Plus Magazine, July-August 2023

BECAUSE YOU'RE MORE THAN YOUR STATUS

WRITER, REBEL, ROLE MODEL

MARK S. KING

2023 TREATMENT GUIDE JOJO SIWA + ELTON JOHN SASHA COLBY + HEIDI N CLOSET

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.

MOST IMPORTANT INFORMATION ABOUT BIKTARVY

BIKTARVY may cause serious side e ects, including:

 Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. 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 fi rst talking to your healthcare provider, as they will need to check your health regularly for several months, and may give you HBV medicine.

ABOUT BIKTARVY

BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults and children who weigh at least 55 pounds. 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, 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.

Tell your healthcare provider about all the medicines you take:

 Keep a list that includes all prescription and over-thecounter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

 BIKTARVY and other medicines may a ect 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.

POSSIBLE SIDE EFFECTS OF BIKTARVY

BIKTARVY may cause serious side e ects, 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 that may have been hidden in your body. 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 e ects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).

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

You are encouraged to report negative side e ects 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

Take BIKTARVY 1 time each day with or without food.

GET MORE INFORMATION

 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, GILEAD, the GILEAD Logo, and KEEP BEING YOU are trademarks of Gilead Sciences, Inc., or its related companies. © 2023 Gilead Sciences, Inc. All rights reserved. US-BVYC-0250 04/23

#1 PRESCRIBED HIV TREATMENT*

No matter where life takes you,

ELIAS SWITCHED TO BIKTARVY

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.

Person featured takes BIKTARVY and is compensated by Gilead.

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

14 ON THE COVER SEX, DRUGS, AND HIV

Avid HIV advocate and awardwinning blogger Mark S. King tells all in his juicy new memoir, My Fabulous Disease.

FEATURE

24 PRINCIPLE PIONEERS

Our cover star shares an excerpt from his GLAAD Award-winning blog concerning the historic 1983 Denver Principles.

ON THE COVER + ABOVE

Mark S. King photographed by Darrell Snedeger / Creative Energy

Photography

2023 TREATMENT GUIDE

26 THE BIG DRUG LIST

Our annual guide to all the most commonly prescribed drugs used for the treatment and prevention of HIV.

35 STAY CLASSY

An explanation of the various drug classes and how they work.

36 ITCH TO SWITCH?

Some reasons why you might consider changing up your meds.

38 ILL EFFECTS

Side effects suck. Here's what you need to know.

40 FREE AT LAST

Treating and preventing HIV is easier than ever.

42 LOOKING AHEAD

The scientific community continues to work on new HIV treatment options.

BUZZWORTHY

6 FIGHT FOR LIFE

LGBTQ+ people with HIV living in intolerant countries are among the most at risk.

8 SAFETY QUEENS

Two of our favorite drag superstars educate about PrEP.

11 HAPPY LIFE, HEALTHY LIFE

Why are some trans women less at risk for HIV?

12 DOWN, BUT NOT DONE

Despite racial inequities, overall HIV rates have gone down.

WELLNESS

44 HANG IN THERE

Some tips on getting through the more difficult days in life.

PARTING SHOT

46 YOU GO, JOJO!

JoJo Siwa joins forces with the Elton John AIDS Foundation.

MICHAEL BUCKNER/VARIETY VIA GETTY IMAGES (SIWA); YOUTUBE/MISTR (CLOSET & COLBY)

editorial director NEAL BROVERMAN

editor in chief DESIRÉE GUERRERO

executive creative director RAINE BASCOS

EDITORIAL

senior copy editor TRUDY RING

contributing editor MARK S. KING

mental health editor GARY MCCLAIN

contributing writer ANDREW J. STILLMAN

ART

graphic designer MARIUSZ WALUS

senior marketing designer ERIK BROCK

digital photo editor NICOLE ARSENEAULT

EQUALPRIDE EDITORIAL

editorial director NEAL BROVERMAN

executive creative director RAINE BASCOS

editor in chief, the advocate DESIRÉE GUERRERO

digital director, the advocate ALEX COOPER

senior editor, the advocate JOHN CASEY sr. national reporter, the advocate CHRISTOPHER WIGGINS

staff writer, the advocate & out MEY RUDE editor in chief, out DANIEL REYNOLDS

digital director, out RAFFY ERMAC

associate digital director, out & pride.com BERNARDO SIM editor in chief, out traveler JACOB ANDERSON-MINSHALL managing editor, out traveler DONALD PADGETT editor in chief, pride.com RACHEL SHATTO

associate editor DYLAN REBER

ADVOCATE CHANNEL

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Plus (ISSN 1522-3086) is published bimonthly by equalpride.

Plus is a registered trademark of equalpride.

Entire contents ©2023 by equalpride. All rights reserved. Printed in the U.S.A.

It is with great joy that I present Plus magazine’s 11th annual Treatment Guide issue. Sure, we give lots of facts, figures, and information on all the current medications available for the prevention and treatment of HIV — but the joy comes from the fact every year more and more lifesaving treatment options become available. The joy comes from knowing no one needs to “suffer” with HIV any longer, and that now people living with HIV can live long, happy, healthy lives — including thriving and satisfying sex lives.

These days most people living with HIV can quickly suppress the virus in their body to undetectable levels once on treatment. And once you reach undetectable, you then have a zero chance of passing HIV to a sexual partner, even without use of a condom. This globally accepted scientific consensus is also known as U=U (undetectable equals untransmittable) and it has freed people living with HIV and their partners to enjoy sex like never before. And it’s all thanks to the amazing advancements made in HIV medications over the last few decades.

These advancements wouldn’t have been possible were it not for early organizations like the Elton John AIDS Foundation and the handful of

celebrities, like Sir Elton, who used their star power to fuel awareness and funding for HIV/AIDS causes, despite the extreme stigma that surrounded the virus at the time. On page 46, read about how dancer and influencer JoJo Siwa is one of the latest celebs to use her platform to help the foundation, which is committed as ever to improving the lives of those affected by HIV.

If anyone knows the history of HIV treatment, it’s our cover star, Mark S. King . King was first diagnosed with HIV in 1985, a full decade before today’s lifesaving antiretroviral treatments were developed. Thankfully, he survived those darker times and overcame addiction in the process, which he writes candidly about in his new memoir, My Fabulous Disease. The GLAAD Awardwinning blogger created the memoir by compiling decades of blog and journal entries. “We have a problem with alcoholism and addiction in our community,” King told Plus. “And it is a constant threat. It is the disease more likely to kill me than HIV…. I think there’s so many of us in our community who struggle with that or know someone who they can’t reach anymore.” Read the full interview starting on page 14.

In this issue, we also keep you updated on the latest news in our Buzzworthy section — like how Drag Race alums Sasha Colby and Heidi N Closet team up with MISTR to promote PrEP (page 8), the highly effective HIV prevention method. Or read about why transgender women who seek gender-affirming care are less likely to acquire HIV (page 11).

Please enjoy this issue — my hope is that, whether you are living with HIV or just looking for information on prevention, we give you all the answers you need. Stay happy, healthy, and informed.

Be well,

Happy summer, readers! The past months have been extraordinary, and we couldn’t do this without you.

Our recent Out Pride issue drop party, in collaboration with Can’t Cancel Pride, was truly a night to remember. Held at Nebula NY, it was a night of joy, unity, and a resounding affirmation of the strength of our community. I want to express my deepest thanks to all who attended and made the evening unforgettable.

June marks the first anniversary of equalpride. We launched equalpride with a simple yet ambitious mission: to create a platform that not only celebrates the LGBTQ+ community but also advocates for its rights, inclusion, and acceptance. In this regard, our journey has just begun, but what a journey it’s been. We have seen our community of readers and storytellers grow, connect, and strengthen. This anniversary is not just equalpride’s; it’s yours. You are the heartbeat of our family of brands, the driving force behind everything we do.

As we move forward, our focus remains steadfast on our Pride 365 initiative, which embodies our commitment to advocating for the LGBTQ+ community every day. This initiative aims to keep the spirit of Pride alive year-round by highlighting the stories, struggles, and victories of our community, providing resources, and pushing for equality at all levels.

We look forward to all that we will accomplish together. Thank you for being a part of this journey, for standing by us, and for making equalpride a beacon of love, equality, authenticity, and pride. Please reach out via email at advocatemarkb@equalpride.com, IG @advocatemarkb.

With gratitude,

Mark Berryhill, Chief Executive Officer

a note from our ceo

FREE TO LOVE, FREE TO LIVE

The latest data shows a dangerous connection between countries with anti-LGBTQ laws and HIV rates.

BY ANDREW J. STILLMAN

In a world where 67 countries still criminalize same-sex relations, with 10 of them even imposing the death penalty, the public health consequences are undeniable.

According to UNAIDS, countries that criminalize same-sex relations experience HIV prevalence rates five times higher among gay men and men who have sex with men compared to those where such relations are not criminalized. In countries with recent prosecutions, this number increases to a staggering 12 times higher.

Acknowledging the urgent need for change, Christine Stegling, deputy executive director of Policy, Advocacy and Knowledge at UNAIDS, emphasized the critical importance of decriminalizing homosexuality and gender diversity. “Decriminalizing will save lives and is a crucial

step towards equality, dignity, and health for all,” she said.

Despite LGBTQ+ individuals being an integral part of societies across cultures and history, they continue to face marginalization and exclusion, whether legally, culturally, or socially. The combination of criminalization, discrimination, and violence obstructs their access to life-saving services, and healthcare providers themselves often face harassment for offering assistance.

Recognizing the detrimental impact of criminal laws on the HIV response, United Nations members made ambitious commitments to remove such laws in the 2021 Political Declaration on HIV, aiming to create environments that do not impede the HIV response for key populations.

Encouragingly, progress has been made in the past year. Several countries, including Antigua and Barbuda, Saint Kitts and Nevis, Singapore, Barbados,

and the Cook Islands have repealed outdated colonial laws that criminalized same-sex relations. Kuwait’s court has also overturned a law that punished those who “imitate the opposite sex.” Brazil has emerged as a leader in advancing LGBTQ+ rights, with the Minister of Health and the Minister of Human Rights announcing the country’s participation in the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination.

However, this positive momentum is threatened by a well-funded, well-organized international movement seeking to enact new antigay and anti-trans legislation, perpetuating

prejudice and discrimination. If successful, these laws would severely impact public health, hindering LGBTQ+ individuals from accessing health care and preventing doctors and nurses from delivering life-saving HIV prevention and treatment services.

On May 17 — International Day against Homophobia, Transphobia, and Biphobia — UNAIDS called on all nations to abolish punitive laws and combat prejudice against lesbian, gay, bisexual, transgender, and intersex people. By creating a more just, equitable, and compassionate world, we can also build a healthier one for everyone.

A couple hugs near a sign that reads “Bolsonaro out” during a Pride parade in June 2022 in Sao Paulo, Brazil. Former Brazilian president Jair Bolsonaro, known for far-right extremism and anti-LGBTQ+ views, lost his bid for re-election last November.

RIGHT An activist in San Salvador, El Salvador, marches with a sign that reads “Love is not decided, it is felt” during a rally to commemorate International Day Against Homophobia, Biphobia and Transphobia in May; the rally was also called to demand the Salvadoran government approve a gender identity law

SHE’S PREPPED!

Drag superstars Sasha Colby and Heidi N Closet star in a funny and informative video about PrEP.

RUPAUL’S DRAG RACE season

15 winner Sasha Colby recently teamed up with Drag Race All Stars

8 contestant Heidi N Closet for the latest installment in MISTR’s Got PrEP video series on YouTube. In the video, “Dr. Closet” consults with Sasha to see if she is a good candidate for the HIV prevention medication.

The video opens with Heidi fangirling over Sasha before talking to her about PrEP (preexposure prophylaxis). Heidi asks her about her sexual preparation and protection when she goes out on tour. “As a woman of the world, a woman do need to be prepared,” quipped Sasha.

According to the CDC, only 25 percent of the 1.2 million people

in the U.S. who would benefit from PrEP are actually using it. And studies have also shown that HIV disproportionately affects transgender women, so it’s great to see a trans celebrity like Ms. Colby helping to educate folks about PrEP.

MISTR, a gay-owned and -operated telehealth platform, aims to increase awareness of PrEP in order to bring that number closer to 100 percent, both through videos like this and by providing easy, discreet online access to no-cost PrEP and long-term HIV care in all 50 states, D.C., and Puerto Rico.

