. For years we’ve been hearing about kick-and-kill, a strategy meant to prime the body’s immune system, then kick the latent HIV awake for the immune system to eliminate. This strategy is an essential component of many in-development HIV vaccines and functional cures. So it was extremely disappointing when researchers announced at the International AIDS Conference that kick-and-kill had failed to eliminate latent reservoirs better than standard antiretroviral therapy. According to the National AIDS Treatment Advocacy Project, this “underlines the difficulty of reactivating latent virus and killing it with ART or—in this case—with an immune system trained by a doublebarreled prime-boost HIV vaccine.”
ASS IS HERE TO STAY
AIDS Survivor’s Syndrome isn’t going away. According to the organization KickASS at this year’s United States Conference on AIDS, nearly 50 percent of poz men experience mental health issues. KickASS says a survey reveals 35 percent of long-term male survivors “still grieve” and 7 percent “still deeply grieve.” A U.K. study of
6,000 people found those living with HIV are three to seven times more likely to suffer from depression and anxiety vs. those without HIV. The rates increase with age and the length of time someone has been living with HIV. A study in AIDS Care earlier this year found that nonprofessional caregivers of poz folks who can no longer care for themselves also struggle with mental health, with 46 percent of caretakers experiencing depression and 27 percent anxiety.
INTERNATIONAL EFFORTS TO END AIDS FALL BEHIND
For years, falling HIV rates have made it seem like AIDS could really be eradicated by 2020, but the IAC revealed that goal is fading fast. Last year, the world saw 1.8 million new HIV cases, a far cry from the 500,000 global new diagnoses UNAIDS once hoped we’d get to by 2020. Instead, UNAIDS reports we’re seeing spikes in new HIV diagnoses among key demographics, including drug users in eastern Europe and adolescent girls in sub-Saharan Africa. A recent report by the Bill and Melinda Gates Foundation fears Zimbabwe, where new HIV diagnoses are down by 49 percent since 2010, could see a reversal because 61 percent of Zimbabweans are under 25 years old, and just “entering the age when they are most at risk for infection.” At this critical moment, the Institute for Health Metrics and Evaluation reports funding for the global fight to end HIV dropped $3 billion between 2012 and 2017.
SHUTTERSTOCK (ALL)
FATTY LIVER DISEASE COMMON
9/27/18 7:52 AM
#LetsEndIt
COURTESY MTV
who taught her to protect herself from sexuallytransmitted infections. She also attended Los Angeles Unified School District, which had a comprehensive sex ed program. Gluckman now shares her story to dispel myths, stereotypes, and stigma around HIV, and to let others know that this virus doesn’t discriminate—even when you’re young, white, straight, and in love. A life-changing coincidence set Gluckman on the path to activism. A cousin introduced her to a mutual acquaintance who happened to be HIV activist Marvelyn Brown, the author of The Naked Truth: Young, Beautiful, and (HIV) Positive. “My cousin connected me with Marvelyn and we talked on the phone for like an hour the first time. We just connected so deeply… I read her book, and I’m like, ‘I want to do that.’” Now 31 years old, Gluckman recently graduated from University of California, Los Angeles, and has become an ambassador for the Elizabeth Taylor AIDS Foundation.
Stigma, ignorance, and parents who he says weren’t “the most responsible people,” only made staying on his meds harder. Then his mother passed away from AIDS-related complications and Rogel fell into a deep depression. After he attempted suicide, his family sent him to stay with relatives in El Salvador. “I thought I knew what struggle was, coming from South Central,” Rogel says. “But there I realized the worst day in my life was an average day in someone else’s.” That’s when Rogel “started trying to put myself back together” and got involved in activism, working with the Student Global AIDS Campaign. He recently graduated from college and works as an HIV prevention specialist for Altamed in East L.A. Although he’s straight, he started the group Queer in Compton. Rogel is involved with the South Central Healin Artz Space, a writing workshop “aimed at telling our stories about our neighborhood, from us and by us.” He’s also part of a local initiative to bring back the old South Central Farm to combat the area’s poverty and lack of green spaces.
limited or no access to sexual health education and other resources,” explains Pacach. He’s also fighting stigma, arguing that “HIV is the only chronic illness that... people are shamed for living with it, regardless of their circumstances.” The 28-year-old has worked with the Risk Reduction Program at Children’s Hospital Los Angeles as a health educator for the LIFE project, and was selected as a youth scholar by both the United States Conference on AIDS and the NMAC’s Youth Initiative to End HIV/AIDS in America. Pacach also created a YouTube series, Closeted Conversations, because he believes in fostering communication between generations. “HIV has been around for over 30 years. That’s a long time,” says Pacach. “The sooner we engage young people, then they can have those conversations with their friends, siblings, and their future kids. Young people [need] understanding mentors that support their sexual health.” The budding filmmaker, adds, “I am very passionate about sharing the stories, experiences, and perspectives from minority communities that challenge social norms and taboos.”
let HIV ruin his life. “I wanted to approach my diagnosis as if I had another chance to redirect my life,” explains Matthews, now 25. “I knew I had power in reaching a larger audience if I stayed proactive and worked strategically to advocate for youth and people of color.” He advises young people who learn they are positive to “not look at the new stage in your life as if you failed, but take this opportunity to better yourself…. You have to take control of your narrative and change pity to excellence.” Matthews urges those who are not poz to get involved too. “Become involved, learn more about the innovative approaches that are available to decrease HIV… do research on prevention measures such as PrEP to stay HIVnegative.” Matthews, who founded the nonprofit Peer HEALTH Educator, was also featured on PBS’s Southern Remedy, which explores issues around healthier living in Mississippi. When he finishes his medical degree, Matthews hopes to work in health policy, to “make sure people of color have an opportunity for healthier living, housing, and services for mental health.”
A REUNION YOU’D WANT TO ATTEND Read about The Real World: San Francisco reunion that happened at the AIDS Memorial on HIVPlusmag.com. HIVPLUSMAG.COM
24-25_PLUS127_World Aids Day_FINAL.indd 25
25
9/27/18 8:02 AM
These include Latinos, Native Americans, sex workers, drug users, trans (and cis) women, Asian-Americans, and so many more. We spoke with a few folks who are making inroads with outside-the-box ideas. 26
LIDYA NADA/UNSPLASH
When the media speaks about people living with HIV, typically the focus is on gay and bi men. But too often overlooked in the conver sation are individuals at equal risk, as well as other communities already living with HIV.
NOVEMBER / DECEMBER 2018
26-33_PLUS127_FEA_The Others_FINAL.indd 26
9/27/18 8:13 AM
WE SEE YOU The unique experience of being HIVpositive and disabled is rarely part of the conversation. It’s time to change that.
