Plus 141 March April 2021

BECAUSE YOU’RE MORE THAN YOUR STATUS

NEIL PATRICK HARRIS ON HIS MODERN (HIV) MASTERPIECE

THE GOOD DOCTOR THE CDC’S UNCONVENTIONAL NEW HIV CZAR DEMETRE DASKALAKIS  CAN WE DITCH OUR DAILY PILLS?  COVID-19 VACCINE 101  FIGHTING DRUG RESISTANCE

MARCH/APRIL 2021 hivplusmag.com

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contents

issue

141

ON THE COVER 30 BRINGING SEXY BACK A government agency leader who looks this good?

Acclaimed doctor DEMETRE DASKALAKIS is the CDC’s new director of HIV prevention.

30 FEATURES 18 IN OUR OWN WORDS A photographer uses science and portraits of real people impacted by HIV to educate and overcome stigma.

26 STIGMA REDUX The fear of those who've had COVID-19 is sadly familiar.

28 RESISTANCE 101 Get the 4-1-1 on what it is, how it develops, and how you can fight HIV med resistance.

38 IT'S THE '80S AGAIN Russell T Davies’s new TV series, It’s a Sin, tackles the early AIDS epidemic in London.

ON THE COVER & ABOVE Demetre Daskalakis photographed

by Magnus Hastings, for his book, Rainbow Revolution

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CONTENTS DAILY DOSE

TREATMENT

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GOODBYE DAILY PILLS? The first monthly HIV injectable treatment is ready now.

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SWEET TREATS There's a new formula for treating babies living with HIV.

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SHOT YOU'RE GONNA WANT Everything you need to know about the COVID vaccine.

LESSONS LEARNED What can long-term survivors teach the world about COVID?

BUZZWORTHY 10

ONE SWEET DAY Mariah Carey and Boyz II Men's song still resonates.

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CRIME AGAINST HUMANITY More states review HIV criminalization laws.

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IRREPLACEABLE ACTIVIST Ken Jones fought for LGBTQ+ and poz Black lives to matter.

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WELLNESS 44 LOVE THYSELF 10 steps to self-compassion.

46 CANNABIS VS. COVID Can marijuana help COVID patients breathe easier?

46 BJ BLUES Oral sex associated with cancer.

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47 SAY MY NAME Discussing undetectability with your doctor.

BACK TALK

FR ANCESCO DI B EN EDE T TO ( 1 8); SANTIAGO FELIPE /G E T T Y IMAG ES (6); SH UT TERSTOCK (4 8); B EN B L ACK ALL /H BO MA X (3 8)

48 NEIL PATRICK HARRIS Talks HIV, starring in It's a Sin, and life in a pandemic.

38 48

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chief executive officer & editorial director DIANE ANDERSON-MINSHALL

evp, group publisher & corporate sales JOE VALENTINO

editor in chief NEAL BROVERMAN

vp, branded partnerships & associate publisher STUART BROCKINGTON

EDITORIAL managing editor DESIRÉE GUERRERO editor at large TYLER CURRY senior copy editor TRUDY RING assistant editor DONALD PADGETT contributing editors KHAFRE ABIF, MARK S. KING mental health editor GARY MCCLAIN staff writer MEY RUDE contributing writers CHARLES STEPHENS, JEANNIE WRAIGHT, TAYLOR HENDERSON, JOHN-MANUEL ANDRIOTE ART executive creative director RAINE BASCOS art director BEN WARD interactive art director CHRISTOPHER HARRITY PRIDE MEDIA EDITORIAL editor in chief, the advocate TRACY E. GILCHRIST digital editor in chief, advocate.com NEAL BROVERMAN editor at large, the advocate JOHN CASEY editor in chief, out DAVID ARTAVIA digital director, out.com MIKELLE STREET editor in chief, out traveler JACOB ANDERSON-MINSHALL editor in chief, pride RAFFY ERMAC deputy editor, pride TAYLOR HENDERSON digital director, pride & senior editor, advocate.com DANIEL REYNOLDS director of podcasts & special projects JEFFREY MASTERS SALES & MARKETING executive director, integrated sales EZRA ALVAREZ senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director, branded partnerships JAMIE TREDWELL creative director, branded partnerships MICHAEL LOMBARDO senior manager, branded partnerships TIM SNOW junior manager, advertising & branded partnerships DEAN FRYN coordinator, advertising & branded partnerships KEIGHTON LI DIGITAL vp, technology & development ERIC BUI digital media manager LAURA VILLELA social media manager CHRISTINE LINNELL social media editor JAVY RODRIGUEZ PRINT PRODUCTION production director JOHN LEWIS production editor JACOB ANDERSON-MINSHALL CIRCULATION director of circulation ARGUS GALINDO FINANCE/ACCOUNTING vp, finance BETSY SKIDMORE accounts receivable controller LORELIE YU accounting manager PAULETTE KADIMYAN ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions Fax (212) 242-8338 EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com

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Plus (ISSN 1522-3086) is published bimonthly by Pride Publishing Inc. Plus is a registered trademark of Pride Publishing Inc. Entire contents ©2021 by Pride Publishing Inc. All rights reserved. Printed in the U.S.A. FOLLOW US ON FACEBOOK AND TWITTER

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EDITOR’S LETTER

LU KE FONTANA

BY N E AL B ROVE R MAN

BEING BORN IN the late ’70s was bad luck, I once thought.

The internet was an opaque concept in my adolescence; few understood it and even fewer had it. It wasn’t until my early 20s — interning at the Hartford Courant newspaper — when I had Yahoo and Hotbot at my fingertips and could secretly locate the dance palaces of New York or (shhh!) uncover the gay bars of Connecticut.

Being queer was a foreign concept to me even in my early 20s; my fear and self-loathing would have abated if some plain-speaking information about gay life, including HIV facts, were available to me outside the confines of an office where I spent 15 hours a week. I envy the generations after me, who could and can just Google anything new or confusing. The internet really has changed everything.

Lately, though, my thinking on my luck has changed. I didn’t wrap my mind around the fact that I was less than straight until about 1993 or 1994; the idea of acting on my desires would not crystallize for at least a couple more years. During this time, HIV research and knowledge were growing by leaps and bounds; by 1997, antiretroviral therapy would become the new standard of HIV care.

Because of when I landed on this Earth, I (luckily!) escaped the deadliest years of the HIV epidemic.

Flash-forward almost a quarter-century and my timing is once again randomly fortuitous. As a healthy person in his early 40s, I’m not at major risk of dying from COVID-19.

That played out as anticipated when I caught the novel

coronavirus in early January after strictly adhering to masking and stay-at-home orders, save for a visit to a supermarket and gas station. My COVID diagnosis woke me up to the fact that this disease was more contagious than I conceived, and more drastic measures were needed, like online grocery shopping and double-masking.

I was sick for about a week but, after a few days, able to work and care for my kids and husband, the latter of whom also caught COVID. My husband suffered more than I did, but he’s now fully recovered, and life has returned to normal.

I couldn’t stop thinking about my dumb luck as I watched screenwriter Russell T Davies’s excellent new series, It’s a Sin (read our interview with Davies on page 38). As the series centers on a group of young friends in 1980s London suddenly plunged into a world of AIDS and death, it was hard not to think of where I would be if I were born 10 years earlier. Maybe I’d be one of the shellshocked characters who made it to the final episode’s credits, maybe not.

Long-term survivors of HIV can be considered lucky too.

But many of them, including John-Manuel Andriote (page 26), have an enviable resilience that has served them well.

Some, like Phill Wilson (page 6), endured the worst days of the epidemic and have used their knowledge to make sure others with HIV live their best lives. There are also the clinicians who have fought HIV for years, like our cover subject, CDC HIV-prevention czar Dr. Demetre Daskalakis (page 30), who utilize the lessons of 40 years ago to inform their HIV efforts today. There is so much these individuals can teach us about strength and self-preservation.

A long life often comes down to privilege, good fortune, and not being in the wrong places at the wrong times.

While personal fortitude and good decisions certainly play a role in longevity, fate can be cruel and unforgiving.

Everyone who survived a diagnosis of HIV, or even COVID, has lessons for those lucky enough to not have caught a potentially deadly disease. Will we listen?

Be well,

NEAL BROVERMAN EDITOR IN CHIEF

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D A I LY D O S E

TAKING THE LONG VIEW

Phill Wilson attends the 2018 Gay Men’s Health Crisis Annual Gala at The Plaza Hotel in New York City.

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W E ’ R E C O M I N G O F F a historic year in 2020. A year that devastated us and empowered us. A year that tested us and made us stronger. A year that put systemic racism and health disparities front and center for the world to see. It reminded us that there is still much work to be done in the fight for equality and equity yet it also inspired us to act toward progress.

We are still in the middle of a pandemic that has claimed the lives of over 400,000 Americans, but amid the struggle we are beginning to see a light at the end of the tunnel. As the COVID vaccine allows us to feel hope, I reflect on what this feeling must be like for long-term survivors of HIV. Many remember when a new unknown virus emerged in the 1980s, which was claiming the lives of their friends and loved ones. A virus that they still live with today.

As we work to manage the current pandemic, many who have been living with HIV for decades once again find themselves losing loved ones. Reliving the past, grateful for what science has brought so quickly, and cautious to not let history repeat itself.

I recently had a conversation with Phill Wilson, founder and former CEO of the Black AIDS Institute.

As many know, Wilson is a Black gay man who has been living with HIV since 1981. He has been a champion and leader in this work for decades and understands better than anyone the concerns facing people living with HIV and the parallels to COVID, especially in Black communities.

“This experience presents both an emotional as well as a physical health risk,” Wilson says. “We’re living dual experiences because we’re not yet finished with the HIV pandemic, and we’re now living with COVID. There is kind of a painful déjà vu going on as COVID-19 is manifesting itself in our communities in the way HIV continues to

SANTIAGO FELIPE /G E T T Y IMAG ES

BLACK AIDS INSTITUTE FOUNDER PHILL WILSON, A LONG-TERM SURVIVOR, OFFERS LESSONS FOR LIVING THROUGH COVID.

