POZ April/May 2021

A SMART+STRONG PUBLICATION APRIL/MAY 2021 POZ.COM $3.99

H E A L T H ,

L I F E

&

H I V

Youth Empowerment Raising HIV awareness among young people

Deondre Moore

A SMART+STRONG PUBLICATION APRIL/MAY 2021 POZ.COM $3.99

H E A L T H ,

L I F E

&

H I V

Youth Empowerment Raising HIV awareness among young people

Deondre Moore

Deondre Moore, 26, is the U.S. partnerships and community engagement manager at the Prevention Access Campaign, which launched the Undetectable Equals Untransmittable campaign in 2016.

“

A HEALTHIER LIFE CAN START WITH HIV TREATMENT.

WATCH H Treatme

It’s important to start HIV treatment as soon

Learn about T

as possible and stick with it. When you do,

see how stayin

it helps stop the damage HIV causes. Plus,

and the peopl

doctors and scientists have found that it

YouTube.co

can help reduce the risk of some infections, certain cancers, and even AIDS.

TREATMENT HELPS PREVENT THE SPREAD OF HIV. If you’re living with HIV, a major goal is to get your viral load to undetectable. This means that there is so little virus in the blood that a test can’t measure it. How can you get to and stay undetectable? By taking HIV treatment every day.

Current research shows that getting to and staying undetectable prevents the spread of HIV to others through sex.

STOPPING TH CAN START W

Watch videos, share i see how we can all he

HelpStopTheV

YouTube.com/Help

TALK TO YOUR HEALTHCARE PROVIDER. Have an open conversation. There’s no cure for HIV, but when you work together it helps your healthcare provider find the treatment that’s right for you.

GILEAD and the GILEAD Logo are tr the property of their respective owne UNBC7277 08/20

HIV: It’s Called “ nt as Prevention ent

Treatment Treatment as as Prevention Prevention (TasP) (TasP) and and

ng ng on on treatment treatment can can help help protect protect you you

e you le you care care about. about.

START

HIV TREATMENT.

om/ om/ HelpStopTheVirus HelpStopTheVirus

HE VIRUS WITH YOU.

information, and elp stop the virus.

Virus.com

pStopTheVirus

rademarks rademarks of of Gilead Gilead Sciences, Sciences, Inc. Inc. All All other other marks marks are are ers. ers. © © 2020 2020 Gilead Gilead Sciences, Sciences, Inc. Inc. All All rights rights reserved. reserved.

HELP PROTECT YOUR HEALTH. There There is is no no cure cure for for HIV, HIV, but but fi find nd out out how how treatment treatment helps helps make make it it possible possible to to live live aa healthier healthier life. life.

SEE INSIDE

CONTENTS

EXCLUSIVELY ON

POZ.COM #ADVOCACY Fighting against HIV/ AIDS has always been a struggle. Much work remains to end the epidemic. POZ encourages you to get involved in advocacy. Go to poz.com/ advocacy to find the latest news and learn how you can make a difference in the fight.

D

#CRIMINALIZATION

D

#UNDETECTABLE The science is clear: People who have an undetectable viral load can’t transmit HIV sexually. In addition to keeping people healthy, effective HIV treatment also means HIV prevention.

Go to poz.com/undetectable for more.

D

POZ DIGITAL Scan the QR code (left) with your smartphone camera to view the current issue, or go to poz.com/ digital to see past issues online.

This year marks 40 years of AIDS, and yet there’s still no HIV vaccine.

24 RAISING HIV AWARENESS AMONG YOUNG PEOPLE Youth advocates seek inclusive sex education for their peers. BY ALICIA GREEN 28 A SHOT IN THE DARK We got COVID-19 vaccines in a year. Why are HIV vaccines taking so long? BY LIZ HIGHLEYMAN 3 FROM THE EDITOR

14 SPOTLIGHT

When I Was Young

Remembering Joseph Sonnabend, MD

4 POZ Q+A

16 ASK POZ

Whether he is pole dancing, modeling in an HIV awareness campaign or working as the president of Impulse Group New York City, Dey Armbrister serves sexual health and builds community.

What are the latest diet and nutrition guidelines?

6 POZ PLANET A fundraising art book by and for the Black and queer creative community • the British hit AIDS series It’s a Sin • how many TV characters have HIV? • #BeGlowdAF • Everyday AIDS milestones

12 VOICES Bryan C. Jones shares why he cofounded a coalition to help Nushawn Williams, a Black man who was labeled an AIDS monster in the ’90s. And Luis Viera, a graduate of the Peer Recovery Education Program at The Alliance for Positive Change, testifies about living with HIV.

