Plus 130 May June 2019

BECAUSE YOU’RE MORE THAN YOUR STATUS

JUST DIAGNOSED? 30 THINGS YOU NEED TO KNOW

PREP SCHOOLED

PREVENTION305’s MARCO TORREALBA IS ON A MISSION TO GET LATINX MIAMI ON PREP

MAY/JUNE 2019 www.hivplusmag.com

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IMPORTANT FACTS FOR BIKTARVY® 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

POSSIBLE SIDE EFFECTS OF BIKTARVY

BIKTARVY may cause serious side effects, including:

BIKTARVY may cause serious side effects, including: } Those in the “Most Important Information About BIKTARVY” section. } 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 (6%), and headache (5%).

} Worsening of Hepatitis B (HBV) infection. If you

have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to check your health regularly for several months.

ABOUT 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. Do NOT take BIKTARVY if you also take a medicine that contains: } dofetilide } rifampin } any other medicines to treat HIV-1

BEFORE TAKING BIKTARVY Tell your healthcare provider if you: } Have or have had any kidney or liver problems,

These are not all the possible side effects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY.

including hepatitis infection. } Have any other health problems. } 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. } Are breastfeeding (nursing) or plan to breastfeed.

Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

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

Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.

HOW TO TAKE BIKTARVY

Tell your healthcare provider about all the medicines you take:

Take BIKTARVY 1 time each day with or without food.

} Keep a list that includes all prescription and over-the-

GET MORE INFORMATION

counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. } BIKTARVY and other medicines may affect each other.

Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.

Get HIV support by downloading a free app at

MyDailyCharge.com

BVYC0102_BIKTARVY_A_7-875x10-5_Plus_KeepPushing2_C1_r1v1jl.indd All Pages 18861 Biktarvy Plus 130.indd 2

} This is only a brief summary of important information

about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more. } Go to BIKTARVY.com or call 1-800-GILEAD-5. } If you need help paying for your medicine,

visit BIKTARVY.com for program information.

BIKTARVY, the BIKTARVY Logo, DAILY CHARGE, the DAILY CHARGE Logo, KEEP PUSHING, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies.

Version date: December 2018 © 2019 Gilead Sciences, Inc. All rights reserved. BVYC0102 01/19

2/28/19 11:54 AM

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

BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.

Ask your healthcare provider if BIKTARVY is right for you.

To learn more, visit BIKTARVY.com.

Please see Important Facts about BIKTARVY, including important warnings, on the previous page and visit BIKTARVY.com.

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BECAUSE YOU’RE MORE THAN YOUR STATUS

MIAMI NICE RAW STORY FOUNDER JOHN K. BYRNE IS ON A MISSION TO GET FLORIDA ON PREP

MAY/JUNE 2019 www.hivplusmag.com

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IN THIS ISSUE

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M AY / J U N E 2 0 1 9

30 ON THE COVER

36

30 MIAMI TWICE Two men—Venezuelan-born Marco Torrealba and Raw Story CEO John Byrne—teamed up to educate Miami's Latinx community about HIV and PrEP. Now other agencies want to learn from their playbook.

FEATURES

RICARDO SALAZAR (30, BOTH); RIC RODRIGUES/PEXELS (36)

36 JUST DIAGNOSED Discovering you are HIV-positive can seem overwhelming, but we're here to help you navigate these critical first steps so you can find a doctor, get help paying for treatment, and live your best life.

40 THE 411 There's a lot of misinformation out there about HIV. We break down the facts and answer 20 of your most pressing questions.

Above (from top left): Prevention305 founder John Byrne; Miami PrEP activist Marco Torrealba; and some advice for the newly diagnosed.

On Cover: Marco Torrealba, courtesy Prevention305

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IN THIS ISSUE M AY / J U N E 2 0 1 9

28 8

UNDETECTABLE 18

FORMULA NONE Is it time for HIV-positive moms to switch from formula to breastfeeding?

SWITCHING MEDS 19

INHIBIT THIS Switching from one kind of inhibitor to another could save your life.

TREATMENT

20 LONDON CALLING He wasn't cured, but this U.K. man's remission is still amazing.

22 BRAIN WAVES Cognitive disorders are often misdiagnosed.

23 FEELING CRAPPY Diarrhea is still an issue for people with HIV.

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ADVICE

24 BE THE BOSS Frustrated that you're not getting your lab results when promised?

Here's how to take control.

BUZZWORTHY

8 TRAILBLAZERS Pedro Zamora scholars are changing the world.

9 AGING GRACEFULLY Gilead is helping long-term survivors.

10 RECHARGED Judge blocks discharge of two poz airmen.

11 WHAT U DON'T KNOW Gay and bi men don't understand U=U. 11 HEADLINERS Elton John and Jussie Smollett made news.

12 ON A MISSION Sanjay Johnson hopes his case will help eradicate laws criminalizing HIV.

DAILY DOSE 13

SICK LEAVE Sometimes a little hypochondria goes a long way.

CHILL 17

SAFETY ZONE How U=U changed the dating game for one queer writer.

I AM THE FIRST

28 OUT OF THE WOODS Ashton Woods is planning to be the first out poz person on the Houston City Council.

BACKTALK

48 HEAD OF STATE Being gay and HIV-positive hasn't derailed the political career of Greg Harris, Illinois House Majority Leader.

Above (from top left): Politician Ashton Woods; scholar Tranisha Arzah; anti-criminalization activist Sanjay Johnson

HIVPLUSMAG.COM

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TEODORO LUNA IV. (28); COURTESY SANJAY JOHNSON (12); COURTESY NATIONAL AIDS MEMORIAL (8)

21 STROKE OF GENIUS An HIV drug could help with stroke recovery.

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

creative director RAINE BASCOS associate art director PATRICK MADISON deputy editor JACOB ANDERSON-MINSHALL editor at large TYLER CURRY-MCGRATH managing editor DAVID ARTAVIA associate editor DESIRÉE GUERRERO assistant to the editor DONALD PADGETT editorial intern ASHLEY SCHEIBELHUT contributing editors KHAFRE ABIF, DIMITRI MOISE, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writer JEANNIE WRAIGHT interactive art director CHRISTOPHER HARRITY online photo and graphics producers MICHAEL LUONG, TEVY KHOU front end developer MAYRA URRUTIA manager, digital media LAURA VILLELA assistant vp, integrated sales STUART BROCKINGTON executive directors, integrated sales ADAM GOLDBERG, EZRA ALVAREZ senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN senior coordinator MICHAEL TIGHE executive vp, branded partnerships GREG BROSSIA designer, branded partnerships MICHAEL LOMBARDO director, branded partnership JAMIE TREDWELL associate directors, branded partnerships ERIC JAMES, MICHAEL RIGGIO associate director, branded partnerships and experiential JOHN O’MALLEY manager, branded partnerships CASEY NOBLE editor, social media DANIEL REYNOLDS branded content writer IAN MARTELLA senior fulfillment manager ARGUS GALINDO office manager HEIDI MEDINA print production director JOHN LEWIS

PRIDE MEDIA chief executive officer NATHAN COYLE chief finance officer JANELLE MITCHELL chief revenue officer ORLANDO REECE corporate executive vice president BERNARD ROOK 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 Pride Publishing Inc. Plus is a registered trademark of Pride Publishing Inc. Entire contents © 2019 by Pride Publishing Inc. All rights reserved. Printed in the U.S.A. Unless otherwise noted, all stock images are of posed models.

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EDITOR’S LETTER

LUKE FONTANA (DIANE)

ABOUT THAT COVER

One particular activist-turnedreporter-turnedentrepreneur I love is Michael Rogers, a former ACT UP activist and fundraiser who launched a personal blog whose biggest draw was outing closeted gay politicians who were actively fighting against LGBTQ rights. (The Washington Post once called him the most feared man on Capitol Hill, long before he outed U.S. Rep. Ed Schrock.)

In 2004, Rogers partnered with John Byrne (above, bottom), founder of Raw Story, and today the two men own one of the largest privately held collections of online LGBTQ-owned news media companies in the U.S. (which includes Raw Story, AlterNet, and The New Civil Rights Movement).

“We believe the future of true independent journalism is one of self-sufficiency, the absence of corporate parents or a venture capital race for the next dollar,” said Byrne when the duo bought AlterNet, the legendary indie media outlet. “We are excited to create a solid future for AlterNet and The New Civil Rights Movement and to safeguard their important missions of strategic journalism, civil rights and social justice, and politics.”

So imagine my delight to discover that Byrne turned that media money into a solid HIV-prevention organization, Prevention305, and hired a Latinx immigrant to help get the people of Miami on PrEP, and shares their successful outreach methods with any organization who asks.

I’m such a fan of Byrne (and Rogers) that it would have been easy to put the Raw Story founder on the cover of Plus. His years of media creation, political organizing, and now HIV prevention funding is astounding. But as Byrne himself argues, sometimes it’s best for the guy with white privilege to take a backseat. Hence, program manager Marco Torrealba (above, top) gets to represent!

In talking about being a white guy running an agency largely for Latinx people, Byrne is aware that “white people have so many structural advantages” when it comes to getting grants for HIV work. “It’s good to see that there are some funders that are now accepting applications in Spanish… but these grants are set up for people to win who went to the Ivy League schools.

They’re not set up to necessarily find the people who need the money. The problem with philanthropy, in general, is that rich people get to pick the winners. It’s a terrible system.”

He hopes to change that, at least in Miami. But for now, Byrne and Torrealba are busy changing lives dramatically with the money they have.

I HAVE A younger friend who recently found out he was HIV-positive—something that still happens with regularity. Although we’re now in the era of U=U, where medical advancements have made living with the virus as easy as living with many other chronic conditions, he soon fell into a downward spiral.

Sinking into depression, shame, and a quarter-life crisis, my friend began to reevaluate everything in his life—doing so without therapy, which is never a good idea. (He’s seeing a therapist now and is on the mend.) The whole situation reminded me of how critically important the months after diagnosis are for maintaining your mental health.

You may also be struggling with fears that HIV has changed everything for you. You may be blaming yourself. If so, please believe me when I assure you that it’s not your fault, you got this, and things get better when you allow others to help you. Had my friend tried to tackle his dark thoughts alone, I could have lost yet another friend to the epidemic.

This is the first year we’ve seen a true global scientific consensus on U=U, or undetectable equals untrasmittable. If you haven’t heard of U=U, you should know that scientists and medical researchers agree (and have tens of thousands of real world examples as part of their research data) that if your HIV viral load is low enough to be undetectable, you cannot transmit HIV to anyone.

How do you become undetectable? Get on treatment as soon as you find out you’re HIV-positive. Get on it, stay on it, take it as prescribed. For most people, that’s enough to become undetectable in a matter of weeks.

And if you have a boyfriend, girlfriend, wife, husband, or frequent playmate who is not living with HIV, ask them to get on PrEP, the HIV prevention treatment strategy that will prevent them from acquiring the virus from anyone who isn’t undetectable. (Please don’t shame them if they have other sexual partners besides you—their health is more important.)

There’s no need for anxiety and self-loathing about being poz. You contracted a virus from someone who may not have even known they had it. Imagine if every time you caught the flu, it sent you into a spiral of shame. This virus, even though transmission happens mainly through sexual contact, is no different. You contract it and you treat it, and when you get on treatment you can’t pass it along, so you stop the cycle. That’s something to be proud of.

HIV doesn’t have to stop you. That’s the message of people living with HIV, such as Greg Harris—the new out, gay, HIV-positive House Majority Leader of Illinois (see page 48)—and other politicians like mayors Sean Strub and John D’Amico; organization directors like Naina Khanna, Bré Campbell, and Bamby Salcedo; and performers like Mel England, Joseph Kibler, and Rae Lewis Thornton. The list goes on (visit HIVPlusMag.com/Amazing-HIV-Positive-People to check out more inspiring poz peeps).

Your life isn’t over, my friend. Your diagnosis is just the beginning. Make the most of it.

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

HIVPLUSMAG.COM

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buzzworthy

Some of the recipients of the 2019 Pedro Zamora Young Leaders Scholarship

HIV VANGUARD Get to know the 2019 recipients of the Pedro Zamora Young Leaders Scholarship.

N

BY DESIRÉE GUERRERO amed in honor of the HIV educator, activist, and beloved reality television pioneer Pedro Zamora (The Real World), who died 25 years ago at the age of 21 due to an AIDS-related illness, the Pedro Zamora Young Leaders Scholarship supports the education of young people who are engaged in a variety of HIV-related work in their schools, communities, and chosen academic fields.

To date, the program—created by the National AIDS Memorial Grove (AIDSMemorial.org)—has awarded a quarter of a million dollars in scholarships, with major support from Gilead Sciences and Wells Fargo. Check out the 2019 recipients, who each received $5,000.

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TRANISHA ARZAH, a native of the Seattle area, is currently a freshman at Seattle Central College pursuing a career in community health and education, with an emphasis on social justice. After college, she plans to continue advocating for women and youth and implementing policies that support comprehensive sexual health models. Plus honored Arzah as one of our Most Amazing HIV-Positive People of 2016, when she was already working as a peer advocate for BABES Network (where she’s worked for 5 years), a support program created by the Seattle YWCA; and serving on the board of Positive Women’s Network-USA. “We thrive to advocate for our sisters and to make a difference, but we connect mostly because we’re women living with HIV,” Arzah noted recently. “I simply treasure spaces where women inspire other women. Without the women who lifted my spirits, I wouldn’t be doing this today.”

KOTA BABCOCK isn’t afraid to fight on the political front lines and spends much of his time and energy advocating to Colorado elected officials on the need to improve preventative care to people at-risk or living with HIV. The freshman at Colorado State University in Denver is pursuing a degree in journalism and wants to help preserve the history and legacy of those who fought and lost their lives to HIV. An intern at Denver’s All the TEA organization, Babcock has also served as an ambassador for National Youth HIV/AIDS Awareness Day. Babcock was recognized for his fearless activism even before graduating high school, as a recipient of the Failure Award scholarship—a tongue-in-cheek name for a very prestigious honor given by the Museum of Contemporary Art Denver to students “who demonstrate a willingness to risk failure in the pursuit of something new.”

MONA BANDOV, a freshman at the University of California, Berkeley, plans to become a global health professional with a goal of establishing accessible and free health clinics, and to provide assistance to marginalized communities in Southeast Asia. Bandov found her calling during an internship with the HIV/AIDS organization, Until There’s a Cure (Until.org).

“I am extremely grateful for this opportunity because as a firstgeneration college student, I realized that anything is attainable if one puts their mind to it,” Bandov wrote in an email to The Daily Californian, adding, “I truly believe that health care should not be a luxury, it should be a basic human right. I would love to bridge the gap between health care and people.”