SHUTTERSTOCK
BY DAVID ARTAVIA n the last 30 years, HIV activists have targeted much of their fervor advocating for wider access to healthcare and eradicating stigma. People who are physically or intellectually disabled (poz and not) have always marched side-byside in the battle, yet, to the general population at least, their needs seldom get the attention they require. People living with disabilities are often excluded from many HIV prevention measures, despite being more at risk than some other marginalized groups. According to the U.S. Census, in 2015 nearly 40 million mericans identified as disabled representing . percent of the population. The data also showed that disabled mericans earned significantly less than ablebodied colleagues. Disabled people are more at risk of losing health coverage if preexisting conditions can be excluded. With added disability-related costs, it’s hard to afford treatment without government aid, and even that was nearly taken away last year. In 2017, when the majority Republican Congress rushed to destroy the ffordable are ct which would have consequently threatened social security benefits li e edicaid disabled rights activists swarmed apitol Hill. any of the activists were also poz. ll of them relied on these benefits for their survival and willingly faced arrest, using their bodies to block members of Congress in hallways or outside buildings. Colleen Flanagan, cofounder of Disability Action, a disability rights organization, was one of them. “Right now on Capitol Hill, scary threats are being made to disability social justice,” Flanagan remarked at the time. “The future of disability rights can not afford us to delay in ta ing action The need for stronger inclusion goes far beyond access to affordable health insurance. ccording to a recent UNAIDS report, people with disabilities (in particular women and girls) are too often turned away from HIV services and considered low priorities. Consequently, they’re not provided equal access to HIV education and prevention efforts. What many don’t seem to realize is that women and girls with physical disabilities are more likely to experience sexual, physical, and emotional violence than those without, all of which can make them more at risk of contracting HIV. Those with mental and intellectual impairments are two to eight times more at ris of being victimized yet they’re commonly left out of data collection in gender-based violence programs. odes of communication are a barrier, too.
Sign language, Braille, large print, or easy-to-read tools are seldom included in HIV prevention strategies. urthermore, medical professionals use di cult to understand jargon, and often assume that disabled people are simply not sexually active (consensual or otherwise) and therefore are “not in need of such services,” the UNAIDS report says. But physically or intellectually disabled people have equal or greater exposure to all known risk factors for HIV contraction. ntiretroviral side effects can also add a variety of une pected complications for disabled poz folks. While vomiting and diarrhea are unwelcome even to those privileged with able-bodies, for those bound to wheelchairs or with physical limitations that slow them down or ma e bending over di cult or impossible, these side effects can become debilitating. UNAIDS points out, “healthcare systems in many countries are designed to provide acute HIV care but lack integration with rehabilitation services that try to prevent impairment and ensure participation and quality of life.” While legislation like the Americans with Disabilities Act have advanced progress toward anti-discrimination in employment, transportation, and other areas of life, very little focus has been made in bridging the gap toward access to care. One group of researchers in KwaZulu-Natal, South Africa, integrated HIV care in a 200-bed public rehabilitation hospital and reported on the experience in AIDS Care, showing the complexities poz people dealing with functional limitations must face. Thanks to the report, activists were able to strengthen South Africa’s dedication to integrated care, set forth in the country’s 2017 National Strategic Plan on HIV and AIDS, a long-term vision which includes implementing better accommodation for disabled people living with HIV. In America, a push for more convenient services for disabled people is ongoing. Accommodations for the disabled rarely think beyond people in wheelchairs, and, as many who use wheelchairs can attest, even “wheelchair accessible” is often a misnomer. There may be a ramp, but an elevated doorframe stops someone from rolling inside; or the doorway may be too narrow for certain chairs. UNAIDS reports that something as simple as providing information in a way that’s accessible for everyone is crucial and should remain a top priority. Solutions li e advancing the integration of rehabilitation into HIV care, offering affordable assistive devices, and using alternative service delivery modes for those confined to wheelchairs, homes, or beds should be at the forefront of such efforts. “The vulnerability of people with disabilities is linked to social and structural drivers, such as increased risk of gender-based violence and multidimensional poverty,” UNAIDS points out, further urging that the “economic empowerment of people with disabilities is crucial to address social and structural factors that increase vulnerability to HIV.” HIVPLUSMAG.COM
26-33_PLUS127_FEA_The Others_FINAL_REVISED_JAM.indd 27
27
9/27/18 4:58 PM
SMACK BACK
A novel approach cuts deaths of injection drug users by 50 percent. an innovative program has been shown to drastically reduce the number of deaths among people living with HIV who also use injection drugs, reports The Lancet. The study was funded by the U.S. National Institutes of Health, but was based in three countries where injection drug use is the primary mode of HIV transmission (Ukraine, Vietnam, and Indonesia). People who use injection drugs have disproportionate rates of HIV. According to the Centers for Disease Control and Prevention, approximately 10 percent of new HIV diagnoses in the United States are attributable to the use of injection drugs. Although annual HIV diagnoses among injection drug users decreased by 48 percent between 2008–2014, the current opioid addiction crisis threatens to undermine those successes. A 2013 global meta-study published in the Bulletin of the World Health Organization demonstrated that poz people who use injection drugs have higher mortality rates than those who do not (most common causes of death were overdoses and AIDS-related conditions). In addition, “People living with HIV who inject drugs often encounter multiple obstacles to beginning and adhering to treatment for HIV infection and substance use,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases in a press release. The new clinical study, HPTN 074, examined whether offering more services and interventions to poz injection drug users would help them get into care and achieve greater viral suppression than the existing options. Researchers recruited 502 HIV28
positive men and women ages 18–60 years old who were injection drug users, and 806 of their non-poz injection partners (people they shared needles with). Some of the study participants received the improved intervention while others only received their country’s basic standard of care for people who use injection drugs: referrals to substance use treatment, needle or syringe exchange programs (if available), risk reduction counseling for both sexual and injection risks, HIV counseling and testing (for non-poz partners), HIV treatment (for poz participants), and testing and treatment for sexually transmitted infections, hepatitis, and tuberculosis, as appropriate. The participants assigned to the new, more intensive interventions received all of the above as well as being immediately prescribed antiretrovirals (if poz) or PrEP (if negative). They were also connected with a systems navigator to help them overcome structural barriers to care for both HIV and substance use, as well as psychosocial counselors to help them overcome psychological obstacles that often interfere with treatment. The experiment proved remarkably successful, lowering mortality rates by over 50 percent. While 15 percent of poz participants who only received the standard of care died, only seven percent who had received the intensive intervention did. “Providing guidance and counseling can help such individuals overcome barriers to starting and staying in care and treatment, leading to a significantly higher rate of HIV suppression and a much lower rate of death,” Fauci said. In addition to dramatically reducing deaths, the intervention also helped poz participants achieve lower viral loads. After a year, 41 percent of those participants had achieved undetectable levels, compared to 24 percent of participants who received only the standard of care. Also, 72 percent of participants who received the intensive intervention reported still being in treatment at the end of the year, compared to 43 percent for the other group. Maintaining treatment and reaching undetectable levels are important not only for long-term health of the poz person, but also to HIV prevention efforts. Also of note: none of the new diagnoses in the trial occurred among injection partners of people living with HIV who received the intensive intervention. The seven injection partners who did become poz during the course of the study had not received PrEP. Due to the success of the program, at the end of the study researchers offered the intensive intervention to study participants who’d been previously limited to the standard of care.
CHRISTIAN STERK/UNSPLASH
BY JACOB ANDERSON-MINSHALL
NOVEMBER / DECEMBER 2018
26-33_PLUS127_FEA_The Others_FINAL.indd 28
9/27/18 8:14 AM
HUSTLE & FLOW
Sex workers, often overlooked in HIV outreach, finally get attention.