18 RESEARCH NOTES

Monthly oral PrEP • the first HIV capsid inhibitor • has a woman in Argentina been cured? • telemedicine concerns

20 CARE AND TREATMENT

FDA OKs monthly injectable Cabenuva • broadly neutralizing antibodies show limited success • updated pregnancy and perinatal guidelines • HIV treatment for all could end the epidemic faster

22 BASICS The ABCs of viral hepatitis

32 HEROES Derek Canas raises HIV awareness from the DJ booth.

POZ (ISSN 1075-5705) is published monthly except for the January/February, April/May, July/August and October/November issues ($19.97 for an 8-issue subscription) by Smart + Strong, 1001 Avenue of the Americas, FL 12, New York, NY 10018-5460. Periodicals postage paid at New York, NY, and additional mailing offices. Issue No. 251. POSTMASTER: Send address changes to POZ/Smart + Strong, 1001 Avenue of the Americas, FL 12, New York, NY 10018-5460. Copyright © 2021 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. Smart + Strong® and POZ® are registered trademarks of CDM Publishing, LLC.

COVER: (MOORE) LYNN LANE; (CLOCK ILLUSTRATION, GAVEL/BOOKS, BARBED WIRE AND MAGNIFYING GLASS) ISTOCK

Opinions still vary on whether criminal law should apply to HIV disclosure, exposure and transmission.

However, there is a growing consensus to make laws reflect current science. Go to poz.com/ criminalization for more on how you can get involved in reform efforts.

FROM THE EDITOR

When I Was Young

EDITOR-IN-CHIEF

ORIOL R. GUTIERREZ JR. MANAGING EDITOR

JENNIFER MORTON DEPUTY EDITOR

TRENT STRAUBE SENIOR EDITOR

I

KATE FERGUSON SCIENCE EDITOR

LIZ HIGHLEYMAN SCIENCE WRITER

HEATHER BOERNER COPY CHIEF

JOE MEJÍA ASSISTANT EDITOR

ALICIA GREEN ART DIRECTOR

DORIOT KIM ART PRODUCTION MANAGER

MICHAEL HALLIDAY CONTRIBUTING WRITERS

SHAWN DECKER, OLIVIA G. FORD, MARK S. KING, TIM MURPHY CONTRIBUTING ARTISTS

JOAN LOBIS BROWN, LIZ DEFRAIN, ARI MICHELSON, JONATHAN TIMMES, BILL WADMAN FOUNDER

SEAN STRUB LEGACY ADVISER

MEGAN STRUB ADVISORY BOARD

A. CORNELIUS BAKER, GUILLERMO CHACÓN, KATHIE HIERS, TIM HORN, PAUL KAWATA, NAINA KHANNA, DANIEL TIETZ, MITCHELL WARREN PRESS REQUESTS

NEWS@POZ.COM SUBSCRIPTIONS

HTTP://ORDER.POZ.COM UNITED STATES: 212-242-2163 SUBSCRIPTION@POZ.COM FEEDBACK

EMAIL WEBSITE@POZ.COM OR EDITOR-IN-CHIEF@POZ.COM

SMART + STRONG PRESIDENT AND COO

IAN E. ANDERSON EDITORIAL DIRECTOR

ORIOL R. GUTIERREZ JR. EXECUTIVE EDITOR

BOB BARNETT CHIEF TECHNOLOGY OFFICER

CHRISTIAN EVANS (SUN ILLUSTRATION) ISTOCK; (GUTIERREZ) JOAN LOBIS BROWN

VICE PRESIDENT, INTEGRATED SALES

DIANE ANDERSON INTEGRATED ADVERTISING MANAGER

JONATHAN GASKELL INTEGRATED ADVERTISING COORDINATOR

IVY PETERSON SALES OFFICE

212-938-2051; SALES@POZ.COM

CDM PUBLISHING, LLC CEO

JEREMY GRAYZEL CONTROLLER

JOEL KAPLAN

POZ.COM/FACEBOOK

POZ.COM/TWITTER

POZ.COM/INSTAGRAM

’M NOT WHAT YOU’D CALL A very dramatic person (although my partner would likely disagree).

However, I will admit to getting incensed from time to time. The past few years certainly gave me good reasons to scream.

