POZ September 2015

A SMART+STRONG PUBLICATION SEPTEMBER 2015 POZ.COM $3.99

H E A L T H ,

L I F E

Clockwise from top: London Gray, Benjamin Ball, Adonis Porch and Ervin Rogers

&

H I V

Suppression Superheroes Reducing viral loads without superpowers

CONTENTS

EXCLUSIVELY ON

POZ.COM

Despite her youth, Ashley Murphy is a longterm survivor.

POZ STORIES

REAL PEOPLE, REAL STORIES

Together, our stories can change the way the world sees HIV/AIDS. They inspire others in the fight and break down the shame, silence and stigma surrounding the disease. Go to poz.com/stories to read stories by others like you and to submit your own story.

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POZ GLOBAL

COVERING THE PANDEMIC

Our domestic fight against HIV/AIDS is different from the other battles against the virus overseas, but our struggles have more in common than not. Go to poz.com/global for news and opinions on HIV/AIDS from around the world.

POZ DIGITAL

READ THE PRINT MAGAZINE ON YOUR COMPUTER OR TABLET

36 SUPPRESSION SUPERHEROES A new program at Housing Works helps participants get and keep their viral loads undetectable without superpowers. BY TIM MURPHY 42 THE GRAYING OF AIDS In 2015, over half of people with HIV in the United States are 50 and older. BY TRENTON STRAUBE

5 FROM THE EDITOR I Need a Hero Go to poz.com/digital to view the current issue and the entire Smart + Strong digital library.

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iSTAYHEALTHY FREE APP FROM POZ

Go to blogs.poz.com/istayhealthy or scan the QR code below with your mobile device to learn how you can better track your lab test results and meds, as well as set alerts to take your meds and much more!

7 FEEDBACK

Your letters and comments

12 POZ Q+A

Michelangelo Signorile and Dan Savage discuss the future of LGBT civil rights, including the fight against HIV/AIDS.

18 POZ PLANET

reflects on GMHC’s Buddy Program and the heroic legacy of love in action.

27 RESEARCH NOTES

Long-acting PrEP implant? • vaccine boosts ARVs • the new HIV cure center in North Carolina • HIV/hep C outbreaks

28 CARE AND TREATMENT

The START study offers proof that early treatment is ideal • combo tablets no better than individual pills? • mental health and med adherence • treating addiction helps HIV • HIV-hep C mortality risk

GMHC relaunches its historic Buddy Program • the buddy book No-Accounts • POZ Stories: Andrew Pulsipher • Doorways in St. Louis • Doug Ireland’s radical voice • an HIV campaign along Indiana highways

Side effects from HIV medications

23 VOICES

48 POZ HEROES

Victoria Noe explains why she chooses to ACT UP. Plus John-Manuel Andriote

35 SURVEY SAYS

Born with HIV, teen activist and singer Ashley Murphy rocks her differences.

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COVER: RAFA ALVAREZ; (GLOBE) ISTOCKPHOTO.COM/DNY59; (TYPEWRITER) ISTOCKPHOTO.COM/CHICTYPE; (MURPHY) MICHELLE GIBSON

44 THE COINFECTION CHALLENGE New treatment options for people living with HIV and hep C. BY BENJAMIN RYAN

FROM THE EDITOR

ORIOL R. GUTIERREZ JR. EDITOR-IN-CHIEF

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I Need a Hero

I

DIDN’T READ COMIC BOOKS as a child. It seemed all they had to offer was a lot of aggression, which was scary to me back then. I was wrong, of course.

Fighting for justice was and still is what superheroes represent.

Despite not really knowing the source material, I did love watching Saturday morning cartoons, especially Super Friends, which featured Superman, Batman and Robin, Wonder Woman, and Aquaman.

Their aggression was trumped by their teamwork (and their skintight outfits).

The Undetectables—a new program from New York City’s Housing Works that helps participants reduce their viral loads—taps into that superhero spirit. The program uses a comic book series to educate participants about HIV treatment adherence. That series was the inspiration for our cover.

The Undetectables comic books include fictional characters, but our cover and the accompanying feature article include real participants in the program. Go to page 36 to read how London Gray, Benjamin Ball, Adonis Porch and Ervin Rogers are lowering their viral loads without superpowers.

For those of us living with HIV, having an undetectable viral load is optimal, but it does not cure the virus. However, for people who are living with both HIV and hepatitis C virus (HCV), curing their hep C is now not only possible, but also easier than ever before. Go to page 44 to read about HCV treatment.

The U.S. Centers for Disease Control and Prevention recommends that everyone born between 1945 and 1965 get tested for hep C. That’s yet another health-related concern that all of us living with HIV need to consider as we get older. Thankfully, more and more of us are indeed living longer.

As of this year, it’s estimated that more than half of people living with HIV in the United States are older than 50. The challenges faced by all people as they get older are increasingly affecting HIV-positive people. We also face unique challenges with aging that HIV-negative folks do not.

The Graying of AIDS project reflects all of the complexity involved in aging with HIV. The project includes photos, videos and interviews, as well as traveling exhibitions and campaigns, spotlighting older people living with the virus. Go to page 42 to read about their current and upcoming efforts.

Living long-term with HIV is heroic all by itself. Overcoming related health problems is more than enough of a battle, let alone the stigma and discrimination that often surface.

However, those who give above and beyond what’s expected are deserving of special praise. I do hope we can all agree on that.

Ashley Murphy is one such person. She’s only 17 years old, but she was born with HIV so that already makes her a long-term survivor.

She was given only weeks to live, but now she gives motivational speeches. Go to page 48 to be inspired by her story.

ORIOL R. GUTIERREZ JR. EDITOR-IN-CHIEF editor-in-chief@poz.com

Want to read more from Oriol? Follow him on Twitter @oriolgutierrez and check out blogs.poz.com/oriol.

poz.com SEPTEMBER 2015 POZ 5

Have an opinion about this month’s POZ? Comment on a specific story on poz.com, post a general comment via poz.com/talktous, or send a letter to POZ, 462 Seventh Ave., Floor 19, New York, NY 10018.

You can also head to our social media pages at facebook.com/pozmagazine, pozmagazine.tumblr.com, instagram.com/pozmagazine or @pozmagazine on Twitter.

SOUTHERN INJUSTICE

In the POZ.com Newsfeed article “HIV Criminalization Trial of Missouri Wrestler Begins” (May 11, 2015), we reported the story of Michael Johnson, a 23-year-old gay black man convicted of “recklessly infecting a partner with HIV.” Johnson currently faces 30 to 60 years in prison.

A NEW VOICE OF HIV/AIDS

In the POZ magazine feature “Telling Their Stories” (June 2015), Trenton Straube went behind the scenes of the Recollectors, a new advocacy group that brings together children who lost their parents to AIDS. With tears in my eyes, I am so happy for each and every one of you guys to have found a place of acceptance.

Together we can rid this world of the stigma of HIV and AIDS. Big love to you all.

ELLIE I HICKS

I lost my mother to #AIDS in 1994. This is truly amazing to hear about a community like the @Recollectors.

TRANISHA ARZAH @TRANISHAA

I was just released after serving nine years on this charge in Missouri prison. At trial, my defense—backed by medical science—was that it was not possible to infect. I knew this. Top HIV doctors at the time volunteered to testify, and did, but were ignored completely. You would not believe what prosecutors can twist and fabricate. So sorry for him!

RICHIE

This whole situation is bizarre. I am following the trial on Twitter. It’s a horrific witch-hunt. The prosecutor told the jury that HIV is terminal disease and that people die from a simple flu

once infected. The jury does not know any better and convicted out of fear.

JOHNIA

In the ’80s and ’90s we were just trying to survive. Now we are charging each other in court. This is what gay rights have come to. Use protection every time you deal with a stranger. Grow up.

MIKE

VIRAL MEMORIES

Mark S. King’s latest POZ magazine essay, “Surviving Life Itself” (June 2015), discussed his relevance as a long-term survivor in the here and now, chronicling his journey through the epidemic since the early ’80s.

As a 25-year survivor myself, I related almost entirely with everything Mr. King experienced. Years ago, I never thought I would live to see my 40th birthday, yet at that age I earned a bachelor’s degree, fought my own battle with substance abuse, and am currently living through the prison experience. Although

FEEDBACK

we are individuals living with HIV as long-time survivors, it really is important to remember that we are all long-time survivors of life, too.

THOMAS S. FORD

I feel like this is the article I’ve been waiting for. I’m an HIV prevention researcher in Lima, Peru. Outside of the global North, there is very little to read about HIV, apart from a vision of stigma and disease. We are very much in need of positive voices.

KKONDA

A moving article that reminds me of the bad memories of the 1980s I so frantically ran from. It is important to have that period in history understood correctly. The details and magnitude of the plague were poorly documented by the public then, and still are now. Acknowledging the past trauma allows survivors—both positive and negative—to get over the shame and fear we held on to for so long, and focus on future possibilities.

DRUMSTICK

POZ ON INSTAGRAM

Highlights from yet another busy month on the POZ calendar. Check out our recent photos from Visual AIDS’s “What is Undetectable?” event at the New Museum in NYC, New York State’s comprehensive new public health campaign to #EndAIDS by 2020 and more, by following @pozmagazine on Instagram.

Heartfelt story about a project bringing a virtual community together. Check out the pictures at the end!

COMPASS CENTER @COMPASSCENTER

I would like to know how I can be a part of the Recollectors. I lost my mom to AIDS 11 years ago. I just want to share my story, and I’m sure that my sister may want to do the same.