TONY ROSS/UNSPLASH
BY SAVAS ABADSIDIS he weekend before the 2018 International AIDS Conference, a group of media representatives toured Amsterdam’s Red Light District, which has the largest concentration of sex workers in the etherlands. msterdam’s efforts to prevent HIV in the sex worker community takes a harmreduction approach, which is perhaps why you are more likely to get an STI from a university student than a sex worker in the country, according to director of the Prostitution Information Center, Nadia van der Linde. The center provides a wealth of material about the local sex work scene. Van der Linde soberly explains that the city’s conservative voices are calling for further curtailing or complete elimination of both the sex and cannabis trades due to what’s being seen as an unsustainable in u of tourists see ing both. Van der Linde joined the PIC board in 2016 when its founder, Mariska Majoor, retired from the role. Van der Linde is also a coordinator at the Red Umbrella Fund, a global grantmaking organization run for and by sex workers. Majoor, a former sex worker, is also cofounder of Proud, a Dutch sex workers union; and author of several books about sex work. Majoor and van der Linde reiterate that the female (both cis and transgender) “freelancers” who work in the Red Light District have lower STIs and HIV transmission rates than female students in the Netherlands. “It’s the stigma,” Majoor says about what makes sex work dangerous, even in Amsterdam’s permissive (but heavily regulated) environment. “The more you criminalize sex work, the more every aspect of the business becomes stigmatized and invites more danger.” And stigma, she underscores, “is what really kills.” Lyle Muns, a student of political science at the University of Amsterdam, agrees. Sex work is Muns’s side hustle. He’s also a vocal advocate for people living with HIV. He came out as HIVpositive last year in a YouTube video. “People with HIV usually do not say they have it, uns says. hile it’s fine to live with this virus, there are a lot of misunderstandings so talking about it is di cult. o, I call it a coming out because I want to emphasize that. If I did not get out of the
26-33_PLUS127_FEA_The Others_FINAL_REVISED2_JAM.indd 29
closet, it wouldn’t fight the stigma as well. he young student is also in favor of global decriminalization of sex work and represented the Netherlands as part of the country’s delegation at the International AIDS Conference. ost of the effort to test and treat se wor ers in msterdam falls on the shoulders of the Prostitution and Health Center 292, which provides general healthcare and STI testing (including HIV), as well as counseling and treatment. While primarily serving women, counselor Sjaak van der Kolk said he sees nearly 300 male sex workers a year, most who have sex with other men. Van der Kolk estimates the total population of male sex workers in the city to be nearly 700— far less than the estimated number of women (3,000). uns supports laws against se tra c ing, but he suggests the enforcement of these laws making sex work a crime can cast a wide net by also putting those who practice consensual sex work in jail. “Look, sex work exists in any kind of society, it doesn’t matter what kind of laws you have,” Muns says bluntly. “Whether you completely criminalize it or completely legalize it, the question is how much you know about it and how able are you to control the issues that are going on in the sector, to provide health, to guarantee security.” With criminalization, comes stigma, fear of retribution, and less control over sex workers’ own agency—all of which can actually invite violence, abuse, and tra c ing. n advocate for r , the HIV prevention strategy that when ta en as prescribed makes it virtually impossible to contract HIV, Muns argues one of the reasons he ac uired HIV was because r is not widely available in the Netherlands and that the cost (nearly $600 a month) is prohibitive for most people. Hopefully that will change. Muns says the LGBTQ community is wor ing towards getting r covered by the government and educating the public.” But there is still a long way to go. “[Doctors]only think that men that have sex with men are the only ones who should have access,” Muns says. “But I think anybody that has certain sexual health ris s should have access to r , right
9/27/18 6:53 PM
Native Americans are addressing HIV within their community by reminding each other of their real names. BY JACOB ANDERSON-MINSHALL he first Americans may also be the most invisible Americans. A recent survey by Reclaiming Native Truth, an effort to dispel myths and misconceptions about Native Americans, found that 40 percent of Americans don’t think Natives still exist. While nearly 60 percent believe the U.S. is “guilty of committing genocide against Native Americans,” only 36 percent of respondents believed Natives currently face a “great deal” or “a lot” of discrimination. Misperceptions about Native Americans have real world impacts, including for those combating HIV among Native populations. Yue Begay and Jonathan Talamantes, who coordinate APLA’s Red Circle Project, say that ignorance plays an 30
DROP THE LABEL MOVEMENT/UNSPLASH
MEDICINE WHEEL
astronomical role in impacting the services available to Native communities. Founded in 2003, Red Circle Project is the only HIV-prevention program in Los ngeles ounty that specifically provides services to the ative merican and Alaska Native community. It offers testing and health navigation, helping atives to connect with culturally-competent healthcare and other culturally-relevant services. In particular, the project focuses on providing services for gay, bisexual, and TwoSpirit men, and transgender individuals. Talamantes says, “One issue we have in our community… in general, there’s hardly any data that’s specific for our communities. ftentimes, we’re ust an asterisk.” Meanwhile, the 2010 census notes that 2.9 million people (or 0.9 percent of the overall population) in the U.S. are American Indian and Alaska Native “alone,” while an additional 2.3 million people, or another 0.7 percent, are American Indian and Alaska Native “in combination with one or more other races.” Those numbers may sound small, and Talamantes argues their population is often deemed “irrelevant… because we are such a small population, but we still are here. egay adds, we have the highest misclassification rate of any other demographic. When someone looks at someone who has a darker skin, they might identify that person as Black… how does it impact programs like [ours]? Funding, it entirely depends on numbers and so when you get a high misclassification rate, you actually end up with a lower number of ative Americans” and less funding for programs. Although many Americans imagine Natives only reside on reservations, according to the U.S. Census Bureau more than seven out of 10 American Indians and Alaska Natives now live in urban areas like Los Angeles and New York City. “I’m an urban Indian,” Talamantes says. “I’m a second generation here in . . y grandparents came out off of the reservation in the s. o, my mother was born out here, and I was born out here. I grew up really involved in the Native community out here. There is a huge Native community… and there’s a ton of services for us.” But, he adds, “there are certain issues because we are off the reservation. ith the ative community it’s a huge diverse group of people. ast oast atives are completely different from outhwest atives, and acific orthwest atives. e all come from our own individual cultures and backgrounds.” Indeed, there are over 560 federally recognized American Indian/Native Alaskan tribes (and dozens more that aren’t federally recognized), whose
NOVEMBER / DECEMBER 2018
26-33_PLUS127_FEA_The Others_FINAL.indd 30
9/27/18 8:14 AM
members speak over 170 languages. Although they share some cultural similarities, Indian nations and tribes are also very different. “In the urban environment, we’re lucky because it’s like a huge bouquet of cultures that are here and it’s a beautiful thing,” Talamantes says. “But it does ma e it a little di cult, too, because some fol s are so far from their homes, their traditional homes. lot of services that are offered on reservations, we aren’t afforded because we’re away from our homeland. The federal government is required to meet our basic human needs, and if we’re off the reservation, they’re not required to.” “I’m not an urban Native,” Begay says. “I grew up in the Navajo Nation. I grew up on the reservation. I’ve been here for almost seven years going on eight—[and] I still experience culture shock. I’m used to hearing my language back home. I’m used to a different mode of thin ing back home. I’m used to different values… it’s completely different, our notions of trust, our notions of healthcare.” According to the Centers for Disease Control and Prevention, American Indians and Alaskan Natives accounted for 1 percent of the total new HIV diagnoses in 2016. Most new cases (81 percent) were among men, 77 percent of whom contracted HIV via male-male sexual contact.