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COU RTESY ASH LE Y IN N ES

by ashle y innes

manifest itself in our communities. Chief among them are the disparities. Black communities were slow to respond to the HIV/AIDS pandemic while we were disproportionately impacted, and policy makers were not sufficiently concerned about our needs. That is being replayed with COVID-19 as well.”

It should be very apparent at this point that ending both viruses is about more than just access to medicine and vaccines. It’s about dismantling the systems of oppression that allow them to thrive and recognizing that Black and other marginalized communities have a long history of distrust of the medical system. Many remain traumatized by the Tuskegee experiment, Henrietta Lacks, the experimental procedures performed on enslaved women, and the list goes on.

“Black people have very legitimate reasons to have medical mistrust because the medical community has not always been responsive to our needs,” Wilson says.

“The most dominant way we have been mistreated by the medical community is by them withholding treatment from us.”

Tuskegee is an example of that, as the Black men involved received no treatment for syphilis. Wilson believes that is exactly why we should be fighting for information and access to the vaccine now.

I wholeheartedly agree, but understand that as much as I urge Black communities to get into HIV care, utilize PrEP, and take the COVID vaccine, I know it’s not that simple. Medical racism is real, and the challenge is on America to overcome it. We can urge people to take this vaccine without shaming them or judging them for being skeptical. It’s not Black people’s fault

THERE IS KIND OF A PAINFUL DÉJÀ VU GOING ON AS COVID-19 IS MANIFESTING ITSELF IN OUR COMMUNITIES IN THE WAY HIV CONTINUES TO MANIFEST ITSELF IN OUR COMMUNITIES. that they don’t trust the medical system.

America has been medically unethical since the founding of this country. That legacy never goes away.

Therefore, my job and that of everyone who calls themselves an advocate or is a part of the medical system in any way is to improve trust by providing equitable care and accurate information that allows people to make informed decisions about their health. We need all of us collectively working together. So many people have already lost their lives. Wilson cautions us to not repeat past mistakes.

“These are lessons that we’ve learned and, frankly, the consequences of screwing up,” he says. “I’m hoping we can take the lessons of HIV/AIDS, apply them, and come up with more equitable solutions as we fight the pandemic. And one of them is making sure that medicine, vaccines, and prevention tactics and strategies are open and accessible to Black, brown, and other marginalized people.”

Simply put, we honor the past by fighting for the now, fighting for the future. Let’s ensure we all survive.

ASHLEY INNES is a writer and HIV advocate. Follow her on Twitter @Ash_Innes.

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IMPORTANT FACTS FOR BIKTARVY®

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

(bik-TAR-vee)

MOST IMPORTANT INFORMATION ABOUT BIKTARVY

POSSIBLE SIDE EFFECTS OF BIKTARVY

BIKTARVY may cause serious side effects, including:

BIKTARVY may cause serious side effects, including:  Those in the “Most Important Information About BIKTARVY” section.  Changes in your immune system. Your immune system may get stronger and begin to fight infections.

Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY.  Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY.  Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.  Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.  The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).

 Worsening of hepatitis B (HBV) infection. If you

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

ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults 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:

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

 Have or have had any kidney or liver problems,

including hepatitis infection.

 Have any other health problems.

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.

 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.

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.

Tell your healthcare provider about all the medicines you take:  Keep a list that includes all prescription and over-the-

counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

 BIKTARVY and other medicines may affect each other.

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

Get HIV support by downloading a free app at

MyDailyCharge.com

BVYC0197_BIKTARVY_A_7-875X10-5_Plus-DEva_r1v1jl.indd All Pages 18998 Gilead Biktarvy Plus 136 May June keep shining.indd 2

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, DAILY CHARGE, the DAILY CHARGE Logo, KEEP SHINING, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. Version date: February 2020 © 2020 Gilead Sciences, Inc. All rights reserved.

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D’EVA LIVING WITH HIV SINCE 2009 REAL BIKTARVY PATIENT

KEEP SHINING.

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.

See D’Eva’s story at BIKTARVY.com.

Featured patient compensated by Gilead.

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

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BUZZWORTHY

Mariah Carey with Boyz II Men bandmates Nathan Morris (left) and Shawn Stockman, backstage at the 2001 Radio Music Awards

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BUZZWORTHY

STILL SO SWEET MARIAH CAREY AND BOYZ II MEN’S SONG ABOUT AIDS CONTINUES TO RESONATE — EVEN 25 YEARS LATER.

FR AN K MICELOT TA ARCHIVES/G E T T Y IMAG ES (OPPOSITE); VIDEO C APTU RES (ABOVE)

BY DANIEL REYNOLDS

A groundbreaking song recorded to honor those lost to AIDS has turned 25 and it’s inspiring a new generation of survivors.

“One Sweet Day,” a track from Mariah Carey and Boyz II Men, was released in November 1995 as the second single in Carey’s album Daydream from Columbia Records. It was an instant success. For 16 weeks, the song topped the Billboard Hot 100 — a record it would hold for 23 years, solidifying it as one of the biggest hits in music history.

The song was an important cultural milestone in the AIDS pandemic.

“One Sweet Day” was created after the January 1995 death of Carey’s longtime collaborator, David Cole, from AIDS-related complications. Co-written and co-produced

by Walter Afanasieff, the song was intended to comfort those impacted by the crisis and to mourn those who had died.

And when Carey’s team approached Boyz II Men, the theme also resonated with the group members, who had recently lost their road manager, Khalil Rountree, to gun violence. As fate would have it, member Nathan Morris had been writing his own song with similar lyrics.

The chorus states, “And I know you’re shining down on me from heaven / Like so many friends we’ve lost along the way / And I know eventually we’ll be together / One sweet day.”

“One Sweet Day” was dedicated to the memory of Cole, an acclaimed music producer and member of C+C Music Factory

who was behind hits like “Gonna Make You Sweat (Everybody Dance Now).” However, its significance has grown throughout the years.

Carey and Boyz II Men would perform the song at the 38th Grammy Awards — where surprisingly, it was snubbed — and later as a tribute to Princess Diana after her death.

Carey also dedicated the song to Prince after he passed.

The song continues to find new fans on social media. The music video’s YouTube posting has been watched over 215 million times, with commenters sharing how it helped them through grief. Many specifically mention another pandemic. “For COVID-19 victims worldwide that lost their battle with the illness,” Chandler Palmer wrote in a comment that has been liked more than 2,500 times.

The video itself remains impactful. At the time of its creation, scheduling conflicts prevented the artists from creating a formal one together. But the spliced footage of them recording the song shifts the focus from the artists to those who had been lost.

The Billboard chart record of “One Sweet Day” was, appropriately, broken by Lil Nas X, the groundbreaking Black gay artist behind “Old Town Road.”

In July 2019, when that happened, Carey tweeted an image of herself passing a torch to Lil Nas X. “‘One Sweet Day’ will always hold a special place in my heart and I want to thank anyone who’s ever told me how this song has affected them and their loved ones,” she wrote.

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buzzworthy

CRIMINALLY CRUEL TWO STATES TRY TO ADDRESS OUTDATED HIV LAWS.

BY TRUDY RING L A W M A K E R S I N N O R T H D A K O TA have

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U.S. states still have laws that criminalize HIV exposure, including Washington, Nevada, and Virginia.

reflec t 21st-centur y m e dic al a dva n ce s ,” sh e told th e H o u se Source: Centers for Judiciary Committee, the Disease Control and Associated Press reports.

Prevention But the committee voted 11-3 against the bill — the only two Democratic members supported it, as did one Republican — and sent it to the full House with a “do not pass” recommendation.

A Republican who voted against the measure, Rep. Steve Vetter, said the $1,000 was a “measly fine,” according to the AP. The next day, the full House rejected it by a vote of 73-18.

In Missouri, Senate Bill 65 was filed in advance of the current session to reduce the penalty for knowingly exposing a person to HIV, without their knowledge or consent, in an activity in which there’s a substantial risk of transmission.

Exposure that doesn’t result in transmission would be a Class D felony (maximum sentence

EZEQ U IEL OCTAVIANO/PIX ABAY

rejected an effort to ease the state’s HIV criminalization law, while those in Missouri are considering changes to their statute.

In North Dakota, the Republican-led House of Representatives overwhelmingly voted down House Bill 1106, which would have made it an infraction, rather than a Class A felony, to “willfully” transfer bodily fluid containing HIV. A Class A felony carries penalties including up to 20 years in prison and a $20,000 fine, according to Fargo newspaper The Forum, while an infraction carries a fine of $1,000 and no jail time. Exposure to other sexually transmitted infections is classified as an infraction.

The newspaper says the law involves “knowingly transmitting HIV,” but the bill’s title refers to “willfully transferring body fluid containing the human immunodeficiency virus,” and the transfer of such a fluid doesn’t always result in transmission. HIV-negative people who faithfully stick to a pre-exposure prophylaxis regimen, the daily dosage of an HIV prevention drug, have virtually no chance of becoming infected with the virus if they are exposed during sex. And HIV-positive people who have suppressed their level of virus to the point that it’s undetectable in lab tests can’t transmit it to sexual partners.

Democratic Rep. Gretchen Dobervich, HB 1106’s lead sponsor, cited current science on HIV transmission in arguing for the legislation. The state should update its law “to appropriately MARC H / APRI L 202 1

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BUZZWORTHY

AMIR JAFFER

GOODBYE, MR. JONES seven years, no minimum) instead of a Class B one (maximum sentence 15 years, minimum five). If the partner does become infected with HIV, the person who transmitted it would be charged with a Class C felony (maximum sentence 10 years, minimum three) instead of a Class A one (maximum sentence life for the most serious crimes, minimum 10 years). The bill was referred to the Health and Pensions Committee, according to the Senate website. A similar bill failed to pass in the House last year.

Laws that criminalize people with HIV for exposing their sexual partners to the virus have the effect of discouraging testing, activists say. “You have a unofficial motto in the local communities where it’s ‘take the test and risk arrest,’ because if you know your diagnosis you know that holds you liable, but if you don’t know?” Tasha Schill, a staffer at AIDS Project of the Ozarks, told Springfield TV station KYTV in December.

“Then we have more people out there who are spreading it and it becomes a domino effect.” Schill was diagnosed with HIV at age 17, she said.