COURTESY NATIONAL AIDS MEMORIAL (PEDRO SCHOLARS, BOTH PAGES)

THE NEW

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JUSTIN BELL recently worked in Liberia as a volunteer with the United Methodist Church Mission Global Health Team and, after seeing firsthand the impact of HIV in the local community there—a lack of education and misinformation about treatment and care—he was inspired to get involved in the fight against HIV stigma as well as in education and prevention. After returning to Atlanta, Bell has been volunteering to promote student health safety on campus at Georgia State University, where he is currently studying political science and finance.

ASAMIA DIABY, a junior at CUNY Lehman in Bronx, N.Y., is a housing advocate dedicated to protecting the rights of HIV-affected individuals.

Diaby says she believes that ending the HIV epidemic requires housing reform, income equality, safe injection facilities, and health care for all. Through her work with H.O.M.E. (Housing Over Monitoring and Eviction) and VOCAL-NY, she works toward achieving “social justice for all.”

SHUTTERSTOCK (SCOOTER)

GRACE GAUTEREAUX, a second-year recipient of the Zamora scholarship, wants to use her education to turn the tide on abstinenceonly education and promote a sex education curriculum that will encourage youth of all sexualities and genders to use condoms and engage in safe sex. In addition to her work with NARAL Pro-Choice Oregon, the junior at Willamette University in Salem, Ore., is also active in multiple on-campus clubs dedicated to sexual health and justice.

The fiery feminist and vocal activist recently studied abroad at the National University of Ireland, Galway. “This experience is one I have been looking forward to for many, many years and will be a wonderful opportunity to reconnect with my Irish heritage while broadening my global perspective,” Gautereaux said on her Go Fund Me page for the trip.

KARLO MANZOARROYO, a freshman at the University of Illinois at Chicago, works in the local Department of Public Health as a certified rapid HIV tester and

counselor, connecting people in need to HIV services throughout Chicago.

He is currently pursuing a degree in accounting to work within his agency’s finance department and ensure continued funding for HIV programs.

EMILY NOLD is a freshman at the University of British Columbia in Vancouver, Canada, and plans to study nonprofit administration and management. The Fox Island, Wash., native helped lead her high school’s AIDS Peer Education Exchange (APEX) Club, and was active in the Pierce County AIDS Foundation (PCAF-WA.org). Working with PCAF, Nold helped organize World AIDS Day observance events, distributed condoms, and coordinated fundraisers.

“This scholarship is giving me the opportunity to continue my studies,” said Nold, and added that she is “incredibly thankful for the National AIDS Memorial and their unfathomable love for youth activism and dedication to supporting the next generation of leaders in the fight against HIV/AIDS.” VERENICE ORTIZ-ROBLES, a freshman at Central New Mexico Community College in Albuquerque, N.M., lost her father to AIDS-related complications. Ortiz-Robles says that she continues the fight in his honor.

She is a member of the International AIDS Society, where she helps translate material and presentations on safe sex.

NICOLAS RIOS was already actively working in HIV advocacy while still finishing high school in Tucson— working with the Southern Arizona AIDS Foundation, serving in its Youth Empowerment LGBTW Leadership Coalition, in addition to serving on the Youth HIV/AIDS Awareness Day and Youth Advisory Council. Rios also founded his school’s first Gender and Sexuality Alliance to educate and normalize discussions around sex and sexuality. The freshman at George Washington University in Washington, D.C., says he plans to study public health policy.

Positive Aging

Gilead dedicates over $17 million to improving the lives of those growing older with HIV. “This is the first time in American history when nearly 50 percent of people living with HIV are over the age of 50,” Gilead Sciences recently noted in a press release announcing a $17.6 million HIV Age Positively initiative to help address the needs of long-term survivors and other older Americans living with HIV. Specifically, the pharmaceutical company behind HIV-related medications such as Truvada is issuing grants to 30 health care or advocacy organizations to address three interwoven goals: helping providers better serve older people with HIV, offering resources and services necessary to health and wellness (including adjacent resources like meal delivery services) for elders, and advocating for policy and government funding to provide more services for those aging with HIV. “Gilead understands science alone is not enough to help people lead longer, healthier lives,” noted Amy Flood, senior vice president of public affairs at Gilead, in a statement to the press. “That’s why we work together with advocates, health care providers, and community organizations to identify the unique challenges people aging with HIV experience and dedicate resources to maximize impact in communities across the country.”

Long-term survivors and other aging HIV-positive people are finding themselves facing unexpected needs—and having to rely on themselves and HIV organizations to meet a growing list of concerns (read our recently report: Bit.ly/LTSNeeds).

“Anyone who lived through the 1980s and ’90s remembers the generation of Americans we lost to the HIV epidemic and the heroic work this community HIVPLUSMAG.COM

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buzzworthy offering legal services (Legal Aid Service of Broward County), and those specifically serving minority populations (American Indian Community House, Us Helping Us, My Brother’s Keeper), older queers (SAGE, New Orleans Advocates for GLBT Elders), and the formerly incarcerated (Center for Health Justice).

Here are a few specific projects funded by the Gilead initiative: The AIDS Institute plans to launch the Institute for Policy, Education & Advocacy Resources for Aging Adults to serve as a clearinghouse of information and educational materials for and about those aging with HIV. American Indian Community House’s Healthy Elders Network will identify ways of improving access to care for Native American elders living with HIV by identifying social determinants of health for this group, engage elders in developing strategies for increasing awareness of culturally competent HIV care needs, and facilitate data collection to guide future policy decisions.

The Association of Nurses in AIDS

JUSTICE FOR ALL A Virginia judge blocks the discharge of two HIV-positive airmen, saying her decision was in line with modern science.

BY TRUDY RING

A federal court has blocked the Department of Defense from discharging two members of the Air Force simply because they are HIV-positive.

Judge Leonie M. Brinkema of the U.S. District Court for the Eastern District of Virginia issued a preliminary injunction February 15 against the discharge of two airmen while their case proceeds to trial. One of them was scheduled to be discharged within 10 days, noted a press release from Lambda Legal, which is representing the men along with OutServe-SLDN and the law firm of Winston and Strawn.

In issuing the injunction and denying the Defense Department’s motion to dismiss the case after hearing arguments from both sides, Judge Brinkema found that the airmen are likely to succeed in their case.

“These are the kinds of people that it seems to me the military wants to keep in the service,” she said in court, according to The Washington Post.

The Air Force sought to discharge the two men, who have been identified only by pseudonyms, on the basis that they could not be 10

Care will partner with major gerontology nursing organizations and schools to train nurses across the U.S. on providing aging people living with HIV optimal care and care coordination.

Borrego Community Health Foundation, which runs 24-hour health clinics in Southern California, will implement a care program for older people living with HIV with co-occurring methamphetamine use disorder. Along with experts from University of California, Borrego will provide training to health care providers in the Palm Springs area in geriatric medicine and Getting Off, an evidence-based meth treatment program developed for gay and bisexual men.

Legal Aid Service of Broward County’s HIV Age Positively Legal Advocacy Program will provide direct legal services to HIV-positive seniors; develop training materials and provide training to assisted living facilities, nursing homes, and shelters; and develop an HIV-positive seniors’ bill of rights and lobby for its adoption in Florida.

—JACOB ANDERSON-MINSHALL

deployed to the Middle East due to their HIV-positive status. However, the “plaintiffs have made a strong preliminary showing that the Air Force’s approach to service members living with HIV is irrational, inconsistent, and at variance with modern science,” she wrote in her ruling, given that the virus can be controlled with medication to the point that it is undetectable—therefore rendering it untransmittable.

Both men, diagnosed in 2017, are on antiretroviral treatment, have no symptoms, and have been pronounced physically fit to deploy by their doctors. Assistant U.S. Attorney Robert Norway, representing the Defense Department, raised the possibility that the men’s medication could be lost while they are overseas and their viral load would again become detectable and the virus transmittable. But Brinkema noted that studies indicate this process would take several weeks.

The airmen had argued their discharge was arbitrary, as other HIV-positive military members had been allowed to remain in the service. The government, however, claimed the two men in question were more likely to be deployed because of their young age. But Judge Brinkema found no barriers to their deployment, and one of the plaintiffs has already served in the Middle East.

“This is a major victory in our fight to ensure everyone living with HIV can serve their country without discrimination,” Scott Schoettes, counsel and HIV project director at Lambda Legal, said in a press release. “These decisions should be based on science, not stigma, as today’s ruling from the bench demonstrates. Despite President Trump’s promise to improve the lives of people living with HIV at the State of the Union this month, his administration continues to defend these policies and others discriminating against people most impacted by HIV. Lambda Legal will keep fighting until these brave and qualified Airmen can serve without limitation.”

“We are thrilled that Judge Brinkema recognized not just that the military’s policies were harming our members who are living and serving with HIV,” added Peter Perkowski, legal and policy director for OutServe-SLDN. “But also indicated that, at least on the evidence before her, the military’s decisions were based on outdated medical science and are categorically denying people living with HIV the same opportunities as their fellow service members.”

SKEEZE/PIXABAY

has done together to increase the life expectancy of people living with HIV,” said Kelsey Louie, CEO at Gay Men’s Health Crisis, one of the organizations to receive funding from the initiative. “As they have in the past, Gilead brought experts together, listened to what our community needed, and identified the organizations best equipped to tackle specific problems.

Funding from HIV Age Positively is going to help long-term survivors combat loneliness, obtain access to the resources and support they need, and create better, more personalized health care.”

Those receiving grants include large organizations like GMHC and the AIDS Institute; nationwide health care associations like The Association of Nurses in AIDS Care and Professional Association of Social Workers in HIV & AIDS; regional care providers like APLA Health & Wellness and San Francisco AIDS Foundation; and research centers like Hektoen Institute for Medical Research and the University of California, San Francisco.

The grants are also helping those providing meals (Project Open Hand) and

MAY / JUNE 2019

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WHAT’S THE NEWS? Two celeb HIV activists are making headlines again—for totally different reasons.

EVAN AGOSTINI/INVISION/AP (JOHN); ZZ/DENNIS VAN TINE/STAR MAX/IPX (SMOLLET)

When HIV activists become a story themselves, it’s usually under the umbrella of advocacy or fighting against stigma of all kinds. But not always. Earlier this year, two famous HIV activists made headlines across the globe—for totally different reasons.

The world is anticipating the premiere of Rocketman, the musical biopic about the life of Elton John, legendary performer and founder of the Elton John AIDS Foundation. Led by the multitalented Taron Egerton, the film premieres May 31 in the U.S. In a 2017 cover story in The Advocate, John reflected on how his foundation was born, in October 1992: “Elizabeth Taylor asked me to join her for a benefit concert… to raise money for HIV [and] AIDS research. It [was] the final catalyst for one of the most important decisions I have ever made in my life: the decision to start an AIDS foundation.”

“As effective as the benefit concert was, just performing at benefit concerts felt piecemeal to me,” he added. “Funding was badly needed to help people in the midst of the epidemic. So we thought of creating a single place where funding could be raised, compiled, and spent strategically for community groups.”

John called his friend John Scott and told him he was starting an AIDS foundation, and that John wanted him to run it. “Two months later,” John explained, “the Elton John AIDS Foundation opened its doors in John Scott’s kitchen in Atlanta.”

Empire actor and former Plus cover star Jussie Smollett became infamous in February after the Chicago police charged him with 16 felony counts of disorderly conduct for allegedly paying two brothers to stage a fake hate-crime assault. Smollett had said he’d been attacked by two men in ski masks who placed a noose around his neck and poured bleach on him while wearing MAGA hats and shouting antigay and anti-Black slurs and proTrump views.

The gay actor had a slew of supporters until media outlets began reporting on the alleged hoax (at press time, Smollett denies the allegations). In a 2016 Plus cover story interview, Smollett spoke about his role in addressing social issues.

Many HIV activists, hoping there’s more to this story, are waiting to hear Smollett’s story in court before making judgement.

“With the light and the platform that we have been given, I’m certainly not gonna shut up now,” he said of his outspokenness on social media.

“Now is not the time. Well, it’s never the time. It’s never the time until it is the time.”

Smollett also spoke about power— something that, to many, he abused himself by committing the alleged hoax.

“Everybody wants somebody to oppress,” he explained. “Really think about that. Everybody wants somebody to oppress, and that’s why even we who are oppressed— whether it be the LGBTQ community … communities of color, whether it be women—we are all oppressed communities, but even the oppressed want to oppress, because we’ve been taught by society that to be the oppressor means that we are the one that holds the power.

Everybody wants to be powerful. It’s just everybody projecting their own insecurities. I promise you—nobody really wants to be homophobic.

Nobody really wants to be that way.

We are a product of our environment and what we are taught. And we are taught to believe that we are supposed to be that way.”

CLUELESS? SOME DON’T GET SCIENCE

An alarming recent survey of over 700 gay and bi men in New York City revealed that only:

39%

believe that maintaining an undetectable viral load offers “a lot of” or “complete” protection from HIV transmission.

Including…

28% 49% 58%

of HIV-negative men and

of male PrEP users and

of HIV-positive men who agree However,

70%

of those surveyed do understand daily PrEP provides that level of protection.

The Centers for Disease Control and Prevention confirms that being undetectable prevents HIV transmission (i.e. that undetectable equals untransmittable is true). You can believe it.

Source: AIDS & Behavior, January 2019 HIVPLUSMAG.COM

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BUZZWORTHY

Sanjay Johnson was charged with “exposing” someone to HIV, despite being virally suppressed. The U=U consensus helped free him.

B Y D AV I D A R TAV I A

A

s of 2018, 26 states still have laws criminalizing HIV on the books. Put in place in the late 1980s and early-1990s, before the development of highly effective antiretroviral therapy when an HIV diagnosis was often considered a death sentence, the laws frequently still equate knowingly exposing someone to HIV with attempted murder.

Decades later, the laws continue to stigmatize poz folks despite the development of medications that suppress HIV to such low levels that it’s undetectable and

AIN’T NOTHING BUT A NUMBER The oldest person living with HIV turns 100.

BY AS H L EY SCHEIBELHUT

CONTINUED ON PAGE

Celebrating a 100th birthday is a huge milestone for anyone. But when Miguel, also known as “the Lisbon Patient,” celebrated his centennial this spring it was also a milestone for the global poz community. That’s because he is the oldest documented person living with HIV in the world. What’s more, his viral load is undetectable, he’s in great geriatric health, and he still lives at home and cares for himself.

In light of persistent HIV stigma, Miguel and his family requested that news outlets not display his face in photos nor share his full name. Maintaining that confidentiality, researchers studying Miguel (a pseudonym) nicknamed him “the Lisbon Patient” when referencing him in their case studies and published reports.

“I feel happy,” the soft-spoken senior told Canada’s CTV News, speaking through a translator at a hospital in Portugal. “I’ve spent these years without hardship and without troubles.”