Contrastingly, 69 percent of AI/AN women who contracted HIV did so via male-female sexual contact. Although they accounted for a small percentage of the overall diagnoses, their rates are increasing: from 2011 to 2015, HIV diagnoses increased 38 percent among AI/ANs overall, and 54 percent among AI/AN gay and bisexual men. Native Americans are also more likely to see their condition progress to HIV Stage 3, or AIDS. In 2015, 53 AI/ANs died from AIDS complications (in 2016, 102 AI/AN people were diagnosed with Stage 3 HIV). Also problematic is the number of HIV-positive Natives who don’t know their status (only 81 percent of poz Native Americans people know they are positive). Attempts to reach Native Americans with prevention messages often fail by not being culturally sensitive, which is why programs like the Red Circle Project are so important. “What we have been is a perfect example of what culturallycompetent services are,” Talamantes says. “For us, we’ve always focused on community. As Native people, community is everything. Your interactions with the community, your role in the community, all that, it’s really big. It’s really important.… [Non-Native] healthcare, it’s about the self, it’s about the singular person. In a tribal community, it’s always about how that self, how that single person fits into the larger scheme of things. “For a program to be culturally competent with Native Americans and address HIV at the same time,” Begay adds, “it would have to know the history of the community and somehow incorporate that holistically, while also incorporating estern biomedicine into its services, li e trying to find that balance. I thin that’s another barrier… in general, there’s this clash always between our traditional medicines, our traditional healing versus Western medicine.” hat con ict has yet to be resolved, even on many reservations. egay says, “On the Navajo Nation, there’s always this feud between medicine men and medicine women who are cultural practitioners and healers versus the doctors
COURTESY APLA/RED CIRCLE PROJECT
Yue Begay pictured with Jonathan Talamantes (top left), Red Circle Project volunteers, and other passionate LGBTQ Native American and Alaska Natives.
HIVPLUSMAG.COM
26-33_PLUS127_FEA_The Others_FINAL_REVISED_JAM.indd 31
31
9/27/18 4:58 PM
32
A volunteer for the Red Circle Project, which helps connect LGBTQ Native American and Alaska Natives with culturally-competent services.
Or people walk by with their kids, [saying] ‘Don’t talk to them. Get away from them.’ But, I’m starting to see a lot more folks that are coming up to me like, ‘Is the mobile unit here? Can we get tested?’ They’re asking for these services.” Additionally, Red Circle is finding new ways to connect HIV prevention efforts to traditional Native teachings. “I love working with the elders in the community,” Talamantes says. “I mean they’re teaching me new things. They’re teaching me new ways of loo ing at the way we’re offering services. I had an elder come up to me and ask me, ‘Can I get one of your medicine bags?’ She was like, ‘The one with the condoms?’ I didn’t think about it that way at all until she said that to me. I’m like, Oh my God! That’s exactly what they are. That’s the medicine. That’s exactly what we’re giving people. Native communities, we consider a lot of things medicine, you know, those dances at those powwows, our prayers, our songs, those are all medicine. I think we’re doing a good job of breaking that stigma [by] relating traditional medicines with new school ideas.” While recognizing the historical trauma that Natives have faced is critical, so is looking beyond it. “People love to focus on the trauma,” Talamantes warns. “They love to focus on all this hurt. And yeah, that is part of our story, but the other part of our story is our resiliency. We’re still here.” ven after years, and concerted efforts to first exterminate and then assimilate Native Americans and Alaska Natives, communities retain their tribal connections and respect for traditional values. As Talamantes says, “We’re still here and we’re the ones who are teaching each other our names now.”
COURTESY APLA/RED CIRCLE PROJECT
at the IHS [Indian Health Service]. It’s like there’s extreme racism between the doctors and our medicine people.” nd li e many in the lac community, atives have con icted relationships with the medical profession because, as Begay explains, “throughout history, Native Americans have been experimented on.” Scholars like Jane Lawrence (in a 2000 issue of American Indian Quarterly) have reported on the thousands of Native women who were forcibly sterilized by the Indian Health Service during the 1960s and ‘70s. “So, you can kind of get a sense why Native people don’t trust Western biomedicine,” Begay explains. Native medicine often relies on holistic approaches and natural-based remedies. “When you talk about harvesting medicine the traditional way, not only are you just harvesting medicine for medicinal purposes, but you’re also learning about creation stories about those plants,” Begay says. “You’re also learning about how they tie into your people as a whole… We have that level of respect for our cultural medicines, whereas in the bio-Western-medicine, it’s just something you extract, a chemical, a compound to manufacture into an injectable form or a pill.” This makes many Natives even more skeptical of pharmaceuticals, whether it’s PrEP for HIV prevention or antiretrovirals used to treat HIV. So while Red Circle does support their usage, it also relies on other, more holistic and culturally-relative approaches. “One of our tools that we have is our workshop series called Strengthening the Circle,” Talamantes says. The evidence-based approach utilizes the medicine wheel to talk about the importance of balancing spiritual, mental, physical, and emotional wellbeing. By connecting cultural touchstones with health education and sex ed, Red Circle is able to connect with Native American and Alaska Native clients on a deeper level. ou can’t really address HIV within ative communities without first tal ing about sexual trauma,” argues Begay. “And you can’t talk about that without addressing historical trauma, intergenerational trauma. What culturallycompetent, or culturally-responsive services look like in that sense, it would have to be a programing that deeply understood historical trauma.” The colonization of the Americas has, Begay says, since the beginning “been built on extermination of Native people.” Wide-spread death in the wake of colonization was followed by broken treaties, forced relocations, and the Indian boarding school era. In the late 19th and mid 20th centuries, thousands of Native children were taken away from their tribes, given Anglican names and clothing, and forced to speak English and follow non- ative cultural practices in an effort to assimilate atives and endanger their culutural survival. “What ICE is doing, detaining children, taking them from their parents? That is exactly what happened in the boarding school era of the mid-19th century,” Begay explains. “You actually had federal agents going into houses and taking children… and processing them into schools. They strategically placed children from different tribes with each other so we couldn’t communicate. Those experiences, even though they happened generations ago, continue to reverberate through time and in uence current HIV outreach to the ative community, Talamantes explains. He recalls one HIV service provider in Seattle telling him the story of a relative who was sent to a boarding school. Although he’d been sent to the same school as his siblings, he wasn’t allowed to speak to them. “Every once in a while, they would pass each other in lines,” Talamantes details. “The older brother would reach out to the younger brother and grab him and shake him and tell him, ‘This is your name. That [English name] is not your name. This is your name.’ hat’s what we’re doing now in the field of HIV prevention in the Native communities: We’re all calling each other by our names. Yeah, we’re Native but we’re also—we’re Diné. We’re Lakota.” Identity affects behavior, egay adds. ome people, they’ve made poor decisions, they quote-unquote, ‘feel lost’ because they don’t really know who they are.” The Red Circle Project helps connect lost Native Americans and Alaska Natives—particularly those making unhealthy decisions—with culturallycompetent services, but also with their histories, their communities, their spirituality, and their identities. Reconnecting these pieces helps Natives feel more “whole,” which leads them to make healthier choices. Just as many other communities continue to struggle with HIV stigma, Begay and Talamantes acknowledge it exists in Native American communities as well. “I will say there’s not as much as there was in the past,” Talamantes says. But it can still be shocking. “Sometimes folks won’t even look at us if we’re out doing outreach. NOVEMBER / DECEMBER 2018
26-33_PLUS127_FEA_The Others_FINAL.indd 32
9/27/18 8:14 AM
HOMBRES EN PELIGRO The latest research shows that young gay and bi Latinos may be closing in on Black men in new HIV diagnoses numbers.