Lynne Meyerkord, the organization’s executive director, told the station it’s very rare that anyone wants to infect someone else with HIV, and if SB 65 passes, it will still provide penalties for “folks that are truly acting recklessly or intentionally.”

HIV criminalization laws also open up the possibility of using a person’s HIV diagnosis against them in relationships that are abusive or end badly, she added.

“Those of us in the HIV community are aware of folks who, the relationship went south and the partner knew the individual had HIV but they claimed they didn’t, and I’ve known of people that have gone to jail for that,” Meyerkord said.

She and Schill additionally cited the current HIV treatment and prevention strategies that make it much harder, even impossible, to transmit the virus. “Get tested, take your meds, you are no longer a risk to the people around you,” Schill said.

AFTER HIS HIV+ DIAGNOSIS, KEN JONES WAS TOLD HE HAD WEEKS TO LIVE. INSTEAD, HE SPENT THE NEXT 30+ YEARS FIGHTING FOR US. Pioneering Black gay activist Ken Jones, 70, who worked for decades to desegregate the LGBTQ+ movement and fight for people living with HIV, died of bladder cancer in January in San Francisco. “Ken Jones was a hero,” wrote his (unrelated) friend Cleve Jones, author of the memoir When We Rise, on Facebook. “He survived many struggles. He deeply loved his family and his community and dedicated his entire life to the movement for peace and justice. He was very grateful to all of you who reached out to him with messages of encouragement and love... Today Ken lost his fight against cancer. A memorial will be arranged when it is safe once more for us to gather. Rest in Power, Ken. I love you.”

Ken Jones, who was told he’d die in three months in 1989 after becoming HIV-positive, wrote on Facebook in December, “Today I decided that it is not how many suns and moons you witness as much as what you are able to undertake (with your whole heart) and fight for…I’ve got many things to do as the clock ticks (loudly).”

Born in New Jersey, Jones served three tours in the Vietnam War before being stationed at San Francisco’s Treasure Island in 1972. In the City by the Bay, he began a lifelong commitment to LGBTQ+ and HIV activism, volunteering with the San Francisco AIDS Foundation and becoming the first African-American chair of San Francisco Pride, where he worked to elevate the voices of marginalized people.

Additionally, he was an ordained deacon.

Jones’s story was featured in Dustin Lance Black’s 2017 TV miniseries about the LGBTQ+ movement, When We Rise. As a young man, Jones was played by Jonathan Majors (Lovecraft Country) and as an older adult by Michael K. Williams (The Wire). Jones told Plus in 2017 that activists in the ’70s “made a mistake. One of our misunderstandings in the beginning was, if there were eight to 10 people at the decision-making table, our thinking was since they’re all gay, white men, two or three are going to have to give up their seat for diversity. Now, they haven’t done anything wrong. They haven’t failed. They’re at the top of their game, they’re doing well, and they’re being asked to give up their seats. How crazy is that?

So, some people left with a whole bunch of anger and resentment towards the people coming in taking those seats. Along the way, we realized it’s a lot more healthy if we add more seats to the table, as opposed to asking people to get up and surrender their seat for the sake of diversity.” — D R H IVPLUS MAG .CO M

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t r e at m e n t

STAMP OF APPROVAL A NEW DAY DAWNS AS THE FDA GREENLIGHTS THE FIRST-EVER MONTHLY TREATMENT FOR PEOPLE LIVING WITH HIV.

BY TRUDY RING

B IOVA NAKOU/PE XELS

M A N Y P E O P L E L I V I N G with HIV will now be able to receive their treatment through a monthly injection rather than a daily pill.

The U.S. Food and Drug Administration in late January approved ViiV Healthcare’s Cabenuva, an injectable regimen combining cabotegravir and rilpivirine. It’s designed as a complete regimen for treatment-experienced adults who have achieved viral suppression and have no history of treatment failure and no known or suspected resistance to either component drug.

“This is the first FDA-approved injectable, complete regimen for HIV-infected adults that is administered once a month,” the agency notes in a statement to the press.

Having to take one or more pills daily poses adherence problems for some people with HIV, so it’s important to have the option of a monthly injection, ViiV officials and scientists say.

“FDA approval of Cabenuva represents a shift in the way HIV is treated, offering people living with HIV a completely new approach to care,” Lynn Baxter, who heads ViiV Healthcare’s North American operations, said in a company news release. “Cabenuva reduces the

treatment dosing days from 365 days to 12 days per year. At ViiV Healthcare, we are dedicated to ensuring no one living with HIV is left behind, and adding this first-of-its-kind regimen to our industryleading portfolio of innovative medicines reinforces our mission.”

“Among the scientific community, we recognize the innovation behind Cabenuva is truly meaningful,” added Dr. David Wohl, professor of medicine at the University of North Carolina Institute of Global Health and Infectious Diseases.

“Not only is it the first, complete longacting regimen, which allows for a dramatic reduction in the frequency of dosing, but it also was preferred by most clinical trial participants when compared to their prior daily oral regimens. The FDA approval of Cabenuva underscores the value of community-centric research and I am pleased this new option will be available for those living with HIV.” The FDA also approved Vocabria, a tablet formulation of cabotegravir, which should be taken in combination with oral rilpivirine (Edurant) for one month prior to starting treatment with Cabenuva to ensure the medications are well-tolerated before switching to the extended-release injectable formulation.

Reg ulators in Canada approved Cabenuva and Vocabria for use there last March, the first approval of a long-acting injectable for HIV anywhere.

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BERRY GOOD NEWS A NEW FRUIT-FLAVORED HIV MEDICATION REVOLUTIONIZES TREATMENT FOR BABIES AND TODDLERS.

BY NEAL BROVERMAN Injectable treatment that reduces the frequency of medication from daily to monthly could change the lives of millions of adults living with HIV (see previous page). Another recently approved treatment advance also has the potential to improve lives around the world — but this time for babies.

Thanks to an international agreement made earlier this year, ViiV Healthcare’s dolutegravir (sold as Tivicay) will soon be available in a babyfriendly version. The medication — specifically for infants at least a month old — will be a strawberry-flavored tablet that dissolves in water or juice. The new formulation is a gamechanger for babies with HIV, since most meds are bitter pills they can’t or won’t swallow or An estimated alcohol-based syrups requiring refrigeration.

The dissolving medication cannot be used for babies less than a month old, but ViiV is developing an appropriate syrup that newborns can take. children died of AIDS-related Globally, about 160,000 babies contract illnesses in 2018.

HIV every year. Without treatment, half will die before their second birthday and 80 percent Source: World Health Organization won’t live to age 5. “[It’s] great news that we finally have dolutegravir for children,” Jessica Burry, a pharmacist with the Doctors Without Borders access campaign, told The New York Times.

The berry tablets come on the heels of another recent option for HIVpositive babies: a strawberry-flavored granulated medication called Quadrimune. That treatment consists of four HIV drugs and is known by many as “sprinkles,” since it can be easily added to a baby’s food or mixed with milk.

Quadrimune was seen as a great advance, though it costs about $365 a year, not inexpensive for many in HIV-affected areas like sub-Saharan Africa. Thankfully, the new dissolvable strawberry-flavored tablet will sell for about one-tenth of that, or $36 annually.

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WHAT PEOPLE LIVING WITH HIV NEED TO KNOW ABOUT COVID-19 VACCINES AS VACCINATIONS ROLL OUT, EVERYONE HAS QUESTIONS. HERE ARE ANSWERS PARTICULARLY RELEVANT TO PLWH.

ARTEM PODREZ /PE XELS

BY TRUDY RING

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t r e at m e n t

The COVID-19 vaccines are rolling out, and some of you may already have received your first or even your second dose. But most Americans haven’t and may have questions about them.

Here we give you answers.

The vaccines are safe to take if you are living with HIV. People with HIV have been included in some clinical trials for the Pfizer and Moderna vaccines, the only ones so far approved by the U.S. Food and Drug Administration. No specific data on HIV-positive people’s response to the vaccines has been released, but so far there is no evidence that those living with HIV have a different reaction. There is some speculation that poz people may receive less protection than others, but that’s not a reason to avoid being vaccinated. The vaccines do not contain live virus, which could potentially pose a problem with those with HIV. Many prominent people have offered their endorsement of the vaccines; for instance, Matthew Hodson, executive director of the U.K. nonprofit NAM AIDSMap, has said that as a person who’s lived with HIV for 22 years, he will not hesitate to be vaccinated for COVID-19.

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COVID-19 vaccines won’t cause problems with your HIV meds. HIV service organizations report that some people have been given misinformation about this, being told that if they’re taking antiretroviral drugs, they shouldn’t be vaccinated. Not true. It’s as important to stay on your meds now as it is at any other time. Also, if you’re on hormone therapy, the vaccines won’t interfere with that.

Being HIV-positive probably won’t allow you to jump the line to get vaccinated sooner.

Each state is setting its own vaccine priorities, although the Centers for Disease Control and Prevention has released recommendations on which populations should get vaccinated first.

Phase 1a, the highest-priority group, consists of frontline health care workers and residents of long-term care facilities. Phase 1b, the next level, includes other frontline essential workers, such as firefighters, police officers, public transit workers, those involved in food production and distribution, teachers and school staffers, and postal workers. People aged 75 and older are also part of Phase 1b (they’re in Phase 1a if they’re in long-term care homes). Phase 1c, which the CDC says may overlap with Phase 1b, covers people aged 65 to 74, those aged 16-64 with underlying medical conditions, and other essential workers, including those in law, information technology, media, and various other fields. HIV is generally understood to be one of the underlying medical conditions, putting those with HIV into Phase 1c if they’re not eligible to be in one of the other

phases because of age or profession. Some activists are pushing for the CDC to include people with HIV in Phase 1a, but this hasn’t happened yet.

But no matter what the CDC recommends, it’s up to states to decide who gets the vaccine when. New York State announced that people with HIV would be eligible for the vaccine on February 15, much earlier than the general population. You can contact your state health department to find out the vaccine schedule; the CDC has links to all state health departments (bit.ly/health_depts). Your health care provider or local HIV service organization may be offering vaccinations as well, so don’t hesitate to contact them.

