MAY+JUNE 2013 by POSITIVELY AWARE

VIE DE FRANCe an interview with david france, directorproducer of ‘how to survive a plague’

May+June 2013

LET’S TALK

ABOUT

SEX Sex TALK

Opening up to your doctor

ATTRACTION

How serodiscordant couples do it

GROOVE ON

Positive women deserve love, too

The

one

for me

Patient model. Pill shown is not actual size.

What is COMPLERA? COMPLERA is a prescription HIV medicine that is used as a complete regimen to treat HIV-1 in adults who have never taken HIV medicines before and who have an amount of HIV in their blood (this is called “viral load”) that is no more than 100,000 copies/mL. COMPLERA contains 3 medicines – rilpivirine, emtricitabine and tenofovir disoproxil fumarate. It is not known if COMPLERA is safe and effective in children under the age of 18 years. ®

COMPLERA® does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Avoid doing things that can spread HIV-1 to others: always practice safer sex and use condoms to lower the chance of sexual contact with body fluids; never reuse or share needles or other items that have body fluids on them, do not share personal items that may contain bodily fluids. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others.

IMPORTANT SAFETY INFORMATION What is the most important information you should know about COMPLERA? COMPLERA® can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold, especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. • Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. • You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. • Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking COMPLERA, your hepatitis may suddenly get worse. Do not stop taking COMPLERA without first talking to your healthcare provider, as they will need to monitor your health. COMPLERA is not approved for the treatment of HBV.

Who should not take COMPLERA? Do not take COMPLERA if you have ever taken other anti-HIV medicines. COMPLERA may change the effect of other medicines and may cause serious side effects. Your healthcare provider may change your other medicines or change their doses. Do not take COMPLERA if you also take these medicines: • anti-seizure medicines: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek) • anti-tuberculosis medicines: rifabutin (Mycobutin), rifampin (Rifater, Rifamate, Rimactane, Rifadin) and rifapentine (Priftin) • proton pump inhibitors for stomach or intestinal problems: esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), dexlansoprazole (Dexilant), omeprazole (Prilosec), pantoprazole sodium (Protonix), rabeprazole (Aciphex) • more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate • St. John’s wort (Hypericum perforatum) If you are taking COMPLERA you should not take other HIV medicines or other medicines containing tenofovir (Viread, Truvada, Stribild or Atripla); other medicines containing emtricitabine or lamivudine (Emtriva, Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir, Atripla, Stribild or Truvada); rilpivirine (Edurant) or adefovir (Hepsera). In addition, tell your healthcare provider if you are taking the following medications because they may interfere with how COMPLERA works and may cause side effects: • certain antacid medicines containing aluminum, magnesium hydroxide, or calcium carbonate (examples: Rolaids, TUMS). These medicines must be taken at least 2 hours before or 4 hours after COMPLERA. • medicines to block stomach acid including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine HCL (Zantac). These medicines must be taken at least 12 hours before or 4 hours after COMPLERA. • any of these medicines: clarithromycin (Biaxin); erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral) methadone (Dolophine); posaconazole (Noxifil), telithromycin (Ketek) or voriconazole (Vfend). • medicines that are eliminated by the kidneys like acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex) and valganciclovir (Valcyte).

COMPLERA.

A complete HIV treatment in only 1 pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and have no more than 100,000 copies/mL of virus in their blood.

Ask your healthcare provider if it’s the one for you.

These are not all the medicines that may cause problems if you take COMPLERA. Tell your healthcare provider about all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take.

The most common side effects reported with COMPLERA are trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Some side effects also reported include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles) and pain.

Before taking COMPLERA, tell your healthcare provider if you: • Have liver problems, including hepatitis B or C virus infection, or have abnormal liver tests • Have kidney problems • Have ever had a mental health problem • Have bone problems • Are pregnant or planning to become pregnant. It is not known if COMPLERA can harm your unborn child • Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their milk to the baby. Also, COMPLERA may pass through breast milk and could cause harm to the baby

This is not a complete list of side effects. Tell your healthcare provider or pharmacist if you notice any side effects while taking COMPLERA, and call your healthcare provider for medical advice about side effects.

COMPLERA can cause additional serious side effects: • New or worsening kidney problems, including kidney failure. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may need to do regular blood tests. • Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself. • Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may need to check your liver enzymes before and during treatment with COMPLERA. • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones. • Changes in body fat can happen in people taking HIV medicine. • Changes in your immune system. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting COMPLERA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch or call 1-800-FDA-1088. Additional Information about taking COMPLERA:

• Always take COMPLERA exactly as your healthcare provider tells you to take it. • Take COMPLERA with a meal. Taking COMPLERA with a meal is important to help

get the right amount of medicine in your body. (A protein drink does not replace a meal).

Stay under the care of your healthcare provider during treatment with COMPLERA and see your healthcare provider regularly. Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

Learn more at www.COMPLERA.com

Patient Information

•

COMPLERA (kom-PLEH-rah) (emtricitabine, rilpivirine, tenofovir disoproxil fumarate) tablets ®

Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information including Patient Information. What is COMPLERA? •

COMPLERA is a prescription HIV (Human Immunodeficiency Virus) medicine that is used to treat HIV-1 in adults – who have never taken HIV medicines before, and – who have an amount of HIV in their blood (this is called ‘viral load’) that is no more than 100,000 copies/mL. Your healthcare provider will measure your viral load.

(HIV is the virus that causes AIDS (Acquired Immunodeficiency Syndrome)). •

COMPLERA contains 3 medicines – rilpivirine, emtricitabine, tenofovir disoproxil fumarate – combined in one tablet. It is a complete regimen to treat HIV-1 infection and should not be used with other HIV medicines.

•

It is not known if COMPLERA is safe and effective in children under the age of 18 years old.

•

COMPLERA does not cure HIV infection or AIDS. You must stay on continuous therapy to control HIV infection and decrease HIV-related illnesses.

•

Ask your healthcare provider if you have any questions about how to prevent passing HIV to other people. Do not share or re-use needles or other injection equipment, and do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal fluids or blood.

Who should not take COMPLERA? Do not take COMPLERA if: • your HIV infection has been previously treated with HIV medicines. •

you are taking any of the following medicines: – anti-seizure medicines: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) – anti-tuberculosis (anti-TB) medicines: rifabutin (Mycobutin); rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) – proton pump inhibitor (PPI) medicine for certain stomach or intestinal problems: esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); dexlansoprazole (Dexilant); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) – more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate – St. John’s wort (Hypericum perforatum)

•

If you take COMPLERA, you should not take: – Other medicines that contain tenofovir (Atripla, Stribild, Truvada, Viread)

What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects, including: • Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – have stomach pain with nausea (feeling sick to your stomach) or vomiting – feel cold, especially in your arms and legs

– Other medicines that contain emtricitabine or lamivudine (Combivir, Emtriva, Epivir or Epivir-HBV, Epzicom, Trizivir, Atripla, Truvada, Stribild) – rilpivirine (Edurant) – adefovir (Hepsera) What should I tell my healthcare provider before taking COMPLERA? Before you take COMPLERA, tell your healthcare provider if you: • have or had liver problems, including hepatitis B or C virus infection, kidney problems, mental health problem or bone problems •

– feel dizzy or lightheaded Severe liver problems. Severe liver problems can happen in people who take COMPLERA. In some cases, these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis). Call your healthcare provider right away if you get any of the following symptoms of liver problems:

•

– your skin or the white part of your eyes turns yellow (jaundice) – dark “tea-colored” urine – light-colored bowel movements (stools)

are breast-feeding or plan to breast-feed. You should not breastfeed if you have HIV because of the risk of passing HIV to your baby. Do not breastfeed if you are taking COMPLERA. At least two of the medicines contained in COMPLERA can be passed to your baby in your breast milk. We do not know whether this could harm your baby. Talk to your healthcare provider about the best way to feed your baby.

– loss of appetite for several days or longer

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

– nausea

•

– stomach pain •

are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child. Pregnancy Registry. There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry.

– have a fast or irregular heartbeat •

Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider. – Do not let your COMPLERA run out. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone. – Do not stop taking COMPLERA without first talking to your healthcare provider. – If you stop taking COMPLERA, your healthcare provider will need to check your health often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA.

You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time.

COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works, and may cause serious side effects. If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help control your HIV infection. The HIV virus in your body may become resistant to COMPLERA or other HIV medicines that are like it.

Especially tell your healthcare provider if you take: • an antacid medicine that contains aluminum, magnesium hydroxide, or calcium carbonate. If you take an antacid during treatment with COMPLERA, take the antacid at least 2 hours before or at least 4 hours after you take COMPLERA. •

•

a medicine to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). If you take one of these medicines during treatment with COMPLERA, take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA. any of these medicines (if taken by mouth or injection): – clarithromycin (Biaxin) – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) – fluconazole (Diflucan)

•

trouble sleeping (insomnia)

•

abnormal dreams

•

headache

•

dizziness

•

diarrhea

•

nausea

•

rash

•

tiredness

•

depression

Additional common side effects include: •

– itraconazole (Sporanox)

vomiting

•

– ketoconazole (Nizoral)

stomach pain or discomfort

•

– methadone (Dolophine)

skin discoloration (small spots or freckles)

•

pain

– posaconazole (Noxafil) – telithromycin (Ketek) – voriconazole (Vfend) •

The most common side effects of COMPLERA include:

medicines that are eliminated by the kidney, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte)

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of COMPLERA. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 (1-800-332-1088).

What are the possible side effects of COMPLERA?

How should I take COMPLERA?

COMPLERA can cause serious side effects, including: • See “What is the most important information I should know about COMPLERA?”

•

Stay under the care of your healthcare provider during treatment with COMPLERA.

•

Take COMPLERA exactly as your healthcare provider tells you to take it.

•

Always take COMPLERA with a meal. Taking COMPLERA with a meal is important to help get the right amount of medicine in your body. A protein drink does not replace a meal.

•

Do not change your dose or stop taking COMPLERA without first talking with your healthcare provider. See your healthcare provider regularly while taking COMPLERA.

•

If you miss a dose of COMPLERA within 12 hours of the time you usually take it, take your dose of COMPLERA with a meal as soon as possible. Then, take your next dose of COMPLERA at the regularly scheduled time. If you miss a dose of COMPLERA by more than 12 hours of the time you usually take it, wait and then take the next dose of COMPLERA at the regularly scheduled time.

•

Do not take more than your prescribed dose to make up for a missed dose.

•

New or worse kidney problems, including kidney failure, can happen in some people who take COMPLERA. Your healthcare provider should do blood tests to check your kidneys before starting treatment with COMPLERA. If you have had kidney problems in the past or need to take another medicine that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA. Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: – feeling sad or hopeless – feeling anxious or restless – have thoughts of hurting yourself (suicide) or have tried to hurt yourself

•

Change in liver enzymes. People with a history of hepatitis B or C virus infection or who have certain liver enzyme changes may have an increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease. Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA.

•

Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones.

•

Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known.

•

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

This Brief Summary summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals, or call 1-800-445-3235 or go to www.COMPLERA.com Issued: January 2013

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. ©2013 Gilead Sciences, Inc. All rights reserved. CPAC0014 03/13

RIDE FOR AIDS Chicago J OU R NALI SM . I NTEG R ITY. HOP E .

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MAY+JUNE 2013 VOLUME 25

D e p ar t m en t s

6 In Box and Readers Poll

7 editor’s Note

Photo: Jim Jurica/ISTOCKPHOTO.COM

Women and PrEP. Babies for poz men. Alicia Keys talks HIV. MTV and Durex launch youth initiative.

15 Survey

Take our survey and tell us what you know about PrEP.

39 CONFERENCE UPDATE

Highlights from the 20th Conference on Retroviruses and Opportunistic Infections.

45 Salient ramblings

On l ine e x t ra s

16 When opposites attract

No glove, no love

‘Touch me with my clothes on.’

21 Getting your groove back

Why women living with HIV deserve sex, love, and happiness.

by Kellee Terrell

28 Better safer than sorry What is safer sex?

by Sue saltmarsh

31 Critical conversations

Finding the best condom. By Sue Saltmarsh

www.positivelyaware.com/2013/13-03/glove

Riding over HIV

Riders cycle to raise money for HIV/AIDS programs. By Lorraine Hayes, LPC

www.positivelyaware.com/2013/13-03/ride

Ask the HIV Specialist Mitochondrial mystery.

By William Lenis, MD, AAHIVS

www.positivelyaware.com/2013/13-03/ask

Sex and the doctor-patient relationship.

by Lisa Fitzpatrick, MD, MPH

34 Vie de France

One-on-one with David France, the director and producer of How to Survive a Plague.

How couples deal with being serodiscordant.

by David DurAN

(Sex) life with HIV.

11 Briefly

F ea t u re s

NU M B E R 3

Interview by Jeff Berry

MaY+JUNE 2013

POSITIVELYAWARE.COM

cover photo by chris knight

I N B OX

R eaders p o l l

inbox@tpan.com + @posaware

In the MARCH+APRIL issue, we asked

Guiding light I just picked up the 17th Annual HIV Drug Guide. I was blown away by the cover photography—very powerful! I am reading this issue word for word from cover to cover. As always, this issue becomes a bible to me, but I want you to know how much it is appreciated before I return to reading the magazine. Thanks for all you do. —Kim Johnson Indianapolis, IN

Thanks for the great magazine. As a peer educator, I’m part of the effort to educate my fellow inmates. On my unit, we teach about HIV/AIDS, as well as STIs, stigma, and safe prisons. We have used your “Reader Polls” as posters and pass the most recent copy of PA around in each class. When the guys come to the class, they are like, “Why am I here? I know it all already.” But by the second day, it’s clear they don’t know it all and are asking questions! Some also come in with big chips on their shoulders, but usually lose them just as fast. We struggle to stay current and to keep the class fun for us and the guys and I wanted to thank you for being a part of that. —Stephen Texas

Thank you for any help that you can give. —Derek Villnave Prevention Health Advocate,

Do you trust that your doctor and/or pharmacist is knowledgeable about possible drug interactions or side effects?

AIDS Community Resources Syracuse, NY

Thank you, Derek, for taking the time to write. We are happy you find the Drug Guide helpful! Anyone who would like additional copies need only contact our Distribution Coordinator at distribution@ tpan.com with the number of copies requested and the address where they should be sent. It’s our mission to get the facts about HIV treatment out to everyone who needs them! —Jeff Berry, Editor-in-Chief First of all, I would like to thank you from the bottom of my heart for what you do! My dad had HIV and that is the reason for this email—he has passed away and therefore no longer needs the magazine. He really enjoyed it, though, and when his doctors had not heard of some of the medications he was on and they were listed in your magazine, he would take it and show it to his doctors. As his daughter, I was better educated about HIV as well and can teach my daughters about it and how to be safe! So, thank you again! —Jennifer

Once again I am writing to praise the Rockford, IL Drug Guide edition of PA. I work Favorite Facebook post for the CJI Program within the correctional system in New York State. As part of our Peer Class we always hand out the PA Drug Guide. It is a welcome information source for inmates across the state. I am writing to request additional copies so we can continue to pass on information where it is desperately needed. C o n n ect to P ositively Aware

YES. My doctor always tells me about them.

YES, but I usually have to ask. NO. I read the patient info sheet and research them myself. UNCERTAIN. They sometimes cannot answer my questions. NO. My providers are not knowledgeable.

Your comments: “Walgreens specialty pharmacy is especially good with finding drug interactions and has a greater understanding of HIV medications than any other pharmacy I’ve ever worked with.” “My providers are knowledgeable, but they are too busy to take time to explain interactions and side effects, unless asked to do so. The same occurs with case managers, overloaded with many different tasks.” “Six years on HIV medication and I do not believe my physician is competent regarding drug interactions. However, I have a great relationship with my pharmacist who always reviews current and new prescription drugs with me.” “On everything regarding being HIVpositive, I do my own research online and by reading books and magazines.” this issue’s poll question:

positivelyaware.com

/PositivelyAware

@PosAware

inbox@tpan.com

All communications (letters, email, etc.) are treated as letters to the editor unless otherwise instructed. We reserve the right to edit for length, style, or clarity. Let us if know you prefer we not use your name and city. You can also write: Positively Aware, 5537 N. Broadway St., Chicago, IL 60640. 6

March+April 2013 | positivelyaware.com

Do you talk about HIV status with potential sex partners? cast your vote at

positivelyaware.com

E ditor ’ s not e

Jeff Berry @PAEditor

(Sex) Life with HIV

Photo: Chris Knight

t’s interesting how, for some of us, engaging in behaviors that may put ourselves or others at risk for HIV and STDs seems less scary than actually talking about those behaviors. We are often more afraid of what someone else will think or how we will be judged, than of the consequences of our actions. Sex is only one facet of many that make up and define who we are, but it’s a biggie. It’s enshrouded in mystery, secrecy, shame, and taboo. It can be used as an escape, a weapon, to barter, or it can turn into an addiction—and it has the power to destroy friendships, relationships, families, and lives.