JEAN PHILIPPE DELBERGHE/UNSPLASH
BY DESIRÉE GUERRERO hen Plus interviewed the original Queer Eye cast member Jai Rodriguez last year, the star of stage and screen was shocked to learn of the Centers for Disease Control and Prevention’s prediction that one in every four gay or bi Latino men will become positive in their lifetime, if 2016 rates continued unabated. “That shook me to my core,” Rodriguez said at the time. The HIV-negative Latino actor has long been involved in HIV causes, mainly through his Broadway connections, and said he thought I really new my stuff. ut, li e many gay and bi Latinos, he wasn’t initially aware that transmission rates were reaching such pervasive levels in his own community. Black gay and bi men currently bear an even higher burden in HIV transmission rates, with the CDC predicting in 2016 that one out of every two gay or bi Black men would become HIV-positive in their lifetime. But two new studies suggest Latinos may be catching up to Black men in new HIV diagnoses. In 2013, the U.S. National HIV Surveillance System began routinely sequencing the DNA of HIV found in newly diagnosed people. This type of analysis can help identify clusters—groups of two or more people whose viruses are so genetically similar that they suggest a common origin. Clusters have historically been analyzed to trace the growth of a localized epidemic, to analyze the viral load in transmission pairs, or to see when different HIV strains first arrived in a population, their transmission networ , and how
long they persist. The NHHS now collects so much data (HIV DNA sequences from 280,000 poz people) that it can determine the current rate of new contractions in particular clusters. It can also identify clusters that are unusually active, which can lead to HIV “hot spots.” Since late 2015, the CDC has been using that data to identify these clusters and calculate contraction rates. In results reported at this year’s Conference on Retroviruses and Opportunistic Infections, the CDC identified priority clusters with especially high rates of HIV transmissions. On average, one in 25 people with HIV in the U.S. transmits their HIV to another person in the course of a year, which statisticians represent as four transmissions per 100 person-years. In these 60 clusters, the average transmission rate was 44 per 100 person-years—or 11 times the national average. In the highest cluster, there were 132 transmissions per 100 person-years. Members of these priority clusters were more likely to share certain characteristics: for example, they were more likely to be men who have sex with men (83 percent versus 59 percent in non-priority clusters) and younger (70 percent under 30 vs. 42 percent over 30). Unexpectedly, Hispanics were over-represented in the priority clusters and Blacks were underrepresented: 38 percent of priority cluster individuals were Hispanics versus 27 percent of non-priority clusters, and Blacks accounted for 31 percent of priority vs 41 percent of non-priority cluster members. esearchers suggest these findings could be early indications of a dramatic shift taking place in the racial makeup of Americans at highest risk of becoming HIV-positive. hese findings suggest rapid transmission in networks involving young MSM, especially young Hispanic MSM,” said the CDC’s Anne Marie France at CROI. “We will be using these data to guide future prevention interventions…. Prioritizing these clusters for public health intervention may have increased potential to reduce future infections.” Aside from this study, additional stats from the CDC reinforce the suggestion that gay and bi Latinos are increasingly at-risk in terms of both new HIV diagnoses—and medical outcomes. From 2011 to 2015, the estimated annual HIV transmission rate increased by 13 percent among gay, bisexual, and other MSM Latinos, and all ages (aside from those between 35-44 and over 65) saw rates increase. In contrast, during that same period, while Black MSM 25-34 saw dramatic increases (30 percent), all other age groups saw significant decreases e.g. - down 25 percent) or stayed the same. If the new studies are indeed representation of broader demographic shifts it may be because— after the alarming one out of every two prediction was announced—activists, service providers, and pharma companies sprang into action. Since then, gay and bi Black men have been heavily targeted through numerous HIV prevention campaigns and it’s starting to ma e a difference. here are encouraging signs that culturally-competent outreach and increasing PrEP access are beginning to have real impacts in reducing HIV transmission rates among Black men. While that’s great news, the latest stats suggest Latinos are being left behind. HIVPLUSMAG.COM
26-33_PLUS127_FEA_The Others_FINAL_REVISED2_JAM.indd 33
33
9/27/18 6:53 PM
34
NOVEMBER / DECEMBER 2018
34-37_PLUS127_FEA_Cover_FINAL.indd 34
9/27/18 8:13 AM
BY DAVID ARTAVIA | PHOTOGRAPHY BY MAXWELL POTH
uck Be A Lady The groundbreaking writer and producer behind Pose and Transparent is also a trans woman living with HIV—and she’s writing truth to power.
OUR LADY J
rarely thinks about being the “first” of anything. The classical musician and writer/ producer of FX’s Pose insists the integrity of one’s art should come before all else. For a slightly reserved writer, who still calls herself a “hillbilly in Hollywood,” being called a trans pioneer is hard to accept. Yet Lady J can’t escape the truth: she’s s a trailblazer. Lady J has been tipping the scale in trans visibility for the last decade. Not only was she the first out trans woman to perform at Carnegie Hall, she was also the first to be hired as a writer on a major TV show and first to be nominated for a Writers Guild
34-37_PLUS127_FEA_Cover_FINAL_REVISED_JAM.indd 35
Award, both for Amazon’s Transparent. This year, Lady J disclosed she’s HIVpositive, adding new firsts in the process. While she had previously mentioned her status on social media, it wasn’t until she told the Pose writing staff—in the midst of writing the show’s first season—that she realized the power of coming out. The experience was nerve-wracking, but it was met with incredible support. “It’s not something a lot of people talk about at work unless they’re close with their coworkers,” she says of disclosing. “But as a writer, the writers’ room is a really safe space, and it is a space where to make these characters real and to give them life, we all share experiences of our own lives.” Today, Lady J is arguably the most powerful out poz TV writer in Hollywood. Writing for the Ryan Murphyled Pose is a perfect fit. Set in the 1980s, during the height of the AIDS crisis, the show is carving a new place in the television landscape, breaking the record for the highest number of transgender actors in series regular roles. Having Lady J’s voice at the table during the writing process sharpens the nuanced portrayal of the issues trans women face living with HIV.
9/27/18 4:58 PM
Dolly Parton helped me get my boobs! That earned me a lot of respect where I come from.
36
Hollywood is a long way from where Lady J started: born and raised at the northern tip of the Appalachian Mountains in southern Pennsylvania, a place that still inspires her. “You can move across the world, but you’ll still have the values instilled by the community that raised you,” she says. Discovering her trans identity wasn’t easy back home. She described the journey as “detangling the lies people had told,” adding that “it didn’t feel like a decision. It felt like I was shedding what didn’t belong to me. The person I am now is the person I was born to be.” She eventually moved to New York City in 2000, and found work as a rehearsal pianist. Before she knew it, she received a helping hand from an unexpected source. “Dolly Parton found out about my music and asked to meet me,” she says. The young singer had been covering a few of Parton’s hits, and when the country legend and fellow Appalachian native found out, she reached out to Lady J. After a friendship developed, Parton helped fund her top surgery. “Dolly Parton helped me get my boobs,” she quips. Because of Parton’s popularity back home, it validated Lady J even more. “That earned me a lot of respect where I come from.” But not everyone was as accepting. “I couldn’t come out at work, so I was presenting male during the day, presenting female at night, until it all finally came into one,” she remembers. “Around that time, I did find community. It was wonderful to have the resources that New York has.” Organizations like Callen-Lorde and GMHC “changed my life” and “gave me a sense of stability in a time that felt so unstable.” Her first love, classical music, also saved her life by providing jobs that paid her bills. Lady J describes playing the music of Tchaikovsky, Beethoven, and Bach as “transcending time” and a “magical experience.” But the magic would come to an end on September 11, 2001, when N.Y.C. changed overnight. She somberly reflects, “I think it’s taken me 17 years
to really grieve that day.” Eventually, her grief prompted a move to Los Angeles. Years later, when Jill Soloway hired her as a writer on Transparent, Lady J channeled the emotional lessons learned in those earlier days to write some of her best work—and many of the show’s most iconic moments. In the process, Lady J says she became closer to the trans community, reflecting, “I think as a singersongwriter I really learned to be loud, and as a writer, I learned to be quiet.” A fine example is the intimate and complex relationship between Trace Lysette and Jay Duplass’s characters on Transparent, which beautifully depicts the rarely explored experiences trans women have when dating cisgender straight men. The two characters fall for each other, only to face conflict when Lysette’s character comes out poz. “That particular storyline came from my life,” the writer says. “I was frustrated with how many men... don’t understand what undetectable is, how many people don’t understand what PrEP is. I’ve been undetectable for 12 years. To still be dating and have men be afraid of contracting HIV from me just spoke to how much misinformation there is out there.” When someone who’s poz reaches undetectability, their viral load is suppressed to such low levels that it’s virtually impossible to transmit HIV. Educating the general population about this fact, Lady J argues, is the key to eradicating stigma. And she intends to take that message to the writers’ room. “I wanted to enlighten and I wanted to educate,” she explains of the Transparent storyline. “I certainly feel a responsibility, now that I am in those rooms, to hire other people and to encourage diversity among my colleagues.” She also advocates for “talent over experience” when giving opportunities to emerging young artists. “We’ve proven you can make trans content with trans people in front of and behind the camera,” Lady J proclaims. “Now that we’ve done that, there’s no excuse. We’re only moving forward from here. And if we do move backwards, thank God for the activists who will say something.”