The vaccines are effective — but don’t let your guard down. Clinical trials have shown a 95 percent efficacy rate for the Pfizer and Moderna vaccines; that may not be the same in the real world, as the population in clinical trials doesn’t perfectly mirror the population at large, but it’s a good indication that the vaccines work. Health experts say they’ll provide protection against COVID-19 (or at least serious complications from it) within a week after the second dose (doses for the Pfizer vaccine are given 21 days apart, for Moderna 28 days). The first dose confers limited protection, but everyone should have both doses. Also, it’s uncertain whether people who’ve been vaccinated can still spread the virus, so keep on masking, social distancing, and washing your hands.

You may have some side effects, but don’t panic. After you’re vaccinated, you should “expect temporary side effects such as soreness in your arm where you got the shot, fatigue, body aches, and perhaps a fever,” Los Angeles-based APLA Health reports. These are similar to the side effects of flu vaccines and not cause for alarm.

It’s too soon to know if vaccine recipients have experienced serious side effects, but health officials will likely be on top of that. If you feel severely ill after being vaccinated, contact your health care provider.

Other things you should know: Even if you’ve already had COVID-19, you should still be vaccinated; according to data reviewed by the CDC, the immunity you develop from having the virus lasts only about 90 days. Stay with the same vaccine for both doses. More vaccines are being developed, including some single-dose ones. And don’t worry about finances: COVID-19 vaccination is free.

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OUR STORIES A new book illustrates why knowing the latest science around HIV is still vital.

Photography by Francesco Di Benedetto Photographer Francesco Di Benedetto has been working on his book project, And So It Happened, for over three years. Now, he is sharing some excerpts with Plus in an effort to eradicate stigma and illustrate the amazing advancements that have been made in HIV treatment as well as in preventative measures, such as PrEP (pre-exposure prophylaxis). The book features personal stories of folks who are undetectable and thriving with HIV, those living in healthy serdicordant relationships, and those using PrEP as HIV prevention.

“Medical advances and the availability of PrEP have certainly improved and changed the lives of the HIV-positive community in recent years,” says Di Benedetto. “Public attitudes, however, have not kept pace. The stigma of an HIV-positive diagnosis endures and the need for better understanding remains. And so this project provides a safe platform where the stories of those either living with HIV or on PrEP can be shared, because openness is key to tolerance and no one should have to hide — whatever their status.”

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OMARE

26 / Poughkeepsie, NY / Fashion Designer and Data Specialist for Planned Parenthood “I believe I contracted the virus in D.C. from a man I didn’t know. We had a ‘quickie’ that l quite enjoyed at the time. Little did I know that day would change my life forever. Soon after I began to get increasingly sick, experiencing flu-like symptoms lasting 2-3 weeks. I knew something had to be wrong with my body but I was unsure if it was seasonal sickness or a disease. I decided a month later to get tested at my local clinic in Northern Virginia. That day my life changed when I received my HIV diagnosis. I have now been HIV-positive for 4 years and undetectable for over 3 years straight.

My life has changed in many ways but the most valuable thing I receive is the State and County benefits allocated for HIV-positive individuals. I currently receive housing assistance which has prevented me from homelessness and eviction. I also receive great care from my infectious disease specialist at least four times a year. My current regimen is a single Genvoya pill once daily, which has maintained my undetectable status.

PrEP is an awesome tool that HIV-negative people can take to at least ease their fears of contracting the virus. But many people still look down at those who are poz or on PrEP, feeling that it’s a sign of promiscuity.”

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RAJAN

32 / On PrEP / Brooklyn, NY / Working in Technology Industry “I was born in India, but I grew up in New York. I’ve gone back and forth between these two worlds typically described in binary terms as East and West. I find this way of thinking very anxiety provoking.... To understand both these worlds, I have always confided in science and in what the power of scientific knowledge can do for societies with deep-rooted beliefs systems. And so PrEP made perfect sense to me because there was enough scientific data to prove that it was a way to end this epidemic....

I get PrEP from Callen-Lorde, an LGBTQ health clinic. My health insurance pays for this medication.... This blue pill does raise many important questions about the nature of our society as a whole, but, ultimately, I believe the collective “we” should choose progress over stagnation, just as we did when we chose cars over horses and carriages, and now driverless vehicles.

I think it is common to associate Truvada with the way people have changed their sexual behavior, however, I think that is misleading. I believe that a pill cannot make people do anything...just like Coca-Cola doesn’t make one happier as portrayed in their commercials. I do feel much safer in having sex because of the scientific evidence this pill has propagated.”

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MARIA

50 / In Serodiscordant Relationship / Bronx, NY / Case Manager “I was diagnosed in 1994. Back then I was in and out of jail and drug treatment programs because of crack-cocaine.

After a while I realized how I contracted the virus: rape.

It took me some time to accept it and educate myself and my family. They never turned their backs on me. My children are in this fight with me and have themselves become advocates. I’ve been on a deathbed; however, God has seen differently because here I am 24 years later. I’m now campaigning for U=U and living my life to the fullest....

My life has changed drastically since my diagnosis. At first I had to go through so many trials and tribulations....

My illness is very manageable for the most part; I take one pill a day, Stribild, and attend mental health therapy.

I’m glad that PrEP is around because it’s given me the opportunity to educate my partner. He’s asked me plenty of questions and has made a decision to seek more information on his own so that he can get on it. PrEP has been keeping others negative and safe.”

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NICHOLAS 22 / Undetectable / Chelsea, NY / Freshman at the Fashion Institute of Technology

“I met a guy who was on vacation in NYC at the beginning of his trip.

He was beautiful, seductive, and convincing.... I was 16 at the time and my lust for him came on quickly and intense, as do most teenage affairs. On the last night of his trip he asked me to return to Texas with him. I threw everything up in the air and said yes. As soon as we deplaned and arrived at his home, I experienced the most terrible shift of my life, the rudest awakening ever....

When I first found out I was positive I immediately thought that my love life would be over. I was so wrong. The men that I have been meeting now are far more intelligent, open-minded, considerate. I would never want to date someone who is uncomfortable being with someone positive, because that just blatantly shows a serious lack of education, intelligence, adaptability, and ignorance.

I suppose that people having access to Truvada helps me in the sense that many who would have never considered being with someone who is positive, now consider it thanks to things like PrEP and PEP.... If you are sexually active, get on PrEP! I wish it existed back then.”

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SHAMÔR

28 / On PrEP / Brooklyn, NY / Public Civil Servant for the Federal Government “I started taking PrEP because my best friend from Uni’s husband is HIV-positive, and my bestie told me that he was taking Truvada....

When I got back to the U.S. from London in 2014, I asked the clinic for PrEP. So I guess I found out about it in 2011, but didn’t start it until 2014. I take it as a precaution. I’ve had partners lie to me before and I wanted to take all measures to have the safest sex possible so that I could make it as enjoyable as possible.

My PCP prescribes me Truvada and I pick it up from Walgreens.

My PCP is very sex-positive and she’s queer so she had no problem giving me Truvada. My insurance covers most of the cost of the medicines and then the Gilead Access Program covers the rest of the cost of the medicine so in the end, my Truvada is completely free.

To be honest, when I was a lot younger, in my earlier 20s, I did some pretty risky things and that was before Truvada was available.

I think if anything, taking Truvada daily is a reminder that I’m making less riskier sexual decisions these days. It’s really had no change on my sex life.”

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DEREK

26 / Undetectable / Brooklyn, NY / Blogger “It happened through a past sexual encounter. I’m super thankful to have such supportive family and friends, as they definitely helped keep me emotionally and mentally strong.

But I also didn’t allow myself to be sad for too long because what’s done is done. There was nothing I could do about it aside from accepting the situation and continuing to live my life to the fullest.... It is what it is; I’m alive and healthy. That’s all that matters right? I’m currently taking Tivicay and Descovy.

Not much has changed because of the infection, to be honest. My dating life has taken quite a blow, not that it was ever prosperous. But a majority of the guys that hit me up are bi and pansexual, who are relatively new to the queer world....

So, many are unaware of HIV, PrEP, and how much medicine has advanced today. Therefore, a lot of them are scared of me... despite my being undetectable, which hurts sometimes.

PrEP has absolutely brought a change! People are so much more educated about HIV and how it works today. As the years have gone by, the amount of people scared of me has decreased as well. The stigma isn’t as intense now, but there is still so much more work to be done.”

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REXY

21 / On PrEP / San Francisco, CA / Drag Activist and Drag Mother “I decided to take PrEP because I wanted to take care of myself and my body. I wanted to have a little more sense of security when it came to being someone who is on my sexual liberation journey. One other part is mainly around safety. As a trans femme, this world is not the safest and, after having been sexually assaulted, I wanted to be able to protect myself in case of an incident like that happening again.

I get my Truvada for free from the health clinic I go to. After I started taking it, I have had an extra sense of security. This also helps when it comes to using a condom since, as we all know, condoms can break or rip or just not work. Having Truvada as a backup when it comes to having sexual encounters with undetectable/positive people really helps.”

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AS AN HIV SURVIVOR, COVID-19 STIGMA IS SADLY FAMILIAR THE SHUNNING AND FEAR ISN’T FACT-BASED. IT’S ALSO AN OBSTACLE IN ENDING A PANDEMIC.

BY JOHN-MANUEL ANDRIOTE

Originally published on NextAvenue.org, this article is part of its Still Here, Still Positive series on the first generation of Americans aging with HIV/AIDS, with support from The John A. Hartford Foundation. Next Avenue is an organization focused on “meeting the needs and unleashing the potential of older Americans through media.”

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Elizabeth Martucci figured it made perfect sense to share the exciting news that she and her 11-year-old son had recovered from COVID-19. The New Jersey resident even had “COVID-19 Survivor” T-shirts made.

Martucci didn’t anticipate the response she’d get to being a survivor — and the sometimes jarring lengths to which some will go because of their fear. As The New York Times reported in a story about Martucci, “Even now, a month into their recovery, some neighbors see them and run.”

“Federal health experts and epidemiologists agree that patients fully recovered from COVID-19 no longer pose risk of infection to others,” said the Times article. “Yet some people who have survived the illness are still confronting a fear-driven stigma from the outside world.”