As with most people, I suspect, my level of aggravation increases the more personal things get. So when it comes to youth and HIV, I become vexed. Having tested HIV positive in 1992 at age 22, I know what it’s like to be forced to learn to live with a potentially deadly retrovirus as adulthood starts.

Youth are as vulnerable as ever to HIV. The numbers speak for themselves. Nearly 45% of people between ages 13 and 24 who are HIV positive don’t know they are living with the virus. Young people account for 21% of new HIV diagnoses annually.

When it comes to LGBTQ young people, the numbers are even more distressing. Of all new HIV diagnoses among youth, 83% are among men who have sex with men (MSM). Black adolescents account for 42% of all new diagnoses among young MSM. These statistics are why National Youth HIV/AIDS Awareness Day is so important.

Observed each year on April 10, this day gives everyone a chance to focus on how we can help make things better. Supporting youth advocates is a great place to start.

Our cover subject, Deondre Moore, is an excellent example. When he tested HIV positive at 19 years old, he didn’t know all the facts about the virus. Now 26, he’s sharing those facts with his fellow young people as the U.S. partnerships and community engagement manager at Prevention Access Campaign. Go to page 24 to read more about raising HIV awareness among youth.

Two advocates who also know something about testing HIV positive as youth are Dey Armbrister and Derek Canas. Go to pages 4 and 32, respectively, to find out more.

Low HIV testing rates and stigma are a few of the reasons young people are unaware of their status. However, inadequate

sex education is the reason many youth advocates cite for the high rate of new HIV diagnoses among young people. Sex ed that includes LGBTQ people is key to turning the tide.

Another key to ending the HIV epidemic is even more elusive—an HIV vaccine. Although it’s true that COVID-19 still keeps us on edge, the future on that front is looking brighter.

The main reasons for hope are the COVID-19 vaccines. Their increasing rollout could soon give us a reprieve from the new coronavirus.

Since we got COVID-19 vaccines in record time, many in the HIV community have been sharing their frustration with the pace of HIV vaccine research. Why are they taking so long?

Go to page 28 to learn just how difficult the task has been—and find out how much COVID-19 vaccines owe to HIV vaccine research.

Promoting sex ed and advancing HIV research were two causes the late Joseph Sonnabend, MD, certainly knew a lot about.

The researcher and clinician was a trailblazer in the fight against HIV/AIDS. He graced our cover in 1998 and blogged regularly for POZ. Go to page 14 to read remembrances of Joe.

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 APRIL/MAY 2021 POZ 3

POZ Q+A

BY TRENT STRAUBE

After an HIV diagnosis, Dey Armbrister found strength on the dance floor. Inset: Armbrister appears in New York state’s “HIV Stops With Me” campaign.

Whether he’s pole dancing or leading Impulse Group NYC, Dey Armbrister builds community.

A

DVOCATES WEAR A LOT OF HATS. THIS ONE HAS A LOT OF names. As the new president of the HIV nonprofit Impulse Group New York City, he’s Dey Armbrister. As a pole dancer with poetic swag, he’s Dey Phoenix. And appearing as a friendly face in the “HIV Stops With Me” public service campaign throughout New York state, he’s simply Dey. (In case you’re curious, Dey is short for DéShaun.)

The multifaceted 31-year-old wasn’t always such an outgoing champion of sexual health, especially during the challenging period in college following his HIV diagnosis. But, as he tells POZ, he took his problems to the dance floor, and an activist and community leader was born.

Tell us about Impulse Group NYC.

Impulse Group is a nonprofit volunteer organization funded by AHF [AIDS Healthcare Foundation]. Basically, the group engages, supports and builds community within the queer community. There are 25 chapters globally and 11 spread throughout the U.S. It was founded by Jose Ramos, the history goes, with seven friends in a kitchen having conversations about all types of things and then wanting to bring that connection to the community. NYC is one of the 25 chapters. We’ve been active for six years. Our chapter most recently has touched base more with the AfricanAmerican community, and Latinos to a degree. But at its core, we are for the whole spectrum of our gay community.

We basically put on a number of different events, from panel discussions and fundraisers to aromatherapy and massage therapy [events] to promote self-care.

