Plus 143 July August 2021 by Equal Pride

BECAUSE YOU’RE MORE THAN YOUR STATUS

THE 2021 HIV TREATMENT GUIDE

MODEL BEHAVIOR TALK SHOW HOST AND CELEBRITY HAIRSTYLIST GRACIE CARTIER COMES OUT ABOUT LIVING WITH HIV IN HOLLYWOOD

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contents

ON THE COVER 12 STATE OF GRACIE Emmy-winning hairstylist, model, and trans advocate Gracie Cartier recently joined the growing number of celebs coming forward about their own journeys living with HIV. Now, she's serving as an inspiration and educator to others.

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2021 TREATMENT GUIDE 28 THE LIST Our annual rundown of most common HIV medications. 34 COMING SOON HIV drugs on horizon are like nothing you've ever seen. 36 CH-CH-CHANGES When should you talk to your doctor about switching meds?

40 NO SIDES, PLEASE Are you experiencing drug side effects? Know the facts. 42 DIGITAL DOC S.O.S. Tips for surviving modern health care communication.

ON THE COVER Photography by Jamaal Murray Hair and styling by Gracie Cartier Makeup by Ernesto Casillas

JOE Y JAM ES SALEHI (C ARTIER); SH UT TERSTOCK (PILLS); AN NA SHVE TS/PE XELS (4 6); PE TER ROCK (4 8); SH UT TERSTOCK (8)

38 CLASS ACT Learn how each drug class fights HIV.

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CONTENTS

DAILY DOSE 6

THE PREP HYPE Is the focus on PrEP hurting those living with HIV?

BUZZWORTHY 8

MODEL CITIZEN Pose's Billy Porter goes public about living with HIV.

RED HOT REVIVAL The iconic musical fundraising institution is at it again.

A REAL DOWNER Is there a link between COVID-19 and erectile dysfunction?

AU REVOIR TO AN ARTIST The HIV battle loses one of its brightest visionaries.

OFF TARGET The world fails to meet the UN's 2020 HIV goals.

WELLNESS

46 WORK, WORK, WORK Some helpful tips on how to survive the daily grind.

PARTING SHOTS

48 PROGRESSIVE PRINCE Musician Prince Johnny holds tight to queer and HIV history.

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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, brand partnerships & associate publisher STUART BROCKINGTON

EDITORIAL managing editor DESIRÉE GUERRERO editor at large TYLER CURRY senior copy editor TRUDY RING associate editor DONALD PADGETT contributing editors KHAFRE ABIF, MARK S. KING mental health editor GARY MCCLAIN staff writer MEY RUDE contributing writers JOHN CASEY, MATTHEW HAYS, JIM PICKETT, CHARLES STEPHENS ART executive creative director RAINE BASCOS art director BEN WARD editor at large digital art CHRISTOPHER HARRITY PRINT PRODUCTION production director JOHN LEWIS production editor JACOB ANDERSON-MINSHALL 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 DANIEL REYNOLDS 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 director of podcasts & special projects JEFFREY MASTERS ADVERTISING & BRAND PARTNERSHIPS senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director, brand partnerships JAMIE TREDWELL creative director, brand partnerships MICHAEL LOMBARDO senior manager, brand partnerships TIM SNOW junior manager, advertising & brand partnerships DEAN FRYN coordinator, advertising & brand partnerships KEIGHTON LI DIGITAL vp, technology & development ERIC BUI digital media manager LAURA VILLELA social media manager CHRISTINE LINNELL social media editor JAVY RODRIGUEZ 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

FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To subscribe, visit HIVPlusMag.com/signup There is a 10-copy minimum. FREE DIGITAL SUBSCRIPTIONS Plus magazine is available free to individual subscribers — a digital copy of each issue can be delivered to the privacy of your computer or reader six times per year. We require only your email address to initiate delivery. You may also share your digital copies with friends. To subscribe, visit HIVPlusMag.com/signup NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, please email our circulation department at Argus.Galindo@pridemedia.com Plus (ISSN 1522-3086) is published bimonthly by Pride Publishing Inc. Plus is a registered trademark of Pride Publishing Inc. Entire contents ©2021 by Pride Publishing Inc. All rights reserved. Printed in the U.S.A.

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EDITOR’S LETTER

BY N E AL B ROVE R MAN

IT’S P R O B A B LY N O T a surprise that my

LU KE FONTANA

best subject in school was English; I’m an editor, after all, and spend my days reading and writing that language, so that tracks. Math and science were a struggle, mostly because I didn’t have much interest in learning about those subjects. Now I want a do-over; I would love to challenge myself to become proficient in trigonometry or statistics or chemistry. The latter especially holds much sway over me, as I marvel at the scientific and medical advances happening every day.

As I sit outside typing on a laptop without a mask, I wonder how our brightest minds came up with the COVID-19 vaccine. It’s incredible how two shots have turned our lives around. Last summer we were separated from friends and family, businesses were cratering, and millions around the world were suffering and dying. Now, whiplashed and a bit worse for the wear, we’re stumbling outside and returning to a version of the normalcy we so long took for granted. None of this would be possible without science and the people who spend their lives studying how our bodies work. The same brilliance that helped bring COVID to its knees (at least in this country) has revolutionized HIV treatment since the virus was first identified 40 years ago. The disease is no longer a death sentence but a manageable condition thanks to the doctors and scientists who have committed their lives to the HIV pandemic. While those heroes haven’t yet reached the pinnacle of their quest — a cure or vaccine — researchers have continually made HIV care less toxic and more proficient. The advances are still occurring as our 9th annual Treatment Guide (page 28) proves.

Years ago, people living with HIV would have to swallow a punishing regimen of pills to stay alive and likely endure debilitating side effects that altered their appearance or made them a slave to the toilet. Now one or two daily pills will treat HIV in most people, and new advances are on the horizon — including monthly shots to keep the virus at bay. These scientific innovations are incredible, but they haven’t defeated another scourge of HIV: stigma. Thankfully, more and more icons of TV, film, music, and sports are speaking freely about living with the condition. Pose star (and Emmy, Grammy, and Tony winner!) Billy Porter (page 8) may be the most famous person to recently come out about his positive status, but our cover star, talk show host Gracie Cartier (page 12), spoke publicly about her life with HIV before she was a household name. Cartier told us that it wasn’t until her mother reminded her that she’s healthy and successful that she began to see herself in a different light — and realize that HIV would not be an impediment to her dreams. As we move forward into an uncertain future, people like Porter, Cartier, and the scientists and doctors who made HIV treatable and COVID defeatable fill me with hope. It feels like we’re living through a memorable era of history — another favorite subject of mine. Be well,

NEAL BROVERMAN EDITOR IN CHIEF

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SH UT TERSTOCK

d a i ly d o s e

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by t yler curry

OUT OF FOCUS WHEN IT COMES TO HIV, THE FIXATION ON PREP OBSCURES ISSUES LIKE HEALTH CARE DISPARITIES AND THE IMPORTANCE OF U=U.

COU RTESY T YLER CU RRY

NO MAT TE R WHO you are, how educated you are, or when you were diagnosed, HIV has a way of forever shifting your perspective on life. And even though I have dedicated my career to advancing the lives and well-being of those living with or at risk for HIV, I must admit something. In general, my life and my livelihood have remained relatively unaffected. Sure, my pill has gotten smaller over the last decade, and I think about the longevity of my life in a whole new way now that I am a parent, but I still rest assured that my treatment will only improve — or even become unnecessary one day.

For those living with HIV who are undetectable and insured, the future looks bright. We are on the precipice of change when it comes to new treatment options that will make less and less of an impact on our daily lives. But I can’t help but feel embarrassed by how little HIV has impacted me when so many are being left behind by our health care system. Whether it’s due to lack of access to insurance, the inability to prioritize health due to unlivable wages, or simply the fear of being “found out” that many in more rural, Southern areas face, the equity gap among HIV-positive people is growing by leaps and bounds. And I often wonder this: Is it because people like me (white, financially secure) occupy the space for visibility and we are so focused on PrEP that HIV advocacy has taken a back seat within our own communities? I get it. Messaging around PrEP is sexy and fun. I follow LGBTQ+ influencers who are often paid by sexual wellness organizations or PrEP delivery companies to ask provocative questions and post flirty/dirty polls about whether their followers are on PrEP, would be

on PrEP, or are opposed to PrEP. As you can imagine, this irked me quite a bit. So much so that I finally pushed back on one particular account with over 100K followers. As I perused through all of the cute Instagram PrEP stories with Ken dolls perched in precarious positions, I urged him to include “undetectable equals untransmittable” messaging so to not exclude any followers who may either test positive while seeking PrEP or already are positive. I pressed again on another post where he asked his followers whether they prefer being on PrEP or using condoms. I replied that I preferred being undetectable and once again urged him to incorporate some status-neutral messaging. Every message was “hearted,” but there has been nary a mention of U=U to this day. This is, of course, a very trivial example of a much larger problem, but an example nonetheless. Whether it’s the fault of our health care organizations, our platforms for LGBTQ+ voices, or our desire to focus on PrEP as a much less complicated piece of sexual wellness, who are we leaving behind? Until we have truly normalized what it means to be U=U and grasp the importance of equitable outcomes for those living with HIV, there can be no moving forward. I am not interested in the progress of treatment until it is accessible to everyone. I am not a representation of HIV; I am a representation of privilege in America. But I am willing to challenge the privilege of those ready to “move on” because we still need every voice in the fight against HIV. For those proudly a part of the LGBTQ+ community, we cannot claim HIV as our legacy until everyone is able to leave it behind.

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

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buzzworthy

FULL DISCLOSURE BILLY PORTER, ONE OF THE BIGGEST STARS OF TV AND BROADWAY, TOOK A SLEDGEHAMMER TO STIGMA BY TELLING THE WORLD HE’S LIVING WITH HIV. BY N E A L B R OV ER M A N A N D T R AC Y E . G I LC H R I S T

Porter also cemented his fame on red carpets in New York and Los Angeles, where he thumbed his nose at gender roles by donning glamorous gowns and heels. Time magazine named him one of the 100 most influential people of 2020. For an actor of Porter’s stature to come out as HIV-positive at the height of his fame is extraordinary, said DaShawn Usher, GLAAD’s associate director for communities of color. “The tremendous levels of stigma facing people living with HIV today can only be broken by icons like Billy Porter showing the world that HIV is not at all a barrier to a healthy and successful life,” Usher said in a statement. “People living with HIV today, when on effective treatment, lead long and healthy lives and cannot transmit HIV. Plus, medications like PrEP protect people who do not have HIV from contracting HIV. But these leaps in HIV prevention and treatment have largely been invisible in the news and entertainment industries.” That’s particularly troubling, Usher adds, because when Pose goes off air, “there will be zero television characters living with HIV. That is truly unacceptable when 1.2 million Americans and about 38 million people globally are living with HIV. Billy’s powerful interview needs to be a wake-up call for media and the general public that it’s time to end the stigma that people living with HIV face and to educate each other about HIV prevention and treatment.” SANTIAGO FELIPE /G E T T Y IMAG ES

Billy Porter has come out as living with HIV, becoming one of the most high-profile people of color to disclose their positive status. The gay Pose star told The Hollywood Reporter that he was diagnosed in June 2007. He kept his status a secret, even from his collaborators on the groundbreaking FX series in which he portrays HIV-positive character, Pray Tell. “I was able to say everything that I wanted to say through a surrogate,” said the 51-yearold Emmy, Grammy, and Tony winner. Porter said he now feels an urgency to share his story with the world. “Why was I spared? Why am I living?” he said. “Well, I’m living so that I can tell the story. There’s a whole generation that was here, and I stand on their shoulders. I can be who I am in this space, at this time, because of the legacy that they left for me. So it’s time to put my big boy pants on and talk.” Before starring in Pose, the award-winning drama revolving around New York City’s queer ballroom scene of the late ’80s and early ’90s, Porter was a critically acclaimed theater actor. The Pittsburgh native appeared in Broadway productions like Miss Saigon and Grease before landing his breakthrough role in Cyndi Lauper and Harvey Fierstein’s Kinky Boots. He won a Tony in 2013 with his portrayal of drag queen and cabaret singer Lola and would later nab a Grammy for the hit musical’s cast album. Then with Pose, Porter made history in 2019 when he became the first out gay Black man to be nominated for and win a Primetime Emmy.