LU IS Q U INTERO/PE XELS (OPPOSTE ); COU RTESY SU B J EC T (AN DRIOTE )

A FAMILIAR STIGMA

An online search for “COVID-19 stigma” yields a raft of stories from across the world about the fear-driven shunning and outright persecution facing people with, or recovered from, the illness. The Times’ story shares anecdotes of a veterinarian who refused to treat a recovered woman’s dog and a laundromat worker who “jumped at seeing an elected official whose illness had been reported on the local news.”

The Japan Times reports that in subSaharan Africa, for example, “landlords evict people from their homes, nurses are abandoned by their husbands, and people are spurned just on suspicion of coming into contact with a COVID-19 patient.”

This kind of extreme stigma is all too familiar to those of us who lived through the early years of the HIV/AIDS pandemic in the 1980s. Far too many people with the virus were evicted from their homes, shunned by their families, denied proper funeral services, and dehumanized as moral degenerates who “brought it on themselves.”

As I looked back across my life to write my book Stonewall Strong, I thought a lot about HIV and what it means to me. I had never seen it as a moral issue, but as simply a virus whose only “meaning” was that there are dangerous things floating around this world of ours.

After my own 2005 diagnosis, I had to get to the point of understanding that living with HIV doesn’t “mean” I have a character defect or moral failing. It means I haven’t always made healthy choices in my sexual behavior.

It means that my life’s traumas sometimes have affected me and undermined my good judgment. It means I am human.

As a person living with HIV, it’s my responsibility to take care of my health — taking my medication as prescribed to maintain viral suppression. This means

better health for me and that I can’t transmit HIV anyone else.

But I can’t change someone else’s perceptions or educate them with fact-based information unless they are receptive to it.

I have bumped up against others’ stigmatizing attitudes, particularly in the dating arena. Even after nearly 40 years of the HIV pandemic, the personal profiles of gay men in online dating sites abound with terms like “clean” and “DDF” (drug- and disease-free) to signal that anyone with HIV — including those with “undetectable” virus loads who pose zero risk — is unwelcome.

CELEBRATING SURVIVAL

With this kind of us-vs-them attitude even in the hardest-hit gay male community, it’s not surprising that stigma is one of the biggest obstacles to ending the HIV/AIDS epidemic.

“Stigma, homophobia, and discrimination affect the health and well-being of gay and bisexual men and may prevent them from seeking and receiving high-quality health services, including HIV testing, treatment and other prevention services,” notes the Centers for Disease Control and Prevention.

“These issues place gay and bisexual men at higher risk for HIV.”

LIKEWISE FOR COVID-19

If survivors have to worry about being shunned, rather than celebrated, then where is the incentive for others to be tested in the first place? What happens when people are so irrationally terrified that they don’t trust the ability of recommended safety precautions to protect them?

We can only choose for ourselves how we think about HIV or COVID-19 and what it “means” for us. Personally, if someone shuns, or runs away, from me because I am open about having — or having had — HIV, I am not likely to feel badly about being “rejected.”

Instead I will pity them because they are driven by fear, not rational thought.

After seeing HIV ravage the bodies and minds of too many of my friends in the years before we had the medications I take each day to keep it under control, I feel profound gratitude to be alive and healthy.

Like Martucci and her son, I celebrate my survival because I’ve known so many who didn’t survive.

After you’ve had the experience of confronting your own vulnerability, and mortality, it’s hard to care for too long what others think about you. Even if they literally run away, you will have the satisfaction of knowing the resilient stuff you are made of, and it will help you face every other challenge life throws your way.

John-Manuel Andriote has reported on HIV/AIDS as a journalist since 1986. He has been open about his own 2005 HIV diagnosis since coming out publicly in a first-person story for The Washington Post.

Andriote’s most recent book is Stonewall Strong: Gay Men’s Heroic Fight for Resilience, Good Health, and a Strong Community, a bookend for his award-winning history Victory Deferred: How AIDS Changed Gay Life in America. Andriote mines his and other gay men’s experiences for insights on resilience in conference and university talks and in his Stonewall Strong blog for Psychology Today.

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Irresistible There’s more hope than ever for HIV-positive folks experiencing drug resistance.

BY JACOB ANDER SON - MINSHALL

A D D ITI O N A L R E SE A R CH BY D E SIR ÉE G U ER R ER O

The word “resistance” might conjure up images of protesters, government workers, or throngs of early voters. But HIV-positive people know all too well the fallout of a different kind of resistance: antiretroviral drug resistance.

Thankfully, the majority of those living with HIV will likely never face antiretroviral drug resistance.

Although the risk of developing resistance increases over time, modern HIV therapies are less vulnerable and have higher adherence rates — two factors that decrease the risks.

Still, we can’t ignore the fact that there’s been a globally documented expansion of HIV drug resistance, which the World Health Organization says has the potential to fuel an increase in new HIV diagnoses and deaths. So what is antiretroviral drug resistance and how can you fight it?

Drug resistance occurs when a disease develops a defense to the mode of attack that a medication is using to fight it. Imagine if you protect your house with a security system and then burglars learn how to hack into it. That’s resistance.

All organisms are constantly evolving to deal with the stressors in their environment, and viruses can change at a disturbingly rapid pace. HIV can create billions of copies of itself in a single day. In all of that replication, mistakes are occasionally made and passed along. Some of those mistakes create mutations that are helpful to the virus. Those versions become more common if they survive the medications you are taking.

As more of the mutated strain replicates, it passes on its drug resistance.

If another error m ake s it e ven more resis t ant to that drug, the 28

level of resistance continues to build. Eventually the medication stops working.

How Common Is Drug Resistance?

Unfortunately, that’s a hard question to answer — however, increased surveillance of global HIV drug resistance in recent years tells us more. And not all is good news. The WHO’s 2019 global report on HIV drug resistance showed that up to 26 percent of people in the world who are initiating HIV treatment are infected with a virus carrying resistance to first-line drugs (such as efavirenz). There’s also been a significant increase in resistance among infants born with HIV, now up to 69 percent globally.

In resource-rich countries like the U.S., due to factors like adherence and access to the latest medications, resistance rates are much lower, somewhere around 10 percent, according to most available data.

Symptoms of Resistance

So how do you know if you have a drug-resistant strain of HIV? The only reliable method is testing. When you are first diagnosed with HIV, your doctor should check which strain you have, since some strains are resistant to different drugs. This genotypic-resistance testing should especially look for mutations impacting reverse transcriptase and protease inhibitors.

When Should I Be Tested?

If you’ve been off treatment for a while, if your viral load increases while you are on treatment (even if you remain undetectable), or if you are planning to switch medications, you should be tested for resistance. In addition, the National Institutes of Health recommends drug-resistance testing for all pregnant women living with HIV,

SH UT TERSTOCK

What Is Drug Resistance?

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whether they are on medication or not, because drug-resistant strains can be perinatally transmitted to a child.

them. If you develop a resistance to one nonnucleoside reverse transcriptase inhibitor (like rilpivirine), then another NNRTI (like efavirenz) is also unlikely to work.

Preventing Resistance

Do Particular Drugs Make a Difference?

The risk of resistance increases when drug levels drop below a certain active level.

This usually occurs only if you miss doses or stop treatment. Any interruption to your treatment plan can have long-term impacts, and WHO reports that those who experience treatment interruptions are three times more likely to develop resistance to efavirenz or nevirapine than first-time users of these drugs.

Your best defenses against developing resistance involve getting on medication, adhering to your treatment as prescribed (meaning: not missing doses, taking the medication at the recommended time of day, and with or without food or other drugs as recommended), and maintaining an undetectable viral load.

Adherence has increased over time due to antiretroviral therapy medications becoming more tolerable (and now available in easy-to-take, single-tablet regimens). “Most ART regimens used for first-line therapy are sufficiently potent to completely block HIV-1 replication and have a genetic barrier to resistance high enough to maintain long-term virological suppression,” a repor t in the journal Infection, Genetics and Evolution noted.

Because gaps in treatment play a pivotal role in the development of drug resistance, WHO’s Global Action Plan on HIV Drug Resistance encourages people with HIV to take medications a s p re s cr ib e d , a n d doc tor s and ser vice provider s to keep poz p e o p le o n t r e a t m e n t , increase viral load testing (to catch viral rebounds that happen as resistance is developing), and quickly facilitate switching to other medications when resistance is suspected.

Some drugs have a higher risk of resistance and only need one mutation for the virus to gain complete resistance. This is particularly true with NNRTIs (nevirapine, efavirenz, rilpivirine, and etravirine), integrase inhibitors (raltegravir), and some nucleoside analogs like 3TC and FTC. These drugs are also more vulnerable if used in combinations that aren’t effective in maintaining viral loads below 50 copies/ml.

Fortunately, some drugs offer more protection against HIV developing resistance. For example, the ODIN trial found that darunavir (marketed under the brand name Prezista and also a component of Prezcobix) has a high genetic barrier to the development of drug resistance. It not only stops the virus from multiplying but cuts down on its ability to mutate, and therefore a resistant strain is unlikely to develop.

What If I Develop Resistance?

Fortunately, if you do develop resistance, numerous treatment options are available to replace your current medication. Talk to your doctor about switching. Just because you’ve developed a resistance to one drug — or even a whole class of drugs — doesn’t mean that other HIV meds won’t work for you.

HIV strains with multiple drug-class resistances are rare, but there’s also new hope for folks who have developed a resistance to most classes of antiretrovirals. Two drugs that can combat resistance are the long-acting injectable ibalizumab (a monoclonal antibody, brand name Trogarzo) and fostemsavir (an attachment inhibitor, brand name Rukobia). Both have been shown to be effective in treating multidrug-resistant HIV when added to a previously failing antiretroviral regimen.

Each drug is in a new class and uses a novel attack on the virus, giving people with HIV more ways to fight antiretroviral resistance.

What’s Cross-Resistance?