NASIR

Editor’s Note: To connect with the group, visit their website at therecollectors.com, email info@therecollectors.com or you can go to facebook.com/ therecollectors.org.

poz.com SEPTEMBER 2015 POZ 7

POZ Q+A

BY ORIOL R. GUTIERREZ JR.

Dan Savage (left) and Michelangelo Signorile

IT’S NOT OVER

I

HAD THE PRIVILEGE OF MODERATING A CONVERSATION EARLIER this year between activists and authors Michelangelo Signorile and Dan Savage.

The talk was engaging (if I do say so myself, but others have told me the same!), which was not unexpected. After all, both men have been at the forefront of LGBT issues for decades.

The event was co-hosted by the New York chapter of NLGJA: The Association of LGBT Journalists and its student chapter at the City University of New York Graduate School of Journalism. Full disclosure: I’m a longtime member of NLGJA, so many thanks to them for the opportunity.

The conversation was prompted by the publication of Signorile’s latest book, It’s Not Over: Getting Beyond Tolerance, Defeating Homophobia, and Winning True Equality.

We explored the premise of the book (extremely brief summary: “victory blindness” is dangerous), as well as the themes in Savage’s most recent book, American Savage: Insights, Slights, and Fights on Faith, Sex, Love, and Politics.

We discussed fighting for full civil rights for LGBTs, challenging media coverage and confronting deep-seated homophobia, as well as how HIV interrupts the victory narrative. Below are edited excerpts from the event.

I’m going to quote Mike’s book: “It’s not over…. There’s a disconnect between the way we talk about the strides forward and the reality on the ground. This narrowing of scope to talk only about successes—that’s victory blindness. And just as often happened in the battles against other forms of bigotry in which groups that thought they had ‘arrived,’ only to see rights stripped away, sometimes decades later, the enemies of lesbian, gay, bisexual and transgender Americans

12 POZ SEPTEMBER 2015 poz.com

will capitalize on it. We’ve got to pay attention now perhaps more than ever before as equality’s opponents gather their forces.”

So “victory blindness” leads to backlash, which you argue threatens the gains of the LGBT movement. As an example of victory blindness and its consequences, you cite the resignation of Brendan Eich, inventor of Javascript and CEO of Mozilla, the maker of Firefox.

Mike, can you elaborate on that?

I use the story in the first chapter of the book about Brendan Eich as one example of this idea of victory blindness.

We’ve been people who’ve been horribly demonized and went through horrendous experiences—including intolerance and complete ignorance during the height of the AIDS epidemic, which decimated us—that when we have these wins, it’s captivating. There’s then an impulse we all can feel to believe [the discrimination is] all over.

Signorile:

COURTESY OF DAN SAVAGE AND MICHELANGELO SIGNORILE

Michelangelo Signorile and Dan Savage discuss LGBT issues beyond marriage equality, including HIV/AIDS.

Brendan Eich gave money to Proposition 8 [the ballot initiative that made same-sex marriage illegal in California].

When [his donation] was revealed in 2012, there was a little bit of an uproar, but not until he was made CEO in 2014 was there much more of a concern.

Rarebit, owned by two gay men, asked Eich if he felt sorry for giving this money and he said no. They decided they weren’t going to do business with him anymore.

Then OKCupid did it and others did it. This was all the free market in operation. No gay activists called for him to step down, but the right wing spun it into that.

My feeling was that too many LGBT people instead of hitting back at that [right wing] backlash were saying, “We shouldn’t have [let him lose his job],” or “We shouldn’t be applauding this,” or “We should be magnanimous,” or “We should be reaching out.”

Our opinion-makers collapsed, and this man gave money to other anti-gay candidates. If he were anti-Semitic and had given money to an anti-Semitic candidate or a racist candidate, he would not have been acceptable. We need to make that argument.

To paraphrase the premise, it’s no longer just about tolerating LGBT people anymore—we have to fully accept them. What social justice issues surface during this ongoing battle?

Savage: We

can tick off issues: LGBT elders—the Stonewall generation, the survivors of the plague—being forced back into the closet in nursing homes; LGBT youth homelessness; violence directed at trans women.

It’s important to emphasize that victory blindness doesn’t mean we’ve had no victories, but we don’t want to walk off the field. We can’t be complacent because things can be rolled back. We still have to fight.

I talk a lot in the book about how the enemies of LGBT rights are trying out all kinds of things. Every time we think they went away, they have another win that’s under the radar. They depend Signorile:

on the media not paying attention; they depend on big business sitting this one out.

That’s true on the political end, but we also have to be aware of the backlash for more marginalized parts of our communities. Take the record numbers of LGBT homeless youth that we’re seeing.

Kids think, “I can come out now,” but then their parents are still religious bigots and throw them out of the house.

The victories create further issues we have to deal with.

Dan, since we’re on the subject of kids, tell us about your TV show.

This ABC sitcom, for which I am one of eight executive producers and I am not writing, is about a queer kid in a Savage:

which is not making PrEP or PEP [postexposure prophylaxis] available to those who need to get it.

We also still haven’t had an explicit sex education campaign around HIV since the beginning of the epidemic. It’s extraordinary.

For LGBT groups that are just about showing great victories, HIV complicates the whole thing. It doesn’t fit the victory narrative.

Worse than that, it then plays out in culture: For all of these LGBT characters on TV, HIV doesn’t exist. But it does in the lives of LGBT Americans. Looking [on HBO] finally got there in the second season, and then it was canceled.

HIV in films is about what happened decades ago, like Dallas Buyers Club. It’s not about what’s happening now.

“When we have these wins, it’s captivating.

The victories create further issues we have to deal with.” family where the parents are divorcing and he comes out in the midst of that, which is kind of my coming out.

This kid is coming out to homophobic parents. I’m advocating for that to be a complicated story, not just another slap of the rainbow windsock, because I don’t think TV needs that. That’s what I’m hoping for.

Back to victory blindness, where does HIV/AIDS fit in?

We still have high infection rates. We have HIV criminalization laws that have criminalized hundreds of people.

That’s all happening under the radar and not really discussed.

[LGBTs] have these fights about PrEP [pre-exposure prophylaxis to prevent HIV] when we should be fighting with the federal health establishment,

Signorile:

Where do we go from here?

Savage: Movements have to push at the

weak spots, secure and take ground, achieve something, try to nail it down, and then go into the never-ending rearguard action defense to hold that.

Signorile: We need to demand a full and

comprehensive civil rights bill. If we had never stopped demanding it, back when it was introduced decades ago, it wouldn’t seem like we’re asking for a lot now.

Instead we went for this strategy of, “Let’s ask for this little bit.” It telegraphs to the other side that you don’t care that much if you’re just asking for a little bit.

It’ll take a long time, but look at what we’ve done. Let’s demand it all.

Go to bit.ly/signorilesavage to watch the complete conversation on POZ.com.

poz.com SEPTEMBER 2015 POZ 13

POZ PLANET

BY TRENTON STRAUBE

BUDDIES ARE BACK! GMHC relaunches its historic support program—with unexpected twists.

Long-term survivors have spoken, and Gay Men’s Health Crisis (GMHC) has listened. What the New York City– based AIDS organization learned was that many of its long-term clients feel isolated and forgotten as they struggle with depression, addiction, stigma and stress. To meet those challenges, GMHC decided to relaunch its iconic Buddy Program.

Started in 1982, the original program trained volunteers to act as “buddies” for people with AIDS, helping them get to doctors, clean their homes and run errands, or just offering friendship.

Funding dried up in 2005, as did a large chu of the need, chunk tha thanks to modern me that revitalized meds

many folks who faced disabilities.

Jeff Rindler, GMHC’s chief program officer, used to train buddies back in the day, and he’s overseeing the reboot. In 2015, he says, the needs of people with HIV are more varied, so the new buddy model is much more flexible. “Although we started the new program with longterm survivors in mind,” Rindler says, “it’s available to everyone, even those diagnosed last week. And we welcome all volunteers.” What’s more, he envisions HIV-positive clients participating as mentors to buddies. Long-term survivors can pass along their experiences, for example, while younger people can share the struggles they face today.

“Back in 1985,” Rindler recalls, “the need was for concrete help—like doing

housekeeping—but today it could be going to the movies or a café. For someone isolated and feeling forgotten, just leaving the house improves mental health and overall well-being. That may lead to the client coming to our meals program or work force program—or they themselves might volunteer as a buddy.

Little steps can lead to miracles.”

GUTS & GLORY G

A Author Tom Glenn knows about biases, battle scars and heroism. An undercover intelligence agent during tthe Vietnam War, Glenn was also, he says, the only heterosexual male volunteer, back in the 1980s, at Whitman-Walker’s buddy program in Washington, DC. His days of caring for gay men dying of AIDS are fictionalized in No-Accounts: Dare Mighty Things. Don’t you dare miss out on this phenomenal tale.

Born with HIV in 1981, Andrew Pulsipher started meds when he was just 8 years old, after losing both parents to the virus. He was raised by an aunt and uncle in a supportive environment, and today he’s happily married in Queen Creek, Arizona, and the proud papa of three HIV-negative kids (the first conceived through a fertility treatment, the other two the old-fashioned way).

Despite the strong family ties, though, he was never very open about his HIV. “That was always the lifestyle I led,” he recalls.

“It never occurred to me to tell everyone.”

Until now.

Earlier this year, he decided to be more public, as a way to help other people with the virus know they could live a long life and even have a family. But how to disclose? “I tried to think of a fun way to say I’m HIV positive and explain it,” he says. “I thought, maybe a photo on Facebook with a few facts about me—not a long story—so I decided to take that angle and see what happens.”