NOVEMBER / DECEMBER 2018
34-37_PLUS127_FEA_Cover_FINAL_REVISED_JAM.indd 36
9/27/18 4:58 PM
HIVPLUSMAG.COM
34-37_PLUS127_FEA_Cover_FINAL.indd 37
37
9/27/18 8:13 AM
Can We (Still) Trust The CDC? UNDER TRUMP’S ADMINISTRATION, IS THEIR SCIENCE STILL SOUND? BY JACOB ANDERSON-MINSHALL
years into the Trump presidency, HIV services have weathered some hits but remain under threat on multiple fronts. As Arneta Rogers, policy director at Positive Women’s NetworkUSA, acknowledges, “We have had cause for alarm on many issues related both directly and indirectly to HIV since Trump took office.” For example, “attempts at repealing the Affordable Care Act and attacks on Medicaid and social services women living with HIV rely on.”
38
NOVEMBER / DECEMBER 2018
38-41_PLUS127_FEA_CDC_FINAL.indd 38
9/27/18 9:25 AM
SHUTTERSTOCK
HIVPLUSMAG.COM
38-41_PLUS127_FEA_CDC_FINAL.indd 39
39
9/27/18 9:25 AM
One of the biggest concerns is Trump’s war on science. As William McColl, AIDS United’s vice president for policy and advocacy says, this administration appears to be “guided by particular ideologies and that in some areas, such as climate change, has had a clear impact on released reports.” And Dr. Craig R. Cohen, a professor of obstetrics, gynecology, and reproductive sciences at University of California, San Francisco, recalls this isn’t the first time we’ve seen an administration politicize science in a way that has negatively impacted specific demographics. “Under the G.W. Bush administration, research on certain topics including reproductive health were derailed and delayed,” Cohen recalls. So, is Trump’s anti-science bias impacting the work of the Centers for Disease Control and Prevention and National Institutes of Health? McColl doesn’t think so: “People working within the HIV field for the government have been strongly professional and generally
“The real worry is that the insane tax cuts for the rich will eventually empty the federal government’s coffers.”
have stayed on course no matter who is
“I think the administration’s war on science—at least at present—
president. In meetings…high-level leadership
isn’t shared by the government more broadly,” Dr. Elvin Geng, associate
of the administration—including the new
professor in the Department of Medicine at UCSF argues. “Even the
Health and Human Services Secretary Alex
Republican-held Congress has utmost respect for and has funded CDC
Azar—is both knowledgeable about HIV and
[and] NIH at historical levels, and will likely continue to do so. I still
committed to ending the epidemic. It’s our
believe in today’s NIH- and CDC-funded science.”
job as AIDS Service Organizations and HIV
But there’s still need for concern. “We are, however, not on safe
advocates to ... keep holding them to a focus
territory at all,” adds Geng. “The real worry is that the insane tax
on ending the HIV epidemic.”
cuts for the rich will eventually empty the federal government’s
Cohen also believes we don’t need to worry. “Support for science by NIH and
coffers, then there won’t be any money to spend on things like health and science.”
CDC remains intact,” he says. “We have
Other financial concerns revolve around the administration
an exemplary peer review system which
reallocating HIV-dedicated funds elsewhere: at least $5.7 billion was
helps to ensure that the highest quality
reportedly transferred from the Ryan White HIV/AIDS Program to
science gets funded. In my particular area
house detained immigrant children earlier this year.
of research, HIV and reproductive health,
Whether due to funding cuts, reorganization, or the stress of their
I have not witnessed any significant effect
working conditions, a growing number of people have left government
stemming from the administration.”
for greener pastures. McColl acknowledges hearing “about lower level
40
NOVEMBER / DECEMBER 2018
38-41_PLUS127_FEA_CDC_FINAL.indd 40
9/27/18 9:25 AM
folks leaving the administration. Moreover, career federal staff have
should be focused on increasing inclusion of
lamented that the administration has often chosen to leave a position
these populations in every study possible. We
unfilled once staff leave.”
are especially concerned about transgender
What impact does that kind of “brain drain” have on the work
people, since inclusion of questions on trans
these agencies do? McColl says, “We have not been hearing that it
identity and experience are both more recent
is so prevalent as to significantly affect operations. Of course, any
and less entrenched than other disparately
time someone leaves an administration, there is real concern about
affected populations.” Earlier this year,
the impact on knowledge and ability to perform. Most notably, the
AIDS United was joined by more than 130
administration has chosen not to fill the positions at the Office of
organizations in signing a letter supporting
National AIDS Policy, and although we are told that they will be
the continuation of a program that provided
filling the President’s Advisory Council on HIV/AIDS ‘soon,’ it has not
the first federal data about transgender health
happened as of now. These are positions that provide coordination,
in the United States. “Unfortunately, with an
advice, and leadership—and their vacancy is worrying.”
administration which seeks to undermine the
Rogers says PWN-USA recognizes “there are still many career
accuracy of reporting, we are going to have
scientists, researchers, and officials within these institutions who have
to continue to review and scrutinize every
been dedicating their energy and talents to understanding HIV and
report to make sure we aren’t seeing troubling
finding the most effective ways of treating and preventing it.”
buzzwords or other signs of bias creeping into
In a written statement, Bert Kelly from the CDC’s media office
them,” the McColl adds. “However, we do not
responded to concerns about the rumored staff shortages and funding
think it is justified to automatically lose trust
issues, stating, “The CDC has the resources it needs to protect our
in the accuracy of these reports. Frankly, that
nation’s health and security. Our mission remains: working 24/7 to
plays into the goal of denying truth and reality,
keep America safe, healthy, and secure. CDC protects the health,
which would serve only President Trump and
safety, and security of Americans using the best available scientific
his followers.”
data. We stand ready as part of the administration to work to protect and advance the health of Americans.”