According to CTV News, Miguel was diagnosed with stage 3 HIV (AIDS) in 2004 when he arrived at a hospital near Lisbon with rare forms of colitis and lymphoma and a low CD4 count. He was 84 then and had no idea he was HIVpositive or how and when he contracted the virus.

After learning about the disease, Miguel told his doctor he wanted to fight.

Dr. Henrique Santos, Miguel’s primary physician, recalled having concerns, telling CTV, “When this patient came to me at this age, I had some doubts that he should be treated.” But Santos went ahead and started Miguel on an CONTINUED ON PAGE

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46

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COURTESY SANJAY JOHNSON (JOHNSON); SHUTTERSTOCK (BIRTHDAY)

POZ MAN WALKS

impossible to transmit. Activists have been fighting for years to update HIV laws to reflect current science and have recently had success with modernizing laws in states such as California and North Carolina.

Yet in other places, people living with HIV continue to be charged with felonies for allegedly failing to disclose their HIV status to a sexual partner, engaging in sex work while HIV-positive, or spitting on a law enforcement officer (despite the fact that saliva cannot transmit HIV). Cases that make it to court rarely turn out well for defendants.

For many activists, one recent case in particular is a reflection of the slow progress toward decriminalization.

Sanjay Johnson was arrested in August 2017 when Little Rock, Ark., police charged him with “knowingly and willfully exposing another to HIV.” For simply having consensual sex with another adult, the 26-year-old was suddenly facing a felony charge carrying a sentence of 10 years or more in prison.

If convicted, he would also have been required to register as a sex offender for the rest of his life.

So activists were happy when, in February, an Arkansas court sentenced Johnson to five years probation and ordered him to pay a $750 fine. It wasn’t an acquittal, but the plea bargain reached by Johnson’s lawyer, Cheryl K. Maples, did win Johnson his freedom, and that was the most important thing.

The prosecutor amended the charge to aggravated assault and Johnson entered a “no contest” plea in which he accepted the ruling but didn’t admit to guilt.

While the lengthy probation and threat of jail time if he violates certain conditions are abhorrently unfair, Johnson’s escape from detention is something that would have unlikely occurred even five years ago.

MAY / JUNE 2019

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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

NO MORE ALARM BELLS COULD HYPOCHONDRIA—OR HYPER VIGILANCE ABOUT MY HEALTH—SAVE MY LIFE? OR JUST MAKE ME AND MY DOCTOR CRAZY? in the free clinic, nervously tapping my foot when realizing the nurse was taking longer than normal to come back with my HIV results. For seven years now, I have been living with the news delivered in that cramped little clinic room. But through sharing my experiences publicly, I have somehow navigated sex and love, marriage, and even the beginnings of building a family. Although these issues may seem massive to some, nothing has been as difficult as wrestling with the subtle but constant fear that something is wrong with my health.

When I am in my rational frame of mind, it is easy to see the statistics of a person’s health with HIV when they eat right, exercise, and stay consistent with treatment. I myself preach about the fact that an HIVpositive person’s life is now limitless and our life span is no different than it was before if we stay vigilant in managing our health. But that’s the rational side of me, and he always keeps his cool.

The emotional side of me, however inconsistent, can usually find something to freak out about and lose sleep over every three to six months.

The emotional side likes to remind me that HIV can make me more at risk of developing other illnesses.

Or that some people living with HIV develop drug resistance, and often don’t realize it until they start to get ill. The emotional side of me is in a state of constant vigilance.

Whether it’s a mole that looks weird or a stuffy nose that lingers

SHUTTERSTOCK (SICK GUY); COURTESY TYLER CURRY-MCGRATH (CURRY-MCGRATH)

I REMEMBER SITTING

or a sharp pain in my stomach, my HIV-positive emotions can go to the worst place possible. And not for nothing, a few years ago I was diagnosed with stage one melanoma (skin cancer) after a rather routine checkup at my dermatologist’s office. With HIV and cancer all before the age of 35, you would think I had a flare for the dramatic, but it was the latter diagnosis that sent me deeper into irrational panic. It’s been over two years since melanoma surgery and all has been golden since. But try telling that to the hypochondriac in me.

So, as I enter into my mid-30s, I’ve decided to force my emotional side to sit down with my rational side to make friends. It isn’t necessarily a bad thing to be alarmed or hyper aware of health issues you are at risk for. My emotional side just has to stop panicking all of the time and ringing the alarm bells every time a new freckle pops up.

Instead, she can politely notify my rational side so both girls can get it together without a fight.

In a way, HIV has kind of become a security system for any triggers or warning signs we all face, regardless of status. I would have been diagnosed with melanoma whether I was positive or negative, but it was because of my HIV that I started scheduling regular checkups in other areas of my health in the first place.

Let’s face it, after 30,000 miles on a body, things can start to break down. But many people without HIV may wait longer and let their concerns go unchecked, which leads to bigger complications and higher medical bills in the future. So maybe, just maybe, a little HIV-related hypochondria might end up saving my life one day. Until then, I’ll keep trying to keep the spastic doomsday freakouts to the bare minimum, at least for my poor doctor’s sake.

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

HIVPLUSMAG.COM

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

WHAT IS DESCOVY®?

DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.

DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about DESCOVY? DESCOVY may cause serious side effects: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to monitor your health.

What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: • Changes in your immune system. Your immune system may get stronger and begin to fight infections.

Tell your healthcare provider if you have any new symptoms after you start taking DESCOVY. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that

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

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

The most common side effect of DESCOVY is nausea.

Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking DESCOVY? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist.

Ask your healthcare provider if it is safe to take DESCOVY with all of your other medicines.

• If you are pregnant or plan to become pregnant.

It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

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

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

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

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

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

POSSIBLE SIDE EFFECTS OF DESCOVY

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

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

• Changes in your immune system.

• New or worse kidney problems, including kidney failure.

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

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

The most common side effect of DESCOVY is nausea.

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

ABOUT DESCOVY • DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is not for use to help reduce the risk of getting HIV-1 infection.

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

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

• Have any other medical condition.

• Are pregnant or plan to become pregnant.

• Are breastfeeding (nursing) or plan to breastfeed.

Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

• Ask your healthcare provider or pharmacist about medicines that should not be taken with DESCOVY.

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

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

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

• Take DESCOVY with or without food.

DESCOVY, the DESCOVY Logo, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: September 2017 © 2017 Gilead Sciences, Inc. All rights reserved. DVYC0085 11/17

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CHILL

U

=

U

BY ZACHARY ZANE

+ ME

SHUTTERSTOCK

HOW I LEARNED TO GET OVER MY FEAR OF DATING PEOPLE LIVING WITH HIV AND CHOOSE LOVE INSTEAD. I’M AN ASS man. Doesn’t matter your gender, race, or status—if you have a plump bubble butt, I will (most likely) want to sleep with you.

In my decade of dating, I’ve been with folks from all walks of life: gay and bi men, bears, straight women, trans and gendernonconforming folks, twinks, and the list goes on. In an era of sexpositivity, I rarely get flak for my sexual openness, but when I do get judgment, it’s when I date people who are HIV-positive.

I exist in numerous kink-friendly queer spaces, where it’s not uncommon to meet positive guys because these atmospheres in general tend to be more welcoming. So my inner circle would never outright shame folks living with HIV. It’s more subtle and insidious.

They act as if getting HIV is a fate worse than death, and when discussing the virus, they still lower their voices as they caution me about my supposed risk, as if by saying the words out loud, I’ll magically acquire HIV. Of course that’s not true. When I am on PrEP (pre-exposure prophylaxis) and my partner has an undetectable viral load, I am more likely to get hit by lightning than acquire the virus, even if we’re having sex without a condom.

In an era filled with misinformation, alternative facts, and oldfashioned lies, peer-reviewed research is one of the few ways to get to the truth. Luckily, there have been numerous studies which include “thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP)” that confirmed the inability to pass on the virus if the person has an undetectable viral load, according to the Centers for Disease Control and Prevention. In fact, there’s been enough research that on National Gay Men’s HIV/ AIDS Awareness Day in 2017, the CDC declared, “When [antiretroviral treatment] results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission.”

Put simply, an HIV-positive person can suppress their HIV levels through taking antiretrovirals daily, and maintaining an undetectable viral load. At undetectable levels, it’s not possible to transmit the

virus—a fact now commonly referred to as undetectable equals untransmittable, or simply U=U. Like many queer men, I used to live in fear of acquiring HIV. Even as a teenager, even before I was having sex with men. I used to force my pediatrician to test me for HIV when I had unprotected oral sex with a woman. He insisted I didn’t require testing, but seeing how anxious I was, he would eventually concede. The results, not surprisingly, always came back negative.

After I first started taking PrEP at 24, I admitted to my therapist that I still didn’t feel comfortable having sex with HIV-positive men, even on PrEP and even when using condoms. Knowing, logically, that there was no foundation for my discomfort just made me feel guilty about my discomfort.

As queer men, we’ve been conditioned from a very young age to fear this virus and to avoid it like the plague. At one time, it was a plague, and in less-developed countries and some parts of the United States, it still is.

And if we’ve learned anything from Trump supporters, it’s that intense (and even not-sointense) fear can override logic.

Today, however, people with HIV live rich and fulfilling lives. Still, HIV-negative gay men continue to perpetuate this culture of fear by using terms like “clean” to describe individuals who believe they are HIV-negative, implying that knowing one’s positive status somehow makes a person “dirty.” Or some reply, “I don’t f*ck poz guys” the moment an out HIVpositive man messages “Hey!” on Grindr. In doing so, we reduce a man down to his status.

(And make numerous assumptions about our own ability to know someone else’s status even when they might not know it themselves—how many HIV-negative men really are getting HIV tests every three months?)

Eventually I got over my fear of having sex with and dating positive men, and a lot of it has to do with the growing body of research showing that sex with a guy who knows he is positive and is on treatment to the point of viral suppression is safer than sex with some guy who doesn’t know his status.

OK, it may have had more to do with getting drunk and thinking, Screw it. He’s undetectable and I’m on PrEP! After having sex with numerous HIV-positive men and remaining negative, I finally began to fully trust the science on an intuitive, gut level.

I’ve been lucky to have dated incredible men who are living with HIV, and the thought of not having dated and loved these men deeply saddens me. And all for what?

Fear that was once—but has long since ceased to be—based in reality.

That’s why, today, I don’t choose fear. I choose love instead.

HIVPLUSMAG.COM

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U N D E T E C TA B L E

GOT MILK? IS IT TIME TO RECONSIDER THE U.S. RECOMMENDATION FOR HIV-POSITIVE WOMEN NOT TO BREASTFEED, EVEN WHEN THEY’RE UNDETECTABLE?

CURRENTLY IN THE United States, the Centers for Disease Control and Prevention continues to recommend that women living with HIV feed their infants formula instead of nursing them, but more and more women—and their doctors—are questioning that advice.

As the Mayo Clinic notes, breastfeeding has long been recognized as the preferable method of nourishing a newborn baby. Breast milk contains the right balance of nutrients and plays a critical role in the development of a child’s immune system, and the bonding that occurs between a mother and child during breastfeeding can help create a healthy emotional relationship.

Despite these well-known advantages, women living with HIV have been warned to avoid breastfeeding out of

18

concern that they could transmit the virus to their child.

Yet, the development of highly effective antiretroviral medications has dramatically reduced rates of vertical transmission (previously called mother-to-child transmission) and in response, the World Health Organization recommends— particularly in low-resource settings where the risk of malnutrition is much higher—that HIV-positive mothers exclusively breastfeed with ongoing antiretroviral therapy.

With the consensus that undetectable equals untransmittable (U=U), proving that if your viral load is suppressed you can’t transmit HIV to others, mothers living with HIV in the U.S. are increasingly questioning the CDC’s anti-breastfeeding recommendations.

The Journal of the International AIDS Society, in an article published in January, examined how health care providers are responding to dual pressures to follow CDC guidelines and to address their patients’ interest in breastfeeding.

Over 75 percent of participating providers reported having a patient with HIV explicitly ask if they could breastfeed their child. The majority of providers (66.7 percent)

reported that they discussed infant feeding with their HIV-positive female patients by using open-ended questions.

While sharing the CDC’s recommendations, providers on the whole also tried to understand and address concerns—and continue to support their patients regardless of what choice they made (29 percent reported having a patient who decided to breastfeed despite recommendations against doing so).

The majority of providers (58 percent) reported that their clients’ primary concern was cultural stigma associated with not breastfeeding.

Meanwhile, 70 percent of providers said their primary concern was about their patients adhering to HIV treatment during breastfeeding. (The doctors feared if a patient didn’t adhere, the child could contract HIV.) Researchers found providers struggled with four main issues: U.S. guidelines that inadequately address the desire to breastfeed among women living with HIV; a need to negotiate patient autonomy amid complex feeding situations; how to create harm reduction approaches to support breastfeeding; and equipping patients to deal with multi-layered stigmatization around breastfeeding (or not) while poz.

Currently, the CDC and the American Academy of Pediatrics advise against breastfeeding while HIV-positive regardless of one’s viral load. The CDC argues online, “The best way to prevent transmission of HIV to an infant through breast milk is to not breastfeed. In the United States, where mothers have access to clean water and affordable replacement feeding, [we] recommend that [HIVpositive] mothers completely avoid breastfeeding their infants, regardless of ART and maternal viral load.”

Although the CDC’s hesitancy to endorse poz women breastfeeding is understandable, breastfeeding has lifelong advantages for children.

And it certainly seems that the strict recommendation to not breastfeed when poz is at odds with the latest science around HIV transmission, particularly in association with those who are virally suppressed and undetectable.

102MESSMANOS/PIXABAY

BY DESIRÉE GUERRERO

MAY / JUNE 2019

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SWITCHING

BY JACOB ANDERSON-MINSHALL

kind of inhibitor to another to treat your HIV could decrease your risks of developing diabetes, obesity, or heart disease, according to a study published recently in the Journal of Antimicrobial Chemotherapy.

The study participants, who were virally suppressed thanks to antiretroviral regimens that included Truvada (tenofovir disoproxil fumarate/emtricitabine) and a ritonavir-boosted protease inhibitor, were switched instead to regimens with an integrase inhibitor (either raltegravir or dolutegravir) and saw improvement in insulin sensitivity, insulin resistance, and serum leptin levels.

The study involved 86 participants living with HIV, 86 percent of whom were men, with an average age of 45.7 years, who had been on treatment for at least two years and virally suppressed for at least six months. Researchers switched 45 participants to raltegravir and the other 41 to dolutegravir. Both groups experienced a significant decrease in mean leptin/insulin concentration. Lipid levels also decreased with both raltegravir and dolutegravir.

Higher concentrations of both insulin and leptin have been associated with obesity, and higher insulin concentrations can also be a sign of prediabetes. Meanwhile, lipid levels are the levels of fat, also known as cholesterol, in the blood. High cholesterol is associated with heart disease, a condition that people living with HIV are more susceptible to.