The results? “The local TV news from

18 POZ SEPTEMBER 2015 poz.com

Phoenix called and said the story had like 8,000 shares. I was like, ‘It does?’ And they said, ‘We want to come to your house and interview you—today!’ I said, ‘I have three small children and need to clean up!’”

The Associated Press ran the piece, as did the Huffington Post and BuzzFeed. People are still coming across the story and leaving him messages. “People always ask, ‘How do you find love?’ And I say, ‘You don’t have to disclose right away. Get to know the person.’ I waited five or six months to tell my wife. She understood—but she was very into science, so that helped.”

Pulsipher hopes to parlay his sudden fame into an actual job. “I think I’d be a benefit to kids living with HIV,” he says.

“I was there. I get it.” Meanwhile, he’s enjoying the spotlight. “People say all

these wonderful The Facebook post that launched a things about me,” viral awareness he says, “but I joke campaign that I haven’t been part of the HIV movement for 34 years, even though I’ve had it for that long. It’s taken me a while.”

He’s certainly making up for lost time.

Visit poz.com/stories to read more.

(HANDS/COFFEE) ISTOCKPHOTO.COM/SHMELJOV; (TYPEWRITER) ISTOCKPHOTO.COM/CHICTYPE; (PULSIPHER) COURTESY OF ANDREW PULSIPHER

POZ Stories: Andrew Pulsipherr

Hot Dates / Sept. 16: Global Female Condom Day / Sept. 18: National HIV/AIDS and Aging

HOUSING MISSOURIANS WITH HIV St. Louis is known as the Gateway to the West. For thousands of Missourians living with HIV, the city’s Doorways Interfaith Residence organization is known as a gateway to stable housing and health services. Doorways offers five different programs, each based on level of need.

Cooper House, for example, is a residential facility for nearly 40 homeless folks needing 24-hour nursing care and meal services. And the Jumpstart program provides support for homeless single parents living with HIV. Doorways owns seven additional residential buildings, providing homes to about 250 residents who are capable of independent living but need financial and health services. Another 1,500 clients are able to live in their own homes and simply require assistance with rent and utilities. And then there’s the Outstate program, which offers similar aid to rural residents in more than 100 counties in Missouri and Illinois, while also providing transportation dollars so clients can get

to medical appointments.

Their client base—about 67 percent are black and 70 percent are male—mirrors the epidemic in the Show Me State. The biggest hurdle they face, according to Doorways president and CEO Opal Jones, is thatt “folks are isolated and stigmatized.

And Missouri not expanding Medicaid d continues to be a challenge—not just for HIV-positive people, but for low-income people period.”

Doorways allows clients to move from one program to another as needed, but providing a home is only part of its services. “What’s exciting is that we’ve expanded our program,” Jones says. “We now have an employment specialist, and we do programming around mental health, substance abuse and physical health. We even do afterschool tutoring and summer camp for children of clients.” This year, Doorways hosted an adult prom, complete with

(ST. LOUIS ARCH) THINKSTOCK; (COOPER HOUSE) COURTESY OF DOORWAYS; (HIV SIGN) COURTESY OF MORÉNIKE GIWA ONAIWU

A RADICAL VOICE WORTH READING Journalist Doug Ireland’s career spanned the AIDS epidemic and the gay rights movement. He died in 2013, but over 30 years of his writings are now collected in The Emperor Has No Clothes: The Radical Voice of Doug Ireland. Why radical? He was openly gay, a leftist and a militant atheist (the result of contracting polio as a child after his Christian Scientist parents refused to have him inoculated).

In the ’60s and ’70s, Ireland worked for labor groups and for politicians such as Bella Abzug, an outspoken progressive. He befriended the likes of Christopher Hitchens, Susan Sontag and Martin Duberman (who wrote the book’s introduction), and Ireland lost his beloved partner, Hervé Couergou, to AIDS. In other words, Ireland was a reporter of considerable intelligence and political insight, unafraid to voice his opinions on everything from U.S. presidents to sexual politics, as in these two articles that first appeared in the pages of POZ: “Hate Thy Neighbor: The Christian Right” and “Don’t Regulate My Body: Closing the Bathhouses.”

Cooper House in St. Louis

the Gateway Men’s Chorus, drag queens and Miss Missouri. “It was a place,” Jones says, “we could take down barriers and just have some fun.”

FURY ROAD

What happens when an HIV campaign in Indiana takes a very wrong turn?

A digital sign along Interstate 65 in Indiana flashed three words: “Warning HIV Outbreak.” When Morénike Giwa Onaiwu saw it, she was filled with three feelings: “shock, nausea and rage.” “I am trying to raise my family free of HIV stigma and shame,” says Onaiwu, an advocate from Texas whose family is affected by HIV. “The sign flew in the face of everything that I believe in with regard to human dignity and nondiscrimination. I wanted it taken down immediately.”

So she sent an image of the sign to her friends at Positive Women’s Network-USA, and with lightning speed, news of the offending campaign spread through social media. The sign was gone the next day. But how’d it get there in the first place? Turns out, there was a “miscommunication” at the Indiana State Department of Health, which is assisting with the HIV outbreak in Scott County. A proper educational campaign is slated to go up on highway signs soon, mostly aimed at truck drivers. Meanwhile, Onaiwu tells POZ she’s “ecstatic. I was floored by the support from all over. Like the African proverb says: When spiderwebs unite, they can tie up a lion.” Somebody ebody should put thatt on a highway sign!

AIDS activists put the brakes on this sign.

Awareness Day / Sept. 27: National Gay Men’s HIV/AIDS Awareness Day

VOICES

BLOGS AND OPINIONS FROM POZ.COM

WHY I ACT UP

A 2015 protest

by ACT UP New York

In her opinion piece titled “Why I ACT UP,” writer-turned-activist Victoria Noe reflects on her initial decision to get involved in the early fight against HIV/AIDS and her recent recommitment to the cause. Here is an edited excerpt.

COURTESY OF MARK APOLLO/OWSSPAG

W

hen you think of ACT UP (AIDS Coalition to Unleash Power), you probably think of gay men. You probably think of Peter Staley and the others in How to Survive a Plague and think that what they did was all in the past.

When I walked into my first ACT UP New York meeting over two years ago, it was a far cry from the overflowing crowds portrayed in that documentary.

Though attendance has steadily risen since then, that day not more than a dozen or so people sat in a circle.

I try to plan my trips from Chicago to New York so I can attend the Monday night meetings at the LGBT Community Center on West 13th Street (everyone’s welcome). Some members have been there since the beginning. Some, like me, burned out on the cause and backed away in the ’90s, only to return when it became clear that the epidemic was far from over. Many of the new members are young, energizing us all.

The men and women come from varying backgrounds, all ages, many ethnic groups. But regardless of education level or tax bracket, they share one thing in common: the desire to put an end to AIDS once and for all.

The introduction of the “cocktail” in 1996 gave me a false sense of security.

The urgency was gone, so my work as an AIDS fundraiser wasn’t as critical.

My friends weren’t dying; in fact, they were thriving. Pages of obituaries were replaced by pages of ads for the latest HIV drugs. Everything was under control.

In 2011, when I contributed to Windy City Times’ “AIDS@30” series about my experience as a straight woman in Chicago’s AIDS community, I wasn’t prepared for my reaction.

The memories, which I’d successfully suppressed for almost 20 years, rushed back. Very few were pleasant. The flood of emotions initially confused me: Where did so much anger come from?

I began to write more about those days and catch up on the current state of the epidemic. Still, it took me two more years to walk into that ACT UP meeting. Though I’ve always been politically active, even lobbying in Washington, DC, for the first Ryan White Care Act, I’d never gotten this involved on the activist side of the epidemic. And let’s face it: I’m not the kind of person who springs to mind when you think of ACT UP. But then I thought, “Why the hell not?”

I’m humbled by the knowledge base of the members of ACT UP. That’s been one of the hallmarks of the organization from the beginning: Those

who advocate must be knowledgeable.

They were not going to be (just) angry voices; they would be angry voices who could hold their own in a debate with legislators, bureaucrats, researchers, the media and medical professionals.

Those skill sets are not the sole purview of gay men in New York City.

They are the skill sets of men and women everywhere who fight for their lives and the lives of their friends. When I say I’m humbled by their knowledge, it’s because there are moments when I sit in the meetings, struggling to understand a report on complex topics, and wonder what the hell I’m doing there. But I keep going back.

So, back to: “Why I ACT UP.” I thought I would have a different answer than I had in the 1980s. I assumed marriage, motherhood, and normal aging would create a new reason for why I walked into that meeting. Thirty years later, I have friends who are long-term survivors. I have a gay nephew. But that’s not it.

As it turns out, I ACT UP for the same reason I got involved in the community all those years ago: because I don’t want to look back and wish I’d done something when I had the chance.

If you need a reason to ACT UP, feel free to borrow mine. ■

poz.com SEPTEMBER 2015 POZ 23

VOICES

BLOGS AND OPINIONS FROM POZ.COM

A GMHC client with his buddy, circa 1990

LOVE IN ACTION OBAMACARE IS HERE

R

obert Washington was 36 years old in 1984. The HIV antibody test wouldn’t be available for another year, but Washington “knew” he was positive, even though his doctor dismissed his symptoms as hypochondria induced by being around people with AIDS. Subsequent testing revealed that he was living with HIV. Comfortable in some of his identities—black man, mental health care provider, father—Washington took some time to grow comfortable revealing other aspects of himself: gay and HIV positive.

But Washington, then in Chicago, got involved with the Cook County buddy program in 1984, in which he acted as friend and helpmate, or “buddy,” to people incapacitated by AIDS. The experience forced him to learn to be comfortable with graver matters than perceptions of his sexuality.