Countries like Australia and England have recently been vocal about the use of PrEP helping their population move toward an elimination of new HIV cases, while U.S. states like Tennessee have implemented laws to prohibit federal funding for HIV-related services. Attacks like this make telehealth services like MISTR all the more vital in ensuring everyone who can benefit from PrEP continues to have access to it.

After a few more questions and some fun banter between the queens, Dr. Closet determines that Sasha is indeed a good candidate for PrEP. —AJS

Drag Race alums Heidi N Closet (left) and Sasha Colby partner with MISTR to discuss PrEP in a new video series

Welcome to long-acting HIV treatment.

Jayson

Stays undetectable with CABENUVA

Results may vary.

CABENUVA is the only complete, long-acting injectable prescription used to replace daily HIV pills in certain adults and adolescents who have their doctor’s approval.

Every-other-month CABENUVA is given by a healthcare provider as 2 injections, initially 1 month apart for 2 months. It works continuously to help you stay undetectable* for 2 months.

Attend all appointments.

Important Facts About CABENUVA

This is only a brief summary of important information about CABENUVA and does not replace talking to your healthcare provider about your condition and treatment. (kab’ en ue vah)

ABOUT CABENUVA

CABENUVA is a complete prescription regimen used to treat HIV-1 infection in adults and adolescents ≥12 years who weigh at least 77 lbs (35 kg) and are replacing their current HIV-1 treatment when their healthcare provider determines that they meet certain requirements.

HIV-1 is the virus that causes Acquired Immune Deficiency Syndrome (AIDS).

CABENUVA contains 2 different medicines:

• cabotegravir

• rilpivirine

It is not known if CABENUVA is safe and effective in children younger than 12 years of age or weighing less than 77 lbs (35 kg).

DO NOT RECEIVE CABENUVA IF YOU

• have ever had an allergic reaction to cabotegravir or rilpivirine.

• are taking the following medicines:

° carbamazepine

° oxcarbazepine

° phenobarbital

° phenytoin

° rifabutin

° rifampin

° rifapentine

° dexamethasone (more than a single-dose treatment)

° St John’s wort (Hypericum perforatum)

Ask your doctor about CABENUVA

BEFORE RECEIVING CABENUVA

Tell your healthcare provider about all your medical conditions, including if you:

• have ever had a skin rash or an allergic reaction to medicines that contain cabotegravir or rilpivirine.

• have ever had liver problems, including hepatitis B or C infection.

• have ever had mental health problems.

• are pregnant or plan to become pregnant. It is not known if CABENUVA will harm your unborn baby. CABENUVA can remain in your body for up to 12 months or longer after the last injection.

Please see additional Important Facts About CABENUVA on the following page.

*Undetectable means the amount of HIV in the blood is below the level that can be measured by a lab test. Results may vary. Jayson has been compensated by ViiV Healthcare.

“With every-other-month CABENUVA, I’m good to go.”

Important Facts About CABENUVA (cont'd)

BEFORE RECEIVING CABENUVA (cont'd)

Tell your healthcare provider about all your medical conditions, including if you: (cont'd)

• are breastfeeding or plan to breastfeed. Do not breastfeed if you take CABENUVA.

° You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. It is not known if CABENUVA can pass to your baby in your breast milk.

° Talk with your healthcare provider about the best way to feed your baby during treatment with CABENUVA.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with CABENUVA. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. You can ask your healthcare provider or pharmacist for a list of medicines that interact with CABENUVA. Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take CABENUVA with other medicines.

POSSIBLE SIDE EFFECTS OF CABENUVA

CABENUVA may cause serious side effects, including:

• Allergic reactions. Call your healthcare provider right away if you develop a rash with CABENUVA. Stop receiving CABENUVA and get medical help right away if you develop a rash with any of the following signs or symptoms:

° fever

° generally ill feeling

° tiredness

° muscle or joint aches

° trouble breathing

° blisters or sores in mouth

° blisters

° redness or swelling of the eyes

° swelling of the mouth, face, lips, or tongue

• Post-injection reactions have happened within minutes in some people after receiving their rilpivirine injection. Most symptoms resolved within minutes after the injection. Symptoms may include:

° trouble breathing

° narrowing of airways

° stomach cramps

° sweating

° numbness of your mouth

° pain (e.g., back and chest)

° feeling anxious

POSSIBLE SIDE EFFECTS OF CABENUVA (cont’d)

CABENUVA may cause serious side effects, including:(cont’d)

• Liver problems. People with a history of hepatitis B or C virus or people who have certain liver function test changes may have an increased risk of developing new or worsening changes in certain liver tests during CABENUVA treatment. Liver problems have also happened in people without history of liver problems or other risk factors. Your healthcare provider may do blood tests to check your liver function. Call your healthcare provider right away if you develop any of the following signs or symptoms of liver problems:

° your skin or the white part of your eyes turns yellow (jaundice)

° dark or “tea-colored” urine

° light-colored stools (bowel movements)

° nausea or vomiting

° loss of appetite

° pain, aching, or tenderness on the right side of your stomach area

° itching

• Depression or mood changes. Call your healthcare provider or get emergency medical help right away if you have any of the following symptoms:

° feeling sad or hopeless

° feeling anxious or restless

° have thoughts of hurting yourself (suicide) or have tried to hurt yourself

The most common side effects of CABENUVA include:

• pain, tenderness, hardened mass or lump, swelling, redness, itching, bruising, and warmth at the injection site

• fever

• tiredness

• headache

• muscle or bone pain

• nausea

• sleep problems

• dizziness

• rash

These are not all the possible side effects of CABENUVA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

GET MORE INFORMATION

° feeling warm

° rash

° feeling light-headed or feeling like you are going to pass out (faint)

° blood pressure changes

• Talk to your healthcare provider or pharmacist.

• Go to CABENUVA.com or call 1-877-844-8872, where you can also get FDA-approved labeling.

March 2022 CBN:4PIL

Trademarks are property of their respective owners.

Caring for Her

The latest research shows trans women who seek genderaffirming are less likely to acquire HIV.

TRANSGENDER WOMEN WHO seek gender-affirming care are less likely to contract HIV, according to a recent study posted in The Lancet HIV. The research also revealed that trans women who didn’t receive genderaffirming care were more socially or economically vulnerable.

“Poor reporting and misgendering trans people has, too often, meant that data on HIV prevalence among trans and gender diverse communities is unreliable,” Matthew Hodson, executive director of Aidsmap, recently told PinkNews . “Recent reports on new infections among trans women, and HIV incidence among trans men, are helping to build a more accurate picture and highlight that trans people remain more vulnerable to HIV than the general cis population.”

An Aidsmap report also showed that discrimination and stigma contributed to many deaths due to hate crimes and poor access to healthcare. It also showed that 14 percent of trans women are currently living with HIV in the U.S.

“Trans communities experience high rates of intimatepartner violence, economic dependence, drug use, insecure housing, and poor emotional health and are more likely to be involved in sex work,” said Hodson.

In order to help mitigate future cases, he suggests that organizations combine gender-affirming care with sexual health to improve the access needed for preventative medication.

“Trans-led services understand trans bodies and can provide assurance that trans people will be welcomed,” Hodson said. “Combining gender-affirmative healthcare with sexual health can improve engagement and may lead to better uptake of HIV prevention tools such as PrEP.”—AJS

62%

Among seven major U.S. cities, the approximate percentage of Black transgender women living with HIV

17%

In those same cities, the approximate percentage of white transgender women living with HIV

Source: CDC: HIV infection, risk, prevention, and testing behaviors among transgender women — National HIV Behavioral Surveillance — 7 U.S. Cities, 2019-2020

BETTER FOR WHO?

HIV rates among young gay and bi men have dropped overall — but communities of color are still disproportionately affected.

ACCORDING TO THE latest data from the Centers for Disease Control and Prevention, new HIV diagnoses in the United States showed a promising decline of 12 percent from 2017 to 2021. Notably, the decrease was largely driven by a significant 34 percent decline in new cases among 13- to 24-year-olds, particularly among gay and bisexual males.

Among young gay and bisexual males, who account for about 80 percent of new diagnoses in this age group, annual HIV rates decreased from 9,300 in 2017 to 6,100 in 2021. This positive trend highlights the impact of improved HIV prevention efforts, including increased accessibility to HIV testing, treatment, and PrEP (a medical HIV prevention method) among this vulnerable population.

CDC director Rochelle P. Walensky emphasized the progress made but stressed the need for accelerated efforts to ensure equitable access to HIV prevention and treatment services. “Longstanding factors, such as systemic inequities, social and economic marginalization, and residential segregation, however, stand between highly effective HIV treatment and prevention and people who could benefit from them,” she said. “Efforts

must be accelerated and strengthened for progress to reach all groups faster and equitably.”

The decline in new HIV infections, however, was not evenly distributed across all racial and ethnic groups. The decrease was comparatively lower among young Black and Latino gay and bisexual males, indicating persistent disparities in HIV prevention and treatment. These disparities reflect broader societal inequalities that impede progress in addressing the HIV epidemic.

While the CDC report highlighted an increase in the number of people prescribed PrEP for HIV prevention, reaching approximately 30 percent of the 1.2 million individuals who could benefit from it in 2021, disparities in prescription rates were observed among racial and ethnic groups. A relatively low proportion of Black and Latinx individuals who could benefit from PrEP received prescriptions compared to their white counterparts.

The CDC data also revealed that the majority of new HIV diagnoses in 2021 occurred among gay and bisexual men, and more than half of the cases among women affected Black women. These statistics emphasize the ongoing need for comprehensive prevention strategies that reach all communities at risk.

To achieve the goal of ending the HIV epidemic in the U.S., the CDC calls for increased investments in proven HIV prevention programs, expansion of HIV selftesting, and the incorporation of HIV services into various health care settings and emphasizes the importance of centering equity in all aspects of HIV prevention and treatment to ensure that interventions effectively reach those disproportionately affected by the virus.—AJS

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Activist, author, and long-term HIV survivor Mark S. King gets real about sex, drugs, and living through the AIDS epidemic in a fascinating new memoir.

BY DESIRÉE GUERRERO PHOTOGRAPHY BY DARRELL SNEDEGER

“A lot of my professional platform or the way people saw me was as a long-term survivor and HIV activist personality,” King tells Plus. “And that’s all well and good, but what I always liked about my blog is that it was whatever was on my mind. The fact is that those of us living with HIV have full and complete lives outside of our HIV status, and other challenges that have nothing to do with HIV, or other things that are triumphs that have nothing to do with HIV. And that is why you’ll see in My Fabulous Disease, there are other sections unrelated to HIV about my sex life, growing up gay, and addiction.”

King has been involved in HIVAIDS causes since being diagnosed as HIV-positive in 1985. Among many accolades he’s received over the years, King was named the 2020 LGBTQ Journalist of the Year by the National Lesbian and Gay Journalist Association (NLGJA). He was also awarded NLGJA’s Excellence in Blogging honor in 2014, 2016, and 2020. In 2020, he won the GLAAD Award for Outstanding Blog and was named one of the “Out100” by Out magazine.

But before accomplishing all that, King, like many 20-somethings, was just trying to find his place in the world. In the early 1980s, after graduating from the University of Houston, King pursued a career in Hollywood and appeared in dozens of TV commercials, “hawking fast food and soft drinks.” He also started Telerotic during this time, which ended up becoming one of the largest gay telephone fantasy services in the country. However, soon after receiving his HIV diagnosis, King sold the company.

It was this specific time period that King reflected upon in his previous memoir, A Place Like This, which focused on his tumultuous time in L.A. in the ’80s. With his new memoir, My Fabulous Disease, he hopes to give a more complete picture of his life. The book’s title is also the name of King’s award-winning, long-running blog (myfabulousdisease.com). In the memoir, King compiles stories from his life collected from his decades of journaling and blogging — and he leaves in all the good, bad, hilarious, and sexy details.

“A lot of it was written in real time, in that I was writing it as it was happening,” he explains. “Certainly, from the ’90s on. It’s funny, it is my therapy. It’s like I’ve had my own version of talk therapy…. And that is, I was talking to myself, I was writing it down, I was processing it.”

“I feel as if I’m an essayist…I am a storyteller,” says award-winning blogger, author, speaker, and HIV activist Mark S. King when asked what the inspiration was for his new memoir, My Fabulous Disease. He explains that he really wanted to illustrate that people living with HIV are more than the virus that affects them — they are simply human beings like everyone else.