Sex can also be used to create intimacy and a bond between partners (casual or long-term) that goes beyond the physical. It allows us to explore deep-rooted fantasies in safe(r) and healthier ways, and discover parts of ourselves that we might otherwise never get to know, giving us the ability to become more whole and end up with fewer hang-ups in the process. Exploration and experimentation give us the freedom to become more connected with that which brings us joy, what turns us on, so that we can ultimately become more accepting and less fearful of what may lie hidden deep, deep down. And sex coupled with love can be the best sex ever! So if sex is such an integral piece of who we are, then why are we so screwed up when it comes to talking about it? Everyone comes to the “sex table” already saddled with their own pre-conceived ideas about what behaviors are acceptable for them (and others), and what is “too much” or goes “too far.” We all know the type at the party who looks down at someone else with disdain and whispers to you that the person has a foot fetish, only to later leave the party to put on leather pig ears and accompanying snout and be flogged by his partner while being ordered to “Squeal like a pig!” These pre-conceived notions of what’s acceptable, combined with our own fears, self-doubts, and biases, make sex downright messy. But sex is made to be messy! It just shouldn’t make us a big mess in the process. This issue of Positively Aware is hopefully just the start of a long overdue and ongoing discussion that needs to take place if we are ever going to stem the tide of new infections. In her first article for PA, Lisa

Fitzpatrick, MD, takes a closer look at the doctor/patient relationship, and the role that physicians can (and should!) play in helping to educate patients about HIV and risk. Three couples in sero-discordant relationships talk to David Duran about the different ways they have found to make their relationships work. Sue Saltmarsh gets into the nitty-gritty of what constitutes “safer” sex, and things you can do to reduce the risks for you and your partner. And Positively Aware newcomer Kellee Terrell talks about the ins and outs of dating for HIV-positive women. Sex has always been an incredibly important part of my life and who I am, especially when I was younger, and it still is. I remember when I first started coming to TPAN over 20 years ago and I saw the sex-positive images on the walls of the agency, as well as in the pages of the magazine—I still have some of those posters hanging in our office today. It’s one of the things that drew me to the organization, because for many years after my diagnosis, I thought I would never again have a fulfilling sex life. But then I met someone who I saw off and on for a while, and who proved me wrong. He was negative, I was positive, we discussed the risks, and he still wanted to be with me. I can recall in detail the first time we hooked up, how in the middle of sex a tear rolled down my cheek. It was a tear of joy, because suddenly I realized that my life was not over after all. I knew right then and there that, as screwed up as life would inevitably get, at least I could still have a great, rewarding sex life. You can too, if you take control, and don’t let it control you. You and your partner, whether casual or longterm, need to have your own discussion about status and risk. Admittedly, I’m still a work in progress, as are we all, but not being afraid to have the conversation is the first step towards a happier, healthier, and more fulfilling (sex) life with HIV.

MaY+JUNE 2013

Exploration and experimentation give us the freedom to become more connected with that which brings us joy, what turns us on, so that we can ultimately become more accepting and less fearful of what may lie hidden deep, deep down.

Take care of yourself, and each other.

POSITIVELYAWARE.COM

Model

InDICAtIOn ISENTRESS速 (raltegravir) is a prescription HIV-1 medicine used with other HIV medicines to treat adults with human immunodeficiency virus (HIV-1) infection. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). The use of other medicines active against HIV-1 in combination with ISENTRESS may increase your ability to fight HIV. ISENTRESS does not cure HIV infection or AIDS. Patients must stay on continuous HIV therapy to control infection and decrease HIV-related illnesses.

IMPOrtAnt rIsK InFOrMAtIOn Severe, potentially life-threatening, and fatal skin reactions and allergic reactions have been reported in some patients taking ISENTRESS. If you develop a rash with any of the following symptoms, stop using ISENTRESS and contact your doctor right away: fever, generally ill feeling, extreme tiredness, muscle or joint aches, blisters or sores in mouth, blisters or peeling of skin, redness or swelling of the eyes, swelling of the mouth or face, problems breathing. Sometimes allergic reactions can affect body organs, like the liver. Contact your doctor right away if you have any of the following signs or symptoms of liver problems: yellowing of the skin or whites of the eyes, dark or tea-colored urine, pale-colored stools/bowel movements, nausea/vomiting, loss of appetite, pain, aching or tenderness on the right side, below the ribs. Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your doctor right away if you start having new symptoms after starting your HIV medicine. People taking ISENTRESS may still develop infections or other conditions associated with HIV infections. The most common side effects of ISENTRESS include: headache, trouble sleeping, nausea, and tiredness. Less common side effects include: weakness, stomach pain, dizziness, depression, and suicidal thoughts and actions.

I am spontaneous. I am adventurous. I am into my work. I am HIV positive. You are special, unique, and different from anyone else. And so is your path to managing HIV. When you’re ready to start HIV therapy, talk to your doctor about a medication that may fit your needs and lifestyle. In a clinical study lasting 156 weeks, patients being treated with HIV medication for the first time who took ISENTRESS® (raltegravir) plus Truvada: Had a low rate of side effects — The most common side effects of moderate to severe intensity (that interfered with or kept patients from performing daily activities) were trouble sleeping (4%), headache (4%), nausea (3%), tiredness (2%) In a clinical study lasting 156 weeks, cholesterol was measured at week 144 and patients who took ISENTRESS plus Truvada experienced less effect on LDL cholesterol (“bad” cholesterol): — Cholesterol increased an average of 7 mg/dL with ISENTRESS plus Truvada versus 22 mg/dL with Sustiva plus Truvada — When they began the study, the average LDL cholesterol of patients on ISENTRESS plus Truvada was 97 mg/dL versus 92 mg/dL for those on Sustiva plus Truvada

Ask your doctor about Isentress. not sure where to start? Visit isentress.com/questions Tell your doctor right away if you get unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This may be a sign of a rare but serious muscle problem that can lead to kidney problems. Rash occurred more often in patients taking ISENTRESS and darunavir/ritonavir (Prezista) together, than with either drug separately, but was generally mild. These are not all the possible side effects of ISENTRESS. For more information, ask your doctor or pharmacist. Tell your doctor if you have any side effect that bothers you or that does not go away. Tell your doctor about all your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. ISENTRESS is not recommended for use during pregnancy. Women with HIV should not breastfeed because their babies could be infected with HIV through their breast milk. Tell your doctor about all the medicines you take, including: prescription medicines like rifampin (a medicine commonly used to treat tuberculosis), non-prescription medicines, vitamins, and herbal supplements. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. Please read the Patient Information on the adjacent page for more detailed information.

Need help paying for ISENTRESS? Call 1-866-350-9232 Brands mentioned are the trademarks of their respective owners. Copyright © 2013 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. INFC-1046459-0001 03/13 isentress.com

Patient Information ISENTRESS ® (eye sen tris) (raltegravir) Film-Coated Tablets Read this Patient Information before you start taking ISENTRESS and each time you get a refill. There may be new information. This information does not take the place of talking with your doctor about your medical condition or your treatment. What is ISENTRESS? ISENTRESS is a prescription HIV medicine used with other HIV medicines to treat adults with human immunodeficiency virus (HIV-1) infection. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). When used with other HIV medicines, ISENTRESS may reduce the amount of HIV in your blood (called “viral load”). ISENTRESS may also help to increase the number of CD4 (T) cells in your blood which help fight off other infections. Reducing the amount of HIV and increasing the CD4 (T) cell count may improve your immune system. This may reduce your risk of death or infections that can happen when your immune system is weak (opportunistic infections). ISENTRESS does not cure HIV infection or AIDS. People taking ISENTRESS may still develop infections or other conditions associated with HIV infection. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infections. Patients must stay on continuous HIV therapy to control infection and decrease HIV-related illnesses. Avoid doing things that can spread HIV-1 infection to others: • Do not share needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. • Do not have any kind of sex without protection. Always practice safe sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. Ask your doctor if you have any questions on how to prevent passing HIV to other people. What should I tell my doctor before taking ISENTRESS? Before taking ISENTRESS, tell your doctor if you: • have liver problems. • have any other medical conditions. • are pregnant or plan to become pregnant. It is not known if ISENTRESS can harm your unborn baby. Pregnancy Registry: You and your doctor will need to decide if taking ISENTRESS is right for you. If you take ISENTRESS while you are pregnant, talk to your doctor about how you can be included in the Antiretroviral Pregnancy Registry. The purpose of the registry is to follow the health of you and your baby. • are breastfeeding or plan to breastfeed. - Do not breastfeed if you are taking ISENTRESS. You should not breastfeed if you have HIV because of the risk of passing HIV to your baby. - Talk with your doctor about the best way to feed your baby. Tell your doctor about all the medicines you take, including: prescription and nonprescription medicines, vitamins, and herbal supplements. Taking ISENTRESS and certain other medicines may affect each other causing serious side effects. ISENTRESS may affect the way other medicines work and other medicines may affect how ISENTRESS works. Especially tell your doctor if you take: • rifampin (Rifadin, Rifamate, Rifater, Rimactane), a medicine commonly used to treat tuberculosis. Ask your doctor or pharmacist if you are not sure whether any of your medicines are included in the list above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine. Do not start any new medicines while you are taking ISENTRESS without first talking with your doctor. How should I take ISENTRESS? • Take ISENTRESS exactly as prescribed by your doctor. • You should stay under the care of your doctor while taking ISENTRESS. • Do not change your dose of ISENTRESS or stop your treatment without talking with your doctor first. • Take ISENTRESS by mouth, with or without food. • ISENTRESS Film-Coated Tablets must be swallowed whole. • If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not double your next dose or take more than your prescribed dose. • If you take too much ISENTRESS, call your doctor or go to the nearest emergency room right away. • Do not run out of ISENTRESS. Get your ISENTRESS refilled from your doctor or pharmacy before you run out. What are the possible side effects of ISENTRESS? ISENTRESS can cause serious side effects including: • Serious skin reactions and allergic reactions. Severe, potentially life-threatening and fatal skin reactions and allergic reactions have been reported in some patients taking ISENTRESS. If you develop a rash with any of the following symptoms, stop using ISENTRESS and contact your doctor right away: ° fever ° muscle or joint aches ° redness or swelling of the eyes ° generally ill feeling ° blisters or sores in mouth ° swelling of the mouth or face extreme tiredness blisters or peeling of the skin ° ° ° problems breathing Sometimes allergic reactions can affect body organs, like the liver. Contact your doctor right away if you have any of the following signs or symptoms of liver problems: ° yellowing of the skin or whites of the eyes ° dark or tea colored urine ° pale colored stools/bowel movements ° nausea/vomiting ° loss of appetite ° pain, aching or tenderness on the right side below the ribs

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your doctor right away if you start having new symptoms after starting your HIV medicine. The most common side effects of ISENTRESS include: • headache • nausea • trouble sleeping • tiredness Less common side effects include: • weakness • depression • stomach pain • suicidal thoughts and actions • dizziness Tell your doctor right away if you get unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This may be a sign of a rare but serious muscle problem that can lead to kidney problems. Rash occurred more often in patients taking ISENTRESS and darunavir/ritonavir together than with either drug separately, but was generally mild. Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of ISENTRESS. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store ISENTRESS? Film-Coated Tablets: • Store ISENTRESS Film-Coated Tablets at room temperature between 68°F to 77°F (20°C to 25°C). Keep ISENTRESS and all medicines out of the reach of children. General information about ISENTRESS Medicines are sometimes prescribed for conditions that are not mentioned in Patient Information Leaflets. Do not use ISENTRESS for a condition for which it was not prescribed. Do not give ISENTRESS to other people, even if they have the same symptoms you have. It may harm them. This leaflet gives you the most important information about ISENTRESS. If you would like to know more, talk with your doctor. You can ask your doctor or pharmacist for information about ISENTRESS that is written for health professionals. For more information go to www.ISENTRESS.com or call 1-800-622-4477. What are the ingredients in ISENTRESS? ISENTRESS Film-Coated Tablets: Active ingredient: raltegravir Inactive ingredients: microcrystalline cellulose, lactose monohydrate, calcium phosphate dibasic anhydrous, hypromellose 2208, poloxamer 407 (contains 0.01% butylated hydroxytoluene as antioxidant), sodium stearyl fumarate, magnesium stearate. The film coating contains: polyvinyl alcohol, titanium dioxide, polyethylene glycol 3350, talc, red iron oxide and black iron oxide. This Patient Information has been approved by the U.S. Food and Drug Administration.

Distributed by: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Whitehouse Station, NJ 08889, USA Revised January 2013 USPPI-T-05181301R021 Copyright © 2007, 2009, 2011 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. INFC-1046459-0001 03/13 U.S. Patent Nos. US 7,169,780

Briefly Enid Vázquez @ENIDVAZQUEZPA

Women URGE action on PrEP The U.S. Women and PrEP Working Group issued a statement in March urging U.S. government agencies to quickly figure out how best to provide Truvada PrEP to women at the highest risk of HIV infection. PrEP stands for pre-exposure prophylaxis, or prevention, any active substance taken ahead of exposure to HIV that may prevent infection. The statement came on the day of the negative news from the VOICE study on PrEP in women (see the CROI section on page 42). “We have a moral imperative to find ways to make PrEP available to women who need it and who can use it,” said nurse practitioner Erika Aaron of Drexel University School of Medicine, Division of Infectious Diseases and HIV Medicine, in a press release. The statement called for plans and funding for demonstration projects of Truvada for women, along with educational campaigns. For more information, go to www.avac.org.

Photo: Joshua Thorne

Changes to Victrelis label The FDA updated the drug label of Victrelis (boceprevir), a hepatitis C medication, in February. People who were null responders (those who had little or no decrease in hepatitis C during treatment) to previous treatment with Victrelis or Incivek (telaprevir), should continue Victrelis treatment for 48 weeks no matter what their hepatitis C viral load is at 8 weeks and 24 weeks, the times at which decisions are made as to whether treatment should be continued or stopped. Moreover, the agency emphasized that anyone who permanently discontinues the use of ribavirin or peg-interferon must discontinue the entire hep C regimen they are taking at that time. The FDA had already added a warning to the Victrelis drug label in November 2012 about the potential for a hypersensitivity reaction (an allergy-like response). They have added a statement advising patients to seek medical attention immediately if they experience any of the following signs of hypersensitivity: hives, difficulty breathing or swallowing, or swelling of the face, lips, throat, tongue, or eyes. Additionally, the agency noted a number of severe skin and subcutaneous tissue reactions that have been seen since the drug came to

market. These include toxic skin eruptions and Stevens-Johnson syndrome (which can include burns on internal organs). See the drug label at drugs@fda.

Babies for HIV-positive men, part 1 The American Fertility Association, a not-for-profit charitable organization, has established an educational program to increase awareness of the ability of HIV-positive men to have biological children without transmission of the virus. “With over 5,000 pregnancies worldwide using assisted reproduction and the sperm from men living with HIV, there has never been a single incident of HIV transmission reported,” said executive director Ken Mosesian in a written statement. The program was funded by Growing Generations, a surrogacy and egg donor agency, and the International Fertility Law Group, established by two MaY+JUNE 2013

POSITIVELYAWARE.COM

gay male lawyers who together with their partners became parents through assisted reproduction and became impassioned about defending the fertility rights of gay couples. See their stories at www. iflg.net. Go to www.theafa.org/hiv or call 888-917-3777.

Babies for HIV-positive men, Part 2 San Francisco General Hospital has established a free support group for HIV-positive men who have sex with women (MSW) and are interested in having children. Providers noted that some of these men also have sex with other men and are then categorized by medical providers as gay or MSM (men who have sex with men), and are then never asked about their desire to have children. Men do not need to be patients of the hospital to participate in the group. For more information, contact weber@ncc.ucsf.edu.

B R I E F LY

E-NEWS |

III substances—like buprenorphine—have a lower potential for abuse compared to Schedule II substances—like methadone—there is justification for the less-restrictive rules on dispensing buprenorphine, according to SAMHSA.” Nevertheless, they point out that individual states can override take-homes with the use of more restrictive rules, addJust like me: Alicia Keys chats with Five ing that, “Still, the final rule HIV-positive women in YouTube video. is a very important first step for OTPs and their patients.” Go to www.atforum.com.

Alicia Keys teams up with Greater Than AIDS

Fourteen-time Grammy Award-winning artist and HIV advocate Alicia Keys has teamed up with Greater Than AIDS to launch Empowered, an awareness campaign for women, but really, for everyone. In a video, Keys talks about how she developed her passion for doing HIV outreach and how after hearing a group of HIV-positive women speak, she realized, “They’re just like me.” “AIDS in America,” she said, “is right here, right now, and we have to start talking about it.” In the video, Keys sits down with five HIV-positive women to hear their stories and their dreams. “I’m not okay with stigma for another 30 years,” says one of the women. “I’ve got things to do!” Keys says, “Whether HIV-positive or negative, we all have a role to play. Let’s get fired up.” To view the video, go to www. greaterthan.org/campaign/empowered.

Buprenorphine at home Addiction Treatment Forum, a progressive and comprehensive newsletter of longstanding advocacy, reported that as of January, opioid treatment programs (OTPs) can dispense buprenorphine take-homes, with no pre-determined waiting period for stable patients. ATForum noted that, “Because Schedule 12

Generic Suboxone now available The FDA in February approved two generic versions of Suboxone (a combination of buprenorphine hydrochloride and naloxone hydrochloride dihydrate), a

tablet medication used for maintenance therapy of opioid (morphine, heroin, and oxycodone, to name a few) dependence. Amneal Pharmaceuticals and Actavis are the companies producing the generics. Both provide two generic doses, 2 mg/0.5 mg or 8 mg/2 mg.

Baby survey for women “Many HIV-positive men with HIV-negative partners would like to become parents but are concerned about the risks of HIV transmission to their partners if they have unprotected sex in order to conceive a child,” say HIV specialists Deborah Cohan and Joelle Brown of the University of California, San Francisco. They are conducting a survey of HIV-negative women ages 18-49 who have an HIV-positive male partner and desire to have children. The survey is confidential and takes about 30 minutes to complete. Participants will receive a $10 gift card after completion of the survey. Take the survey at www. surveymonkey.com/s/D5YQ77L . For more information, call 415-206-8919.

MTV, Durex launch sexual health campaign The MTV Staying Alive Foundation and condom manufacturer Durex have joined forces to launch Ignite Change, a global sexual health initiative that aims to inspire young people to take charge of their sexual health. MTV has long been at the forefront of promoting HIV awareness and health among youth, and Durex has been a leader in promoting sexual health and social responsibility. The two organizations hope to use their knowledge, expertise, and global reach with young people to ultimately “create a supportive environment, with a language and style young people can identify with, to ignite their motivation, and give them the means and the know-how to make a difference.” Go to www.ignitechangetoday.com to learn more.—Jeff Berry

MAY+JUNE 2013

POSITIVELYAWARE.COM

YOu’VE COmE A LONg WAY mANAgINg YOuR HIV.