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Billy Porter during his fitting for the 92nd Academy Awards. Styled by Sam Ratelle and designed by The Blonds

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buzzworthy

A RECENT STUDY FOUND THAT COVID-19 MAY REMAIN IN PENILE TISSUE MONTHS AFTER RECOVERY AND LEAD TO ERECTILE DYSFUNCTION. BY D E S I R É E G U E R R E R O

A recent study published in the World Journal of Men’s Health may have uncovered a link between the COVID-19 virus and erectile issues. The study, conducted by researchers at the University of Miami, discovered for the first time that traces of the virus could be found in penile tissue. The most concerning part of the discovery was that these traces were found long after recovery, suggesting the virus may remain active in men’s genitals for several months. Researchers are concerned that this could possibly cause future erectile dysfunction or other issues. “Our research shows that COVID-19 can cause widespread endothelial dysfunction in organ systems beyond the lungs and kidneys. The underlying endothelial dysfunction that happens because of COVID-19 can enter the endothelial cells and affect many organs, including the penis,” noted study author Dr. Ranjith Ramasamy, director of the Miller School’s Reproductive Urology Program. “In our pilot study, we found that men who previously did not complain of erectile dysfunction developed pretty severe erectile dysfunction after the onset of COVID-19 infection.”

F o r t h e s t u d y, Ramasamy and his team collected penile tissue samples from two men who had p e n i l e p ro s t h e s i s surgery for ED and also previously had COVID. One man got very ill from the virus and was hospitalized, while the other only ex p e r i e n ce d m i l d symptom s . Penile samples were also taken from two other men who had undergone an ED surgery, except these individuals had never contracted COVID-19. Both of men who had recovered from COVID-19 showed signs of the virus within their penile tissue — and both also showed signs of endothelial dysfunction, which is a widespread blood vessel dysfunction. “This suggests that men who develop COVID-19 infection should be aware that erectile dysfunction could be an adverse effect of the virus, and they should go to a physician if they develop ED symptoms,” said Ramasamy. Research has previously suggested that many other conditions may be linked to COVID, such as increased risk of heart disease or neurological symptoms, so unfortunately these findings are not out of line based on what we already know. Ramasamy also said the study revealed evidence that COVID-19 can invade the testicles of some infected men. “These latest findings are yet another reason that we should all do our best to avoid COVID-19,” adds first author Eliyahu Kresch, a medical student working with Dr. Ramasamy. “We recommend vaccination and to try to stay safe in general.”

RED HOT RETURNS T H E I CO N I C M U S I C A L F U N D R A I S I N G PROJECT’S LATEST ALBUM, RED HOT + FREE, WILL LIFT YOUR SPIRITS AND PUT A PEP IN YOUR STEP. 10

For over 30 years, the Red Hot organization has been creating beautiful music while raising millions for charity with its Red Hot + series of LPs. Starting with Red Hot + Blue back in 1990, Red Hot has released 20 full-length albums and raised over $15 million for charities, much of which has gone to HIV organizations. The project’s artistic contributors have included some of music’s biggest names, often in priceless collaborations, including Debbie Harry and Iggy Pop, Childish Gambino and Just a Band. Its latest album, Red Hot + Free, has once again been blessed by the music gods with an inspiring collab by Sofi Tukker and Amadou & Mariam (pictured) called “Mon Cheri.” The American musical duo, Sophie Hawley-Weld and Tucker Halpern, says it was a dream come true to work with the legendary West African musicians. “When Red Hot approached us about doing a collaboration, they asked us who our dream collaborators would be,” Halpern recalled. “We said Amadou & Mariam. We thought it may be a long shot but would be worth trying! Soph grew up listening to Amadou & Mariam all the time and in college, studied West African dance and music.” Ultimately, the two Grammy-nominated duos produced a beautifully uplifting song and another wonderful addition to the Red Hot legacy. The complete Red Hot + Free LP features new music from Billy Porter, who recently came out as HIV-positive (see page 8), as well as Gloria Gaynor, Allie X, Casey Spooner, the Crickets, Sam Sparro, Titus Burgess, and many more. Produced by industry mastermind Bill Coleman, the double album of joyful dance music is intended to “liberate bodies and minds from an unprecedented state of lockdown.”—DG

SH UT TERSTOCK (BANANAS); RED HOT + FREE (COU RTESY );

HARD FACTS

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BUZZWORTHY

MISSING THE MARK THE WORLD FAILED TO MEET THE UN’S GOALS FOR LIMITING NEW HIV DIAGNOSES AND RELATED DEATHS. NOW WHAT?

VIGIL FOR A VISIONARY

THOMAS MCGOVERN/G E T T Y IMAG ES (O’CON N ELL); SH UT TERSTOCK

PATRICK O’CONNELL HARVESTED THE CREATIVITY OF THE ART WORLD TO BRING THE TOLL OF HIV AND AIDS TO AMERICA’S LIVING ROOMS. Patrick O’Connell, an icon of HIV activism and a leader in establishing public awareness of the disease, died recently from AIDS-related complications in a New York hospital. He was 67. The New York-born O’Connell immersed himself in the Empire State art scene of the 1980s, running art centers and galleries in Buffalo and, soon after, Manhattan, working with legends like Cindy Sherman. His own art career was ascending as the AIDS epidemic began to decimate New York and, especially, its creative communities. O’Connell, diagnosed with HIV in the mid-’80s, leapt into action. Along with other artists and creatives, he began Visual AIDS, an organization that The New York Times credited with creating “conceptual art-based awareness campaigns that forced the public to reckon with the disease.” Under O’Connell’s guidance, Visual AIDS launched events like 1989’s “Day Without Art,” which shrouded famous artworks in New York and Los Angeles museums to evoke the human toll of AIDS-related deaths; the event was celebrated annually for many years. Soon after, the Visual AIDS-sponsored “Night Without Light” blanketed New York’s skyline in darkness to increase media coverage and public awareness of HIV. President Bill Clinton followed suit, covering the White House in darkness for World AIDS Day in 1993. O’Connell’s most iconic invention was the Ribbon Project, which, in 1991, created and distributed simple red ribbons around New York. The color evoked the blood that runs through all human veins, while the simple design represented the public and government’s relative ignorance and silence about HIV at the time. The ribbons created conversations and discussions, and O’Connell plotted an even bigger platform for them: the Tony Awards. Through his connections and tenacity, O’Connell’s ribbons were seen on numerous celebrities at the 1991 Tonys, including co-host Jeremy Irons. Soon, Hollywood awards shows would follow, with Elizabeth Taylor donning the red ribbon at the 1992 Academy Awards. “People want to say something, not necessarily with anger and confrontation all the time,” O’Connell told the Times that year. “This allows them. And even if it is only an easy first step, that’s great with me. It won’t be their last.”— N B

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Five years ago, the United Nations General Assembly set goals for reducing HIV transmissions and deaths by 2020 — and the world missed both targets by a mile. In 2016, the General Assembly established efforts to reduce new HIV infections to 500,000 and AIDS-related deaths to 500,000 globally by 2020. But amid the COVID-19 pandemic, new cases swelled to 1.7 million, over three times the target. Deaths related to AIDS reached 690,000, also well over the goal. Now, UN officials are working to explain last year’s failures and set targets for the future. “It is imperative to break out of an increasingly costly and unsustainable cycle of achieving some progress against HIV but ultimately not enough to bring about an end to the pandemic,” UN Secretary-General António Guterres stated in a recent report.

UN officials still believe the world can eradicate HIV and AIDS by the end of the decade,

setting goals of 370,000 new diagnoses and 250,000 AIDS-related deaths in 2025. Winnie Byanyima, executive director of UNAIDS, cited a need for “evidence-informed strategies and human rights-based approaches.” Guterres said in his report that stigma discourages women from testing and vulnerable communities (LGBTQ+ people, migrants, and sex workers) don’t receive adequate information on HIV facts and prevention. Guterres wants a massive investment in reaching these groups in lowand middle-income countries, with a global commitment of $25 billion by 2025. “Inequalities are the key reason why the 2020 global targets were missed. By ending inequalities, transformative outcomes can be achieved,” Guterres concluded.— N B

2030

The year the United Nations has set for full eradication of HIV and AIDS.

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Trans advocate and Emmy-nominated hairstylist GRACIE CARTIER once let internal voices of shame dictate her actions. Now, living proudly and publicly with HIV, Cartier has changed the station. By M E Y RU DE Photography by M A RT I N S A L G O Makeup E R N E S T O C A SI L L A S Hair GR ACI E C A RT I E R Stylist M E LV I N S A N DE R S

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After recently coming out as living with HIV — in a stirring personal essay — celebrity hairstylist, model, and Black trans advocate Gracie Cartier is ready to keep living her best life. No matter how much hard work it takes. Cartier discovered she was HIV-positive in 2003, when she was 24 years old and living in Philadelphia. But she waited nearly two decades to go public with the information. A lot of that had to do with her own personal stigmas around the diagnosis. At first, Cartier thought her poz status was a death sentence. She thought it meant she couldn’t have goals, dreams, or happiness. Now she knows just how wrong she was. Two years after being diagnosed, Cartier moved to New York City to enroll in the Aveda Institute to continue her training as a hairstylist. From there she headed to Atlanta and then Los Angeles, rising in the ranks of celebrity hairstylists. Cartier has worked with stars like Jada Pinkett Smith, Tia and Tamera Mowry, Alicia Silverstone, and Danai Gurira, and even received a Daytime Emmy nomination for her work on the talk show The Real in 2015. Today, Cartier is surrounded by a loving chosen family, who support her and cheer her on no matter what. But they have a lot to celebrate. Cartier is healthy and living a full life, and she just started hosting a talk show called Transcend on +Life, an HIV-focused digital platform launched by poz journalist Karl Schmid. “Any opportunity that I get to live in the fullest expression of myself and reach the highest potential, they truly cheer me on,” she says of her friends. “They know how hard and how rough my journey has been, so they just do nothing but celebrate and hold that sacred space for me to just be all the extensions of me — the good, the bad, the ugly, the hurt, the healing, the happy. They hold space for it all. And I’m so grateful for them.” But it’s not just her chosen family cheering her on; Cartier’s biggest supporter is herself. But it wasn’t always that way. In fact, it wasn’t until her mom pointed out how happy and healthy she is that she realized the truth. Cartier will never forget that day. “My mother was just like, ‘You know, I’m just so happy. I’m just so proud of you. You’re going after your dreams. You’re happy. You’re healthy.’” Cartier responded by reminding her mom that she’s living with HIV. Her mom didn’t skip a beat.