Since kidney disease and heart attacks now kill more poz folks than HIV-related illnesses, lowering these levels can be a good reason to switch from a protease to an integrase inhibitor.

Researchers concluded that “the switch from a [protease inhibitor] to raltegravir or dolutegravir proved effective in improving insulin sensitivity, and also reduced certain inflammatory markers and lipid parameters. Further, larger, randomized trials are clearly needed in order to better define the effect of these switch strategies on glucose metabolism in patients with HIV infection.”

Numerous studies have confirmed that it is safe to switch from your current antiretroviral therapy while you are undetectable without risking your viral suppression. If you are having disconcerting side effects or are dealing with a comorbidity (like high cholesterol or liver disease), reevaluating your medications can be a smart choice for your overall health. Talk it over with your doctor to determine which medications may be right for you. A simple switch of medication could reduce your risk of developing what could end up being a lifethreatening disease.

SWITCHING FROM ONE

CLASS WARFARE

THOMAS VANHAECHT/PEXELS

A SIMPLE MOVE FROM ONE CLASS OF INHIBITOR TO ANOTHER COULD SAVE YOUR LIFE BY DECREASING YOUR RISK OF DEVELOPING LIFETHREATENING DISEASES.

HIVPLUSMAG.COM

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treatment

LONDON CALLING Despite reports to the contrary, a remission is not a cure. But we are closer than ever to one.

E A R L I E R T H I S Y E A R , headlines trumpeted the “cure” of a London man who’d previously been HIV-positive but is currently showing no trace of the virus after more than 18 months off antiretroviral drugs. That this feat—while notable—was hyped as a cure just shows how little the general public understands HIV and cure research.

The unidentified man had a bone marrow stem cell transplant from a donor with a rare genetic mutation resistant to HIV called Delta32—a mutation that prevents a protein called CCR5 from rising to the surface of T cells where HIV can latch on to it. When CCR5 isn’t there to latch on to the virus, HIV is inadvertently unwelcome and thus closed off from infecting cells.

Scientists believe this genetic mutation has been inherited from ancestors who survived the massive bubonic plague outbreaks in Europe centuries ago. Perhaps 1 percent of Caucasians have the mutation, making them virtually immune to HIV. It is much rarer among Native Americans, Asians, and Africans.

Delta32 and CCR5 first became the talk of the town in HIV research nearly 12 years ago when Timothy Ray Brown (dubbed the “Berlin Patient”) was cleared of HIV after receiving stem cell transplants from a donor with the Delta32 mutation to treat cancer (as did the “London Patient”).

According to many reports, Brown’s virus has not returned, which makes him the longest functionally HIVcured person that we know of. This is all great news, but let’s not forget some inconvenient facts.

For example, as of 2017, an estimated 36.9 million people were living with HIV—and yet Brown is the only individual who has remained free of the virus for a decade or more. And the treatment in both Brown’s and the London Patient’s cases is invasive and potentially lethal, which is why it’s only been utilized in cases where the person is fighting terminal cancer.

Other people have been “cured” before—and in every case except for Brown’s, their HIV has rebounded, usually within a few years. Eighteen months HIV-free, while remarkable, is simply not proof that one’s HIV will remain in remission.

There’s also a difference between what is called a “functional cure” and an “eradication cure.” For doctors to claim an HIV-positive person functionally cured, they need to make certain that levels of HIV are undetectable in the bloodstream and those levels don’t rebound when that person stops taking antiretroviral medication.

Today’s HIV treatment medications can suppress the virus to such low levels that it is no longer detectable in the bloodstream, and is no longer transmittable to others. This fact is at the heart of the statement undetectable equals untransmittable (U=U), which is now supported by reams of research and affirmed by hundreds of doctors, advocates, 20

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organizations, and governmental agencies like the U.S. Centers for Disease Control and Prevention.

We’re closing in on a time where daily drugs are no longer needed to keep the virus suppressed. Several long-acting HIV medications are in the pipeline and should be available in the next few years.

And promising studies involving vaccines suggest they could be used to keep HIV virally suppressed for years at a time.

Even in the best-case scenarios, researchers admit that functional cures will likely last no more than a decade. A functional cure means the virus is still in the person’s system, hiding in what are known as HIV reservoirs, from which it can rebound at any point once treatment is stopped.

An eradication cure is different. It would entail the complete elimination of the virus from the body altogether.

That means getting rid of every ounce of active (and dormant) HIV from the blood, organs, and reservoirs. And we’re not there yet. To be frank—we’re not even close. In fact, as top researchers told Plus in 2017, full eradication is no longer the focus of most research.

“We’ve not given up entirely on the notion of eradication,” Dr. Warner Greene, director of Gladstone Institute of Virology and Immunology and a leading cure researcher, told us. “But I think where the successes and the gains are being made is around the area of being able to reduce and control the virus.”

Despite a person being on medication and undetectable, HIV can remain dormant in reservoirs and they are the biggest barriers to eradicating HIV. Once a person gets off treatment, these cells can reawaken and start multiplying all over again, which allows viral loads to rebound and become detectable again. The period of time between when treatment stops and the virus rebounds is referred to as “sustained HIV remission.”

Ravindra Gupta, a professor and HIV biologist who co-led a team of doctors treating the London Patient, has specifically referred to him as “in remission,” explaining to Reuters, “It’s too early to say he’s cured.”

The Berlin and London patients share similar parallels in that they both received bone marrow stem cell transplants from donors with the Delta32 mutation. The procedure itself is so risky that only 38 people in the world have received them, according to The New York Times. The London Patient was number 36.

Both the Berlin and London patients also suffered through a period of “graftversus-host” disease, which is basically a continued on page

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suffer paralysis or lose speech. When CCR5 A N E W ST U DY found that an HIV drug, is missing or blocked, neurons can make new as well as a genetic mutation linked to HIV connections and rewire the brain, enabling resistance, can improve recovery from stroke patients to regain some lost function.” or traumatic brain injury.

Previous research indicates that the Published in the journal Cell, the study Delta32 mutation may be most common had two prongs: The first, in mice, found that among those whose ancestors survived the the HIV entry inhibitor maraviroc enhances devastating bubonic plague outbreaks in recovery of motor skills after strokes and Europe between mid-1300s and 1750. That improves cognitive function after traumatic mutation appears to render people immune brain injury. The second prong, which looked to HIV and—according to these findings— at people who’d had a stroke who also have more likely to recover from a stroke. a the CCR5 mutation known as Delta32, This study was a collaboration between found they experience greater recovery of several research schools. A team at neurological impairments and cognitive University of California Los Angeles led by function after neurological events even Carmichael, set out to evaluate whether without medication like maraviroc. targeting CCR5 with maraviroc could speed The Delta32 mutation has made headlines up post-stroke recovery. They enlisted recently after an HIV-positive man who pharmacologist Esther Shohami, at Hebrew received a bone marrow stem cell transplant University, to test maraviroc’s effectiveness from a donor with Delta32 went into HIVin suppressing CCR5 remission (see story in mice. The results to left). The mutation were positive. prevents a protein “We found that called CCR5 from maraviroc blocked rising to the surface CCR5 in mice of T cells, where HIV and boosted the can attach to it and animals’ recovery invade cells. f ro m t ra u m a t i c Maraviroc also brain injury and uses CCR5 to prevent stroke,” Carmichael HIV from infecting reported. “The big more T cells, and question left to it is prescribed in answer was whether conjunction with eliminating CCR5 other antiretrovirals. wo u l d p ro d u c e Maraviroc covers the the same results in CCR5, where HIV people.” would normally grab Aware that the on, thus preventing CCR5 mutation is the virus from common among attaching.

But how does Ashkenazi Jews, s o m e t h i n g t h at Carmichael’s team An HIV drug may help people fights HIV also help contacted Tel Aviv recover faster from strokes. in recovery after University in Israel, stroke or traumatic where neuroscientist brain injury?

Einor Ben Assayag, It turns out CCR5 is also expressed in was already evaluating the recovery of cortical neurons, but only during or after a people who had suffered mild or moderate stroke. Researchers believe that blocking strokes.

CCR5 helps speed recovery by enhancing “Einor’s lab had the patients’ blood what’s known as plasticity, the brain’s ability samples and was evaluating their recovery to rewire itself after injury. Repairing or from stroke after intervals of six months, rerouting neural pathways allows people to one year, and two years,” said Carmichael, recover cognitive and motor skills that may adding that those with the Delta32 have been lost due to damage to the brain mutation “showed significantly greater (whether caused by a blood clot as in a stroke, recovery in motor skills, language, and or a traumatic brain injury). sensory function.”

“When you suffer a stroke, part of your Fortunately, in maraviroc (Selzentry), brain dies, severing those cells’ connections scientists already have a drug that can mimic with neurons in other regions,” said senior the impact of Delta32. Next, researchers author, Dr. S. Thomas Carmichael, chair of plan to put the drug through clinical trials. the neurology department at the David Having been previously proven safe for Geffen School of Medicine at UCLA, to humans gives maraviroc a head start toward Genetic Engineering and Biotechnology Food and Drug Administration approval.

News. “That’s why stroke patients often —JACOB ANDERSON-MINSHALL

STROKE OF GENIUS

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BRAIN FOG? IT MAY NOT BE HIV

A new study finds an overdiagnosis of HIV-associated cognitive disorder.

HIV-associated cognitive disorder is a significant concern for those living with the virus, but U.K. researchers argue it’s being widely overdiagnosed.

Clinicians from Brighton, England collected data from patients attending an HIV memory clinic and published their findings in Brain Sciences.

The team discovered that only a third of those attending Orange Clinic, a collaboration between local memory services and the Brighton and Sussex Medical School, truly met the criteria for HIVassociated neurocognitive disorder (HAND).

“HIV clinics have always been active in adapting and innovating care models to provide for the changing needs of their patients,” the study authors noted in a report by NAM’s AIDSMap. “The Orange Clinic represents such a model—a novel, needsdriven, efficient, and coordinated service for the aging population of [people living with HIV] who experience neurocognitive issues.”

Though cases of HIV-associated dementia have decreased after the rise of highly effective antiretroviral therapy, previous studies suggested that as many as a quarter of HIV-positive people aged 50 years and older could have at least a mild version of HAND. Assessment for HAND is made using the Frascati criteria, an analysis of neuropsychological testing results. However, some researchers have pointed to a lack of precision within the criteria, which also does not take into consideration the complexity of pathogenic mechanisms contributing to cognitive impairment.

Regardless of the precise diagnosis, HIV-positive people with cognitive and memory problems require specialist support. HIV clinicians in Brighton therefore collaborated with local memory services and the Brighton and Sussex Medical School to establish a specialist clinic to assess, manage, and support HIV-positive people with suspected cognitive impairment.

Orange Clinic patients underwent a range of neuropsychological tests, including assessment of IQ, memory, attention, language processing, visuo-spatial processing, and executive function.

Diagnoses are based on clinical interpretation of each individual’s test results, along with factors that can affect cognitive performance—including mood, mental health, and sleep.

Researchers in this study followed 52 people who received care at the clinic between June 2016 and May 2018. The median age of participants was 55 years old, while 79 percent were male, 83 percent were white, and the median time since learning their HIV 22

diagnosis was 17 years. Only one person was not currently in treatment for HIV and only four others still had a detectable viral load. A third of the clinic’s clients reported recreational drug use. On average, the participants were taking five non-HIV medications. Additionally, 46 percent were also being treated with antidepressants.

According to the Frascati evaluation, a whopping 81 percent of those studied had HIV-associated neurocognitive disorder. However, when the clinicians used their own more sophisticated diagnostic criteria, the results were wildly different.

Under the newly refined criteria, only 31 percent were found to truly suffer from HAND while the others suffered from cognitive impairment due to other causes. Twenty-seven percent had a secondary mental health issue, such as depression, anxiety, drug/alcohol use, or poor sleep; 14 percent had a non-HIVrelated cause, such as cerebrovascular disease or brain injury; and four percent were diagnosed with age-related dementia (one due to Alzheimer’s).

“It is significant that 27 percent of those who attended the clinic had a mental health condition, which was likely to be responsible for their objective cognitive impairment,” the study authors stated.

The authors suggest that HIV-related cognitive impairment has evolved along with the development of combination therapy. In the years before effective treatment, HIV-associated dementia was “characterized by progressive subcortical dementia with prominent degeneration of cognitive and motor functions.”

These days, people living with HIV are more likely to have their HIV in check—which leads to less cognitive damage—and they are less likely to be on medications that cause brain fog as a side effect. Researchers argue that those diagnosed with HAND have subtler memory impairments, as well as milder impairments to attention, visuospatial skills, and language.

The study’s conclusion immediately had real world consequences, when 23 people were determined to have been misdiagnosed and were discharged from the Orange Clinic. Nine were found to have no “objective” cognitive impairment; eight had impairment that was deemed due to mental health problems—which the clinic argued would be better treated more effectively elsewhere—and three were deemed to have such a mild form of HAND that they did not need treatment. continued on page

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CAN’T QUIT YOU

Diarrhea. It may be embarrassing to talk about, but people with HIV still experience it—way more than doctors expect.

BY JEANNIE WRAIGHT

VIKTOR HANACEK/PICJUMBO

A study presented at AIDS 2018 last November showed that the rate of noninfectious, HIV-related diarrhea hasn’t changed significantly over the past nine years—and continues to effect 17 percent of people living with HIV. The results of this large clinical trial review are highly compelling because chronic HIV-related diarrhea not only has a direct physical effect, but it can also have severe consequences to one’s quality of life, mental well-being, drug effectiveness, and adherence to antiretroviral treatment. Unfortunately, even now, diarrhea is not well addressed as an important health concern in people living with HIV. Researchers examined data from 38 HIV clinical trials, with a total of 20,000 participants, in studies posted on ClinicalTrials.gov from 2008 to 2017. Selected studies included over 100 participants each and were U.S.-based, though some included sites in additional countries. All studies looked at the efficacy of specific HIV antiretrovirals or ARV regimens, and reported incidences of diarrhea as an adverse event.

Of the 38 trials reviewed, 21 had enrolled participants new to ARV treatment; 11 enrolled participants who had been on treatment for a while and seen their viral loads suppressed to undetectable levels, who then switched to different ARVs; and five enrolled those whose first antiretroviral regimen was failing to fully suppress their HIV (which is often indication of transmitted drug resistance). One study included participants who were both treatment naive and experienced. Participants in the comparative arms were also included in this study.

The point of treatment in those studied (naive, treatment-experienced, or treatment-failures) is important because possible side effects (including diarrhea) after starting new ARVs is somewhat expected. The body often adjusts to new medications so these side effects can

ultimately diminish over time. However, long-term noninfectious diarrhea may indicate a different cause such as HIV-enteropathy or may represent a side effect of a specific ARV. In these cases, measures should be taken to diagnose the cause, and treatment or drug changes should be provided where possible.