NOW, ON TO HIV-RELATED EXCESS AbDOmINAL FAT.

www.egrifta.com

Indication: EGRIFTA® (tesamorelin for injection) is a daily injectable prescription medicine to reduce the excess abdominal fat in HIV-infected patients with lipodystrophy. Limitations of use: • The impact and safety of EGRIFTA® on cardiovascular health has not been studied • EGRIFTA® is not indicated for weight-loss management • It’s not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications • EGRIFTA® is not recommended to be used in children Important Risk Information Do not use EGRIFTA® if you: • Have pituitary gland tumor, pituitary gland surgery, or other problems related to your pituitary gland • Have active cancer (either newly diagnosed or recurrent) or are receiving treatment for cancer • Are allergic to tesamorelin or any of the ingredients in EGRIFTA®, including mannitol or sterile water • Are pregnant or become pregnant before using EGRIFTA®, tell your healthcare provider if you: • Have or have had cancer • Have diabetes • Are breastfeeding or plan to breastfeed • Have kidney or liver problems • Have any other medical condition • Take prescription or non-prescription medicines, vitamins, or herbal supplements EGRIFTA® may cause serious side effects, including: • Serious allergic reaction. Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: rash over your body, hives, swelling of your face or throat, shortness of breath or trouble breathing, fast heartbeat, feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome) • Increase in glucose (blood sugar) intolerance and diabetes. Your healthcare provider will measure your blood sugar periodically • Injection-site reactions, such as redness, itching, pain, irritation, bleeding, rash, and swelling. Change (rotate) your injection site to help lower your risk for injection-site reactions The most common side effects of EGRIFTA® include: • joint pain • numbness and pricking • pain in legs and arms • nausea • swelling in your legs • vomiting • muscle soreness • rash • tingling • itching EGRIFTA® will NOT cure HIV or lower your chance of passing HIV to others. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Actual patient living with HIV since 2000

You can receive valuable information about ways to discuss this condition and EGRIFTA® with your doctor when you sign up at egrifta.com/info or call the AXIS Center2/13 at 877-714-AXIS (2947) 111122-102311

Please see Consumer Brief Summary of EGRIFTA® on following page.

Consumer brief Summary for EGRIFTA® (tesamorelin for injection) EGRIFTA® (eh-GRIF-tuh) (tesamorelin for injection) for subcutaneous use Read the Patient Information that comes with EGRIFTA® before you start to take it and each time you get a refill. There may be new information. This leaflet does not take the place of talking to your healthcare provider about your medical condition or your treatment. What is EGRIFTA®? • EGRIFTA® is an injectable prescription medicine to reduce the excess in abdominal fat in HIV-infected patients with lipodystrophy. EGRIFTA® contains a growth hormonereleasing factor (GRF) • The impact and safety of EGRIFTA® on cardiovascular health has not been studied • EGRIFTA® is not indicated for weight-loss management • It is not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications • It is not known if EGRIFTA® is safe and effective in children. EGRIFTA® is not recommended to be used in children Who should not use EGRIFTA®? Do not use EGRIFTA® if you: • have pituitary gland tumor, pituitary gland surgery, or other problems related to your pituitary gland • have or have had a history of active cancer (either newly diagnosed or recurrent) • are allergic to tesamorelin or any of the ingredients in EGRIFTA®. See the end of this leaflet for a complete list of ingredients in EGRIFTA® • are pregnant or become pregnant. If you become pregnant, stop using EGRIFTA® and talk with your healthcare provider. See “What should I tell my healthcare provider before using EGRIFTA®?” What should I tell my healthcare provider before using EGRIFTA®? Before using EGRIFTA®, tell your healthcare provider if you: • have or have had cancer • have diabetes • are breastfeeding or plan to breastfeed. It is not known if EGRIFTA® passes into your breast milk. The Centers for Disease Control and Prevention (CDC) recommends that HIV-infected mothers not breastfeed to avoid the risk of passing HIV infection to your baby. Talk with your healthcare provider about the best way to feed your baby if you are taking EGRIFTA® • have kidney or liver problems • have any other medical condition Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. EGRIFTA® may affect the way other medicines work, and other medicines may affect how EGRIFTA® works. Know the medicines you take. Keep a list with you to show your healthcare provider and pharmacist when you get a new medicine. How should I use EGRIFTA®? • Read the detailed “Instructions for use” that comes with EGRIFTA® before you start using EGRIFTA®. Your healthcare provider will show you how to inject EGRIFTA® • Use EGRIFTA® exactly as prescribed by your healthcare provider • Inject EGRIFTA® under the skin (subcutaneously) of your stomach area (abdomen) • Change (rotate) the injection site on your stomach area (abdomen) with each dose. Do not inject EGRIFTA® into scar tissue, bruises, or your navel • Do not share needles or syringes with other people. Sharing of needles can result in the transmission of infectious diseases, such as HIV What are the possible side effects of EGRIFTA®? EGRIFTA® may cause serious side effects including: • Serious allergic reaction. Some people taking EGRIFTA® may have an allergic reaction. Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: – a rash over your body

– hives – swelling of your face or throat – shortness of breath or trouble breathing – fast heartbeat – feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome) • Increase in glucose (blood sugar) intolerance and diabetes. Your healthcare provider

will measure your blood sugar periodically • Injection-site reactions. Change (rotate) your injection site to help lower your risk for

injection-site reactions. Call your healthcare provider for medical advice if you have the following symptoms around the area of the injection site: – bleeding – redness – rash – itching – swelling – pain – irritation The most common side effects of EGRIFTA® include: – joint pain – nausea – vomiting – pain in legs and arms – rash – swelling in your legs – itching – muscle soreness – tingling, numbness, and pricking Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of EGRIFTA®. For more information, ask your healthcare provider or pharmacist. Call your healthcare provider for medical advice about side effects. To report side effects, contact EMD Serono toll-free at 1-800-283-8088, ext. 5563. You may report side effects to the FDA at 1-800-FDA-1088. Keep EGRIFTA® and all medicines out of the reach of children. general information about the safe and effective use of EGRIFTA®: Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use EGRIFTA® for a condition for which it was not prescribed. Do not give EGRIFTA® to other people, even if they have the same symptoms you have. It may harm them. Do not share your EGRIFTA® syringe with another person, even if the needle is changed. Do not share your EGRIFTA® needles with another person. This Patient Information leaflet summarizes the most important information about EGRIFTA®. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about EGRIFTA® that is written for healthcare professionals. For more information about EGRIFTA®, go to www.EGRIFTA.com or contact the AXIS Center toll-free at 1-877-714-2947. What are the ingredients in EGRIFTA®? Active ingredient: tesamorelin Inactive ingredients: mannitol and Sterile Water for Injection

EMD Serono, Inc. is a subsidiary of Merck KGaA, Darmstadt, Germany

S U RV E Y

PrEP Survey

✂

1. Have you heard of PrEP? o Yes o No

7. If you are HIV-positive, based

on what you currently know, would you recommend PrEP to an HIV-negative partner? o Yes o No

Why or why not?

2. How knowledgeable are you

about PrEP? o Very o Moderately o Somewhat o Not at all

3. If you are HIV-negative, are B:10.75”

S:9.5”

T:10.5”

Cut this page and submit your completed PreP survey. FAX: 773-989-9494. Scan and Email: inbox@tpan.com or mail to: PrEP Survey c/o TPAN, 5537 N. Broadway St., Chicago, IL 60640. or take the survey online: www.positivelyaware.com/prepsurvey

n upcoming issue of POSITIVELY AWARE will be focused on PrEP (pre-exposure prophylaxis), a medication that can be taken by HIV-negative people, who are at high risk for HIV, to help them stay negative. Your confidential responses to this survey will help us to understand the level of community knowledge about PrEP. Take the survey, then provide your e-mail address if you’d like to be eligible to win a free $50 Amazon.com gift card. (We will never share or sell your email or personal information.) You can also take the survey online at www.positivelyaware.com/prepsurvey. Thanks for your participation!

______________________

you currently taking PrEP? o Yes o No o N/A

4. If you are HIV-negative,

______________________

would you consider taking PrEP? o Yes o No o N/A

8. If you answered yes to #7,

would it change the way you practice safer sex? o Yes o No

9. If yes, please explain: Why or why not? ______________________

______________________ ______________________ ______________________

5. Would you feel comfortable

asking your medical provider about PrEP? o Yes o No

6. Based on what you currently

know, would you recommend PrEP to a friend or partner? o Yes o No Why or why not?

______________________ ______________________

10. Do you know anyone

currently on PrEP? o Yes o No

11. Do you know where to find

more information about PrEP? o Yes o No

12. What would you most like to

know about PrEP? (Check two:) o Who is a candidate for PrEP? o What is the dose? o What are the side effects? o Why is adherence important? o PrEP and pregnancy? o What does it cost?

13. What is your age? o Younger than 18 o 18–25 o 26–35 o 36–45 o 46–55 o 55+

14. What is your gender? o Male o Female o F to M Transgender o M to F Transgender

15. What is your race/ethnicity? o Black/African American o White/Caucasian o Latino/a o Asian/Pacific Islander o Native American

(American Indian) o Multiracial o Other: ______________________

16. What is your sexual orientation? o Gay o Lesbian o Heterosexual o Bisexual o Other: ______________________

o Yes. I’d like to enter the drawing to win a free $50 Amazon.com gift card! Here’s my email address. Email address:

WHEN

opposites

Attract

How couples deal with being serodiscordant By David Duran

ex is a topic that most are reluctant to discuss openly. Some feel awkward or embarrassed or even guilty discussing their feelings about sex openly and honestly. Now toss in HIV with sex and the discussion comes to an overwhelming standstill. Well, not for everyone, but for most. Living with HIV can, at times, take over your life and make you feel like an outsider. Disclosing your positive status to anyone is not an easy task. Many struggle with telling friends and family, not to mention a potential partner. It’s a topic that has been off-limits for too long and it’s time those living with HIV gain the confidence to disclose openly and without fear of rejection. Sex is a natural part of life and we need it, even those of us living with HIV.

New love: Jason and Zach

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Photo:

t’s a typical boy-meets-boy story but modernized since the two met on the gay mobile dating app Grindr. Jason, an unapologetic HIV activist, has no shame telling anyone how he met his boyfriend. “Mobile sex apps can surprise you every once in awhile,” he said. “You never know when or where you will find Mr. Right.” The two have been together under a year and are committed to each other. Jason, who has been open about his status for years and has served as an HIV advocate in numerous ways, including being a national spokesperson, said he had no struggles bringing up the subject of his status when he first met Zach, telling him on their second date. “In the eight years that I’ve been aware of my status, I’ve found that telling

Photo COURTESY OF JASON VILLALOBOS

So how does someone with HIV go about dating, hooking up, or meeting a potential partner? Should they only seek out others who are also HIV-positive? Or should they immediately disclose their status on the first date? These are questions that everyone has an opinion about, and it’s time we started openly discussing these opinions so that from within, we can identify those responses that are ignorant and uneducated and instead of automatically degrading the person who made them or brushing their comments aside, we can help change minds by educating and enlightening. So what’s a serodiscordant couple? To put it simply, it’s when one person in the relationship is HIV-positive and the other is negative. It’s normal, they are out there, and they come in all different combinations, gay and straight.

JASON and ZACH

Photo:

are your typical boy-meets-boy story, but with a positive spin.

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Shawn and Gwenn

the truth and being up front and honest has never come back to bite me in the ass.” Zach was impressed with Jason’s honesty and it made a great impression on him. Jason wasn’t always as comfortable with his status as he is today. He recalls breaking down in tears each time he disclosed to potential partners. “It was a fear of rejection and just the simple fact that I had not come to a place of peace with my status.” With time, he realized that the more he talked about it and became more open, the better it was for his confidence and for always being prepared for the worst reactions from men. Zach, who is over ten years younger

than Jason, is part of a new generation that never experienced the worst of the AIDS epidemic and has been led to believe that HIV is a one-pill-a-day manageable disease. Jason didn’t expect him to be as understanding and educated as he was on the subject, but Zach was different. “I feel bad for underestimating him and expecting a more frightened, stereotypical response based simply on him being 21,” said Jason. Zach was aware of how the virus is transmitted but admits to having gone on the Internet to do more research after their second date, for peace of mind. He then went to Jason with his questions and the two had many open and frank conversations. “We’re

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always so scared to disclose, and I think we’re doing a disservice to ourselves and our community by assuming that this will be a deal breaker,” said Jason. When it comes to sex, Jason says both of them are sex-positive. They established some general rules like using condoms for anal sex every time, and that was about it. “My boyfriend and I love to have sex, and we act in accordance with what we both feel is safe behavior that will protect him from the virus, and then we just sort of let all of that fall away and get down to business…and it’s very fun business.” Jason has an undetectable viral load, so the risk of transmission is extremely low, and the couple is relatively

Photo: JEN FArielo

have been educating people together, using humor and candor to talk about their tenyear relationship.

new couple, and they are a serodiscordant couple who are open about their feelings and who take the time to communicate. Jason is an advocate who has done much for his community and serves as a role model and inspiration to many. His openness, awareness, humility, and no-shame attitude has touched others and saved lives. “I feel disclosing early takes an incredible weight off one’s shoulders, as that piece of information hangs out in the back of your mind, gradually pulsing so loudly and nervously that it begins to inhibit your own thought process and behavior. Just spit it out and do so in a way that’s very calm and straightforward, and be receptive to answering all questions.”

Educating together: Shawn and Gwenn

carefree when it comes to oral sex and other non-penetrating activities. Zach’s family wasn’t as progressive as their son in the beginning. His family was giving him inaccurate facts about transmission and HIV in general. After addressing these topics together, Jason encouraged him to make an appointment with his doctor to ask any questions if he wanted an impartial source of information. “I’ve also had some very frank, sometimes a bit tense—for them—conversations with his friends and family, but in the end, I think everyone walks happier when concerns are raised and dealt with in a timely, non-dramatic manner.” Jason and Zach are a young couple, a

or more than 10 years, Shawn and Gwenn have been educating people together, putting themselves out there and openly talking about their relationship as a way to open up dialogue about issues of sexual health. Their use of humor and candor has successfully engaged tens of thousands of people as their messages have been shared through mainstream media outlets. Their more recent venture has been with their YouTube channel, YouTube.com/ shawnandgwenn. The couple vlog about current events relating to HIV, but do it in a way that’s fun and very easy to watch. The two met when Gwenn was in graduate school doing research on HIV and looking for an HIV-positive speaker for a presentation. She was put in touch with Shawn through a local AIDS service organization. The two didn’t end up working together on her project but met a month later when both were attending a discussion being given by Jeanne White, Ryan White’s mother. Disclosure wasn’t an issue for the couple, as Gwenn knew from the initial call that Shawn was HIV-positive. “As we were both HIV educators the issues surrounding HIV came up frequently in conversation, and those conversations didn’t stop when we realized [our] feelings went beyond friendship and we were falling in love,” said Shawn. When they decided they were going to be a couple, Gwenn did have some concerns about what it would be like to be in a relationship with someone who was HIVpositive. She knew about HIV prevention,

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P OS ITIV ELYAWA R E .CO M

“Disclosure is a difficult topic because the positive person needs to feel like their trust has been earned and if that takes a while, the person receiving the information can feel like it took too long.” but what helped her most was having a friend who happened to be in a serodiscordant relationship. Through the help of her friend, she was able to ask him questions about his relationship with his partner. “Having this resource is rare, but was extremely important to her,” says Shawn. Shawn, who was diagnosed at the age of 11 after contracting HIV through infected blood products used to treat his hemophilia, admits that disclosure wasn’t always this easy for him. “It wasn’t until 10 years after my diagnosis that I was comfortable leading with that information. Disclosure is a difficult topic because the positive person needs to feel like their trust has been earned and if that takes a while, the person receiving the information can feel like it took too long.” Shawn now finds it much easier to be confident in his status and not be consumed by fear of rejection, but also admits that getting there takes time. When it comes to sex, the couple uses condoms and says they are very open with each other about what they are both comfortable with. “Fortunately, we have always been on the same page where that is concerned and those discussions have evolved over time,” said Shawn. “My medications work and I have had an undetectable viral load for a long time. This, combined with condom use and the knowledge that transmission under these circumstances is practically non-existent, allows us to have a stress-free sex life.”

Preaching what you believe: Vicki and Virgil

icki has taken her diagnosis by the reins and instead of letting it consume her, she is out in her community spreading her message and making a difference. She works with several different HIV organizations and promotes abstinence before marriage to everyone, as well as forms of contraception to those who are not aligned with her personal beliefs. She speaks about how people of faith 19

respond to HIV and AIDS. She also provides prevention education to those in need, as well as testing and peer navigation. She is a leader at pulling her community together, especially in observance of HIV/AIDS days and events.

not disclose their status without first giving it some thought. “It takes time to adjust to being HIV-positive, and one should always disclose in a safe place.” When it comes to sex, Vicki says she and Virgil use condoms every time, even for oral sex. “We enjoy trying different condoms, it’s great foreplay.” She is confident in her prevention methods and doesn’t feel like she is facing any issues with her sex life. Vicki has been on antiretroviral medications for over 10 years and has been with Virgil for 12 years.