LONG- C ING

APRETUDE is a prescription medicine used for HIV-1 PrEP to reduce the risk of getting HIV-1 infection in adults and adolescents who weigh at least 77 pounds (at least 35 kg).

i he fi n nl l ng- ing, inje le f e ing he i f ge ing HIV-1

I ’ n inje i n given eve he m n h, in e f pill e eve

S ie in HIV-1 neg ive i gen e men, n gen e w men, n i gen e w men i f ge ing HIV-1

APRETUDE is given every other month by a healthcare provider after initiation injections have been given 1 month apart for 2 consecutive months. Stay under a provider’s care while receiving APRETUDE. You must receive it as scheduled. If you will miss a scheduled injection by more than 7 days, call your provider right away.

IMPORTANT FACTS ABOUT APRETUDE

This is only a brief summary of important information about APRETUDE and does not replace talking to your healthcare provider about your medicine.

AP-reh-tood

MOST IMPORTANT INFORMATION ABOUT APRETUDE

Important information for people who receive APRETUDE to help reduce their risk of getting human immunodeficiency virus-1 (HIV-1) infection, also called pre-exposure prophylaxis or “PrEP”:

MOST IMPORTANT INFORMATION ABOUT APRETUDE (cont'd)

Before receiving APRETUDE to reduce your risk of getting HIV-1:

• You must be HIV-1 negative to start APRETUDE. You must get tested to make sure that you do not already have HIV-1 infection.

• Do not receive APRETUDE for HIV-1 PrEP unless you are confirmed to be HIV-1 negative.

• Some HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. If you have flu-like symptoms, you could have recently become infected with HIV-1. Tell your healthcare provider if you had a flu-like illness within the last month before starting APRETUDE or at any time while receiving APRETUDE. Symptoms of new HIV-1 infection include: tiredness; joint or muscle aches; sore throat; rash; enlarged lymph nodes in the neck or groin; fever; headache; vomiting or diarrhea; night sweats. Please see additional Important Facts About APRETUDE at right.

Eligible patients may p li le $0 -p pe inje i n on prescribed APRETUDE.

IMPORTANT FACTS ABOUT APRETUDE (cont'd)

MOST IMPORTANT INFORMATION ABOUT APRETUDE (cont'd)

While you are receiving APRETUDE for HIV-1 PrEP:

• APRETUDE does not prevent other sexually transmitted infections. Practice safer sex by using a latex or polyurethane condom to reduce the risk of getting sexually transmitted infections.

• You must stay HIV-1 negative to keep receiving APRETUDE for HIV-1 PrEP.

° Know your HIV-1 status and the HIV-1 status of your partners.

° Ask your partners with HIV-1 if they are taking anti-HIV-1 medicines and have an undetectable viral load. An undetectable viral load is when the amount of virus in the blood is too low to be measured in a lab test. To maintain an undetectable viral load, your partners must keep taking HIV-1 medicine as prescribed. Your risk of getting HIV-1 is lower if your partners with HIV-1 are taking effective treatment.

° Get tested for HIV-1 with each APRETUDE injection or when your healthcare provider tells you. You should not miss any HIV-1 tests. If you become HIV-1 infected and continue receiving APRETUDE because you do not know you are HIV-1 infected, the HIV-1 infection may become harder to treat.

° Get tested for other sexually transmitted infections such as syphilis, chlamydia, and gonorrhea. These infections make it easier for HIV-1 to infect you.

° If you think you were exposed to HIV-1, tell your healthcare provider right away. They may want to do more tests to be sure you are still HIV-1 negative.

° Get information and support to help reduce sexual risk behaviors.

° Do not miss any injections of APRETUDE. Missing injections increases your risk of getting HIV-1 infection.

° If you do become HIV-1 positive, you will need to take other medicines to treat HIV-1. APRETUDE is not approved for treatment of HIV-1.

If you have HIV-1 and receive only APRETUDE, over time your HIV-1 may become harder to treat.

ABOUT APRETUDE

APRETUDE is a prescription medicine used for HIV-1 PrEP to reduce the risk of getting HIV-1 infection in adults and adolescents who weigh at least 77 pounds (at least 35 kg). HIV-1 is the virus that causes Acquired Immune Deficiency Syndrome (AIDS).

It is not known if APRETUDE is safe and effective in children younger than 12 years of age or weighing less than 77 pounds (less than 35 kg).

DO NOT RECEIVE APRETUDE IF YOU:

• already have HIV-1 infection. If you are HIV-1 positive, you will need to take other medicines to treat HIV-1. APRETUDE is not approved for treatment of HIV-1.

• do not know your HIV-1 infection status. You may already be HIV-1 positive. You need to take other medicines to treat HIV-1. APRETUDE can only help reduce your risk of getting HIV-1 infection before you are infected.

• are allergic to cabotegravir.

• are taking any of the following medicines: carbamazepine; oxcarbazepine; phenobarbital; phenytoin; rifampin; rifapentine.

BEFORE RECEIVING APRETUDE

Tell your healthcare provider about all your medical conditions, including if you:

• have ever had a skin rash or an allergic reaction to medicines that contain cabotegravir.

• have or have had liver problems.

• have ever had mental health problems.

• are pregnant or plan to become pregnant. It is not known if APRETUDE will harm your unborn baby. APRETUDE can remain in your body for up to 12 months or longer after the last injection. Tell your healthcare provider if you become pregnant while receiving APRETUDE.

BEFORE RECEIVING APRETUDE (cont'd)

• are breastfeeding or plan to breastfeed. It is not known if APRETUDE can pass to your baby in your breast milk. Talk with your healthcare provider about the best way to feed your baby while receiving APRETUDE.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines may interact with APRETUDE. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. You can ask your healthcare provider or pharmacist for a list of medicines that interact with APRETUDE.

Do not start a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to receive APRETUDE with other medicines.

POSSIBLE SIDE EFFECTS OF APRETUDE

APRETUDE may cause serious side effects, including:

• Allergic reactions. Call your healthcare provider right away if you develop a rash with APRETUDE. Stop receiving APRETUDE and get medical help right away if you develop a rash with any of the following signs or symptoms: fever; generally ill feeling; tiredness; muscle or joint aches; trouble breathing; blisters or sores in mouth; blisters; redness or swelling of the eyes; swelling of the mouth, face, lips, or tongue.

• Liver problems. Liver problems have happened in people with or without a history of liver problems or other risk factors. Your healthcare provider may do blood tests to check your liver function. Call your healthcare provider right away if you develop any of the following signs or symptoms of liver problems: your skin or the white part of your eyes turns yellow (jaundice); dark or "tea-colored" urine; lightcolored stools (bowel movements); nausea or vomiting; loss of appetite; pain, aching, or tenderness on the right side of your stomach area; itching.

• Depression or mood changes. Call your healthcare provider or get medical help right away if you have any of the following symptoms: feeling sad or hopeless; feeling anxious or restless; have thoughts of hurting yourself (suicide) or have tried to hurt yourself.

The most common side effects of APRETUDE include: pain, tenderness, hardened mass or lump, swelling, bruising, redness, itching, warmth, loss of sensation at the injection site, abscess, and discoloration; diarrhea; headache; fever; tiredness; sleep problems; nausea; dizziness; passing gas; stomach pain; vomiting; muscle pain; rash; loss of appetite; drowsiness; back pain; upper respiratory infection. These are not all the possible side effects of APRETUDE.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

GET MORE INFORMATION

• Talk to your healthcare provider or pharmacist.

• Go to APRETUDE.com or call 1-877-844-8872 where you can also get FDA-approved labeling.

December 2021 APR:1PIL

Trademark is owned by or licensed to the ViiV Healthcare group of companies. ©2022 ViiV Healthcare or licensor.

CBTADVT220011 August 2022

Produced in USA.

SAYING, ‘HOW DO I FEEL ABOUT THIS? HOW DO I REALLY FEEL?”

“MY MOST REFLECTIVE, MEDITATIVE TIMES ARE SITTING IN FRONT OF MY LAPTOP STARING INTO SPACE

“I’ve been to therapists before [and] I had visited a new therapist before who was practically licking their chops when they discovered and learned that I’d been living with HIV for so long,” says King with a laugh. “You could tell, oh my, they were going to have so much material to work with here with this client! And I would have to say, no, no, just relax. I’m okay with all of that. Now let me talk about my relationship.”

Ultimately, King says it was mainly through his writing that he’s been truly able to heal and figure things out about life and himself. “My most reflective, meditative times are sitting in front of my laptop staring into space saying, ‘How do I feel about this? How do I really feel?’”

He certainly keeps it real in the new memoir, including the frank discussion of sex and drugs — and their particular connection to gay culture.

“We have a problem with alcoholism and addiction in our community,” says King. “And it is a constant threat. It is the disease more likely to kill me than HIV. And especially me, I have that history. I think there’s so many of us in our community who struggle with that or know someone who they can’t reach anymore.”

“It’s worth talking about and sharing and writing about it,” adds King. “And I know that crystal meth…it has such a culturally specific grip on gay men. It has this kind of mythological, sexual-superstar drug reputation. And if you’re young and you’re trying to find your place, and you believe that in order to be a successful gay man you need to have zero inhibitions and feel and look pornographically hot, then there’s a drug that can make you feel that way.”

King says he was especially honored to have former Olympic diver and fellow longtime HIV advocate Greg Louganis write the forward for My Fabulous Disease.

“Greg has just always been one of those people that I kind of know peripherally,” he says. “But clearly I admire him. And when I thought about the foreword, he was just the first person I thought of because he knows a little something about living life out loud and publicly…. He has aspects of the story that are very different from mine, but a lot of it is just how we release ourselves from shame and celebrate who we really are. We would all be out more naturally if other people weren’t pushing us back or [perpetuating] the shame that they engender in us.”

King now lives with his husband, Michael, “a real smarty pants involved in national healthcare access [and] a much better person than [me],” he jokes. King often finds himself traveling from their home in Atlanta, reporting on the latest news out of health conferences and giving speeches at colleges, nonprofits, and to groups of people, who like him, are living fabulously with HIV.

My Fabulous Disease is available September 1 at most major booksellers.

ANGRY MEN

Four decades ago, “The Denver Principles” dared to bring humanity and sex-positivity into the conversation around HIV — and changed healthcare forever.

BY MARK S. KING

You must know this, because it matters. Because it has already changed your life, no matter who you are, and you may not even realize it.

It was 1983. Just a year prior, Acquired Immune Deficiency Syndrome (AIDS) became the fearful nameplate for the murderer of gay friends and lovers. The virus that caused it, HIV, had only been identified a few weeks earlier. Amidst this atmosphere of unremitting grief and fear, a group of activists met in Denver as part of a gay and lesbian health conference. Among them, a dozen men with AIDS. And among their number, the inspirational Michael Callen of New York City and safe sex architect Richard Berkowitz (and author of Sex Positive), the only surviving member of the group today. They were about to do something that would change our response to AIDS — and healthcare in general — forever.

As the conference drew to a close, the activists asked to address the attendees. Rather than having a report presented about the state of the AIDS crisis, they wanted to speak for themselves. If the word “empowerment” hadn’t yet been a part of the health care lexicon, it was about to be.

The group took turns reading a document to the conference they had just created themselves, during hours sitting in a hospitality suite of the hotel. It was their Bill of Rights and Declaration of Independence rolled into one. It would be known as The Denver Principles, and it began like this: “We condemn attempts to label us as ‘victims,’ which implies defeat, and we are only occasionally ‘patients,’ which implies passivity, helplessness, and dependence upon the care of others. We are ‘people with AIDS.’”

The seminal moment in AIDS activism was arguably those few minutes, when the principles were outlined by these brave “people with AIDS.” Identifying themselves as such,

The slogan “Fighting for Our Lives,” often seen on banners during gay rights and AIDS marches in the 1980s, was popularized by The Denver Principles

that alone, was startling at the time. How could they not be seen as anything but victims of an arbitrary and cruel killer? But they would have none of it. And they did not stop there.

They outlined 17 principles that covered everything from health care decisions to civil rights to sexual conduct. And their impact on all of us is so obvious today it can easily be taken for granted. Please honor their service and read on.

They demanded that physicians see their patients as “whole people,” and provide “accurate information.” They believed their opinion on their care should be awarded equal weight, and this was revolutionary. The next time your doctor consults you about a change of medications or whether a diagnostic test may be required, you can thank The Denver Principles.

They asked “all people” to fight against AIDS discrimination in the workplace and in housing, which was a provocative concept in the fearsome days of 1983 when people recoiled from those with HIV.