Researchers found that the rate of diarrhea in the studies reviewed was approximately 17-18 percent and remained consistent over the past nine years, which runs against the common belief that the rates of diarrhea among HIV-positive patients has declined significantly in recent years. This rate was similar in both participants who were taking FDA-approved ARVs and those given experimental therapies. The average reported diarrhea incidence was significantly higher for participants who were treatment-naive versus those who were treatment-experienced at 19.72 percent vs 13.74 percent, respectively.

Researchers also analyzed adverse events reported data from specific ARVs and compared it to corresponding FDA-approved package inserts, and found that the rates of diarrhea reported by drug makers varied greatly from the rates of those in the clinical trials.

For example, the rate reported for Stribild on the package insert was 12 percent, however, the meta-analysis re p o r t e d 2 0 . 6 percent. Similarly for Genvoya, the package insert reported half the rate of the meta-analysis at 7 percent versus 14 percent. For Triumeq, 1 percent (grade 2) versus 16.1 percent; Isentress, none versus

17.2 percent; and Evotaz 11 percent versus 22.1 percent.

This distinction is important since the package inserts report the rates of new or “treatment emergent” incidents of diarrhea attributed to a specific ARV, whereas the clinical trial adverse events (in this case diarrhea) reported in the studies reviewed on ClinicalTrials.gov represent the background rates of diarrhea and highlight the persistence of this important morbidity in the modern era.

“It remains consistent that patients who are living with HIV are still experiencing loose stools and diarrhea

irrespective of being on the most current or older antiretroviral regimens.

It is also paramount that clinicians not rely solely upon package insert reported rates of adverse events and instead seek the actual occurrence. Any and all efforts undertaken to enhance the quality of life for persons with HIV on antiretrovirals can only hope to improve outcomes, decrease transmissions, and move toward the end of the epidemic,” stated Patrick G. Clay, professor of Pharmacotherapy at the

University of North Texas System College of Pharmacy and co-author of the study.

Chronic HIV-related diarrhea is rarely a d d re s s e d d u r i n g conversations between people living with HIV and their care providers, and thus can remain untreated. Living with this condition for years can create a sense of acceptance combined with a belief that there’s no point in complaining, continued on page

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ADVICE

HOW TO GET THE TEST RESULTS YOU NEED WAITING FOR LAB RESULTS IS STRESSFUL ENOUGH. WHAT DO YOU DO WHEN THEY DON’T COME BACK AT ALL?

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DURING A RECENT visit to her doctor, Sara (not her real name) had her blood drawn for some tests. She’d experienced new symptoms the last few weeks that seemingly came out of nowhere. She wasn’t feeling sick but thought her doctor should be aware, and the doc had sent her for blood work to see what might be going on. Her results should have been in days ago, but no one has called and she’s starting to freak out.

Sara is the first to admit that being HIV-positive has made her especially apprehensive about any and all symptoms that pop up and require additional testing. Sure, she’s undetectable—she constantly reminds herself of this when her friends aren’t also reminding her.

And there’s no reason she should be especially worried, but even with routine lab work, she just hates the waiting game.

“I’ll have the results in about three days,” her doctor had told her. “We’ll give you a call when they come in.” Generally, her doctor follows up as promised and leaves a message if Sara is not able to answer her phone. Though, to be honest, she sometimes has had to follow up with her doctor’s office if she hasn’t heard back as expected.

Still waiting to hear about the lab work, Sara is continuing to experience the symptoms she’d told her doctor about—in fact, the symptoms have gotten worse. After four days, Sara calls her doctor’s office. The person who answers the phone checked for her and tells her the results haven’t yet come in. She promises to follow up.

Two more days pass without any contact. Sara calls again. She speaks with another member of her doctor’s staff, who informs her that someone has “sent a fax” to check on her lab results but hasn’t heard back yet. They also promise to follow up.

Another day goes by.

This time when Sara calls she’s told that the blood samples have been lost, and she needs to come back in to have her blood drawn again. Not surprisingly, Sara feels really frustrated at this point. She wonders what she should have done to prevent this.

PEXELS

BY GARY MCCLAIN

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Has this ever happened to you? In today’s health care environment, doctors have less time to follow up with patients. Offices are frequently understaffed. Even critical items needing a follow-up sometimes fall by the wayside. Laboratories that process blood tests are also overwhelmed, and they’re even less likely to employ customer service staff who might track down your lab work for you.

THE ANSWER? BE A STRONGER ADVOCATE FOR YOURSELF FROM THE GET GO. HERE ARE SOME SUGGESTIONS ON HOW: • Ask your doctor to be specific. Clarify which tests are being performed, how much time is required to run them, when the lab should provide the results to

•

•

If you don’t trust the answer you are getting, ask to speak with the office manager. When you do follow up on lab results, you may not trust that the person you are talking with is making your concerns their priority. So it may be time to kick your request up a level. You don’t have to do so in anger. But you are a patient and the staff is there to serve you.

You can use a friendly but firm tone of voice and say something like, “I’m really concerned about this. Please let me speak with the office manager.”

Also consider leaving a message for your doctor. You may want to make sure your doctor is aware that your results were not provided on time or as

IF YOU DON’T TRUST THE ANSWER YOU ARE GETTING, ASK TO SPEAK WITH THE OFFICE MANAGER

•

•

MAXIMILIAN IMAGING

•

your doctor, and who from your medical team will tell you when the results are in. Know which day you should hear back on and, ideally, what time of day.

If possible, also find out who will be delivering the results—your doctor or a staff member—and whether you’ll have to come into the office or check for results on a website (if it’s the latter, make sure you have the log-in info).

Mark the date on your calendar.

There are wellness-specific calendar apps that can support you in managing your health and making sure you don’t miss important appointments. Of course you can also use the same calendar you use to manage your daily life—whether it’s digital or hanging on your wall with inspirational photos. Either way, make sure you highlight the date on which your lab results are promised.

If follow-up is required, ask who will be following up and how. Your doctor may have a procedure in place for patients to follow up on lab results and may even make this the responsibility of patients, e.g. through a call-in number or a medical website. Don’t leave the office until you are fully aware of exactly what you need to know to follow up if you don’t get your results as promised.

If you don’t receive your results, follow up immediately. Don’t even wait one extra day. You were promised, after all. Remember, this is your health we’re talking about. And you have a right to insist upon accountability.

•

•

promised. Doctors are busy; they have a lot of patients, and the lab results of one individual patient may fall through the cracks. Keep in mind that your doctor may also be concerned about your results but, with so many patients, may not have the time to check in. So remind them that you’re still waiting.

In fact, keep your doctor in the loop.

Whether by contacting them directly or waiting until the next appointment, let your doctor know what happened with your lab results, what was involved in receiving them, and how this impacted you. If you can’t get your results, or if you have to return to provide another specimen, definitely get in touch with the doctor immediately. Doctors aren’t always as aware as they need to be of how their patients are being treated by the office staff. But they do care, and they want to know you’re getting the care and support you should be.

Most of all, don’t hesitate to be “high maintenance.” If you earn the reputation as the one who is a little obsessive about your lab results, so be it.

This should hopefully result in the staff being that much more diligent in making sure they get back to you, to avoid the calls they are going to get when they don’t. Don’t sit back and wait for your doctor’s staff to do their job. Being a team means taking responsibility for making sure you get what you need, when you need it. So when your labs aren’t available as promised, follow up. Speak up. Be your own best advocate.

Plus mental health editor Dr. Gary McClain is a New York-based therapist, patient advocate, and author who specializes in working with individuals diagnosed with chronic and catastrophic medical conditions, their caregivers, and professionals.

(JustGotDiagnosed.com)

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BY DAV I D A RTAV I A ven after being hit by Hurricane Harvey in 2017, Houston has continued to thrive with a growing economy, plentiful business opportunities, and a vibrant cultural scene. If anything, the hurricane gave the city’s power players a chance to build an even better municipality through thoughtful planning and collaboration across demographics and cultures.

If elected this November, Ashton P. Woods hopes to bring issues of health care, public safety, and racial justice to the forefront of that planning process—and he’s using his own life as a springboard. His campaign is historic in itself.

Woods is the first out gay Black person to run for Houston City Council, and the first out HIV-positive person of color as well. While other LGBTQ folks of color have had stints as local legislators, they all came out after they were elected. If Woods wins, he will become the first out HIV-positive city council member and only the second poz elected official in the city (following Judge Beau Miller, who was elected last November).

The candidate is running for a Houston City Council At–Large seat that has been held by Jack Christie since 2011. A staunch HIV activist in his own right, Woods has been a fearless advocate for the local LGBTQ community, having been appointed to Houston’s first LGBTQ advisory board in 2016.

He is also the cofounder and lead organizer for Black Lives Matter Houston and acts as cochair for the Black Humanist Alliance, a coalition of secular activists under the American Humanist Association.

Woods’s proposed policies are progressive in themselves. In February, he helped to block the city’s planned expansion of the district attorney’s office. Hiring a hundred new prosecutors, Woods argues, would have been counterproductive to bettering the livelihood of Houstonians.

“What if we took that money and partnered with other counties, other entities inside of the state to focus on public safety through infrastructure?” he suggests instead, pointing out that many areas in the city still don’t have sidewalks or well-lit streets. “If I win, I want to do everything I can to make people safer.” He believes that’s more achievable through infrastructure improvements than through criminal prosecutions.

Health care is another critical service Woods is pushing forward. “I’m exploring how to force the city of Houston into creating a health care network,” he explains. “There’s a point in time where we have to stop waiting on the federal government to provide Medicare for all or universal health care, or anything of the sort, when we have so many resources right here in Houston, right here in Texas.”

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COURTESY ASHTON WOODS

ASHTON P. WOODS WANTS TO LEAD THE TEXAS CITY INTO THE NEXT DECADE.

A New Orleans native, Woods first made the move to Houston in 2005 shortly before Hurricane Katrina. It didn’t take long for him to start working alongside local organizations, and eventually end up working on Mayor Sylvester Turner’s campaign. But lately, Woods is craving a shift in local politics and believes being part of the City Council himself is the answer, in that it will provide a necessary platform to speak on issues important to him.

“Houston is heavily impacted as a Black community,” he says. “The Black community as a whole needs to be addressed, [including] the HIV rate. It’s 2019, and there’s still an epidemic. We need to know why there’s still an epidemic,” he says, adding that HIV treatment and education should be top priorities.

As a candidate, he says, “what I will be talking about is de-stigmatizing HIV and teaching people [they] are affected by this, whether you know it or not. If you can respect me as an activist, then you respect the fact that I have HIV, regardless of how I contracted it. I am still a human being and I exist. And because of this existence you can see that I am surviving and thriving, and that I am not a threat to you, and you are not a threat to me.”

De-stigmatizing HIV, Woods adds, will lead to a greater conversation about health care in general.

As he puts it: “Imagine if Ryan White [a federal HIV care program] was available to everybody.”

“I’m on Ryan White right now,” he shares, “because I can’t afford Medicare, or medical care, or insurance. So, if there was no legacy community help, or foundation, or the help of other organizations here in Houston that get funding from Ryan White, and even if somebody needed assistance—you know, these things translate into housing discrimination, these things translate into an issue that affects the larger Houston population.”

Woods’s passion is contagious, which may be why his family has been anticipating his jump into a life of politics.

“Everybody I told were like, ‘It’s about time.’

I was like, ‘What do you mean, it’s about time?’” he says of his family. “My focus was more on community at that time, there was a lot of things that happened in Houston, and in this country, that required my attention as an activist that were more important. And now, I feel that I can do both.”

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I AM THE FIRST B Y D AV I D A R TAV I A

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TWO MEN FROM VERY DIFFERENT WORLDS ARE CHANGING HOW MIAMI’S LATINX COMMUNITY ACCESSES PREP—IN A CITY WHERE 5 PERCENT OF PEOPLE ARE LIVING WITH HIV. THAT’S MORE THAN NEW YORK, L.A., OR SAN FRANCISCO.

SHUTTERSTOCK

BY DIANE ANDERSON-MINSHALL

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hen the United Nations Commission on Human Rights declared last year that Venezuela was in “a downward spiral with no end in sight,” Marco Torrealba knew exactly what that meant. A former corporate journalist, Torrealba fled Venezuela in 2015 leaving behind his family, friends, and career.

“I grew up in a very poor area in Caracas called La Vega,” Torrealba recalls. “It’s what some people here call the ghetto or favela.” The Brazilian Portuguese word for slum accurately described his humble beginnings, but Torrealba says, “Because my parents pushed me, I made it to college.”

Torrealba isn’t the only Venezuelan college grad making moves into the U.S. According to an analysis by Pew Trust’s Stateline of American Community Survey data from the University of Minnesota, “Venezuelans are the most educated Latin American group in the United States— more than half of adults have college degrees, compared with fewer than 10 percent for those from Mexico and Central American countries.”

Florida is one of the five states with the most Venezuelan immigrants (there are about 200,000 living in the state right now). The “Bolivarian diaspora” is the largest refugee crisis in the Americas on record, with four million Venezuelans (or 10 percent of the country’s population) fleeing their native country during the presidency of Nicolás Maduro (and that of his predecessor Hugo Chávez). It’s a crisis comparable to those of Syrian refugees and Cuban exiles (many of whom also fled to Florida), and it’s not over. In 2016, nearly 60 percent of those remaining in Venezuela said they still hoped to leave.

Torrealba says he left when his life was in danger, the reason many others fled. He is chagrined to talk about it, for fear of what could happen to his family still back home.

But he admits, that if someone “disagrees with the government, you put yourself, work, life, and even your family at risk.”

The fact that he’s a gay man made life in Venezuela even more difficult. The country offers no legal protections for LGBTQ people.

So, Torrealba says, he came to the U.S. and “started from zero in this country.”

Of course, that meant his career had to be rebooted too.

“You have to adapt yourself to whatever is the work that you have to do,” he admits. “Work really dignifies people. The American culture is about hard work and achieving your goals. That is something you learn here.”

Torrealba says after nearly two years of seeking “something better,” his foray into HIV prevention came after “meeting amazing people who work in the field.”

His journey eventually led him to 32

Prevention305, an organization aiming to improve PrEP education and access in Miami-Dade County. “Prevention305 allowed me to realize kind of part of my American dream,” Torrealba says. “A dream that was not in my agenda, but it is happening now.

How many people have the opportunity to bring an organization to a point where it has an impact in the community and is helping others in need?”

Getting the organization to that point has been the fruition of work by Prevention305’s founder John K. Byrne. Though both men are gay, Byrne’s childhood couldn’t have been more different from Torrealba’s.

Raised in a Boston suburb, by a doctor father and a mother who was a circuit judge on the Massachusetts District Court, Byrne attended the affluent Concord Academy, one of the top 15 prep schools in the U.S. ranked by SAT scores (other famous grads include Caroline Kennedy and Queen Noor of Jordan). Byrne went to college at Oberlin, starting a journalism career that would lead to The Boston Globe and later to founding Raw Story, a progressive news site keen on political coverage. He was only 24.