Truvada as PrEP

ruvada, one of the most used antiretroviral drugs on the market, was recently approved as a prevention method for HIV-negative people considered at high risk of being infected. The controversial use of this drug has sparked a lot of debate on who should be taking it and who is considered “high risk.” It seems like an ideal option for serodiscordant couples, but that wasn’t the case for the couples interviewed in this story. All three said they were confident with their prevention methods and didn’t feel the need to put the HIVnegative partner through the pitfalls and side effects that taking HIV medication can cause. It’s important to note that the use of Truvada as PrEP, like other forms of prevention, is not 100% effective. Many recent Vicki and Virgil have Learned to keep studies have proven the drug to be the pleasure in their marriage. most successful in prevention when used correctly and in combination She met her husband Virgil through a with other prevention methods. mutual friend and said her status came It’s time to talk up during a conversation one evening or some serodiscordant about a month after they’d been dating couples, it may be time for further and abstaining. “I just asked him what he conversations. No matter what knew about HIV and he told me he knew stage of the relationship you’re it caused AIDS.” At that time, Vicki had in, open dialogue and reaffirming recently gone to get tested herself but discussions are never bad things to had not gotten her results. She and her exhusband had discovered at the time of their have from time to time. For those that might need help starting the divorce that he in fact was HIV-positive. conversation, Test Positive Aware And that’s when Virgil decided to get Network (TPAN) in Chicago has a tested as well. His results came back negatherapy group aimed directly at tive, but not Vicki’s. “He was devastated local-area serodiscordant couples. at first but willing to get educated about TheTwoOfUs is a free six-week HIV,” said Vicki. She feels that one should

MAY+JUNE 2013 | POSITIVELYAWARE.COM

group that provides prevention education, therapy, and support for up to five couples at a time. There are no restrictions on sexual orientation or gender identities for this particular group and all are welcome. For those not in Chicago, check with your local AIDS service organization—if they don’t offer such a group, suggest it! And it’s not just sex we should be talking and learning about. Education is key to learning about new drug treatments or the latest advances in research and prevention. Keeping healthy and knowing and understanding everything about HIV empowers couples and strengthens relationships. If something has been working for you within your serodiscordant relationship for years, it doesn’t mean that there aren’t other options. You never know, you could even enhance your sex life!

Eliminate shame

isclosure becomes easier and easier once you are comfortable with who you are. Being confident and knowledgeable in what you are talking about shines through and is self-empowering when “coming out” to someone about your status. And we’ve all been rejected at some point in our lives, for a variety of reasons, so why should being rejected due to HIV hurt any more or less? Doing away with the shame is what helps kill the stigma and fears about HIV. It’s easier said than done. And it may take longer for some than others. Acceptance of your HIV-positive status is key to your health. The mental anguish caused when first learning about your status can affect some for the rest of their lives—it’s a pain that is often deeply rooted in confusion, mistrust, anger, sadness, and shame. But once you learn to accept yourself for who you are, like Jason, Shawn, and Vicki, you can have long, lasting, and loving relationships with just about anyone. David Duran is an

LGBT-focused freelance journalist who frequently contributes to publications such as The Advocate, The Bay Area Reporter, Instinct, and the Huffington Post.

Photo Courtesy of Vicki Reid | DAVID DURAN PHOTO © TROY DEAN PHOTOGRAPHY

“We enjoy trying different condoms, it’s great foreplay.”

Getting Your Groove Back Why women living with HIV deserve sex, love, and happiness By Kellee Terrell

W Photo: iStockPhoto.com

hen Kari Farmer, 33, a Texarkana, Arkansas resident, was diagnosed HIV-positive in 2010, the mother of one was convinced that she was never going to have sex again. “That part of me was dead and I swore I was going to be celibate for the rest of my life,” she says. “I was so afraid that no one would want me or that I could be thrown in jail for having sex, that I said forget about it.” Michelle Anderson, 42, from Dallas, can relate. She remembers isolating herself from men for a long time after learning she was positive in 1999, because of her insecurity around rejection. “It happened so many times from men I liked that it just broke me down and I stopped dating for years.” Farmer’s and Anderson’s feelings about sex aren’t rare for women living with HIV. Whether you are newly diagnosed or a long-term survivor, it’s completely

normal to feel defeated about sex, love, and relationships at some time in your life post-diagnosis. And who can blame you? With societal stigma and biased and unfair criminalization laws, it’s clear that society (and the law) have serious problems with HIV-positive women having sex. Not to mention that with disclosure in romantic relationships may come the serious threat of violence and abuse from the hands of one’s partner. A recent report found that MaY+JUNE 2013

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55 percent of all women living with HIV/ AIDS have experienced domestic violence, which is more than twice the rate of the general population. Also, recent results from the Women’s Interagency HIV Study, the largest ongoing study about HIV-positive women in the United States, found 36 percent experienced abuse that had occurred in the past three months. Perhaps for some positive women, isolating themselves and giving up on sex is an act of resistance against abuse. While these external factors are crucial in understanding the hostile climate that HIV-positive women may live in as they navigate their love and sex lives, Dázon Dixon Diallo, founder and president of SisterLove, Inc. in Atlanta, points out that there are some serious inner emotional factors that many women are dealing with that need to be addressed as well. 21

Once I learned that there were ways to reduce the chance of transmitting the virus to someone else, I soon realized that not having sex wasn’t going to work for me. “Yes, the threat of violence or going to jail for disclosing is definitely on the minds of [most] women living with HIV, but we have to look at self-stigmatizing, issues with desirability, and feelings of being tainted if we want to really address and understand positive women’s barriers and hang-ups.” Anderson can speak to this self-defeating behavior. “I had this voice in my head that would tell me that I was unworthy of love, because of this disease.” Her “aha moment” came from being sick and tired of being isolated and alone. “It wasn’t easy, but I worked on getting past my own stigma to see I deserved love, but most importantly, I needed to have sex, because hello, I am human!” Farmer went through a self-realization process that included educating herself about HIV and her warped attitudes about herself began to change for the better. “Once I learned that there were ways to reduce the chance of transmitting the virus to someone else, I soon realized that not

having sex wasn’t going to work for me,” she laughs. “Sex is an important part of my life”

Let the healing begin

hile it sounds cliché, before you can love someone else, you have to love yourself first. And for Anderson that process began with forgiving herself for becoming positive in the first place. “I had to believe that I didn’t do anything wrong and that HIV could have happened to anyone,” she says. “It took me years to understand that, but once I did, it really helped me get over my own stuff.” But most importantly, Anderson used therapy and counseling to address her own complicated feelings about sex, her past history of sexual abuse, sex work, and drug abuse. “I was molested as a child and never had a healthy attitude about sex and love and so I have struggled with opening myself up for love and being vulnerable,” she says. “I am still a work in progress, but at least I recognize it’s an issue and have been working to change it.” Yet, Anderson brings up an important point that women—regardless of HIV status—can relate to. Many women have been conditioned to believe that sex is “dirty,” masturbation is wrong, and that our bodies are problematic. Coupled with past sexual

abuse, confronting all of these issues and “un-learning” unhealthy attitudes about sex is an important step in healing, says Marsha Jones, the co-founder and executive director of the Dallas-based Afiya Center, an HIV-prevention and reproductive justice organization. Jones works with positive women to tap into their sexuality and develop a more affirming sense of self. Some of the techniques she uses include getting women to masturbate more and play with sex toys at home, as well as encouraging women to have a lot more sex with their partner. One of her favorite exercises is asking participants to walk around naked in their homes. Jones admits that not all women like this exercise, but stresses to them that being able to see yourself in the light is incredibly empowering, and it can also shift the power in the bedroom. “Too many women are having sex in the dark out of shame and they don’t know what is really going on under the sheets. Is he using a condom? How do you know that you are not at risk?” She adds, “But it’s also important to home in on the fact that sex is something women can have control over and have a better sense of the sex they want to be having.” For Cassandra Whitty, 55, diagnosed in 2000, learning more about her sexuality and safer sex post-diagnosis has helped her

All the single ladies! Cassandra Whitty Baton Rouge, LousianA Diagnosis Date: 2000

Advice: In order for someone else to accept your diagnosis, you have to come to grips with being HIV-positive, which means not allowing the virus to take over your life. I found that when I took control of the virus, my life changed for the better.

searching. Get to know yourself and get the therapy you need to deal with what made you vulnerable to being positive in the first place. If you don’t feel worthy, they will see that. Your king is waiting, you just have to open yourself up to being loved and it will happen.

about this disease, I learned that I can have sex—I need to use condoms. I also learned that being undetectable helps reduce the chance of passing the virus to someone else. Knowing the facts helped my attitude about sex.

Jeannie Wraight Kari Farmer

Bronx, New York

Texarkana, Arkansas

Diagnosis Date: 1994

Michelle Anderson

Diagnosis Date: 2011

Dallas, Texas

Advice: You can still have sex! Don’t let anyone tell you different. The more I got educated

Advice: As a woman with HIV, the concept of dating can be very intimidating. The reality is that the feeling of being

Diagnosis Date: 1999

Advice: Do your own soul 22

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‘diseased’ or ‘damaged goods’ and the fear of rejection are all normal for us to experience. But the truth is that we are strong, beautiful women who know how to endure, survive, and flourish. So get flourishing and find yourself someone who will be good to you. Never, ever settle or feel that you have to accept less than what you want or deserve because you have a virus in your body. Know the facts so you can share them with a potential partner when you disclose your status.

Photo:

Positive women offer advice on dating, disclosure, and self-esteem

I have gotten to a place where I still feel pretty, I still feel like a woman. And I know that one day I will get married and give my daughter that little baby sister. be firmer with men about why it’s necessary to use condoms. “Now, I have no issues letting a man know you gotta strap it up or we can use a female condom, but we have to use some type of protection,” says the Baton Rouge, Louisiana resident. “I never did that when I was negative, which is what put me at risk for HIV in the first place. I try to relay these messages to negative women in hopes to help empower them to take more control of their sex lives.” For Farmer, her healing process has included being around other positive people and being involved in HIV/AIDS advocacy has helped affirm her healing. “I have gotten to a place where I still feel pretty, I still feel like a woman,” she says. “And I know that one day I will get married and give my daughter that little baby sister she’s been begging me for.”

Rejection isn’t the only response

es, rejection will rear its

ugly head every now and then, but that is about the other person’s ignorance about the disease, not about who you are. Also keep in mind that rejection won’t happen with every potential partner you meet. You have to put yourself out there once in a while and disclose—only when you are ready, of course—to know for sure. “I’ve learned that not every man is going to turn his back on me, or look at my HIV status as a horrible thing,” says Anderson. “And for the men who have questions, I use it as an opportunity to teach them about HIV. If they don’t want me, that’s their issue.” Anderson is currently in a loving relationship with a man she met five months ago. “I am fully out with my status, so when I met him, I asked him if being positive was a problem and he replied, ‘I don’t feel any different—you are Michelle, and I don’t see you as HIV.’” Anderson, who is a highly visible AIDS

activist, says her boyfriend attends her events and cheers her on. “I have had issues with some men who have wanted me to be less out about my status and I am not going to do that. This boyfriend is so proud of me and the work that I do and actually wants to help educate other people about HIV.” Whitty is also in a loving relationship. Her new beau is a man from her past and their romance was rekindled through Facebook, of all places. Whitty says she couldn’t be happier. “He loves me for me and makes me feel so amazing,” she says. Diallo can also speak to relationship success stories that she has seen from her work with positive women throughout the world. “Just alone at SisterLove, we have seen marriages between positive women and negative men and babies being born and this sends the message that you can still disclose, still be who you are, and still be happy. And that’s not different than anyone else.”

Know your worth

hile acceptance is a wonderful thing, just know that you don’t have to be with every person who accepts your status. Acceptance doesn’t mean the relationship is going to be healthy or good for you. Keep in mind that you have the right to make choices about who you want to be with and you do not have to tolerate disrespect from anyone because you’re afraid that this is the only person who will “love” you. Farmer once had a boyfriend who accepted her status, but his family had serious issues with her. “I learned from that experience, that him accepting me wasn’t enough. He wasn’t strong enough to stick up for me, and I learned that’s really important if you want to be with me.” In the end, being a positive woman and dating can be a tricky and intimidating journey. But when you think about it, that’s love in general because, regardless of HIV status, all couples have ups and downs and worry about money and their kids or infidelity and trust. If anything, always keep in mind that you are more than this virus. You deserve to be treated with respect MaY+JUNE 2013

POSITIVELYAWARE.COM

OK, Cupid? Things to keep in mind before you jump into the online dating world Living in the age of the Internet, it’s totally cool to meet friends and potential partners online or through social media sites. But the key is to be smart and safe about it:

Beware of scammers: Unfortunately, there are a lot of scammers on free online dating sites. If people seem to be too good to be true, most likely they are. Also, don’t give anyone who asks for it your personal and financial information such as your social security number, credit card/debit card numbers, and bank account routing numbers. It happens more often than you think.

Meet in a public place: If you’ve met someone online and they want to meet, great for you! Just make sure you set up a location to meet them in a public place where other people are around. Tell a friend or family member about first meet-ups: There is nothing wrong with giving a friend or a loved one a heads up about an outing you are going on, especially if you are meeting up with someone for the first time.

and cherished for the amazing person that you are. You deserve to be sexual and feel like a woman again. But most important, you deserve to be loved and whatever you do, don’t let anyone make you think otherwise. Kellee Terrell is an awardwinning Chicago-based freelance writer who writes about race, gender, health, and pop culture. Her work has been featured in Essence, The Advocate, The Root, BET.com, and The Huffington Post. She is the former news editor of TheBody.com. 23

ABOUT PREZISTA

PREZISTA® is always taken with and at the same time as ritonavir (Norvir ®), in combination with other HIV medicines for the treatment of HIV infection in adults. PREZISTA® should also be taken with food. • The use of other medicines active against HIV in combination with PREZISTA®/ritonavir (Norvir ®) may increase your ability to fight HIV. Your healthcare professional will work with you to find the right combination of HIV medicines • It is important that you remain under the care of your healthcare professional during treatment with PREZISTA® PREZISTA® does not cure HIV infection or AIDS and you may continue to experience illnesses associated with HIV-1 infection, including opportunistic infections. You should remain under the care of a doctor when using PREZISTA.® Please read Important Safety Information below, and talk to your healthcare professional to learn if PREZISTA® is right for you.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about PREZISTA®? • PREZISTA® can interact with other medicines and cause serious side effects. See “Who should not take PREZISTA®?” • PREZISTA® may cause liver problems. Some people taking PREZISTA,® together with Norvir ® (ritonavir), have developed liver problems which may be life-threatening. Your healthcare professional should do blood tests before and during your combination treatment with PREZISTA.® If you have chronic hepatitis B or C infection, your healthcare professional should check your blood tests more often because you have an increased chance of developing liver problems • Tell your healthcare professional if you have any of these signs and symptoms of liver problems: dark (tea-colored) urine, yellowing of your skin or whites of your eyes, pale-colored stools (bowel movements), nausea, vomiting, pain or tenderness on your right side below your ribs, or loss of appetite • PREZISTA® may cause a severe or life-threatening skin reaction or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. You should call your healthcare professional immediately if you develop a rash. However, stop taking PREZISTA® and ritonavir combination treatment and call your healthcare professional immediately if you develop any skin changes with these symptoms: fever, tiredness, muscle or joint pain, blisters or skin lesions, mouth sores or ulcers, red or inflamed eyes, like “pink eye.” Rash occurred more often in patients taking PREZISTA® and raltegravir together than with either drug separately, but was generally mild Who should not take PREZISTA®? • Do not take PREZISTA® if you are taking the following medicines: alfuzosin (Uroxatral®), dihydroergotamine (D.H.E.45,® Embolex,® Migranal®), ergonovine, ergotamine (Cafergot,® Ergomar ®), methylergonovine, cisapride (Propulsid®), pimozide (Orap®), oral midazolam, triazolam (Halcion®), the herbal supplement St. John’s wort (Hypericum perforatum), lovastatin (Mevacor,® Altoprev,® Advicor ®), simvastatin (Zocor,® Simcor,® Vytorin®), rifampin (Rifadin,® Rifater,®

Rifamate,® Rimactane®), sildenafil (Revatio®) when used to treat pulmonary arterial hypertension, indinavir (Crixivan®), lopinavir/ ritonavir (Kaletra®), saquinavir (Invirase®), boceprevir (Victrelis™), or telaprevir (Incivek™) • Before taking PREZISTA,® tell your healthcare professional if you are taking sildenafil (Viagra,® Revatio®), vardenafil (Levitra,® Staxyn®), tadalafil (Cialis,® Adcirca®), atorvastatin (Lipitor®), rosuvastatin (Crestor®), pravastatin (Pravachol®), or colchicine (Colcrys,® Col-Probenecid®). Tell your healthcare professional if you are taking estrogen-based contraceptives (birth control). PREZISTA® might reduce the effectiveness of estrogen-based contraceptives. You must take additional precautions for birth control, such as condoms This is not a complete list of medicines. Be sure to tell your healthcare professional about all the medicines you are taking or plan to take, including prescription and nonprescription medicines, vitamins, and herbal supplements. What should I tell my doctor before I take PREZISTA®? • Before taking PREZISTA,® tell your healthcare professional if you have any medical conditions, including liver problems (including hepatitis B or C), allergy to sulfa medicines, diabetes, or hemophilia • Tell your healthcare professional if you are pregnant or planning to become pregnant, or are breastfeeding — The effects of PREZISTA® on pregnant women or their unborn babies are not known. You and your healthcare professional will need to decide if taking PREZISTA® is right for you — Do not breastfeed. It is not known if PREZISTA® can be passed to your baby in your breast milk and whether it could harm your baby. Also, mothers with HIV should not breastfeed because HIV can be passed to your baby in the breast milk What are the possible side effects of PREZISTA®? • High blood sugar, diabetes or worsening of diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZISTA® • Changes in body fat have been seen in some patients taking HIV medicines, including PREZISTA.® The cause and long-term health effects of these conditions are not known at this time • Changes in your immune system can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden • The most common side effects related to taking PREZISTA® include diarrhea, nausea, rash, headache, stomach pain, and vomiting. This is not a complete list of all possible side effects. If you experience these or other side effects, talk to your healthcare professional. Do not stop taking PREZISTA® or any other medicines without first talking to your healthcare professional You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please refer to the ritonavir (Norvir®) Product Information (PI and PPI) for additional information on precautionary measures. Please read accompanying Patient Information for PREZISTA® and discuss any questions you have with your doctor.