Washington’s buddy lived for nine months, during which time they became almost constant companions. “It was the first time that I was a witness, an intimate witness, to the dying of somebody. And it changed me,” he says. Although he is a psychologist, Washington had no formal training in work with death and the dying at that point, so he acted from the gut.

He recalls, “When it became clear he was going to die, he called me and

24 POZ SEPTEMBER 2015 poz.com

told me. I picked him up—literally, I had to pick him up and carry him down the stairs—and took him to the Cook County Hospital. He died peacefully, a couple of months after his 21st birthday.”

With little money and few resources, but an abundance of compassion and solidarity, the HIV/AIDS service organizations LGBT people created from scratch in the 1980s sponsored buddy programs and other services.

Thousands of other AIDS “buddies”— many gay, others not—had personal experiences much like Washington’s.

On June 5 of this year, New York City’s Gay Men’s Health Crisis (GMHC) announced it would relaunch its historic Buddy Program to help meet the needs of long-term survivors. As a journalist who has reported on HIV/AIDS for three decades, I recognized this wasn’t just another press release.

Nor was it just an acknowledgment that people who have been living with HIV for many years have unique challenges—including isolation, the stresses of living with chronic illness, and the high risk of depression, substance abuse and suicidal ideation.

I’d go so far as to say the revival of the GMHC Buddy Program is a reaffirmation of LGBT America’s heroic legacy in the AIDS plague—a reminder of how profoundly, and creatively, our people showed the world what love in action

looks like, even in our darkest hours.

The first AIDS buddy program was created by the Shanti Project in San Francisco in the epidemic’s earliest years. To help people with AIDS take control of their lives and function as normally as possible, Shanti’s buddy program—along with the GMHC program, originally launched in 1982, and others like it in communities across the country—helped out with practical matters, such as grocery shopping, cleaning and cooking.

Typically, buddies weren’t expected to provide emotional support. But it’s probably impossible to come as a stranger into someone’s home, help him to retain his dignity and ability to function, and not become a friend.

In many cases, gay men had no one to count on. Families were often far away, possibly alienated. Good-time friends stopped calling. Fortunately, there were many “buddies”—people who, though probably also living far from their own families and perhaps their pasts, understood the importance of connection to others who cared.

We can be proud of how LGBTs and our supporters demonstrated love for one another in the past. Recommitting ourselves to support one another’s health and well-being going forward is the best possible way we can mark and celebrate our continuing LGBT pride. ■

COURTESY OF GMHC

In an opinion piece titled “Our Heroic Legacy of Love in Action,” longtime HIV/AIDS journalist and author John-Manuel Andriote reflects on GMHC’s relaunch of its Buddy Program earlier this year. Here is an edited excerpt.

RESEARCH NOTES

BY BENJAMIN RYAN

PREVENTION

TREATMENT

CURE

CONCERNS

A subdermal implant that delivers the HIV antiretroviral tenofovir alafenamide (TAF) has shown promise as an alternative to daily preexposure prophylaxis (PrEP) in an animal study.

Researchers implanted the matchstick-sized device in beagle dogs and tested its ability to deliver TAF over a 40-day period. Truvada as PrEP is made up of two drugs, tenofovir disoproxil fumarate (TDF) and emtricitabine. TAF is an updated version of TDF that better targets cells and requires a smaller dose to be effective, thus lowering the risk of side effects to the kidneys and bones. The investigators found high levels of tenofovir in key blood cells during the first 35 days after implanting the device, levels 30 times higher than those estimated to be needed for PrEP to work well in humans. The study authors concluded that the implant “holds significant promise as a candidate for HIV prophylaxis in vulnerable populations.”

A vaccine containing a protein key to HIV replication has been found to improve the effectiveness of antiretrovirals (ARVs).

Researchers injected 168 HIV-positive study members with a vaccine that contained either 7.5 or 30 micrograms of Tat, a protein that fuels the virus’s life cycle. The participants, who were all on ARVs, were given the vaccine once a month for either three or five months.

The vaccine prompted participants’ immune systems to develop antibodies to the protein.

The study members also experienced rising CD4 levels as well as higher levels of T, B and other immune cells. These effects lasted for the entire three-year study. The larger dose of the vaccine, when given over a three-month period, led to the greatest effect. The vaccine was also linked to a drop in HIV proviral DNA, which is an indication of a diminished viral reservoir.

GSK (GlaxoSmithKline) has teamed up with the University of North Carolina at Chapel Hill to pursue HIV cure strategies. The HIV Cure center will have a home at the university and will partner with a new venture called Qura Therapeutics, owned jointly by GSK and the university. Qura will handle intellectual property, commercialization, manufacturing and governance of the center’s pursuits. GSK has pledged $20 million toward the partnership over its first five years. A small team of researchers from the company will move to Chapel Hill to work at the center, where one focus will be on the “shock and kill” approach to curing HIV. In this method, HIV is brought out of its latent state in certain infected cells while the immune system is primed to better fight the virus.

The Centers for Disease Control and Prevention (CDC) has issued an alert to public health departments and clinicians to be vigilant for HIV outbreaks similar to the one hitting injection drug users (IDUs) in Indiana, while warning of overlapping hepatitis C virus (HCV) transmission among IDUs. Nationally, the number of Americans identified as recently infected with hep C rose 150 percent between 2010 and 2013, as an epidemic of addiction to opioid painkillers has swept the country. Such addiction has often led people to inject heroin as a cheaper or more readily available alternative to prescription drugs such as Oxycontin (oxycodone) and Vicodin (hydrocodone). The CDC recommends regular testing for those at risk for either virus. For IDUs, the agency stresses the importance of access to drug treatment, opioid replacement therapy, counseling on safe injection methods, and sterile injection equipment.

ALL IMAGES: THINKSTOCK

PrEP Implant?

Vaccine Boosts ARVs

New Cure Center

HIV/Hep C Outbreaks

poz.com SEPTEMBER 2015 POZ 27

CARE AND TREATMENT

BY BENJAMIN RYAN

PROOF THAT EARLY TREATMENT IS IDEAL

Researchers have finally produced gold-standard scientific evidence that starting antiretroviral (ARV) treatment soon after an HIV diagnosis reduces the risk of sickness and death when compared with putting off treatment until HIV disease progresses.

Although U.S. treatment guidelines have recommended universal treatment regardless of CD4 count since 2012, this policy was backed by research that provided a lower standard of proof than this new, definitive research.

The START study was a randomized controlled trial including 4,685 HIV-positive women and men who had never been treated for the virus and who began the trial with CD4 counts above 500. The participants, who lived in 35 countries, were randomly assigned to begin treatment immediately or to wait until one of the following occurred: their CD4s dropped to 350 or below; they developed AIDS or other serious illnesses; or they met other qualifications for starting treatment according to local guidelines, such as by becoming pregnant.

The participants began the trial a median of one year after being diagnosed with HIV and with a median CD4 count of 650. The members of the immediate treatment group went on ARVs at that point. Almost half of the deferred group eventually started treatment, with an average of about 400 CD4s. The main reason those in the delayed arm began ARVs was because they fell below the 350 threshold. Aside from that, some developed AIDS-defining illnesses, others became pregnant, and some asked to start treatment when their viral loads rose or their CD4 levels dropped considerably, although not to 350.

Participants were allowed to start treatment at any time they chose and for any reason.

The study began enrollment in 2011 and was intended to run under its established protocol through the end of 2016. However, in the spring of 2015 an independent safety monitoring board determined that early treatment was already clearly very beneficial, reducing by 53 percent the risk of AIDS diagnoses, serious non-AIDS illnesses—including a major cardiovascular problem, kidney or liver disease, and cancer—and death. (During an average of about three years of follow-up there were 41 instances of these outcomes in the early treatment group and 86 in the delayed group—low numbers in each category.) So all of those who were in the deferred treatment group were then offered ARVs immediately.

During a May 27 teleconference, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, remarked that the trial results bring into better sync the dual use of ARVs among people living with HIV: as prevention (successful treatment vastly reduces the risk of passing on the virus), and as life-saving treatment.

Calling the START results “more scientific evidence to back what we’ve been saying for a long time now,” Fauci said the findings are “another reason why we should be more aggressive seeking out voluntary testing, linking to care and putting people on treatment.”

28 POZ SEPTEMBER 2015 poz.com

Outside of convenience, the only major benefit of multi-antiretroviral (ARV) combination tablets could be to pharmaceutical companies’ bottom line.

Taking individual pills— which can be much cheaper if generic components are available—apparently combats HIV just as well.

This is according to a review of nine trials, including over 2,500 HIV-positive participants, that compared singletablet HIV regimens with their individual-tablet equivalents. All of the singletablet regimen comparison trials included virally suppressed participants switching from stable ARV treatment to a new regimen.

The rate of virologic failure, defined as having a viral load above 400 in two consecutive tests, was comparable between those taking combination tablets and those taking individual pills. There was no significant difference in the rate of drug resistance or of people switching treatment because of side effects.

The study’s head, Andrew Hill, PhD, a senior research fellow at Liverpool University, notes that the crop of available generic HIV medications will expand in the coming years. “There is the potential for huge savings by switching from patented single-tablet regimens to generic alternatives,” he says.

BOTH IMAGES: THINKSTOCK

Combo Pills No Better?

HEALTHY MIND, HEALTHY BODY

HIV-positive people who enjoy good psychological well-being are more likely to adhere to their antiretroviral (ARV) regimen. In fact, in a recent study of mixed-HIV-status heterosexual couples, an absence of symptoms of depression was the only factor that predicted good adherence.