Today, Byrne is the CEO and co-owner of Raw Story Media, which owns and publishes RawStory.com, AlterNet.org, and TheNewCivilRightsMovement.com. But in 2015, while taking PrEP, the HIV prevention treatment strategy, Byrne had a false positive result, which he later wrote about in The Atlantic. The story was a viral hit, causing a lot of debate among gay and bi men over PrEP use.

If Byrne had indeed been positive, it would have been an extremely rare occurrence (so far only a handful of people have acquired HIV while properly practicing PrEP).

Once Byrne learned he was still HIV-negative, the media mogul threw himself into educating others about HIV and PrEP, inspired by activist Peter Staley’s campaign against crystal meth. “[Staley] paid for the ads and the phone lists himself,” explains Byrne. “And he was like, ‘If our government isn’t doing anything, if people aren’t doing anything, just do it. You have the money. Just do it. Do it yourself. Don’t wait for somebody to do it.’ And I think that was inspiring because I didn’t start the nonprofit until two years after I was doing the work.”

Byrne started using his own money and creating prevention brochures and educational posters in English and Spanish, partnering with local organizations but also taking the posters out to nightclubs and bars. That’s when the nonprofit really started to emerge, but the pivital moment came when he realized Prevention305 would need more—more money and more personnel—than he could provide by himself. He officially founded Prevention305 and began applying for grants.

The organization’s first big get came from

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Gilead, Byrne recalls, “and AIDS United also took a chance on us as a new agency, which I was surprised and impressed by, and then from that, we had the amount of the budget to start the program, which we did early in 2018.”

The first step was hiring a program director, and Byrne knew he needed a Spanish speaker.

He found his match in the Venezuelan immigrant Torrealba, but it was a comical and costly error that led them to each other.

“I knew my Spanish was terrible, so I would have my friend who spoke Spanish help me translate,” Byrne recalls of working on one of Prevention305’s early public education campaigns. The ad featured a man holding a Truvada pill (the first medication approved as PrEP) and the words, “Swallow This.” Byrne’s earlier translated posters had been fine, but this one, with the literal Spanish translation of tragate esto just didn’t work. “I brought it to a health department work group and everyone smiles, ‘Oh, look at this white guy, doing this nice little thing.’”

But after some chuckles, someone came to Byrne and said, “You know what this means, right?”

Turns out in Google translate “tragate esto” is indeed “swallow this.” But on the streets the translation means something a little more risque: “suck my dick,” which, as Byrnes says, was “not what I was trying to come up with.” From that moment, he knew he had to hire someone directly from the immigrant community.

According to the United Nations Development Program, Miami has the highest percentage of foreign-born residents (59 percent) of any

city in America. Most are from Latin America.

Spanish expert Gerald Erichsen reports that Miami also “has the largest Spanish-speaking population in the Western Hemisphere, outside Latin America.”

“It’s a very, very unique environment,” says Byrne, and so he went in search of Marco Torrealba, who had been waiting years for just this kind of opportunity.

“When I started, it was mind-blowing,” Torrealba recalls. “It changed my mindset about public health and the perspective of how we talk or related to HIV in Latin America. I learned that I had lot of stigma, ignorance, and fear. The HIV prevention work touches your heart and changed all of that. It has become a passion to transfer knowledge about HIV prevention to my Latino community, see how others receive care or treatment, but also how that has an impact in their emotions, minds, and their lives.”

The first thing Torrealba did as program director was to shake up all the organizational thinking about reaching Latinx in Miami. In fact, in his job interview, Torrealba recalls telling Byrne, “‘This is totally wrong. This is what we have to change.’ I said to him, ‘Immigrant, Latinx, we just don’t speak different, we just don’t look different, we also feel different. We have different perceptions about everything.’ A Venezuelan will see things different than someone from Colombia. Someone who is from Peru will see sexuality differently than someone who is from the Caribbean. So technically, what we did is try to embrace all these cultures and started to talk

Above: John Byrne founded Prevention305 to address Miami’s astronomically high HIV rates

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even in Spanish in our communications. But I had no idea, no clue about how to do it.”

There are the already-developed outreach programs via dating and hookup apps like Grindr, but Torrealba convinced Byrne that Instagram is the new Grindr—and a good way to reach gay and bisexual men.

“Everyone is on their phones,” says Torrealba.

“No one wants to have a flyer in their pocket.

Everyone wants to be private about whether they are on PrEP or on treatment as prevention, or condoms, or even for sex. So we developed this website where we put this form and we collect information. We refer clients from the dating apps to the website, or from social media to the website. We forgo those hashtags like PrEP, HIV prevention… we started to use hashtags that are related to Cubanos in Miami, Venezuelans, Colombianos in Miami, everything in Spanish mostly.”

“People read the information there [and] within 24 to 48 hours we have an appointment set up for them, with dates, with times, with the documents they have to bring in order to get PrEP in Miami,” Torrealba continues. “Sometimes we get people from Broward [County, Florida] and we help those people. We are getting people from New York and New Jersey. For those people, we send a list of different places close to their zip codes where they can go and get PrEP. We are getting people now from Panama asking for PrEP, people from Peru asking for PrEP, and that is because of social media. People are finding us through Instagram, and also through different international media that has been interviewing us.”

Byrne adds that Torrealba’s program work has really been what’s made Prevention305 successful.

“My main focus is sort of like, let me tell you the numbers I want and let me write the grants,” the group’s founder says. “Frankly, my white privilege that I can write grants in English is really good for raising money. That’s another problem in Miami, honestly. A lot of these grants only accept applications in English and so even if you do speak English, as a native Spanish speaker, you don’t necessarily have the language capabilities of someone who went to an elite school. And you’re competing for the same money with people from Boston and New York and San Francisco.”

Torrealba agrees, and he knows the immigrant experience that potential clients continue to face. “When you migrate, most of the things in life get another perspective,” he shares. “When you are alone and some things are uncertain to you, or you just don’t understand, you learn to keep it cool. To be still.”

Since Prevention305 has no fixed office, Torrealba and Byrne have launched a clinic inside a mobile PrEP van that can move neighborhoods each day.

“There’s so many problems with the centers that we were trying to refer people to,” explains Byrne. Initially people they meet on apps like 34

Grindr go to Prevention305’s website and register their interest in PrEP. People can give information about their availability and then navigators reach out to them to make an appointment. But it wasn’t always easy.

“We were having all these problems with places where we were referring people until we basically decided, well, we just have to set up our own clinic,” Byrne says. Originally, the clinic was going to be in a gay hotel that had volunteered to renovate space for the group, but the city nixed the plans over zoning issues. The commissioners ultimately approved a project that Prevention305 is doing in partnership with a local cancer center and the University of Miami Medical School. In some areas, the van draws more folks seeking cancer screenings, but in “Miami Beach, it’s mainly PrEP,” Byrne says.

UM supplies the medical staff; Prevention305 supplies clients. Torrealba and his crew meet clients online and then set up an appointment at the van where they receive rapid HIV testing and then can get a prescription for PrEP, typically the same day. The van has been operating for six months now, traveling between neighborhoods like Miami Beach, Little Haiti, and Overtown.

“We supplied 90 percent of the PrEP clients,” says Byrne. “I had a dinner with a high-level Gilead person and he said that it is the first successful HIV prevention van in the country.”

One reason, he argues, is that other programs expect walk-ins. Torrealba and his peer navigators schedule five to six people a day when the van is in a neighborhood instead of waiting for people to just show up.

“It’s basically three or four days a week in different locations,” Byrne says. Prevention305 is officially a referral agency that works with more than 10 agencies. Generally, the minute someone sees their message or meets a navigator on an app or social media site and then goes to fill out the request form, it takes 24 hours to get them in for an appointment. The peer navigators educate clients in both English and Spanish, and someone is present at the client’s first appointment for moral support and to help ease any language barriers.

“We have a small, smart, multicultural team that includes a Black-African-American transgender woman, a Black-AfricanAmerican-Latinx lady, two Latino immigrants, and we are interviewing more Latinx [people],” Torrealba says. The immigrant teammates are critical to their clientele. “When you are an immigrant, you are vulnerable. You are starting every aspect almost from zero. Your brain doesn’t work the same. You have left a lot behind you. You have to unlearn and start a new learning process. Navigating a health system that it is in English could be difficult and intimidating. You don’t want a big bill coming towards you.”

He says that while many agencies in Miami

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now include Spanish and Creole speakers as part of their staff, speaking to Latinx immigrants takes special care. “It’s time to change the vocabulary,” adds Torrealba.

“It’s time to change the speech, what we are putting out there about PrEP. Our strategy is to normalize the conversation about PrEP, understanding it as an HIV prevention option for everyone.” He says “joy” is part of the spiel.

In addition to the peer navigators, one of whom is well-known trans performer Latavia Goldson (a.k.a. Fantasia Royale), Torrealba works with numerous Latinx influencers.

Among them are E! TV host Daniela Kosan (a former Miss Venezuela International), Venezuelan broadcast journalist Sergio Novelli, celebrity trainer Juan Cortes, Emmy winner and Instagram influencer Antonio Torrealba (no relation to Marco), and theater producerdirector Enrique Salas.

Prevention305 takes a different approach to PrEP. It’s something they talk about with families and straight people. With the media, Torrealba says, “we talk about PrEP like we are talking about condoms, like we are talking about something normal. Of course we talk about the high number of HIV [transmissions] in Miami, but we are also talking about solutions.”

Though Byrne originally created their prevention plan around dating apps, Torrelba was the first to explain that “immigrants look to people’s Instagram profile to validate the organization,” Byrne says. “He was like, ‘We need to have a good Instagram profile.’ And then what

he would do is he would post something and then hashtag PrEP and then hashtag a popular event like Winter Party or something like that.

He actually found people coming in from the hashtags and then messaging our account looking for PrEP, which was crazy to me. Because it’s not even like they were following us. They were coming in through a hashtag.”

Byrne is endlessly happy with the agency’s success so far, but he’s not in it for the fame or glory.

“For me, I think it’s really about giving people the options that I have. I think people are like, ‘Oh, well, why isn’t everyone on PrEP?’ and ‘You need to get these many people on PrEP and you need to do it here,’” Byrne says. “But for me, it’s more important that people just know they have access to it for free.”

The media CEO says that Prevention305 is about bridging gaps. What he’s trying to do “is to make a difference in a community where I am not representative of the community.”

Eventually, the end game is to eliminate himself. After all, he says, “The director of a nonprofit should be from the community that’s being served.”

Still, the structural impediments in raising money as a nonwhite person without an elite education are challenging. Byrne has done fundraisers for Democratic House candidates, is affluent and well connected, and has access to those communities in terms of fundraising. He’s aware of the privilege that he has and is trying hard to mitigate that for his organization.

Above: Prevention305’s program manager, Marco Torrealba brings an immigrant’s insight to reaching Miami’s Latinx community.

continued on page

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I’M HIVPOSITIVE. WHAT NOW?

YOUR DIAGNOSIS MAY SEEM OVERWHELMING, BUT WE CAN HELP YOU THROUGH IT. HERE’S WHAT YOU NEED TO DO NEXT.

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You just found out you are HIV-positive. You have a lot of questions (find answers to 20 of them on page 40), and the biggest one is “What do I do next?”

Here’s your guide to getting through the first days and weeks after learning your status.

BREATHE. Freaking out is a normal response after learning you’re living with HIV. But take a moment to breathe because the news is not as bad as you think. Having HIV is not what it used to be. Things have changed tremendously even in the past couple of years. HIV is a manageable chronic illness, similar to diabetes. You will keep living, you will keep loving, you will still have a long happy life. So breathe. Be positive. Very little about your future needs to change.

DON’T WAIT TOO LONG. You want time to process, to grieve the healthy life you think you’ve lost. That’s OK. But while you’re doing that, make an appointment, go to it, fill your prescription, and start taking your meds right away. This is really important because it may affect the rest of your life. Studies show that getting on treatment early can improve your long-term health outlook significantly.

START TREATMENT, TODAY. Ideally you should begin treatment the day you get your positive result. Some cities or counties offer care navigators who immediately connect you with all the wrap-around services you may need (and be entitled to) as someone living with HIV. Not every jurisdiction offers immediate care upon receiving a positive test result, but you should make a clinic or doctor’s appointment as soon as you can. The sooner you’re on treatment, the sooner you can lower your viral load and reach undetectable levels so it becomes functionally impossible for you to transmit HIV to someone else.

FIND A CARE PROVIDER. There are resources that can help you find the appropriate providers, including: ˜

State HIV/AIDS Hotlines: The Health Resources and Services Administration maintains a list of HIV/AIDS hotlines for all 50 states, the District of Columbia, the U.S. Virgin Islands, and Puerto Rico. (Bit.ly/HIVHotlines)

˜

Ryan White HIV/AIDS Medical Care Provider List: The federal Ryan White HIV/AIDS Program provides HIV treatment services to those who are under-insured or uninsured. HRSA offers a searchable online directory of medical providers in your area who are part of the Ryan White program. (FindHIVCare.HRSA.gov)

˜

HIV Care Services Locator: Another search tool for providers in your area includes medical centers participating in the Ryan White program as well as local mental health services, housing assistance programs, and substance abuse treatment facilities. (Locator.AIDS.gov)

FIND HELP PAYING FOR CARE. Sure, if you have good insurance it will probably cover most of your care, but there are also options for those who don’t, and additional financial assistance for those who need it. For example, the Ryan White program also provides fiscal support, and you may qualify for Medicare or Medicaid. The state hotlines listed above should direct you to assistance. You’ll also find resources at HIV.gov (Bit.ly/FedHIVPay), including links for special programs for veterans, children, and Native Americans.

UNDERGO A BASELINE EVALUATION. Your first appointment will likely involve what is known as an HIV baseline evaluation, a review of your health and medical history, a physical exam, and lab tests. Your blood work will reveal your initial CD4 count, viral load, and potential drug resistance.

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The CD4 count is the number of disease-fighting white blood cells you have in your body, and your viral load is the number of copies of HIV in your blood. You want your CD4 count to go up and your viral load to go down. Antiretroviral medications make this possible, and your goal is to suppress your viral load to undetectable levels.

R E V I E W T R E AT M E N T O P T I O N S .

There are about a half-dozen classes of HIV medications, each of which fights the virus in a different manner. (Our next issue features Plus magazine’s annual Treatment Guide, but in the meantime you can find last year’s guide to medications at Bit.ly/HIVDrugs2018.) Because HIV mutates quickly and is hard to kill, doctors use a combination of several medications to treat it. Typically, those just diagnosed with HIV will be started on combination treatment, with the most common being two nucleoside reverse transcriptase inhibitors plus one drug from another class. But your doctor will consider a number of factors (including your kidney health and lifestyle) in regard to the specific medication they prescribe. One lab test they order in the baseline evaluation helps determine whether the specific strain of HIV you have is resistant to any medications. Around 10 to 20 percent of those newly diagnosed with HIV have a strain resistant to some drugs. Whether you have one or not will help determine which medication(s) your doctor recommends.

