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INDICATION: REYATAZ is a prescription medicine used in combination with other medicines to treat people who are infected with the human immunodeficiency virus (HIV). REYATAZ has been studied in a 48-week trial in patients who have taken anti-HIV medicines and a 96-week trial in patients who have never taken anti-HIV medicines. REYATAZ does not cure HIV or lower your chance of passing HIV to others.

On REYATAZ,

IMPORTANT SAFETY INFORMATION: Do not take REYATAZ if you are taking the following medicines due to potential for serious, life-threatening side effects or death: Versed® (midazolam) when taken by mouth, Halcion® (triazolam), ergot medicines (dihydroergotamine, ergonovine, ergotamine, and methylergonovine such as Cafergot®, Migranal®, D.H.E. 45®, ergotrate maleate, Methergine®, and others), Propulsid® (cisapride), or Orap® (pimozide). Do not take REYATAZ with the following medicines due to potential for serious side effects: Camptosar® (irinotecan), Crixivan® (indinavir), Mevacor® (lovastatin), Zocor® (simvastatin), Uroxatral® (alfuzosin), or Revatio® (sildenafil). Do not take REYATAZ with the following medicines as they may lower the amount of REYATAZ in your blood, which may lead to increased HIV viral load and resistance to REYATAZ or other anti-HIV medicines: rifampin (also known as Rimactane®, Rifadin®, Rifater®, or Rifamate®), St. John’s wort (Hypericum perforatum)-containing products, or Viramune® (nevirapine). Serevent Diskus® (salmeterol) and Advair® (salmeterol with fluticasone) are not recommended with REYATAZ. Do not take Vfend® (voriconazole) if you are taking REYATAZ and Norvir® (ritonavir). The above lists of medicines are not complete. Taking REYATAZ with some other medicines may require your therapy to be monitored more closely or may require a change in dose or dose schedule of REYATAZ or the other medicine. Discuss with your healthcare provider all prescription and non-prescription medicines, vitamin and herbal supplements, or other health preparations you are taking or plan to take. Tell your healthcare provider if you are pregnant, breast-feeding, planning to become pregnant or breast-feed, or if you have end-stage kidney disease managed with hemodialysis or severe liver dysfunction. Tell your healthcare provider right away if you have any side effects, symptoms, or conditions, including the following: • Mild rash (redness and itching) without other symptoms sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started, and usually goes away within 2 weeks with no change in treatment. • Severe rash has occurred in a small number of patients taking REYATAZ. This type of rash is associated with other symptoms that could be serious and potentially cause death. If you develop a rash with any of the following symptoms, stop using REYATAZ and call your healthcare provider right away: – Conjunctivitis (red or inflamed eyes, – Shortness of breath like “pink-eye”) – General ill-feeling or “flu-like” – Blisters symptoms – Mouth sores – Fever – Swelling of your face – Muscle or joint aches • Yellowing of the skin and/or eyes may occur due to increases in bilirubin levels in the blood (bilirubin is made by the liver). • A change in the way your heart beats may occur. You may feel dizzy or lightheaded. These could be symptoms of a heart problem. • Diabetes and high blood sugar may occur in patients taking protease inhibitor medicines like REYATAZ. Some patients may need changes in their diabetes medicine. • If you have liver disease, including hepatitis B or C, it may get worse when you take anti-HIV medicines like REYATAZ. • Kidney stones have been reported in patients taking REYATAZ. Signs or symptoms of kidney stones include pain in your side, blood in your urine, and pain when you urinate. • Some patients with hemophilia have increased bleeding problems with protease inhibitor medicines like REYATAZ. • Changes in body fat have been seen in some patients taking anti-HIV medicines. The cause and long-term effects are not known at this time. • Gallbladder disorders (including gallstones and gallbladder inflammation) have been reported in patients taking REYATAZ. Other common side effects of REYATAZ taken with other anti-HIV medicines include: nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness; trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain. You should take REYATAZ once daily with food (a meal or snack). Swallow the capsules whole; do not open the capsules. You should take REYATAZ and your other anti-HIV medicines exactly as instructed by your healthcare provider.

Wedn esda y Ma ry ’s birthd ay pa rty Thursda y 5:30 C h oi r e practic

Bu y new shoes for Latish a

Fight HIV your way.

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

Please see Important Patient Information about REYATAZ on the adjacent pages.

how you spend your time is up to you.

Individual results may vary.

Once-daily REYATAZ can help fight your HIV. REYATAZ, a protease inhibitor (PI), in HIV combination therapy: ◆ Can

help lower your viral load and raise your T-cell (CD4+ cell) count

Find out if you can save on REYATAZ. Call 1-888-281-8981 or visit ReyatazSavings.com for details.

◆ Has

a low chance of diarrhea (shown in clinical trials) - REYATAZ in combination therapy had a 1%-3% rate of moderate-to-severe diarrhea in adults

◆ Is

taken once a day with a snack or meal

Subject to terms and conditions. Restrictions apply.

REYATAZ is one of several treatment options your doctor may consider.

Do not take REYATAZ if you are allergic to REYATAZ or to any of its ingredients.

Ask your healthcare team about REYATAZ

www.REYATAZ.com

REYATAZ does not cure HIV and has not been shown to reduce the risk of passing HIV to others.

REYATAZ is a registered trademark of Bristol-Myers Squibb. All other trademarks are the property of their respective owners and not of Bristol-Myers Squibb. © 2010 Bristol-Myers Squibb, Princeton, NJ 08543 U.S.A. 687US10AB06407 06/10

FDA-Approved Patient Labeling Patient Information

REYATAZÂŽ (RAY-ah-taz) (generic name = atazanavir sulfate) Capsules

ALERT: Find out about medicines that should NOT be taken with REYATAZ. Read the section â&#x20AC;&#x153;What important information should I know about taking REYATAZ with other medicines?â&#x20AC;? Read the Patient Information that comes with REYATAZ before you start using it and each time you get a refill. There may be new information. This leaflet provides a summary about REYATAZ and does not include everything there is to know about your medicine. This information does not take the place of talking with your healthcare provider about your medical condition or treatment. What is REYATAZ? REYATAZ is a prescription medicine used with other anti-HIV medicines to treat people who are infected with the human immunodeficiency virus (HIV). HIV is the virus that causes acquired immune deficiency syndrome (AIDS). REYATAZ is a type of anti-HIV medicine called a protease inhibitor. HIV infection destroys CD4+ (T) cells, which are important to the immune system. The immune system helps fight infection. After a large number of (T) cells are destroyed, AIDS develops. REYATAZ helps to block HIV protease, an enzyme that is needed for the HIV virus to multiply. REYATAZ may lower the amount of HIV in your blood, help your body keep its supply of CD4+ (T) cells, and reduce the risk of death and illness associated with HIV. Does REYATAZ cure HIV or AIDS? REYATAZ does not cure HIV infection or AIDS. At present there is no cure for HIV infection. People taking REYATAZ may still get opportunistic infections or other conditions that happen with HIV infection. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infections. It is very important that you see your healthcare provider regularly while taking REYATAZ. REYATAZ does not lower your chance of passing HIV to other people through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safer sex by using a latex or polyurethane condom or other barrier to lower the chance of sexual contact with semen, vaginal secretions, or blood. Never use or share dirty needles. Who should not take REYATAZ? Do not take REYATAZ if you: t are taking certain medicines. (See â&#x20AC;&#x153;What important information should I know about taking REYATAZ with other medicines?â&#x20AC;?) Serious life-threatening side effects or death may happen. Before you take REYATAZ, tell your healthcare provider about all medicines you are taking or planning to take. These include other prescription and nonprescription medicines, vitamins, and herbal supplements. t are allergic to REYATAZ or to any of its ingredients. The active ingredient is atazanavir sulfate. See the end of this leaflet for a complete list of ingredients in REYATAZ. Tell your healthcare provider if you think you have had an allergic reaction to any of these ingredients. What should I tell my healthcare provider before I take REYATAZ? Tell your healthcare provider: t If you are pregnant or planning to become pregnant. It is not known if REYATAZ can harm your unborn baby. Pregnant women have experienced serious side effects when taking REYATAZ with other HIV medicines called nucleoside analogues. You and your healthcare provider will need to decide if REYATAZ is right for you. If you use REYATAZ while you are pregnant, talk to your healthcare provider about the Antiretroviral Pregnancy Registry. t If you are breast-feeding. You should not breast-feed if you are HIV-positive because of the chance of passing HIV to your baby. Also, it is not known if REYATAZ can pass into your breast milk and if it can harm your baby. If you are a woman who has or will have a baby, talk with your healthcare provider about the best way to feed your baby. t If you have liver problems or are infected with the hepatitis B or C virus. See â&#x20AC;&#x153;What are the possible side effects of REYATAZ?â&#x20AC;? t If you have end stage kidney disease managed with hemodialysis. t If you have diabetes. See â&#x20AC;&#x153;What are the possible side effects of REYATAZ?â&#x20AC;? t If you have hemophilia. See â&#x20AC;&#x153;What are the possible side effects of REYATAZ?â&#x20AC;? t About all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Keep a list of your medicines with you to show your healthcare provider. For more information, see â&#x20AC;&#x153;What important information should I know about taking REYATAZ with other medicines?â&#x20AC;? and â&#x20AC;&#x153;Who should not take REYATAZ?â&#x20AC;? Some medicines can cause serious side effects if taken with REYATAZ.

REYATAZÂŽ (atazanavir sulfate) How should I take REYATAZ? t Take REYATAZ once every day exactly as instructed by your healthcare provider. Your healthcare provider will prescribe the amount of REYATAZ that is right for you. t 'PS BEVMUT XIP IBWF OFWFS UBLFO BOUJ )*7 NFEJDJOFT CFGPSF UIF EPTF is 300 mg once daily with 100 mg of NORVIRÂŽ (ritonavir) once daily taken with food. For adults who are unable to tolerate ritonavir, 400 mg (two 200-mg capsules) once daily (without NORVIRÂŽ) taken with food is recommended. t 'PS BEVMUT XIP IBWF UBLFO BOUJ )*7 NFEJDJOFT JO UIF QBTU UIF VTVBM dose is 300 mg plus 100 mg of NORVIRÂŽ (ritonavir) once daily taken with food. t :PVS EPTF XJMM EFQFOE PO ZPVS MJWFS GVODUJPO BOE PO UIF PUIFS BOUJ )*7 medicines that you are taking. REYATAZ is always used with other anti-HIV medicines. If you are taking REYATAZ with SUSTIVAÂŽ (efavirenz) or with VIREADÂŽ (tenofovir disoproxil fumarate), you should also be taking NORVIRÂŽ (ritonavir). t Always take REYATAZ with food (a meal or snack) to help it work better. Swallow the capsules whole. Do not open the capsules. Take REYATAZ at the same time each day. t If you are taking antacids or didanosine (VIDEXÂŽ or VIDEXÂŽ EC), take REYATAZ 2 hours before or 1 hour after these medicines. t If you are taking medicines for indigestion, heartburn, or ulcers such as AXIDÂŽ (nizatidine), PEPCID ACÂŽ (famotidine), TAGAMETÂŽ (cimetidine), ZANTACÂŽ (ranitidine), AcipHexÂŽ (rabeprazole), NEXIUMÂŽ (esomeprazole), PREVACIDÂŽ (lansoprazole), PRILOSECÂŽ (omeprazole), or PROTONIXÂŽ (pantoprazole), talk to your healthcare provider. t Do not change your dose or stop taking REYATAZ without first talking with your healthcare provider. It is important to stay under a healthcare providerâ&#x20AC;&#x2122;s care while taking REYATAZ. t When your supply of REYATAZ starts to run low, get more from your healthcare provider or pharmacy. It is important not to run out of REYATAZ. The amount of HIV in your blood may increase if the medicine is stopped for even a short time. t If you miss a dose of REYATAZ, take it as soon as possible and then take your next scheduled dose at its regular time. If, however, it is within 6 hours of your next dose, do not take the missed dose. Wait and take the next dose at the regular time. Do not double the next dose. It is important that you do not miss any doses of REYATAZ or your other anti-HIV medicines. t If you take more than the prescribed dose of REYATAZ, call your healthcare provider or poison control center right away. Can children take REYATAZ? Dosing recommendations are available for children 6 years of age and older for REYATAZ Capsules. Dosing recommendations are not available for children from 3 months to less than 6 years of age. REYATAZ should not be used in babies under the age of 3 months. What are the possible side effects of REYATAZ? The following list of side effects is not complete. Report any new or continuing symptoms to your healthcare provider. If you have questions about side effects, ask your healthcare provider. Your healthcare provider may be able to help you manage these side effects. The following side effects have been reported with REYATAZ: t mild rash (redness and itching) without other symptoms sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started. Rashes usually go away within 2 weeks with no change in treatment. Tell your healthcare provider if rash occurs. t severe rash: In a small number of patients, a rash can develop that is associated with other symptoms which could be serious and potentially cause death. If you develop a rash with any of the following symptoms stop using REYATAZ and call your healthcare provider right away: t TIPSUOFTT PG CSFBUI t HFOFSBM JMM GFFMJOH PS iGMV MJLFw TZNQUPNT t GFWFS t NVTDMF PS KPJOU BDIFT t DPOKVODUJWJUJT SFE PS JOGMBNFE FZFT MJLF iQJOL FZFw

t CMJTUFST t NPVUI TPSFT t TXFMMJOH PG ZPVS GBDF t yellowing of the skin or eyes. These effects may be due to increases in bilirubin levels in the blood (bilirubin is made by the liver). Call your healthcare provider if your skin or the white part of your eyes turn yellow. Although these effects may not be damaging to your liver, skin, or eyes, it is important to tell your healthcare provider promptly if they occur.

REYATAZÂŽ (atazanavir sulfate) a change in the way your heart beats (heart rhythm change). Call your healthcare provider right away if you get dizzy or lightheaded. These could be symptoms of a heart problem. t diabetes and high blood sugar (hyperglycemia) sometimes happen in patients taking protease inhibitor medicines like REYATAZ. Some patients had diabetes before taking protease inhibitors while others did not. Some patients may need changes in their diabetes medicine. t if you have liver disease including hepatitis B or C, your liver disease may get worse when you take anti-HIV medicines like REYATAZ. t kidney stones have been reported in patients taking REYATAZ. If you develop signs or symptoms of kidney stones (pain in your side, blood in your urine, pain when you urinate) tell your healthcare provider promptly. t some patients with hemophilia have increased bleeding problems with protease inhibitors like REYATAZ. t changes in body fat. These changes may include an increased amount of fat in the upper back and neck (â&#x20AC;&#x153;buffalo humpâ&#x20AC;?), breast, and around the trunk. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these conditions are not known at this time. Other common side effects of REYATAZ taken with other anti-HIV medicines include nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness; trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain. Gallbladder disorders (which may include gallstones and gallbladder inflammation) have been reported in patients taking REYATAZ. What important information should I know about taking REYATAZ with other medicines? Do not take REYATAZ if you take the following medicines (not all brands may be listed; tell your healthcare provider about all the medicines you take). REYATAZ may cause serious, life-threatening side effects or death when used with these medicines. t &SHPU NFEJDJOFT EJIZESPFSHPUBNJOF FSHPOPWJOF FSHPUBNJOF BOE methylergonovine such as CAFERGOTÂŽ, MIGRANALÂŽ, D.H.E. 45ÂŽ, ergotrate maleate, METHERGINEÂŽ, and others (used for migraine headaches). t 03"1ÂŽ (pimozide, used for Touretteâ&#x20AC;&#x2122;s disorder). t 13016-4*%ÂŽ (cisapride, used for certain stomach problems). t 5SJB[PMBN BMTP LOPXO BT )"-$*0/ÂŽ (used for insomnia). t . JEB[PMBN BMTP LOPXO BT 7&34&%ÂŽ (used for sedation), when taken by mouth. Do not take the following medicines with REYATAZ because of possible serious side effects: t $".1504"3ÂŽ (irinotecan, used for cancer). t $3*9*7"/ÂŽ JOEJOBWJS VTFE GPS )*7 JOGFDUJPO #PUI 3&:"5"; BOE $3*9*7"/ sometimes cause increased levels of bilirubin in the blood. t Cholesterol-lowering medicines MEVACORÂŽ (lovastatin) or ZOCORÂŽ (simvastatin). t 6309"53"-ÂŽ (alfuzosin, used to treat benign enlargement of the prostate). t 3&7"5*0ÂŽ (sildenafil, used to treat pulmonary arterial hypertension). Do not take the following medicines with REYATAZ because they may lower the amount of REYATAZ in your blood. This may lead to an increased HIV viral load. Resistance to REYATAZ or cross-resistance to other HIV medicines may EFWFMPQ t 3JGBNQJO BMTP LOPXO BT 3*."$5"/&ÂŽ, RIFADINÂŽ, RIFATERÂŽ, or RIFAMATEÂŽ, used for tuberculosis). t 4U +PIO T XPSU (Hypericum perforatum), an herbal product sold as a dietary TVQQMFNFOU PS QSPEVDUT DPOUBJOJOH 4U +PIO T XPSU t 7*3".6/&ÂŽ (nevirapine, used for HIV infection). The following medicines are not recommended with REYATAZ: t 4&3&7&/5 %*4,64ÂŽ (salmeterol) and ADVAIRÂŽ (salmeterol with fluticasone), used to treat asthma, emphysema/chronic obstructive pulmonary disease also known as COPD. Do not take the following medicine if you are taking REYATAZ and NORVIRÂŽ together: t 7'&/%ÂŽ (voriconazole). The following medicines may require your healthcare provider to monitor your therapy more closely (for some medicines a change in the dose or dose schedule may be needed): t $*"-*4ÂŽ (tadalafil), LEVITRAÂŽ (vardenafil), or VIAGRAÂŽ (sildenafil), used to treat erectile dysfunction. REYATAZ may increase the chances of serious side effects that can happen with CIALIS, LEVITRA, or VIAGRA. Do not use CIALIS, LEVITRA, or VIAGRA while you are taking REYATAZ unless your healthcare provider tells you it is okay. t "%$*3$"ÂŽ (tadalafil) or TRACLEERÂŽ (bosentan), used to treat pulmonary arterial hypertension. t -*1*503ÂŽ (atorvastatin) or CRESTORÂŽ (rosuvastatin). There is an increased chance of serious side effects if you take REYATAZ with this cholesterollowering medicine. t