Steven Safren, PhD, the director of behavioral medicine at Massachusetts General Hospital in Boston and the paper’s lead author, says that HIV treatment programs “should consider assessing and intervening with individuals who may have mental health concerns.”

However, mental health treatment does not offer a clear-cut route to improved adherence rates. In some other studies, Safren points out, psychological treatment has improved mental health but not adherence rates.

Just the same, he says that it’s vital to provide support for psychological health and for adherence.

“Once their mental health is cleared up or improved a bit, then someone may be more likely to benefit from other forms of adherence support,” Safren says.

BOTH IMAGES: THINKSTOCK

Treating Addiction Helps HIV Opioid substitution treatment (OST) increases the likelihood that addicts will take their HIV antiretrovirals (ARVs) as prescribed.

To determine this, researchers in British Columbia, Canada, followed 1,852 HIV-positive injection drug users (IDUs) for a median five and a half years between 1996 and 2010.

While on OST, participants took ARVs 56 percent of the time; when not on OST, participants took ARVs 36 percent of the time. After accounting for various factors that may have influenced these rates, the researchers found that OST upped adherence by 68 percent.

The study’s lead author, Bohdan Nosyk, PhD, a research scientist at the BC Centre for Excellence in HIV/AIDS and an associate professor at Simon Fraser University, attributes this beneficial effect of drug treatment to “the greater linkage to health care that comes with initiating OST, and also the stability that

OST can provide to people with opioid dependence.”

Nosyk says that his study “demonstrates that comprehensive and integrated health care, incorporating addiction treatment in primary care, is clearly critical for the successful treatment of HIV-positive individuals who inject drugs.”

HIV-HEP C MORTALITY RISK

Hepatitis C virus (HCV) doesn’t significantly impact the risk of death unless it occurs along with other severe diseases, including HIV, cancer, chronic kidney disease or alcohol use disorders. This is according to research of 112,000 HCV-positive people hospitalized in France between 2008 and 2012.

According to the leader of the study, Michaël Schwarzinger, MD, PhD, director of THEN (Translational Health Economics Network) in Paris, HIV infection was not linked to a higher risk of liver-related illnesses or death among the participants, but was associated with a raised risk of death from other causes.

poz.com SEPTEMBER 2015 POZ 29

www.2016usca.org

POZ SURVEY SAYS

BY JENNIFER MORTON

Adverse Reactions

Most people living with HIV experience side effects from their HIV meds at one time or another. It’s important to talk to your health care provider if side effects are bothering you, especially if they are making it difficult to adhere to your meds. POZ asked you to tell us about your side effects and how they affect your life. Here are your responses:

55%

45% YES

NO

HOW MUCH DO SIDE EFFECTS AFFECT YOUR DAY-TO-DAY LIFE?

21%

NOT AT ALL

THE TOP 4 SIDE EFFECTS 1 Fatigue or loss

HAVE YOU EVER SWITCHED OR STOPPED YOUR HIV MEDS BECAUSE OF SIDE EFFECTS?

of energy

46

%

SOMEWHAT

33%

2 Difficulty

sleeping

3 Depression

47% NO

53% YES

4 Pain, numbness

A LOT

or tingling in the hands or feet

HAVE YOUR SIDE EFFECTS EVER PREVENTED YOU FROM WORKING FOR ANY LENGTH OF TIME?

WHAT HAVE YOU DONE TO ALLEVIATE SIDE EFFECTS? 33% NO

67% YES

45%

48% taken prescription drugs

changed your lifestyle

35% taken over-thecounter drugs

WERE YOU WORRIED ABOUT POTENTIAL SIDE EFFECTS BEFORE YOU STARTED HIV MEDS?

28% NO

72% YES

26% used marijuana (medical or otherwise)

24% used herbal or other alternative remedies

ARE YOU WORRIED ABOUT POTENTIAL LONG-TERM SIDE EFFECTS OF HIV MEDS?

Source: April/May 2015 POZ poz.com SEPTEMBER 2015 POZ 35

Benjamin Ball

Ervin Rogers

Adonis Porch

CREDIT

London Gray

36 POZ SEPTEMBER 2015 poz.com

A super new program at New York City‛s Housing Works helps participants get and keep their viral loads undetectable…

BY TIM MURPHY ILLUSTRATIONS BY RAFA ALVAREZ

…with incentives and without superpowers.

YEAR AGO, LONDON GRAY WAS VERY DEPRESSED—AND, consequently, not regularly taking her HIV meds. Sure, this 30-year-old transgender Brooklynite, a former staffer at the harm-reduction center Positive Health Project, had been diagnosed with HIV nearly a decade ago—but she‛d never really made peace with it. “I had trouble with the thought of being positive, so I didn‛t really stay focused on my health,” she says. “I‛d stop and start my meds, and sometimes I‛d sell them to make ends meet.”

Four of the Undetectables program participants as imagined by the illustrator of the program’s comic books.

poz.com SEPTEMBER 2015 POZ 37

Sure enough, her CD4 count fell, and her viral load rose. “I don’t remember the exact numbers,” she says, “but it was sky-high. I didn’t care about myself or anybody else. I’d stay in the house all day. I hated having to go to the doctor every three months—I hated being around other people who also had HIV and were always talking about their struggles—so I started skipping appointments.”

Eventually, she says, she started to feel physically sick.

“Moody, lazy, no energy, no appetite. I had no one around to say, ‘Here, take your meds like you’re supposed to.’”

But Gray was a member of Housing Works, the pioneering New York City nonprofit that serves homeless and low-income people with HIV/AIDS. And last year, Vaty Poitevien, MD, Housing Works’ chief medical officer, asked Gray if g she wanted to be part of a unique and exciting s, an new program called the Undetectables, agency-wide effort to get 80 percent or more of HIV-positive people in the Housing Works community to take their meds consistently and thus have undetectable levels of virus in their blood. (Undetectability not only promotes long-term health and longevity, it also keeps positive people from transmitting the virus to others.) To reach that goal, Housing Works’ care teams would help clients look at their whole lives to identify roadblocks to taking meds consistently. Then the er team and the client would work together toward removing those roadblocks.

The program included something to sweeten the deal: Every time participants proved undetectable on lab tests, at three-month intervals, they would receive a gift card for $100 to spend however they wanted. “Dr. Vaty made it seem like it was exciting to be part of the program,” Gray says. “I wanted to take care of myself. But there was an added incentive, too. It was like, ‘Woo, how much do I get for taking care of myself?’”

So Gray signed on, embarking on an amazing journey with the entire Housing Works community—and potentially even with New York State, which is looking to the Undetectables as a model of how to become the first state to essentially end its AIDS epidemic by 2020.

A

CCOR DI NG T O P OI T E V I E N A N D H E R Undetectables co-director, Ginny Shubert, who is also Housing Works’ senior adviser on research and policy, 700 community members have signed on since the program began in May 2014—and 85 percent of the ones who’ve been enrolled for six months or more have undetectable virus levels on their latest labs. In conjunction with Toorjo Ghose, PhD, Housing Works’ research and program partner at the University of Pennsylvania, the agency wants to present data showing the

38 POZ SEPTEMBER 2015 poz.com

effectiveness of the Undetectables program in 2016, possibly at the 21st International AIDS Conference—a.k.a. AIDS 2016—in Durban, South Africa.

How did it all begin? According to Shubert, Housing Works wanted to put its money where its mouth was in terms of ending the AIDS epidemic in New York State—something the agency, with other local activists, has been urging state lawmakers to prioritize the past several years. “We felt that we needed to do our part by achieving a community rate of viral load suppression [undetectability] of 80 percent or more,” Shubert says.

“We had to figure out how to get our community members to understand the role of taking care of your own health as part of the overall end of the epidemic.”

To reach that goal, Housing Works did three g First, it undertook a major, agency-wide things. public relations campaign to make sure that the whole community understood the li link between meds adherence, undetectability, good health and stopping HIV’s further spread. “We wanted to destigmatize talking about viralload suppression and make it a heroic act, something to be proud of,” Shubert says. The agency asked Berlin-based illustrator Rafa Gonzalez to create a comic book about a group of Housing Works superheroes called, natch, the Undetectables, who fight shame, st stig ma and hopelessness in New York York’s HIV-positive population, empowering folks f to get the support they need to take their meds and keep themselves—and their communities—free from AIDS. “The term ‘Undetectables’ just sounded like superheroes to us,” says Juan Astasio, Housing Works’ creative director, who wrote the comic book’s storyline with an in-house team.

They even created a pin that the heroes wear, now also worn by countless real-life folks around the agency, such as cofounder Charles King. “Charles wears his pin everywhere to start a conversation about being undetectable,” says Astasio— including in meetings with New York governor Andrew Cuomo, who has thrown his weight behind the state’s End AIDS campaign.

Secondly, Housing Works looked at previous results of programs that used financial incentives as part of a medsadherence program. Ghose had experienced earlier success with that element in India, where he was involved with a program that involved giving HIV-positive sex workers free condoms and rooms to work in if they adhered to meds and maintained undetectability.

But Housing Works took a key conclusion from the India program and other previous efforts: Financial incentives worked best when they were part of a holistic effort to help patients identify and fix deep underlying factors that affect people’s adherence to their meds, such as not being stably

(UNDETECTABLES) COURTESY OF SUBJECTS; (PATTERN BACKGROUND) THINKSTOCK

housed or having enough money for food; experiencing depression and other mental illness; and substance abuse. So the agency created a tiered program, which would begin with an in-house team of health care providers and caseworkers meeting with enrollees to examine their lives and complications.