GET YOUR MEDS. Fill your prescription right away and start taking your medication religiously. Study after study shows that starting treatment quickly and adhering to your treatment plan is the best way to ensure your health won’t be compromised, now or in years to come.

Sticking to your plan not only means taking the medication every day (at least until longlasting medications become available in the next few years) but also following the manufacturer directions. That’s because some HIV drugs need to be taken with food, or at specific times of day in order to be the most effective.

F I N D H E L P PAY I N G F O R Y O U R P R E S C R I P T I O N S . HIV meds can be notoriously expensive, but that should never be a reason not to take them—and there are a bunch of resources that can help you cover prescription costs, including: ˜

ADAP Directory: State AIDS Drug Assistance Programs (ADAPs) can help you pay for HIV medicines and other services if you need financial assistance or don’t have sufficient health insurance. The ADAP Directory (ADAP.directory) has more information and includes eligibility requirements (each state has its own), formulary (i.e. which drugs are covered), links, and contact info for all 50 states, the District of Columbia, and several U.S. territories.

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˜

NASTAD Membership Directory: The National Alliance of State and Territorial AIDS Directors’ directory can help you find health care specialists involved with the ADAP in your state.

(NASTAD.org/membership-directory)

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Drug Companies: Most of the pharmaceutical companies that make HIV medications offer patient assistance programs that will help cover the costs of your prescription. Find the info on each company’s website (for example, Bit.ly/GileadPAP). We also have links or phone numbers for most of them online (Bit.ly/HIVRXPay).

GET MORE HELP. If all of this feels overwhelming, you are not alone.

Most people need help navigating this new experience and getting their bearings in a new HIV-positive world they’re now a part of. The amazing thing is there are tons of organizations and peer support groups out there ready to give you the assistance you need. They can help you with each of the steps above, especially if you need extra help because you’re disabled, a non-native English speaker, experiencing homelessness, or you have mental health or substance abuse issues. Visit ProjectInform.org/hotlines for state-by-state helplines or check out amfAR’s list of additional resources (Bit.ly/HIVOrgsList).

GET EDUCATED. Eventually you are going to want to tell some of your friends and family you are living with HIV, and when you do you'll want to be armed with the latest information. There’s still a lot of stigma and fear around HIV, so you want to be ready to debunk myths and answer questions.

For example, your family needn’t fear sharing silverware with you—they can’t contract HIV that way. They’ll also want to know what this means for your health and your love life, so do the research ahead of time.

LEARN ABOUT U=U. Undetectable equals untransmittable is the government-backed consensus that says if your viral load is undetectable, you can no longer transmit HIV to someone else. Read information from reliable sources, such as the Centers for Disease Control and Prevention (CDC.gov/hiv), the U.S. Department of Health and Human Services (HIV.gov), magazines like Plus, HIV specialists, and material put together

by HIV organizations.

TELL SOMEONE. Coming out about your HIV status can still be difficult, even though it should be no different than telling someone about another chronic condition like diabetes. You may be afraid of how the person you are telling is going to react. Will your friends still be there when they find out you’re poz? Will your parents be disappointed? Will the guy you’re seeing break things off? Not knowing how the important people in your life are going to react can be scary. For the most part, people will probably surprise you. Those who care about you don’t stop just because you’re HIV-positive. They want to know you’re going to be OK. And you will be. Meet with those people in person, take your time, and be prepared for it to get emotional. It may be easier to start by telling someone who doesn’t need to ask questions, or whose opinion doesn’t matter to you.

Know someone who is poz? Tell them. Or call a hotline and tell them.

Talking about living with HIV does get easier the more you do it.

FIND A SUPPORT GROUP. There’s strength in numbers. And sometimes you need to talk to someone who is going through the same thing you are. While talking to someone who has been poz for 10 years has its own rewards, they haven’t experienced what you’re going through for a long time—or possibly ever. What it means to live with HIV has changed dramatically in the past decade. You should also talk with someone else who is at the same place in this journey—another person who was just diagnosed. You’ll find them in local (or online) support groups.

END BAD HABITS. Using street drugs or abusing prescription ones can be bad for your health. Whether they may have played a role in your becoming HIV-positive or not, studies show that they negatively impact your health outcomes going forward. The Journal of Acquired Immune

You want TIME to PROCESS, to GRIEVE the healthy LIFE you think you’ve lost.

Deficiency Syndromes recently reported that even “light cocaine use” is associated with medication adherence issues. Cigarettes, while not as problematic, are still deadly. In fact, a 2017 study showed that poz smokers are up to 13 times more likely to die from lung cancer than AIDS. And even smoking cannabis may raise HIV-positive people’s risks of developing lung disease, according to a new study in EClinicalMedicine. So get help breaking your addictions and bad habits to help make sure you live healthily with HIV. GET HEALTHY. As many studies (including the cannabis study mentioned above) have shown, people living with HIV are more susceptible to other health concerns than people who are HIV-negative. Earlier this year, The Lancet HIV revealed that high cholesterol levels and high blood pressure are common among people with HIV, and if left untreated can become more deadly than the virus. You’ll also be healthier and happier if you watch your diet (studies continue to rank the Mediterranean diet the best), exercise regularly, and consider taking up meditation.

GET ON WITH YOUR LIFE (INCLUDING YOUR LOVE LIFE). HIV doesn’t have to define you or change your goals and plans for the future.

Finding out you’re HIV-positive isn’t a reason to give up on love or to stop dating. You are as sexy, smart, unique, and amazing as you were the day before your diagnosis. If anyone tries to tell you otherwise, kick them to the curb. Living with HIV today is like living with asthma or diabetes. Sure there are new limitations you may discover, and new challenges that HIV will place in your way, but those are things you can overcome and adapt to. There really is no reason to be negative about being poz.

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QUESTIONS ABOUT HIV JUST LEARNED YOU’RE HIV-POSITIVE? WE ANSWER YOUR TOP CONCERNS ABOUT HIV.

BY P LU S E D I TO R S

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that it is simply a chronic illness like diabetes.

You, your family, friends, and even casual acquaintances may fear you’ll pass HIV to them. But the virus is transmitted via the kind of contact with sexual fluids and blood that you don’t generally have with family members and even close friends (except those with benefits). The Centers for Disease Control and Prevention is clear that HIV is not transmitted via saliva (spitting or kissing) or by sharing a toilet, drinks, or eating utensils.

Is it my fault?

No. HIV isn’t some kind of divine retribution.

It is a virus that is communicable and therefore travels between people. Certain types of activities may increase your risks, but these don’t make you responsible for getting sick.

We don’t blame diabetics for their diabetes even though Type 2 diabetes is preventable, so we needn’t assign blame for HIV either.

What are the first symptoms of HIV? Initial symptoms of HIV are much like the flu: fatigue, fever, sore throat, body aches, headache, and swollen lymph nodes.

How did I get HIV? You likely acquired the virus by coming in contact with the blood or sexual fluids of someone who is HIV-positive. The most common modes of transmission include unprotected anal or vaginal sex and sharing needles (regardless of whether they are for injecting drugs or medication like genderconfirming hormones).

My partner’s test was negative—are they in the clear?

Not necessarily. It takes time for what’s known as seroconversion to occur, the period after exposure when your body begins to produce the antigens and antibodies HIV tests are looking for. “The period between exposure to HIV and seroconversion is variable, but most people will test positive within several weeks of exposure,” according to the Johns Hopkins Bloomberg School of Public Health. Still, someone with a just-diagnosed partner should retest in three months to confirm their results.

Am I going to transmit HIV to my family and friends?

No. A lot of fear and misunderstanding still surrounds HIV, even though treatments have advanced in the past decades to the point

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I thought “tops” couldn’t get HIV? Although the receptive partner or “bottom” in anal sex is 13 times more likely to acquire HIV than the “top” or insertive partner, according to the CDC, tops still can and do get HIV from having unprotected sex.

Does being HIV-positive mean I also have AIDS? No. Confusing HIV with AIDS or using the terms interchangeably are some of the most frequent mistakes made by ordinary people and even media outlets. In the U.S., the majority of people living with HIV will never develop AIDS, the most advanced stage. HIV is the virus that causes AIDS, but for most people, proper treatment and regular medical care keep their immune system strong enough to prevent stage 3 HIV and associated illnesses.

An AIDS diagnosis only occurs if your CD4 cell count plummets below 200 and your immune system is so damaged that you are susceptible to life-threatening illnesses. Getting on and staying on treatment is the best way to ensure your HIV never develops into AIDS. Am I going to die?

Probably not from HIV. A person diagnosed today has roughly the same life expectancy as a person who is HIV-negative. However, your virus does make you more susceptible to other health problems that you need to be aware of, including cardiovascular disease, kidney problems, and bone density loss. But these can be prevented with lifestyle changes and the right medication.

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Why are health outcome worse for some HIV-positive people?

People of color, transgender women, and those living in Southern states continue to have higher mortality rates from AIDS complications. Some of those disparities have to do with barriers to health care, racial inequalities and discrimination, poverty, substance abuse, and untreated mental health issues. But getting and staying on treatment is the first step in altering those disparities and there are government programs that can help you afford it.

PIXABAY

Is there a cure for HIV? Not yet. Although Timothy Brown (or "The Berlin Patient") has continued to live HIVfree for over a decade, he remains the only person to have been functionally cured for such a long period of time. (Researchers recently announced another patient has been HIV-free for 18 months, but scientists warn it’s premature to call that a cure; see the story on page 20.) At the 2018 International AIDS Conference in Amsterdam, researchers announced three major strategies scientists are focusing on in seeking a cure for HIV. The first involves reversing HIV latency—making it so the immune system can recognize HIVinfected cells that were previously invisible in reservoirs. This is called “blocking and locking” due to its goal of permanently stopping the virus from reproducing. The second has to do with using a variety of agents, such as neutralizing antibodies, to strengthen the immune system; it would probably require a combination of substances. The third involves genetically engineering cells to make them resistant to HIV or improve their ability to clear HIV-infected cells. This method has already been enormously successful in genetically-altered “humanized” mice and researchers hope to start human trials soon.

Do I have to take antiretrovirals every day? Forever?

Yes and no. Staying on your meds is hugely important, and combining early treatment with continuous adherence is the best way to maintain your long-term health. But doctors and pharmaceutical companies alike realize that maintaining a daily regimen can be a real struggle, and new long-acting options are nearing approval. So yes, you do need to stay on your treatment religiously (pretend it’s like going to the gym or taking daily vitamins) but your treatment may not end up being a daily medication for long.

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antibiotic-resistant strains are threatening to heighten their potential to do lasting damage. Living with HIV can make you more susceptible to other STIs.

What is an undetectable viral load?

Those on antiretroviral therapy can see their viral load (the amount of blood detectable in a blood test) reach undetectable levels.

Also called viral suppression and defined as reducing the amount of HIV to less than 200 copies/ml, or becoming undetectable, has been proven to prevent HIV transmission.

What does U=U mean?

Undetectable equals untransmittable. The CDC has endorsed research findings that those who are undetectable are no longer able to transmit HIV, stating in 2017, “Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP), no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed. This means that people who take [antiretroviral therapy] daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of transmitting the virus to an HIV-negative partner.”

So, I can throw away my condoms?

You probably shouldn’t. Even if you are virally suppressed and/or your sexual partners are on PrEP and you aren’t concerned about HIV transmission, you are still at risk for contracting other sexually transmitted infections. Getting gonorrhea or syphilis can lead to serious health complications, and new,

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Can I still have kids?

Yes, you can still have kids if you are HIVpositive. The great news is that if you have your viral load suppressed to undetectable levels you likely won’t have to do anything special, as you can no longer transmit the virus. Still, if you are planning to make a baby the old-fashioned way, you should speak with a specialist first. For those whose viral load isn’t suppressed, there are specialists who deal with HIV, fertility, and insemination. If you’re a woman who is living with unsuppressed HIV, additional medications can also decrease your chance of transmission to your child. If you’re a man with detectable HIV, your sperm may need to be “washed” of HIV and then inseminated into your partner, wife, or surrogate. If you want to adopt, there are protections for HIV-positive parents-to-be that ensure you can’t be discriminated against by agencies.

Can I still breastfeed?

Federal guidelines currently recommend HIV-positive women not breastfeed and instead rely exclusively on formula (see page 18). But nearly one-third of poz moms may be disregarding those recommendations, according to new research in the Journal of the International AIDS Society. Previous studies have shown the chances of HIV transmission are below 3 percent if an HIV-positive mom is on antiretroviral treatment prior and during breastfeeding. And ongoing research into viral suppression suggests that being undetectable means not being able to transmit HIV via breast milk.

What is HIV criminalization?

As of 2018, 26 states still had laws on their books that criminalize HIV exposure or nondisclosure. Most of these outdated laws were put in place back in the 1990s, before the development of today’s highly effective antiretroviral treatment, at a time when HIV was often a terminal diagnosis. Today, most HIV-positive people in the U.S. have been able to lower their viral loads to undetectable levels while on treatment, thus making it virtually impossible to transmit the virus to a sexual partner. Yet poz folks are still being arrested and charged for “exposing” partners to HIV despite being undetectable.

Though some states, like California, have

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begun decriminalizing HIV, many others have not—so it’s important to educate yourself on the specific laws regarding HIV disclosure and exposure in your state. If you find yourself in trouble with the law due to your HIV status, check out the HIV Justice Network (HIVJustice.net), which has a wealth of information on the subject along with a HIV defense lawyer database.

Do a lot of people with HIV also have hepatitis C? About 25 to 30 percent of people with HIV in the U.S. also have hepatitis C (or HCV).

This can be a concern because those with this comorbidity are at higher risk for health issues like cirrhosis and end-stage liver disease.

According to the CDC, the most common way hep C is transmitted is through the reuse or sharing of needles, but it can also be sexually transmitted, and having a STI or HIV can increase the risk of acquiring hepatitis C. The good news: there are new curative treatments for hep C.

PIXABAY

Will being HIV-positive affect my ability to undergo gender-confirmation surgery, plastic surgery, or gastric bypass surgery?

A study published in 2006 in The Journal of the American Medical Association compared surgery data for both HIV-positive and HIVnegative patients and found that the two groups had the same level of complications from surgery. Still, you may have to work harder to find a surgeon who has worked with HIV-positive patients, or if you’re transgender, a doctor who can work with both your HIV specialist and your genderconfirmation surgeon.

Do HIV meds interfere with estrogen or testosterone levels?