Astonishingly, they even advocated for “as full and satisfying sexual and emotional lives as anyone else” for people with AIDS. Imagine that, at a time when a new bloodand sexual contact-driven disease was in full bloom, a group of people suffering from it wanted sexual rights. Amazing. And yet today, if you are HIV-positive and disclose your status to potential partners without feeling like a diseased pariah (or you have observed sexual evolution, like serosorting and sex clubs for positives), you can thank The Denver Principles. For that matter, if you’re HIV-negative and negotiate sex with partners of any stripe, you can thank the Principles for believing that we all deserve a satisfying sexual life.

While gay men were the designers of the document, The Subversive Librarian notes that this was a situation in which lesbians and gay men worked together very effectively. As Walt Senterfitt wrote in 1998: “Part of the widespread acceptance of the notion of self-empowerment must be attributed to lessons learned from the feminist and civil rights struggles. Many of the earliest and most vocal supporters of the right to self-empowerment were the lesbians and feminists among the AIDS Network attendees.”

A clear line can be drawn between how all of us participate in our own health care decisions and The Denver Principles. It has influenced the doctor/patient relationship in every disease category, benefiting millions of patients.

When longtime activist and POZ magazine founder Sean Strub delivered the keynote speech at the Campaign to End AIDS’ 5th Anniversary event a few years ago, he devoted his powerful remarks to the historic importance of The Denver Principles and announced a plan to create a Denver Principles Empowerment Index that will hold AIDS groups accountable to the people they serve.

Sean knows a thing or two about accountability. When I worked for various AIDS organizations through the 1980s and ’90s, we were shaking in our boots each year when POZ magazine produced their chart outlining which of the country’s AIDS organizations met certain criteria. The chart rated things like financial transparency, the cost of fund raising, and how many HIVpositive people served on the board (for which, by the way, you can thank The Denver Principles, which demanded people with AIDS “be included in all AIDS forums”).

So, the Denver Principles live on. A list of profound basic rights was outlined during the dawn of this epidemic that continue to have an impact on us today. Anyone facing a chronic illness should laud the amazing journey and profound importance of this document.

You can read the complete, original Denver Principles document at unaids.org.

Activist Richard Berkowitz, author of Sex Positive, was an early advocate of safe sex in response to the AIDS crisis among gay men in the 1980s

THE 11TH ANNUAL HIV TREATMENT GUIDE

Our breakdown of the most commonly prescribed, FDA-approved medications for the treatment (and prevention) of HIV and its related conditions.

BY PLUS EDITORS

Aptivus

generic name: tripanavir

class of drug: protease inhibitor

maker: Boehringer Ingelheim

who is it for? For experienced patients, in combination with Norvir (ritonavir) and other anti-HIV drugs.

traditional dosage: For those 12 years and above, the recommended dose is 500 mg (two capsules or 5 ml of oral solution) twice daily, in combination with other anti-HIV drugs. Children between 2 and 12 years should use the oral solution; the doseage amount depends on body surface area. Must be taken food. Aptivus should only be used in patients who have no other treatment options.

Atripla

generic name: efavirenz, emtricitabine, and tenofovir disoproxil fumarate

class of drug: single-tablet regimen

maker: Gilead Sciences

who is it for? For those 12 years and older weighing at least 40 kg as an initial regimen. Should not be used for those with moderate or severe kidney or liver impairment, those with neuropsychiatric issues, or women who are pregnant or may become pregnant.

traditional dosage: One tablet once daily. Tablet contains 600 mg efavirenz (Sustiva, an NNRTI), 200 mg emtricitabine (Emtriva, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

Biktarvy

generic name: bictegravir, emtricitabine, and tenofovir alafenamide

class of drug: single-tablet regimen

maker: Gilead Sciences

who is it for? For those who have no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (less than 50 copies per mL) on a stable antiretroviral regimen for at least three months with no history of treatment failure and no known resistance to the components of Biktarvy. Not recommended for

those with creatinine clearance below 30 mL per minute, hepatitis B, or severe liver impairment.

traditional dosage: One tablet once daily. Adult tablet includes 50 mg of bictegravir (an INSTI), 200 mg of emtricitabine (Emtriva, an NRTI), and 25 mg of tenofovir alafenamide (an NRTI). This year, the FDA approved a new low-dose tablet (30 mg bictegravir/120 mg emtricitabine/15 mg tenofovir alafenamide) for pediatric patients weighing at least 14 kg to less than 25 kg who are virologically suppressed or new to antiretroviral therapy. Does not need to be taken with other HIV drugs.

Cabenuva

Combivir

generic name: zidovudine and lamivudine

class of drug: combination regimen

maker: ViiV Healthcare who is it for? For adults, adolescents, and children weighing at least 66 pounds and living with HIV, in combination with other anti-HIV drugs. traditional dosage: One tablet, containing 300 mg of zidovudine and 150 mg of lamivudine, twice daily.

Complera

generic name: emtricitabine, rilpivirine, and tenofovir disoproxil fumarate

class of drug: single-tablet regimen

maker: Gilead Sciences

generic name: cabotegravir and rilpivirine

class of drug: single-injection regimen

maker: ViiV Healthcare who is it for? Those 12 and older weighing at least 35 kg who have no history of treatment failure and no known or suspected resistance to either cabotegravir or rilpivirine.

traditional dosage: Monthly injection of 400 mg of cabotegravir and 600 mg of rilpivirine, after an initial injection of 600 mg of cabotegravir and 900 mg of rilpivirine. (An oral lead-in period of one month prior to your first injection is no longer required.)

Cimduo

generic name: lamivudine and tenofovir disoproxil fumarate class of drug: combination of two nucleoside reverse transcriptase inhibitors

maker: Mylan who is it for? For adults and children weighing at least 35 kg. Should not be used for those with creatinine clearance below 30 mL per minute or those on dialysis.

traditional dosage: One tablet once daily in combination with other antiretrovirals. Tablet contains 300 mg lamivudine (Epivir/3TC) and 300 mg tenofovir disoproxil fumarate (Viread).

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

Delstrigo

generic name: doravirine, lamivudine, and tenofovir disoproxil fumarate

class of drug: single-tablet regimen

maker: Merck who is it for? For adults new to HIV medication. Not recommended for those with creatinine clearance below 50 mL per minute and should not be used by those with moderate to severe kidney impairment or severe liver impairment.

traditional dosage: One tablet once daily. Tablet contains 100 mg doravirine (Pifeltro, an NNRTI), 300 mg lamivudine (Epivir, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

Unless otherwise noted, all dosages are the traditional adult dose.

Descovy

generic name: emtricitabine and tenofovir alafenamide

class of drug: two nucleoside reverse transcriptase inhibitors

maker: Gilead Sciences

who is it for? For adults and children who weigh at least 35 kg, as well as for children who weigh 25 to 34 kg when used with certain other antiretrovirals. Should not be used for those with creatinine clearance below 30 mL per minute or those on dialysis. for hiv treatment: One tablet per day in combination with other antiretrovirals. Each tablet contains 200 mg emtricitabine (Emtriva) and 25 mg tenofovir alafenamide (TAF). A lower-dose option (120 mg Emtriva, 15 mg TAF) is also now available. for hiv prevention: One tablet once daily. Must be paired with regular HIV tests and safer sex practices. Descovy for PrEP is not currently FDA-approved for individuals assigned female at birth.

Dovato

generic name: dolutegravir and lamivudine

class of drug single-tablet regimen

maker: ViiV Healthcare

who is it for? For adults new to HIV medication. Not recommended for those with severe liver impairment. traditional dosage: One tablet per day. Each tablet contains 50 mg dolutegravir (Tivicay, an II) and 300 mg lamivudine (Epivir, an NRTI).

Edurant

generic name: rilpivirine

class of drug: nonnucleoside reverse transcriptase inhibitor

maker: Janssen

who is it for? For treatment of HIV-1 in adults and children 12 and older weighing at least 35 kg who haven’t previously taken antiretroviral drugs and have a viral load of 100,000 copies per mL or less.

traditional dosage: One 25 mg tablet once daily with meal. It is always taken with other antiretrovirals. Is also a component in single-tablet regimens Complera, Odefsey, and Juluca.

Emtriva

generic name: emtricitabine class of drug: nucleoside reverse transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children as a component of an initial regimen. Dosing needs to be adjusted for those with decreased kidney function. Use caution if also positive for hepatitis B. traditional dosage: One 200 mg capsule once daily. There is also a 10-mg/mL oral solution available (daily dosage is adjusted depending on patient’s current creatinine levels).

Epivir

generic name: lamivudine or 3TC class of drug: nucleoside reverse transcriptase inhibitor maker: ViiV Healthcare who is it for? For adults and children at least 3 months old, as a component of an initial regimen. Dosing needs to be adjusted for those with decreased kidney function.

traditional dosage: One 300 mg tablet once daily, or one 150 mg tablet twice daily. A 10-mg/mL oral solution is also available for children or others who have difficulty swallowing tablets (daily dosage based on patient’s weight).

Evotaz

generic name: atazanavir and cobicistat

class of drug: a protease inhibitor and a pharmacokinetic enhancer/ booster

maker: Bristol-Myers Squibb who is it for? For those initiating treatment as a component of a regimen. Not recommended for those with liver impairment. Use with caution if you have heart or kidney problems; diabetes; hemophilia; or are pregnant, plan to become pregnant, or are using hormonal birth control. Do not breastfeed.

traditional dosage: One tablet once daily, in combination with other antiretroviral drugs. Tablet includs 300 mg atazanavir (Reyataz, a PI) and 150 mg cobicistat (Tybost, a PKE).

Fuzeon

generic name: enfurvitide

class of drug: fusion inhibitor

maker: Roche

who is it for? For treatment-experienced adults whose viral levels have continued to increase while on other anti-HIV drugs.

traditional dosage: 90 mg by subcutaneous injection twice daily.

Genvoya

generic name: elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide

class of drug: single-tablet regimen

maker: Gilead Sciences

who is it for? For those 12 or older who weigh at least 25 kg and are new to antiretroviral therapy; or as replacement therapy for those virologically suppressed for at least six months, with no previous virologic failure, and no drug resistance to the components of Genvoya. Not recommended for those who have a creatinine clearance below 30 mL per minute.

traditional dosage: One tablet once daily. Tablet contains 150 mg of elvitegravir (an INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 10 mg tenofovir alafenamide (an NRTI).

Intelence

generic name: etravirine

class of drug: nonnucleoside reverse transcriptase inhibitor

maker: Janssen

who is it for? For treatmentexperienced HIV-1 patients with viral strains resistant to an NNRTI and other antiretroviral agents. For adults, children 6 years or older weighing at least 16 kg.

traditional dosage: One 200 mg tablet (or two 100 mg tablets) twice daily following meal. Pediatric patients (6-18 years old) should be dosed by medical professionals based on body weight.

Want to stay undetectable* with fewer medicines?

DOVATO is different: unlike other HIV treatments that contain 3 or 4 medicines, DOVATO contains just 2 medicines in 1 pill.

DOVATO is a complete prescription regimen for adults new to HIV-1 treatment or replacing their current HIV-1 regimen when their doctor determines they meet certain requirements.

Learn more at DOVATO.com

Important Facts About DOVATO

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

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

If you have both human immunodeficiency virus-1 (HIV-1) infection and Hepatitis B virus (HBV) infection, DOVATO can cause serious side effects, including:

• Resistant HBV. Your healthcare provider will test you for HBV infection before you start treatment with DOVATO. If you have HIV-1 and hepatitis B, the HBV can change (mutate) during your treatment with DOVATO and become harder to treat (resistant). It is not known if DOVATO is safe and effective in people who have HIV-1 and HBV infection.

• Worsening of HBV infection. If you have HBV infection and take DOVATO, your HBV may get worse (flare-up) if you stop taking DOVATO. A “flare-up” is when your HBV infection suddenly returns in a worse way than before.

° Do not run out of DOVATO. Refill your prescription or talk to your healthcare provider before your DOVATO is all gone.

Results may vary.

*Undetectable means reducing the HIV in your blood to very low levels (less than 50 copies per mL).

†Compared to a tenofovir alafenamide–based 3- or 4-drug regimen.

° Do not stop DOVATO without first talking to your healthcare provider.

° If you stop taking DOVATO, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your liver function and monitor your HBV infection. It may be necessary to give you a medicine to treat hepatitis B. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking DOVATO.

For more information about side effects, see “What are possible side effects of DOVATO?”

What is DOVATO?