When the virus develops a resistance, there is often cross-resistance to the whole drug class. Cross-resistance occurs when a mutation that gives the virus an edge against one medication also works against similar drugs, even if you’ve never taken H IVPLUS MAG .CO M

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THE DOCTOR IS IN DR. DEMETRE DASKALAKIS, THE CDC’S NEW DIRECTOR OF HIV PREVENTION EFFORTS, ENTERS HIS NEW ROLE DURING THE MOST CHALLENGING HEALTH CRISIS IN DECADES.

MAG N US HASTINGS

BY NEAL BROVERMAN

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IF DEMETRE DASKALAKIS is harboring anxieties over taking a new national health position in the middle of two global pandemics, it doesn’t show.

Formerly the deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, Daskalakis was hired as director of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention late last year. His first weeks on the job coincided with a frightening transition of presidential leadership, an insurrection at the U.S. Capitol, and devastating numbers of COVID deaths in the nation — typically between 2,000 and 4,000 fatalities a day.

But Daskalakis, one of the most visible government officials overseeing HIV policy, does not sound panicked or overwhelmed in conversation with Plus.

“It’s a great time to land,” Daskalakis says. “We’re at a crossroads of strategy and implementation. Leading CDC’s Division of HIV/AIDS Prevention is my dream job.

I believe that everything I’ve done in my career has been leading me to this role.”

Daskalakis is indeed perfect for the job of overseeing HIV prevention efforts at the CDC, officials from the government agency noted when announcing his hiring.

Daskalakis was central in leading many HIV and STI programs in the nation’s largest city, including the Ending the Epidemic program, credited with bringing HIV cases to historic lows.

The gay doctor is known as an “activist physician” to some, as he’s been happy to serve as a public advocate for people with or at risk of sexually transmitted infections — giving interviews, attending fundraisers, dressing in drag to administer meningitis vaccines, and participating in public service announcements about the importance of treatment and prevention (one of his stigma-battling efforts involved hosting Plus magazine’s web series, The T With Dr. D).

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Daskalakis was always more than a public face or figurehead, though. Raised in Virginia and trained in prestigious New York and Boston hospitals, Daskalakis was an attending physician at the Big Apple’s Bellevue Hospital and medical director for the city’s nationally respected Mount Sinai Health System before being hired in 2014 as assistant commissioner of disease control for New York’s Department of Health. At that time, the doctor saw a huge opportunity with the Affordable Care Act and the expansion of health insurance, especially among many young people. Daskalakis aggressively promoted PrEP (pre-exposure prophylaxis) for those at risk of HIV and TasP (treatment as prevention) for those living with it.

As part of his TasP efforts, Daskalakis spearheaded an effort known as “statusneutral care,” which aims to treat all patients the same, regardless of HIV status. That approach includes testing all patients unaware of their HIV status and then offering follow-up care, regardless of the test’s results. The goal is to keep as many people as possible HIV-negative (and on PrEP if at risk) or unable to transmit the v irus (by becoming undetectable through treatment). Not only does the method expedite care and prevention, it also tackles stigma by treating everyone the same and not assuming anyone is specifically susceptible to HIV. Between 2013 — shortly before Daskalakis joined the NYC Department of Health — and 2017, the rate of new HIV infections in the city among gay and bisexual men dropped by approximately 35 percent.

Now many look to Daskalakis to replicate his efforts on a national level, during a time when the COVID-19 pandemic is exacerbating physical and mental stresses for everyone on the planet, including people living with HIV. The CDC’s new not-so-secret weapon connected with Plus to share his plans moving forward.

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L ARS NIKI/G E T T Y IMAG ES FOR HOUSING WORKS

Dr. Demetre Daskalakis (right) with Housing Works CEO Charles King at the 2017 U=U Rally & Dance Party to End HIV Stigma at the NYC AIDS Memorial

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Demetre Daskalakis (left) and Jesus Aguais attend AID FOR AIDS My Hero Gala in 2019

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If you have HIV and are taking your medicine, it is important to take everyday preventive actions, like wearing a mask, to prevent getting COVID-19; continue your HIV treatment; and follow the advice of your health care provider.

Congratulations on your new position at the CDC. Did you have second thoughts about taking on such an important role amid the COVID pandemic?

I am very excited about this opportunity.… [The] CDC leads HIV prevention efforts in the U.S. and is playing a key role in the Ending the HIV Epidemic initiative. This federal initiative builds on the work CDC has been doing and aims to accelerate the reduction of new HIV transmissions by at least 90 percent by 2030.

I believe that the EHE initiative and the national strategy provide a great road map for addressing HIV. My goal is to push CDC’s role in implementing the HIV strategy forward and tweak it so it is more operational for delivering HIV services and data to end the epidemic.

To end the epidemic, we must have a clear focus on the STI and hepatitis syndemics and we must address the systemic racism, sexism, homophobia, and transphobia that hamper our progress. I’m thrilled that we are going to approach addressing HIV like a new outbreak all over again so we can end it.

Are there similarities or links in strategies to getting COVID and HIV under control?

Much of the infrastructure for COVID-19 is being built and utilized simultaneously. We need to ask questions about what assets from the COVID-19 infrastructure we could leverage for HIV and other health conditions once COVID-19 is under better control. For example, CDC has strongly encouraged the EHE jurisdictions to use novel and innovative activities to meet local needs in a tailored way,

especially during COVID-19. Innovations in testing and care delivery spurred by COVID19 could help us overcome longstanding barriers to HIV prevention and care in the long term by providing testing and care in more accessible, modern ways. These kinds of innovative approaches include the use or expansion of telemedicine and telehealth, rapid HIV self-tests, mail-in self-tests, and other locally tailored, creative solutions.

It is also important to consider the lab and vaccine infrastructure being built for COVID-19 and how it can be leveraged for our other syndemics.

What should people living with HIV know about the threat of COVID, the isolation involved in lockdowns, and the financial stress caused by the pandemic?

We are still learning about COVID-19 and how it affects people with HIV. Based on limited data, we believe people with HIV who are on effective HIV treatment have the same risk for COVID-19 as people who do not have HIV. However, the available data do indicate that people with HIV and serious H IVPLUS MAG .CO M

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underlying medical conditions might be at increased risk for severe illness. In some studies, people with HIV were also more likely to have these comorbidities than others with COVID-19 infection. Higher rates of COVID-related hospitalization, admission into intensive care units, and/ or death among people with HIV seem to be driven by underlying conditions, lower CD4 cell count, and not being on effective HIV treatment.

During the COVID-19 pandemic, it is natural to feel stress, anxiety, and other emotions. Some healthy ways to cope with these feelings include taking breaks from the news, taking care of your body by eating right and getting at least eight hours of sleep, making time to do the activities you enjoy, and safely connecting with others to discuss your concerns and how you are feeling. If you have HIV and are taking your medicine, it is important to take everyday preventive actions, like wearing a mask, to prevent getting COVID-19; continue your HIV treatment; and follow the advice of your health care provider.

Tell us more about how your efforts in New York can succeed nationally.

I think that lessons I have learned both in my work in HIV in as well as my role as incident commander over the measles outbreak of 2019 and COVID-19 in New York City will be helpful to guide my work at DHAP on the national level. Listening more and talking less was an important part of my strategy in New York City and will be valuable in my new role at the CDC. Connecting to community, advocates, and my colleagues working on EHE will be a critical part of my new role. I am optimistic that my experience in New York City will be an important ingredient along with a healthy dose of humility and the voice of the national stakeholders in advancing my work at CDC. Injectable HIV treatment has received Food and Drug Administration approval. Do you see that as an effective way to improve adherence for people living with HIV? I think that the more options we have for treatment and prevention, the more likely individuals will be able to find an option that works in their lives. Similar to birth control, not every option is perfect for every person, nor is any one option the definitive solution to adherence problems.

The amazing advances we are making in 36

Listening more and talking less was an important part of my strategy in New York City and will be valuable in my new role at the CDC. technology provide for a critical opportunity to implement multiple strategies at the same time with the goal of giving choices to an increasing number of people. Some people like pills. Some people will like shots. Some people will like implants. The more ways we have to deliver safe and effective medications, the more likely we are to find the right strategy for a larger number of people.

The concept of U=U (undetectable equals untransmittable) is becoming more widespread but isn’t really part of the mainstream health conversation. How can we increase awareness of it?

U=U ha s b e en a n i mp or t a nt way t o communicate that people w ith HIV on effective therapy with suppressed viral loads do not transmit the virus. I think that we need to continue to magnify the data to the community of providers that serve people with HIV as well as people who are otherwise affected. Working to create more status-neutral delivery of care regardless of HIV status is a way to bring the U=U message to life and address the institutions that maintain systems that support a divide between people with and without HIV. We have a way to go, but I am excited to work to further mainstream this important science.

Do you have any plans to battle HIV stigma as part of your position at the CDC? Controlling the HIV epidemic means that we need to relentlessly address the root causes and social determinants that stand in our way.

We need to aggressively work to disrupt the systems that create the schism between people based on their identity, including the result of their HIV test. Our work must challenge the core drivers of HIV, including stigma. This job, at its core, is an opportunity to dismantle stigma, a challenge that has been key to my entire career.

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BY NEAL BROVERMAN

Sinfully Good Russell T Davies’s superb new series, It’s a Sin, is set during the AIDS epidemic in 1980s London. The legendary writer and producer talks to Plus about the experience of promoting a show about a pandemic while living through a new one.

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The characters of It’s a Sin take part in AIDS activism, like this die-in to demand affordable treatments

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Face masks, gloves, quarantines, stigma, and panic.

The recently released HBO Max miniseries, It’s a Sin, from British TV mastermind Russell T Davies (Queer as Folk, Years and Years), features the hallmarks of life in the early 2020s. But the exquisite new series takes place 40 years ago, as HIV disrupts a group of young Londoners and death haunts the pubs, flats, and dance clubs that once offered them freedom and community.

“We stopped shooting It’s a Sin on the last day of January [2020] and [the United Kingdom] went into lockdown on March 23,” Davies tells Plus. The bizarre timing is “fascinating and annoying and enlightening and exasperating,” he says. “At my age, 57, to hear people talk about the first great virus of their lives is really annoying when there’s clearly been another. Amazingly, people are happy to talk about the Spanish flu of 1918. What about HIV? It’s amazing how it gets written out of the picture because the world’s history is written by straight people.”