Many activists and researchers alike point to the appointment of Robert Redfield to
The CDC declined to directly comment on Plus’s inquiry as to whether
head the CDC as another good sign. Before
HIV research could be impacted by the Trump administration’s alleged
his appointment, Redfield cofounded
antagonism toward science and towards some communities greatly
the Institute for Human Virology, which,
impacted by HIV (e.g. people of color and transgender individuals).
according to The New York Times, “provides
“The administration’s staunch opposition to collecting data
HIV treatment to more than 6,000 patients
concerning sexual orientation and gender identity leaves room to
in the Baltimore-Washington area and
speculate that the accuracy of overall surveillance data could be
more than one million people in Africa and
compromised,” notes Rogers. “And lack of that data will certainly
the Caribbean.”
frustrate efforts to target testing, treatment, and prevention efforts for
“[Redfield] has publicly stated that he
the communities most impacted by HIV. Further, it stands to reason
believes we can end the epidemic in seven
that when an administration is as openly hostile to communities
years,” says McColl. “The Centers’ staff for
of color and the LGBTQ community as this one is, and additionally
HIV are currently very strong, and it’s clear
questions and rejects established scientific consensus, [then] funding
that they want to prevent as many cases of
and support for HIV research and programs will likely be scrutinized
HIV as possible. Given Dr. Redfield’s and CDC
and deprioritized.”
staff professionalism, we would be surprised
“Efforts to erase LGBTQ people and people of color are absolutely unacceptable,” McColl adds. “In fact, this administration actually
if the quality of their reports change. But we’ll be watching!” HIVPLUSMAG.COM
38-41_PLUS127_FEA_CDC_FINAL_REVISED_JAM.indd 41
41
9/27/18 4:58 PM
TAKE P r EP TO N"F@ J @J NI PREVENT HIV JK@P@!N CDP PrEP is a safe, daily pill that reduces your risk of HIV infection. PrEP will not interfere with your hormone therapy. Use condoms to protect against other sexually transmitted infections.
PrEP-Plus-1_rip.indd 1
PrEP is available regardless of your ability to pay. Talk to your doctor or visit nyc.gov/health and search “PrEP.”
8/4/18 12:34 PM
VIRGIN ALERT!
NEW TO LIVING WITH HIV? SCIENCE JUST SCORED TWO NEW DRUGS YOU SHOULD CONSIDER.
T
In trials, Pifeltro demonstrated sustained viral suppression compared to DRV+r (darunavir plus ritonavir), each in combination with Truvada (emtricitabine and tenofovir disoproxil fumarate). For example, 84 percent of those on Pifeltro and Truvada achieved viral suppression compared to 80 percent of those on DRV+r and Truvada. Greater success in reaching viral suppression is particularly important because becoming undetectable makes it virtually impossible to transmit HIV. Those on Pifeltro also demonstrated statistically significant impacts in reducing “bad” cholesterol levels—although researchers say the health benefit of these findings have not been evaluated. Explaining how the process worked from the development of Merck’s innovative therapy to FDA approval, Hwang says, “These are large trials that we sponsor and we enlist investigators worldwide to enroll participants into the trials to evaluate doravirine against other approved antiretrovirals. The primary efficacy endpoint is looking at whether, in this case doravirine, is non-inferior to our competitor FDA-approved comparator drugs that are currently on the market.” Pharma companies must show their drug is at least as good as competitive medications already on the market. Ideally, they want to show—as Merck has with both Pifeltro and Delstrigo—that the new medication has advantages compared to other drugs. Dr. Hwang’s career HIV has spanned decades, and ranged from collecting blood samples to patient care to clinical research and the development of new drugs. “I treated patients with HIV in the clinic... at Vanderbilt. You develop one-on-one relationships with patients to help them on an individual level to successfully treat their HIV. [But] if you can help develop a drug that improves the lives of people living with HIV, you can potentially positively impact thousands, if not millions of lives.” Pifeltro (DOR) is also being evaluated in a Phase 3 trial called DRIVE-SHIFT, a trial evaluating if those who have HIV and are currently virologically suppressed on another antiretroviral regimen can switch to Pifeltro and Truvada without having their viral loads rebound. If that trial is successful, Pifeltro will also be available for those looking to switch medications—rather than limited to those new to treatment, which is what it has currently been approved for. —SAVAS ABADSIDIS
SHUTTERSTOCK
he FDA has approved two new antiretroviral medications for those just starting HIV treatment. Pifeltro (doravirine) is a new non-nucleoside reverse transcriptase inhibitor, while Delstrigo (doravirine/ lamivudine/tenofovir disoproxil fumarate) includes a NNRTI and two nucleoside reverse transcriptase inhibitors. Both drugs are manufactured by Merck, and should be taken orally, once daily, for HIV-positive adults with no history of antiretroviral treatment. While Pifeltro is prescribed in combination with other HIV meds, Delstrigo is a stand-alone, single-tablet regimen. Dr. Carey Hwang, executive director of infectious diseases, global clinical development at Merck Research Laboratories says having another single-tablet option is important because, “There are some studies which suggest better adherence with once-daily antiretroviral regimens compared to older regimens or multiple pill regimens,” Hwang says. “Tolerability of a treatment plays an important role in adherence, as missed doses may lead to the development of viral drug resistance.” One of the studies that served as the basis for the approval is known as DRIVE-FORWARD, which showed a statistically significant lower proportion of participants taking Delstrigo reported fewer “neuropsychiatric adverse events” or side effects than those taking efavirenz (brand name Sustiva), including dizziness (9 percent on Delstrigo reported this, versus 37 percent on efavirenz), sleep disorders and disturbances (12 percent vs 26 percent), and an inability to think clearly or concentrate (4 percent versus 8 percent). More importantly, through 48 weeks of treatment, fewer Delstrigo-treated participants developed viral drug resistance than those in the efavirenz-treatment group. Developing drug resistance is a significant problem for those with HIV, and any drug with less risk of developing resistance is a welcome addition to the HIV medicine chest. When it comes to Pifeltro, Hwang says “doravirine is potent and has been shown to be non-inferior in two Phase Three clinical trials against well-established comparators. I think it addresses several of the issues that have been associated with the first and second generation antiretroviral drugs in the class, such as neuropsychiatric adverse events, requirements to take with a high fat meal and some of the drug interactions.” Neither Delstrigo nor Pifeltro need to be taken with a meal.
44-48_PLUS127_Treatment_FINAL_revised.indd 45
10/1/18 3:37 PM
THE TO
KEY
THE
THE RARE FOLKS WHO MAINTAIN VIRAL SUPPRESSION EVEN DURING TREATMENT INTERRUPTIONS COULD HOLD THE KEY TO A FUNCTIONAL CURE.