DOVATO is a prescription medicine that is used without other HIV-1 medicines to treat human immunodeficiency virus-1 (HIV-1) infection in adults: who have not received HIV-1 medicines in the past, or to replace their current HIV-1 medicines when their healthcare provider determines that they meet certain requirements. HIV-1 is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). It is not known if DOVATO is safe and effective in children.

Please see additional Important Facts About DOVATO on the following page.

Ask your doctor about staying undetectable with fewer medicines in 1 pill.

Armando Foodie Switched to DOVATO Compensated by ViiV Healthcare

No other complete HIV pill uses fewer medicines to help keep you undetectable.†

Important Facts About DOVATO (cont’d)

Who should not take DOVATO?

Do not take DOVATO if you:

• have ever had an allergic reaction to a medicine that contains dolutegravir or lamivudine.

• take dofetilide. Taking DOVATO and dofetilide can cause side effects that may be serious or life-threatening.

What should I tell my healthcare provider before using DOVATO?

Tell your healthcare provider about all of your medical conditions, including if you:

• have or have had liver problems, including hepatitis B or C infection.

• have kidney problems.

• are pregnant or plan to become pregnant. One of the medicines in DOVATO (dolutegravir) may harm your unborn baby.

° Your healthcare provider may prescribe a different medicine than DOVATO if you are planning to become pregnant or if pregnancy is confirmed during the first 12 weeks of pregnancy.

° If you can become pregnant, your healthcare provider may perform a pregnancy test before you start treatment with DOVATO.

° If you can become pregnant, you and your healthcare provider should talk about the use of effective birth control (contraception) during treatment with DOVATO.

° Tell your healthcare provider right away if you are planning to become pregnant, you become pregnant, or think you may be pregnant during treatment with DOVATO.

• are breastfeeding or plan to breastfeed. Do not breastfeed if you take DOVATO.

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

° DOVATO passes to your baby in your breast milk.

° Talk with your healthcare provider about the best way to feed your baby. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Some medicines interact with DOVATO. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.

• You can ask your healthcare provider or pharmacist for a list of medicines that interact with DOVATO.

• Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take DOVATO with other medicines.

What are possible side effects of DOVATO?

DOVATO can cause serious side effects, including:

• See “What is the most important information I should know about DOVATO?”

What are possible side effects of DOVATO? (cont’d)

• Allergic reactions. Call your healthcare provider right away if you develop a rash with DOVATO. Stop taking DOVATO and get medical help right away if you develop a rash with any of the following signs or symptoms: fever; generally ill feeling; tiredness; muscle or joint aches; blisters or sores in mouth; blisters or peeling of the skin; redness or swelling of the eyes; swelling of the mouth, face, lips, or tongue; problems breathing.

• Liver problems. People with a history of hepatitis B or C virus may have an increased risk of developing new or worsening changes in certain liver tests during treatment with DOVATO. Liver problems, including liver failure, have also happened in people without a history of liver disease or other risk factors. Your healthcare provider may do blood tests to check your liver. Tell your healthcare provider right away if you get any of the following signs or symptoms of liver problems: your skin or the white part of your eyes turns yellow (jaundice); dark or “tea-colored” urine; light-colored stools (bowel movements); nausea or vomiting; loss of appetite; and/or pain, aching, or tenderness on the right side of your stomach area.

• Too much lactic acid in your blood (lactic acidosis). Too much lactic acid is a serious medical emergency that can lead to death. Tell your healthcare provider right away if you get any of the following symptoms that could be signs of lactic acidosis: feel very weak or tired; unusual (not normal) muscle pain; trouble breathing; stomach pain with nausea and vomiting; feel cold, especially in your arms and legs; feel dizzy or lightheaded; and/or a fast or irregular heartbeat.

• Lactic acidosis can also lead to severe liver problems, which can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis). Tell your healthcare provider right away if you get any of the signs or symptoms of liver problems which are listed above under “Liver problems.”

• You may be more likely to get lactic acidosis or severe liver problems if you are female or very overweight (obese).

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider right away if you start having new symptoms after you start taking DOVATO.

• The most common side effects of DOVATO include: headache; nausea; diarrhea; trouble sleeping; tiredness; and anxiety.

These are not all the possible side effects of DOVATO. Call your doctor for medical advice about side effects.

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.

Where can I find more information?

• Talk to your healthcare provider or pharmacist.

• Go to DOVATO.com or call 1-877-844-8872, where you can also get FDA-approved labeling.

Trademarks are owned by or licensed to the ViiV Healthcare group of companies.

October 2022 DVT:7PIL

Isentress

generic name: raltegravir class of drug: integrase inhibitor

maker: Merck

who is it for? For those new to treatment or treatment experienced, as a component of a regimen. For adults and children weighing at least 2 kg. Tell your doctor if you have tuberculosis, or liver problems or phenylketonuria.

traditional dosage: One 400 mg tablet twice daily for those with treatment experience. Those new to treatment or with undetectable viral loads may either take one 400 mg tablet twice daily or two 600 mg tablets once daily.

Juluca

generic name: dolutegravir and rilpivirine

class of drug: single-tablet regimen who is it for? For adults who are virally suppressed for at least six months.

maker: ViiV Healthcare

traditional dosage: One tablet once daily, with a meal. Each tablet contains 50 mg dolutegravir (Tivicay, an II) and 25 mg rilpivirine (Edurant, an NRTI).

Kaletra

generic name: lopinavir and ritonavir class of drug: combination treatment

maker: AbbVie who is it for? For adults and children with HIV, used in combination with other anti-HIV drugs.

traditional dosage: Tablets contain either 200 mg lopinavir and 50 mg ritonavir or 100 mg lopinavir and 25 mg ritonavir; take either four of the former or two of the latter twice daily. Also available as an oral solution.

Norvir

generic name: ritonavir

class of drug: protease inhibitor

maker: AbbVie

who is it for? For adults and children, used only in combination with other

antiretrovirals, as a component of initial regimen. Reduced dosage recommended for people taking other protease inhibitors.

traditional dosage: Six 100 mg tablets taken twice daily.

Odefsey

generic name: emtricitabine, rilpivirine, and tenofovir alafenamide

class of drug: single-tablet regimen

maker: Gilead Sciences who is it for? For adults and children

12 years and older weighing at least 35 kg who are new to antiretroviral drugs, who have a viral load of 100,000 copies per mL or less; or can be used as a replacement regimen for individuals with a viral load of 50 copies per mL or less, who have been virologically-suppressed for at least six months.

traditional dosage: One tablet once daily. Tablet contains 200 mg of emtricitabine (Emtriva, an NRTI), 25 mg of rilpivirine (Edurant, an NNRTI), and 25 mg of tenofovir alafenamide (an NRTI).

Pifeltro

generic name: doravirine

class of drug: nonnucleoside reverse transcriptase inhibitor maker: Merck who is it for? For adults as part of an initial regimen.

traditional dosage: One tablet, 100 mg, once daily, taken in combination with other antiretrovirals.

Prezcobix

generic name: darunavir and cobicistat

class of drug: protease inhibitor and a pharmacokinetic enhancer/booster maker: Janssen who is it for? For both treatmentnaive and treatment-experienced adults with no darunavir-related resistance. Should be used in combination with other antiretroviral medicines. Use with caution if you have liver or kidney problems; or if you are pregnant, breastfeeding, or

plan to become pregnant.

traditional dosage: One tablet once daily with food. Tablet contains 800 mg of darunavir (Prezista, a PI) and 150 mg of cobicistat (Tybost, a PKE).

Prezista

generic name: darunavir

class of drug: protease inhibitor

maker: Janssen

who is it for? For treatment of HIV-1, both those initiating treatment and those who have previously been on antiretroviral therapy, including those with some drug resistance to PIs. For adults and children 3 years or older weighing at least 10 kg. May reduce effectiveness of birth control pills.

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

Retrovir

generic name: zidovudine

class of drug: nucleoside reverse transcriptase inhibitor

maker: ViiV Healthcare

who is it for? For adults and children with HIV, used in combination with other drugs. This drug has proven very effective for the prevention of mother-to-child HIV transmission in pregnant women, as well as for HIV treatment in young children.

traditional dosage: 600 mg daily in divided doses, either 300-mg tablets or 100-mg capsules. Also available as an intravenous infusion (IV), subcutaneous injection, or in syrup form. Ask your health care provider about what types are available and best suited for you.

Reyataz

generic name: atazanavir class of drug: protease inhibitor maker: Bristol-Myers Squibb who is it for? For both treatment naive and treatment-experienced individuals.

traditional dosage: 300 mg capsule, taken with 100 mg of Norvir or 150 mg Tybost, once daily.

Rukobia

generic name: fostemsavir class of drug: attachment inhibitor maker: ViiV Healthcare who is it for? Adults who have received several antiretroviral regimens in the past, who have virus that is resistant to many antiretroviral drugs, and whose current antiretroviral therapy is either ineffective, causing side effects the patient cannot tolerate, or causing other safety concerns.

traditional dosage: One 600mg tablet, twice daily, around the same time each day, with or without food, and in combination with other antiretroviral drugs.

Selzentry

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

traditional dosage: 300 mg twice daily; or 150 mg twice daily if taken with CYP3A inhibitors; or 600 mg twice daily if taken with CYP3A inducers.

Stribild

generic name: elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate

class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older, who weigh at least 35 kg, and are new to antiretroviral therapy; or as a replacement regimen for those virologically suppressed on their current regimen for at least six months, who have no previous virologic failures, and no drug resistance to Stribild components. Not recommended for use during pregnancy and for those with a creatinine clearance below 70 mL per minute, severe liver problems, or hepatitis B.

traditional dosage: One tablet once daily. Tablet contains 150 mg of elvitegravir (an INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

Sunlenca

Sustiva

generic name: efavirenz

class of drug: nonnucleoside reverse transcriptase inhibitor

maker: Bristol-Myers Squibb who is it for? For adults and children

3 months and older weighing at least 3.5 kg as a component of initial regimen. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures.

traditional dosage: One tablet of 600 mg once daily. It is also a component in the single-tablet regimen Atripla

Symfi/Symfi Lo

generic name: efavirenz, lamivudine, and tenofovir disoproxil fumarate

class of drug: single-tablet regimen

maker: Mylan who is it for? For adults and children weighing at least 40 kg (those weighing at least 35 kg can take Symfi Lo).

generic name: lenacapavir class of drug: capsid inhibitor maker: Gilead Sciences who is it for? For treatmentexperienced adults whose HIV cannot be successfully managed on their current regimen due to drug resistance, intolerance, or safety considerations. I

traditional dosage: Initiated with two subcutaneous injections of 1.5 milliliters each (total 927 milligrams), followed the next day by two tablets of 300 milligrams each, taken orally, then an injection of 927 milligrams every six months. Can also be initiated with two oral tablets on days 1 and 2, one oral tablet on day 8, and subcutaneous injections on day 15.

traditional dosage: One tablet, once daily, on an empty stomach. Symfi contains 600 mg efavirenz (Sustiva, an NNRTI), 300 mg lamivudine (Epivir, an NRTI) and and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI). Symfi Lo contains 400 mg efavirenz, 300 mg lamivudine, and 300 mg TDF.

Symtuza

generic name: darunavir, cobicistat, emtricitabine, and tenofovir alafenamide

class of drug: single-tablet regimen

maker: Janssen who is it for? For treatment-naive or those with a suppressed viral load on a stable HIV regimen for at least six months with no known resistance to darunavir or TAF. Not for those with severe liver or kidney impairment.

traditional dosage: One tablet, once daily, with food. Each tablet contains 800 mg darunavir (Prezista, a protease inhibitor), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 10 mg TAF (an NRTI).

PROUD TO BE: PROUD TO BE:

ME! ME!

Temixys

generic name: lamivudine and tenofovir disoproxil fumarate class of drug: Two nucleoside reverse transcriptase inhibitors maker: Celltrion who is it for? For adults and children weighing at least 35 kg as component of an initial regimen. Not recommended for patients with impaired kidney function. Patients should be tested for hepatitis B before beginning treatment.

traditional dosage: One tablet once daily. Contains 300 mg lamivudine (Epivir) and 300 mg TDF.

Tivicay

generic name: dolutegravir class of drug: integrase inhibitor maker: GlaxoSmithKline who is it for? For both those new to treatment and those who have taken integrase inhibitors previously and may have resistance to such drugs. For adults and children at least 30 kg. Take during pregnancy only if potential benefits outweigh risk.

traditional dosage: One 50 mg tablet, once daily for those new to antiretrovirals; twice daily for those who take certain other antiretrovirals or have taken integrase inhibitors and may have resistance.