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“She said, ‘What does that have to do with anything? You are healthy, you’re breathing, you’re walking. You’re living your existence. And you’re following your path and doing all the things that you said you wanted to do.’” That’s when it hit her. “It’s not like I’m bedridden or not able to continue living. And when she said that to me, it was like a light bulb went on inside of my head. The fact that I get to get up every day and take my medicine and do what I need to do and work out, and even if I’m doing my makeup and doing my hair, that’s all a part of a healthy routine.” Now Cartier wants others living with HIV to know they too can be happy, healthy, and confident. For Car tier, gaining that conf idence meant getting past the idea that “no one’s ever going to love you, no one’s going to want to be with someone who’s positive, if your job finds out, they’re not going to want to have you. It was just all of these toxic, unhealthy stories and lies that I was telling myself. And what you feel within yourself, you radiate that out into the world. So if I’m sitting here telling myself, ‘No one’s going to love me. I’m not going to have any job opportunities,’ then the universe is going to reflect that back to you and you’ll experience that.” That’s a lesson Cartier admits she has to remind herself of and she still has to challenge her own stigmas about HIV. “It’s something that never ends,” she muses. “It just doesn’t. Now, because I came out this year and disclosed my status, it doesn’t mean that it all just went away like that. Personally, I feel that’s when the work really begins.” In order to do that work, she has to be completely open with who she is and to learn to face those difficult parts of herself so that she can learn to love them. “It is the affirmation, it is continuing to face those parts of yourself that you always wanted to tuck away, and I think now the fact that I came out, it’s easier for me to believe the beautiful, positive things about myself than it is the negative.” She sees others coming out about their positive status as a huge asset, and she brings up Pose star Billy Porter, who also recently came out about living with HIV (see page 8). “I’m just so

happy,” she says. “I’m just so proud of him, I stand in solidarity and support with him.” She also knows that with Porter’s large platform, he can reach even more people who need to hear that they can be both HIVpositive and successful. “The reality of it is that we live in a celebrity-driven culture,” she says. “So someone who is at the height of his success and has the platform that he has, he has the power to reach more, to be heard by more, and to be seen by more.” But Cartier doesn’t think being public about being positive is for everyone. In fact, if someone were to ask when the time is right for them to come out with that status, she’d tell them to be “patient with themselves. To be kind and gentle with themselves. And to know and to understand that we all have our own unique journey.” She continues, “I believe that not everyone is meant to be out in public about this, I do. I think sometimes when seeing or hearing others share their story, it sometimes puts this pressure on you.” Cartier encourages people living with HIV to do what feels right for them. “In your own time when you’re ready to share, share. If you don’t want to share, that’s fine also,” she says. “But in the meantime, just really nurture and pour as much as love and support into yourself that you can when you’re alone.” That’s what’s really important. In spite of all the inner and outer turmoil that comes from being a Black trans woman living with HIV, Cartier loves herself and her life, and wants that for others as well. “I still got to live a good life. I still was able to thrive in spite of the inner turmoil I was living in. And now looking at it, it’s like, You were still pushing through. You were still making your dream happen. You were still living the life that you always dreamt of,” she says. “I’ve always been hopeful. And I think that that’s part of my testimony… I’m just hopeful in people realizing that regardless of whatever developments happen that you are still able to live your best life.”

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Hair S TA N L E Y ROBI NS ON Makeup E R N E S T O C A SI L L A S Styling M E LV I N S A N DE R S

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We Need an HIV Vaccine.

Here’s What You Can Do to Help This HIV advocate says we must keep the momentum going.

We need a safe and effective HIV vaccine. While we have developed, and are developing, exciting new choices for the HIV prevention buffet, an HIV vaccine is still not on the menu. According to UNAIDS, 1.5 million people across the world were infected with HIV in 2020, and 690,000 died from HIV-related illnesses. The number of new HIV infections in the United States has been trending downward, slightly, over the last few years, with approximately 38,000 diagnoses in 2018. However, Black gay, same-gender-loving, and bisexual men, Black women (including transgender women), and Latinx gay and bisexual men remain disproportionately impacted. From 2014 to 2018, HIV diagnoses decreased 7 percent among gay and bisexual men overall, but rates remained stable among Black and Latinx gay men. Approximately 1.2 million people are living with HIV in the U.S.

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STOCKSNAP/PIX ABAY

BY J I M P I C K E T T

6/11/21 8:29 AM

FACEBOOK

HIV Vaccine Awareness Day, observed each May 18, has passed this year, but it’s still important to thank the many thousands of volunteers who have participated in HIV vaccine clinical trials; to recognize the 24/7/365 efforts of countless scientists and health care workers conducting these trials; and to thank the Goddess for the loudmouth activists and advocates who play critical roles in engaging communities and holding the research enterprise accountable. It is also important to show gratitude to the funders — dominated by the United States government but including other nations as well as philanthropic and private support — who have pumped over $15 billion into the quest over 30 years. And to demand more. Every day. More. More. More. More money. In 2019, $848 million was spent on HIV vaccine research and development. While this level of investment has been essentially flat since 2008, it’s a decent chunk of change, dwarfing the $300 million spent in the same year across all other HIV prevention technologies. The U.S. public sector — I’m looking at you, fellow taxpayers — contributed three-fourths of that global funding, equaling $871 million of the $1.14 billion total on all prevention research. All that looks like chump change, unsalted peanuts even, when you consider that we — the royal planetary we — dedicated $39 billion to COVID-19 vaccine research and development in 2020. In one short (and insanely long) year, we spent more than double what we’ve spent on HIV vaccines for more than three decades. This unparalleled investment, significantly buoyed by expertise and learning developed in the pursuit of an HIV vaccine, produced several safe and effective vaccines against novel SARS-CoV-2, three of which have been approved for use in the U.S. Not only were unparalleled mounds of cash committed, but the global research community also engaged in unprecedented and incredibly focused coordination, cooperation, and collaboration. Is the answer to an HIV vaccine all about the money, honey? Well, for sure, flat funding won’t get us to the promised land — more robust investments from our government and other funders are essential. HIV is an especially tricky beast of a virus, wilier a foe than COVID in a few key ways. HIV targets and kills the very immune cells (T cells) the body uses to defend against disease, so our immune system is not able to mount an effective response and get rid of HIV on its own. This means scientists must develop an HIV vaccine that stimulates a stronger immune response than the body can mount on its own. The virus also mutates and can learn how to avoid the effects of a vaccine. The mutation further leads to different subtypes (or clades) of the virus throughout the world. Each subtype reacts differently to different vaccine candidates. For this reason, testing in many countries is necessary. As I said, HIV is very tricky. Diabolical, really. So get on the phone and call your federal elected officials — your U.S. representative, both of your U.S. senators, and Uncle Joe — and tell them you want more of your tax dollars spent on HIV vaccine research. Get their phone numbers at USA.gov.

Better yet, tell them you want to see more of the U.S. budget spent on all activities supporting the research and development of new HI V prevention technologies writ large, including other interventions in addition to vaccines like long-acting injectable formulations, monthly pills, quarterly vaginal rings, yearly implants, and rectal douches you can use for booty freshness and protection when the time is right. Here is a quick list of talking points you can use, based on lessons from COVID-19 vaccines, courtesy of my friends at AVAC: Global Advocacy for HIV Prevention with a little extra fluffing and folding on my part. 1. Communities must continue to be placed at the center of all new research into HIV prevention technologies. Nothing for us without us — period. 2. We need sufficient and diversified research funding for HIV vaccines and other new HIV prevention technologies. 3. We m u s t i m p r o v e g l o b a l coordination and collaboration in the quest for HIV vaccines as well as new molecules and modalities to prevent HIV; from long-acting, systemic choices to short-acting, localized, usercontrolled methods. 4. In an era with a prevention buffet featuring new and effective choices, we must support research innovation and novel trial designs — the buffet is still lacking. 5. Pol it ic a l c om m it ment a nd urgency must be strengthened. 6. Pl a n n i n g for s uc c e s s a nd equitable access must start early — like yesterday. Most of the planet’s inhabitants have yet to be vaccinated against COVID-19 — and many will likely wait years. This is wholly unacceptable and means none of us are out of the woods. Similarly, we won’t end the HIV epidemic here, there, or any where if people don’t have access to all the care and prevention tools we have. Now is a good time to call those elected officials. Remind them you are a voter and a taxpayer. There’s nothing like the present.

J I M P IC K E T T is the senior director of prevention advocacy at the AIDS Foundation Chicago. (AIDSChicago.org)

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SH UT TERSTOCK

“Being able to find and have access to health care providers who affirm one’s identities and experiences is critical to the health and well-being of trans and gender-diverse people”

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AN INNOVATIVE NEW HEALTH CENTER ADDRESSES THE SPECIFIC NEEDS OF TRANS PATIENTS, INCLUDING THOSE LIVING WITH HIV. BY NE AL BROVE RMAN

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“Being able to find and have access to health care providers who affirm one’s identities and experiences is critical to the health and well-being of trans and genderdiverse people,” Brooke Stott, project manager at Transhealth Northampton, says in a statement. “Our team is committed to being community-led and ensuring that patients have a health care experience that celebrates and empowers them.” Gender-affirming care may be hard to explain to cisgender, or nontrans, people, but it’s a very easy thing for gender-diverse folks to recognize, Ducar says. “We’re really focusing on caring for someone and their relationship to their gender,” she says. “It’s synonymous with patient-centered care. Someone’s gender really impacts many, many different parts of their life. Where you use the bathroom, where you sometimes go to school, how you receive your health care, how you are referred to in public, what it’s like to go through an airport scanner. All these different parts of society are situated in the context of someone’s gender.” While gender-affirming care is not new to many mainstream health centers in big cities, Ducar says programs geared toward trans patients are usually the first things cut in a budget crunch. Gender-diverse patients will always be the first priority at Transhealth Northampton, according to the CEO. “[We’re] reshaping health care that is responsive to one’s identity,” she says. “Really

REB ECC A JON ES

A S P O L I T I C I A N S A C R O S S the country introduced and passed bills attacking transgender people — restricting their right to use public restrooms and their ability to play school sports, or establishing limits on what health care services trans youth can obtain — a small but revolutionary thing happened. The nation’s first independent comprehensive trans health care center opened, expanding access to gender-affirming care, including hormones, mental health services, primary and pediatric care, and HIV treatment. Transhealth Nor thampton officially opened May 4 in western Massachusetts, far from population centers like Boston or Albany. While some may assume that finding gender-affirming care would not be a problem in a state like Massachusetts, Transhealth Northampton CEO Dallas Ducar says that’s not the case. Respondents to a 2020 study from the Fenway Institute, Cooley Dickinson Hospital, and Harvard Medical School found local trans residents reported a “lack of provider availability and competency,” Ducar tells Plus. Respondents also noted a “lack of clinical skill and a desperate need for pediatric and mental health services and sexual and reproductive health.” Ducar, who is trans, said she would often commute hours to find gender-affirming doctors — and many people do not have the financial resources or work flexibility for such care. J U LY / AU G UST 202 1

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REB ECC A JON ES

OPPOSITE Transhealth Northampton offers comprehensive health care for trans and genderdiverse clients. THIS PAGE Transhealth Northampton CEO Dallas Ducar at the clinic’s opening

restoring the humanity to health care. We’re guided by civil rights movements and really saying we are here to serve you; we are here to help you become the person you want to be. It’s not just about names and pronouns, but knowing your values, your goals.” The staff of Transhealth Northampton reflects their patients, with the staff being majority transgender and predominantly LGBTQ+. Ducar said having gender-diverse employees can create spaces where patients can act authentically and speak frankly about their needs. Comfort is also an important aspect of Transhealth Northampton’s HIV services, a vital aspect of the center’s services. Trans people continue to be disproportionately affected by the virus — a recent study by the Centers for Disease Control and Prevention found that 42 percent of transgender women in seven major U.S. cities reported living with HIV. “ We h ave a f a bu lou s nu r s e c a r e coordinator,” Ducar says. “Along with assessments and being there to help you navigate the health care system in general, she’s there to help you navigate these insurance and pharmacy logistical problems. We have primary care and mental care as well, so for HIV-positive patients, we will also have people who are very skilled in caring for many different populations, prescribing PeP and PrEP, doing assessments that are really based on informed consent and trauma-informed.” Mental health services will also be available for newly diagnosed and long-term survivors. Advocacy is also a hallmark of Transhealth Northampton, Ducar says. That includes everything from pressing insurance providers to cover more gender-affirming care to lobbying politicians to stop using trans people, especially vulnerable trans youth, as political scapegoats.