No. Studies show that antiretroviral medications don’t affect hormone levels and are safe for transgender people to take with their feminizing or masculinizing treatments.

But estrogen may in fact impact the effectiveness of HIV drugs. The good news is a recent study of trans women using Truvada for the HIV prevention strategy PrEP found, while levels of the drug tenofovir dropped about 13 percent in the presence of estradiol (a form of estrogen), that was not enough to render it ineffective. Work with your doctor to find the right medication regimen to control your HIV while staying on your hormones and living in your authentic gender.

HIVPLUSMAG.COM

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SANJAY JOHNSON (continued from page 12)

continued from page

Maples credits the scientific consensus of U=U, or undetectable equals untransmittable, as a major reason why the state’s HIV crime law did not apply to Johnson’s case.

When an HIV-positive person has an undetectable viral load, it is impossible for them to transmit HIV to a negative partner—and therefore any arguments about “exposure” should hold no water in legal proceedings.

Maples plans on taking Johnson’s case to federal court, arguing that the law is unconstitutional.

“I feel that I have an excellent chance of success,” says Maples, who is also representing another poz client with the same charge. “If I am successful in federal court, my other client won’t have to face possible conviction under the statute—and neither will anyone else.”

As it currently stands in Arkansas, an HIV-positive person must inform their partner of the “existence” of the virus, Maples explains, and failure to disclose can result in a sentence of up to 30 years in prison and having to register as a sex offender for the rest of your life.

If their case is successful, the duo hope it will force Arkansas to implement a major revision of the law, perhaps in line with changes California and North Carolina have made, reducing the charge from a felony to a misdemeanor and preventing defendants who have been undetectable for at least six months from serving jail time.

Johnson, who will be the lead plaintiff in the federal lawsuit, has become an activist for the cause and remains optimistic about the process.

“I hope my case basically started [a] conversation about HIV today not [being] what it was,” he explains. “Considering modern medicine, just for one thing. Having more education about it in schools, and just in general, whoever you are—Black or white, gay, straight, bi, trans—having a conversation.”

Admittedly, the Osceola, Ark.-born Johnson says he wasn’t well informed before he was charged, which is what fuels him to educate other people about the issue today. He continues his mission despite the added burdens of being on probation, such as requirements that he now obtain permission from the court in order to travel out of the state. Because he didn’t “win” he’s also responsible for court fees, and, he says, if he misses a payment, he risks violating probation.

“What I feel as a Black man in the system now— unfortunately, they are probably looking for me [to] mess up,” he says of the five-year probation—an unusually long time given that a typical probation period for a misdemeanor is one to three years.

“To be honest, I believe politics unfortunately played into it,” he adds. “My mug shot was plastered all over social media while I was in jail. People automatically assumed that I’m out here infecting other people and stuff like that, and that’s not the case.” He says that experience has made him think twice about assuming the guilt of those arrested or accused of crimes.

“That’s why, for me personally, when I see a mug shot of anyone else, I don’t say anything because I know how my case was.”

One thing is for sure. This isn’t the end of the fight for Johnson. “In five years or less I hope to see more education about [HIV criminalization] and conversations…because [another case like mine] will happen in the future if it’s not being talked about.”

Noting predictions “that by 2030, 73 percent of [people living with HIV] will be over 50 years of age,” the authors concluded, “Multidisciplinary working is vital to the successful management of such patients where complex multimorbidity is likely to be the norm.” The researchers argue that their evaluation criteria will help better diagnose those with cognitive impairment and help ensure that people living with HIV get the care that they need.

That fewer people living with HIV have neurocognitive disorders than thought is certainly good news. But critics caution that the study’s small size (just 52 participants) make it unwise to extrapolate without further research. And HIV activists would certainly question any effort that suggests depression, anxiety, drug and alcohol use, and poor sleep cannot be directly linked to the stress of dealing with the chronic illness, especially in a world that still deeply stigmatizes living with HIV. And long-term survivors are arguing elsewhere that these symptoms are common among their cohort who survived the early days of the epidemic, watched friends die, were treated as pariahs, and weren’t provided adequate treatment until their health was already compromised.

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as many patients, as well as providers, are unaware that an effective, FDAapproved treatment exists.

Some patients and clinicians may reflexively turn to over-the-counter remedies like loperamide (brand name Imodium), even though it is not indicated for long-term use for chronic diarrhea or HIV-related diarrhea based on its mechanism of action. Further, loperamide is under heightened scrutiny in the context of the opioid epidemic for its potential for abuse, as it is a synthetic opioid.

Currently, there is only one FDA-approved drug to treat such HIVassociated diarrhea: Mytesi (generic name crofelemer), which surprisingly is not widely known nor prescribed.

In some states, such as New York, Medicaid requires a prior authorization before crofelemer can be prescribed. This creates a barrier to access and contributes to many people not receiving the drug when needed.

This study shows diarrhea is still a common condition for people living with HIV and should be more actively addressed. Underreporting of diarrhea, a belief among many HIV specialists that diarrhea is no longer a problem, as well as physicians being unaware of the benefits of the only available treatment, all contribute to untreated diarrhea remaining a serious morbidity for nearly one-fifth of people living with HIV. OLDEST LIVING POZ PERSON (continued from page 12)

aggressive course of chemotherapy. “Everything went well, but it could have gone wrong,” he said. “There could have been signs of toxicity. He could have not been able to bear the treatment. He could have missed the treatment. We had to consider those scenarios.”

Fifteen years later it’s clear that Miguel and his medical team made the right decision.

Inês Pintassilgo, a medical resident who has been part of Miguel’s treatment team for the past three years, said his health and longevity can be attributed to the fact that he has lived a healthy and active life, and since his diagnosis takes his HIV meds daily.

“I think he teaches us that you can live with HIV as long as you have all the other background and lifestyle and comorbidities under control,” Pintassilgo told CTV News. “I would say, of course, HIV maybe plays a little role in this, but if it’s well-managed and wellcontrolled, it will not be that big of an issue.”

HIV specialist Giovanni Guaraldi who works at the University of Modena in Italy said, “I believe that the Lisbon Patient is a sign of hope for people living with HIV to say you still have the capacity not just to live longer but to live in health, to experience healthy aging….

He is a proof of principle for us researchers and doctors to say we can provide better care to people.”

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“The issue of fundraising is so integral to nonprofits, and because white people have so many structural advantages around making money, I think that it’s such a problem,” he says. “It’s good to see that there are some funders that are now accepting applications in Spanish and also there are some funders that are accepting, like, video applications. But, you know, these grants are set up for people to win who went to the Ivy League schools. They’re not set up to necessarily find the people who need the money.”

Miami developed a Getting to Zero commission, modeled on other cities’ efforts. “But it was just politics,” argues Byrne. “It’s an unfunded mandate. They’ve done nothing from it, except put an ad on buses which don’t even mention PrEP. It’s just so clearly political.”

One issue may be that immigrants come from countries with no discussion of HIV, no discussion of condoms, let alone, gay issues, he adds. “You’re coming from an area where the HIV rate is really low and you’re coming into an area where—in South Beach the HIV rate is 5 percent of the general population, which is higher than sub-Saharan Africa—your risk is astronomically high. You can’t afford the same kind of sexual practices that you would have in Iowa or wherever. I’m sure there are plenty of people not using condoms in other places who are not getting HIV simply because the HIV prevalence in the population is so much lower.”

Tourism plays a role too, but beyond the movements of immigrants and tourists, Miami’s high HIV rates may be due to decisions made 483 miles away, in the state’s capital, Tallahassee.

“I kind of blame Tallahassee more than I blame Miami, and maybe it’s just out of convenience,” Byrne admits. “But Tallahassee is in a different country compared to Miami. It’s a white people, Southern place. I mean Florida is the one state where the North is the South, and the South is the North. So there’s a real disconnect between the continuing Republican administrations in Tallahassee—I think even Democrats there would probably have a similar problem.”

The activist recalls when someone from Tallahassee came to a Getting to Zero meeting and her “concern was perinatal infections—and perinatal infections in Florida is like four people a year. I’m just sitting there floored. I think it’s like 1,400 people get HIV in Miami Dade County every year. There’s just like this huge disconnect between Tallahassee and the rest of the state.”

In fact, Miami has more residents with HIV per capita than New York, Los Angeles, and San Francisco.

He says that Florida’s leaders have seen the HIV rates remain steady for so many years “that I think it’s just sort of like, ‘Well, what are we going to do? People are not changing their behaviors. We don’t have this big budget.’ I think there’s sort of a paralysis and a hopelessness” from political leaders.

Today in Miami, fewer than 2,000 people are taking PrEP. “You’re not going to stop an epidemic with that,” Byrne says.

If Torrealba has his way, that number will change. “The stigma is there, racism is there, the political fear can be there,” Torrealba admits. “But you have to be [think] like Martin Luther King.” He paraphrases MLK Jr. in describing his Miami mission: “You cannot drive a person out of darkness with darkness,” he says. “You have to show people what their possibilities are.”

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condition whereby the donor’s immune cells attack the recipient’s immune cells on contact. Brown reportedly suffered through this condition for months and was even placed in an induced coma at one point. He nearly died. “[Brown] was really beaten up by the whole procedure,” reflected Dr. Steven Deeks, an HIV expert who has treated Brown, to The Times. “And so we’ve always wondered whether all that conditioning, a massive amount of destruction to his immune system, explained why Timothy was cured but no one else [was].”

One hopeful sign with the London Patient is that his recovery from the procedure was reported as being more like that experienced by transplant patients.

Having not taken antiretroviral drugs since September 2017 and still in remission, the London Patient is now the second person since Brown to remain virally suppressed following the procedure for over a year after stopping HIV treatment.

Scientists have previously tried to repeat Brown’s success with no luck.

In 2012, researchers reported on cases of two HIVpositive men who’d also received stem cell transplants and went into remission after the procedure—but their HIV rebounded months later. (In both cases, their donors did not have the Delta32 mutation.)

The following year, a baby from Mississippi who was born with HIV also appeared to have been cured. Scientists credited early HIV treatment as a reason why the baby remained undetectable for 27 months before rebounding.

(In that case the child had not been consistently followed by researchers, so its medical history is not as well documented as that of the adult patients. And the length of time in remission isn’t considered reliable.)

Also that year, an HIV-positive 12-year-old from Minnesota received the same stem cell transplant as Brown and the London Patient. Sadly, he died of graftversus-host disease before scientists were able to test whether or not the procedure worked in suppressing his HIV. (And it’s sort of moot as to whether he was cured of HIV, if the cure itself proved deadly. In fact, researchers have previously noted the risk of death is one reason they don’t recommend these potentially curative treatments more broadly, especially given that people with HIV can live long and healthy lives with current treatment.)

All this being said, optimism is still important—and warranted. HIV is being controlled better than ever, and someone diagnosed with HIV today has nearly the same life expectancy as their HIV-negative peers.

There has been great progress toward longer-lasting treatments and even functional cures. But we shouldn’t confuse that with the fantasy that an eradication cure is just around the corner or could be widely available to the public within a few years. Those things simply are not the case.

But the truth is, HIV activists and advocates really do think we can eradicate HIV in the U.S. It’s just that when they talk about “eradicating” HIV or “ending AIDS,” they aren’t speaking about a hypothetical cure. Instead, they are talking about a well-funded approach to eliminating HIV transmission via proven methods like access to PrEP and embracing the true potential behind U=U. If more people know their status, HIV-negative people at risk take PrEP, and people living with HIV have their viral loads suppressed, we can stop the epidemic.

Then researchers can focus on making sure those with HIV can live long and healthy lives.

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B AC K TA L K

BY T R U DY R I N G

GAY, HIV-POSITIVE,

AND

RUNNING ILLINOIS

THE RAINBOW WAVE of last year’s midterm election is still resounding. As a record number of out LGBTQ lawmakers take their seats in state, local, and national offices, a record number are also gaining leadership positions in state legislatures.

The midterms saw more than 150 out LGBTQ candidates elected at all levels of government, according to the LGBTQ Victory Fund, which endorses and works to elect such candidates. That brings the total to 680 serving in state bodies, local offices, and Congress, Victory Fund notes.

And at the start of the 2019 legislative session, seven out LGBTQ lawmakers were chosen for state-level leadership positions, bringing the total to a historic high of 17.

One of them, Rep. Greg Harris of Illinois, is a gay man living with HIV. Harris, a Chicago native and Democrat, was named Illinois House Majority Leader in January by Speaker Mike Madigan, making him second only to the speaker in the state’s House hierarchy.

Harris is the first out gay lawmaker to hold that position.

“There are more and more [LGBTQ] people who are ascending to leadership, and that’s a good thing,” says Harris, who was first elected to the House in 2006.

Harris was previously an executive for a trade association and chief of staff to a Chicago city council member. He first became involved in politics in the early 1990s, during the height of the AIDS

48

crisis. Like most gay men, he notes, he saw people dying all around him.

“That’s when a lot of us got going,” he says. His appointment makes Harris one of only a handful of out HIV-positive people holding public office in the U.S. and one of the highest ranking.

Surprisingly, Harris admits that neither being gay nor being HIVpositive has impeded his political career. “I think I’ve been very fortunate,” he points out.

As majority leader, he’ll help set legislative priorities and advocate for key causes. One of them is improving access to affordable health care, something that’s especially important to LGBTQ and HIV-positive people as well as other minority demographic groups. “My number one job,” he adds, “is restoring fiscal stability and confidence” in Illinois, which during Republican Gov. Bruce Rauner’s tenure went without a complete budget for more than two years due to an impasse between Rauner and the Democratic majority legislature.

The impasse ended when legislators overrode Rauner’s veto of a budget in 2017, and last year Rauner lost his reelection bid to Democrat J.B. Pritzker. Harris is looking forward to working with Pritzker, “who’s going to be just great,” he says. “We’re going to have a progressive governor and a man who is a coalition-builder.”

Harris adds that he hopes legislators and the governor can give the people what they want, which he sums up by saying, “I think people want government to get down there and solve problems and make their lives better.”

The ascension of Harris and other out legislators to leadership positions is encouraging to Victory Fund and its sibling organization, Victory Institute, which provides training and support to LGBTQ politicians.

“While LGBTQ people are severely underrepresented in state legislatures across the nation, more and more we are chosen for key leadership positions in those statehouses—a true testament to the effectiveness of LGBTQ elected officials,” Victory Institute vice president Ruben Gonzales said. “Rep. Harris’s ability to successfully navigate the legislative process and secure big wins for Illinoisans is why he was chosen House majority leader. But as an openly [gay] man, this elevated position allows him to champion and advance LGBTQ equality legislation and become an even greater role model for LGBTQ youth throughout the state.”

RUSS NAGEL

GREG HARRIS, THE NEW ILLINOIS HOUSE MAJORITY LEADER, IS ONE OF SEVERAL OUT LGBTQ LAWMAKERS ASCENDING TO KEY POSTS

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