REYATAZÂŽ (atazanavir sulfate) FEJDJOFT GPS BCOPSNBM IFBSU SIZUIN $03%"30/&ÂŽ (amiodarone), lidocaine, . quinidine (also known as CARDIOQUINÂŽ 26*/*%&9ÂŽ, and others). t .:$0#65*/ÂŽ (rifabutin, an antibiotic used to treat tuberculosis). t #613&/&9ÂŽ 46#65&9ÂŽ 46#090/&ÂŽ, (buprenorphine or buprenorphine/ naloxone, used to treat pain and addiction to narcotic painkillers). t 7"4$03ÂŽ (bepridil, used for chest pain). t $06."%*/ÂŽ (warfarin). t 5SJDZDMJD BOUJEFQSFTTBOUT TVDI BT &-"7*-ÂŽ (amitriptyline), NORPRAMINÂŽ (desipramine), SINEQUANÂŽ (doxepin), SURMONTILÂŽ (trimipramine), TOFRANILÂŽ (imipramine), or VIVACTILÂŽ (protriptyline). t .FEJDJOFT UP QSFWFOU PSHBO USBOTQMBOU SFKFDUJPO 4"/%*..6/&ÂŽ or NEORALÂŽ (cyclosporin), RAPAMUNEÂŽ (sirolimus), or PROGRAFÂŽ (tacrolimus). t 5IF BOUJEFQSFTTBOU USB[PEPOF %&4:3&-ÂŽ and others). t 'MVUJDBTPOF QSPQJPOBUF '-0/"4&ÂŽ, FLOVENTÂŽ), given by nose or inhaled to treat allergic symptoms or asthma. Your doctor may choose not to keep you on fluticasone, especially if you are also taking NORVIRÂŽ. t $PMDIJDJOF $0-$3:4ÂŽ), used to prevent or treat gout or treat familial Mediterranean fever. The following medicines may require a change in the dose or dose schedule of either REYATAZ or the other medicine: t */7*3"4&ÂŽ (saquinavir). t /037*3ÂŽ (ritonavir). t 4645*7"ÂŽ (efavirenz). t "OUBDJET PS CVGGFSFE NFEJDJOFT t 7*%&9ÂŽ (didanosine). t 7*3&"%ÂŽ (tenofovir disoproxil fumarate). t .:$0#65*/ÂŽ (rifabutin). t $BMDJVN DIBOOFM CMPDLFST TVDI BT $"3%*;&.ÂŽ or TIAZACÂŽ (diltiazem), COVERA-HSÂŽ or ISOPTIN SRÂŽ (verapamil) and others. t #*"9*/ÂŽ (clarithromycin). t .FEJDJOFT GPS JOEJHFTUJPO IFBSUCVSO PS VMDFST TVDI BT "9*%ÂŽ (nizatidine), PEPCID ACÂŽ (famotidine), TAGAMETÂŽ (cimetidine), or ZANTACÂŽ (ranitidine). Talk to your healthcare provider about choosing an effective method of contraception. REYATAZ may affect the safety and effectiveness of hormonal contraceptives such as birth control pills or the contraceptive patch. Hormonal contraceptives do not prevent the spread of HIV to others. Remember: 1. Know all the medicines you take. 2. Tell your healthcare provider about all the medicines you take. 3. Do not start a new medicine without talking to your healthcare provider. How should I store REYATAZ? t 4UPSF 3&:"5"; $BQTVMFT BU SPPN UFNQFSBUVSF ÂĄ UP ÂĄ ' ÂĄ UP ÂĄ $ Do not store this medicine in a damp place such as a bathroom medicine cabinet or near the kitchen sink. t ,FFQ ZPVS NFEJDJOF JO B UJHIUMZ DMPTFE DPOUBJOFS t ,FFQ BMM NFEJDJOFT PVU PG UIF SFBDI PG DIJMESFO BOE QFUT BU BMM UJNFT %P OPU keep medicine that is out of date or that you no longer need. Dispose of unused medicines through community take-back disposal programs when available or place REYATAZ in an unrecognizable, closed container in the household trash. General information about REYATAZ This medicine was prescribed for your particular condition. Do not use REYATAZ for another condition. Do not give REYATAZ to other people, even if they have the same symptoms you have. It may harm them. Keep REYATAZ and all medicines out of the reach of children and pets. This summary does not include everything there is to know about REYATAZ. Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Remember no written summary can replace careful discussion with your healthcare provider. If you would like more information, talk XJUI ZPVS IFBMUIDBSF QSPWJEFS PS ZPV DBO DBMM What are the ingredients in REYATAZ? Active Ingredient: atazanavir sulfate Inactive Ingredients: Crospovidone, lactose monohydrate (milk sugar), magnesium stearate, gelatin, FD&C Blue #2, and titanium dioxide. 7*%&9ÂŽ and REYATAZÂŽ are registered trademarks of Bristol-Myers Squibb Company. COUMADINÂŽ and SUSTIVAÂŽ are registered trademarks of Bristol-Myers Squibb Pharma Company. DESYRELÂŽ JT B SFHJTUFSFE USBEFNBSL PG .FBE +PIOTPO and Company. Other brands listed are the trademarks of their respective owners and are not trademarks of Bristol-Myers Squibb Company. t

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34 THE POZ 100 The year 2010 was a banner year for waging war on AIDS in America. The National HIV/AIDS Strategy was launched, needle exchange was approved, health care reform became law and the travel ban for HIVpositive people entering the United States was lifted. To continue the momentum and to secure the funds required to successfully beat down AIDS, we need the bravest, most dogged and downright effective AIDS fighters we know. Meet the POZ 100. 5 EDITOR’S LETTER Secrets of Success

10 YOUR FEEDBACK

On homophobia, the church and HIV, and on remembering Ryan White

15 TALKING

A new documentary about the blood supply • honoring two HIV-positive legends at the Kennedy Center • Pepsi

offers the community a challenge to combat HIV • a new ad campaign highlights the link between HIV and partying • Pozarazzi • fighting homophobia in New York City subways • Hot Dates for World AIDS Day

International AIDS Conference in Vienna • ARVs to fight HIV and inflammation • a new blood test can diagnose HIV earlier • when to remove anal warts • spice up your life

24 LIVING

Jackie Gethner uses her healing touch to improve the lives of people living with HIV.

Tips for dealing with posttraumatic stress disorder • highlights from the XVIII

48 ACHIEVING

POZ (ISSN 1075-5705) is published monthly except for the January/February, April/May, July/August and October/November issues ($19.97 for a 8-issue subscription) by Smart + Strong, 462 Seventh Ave., 19th Floor, New York, NY 10018-7424. Periodicals postage paid at New York, NY, and additional mailing offices. Issue No. 168. POSTMASTER: Send address changes to POZ, PO Box 8788, Virginia Beach, VA 23450-4884. Copyright © 2010 CDM Publishing, LLC. All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted, in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the written permission of the publisher.

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Secrets of Success

HEN FASHION DESIGNER (AND THIS MONTH’S COVER subject) Mondo Guerra disclosed his HIV status this fall on Project Runway, like many other viewers, I got a little teary-eyed. But when he told judge Nina Garcia, “I feel a lot better. I feel free,” I lost it. I knew exactly what he meant: The stigma around HIV puts so many of us into a cage of solitude and silence. And if we find the courage or impetus to escape, the relief is often enormous. When I interviewed him a few weeks after the episode aired (read the interview on my blog at POZ.com), Guerra told me his CD4 count had shot up. He said he felt healthier than ever—and the numbers showed it. A mere month after I started at POZ and told my story on the cover, the same thing happened to me: For the first time in a decade, though I changed nothing else in my life, my CD4 count shot up by 200. And stayed there. It only makes sense. Secrets can eat us alive when kept to ourselves. POZ founder Sean Strub recently reminded me of a quote by U.S. Supreme Court Justice Louis Brandeis: “Sunlight is the best disinfectant.” There is nothing as damaging to a poisonous secret as its release. When we tell our truth, we own it—it doesn’t own us in the way it can when we keep it hidden. I told my sister and parents I was HIV positive three months after my diagnosis. Their unwavering, nonjudgmental understanding and support have bolstered me every bit as much as medical care. But it wasn’t until I told my story to others that I was truly free. Guerra told me his parents were relieved, in a way, to finally understand what he was facing. His mom said she knew something was wrong. Guerra had been in and out of the hospital; once he had been so sick he’d developed Kaposi’s sarcoma, a rare sight today. That Guerra’s health had declined to such extremes probably had a lot to do with the fact that he kept his status a secret for so long. I’m glad he was finally able to share his story. He is a fantastic young man, a really talented designer and now, a role model for people living with HIV. Which is why we put him on our cover for the POZ 100. Some might ask, “Why is merely saying you have HIV—even on national TV—enough to get you on the list?” To which I answer: Because it is incredibly hard to disclose your HIV status. And it is exponentially harder when millions of people are watching you. By sharing his story not only did Guerra demonstrate remarkable courage, but he also leveraged his position in the limelight to illuminate the fact that HIV is still very much an issue today. On the occasion of World AIDS Day, December 1, 2010, we tip our hats to Guerra and 99 others who are among the best AIDS fighters we know. They have shown us, and will likely continue to show us, the way forward to a world where HIV is seen exactly as it should be: just another disease. And maybe a thing of the past. Surviving HIV day in and out is reason enough to make you a hero in our eyes. So, as we celebrate the POZ 100 we also raise a toast to all of you. May you have safe, healthy and joyful holidays. And may 2011, the 30th anniversary of the discovery of the virus, bring us a year closer to the end of HIV/AIDS.

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DECEMBER 2010 POZ 5

ATRIPLA Important Safety Information and Indication INDICATION ATRIPLA® (efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate [DF] 300 mg) is a prescription medication used alone as a complete regimen or with other medicines to treat HIV-1 infection in adults. ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others. The long-term effects of ATRIPLA are not known at this time. People taking ATRIPLA may still get infections that develop because the immune system is weak or other conditions that happen with HIV-1 infection. Do not stop taking ATRIPLA unless directed by your healthcare provider. See your healthcare provider regularly.

•Have ever had seizures: Seizures have occurred in patients taking a component of ATRIPLA, usually in those with a history of seizures. If you have ever had seizures, or take medicine for seizures, your healthcare provider may want to switch you to another medicine or monitor you. •Have ever had mental illness or use drugs or alcohol. Contact your healthcare provider right away if you experience any of the following serious or common side effects:

Serious side effects associated with ATRIPLA: •Severe depression, strange thoughts, or angry behavior have been reported by a small number of patients. Some patients have had thoughts of suicide, and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness. IMPORTANT SAFETY INFORMATION Contact your healthcare provider right away if you get the following •Kidney problems (including decline or failure of kidney function). side effects or conditions associated with ATRIPLA: If you have had kidney problems, or take other medicines that may • Nausea, vomiting, unusual muscle pain, and/or weakness. These cause kidney problems, your healthcare provider should do regular blood tests. Symptoms that may be related to kidney problems include may be signs of a buildup of acid in the blood (lactic acidosis), a high volume of urine, thirst, muscle pain, and muscle weakness. which is a serious medical condition. • Light-colored stools, dark-colored urine, and/or if your skin or the •Other serious liver problems. Some patients have experienced serious liver problems, including liver failure resulting in transplantation whites of your eyes turn yellow. These may be signs of serious or death. Most of these serious side effects occurred in patients with a liver problems. chronic liver disease such as hepatitis infection, but there have also • If you have HIV-1 and hepatitis B virus (HBV), your liver disease been a few reports in patients without any existing liver disease. may suddenly get worse if you stop taking ATRIPLA. •Bone changes. Lab tests show changes in the bones of patients treated Do not take ATRIPLA if you are taking the following medicines with tenofovir DF, a component of ATRIPLA. Some HIV patients treated because serious and life-threatening side effects may occur when with tenofovir DF developed thinning of the bones (osteopenia), which taken together: Vascor® (bepridil), Propulsid® (cisapride), could lead to fractures. Also, bone pain and softening of the bone Versed® (midazolam), Orap® (pimozide), Halcion® (triazolam), (which may lead to fractures) may occur as a consequence of kidney or ergot medications (for example, Wigraine® and Cafergot®). problems. If you have had bone problems in the past, your healthcare In addition, ATRIPLA should not be taken with: provider may want to check your bones. ® ® ® Combivir (lamivudine/zidovudine), EMTRIVA (emtricitabine), Epivir Common side effects: or Epivir-HBV® (lamivudine), Epzicom® (abacavir sulfate/lamivudine), SUSTIVA® (efavirenz), Trizivir® (abacavir sulfate/lamivudine/zidovudine), •Dizziness, headache, trouble sleeping, drowsiness, trouble ® ® TRUVADA (emtricitabine/tenofovir DF), or VIREAD (tenofovir DF), concentrating, and/or unusual dreams. These side effects tend to because they contain the same or similar active ingredients as ATRIPLA. go away after taking ATRIPLA for a few weeks. These symptoms may ATRIPLA should not be used with HEPSERA® (adefovir dipivoxil). be more severe with the use of alcohol and/or mood-altering (street) drugs. If you are dizzy, have trouble concentrating, and/or are drowsy, Vfend® (voriconazole) or REYATAZ® (atazanavir sulfate) with or without ® avoid activities that may be dangerous, such as driving or operating Norvir (ritonavir) should not be taken with ATRIPLA since they may lose their effect and may also increase the chance of having side effects machinery. from ATRIPLA. Fortovase® or Invirase® (saquinavir) should not be used •Rash is a common side effect that usually goes away without any as the only protease inhibitor in combination with ATRIPLA. change in treatment, but may be serious in a small number of patients. Taking ATRIPLA with St. John’s wort or products containing St. John’s wort •Other common side effects include: tiredness, upset stomach, vomiting, is not recommended as it may cause decreased levels of ATRIPLA, gas, and diarrhea. increased viral load, and possible resistance to ATRIPLA or Other possible side effects: cross-resistance to other anti-HIV drugs. This list of medicines is not complete. Discuss with your healthcare •Changes in body fat have been seen in some people taking anti-HIV-1 provider all prescription and nonprescription medicines, vitamins, medicines. The cause and long-term health effects are not known. or herbal supplements you are taking or plan to take. •Skin discoloration (small spots or freckles) may also happen. Tell your healthcare provider if you: •If you notice any symptoms of infection, contact your healthcare •Are pregnant: Women should not become pregnant while taking provider right away. ATRIPLA and for 12 weeks after stopping ATRIPLA. Serious birth defects •Additional side effects are inflammation of the pancreas, allergic have been seen in children of women treated during pregnancy with reaction (including swelling of the face, lips, tongue, or throat), one of the medicines in ATRIPLA. Women must use a reliable form of shortness of breath, pain, stomach pain, weakness, and indigestion. barrier contraception, such as a condom or diaphragm, even if they also You should take ATRIPLA once daily on an empty stomach. Taking use other methods of birth control, while on ATRIPLA and for 12 weeks ATRIPLA at bedtime may make some side effects less bothersome. after stopping ATRIPLA. •Are breastfeeding: Women with HIV should not breastfeed ATRIPLA is one of several treatment options your doctor may consider. because they can pass HIV through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm You are encouraged to report negative side effects to the baby. of prescription drugs to the FDA. •Have liver problems, including hepatitis B or C virus infection. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please Please see see Patient Patient Information Information on on the the following following pages. pages. © 2010 Bristol-Myers Squibb & Gilead Sciences, LLC. All rights reserved. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, VIREAD, and TRUVADA are trademarks of Gilead Sciences, Inc. SUSTIVA and REYATAZ are registered trademarks of Bristol-Myers Squibb. All other trademarks are owned by third parties. 697US09AB07049/TR7169 10/10

“All my HIV meds in one pill daily. I like that.” Shawn

on ATRIPLA for 21/2 years

ATRIPLA is the #1 prescribed HIV regimen.* About ATRIPLA: • Only ATRIPLA combines 3 HIV medications in 1 pill daily. †

• Proven to lower viral load to undetectable in approximately 7 out of 10 patients new to therapy, and also raise T-cell‡ (CD4+) count to help control HIV through 3 years of a clinical study.§ • ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others.

Selected Important Safety Information: Some people who have taken medicine like ATRIPLA have developed the following: a serious condition of acid buildup in the blood (lactic acidosis), and serious liver problems (hepatotoxicity). For patients with both HIV-1 and hepatitis B virus (HBV), hepatitis may suddenly worsen if ATRIPLA is discontinued. Please see detailed and additional Important Safety Information, including the bolded information to the left. †

Defined as a viral load of less than 400 copies/mL. Average increase of 312 cells/mm3. § In this study, 227 patients took the meds in ATRIPLA. ‡

Patient model. Individual results may vary.

Your doctor may prescribe ATRIPLA alone or with other HIV medications.

Talk to your doctor to see if ATRIPLA is right for you. * Synovate Healthcare Data; US HIV Monitor, Q1 2010.

To learn more, visit www.ATRIPLA.com

FDA-Approved Patient Labeling Patient Information ATRIPLA® (uh TRIP luh) Tablets ALERT: Find out about medicines that should NOT be taken with ATRIPLA. Please also read the section “MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA.” Generic name: efavirenz, emtricitabine and tenofovir disoproxil fumarate (eh FAH vih renz, em tri SIT uh bean and te NOE’ fo veer dye soe PROX il FYOU mar ate) Read the Patient Information that comes with ATRIPLA® (efavirenz/emtricitabine/tenofovir disoproxil fumarate) before you start taking it and each time you get a refill since there may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment. You should stay under a healthcare provider’s care when taking ATRIPLA. Do not change or stop your medicine without first talking with your healthcare provider. Talk to your healthcare provider or pharmacist if you have any questions about ATRIPLA. What is the most important information I should know about ATRIPLA? • Some people who have taken medicine like ATRIPLA (which contains nucleoside analogs) have developed a serious condition called lactic acidosis (buildup of an acid in the blood). Lactic acidosis can be a medical emergency and may need to be treated in the hospital. Call your healthcare provider right away if you get the following signs or symptoms of lactic acidosis: • You feel very weak or tired. • You have unusual (not normal) muscle pain. • You have trouble breathing. • You have stomach pain with nausea and vomiting. • You feel cold, especially in your arms and legs. • You feel dizzy or lightheaded. • You have a fast or irregular heartbeat. • Some people who have taken medicines like ATRIPLA have developed serious liver problems called hepatotoxicity, with liver enlargement (hepatomegaly) and fat in the liver (steatosis). Call your healthcare provider right away if you get the following signs or symptoms of liver problems: • Your skin or the white part of your eyes turns yellow (jaundice). • Your urine turns dark. • Your bowel movements (stools) turn light in color. • You don’t feel like eating food for several days or longer. • You feel sick to your stomach (nausea). • You have lower stomach area (abdominal) pain. • You may be more likely to get lactic acidosis or liver problems if you are female, very overweight (obese), or have been taking nucleoside analog-containing medicines, like ATRIPLA, for a long time. • If you also have hepatitis B virus (HBV) infection and you stop taking ATRIPLA, you may get a “flare-up” of your hepatitis. A “flare-up” is when the disease suddenly returns in a worse way than before. Patients with HBV who stop taking ATRIPLA need close medical follow-up for several months, including medical exams and blood tests to check for hepatitis that could be getting worse. ATRIPLA is not approved for the treatment of HBV, so you must discuss your HBV therapy with your healthcare provider. What is ATRIPLA? ATRIPLA contains 3 medicines, SUSTIVA® (efavirenz), EMTRIVA® (emtricitabine) and VIREAD® (tenofovir disoproxil fumarate also called tenofovir DF) combined in one pill. EMTRIVA and VIREAD are HIV-1 (human immunodeficiency virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and SUSTIVA is an HIV-1 non-nucleoside analog reverse transcriptase inhibitor (NNRTI). VIREAD and EMTRIVA are the components of TRUVADA®. ATRIPLA can be used alone as a complete regimen, or in combination with other anti-HIV-1 medicines to treat people with HIV-1 infection. ATRIPLA is for adults age 18 and over. ATRIPLA has not been studied in children under age 18 or adults over age 65. HIV infection destroys CD4+ T cells, which are important to the immune system. The immune system helps fight infection. After a large number of T cells are destroyed, acquired immune deficiency syndrome (AIDS) develops. ATRIPLA helps block HIV-1 reverse transcriptase, a viral chemical in your body (enzyme) that is needed for HIV-1 to multiply. ATRIPLA lowers the amount of HIV-1 in the blood (viral load). ATRIPLA may also help to increase the number of T cells (CD4+ cells), allowing your immune system to improve. Lowering the amount of HIV-1 in the blood lowers the chance of death or infections that happen when your immune system is weak (opportunistic infections). Does ATRIPLA cure HIV-1 or AIDS? ATRIPLA does not cure HIV-1 infection or AIDS. The long-term effects of ATRIPLA are not known at this time. People taking ATRIPLA may still get opportunistic infections or other conditions that happen with HIV-1 infection. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infection. It is very important that you see your healthcare provider regularly while taking ATRIPLA. Does ATRIPLA reduce the risk of passing HIV-1 to others? ATRIPLA has not been shown to lower your chance of passing HIV-1 to other people through sexual contact, sharing needles, or being exposed to your blood. • Do not share needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes or razor blades.