“These medical bans [on gender-affirming care for trans youth] really should be considered as advancing genocide,” Ducar says. “I view this as an attack on American liberty and American freedom. Kids are still going to get their hormones. Banning this does not work. We saw this with the war on drugs. [These bills create] suicidal ideation. It’s time for folks to call it like it is. We all deserve a right to self-identify.” While Ducar is disappointed and angry at the fact that “trans people have constantly been locked out of American society,” she sees her health center as a huge advance amid all the darkness. As she puts it: “We’ll be a bright light.” H IVPLUS MAG .CO M

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FOTOGRAFIERENDE/PEXELS

OUR 9TH ANNUAL HIV TREATMENT GUIDE

6/11/21 8:33 AM

A RUNDOWN OF THE MOST COMMONLYPRESCRIBED MEDICATIONS APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION FOR THE TREATMENT OF HIV AND ITS RELATED CONDITIONS.

RESEARCH BY JACOB ANDERSON-MINSHALL DESIRÉE GUERRERO AND TRUDY RING

SHUTTERSTOCK

Editor’s note: This info was culled from the National Institutes of Health’s drug database, the FDA, and individual pharmaceutical companies.

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Unless otherwise noted, all dosages are traditional adult dose.

Atripla generic name: efavirenz, emtricitabine, and tenofovir disoproxil fumarate

class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults and children

12 years and older weighing at least 40 kg as an initial regimen. Should not be used for those with moderate or severe kidney or liver impairment, those with neuropsychiatric issues, or women who are pregnant or may become pregnant. traditional dosage: One tablet once daily. Tablet contains 600 mg efavirenz (Sustiva, an NNRTI), 200 mg emtricitabine (Emtriva, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

Biktarvy generic name: bictegravir,

emtricitabine, and tenofovir alafenamide

class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults who have no

antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (less than 50 copies per mL) on a stable antiretroviral regimen for at least three months with no history of treatment failure and no known resistance to the components of Biktarvy. Not recommended for those with creatinine clearance below 30 mL per minute, those with hepatitis B, or those with severe liver impairment. traditional dosage: One tablet once daily. Tablet includes 50 mg of bictegravir (an INSTI), 200 mg of emtricitabine (Emtriva, an NRTI), and 25 mg of tenofovir alafenamide (an NRTI). Doesn’t need to be taken with other HIV drugs.

Cabenuva

have no history of treatment failure and no known or suspected resistance to either cabotegravir or rilpivirine. traditional dosage: Monthly injection of 400 mg of cabotegravir and 600 mg of rilpivirine, after an initial injection of 600 mg of cabotegravir and 900 mg of rilpivirine. Injections are to begin after a one-month lead-in period of taking one 30mg cabotegravir tablet and one 25mg rilpivirine tablet daily with a meal.

Cimduo

rilpivirine

class of drug: single-injection regimen maker: ViiV Healthcare who is it for? Adults who have achieved viral suppression on a stable regimen and

Descovy generic name: emtricitabine and tenofovir alafenamide

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

class of drug: combination of two

nucleoside reverse transcriptase inhibitors maker: Mylan who is it for? For adults and children weighing at least 35 kg. Should not be used for those with creatinine clearance below 30 mL per minute or those on dialysis. traditional dosage: One tablet once daily in combination with other antiretrovirals. Tablet contains 300 mg lamivudine (Epivir/3TC) and 300 mg tenofovir disoproxil fumarate (Viread).

Complera

transcriptase inhibitors

maker: Gilead Sciences who is it for? For adults and children who weigh at least 35 kg, as well as for children who weigh 25 to 34 kg when used with certain other antiretrovirals. Should not be used for those with creatinine clearance below 30 mL per minute or those on dialysis. traditional dosage: One tablet per day in combination with other antiretrovirals. Each tablet contains 200 mg emtricitabine (Emtriva) and 25 mg tenofovir alafenamide (TAF).

Dovato generic name: dolutegravir and

generic name: emtricitabine, rilpivirine,

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

Delstrigo generic name: doravirine, lamivudine,

generic name: cabotegravir and

those with moderate to severe kidney impairment or severe liver impairment. traditional dosage: One tablet once daily. Tablet contains 100 mg doravirine (Pifeltro, an NNRTI), 300 mg lamivudine (Epivir, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

and tenofovir disoproxil fumarate

class of drug: single-tablet regimen maker: Merck who is it for? For adults new to HIV

medication. Not recommended for those with creatinine clearance below 50 mL per minute and should not be used by

lamivudine

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

Edurant generic name: rilpivirine class of drug: non-nucleoside reverse transcriptase inhibitor

maker: Janssen who is it for? For treatment of HIV-1 in adults and children 12 and older weighing at least 35 kg who haven’t previously taken antiretroviral drugs and have a viral load of 100,000 copies per mL or less. traditional dosage: One 25 mg tablet once daily with meal. It is always taken with other antiretrovirals. Is also a component in single-tablet regimens Complera, Odefsey, and Juluca.

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Emtriva generic name: emtricitabine class of drug: nucleoside reverse

transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children as a component of an initial regimen. Dosing needs to be adjusted for those with decreased kidney function. Use caution if also positive for hepatitis B. traditional dosage: One 200 mg capsule once daily.

Epivir generic name: lamivudine or 3TC class of drug: nucleoside reverse transcriptase inhibitor

maker: ViiV Healthcare who is it for? For adults and children

at least 3 months old, as a component of an initial regimen. Dosing needs to be adjusted for those with decreased kidney function. traditional dosage: One 300 mg tablet once daily, or one 150 mg tablet twice daily.

Epzicom

traditional dosage: One tablet

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

Genvoya generic name: elvitegravir, cobicistat,

emtricitabine, and tenofovir alafenamide

class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older

who weigh at least 35 kg and are new to antiretroviral therapy; or as replacement therapy for those virologically suppressed for at least six months, with no previous virologic failure, and no drug resistance to the components of Genvoya. Not recommended for those who have a creatinine clearance below 30 mL per minute. traditional dosage: One tablet once daily. Tablet contains 150 mg of elvitegravir (an INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 10 mg tenofovir alafenamide (an NRTI).

Intelence generic name: etravirine class of drug: non-nucleoside reverse

transcriptase inhibitors maker: ViiV Healthcare who is it for? For adults and children weighing 25 kg or more as a component of an initial regimen. Not recommended for those with decreased kidney function. traditional dosage: One tablet once daily. Tablet contains 600 mg abacavir sulfate (Ziagen) and 300 mg lamivudine (Epivir).

transcriptase inhibitor maker: Janssen who is it for? For treatmentexperienced HIV-1 patients with viral strains resistant to an NNRTI and other antiretroviral agents. For adults, children 6 years or older weighing at least 16 kg. traditional dosage: One 200 mg tablet (or two 100 mg tablets) twice daily following meal. Pediatric patients (6-18 years old) should be dosed by medical professionals based on body weight.

Evotaz

Isentress

generic name: atazanavir and cobicistat class of drug: a protease inhibitor and

generic name: raltegravir class of drug: integrase inhibitor maker: Merck who is it for? For those new to

generic name: abacavir sulfate and lamivudine

class of drug: two nucleoside reverse

a pharmacokinetic enhancer/booster

maker: Bristol-Myers Squibb who is it for? For those initiating

treatment as a component of a regimen. Not recommended for those with liver impairment. Use with caution if you have heart or kidney problems; diabetes; hemophilia; or are pregnant, plan to become pregnant, or are using hormonal birth control. Do not breastfeed.

treatment or treatment experienced, as a component of a regimen. For adults and children weighing at least 2 kg. Tell your doctor if you have tuberculosis, or liver problems or phenylketonuria. traditional dosage: One 400 mg tablet twice daily for those with treatment experience. Those new to treatment or

with undetectable viral loads may either take one 400 mg tablet twice daily or two 600 mg tablets once daily.

Juluca generic name: dolutegravir and rilpivirine

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

maker: ViiV Healthcare traditional dosage: One tablet once

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

Norvir generic name: ritonavir class of drug: protease inhibitor maker: AbbVie who is it for? For adults and children,

used only in combination with other antiretrovirals, as a component of initial regimen. Reduced dosage recommended for people taking other protease inhibitors. traditional dosage: Six 100 mg tablets taken twice daily.

Odefsey generic name: emtricitabine, rilpivirine, and tenofovir alafenamide

class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults and children

12 years and older weighing at least 35 kg who are new to antiretroviral drugs, who have a viral load of 100,000 copies per mL or less; or can be used as a replacement regimen for individuals with a viral load of 50 copies per mL or less, who have been virologically-suppressed for at least six months. traditional dosage: One tablet once daily. Tablet contains 200 mg of emtricitabine (Emtriva, an NRTI), 25 mg of rilpivirine (Edurant, an NNRTI), and 25 mg of tenofovir alafenamide (an NRTI).

Pifeltro generic name: doravirine class of drug: nonnucleoside reverse transcriptase inhibitor

maker: Merck

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who is it for? For adults as part of an initial regimen.

traditional dosage: One tablet, 300

mg, once daily, taken in combination with other antiretrovirals.

Prezcobix generic name: darunavir and cobicistat class of drug: protease inhibitor and a

pharmacokinetic enhancer/booster maker: Janssen who is it for?: For both treatmentnaive and treatment-experienced adults with no darunavir-related resistance. Should be used in combination with other antiretroviral medicines. Use with caution if you have liver or kidney problems; or if you are pregnant, breastfeeding, or plan to become pregnant. traditional dosage: One tablet once daily with food. Tablet contains 800 mg of darunavir (Prezista, a PI) and 150 mg of cobicistat (Tybost, a PKE).

Prezista generic name: darunavir class of drug: protease inhibitor maker: Janssen who is it for? For treatment of HIV-1,

both those initiating treatment and those who have previously been on antiretroviral therapy, including those with some drug resistance to PIs. For adults and children 3 years or older weighing at least 10 kg. May reduce effectiveness of birth control pills. traditional dosage: One 800 mg tablet once daily with 100 mg Norvir or 150 mg Tybost for those without resistance. One 600 mg tablet with 100 mg Norvir taken twice daily for pregnant women and those with Prezista-related resistance. Must be taken with a booster like Norvir or Tybost. Pediatric patients (3 years to less than 18 years old and weighing at least 10 kg) should be dosed by a medical professional based on body weight. Should always be taken with food.

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

traditional dosage: 300 mg capsule, 32

taken with 100 mg of Norvir or 150 mg Tybost, once daily.

Rukobia generic name: fostemsavir class of drug: attachment inhibitor maker: ViiV Healthcare who is it for? Adults who have received

several antiretroviral regimens in the past, who have virus that is resistant to many antiretroviral drugs, and whose current antiretroviral therapy is either ineffective, causing side effects the patient cannot tolerate, or causing other safety concerns. traditional dosage: One 600mg tablet, twice daily, around the same time each day, with or without food, and in combination with other antiretroviral drugs.

Selzentry generic name: maraviroc class of drug: entry inhibitor maker: ViiV Healthcare who is it for? For the treatment of only

CCR5-tropic HIV-1 infection in adults and children 2 years or older, weighing at least 10 kg, and having a creatinine clearance of at least 30 mL per minute. Not recommended as a component of an initial regimen. Tell your doctor if you have heart or kidney problems, or if you have low blood pressure or take medication to lower it. traditional dosage: 300 mg twice daily; or 150 mg twice daily if taken with CYP3A inhibitors; or 600 mg twice daily if taken with CYP3A inducers.

Stribild generic name: elvitegravir, cobicistat,

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

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

Sustiva generic name: efavirenz class of drug: nonnucleoside reverse transcriptase inhibitor

maker: Bristol-Myers Squibb who is it for? For adults and children 3 months and older weighing at least 3.5 kg as a component of initial regimen. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures. traditional dosage: One tablet of 600 mg once daily. It is also a component in the single-tablet regimen Atripla.