Even without the COVID association, Davies’s critically acclaimed series would resonate with audiences because of its truthful writing, spot-on casting, and pitch-perfect acting (not to mention sets that pop with color and a soundtrack that makes the ’80s feel like yesterday).

The timing does add another dimension to the five-episode series, though. While watching Sin’s characters — consisting mainly of queer men and their female friends and relatives — react to news of a fatal disease mostly afflicting gays, it’s hard not to see the denial and panic in our own reaction to COVID. It’s also deflating to see how much of the initial fear and stigma about HIV remains four decades on, even after medications rendered the virus a manageable condition instead of a death sentence.

“Some people don’t know the difference between a virus and a bacteria and a germ,” Davies says. “Some ask if a man with HIV sneezes in the same room as you, can you get sick? Still vexes people.

I can ask friends of mine, gay friends, and you can see the doubt and hesitancy in their minds. Yes, you’re completely fine! We’ve seen the ignorance lead to QAnon, leads to your capitol being invaded. At least [the ignorance] was easier to fight in the ’80s once we got our heads around what was happening. It’s insane now.”

While information on HIV and COVID is at most people’s fingertips thanks to the internet, some people still choose ignorance. Forty, even 35 years ago, information on HIV was so scant, most people had to hunt it down. One memorable scene on It’s a Sin involves one character begging a friend to pick up newspapers about AIDS when they go to New York for a business trip, since there was nearly no HIV information in Britain at the time.

The characters of It’s a Sin, many of them newly out and liberated from their conservative hometowns and now in cosmopolitan London, struggle with the threat of HIV and the limits it places on their newfound happiness. Some deny the threat, some mock it, others accept it. Their pain and confusion are palpable, as is the injustice of these young people being forced to face their mortality decades before they should have to. Then, when the deaths arrive, viewers of 2021 will be jolted into experiencing what people of Davies’s generation endured.

“I do know people who would not agree there was a collective trauma [with AIDS],” Davies says. “I envy their happy lives. Friends of 40

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ABOVE: The characters’ burgeoning activism is a central theme of the series LEFT: Callum Scott Howells (left) and Omari Douglas play unlikely roommates in It’s a Sin

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CLOCKWISE FROM TOP: The central characters of It’s a Sin; Olly Alexander and Lydia West portray protagonists Ritchie Tozier and Jill Baxter; Neil Patrick Harris and Callum Scott Howells play coworkers and confidantes in the series

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Screenwriter and producer Russell T Davies

mine regularly disappeared; vanished. They went home, and w ith no mobile phones and internet, they’d literally walk out of your life. Some of them I still presume are dead to this day and I’m not quite sure. And that looks so alien and strange [to people today].”

Re-creating urban gay life in the 1980s and early ’90s also means making room for the joy and levity that AIDS could not eradicate. The show is as much a testament to friendship, chosen family, growing up, finding your place, and the hedonistic joys of city life as it is about the scourge of a pandemic.

“When I watch something as furious as The Normal Heart — which is brilliant, polemic, a masterpiece — in a strange way it releases me to not be quite so angry,” Davies says. “I have seen very furious and very sad

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“...to hear people talk about the first great virus of their lives is really annoying when there’s clearly been another. Amazingly, people are happy to talk about the Spanish flu of 1918. What about HIV?” pieces, so it’s time for me to look elsewhere, and actually it’s being fair to the memory because I want to remember the boys who died. My task was to remember those boys we lost, and I don’t remember them in tears, I remember the joys and the laughter. Those chorus boys from the West End, those funny friends you’d be clutching your sides with laughter with.”

Tackling both queer life and HIV is a new endeavor for Davies, who pointedly didn’t include storylines about the disease in Queer as Folk, his history-making U.K. gay series from the late ’90s (later adapted into the hit U.S.-set Showtime drama). When writing QAF in 1998, Davies felt boxed in by HIV,

feeling it was exclusively associated with LGBTQ+ characters who were not allowed to be seen outside the context of the virus. “[LGBTQ+ people at the time] had no independent life, we had no freedom, we were simply a story of sickness and disease,” Davies recalls. “All that stigma and fear still followed us; even when that narrative was kind, it was related to death and disease. I absolutely decided that was not my life, that I had so much more to say and be on the earth as a gay man.”

At a press conference before Q A F premiered, furious journalists railed on Davies for excluding HIV. “You wouldn’t sit at a straight press launch and say, ‘I want to see the man putting on a condom,’” Davies says. “You wouldn’t say [about] a straight drama, ‘You have to have cancer because disease needs to be represented.’ So I came out swinging at that [criticism] and I’m still swinging.”

Twenty years later, with the world so changed, Davies wanted to revisit the days of his youth and honor the innumerable friends and lovers he lost; he also centers the story of women who cared for the sick and dying men. The character of Jill, brilliantly portrayed by Lydia West, is really the hero of the series, serving as a threedimensional voice of sense, sacrifice, and compassion.

“In reaction to It ’s a Sin, people say, ‘It’s a lost generation.’ I say it’s not a lost generation,” Davies says. “There’s an awful lot of us left because a lot of people did such good work so fast and word spread so quickly about safe sex. And maybe people got scared, but they acted, and maybe it did stop the death of a generation. It’s not true; it’s neglecting the good work that people did and do.”

Writing It’s a Sin was truly a “catharsis,” Davies says. “There’s a need to write these things down and remind the new generation this has happened.”

After Davies so faithfully recreated the worst days of AIDS, it’s easy to imagine him putting his own narrative spin on our current harrowing times — and to look forward to the beautiful art that will inevitably be made from all this pain.

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10 STEPS TO SELF-COMPASSION CONSTANTLY INDULGING THAT INNER VOICE OF SELF-CRITICISM CAN HAVE A NEGATIVE IMPACT ON YOUR EMOTIONAL WELLNESS.

BY GARY MCCLAIN

“ YO U K N E W T H AT would happen!” “Can’t you do anything right?”

Or how about: “Idiot!”

Who’s saying all those mean things to you? Most likely, your own harshest critic. You! We human beings sure can be tough on ourselves.

Pointing out our mistakes, our misjudgments. Anything we do that falls short of a demand we didn’t meet. All too often demands we created for ourselves and that weren’t realistic in the first place.

And just where does that critical voice come from?

I suspect it’s a voice we hear as children, maybe from parents who criticized and scolded when we were judged as not having met the demands placed on us.

Or teachers. Maybe other kids. Somewhere along the way we learn that when

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we make a mistake or can’t quite perform as well as someone else thinks we should, we’re going to hear about it. Often with some pretty harsh words.

Turn Off the Self-Criticism.

Replace It With Kindness.

Sure, criticism can make us better. That’s probably what was behind all that criticism that came your way as a child. Or at least that’s what you were told. But as we become adults, that baton magically gets passed to us. And unfortunately, we latch on to it. By doing so, we invite those critical voices into our minds and give them free rein to sound off at will. And do they ever take advantage of every opportunity, while compassion for ourselves gets pushed off to the side. If you’re living with HIV, you know about demands.

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wellness

Staying on top of your regimen. Paying attention to your emotional and physical wellness. Maintaining a support network.

Let me ask you something: Have you ever thought about the toll it takes on you when the person in the mirror always has a good scolding at the ready, just waiting to unleash it? That’s a lot of pressure to live with. And another question: Is it possible that you might be demanding a little too much of yourself in some areas of your life? And how about this: Is all the scolding the only way you have to keep yourself motivated?

You’ve heard that expression “With friends like these, who needs enemies?” So I have to ask: Are you being a friend to yourself?

And I have to add something here. When you’re that hard on yourself, your critical eye becomes your view of the world. And that can translate into being hard on other people too.

Here’s a challenge: How about making a commitment to be kinder to yourself? Here’s how to get started.

Set priorities. Sit down with yourself and think about what you really need to do to take the best possible care of yourself. Focus on the basics, what you need to do maintain your optimal health, physically, emotionally, and in your relationships. Make a list. And a schedule.

These are your priorities.

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Remind yourself that not everything is a crisis. One of the best ways to give yourself a rough time is to look at anything less than perfection as an absolute catastrophe and then make yourself at fault. Take a step back and consider the situation. Is this something that can be fixed? Do you know how to get things back on track? And if not, is there someone who can help? All that energy spent on self-criticism can be channeled toward finding a solution.

Focus on the big picture. Who knows, you may even decide that what felt like a crisis at the moment was only a bump in a much longer road. What a relief, right?

Look for the lesson. Here’s where you have a choice. You can look at a mistake or a setback as a reason for punishment, and call yourself lazy, stupid, etc. Or you can turn this into an opportunity for learning. Try this: “Oh, so that’s what happens if I…. At least I know how to avoid this problem in the future.” And then move forward, that much more educated.

Watch your self-talk. We spend our waking hours talking to ourselves. Evaluating, predicting, explaining…judging. And it’s that judgment talk that can make us very

unhappy. So be more aware of your self-talk.

When you feel the critical voice gearing up to let loose with a good old scolding, tell him/ her to be quiet. And then engage that kindly, compassionate voice that’s been cowering in the corner for too long.

Give yourself a break. Ask that voice of kindness for a little pep talk. Remind yourself: “I’m human. I’m trying hard. This is not an easy road. And I am doing the best I can, even if not everything I do is perfect.” Having trouble conjuring up that voice? It might help to sit down with a sheet of paper and do some journaling. Give yourself a positive selftalk script you can read when you need a lift.

Try some affirmations. Start out with: “I am a work in progress. I get better every day.”

And let yourself feel. One of the ways we punish ourselves is by telling ourselves that we shouldn’t be feeling the way we feel. But there is no right or wrong way to feel. So as emotions come up, don’t swallow them. Let yourself feel, whether that judging voice approves or not. Sad, mad, afraid. It’s all part of being human. That’s being kind to yourself.

Replace punishment with rewards. Chances are, if you are letting loose on yourself with that critical voice, you may also be punishing yourself in some way. Avoiding people. Not doing things you know you would enjoy.

Pushing yourself to overwork. What if you gave yourself some rewards when you meet an expectation you have for yourself? This is a way to shift your focus to what’s going well and to give yourself some encouragement to keep up whatever you’re doing that got you there.