28PRZDTC0288R8

PREZISTA® (darunavir) is a prescription medicine. It is one treatment option in the class of HIV (human immunodeficiency virus) medicines known as protease inhibitors.

ily

Once-Da

PREZISTA ^ EXPERIENCE

Discover the

Once-Daily PREZISTA® (darunavir) isn’t just an HIV treatment. It’s an HIV treatment experience as unique as you. That’s why you should ask your healthcare professional if the PREZISTA® Experience is right for you. Once-Daily PREZISTA® taken with ritonavir and in combination with other HIV medications can help lower your viral load and keep your HIV under control over the long term. In a clinical study* of almost 4 years (192 weeks), 7 out of 10 adults who had never taken HIV medications before maintained undetectable† viral loads with PREZISTA® plus ritonavir and Truvada.® Ask your healthcare professional about the PREZISTA® Experience. And be sure to visit DiscoverPREZISTA.com for tools and helpful information to find out if the PREZISTA® Experience might be right for you.

Please read the Important Safety Information and Patient Information on adjacent pages.

Snap a quick pic of our logo to show your doctor and get the conversation started. *A randomized open label Phase 3 trial comparing PREZISTA®/ritonavir 800/100 mg once daily (n=343) vs. Kaletra®/ritonavir 800/200 mg/day (n=346). †Undetectable was defined as a viral load of less than 50 copies per mL. Registered trademarks are the property of their respective owners.

Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2013 02/13 K28PRZ121037

IMPORTANT PATIENT INFORMATION PREZISTA (pre-ZIS-ta) (darunavir) Oral Suspension PREZISTA (pre-ZIS-ta) (darunavir) Tablets Read this Patient Information before you start taking PREZISTA and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or your treatment. Also read the Patient Information leaflet for NORVIR® (ritonavir). What is the most important information I should know about PREZISTA? • PREZISTA can interact with other medicines and cause serious side effects. It is important to know the medicines that should not be taken with PREZISTA. See the section “Who should not take PREZISTA?” • PREZISTA may cause liver problems. Some people taking PREZISTA in combination with NORVIR® (ritonavir) have developed liver problems which may be life-threatening. Your healthcare provider should do blood tests before and during your combination treatment with PREZISTA. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems. • Tell your healthcare provider if you have any of the below signs and symptoms of liver problems. • Dark (tea colored) urine • yellowing of your skin or whites of your eyes • pale colored stools (bowel movements) • nausea • vomiting • pain or tenderness on your right side below your ribs • loss of appetite PREZISTA may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. You should call your healthcare provider immediately if you develop a rash. However, stop taking PREZISTA and ritonavir combination treatment and call your healthcare provider immediately if you develop any skin changes with symptoms below: • fever • tiredness • muscle or joint pain • blisters or skin lesions • mouth sores or ulcers • red or inflamed eyes, like “pink eye” (conjunctivitis) Rash occurred more often in people taking PREZISTA and raltegravir together than with either drug separately, but was generally mild. See “What are the possible side effects of PREZISTA?” for more information about side effects. What is PREZISTA? PREZISTA is a prescription anti-HIV medicine used with ritonavir and other anti-HIV medicines to treat adults with human immunodeficiency virus (HIV-1) infection. PREZISTA is a type of anti-HIV medicine called a protease inhibitor. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). When used with other HIV medicines, PREZISTA may help to reduce the amount of HIV in your blood (called “viral load”). PREZISTA may also help to increase the number of white blood cells called CD4 (T) cell which help fight off other infections. Reducing the amount of HIV and increasing the CD4 (T) cell count may improve your immune system. This may reduce your risk of death or infections that can happen when your immune system is weak (opportunistic infections). PREZISTA does not cure HIV infection or AIDS and you may continue to experience illnesses associated with HIV-1 infection, including opportunistic infections. You should remain under the care of a doctor when using PREZISTA. Avoid doing things that can spread HIV-1 infection. • Do not share needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades.

• D o not have any kind of sex without protection. Always practice safe sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people. Who should not take PREZISTA? Do not take PREZISTA with any of the following medicines: • alfuzosin (Uroxatral®) • dihydroergotamine (D.H.E. 45®, Embolex®, Migranal®), ergonovine, ergotamine (Cafergot®, Ergomar®) methylergonovine • cisapride • pimozide (Orap®) • oral midazolam, triazolam (Halcion®) • the herbal supplement St. John’s Wort (Hypericum perforatum) • the cholesterol lowering medicines lovastatin (Mevacor®, Altoprev®, Advicor®) or simvastatin (Zocor®, Simcor®, Vytorin®) • rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®) • sildenafil (Revatio®) only when used for the treatment of pulmonary arterial hypertension. Serious problems can happen if you take any of these medicines with PREZISTA. What should I tell my doctor before I take PREZISTA? PREZISTA may not be right for you. Before taking PREZISTA, tell your healthcare provider if you: • have liver problems, including hepatitis B or hepatitis C • are allergic to sulfa medicines • have high blood sugar (diabetes) • have hemophilia • are pregnant or planning to become pregnant. It is not known if PREZISTA will harm your unborn baby. Pregnancy Registry: You and your healthcare provider will need to decide if taking PREZISTA is right for you. If you take PREZISTA while you are pregnant, talk to your healthcare provider about how you can be included in the Antiretroviral Pregnancy Registry. The purpose of the registry is follow the health of you and your baby. • are breastfeeding or plan to breastfeed. Do not breastfeed. We do not know if PREZISTA can be passed to your baby in your breast milk and whether it could harm your baby. Also, mothers with HIV-1 should not breastfeed because HIV-1 can be passed to the baby in the breast milk. Tell your healthcare provider about all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Using PREZISTA and certain other medicines may affect each other causing serious side effects. PREZISTA may affect the way other medicines work and other medicines may affect how PREZISTA works. Especially tell your healthcare provider if you take: • other medicine to treat HIV • estrogen-based contraceptives (birth control). PREZISTA might reduce the effectiveness of estrogen-based contraceptives. You must take additional precautions for birth control such as a condom. • medicine for your heart such as bepridil, lidocaine (Xylocaine Viscous®), quinidine (Nuedexta®), amiodarone (Pacerone®, Cardarone®), digoxin (Lanoxin®), flecainide (Tambocor®), propafenone (Rythmol®) • warfarin (Coumadin®, Jantoven®) • medicine for seizures such as carbamazepine (Carbatrol®, Equetro®, Tegretol®, Epitol®), phenobarbital, phenytoin (Dilantin®, Phenytek®) • medicine for depression such as trazadone and desipramine (Norpramin®) • clarithromycin (Prevpac®, Biaxin®) • medicine for fungal infections such as ketoconazole (Nizoral®), itraconazole (Sporanox®, Onmel®), voriconazole (VFend®) • colchicine (Colcrys®, Col-Probenecid®) • rifabutin (Mycobutin®) • medicine used to treat blood pressure, a heart attack, heart failure, or to lower pressure in the eye such as metoprolol (Lopressor®, Toprol-XL®), timolol (Cosopt®, Betimol®, Timoptic®, Isatolol®, Combigan®) • midazolam administered by injection • medicine for heart disease such as felodipine (Plendil®), nifedipine (Procardia®, Adalat CC®, Afeditab CR®), nicardipine (Cardene®) • steroids such as dexamethasone, fluticasone (Advair Diskus®, Veramyst®, Flovent®, Flonase®) • bosentan (Tracleer®) • medicine to treat chronic hepatitis C such as boceprevir (VictrelisTM), telaprevir (IncivekTM)

IMPORTANT PATIENT INFORMATION • m edicine for cholesterol such as pravastatin (Pravachol®), atorvastatin (Lipitor®), rosuvastatin (Crestor®) • medicine to prevent organ transplant failure such as cyclosporine (Gengraf®, Sandimmune®, Neoral®), tacrolimus (Prograf®), sirolimus (Rapamune®) • salmeterol (Advair®, Serevent®) • medicine for narcotic withdrawal such as methadone (Methadose®, Dolophine Hydrochloride), buprenorphine (Butrans®, Buprenex®, Subutex®), buprenorphine/naloxone (Suboxone®) • medicine to treat schizophrenia such as risperidone (Risperdal®), thioridazine • medicine to treat erectile dysfunction or pulmonary hypertension such as sildenafil (Viagra®, Revatio®), vardenafil (Levitra®, Staxyn®), tadalafil (Cialis®, Adcirca®) • medicine to treat anxiety, depression or panic disorder such as sertraline (Zoloft®), paroxetine (Paxil®, Pexeva®) • medicine to treat malaria (Coartem®) This is not a complete list of medicines that you should tell your healthcare provider that you are taking. Ask your healthcare provider or pharmacist if you are not sure if your medicine is one that is listed above. Know the medicines you take. Keep a list of them to show your doctor or pharmacist when you get a new medicine. Do not start any new medicines while you are taking PREZISTA without first talking with your healthcare provider. How should I take PREZISTA? • Take PREZISTA every day exactly as prescribed by your healthcare provider. • You must take ritonavir (NORVIR®) at the same time as PREZISTA. • Do not change your dose of PREZISTA or stop treatment without talking to your healthcare provider first. • Take PREZISTA and ritonavir (NORVIR®) with food. • Swallow PREZISTA tablets whole with a drink. If you have difficulty swallowing PREZISTA tablets, PREZISTA oral suspension is also available. Your health care provider will help decide whether PREZISTA tablets or oral suspension is right for you. • PREZISTA oral suspension should be given with the supplied oral dosing syringe. Shake the suspension well before each use. See the Instructions for Use that with PREZISTA oral suspension for information about the right way to prepare and take a dose. • If your prescribed dose of PREZISTA oral suspension is more than 6 mL, you will need to divide the dose. Follow the instructions given to you by your healthcare provider or pharmacist about how to divide the dose. Ask your healthcare provider or pharmacist if you are not sure. • If you take too much PREZISTA, call your healthcare provider or go to the nearest hospital emergency room right away. What should I do if I miss a dose? People who take PREZISTA one time a day: • If you miss a dose of PREZISTA by less than 12 hours, take your missed dose of PREZISTA right away. Then take your next dose of PREZISTA at your regularly scheduled time. • If you miss a dose of PREZISTA by more than 12 hours, wait and then take the next dose of PREZISTA at your regularly scheduled time. People who take PREZISTA two times a day • If you miss a dose of PREZISTA by less than 6 hours, take your missed dose of PREZISTA right away. Then take your next dose of PREZISTA at your regularly scheduled time. • If you miss a dose of PREZISTA by more than 6 hours, wait and then take the next dose of PREZISTA at your regularly scheduled time. If a dose of PREZISTA is skipped, do not double the next dose. Do not take more or less than your prescribed dose of PREZISTA at any one time. What are the possible side effects of PREZISTA? PREZISTA can cause side effects including: • See “What is the most important information I should know about PREZISTA?” • Diabetes and high blood sugar (hyperglycemia). Some people who take protease inhibitors including PREZISTA can get high blood sugar, develop diabetes, or your diabetes can get worse. Tell your healthcare provider if you notice an increase in thirst or urinate often while taking PREZISTA. • Changes in body fat. These changes can happen in people who take antiretroviral therapy. The changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the back, chest, and stomach area. Loss of fat from the legs, arms, and face may also happen. The exact cause and longterm health effects of these conditions are not known.

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Call your healthcare provider right away if you start having new symptoms after starting your HIV medicine. • Increased bleeding for hemophiliacs. Some people with hemophilia have increased bleeding with protease inhibitors including PREZISTA. The most common side effects of PREZISTA include: • diarrhea • headache • nausea • abdominal pain • rash • vomiting Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all of the possible side effects of PREZISTA. For more information, ask your health care provider. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. How should I store PREZISTA? • Store PREZISTA oral suspension and tablets at room temperature [77°F (25°C)]. • Do not refrigerate or freeze PREZISTA oral suspension. • Keep PREZISTA away from high heat. • PREZISTA oral suspension should be stored in the original container. Keep PREZISTA and all medicines out of the reach of children. General information about PREZISTA Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use PREZISTA for a condition for which it was not prescribed. Do not give PREZISTA to other people even if they have the same condition you have. It may harm them. This leaflet summarizes the most important information about PREZISTA. If you would like more information, talk to your healthcare provider. You can ask your healthcare provider or pharmacist for information about PREZISTA that is written for health professionals. For more information, call 1-800-526-7736. What are the ingredients in PREZISTA? Active ingredient: darunavir Inactive ingredients: PREZISTA Oral Suspension: hydroxypropyl cellulose, microcrystalline cellulose, sodium carboxymethylcellulose, methylparaben sodium, citric acid monohydrate, sucralose, masking flavor, strawberry cream flavor, hydrochloric acid (for pH adjustment), purified water. PREZISTA 75 mg and 150 mg Tablets: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose. The film coating contains: OPADRY® White (polyethylene glycol 3350, polyvinyl alcohol-partially hydrolyzed, talc, titanium dioxide). PREZISTA 400 mg and 600 mg Tablets: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose. The film coating contains: OPADRY® Orange (FD&C Yellow No. 6, polyethylene glycol 3350, polyvinyl alcohol-partially hydrolyzed, talc, titanium dioxide). PREZISTA 800 mg Tablets: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose, hypromellose. The film coating contains: OPADRY® Dark Red (iron oxide red, polyethylene glycol 3350, polyvinyl alcohol-partially hydrolyzed, talc, titanium dioxide). This Patient Information has been approved by the U.S Food and Drug Administration. Manufactured by: PREZISTA Oral Suspension PREZISTA Tablets Janssen Pharmaceutica, N.V. Janssen Ortho LLC, Beerse, Belgium Gurabo, PR 00778 Manufactured for: Janssen Therapeutics, Division of Janssen Products, LP, Titusville NJ 08560 Revised: February 2013 NORVIR® is a registered trademark of its respective owner. PREZISTA® is a registered trademark of Janssen Pharmaceuticals © Janssen Pharmaceuticals, Inc. 2006 990754P

Better

Safer than Sorry What is safer sex?

n ex of mine once told me that as soon as boys figure out that they can get hard-ons, they start thinking about interesting places to put them. The vast array of human sexual behavior would seem to prove that to be true.

As unrealistic as it is, many would tell you that the only truly safe sex is no sex at all. But in case you count yourself among those who embrace all the beauties of being sexually active in the 21st century, there are things you can do to decrease your risk of getting HIV or passing it on. And for those who have already missed that boat, other sexually transmitted infections (STIs), as well as becoming a parent when you don’t want to be one or can’t do it well, can also be avoided by knowing what the risks are. Excluded from this is the risk of transmission from sharing needles for injection drug use—sex is the focus here. And for the purposes of this article, I’m going to presume that at least one partner involved is HIV-positive, though

much may be informative for HIV-negative folks who want to prevent HIV, other STIs, pregnancy, or don’t know the HIV status of partners. HIV is transmitted through blood, semen (cum), vaginal fluid, and breast milk. It is not transmitted through saliva, sweat, or tears. The virus itself is ironically fragile—it doesn’t live long outside the body and can’t survive digestive juices. It must get into your blood stream in order for it to begin its nefarious life cycle. Therefore, if your HIV-positive partner’s cum gets on the sheet and you accidentally roll over onto it, unless you have a deep, bleeding wound that comes in contact with it, you are not at risk. However, if you’re giving an HIVpositive man a blow job without a condom,

MAY+JUNE 2013

POSITIVELYAWARE.COM

have bleeding gums or open sores in your mouth, and his cum makes contact with those gums or sores, your risk increases. While most of the preventive measures mentioned here involve something other than what comes with or occurs in your body, there are some natural interventions such as the famous “withdrawal” method (pulling out just before cumming inside an orifice), cumming outside an orifice without ever penetrating (as in mutual masturbation—see “Safest”), and seroadaptive methods like sero-positioning (the practice of HIV-negative partners being the top [insertive] rather than the bottom [receptive] with partners who are positive or whose HIV status is unknown), and serosorting (choosing sexual partners who have the same HIV status). Of course, condom use increases the preventive effects of almost all of these methods. While we can’t begin to cover every possible scenario in the variety of ways we celebrate sexuality, the following are some

Photo: iSTOCKPHOTO.COM

By Sue Saltmarsh

Male-to-female vaginal sex without a condom. If the man is HIV-positive, the woman is at risk for the full range of possible dangers: HIV, STIs, HPV, and pregnancy. If she’s the positive partner, he is at risk for it all too, though a lower risk for HIV.

Somewhat safer

Oral sex without a condom or barrier— though HIV can’t survive stomach acid, there is risk for HIV if cum from a positive partner gets into a cut or sore in the mouth or gums, though if the HIV-positive partner’s viral load is undetectable the risk is almost nonexistent. There is risk for other STIs, however, including gonorrhea, syphilis, and herpes.

Safer

Condoms, condoms, condoms—for

basic activities that will hopefully help you know your risk and choose your actions wisely before the heat of passion (or lust) melts the wisdom away.