Symfi/Symfi Lo generic name: efavirenz, lamivudine, and tenofovir disoproxil fumarate

class of drug: single-tablet regimen maker: Mylan who is it for? For adults and children weighing at least 40 kg (those weighing at least 35 kg can take Symfi Lo). traditional dosage: One tablet, once daily, on an empty stomach. Symfi contains 600 mg efavirenz (Sustiva, an NNRTI), 300 mg lamivudine (Epivir, an NRTI) and and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI). Symfi Lo contains 400 mg efavirenz, 300 mg lamivudine, and 300 mg TDF.

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

class of drug: single-tablet regimen maker: Janssen who is it for? For treatment-naive or

those with a suppressed viral load on a stable HIV regimen for at least six months with no known resistance to darunavir or TAF. Not for those with severe liver or kidney impairment. traditional dosage: One tablet, once daily, with food. Each tablet contains 800 mg darunavir (Prezista, a protease inhibitor), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 10 mg TAF (an NRTI).

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Temixys

Trogarzo

generic name: tenofovir disoproxil

generic name: lamivudine and tenofovir disoproxil fumarate class of drug: Two nucleoside reverse transcriptase inhibitors maker: Celltrion who is it for? For adults and children weighing at least 35 kg as component of an initial regimen. Not recommended for patients with impaired kidney function. Patients should be tested for hepatitis B before beginning treatment. traditional dosage: One tablet once daily. Contains 300 mg lamivudine (Epivir) and 300 mg TDF.

generic name: ibalizumab class of drug: post-attachment inhibitor maker: Theratechnologies

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

Tivicay

Truvada

generic name: dolutegravir class of drug: integrase inhibitor maker: GlaxoSmithKline who is it for? For both those new

generic name: emtricitabine and

to treatment and those who have taken integrase inhibitors previously and may have resistance to such drugs. For adults and children at least 30 kg. Take during pregnancy only if potential benefits outweigh risk. traditional dosage: One 50 mg tablet, once daily for those new to antiretrovirals; twice daily for those who take certain other antiretrovirals or have taken integrase inhibitors and may have resistance.

Triumeq generic name: abacavir sulfate,

dolutegravir, and lamivudine class of drug: single- tablet regimen maker: ViiV Healthcare who is it for? For adults and children weighing at least 40 kg as initial regimen. Not recommended for those with a creatinine clearance below 50 mL per minute or those with liver impairment. traditional dosage: One tablet once daily. Tablet contains 600 mg abacavir sulfate (Ziagen, an NRTI), 50 mg dolutegravir (Tivicay, an INSTI), and 300 mg lamivudine (Epivir, an NRTI).

Viread

tenofovir disoproxil fumarate

class of drug: two nucleoside reverse transcriptase inhibitors

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

Tybost generic name: cobicistat class of drug: pharmacokinetic enhancer/CYP3A inhibitor/ booster

maker: Gilead Sciences who is it for? For adults taking

fumarate

class of drug: nucleoside reverse transcriptase inhibitor

maker: Gilead Sciences who is it for? For adults and children at least 2 years old and weighing at least 10 kg, used in combination with other antiretrovirals to treat HIV-1 infection. Dosage adjustments recommended for those with kidney problems. traditional dosage: One 300 mg tablet once daily.

Vocabria generic name: cabotegravir class of drug: integrase strand transfer inhibitor

maker: ViiV Healthcare who is it for? Adults who have achieved viral suppression on a stable regimen and have no history of treatment failure and no known or suspected resistance to cabotegravir. To be used either as a month-long lead-in to monthly injections of Cabenuva (cabotegravir and rilpivirine) or by patients who will miss an injection. traditional dosage: One 30mg tablet with one 25mg rilpivirine tablet, once daily, with a meal.

Ziagen generic name: abacavir class of drug: nucleoside reverse transcriptase inhibitor

maker: GlaxoSmithKline who is it for? For adults and children

at least 3 months old, as a component of initial regimen. Dosage adjustments not needed for those with kidney problems. traditional dosage: One 300 mg twice daily or two 300 mg once daily. Individuals with mild liver impairment should take 200 mg twice daily.

atazanavir (Reyataz) or darunavir (Prezista). Tybost is not an HIV medicine and does not treat HIV: it interferes with the breakdown of these HIV drugs, increasing the blood levels of these drugs and making them more effective. traditional dosage: One 150 mg tablet daily with food, with either 300 mg atazanavir or 800 mg darunavir. H IVPLUS MAG .CO M

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THE FUTURE OF HIV DRUGS DRUGS IN DEVELOPMENT TAKE A VARIETY OF APPROACHES TO FIGHTING HIV, AND PRIORITIES INCLUDE LONG-ACTING TREATMENTS AND REPLACING FAILED REGIMENS. BY TRUDY RING

Scientists developing HIV drugs are taking diverse approaches to attacking the virus, such as targeting certain proteins on cells or keeping HIV from maturing. Some seek to eliminate the reservoir of latent HIV that remains even when the virus has become undetectable. Others are focused on treating HIV in patients who have developed resistance to other drugs. Longlasting treatments and preventive drugs (some injectable) for people who find it troublesome to take a pill every day are another priority. Several drugs in the pipeline have potential to be used in both treatment and prevention. Here’s a look at what could be on the way in the near future.

VYROLOGIX (LERONLIMAB-PRO 140): CytoDyn’s viral-entry inhibitor is a monoclonal antibody that would be the first self-injectable subcutaneous HIV drug. It works by masking CCR5, a protein on the surface of white blood cells, thus inhibiting HIV’s ability to enter healthy T cells. There have been nine clinical trials indicating it could significantly reduce or control viral load. For instance, a Phase III trial involving treatment-experienced patients showed that in combination with other antiretroviral drugs, it helped 81 percent of participants achieve significant viral suppression (less than 50 copies per mL). This summer, CytoDyn plans to submit its application for Food and Drug Administration approval of Vyrologix for use in combination therapy. It is also being studied as a single therapy for HIV; for use as pre-exposure prophylaxis; and as a treatment for 34

COVID-19, metastatic cancer, stroke, and nonalcoholic steatohepatitis, a chronic liver disease. However, the FDA has said studies of its use for COVID did not show significant benefits to patients. PGT121: A small study showed that an experimental monoclonal antibody called PGT121 led to viral suppression that lasted for up to six months in HIV-positive people who started with a low viral load. Being developed by a collaboration that includes the International AIDS Vaccine Initiative, the Bill & Melinda Gates Foundation, the Scripps Institute, and Theraclone Sciences, the recombinant monoclonal antibody targets the V3 glycan site on the outer envelope of HIV. At the 2019 Conference on Retroviruses and Opportunistic Infections, researchers reported that two participants with low viral loads experienced treatment-free viral suppression, which for one lasted over five months and for the other was still ongoing at six months. Then a study published in 2021 reported that PGT121, in combination with other drugs, delayed rebound of simian HIV in monkeys whose antiretroviral treatment had been interrupted. PGT121 could eventually become a very long-acting HIV medication or a functional cure that maintains viral suppression after antiretroviral therapy has ended. UB-421: In a Phase II trial, this broadly neutralizing antibody targeted domain 1 of CD4, and was shown to maintain viral suppression after treatment ended. Weekly or biweekly intravenous infusions of UB-421 kept the viral loads of all 29 participants suppressed after they stopped taking oral HIV meds. Research is continuing into the antibody’s potential as a functional cure as well as its efficacy in patients with multidrug-resistant HIV. LENCAPAVIR (GS-6207): Developed by Gilead Sciences, this first-in-class long-acting capsid inhibitor interferes with the transport of the viral genetic material and replication of HIV’s genetic blueprint into a host cell’s nucleus. It is given subcutaneously. At the 2021 Conference on Retroviruses and Opportunistic Infections, researchers reported that lenacapavir administered subcutaneously every six months helped patients maintain high rates of viral suppression through 26 weeks. The early trials show the drug has potential as a long-acting treatment for HIV, including for people who have developed resistance to multiple drug classes and those who are unable to take a daily pill. ISLATRAVIR (MK-8591): This Merck drug is the first nucleoside reverse transcriptase translocation inhibitor (NRTTI). In Phase IIb trials of treatmentnaive adults receiving islatravir as part of a combination antiretroviral regimen, it was shown to have less of a (negative) impact on bone mineral density, making it a potential replacement for those with poor bone health. The drug uses a variety of methods to block the HIV enzyme known as reverse transcriptase, and researchers say it may be effective against HIV strains that are resistant to other drugs. A Phase Ib trial, results of which were published in The Lancet in 2020, found a single oral dose of islatravir in treatment-naive patients significantly suppressed HIV; the drug was also well-tolerated. Interim results from a Phase IIb study, published in 2021, indicated that islatravir plus doravirine (brand name Pifeltro) made an effective and well-tolerated regimen, and researchers recommended further study of this combination. Islatravir is also being studied for HIV prevention, both as an oral med and as an implant. LENCAPAVIR AND ISLATRAVIR: Gilead and Merck recently announced an agreement to join in developing treatments that combine these two drugs. The initial focus will be on long-acting formulations, both oral and injectable, but other formulations may be added. The first clinical studies of the oral combination are expected to begin in the second half of 2021. LEFITOLIMOD (MGN1703): Lefitolimod is a type of latency-reversing agent called a toll-like receptor 9 agonist — toll-like receptors, or TLRs, are proteins that help the immune system recognize dangers, and agonists are used to enhance this activity. Researchers believe lefitolimod may improve the body’s immune response to HIV in addition to its effect on latent virus cells. Researchers in Denmark tested lefitolimod in the TEACH study, which showed it to be safe in early-phase trials. A Phase IIa study, TITAN, began in 2019 at Denmark’s Aarhaus University, in which patients on antiretroviral treatment are being given Lefitolimod along with virus-neutralizing antibodies developed by Rockefeller University to see if the therapy can reduce the viral reservoir. Lefitolimod was

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developed by German company Mologen, and the TITAN study is being funded by Gilead Sciences. VESATOLIMOD (GS-9620 AND GS-986): These are also TLR agonists, targeting receptor 7 (researchers have identified at least 10 such receptors in humans), and likewise aimed at reducing or eliminating viral reservoirs, which remain even in people who have achieved viral suppression and are an obstacle to curing HIV. Vesatolimod is being researched as part of a potential functional cure. At CROI 2020, Gilead Sciences’ toll-like receptor 7 agonist (TLR7) — an agonist is a chemical that binds to a receptor — was shown to increase the time to viral rebound, enhance immune function, and decrease levels of intact HIV DNA. Later that year, at the International AIDS Conference, one study that was presented indicated that injectable vesatolimod, used with other antiretroviral drugs, helped speed up HIV suppression in monkeys. Another study presented at the latter conference looked at humans who are HIV controllers — those in whom HIV doesn’t replicate for an extended period even if they aren’t on antiretroviral treatment, but who may need to go on treatment eventually. That study found that in controllers who had finally begun treatment, the addition of oral vesatolimod enhanced the immune system’s response, a promising if early result. A study in Spain is now looking at combining the drug with therapeutic vaccines — vaccines that are given not to prevent an infection but to control one.