ATRIPLA® (efavirenz/emtricitabine/tenofovir disoproxil fumarate) e) •

Do not have any kind of sex without protection. Always practice safer sex by using a latex ex oor polyurethane condom or other barrier to reduce the chance of sexual contact with semen, n, vaginal secretions, or blood. v Who should not take ATRIPLA? Together with your healthcare provider, you need to decide whether ATRIPLA is right for you. Do not take ATRIPLA if you are allergic to ATRIPLA or any of its ingredients. The active ingredients ts oof ATRIPLA are efavirenz, emtricitabine, and tenofovir DF. See the end of this leaflet for a complete te list of ingredients. l What should I tell my healthcare provider before taking ATRIPLA? Tell your healthcare re pprovider if you: • Are pregnant or planning to become pregnant (see “What should I avoid while taking ng AATRIPLA?”). • Are breast-feeding (see “What should I avoid while taking ATRIPLA?”). • Have kidney problems or are undergoing kidney dialysis treatment. • Have bone problems. • Have liver problems, including hepatitis B virus infection. Your healthcare provider may ay wwant to do tests to check your liver while you take ATRIPLA. • Have ever had mental illness or are using drugs or alcohol. • Have ever had seizures or are taking medicine for seizures. What important information should I know about taking other medicines with ATRIPLA? ATRIPLA may change the effect of other medicines, including the ones for HIV-1, and may ay ccause serious side effects. Your healthcare provider may change your other medicines or change ge their doses. Other medicines, including herbal products, may affect ATRIPLA. For this reason, it t isis very important to let all your healthcare providers and pharmacists know what medications, herbal v al ssupplements, or vitamins you are taking. MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA • The following medicines may cause serious and life-threatening side effects when taken en wwith ATRIPLA. You should not take any of these medicines while taking ATRIPLA: Vascor or (bepridil), Propulsid (cisapride), Versed (midazolam), Orap (pimozide), Halcion (triazolam), ( m), ergot medications (for example, Wigraine and Cafergot). e • ATRIPLA also should not be used with Combivir (lamivudine/zidovudine), EMTRIVA, Epivir, ir, EEpivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), Trizivir (abacavir vir sulfate/lamivudine/zidovudine), SUSTIVA, TRUVADA, or VIREAD. s • Vfend (voriconazole) should not be taken with ATRIPLA since it may lose its effect or may ay i increase the chance of having side effects from ATRIPLA. • Do not take St. John’s wort (Hypericum perforatum), or products containing St. John’s ’s wwort with ATRIPLA. St. John’s wort is an herbal product sold as a dietary supplement. Talk lk with your healthcare provider if you are taking or are planning to take St. John’s wort. Taking w ng St. John’s wort may decrease ATRIPLA levels and lead to increased viral load and possible S le rresistance to ATRIPLA or cross-resistance to other anti-HIV-1 drugs. • ATRIPLA should not be used with HEPSERA® (adefovir dipivoxil). It is also important to tell your healthcare provider if you are taking any of the following: • Fortovase, Invirase (saquinavir), Biaxin (clarithromycin), Noxafil (posaconazole), oror SSporanox (itraconazole); these medicines may need to be replaced with another er mmedicine when taken with ATRIPLA. • Calcium channel blockers such as Cardizem or Tiazac (diltiazem), Covera HS or Isoptin in ((verapamil) and others; Crixivan (indinavir), Selzentry (maraviroc); the immunosuppressant nt mmedicines cyclosporine (Gengraf, Neoral, Sandimmune, and others), Prograf (tacrolimus),oror RRapamune (sirolimus); Methadone; Mycobutin (rifabutin); Rifampin; cholesterol-lowering ng mmedicines such as Lipitor (atorvastatin), Pravachol (pravastatin sodium), and Zocor or ((simvastatin); or Zoloft (sertraline); these medicines may need to have their dose se cchanged when taken with ATRIPLA. • Videx, Videx EC (didanosine); tenofovir DF (a component of ATRIPLA) may increase he the aamount of didanosine in your blood, which could result in more side effects. You may need ed the tto be monitored more carefully if you are taking ATRIPLA and didanosine together. Also, he ddose of didanosine may need to be changed. • Reyataz (atazanavir sulfate) or Kaletra (lopinavir/ritonavir); these medicines may increase he the aamount of tenofovir DF (a component of ATRIPLA) in your blood, which could result in more re sside effects. Reyataz is not recommended with ATRIPLA. You may need to be monitored ed more carefully if you are taking ATRIPLA and Kaletra together. Also, the dose of Kaletra may m ay nneed to be changed. • Medicine for seizures [for example, Dilantin (phenytoin), Tegretol (carbamazepine), oror pphenobarbital]; your healthcare provider may want to switch you to another medicine oror ccheck drug levels in your blood from time to time. These are not all the medicines that may cause problems if you take ATRIPLA. Be sure to tell ell yyour healthcare provider about all medicines that you take. Keep a complete list of all the prescription and nonprescription medicines as well as any herbal al rremedies that you are taking, how much you take, and how often you take them. Make a new list st when medicines or herbal remedies are added or stopped, or if the dose changes. Give copies w ofof tthis list to all of your healthcare providers and pharmacists every time you visit your healthcare re pprovider or fill a prescription. This will give your healthcare provider a complete picture of the he mmedicines you use. Then he or she can decide the best approach for your situation.

ATRIPLA® (efavirenz/emtricitabine/tenofovir disoproxil fumarate) How should I take ATRIPLA? • Take the exact amount of ATRIPLA your healthcare provider prescribes. Never change the dose on your own. Do not stop this medicine unless your healthcare provider tells you to stop. • You should take ATRIPLA on an empty stomach. • Swallow ATRIPLA with water. • Taking ATRIPLA at bedtime may make some side effects less bothersome. • Do not miss a dose of ATRIPLA. If you forget to take ATRIPLA, take the missed dose right away, unless it is almost time for your next dose. Do not double the next dose. Carry on with your regular dosing schedule. If you need help in planning the best times to take your medicine, ask your healthcare provider or pharmacist. • If you believe you took more than the prescribed amount of ATRIPLA, contact your local poison control center or emergency room right away. • Tell your healthcare provider if you start any new medicine or change how you take old ones. Your doses may need adjustment. • When your ATRIPLA supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to ATRIPLA and become harder to treat. • Your healthcare provider may want to do blood tests to check for certain side effects while you take ATRIPLA. What should I avoid while taking ATRIPLA? • Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping it. Serious birth defects have been seen in the babies of animals and women treated with efavirenz (a component of ATRIPLA) during pregnancy. It is not known whether efavirenz caused these defects. Tell your healthcare provider right away if you are pregnant. Also talk with your healthcare provider if you want to become pregnant. • Women should not rely only on hormone-based birth control, such as pills, injections, or implants, because ATRIPLA may make these contraceptives ineffective. Women must use a reliable form of barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control. Efavirenz, a component of ATRIPLA, may remain in your blood for a time after therapy is stopped. Therefore, you should continue to use contraceptive measures for 12 weeks after you stop taking ATRIPLA. • Do not breast-feed if you are taking ATRIPLA. The Centers for Disease Control and Prevention recommend that mothers with HIV not breast-feed because they can pass the HIV through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby. Talk with your healthcare provider if you are breast-feeding. You should stop breast-feeding or may need to use a different medicine. • Taking ATRIPLA with alcohol or other medicines causing similar side effects as ATRIPLA, such as drowsiness, may increase those side effects. • Do not take any other medicines, including prescription and nonprescription medicines and herbal products, without checking with your healthcare provider. • Avoid doing things that can spread HIV-1 infection since ATRIPLA does not stop you from passing the HIV-1 infection to others. What are the possible side effects of ATRIPLA? ATRIPLA may cause the following serious side effects: • Lactic acidosis (buildup of an acid in the blood). Lactic acidosis can be a medical emergency and may need to be treated in the hospital. Call your healthcare provider right away if you get signs of lactic acidosis. (See “What is the most important information I should know about ATRIPLA?”) • Serious liver problems (hepatotoxicity), with liver enlargement (hepatomegaly) and fat in the liver (steatosis). Call your healthcare provider right away if you get any signs of liver problems. (See “What is the most important information I should know about ATRIPLA?”) • “Flare-ups” of hepatitis B virus (HBV) infection, in which the disease suddenly returns in a worse way than before, can occur if you have HBV and you stop taking ATRIPLA. Your healthcare provider will monitor your condition for several months after stopping ATRIPLA if you have both HIV-1 and HBV infection and may recommend treatment for your HBV. ATRIPLA is not approved for the treatment of hepatitis B virus infection. If you have advanced liver disease and stop treatment with ATRIPLA, the “flare-up” of hepatitis B may cause your liver function to decline. • Serious psychiatric problems. A small number of patients may experience severe depression, strange thoughts, or angry behavior while taking ATRIPLA. Some patients have thoughts of suicide and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness. Contact your healthcare provider right away if you think you are having these psychiatric symptoms, so your healthcare provider can decide if you should continue to take ATRIPLA. • Kidney problems (including decline or failure of kidney function). If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider should do regular blood tests to check your kidneys. Symptoms that may be related to kidney problems include a high volume of urine, thirst, muscle pain, and muscle weakness. • Other serious liver problems. Some patients have experienced serious liver problems including liver failure resulting in transplantation or death. Most of these serious side effects occurred in patients with a chronic liver disease such as hepatitis infection, but there have also been a few reports in patients without any existing liver disease.

ATRIPLA® (efavirenz/emtricitabine/tenofovir disoproxil fumarate) Changes in bone mineral density (thinning bones). Laboratory tests show changes in the bones of patients treated with tenofovir DF, a component of ATRIPLA. Some HIV patients treated with tenofovir DF developed thinning of the bones (osteopenia) which could lead to fractures. If you have had bone problems in the past, your healthcare provider may need to do tests to check your bone mineral density or may prescribe medicines to help your bone mineral density. Additionally, bone pain and softening of the bone (which may contribute to fractures) may occur as a consequence of kidney problems. Common side effects: Patients may have dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, and/or unusual dreams during treatment with ATRIPLA. These side effects may be reduced if you take ATRIPLA at bedtime on an empty stomach. They also tend to go away after you have taken the medicine for a few weeks. If you have these common side effects, such as dizziness, it does not mean that you will also have serious psychiatric problems, such as severe depression, strange thoughts, or angry behavior. Tell your healthcare provider right away if any of these side effects continue or if they bother you. It is possible that these symptoms may be more severe if ATRIPLA is used with alcohol or mood altering (street) drugs. If you are dizzy, have trouble concentrating, or are drowsy, avoid activities that may be dangerous, such as driving or operating machinery. Rash may be common. Rashes usually go away without any change in treatment. In a small number of patients, rash may be serious. If you develop a rash, call your healthcare provider right away. Other common side effects include tiredness, upset stomach, vomiting, gas, and diarrhea. Other possible side effects with ATRIPLA: • Changes in body fat. Changes in body fat develop in some patients taking anti-HIV-1 medicine. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), in the breasts, and around the trunk. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these fat changes are not known. • Skin discoloration (small spots or freckles) may also happen with ATRIPLA. • In some patients with advanced HIV infection (AIDS), signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is started. It is believed that these symptoms are due to an improvement in the body’s immune response, enabling the body to fight infections that may have been present with no obvious symptoms. If you notice any symptoms of infection, please inform your doctor immediately. • Additional side effects are inflammation of the pancreas, allergic reaction (including swelling of the face, lips, tongue, or throat), shortness of breath, pain, stomach pain, weakness and indigestion. Tell your healthcare provider or pharmacist if you notice any side effects while taking ATRIPLA. Contact your healthcare provider before stopping ATRIPLA because of side effects or for any other reason. This is not a complete list of side effects possible with ATRIPLA. Ask your healthcare provider or pharmacist for a more complete list of side effects of ATRIPLA and all the medicines you will take. How do I store ATRIPLA? • Keep ATRIPLA and all other medicines out of reach of children. • Store ATRIPLA at room temperature 77 °F (25 °C). • Keep ATRIPLA in its original container and keep the container tightly closed. • Do not keep medicine that is out of date or that you no longer need. If you throw any medicines away make sure that children will not find them. General information about ATRIPLA: Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use ATRIPLA for a condition for which it was not prescribed. Do not give ATRIPLA to other people, even if they have the same symptoms you have. It may harm them. This leaflet summarizes the most important information about ATRIPLA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ATRIPLA that is written for health professionals. Do not use ATRIPLA if the seal over bottle opening is broken or missing. What are the ingredients of ATRIPLA? Active Ingredients: efavirenz, emtricitabine, and tenofovir disoproxil fumarate Inactive Ingredients: croscarmellose sodium, hydroxypropyl cellulose, microcrystalline cellulose, magnesium stearate, sodium lauryl sulfate. The film coating contains black iron oxide, polyethylene glycol, polyvinyl alcohol, red iron oxide, talc, and titanium dioxide. •

May 2010 ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, TRUVADA, HEPSERA and VIREAD are trademarks of Gilead Sciences, Inc. SUSTIVA is a trademark of Bristol-Myers Squibb Pharma Company. Reyataz and Videx are trademarks of Bristol-Myers Squibb Company. Pravachol is a trademark of ER Squibb & Sons, LLC. Other brands listed are the trademarks of their respective owners.

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May 2010

YOUR FEEDBACK community for others recovering from this kind of religious abuse. I am so glad I am gay! I have never been more content and happy. Ex-gay? No way! JALLEN RIX, EDD SAN FRANCISCO

Thank you so much for this article. It tells the truth of increased HIV risk for those who have gone through the ex-gay movement, reparative therapy or conversion therapy. Many of us who are working in HIV prevention, as I am, and who went through the ex-gay movement for years, as I did, have long understood these painful realities. R. SCOTT HARRISON PITTSBURGH

BAD RELIGION “Thou Shalt Fear AIDS” (September 2010) explored how the ex-gay movement and reparative therapy to “cure” homosexuality can lead to physical and psychological harm—including elevated risks for HIV. It saddens me that so many gay people damn themselves over a man-made concept such as religion, allowing it to dictate how they should feel about themselves. By planting guilt deep within their victims, those in control of these religious movements have accomplished their mission for more control. I refuse to give them power over me. I neither need nor ask for their approval. I am far too secure with who I am to allow them to govern my happiness and existence. ANTONIO MARQUEZ DENVER

Great reporting! Indeed, it is often the “ex-gay survivor” who gets lost in the shufﬂe of Bible banging and [media shouting] and who feels like a failure. I too made it through these cult-like organizations to eventually accepting and loving myself for who I am. Now there is support, strength and

Talk To Us 10 POZ DECEMBER 2010

An important P.S. to this story is that behavioral scientists presented a number of papers at the recent XVIII International AIDS Conference in Vienna that scientiﬁcally prove that shame, guilt and internalized homophobia [during] childhood are directly related to increased risky sex and drug use and the resulting HIV infection and AIDS that we are seeing in adult MSM. DAVID G. OSTROW, MD, PHD CHICAGO

IN MEMORY OF RYAN WHITE In “The Importance of Remembering Ryan White” (September 2010), Shawn Decker recalled the teenage White’s advocacy for all people living with HIV and his legacy, which continues to improve the quality of life for the HIV community. Great article Shawn! The ﬁ rst time I heard about Ryan was when he passed away on my 25th birthday in 1991— I was in my second year of being HIV positive. As I learned more about Ryan’s plight, I was inspired to become an advocate. I ﬁ nd it sad that today many who are positive do not know the true meaning of advocacy and what Ryan stood for. Had it not been for his struggles and tenacity, I’m afraid I

wouldn’t be here today. I hope that one day we will see more responsible sex education in schools and at home. PATRICIA STEEN KANSAS CITY, MO

Thank you Shawn for writing about Ryan White and evoking his memory, his story and his legacy with the children’s museum. I am certain if Ryan were alive today and healthy he would continue to ﬁght for treatment advocacy and equality for all living with HIV. As someone who was around when Ryan was still alive and who also beneﬁted from the Ryan White CARE Act as an AIDS counselor back in those dark days, [I recall] Ryan’s mother as the light that shone strong for us. SHERRI LOS ANGELES

Corrections: In “Crying Uncle” (September 2010), the name of the character getting an HIV test on Brothers & Sisters is Saul. In “POZ Q&A: Jeffrey Crowley” (October/November 2010), the correct name of the law referenced in Crowley’s response to the question on funding increases is the Affordable Care Act.

POZ POLL Does the ex-gay movement increase HIV risk?

80% yes

20% no

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Hey, have you heard the news? For eligible patients, Merck covers up to $400 on out-of-pocket costs, for each of up to 12 prescriptions. Introducing the Savings Coupona for ISENTRESS. Eligibility restrictions, terms, and conditions apply.a To find out more, call

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eligible privately insured patients. Not valid for residents of Massachusetts. Restrictions apply. Please see full Terms and Conditions on isentress.com.

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1-866-350-9232 or visit isentress.com.

INDICATIONS ISENTRESS is an anti-HIV medicine used for the treatment of HIV. ISENTRESS must be used with other anti-HIV medicines, which may increase the likelihood of response to treatment. The safety and effectiveness of ISENTRESS in children has not been studied. It is important that you remain under your doctorâ&#x20AC;&#x2122;s care. ISENTRESS will NOT cure HIV infection or reduce your chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood.

IMPORTANT RISK INFORMATION A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when anti-HIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to treat the HIV infection and strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS. Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions muscle problems can be serious and can lead to kidney damage. When ISENTRESS has been given with other anti-HIV drugs, side effects included nausea, headache, tiredness, weakness, trouble sleeping, stomach pain, dizziness, depression, and suicidal thoughts and actions. Rash occurred more often in patients taking ISENTRESS and darunavir together than with either drug separately, but was generally mild.

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 clinical studies lasting 96 weeks, patients being treated with HIV medication for the first time who took ISENTRESS plus Truvada: Had a low rate of side effects — The most common side effect of moderate to severe intensity (that interfered with or kept patients from performing daily activities) was trouble sleeping — This side effect occurred more often in patients taking ISENTRESS plus Truvada (4%) versus Sustiva plus Truvada (3%) Experienced less effect on LDL cholesterol (“bad” cholesterol) — Cholesterol increased an average of 7 mg/dL with ISENTRESS plus Truvada versus 21 mg/dL with Sustiva plus Truvada

Ask your doctor about ISENTRESS. Not sure where to start? Visit isentress.com/questions

People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection. Tell your doctor about all of your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breast-feeding or plan to breast-feed. ISENTRESS is not recommended for use during pregnancy. Women with HIV should not breast-feed 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 used to treat infections such as 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. For more information about ISENTRESS, please read the Patient Information on the following page.

Need help paying for ISENTRESS? Call 1-866-350-9232 ISENTRESS is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Copyright © 2010 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. 21052250(4)(110)-10/10-ISN-CON Sustiva is a registered trademark of Bristol-Myers Squibb Truvada is a registered trademark of Gilead Sciences, Inc.

Patient Information ISENTRESS ® (eye sen tris) (raltegravir) Tablets Read the patient information that comes with ISENTRESS1 before you start taking it and each time you get a refill. There may be new information. This leaflet is a summary of the information for patients. Your doctor or pharmacist can give you additional information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment. What is ISENTRESS? • ISENTRESS is an anti-HIV (antiretroviral) medicine used for the treatment of HIV. The term HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). ISENTRESS is used along with other anti-HIV medicines. ISENTRESS will NOT cure HIV infection. • People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that happen with HIV infection. • Stay under the care of your doctor during treatment with ISENTRESS. • The safety and effectiveness of ISENTRESS in children has not been studied. ISENTRESS must be used with other anti-HIV medicines. How does ISENTRESS work? • ISENTRESS blocks an enzyme which the virus (HIV) needs in order to make more virus. The enzyme that ISENTRESS blocks is called HIV integrase. • When used with other anti-HIV medicines, ISENTRESS may do two things: 1. Reduce the amount of HIV in your blood. This is called your “viral load”. 2. Increase the number of white blood cells called CD4 (T) cells. • ISENTRESS may not have these effects in all patients. Does ISENTRESS lower the chance of passing HIV to other people? No. ISENTRESS does not reduce the chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood. • Continue to practice safer sex. • Use latex or polyurethane condoms or other barrier methods to lower the chance of sexual contact with any body fluids. This includes semen from a man, vaginal secretions from a woman, or blood. • Never re-use or share needles. Ask your doctor if you have any questions about safer sex or how to prevent passing HIV to other people. What should I tell my doctor before and during treatment with ISENTRESS? Tell your doctor about all of your medical conditions. Include any of the following that applies to you: • You have any allergies. • You are pregnant or plan to become pregnant. - ISENTRESS is not recommended for use during pregnancy. ISENTRESS has not been studied in pregnant women. If you take ISENTRESS while you are pregnant, talk to your doctor about how you can be included in the Antiretroviral Pregnancy Registry. • You are breast-feeding or plan to breast-feed. - It is recommended that HIV-infected women should not breast-feed their infants. This is because their babies could be infected with HIV through their breast milk. - Talk with your doctor about the best way to feed your baby. Tell your doctor about all the medicines you take. Include the following: • prescription medicines, including rifampin (a medicine used to treat some infections such as tuberculosis) • non-prescription medicines • vitamins • herbal supplements Know the medicines you take. • Keep a list of your medicines. Show the list to your doctor and pharmacist when you get a new medicine. How should I take ISENTRESS? Take ISENTRESS exactly as your doctor has prescribed. The recommended dose is as follows: • Take only one 400-mg tablet at a time. • Take it twice a day. • Take it by mouth. • Take it with or without food. Do not change your dose or stop taking ISENTRESS or your other anti-HIV medicines without first talking with your doctor.