And once they did, says Poitevien, they started peeling back the layers behind some enrollees’ seeming reluctance to take their meds. “I had a longtime patient, a grandmother in her early 50s, who’s only been undetectable once,” she says. “Her T-cells had dropped to 12, but she wasn’t fazed.” Yet after a few visits, the grandmother’s team realized that “she was overwhelmed with so many issues,” Poitevien continues. Not only was the client distraught over grandchildren who were in jail or being abused, but she also had very bad neuropathy in her legs that made it painful for her to cook or clean, or even get to her doctor appointments. The Housing Works team connected her to rides to her appointments, a home attendant to help with chores and reminders on her phone about her meds.

“She became undetectable,” says Poitevien. Prior to the Undetectables program, she adds, she would have told this patient and others like her simply to divide up their meds for the week in pillboxes. “But she said to me, ‘I’m not a child; I know how to take my medication.’” The reasons blocking her adherence were unique to her and needed unique fixes, which is just what the program provided.

If that first tier of intervention isn’t enough to help participants, the program offers two more. One is overseeing a support group where enrollees meet to talk through their adherence issues and derive help from one another. And for the most challenged enrollees—the ones often struggling with mental illness or intermittent or heavy drug use—the program employs directly observed therapy, in which a Housing Works staffer comes to the enrollee’s residence daily with meds and watches the enrollee take them.

According to Ghose, the Housing Works approach is offsetting prior studies (particularly a large New York City study released earlier this year) that showed decidedly mixed results when it came to offering people financial incentives to take their meds. Why? Because, says Ghose, the Undetectables provides “incentives married to several other interventions, [and] case managers connecting you up to” key needs like housing, food, and mental-health and substance-use treatment. “It’s not just financial incentives floating free, which has been tried before.”

And both Shubert and Poitevien insist that a major reason for the Undetectables’ success so far is that Housing Works has made the program a big, splashy community-wide effort, not just something discussed privately between a health care provider and patient. “Case managers talking to patients about viral suppression had been going on, Four Undetectables but it had never been articulated program participants reveal their real strengths organizationally as a shared goal,” by unmasking their true Shubert says. “Even though it was identities—and by sharing very real struggles with supposed to be a team effort, it theirgetting and keeping their viral loads undetectable. wasn’t really happening.”

London Gray

Benjamin Ball

Ervin Rogers

Adonis Porch

poz.com SEPTEMBER 2015 POZ 39

40 POZ SEPTEMBER 2015 poz.com

scream,” Porch recalls, laughing, “so finally I said, ‘Where do I sign up?’” He freely admits that the financial incentive is what initially hooked him, “but once my doctor told me the first time, ‘You’re undetectable,’ that motivated me to continue.” That, he says, and the fact that his caseworker cared enough to call him every day to ask if he’d taken his meds.

“I feel great,” Porch says. “Being undetectable is letting me know that I’m finally doing something right with my life.”

Then there’s Ervin Rogers, 54, a Housing Works peer educator and needle-exchange counselor. Diagnosed with HIV in 2002, he was occasionally skipping meds because they The Undetectables is a campaign by Housing Works to end the AIDS epidemic in New York State through HIV testing, prevention, viral load suppression and activism. A comic book series educates program participants.

COURTESY OF HOUSING WORKS

B

UT NOW, IT SEEMS LIKE IT IS HAPPENING— and the team effort is making a big difference in the lives of myriad Housing Works community members. Take Adonis Porch, a 29-year-old childcare provider and volunteer at an HIV youth drop-in center. Diagnosed with HIV nearly a decade ago, he’d long had trouble adhering to his meds, often missing them as much as five days a week. “Every time I looked at those pills, it made me feel bad about myself,” he says. He also suffered depression from being harassed in college after coming out with his HIV status, not to mention rejections from potential love interests because of it.

Then the folks at Housing Works gave him the Undetectables comic book, and asked him again and again if he’d join the force. “If one more person asked me, I was gonna

makes it all the easier to enjoy his favorite TV show, Empire. His favorite character? Cookie, of course. “She reminds me of my mother,” he says, “outspoken, brash and sassy.” Perhaps Cookie could be his next adherence manager?

He laughs. “She’d say, ‘Get up off your ass and take these meds!’”

“WE WANTED TO DESTIGMATIZE TALKING ABOUT VIRAL-LOAD SUPPRESSION AND MAKE IT A HEROIC ACT.”

requ required that he take them in the morning with food— some something he didn’t always have. Then he joined a Housing Work Works day program that came with breakfast, which helped him become adherent. (Shortly thereafter, his Housing Wor Works doctor helped him switch to a once-daily regimen that doesn’t require food.)

Ro Rogers was soon asked to join the Undetectables. “My reaso reason for staying undetectable is because I want to live,” he says says. “But the money is an incentive, I’m not going to lie.

Who couldn’t use an extra $100 every three months?” He’s also on the program’s board. “I find enjoyment in helping othe others,” he says. “I love seeing the light bulbs go off in people’s eyes when they realize that if they take their meds, they’re gonn gonna live longer. They’re battling addiction, hep C, HIV. Som Sometimes taking meds is not very high on their totem pole, so I’m an ear for them.”

Ce Certainly, taking HIV meds regularly wasn’t priority No. 1 for B Benjamin Ball, 38, who lives in one of Housing Works’ residenc idences. Diagnosed with HIV in 1999, he’d struggled for years to ta take his meds. “Fifteen pills a day was too much for me to wrap my brain around,” he says of those days. Over the years, he continued to miss meds and became deeply depressed. He got very sick, with his CD4 count dropping to zero.

Last year, he was asked to join the Undetectables. “I wanted to be a part of it because I wanna live,” he says. Ball is in the most intensive tier of the Undetectables, those who have a staffer come to their home every day to watch them take their meds. “I’m not a great morning person, but the person who comes here doesn’t feel like a stranger,” he says. “We have great conversations.” He also attends a monthly Undetectables support group.

Since becoming an Undetectable, Ball has seen his CD4s climb to 44 and his viral load fall to about 1,500 (technically, being “undetectable” means lab tests can’t detect HIV in your blood, but the Housing Works program focuses first on lowering your viral load). He’s feeling good about his life—which

H

O U S I N G Works is very proud of the fact that the Undetectables is now being considered as a model for statewide viral suppression by New York’s campaign to end AIDS by 2020. “They’re really behind our concept of eradicating HIV,” Toorjo Ghose says, adding that he believes multitiered programs like the Undetectables will be “the next wave of intervention.”

Of course, addressing the deep underlying issues that contribute to non-adherence—such as lack of access to stable housing, food, and mental-health and substance-abuse treatment—is easier in a contained agency environment like Housing Works than it is across the whole city or state.

According to Undetectables co-director Shubert, New York City could help with a huge piece of the puzzle by finally passing a long-demanded expansion of housing assistance to all income-qualifying people with HIV, not just those with an AIDS diagnosis (defined as 200 or fewer CD4s or at least two opportunistic infections), which has long been the rule in the city. That’s especially important, she says, now that we know definitively that it’s best to start HIV treatment immediately after infection.

But of course, that and other systemic fixes will take political will and a reallocation of city and state funds. “It’s challenging any time people have to consider a reshuffling of existing resources,” Shubert says.

Meanwhile, the Undetectables continues to make everyday superheroes out of folks in the Housing Works community.

According to Shubert, 83 percent of those who signed up for the program a year ago are still involved.

And one of them is London Gray. The Undetectables team helped her realize that she had untreated depression. “I didn’t believe in antidepressants,” she says. “I was so ignorant about them.” So she started them and began attending support groups. “Since then I’ve been feeling really good,” she says, which, in turn, has helped change her attitude about meds.

With the help of daily phone alerts, she’s been undetectable now for months—and she’s earned the bucks for it. “I got my hair and nails done and bought new summer sandals,” she says. But the biggest rewards, she knows, can’t be found in a store: her improved health.

Go to liveundetectable.org for more information.

poz.com SEPTEMBER 2015 POZ 41

Close-up OLDER, WISER, READY FOR THEIR

DOCUMENTING THE GRAYING OF AIDS

BY TRENTON STRAUBE

42 POZ SEPTEMBER 2015 poz.com

have been creating portraits and brief oral histories of older HIV-positive people. They first set up a booth and installation at the AIDS 2012 international conference in Washington, DC, then at AIDS 2014 in Melbourne, Australia. (Next stop: AIDS 2016 in Durban, South Africa.)

Heinemann recalls one man who, after circling their booth, decided to participate. Turns out, it was the first time he’d gone public about his status. A few days later, a passerby who was also secretive about his own HIV status saw the man’s portrait and recognized him from his circle of friends. Inspired, the passerby decided to pose for a public portrait too.

Most participants, Heinemann says, “are concerned with stigma, sexuality, intimacy, mortality, and general frustration with being in old age and how their bodies are changing, which is pretty universal.” But, she adds, “they have a desire to share their stories, to combat the isolation and to ultimately make life easier for others.” ■

(WOMAN WRITING) COURTESY OF ALLISON SHELLEY; ALL OTHER IMAGES: COURTESY OF THE GRAYING OF AIDS

2015

marks a turning point in our nation’s HIV epidemic: It’s estimated that as of this year, more than half of Americans living with the virus are older than 50.

This is not news to visual journalist Katja Heinemann. Back in 2006, she published “The Graying of AIDS”—portraits of long-term survivors—in Time magazine, coinciding with the epidemic’s 25th year. The project, like its subjects, didn’t die.