Indulge in something you enjoy that promotes your wellness — a little break, a favorite activity, some fun with a loved one. You deserve it!

Let somebody help. Limit your time with people who take away the need to criticize yourself because they are so good at doing it for you. Instead, try to surround yourself with people who bring out the best in you. Be kind back. Kindness leads to more kindness. And it sure feels a whole lot better than criticism!

Smile at your imperfections. Nobody’s perfect. Now, how do such imperfect people manage to dress themselves in the morning?

It’s a mystery. We’re all so imperfect that we just have to shake our heads and laugh at ourselves sometimes. How’s that for lightening up?

You’re dealing with a lot. So how about giving yourself credit for doing the best you can?

Show yourself some compassion. And some love while you’re at it. Be kind to yourself.

Mental health editor GARY MCCLAIN, PH.D. is a therapist, patient advocate, and author in New York City who specializes in working with individuals diagnosed with chronic and catastrophic medical conditions.

(JustGotDiagnosed.com)

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HIGH AND MIGHTY

MARIJUANA HAS SHOWN PROMISE IN KEEPING SOME COVID PATIENTS OFF VENTILATORS.

BY MEY RUDE

Certain cannabis strains may offer help in preventing acute respiratory distress in patients who have COVID-19, researchers at the University of Lethbridge in Canada have discovered.

Acute respiratory distress happens with COVID patients when the virus overloads their immune system to the point where the body attacks itself and the patient needs to be placed on a ventilator. The new study indicates that certain strains of marijuana might slow that process down or even stop it.

“In this study, we identified three extracts that are very, very good strains; some strains identified in previous studies were also pretty good,” said Dr. Olga Kovalchuk, one of the researchers who conducted the study. “All together, we have five strains we could formulate a clinical trial on right now. We need a chance to bring it to the evidencebased medicine realm.”

A clinical trial that can be peer-reviewed will be the next step in the research. Cannabis therapy wouldn’t be a substitute for any other medical treatment needed for COVID, but combined with what is already available, it could lessen the need for patients to take up hospital beds and ventilators.

The specific strains that have been most helpful are sativas, which are known to offer cannabis users more energy than indicas, which can sometimes induce lethargy. Researchers haven’t yet publicly released the specific strains most useful for COVID patients.

CAN ORAL SEX CAUSE CANCER? Having a large number of oral sex partners leads to a higher risk of contracting HPV-related cancer of the mouth and throat, a new study published in the American Cancer Society’s peer-reviewed journal Cancer indicates.

The study, done by a team of researchers at Johns Hopkins University, surveyed over 500 people about their sexual activity. One-third of participants had been diagnosed with human papillomavirus (HPV) and about two-thirds had not.

Having had 10 or more prior oral sex partners was associated with a 4.3 times higher likelihood of getting HPV-related cancer of the throat or mouth, according to the study. Additionally, having oral sex at a younger age, having a large number of partners in a short period of time, and engaging in extramarital sex were also linked to higher rates of HPV-related cancers.

Researchers also found that having genitalto-genital sex before oral sex lowers the risk for those participating. They said that if your initial 46

exposure to HPV is through your genitals, it creates a “robust immune response” that better fights the virus than if introduced orally.

“Our study builds on previous research to demonstrate that it is not only the number of oral sexual partners, but also other factors not previously appreciated that contribute to the risk of exposure to HPV orally and subsequent HPV-related oropharyngeal cancer,” said Dr. Virginia Drake, lead author of the study.

Overall, the study doesn’t really show that blow jobs can give you cancer. More accurately stated, it indicates that those who engage in more and higher-risk sexual behavior have a greater chance of getting HPV and therefore have a greater chance of HPV-related cancers .­— M R

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A NEW STUDY PROMPTS CONCERNS ABOUT HPV.

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TALK THAT TALK Discussing U=U with your doctor is essential to staying both informed and healthy.

BY NEAL BROVERMAN

Knowledge is power, and a new global study shows The differing rates of that many people with HIV are living in strength. communication between Surveying nearly 2,400 people with HIV in 2019 individual groups and 2020, the recently released Positive Perspectives suggest that “tailored” Study found a majority of respondents were well aware communication from doctors of Undetectable Equals Untransmittable (or U=U, that consider cultural and of people living with for short), the medically recognized concept that if community differences HIV discussed U=U a person achieves and maintains viral suppression would be most effective. with their health through their HIV regimen they cannot transmit the The Positive Perspectives care provider virus to anyone.

Study also highlights how Connecting with people in over 25 countries and standardizing and possibly Source: Positive several continents, the survey found that two-thirds enforcing U=U discussions Perspectives Study discussed U=U with their doctor or health care team. among health care “These people were more likely to report a range professionals would wield of good health outcomes compared to those who enormous benefits, especially were unaware of U=U or had learnt about it from other sources,” since a sizable number of people living with according to the HIV website Avert.org.

HIV are still not having this conversation Specifically, those who talked about U=U with their medical with their health professionals. providers were more likely to adhere to treatment, be virally “Providers caring for patients with HIV suppressed, have positive outcomes in regard to their overall sexual should universally inform their patients health, and be actively engaged in their HIV care. They were also about U=U as part of their routine care,” more likely to inform their sexual partners they’re living with Sarah Calabrese of George Washington HIV. For those who learned of or discussed U=U with nonmedical University and Ken Mayer of the Harvard sources, the information was still beneficial, but their outcomes Medical School and Fenway Institute were not as strong as those of people who communicated with their previously wrote in The Lancet HIV. doctors about it.

“Conveying benefits and risks surrounding Black individuals, those with casual sex partners, and transgender any treatment is fundamental to patients’ people most often discussed U=U in health care settings, with 77 decision making, and this HIV treatment percent of trans participants indicating they spoke to their doctors benefit should be no exception.” about remaining undetectable and unable to transmit the virus.

Men who had sex with women and people living in Asia had the Find out more about U=U at lowest frequencies of discussing U=U with their doctors.

HIVPlusMag.com.

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B A C K TA L K

B Y TAY L O R H E N D E R S O N

It’s a Sin is starting some great conversations about HIV as well as pandemics in general. Why did you take your role as Henry Coltrane?

STARRING IN A NEW HIV DRAMA, NEIL PATRICK HARRIS HAS A LOT TO SAY ABOUT STIGMA AND KEEPING HEALTHY DURING COVID. NEED SOME EXTRA tips for safe shopping?

Neil Patrick Harris has you covered.

In a new partnership with PayPal and Venmo, the actor shares tips and tricks for safe instore shopping in a hilarious promotional video, including paying touch-free with PayPal and Venmo QR codes at CVS. “We have all learned how important it is to follow safety protocols like wearing a mask and practicing social distancing to help contain and slow the spread of the virus,” says Harris.

Plus caught up with Harris to chat about his own family, finding gratitude in a pandemic, and his role in the critically acclaimed British drama It’s a Sin (see page 36). From the mind of beloved writer and producer Russell T Davies, the show celebrates the lives of characters living through the HIV crisis in 1980s London.

Tell us about this Venmo/PayPal system and why this is your preferred way of paying right now.

I think everyone needs to be doing everything they can to help contain further spread of the virus, right? When PayPal asked if I wanted to partner up with them to discuss ways to do it, at a CVS no less, I said sure! I shop at CVS, I use Paypal and Venmo, this makes perfect sense.

We filmed the spot overnight in a CVS all about the different ways you can maintain safety protocols.

Try going at off hours, do wear masks over your nose, wash your hands, be nice to each other, and download this app that allows you to be touch-free with PayPal and QR codes. It’s great — you don’t have to touch anything.

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It’s eerie looking at the show and seeing some of the similarities between HIV and COVID. Did you feel any parallels watching it now?

The only parallel I took when I was watching it was that sense of unknowing.... Of realizing that something is not just a story you read in the paper or online but is actually happening and uncontained.

That kind of observation of an uncontained scare, it’s traumatic.

Watching the history of the ’80s and HIV/AIDS in the U.K., it certainly adds a level of sadness knowing what it became, and that’s even more profound sitting in lockdown where you’re in, not similar situations, but in your own unknown bubble.

What do you hope audiences take from the show?

What Russell does so well is the entertaining. He can entertain and at the same time educate you.... To be able to learn about a very important time in LGBTQ history and not have it be rudimentary and wrote as if it’s medical, but have it be more visceral, like you’re on the dance floor, dancing alongside, feeling sexy. That’s a really important way to teach, and I’m glad that people around the world are responding to it the way they are.

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I honestly would’ve taken any role Russell T Davies wrote and asked me to be a part of. He’s so smart and so eff usive and kind and normal and writes about such epic and large and dangerous subjects, whether that be Years and Years, Queer as Folk, or now, It’s a Sin. I’m a big fan.

Getting to take on a part...[in] a story that an older generation can relate to but a younger generation can respond to? I think that’s important.

There are a lot of people in their 20s and younger that don’t know much about HIV/AIDS at all. While I don’t think they need to be grabbed by their shoulders and shaken, I certainly think they need to have different points of perspective.

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Callen-Lorde provides affirming and supportive healthcare to LGBTQ+ communities and people living with HIV/AIDS, regardless of ability to pay. We are proudly welcoming patients at our new Brooklyn location for in-person and virtual care!

Learn more at callen-lorde.org/brooklyn

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HOW DOES HIV TREATMENT WORK AS HIV PREVENTION Starting and sticking with HIV treatment every day helps lower the amount of HIV in your body. It can get so low it can’t be measured by a test.

That’s undetectable.

Less HIV in your body means it causes less damage. And according to current research, getting to and staying undetectable prevents the spread of HIV through sex.

It’s called Treatment as Prevention. Or TasP for short.

There’s no cure for HIV, but if you stick with treatment you can protect yourself and the people you care about.

Talk to a healthcare provider and watch It’s Called Treatment as Prevention at YouTube.com/HelpStopTheVirus

GILEAD and the GILEAD Logo are trademarks of Gilead Sciences, Inc. All other marks are the property of their respective owners. © 2020 Gilead Sciences, Inc. All rights reserved. UNBC7269 08/20

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