If you fail to take ISENTRESS the way you should, here’s what to do: • 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 take two tablets of ISENTRESS at the same time. In other words, do NOT take a double dose. • If you take too much ISENTRESS, call your doctor or local Poison Control Center. Be sure to keep a supply of your anti-HIV medicines. • When your ISENTRESS supply starts to run low, get more from your doctor or pharmacy. • Do not wait until your medicine runs out to get more. What are the possible side effects of ISENTRESS? When ISENTRESS has been given with other anti-HIV drugs, side effects included: • nausea • headache • tiredness • weakness • trouble sleeping • stomach pain • dizziness • depression • suicidal thoughts and actions Other side effects include rash, severe skin reactions, feeling anxious, paranoia, low blood platelet count. A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when combination antiretroviral treatment is started. Signs and symptoms of inflammation from opportunistic infections that a person has or had may occur as the medicines work to treat the HIV infection and help to strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS with other anti-HIV medicines. Contact your doctor promptly if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions, muscle problems can be serious and can lead to kidney damage. Rash occurred more often in patients taking ISENTRESS and darunavir together than with either drug separately, but was generally mild. Tell your doctor if you have any side effects that bother you. These are not all the side effects of ISENTRESS. For more information, ask your doctor or pharmacist. How should I store ISENTRESS? • Store ISENTRESS at room temperature (68 to 77°F). • Keep ISENTRESS and all medicines out of the reach of children. General information about the use of 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 additional 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? Active ingredient: Each film-coated tablet contains 400 mg of 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. In addition, the film coating contains the following inactive ingredients: polyvinyl alcohol, titanium dioxide, polyethylene glycol 3350, talc, red iron oxide and black iron oxide.

IMPORTANT: Take ISENTRESS exactly as your doctor prescribed and at the right times of day because if you don’t: • The amount of virus (HIV) in your blood may increase if the medicine is stopped for even a short period of time. • The virus may develop resistance to ISENTRESS and become harder to treat. • Your medicines may stop working to fight HIV. • The activity of ISENTRESS may be reduced (due to resistance).

Distributed by: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Whitehouse Station, NJ 08889, USA

Revised June 2010 9795110 U.S. Patent Nos. US 7,169,780 21052250(4)(110)-10/10-ISN-CON

talking Blood, Sweat and Tears

POZ speaks with Marilyn Ness, Emmy Award–winning producer, about Bad Blood, a documentary that chronicles how the hemophilia community fought to protect the blood supply from HIV. What inspired you to make a documentary about this often forgotten chapter in HIV/AIDS history?

I grew up with Mathew Kleiner [an HIV-positive advocate who died in 2003 of hepatitis and complications due to HIV] in Brooklyn. I knew he had hemophilia, but other than [when we discussed] how rough we could get on the monkey bars, it didn’t really come up much. Coincidentally, my sister wound up in college with him at Cornell University [in New York state]. They became friends, so we all reconnected. In his junior year at Cornell, he decided to come out publicly [about the fact] that he had HIV and told his story of contracting HIV from Factor VIII, a bloodbased medication that had been approved by the Food and Drug Administration (FDA). Is that when you first learned that many people with hemophilia had contracted HIV through blood products?

I knew AIDS affected the “four Hs”: homosexuals, Haitians, hemophiliacs and heroin addicts. Like most people, I never stopped to consider how hemophiliacs got it. I knew it had something to do with blood, but I guess I thought Bad Blood they got it from a blood transfusion. movie What startled me is that many hemophiliacs poster

got it from Factor VIII. In order to make Factor VIII, blood went through rounds and rounds of treatment and processing that ultimately turned it into white powder. In the process, HIV-tainted blood was used. There was opportunity at each stage of production to address the viral contamination. But no one did, because no one knew what had happened. Before HIV/AIDS, the hemophilia community went through a similar situation in which people were exposed accidentally to

DECEMBER 2010 POZ 15

T A L K I N G

hepatitis B. Were the lax response to that incident and the resulting infections warning signs of things to come?

Yes, neither the pharmaceutical companies nor the FDA nor the doctors nor the patient advocacy groups insisted the product be cleaned of viruses. It’s actually such an unbelievable notion in many ways. [And they certainly didn’t advertise what happened.] I’m not surprised people don’t understand how hemophiliacs contracted HIV. What do you hope people w i l l t a ke aw ay f r o m watching Bad Blood?

Once the hemophilia communit y began to [contract HIV], experts at the Centers for Disease Control and Prevention [CDC] realized pretty quickly it meant the virus was in the blood supply. Had the CDC warnings been heeded, then steps could have—and should have—been taken to change the blood collection process in the United States. It is widely accepted that, had those changes been made, a good nu mber of t he 12,000 people who cont racted H I V th rough blood transfusions [in addition to the 10,000 hemophiliacs] during t hat era m ig ht have been saved. My hope is that this film, by raising awareness of what happened, will help keep the blood supply safe.

Both the hemophilia and gay communities have lost so many people to this epidemic, it’s understandable that passions run so deep on both sides

of the film shows how the hemophilia community became politically active regarding blood safety. It’s similar to how the gay community were leaders in advocating for condom use. Blood safety gained national attention again in 2010 over discussions regarding the ban on blood donations by homosexuals. It was issued more than 20 years ago as an initial response remove it. Do you believe the ban should be lifted?

In 1980, the gay community donated 5 percent of 16 POZ DECEMBER 2010

Marilyn Ness and stills from Bad Blood

In every way, what happened in the hemophilia community was an early warning sign about the safety of the U.S. blood supply. And though many people with hemophilia no longer use blood-based therapies [they use genetically engineered products], that community still considers itself the guardians of the nation’s blood supply, [hoping to ensure] a tragedy like the one chronicled in Bad Blood will never again happen on their watch. Personally, I feel we owe them a debt of gratitude for that. —SHAWN DECKER

Go to badblooddocumentary.com for more information.

IMAGES COURTESY OF BAD BLOOD DOCUMENTARY

regarding gay donors.

One of my favorite parts

to the AIDS crisis. But arguably it may be time to

the nation’s blood. It was a true act of altruism and civic responsibility, considering less than 5 percent of all eligible donors donate today. So I understand fully the frustration of the gay community in being prohibited from donating blood in the United States. On the flip side, I know the hemophilia community well and know they will bear 100 percent of the risk if another infectious agent makes its way into the U.S. blood supply. I am hugely gratified that Gay Men’s Health Crisis [GMHC] saw Bad Blood and reached out to the bleeding groups to work together on com i ng up w ith a thoughtful process to reconsider the gay donor blood ban. GMHC wants to use Bad Blood to educate its community on why patience is needed as scientists, public health officials and advocates li ke GM HC and the bleeding groups work together to make safe and fair blood donor policies in the United States.

KALETRA® (kuh-LEE-tra) (lopinavir/ritonavir) Tablets KALETRA® (kuh-LEE-tra) (lopinavir/ritonavir) Oral Solution Patient Information What is the most important information I should know about KALETRA? KALETRA may cause serious side effects, including: • Interactions with other medicines. It is important to know the medicines that should not be taken with KALETRA. Read the section “What should I tell my doctor before taking KALETRA?” • Changes in your heart rhythm and the electrical activity of your heart. These changes may be seen on an EKG (electrocardiogram) and can lead to serious heart problems. Your risk for these problems may be higher if you: ° already have a history of abnormal heart rhythm or other types of heart disease. ° take other medicines that can affect your heart rhythm while you take KALETRA. Tell your doctor right away if you have any of these symptoms while taking KALETRA: • dizziness • lightheadedness • fainting • sensation of abnormal heartbeats See the section below “What are the possible side effects of KALETRA?” for more information about serious side effects.

CONSUMER BRIEF SUMMARY CONSULT PACKAGE INSERT FOR FULL PRESCRIBING INFORMATION

Read the Medication Guide that comes with KALETRA before you start taking it 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 treatment. You and your doctor should talk about your treatment with KALETRA before you start taking it and at regular check-ups. You should stay under your doctor’s care when taking KALETRA.

Who should not take KALETRA? • Do not take KALETRA if you are taking certain medicines. For more information about medicines you should not take with KALETRA, please see “Can I take other medicines with KALETRA?” and consult with your doctor about all other medicines you take. • Do not take KALETRA if you have an allergy to KALETRA or any of its ingredients, including ritonavir and lopinavir.

What should I tell my doctor before taking KALETRA?

KALETRA may not be right for you. Tell your doctor about all your medical conditions, including if you: • have any heart problems, including if you have a condition called Congenital Long QT Syndrome. • have liver problems, including Hepatitis B or Hepatitis C. • have diabetes. • have hemophilia. People who take KALETRA may have increased bleeding. • have low potassium in your blood. • are pregnant or plan to become pregnant. It is not known if KALETRA will harm your unborn baby. Birth control pills or patches may not work as well while you take KALETRA. To prevent pregnancy while taking KALETRA, women who take birth control pills or use estrogen patch for birth control should either use a different type of birth What is KALETRA? control or an extra form of birth control. Talk to your doctor about how to prevent KALETRA is a prescription anti-HIV pregnancy while taking KALETRA. medicine that contains two medicines: lopinavir and ritonavir. KALETRA is called • take KALETRA during pregnancy, talk with your doctor about how you can a protease inhibitor that is used with other take part in an antiretroviral pregnancy anti-HIV-1 medicines to treat people with registry. The purpose of the pregnancy human immunodeficiency virus (HIV-1) registry is to follow the health of you infection. HIV-1 is the virus that causes and your baby. AIDS (Acquired Immune Deficiency • are breast-feeding. Do not breast-feed if Syndrome). you are taking KALETRA. You should not It is not known if KALETRA is safe and breast-feed if you have HIV-1. If you are effective in children under 14 days old.

a woman who has or will have a baby while taking KALETRA, talk with your doctor about the best way to feed your baby. If your baby does not already have HIV-1, there is a chance that HIV-1 can be passed to your baby through your breast milk. Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Many medicines interact with KALETRA. Do not start taking a new medicine without telling your doctor or pharmacist. Your doctor can tell you if it is safe to take KALETRA with other medicines. Your doctor may need to change the dose of other medicines while you take KALETRA.

Medicines you should not take with KALETRA. Serious problems or death can happen if you take these medicines with KALETRA: • ergot containing medicines, including: ° ergotamine tartrate (Cafergot®, Migergot, Ergomar, Ergostat, Medihaler Ergotamine, Wigraine, Wigrettes) mesylate ° dihydroergotamine (D.H.E. 45®, Embolex, Migranal®) ° ergonovine, ergonovine and methylergonovine (Ergotrate, Methergine), ergotamine and methylergonovine ° Ergotrate Maleate, methylergonovine maleate (Methergine) • triazolam (Halcion®), midazolam hydrochloride oral syrup • pimozide (Orap®) • the cholesterol lowering medicines lovastatin (Mevacor®) or simvastatin (Zocor®) • sildenafil (Revatio®) only when used for the treatment of pulmonary arterial hypertension. (See “Medicines that may need changes” and “What are the

possible side effects of Kaletra?” for information about the use of sildenafil for erectile problems.) • alfuzosin (Uroxatral®) Medicines that you should not take with KALETRA since they may make KALETRA not work as well: • the herbal supplement St. John’s Wort (hypericum perforatum) • rifampin (Rimactane®, Rifadin®, Rifater®, or Rifamate®) Medicines that may need changes: • birth control pills that contain estrogen (“the pill”) or the birth control (contraceptive) patches • certain anticancer medicines, such as nilotinib (Tasigna®) and dasatinib (Sprycel®) • certain cholesterol lowering medicines, such as atorvastatin (Lipitor®) or rosuvastatin (Crestor®) • certain other antiretroviral medicines, such as efavirenz (Atripla® and Sustiva®), nevirapine (Viramune®), amprenavir (Agenerase®) and nelfinavir (Viracept®) • anti-seizure medicines, such as phenytoin (Dilantin®) carbamazepine, (Tegretol®), phenobarbital • medicines for erectile problems, such as sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®) • medicines for tuberculosis (TB), such as rifabutin (Mycobutin®) • inhaled steroid medicines, such as fluticasone propionate (Flonase®) • inhaled medicines such as salmeterol (Serevent®) or salmeterol in combination with fluticasone propionate (Advair®). Your doctor may need to change to a different medicine • medicines for gout, such as colchicine (Colcrys®) • medicines to treat pulmonary arterial hypertension (PAH), such as bosentan (Tracleer®) or tadalafil (Adcirca®) • pain medicines, such as fentanyl (Duragesic®, IonsysTM, Fentora®) and methadone If you are not sure if you are taking a medicine above, ask your doctor.

• KALETRA tablets can be taken with or without food. • If you are taking both Videx® (didanosine) and KALETRA: ° didanosine can be taken at the same time as KALETRA tablets, without food. ° take didanosine either one hour before or two hours after taking KALETRA oral solution. • Do not miss a dose of KALETRA. This could make the virus harder to treat. If you forget to take KALETRA, take the missed dose right away. If it is almost time for your next dose, do not take the missed dose. Instead, follow your regular dosing schedule by taking your next dose at its regular time. Do not take more than one dose of KALETRA at one time. • If you take more than the prescribed dose of KALETRA, call your local poison control center or emergency room right away. • Take KALETRA oral solution with food to help it work better. • If KALETRA is being used for your child, tell your doctor if your child’s weight changes. • KALETRA should not be given one time each day in children. When giving KALETRA to your child, give KALETRA exactly as prescribed. • KALETRA oral solution contains a large amount of alcohol. ° If a young child drinks more than the recommended dose, it could make them sick from too much alcohol. Contact your local poison control center or emergency room right away. ° Talk with your doctor if you take or plan to take metronidazole or disulfiram. You can have severe nausea and vomiting if you take these medicines with KALETRA. • When your KALETRA supply starts to run low, get more from your doctor or pharmacy. It is important not to run out of KALETRA. The amount of HIV-1 virus in your blood may increase if the medicine is stopped for even a short time. The virus may become resistant to KALETRA and become harder to treat. How should I take KALETRA? • KALETRA can be taken with acid • Take KALETRA every day exactly as reducing agents used for heartburn or prescribed by your doctor. reflux such as omeprazole (Prilosec®) • It is very important to set up a dosing and ranitidine (Zantac® ) with no dose schedule and follow it every day. adjustment. • Do not change your treatment or stop • KALETRA should not be administered treatment without first talking with your once daily in combination with doctor. carbamazepine (Tegretol® and Epitol®), • Swallow KALETRA tablets whole. Do phenobarbital (Luminal®), or phenytoin not chew, break, or crush KALETRA (Dilantin®). tablets.

Avoid doing things that can spread HIV infection. KALETRA does not stop you from passing HIV infection to others. Do not share needles, other injection equipment or 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 secretions, or blood.

What are the possible side effects of KALETRA? KALETRA can cause serious side effects. • See “What is the most important information I should know about KALETRA?” • Liver problems. Liver problems, including death, can happen in people who take KALETRA. Blood tests in people who take KALETRA may show possible liver problems. People with liver disease such as Hepatitis B and Hepatitis C who take KALETRA may have worsening liver disease. Tell your healthcare provider right away if you have any of these signs and symptoms of liver problems: ° loss of appetite ° yellow skin and whites of eyes (jaundice) ° dark-colored urine ° pale colored stools, itchy skin ° stomach area (abdominal) pain. • Inflammation of the pancreas (pancreatitis). Some people who take KALETRA get inflammation of the pancreas which may be serious and cause death. You have a higher chance of getting pancreatitis if you have had it before. Tell your doctor if you have nausea, vomiting, or abdominal pain while taking KALETRA. These may be signs of pancreatitis. • Increases in certain fat (triglycerides and cholesterol) levels in your blood. Large increases of triglycerides and cholesterol can be seen in blood test results of some people who take KALETRA. The longterm chance of getting complications such as heart attacks or stroke due to increases in triglycerides and cholesterol caused by protease inhibitors is not known at this time. • Diabetes and high blood sugar (hyperglycemia). Some people who take protease inhibitors including KALETRA get new or more serious diabetes, or high blood sugar. Tell your doctor if you notice an increase in thirst or urinate often while taking KALETRA.

• Changes in body fat. Changes in body fat in some people who take antiretroviral therapy. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the trunk. Loss of fat from the legs, arms and face may also happen. The cause and long-term health effects of these conditions are not known at this time. • Increased bleeding for hemophiliacs. Some people with hemophilia have increased bleeding with protease inhibitors including KALETRA. • Increased risk of certain problems when you take medicines used for the treatment of erectile problems such as sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®) with KALETRA: ° low blood pressure. If you get dizzy or faint, you need to lie down. Tell your doctor if you feel dizzy, or have fainting spells. ° vision changes. Tell your doctor right away if you have vision changes. ° penis erection lasting more than 4 hours. If you are a male and have an erection that lasts longer than 4 hours, get medical help right away to avoid permanent damage to your penis. Your doctor can explain these symptoms to you. • Allergic reactions. Skin rashes, some of them severe, can occur in people who take KALETRA. Tell your healthcare provider if you had a rash when you took another medicine for your HIV infection or if you notice any skin rash when you take KALETRA. Common side effects of KALETRA include:

How should I store KALETRA?

polyethylene glycol 400, hydroxypropyl cellulose, talc, colloidal silicon dioxide, KALETRA tablets: polyethylene glycol 3350, yellow ferric • Store KALETRA tablets at room oxide 172, and polysorbate 80. temperature, between 59°F to 86°F KALETRA 100 mg lopinavir and (15°C to 30°C). • Do not keep KALETRA tablets out of the 25 mg ritonavir tablets: copovidone, sorbitan monolaurate, colloidal silicon container it comes in for longer than dioxide, and sodium stearyl fumarate. The 2 weeks, especially in areas where film coating contains: polyvinyl alcohol, there is a lot of humidity. Keep the titanium dioxide, talc, polytheylene glycol container closed tightly. 3350, and yellow ferric oxide E172. KALETRA oral solution: KALETRA oral solution: acesulfame • Store KALETRA oral solution in a refrigerator, between 36°F to 46°F (2°C potassium, alcohol, artificial cotton candy flavor, citric acid, glycerin, high to 8°C). KALETRA oral solution that is kept refrigerated may be used until the fructose corn syrup, Magnasweet-110 flavor, menthol, natural and artificial expiration date printed on the label. vanilla flavor, peppermint oil, polyoxyl • KALETRA oral solution that is stored at 40 hydrogenated castor oil, povidone, room temperature (less than 77°F or 25°C) should be used within 2 months. propylene glycol, saccharin sodium, sodium chloride, sodium citrate, and • Keep KALETRA away from high heat. water. Throw away any medicine that is out of KALETRA oral solution contains date or that you no longer need. 42.4% alcohol (v/v). “See How Keep KALETRA and all medicines out should I take KALETRA?”. of the reach of children. KALETRA Tablets, 200 mg lopinavir/50 mg General information about ritonavir Manufactured by Abbott Pharmaceuticals KALETRA PR Ltd., Barceloneta, PR 00617 KALETRA does not cure HIV-1 or AIDS. for Abbott Laboratories, North Chicago, IL The long-term effects of KALETRA are not 60064, U.S.A. known at this time. People taking KALETRA KALETRA Tablets, 100 mg lopinavir/25 mg may still get opportunistic infections or ritonavir and KALETRA Oral Solution other conditions that happen with HIV-1 Abbott Laboratories, North Chicago, IL infection. Some of these conditions are 60064, U.S.A. pneumonia, herpes virus infections, and 2010, ALL RIGHTS RESERVED Mycobacterium avium complex (MAC) infections. * The brands listed are trademarks of their Medicines are sometimes prescribed respective owners and are not trademarks for purposes other than those listed in a of Abbott Laboratories. The makers of Medication Guide. Do not use KALETRA for these brands are not affiliated with and a condition for which it was not prescribed. do not endorse Abbott Laboratories or its Do not give KALETRA to other people, even products. if they have the same condition you have. It may harm them. This Medication Guide has been approved by the U.S. Food and Drug Administration. • diarrhea This Medication Guide summarizes • nausea the most important information about Ref: 03-A387-R8 • stomach area (abdominal) pain KALETRA. If you would like more • feeling weak Revised: June, 2010 information, talk with your doctor. You • vomiting 036-395112 MASTER can ask your pharmacist or doctor for • headache information about KALETRA that is • upset stomach written for health professionals. For more These are not all of the possible side information about KALETRA call 1-800effects of KALETRA. For more information, 633-9110 or go to www.KALETRA.com. 039-403014 ask your doctor or pharmacist. Tell your doctor about any side effect that bothers What are the ingredients in KALETRA? you or that does not go away. Active ingredient: lopinavir and ritonavir Call your doctor for medical advice about Inactive ingredients: side effects. You may report side effects KALETRA 200 mg lopinavir and 50 mg to FDA at 1-800-FDA-1088. ritonavir tablets: copovidone, sorbitan monolaurate, colloidal silicon dioxide, and sodium stearyl fumarate. The film coating contains: hypromellose, titanium dioxide,