POLINA TANKILEVITCH/PEXELS

GSK3640254: This is a maturation inhibitor; it prevents HIV from reaching its end stage. It does so by blocking a key step in the processing of gag, a protein that assembles HIV. Results of a proof-of-concept study, presented in March at CROI 2021, showed that the drug was safe and well-tolerated, and helped suppress HIV in treatment-naive adults. Participants in the study received various doses of GSK3640254 or a placebo over several days; the 140mg and 200mg doses were most effective against the virus. Now GSK3640254 is being studied as part of combination therapy in treatment-naive people; such maturation inhibitors also may offer a new option to people for whom other treatments haven’t worked. GSK3640254 comes from ViiV Healthcare. ABX464: This drug being developed by Abivax is a Rev inhibitor, which interferes with the protein of that name to prevent HIV from multiplying. Researchers believe it may reduce or eliminate the HIV reservoir that remains even after the virus is suppressed. A study in humanized mice showed long-term control of the virus even after treatment ended, and a human study showed reduction of viral reservoirs in blood and rectal tissue in virally suppressed patients.

MK-8504 AND MK-8583: These NRTIs being developed by Merck are new prodrugs of tenofovir, itself a component of many HIV treatments; a prodrug is a substance that has to be broken down by the body to become active. MK-8504 and MK-8583 were developed with an eye to them being weekly treatments due to the long half-life of the drugs, but Phase I studies presented at CROI in 2020 showed weekly doses had only modest and transient activity against HIV. Daily doses may produce a better result, researchers said.

ELPIDA (ELSULFAVIRINE, VM1500A): This is an NNRTI by maker Viriom. It was approved in Russia in 2017 as a once-daily oral HIV drug. Clinical studies are continuing into its use for dosing daily or weekly and have so far shown effectiveness, safety, and tolerability. Researchers are also looking at its use as part of a combination treatment and for HIV prevention, including as an injectable.

ALBUVIRTIDE AND 3BNC117: Albuvirtide is a fusion inhibitor, meaning it keeps HIV from entering certain cells in the immune system. From Frontier Biotechnologies, it is already approved for use in China. In the U.S., it is being studied in combination with 3BNC117, a broadly neutralizing antibody developed by Rockefeller University, for treatment of patients whose antiretroviral regimen is failing. Broadly neutralizing antibodies can block HIV from entering healthy cells and activate other immune cells to help destroy infected cells. Scientists are also looking into the possibility of using 3BNC117 in HIV prevention. H IVPLUS MAG .CO M

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TO SWITCH OR NOT TO SWITCH

THESE DAYS, THERE ARE MORE SAFE AND EFFECTIVE OPTIONS THAN EVER TO TREAT HIV. HERE’S HOW TO KNOW WHEN A CHANGE IN YOUR REGIMEN MIGHT DO YOU GOOD.

If your HIV medication is working well for you without any significant side effects or issues, there may be no need to consider switching up your regimen. However, if you’ve ever considered changing meds, it is now well documented that it is safe — and sometimes highly advantageous — to switch from one HIV treatment to another. But with more options available than ever, it can be challenging to try to figure out which regimen might be right for you — which is why it’s important to discuss it with your doctor. If you are already undetectable, you can switch without risking your 36

viral suppression. If you are struggling to take your meds as prescribed, facing daunting side effects, dealing with a comorbidity (like high cholesterol or liver disease), experiencing certain health concerns (say, fragility as you age), or have changing lifestyle issues (such as unusual work hours), then talking to your doctor about reevaluating your medications can be the right choice. They’ll most likely be able to fine-tune your regimen just for you, which could in turn greatly improve your quality of life. Read on for our tips to know when it may be a good time to discuss switching with your doc (and don’t forgot to bring our annual Treatment Guide with you!):

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IF YOU ARE WORRIED ABOUT DRUG RESISTANCE. Some drugs offer more protection against HIV developing resistance. For example, the ODIN trial found that darunavir (a component of both Prezista and Prezcobix) stops the virus from multiplying and mutating. (Symtuza, which also contains darunavir, offers a high barrier to resistance but isn’t recommended in most cases for those already on treatment.) The fact that you’ve developed a resistance to one drug, or one or more classes of drugs, doesn’t mean that other HIV meds won’t work for you. For example, Trogarzo (ibalizumab), a long-acting injectable, fights multidrug-resistant HIV when added to a previously failing antiretroviral regimen.

IF YOU WANT TO REDUCE THE NUMBER OF DRUGS YOU TAKE. Although three-drug regimens were once considered essential in preventing the development of HIV drug resistance, new two-drug regimens have proven to be just as effective. Their advantages include fewer side effects, and a reduction in toxicity associated with long-term drug therapies. Juluca (dolutegravir/rilpivirine) was the first two-drug regimen approved by the Food and Drug Administration. In 2020, the DUALIS study demonstrated that dolutegravir and boosted darunavir are as effective as a three-med regimen.

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IF YOU TAKE YOUR MEDS WITHOUT FOOD. A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (protein or a hearty meal, rather than a snack). So if you’re the kind of person who either doesn’t eat that way or forgets your meds until later, you should consider a drug that has no food intake requirements, such as Biktarvy (bictegravir/ emtricitabine/tenofovir alafenamide) or Triumeq (dolutegravir/abacavir/lamivudine). IF YOU ALSO HAVE HEPATITIS C. According to the Centers for Disease Control and Prevention, approximately 25 percent of people with HIV in the United States also have hepatitis C. There are new, curative hep C treatments available, but some HCV drugs interact with HIV drugs, so it’s important for your doctor to carefully consider which medications you can take while treating them simultaneously. IF YOU ARE PREGNANT. “When a woman living with HIV is expecting, she can be confident that the same antiretroviral therapy she takes every day to protect her own health also helps protects her future child from acquiring HIV,” Anthony S. Fauci, chief medical adviser to

President Biden, reiterated at last year’s Conference on Retroviruses and Opportunistic Infections. “Findings from the VESTED study suggest that a drug regimen containing dolutegravir provides the safest, most effective HIV treatment available during this critical time for women and their infants.”

IF YOU HAVE KIDNEY OR LIVER PROBLEMS. Tenofovir disoproxil fumarate (TDF, brand name Viread, and a component of drugs including Atripla, Complera, Delstrigo, and Stribild) has been linked to kidney problems in susceptible individuals, so those with kidney issues might consider regimens that instead use tenofovir alafenamide (TAF), such as Genvoya, Odefsey, or Descovy. It should be noted that Juluca, a single-drug regimen that overall promises fewer side effects, has seen some users develop new or worse liver problems.

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IF YOU CAN’T DEAL WITH THE SIDE EFFECTS. Every medication has potential side effects — some minor, some life-threatening. Not everyone taking a certain medication will experience the same side effects, and some people experience them more intensely. Only you can decide if the side effects aren’t worth the benefits you’re getting from a particular medication. With so many treatment options now available, don’t hesitate to talk to your doctor if you feel side effects are negatively affecting your daily life. IF YOU ARE AFRICAN-AMERICAN. A sad truth is that few drug trials test the impact of a treatment on people of color, especially women. That’s what makes 2020’s BRAAVE study so remarkable. It involved 495 selfidentified Black or African-American HIV-positive people (32 percent were cisgender women) who switched to Biktarvy from a variety of regimens. Virtually all of those who switched maintained viral suppression.

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

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HEAD OF THE CLASS LEARN ABOUT THE DIFFERENT CLASSES OF HIV DRUGS AND HOW EACH UNIQUELY FIGHTS THE VIRUS. BY PLUS EDITORS Drugs that treat HIV, known broadly as antiretroviral medications, are grouped in various classes based on the method the drug uses to attack the virus. HIV treatment regimens include drugs from multiple classes to improve their combined effectiveness and help prevent the development of drug resistance. Here’s brief descriptions of these classes and how they work.

BROADLY NEUTRALIZING ANTIBODIES (BNABS): Drugs in this class are antibodies that can recognize and block HIV or activate other immune cells to help destroy the virus. Some hold potential to treat HIV without other medications. CCR5 ANTAGONISTS (CAS): Drugs in this class block the CCR5 coreceptor on the surface of CD4 cells preventing HIV from binding and entering the cells. CAPSID INHIBITORS (CIS): They are still in trials and not yet FDAapproved, but drugs in this class help inhibit the proteins that protect HIV’s genetic material. CIs are currently being used as a component in experimental long-acting regimens such as injectables. They may not need to be taken with other HIV medications. ENTRY AND FUSION INHIBITORS (EIS AND FIS): Drugs in this class help block HIV from binding, fusing, and entering T cells. They are always taken with other HIV medication. INTEGRASE STRAND TRANSFER INHIBITORS (INSTIS): Drugs in this class block integrase, an enzyme HIV needs in order to reproduce. HIV uses integrase to insert its viral DNA into the DNA of T cells. Blocking the integration process prevents HIV from replicating. They are always taken with other HIV medication.

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NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIS, ALSO KNOWN AS NUKES): Drugs in this class block reverse transcriptase, an enzyme that HIV needs in order to reproduce. HIV uses reverse transcriptase to convert its RNA into DNA; blocking the process prevents HIV from replicating. They are always taken with at least one other HIV med. NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIS, ALSO KNOWN AS NONNUKES): Drugs in this class also block reverse transcriptase, as NRTIs do, but in a different way. They are always taken with at least one other HIV medication.

NUCLEOSIDE REVERSE TRANSCRIPTASE TRANSLOCATION INHIBITORS (NRTTIS): Drugs in this class also block reverse transcriptase but do so by preventing translocation of an enzyme. They are always taken with other HIV medication. PHARMACOKINETIC ENHANCER/ CYP3A INHIBITORS (PKES, ALSO KNOWN AS BOOSTERS): Drugs in this class boost the effectiveness of antiretroviral medication. When the two are taken together, the pharmacokinetic enhancer slows the breakdown of the other drug, which allows the drug to remain in the body longer at a higher concentration. They are always taken with other HIV medication. POST-ATTACHMENT INHIBITORS (PAIS): Drugs in this class bind to CD4 cells after HIV has attached to them but still inhibit the virus from infecting those cells. They are always taken with other HIV medications. PROTEASE INHIBITORS (PIS): Drugs in this class block activation of protease, an enzyme HIV needs to develop. Blocking protease prevents immature forms of HIV from becoming a mature virus capable of infecting other T cells. They are always taken with other HIV medication. SINGLE-TABLET REGIMENS (STRS): Drugs in this category are fixeddose pills that combine multiple anti-HIV medications (often from more than one class of drug) into a single tablet, which is usually taken just once a day. They do not need to be taken with other HIV medication. TOLL-LIKE RECEPTORS (TLR): Drugs in this class stimulate the immune system’s T cells, activating a more robust response to the viral invader. They are always taken with other HIV medications.

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Side effect: hypertension/ high blood pressure

PEOPLE LIVING WITH HIV MAY EXPERIENCE MEDICATION SIDE EFFECTS — AND COMORBIDITIES, THE SIMULTANEOUS PRESENCE OF AT LEAST TWO DISEASES. HERE’S WHAT THE MOST COMMON ARE AND HOW TO TREAT THEM. BY DIANE ANDERSON-MINSHALL Side effect: diarrhea

how common: Extremely; in fact, diarrhea is among the most common reasons why people with HIV stop or switch their HIV meds. treatment: Three options: over-the-counter anti-diarrheal medicines such as Imodium (loperamide); Lomotil (diphenoxylate and atropine), which slows the gut to combat diarrhea and is commonly given to cancer patients; or Mytesi (crofelemer), the only Food and Drug Administration-approved drug to relieve noninfectious diarrhea in HIV-positive people. Derived from the red sap of the Croton lechleri plant, Mytesi is only the second botanical prescription drug approved by the FDA.