Unsafe

Anal sex without a condom, no matter what sex or sexual orientation the partners are—this is the least safe, though riskier for the receptive (bottom) partner than the penetrating (top) one. The only thing you’re not at risk for with ass action is pregnancy. Even if both partners are HIV-positive, anal sex without a condom carries the risk of getting other STIs, as well as becoming infected with multiple strains of HIV. There’s evidence that this rarely occurs for HIV-positive people who are adherently on ART (antiretroviral therapy), but why pile on? Many couples who are both HIVpositive choose not to use condoms and of course, it’s a choice everyone must make at some point. Just know the facts so your decision is informed.

men or women, colored or not, textured or smooth, the fact is that the risk of contracting HIV is 80% less with a properly used condom. Condoms are also highly effective at preventing other STIs, HPV, and pregnancy, so use them! Obviously, there are always going to be people who just won’t even consider condoms. And it is admittedly a policy of most sex-positive organizations (including this one) never to be judgmental about people’s choices. But just let me say this from my personal perspective—before you start complaining about how it doesn’t feel as good, ask yourself if you’re willing to risk your health and possible quality of life for a few minutes of physical gratification. HIV may not be a death sentence anymore, but it’s not a walk in the park either. Neither are other STIs or figuring out what to do about an unwanted pregnancy. Instead, try getting creative! Use your hands, some toys, find all your partner’s erogenous zones and help him or her find yours before it’s time to roll the condom on (or insert the female one). If you’re both worked up to the moment, chances are the latex (or polyurethane or sheepskin) won’t prevent an orgasm! Oral sex with a condom or barrier. The feel and taste of latex (or whatever) may be a bit of a buzz kill, but it does protect you both. You can always try flavored condoms or add some jelly, chocolate sauce, or some other food substance to the latex-covered MaY+JUNE 2013

POSITIVELYAWARE.COM

man or lady parts to improve your taste experience! Male-to-female vaginal sex with a condom. Though of course this carries with it the classic “broken condom” possibility. If you use lube with the condom (remember: water- or silicone-based lube—no Vaseline or petroleum products!), are careful when taking it off after the big O, and dispose of it properly, risk is low. Anal sex with a condom. No matter the sex or sexual orientation of the partners, if you’re going to have anal sex, this is one of the safest ways (also see the section on PrEP). Again, use plenty of condomcompatible lube, be sure to leave enough room at the tip of a male condom to cut down the risk of breakage, be careful when removing it, dispose of it properly, and don’t ever try to reuse a condom. Besides the risk of tearing, breaking, and exposure to cum, come on, that’s just gross. Again, consistent, correct use is the key.

Safest

Sex toys—and you don’t even need a partner! Though using sex toys together can be fun. Just make sure they’re cleaned after every use. And don’t use a plug-in in the bathtub, duh. Mutual masturbation. No matter your sex or that of your partner, give each other a hand. Or some fingers and don’t forget the lube! If there are open wounds and one of you is positive, use those sexy surgical gloves. Non-penetrative S&M, B&D, role-playing, and fetish activity. Perhaps there’s some level of other risks, but as long as the body fluid vectors are not exchanged, go ahead and spank, bind, suck some toes, or whatever floats both your boats. Just make sure both (all) of you are willing participants and respect the safeword! Rimming. Though safe in terms of HIV, other risks are involved for the one doing the rimming, namely parasites and hepatitis. And sorry, but enemas of various kinds or just being “super clean” won’t take care of the microscopic eggs of parasites, not to mention bacteria like E. coli. Being the receptive partner carries the risk of herpes and warts. Golden Showers. There’s no risk of pregnancy, but fungal, bacterial, and viral 29

infections can all be transmitted through urine whenever you’re the one being peed on or if there’s other kinds of exposure. The biggest concern is hepatitis B which can be transmitted through urine even if no symptoms are showing. Cytomegalovirus (CMV), genital herpes, Chlamydia, and gonorrhea may be transmitted, either through ingestion or exposure to open wounds. There are no known incidents of HIV transmission through golden showers, though the virus can be found in urine, so it’s theoretically possible. Fingering. Inserting fingers in the asshole or vagina is safe for HIV as long as there are no open cuts or cum near them. You can use gloves or little “finger condoms” called cots and keep unwashed fingers away from your mouth or your own orifices to prevent parasites and hepatitis. For the receptive partner, as long as the inserted fingers don’t have sharp or jagged nails and haven’t been in someone else’s orifices or cum, being fingered is safe. Fisting. The insertion of any large object in the rectum is not risky for HIV, but it can be seriously dangerous due to the easiness with which the colon’s walls can be torn or scratched with a sharp edge of any kind (and don’t get me started on gerbils). All sorts of trouble can ensue, including internal bleeding, bacterial infection, even peritonitis (poisoning of the system). If you feel any sharp pain, fever, weakness, or bleeding after fisting it’s best to go to an emergency room immediately, embarrassment be damned! And, though there are conflicting views on this—most doctors say no, the personal experiences of some people say yes—it seems possible that frequently stretching the sphincter enough to take an arm or horse-sized dildo could cause the muscles to loosen, which could lead to incontinence problems. Just sayin’…

Not yet

Though research is constantly under-

Something to call your elected representatives about!

Unrealistic

Abstinence. Sure, go ahead and try it. See The Book of Mormon, listen to CNN, or follow the antics of April on Grey’s Anatomy to see how it’s working for Mormons, priests, and “virgins.” But keep the condoms in the nightstand just in case. You’re only human and humans were designed to enjoy sex, despite what repressive theology says, so don’t place unrealistic restrictions on yourself.

If you’re already HIV-positive

It’s a fact that research has proven—if you are on antiretroviral treatment, are taking your meds every day as your doctor directs, and your viral load is suppressed to an undetectable level, you are significantly less likely (96% less likely, in fact, for the straight couples in the HPTN 052 study) to transmit the virus to your partner. If you’re also using condoms correctly and consistently, and/or your partner is on PrEP, your risk is negligible. This does not mean that if your viral load is undetectable, you can bareback your way through the bathhouse with no chance of infecting someone. The same kind of study that found treatment preventive for straight couples has yet to be done with gay men, though it’s thought that the level of protection is high. It’s one thing for two (or more) people to decide not to use a condom if they all know and accept the risks, but it’s another to perpetuate misconceptions. If a potential partner is under the impression that your undetectable viral load makes condoms unnecessary, make sure they understand the facts before proceeding. Use your head (the one on your shoulders), and be proud of yourself for taking care of you and everyone you have sex with. Every infection that’s prevented is one less that’s perpetuating the epidemic.

way, so far there are no viable vaccines, gene therapies, or microbicides available to anyone outside of clinical trials. We can only hope that the sequester and other funding cuts to medical research don’t slow down or even stop this crucial research.

Though approved by the FDA in 2012, doctors have been prescribing Truvada off label for years to prevent HIV-negative people from getting infected, something

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PrEP

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that’s especially relevant to serodiscordant couples. But here’s the thing: In order for it to be as effective as it can be you have to take that pill every day. Every day. Without fail. Just as HIV-positive people must take their meds as directed every day if they want their treatment to work and just as using a condom every time if you want to prevent infections or pregnancy, PrEP requires commitment. Though there is currently research being conducted on the possibility of being able to take Truvada for PrEP less often, it has not been proven. And even if you can be adherent, guidelines say you should use a condom anyway. Even though your partner had an undetectable viral load the last time they had blood work done, you don’t know if he or she still does. And of course, PrEP doesn’t protect against pregnancy or other STIs.

Play safe

We’ve all had experiences when we knew we dodged a bullet and we have the opportunity to learn from those “phew” moments. What’s true for unwanted pregnancy is also true for HIV—it only takes once and you’ll have to deal with the consequences for the rest of your life. Also true for both: the best choice is to prevent it from happening in the first place. All in all, whether you believe sex is an evil perpetrated by that vixen Eve, an evolutionary imperative that has guaranteed the survival of the human race, or a way to celebrate the mere fact of being alive, there have always been “cons” intertwined with the “pros,” no matter if you’re straight, gay, lesbian, bi, or whatever. And let’s face it, risk can sometimes spice it up, though in your teenage days, the danger involved in your parents catching you indulging in some “playtime” with the kid next door was a lot less traumatic, and costly, than finding out you have HIV. So give yourself the right and the power to enjoy sex in whatever ways you like it, but also let yourself discover ways to keep yourself and your partner(s) safe. Whether your preference is rough or romantic, monogamous or multiple, sweaty or sweet, it can all be fun!

Critical Conversations Sex and the doctor-patient relationship By Lisa Fitzpatrick, MD, MPH

Photo: ISTOCKPHOTO.COM

doctor has seen you naked. A doctor has given you a breast, testicle, or rectal exam. A doctor knows the location of your most discrete tattoos. A doctor knows how regularly you poop. A doctor knows your home address and Social Security number. If doctors know some of the most intimate details about patients, why do we fail to have critical conversations about sex? Over the years, many of my colleagues have shared their awkwardness and feelings of embarrassment when discussing sexuality with patients. Similarly, most patients do not voluntarily discuss sexual behavior and are shocked when I inquire about their sexual habits. The shock is not due to shame or embarrassment but genuine surprise because no one has ever asked them. These conversations about sex are imperative, particularly if we hope

to end the HIV epidemic in our lifetime. Conversations about sex and behavior are critical because they are a sacred time of education, sharing, and ultimately healing. They are critical because they destroy barriers between patients and providers—if you can talk to your doctor about sex, you can talk about anything. A recent patient encounter highlights why both patients and providers must change our ways and learn to openly discuss this sensitive topic. MaY+JUNE 2013

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Unwelcome surprise

few weeks ago, I saw a 21-year-old, newly diagnosed, HIV-positive man. He was stunned by his diagnosis because of his consistent condom usage and habit of serial HIV testing. He said his HIV test three months prior to his positive test was negative. He exclaimed in sadness and frustration, “This wasn’t supposed to happen to me! I am always careful!” I sat with him in silence for a minute or two watching him as tears rolled down his face. He wanted to dwell on how he had become infected. I asked him to tell me his biggest concerns and fears about being HIV-positive. His biggest fear was the need to disclose his status to his girlfriend. He said it would break her heart and she would think he gave it to her. I asked how he knew she hadn’t given it to him. He paused and said, “I didn’t get it from her. I think I know who gave it to me.” I asked again how he knew. He hesitated and looked at me as if to discern whether or not he wanted to give me the information I was seeking. He took a breath and began relating his sexual encounter, but I noticed his responses became gender neutral—he substituted “they” for “he” or “she.” At this point, my intuition led me to believe we had developed rapport and it was safe for me to impose my speculations 31

What are the risks? 2,000x

The relative risks of someone HIV-positive transmitting the virus, according to sexual acitivity and condom use. For example, insertive oral sex with a condom has a low risk for HIV transmission. However, receptive anal sex without a condom is 2,000 times riskier.

with condom

these symptoms and his casual sexual encounter. I explained why it was important for his girlfriend to get tested because he admitted they had been sexually active since his casual encounter. Finally, I showed him the chart shown in Figure 1 and asked if he knew receptive anal sex was the highest risk behavior for contracting HIV. He didn’t. This was a critical conversation for both of us. It is a conversation that is all too often omitted from the doctor-patient relationship. This patient encounter led to us both learning a few lessons and there were some reminders for me.

without condom

Ask the questions

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Source: Centers for disease control and prevention

irst, patients rarely, if ever, voluntarily share intimate details about sex. Most will do so upon prompting. 400x Patients confide in health care providers daily about many things, but details 260x and preferences about 200x sexual partners and activities will often be omitted. 100x Sometimes diagnosing a condition is like detective 40x 20x 20x 13x 10x 2x 1 work. If all the clues are not available, a doctor will reach Insertive receptive Insertive receptive Insertive receptive the wrong conclusion or ORal Sex Vaginal Sex Anal Sex prescribe the wrong treatment. Both patients and providers must become diliso I asked directly, “Did he use a condom?” condom just before he came. As he relived gent about openly discussing sexual inforHe said they had. I then asked if he was the the moment he began to cry and repeated mation because it leads to effective patient receiver or the giver. He looked puzzled over and over that “this wasn’t supposed education and, in many cases, prevention. but nodded his head. I could tell he didn’t to happen to him.” I let him cry. After a This open discussion takes practice, but it know what I meant so I asked, “Were you few moments, I asked him if he had ever can’t and shouldn’t be avoided. the top or the bottom?” He said, “Bottom.” heard of acute HIV infection, the period Second, patient and provider commuHe didn’t appear embarrassed or uncombetween being exposed to HIV and having nication is too often like ships passing in fortable and I continued. I asked if he was a positive test. He hadn’t. We talked about the night. Each makes assumptions about able to see what was happening the entire this and I explained the symptoms. He what the other knows and believes and time and he shared his suspicions that recalled having a “cold” several weeks prethese misunderstandings may go on for the casual male partner had removed the viously but made no connection between many visits. This most often happens when

Open and honest communication about difficult topics is the responsibility of both the patient and the provider.

a provider is explaining health information and the patient nods in agreement just as my patient did, appearing to understand the information despite confusion about what is being said. Patients should always remember to stop the provider and ask to have the information shared in a different way. If a provider doesn’t remember to speak in laymen’s language, it is okay to interrupt and ask for clarification. Third, providers must become comfortable and proficient asking for details about sexual history. For many, this conversation is uncomfortable. However, this is not an excuse for failing to obtain necessary information. Asking patients about sexual habits in a non-judgmental way is the key to

obtaining honest information. For patients with providers who never ask about sexual history, assist by volunteering the information and consider asking your health care provider why this information is never discussed. Open and honest communication about difficult topics is the responsibility of both the patient and the provider. It is unclear to me why health care providers don’t feel comfortable taking a sexual history and talking about sex with patients. Sex is a natural desire and part of almost everyone’s life in one way or another. We are bombarded with sex in the media and patients often request prescriptions for medications like Viagra

and Cialis regularly. Yet we are reluctant to discuss the same topics we are confronted with on a daily basis. Many people are now talking about the end of the HIV epidemic. I believe we have the vision and probably even the resources to end the epidemic. However, I don’t believe it’s near. Despite all the advances in treatment and prevention, there is still a need to remind health care providers, some of our greatest allies, not to shy away from these critical conversations. It’s time to for us all to be better and bolder. Let’s talk about sex. It will certainly move us toward the epidemic’s end and it could very well save a life.

Dr. Lisa Fitzpatrick is an infectious diseases physician and CDC-trained medical epidemiologist. She is Medical Director of the Infectious Diseases Center of Care at the United Medical Center in Washington, DC. She is also an adjunct faculty member at the George Washington School of Public Health and the Howard University School of Medicine and a guest blogger for the Huffington Post. She earned a BA/MD at the University of Missouri-Kansas City and a Masters in Public Health from the University of California-Berkeley School of Public Health.

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VIE DE FRANCE An interview with David France, director and producer of How to Survive a Plague By Jeff Berry

MAY+JUNE 2013

| POSITIVELYAWARE.COM

ust a few short days following the Academy Awards show this past February I had the opportunity to chat with David France, director/producer of the Oscar-nominated documentary How to Survive a Plague. France, a former Newsweek senior editor and current contributing editor for New York magazine, is also the author of three books including Our Fathers, an investigation of the sexual abuse crisis in the Catholic Church. During the interview we talked about what it was like living in New York during the period in which the film takes place, some new projects he has in the works, and how he somehow managed to survive the same high school that we both attended while growing up gay.

Jeff Berry: Thank you so much for

taking the time to talk with us, I know it’s been a whirlwind week for you. David France: That’s to say the least,

it’s been crazy! First of all, congratulations on HTSAP’s Academy Award nomination for Best Documentary and for all the other recognition and acclaim that it has received. I think there are many out there, myself included, who feel that even though you didn’t technically win an Oscar, you’ve already won in so many other ways. What has this experience been like for you?

Well, you know, when I started the project back in 2008, there were many people that felt we weren’t ready to go back and relive those early years and who said I’d have trouble finding an audience for the story. And I just didn’t think that was true. I felt that people misunderstood the story of the plague years in America as a story of victimhood and hadn’t really seen the historic response and empowerment, and triumph that we saw alongside the tragedy. So when we finished the film and we got accepted into Sundance, I knew that we were on to something that could really be a powerful redefining of our history and that the film could be a tool to share that

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When I look back at it, it was not just a will to live, it was a will to live a certain sort

How did the movie first come about? Did you already plan to make a film about the topic and then find the footage or were you already aware that that the tapes existed before you decided to make a documentary? I was on the ground as a young journalist in the early days of AIDS. I was the first journalist to write about ACT UP and so I remembered these activists were an unusual early example of a community of people creating their own video history. I knew there was an archive of some of those tapes at the New York Public Library, so I went to those tapes to try to refresh my memory about those years to enhance the notes that I took, and I saw the beauty and the intimacy and the immediacy in that old footage. I thought it might be possible to find enough of it to be able to tell this epic, nine-year story of those years from 1987–1996 through that footage alone, and that’s what set me on the path to doing the documentary. It sounds like the process must have been incredibly complex—I understand you had a “Wanted” wall where you posted up the faces of people who were in the various video tapes to help you keep track of them all, because so many people appeared in so many different tapes. 36

People went through so many New York phases, the styles changed, hairlines changed, eyeglasses changed. As people got sicker, their entire countenance changed, so they became harder to discover, but we were able to piece it together with this progression of photographs that we found and to build that wall, that “Wanted” wall for our staff who were just sifting and sifting through all this old footage trying to find our people. Garance Franke-Ruta, one of the people in the documentary, she first appears in the documentary at age 16, and even in this crowd she was kind of an extreme fashion plate, so from one year to the next as she changed styles and grew older, she became kind of a challenge for us to keep track ofin the footage, but we managed [laughs]. You lived in New York City, in the East Village at the time. Can you talk a little bit about what that was like, being there, as a spectator? I began my career in journalism in response to the epidemic—it was what I felt I could do back in 1981, 1982. I could ask questions and see if I could share the answers with the audience that desperately needed them. And so that’s what brought me into ACT UP in 1987 and then I saw, for the first time, members of our community who were trying to climb into the halls of science and understand what was going on there. And it was all in the service of saving lives. At the beginnings of the meetings, after welcoming everyone, the first reports were what they called “life-saving reports” and anyone who had information that was lifesaving could speak. After a while, the first piece of business became obituaries and the recitation on this Monday of all the people who’d died since last Monday. And then, the life-saving information to try to keep people alive until next Monday. There was never a moment they forgot in that room what the stakes were, but that didn’t mean it was a somber room. It was full of hilarity and love and commitment and savvy and life at a time when life was so precious. What did you learn or discover during the making of the film that maybe you didn’t MAY+JUNE 2013

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Tour de france: with peter staley (far right) in bergen, norway to attend the bergen film festival.

know beforehand that was the most meaningful or memorable, that stands out the most for you? I think the sense of community is something that I may not have recognized right then, the sense of the organization’s ability to inspire a kind of community love—but also to require individuals to love themselves, to reinforce that. “You have to want to live and we are going to make you want to live, and we’re going to do what we have to do to help you get there.” That was inspiring for people who were positive as much as it was for people who were negative. We all had a responsibility to life, individually, for ourselves, and for the community. When I look back at it, it was not just a will to live, it was a will to live a certain sort of brilliant life.

history, not just for us who were there but for younger lesbian and gay people who we know are very hungry for history of their community and for everybody in America. This is the story of the America we all inherited thanks to the work that gay people did back then—gay men, lesbians, and their allies—when no one else was doing anything. And then we got nominated for an Oscar. You only dream of something like that. I thought, “People see it, people are starting to see it. They’re starting to see the contribution—the incredible and profound contribution—that AIDS gave occasion to.” We have, in fact, a large number of heroes from that period, most of them gay, and many of them included in the story of How to Survive a Plague, and what they left behind is a real legacy for all America.

of brilliant life. to New York in my belief that I needed to find a way to live as a gay man. I went to college in Michigan and got to New York minutes after graduation. And immediately after having found my freedom in 1981 came the first reports of AIDS, and I knew that survival was going to be more difficult than I thought. You know, at the time I was studying philosophy in New York and I left that to do this investigation around AIDS and I’m still investigating AIDS, so it’s probably the mission of my career or even of my life, to understand that thoroughly, to understand our community thoroughly. I have to mention the recent loss of Spencer Cox who was featured in the film and passed away in December, that’s starting to shed some light on the fact that surviving AIDS does not come without a price to pay for many who are now either burnt out or have lost direction or continue to struggle with their own demons. Have you thought of any ways we can address those issues—or is that even possible?