T A L K I N G

Jerry Herman

Bill T. Jones

Positive Rewards

(HERMAN) GETTY IMAGES/DIMITRIOS KAMBOURIS; (JONES) GETTY IMAGES/BRAD BARKET

BILL T. JONES AND JERRY HERMAN RECEIVE KENNEDY CENTER HONORS. On December 28, CBS is scheduled to broadcast The Kennedy Center Honors, a program that “redeﬁnes America’s perception of its artistic legacy” by “reinventing the way this nation rewards its artists.” This year’s program will add five names to the historic roster of 166 big-deal dancers, singers, actors, composers, playwrights and TV celebs anointed inside the illustrious Washington, DC, structure. The telecast, always an Emmy darling, will be especially distinguished this year—and not just because it is one of the few remaining awards programs to escape the

clutches of actor turned award-show host extraordinaire Neil Patrick Harris. For the first time in the event’s 33-year history, it will induct two artists openly living with HIV: choreographer Bill T. Jones and Broadway composer and lyricist Jerry Herman. Both men have appeared on POZ covers; Jones in July/August 1994 and Herman in February 1997. The pair will sit beside President Barack Obama as a parade of colleagues pays tribute to their careers. (Other inductees this year include Merle Haggard, Paul McCartney and Oprah Winfrey.) The show’s organizers would not

reveal if the celebration will mention Jones’s and Herman’s triumphs in the face of HIV. But this much we know: Too often, HIV has rewarded this nation’s finest artists not with laurels but with death. Jones, 58, and Herman, 79, have both borne witness to AIDS devastating leagues of their colleagues, including choreographer Alvin Ailey (honored by the Kennedy Center in 1998). AIDS has also touched Jones personally when, in 1988, he lost his longtime partner, Arnie Zane, to the disease. He and Zane had formed the genrebending Bill T. Jones/Arnie Zane Dance Company. Jones then confronted not only grief, but also the phobias of America’s most celebrated critics. In 1994, The New Yorker’s Arlene Croce wrote that she would not attend Jones’s Still/Here, dismissing it as “victim art.” The work is now considered monumental. Jones has been named a MacArthur Fellow, has won two Tonys (for Spring Awakening and Fela!) and crafted more than 100 dances. Jerry Herman, meanwhile, has been nominated for ﬁve Tonys (he’s won two) during his 50-year Broadway career. He wrote and composed Mack and Mabel, La Cage Aux Folles, Mame and Hello, Dolly! It is no accident that his works teem with never-say-die characters—from the life-loving Mame Dennis to the irrepressible Dolly Levi to the enduring drag contingent of La Cage. As Jones and Herman shake the president’s hand and join the Kennedy Center’s legendary greats like Mikhail Baryshnikov, Andrew Lloyd Webber, Fred Astaire and Jerome Robbins, they show the world that far from being victim artists—they are still very much alive and kicking. —BOB ICKES

Pop Projects

PEPSI OFFERS A REFRESHING WAY TO COMBAT HIV. AIDS advocates all over are taking the Pepsi challenge. Throughout 2010, the beverage giant has been awarding 32 grants each month as part of its community-improving Pepsi Refresh Project. Individuals, businesses and nonproﬁts submit proposals online, where peers are able to determine the winning grants by voting for their favorite ideas. So far, more than two dozen submissions revolved around HIV/AIDS, including one from POZ contributor/blogger Shawn Decker and his wife, Gwenn Barringer, who propose providing sexual health education to 50,000 teenagers in 50 states. In June, AIDS Research Alliance of America proposed purchasing state-of-the-art laboratory

equipment for its quest to find a cure. The idea finished in that month’s top two—and garnered a $250,000 prize. (Other grant increments include $5,000, $25,000 and $50,000, and they’re divided among six categories—health, arts and culture, food and shelter, the planet, neighborhoods and education.) By year’s end, Pepsi will have awarded up to $1.3 million in Refresh grants. And there’s talk that the cola company might extend the program into 2011. Let’s hope so, because like an unopened bottle of pop, HIV/AIDS advocacy and its ability to improve a community never go flat. —WILLETTE FRANCIS For more information about the Pepsi Refresh Project, go to refresheverything.com. DECEMBER 2010 POZ 21

T A L K I N G

Party Favors

HARM REDUCTION ADS HIGHLIGHT THE LINK BETWEEN PARTYING AND HIV. Imagine you’re a guy at a house party surrounded by sexy women. A voice-over describes the unfolding action. “You passed the blunt. You ordered the food. You undid her top.…” Then comes the tag line: “So you can use a condom.

After party. Hit it right.” That’s one of four new 60-second ads released this fall as part of the “After Party” online campaign from New York City–based Harm Reduction Coalition. (Check them out on

YouTube, Facebook, Twitter and Tumblr.) In addition to marijuana, the spots focus on cocaine, alcohol and ecstasy. All four ads present upbeat, MTV-style scenarios and address the link between partying and the ensuing risky behavior that can lead to HIV and other sexually transmitted infections. “We wanted to do something that was fun, youthful, sexy—but didn’t say you shouldn’t be drinking, you shouldn’t be partying, you shouldn’t be having fun. But ﬂip the message around and say you could have fun and remember to use a condom at the same time,” says Daniel Raymond, policy director at Harm Reduction Coalition. Two of the videos are geared toward men who have sex with men (MSM)—though in a clever directorial twist, since the camera acts as the eyes of the viewer, it’s not a stretch for ladies to imagine themselves as the ones scoring the studly dates. “After Party” further stands out because it highlights a risk factor many prevention campaigns overlook: alcohol. “When we talk about substance abuse, we often think about drug injection,” Raymond says. “But really alcohol is way more common in that when you hear stories about people talking about sexual decision making, alcohol is often in the mix.” Having fun and remaining safe? Party on! —WILLETTE FRANCIS Go to harmreduction.org for more information.

POZ on Location: In September, POZ attended the 2010 United States Conference on AIDS (USCA), sponsored by the National Minority AIDS Council (NMAC), in Orlando. USCA brings together thousands of people in the HIV/AIDS community. From left to right: 1. Vanessa McDowell, community outreach coordinator of Pennsylvania’s Keystone Rural Health, poses with POZ’s Giovanni Vitacolonna at the POZ booth. 2. Joyce Turner Keller shows off her “Positive Diva” merchandise. 3. Paul Kawata, executive director of NMAC. 4. Conference participants spread the knowledge through poster presentations. 5. Tim Horn, president and editor-in-chief of AIDSmeds.com, and Matt Sharp, director of treatment and prevention advocacy of Project Inform. 6. Kathleen Sebelius, secretary of Health and Human Services. 7. Jack Mackenroth, fashion designer, model and the first openly HIV-positive contestant on Project Runway. 8. Protesters demonstrate during Sebelius’s speech. 9. Henry Ocampo and Evonne Bennett-Barnes are all smiles at the Office of Minority Health booth.

22 POZ DECEMBER 2010

(POZARAZZI) JENNIFER MORTON

POZARAZZI

T A L K I N G

HOT DATES DECEMBER 1 WORLD AIDS DAY More than 33 million people are living with HIV across the globe, according to UNAIDS, and more than 2 million of them are children. Since 1988, World AIDS Day has fought to raise money and awareness about the epidemic, and the annual event continues to push for prevention and funding. This year’s theme, Universal Access and Human Rights, focuses on the protection of human rights as a fundamental way to ﬁght HIV/AIDS. Below are just a few of the happenings that will be taking place across the globe on Wednesday, December 1. Check the POZ.com calendar for an event near you. LIGHT FOR RIGHTS 100 cities worldwide lightforrights.org WORLD AIDS DAY OBSERVANCE AT THE NATIONAL AIDS MEMORIAL GROVE San Francisco aidsmemorial.org

Men in Love

GMHC FIGHTS HOMOPHOBIA AND HIV WITH A CAMPAIGN ON NEW YORK CITY SUBWAYS. No chiseled bodies, no oiled up chests. Just regular guys, holding hands, about to kiss—and in love. Gay Men’s Health Crisis (GMHC) has relaunched the “I Love My Boo” campaign in New York City to fight homophobia and stop the spread of HIV. It features images of real men of color in real moments. “Young men of color have very little representation,” said Francisco Roque, director of community health at New York City–based GMHC. “This campaign is about trust and intimacy and the way gay men support each other.” By running the spots in 1,000 subway cars and 150 subway stations in October, GMHC wanted to empower black and Latino men who have sex with men (MSM) by showing them positive images of themselves—and hopefully, as a result, moving them to choose safer sex. The campaign debuted a week after a study

released by the Centers for Disease Control and Prevention found that one in five gay and bisexual men in 21 major U.S. cities has HIV and nearly half of those men don’t even know it. Of the gay men studied, young men and blacks and Latinos were least likely to know their HIV status. “In seeing these ads in a public place, we are communicating that black and Latino men matter,” Roque said of the subway campaign. “And if they think they matter, they can make healthier choices regarding HIV/AIDS and sexual health.” In that spirit, the campaign launched a Facebook page to collect snapshots of couples. It also hit bars and clubs with special “I Love My Boo” condom packs for boos—slang for boyfriends—taking the next step toward loving each other, safely. —CRISTINA GONZÁLEZ Go to gmhc.org for more information.

HOWARD UNIVERSITY INTERNATIONAL CONFERENCE ON STIGMA Washington, DC whocanyoutell.com/info.html THE SALVATION ARMY’S RED BALLOON WALK Los Angeles redballoonwalk.org CANDLELIGHT VIGIL Houston worldaidsdayhouston.org WORLD OF CHOCOLATE Chicago aidschicago.org SIXTH ANNUAL WORLD AIDS DAY GALA CONCERT IN CAPE TOWN Cape Town aidscentre.sun.ac.za

Go to poz.com/calendar for more World AIDS Day events.

DECEMBER 2010 POZ 23

How HIV can both lead to post-traumatic stress disorder and be the result of the syndrome itself.

RITERS FREQUENTLY DESCRIBE THE AIDS EPIDEMIC IN military terms, referring to battles waged and lost. Perhaps those war metaphors are apt. In fact, a syndrome commonly associated with soldiers, post-traumatic stress disorder (PTSD), is deeply linked to HIV—and the connection runs both ways. While some people are so traumatized by their HIV diagnosis that they develop PTSD, for others the situation is reversed: They experienced the stress disorder before contracting the virus. That was the case for Jeff Nehrbas, who tested HIV positive in 1984 at the age of 26. His trauma began when he was barely a teenager. “When I was 14 I was [sexually] molested by [a close relative],” he says. The resulting stress was amplified in his junior year of high school when word got out that the relative was molesting other boys too. Aside from the horror For Jeff of learning that his own private hell was being visited on his classmates, Nehrbas, PTSD may Nehrbas also had to deal with stigma and rejection from others in his have led community. His best friend tapped him on the shoulder one day in to HIV.

24 POZ DECEMBER 2010

STEVE MORRISON

Stress Test

basketball practice and said, “We heard about your family, you fucking faggot.” Nehrbas spent nearly seven years in therapy coming to terms with what had happened to him. He feels that the trauma he experienced and his inability to cope with it prompted him to take sexual risks in his early 20s. Those risks in turn led to his contracting HIV. Conall O’Cleirigh, PhD, is a behavioral scientist at The Fenway Institute, an LGBT health center, and instructor in psychiatry at Harvard Medical School in Boston. Sexual trauma and HIV often go hand in hand, he says, creating a dangerous intersection of PTSD and HIV. According to O’Cleirigh, “PTSD is a complex disorder. One of the core features of its diagnosis is that it’s a reaction to a traumatic event—and not just losing your job or breaking up with your girlfriend or your boyfriend.” Dramatically

traumatic events trigger PTSD and produce feelings of helplessness, terror or horror. Most experts specify that such trauma causes the sufferers to believe they or someone close to them is going to be killed or seriously injured. Until 1980, PTSD didn’t have its own formal diagnostic criteria. But the syndrome has long been known to those who treat veterans; it was called “soldier’s heart” during the Civil War and “shell shock” after World War II. Since 1980, however, clinicians have increasingly found that many kinds of trauma— ranging from plane crashes to rape, sexual abuse and assault—can provoke the same symptoms that plague soldiers returning from the battlefield. O’Cleirigh says most people who survive traumas experience three types of symptoms. These include: intrusive thoughts, memories and emotions about the event; the strong desire to avoid places and things that provoke those memories and emotions; and a hyper-aroused state in which a person is vigilantly guarding against danger and is easily startled. For most people, O’Cleirigh says, these symptoms gradually subside over time. In someone with PTSD, however, they persist and may even worsen. “Some people can be very severely distressed,

and their [attempts at] avoidance take up all their [time and energy],” he says. We don’t yet fully know why some people end up with PTSD while others handle trauma without lasting effects, but researchers are looking at a number of factors. Most of these involve a complex interplay between the way the brain is wired and the chemical soup that controls brain function. In simplified form, O’Cleirigh explains it this way: “[People with PTSD] just remember [the event] in the wrong place in the brain, and there’s too much emotion attached to it.” “I think one of the reasons why PTSD ends up being so important in HIV,” O’Cleirigh says, “is that HIV [often] affects people who have a fairly substantial trauma history.” Studies do show that people living with HIV are as much as 30 to 50 percent more likely than the general population to have been sexually abused as children or teens, or subjected to sexual violence as adults. PTSD can lead to drug and alcohol binges and heightened risk-taking, making for a dangerous combination. But which came first, the virus or PTSD? While it’s been clear for some time that PTSD can increase a person’s risk for contracting HIV, researchers have lately wondered whether the re-

verse might also be true: that an HIV diagnosis, or the stress of living and surviving HIV, might actually lead to PTSD. That question is more than theoretical for Joe Killfoile, 56, a Montreal resident who is HIV positive and was recently diagnosed with PTSD. For Killfoile, the worst symptom of his PTSD has been unrelenting night and day terrors, where the faces of countless friends who died of HIV flood his mind. “[When it happens] I recognize every single face, and I’ve even had [the terrors] while standing in line at the grocery store,” he says. “Somebody will bump me to move up, and it’s like I’ve woken up from this deep fog.” Killfoile says the intrusive memories got so bad a couple of years ago that he couldn’t sleep and had a hard time functioning. He thinks a lot of the trauma comes from the helplessness he felt when his friends were dying. He also says that these losses were a constant reminder of his own mortality. K i l l foi le’s stor y i s not u n ique. O’Cleirigh says a number of causes can trigger PTSD in people with HIV, including illness, bereavement and stigma. He points to one study where the defining traumatic event for 40 percent of a group of HIV-positive people with PTSD was

THE BASICS Defining (and treating) post-traumatic stress disorder What It Is: Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by a traumatic experience, provoking feelings of terror that your life or the lives of those around you are in peril. Symptoms: Flashbacks of the event, nightmares, avoiding things that arouse painful memories, being easily

startled, feeling constantly on edge, difficulty sleeping, angry outbursts. Treatment: Ask your health care provider about specific therapies for PTSD (for a list of recommended techniques, see “Removing Memory’s Sting,” next page). Your doctor may prescribe medications for depression or anxiety.

Finding Help: To learn more about PTSD and other anxiety disorders, and to find a mental health provider near you, contact: ●

●

Anxiety Disorders Association of America, adaa.org, 240.485.1001 Association for Behavioral and Cognitive Therapies, abct.org, 212.647.1890 —DE

DECEMBER 2010 POZ 25

‘‘

The core of most PTSD therapy involves changing how a person relates to memories of the events that shattered his or her world. receiving an HIV diagnosis. Another recent study in HIV-positive men in England found, surprisingly, that the most significant factor associated with the onset of PTSD symptoms was starting to take HIV medication. One of the study’s authors, Anthony Theuninck, PhD, a researcher at the Oxleas NHS Foundation Trust in London, says more research is needed to understand precisely what it is about treatment that is so traumatic for some. He offers a possible explanation: “Taking medication may be perceived as signaling HIV’s defeat of the body’s resilience, and the person may become fixed on thinking about the virus killing him or her. “If people believe that a healthy lifestyle, or religious devotion for that matter, will assure them health,” Theuninck adds, “the start of antiretrovirals may be perceived as undermining the very bedrock of how their world works.” A hallmark of PTSD is needing to avoid painful memories. That can pose particular danger for people with HIV, if, say, lifesaving activities such as visiting a doctor and taking meds reawaken trauma. That could push people to avoid their drugs and health care providers. “Say somebody is afraid for their life, or is ashamed or guilty, or is feeling the full brunt of societal stigma and they want to avoid that sor t of st uf f,” O’Cleirigh says. “[Those feelings could lead them] to avoid reminders of HIV. That could mean they’ll be less likely to get connected into care, and they may avoid taking a look at their medications. 26 POZ DECEMBER 2010

Their adherence is going to suffer.” The core of most PTSD therapy involves changing how a person relates to memories of the events that shattered his or her world. Joshua Matacotta, a graduate student and therapist in training in San Francisco, has used this approach in working with PTSD sufferers. “The goal of treatment,” he says, “is finding a way for people to acknowledge the reality of what happened to them, to integrate the experience into autobiographical memory, and to do so without having to re-experience the trauma all over again.” For Jeff Nehrbas, healing involves writing down his story. Originally he intended to focus mostly on how he’s survived multiple tragedies over the years. He’s since realized, however, that the molestation is where it all began, and that talking about it could help him heal—both himself and others who’ve been through the same thing. Both Nerhbas and Killfoile have relied heavily on therapy to get them through, and Matacotta thinks this is vital. “I can’t stress enough,” he says, “the importance of finding a therapist who is a good match for you and is trained in working with PTSD and HIV-related PTSD.” Killfoile’s recovery now includes pulling out his photo albums and remembering his lost friends in a different way. Instead of recalling them on their deathbeds, he now tries to remember the joy and the love he shared with them. He also finds meaning—and healing—on the POZ online forums (poz.com/forums).

There, he helps newly diagnosed people navigate the terrain of learning to live with HIV. W hen asked what he would tell someone who reported symptoms of PTSD, he doesn’t hesitate. “There’s still a lot of stigma with HIV, but there’s also a lot of stigma about mental health,” he says. “And even if you don’t fit the mold of some diagnosis, if you feel that you need some help, you need to get that help,” he says. —DAVID EVANS

REMOVING MEMORY’S STING The National Institute of Mental Health recommends three types of cognitive therapy for healing from PTSD: EXPOSURE THERAPY re-exposes people to the trauma they experienced, but in a safe way, using mental imagery, writing or visits to the place where the event happened. The therapist uses these tools to help people with PTSD face and cope with the feelings triggered by the traumatic event. COGNITIVE RESTRUCTURING helps people reinterpret and understand bad memories and the negative emotions—such as guilt or shame—they associate with the event. The therapist helps people with PTSD look at what happened in a realistic way. STRESS INOCULATION TRAINING tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. As with cognitive restructuring, this treatment helps people handle their memories in a healthier way. —DE

ISSUES treatment

DECEMBER2010

ISSUES

Treatment The Role of ARVs in HIV Prevention: Microbicides and PrEP By Sam Kalibala and Sarah Littleﬁeld

Introduction The evolving list of HIV prevention interventions that currently rely on antiretrovirals (ARVs) include prevention of mother-to-child transmission (PMTCT), Post Exposure Prophylaxis (PEP), and highly active antiretroviral therapy (HAART) as prevention.1 Current research is underway to expand this list of interventions to include ARV-based microbicides, and Pre-Exposure Prophylaxis (PrEP); both of which recently demonstrated promising results in clinical trials. Twenty years ago, these interventions were merely a wish list based on the logic that if a drug can lower the viral load of HIV in the body, then it should be able to reduce transmission of the virus. Further, if a drug can limit the replication of HIV, it can help abort HIV infection before it takes root in the body.2 Slowly, these wishes are becoming realities and some have been translated into standards of care.3 In this article, we discuss recent breakthroughs in ARV-based microbicides and PrEP, what the likely policy and programmatic implications and drawbacks may be, and how they can be addressed.