44-48_PLUS127_Treatment_FINAL_revised.indd 46
PHOTO CREDIT
CURE 10/1/18 3:37 PM
TREATMENT
SHUTTERSTOCK
A
unique group of poz folks called posttreatment controllers are able to maintain viral suppression even during periods of treatment interruption. Although they aren’t actively taking antiretroviral medications, they remain undetectable. New research suggests how these rarities may hold the key to a functional cure. Post-treatment controllers should not be confused with elite controllers, people who test positive for HIV but don’t become ill or show other signs of being poz, despite never going on antiretroviral treatment. Post-treatment controllers are the handful of HIV-positive people who begin antiretroviral therapy then go off HIV medications and are still able to maintain viral suppression. Usually such treatment interruptions lead to HIV rebounding within three to four weeks, but a very small minority of people have kept the virus suppressed for 24 weeks or longer after interruption. Naturally, researchers want to understand who these people are and how they are able to maintain viral suppression without medication. Two new studies have provided keys to both. “Post-treatment controllers represent a natural model of sustained remission,” Jonathan Li, M.D., of Brigham and Women’s Hospital’s Infectious Disease Clinic and lead author on both studies told Science Daily. “Understanding these individuals can lead to new insights for HIV therapies.” Reviewing the data collected from 14 clinical studies involving treatment interruption, the researchers found that 67 people out of 700 participants had managed to maintain viral loads of 400/ml or lower for at least 24 weeks after their antiretroviral treatment was interrupted. Further results, published in The Journal of Infectious Disease, showed that those who were treated soon after diagnosis were significantly more likely to become posttreatment controllers than those who started treatment later. Other long-term benefits of early intervention (rather than withholding treatment until someone gets sick) have been recognized for years, and since 2015, the World Health Organization has recommended early treatment for everyone diagnosed with HIV. A second study on post-treatment controllers, published in The Journal of Clinical Investigation, specifically compared HIV reservoirs in post-treatment controllers and posttreatment non-controllers (those who don’t maintain viral suppression after treatment interruption). HIV is known to “hide” in such reservoirs, where it isn’t susceptible to antiretrovirals nor seen in blood tests, but from which it can later rebound, if treatment is interrupted. In the second study, Li’s team examined HIV DNA sequences in the cells of both groups. Before treatment interruption, researchers noted that post-treatment controllers had significantly smaller reservoirs (despite having roughly the same amount of active/inactive viral DNA overall). Previously, research noted that low levels of total HIV DNA
had been associated with short-term delays in viral rebound. Two Boston patients who underwent stem cell transplants retained viral suppression afterwards for 12 and 32 weeks respectively. But the new study suggests “factors in addition to reservoir size must play an important role in determining time to rebound. Such factors could include differences in viral replication rate and/or robust anti-HIV immune responses.” Another intriguing discovery was that reservoirs of even defective viral DNA could play a part in whether someone is able to maintain viral suppression off of antiretroviral medications. Individuals with delayed viral rebound had smaller percentages of defective viral DNA than those whose HIV rebounded quickly. Researchers admitted, “The reason behind this counterintuitive result is unclear.” (One would think more defective DNA would make HIV more robost, not less.) Possible explanations include that more defective viral DNA may be a sign of bigger HIV reservoirs. Researchers also found “an association between higher levels of [natural killer] cell activation and HIV-specific T cell activity with lower levels of total and defective proviral genomes.” Natural killer cells play a critical role in viral immunity and viral control. They found more natural killer cells when there was less defective HIV DNA. “This suggests that a more robust HIV-specific immune response can identify and effectively eliminate HIV-infected cells, even those harboring defective proviruses,” the researchers wrote. “These findings support the concept that defective HIV genomes can lead to viral RNA transcription and antigen production, which leads to interactions of cells harboring defective HIV genomes with both the innate and adaptive immune system.” The Journal of Clinical Investigation report concluded, “Until recently, the defective proviral reservoir appears to have been underappreciated, but these results support the concept that defective proviruses are far from [dormant] and are likely playing key roles in immune activation, shaping anti-HIV immune responses, and may be a marker of the timing of plasma viral emergence after ART discontinuation.” Those with lower levels of defective viral DNA may have more chance of retaining viral suppression despite interruptions in treatment. “Each year, there are millions of new HIV [diagnoses],” Li said to Science Daily. “The results of these studies may help inform the design of strategies and trials aimed at achieving HIV remission, which we hope will bend the curve of this epidemic.” Post-treatment controllers may be considered functionally cured while their viral loads remain suppressed during their periods of treatment interruption, however the majority will experience a viral rebound eventually. According to the Journal of Infectious Diseases report, 55 percent of the post-treatment controllers maintained HIV control for two years, and approximately 20 percent maintained viral suppression for five years or more. Even controlling HIV for two years without antiretroviral medication would be a huge boon for those living with HIV. Without a doubt, a longer functional cure is everyone’s end goal. —JACOB ANDERSON-MINSHALL
HIVPLUSMAG.COM
44-48_PLUS127_Treatment_FINAL_revised.indd 47
47
10/1/18 3:37 PM
TREATMENT
GROWING PAINS New findings published in the June issue of the medical journal AIDS reveal that frailty is twice as prevalent in middle-aged and elderly men living with HIV as it is with HIV-negative men. Researchers also found that men living with HIV who had high waist measurements were more likely to suffer from frailty than men with smaller waists. Frailty generally includes weakness, exhaustion, slowness, low physical activity, and or unintentional weight loss, according to Johns Hopkins University School of Medicine researcher Qian-Li Xue, who reported on the frailty syndrome for the journal Clinics in Geriatric Medicine. People living with HIV age somewhat differently than those without it overall, but the team behind this study focused on assessing the extent of differences in aging for men. Investigators from the Multicenter AIDS Cohort Study (MACS) studied 399 men, 200 being HIV-negative and 199 being HIV-positive. MACS is an ongoing 30-year study of men living with the virus. All of the men who were assessed for the project were between the ages of 50 and 69. The prevalence of frailty was found to 48
be twice as common in HIV-positive men—16 percent compared to 8 percent. All HIV-positive men were taking antiretroviral drugs and most were virally suppressed. Risk factors associated with frailty included abdominal obesity and loss of skeletal muscle mass, most commonly due to either sarcopenia or osteoporosis. Investigators assessed body composition, including the mens’ body mass index, waist circumference, and bone density. The risk factors, however, did not differ by HIV status. “We found robust associations between frailty and central adiposity and sarcopenia. To the best of our knowledge, the association between frailty and VAT [visceral adipose tissue] area in adult men with HIV has not been previously reported,” the study’s authors said. The combination of these symptoms, researchers said, is probably due to underlying chronic inflammation and immune response. Researchers have called frailty the “Silent Epidemic,” and it has been a real concern for people living with HIV. It is connected to low bone density and muscle mass, and can hamper the ability to carry out common daily tasks. Ironically, frailty can be caused by high waistlines, though the
characteristics can also include weight loss. Additionally, it can cause exhaustion, slow walking speed, and low levels of strength. The connection between frailty and body composition in men living with HIV is not completely understood. Several other studies in recent years have attempted to decode how frailty is related to HIV. There are a few things that men living with HIV can do to avoid being limited by frailty, including taking Vitamin D supplements. The best thing you can do is simply be aware of the real risks that are associated with HIV-related bone density loss and related problems. The loss of skeletal muscle mass is something men living with HIV need to be aware of. “Higher abdominal obesity and sarcopenia were associated with frailty among men with and without HIV,” investigators concluded. “Assessment of these body composition parameters may help detect frailty in the clinical setting.” The constant inflammatory effect of HIV is one of the ways the virus may cause frailty in middleaged and older men living with the chronic condition. Watching your waistline and keeping track of what foods you are eating can help prevent frailty problems further down the line. —BENJAMIN M. ADAMS
SHUTTERSTOCK
The aches in your joints and muscles aren’t just in your imagination.
NOVEMBER / DECEMBER 2018
44-48_PLUS127_Treatment_FINAL_revised.indd 48
10/1/18 3:37 PM
Thursday, November 8, 6pm Tribeca Rooftop, New York City Honoring: Jenna Wortham
Award Winning Journalist for The New York Times
Karen SauvignĂŠ
Longtime Callen-Lorde Supporter, and Former Board Chair
Dr. Marci Bowers Sponsorship opportunities and tickets are available at callen-lorde.org/cha
18757 callen Lorde Plus.indd 1
9/28/18 1:55 PM
CHILL CHILL URBAN DICTIONARY DEF: COOL, TIGHT, WICKED, SICK, SWEET, NICE, EASY GOING, SEX
A MAGAZINE FOR US P R E M I E R I N G A P R I L / M AY 2 0 1 8
OUR DEF: A NEW MEN’S MAG THAT’S ALL THAT AND MORE C H I L L . U S | @ C H I L LT H E M A G
CHILL.US
•
@ C H I L LT H E M A G Photo by Alex D. Rogers
Plus_FP4C_Template.indd 1
9/28/18 9:25 AM