Side effect: mood changes, including depression and anxiety

how common: According to a 2019 study published in International Journal of Environmental Research and Public Health, 39 percent of people living with HIV were currently experiencing depression. AIDS Beacon previously reported that 63 percent of HIVpositive participants “reported symptoms of depression currently or at some point in the past. Overall, 26 percent of patients reported having had thoughts of suicide and 13 percent of participants reported having attempted suicide in their lifetimes.” treatment options: Selective serotonin reuptake inhibitors (SSRIs) are most effective. According to the National Institutes of Health, medications that have shown efficacy in treating depression in patients with HIV include (generic names) imipramine, desipramine, nortriptyline, amitriptyline, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, nefazodone, trazodone, bupropion, and mirtazapine. 40

Comorbidity: osteoporosis and osteopenia

how common: Osteopenia and osteoporosis are both forms of bone density loss, with the latter being more severe. Far more people with HIV have osteopenia (60 percent) versus osteoporosis (10-15 percent). The lower your body weight, the more susceptible you are to both. Fracture injuries are more common in young poz people because of it. treatment: Bisphosphonate therapy with vitamin D and calcium supplementation and medications including Fosamax, Boniva, Actonel, Atelvia, and Reclast. And just this year, a study presented at the virtual Conference on Retroviruses and Opportunistic Infections indicated that a “short course of alendronate” (the generic term for Fosamax and Binosto) at the beginning of tenofovir-based antiretroviral therapy can help prevent bone loss.

Comorbidity: cardiovascular disease

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

Comorbidity: diabetes

how common: There’s a type of diabetes caused by pancreatic damage brought on by HIV medications. It’s less common than the other two types, Type 1 and Type 2, but equally damaging. treatment: Controlling blood sugar, medication, insulin treatment, and proper diet are the main treatments, with regular doctor screenings for easy-to-miss complications. Diabetes meds include Lantus, Januvia, Humalog, NovoRapid, Victoza, Farxiga, and about a dozen more.

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KNOW YOUR SIDE EFFECTS AND COMORBIDITIES

how common: Very. The U.S. Department of Veterans Affairs, for example, reports that 45 percent of its patients with HIV also have a hypertension diagnosis. A report from last year found that a quarter of all people with HIV also have hypertension, with the comorbidity most prevalent in North America and Western Europe. A 2018 review of findings, published in Hypertension, suggests that chronic inflammation associated with HIV and antiretroviral therapy is a major factor in the high rates of hypertension. treatment: Stop smoking. Medications include vasodilators (hydralazine), antihypertensives (Cozaar, Avapro, Diovan), ACE inhibitors (Prinivil, Lotensin), calcium channel blockers (Norvasc, Procardia, Plendil), and diuretics (Microzide, Diuril, Zestoretic).

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MISSING IN ACTION

MICHELLE LEMAN/PEXELS

THE REDIRECTION OF RESEARCHERS AND RESOURCES TO COVID-19 — AND AWAY FROM HIV — COULD HAVE LASTING IMPACTS ON NEW TREATMENT DEVELOPMENT. BY JACOB ANDERSON-MINSHALL The COVID-19 pandemic and subsequent lockdowns have dramatically affected those who have HIV, many of whom struggled to maintain their treatment regimens during the crisis. While the impact on individuals has been tragic, the crisis has broader and potentially more damaging ramifications for the future of HIV treatment and prevention. Kaiser Health News reports that the pandemic has disrupted “almost every aspect” of the battle against HIV, “grounding outreach teams, sharply curtailing testing, and diverting critical staff away from laboratories and medical centers.” That’s going to affect efforts to fight HIV for years to come. Tiffany Chenneville, a psychology professor at the University of South Florida’s St. Petersburg campus says that the damage to mental health caused by the current crisis will also have ramifications on treatment and research. Chenneville co-authored “The Impact of COVID-19 on HIV Treatment and Research: A Call to Action,” published last year in the International Journal of Environmental Research a n d P u b l i c H e a l t h. She notes some of her c o nc er n s h ave b e e n confirmed. “HIV services have b e en d i sr upt e d and, in some places, HIV clinics have closed.” Many, if not most, of the HIV drug trials and research ef for t s were simply shut down. Other researchers found that the pandemic cou ld skew their results. In a n a r t ic le p ubl i she d in the Jour nal of the Inter national A IDS Society last year, Peter F. Rebeiro, from Vanderbilt Un iver sit y S cho ol of Medicine’s Divisions of

Infectious Diseases and Epidemiology, noted that not all participants could access telehealth visits, and that self-reporting may produce different results compared to third-party observations. Rebeiro tells Plus that researchers may now need to factor in additional data. Did the participants have to change doctors, see someone via Zoom, or otherwise interrupt their routines? Scientists may also need to employ new resources (like electronic patient portals or secure texting) and integrate information about local health infrastructure and health-related policies into their reports. In addition, he says, “We may need to reevaluate how we measure certain constructs like ‘engagement in care’ or ‘retention in care,’ as the data typically used to measure these may not be available for long periods of time, or because definitions based on frequency of in-person clinical contact may no longer meaningfully apply.” The pandemic has brought some positives in the field of HIV treatment. Carl Dieffenbach from the National Institutes of Health summarized insights from this year’s Conference on Retroviruses and Opportunistic Infections, and noted that successful COVID-19 treatments and vaccine efforts could inform advances for HIV. Dieffenback asked rhetorically, “Can we get to a longacting antibody that could either be used independent of a medication for the treatment or prevention of [HIV]?” An antibody “cocktail” administered either as a pill or injectable could “allow people to live their truths of U=U [undetectable equals untransmittable] but not have to take a pill a day,” Dieffenbach explained. The downstream impacts of the pandemic will continue to reverberate for years — or decades. It’s hard to say at this point whether the cumulative impact on HIV treatment will remain negative or spawn revolutionary breakthroughs.

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Virtual Reality

HOW TO GET COMFORTABLE WITH 21ST-CENTURY BEDSIDE MANNERS. BY GARY MCCLAIN So your doctor (or physician assistant or nurse or nurse practitioner) walks in the examination room, greets you, and sits down in front of a laptop computer, either the one that was already in their hands or the one that is already there on a desk or mounted to the wall. Your doctor asks you a series of questions, eyes not on you but on the computer screen. They tap away on the keyboard, clicking from one field to the next on the online form. Your doctor nods as you talk, maybe asking for more detail here and there. Sound familiar? Clients often talk to me about how the experience of meeting with their physician feels less and less personal. All that tapping and clicking is one of the reasons they feel this way. “I went in to talk to her about a few things and she spent the whole time clicking at me. I sure miss the good old days when she talked to me and not at a computer screen!” a client said recently. Regardless of what era you were born in, it has been my experience that clients living with HIV want to have a personal relationship with their primary health care providers, since it will most likely be an ongoing relationship. So it can be especially frustrating to feel the disconnection and the barrier a computer screen and a mouse can create. But guess what? Health care providers feel the same way: “I used to be able to talk with my patients. Now I have to click at them.” The computer monitor can feel like an electronic barrier between you and your doctor. You’re feeling it, and your doctor is feeling it. And to make your time together feel even less personal, that monitor has an electronic form that needs to be completed. This forces your doctor to ask a series of questions, making your conversation feel even more mechanical. You might remember the days when doctors recorded a few voice comments at the end of your appointment that got sent off to a medical transcriber. Those days are over. The way that medicine is practiced has changed dramatically, as I am sure you know, and that includes the ways in which doctors have to keep records. Tap. Tap. Click!

Is there anything you can do? Well, yes and no. But here’s a start: First, accept. Health care has to be delivered within certain best practice guidelines and, like it or not, all that record-keeping is part of the deal. The tools of the trade include stethoscope, thermometer (digital), keyboard, and mouse. It’s the world we live in. Don’t take it personally. Just because the computer monitor is the one getting all the eye contact doesn’t mean your doctor doesn’t want to have a conversation with you or doesn’t care about your well-being. The rules have changed, not your doctor’s commitment to you. Have a sense of humor. One of the best ways to deal with a frustrating situation is to laugh it off. And there has to be something funny about two human beings talking to an electronic device instead of each other. Who knows, your doctor might even appreciate you cracking a joke. Look for the benefit. In spite of the lack of humanity, accurate and detailed record-keeping does have a benefit. That electronic form forces your doctor to ask you questions they might forget in a more casual conversation. It helps to assure that your doctor can more effectively monitor your condition through tracking symptoms that emerge over time as well as the progress you are making. And these records also assure that historical information that may be needed later is readily available. Initiate a real conversation. Sure, your doctor has a limited amount of time with you. But still, you are not exclusively limited to whatever the computer wants to know. After your doctor has gotten the tapping and clicking out of the way, you can still ask any questions you might have brought in with you. You may want to use your sense of humor again here: “I know I’m not half as interesting as that computer screen, but can we talk for a minute about…?” (Ask it with a smile.) Clicking that computer mouse has become standard practice during your visit. Learn to live with it. Recognize the benefit. But don’t let it completely replace good old-fashioned eye contact. You still appreciate it, and so do they. H IVPLUS MAG .CO M

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WHEN WORK IS WORKING YOUR LAST NERVE WHETHER YOU’RE AT HOME, IN AN OFFICE, OR DEALING WITH THE PUBLIC, WORK CAN BE A BIG CONTRIBUTOR TO LIFE STRESS. HERE’S HELP. BY GA RY M CC L A I N S O H E R E ’ S H OW the cycle works: It’s a hard day at work. You hit traffic on the way in. The boss is in a bad mood. A co-worker is out sick and you have to pick up the slack. Customers are acting like customers and being especially difficult. Under pressure, you crank out a rush job. And you make an error. The result? You guessed it! Stress. And what didn’t happen that day? You didn’t quite get around to taking a lunch break. So you hit the vending machine later in the afternoon. You thought a few extra cups of coffee would help you focus, so you had one cup after another. Whoops, you forgot to take your medication. When you got home that night, you were too keyed up to have a real meal for dinner, so you grabbed some fast food on the way home. It’s too late to cook anyway. Or you picked your way through dinner. The last thing you needed was to deal with more people, and you were a little snappy with your partner or kids. Forget that walk or the trip to the gym you had planned. You ended up watching TV for what was left of the evening. That is, if you didn’t have email to answer or something else to finish. Tomorrow is another day. Maybe even more of the same. And if it is, chances are your self-care routine will be left on the shelf yet another day to gather dust. And maybe another. A pattern emerges: Stress at work…stress at home…and ignoring your self-care routine. Does this cycle sound familiar? It seems that we humans have a way of putting ourselves on a treadmill as we try to react to all the demands around us, often starting with the job. As a result, our own needs can end up in last place. We forget that only by managing our self-care can we be truly effective in our jobs and in our home life. And so the negative cycle begins. It also seems to me that once you put your physical and emotional self-care up on the shelf while you scramble around trying to respond to all those competing demands, it’s all too easy to leave it sitting there. Operating 44

in stress mode can start to feel normal. But whether you’re aware of it or not, operating in stress mode and neglecting self-care can lead to feeling more and more depleted, which can lead to burnout. If you are feeling burned out, you may be even more likely to neglect your selfcare. Your emotional and physical health are at risk! Another consequence: When your self-care routine is off the rails, it may seem that much harder to start up again. The cycle continues… Here’s the bottom line. If you let work stress get in the way of taking good care of yourself, you run the risk of being less able to cope effectively. As a result, stress leads to more stress. So what can you do to avoid the work stress, home stress, life stress cycle? Here are some ideas to think about: Be aware of your basic self-care needs. Take an inventory of what you need to function at your best every day. What do your meals need to look like? How many hours of sleep? Exercise? Breaks? Timing of your medication regimen? Sure, on some days, you may have to settle for meeting the baseline requirements — diet, medication, and as much rest as reasonably possible. But don’t allow yourself to let the self-care regimen slide day after day. Take a look at what triggers the stress cycle at work. While doing that inventory, you might also think about the last time you fell into the stress cycle that brought your self-care crashing to a halt. What happened at your job that kicked it off? Was it a crunch? A rough spot with a difficult boss? A change in routine? Scary rumors about the future? A not-so-great performance review? Or yes, a global pandemic? Create a strategy for coping with triggers Once you’re aware of what can kick off the stress cycle, then you can also build in ways to cope. Is there someone you can vent to when the pressure builds up? Get support! Talking can help release those pent up-emotions. Is there a way to prepare for the crunch times? Is it time to look at updating your skills? Can you reach out for some help in how to manage that difficult boss? Are there times when you could be delegating some of the work or asking for help? That need to be perfect — or to be the hero — can lead to additional stress that doesn’t need to be there. Be proactive: Set daily goals. You probably have a list of what you need to accomplish every day at your job. So consider adding your self-care to that list. Include the key tasks from that inventory you did. Healthy food? Check. A Mental health editor GARY PH.D. is a break? Check. Medication? Check. You might MCCLAIN, therapist, patient advocate, and enlist a friend of family member to help you be author in New York City who accountable for maintaining your daily self-care. specializes in working with diagnosed with Schedule, schedule, schedule. You put individuals chronic and catastrophic medical your hours of work on your schedule. You conditions. put family obligations on your schedule. JustGotDiagnosed.com