Triumeq

generic name: abacavir sulfate, dolutegravir, and lamivudine class of drug: single- tablet regimen maker: ViiV Healthcare who is it for? For adults and children weighing at least 40 kg as initial regimen. Not recommended for those with a creatinine clearance below 50 mL per minute or those with liver impairment.

traditional dosage: One tablet once daily. Tablet contains 600 mg abacavir sulfate (Ziagen, an NRTI), 50 mg dolutegravir (Tivicay, an INSTI), and 300 mg lamivudine (Epivir, an NRTI).

Trogarzo

Viread

generic name: tenofovir disoproxil fumarate

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

Truvada

generic name: emtricitabine and tenofovir disoproxil fumarate class of drug: two nucleoside reverse transcriptase inhibitors maker: Gilead Sciences who is it for? For those with HIV or at high risk of becoming HIV-positive. As treatment for HIV, for adults and children weighing at least 17 kg. As HIV prevention, for adults and adolescents 15 or older weighing at least 35 kg. Dosing adjustments necessary for those with decreased kidney function. for hiv treatment: One tablet once daily, in combination with other HIV medications. Tablet includes 200 mg emtricitabine (Emtriva) and 300 mg tenofovir disoproxil fumarate (Viread). for hiv prevention: One tablet once daily. Must be paired with regular HIV tests and safer sex practices.

Tybost

generic name: cobicistat class of drug: pharmacokinetic enhancer/CYP3A inhibitor/ booster maker: Gilead Sciences

who is it for? For adults taking atazanavir (Reyataz) or darunavir (Prezista). Tybost is not an HIV medicine and does not treat HIV: it interferes with the breakdown of these HIV drugs, increasing the blood levels of these drugs and making them more effective.

traditional dosage: One 150 mg tablet daily with food, with either 300 mg atazanavir or 800 mg darunavir.

class of drug: nucleoside reverse transcriptase inhibitor

maker: Gilead Sciences

who is it for? For adults and children at least 2 years old and weighing at least 10 kg, used in combination with other antiretrovirals to treat HIV-1 infection. Dosage adjustments recommended for those with kidney problems.

traditional dosage: One 300 mg tablet once daily.

Vocabria

generic name: cabotegravir

class of drug: integrase strand transfer inhibitor

maker: ViiV Healthcare who is it for? Adults who have achieved viral suppression on a stable regimen and have no history of treatment failure and no known or suspected resistance to cabotegravir. To be used either as a monthlong lead-in to monthly injections of Cabenuva (cabotegravir and rilpivirine) or by patients who will miss an injection.

traditional dosage: One 30mg tablet with one 25mg rilpivirine tablet, once daily, with a meal.

Ziagen

generic name: abacavir class of drug: nucleoside reverse transcriptase inhibitor maker: GlaxoSmithKline who is it for? For adults and children at least 3 months old, as a component of initial regimen. Dosage adjustments not needed for those with kidney problems.

traditional dosage: 300 mg of oral solution twice daily. Individuals with mild liver impairment should take 200 mg twice daily. (The tablet version is expected to be discontinued by the end of 2023.)

MEDS 101

Different HIV drug classes control the virus in distinct ways.

BY PLUS EDITORS

HIV has bedeviled scientists for over 40 years. One of the reasons HIV has been so hard to cure is that it’s a retrovirus. This means it contains single-stranded RNA (ribonucleic acid) instead of the typical double-stranded DNA that human cells carry. Retroviruses also carry an enzyme called “reverse transcriptase,” which allows it to copy RNA into DNA — and then use that DNA copy to invade human cells.

Fortunately scientists developed antiretroviral drugs three decades ago that were able to prevent HIV from replicating in the human body. This breakthrough was huge, changing HIV from an often fatal disease to a manageable chronic condition. Since then, HIV drugs have only grown more effective and less toxic.

HIV treatment regimens include drugs from multiple classes to improve their combined effectiveness, decrease toxicity, and help prevent the development of drug resistance. Here’s brief descriptions of these classes and how they work.

BROADLY NEUTRALIZING ANTIBODIES (bNAbs)

Drugs in this class are antibodies that can recognize and block HIV or activate other immune cells to help destroy the virus. Some hold potential to treat HIV without other medications.

CCR5 ANTAGONISTS (CAS)

Drugs in this class block the CCR5 coreceptor on the surface of CD4 cells preventing HIV from binding and entering the cells.

CAPSID INHIBITORS (CIs)

Meds in this class help inhibit the proteins that protect HIV’s genetic material. In Dececember, Gilead Sciences’ injectable Sunlenca (lenacapavir) became the first and only approved capsid inhibitorbased HIV treatment option. Taken in combination with other antiretrovirals, lenacapavir is prescribed for adults with multi-drug resistant HIV.

ENTRY AND FUSION INHIBITORS (EIS AND FIS)

Drugs in this class help block HIV from binding, fusing, and entering T cells. They are always taken with other HIV medication.

INTEGRASE STRAND TRANSFER INHIBITORS (INSTIs):

Drugs in this class block integrase, an enzyme HIV needs in order to reproduce. HIV uses integrase to insert its viral DNA into the DNA of T cells. Blocking the integration process prevents HIV from replicating. They are always taken with other HIV medication.

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIS, ALSO KNOWN AS NUKES)

Drugs in this class block reverse transcriptase, an enzyme that HIV needs in order to reproduce. HIV uses reverse transcriptase to convert its RNA into

DNA; blocking the process prevents HIV from replicating. They are always taken with at least one other HIV med.

NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs, also known as nonnukes)

Drugs in this class also block reverse transcriptase, as NRTIs do, but in a different way. They are always taken with at least one other HIV medication.

NUCLEOSIDE REVERSE TRANSCRIPTASE TRANSLOCATION INHIBITORS (NRTTIs)

Drugs in this class also block reverse transcriptase but do so by preventing translocation of an enzyme. They are always taken with other HIV medication.

PHARMACOKINETIC ENHANCER/ CYP3A INHIBITORS (PKEs, also known as boosters)

Drugs in this class boost the effectiveness of antiretroviral medication. When the two are taken together, the pharmacokinetic enhancer slows the breakdown of the other drug, which allows the drug to remain in the body longer at a higher concentration. They are always taken with other HIV medication.

POST-ATTACHMENT INHIBITORS (PAIS)

Drugs in this class bind to CD4 cells after HIV has attached to them but still inhibit the virus from infecting those cells. They are always taken with other HIV medications.

PROTEASE INHIBITORS

(PIs)

Drugs in this class block activation of protease, an enzyme HIV needs to develop. Blocking protease prevents immature forms of HIV from becoming a mature virus capable of infecting other T cells. They are always taken with other HIV medication.

SINGLE-TABLET REGIMENS (STRS):

Drugs in this category are fixed-dose pills that combine multiple anti-HIV medications (often from more than one class of drug) into a single tablet, which is usually taken just once a day. They do not need to be taken with other HIV medication.

TOLL-LIKE RECEPTORS (TLR)

Drugs in this class stimulate the immune system’s T cells, activating a more robust response to the viral invader. They are always taken with other HIV medications.

READY FOR A CHANGE

Updating your HIV treatment could improve how you feel physically and mentally. Here are 10 reasons to consider switching things up.

BY PLUS EDITORS

If your HIV meds are working well without any significant side effects or issues — that’s great! But if you are suffering from side effects or struggling with adherence, it’s typically safe to switch from one HIV regimen to another. With more options than ever before, including the new long-lasting injectables, it can be challenging to choose which treatment might be right for you — which is why it’s important to talk to your doctor or health care provider. Start the process by reading the following list on sensible reasons to switch gears on your regimen.

1

IF YOU ARE WORRIED ABOUT DRUG RESISTANCE. Some drugs offer more protection against resistance developing. Darunavir (a component of both Prezista and Prezcobix) stops the virus from mutating, and thus developing resistance. A three-year study of those taking Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) found no drug resistance. If you do develop a drug resistance, other HIV meds can still work for you. For example, long-acting injectables Trogarzo and Sunlenca can help fight multi-drug resistant HIV when added to a previously failing antiretroviral regimen. 2

IF YOU WANT TO REDUCE THE NUMBER OF MEDS YOU TAKE. Although three-drug regimens were once considered essential in preventing drug resistance, two-drug regimens have proven to be just as effective. Their advantages include fewer side effects and a reduction in toxicity associated with long-term drug therapies. These days, there a several one- and two-drug regimens that are higly effective and approved by the Food and Drug Administration. 3

IF YOU TAKE YOUR MEDS WITHOUT FOOD. A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (with protein or a hearty meal, rather than just a snack). If you don’t eat big meals or prefer to take your meds at bedtime instead, or if you often forget to take your meds when you go out or while traveling, you should consider a drug that has no food intake requirements, such as Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) or Triumeq (dolutegravir/abacavir/lamivudine). 4

IF YOU ALSO HAVE HEPATITIS C. According to the Centers for Disease Control and Prevention, approximately 25 percent of people with HIV in the United States also have hepatitis C. There are new, curative hep C treatments available, but some HCV drugs interact with HIV drugs, so it’s important for your doctor to carefully consider which medications you can take while treating them simultaneously. 5

IF YOU ARE PREGNANT. Some HIV medications may increase risks of birth defects and the effect of others, like cabotegravir, on fetuses haven’t been well studied. In updated guidelines, the Department of Health and Human Services’ Panel on Treatment of HIV During

Pregnancy and Prevention of Perinatal Transmission recommend dolutegravir-based regimens for pregnant people, irrespective of trimester, and for people who are trying to conceive. Based on additional data, the panel now also recommends tenofovir alafenamide as a preferred NRTI for antiretroviral regimens in people who are pregnant or trying to conceive. 6

IF YOU HAVE KIDNEY OR LIVER PROBLEMS. Tenofovir disoproxil fumarate (TDF), brand name Viread, is a component of drugs including Atripla, Truvada, Stribild, and Complera and has been linked to kidney problems in susceptible individuals. Those with kidney issues might consider regimens that instead use tenofovir alafenamide (TAF), like Biktarvy, Genvoya, Odefsey, or Descovy. Juluca has fewer overall side effects, but has seen some users develop new or worse liver problems. 7IF YOU CAN’T DEAL WITH THE SIDE EFFECTS. Every medication has potential side effects — some minor, some life-threatening. Not everyone taking a certain medication will experience the same side effects, and some people experience them more intensely. Only you can decide if the side effects aren’t worth the benefits you’re getting from a particular medication. With so many treatment options now available, don’t hesitate to talk to your doctor if you feel side effects are negatively affecting your daily life. 8

IF YOU ARE A PERSON OF COLOR. A sad truth is that few drug trials test the impact of a treatment on people of color, especially women. That’s what makes 2020’s BRAAVE study so remarkable. It involved 495 selfidentified Black or African-American HIV-positive people (32 percent were cisgender women) who switched to Biktarvy from a variety of regimens. Virtually all of those who switched maintained viral suppression.

IF YOU ARE CONCERNED ABOUT GAINING WEIGHT. At CROI 2021, researchers shared more data confirming that some HIV drugs lead to weight gain. Taking integrase inhibitors (dolutegravir or raltegravir) was previously associated with greater weight gain than taking nucleoside reverse transcriptase inhibitors. Recent studies indicate, however, that tenofovir alafenamide, an NRTI, is linked to weight gain. Weight gain can also raise your risks of diabetes and heart disease, so if these are concerns of yours, remember to discuss them with your doctor.

IF YOU WANT TO STOP TAKING PILLS ALL TOGETHER. In 2021, the FDA approved Cabenuva (rilpivirine and cabotegravir), making it the first complete antiretroviral regimen that comes in an injection form. Doses are administered every two months at your doctor’s office.

SIDE EFFECTS MAY INCLUDE…

Knowledge is power when it comes to common HIV side effects, as well as related comorbidities affecting many people living with HIV. The following list has all the must-know details on HIV-related concerns and tips for how to treat them.

BY PLUS EDITORS

SIDE EFFECT: DIARRHEA

HOW COMMON: Extremely; in fact, diarrhea is among the most common reasons why people with HIV stop or switch their meds.

TREATMENT: Three options: over-the-counter antidiarrheal medicines such as Imodium (loperamide); Lomotil (diphenoxylate and atropine), which slows the gut to combat diarrhea and is commonly given to cancer patients; or Mytesi (crofelemer), the only Food and Drug Administration-approved drug to relieve noninfectious diarrhea in HIV-positive people. Derived from the red sap of the Croton lechleri plant, Mytesi is only the second botanical prescription drug approved by the FDA.