Not to change the subject, but what’s it been like the last couple weeks, seeing your work embraced by other members of the film industry? I imagine you’ve made a few new friends? [laughs] I did. Who knows if these friendships will last, but every few nights I was hanging out with Sally Field, and I like to think that she’ll be a lifelong friend. I met her at an awards ceremony in New York and her son brought her over to me, you know she has a gay son. He brought her over—and he’s really adorable—and he wanted to introduce her to me and tell her again that she had to see the film. He had seen it and was a fan of it and it was important to him for her to see it and she hadn’t yet. So she was able to report to me, as our progression through the

awards circuit went on, that he had indeed convinced her to see it and she now understood why it meant so much to him. A lot of your reporting and writing over the years has focused on the topic of HIV/AIDS and you’ve talked about gay rights, including the article in New York magazine on the rise and fall of HIV physician Gabriel Torres, and the great piece on HIV and aging that you did. Was that a conscious decision on your part, or were you kind of the go-to guy when they wanted a story on the topic? From the get-go did you know that was what you wanted to do, coming out of Forest Hills [Northern High School in Grand Rapids, Michigan]? Coming out of Forest Hills I remember having a desire to survive, so I slowly crawled MaY+JUNE 2013

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It’s certainly possible and, as a journalist, I’m not so good at the mental health stuff, but the one thing I can do—and I think this is very important—is to validate a past through a campaign to tell the story and share the stories. Validation is, I think, an essential part for those of us who survived those years to begin building a bridge between our present and our past and keeping that connected and fluent. I think that will certainly help. My story about Dr. Torres is what made me realize that I had to go back to that time and try to analyze it and find meaning—if possible—in the plague. In the course of my reporting on Dr. Torres, the person whose comments turned me in that direction was Spencer Cox. Spencer understood it. He understood that we had to heal ourselves in the present in relationship to our past. He’d always been, for 25 years he’d been one of the smartest people I know [who knew] about every part of our condition and our journey, and he knew even then in 2008 that some of us, most of us, carry a heavy burden as a result of our survival. But knowing that and being able to find your way through that tunnel is another matter. >>> 37

AIDS hit a community of completely disenfranchised individuals, in an almost backwards time in America, and that was only 30 years ago.

undertook and ultimately the work that is shared by people outside the community joining hands with the activists changed America. That’s what I want to talk about in my book.

The thing about Spencer is: he died of AIDS, and this is what AIDS looks like today for people who have long-term infections. It’s still a plague. We still have 18,000 people dying every year of AIDS in America. The pills are not a cure. And unless we keep talking about it and keep organizing around it, keep the conversation in the minds of Americans, we’re not going to vanquish any of this stuff.

won’t revisit it until after we finish this to see whether or not there’s still a way to do a feature film. But the subject itself is worthy of many feature films and maybe others will get there.

I just saw a post on Facebook that you’ve talked to ABC television about a project?

Oh, absolutely! This is “event” television, that’s what we’re working on. We’re going to reach so many millions of people, more than an Argo or Zero Dark Thirty or any Hollywood historical drama can touch. We’re going to talk about something enormous and we’re going to talk about it to a huge number of people.

So you did see our news. We are doing a remake of the film as a scripted miniseries for ABC television. This is actually the way that I hoped we could go forward, and luckily we found ABC was really, really interested in revisiting it. It’s commitment to the miniseries—you know, they are the one who brought us Roots, which was such a defining miniseries in my youth—I thought, there’s got to be a modern way to go back and do this. And bring this to a huge audience, the story of AIDS, and AIDS activism, and the gay community’s empowering response to it.

Talk about keeping HIV/AIDS at the forefront as a topic of discussion, I imagine there’s going to be a lot of water cooler discussions.

So you’re going to be basically using some of the same characters? Yeah, you know, How to Survive a Plague is a documentary, it focuses on a very small group of people in New York and the story is much larger than that and much deeper than that, but it will still be an ensemble piece.

That’s so amazing, it’s kind of a continuation of the whole reason you did the documentary in the first place, I imagine.

So you’re going to be writing the teleplay?

What I’d love to do with this piece of it—and this is sort of a continuation of that project—is to make sure the world knows what happened in the AIDS crisis, and how it happened. AIDS hit a community of completely disenfranchised individuals, in an almost backwards time in America, and that was only 30 years ago.

OK, well, best of luck to you. So I also understand you’re working on a book on the history of HIV/AIDS, due out next year—want to talk a little about that?

Have there been any discussions about making a feature film based on the documentary? I think that would be amazing! I have held that conversation off and we 38

Yeah, I’m producing and I’ll be writing it.

What I’m trying to do there is pick up where Randy Shilts left off. Randy’s last chapter of And the Band Played On takes place in 1985. So he told an epic story about the first four years of the plague, before ACT UP activism and before there was any positive development. And it leaves you off at one of the worst times in that history. The work that the community MAY+JUNE 2013

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Where can people see the film? It’s on Amazon.com and Netflix, right? Anyplace they want! It’s on all the streaming platforms, it’s out on DVD, and if you want your local theatre to play it, we are organizing theatrical screenings through Gathr—and it’s worth it. I believe you should see the film in a theatre, because it really is a cinematic experience. I saw it when it was in Chicago, and was blown away when Larry Kramer erupted and screamed, “PLAGUE!” It was all I could do to hold it together because I was just going to break down. Very powerful. I couldn’t believe we found that tape. Yeah, I know. That was a pivotal moment. But there were [other] parts that were funny and thrilling—anyway, I’m sure you’ve heard all this before, so I really appreciate you taking the time to talk to me. Peter [Staley] had one of the most wonderful experiences with the film. He traveled on World AIDS Day to San Francisco—we all dispatched around the country—and he showed it to a sold-out crowd at the Castro [Theatre]—it’s a 1,500-seat theatre, you know, and they turned away hundreds. San Franciscans watch films there like they did in the old Times Square theatres. There’s a lot of talking back to the movie and the room was just erupting in response to the film. Then he got to take the stage afterwards and kind of received that energy. I’m still jealous. It sounds like he really enjoyed that. He did, I don’t know if you’ve heard anything about the screening but when the applause died down, people got back in their seats and he said, with a very straight face. “If I can’t get laid in this town tonight…”

CROI 2013 UPDATE By Enid Vázquez and Jeff Berry

Lose the nukes, keep the efficacy

The new tenofovir

The benefits of using the oldest class of HIV drugs on the market, the nucleoside reverse transcriptase inhibitors (NRTIs, or nukes for short), have been questioned for some time due to side effects and toxicities. Examples of the nuke drug class include AZT (zidovudine) and Truvada (a dual nuke combo of emtricitabine and tenofovir DF). Can people with HIV say goodbye to the old drugs and just stick to the new powerful ones? New research says yes.

There were continuing good results seen with the new investigational version of tenofovir, tenofovir alafenamide (TAF). TAF was compared to tenofovir disoproxil fumarate (TDF), currently on the market under the brand name Viread (also found in Truvada, Atripla, Complera, and Stribild). Although TDF is tolerable, it is known for its potential to negatively affect kidney function and bone mineral density. Because tenofovir is not bioavailable (easily used by the body), its pro-drugs TAF and TDF allow the body to absorb the medication. In 24-week data from a small study comparing TAF and TDF, using two single tablet regimens consisting of one form of tenofovir or the other along with elvitegravir/cobicistat/emtricitabine, TAF showed similar efficacy but statistically significant improvement in renal and bone safety profile compared with TDF (used in the study as Stribild). With TAF, there is a 90% lower circulating blood level of tenofovir than is seen with TDF (a good thing), but a higher level, by 10 times, of active compound in the cells (where it needs to be), making it both safer and more effective. Presenter Andrew Zolopa, MD, of Stanford University, said TAF selects for more cells than TDF does, and that its smaller dose (25 mg vs. 300 mg for TDF) also makes it safer, as well as easier to combine with other drugs. This study used 10 mg of TAF because it was studied in a co-formulated pill that included the blood level booster cobicistat, which increases TAF levels 2.2 fold, matching the potency of 25 mg of TAF by itself. Elvitegravir is an integrase inhibitor (the same drug class as Isentress) that is not available on its own, but is commercially available in Stribild.

Treatment guidelines recommend regimens consisting of drugs from different classes that target HIV in different ways. NRTIs (typically two) have acted as “backbones” for these regimens, with at least one other drug from a different class acting as the “base.” The ACTG (AIDS Clinical Trials Group) OPTIONS study showed that for people with experience with drugs from three classes and/or viral drug resistance, it was safe to omit a nuke backbone if an active regimen (without drug resistance for the individual) of at least two drugs could be constructed. In the study, these individuals did just as well without nukes at 48 weeks as those who also added nukes to their new therapy. Presenter Karen T. Tashima, MD, of Miriam Hospital in Providence, Rhode Island, said in a press conference, “Providers are used to these older drugs, but we’ve shown we don’t need them.” CROI Vice-Chair Scott Hammer, MD, of Columbia University, who led the press conference, said, “This is part of the improvement seen from fewer pills and better drugs.” More than half of the people who used a new regimen without nukes took Isentress, Intelence, and Prezista boosted with a small dose of Norvir. The other drugs used to construct new regimens (leaving out the nukes) were Fuzeon, Selzentry, and boosted Aptivus (used with a small dose of Norvir). All participants took three or four drugs, even those not taking nukes. It is common for subsequent regimens to get more complicated, which is one of the reasons why the first regimen should be taken as correctly as possible

(all pills, on time, with or without food, etc.). When efficacy is shown, the benefits of reduced cost and pill burden, not to mention the reduction in side effects, from dropping the nukes are obvious. In fact, there were no deaths in the non-nuke group but six in the nuke one, with one (from renal failure) that could not be ruled out as resulting from therapy. All of the participants in the study were changing their treatment due to virologic failure (inability to reach undetectable viral loads of less than 50 copies per mL) with their antiviral therapy. At 48 weeks, 64% of those who omitted nukes from their new regimen had a viral load of less than 50 (106 out of 165 individuals), compared to 66% of those whose new therapy included nukes (112 out of 169 persons). According to the team’s research abstract, “Guideline panels and clinicians should consider these results when recommending regimens for treatment-experienced patients.” Joel Gallant, MD, of Johns Hopkins University and author of 100 Questions & Answers About HIV and AIDS, told Positively Aware, “This was an important study, proving once and for all that no class of drugs has ‘magic powers’ as long as you have enough active drugs in a regimen. If you have more than two [his emphasis] active drugs in a salvage regimen, as they did in the OPTIONS study, you don’t need more than that. It was once common to include recycled nukes [used over and over] in every regimen, even in people who had extensive nucleoside resistance. OPTIONS tells us that’s not necessary—provided there are enough other active drugs in the regimen.” MaY+JUNE 2013

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New HIV drug may also reduce inflammation Houston HIV specialist Joseph Gathe Jr., MD, presented early 24-week data on 39

Highlights from the 20th conference on retroviruses and opportunistic infections

cenicriviroc (CVC), an investigational HIV medication that also decreased levels of a marker of inflammation called sCD14. Chronic inflammation, which contributes to cardiovascular and other diseases, is associated with HIV. Gathe reported similar levels of undetectable viral load (less than 50 copies per mL) seen with cenicriviroc 100 mg and 200 mg compared to efavirenz (Sustiva), one of the drugs to beat in HIV care. The medications were all given with a backbone of tenofovir DF/emtricitabine (taken as the brand Truvada). For the 143 participants, undetectable viral load was achieved by 76% of those taking CVC 100 mg; 73% of those taking 200 mg of CVC; and 71% of those on efavirenz. All participants were on first-time HIV therapy, the group that does best with antiviral treatment. However, there was more virologic non-response seen with CVC (12%, 14%, and 4% respectively for the three groups), which was balanced by fewer discontinuations due to adverse events with cenicriviroc: none for 100 mg; one person (2%) for 200 mg; and five individuals (18%) for efavirenz. Gathe noted that the only CVC pill available at the time of the study, 50 mg, along with the trial design (double-blind, double placebo-control), made for a complex regimen of four pills in the morning and four at night, with food restrictions. Such complexity and pill burden might have negatively affected adherence and treatment results.

Heart attack risk and HIV For years, HIV researchers have discussed premature aging in people living with the virus, along with greater, and earlier, risk of age-related conditions such as heart attacks (myocardial infarction, or MI). Keri Althoff, PhD, of Johns Hopkins Bloomberg School of Public Health, reported bad news/good news from a study showing that while HIV-positive individuals were at much greater risk of heart attacks and 40

other conditions, they experienced them at about the same age as the HIV-negative people in the study. For example, there was an increased risk of 81% for MI. The age at which MI occurred, however, was about the same for both groups: 55.3 years of age for both the HIV-positive individuals and the HIV-negative ones. The research abstract (summary of the study) noted that, “Premature aging in HIV[positive] adults is not the same as being at increased risk for disease. One may be at greater risk of disease yet may experience events at similar or dissimilar ages.” The medical records of more than 90,000 veterans enrolled in VA medical care were included in this study, with two HIVnegative individuals for every positive one. The D:A:D (Data Collection on Adverse events of Anti-HIV Drugs) cohort study had similarly good news. The relative risk of MI with age was not different between D:A:D and the general population. According to the D:A:D abstract, “It is unclear whether the risk of cardiovascular disease (CVD) is increasing more rapidly with age in [HIV-positive] patients. We hypothesize that accelerated aging in [these] patients would mean an accelerating risk of CVD with older age, and that the increased risk per year older would be higher in D:A:D relative to the general population.” They concluded that they found “limited evidence of accelerating risk of CVD with age in D:A:D. The absolute risk of CVD associated with HIV infection remains unknown.” The study looked at the medical records of more than 27,000 men living with HIV. Researchers from Massachusetts General Hospital in Boston reported, “HIV infection has been associated with increased risk of MI, yet the use of aspirin for primary prevention has not been studied in this group.” While they found a lower rate of aspirin prescriptions or over-the-counter use noted on the charts of HIV-positive people than for HIVnegative ones, they also found a significantly decreased risk of MI associated with MAY+JUNE 2013

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aspirin use in the negative individuals but not so for the positive ones. They reported that further studies are needed to “investigate optimal indications and strategies for aspirin use” in HIV. In a press conference, lead researcher Sujit Suchindran, MD, said the findings do not necessarily indicate that HIV-positive individuals should avoid aspirin. He noted that among HIV-negative people, aspirin use was associated with strong evidence of prevention of a first or subsequent heart attack. In this study, nearly 3,700 HIV-positive individuals had their medical charts compared to those of more than 33,000 HIV-negative persons. Aspirin use was found in 5.5% of positive individuals vs. 6.7% of HIV-negative ones for those with 0–1 coronary heart disease (CHD) risk factors and in 22.1% of positive people vs. 42.4% negative ones who had two or more CHD risk factors.

MK-1439 could be a once-daily non-nuke MK-1439 is a next generation NNRTI in development by Merck which shows activity against select NNRTI resistant mutations, including the Y181C mutation that is more commonly seen when resistance develops to first-generation non-nukes such as Sustiva or Viramune (nevirapine). This could potentially mean that if you developed resistance to one of these drugs, that MK-1439 might still be effective. It has the potential for once-daily dosing, low rates of CNS toxicity, coformulations with other agents, and the ability to be taken with or without food. This was a double-blinded, placebocontrolled Phase 1b safety study in 18 treatment-naïve HIV-positive individuals in one of three treatment groups: 25 mg or 200 mg MK-1439, or placebo, once daily (QD) for seven days. Patients were given antiretroviral standard of care (SOC) for 10 days following dosing to avoid developing resistance during the MK-1439 washout period (as it leaves the bloodstream).

Adverse events (AEs) were limited in number, transient, and generally mild to moderate in intensity with no significant laboratory safety signals observed. There was one serious AE of a newly acquired HCV infection accompanied by elevated liver enzymes, which was judged unlikely to be related to MK-1439. After seven days of monotherapy, no patient showed evidence of viral breakthrough. MK-1439 is now in Phase 2b study.