ARV-based Microbicides In July 2010, microbicides researchers received a long awaited ‘proof of concept’ with the results of the CAPRISA 004 trial. The double-blind, randomized, controlled trial was conducted to assess the effectiveness and safety of a vaginal gel formulation of 1% tenofovir gel, a nucleotide reverse transcriptase inhibitor (NRTI), for prevention of HIV in women.4 The study was conducted among 889 women, aged 18–40, in urban and rural KwaZulu-Natal, South Africa between

May 2007 and March 2010. Results from the study found that tenofovir gel reduced HIV acquisition by an estimated 39% among participants. Further, the trial demonstrated no change in tenofovir resistance in HIV seroconverters. The only adverse event found more frequently in the tenofovir gel arm was diarrhea and gastrointestinal infections (16.9% vs. 11.0%, p=0.015), however the reported cases of diarrhea were mild and rarely required medication. Though this is not the ﬁrst microbicide trial to be conducted, it is the ﬁrst to show efficacy. One hypothesis for the lack of effectiveness in past microbicide trials is that adherence had not been high enough

Tenofovir gel reduced HIV acquisition by an estimated 39% among participants. to demonstrate effectiveness.5,6,7 The CAPRISA 004 trial showed that in high adherers, deﬁned as women who had greater than 80% gel adherence, HIV incidence was 54% lower in the tenofovir arm. HIV incidence was reduced by 38% and 28% in intermediate and low gel adherers, respectively. It is important to note that women in the CAPRISA 004 trial followed a coitally dependent dosing strategy, known as ‘BAT24.’ Modeled on the proven strategy of dosing for preventing mother-to-child HIV transmission, women were instructed to use one dose of gel within 12 hours before sex and another dose as soon as possible

within 12 hours after sex, and no more than two doses in a 24-hour time period. Due to the dosing strategy, no conclusions can be drawn about the effectiveness of the gel in relation to the timing of application. The CAPRISA 004 trial results are only the first step towards an effective ARV-based microbicide. The trial was conducted on a specific population and the relatively small sample size limits the generalizability of the results. Additional studies are necessary to support and confirm the CAPRISA 004 findings, as well as provide further information on the use of daily versus coitally dependent gels, oral versus gel formulations, and the safety and effectiveness of the use of tenofovir gel rectally.

Pre-Exposure Prophylaxis In addition to the positive safety findings for tenofovir in a vaginal gel formulation, preliminary analysis suggests no safety concerns from the first study examining the safety of daily oral tenofovir for HIV prevention among gay and bisexual men. The Phase II study, conducted among 400 HIV-negative men who have sex with men (MSM) in San Francisco, Atlanta, and Boston, randomized men to one of four study arms: two arms of the study received either a daily 300 mg tablet of tenofovir or placebo immediately upon enrollment, and the two remaining arms received either tenofovir or placebo after nine months of enrollment.8 This study design allowed researchers to compare risk behaviors among those men taking a daily pill and those who are not. Prior studies have found the daily tenofovir regimen safe among high-risk heterosexual women in Ghana, Nigeria, and Cameroon, but this is the first PrEP study to focus solely on safety among gay and bisexual men, as well as the first to assess the potential impact of a daily preventative drug on HIV risk behaviors. Preliminary analysis suggest there was no increased risk, or “behavioral dis-inhibition,” in men taking a study pill compared to those not yet taking study pills.8 It is important to note that this study was not designed to provide conclusions about the potential efficacy of PrEP in preventing HIV infection. As analysis continues, this study will provide useful information on the relationship among adherence, perception of treatment arm, perception of efficacy and individual risk behavior, as well as acceptability and feasibility of daily PrEP for the study population.

Policy and Programmatic Implications An over-arching programmatic implication for potential ARV-based microbicides and PrEP is the cost and provision of supply. Pharmaceutical industry partners have been generous in supplying certain drugs for the ongoing and planned clinical trials. Conversations surrounding the manufacturing, distribution, and pricing for these potential prevention options need to be ongoing throughout their development so as to establish a ﬁrm and sustainable process should trial results continue to be positive. Further, the general consensus among leaders in HIV prevention is that both ARV-based microbicides and PrEP will be offered through prescription, not as an over-the-counter prevention method, such as condoms. There needs to be careful planning and development related to the infrastructure of how these prevention methods would be distributed, regulated, and overseen in the markets for which they are most needed. Microbicides should be promoted as part of a prevention package: The target population for a vaginal ARV-based microbicide gel will be women in sub-Saharan African and other regions where women are having unprotected sex with multiple partners (such as sex workers), are unable to practice mutual monogamy, and/or are unable to negotiate condom use with their sexual partners. Further, should ARV-based microbicides prove effective in protecting HIV transmission through anal sex, receptive partners in MSM relations would also be a target population. This suggests that both target populations will be largely self-identifying. Hence, the successful implementation of an ARV-based microbicide will depend on extensive community education and accessible and conﬁdential counseling services, coupled with provision of condoms. Further, ARV-based microbicides will only be partially effective. Thus, it will be vital that it is promoted as part of a package of preventive interventions, rather than as a single magic bullet. PrEP will require regular HIV testing and partner disclosure: The current regimens being explored for PrEP use a single ARV, tenofovir. If taken by a person who is HIV-positive, there is danger of the development of resistance. Logically, PrEP would only be considered for people proven to be HIV-negative, which would require initial HIV testing and consistent re-testing. This will require infrastructure and accountability.

ARV-based microbicides will only be partially effective, thus it will be vital that it is promoted as part of a package of preventive interventions, rather than as a single magic bullet.

DECEMBER 2010

If proven effective, PrEP will likely be targeted at individuals who are most at risk, such as HIV-negative partners in discordant couples. Theoretically, these partners may be easy to reach through their HIVpositive partners who are attending HIV care and treatment services. However, there are reports of people living with HIV/AIDS (PLHAs) who do not disclose their HIV status to their partners and continue to have unprotected sex.9 Thus, a key pre-requisite for PrEP among discordant couples is going to be increased counseling of PLHA about disclosure, provision of couples communication and counseling, and access to couples voluntary testing and counseling (CVCT). PrEP may also be recommended for individuals, especially women, who are in a sexual relationship with an individual who is at high-risk, including sex workers and their clients, certain men who have sex with men (MSM), intravenous drug users (IDU), and polygamous men. If PrEP is proven effective, it will require extensive community education as well as the availability of confidential counseling and testing to enable such individuals at risk to seek services, and to receive HIV testing and counseling followed by PrEP.

understood they were testing a drug not proven to prevent HIV. If PrEP is proven effective, additional research and interventions will be necessary to prevent the increase of risk behaviors in real world settings. An increase in risk-taking behavior resulting from a false sense of protection could easily outweigh the beneďŹ ts of any ARV-based prevention method.

Overcoming these drawbacks and the way forward Overall strengthening of health services: Programming and distribution of these two potential ARV-based prevention methods would inevitably be centered on health care facilities. It should not be assumed that health facilities and systems are optimally functional and have enough personnel, infrastructure, and supplies to provide high quality services that are available to the most vulnerable people. Further, as the HIV prevention toolkit expands, the HIV response needs to consider the integrated health systems strengthening approach. It would be prudent to begin conducting cost and systems analysis of this integrated approach compared to the currently accepted vertical approach of specialized HIV projects, such as PMTCT, HAART and male circumcision. This is an area which requires critical review if ARV-based prevention methods are going to play an increased role in HIV/AIDS programming in developing countries.11 Comprehensive education to PLHA about ARVs and HIV prevention: Now is the time, in anticipation of the expanding list of HIV-prevention methods that rely on ARV, to take the bull by the horns and revise education and counseling messages to PLHAs and the general community about issues regarding the role of ARVs in HIV prevention. Education needs to be accurate and available to properly inform PLHAs that ARVs lower their viral loads and make them less infectious, 1 and that taking ARVs before or immediately after exposure to HIV can abort the infection.12 Further, correct and timely information about newly emerging prevention methods, such as ARV-based microbicides and PrEP, needs to be continually updated and available for public consumption. Both prevention methods are still in the clinical development phase, and each new result will bring new information and inevitable new questions.

Recent data from the PrEP safety trial described above suggest there was no increased risk-behavior in men taking the study pill versus those not yet taking the pills.

General drawbacks of using ARVs as a preventive technology Potential for ARV resistant strains of HIV: If ARVs are used as prevention interventions there is a potential for widespread or indiscriminate use of ARVs beyond the currently controlled use in HAART or PMTCT. Even if provided through prescription, potential exists for pill sharing and non-compliance to recommended adherence and dosing. Use of PrEP without strict HIV testing to restrict it to HIV-negative individuals could also result in HIV-positive people receiving mono- or dualARV therapy, which could lead to development of resistance. Behavior Dis-Inhibition: While behavior dis-inhibition in the advent of ARV therapy has been reported among MSM in San Francisco,10 this was before observation studies showed that highly active antiretroviral therapy (HAART) has a preventive effect.4 Further, the more recent data from the PrEP safety trial described above suggest there was no increased risk-behavior in men taking the study pill versus those not yet taking the pills. However, this was in a controlled setting where extensive steps were taken to ensure participants

GMHC

GMHC.ORG

treatment

ISSUES ISSUES

Treatment

EDITOR: ROBERT VALADÉZ ASSISTANT EDITORS: SEAN CAHILL, NATHAN SCHAEFER ART DIRECTOR: ADAM FREDERICKS GMHC Treatment Issues is published by GMHC, Inc. All rights reserved. Noncommercial reproduction is encouraged. GMHC Treatment Issues The Tisch Building 119 W. 24th Street, New York, NY 10011 gmhc.org © 2010 Gay Men’s Health Crisis, Inc.

Sarah Littleﬁeld, MPH, is a Clinical Trial Specialist in the HIV/AIDS Program at the Population Council. Based at their Center for Biomedical Research in New York City, her current projects seek to improve microbicide clinical trial design, with a focus on recruitment and the reporting of adherence in microbicide trials.

References 1

Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: A prospective cohort analysis. Lancet. 2010; 375: 2092–98.

Cohen MS. HAART and prevention of HIV transmission. Medscape HIV/AIDS. Posted: 07/11/2002.

Cohen MS, Kashuba A. Antiretroviral drugs and the prevention of sexual transmission of HIV. Medscape CME. Posted: 09/24/2003.

Support for GMHC Treatment Issues was made possible through educational grants or charitable contributions from the following:

Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010 Sep 3; 329(5996): 1168–74.

GlaxoSmithKline, Pﬁzer, Roche

Skoler-Karpoff S, Ramjee G, Ahmed K, et al. Efficacy of Carraguard for prevention of HIV infection in women in South Africa: A randomised, double-blind, placebo-controlled trial. Lancet. 2008 Dec 6; 372(9654): 1977–87.

McCormack S, Ramjee G, Kamali A, et al. PRO2000 vaginal gel for prevention of HIV-1 infection (Microbicides Development Programme 301): A phase 3, randomised, double-blind, parallelgroup trial. Lancet. E-pub: 9/17/2010.

Karim SA, Coletti A, Richardson B, et al. Safety and effectiveness of vaginal microbicides BufferGel and 0.5% PRO 2000/5 gel for the prevention of HIV infection in women: Results of the HPTN 035 trial. 16th Conference on Retroviruses and Opportunistic Infections; Feb 8–11, 2009; Montreal, Canada (abstr 48LB).

Centers for Disease Control. Preliminary results from first safety study of daily tenofovir for HIV prevention among MSM find no significant concerns. Press release posted: July 23, 2010.

Luchters S, Sarna A, Geibel S, et al. Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: A prospective cohort. AIDS Patient Care and STDs. 2008; 22(7): 587–594.

Setting aside some ARVs for prevention: In order to reduce the risk of developing or transmitting ARV resistant strains, it may be reasonable to propose that certain ARVs be set aside for preventive strategies. The criteria for selecting such ARVs will require much thought. First, they must be proven effective through clinical trials. Second, they should have the least side effects, as they are going to be taken by persons who have no illness, and thus may easily give them up if they are toxic. Third, they should not be the platform for ﬁrst or second-line HAART regimens in the developing world since the withdrawal of these agents, due to widespread resistance, could spell disaster if there are no cheap alternatives.

Conclusion The recent safety and efficacy data surrounding ARVbased microbicides and PrEP has breathed new life and hope into the ﬁeld of ARV-based HIV prevention interventions. As the clinical science moves forward, there are policy and programmatic implications for expanding the ARV-based HIV prevention toolkit. Now is the time to address policy, programmatic, and ethical drawbacks so we can forge a clear path forward.

Samuel Kalibala, MD, a physician who started providing AIDS care in his native Uganda in 1988, is a Senior Associate and Country Director (Kenya) at the Population Council. Based in Nairobi, for the past 10 years he has been engaged in operations research to ensure efficient and effective delivery of new interventions against HIV/ AIDS, including PMTCT and HAART.

10 Baggaley RF, Ferguson NM, Garnett GP. The epidemiological impact of antiretroviral use predicted by mathematical models: A review. Emerg Themes Epidemiol. 2005 Sep 10; 2:9. 11

Handford CD, Tynan AM, Rackal JM, et al. Setting and organization of care for persons living with HIV/AIDS. Cochrane Database Syst Rev. 2006; 3:CD004348.

12 Cohen MS, Kashuba A. Antiretroviral drugs and the prevention of sexual transmission of HIV. Medscape CME. Posted: 09/24/2003.

DECEMBER 2010

I V I N G

Treatment Twofer

ARVs That Fight HIV and Inﬂammation

Delegates at the XVIII International AIDS Conference

Vital Insights From Vienna

(DELEGATES) COURTESY OF IAS/MARCUS ROSE; (ILLUSTRATION) GETTY IMAGES/DOUG ROSS

This past July, experts in the fields of HIV/AIDS science, policy and activism, as well as HIV-positive people, journalists, government officials, religious leaders and the staffs of AIDS service organizations gathered in Vienna for the XVIII International AIDS Conference. POZ and AIDSmeds were there, covering everything from breaking treatment and advocacy news to the latest reports on vaccines, new drugs in the development pipeline, microbicides, criminalization and condoms. Log on to poz.com/aids2010 for our extensive coverage. In the meantime, we’ve compiled some HIV treatment and prevention highlights from this year’s confab: When to Start? Current HIV treatment recommendations—start when CD4s fall below 500—are on the mark in terms of reducing the risk of AIDS or death, according to results from the CASCADE cohort study. No benefit was seen among those starting with 500 or more CD4s over the three-year study period, though it is possible a benefit may become apparent over a longer period of time. Spare Me. Two novel regimens showed promise in Vienna: Reyataz plus Isentress (without Norvir or nukes) and Kaletra plus Isentress (without nukes). While not yet ready for prime time, both regimens are proving comparable with standard combos. Isentress resistance is of concern, however.

A new study suggests that some protease inhibitors (PIs) might be doing double duty—stopping viral reproduction and calming down a hyperactive immune system. A team led by Luigi Racioppi, PhD, in Italy, looked at the maturation process of a type of immune cell known as dendritic cells (DCs) in the presence of a handful of older PIs. They found that both Norvir (ritonavir) and Invirase (saquinavir) caused newly matured DCs to behave oddly. The cells barely responded to the presence of a bacterium that circulates widely in people with HIV. In most cases a robust immune response is the goal, but experts now think that chronic inﬂammation—both against HIV and bacteria that leak out of HIV-damaged cells in the gut—is at the root of a lot of bad stuff, namely cardiovascular disease and certain cancers. In this case, grown-up DCs that don’t overreact to gut bacteria could be just what the doctor ordered. Racioppi’s team is set to look at newer PIs such as Prezista (darunavir) and Reyataz (atazanavir). Studying the anti-inﬂammatory properties of these drugs, he says, “would open [new avenues] for designing PIs with more powerful activity on the immune —DAVID EVANS system.”

Dueling Nukes. Epzicom appears to work just as well as Truvada as components of first-line therapy, according to a Canadian study. These findings challenge earlier trials suggesting that Truvada trumps Epzicom in patients with high pre-treatment viral loads. New Drug News. ViiV’s integrase inhibitor S/GSK-572 is performing well in a first-time treatment study and shows potential for some people with Isentress-resistant HIV. Tibotec’s non-nuke rilpivirine had similar efficacy and fewer side effects than Sustiva in two clinical trials, though the potential for HIV resistance to non-nuke Intelence is worrisome. And making its data debut was Boehringer Ingelheim’s Viramune XR—an extended release, once-daily version of the non-nuke. Treatment as Prevention. A vaginal microbicide containing the nuke tenofovir cut HIV infection rates by 39 percent in a clinical trial of nearly 900 South African women. Among those who used the gel correctly at least 80 percent of the time they had intercourse, HIV transmission rates were slashed 54 percent. Watch for studies using a two-drug gel— tenofovir and emtricitabine—and similar microbicides for anal use. —TIM HORN DECEMBER 2010 POZ 31

I V I N G

WORRY WART

Anal warts might be cancerous after all—and need to be removed. A recent study reported in Clinical Infectious Diseases found that anal warts in men who have sex with men (MSM), notably those living with HIV, often contain cancerous and precancerous cells and should be surgically removed. Anal warts are typically caused by two strains of the human papillomavirus (HPV): HPV types 6 and 11. Because these strains are thought to be low risk for cancer, most people either forgo treatment or opt for minimally invasive procedures such as freezing or burning. But considering the ﬁnding that almost half the anal warts collected from MSMs (47 percent) were studded with cancerous or precancerous cells, caused by more sinister HPV types, the study authors claim invasive removal of anal warts is necessary. Joel Palefsky, MD, an HPV expert at the University of California at San Francisco, cautions that more research is needed to show whether surgically removing those warts will reduce cancer rates. Until then, he suggests people have their anal warts biopsied— and consider more aggressive treatments if the warts prove precancerous or cancerous or if they return. —CRISTINA GONZÁLEZ

HIV TESTING, SOONER

32 POZ DECEMBER 2010

Spice It Up

Trying to lose weight or gain nutrition? Here’s a tip: Substitute taste for fat and calories. Say you are having a salad. Adding ingredients with big ﬂavor and texture—thinly sliced radishes and red peppers, for instance— to plain old lettuce can make up for high-cal or high-fat add-ons such as dried fruit, salami or sun-dried tomatoes. Mix some pungent spices (mustard, red pepper ﬂakes or curry powder, for starters) into a low-cal vinaigrette to keep you from missing that fatty ranch or blue cheese dressing too. And to cut back on salt (the ubiquitous additive that can raise your blood pressure), squeeze some tangy lemon juice on your dish, with a bit of paprika and dried or fresh herbs. —LAURA WHITEHORN

(CLOCK) GETTY IMAGES; (SPICES) ISTOCKPHOTO/GEORGINA PALMER

Infant Formula

A new blood test can diagnose HIV as soon as 14 days after infection, thus reducing the length of the “window period” between infection and when the virus can be detected. Abbott’s new Architect HIV Ag/Ab Combo assay detects HIV sooner because it looks for HIV antibodies, which can take weeks to appear, and antigens—fragments of HIV itself— which become detectable within days of infection. Though Architect ﬁnds HIV earlier, its testing process takes longer than the 20-minute oral swab test (which detects HIV four to six weeks post transmission). Furthermore, results may not be available until the next day. Architect will be particularly useful in high-risk groups, such as gay men and people of color, as studies have found rapid oral swab tests have missed up to 10 percent of new infections. “[Architect] is the ﬁrst of what we expect to be several combo tests” to be approved in coming years, says Bernard Branson, MD, who oversees HIV testing at the U.S. Centers for Disease Control and Prevention. Meanwhile, the oral swab test will likely remain more popular. Most HIV infections are not recent, and unlike Architect, oral-swab testing doesn’t involve blood. Nor does it rely on test takers to be brave enough to come back for their results. If you think you’ve been exposed to HIV in the past six weeks, ask your doc to test you using Architect. If it’s been longer than that, go with the oral-swab test. —TIM MURPHY

NEVER FORGET 1 7 T H A N N UA L O B S E R VA N C E

WORLD AIDS DAY National AIDS Memorial Grove, Golden Gate Park, San Francisco The 2010 World AIDS Day event begins at 12:00 noon sharp on December 1, 2010 in the meadow.

Local Unsung Hero Award Laura Thomas—Deputy State Director, Drug Policy Alliance; co-chair San Francisco CARE Council.