SIDE EFFECT: MOOD CHANGES, INCLUDING DEPRESSION AND ANXIETY

HOW COMMON: According to a 2019 study published in International Journal of Environmental Research and Public Health, 39 percent of people living with HIV were currently experiencing depression. AIDS Beacon previously reported that 63 percent of HIV- positive participants “reported symptoms of depression currently or at some point in the past. Overall, 26 percent of patients reported having had thoughts of suicide and 13 percent of participants reported having attempted suicide in their lifetimes.”

TREATMENT: Selective serotonin reuptake inhibitors (SSRIs) are most effective. According to the National Institutes of Health, medications that have shown efficacy in treating depression in patients with HIV include (generic names) imipramine, desipramine, nortriptyline, amitriptyline, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, nefazodone, trazodone, bupropion, and mirtazapine.

SIDE EFFECT:

HYPERTENSION/HIGH BLOOD PRESSURE

HOW COMMON: Very. The U.S. Department of Veterans Affairs, for example, reports that 45 percent of its patients with HIV also have a hypertension diagnosis. A report from last year found that a quarter of all people with HIV also have hypertension, with the comorbidity most prevalent in North America and Western Europe. A 2018 review of findings, published in Hypertension, suggests that chronic inflammation associated with HIV and antiretroviral therapy is a major factor in the high rates of hypertension.

TREATMENT: Stop smoking. Medications include vasodilators (hydralazine), antihypertensives (Cozaar, Avapro, Diovan), ACE inhibitors (Prinivil, Lotensin), calcium channel blockers (Norvasc, Procardia, Plendil), and diuretics (Microzide, Diuril, Zestoretic).

COMORBIDITY:

OSTEOPOROSIS AND OSTEOPENIA

HOW COMMON: Osteopenia and osteoporosis are both forms of bone density loss, with the latter being more severe. Far more people with HIV have osteopenia (60 percent) versus osteoporosis (10-15 percent). The lower your body weight, the more susceptible you are to both. Fracture injuries are more common in young poz people because of it.

TREATMENT: Bisphosphonate therapy with vitamin D and calcium supplementation and medications including Fosamax, Boniva, Actonel, Atelvia, and Reclast. And just this year, a study presented at the virtual Conference on Retroviruses and Opportunistic Infections indicated that a “short course of alendronate” (the generic termfor Fosamax and Binosto) at the beginning of tenofovir-based antiretroviral therapy can help prevent bone loss.

COMORBIDITY: CARDIOVASCULAR DISEASE

HOW COMMON: It’s the second leading cause of death among people living with HIV.

TREATMENT: It may include a variety of approaches. There are cholesterol-lowering statin drugs such as Crestor, Lipitor, Zocor, Vytorin, Lescol, Mevacor, Altoprev, Livalo, Pravachol, Advicor, and Simlup. Programs that help you stop smoking, shed excess pounds, and exercise more are all useful. Reduce alcohol and sodium consumption. If your blood pressure is not in a healthy range, your doctor may prescribe medication. Among the options are ACE inhibitors (Vasotec, Prinivil, Zestril, Altace); angiotensin II receptor blockers (Cozaar, Atacand, Diovan); beta blockers (Lopressor, Toprol XL, Corgard, Tenormin); or calcium channel blockers (Norvasc, Cardizem, Dilacor XR, Adalat CC, Procardia).

COMORBIDITY: DIABETES

HOW COMMON: There’s a type of diabetes caused by pancreatic damage brought on by HIV medications. It’s less common than the other two types, Type 1 and Type 2, but equally damaging.

TREATMENT: Controlling bloodsugar, medication, insulin treatment, and proper diet are the main treatments, with regular doctor screenings for easyto-miss complications. Diabetes meds include Lantus, Januvia, Humalog, NovoRapid, Victoza, Farxiga, and about a dozen more.

LATEST + GREATEST

BY DESIRÉE GUERRERO

In the mid-1990s, the development of antiretroviral drugs revolutionized the fight against HIV. And these days, when on treatment, people living with HIV typically have the same life expectancy as those who are HIV-negative. Now a new revolution is happening in the world of HIV treatment: long-acting injectables. Rather than take a daily pill, or pills, you can now get a shot every two months to stay undetectable.

In addition to the life-altering advancements that have been made in HIV treatment, there have been some huge strides in terms of HIV prevention as well. A few years back, researchers discovered that some of the drugs they had developed to treat HIV were also effective in preventing the transmission of the virus to an HIV-negative person. This highly effective method is known as PrEP, or pre-exposure prophylaxis. When taken as prescribed, PrEP reduces the risk of getting HIV from sex by about 99 percent. And there now is an injectable version of PrEP, too.

Read on to learn more about the latest advancements in HIV prevention and treatment that are setting people living with HIV — and their partners — free.

We’ve come a long way, baby. With the advent of long-acting injectables and PrEP, today’s options for HIV treatment and prevention are better than ever.

PReP

Apretude

Descovy for PrEP

Truvada for PrEP

Apretude (cabotegravir extendedrelease injectable suspension, or CAB LA) is the most recent form of PrEP approved by the Food and Drug Administration. It is game-changing in that it is an injectable, which makes it a much more attractive option to those at risk of contracting HIV. For many, stopping by the clinic every couple of months for a shot in the booty may be a lot more convenient than trying to remember a daily pill. Unlike the pill forms of PrEP, Apretude is not also used to treat HIV.

who ’s it for? HIV-negative adults and adolescents weighing at least 77 pounds (35 kg) for the prevention of HIV.

dosage info : One long-acting intramuscular gluteal (butt muscle) 600 mg injection (3 mL) is given monthly for the first two months, and then one injection every two months thereafter. There are no food restrictions, and an oral lead-in period is no longer required.

In October of 2019, another pill form of PrEP was approved by the FDA called Descovy for PrEP (emtricitabine and tenofovir alafenamide). It is just as effective as its predecessor, Truvada. There are some differences though, so you should talk to your doctor about which might work better for you. For example, Descovy is safer for people with bone density or kidney issues, and the pill is much smaller — however, it may slightly raise LDL cholesterol levels. Also, unlike Truvada and Apretude, Descovy is not currently approved for those assigned female at birth due to a lack of research in its effectiveness. who’s it for? HIV-negative adults and adolescents assigned male at birth weighing at least 77 pounds (35 kg) for the prevention of HIV.

dosage info: One tablet once daily, without regard to food. The tablet contains 200 mg emtricitabine and 25 mg tenofovir alafenamide. Take a missed dose as soon as possible, unless it is closer to the time of your next dose. Don’t double up on your next dose.

INJECTABLES

Truvada, our great PrEP pioneer, is now celebrating its 11th year of FDAapproval.It was the first medicine available in the U.S. for use to prevent HIV transmission after it was shown in studies to be highly effective when taken daily. Truvada consists of the drugs emtricitabine and tenofovir. who’s it for? HIV-negative adults and adolescents weighing at least 77 pounds (35 kg), one tablet once daily, without regard to food. People with bone density or kidney issues should avoid and consider Descovy instead.

dosage info: One tablet daily with food. The tablet contains 200 mg emtricitabine and 300 mg tenofovir disoproxil fumarate. Take a missed dose as soon as possible, unless it is closer to the time of your next dose. Don’t double up on your next dose.

For more information about PrEP and how to get a prescription, visit PlannedParenthood.org, HIV.gov, or CDC.gov/hiv/basics/prep.

These new long-acting injectable HIV treatments just may set you free.

In 2021, the Food and Drug Administration approved the first ever long-acting injectable for the treatment of HIV. Cabenuva, from ViiV Healthcare, has been a gamechanger for many living with HIV, especially those struggling with taking daily pills. Depending on your personal treatment plan, Cabenuva can be given in monthly doses or every two months. If you are able to do the every-two-month option, you’ll need to get a monthly shot for the first two months only.

Cabenuva is a combination of cabotegravir and rilpivirine, so it’s not recommended for those who’ve had a history of treatment failure or resistance, or an allergic reaction, to either ingredient. Cabenuva is also not recommended for those with a history of liver problems. Your health care provider can test the health of your liver before getting on Cabenuva if you are unsure.

Just recently, another injectable for HIV treatment was greenlit by the FDA. Sunlenca, from Gilead Sciences, was approved in December of 2022 to help those dealing with multi-drug resistance. Unlike Cabenuva, which is a complete HIV treatment regimen, Sunlenca is an injectable given twice a year in addition to other antiretroviral medications. It was created for adults whose HIV is not adequately controlled by their current treatment regimen.

“This news is an important milestone in the work to help end the HIV epidemic as Sunlenca is now the only FDA-approved twice-yearly treatment for people with multi-drug resistant HIV,” said Daniel O’Day, chairman and chief executive officer of Gilead Sciences. “Our goal is to deliver multiple long-acting options for treatment and prevention that are tailored to the needs of people living with HIV and people who could benefit from PrEP medicines.”

It’s easier than ever to prevent HIV. PrEP can be taken as a daily pill, or now as an injection every two months.

DRUGS IN DEVELOPMENT

Read up on some of the potential HIV therapies scientists could be bringing to a pharmacy or doctor’s office near you.

BY TRUDY RING AND NEAL BROVERMAN

IT’S INCREDIBLE TO think about the scientific and medical advances witnessed since the discovery of HIV and AIDS in the early 1980s. Moving from a fatal diagnosis to a chronic condition, HIV can now be managed thanks to various medications approved by the Food and Drug Administration (FDA) over the past 40 years. Still, much work remains when it comes to managing HIV’s side effects and treating those resistant to typical antiretrovirals diagnosed for those living with HIV. Advances are happening all the time, including on a long-sought cure for HIV. Here is a sampling of some HIV drugs currently in the development pipeline.

ISLATRAVIR

This first-in-class nucleoside reverse transcriptase translocation inhibitor (NRTTI) was being studied at one point for use as pre-exposure prophylaxis, but those trials were discontinued. Still, drugmaker Merck is moving forward with clinical trials of islatravir for those already living with HIV. The drug, as part of a once-daily combination with Merck’s approved NNRTI doravirine, showed good results in people previously untreated for HIV. Another study, according to aidsmap.com, showed that this combo maintained viral suppression among those who switched from their current regimen. Merck is also working on a study of islatravir paired with Gilead’s lenacapavir (Sunlenca), an HIV treatment granted approval by the Food and Drug Administration late last year.

VYROLOGIX (LERONLIMAB-PRO 140)

CytoDyn’s viral-entry inhibitor is a monoclonal antibody that could be the first self-injectable subcutaneous (under the skin) HIV drug. It works by masking CCR5, a protein on the surface of white blood cells, thus inhibiting HIV’s ability to enter healthy T cells. There have been several clinical trials indicating it could significantly reduce or control viral load. For instance, a Phase III trial involving treatmentexperienced patients showed that in combination with other antiretroviral drugs, it helped 81 percent of participants achieve significant viral suppression (less than 50 copies per mL). CytoDyn announced in July 2022 a preclinical study in nonhuman primates that will explore the use of vyrologix to treat HIV as a single-injection gene therapy. Funded through a $5 million grant, “the study will examine if this gene-therapy approach could provide

the potential for a ‘functional cure’” for HIV, according to Precision Vaccinations. The research on Vyrologix as a potential cure is being led by CytoDyn scientific advisor and Oregon Health & Science University researcher Jonah Sacha, Ph.D.

PGT121

A small study showed that an experimental monoclonal antibody called PGT121 led to viral suppression that lasted for up to six months in HIV-positive people who started with a low viral load. Being developed by a collaboration that includes the International AIDS Vaccine Initiative, the Bill & Melinda Gates Foundation, the Scripps Institute, and Theraclone Sciences, the recombinant monoclonal antibody targets the V3 glycan site on the outer envelope of HIV. A study published in 2021 reported that PGT121, in combination with other drugs, delayed rebound of simian HIV in monkeys whose antiretroviral treatment has been interrupted. PGT121 could eventually become a very long-acting HIV medication or a functional cure that maintains viral suppression after antiretroviral therapy has ended. A study published last year of subcutaneous injections of PGT121 and another broadly naturalized antibody, VRC07-523LS, for HIV prevention, found the drugs were safe and well-tolerated, and recommended further research.