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You put your other commitments on your schedule. So how about putting your self-care on your schedule? Schedule a few minutes to clear your mind, even if it means taking a walk away from your work area for a quick change of scenery. Give yourself a bedtime every night. And don’t forget mealtimes, and with enough time to get real food and not have to raid the vending machine. If you treat doing what you need to do to take care yourself as an afterthought and fit it in only when and if you can, chances are it won’t get done. Create a buffer zone between work and home. One big contributor to the stress cycle is bringing your work and the stress that goes along with it home with you. So think about how you can leave as much of that stress behind as possible. One way to do this is by building in a mental break— a buffer zone — that allows you to regroup before you go home at the end of the workday. You might stop at a bookstore for a few minutes or for a quick cup of coffee. Or put on some relaxing or upbeat music instead of the news as you drive home. Maybe take the scenic route instead of the highway. If you are working at home, you still need a buffer at the end of the day before you transition back into your nonwork life! Anything that might help you to feel like yourself before you arrive at home. Recognize where you have control. And where you don’t. The pressures of work are not going away. You may not have control over the demands of your job. But you do have control over how you handle those demands, starting with making sure you stay on top of what you need to do to take care of yourself. Your job is your job, and the stress is not going away. But stress doesn’t have to derail your self-care routine. Put yourself at the top of your daily list of priorities. If you’re taking care of yourself, you’ll be that much better able to cope with the demands of the workday. And to be there for yourself and your other priorities in life. So take good care of yourself. Every day!

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We Are All Patient Zero How depression and stigma touched writer Richard Vaughn and made clear what hasn’t changed since Gaetan Dugas was unfairly branded a modern-day Typhoid Mary. BY M AT T H E W H AYS

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FADOO PRODUC TIONS (DUGAS , PIC TU RED LEF T ); COU RTESY MAT TH E W HAYS ( VAUG H N & HAYS)

and around the world as people wa s a beaut if u l, worried about his disappearance. sunny spring Richard and I had discussed the morning in 2019. I issue of suicide because a year earlier awoke to a message a close friend of his, a popular artist f r om m y f r i e n d who ran a Toronto gallery for a time, R ichard Vaughan, who was in had taken her own life, and he was Toronto and had caught the opening gutted by it. I spent half a day with of a new film at the Hot Docs Film him in Montreal after he got the news, Festival the previous night. and we wandered through the city, “Hey, did you hear?” he wrote. “We talking about his friend and the hole just won the queer lottery: You and her absence left. He knew how cruel I are in a documentary with Fran ABOVE Richard Vaughan, left, with the author. suicide is for those left behind. Why Lebowitz!” OPPOSITE Gaten Dugas was slut-shamed and would he do this? It was a typical jovial message from unfairly blamed for the early AIDS epidemic Within days, his body was found by Richard, my friend who maintained a prolific output, writing novels, nonfiction books, reviews, police, and I would learn that he had in fact left a note, poetry, and plays. The film he was messaging about one made up of a mere four words: “Suicide notes are was Killing Patient Zero, and being involved was indeed a tacky.” It was pure Richard: funny, absurd, biting. It left reason for pride. Directed by Laurie Lynd, the documentary me in one of those surreal collisions of emotion: As I read tells the story of French-Canadian flight attendant Gaetan it and reread it, I laughed and wept simultaneously. Suicide, of course, leaves behind it a litany of Dugas, who died of complications from AIDS early in the epidemic, only to later be branded as “Patient Zero.” The agonizing questions. Richard’s was no exception. I had name led to a bizarre theory that attempted to explain how just exchanged messages with him hours before he was HIV came to North America by blaming one promiscuous reported missing. While his next steps weren’t entirely gay man. Lynd meticulously traces the life of Dugas, while clear, he did have new projects on the go. I knew that as a making his story about the larger cultural history of HIV writer and curator Richard lived on very little money, but and AIDS and how the pandemic was interpreted by the he always managed to get by. The jarring irony of our appearance in Killing Patient media at the time (spoiler alert: They got much of it wrong). Besides Lebowitz, Vaughan, and myself, Killing Zero was not lost on me. Richard and I had many Patient Zero’s talking heads include filmmaker John conversations about HIV and the impact it had on our Greyson and critic and author B. Ruby Rich, and it communities and our lives. Both in our 50s, we had also features never-before-seen archival footage of managed to do what AIDS activists and educators were Dugas himself. The film rightly earned critical raves. It urging us to do in the darkest days of the AIDS crisis: We managed to correct the distorted record of Dugas (no, he remained sexually active but practiced safer sex and thus was not the reason HIV came to North America) while didn’t seroconvert. We both had survivor’s guilt and had pointing to the cruelty and vicious homophobia that was discussed that at length too. So Richard had survived, but not really. For many inherent in the Patient Zero mythology. Little over a year later, I exchanged a few messages with years, HIV was on our minds pretty much constantly. Richard. They were the usual: We were busy complaining We were always hearing about friends who were ill or about how rough the freelance writing business had dying. We wrote about the crisis and got involved with become. Richard was on the East Coast, where he was activist organizations. The AIDS crisis never really ended, finishing up his time being a writer in residence at a of course — it just evolved. But that Richard would have university. He said something bitchy, then something come through all of this loss and sadness and still choose to end his life added to my despair about losing him. absurd. It made me laugh out loud. If Richard Vaughan’s life is to mean anything, I hope the The next day, I got a frantic message from a mutual friend: Richard had gone missing. No one knew where he queer community will take more time to ponder the various was, and the police were searching for him. Though he ways homophobia manifests itself in our daily lives. HIV had been living in a good place (a friend’s basement), his remains an ongoing health issue, as does substance abuse university gig would soon be over, and Richard had given and addiction, and depression, anxiety, and suicide (all of up his apartment in Montreal and was uncertain of what the above are things we experience at higher rates than the general population). It’s obvious Richard was suffering. My was next. The pandemic wasn’t helping matters. My worst suspicions immediately sprung to mind. only wish is that I could go back and convince him his life Richard and I had discussed battling depression, and I was worth living. One of his most beautiful qualities was knew his dark side well. We had many conversations about how gentle he was with others. It was something that didn’t despair and loneliness as well as the uphill battle of being always extend to his feelings AT T H E W H AY S has a creative type. He was public about his demons, having about himself. Internalized M contributed to The Advocate, written an entire book about his chronic insomnia. As a homophobia is one of the most The Guardian, Vice, Cineaste, the Toronto Star, and The New suicide risk, he was a double whammy: queer and a writer. daunting challenges we face. York Times. He is a Lambda Please watch Killing Patient Award-winning author and But another inner voice pushed back, wondering how courses in media Richard could possibly take his own life. In addition to Zero and take in some of the teaches studies at Marianopolis College being an accomplished author and journalist, he had many w isdom of my late f r iend and Concordia University in He is the coeditor friends and knew he was dearly loved. This was reflected in Richard. There will never be Montreal. (with Tom Waugh) of the Queer the huge outpouring of concern from people across Canada another person quite like him. Film Classics book series. H IVPLUS MAG .CO M

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STUPID SEX, SMART ART PRINCE JOHNNY’S THOUGHT-PROVOKING NEW ALBUM, STUPID SEX, REVISITS THE JOYS AND SORROWS OF QUEER HISTORY THROUGH AN INTROSPECTIVE, MILLENNIAL LENS. IN A HYPNOTIC mix of indie rock, cabaret, electro-pop, and piano ballads, Prince Johnny’s new album, Stupid Sex, is a poetic ode to the trauma — and untethered joy — of moving through this world as a queer person. Though the genredefying, Brooklyn-based musician didn’t live through things like the Stonewall Riots or the start of the AIDS epidemic, the 27-year-old is deeply connected to their queer history and the impact it continues to have on younger generations.

“I believe the trauma the queer community experienced in the AIDS epidemic has impacted each generation since in a profound and pervasive way,” says Prince Johnny, who uses they/them pronouns. “I explore queer intergenerational trauma in my writing. The concept that trauma can be passed down from generation to generation is a relatively

by desirée guerrero

new field of study, starting in the mid-’60s as psychologists began to study the lineage of people who had survived the Holocaust. There’s a 1988 study that found grandchildren of Holocaust survivors were overrepresented by about 300 percent in psychiatric referrals.” The singer-songwriter and multi-instrumentalist was born Viktor Vladimirovich to Jewish refugee parents who had fled a then-crumbling Soviet Union in the mid’90s. After a childhood spent listening to their father’s bootleg MP3s (which included Russian alt-rock acts like Zemfira and t.A.T.u.), Prince Johnny began teaching themselves piano at age 13, via Regina Spektor YouTube tutorials. Now, in Stupid Sex, they’re using their art to communicate ideas about how LGBTQ+ people are inextricably linked to generations past. “I imagine children [in the ’80s and ’90s] learning about queer people from caregivers whose voices are heavy with stigma and fear,” they say. “I think of blood banks nosily inquiring about sexual partners and turning donors away. I remember my own mother telling me, ‘Eighty-five percent of gay men have HIV,’ years before I even came out. The way I approached my sexuality was insidiously informed by the thousands of shameful and fearful messages I internalized growing up.” Prince Johnny, who, in a nutshell, describes their musical style as “St. Vincent hitting on Regina Spektor at Leonard Cohen’s funeral,” was recently inspired to create the Troubadour Lounge, a monthly queer singersongwriter charity showcase, “like Sofar Sounds mixed with Tiny Desk, but queer.” Pre-pandemic, Prince Johnny and their team raised over $1,000 for the Ally Coalition, and they’ll resume the shows as soon as safely possible. Other performers who’ve influenced the artist include Amanda Palmer, Nina Simone, Perfume Genius, Sade, Mitski, Frank Ocean, and Fiona Apple. In addition to some of the deeper messaging, Stupid Sex includes lots of fun musical surprises — such as a sample of drag artist Alyssa Edwards’s famous tonguepop sound, a drumbeat borrowed from Chicago’s “When You’re Good to Mama,” and a queer boy reimagining of Cyndi Lauper’s “Girls Just Want to Have Fun.” The artist explains why they wanted to touch on the era of queer history just before the AIDS epidemic struck, like they did in “Sex Party,” which samples actual interview sound bites from the documentary Gay Sex in the 70s. “The ’70s are such a fascinating time to me because it seems to me like it was the closest we got to widespread sexual freedom,” Prince Johnny explains. “I see it as this shining and joyful apex right before the hammer of the AIDS crisis slammed down and reversed so many advancements. I wanted to contrast the freedom of the ’70s to the restriction of the ’80s and imagine where we’ll go from there.” “I see a link between the current-day fixation on body image and the desire of AIDS victims [in the ’80s and ’90s] to not let their bodies show signs of the virus,” they add. “I see current-day hypersexualization as an exaggerated way to reclaim sexuality that was steeped in shame and exiled away. All of these attitudes and behaviors are ricocheting off us and into the media we consume and back to us.”

PE TER ROCK @ ROCKPORTR AITS

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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

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