Instead, Heinemann teamed up with public health educator Naomi Schegloff, MPH, to launch GrayingOfAIDS.org, an archive of sorts for their various projects that document older HIV-positive people across the world. Constantly updated, the site includes photos, videos and interviews as well as reports on their traveling exhibitions and campaigns.

“Our overarching goal,” Heinemann says, “is greater visibility, because the HIV population is extremely invisible and isolated.”

Elders, she says, shouldn’t feel pushed aside—“they should be represented more as resources, as opposed to problems.”

Below: Jennifer, 54, from Namibia, writes To get their message out, Heineon a message board mann and Schegloff have teamed up as part of the “Graying with AIDS groups, university proPandemic” project. fessors, journalists, nonprofits and Right: the Walgreens Walgreens. The pharmacy’s “Well exhibition in Miami.

Beyond HIV” campaign is currently traveling the country, placing large, impressive panels of images in public spaces as well as creating pop-up art e x h i b it io n s a nd community events.

For their global project “A Graying Pandemic,” Heinemann and Schegloff

The ongoing global project “A Graying Pandemic” includes portraits and interviews. From bottom to top: Michael, 62, from New Zealand, talks about contracting g HIV in older age; Dorothy, 55, from Kenya, speaks aboutt the stigma against older women who are sexually active; and Glenn, 50, from Australia, mentions the pressure to look and be well. You can read more about them and many others on AGrayingPandemic.org.

Sex & the Senior T The Graying of AIDS project’s two co-directors w worked with the HIV organization ACRIA in 2014 to create portraits for the “Age Is Not a Condom” HIV testing and prevention campaign. Appearing H on bus shelters throughout New York City, the o project gave the Graying of AIDS team a chance, p in their words, to “counteract ageism by creating beautiful images that celebrate the intimacy that b older adults enjoy in their relationships.” o

poz.com SEPTEMBER 2015 POZ 43

CREDIT

Although he’s still living with HIV, Jeffrey Mende is enjoying his California view a bit more now that he has cured his hep C.

THE

CHALLENGE NEW TREATMENT OPTIONS FOR PEOPLE LIVING WITH HIV AND HEPATITIS C

BY BENJAMIN RYAN PHOTOGRAPHY BY TOKY

TOKY

T

HE FIRST TIME JEFFREY MENDE ATTEMPTED a cure his hepatitis C virus (HCV), the medications saddled him with such dreadful flu-like symptoms, depression and crippling fatigue, he could hardly function.

“I literally couldn’t make it down to the car without becoming completely exhausted,” recalls the 51-year-old Frazier Park, California, resident. HIV positive since 1987, he says he likely contracted hep C from a contaminated tattoo needle in 2003; a routine test came up positive the following year.

About halfway through what was supposed to be a sixmonth hep C treatment, Mende told his doctor he’d rather die than feel so sick any longer. They agreed it was best to take him off the drugs and try again once treatments had improved, but hopefully not before the virus led to significant scarring—known as fibrosis—of his still fairly healthy liver.

While Mende’s first treatment attempt was as recent as 2010, dreary HCV therapy experiences such as the one he suffered have today, for the most part, been relegated to the history books. Over the past few years, game-changing new hep C treatments have hit the market. These direct-acting antivirals (DAAs) have reduced typical side effects to much more tolerable levels.

The new drugs have also greatly improved the chances of vanquishing HCV—the cure rate is 95 percent and up for many subgroups of the hep C population—and they have reduced the required treatment time to just eight or 12 weeks for most people with hep C, although others need 16 or 24 weeks.

Mende, who is on disability and works part-time as an Uber and Lyft driver, was enrolled in a clinical trial with a DAA called telaprevir, which was approved by the U.S. Food and Drug Administration (FDA) in 2011 under the brand name Incivek.

While Incivek had shaved down treatment times and raised cure rates compared with previous protocols, the drug still had to be paired with the dreaded mainstay of hep C treatment: weekly injections of interferon (responsible for the worst of the side effects) plus daily ribavirin pills (which can cause anemia). That’s why Mende elected to nix his treatment.

COME THE END OF 2013, THE INTRODUCTION OF Gilead Sciences’ blockbuster Sovaldi (sofosbuvir) allowed for the long-awaited phase-out of interferon to begin. The bad news was that treatment cost a notorious $1,000 a day. A year later, Gilead’s once-a-day single-pill combination tablet Harvoni (ledipasvir/sofosbuvir) gave many people living with hep C the chance to avoid ribavirin as well.

Even more exciting for the coinfected population, HIV is no longer a barrier to successful hep C treatment. While hep C cure rates with older treatments were lower among those with HIV, the current crop of hep C treatments has erased this deficit.

Over the past winter, Mende went on Harvoni and had a relatively breezy 12 weeks of treatment. Come springtime, he was pronounced cured of HCV. Mende is fortunate to have his liver still in relatively good shape, with only minimal fibrosis. When compared with monoinfected individuals, people also living with HIV have a greater risk of liver disease progression and other health complications resulting from hep C. Consequently, the American Association for the Study of Liver Diseases (AASLD) recommends that the estimated one in four HIV-positive Americans who are coinfected with HCV receive a higher priority for hep C treatment.

Hep C may also contribute to other health problems that already occur at higher rates among people living with HIV,

poz.com SEPTEMBER 2015 POZ 45

such as diabetes, kidney disease and cardiovascular disease.

Daniel Fierer, MD, an associate professor of medicine in infectious diseases at Mount Sinai Hospital in New York City, sees a large coinfected population. He says that until recently many coinfected people were so alienated by the bleakness of hep C therapies that they often dropped out of care for that virus.

The arrival of new treatments has meant re-engaging those individuals and encouraging them to get on the meds. Fierer puts it simply and bluntly: “Get in now; we can do it now!”

According to Fierer, it’s vital that anyone with hep C see an infectious disease physician, liver specialist or gastroenterologist who specializes in the virus to establish the level of damage to the liver. Those who have cirrhosis, the most advanced stage of liver disease, are in the most urgent need of treatment.

SEEKING HCV TREATMENT IS ESPECIALLY CRITICAL for coinfected people, since liver disease is one of the leading causes of hospitalization and death among HI Vpositive people. Unfortunately, however, cure rates with currently available treatments can be lower for those with cirrhosis (though new treatments on the horizon may improve their chances).

Successful hep C treatment typically stops further liver scarring and may even reverse it, to an extent. Clearing HCV also lowers, but doesn’t necessarily eliminate, the elevated risk of cirrhosis, liver cancer, liver failure (if someone hasn’t already developed these conditions) and death among people with hep C. A recent modeling study found that coinfected people who delay treatment until they have advanced fibrosis or cirrhosis are at a much greater risk of dying than those who are treated when they have minimal or no scarring.

Michael Gottlieb, MD, a Los Angeles HIV specialist who is Jeffrey Mende’s physician, says that one reason to consider delaying hep C treatment is if someone just isn’t ready to adhere to such an expensive regimen. Treatment costs may run $100,000 or more, so insurance coverage can be a challenge to secure, even when the physician, as Gottlieb says, “plays the HIV card” with the insurer.

One challenge HIV-coinfected people and their physicians need to negotiate is the potential for interactions between HIV and hep C medications. Some pairings may cause the levels of one of the drugs to drop, potentially jeopardizing the effectiveness of that treatment and leading to drug resistance.

Conversely, drug levels may increase and lead to toxic effects, such as damage to the kidneys in the case of raised levels of the widely prescribed HIV medication Viread (tenofovir), which is included in several combination tablets.

Fierer, for one, tries to avoid switching his patients’ HIV

regimens to accommodate particular hep C treatments, preferring a treatment for the latter virus that is likely to have fewer interactions with HIV meds.

For example, AbbVie’s Viekira Pak (ombitasvir/paritaprevir/ ritonavir; dasabuvir), which was approved in late 2014, has a greater number of identified serious potential drug interactions with HIV medications than Harvoni.

“The unintended consequences of switching antiretrovirals cannot be underestimated,” Fierer stresses. He points to scenarios such as someone missing a week of HIV treatment because the pharmacy fails to deliver the new regimen on time, or someone getting confused and taking multiple HIV regimens at once. Switching HIV meds may also introduce new side effects or other toxicities.

MEANWHILE, KRIS KOWDLEY, MD, DIRECTOR OF THE Liver Care Network at Swedish Medical Center in Seattle, doesn’t see much cause for worry when it comes to finding the right hep C treatments for his coinfected patients.

“It requires an additional step in the HIV-positive patient to make sure that they’re on an antiretroviral regimen that will not be a problem,” Kowdley says, adding that “some adjustment of the HIV regimen might need to be made.”

This could mean tinkering with the dose of certain medications, which would require switching to individual pills instead of a single-tablet combination HIV regimen if a person is taking one of those.

In addition, some HCV/HIV drug combinations may simply need close monitoring to make sure they aren’t causing any health problems—for example, conducting regular tests of kidney function if someone is taking Viread.

Considering these potential drug-drug interactions, Jacob Langness, PharmD, a clinical pharmacy specialist in HIV and hepatology at the University of Colorado Hospital, says it’s important to see a clinician who is experienced in coinfection treatment and is hopefully up to date on the evolving hep C research landscape.

Another good way to ensure your safety is by getting your medications from a pharmacy that regularly fills HIV and HCV prescriptions, which should hopefully have staff who are knowledgeable about potential negative interactions with hep C therapies.

As for Jeffrey Mende, his HIV medications weren’t among the few that cause conflicts with Harvoni, so he was able to sail through hep C treatment with no shifts to his HIV regimen and no interactions between medications.