UB-421

In a Phase II trial, this broadly neutralizing antibody from United BioPharma was shown to maintain viral suppression after other treatment options ended. Weekly or biweekly intravenous infusions of UB-421 kept the viral loads of all 29 participants suppressed after they stopped taking oral HIV meds. Research is continuing on UB-421, both for its potential for a cure, as well as its efficacy in patients with multi-drug resistant HIV; the Food and Drug Administration approved another Phase II trial last year to study the latter issue.

LEFITOLIMOD (MGN1703)

Lefitolimod is a type of latency-reversing agent called a toll-like receptor 9 agonist — toll-like receptors, or TLRs, are proteins that help the immune system recognize dangers, and agonists are chemicals used to enhance this activity. Researchers believe lefitolimod may improve the body’s immune response to HIV in addition to its effect on

latent virus cells. The drug, from the company Mologen, is being studied not only for HIV, but for the treatment of solid tumors and small cell lung cancer.

VESATOLIMOD (GS-9620 AND GS-986)

Gilead Sciences’ toll-like receptor 7 agonist known as vesatolimod (agonists target viral reservoirs and could lead to a functional cure) was shown to increase the time to viral rebound, enhance immune function, and decrease levels of intact HIV DNA in 2020. Later that year, at the International AIDS Conference, one study presented indicated that injectable vesatolimod, used with other antiretroviral drugs, helped speed up HIV suppression in monkeys. Another study presented at the latter conference looked at humans who are HIV controllers — those in whom HIV doesn’t replicate for an extended period even if they aren’t on antiretroviral treatment, but who may need to go on treatment eventually. That study found that in controllers who had finally begun treatment, the addition of oral vesatolimod enhanced the immune system’s response, a promising if early result. A recent study in Spain looked at combining the drug with therapeutic vaccines — vaccines that are given not to prevent an infection but to control one. At the 2023 CROI conference, details were shared on a combination of vesatolimod with a therapeutic vaccine being developed by the company Aelix.

“Data from the phase 2 Aelix-003 study suggested that patients receiving the vaccine/vesatolimod combo were less likely to experience a rebound in viral load versus those on placebo,” according to evaluate.com. “This

was tested by interrupting antiretroviral therapy for up to 24 weeks; plasma viral load was monitored weekly, and therapy was resumed if viral load went above a predetermined threshold.”

ELPIDA (ELSULFAVIRINE, VM1500A)

This is an NNRTI by drugmaker Viriom. It was approved in Russia in 2017 as a once-daily oral HIV drug. Clinical studies are continuing into its use for dosing daily or weekly and have so far shown effectiveness, safety, and tolerability. Researchers are also looking at its use as part of a combination treatment. It may also be suitable to treat COVID-19.

ALBUVIRTIDE AND 3BNC117

Albuvirtide is a fusion inhibitor, meaning it keeps HIV from entering certain cells in the immune system. From Frontier Biotechnologies, it is already approved for use in China. In the U.S., it is being studied in combination with 3BNC117, a broadly neutralizing antibody developed by Rockefeller University for treatment of patients whose antiretroviral regimen is failing. Broadly neutralizing antibodies can block HIV from entering healthy cells and activate other immune cells to help destroy infected cells. Additionally, Frontier announced in July 2021 a successful study of albuvirtide paired with the antiretroviral drug lopinavir, reporting the two-drug combination was nearly as effective as a lopinavirbased three-drug treatment. Various combinations of 3BNC117 paired with other drugs have shown success in suppressing HIV and scientists are also looking into the possibility of using 3BNC117 in HIV prevention.

THIS TOO SHALL PASS

Learning to be okay on those days when things don’t feel okay.

DR. GARY MCCLAIN

TERRY WOKE UP with kind of a vague feeling that something wasn’t quite right. It wasn’t anything she could put her finger on. But her energy felt lower. And so did her mood. She wasn’t experiencing anything she would call feeling sick, but she wasn’t feeling all that great either.

Terry didn’t feel like she needed to raise any alarms with her doctor. But she was concerned.

In a way, Terry wondered if it wasn’t almost worse to feel just generally out of sorts than to actually be feeling sick. Why? Because she knew from experience that on days when she was a little off kilter, and without a clear reason why, her mind tended to go to dark places.

“It’s not like you’re sick,” she told herself. “You can still do the basics today, even go to work.” But she couldn’t help but also ask herself: “Is there something going on with me? And finally: “Is there something lurking around the corner and about to strike?”

It wasn’t like Terry hadn’t talked to her doctor about the potential of having days when she wasn’t feeling at her best. She had even told Terry about what symptoms to contact her about.

But still… Terry couldn’t help but feel concerned.

How about you? Do you have days when you aren’t feeling yourself and can’t help but feel alarmed that something isn’t quite right? A rational mind is your first defense on those days when you’re not feeling your best. Here’s some help in coping on those days:

Give yourself a pep talk.

The last thing you need to do is to fall into self-criticism. Instead, be kind to yourself by talking back to any negative self-talk with words of encouragement. Remind yourself that you’ve had not-so-great days before. That you’re doing what you need to do to take care of yourself. And you’ve got a healthcare team you trust backing you up. A good pep talk can help keep your mind from wandering into darker territory.

Avoid catastrophizing.

Use your self-talk to help keep your perspective on the big picture. Remind yourself that a day when you don’t feel at your best is just that: It’s a day when you don’t feel at your best. Nothing more. Don’t turn it into a catastrophe by giving it meaning it doesn’t need to have. Engage your rational mind.

Remember: Normal is a moving target. You can waver from feeling your absolute best self and still be at what, for you, is your range of what’s normal. Most likely, if you haven’t already discovered this, you will be more able to take a day like this in stride.

Talk it out.

One of the best ways to regain your perspective, and stay focused on the big picture, is by talking things out with someone you trust, someone who can listen without judging you or telling you what to do. Someone who knows you can help you sort out how you’re feeling, and remind you of some of those other days, when you felt more like yourself, or even when you didn’t feel so great but found a way to cope. Distract yourself.

When you spend too much time focusing on what’s bothering you, you can end up magnifying it and making it feel bigger, or even come up with some other reasons to feel bad. That’s the pathway to catastrophizing. So try some positive distractions. Getting involved in your daily tasks. Doing something you enjoy or that relaxes you. Socializing.

Push forward, but not too hard.

The message here is to stay involved in your life. That’s what I mean by pushing forward. But be careful about pushing so hard that you end up making yourself feel worse by tiring yourself out or bringing on symptoms that weren’t there before. Take things one step at a time. Rest when you need to. Be nice to yourself.

Listen for a message.

Keep in mind that a day when you feel out of sorts may be the result of pushing yourself too hard the day before. Listen to your body. Is it trying to tell you something?

Trust your instinct.

There is a difference between pushing through a day when you’re not at your best and denial of symptoms you need to pay attention to. You know your body. If your instinct tells you something is not quite right, then do what you need to, including calling your doctor and letting him/her know what’s going on. If an alarm is going off, that call may be just the reassurance you need.

Not quite feeling yourself today?

Not feeling all that okay doesn’t mean you’re not okay. Stay focused on the big picture. Each day – a good day, a not so good day – is another opportunity to learn how to listen to the messages your body sends you. And to take your life in stride.

Gary McClain, PhD, is a therapist, relationship coach, and author in New York City, who specializes in working with individuals diagnosed with chronic and catastrophic medical conditions, their caregivers, and professionals. His book, The Power of Closure: Why We Need It, How to Get It, and When to Walk Away, will be published by Tarcher Perigee in the spring of 2024. His website is justgotdiagnosed.com.

ROCKET GIRL

JoJo Siwa joins forces with the Elton John AIDS Foundation’s Rocket Fund.

The Elton John AIDS Foundation recently announced the establishment of the Rocket Fund, a new $125 million initiative created to reignite the conversation around HIV, and the multihyphenated JoJo Siwa is lending her voice to the program as a youth ambassador.

The Rocket Fund was launched to continue the fight against HIV and AIDS and to reach the most vulnerable — including young people, LGBTQ+ people, those who use drugs, and other marginalized and impoverished communities at higher risk of acquiring HIV. The June announcement of the Rocket Fund came on the anniversary of the Centers for Disease Control and Prevention releasing, in 1981, its first report on what would become known as AIDS.

“For years, HIV/AIDS has caused enormous pain across the world, but I pray that soon this epidemic will be a thing of the past” said Elton John in a press release. “More than 30 years after I launched the Elton John AIDS Foundation, my passion for reaching everyone, everywhere with education and compassionate care is still as strong as ever. The Rocket Fund will turbo-charge our mission and reach those most at risk from this terrible disease. Now is the time. This epidemic has gone on too long. We must all act together to see AIDS defeated in our lifetimes.”

Siwa is a wildly popular dancer, singer, actress, and social media influencer with over 50 million TikTok followers. Her involvement stems from her experience as a young member of the LGBTQ+ community, her personal passion for ending the HIV epidemic, and her position as a role model for this generation.

“The crazy thing is that before I ever met him, I worshipped Elton John,” Siwa told our sister publication, The Advocate. “I have always respected him so much and he was such an inspiration. I loved watching him, listening to him sing, and whenever he said anything, I always paid attention and listened. Now, to be able to

know him and help his incredible foundation, it just blows my mind.”

The LGBTQ+ community is disproportionately affected by HIV. Men who have sex with men are 35 times more likely to acquire HIV than the general population, according to the foundation. Transgender women are 14 times more likely. In addition, people who inject drugs are 35 times more likely to acquire HIV than the general population. And among young people aged 15-19 globally, AIDS is among the main causes of death. In sub-Saharan Africa, it is the leading cause. The Rocket Fund will provide support for HIV prevention and treatment services for over 1 million people, according to the organization. That support includes access to HIV tests, antiretroviral therapies, and PrEP (a medical HIV prevention method).

Siwa explained that HIV is not something of the past, and the virus is still relevant, particularly for a younger generation who she said, “don’t know enough about the disease and need to be

BELOW David Furnish and Heidi Klum attend the Elton John AIDS Foundation’s 31st Annual Academy Awards Viewing Party in West Hollywood in March

parting shot by john casey

JoJo Siwa attends the 2022 Industry Dance Awards at Avalon Hollywood & Bardot in Los Angeles

aware.” The celebrated creative added that “the Rocket Fund, and Elton, will hopefully provide more context and help lessen the awkwardness and stigma around the disease.”

“There is, of course, the medical side to this and to finding a cure, but I know in my personal life that people are still judgmental [when it comes to HIV]. One of my closest friends recently went to be tested, and he was so frightened that he would be positive and so scared about what people would think if they

found out he might be,” Siwa shared. “That’s the goal for the Rocket Fund — to lessen those worries, work towards a cure, and take away any embarrassment or shame.”

The press release from the foundation went on to thank the Rocket Fund’s co-chairs for their contributions, “including Donatella Versace, Tani Austin, David Furnish, and David Geffen. The Foundation would also like to thank the Founding Partners of The Rocket Fund: A+E Networks, Charlotte Tilbury, David Geffen Foundation, Ford Foundation, Gilead Sciences, Inc., Saks Fifth Avenue, Allegra Versace Beck, and The Versace Foundation.”

During June of this year, in celebration of Pride month, Sir Elton John and the Rocket Fund co-chairs challenged supporters to “let their #InnerElton out.” This social media campaign encourages people to post photos of themselves wearing “their own take on Elton’s signature looks, or whatever makes them feel their true self.” Some notable folks that participated include Dolly Parton, Michaela Jaé Rodriguez, Heidi Klum, and Smokey Robinson. Search the hashtag #InnerElton to see these fabulous photos for yourself!

For more information about how you can support the Rocket Fund visit eltonjohnaidsfoundation.org.

MICHAEL BUCKNER/VARIETY VIA GETTY IMAGES) (SIWA); SIMONE JOYNER/GETTY IMAGES (JOHN)

RIGHT Sir Elton John performs live on stage during his “Farewell Yellow Brick Road” tour at the O2 Arena in London

LEFT JoJo Siwa at Disney+’s Elton John Live: Farewell from Dodger Stadium Yellow Brick Road event in Los Angeles

Starting + Staying

By starting HIV treatment as soon as possible after diagnosis and staying on treatment as prescribed, you can help control your HIV viral load, which can help you live a longer and healthier life.

Today’s HIV treatments can fit into your schedule, and some can even be started right away. So be sure to talk to your healthcare provider about what’s right for you.

And remember, you are not alone. There are many people to help support you, alongside your healthcare provider.

Work together with your healthcare provider to find an HIV treatment option that is right for you and start your treatment journey today.

The best time to start treatment is ASAP after diagnosis

You can live well with HIV

on HIV treatment

Model portrayal

Model portrayal