Smooth SAILING for dolutegravir? SAILING is a 48-week Phase 3 study of 715 treatment experienced, integrase-naïve adults randomized to receive either 50 mg dolutegravir (DTG) once daily or 400 mg Isentress (raltegravir) twice daily plus an investigator-selected background regimen of no more than two agents, one of which is fully active. A 24-week interim analysis showed that 79% of those in the DTG group had undetectable viral loads (less than 50 copies/mL), compared to 70% of those in the raltegravir (RAL) group, demonstrating statistical superiority. In the words of Richard Haubrich, MD, Professor of Medicine at University of California San Diego, “It looks like smooth sailing for dolutegravir.” Also at 24 weeks, more protocoldefined virologic failures occurred in the RAL group (9%) vs. the DTG group (4%), largely due to virologic non-response, which resulted in significantly fewer subjects failing with integrase resistance on DTG than on RAL (0.6% vs. 2.8%). The average increase in CD4 cell count was 114 cells/mm3 (DTG) and 106 cells/ mm3 (RAL). Drug-related adverse events occurred at similar rates (DTG 20%; RAL 23%), and discontinuations due to safety events were 2% and 4% for DTG and RAL, respectively, but safety and tolerability were similar with both drugs. In February, the FDA granted a priority review designation to dolutegravir, which

CROI on YouTube Videos from the conference produced by IFARA are available on YouTube at www. youtube.com/user/AccessHIV and www. accesshiv.org. These are interviews and panels available in English, French, Italian, and Spanish on topics ranging from hepatitis and HIV eradication to complications and advances in treatment. PA editor-in-chief Jeff Berry heads up the annual treatment update panel with guests Joel Gallant, MD, and Richard Haubrich, MD, while PA associate editor Enid Vázquez talks with HIV treatment advocate Rob Camp (in Spanish) about the results of the important VOICE study, looking at HIV prevention in women.

is given to drugs that may offer a significant improvement compared to currently available drugs. The FDA has assigned dolutegravir a Prescription Drug User Fee Act (a law which allows the FDA to collect fees from drug manufacturers to fund the new drug approval process) target date of August 17, 2013 (which is the last day to act on whether or not to approve the drug).

GSK744 as once-monthly treatment, PrEP One exciting area of research in HIV is with long-acting antivirals (LAAs), which are injectable HIV antiretrovirals taken once-monthly (or potentially even less frequently), for treatment or to prevent infection (called pre-exposure prophylaxis, or PrEP). Nano-formulated drugs target cells directly, as opposed to current oral drugs that must first be absorbed and metabolized by the body before making their way to cells. They are long-acting because they have an incredibly long halflife of sometimes days or weeks, compared MaY+JUNE 2013

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to just hours for oral formulations. HIV drugs must be taken in combination to be effective treatment for HIV, so they would only work if there are more than one of these LAAs available, and there are now several of them in development. Research was presented at last year’s CROI which showed that a long-acting form of rilpivirine (brand name Edurant, a non-nuke) was safe and well tolerated in the first ever trial in humans of an injectable, once-a-month formulation of an HIV drug. Data were presented at this year’s CROI on GSK1265744 (GSK744), which is an analogue (close cousin) of the integrase inhibitor dolutegravir, demonstrating 100% protection in eight rhesus macaque monkeys who received repeated intrarectal exposures to SHIV (simian, or monkey, form of HIV) and had been treated with GSK744LAP (long-acting parenteral, meaning it was administered by injection). The authors concluded, “GSK744LAP appears to be a promising next-generation PrEP agent suitable for monthly to quarterly injections.” In another related study presented at the conference a tenofovir DF (TDF) intravaginal ring showed complete protection in female macaques that received repeated SHIV vaginal exposures. 41

Highlights from the 20th conference on retroviruses and opportunistic infections

A troubled VOICE Large study again shows that many women don’t take treatment to prevent infection by Enid Vázquez

The “sad truth”, according to lead VOICE researcher Jeanne Marrazzo, MD, of the University of Washington in Seattle, was that drug levels of the gel or the pills were found in only 30% of the first blood samples collected and went down from there. More than half of the women never had any drug detected in their blood at all. The study looked at the concept of PrEP, or pre-exposure prophylaxis (prevention), using a vaginal gel or pills. Hence the name VOICE, for Vaginal and Oral Interventions to Control the Epidemic. More than 5,000 women (4,000 from South Africa; the rest from Uganda and Zimbabwe) participated in VOICE. At a community forum held by SisterLove in Atlanta and AVAC (AIDS Vaccine Action Coalition), an HIV prevention advocacy group based in Washington, D.C., Marrazzo wondered, “How can we get what we believe are biologically effective agents to be taken by people at risk?” It was a mystery why the women reported a high level of drug adherence at their intensive monthly visits for pregnancy testing, intensified adherence counseling, and behavioral risk assessment for STIs. A new set of VOICE researchers will look into adherence issues, Marrazzo said, including an assessment of community perceptions of PrEP with the women’s male partners. She noted there is still a great deal of stigma in Africa around HIV medications, even among people living with the virus. “For the record,” Marrazzo told the forum audience in response to a comment, “I never used the word ‘failure.’ ” 42

In response to questions, Marrazzo said she didn’t believe side effects played a role in the results because they usually go away soon after therapy starts. Adherence to prevention medications— the ability to take them and take them correctly—has been a bugaboo for PrEP research before, including parts of VOICE that had to be discontinued. In 2011, oral tenofovir (brand name Viread) and tenofovir gel used vaginally (not commercially available) were found to be safe but not effective, and VOICE stopped providing those regimens to the women in the study. Only oral Truvada PrEP was carried forward to the end of the study. All three were tested against a placebo (inactive drug) group. The CROI presentation represents final results for all three medications. It was now shown that women were not using the vaginal gel or taking the pills. This is probably why there were as many HIV infections for the women given those products as for the women given placebos for comparison purposes (which thus led to early termination of the gel and Viread arms of the study). Viread, Truvada, and tenofovir gel have all been shown to have efficacy at preventing HIV in women in other studies, including transgender women (Partners PrEP, CAPRISA 004, iPrEx, and TDF2). It was hoped that VOICE would add additional data to support the use of PrEP with these products for women (as well as men), both in the U.S. and around the world. Yet, PrEP has also been shown to be MAY+JUNE 2013

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Dr. Jeanne Marazzo (right) pondered the question of how to get people to take their meds.

unable to stop HIV, again due to lack of adherence leading to inadequate blood levels, for both men and women, including transgender women. In FemPrEP, for example, as many women got infected while given Truvada as were infected when taking placebos. It was thought that these women didn’t take Truvada because they didn’t believe they were at risk for HIV infection. While Truvada was sufficiently successful at stopping HIV to become, in 2012, the first FDA approved drug for prevention of the virus, the VOICE results show that adherence continues to be a well-known problem with the new therapy in research. (There is no data from the real world usage of Truvada PrEP to date.) The VOICE research team, part of the Microbicide Trials Network (MTN), had estimated an HIV infection rate of 4% in their placebo controlled study, but instead saw a higher rate of 5.7%, with a range of

Photo: Enid Vázquez

he much anticipated final results from the VOICE study of HIV prevention for women showed once again that medication used to stop the virus can only work if you take it. Instead, the women in the study, by and large, did not take the pills or use the vaginal gel they were given. Therefore, prevention of HIV could not be shown.

Functional Cure? The baby who caused a stir at CROI by Donna M. Kaminski, DO, MPH

t the 20th Conference on Retroviruses and Opportunistic Infections (CROI), the story of a newborn baby thought to have been cured of HIV was presented, and received worldwide attention. Even before the case was presented, my morning emails featured a release from an online HIV newsletter labeling an infant as now “cured” of HIV. As I sat in the presentation, every seat was taken, and everyone’s eyes, including mine, were glued on the presenter, Deborah Persaud, MD, of Johns Hopkins Children’s Center, as she shared the story of this baby’s experience.

0.8 to 9.9%, showing that indeed, these were women in need of protection from the virus. The VOICE research abstract (summary) concluded that, “The VOICE results are consistent with FemPrEP and suggest that products that are long acting and require minimal daily adherence may be more suitable for this population. Understanding of HIV risk perception and biomedical, social, and cultural determinants of adherence in this high-risk population is urgently needed.” Asked what the women didn’t like about their regimens, Marrazzo said, “I think it’s that one size doesn’t fit all. Some want intermittent use [for example, weekly or three-times-a-week dosing instead of daily pills]. We need to explore all options.” Go to positivelyaware.com

to read an expanded version of this article.

In the evening, as I returned to my hotel, I couldn’t help but notice a CNN interview with Anthony Fauci, MD, a leading HIV researcher and physician commenting on whether the baby was cured. Everyone has been abuzz about the story—understandably so—as we, as a global society, have been waiting for the day when we can use the word “cure” together with HIV. I’d like to both take a closer look at the details behind this patient’s story, and explore what it does and doesn’t show, as well as why it’s not yet the cure that many of us have been hoping for.

HIV-positive at birth

he story begins in Mississippi, where a pregnant mother came into the hospital in active labor. She had had no prenatal care. Her labor came on strong and fast, and was precipitous, and while she was tested for HIV, the results didn’t come back until after her baby was delivered. The mother was positive. No HIV medications had been given during delivery. Quickly, the newborn was transferred to a larger nearby hospital, and there, at just 30 hours of life, she was tested both for HIV DNA and RNA, and both tests came back positive. Two positive tests confirmed it: the baby had HIV, with a viral load close to 20,000 copies/mL. A three-drug combination was immediately started just 31 hours after

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birth. Interestingly, instead of a preventive, or prophylactic, regimen, one of the three drugs used, nevirapine, was started at a more frequent dosage than is usually considered for newborns, while the other two medications, zidovudine (AZT) and lamivudine (Epivir) were started at the usual therapeutic doses due to the treating clinician’s judgment that the infant was at high risk of infection. The child was eventually transitioned into a combination that included lopinavir/ritonavir (Kaletra) instead of nevirapine, and continued on HIV medications for 18 months. As we might have expected, her viral load came down beautifully to undetectable levels as she continued HIV medications. And then something interesting happened. For five months, no one heard of the newborn or her mother—they were lost to care. The baby had stopped receiving medications, and stopped coming to doctors’ visits. Five months later, when the baby returned to care, the doctors quickly tested her viral load and were surprised to find that HIV was undetectable, even after a five-month hiatus from HIV medications. And while this child isn’t the first to have missed HIV medications for a period of time, others haven’t remained undetectable, except in a few, rare case reports. In this baby, who is now nearing three years old, viral loads have stayed undetectable 43

Highlights from the 20th conference on retroviruses and opportunistic infections

Berlin meets Mississippi

f true, this would

Dr. Deborah Persaud

for over 10 months of follow up. Also intriguing is that not only are her HIV DNA and RNA levels negative or extremely low, but antibody levels are also negative. The researchers have done several ultra-sensitive virologic and immunological assays, and all of them seem to show no sign of active HIV infection.

“Crossing” the reservoirs

hese results have many asking the question: could we have just found a way to keep HIV from starting what has become a well known problem—latent reservoirs? One of the biggest obstacles to eliminating HIV entirely from the body has been these reservoirs, or pockets, of HIV that become established in numerous parts of the body. While HIV medications work well to dramatically lower HIV levels to “undetectable,”

be the first time we’ve seen an infant test positive for HIV, respond to HIV treatment, and then lose all signs of the virus altogether. In many ways, it mimics what we saw and were amazed by several years ago in Timothy Brown, the “Berlin patient.” In 2009, Brown, who had a longstanding history of HIV and leukemia, was living in Berlin and needed a bone marrow transplant. He had two transplants, both from a donor who had a mutation (CCR5-delta 32) that was resistant to HIV. Brown also happened to have one allele (an alternative form of the same gene) for the same mutation. Several months later, while off HIV medications, he had no detectable levels of HIV and declining levels of antibodies to HIV. He continues to remain healthy off treatment for more than five years now. This was the first case of a “functional” cure, and generated much excitement regarding a cure. Many wonder if the “Mississippi baby,” as she’s been called, is a second example of a similar concept. MAY+JUNE 2013

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While it is tempting to say yes, there are many questions that remain unanswered. Some wonder if this effect is long-lasting and will remain in the years to come. Others wonder if the levels of HIV first detected in the baby were actually levels of the newborn’s mother’s HIV. Still others wonder if there is a protective mechanism or factor responsible for the effect that we are seeing. And if it’s true that the baby is cured, how do we translate this into larger populations globally?

Questions remain

hile there are many questions, these reports highlight the role that latent reservoirs play in HIV. It is clear that a true cure will need to find a way to eradicate or prevent latent reservoirs from forming. Discoveries such as these open the door for research that is needed regarding latent reservoirs. For example, another group, Siliciano and colleagues, have been studying medications called latency-reversing agents that have been shown to reduce the size of latent reservoirs in the test tube. They are hoping to test these agents in a larger group of HIV-positive individuals. Strategies such as these will be essential in truly helping us find a preventative and therapeutic cure. In summary, it may be premature to call the “functional cure” baby truly cured. Further testing and evaluation will help us to know if this is a true cure, and how it can be used to prevent and treat HIV in the future. However, it gives us hope that every day, every month, every year, we come one step closer to finding a true cure.

Donna M. Kaminski, DO, MPH is

currently Chief Resident at Somerset Medical Center’s Family Practice Program in Somerville, NJ. She worked in HIV research at the National Institutes of Health and HIV treatment education at Gay Men’s Health Crisis and ACRIA before deciding to become a doctor.

Photo: Johns Hopkins Medicine

once the medications are stopped, these pockets, or reservoirs, will produce copious amounts of HIV. And here, in this child, we don’t seem to see any HIV that is capable of replicating, and no signs of HIV reservoirs as per the ultrasensitive virological and immunological testing that was done. It may be that starting full-dose HIV medications as early as 31 hours after exposure is the key to keeping HIV from establishing these latent reservoirs.

Salient ramblings

sal iacopelli

‘Honey, touch me with my clothes on.’

—Gilda Radner

have had my share of sex, enough for the next dozen or so lifetimes. What I’d like to do with whom, where, and how dominates an inordinate amount of my consciousness. In my 50s, the obsession has somewhat abated. Though still present, sex falls much lower in my hierarchy of needs, certainly lower than food, excelling at my job, gardening, and playing with my dog Sofi. Hell, sometimes washing my windows wins out.

I used to have such strong yearnings for sexual contact that they would propel me out the door at least once a day. Now, I am much more interested in quality than in quantity. Plus, I am too goddamned tired to chase dick as much as I used to. Currently, I enjoy bi-monthly attendance at Bear Naked parties where I strip and wander through a horde of naked men, sampling the tasty wares on display. The gatherings seem to be constructed from my dreams, as most of the members fit my exact desired physical type—older, hairy, and slutty. The first time I attended, three guys and I huddled with our arms around each other and jerked each other off. I felt as if I had found home. Plus, unbelievably, pizza is served! A friend told me about issues she’s having with her husband who is completely inattentive. All she wants is to be touched and desired by someone who pays loving attention. Isn’t that all any of us want? I sometimes wonder if sex is reaching out for spiritual connectedness. Sex has so many layers of emotions, symbols, and meaning. Is sex, in its simplest form, the reaching out to our God/ Goddess selves? An acceptance of ourselves and others? Can the vulnerability and surrender required when engaging in sex be the yearning to reach a higher experience? The most erotic moment I’ve experienced wasn’t necessarily sexual. A guy I dated for a short time, Marshall, had me over to his apartment one cool, cloudy, breezy summer afternoon. We sat on his bed while gauzy sheers at the window undulated gently and seductively. Fully clothed, I held him on my lap and kissed him for a long time. I felt so sensuously vulnerable. My feelings about my own sexual attractiveness have also changed over the years. In my 30s, I performed in a nude show for two years. It was absolutely liberating to

gaze across stage at my six fellow actors, all of us without a stitch, completely at home with each other and our bodies. Could I do so today? Probably not without losing 30 pounds, since that was before my butt sagged and my belly expanded. A fascinating question to ask is, “If you were cloned, would you have sex with yourself?” A straight man I asked responded, “I wouldn’t leave the house. I’d be too busy blowing myself.” Personally, I’d climb on my back in a minute, but surprisingly, many gay men would not. As one friend said, “I wouldn’t buy myself a drink in a bar.” Our culture is obsessed with youth, and idealized physical perfection, glorifying, for the vast majority, the unachievable body. I know a guy who is handsome, works out constantly, and has a stunning body, yet felt his penis wasn’t large enough, and so had cosmetic surgery. He endured a series of operations where fat tissue was removed from his ass and wrapped around his dick. His cock is now as fat as a beer can but looks oddly disproportionate because the head is still the original size. And unfortunately, the surgeon screwed up the fat removal process and his ass looks like a sack of potatoes. I am not above such tortured ministrations. I prefer not to let someone near my dick with a scalpel, but I do everything possible, except quitting smoking, to reduce the effects of aging on my body. I recently underwent a cosmetic procedure to improve puffy lower eyelid “bags” and reduce wrinkles. Overall, I’m glad I did it and am happy to be one of those people you can point to and say, “Oh, her? She’s had work done.” But couldn’t I simply have accepted my own aging process? Accepted my own worth and the fact that I will become increasingly older, wrinkled, bald, and less of a sexual commodity? A few years ago I had sex with a guy who unceremoniously took out his teeth and treated me to a stellar blow job. Perhaps “gum jobs” are something we aging gay men can look forward to. Actually, I quite recommend them.

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I am a caregiver, a partner, and a motivational speaker. And I am living with HIV. TM

Maria (right) has lived with HIV since 1991.

Get the facts. Get tested. Get involved. www.cdc.gov/ActAgainstAIDS