National Leadership Recognition Award Jeanne White Ginder—activist and mother of the late Ryan White. The late Senator Edward “Ted” Kennedy—the lead Senate sponsor of the Ryan White CARE Act.

www.aidsmemorial.org W E D N E S D AY DECEMBER 1, 2010 SILVA WATSON MOONWALK W FUND

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POZ

THE

100 Some of the bravest, most dogged and downright effective AIDS ﬁghters we know

BLAKE LITTLE

HIS PAST YEAR WAS A BANNER ONE for waging war on AIDS in America. President Obama staffed up the President’s Advisory Council on HIV/AIDS (PACHA), reopened the Office of National AIDS Policy and invited several hundred people (many of them living with HIV) to the White House to celebrate the launch of a National HIV/AIDS Strategy. Needle exchange was approved—as was the Affordable Care Act (a.k.a. the health care reform bill that will insure many who have HIV, albeit not until 2014). And the travel ban for HIV-positive people entering the United States was lifted. It was announced that, for the first time since 1990, the International AIDS Conference will again be held in America, this time in Washington, DC, in 2012. The money is starting to flow: The president pledged $30 million additional dollars for HIV prevention, infused the crumbling AIDS Drug Assistance Program with $25 million in emergency funding (though unfortunately the need still outpaces the support) and secured from Congress $50 million more for the Social Innovative Fund—some of which has already been awarded to organizations that fight AIDS in America (for example, the National AIDS Mondo Fund). The Global Health Initiative was estab- Guerra faces HIV lished, securing the President’s Emergency Plan with style.

for AIDS Relief’s $48 billion budget (for the moment). Science also upped the ante. For the first time in years, HIV researchers will say a cure for AIDS is feasible. And results of recent studies show there is good hope for microbicide and vaccine development (though much work to do). Anthony Fauci, MD, director of the National Institute for Allergy and Infectious Diseases at the National Institutes of Health (NIH), said NIH will concentrate more funding on AIDS cure research in the near term. And Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), named HIV/AIDS one of six “winnable battles” the CDC will focus on fighting. Never in the three decades we’ve battled this beast have we been better poised to administer a TKO to HIV. But perhaps the most important development is that we’re zeroing in on who is at risk for HIV in America today—and why. And we’re developing successful ways to help. It’s critical that we do: Of the 1.2 million Americans estimated to be living with the virus, 21 percent don’t know their status. In addition, more than 650,000 of them are not connected to care. Why is this true? Many people living with HIV in America today face a unique set of structural and lifestyle challenges, including, but not limited to: poverty, hunger, under- or unemployment, illiteracy, racism, discrimination, immigration issues, homelessness, DECEMBER 2010 POZ 35

stigma, previous or current incarceration, sexual or domestic violence, homophobia, substance use, criminalization, addiction, and childcare and mental health issues. Much of what we have learned about fighting HIV has to be reconsidered in light of who is contracting the virus today and why. Which is why we’re taking education and outreach efforts to the streets in ways that are specific to the various communities impacted by this disease. HIV/AIDS is disproportionately affecting people of color in the United States, men who have sex with men (MSM) and youth. And you can’t talk to all these people the same way, or reach them in the same places. For starters, they don’t face the same challenges. Even within subpopulations, the reasons why someone may be more likely to get HIV, or to develop AIDS, differ widely. A gay Latino teenager in Arizona faces different cultural and health care hurdles than a gay black teenager in Baltimore. Yes, they’re both young gay men of color, but they need different kinds of help, support and education. Different messages will move them to get tested, to seek support, to link to care. But we’re making headway by directing federal and state health care dollars and the support of the pharmaceutical in-

things in common. They are effective—and can prove it with measurable, evidence-based outcomes. They are relentless and tireless in the face of people constantly telling them no, it can’t be done; no, we don’t have the money. They bravely lay their heads on the chopping block; they take risks—and sometimes body blows—occasionally falling down but getting up quickly. They are in the trenches and on the right path. They know how to think outside the box, get inside the system and draw the spotlight. They are alternately diplomats and troublemakers. They can galvanize, get the inside scoop and rabble rouse. People trust them, listen to them, invite them to tell it like it is. What they say is not always popular, but it often informs the next step or shows us a new path. Some of the people on the POZ 100 will seem like the usual suspects. A good portion of this list is names of people who have been at this work since the beginning of the pandemic. That is a tribute to their adaptability, resilience and talent. Some are people you may never have heard of before. They are the newcomers, the upstarts, the young guns. Who’s not on this list? Pharmaceutical and industry people, people in the federal government whose work is focused on HIV/AIDS and people who individually donate millions. We left off the who’s who of the global AIDS arena; A-list celebrities; members of the media who focus on HIV/ AIDS and doctors and nurses who treat people living with HIV/AIDS (though you will see “MD” or “MPH” after some names, the people we’ve chosen aren’t currently treating patients, with one or two exceptions, but it is their work in other arenas that landed them on the list). We’ve also not included our fallen icons, the brilliant ones we have lost to HIV—many of whom are why we’re alive today. It would take a volume of POZ the size of a New York City phone book to do justice to all the incredible people who are not on this list. Our choices are sure to cause controversy so we want your feedback. Be sure to let us know if you think we missed a key player in the fight. To comment on our selections go to poz.com/100. In short, the POZ 100 is a powerful, influential, inspirational corps of warriors well-positioned to help shepherd in the end of the AIDS pandemic. Those on this list are leading the charge to abolish the stigma, discrimination and criminalization of HIV that keep people from getting tested, getting support—and connecting to lifesaving care. To banish HIV for good, we will need the help of many others already involved in or willing to join the fight. We hope you will also celebrate the people on the POZ 100 and their good work. Support them. Write about them. Give them your ideas. Listen to them. Offer to work beside or for them. And, of course, applaud them. As we do now. Bravo to the 100 of you who tirelessly help those living with HIV/AIDS and who work to ensure others don’t contract the virus.

“NEVER IN THE THREE DECADES WE’VE BATTLED THIS BEAST HAVE WE BEEN BETTER POISED TO ADMINISTER A TKO TO HIV.” dustry to brave new worlds. We’re testing people for HIV at the Division of Motor Vehicles, babysitting their kids so they can get to a support group or a microbicide trial, teaching them about AIDS at quilting workshops in church basements and in local hair salons, employing the help of faith leaders and using spoken word poets, YouTube videos, smart phone apps, Twitter and Facebook to teach things like safer sex. And we’re not shying away from real-life solutions like handing out clean needles, giving kids condoms and teaching prevention tactics like cheeking and mutual masturbation. For the momentum to continue, to ensure that high-level promises are kept and to get the funding we need to effectively implement the tenets of the National HIV/AIDS Strategy, we need our A-list soldiers on the line. In that spirit, we offer the following list of 100 people we feel have great impact on HIV/AIDS in the United States today. We have many of them to thank for the progress we’ve recently made. These people are also likely to keep the heat on in the months and years to come. The tenure of their experience, areas of expertise and methods they employ vary wildly. But they all have several 36 POZ DECEMBER 2010

—REGAN HOFMANN

The POZ 100 is listed in alphabetical order by last name.

THE POZ 100 1. DAVID ACOSTA The prevention coordinator in Philly’s Department of Health, Acosta is also a writer and activist for health care reform, Native American rights and LGBT rights. He founded the Gay and Lesbian Latino AIDS Education Initiative, cofounded the Philadelphia Working Fund for Artists with HIV/AIDS and founded the National Campaign for Freedom of Expression. He uses art and conversation to address cultural social change and undo the ties—and tongues—that bind. 2. ADAORA ADIMORA, MPH An infectious disease epidemiologist at the University of North Carolina, associate professor Adimora seeks to understand how and why African-American women in the South are at such high risk for HIV infection. Her work has helped ensure that by the end of the ’00s the rate of new AIDS cases in women stabilized for the first time in more than a decade. 3. RANDY ALLGAIER The 25-year survivor of HIV and hepatitis C knows the ins and outs of accessing care. He has fought for significant increases to ADAP funding in California, protected gay rights and helped people with HIV navigate Medicare. Today, he ensures that people with HIV/AIDS receive the help they need via Ryan White programs in San Francisco, Marin and San Mateo counties. 4. GERARDO ANGULO The comprehensive risk counseling and services coordinator for Track Change, a program in Phoenix that reaches Native Americans, Latinos, African Americans and Asians, Angulo counsels young men (ages 14 to 24) of color who have sex with men, educating them to make healthy choices to protect themselves and their health. 5. JUDY AUERBACH, PHD The deputy executive director of the San Francisco AIDS Foundation (SFAF), Auerbach has a long and illustrious career of HIV/AIDS policy activism. She develops and leads SFAF’s local, state, national and international policy agendas. She has been instrumental in getting AIDS research to focus on women and girls. We all can sleep better knowing she’s speaking our truth to those whose decisions influence our lives. 6. DAWN AVERITT-BRIDGE The founder and chair of the board of The Well Project ensured from the earliest days of the epidemic that women got access to information tailored to their needs—and bodies. A 22-year survivor of HIV, she developed the Women’s Research Initiative on HIV/AIDS, which influences how the FDA labels drugs and advises pharmaceutical companies on drug development. A member of the President’s Advisory Council on HIV/AIDS (PACHA), she makes sure women everywhere caption goes here. are armed with what they need to know about HIV/ caption goes here. AIDS—most important, how not to get it.

7. CORNELIUS BAKER Fun and ebullient, he is one of the community’s best builders of organizations. Currently the national policy advisor for the National Black Gay Men’s Advocacy Coalition in Washington, DC, Baker is often called on to advise behind the scenes and to moderate many a public forum. When he takes the stage, people take note.

8. JOHN BARNES The executive director of Funders Concerned About AIDS, which is based in Crystal City, Virginia, has a long career in public service and fund-raising. He has assisted with child welfare, fed the hungry and fought domestic violence. Today, he’s coalescing the communal power of government, big business and the general public to find the finances necessary to beat down HIV/AIDS. And when he invites George Soros and Bill Gates to his party, they come. 9. DAVID BARR The longtime treatment advocate and educator has done stints at Lambda Legal, Gay Men’s Health Crisis and the Drug Policy Alliance. One of ACT UP New York’s early members and a founding member of the Treatment Action Group, Barr has been invited to weigh in at the National Institute of Medicine’s AIDS Roundatable, the Ford Foundation, the Kaiser Family Foundation, UNAIDS and the NIH’s National Institute of Mental Health, to name a few. As director of the Collaborative Fund for HIV Treatment Preparedness (a project of the Tides Network and the International Treatment Preparedness Coalition) he continues to improve the lives of people living with HIV. 10. JON BENORDEN Straight outta Alaska (yes that’s his rod and those are his waders in the photo), this notable newcomer is now the HIV Health Services Planning Council program coordinator at the Center for AIDS Research, Education and Services (CARES) in Sacramento, California. 11. SETH BERKLEY, MD Tasked with finding a vaccine to end this bloody pandemic, Berkley, president and CEO of the International AIDS Vaccine Initiative, has a childlike enthusiasm for the science of HIV/AIDS. Tirelessly supporting those who seek both a therapeutic and preventive cure, Berkley is scary smart and refreshingly down-to-earth. His energy and conviction that we can find a vaccine are, well, contagious. 12. NANCY BERNSTINE Understanding the important link between having a safe place to lay your head, keep your pills and stay warm and dry, the executive director of the National AIDS Housing Coalition in Washington, DC, advocates for real roofs for people with HIV, not houses made out of cardboard, or cards. 13. LEIGH BLAKE Founder and president of Keep a Child Alive (KCA), Blake has saved the lives of millions of African children who have lost their parents to HIV/AIDS. She DECEMBER 2010 POZ 37

The Reverend Stacey Latimer

Jon Benorden

Naina Khanna

Julie Davids

produced the Red Hot + Blue CDs to benefit AIDS and was the executive director of Artists Against AIDS Worldwide. With the help of Alicia Keys, KCA has modernized the model of charitable organizations and ensures the health of women and children stigmatized by HIV/AIDS. 14. DON BLANCHON As the executive director of the Whitman-Walker Clinic in Washington, DC, Blanchon has evolved the community health center from a drop-in point for health emergencies to a model for modern HIV outreach and a continuum of care. Offering mobile testing vans, support groups, a pharmacy, dental care and more, WhitmanWalker sets today’s gold standard for HIV/AIDS care. 15. SUSAN BLUMENTHAL, MPA The former assistant surgeon general and two-star rear admiral is a renowned national and global health expert. She currently serves as the director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress and as senior policy and medical advisor to amfAR, the Foundation for AIDS Research. When she leads, many follow.

(BENORDEN) CLARK MISHLER; (LATIMER) CLAY PATRICK MCBRIDE; (KHANNA) HECTOR EMANUEL; (DAVIDS) MICHAEL BONFIGLION

16. LARRY BRYANT The onetime all-American football star now works as the national field organizer for Housing Works’ Federal Advocacy Office in Washington, DC. We’d like to see more people pass the ball to Bryant. He’s quick, he’s tough—and he knows how to beeline it to the end zone. 17. CHRISTINE CAMPBELL The vice president of national advocacy and organizing at Housing Works oversees the group’s support of the Campaign to End AIDS. She’s here, she’s there, she is everywhere. 18. SCOTT CAMPBELL Handing out money from the Elton John AIDS Foundation to support innovative HIV prevention programs and efforts to eliminate stigma may sound fun and easy. But when you have executive director Campbell’s discerning taste and insistence on measurable outcomes, the job is harder than you might think. Fortunately for the recipients of Elton John’s generosity, Campbell knows precisely what he is looking for. 19. GUILLERMO CHACÓN The president and CEO of the Latino Commission on AIDS helps lead the powerful organization to protect Latinos nationwide. Thanks to Chacón, we might raise awareness of HIV/AIDS in the Latino community before it’s too late. 20. ALLAN CLEAR The executive director of the Harm Reduction Coalition has long fought for the rights and safety of injection drug users. When the debate around syringe exchange got heated, Clear was sharply on point—syringe exchange is now legal. 21. CHRIS COLLINS As vice president and director of public policy of amfAR, Collins is a well-known face and force on Capitol Hill. Genteel, laser-focused and diplomatic, he is one to watch as the political environment gets ever

more heated. He is one of the main reasons HIV/AIDS has the political prominence it does today up on the Hill. 22. HUMBERTO CRUZ The director of HIV Health Care at the New York State AIDS Institute, a member of PACHA and the HIV Health and Human Services Planning Council, Cruz harkens from the early days; he lends his wisdom and power to advance today’s ever-evolving agenda. 23. JULIE DAVIDS Formerly the codirector for the Community HIV/AIDS Mobilization Project (CHAMP), Davids nearly single-handedly revitalized the HIV/AIDS community at its roots. Sadly, CHAMP’s doors closed recently— proof positive that HIV/AIDS is not overfunded, as some claim. Luckily, two of her CHAMP programs—Project Unshackle and the HIV Prevention Justice Alliance— have been absorbed by other agencies, and she will solider on. Hopefully, soon, she’ll be a general again. 24. SHAWN DECKER This HIV educator, along with his wife Gwenn Barringer, tells youth all over America how not to become a “positoid”—his classically media-savvy term for people living with HIV. 25. LYNDA DEE A founder of the AIDS Treatment Activist Coalition and AIDS Action Baltimore, Dee is a sassy, tough-talking broad (in the best sense of the word) whose candor and courage are inspiring and highly influential. 26. DÁZON DIXON DIALLO, MPH As founder and president of SisterLove Inc., the first women’s HIV/AIDS organization in the Southeastern United States, Diallo is a constant on the scene of sisters helping sisters. 27. N.Y. STATE SENATOR TOM DUANE An openly HIV-positive American politician who fights tirelessly for the rights of people with HIV. Need we say more? 28. GREGORY EDWARDS As executive director of the Flowers Heritage Foundation, Edwards sees to it that lowincome, minority, uninsured people living with HIV get access to their meds—even if they’re on an AIDS Drug Assistance Program (ADAP) waiting list. Under his watch, people need not die in America because they lack treatment. 29. SERGIO FARFAN The cofounder of the Louisiana Latino Health Coalition for HIV/AIDS Awareness gets it done down in the Delta where life is a real challenge, particularly for people with HIV/AIDS. 30. KANDY FERREE As president and CEO of the National AIDS Fund, Ferree wields her foundation’s millions to build partnerships with corporations, national organizations and other foundations looking to strengthen and sustain HIV/AIDS prevention and care services. Super smart, bold and funny, she’s partial to innovative publicprivate partnerships that empower community-level decision making. If she’s funding it, keep your eye on it. DECEMBER 2010 POZ 39

32. INGRID FLOYD The executive director of Iris House in New York City enables disenfranchised women and their families in Harlem and the Bronx to feel wonderful about themselves in the face of the unthinkable. 33. ROBERT FOLEY The executive director of National Native American AIDS Prevention Center in Denver keeps the pulse of the many native nations he leads. Where he goes, they will follow. 34. ANSELMO FONSECA The AIDS activist extraordinaire teams with his partner José F. Colón to fight for the rights of positive people in Puerto Rico. 35. JANE FOWLER The founder of HIV Wisdom for Older Women, Fowler has long championed the rights of people aging with HIV. Today, thankfully, an ever-increasing number of us will need her wise words. 36. KEVIN FROST When amfAR founder Mathilde Krim, PhD, placed Frost at the organization’s helm, she told him to “take amfAR further.” And he did. Frost launched the über successful Treat Asia program that educates communities and health care workers and tracks thousands of positive people in the Pacific Rim. He’s never been afraid to utter the (other) C word: The Cure. Once, people scoffed at his bold vision. Today, they try to catch up as amfAR continues to fuel the most promising research avenues to end AIDS. 37. ROBERT FULLILOVE, EDD The associate dean for community and minority affairs and professor of clinical sociomedical sciences and codirector of the Community Research Group at Columbia University Mailman School of Public Health, Fullilove is a bonafide civil rights hero and a champion of minority health. He fights substance abuse, addiction and sexually transmitted infections in urban settings. 38. BAMBI GADDIST, PHD The cofounder and executive director of the South Carolina HIV/AIDS Council in Columbia, Bambi is refreshingly outspoken. She is the first one with her hand in the air when people ask, “Any comments?” 39. RONDA GOLDFEIN, ESQ. The executive director of the AIDS Law Project of Pennsylvania, Goldfein battles for HIV-positive people by fighting against the stigma, discrimination and ignorance that would otherwise land her clients behind bars. 40. GREGG GONSALVES The legendary treatment activist—involved with ACT UP New York, Gay Men’s Health Crisis, Treatment Action Group (he was a founding member) and most recently the AIDS and Rights Alliance of Southern Africa—is now a student at Yale University. Known for community-rousing speeches and points of view 40 POZ DECEMBER 2010

that ring around the rafters long after he’s left the stage, Gonsalves knows how to command the microphone stand. 41. ROBERT GREENWALD The managing director of the Legal Services Center of Harvard Law School, the director of the Law School’s Health Law and Policy Clinic, a cochair of the HIV Health Care Access Working Group and a PACHA member, Greenwald is one of the community’s more powerful weapons working in the public eye, and behind the scenes, on Capitol Hill. 42. MONDO GUERRA The newly openly HIV-positive star of Project Runway disclosed his status in a tearinducing moment of truth in front of millions, redirecting the spotlight to the cause and reminding the viewing public that AIDS is anything but over in America. 43. REBECCA HAAG When the Office of National AIDS Policy started talking about developing a National HIV/ AIDS Strategy, Haag assembled her own watchdog group to make sure the policy makers got it right. The president and CEO of the AIDS Action Committee of Massachusetts is a stalwart defender of people with HIV and one of the most listened-to voices on the national stage. 44. CATHERINE HANSSENS, ESQ. Leveraging her incredible intellect and silver tongue, Hanssens directs The Center for HIV Law & Policy to protect the health care and human rights of people living with HIV. She is particularly focused on addressing the wrongful criminalization of positive people. 45. MARK HARRINGTON The executive director of the Treatment Action Group (TAG) is a legendary warrior for people with HIV. Thankfully, he has taken the battle global. 46. MARJORIE HILL, PHD The CEO of Gay Men’s Health Crisis in New York, Hill has had the unenviable task of moving the mighty GMHC to new digs by the end of the year. She survived the firestorm of criticism with her usual strength and grace. After the move is made, if people are served better than ever before, you bet she’ll never say, “I told you so.” She lets her actions speak for themselves. 47. DEBRA HICKMAN As president and CEO of Sisters Together and Reaching in Baltimore, and as a member of the CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment (CHAC), Hickman graciously tells it like it is. She relentlessly steers the conversation to topics we need to discuss, such as drug use, homelessness, poverty and the needs of commercial sex workers. She knows that fixing these underpinnings of the epidemic will help stop AIDS. 48. KATHIE HIERS As chief executive officer of AIDS Alabama and a member of PACHA, longtime AIDS activist Hiers was one of the first to sound a clarion call about the burgeoning epidemic in the Southeast.