Since getting cured of hep C, he says, “I feel so much more energized. I’m sleeping better.” On the other hand, “My anxiety’s been high. But I think that’s just because we’re buying a house.” ■

HIV IS NO LONGER A BARRIER TO SUCCESSFUL HEP C TREATMENT.

46 POZ SEPTEMBER 2015 poz.com

If you’re living with hep C, various factors will influence which treatments will be recommended for you, as well as how long you should take it (8, 12, 16 or 24 weeks), and what your likelihood of a cure will be.

The first factor is which genotype (genetic variant) of the virus you have. About 70 percent of Americans have genotype 1 (which is divided into types 1a and 1b), HARVONI (ledipasvir/sofosbuvir)

(Gilead) This single-tablet, once-a-day treatment is by far the most widely prescribed hep C regimen.

For those with genotype 1, cure rates in clinical trials of Harvoni were between 94 and 99 percent. Eight weeks of the single-tablet regimen are recommended if someone has not been treated before, does not have cirrhosis, and has a viral load below 6 million. Otherwise, people with genotype 1 should take 12 weeks of treatment, and 24 weeks if they have been treated before and have cirrhosis.

Harvoni is not FDA-approved to treat genotype 4, but it may be prescribed off-label for this purpose. In a recent study, 12 weeks of Harvoni cured 93 percent of people with genotype 4, half of whom had cirrhosis.

Harvoni is considered safe to combine with most HIV antiretrovirals.

VIEKIRA PAK (ombitasvir/ paritaprevir/ritonavir; dasabuvir) (AbbVie) This regimen, which requires taking multiple pills each day, is an alternative to Harvoni for the treatment of genotypes 1 and 4, although treating the latter genotype is not FDA-approved.

Twelve weeks of treatment are recommended. Individuals with genotype 1a (a subtype of genotype 1) or who have cirrhosis should be treated for 24 weeks. Ribavirin is recommended as an adjunct for those with genotypes 1a and 4 and for those with genotype 1b who have cirrhosis.

Cure rates for those with genotype 1 are comparable to Harvoni’s.

People with genotype 4 don’t need

with the rest largely split between genotypes 2 and 3.

Genotypes 4, 5 and 6 are rarer in the United States.

Other variables include whether you have been treated for hep C before and if you have cirrhosis.

The treatment recommendations below are according to the American Association for the Study of Liver Disease (AASLD) guidelines.

to take the dasabuvir component of Viekira Pak. In a recent trial of treatment-naive people with genotype 4 who did not have cirrhosis, 100 percent were cured if they took Viekira Pak (minus dasabuvir) with ribavirin and 91 percent were cured if they did not take ribavirin.

Taking Viekira Pak with HIV meds can be more complicated than with Harvoni. It is not recommended to pair the regimen with Sustiva (efavirenz), Norvir (ritonavir)–boosted Reyataz (atazanavir), Kaletra (lopinavir/ ritonavir) or Edurant (rilpivirine).

SOVALDI (sofosbuvir) (Gilead) For those with genotype 2, a Sovaldi and ribavirin regimen is recommended for 12 weeks, or 16 weeks if they have cirrhosis. Genotype 2s with little or no fibrosis have a greater than 90 percent chance of a cure. In a recent small trial, treatment-experienced people with cirrhosis had an 87 percent cure rate after 16 weeks of treatment and 100 percent after 24 weeks. If they also took interferon and were treated for 12 weeks, the cure rate was 94 percent.

Genotype 3 is considered the most difficult to treat. Currently, 24 weeks of Sovaldi and ribavirin is the recommended regimen, although this will likely change if daclatasvir is approved. Those being treated for the first time have about a 92 to 94 percent chance of a cure, while those who failed a previous hep C regimen have a success rate in the 80 percent range, and people who have cirrhosis have only about a 60 percent cure rate.

Sovaldi is considered safe to use with most HIV medications.

OLYSIO (simeprevir)

(Janssen) Olysio is not approved for use among people with HIV, although it may be prescribed off-label. There are numerous HIV medications that aren’t considered a safe pairing with the hep C therapy, although finding a good combination is certainly feasible.

The following are awaiting FDA approval (as of press time):

DACLATASVIR

(Bristol-Myers Squibb) Daclatasvir, which is up for FDA approval for use in combination with Sovaldi to treat genotype 3 of hep C, will likely receive the green light in the fall of 2015, possibly by the time this issue of POZ is published. In a major clinical trial of 12 weeks of the regimen given to people with genotype 3, including those with cirrhosis, 86 percent of those who had been treated before were cured, as were 90 percent of those treated for the first time.

Daclatasvir has minimal identified interactions with HIV medications.

GRAZOPREVIR/ELBASVIR

(Merck) This fixed-dose combo tablet will likely be approved to treat genotypes 1, 4 and 6 toward the end of 2015. In recent trials, participants with these genotypes had a 92 percent to 100 percent cure rate after 12 weeks of treatment, unless they had cirrhosis, in which case 89 percent were cured.

Grazoprevir/elbasvir is not recommended to be taken with Sustiva, Kaletra, or Norvir–boosted Prezista (darunavir) or Reyataz.

poz.com SEPTEMBER 2015 POZ 47

HEROES

BY CASEY HALTER

In many ways, Ashley Murphy is just a normal 17-year-old getting ready to start her senior year of high school. She talks about summer vacation, how tough math can be, and the rock band she sings in with her dad. But she’s also a sassy young HIV activist looking to change the world.

Ashley was diagnosed with AIDS in 1998 when she was just six weeks old. She was infected by her late birth mother, who was addicted to crack and alcohol. Kari and Don Murphy, Ashley’s foster parents at the time (they later adopted her), were told by doctors in Toronto that she only had a few weeks to live. Ashley clearly had other plans.

When she was 7 years old, Ashley was told by her parents that she had HIV but warned not to mention it to anybody. “I just asked, ‘Why? I didn’t do anything wrong.’” She laughs, “I started telling everybody. I’d be at school with a friend on the swings or something and I’d say it: ‘I have HIV.’” At first, a few parents tried to exclude Ashley from sleepovers, or give her disposable plates and cups to use at dinner. Interestingly, Ashley says there was a generational divide when it came to people’s reaction to HIV. “When I told kids or my friends, they wouldn’t have a problem with it. It was mostly the adults,” she recalls.

So Ashley began her work educating others about the virus. When she was 12 years old, she did her first national TV interview. Ever since, the young advocate has been hooked.

Today she lives in Ajax, Ontario, with 10 other brothers and sisters, eight of whom have special needs such as cerebral palsy and blindness. Many of the children were taken in from foster care programs, just like Ashley. Growing up with these challenges bonded the siblings and helped give Ashley the confidence to live openly with HIV. “The big reason I decided to speak out is due to stigma,” Ashley says. “As long as there are uninformed people out there, I still have a job to do.”

Ashley is a regular speaker at We Day, a charity initiative by Free the Children, which works to engage young people in promoting social change.

She was recently asked to speak at this year’s UNAIDS conference in Geneva about mother-tochild transmission. Ashley has also given motivational speeches throughout Canada and has participated in several HIV conferences around the world. She recently finished up a TED Talk and is now working on recording her first album to raise funds and awareness for HIV/AIDS. Ashley ends many of her speeches with the tagline: “Rock your differences, own them and be you.” She explains, “Everybody goes through some sort of life struggle that we have to carry for the rest of our lives. For me, it’s HIV. For others, it could be depression, bullying, diabetes, anything.

To know that you are not alone and that you can overcome [your struggle], that’s super powerful.”

Rock on, Ashley.

48 POZ SEPTEMBER 2015 poz.com

Teen activist Ashley Murphy is a long-term survivor.

MICHELLE GIBSON

Rocking Her Differences

SURVEY

6

Have you ever switched your HIV meds because of your viral load?

❑ Yes ❑ No 7

How likely are you to engage in condomless sex if your viral load is undetectable versus detectable?

❑ Very likely ❑ Somewhat likely ❑ Not at all likely 8

How likely are you to disclose your HIV status to a potential sex partner if your viral load is undetectable versus detectable?

❑ Very likely ❑ Somewhat likely ❑ Not at all likely

UNDETECTABLE The goal of HIV medication is to keep the level of virus low or undetectable in the body. In addition to keeping you healthy, an undetectable viral load also means it’s virtually impossible to transmit HIV to your partner. POZ wants to know about your undetectable status and your thoughts about what it means to be undetectable.

1

THINKSTOCK

Do you think that programs that provide incentives for an undetectable viral load are a good idea?

❑ Yes ❑ No 11

What year were you born? _ _ _ _ _ _ _ _

12

What is your gender?

❑ Male ❑ Female ❑ Transgender ❑ Other 13

What is your sexual orientation?

❑ Straight ❑ Bisexual ❑ Gay/lesbian ❑ Other 14

15

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❑ Some high school ❑ High school graduate ❑ Some college ❑ Bachelor’s degree or higher

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❑ Yes ❑ No

What is your ethnicity? (Check all that apply.)

❑ 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 (please specify):_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

When was the last time you had your viral load checked?

❑ 0–3 months ago ❑ 3–6 months ago ❑ 6–9 months ago ❑ 9–12 months ago ❑ More than 12 months ago 5

10

How long has your viral load been undetectable?

❑ Less than one year ❑ 1–2 years ❑ 2–5 years ❑ More than 5 years 4

❑ Yes ❑ No

Is your viral load undetectable?

❑ Yes ❑ No 3

Has a sex partner ever asked whether or not you are undetectable?

Are you currently taking antiretrovirals?

❑ Yes ❑ No 2

9

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 #206, 462 Seventh Avenue, 19th Floor, New York, NY 10018-7424