(SCRUGGS) HECTOR EMANUEL; (JOHNSON) CLAY PATRICK MCBRIDE; (RAJNER) BRIAN SMITH; (PEARL) NICHOLAS ROBERTS

31. C. VIRGINIA FIELDS As CEO of the National Black Leadership Commission on AIDS, Fields uses her political wit to champion the rights and needs of her community.

Linda Scruggs

Jeremiah Johnson

Michael Emanuel Rajner

Karen Pearl

Phill Wilson

THE CURE HUNTERS Sheryl Lee Ralph

The Reverend Charles King

Cathy Olufs

49. DAVID HOLTGRAVE, PHD The professor and chair of the Department of Health, Behavior and Society at Johns Hopkins Bloomberg School of Public Health in Baltimore is the go-to man for anyone (including the federal government, pharmaceutical companies and groups like the National AIDS Fund) who wants to understand the statistical intricacies of AIDS in America. Soft-spoken and gentle, Holtgrave is living proof that you can walk softly and carry a big stick. 50. ERNEST HOPKINS The federal affairs director of the San Francisco AIDS Foundation and CHAC member is called on constantly to provide his perspective—which is invariably well-informed, well-considered and delivered with statesman-like aplomb. Listen to him. People in the know do.

(KING) BILL WADMAN; (WILSON) TOKY; (RALPH) COURTESY OF REGGIE ANDERSON: REGGIEPHOTOS4U.COM; (OLUFS) DENNIS DRENNER

51. MARK ISHAUG The president and CEO of the AIDS Foundation of Chicago, the Midwest’s largest HIV/AIDS service organization, Ishaug fights for people living with HIV and supports the services that support them. His career has taken him from Chi-Town to Africa to DC and back. Under his leadership, AFC has vastly expanded its network of support on policy, prevention and services. 52. JEREMIAH JOHNSON This former Peace Corps member contracted HIV while on the job—and was then fired. As a result, an activist was born—one who changed the Corps’ policy on employing HIV-positive people. He now works at the Northern Colorado AIDS Project. 53. RON JOHNSON The deputy executive director of the AIDS Action Council in Washington, DC, has more than 30 years of experience in nonprofit program planning, development, administration, public policy and advocacy. He has counseled many in the community, including President Clinton. Here’s hoping Obama listens, too. 54. FORTUNATA KASEGE Originally from Tanzania, this activist and her daughter Florida now live in Texas and stand up for the power of antiretroviral drugs to prevent mother-to-child transmission. Sharing their story, this mother and daughter team inspire women the world over to protect their children—from the virus and its stigma. 55. PAUL KAWATA The executive director of the National Minority AIDS Council really needs no introduction, does he? A powerful voice on the Hill, a commanding presence on stage and a longtime champion of people with HIV everywhere. And, one heck of a snazzy dresser. 56. NAINA KHANNA The PACHA member and director of policy and community organizing at Women Organized to Respond to Life-Threatening Disease (WORLD) is one of the new superstars in advocacy. She’s tough, brilliant and not going home until it’s all said and done. 57. REVEREND CHARLES KING A longtime advocate for the needs of homeless people with HIV/AIDS, King practices what he preaches: He sleeps under the same roof as the

clients he serves. As president and CEO of Housing Works in New York, he is known for his outspoken nature (“Excuse me, Mr. President!”) and his propensity for rallying his troops to protest whatever ills may be. Until recently, he was known for his signature long, gray ponytail, but King donated it to charity—to support those in Haiti living with HIV. 58. KATE KRAUSS As executive director of the AIDS Policy Project, Krauss has nearly single-handedly resuscitated the notion of advocating for the cure for AIDS. The mile-aminute pace at which she expounds on the hunt for the cure underscores her drive, which rivals that of the Amtrak Acela. 59. JAMES KRELLENSTEIN He founded pepnow.org because accidents happen and when they do, people have a right to get connected to the information on post-exposure prophylaxis, or PEP, and resources that could save their lives. 60. REVEREND STACEY LATIMER The founder and chairman of Love Alive International was still married to his wife when he found out he had HIV. They later separated, and he embraced the fact that he’s gay. Now, he helps many other African-American men seek their truth too—all while clutching The Good Book close to his heart. 61. JULES LEVIN The founder of the National AIDS Treatment Advocacy Project (NATAP), Levin is an ex-Wall Streeter who has used his smarts to educate the world about HIV and to advocate for the health of people with HIV and hepatitis. He also leads the way in HIV and aging advocacy. 62. KALI LINDSEY The senior director of federal policy at Harlem United is a powerful young gun. One to watch. We saw him stand down President Clinton during last year’s World AIDS Day without a flinch. 63. NANCY MAHON, ESQ. The senior vice president of M·A·C Cosmetics and the executive director of the M·A·C AIDS Fund decides where to allocate millions of dollars. Lucky for us, she bravely funds things others won’t touch. 64. MARSHA MARTIN The director of Get Screened Oakland runs one of the nation’s most effective outreach, testing and linkage to care programs. She has battled homelessness and HIV/AIDS for years; in Oakland, California, she combines her talents to deliver a one-two punch to the epidemic. 65. TERRY MCGOVERN The senior program officer at the Ford Foundation hands out funding to organizations that bolster human rights issues and programs that help the underserved communities hardest hit by HIV/AIDS. She founded the HIV Law Project, wrote a federal regulation authorizing the FDA to halt any clinical trial for a lifethreatening disease that excludes women and has testified numerous times before Congress. In other words, she rocks. 66. JESSE MILAN JR., JD The vice president and director of the community health systems at the Altarum Institute DECEMBER 2010 POZ 43

67. DANIEL MONTOYA He’s the director of external affairs of health programs at the American Institutes for Research in Washington, DC. In that role, he helps guide the CDC’s communications to the public about HIV/AIDS. But what he does behind the scenes is equally powerful. 68. DAVID MUNAR When not running marathons to raise money for AIDS, Munar helps run the AIDS Foundation of Chicago (he’s the vice president). He also runs back and forth to DC to advocate on the Hill, and he helped run the “shadow National HIV/AIDS Strategy group” that ensured the leadership in Washington got a clear picture of what is needed to end AIDS in America. An openly gay, HIV-positive Latino man, Munar offers a powerful voice that speaks to many intersecting factors that fuel the spread of the virus. 69. PATRICIA NALLS As founder and executive director of The Women’s Collective in Washington, DC, Nalls works on the cutting-edge—and keeps women from falling over it. 70. CATHY OLUFS The education services director of the Center for Health Justice in Hollywood, California, Olufs has long championed the rights of positive people in prison. She’s an activist, a teacher and a voice of reason. 71. TOKES OSUBU The executive director of Gay Men of African Descent provides health and social services to black gay men while battling the homophobia and stigmatization of MSM in the black community. Addressing the challenges of living with HIV as a black American, Osubu helps his people get whole. 72. KAREN PEARL As president and CEO of God’s Love We Deliver in Manhattan, Pearl sees to it that people living with HIV/AIDS (and other illnesses that keep them housebound) get fresh, nutritious, homemade food delivered daily. The former head of Planned Parenthood sees food and the personal touches offered by her staff that drop off meals as lifelines for people trying to survive. Making patients feel human again is her recipe for success. 73. JIM PICKETT The director of advocacy at the AIDS Foundation of Chicago also champions the idea of developing microbicides for rectal use. His work as chairman of the International Rectal Microbicides Advocates is instrumental in fighting for much-needed new prevention methods. 74. GINA QUATTROCHI The executive director of Bailey House in New York runs an award-winning communitybased organization that provides housing, services and technical assistance to people with HIV. Quattrochi adjusts her services to the changing needs of her clients. For example, handing out warm meals and clean needles together. 44 POZ DECEMBER 2010

75. MICHAEL EMANUEL RAJNER The one-man powerhouse from Fort Lauderdale is a regular on the political scene from local Dade County to Capitol Hill. He calls, and asks, shows up and demands until people hear his words of wisdom. Imagine the impact he could have with more backing. 76. SHERYL LEE RALPH The founder and director of The Diva Foundation in West Hollywood, California, lights up a stage and sends shivers down your spine. Quick, someone get her a gig at the White House. Maybe then the First Lady will listen to the fact that HIV/AIDS is the No. 1 killer of African-American women ages 25 to 34. 77. JOSÉ RAMIREZ As youth empowerment program coordinator at La Clínica del Pueblo in DC, Ramirez talks turkey to the teens and young adults he counsels. Whenever this out, gay, HIV-positive young Latino speaks, his peers are all ears. 78. SUSAN RODRIGUEZ The president and founding director of Sisterhood Mobilized for HIV/AIDS Treatment (SMART) University in New York is living with HIV—and living with a teenage HIV-positive daughter. Her organization provides free treatment and prevention classes for women. She and her daughter provide role modeling for how to gracefully live in spite of the virus. 79. FRANCISCO RUIZ As the manager of the Racial/ Ethnic Health Disparities program at the National Alliance of State and Territorial AIDS Directors (NASTAD), Ruiz focuses on Latino youth. He’s a real up-and-comer. 80. ERIC SAWYER The civil society partnerships advisor to UNAIDS has lived with HIV for as many years as we’ve known it was the virus that causes AIDS. A founding member of the original ACT UP, Sawyer leverages three decades of advocacy experience to help those in need and keep others from landing in the same boat. He’s brilliant. 81. CARL SCHMID The deputy executive director of The AIDS Institute is at every government meeting to which the public is invited, and many the public is not. He stands tirelessly for the rights of people with HIV and fought to get more funding for the AIDS Drug Assistance Program. Schmid not only saves lives but also shows that a consistent message, if heard, can lead to positive change. 82. JULIE SCOFIELD The executive director of NASTAD ensures that the link between federal funding and state-run AIDS programs stays strong. Her strategic vision and diplomacy are often tapped to hone strategies and policies. 83. LINDA SCRUGGS The director of programs for AIDS Alliance for Children, Youth and Families, Scruggs has survived more hardship than many of us can imagine— and done so with a grace and steadiness that inspire. This AIDS educator is living proof that you can’t keep a good woman down.

(LINDSEY) MACKENZIE STROH; (HARRINGTON) KEVIN MCDERMOTT; (LEVIN) CHRISTIAN GIANELLI; (FOWLER) SCOTT PASFIELD

in Washington, DC, Milan is a 26-year survivor of HIV and a national expert on and advocate for HIV/AIDS policies and programs. His awards and former appointments are too many for this space, but with Milan, much good gets done.

Fortunata Kasege

Mark Harrington

Jules Levin

Jane Fowler

Gregg Gonsalves

Gerardo Angulo

Leigh Blake (with Noah Mushimiyimana)

Larry Bryant

84. PERNESSA C. SEELE The founder and CEO of the Balm in Gilead uses faith to combat HIV/AIDS. Her organization provides faith-based institutions around the nation with help and support as they reach out from the pulpit to save their congregants. Can we get an Amen? 85. RON SIMMONS, PHD A national leader in AIDS education and outreach to African-American communities, Simmons is most known for his leadership of Us Helping Us, People Into Living, one of the largest black nonprofit AIDS organizations. A photographer and writer active in DC’s black gay arts renaissance, he turns AIDS activism into art. 86. DEBORAH PETERSON SMALL The disproportionate number of people of color incarcerated for drug offenses inspired the executive director of Break the Chains to advocate for drug policy reform. She helps people break free of stigma and discrimination—and then throws away the key.

(ANGULO) DAN COOGAN; (GONSALVES) ERIC MILLER; (BLAKE) CHAD MURRAY; (BRYANT) ANDREW MCLEOD

87. WENDY STARK As executive director for New York City’s Callen-Lorde Community Health Center, one of the nation’s leading health care facilities for the LGBT community, Stark has launched an on-site pharmacy and now sends her staff out into the field. Her vision is based on doing whatever it takes to break down barriers to top-notch care and to align human rights and health care. 88. VALERIE STONE, MPH The associate professor of medicine at Harvard has dedicated her career to serving HIV-positive women of color and to reducing health care disparities in the black and Latino communities. Her recent book, HIV/AIDS in U.S. Communities of Color, will undoubtedly help us turn the page to a better chapter in HIV/AIDS. 89. STEFFANIE STRATHDEE, PHD The associate dean of Global Health Sciences at the University of San Diego’s School of Medicine, Strathdee focuses on migration and health. She works to stop the spread of HIV along the U.S./Mexico border and understands that the virus has no country of origin. 90. SEAN STRUB POZ’s founder and AIDS activist extraordinaire is at it again—with a vengenance. Strub is the senior advisor to the Center for HIV Law and Policy’s Positive Justice Project and is working to combat the stigma and discrimination against people with HIV in the criminal justice system. 91. TRACY SWAN As hepatitis/HIV project director at Treatment Action Group, Swan is a long-term activist who has served in the direct-care trenches for decades. She knows prevention, counseling, testing, treatment education and how to help people access care, pills and syringes. Regulators, researchers and pharmaceutical reps rely on her. We do too.

92. DONNA SWEET, MACP As principal investigator and director of the Kansas AIDS Education and Training Center and the cochair of CHAC, Sweet takes the pulse of HIV in the heartland—and across the nation. 93. JOHN TEDSTROM The president and CEO of the Global Business Coalition to Fight TB, Malaria and AIDS, Tedstrom has convinced big business around the world to get some skin in the AIDS game. A born leader and a diplomat, Tedstrom is a hard person to say no to. 94. ADAM TENNER As executive director of Metro Teen AIDS, Tenner fights for the rights of young people with HIV and tries to protect others from joining the club. 95. ED TEPPORN The HIV program director for the Asian & Pacific Islander American Health Forum (APIAHF) helps strengthen policies, programs and research to improve the health and well-being of Asian Americans, Native Hawaiians and Pacific Islanders. He helps bridge the gaps between evidence-based and culturally appropriate interventions—and understands you need good data to do much good. 96. LANCE TOMA The executive director of the Asian and Pacific Islander Wellness Center caters to the needs of his oft-underserved community. He has received national attention for bringing awareness to the lack of focus on APIs with AIDS. 97. NELSON VERGEL Treatment guru Vergel founded the Program for Wellness Restoration in Houston. His online mailing list reaches people all over the nation looking for treatment updates and insights. 98. TOM VIOLA The executive director of Broadway Cares/Equity Fights AIDS leverages the wattage of the Great White Way to raise money and awareness for HIV/ AIDS. When the curtain drops, his show starts. To date, Broadway Cares has raised more than $51 million from its audiences. 99. MITCHELL WARREN The bio of the executive director of AIDS Vaccine Advocacy Coalition (AVAC) says he “uses public education, policy analysis, advocacy and community mobilization to accelerate the ethical development and global delivery of AIDS vaccines and other HIV prevention options” (such as microbicides). We couldn’t say it better ourselves. So we didn’t try. 100. PHILL WILSON As president, CEO and founder of The Black AIDS Institute, Wilson leads a nimble army of specialists on AIDS among black Americans. Tapping deep into his African-American heritage, the PACHA member created GreaterThan.org, a website and campaign that is about the power of individuals acting together to achieve a greater goal. Sounds like a mighty powerful idea. DECEMBER 2010 POZ 47

A C H I E V I N G

Jacki Gethner didn’t know a lot about HIV/AIDS when she completed her certiﬁcation in massage therapy in 1988. But after learning her best friend, Bonnie Hamann, was HIV positive, Gethner wanted to use her healing touch to help improve the lives, minds and bodies of people affected by and living with HIV. Her previous experience as a mental health counselor sparked a desire to use bodywork to relieve the stress of dealing with health conditions. “I wanted to reach out because the response [to people living with HIV] was so negative,” she says. The chance to further her education and simultaneously offer support arrived in 1987 at the First Annual Holistic and Western Medicine AIDS Conference: AIDS, Medicine and Miracles. Gethner offered her massage skills in exchange for a chance to attend the conference and learn about the virus. She encouraged other massage therapists to attend because she believed it was a great way to share accurate HIV/AIDS information with their communities. During the conference, Gethner also taught HIV-positive people and their families massage skills so they could improve each other’s well-being. “Teaching people allows them to have more control over their illness, and it helps with selfesteem,” Gethner says, adding that it also helps them adhere to medication. “A lot of physical changes go on when someone becomes ill with HIV, so touch is a very nurturing thing.” Gethner has dedicated more than 20 years to supporting and educating people living with the virus about massage therapy. In November 2009, her work was recognized when she received the Kaiser Permanente HIV/AIDS Diversity Award for being a pioneer in treating HIV-positive people with complementary medicine. She is using the award to continue the Women of a Certain Age program she cofounded with Sharon Lund, PhD, an AIDS activist, and Sally Fisher, who has been living with HIV for nearly 30 years. The program, based in Oregon, is for women ages 50 and older and offers peer education and outreach in community settings such as churches, garden groups and workplace sites. In addition to talking about condoms and HIV tests and prevention, volunteers provide referrals to local HIV care and services—certainly important information for women of any age. —WILLETTE FRANCIS

44 POZ OCTOBER/NOVEMBER 48 DECEMBER 2010 2010

LINCOLN BARBOUR

Healing Touch

Long-Term Survival These days, many HIV-positive people can live long, healthy lives. But for those who have access to care and treatment, years of popping pills can take a toll on one’s body. Are you a long-term survivor? POZ wants to hear how you’ve handled living with the virus through the years.

How long have you been diagnosed with HIV?

❑ More than 25 years ❑ 15–19 years ❑ 5–9 years 2

Have you ever been diagnosed with AIDS (fewer than 200 CD4 cells or had one or more opportunistic infections)?

❑ Yes 3

❑ No

❑ I don’t know

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❑ No

Have you ever taken a structured treatment interruption (STI) or “drug holiday”?

❑ Yes 6

❑ No

Have you ever had any of the following? (Check all that apply.)

❑ Atherosclerosis (stiff blood vessels) ❑ Cancer (any type) ❑ Chronic breathing problems ❑ Depression ❑ Heart attack ❑ High blood fat levels (e.g., cholesterol or triglycerides) ❑ High blood pressure ❑ Hepatitis B or C ❑ Kidney disease ❑ Mental deterioration/dementia ❑ Osteoporosis (severe bone loss) ❑ Peripheral neuropathy ❑ Pneumonia ❑ Stroke 7

Based on your own experience, how accurate is the phrase “HIV is a manageable disease”?

❑ Very accurate ❑ Somewhat accurate ❑ Not at all accurate 10 Have you ever been on disability (e.g., SSDI or SSI) for more than three months because of your HIV?

Since you started taking antiretrovirals, has your viral load been consistently undetectable?

❑ Yes 5

Have you ever had lipodystrophy? (Check all that apply.)

❑ Yes—loss of fat in my face ❑ Yes—loss of fat in my limbs ❑ Yes—fat accumulation in my belly ❑ Yes—fat accumulation in my upper back ❑ No

How long have you been taking antiretroviral meds?

❑ More than 25 years ❑ 20–24 years ❑ 15–19 years ❑ 10–14 years ❑ 5–9 years ❑ Less than 5 years ❑ I am not on medication (Skip to question 6) 4

❑ 20–24 years ❑ 10–14 years ❑ Less than 5 years

Do you suffer from chronic fatigue?

❑ Yes

❑ No

❑ Yes 11

❑ No (Skip to question 12)

If your health improved, did you discontinue disability and go back to work?

❑ Yes

❑ No

12 What year were you born?

__ __ __ __

13 What is your gender?

❑ Male ❑ Transgender

❑ Female ❑ Other

14 What is your sexual orientation?

❑ Straight ❑ Bisexual

❑ Gay or lesbian ❑ Other

15 What is your ethnicity?

❑ American Indian or Alaska Native ❑ Arab or Middle Eastern ❑ Asian ❑ Black or African American ❑ Hispanic or Latino ❑ Native Hawaiian or other Pacific Islander ❑ White ❑ Other:_____ 16 What is your zip code? _ _ _ _ _ _ _ _ _ _

Please fill out this confidential survey at poz.com/survey or mail it to: Smart + Strong, ATTN: POZ Survey #168, 462 Seventh Avenue, 19th Floor, New York, NY 10018-7424