4 POZ APRIL/MAY 2021 poz.com

The first event I attended was a Fire Island pool party in 2016. Then I volunteered in 2019 for an event called Party for a Purpose, to raise money for two local nonprofits. Then I became the director of advocacy. I would identify what topics were pertinent to discuss, and then we would “impulsify” them and bring them to the community through events. We touch on a variety of topics from sexual health and HIV to body positivity and mental health. And I just got elected as president of Impulse Group NYC for 2021–2022.

One event we consistently do is a T7 dinner, short for Table for Seven, which goes back to the original seven members of Impulse. That event stays consistent, at least in NYC. We invite community members to a dinner-type setting—but because of COVID, that changed. We had a virtual brunch and provided Seamless gift cards and had breakout sessions for topics.

For 2020, we couldn’t engage people in person for our Party for a Purpose

(ARMBRISTER) COURTESY OF DEY PHOENIX/KIRI WAWATAI; (CAMPAIGN IMAGE) COURTESY OF HIVSTOPSWITHME.ORG

SERVING SEXUAL HEALTH

fundraising event. Our vice president, DeMarkis Bonner, came up with the idea of doing a coffee-table book for our queer community, almost like a scrapbook telling a family history. It really did start off as a book where we wanted to own eroticism and kink. What would it look like if we took pride in that instead of shunning it? Throughout 2020, Impulse Group NYC put on a theme of “transparency”—what this meant for us is encouraging our community to own our truths and identities and unique qualities, including kinks and fetishes and gender expression that might be taboo. And due to racial injustices, we wanted to speak on being revolutionaries. It was very pertinent to highlight Black and brown queer and trans people—and HIV—and even those who might have disabilities. I describe the book as a visual manifesto for our resistance. [Editor’s note: Turn to page 6 to read more about the book, Our Light Through Darkness, which is curated by LaQuann Dawson and includes photography, illustrations, essays and more.]

come out about my HIV status with my mom. After she knew, everything else slowly opened up. Because my mom is like my world. Once she knew, it didn’t really matter who knew.

What aspect did pole dancing play in your journey?

Basically, I had dreams and aspirations of dancing and owning a dance studio. I started out in college with hip hop and street jazz. [While I was struggling with my HIV diagnosis], a friend nicknamed Princess told me to take everything out on the dance floor. Verbally, I didn’t know the words to say or how to approach certain people when it came to my status, but I was able to always dance. That was a time that dance really did save my life.

(ARMBRISTER) INSTAGRAM/IMPULSEGROUPNYC

You’re featured in the book, including an HIV-related poem by Dey Phoenix that relates part of your HIV journey.

I did write the book’s foreword [as Dey Armbrister]. And, funny enough, I did write a poem called “Black Phoenix Dance.” Dey Phoenix is my creative moniker. For me, Phoenix is about reincarnation and rebirth. Not just from HIV, but also my mom and I were burned out of an apartment in Brooklyn. So no matter what hardship I go through, I can come out a better person from the ashes.

Eleven years ago, I was diagnosed with HIV. I was just about to turn 20. I was in a relationship when a [former boyfriend tested HIV positive] and he did the due diligence to bring it to my attention. It wasn’t anything malicious.

But it shook my world up. I was a broke college student, and things were looking bleak. But I linked myself to care through the HEAT [Health & Education Alternatives for Teens] program based out of Brooklyn. I’ll never forget my doctor. He put me on the right track, getting me case management and medication right away, which in turn helped me

Dey Armbrister

or emotional labor of it versus those who might do full-service sex work. So I do fall into that spectrum, and I have owned it. We’re in a society where we can consume so much porn and sex and violence and XYZ, yet we’re expected to hide our true desires. My thought process on this is, if it’s consensual, then why not celebrate it? Why not celebrate the bodies that we’re in? If someone chooses to get naked on the internet, why can’t they get equity and get paid?

Also, if you know strippers, you’ll know them to be advocates, to be strong people who speak for their community and who look out for one another. All of those things, when it comes to my HIV journey, have really helped me cope and mend and be a strong person and an advocate too.

“We’re telling our stories.

We’re engaging the community to be better.”

Fast-forward to pole dancing. That reinvigorated my life even more, because I found a certain amount of freedom within expressing my sexuality and owning my sensuality. In all honesty, I started pole dancing because I had a very high regard for strippers, and I always wanted to low-key be one myself. That’s legit why I started it.

I’ve been very transparent about my journey as a stripper. I have worked strip clubs briefly, and during the COVID pandemic, there’s been virtual strip club experiences via Zoom.

In turn, that has made me a strong advocate for sex workers rights too.

When we talk about sex work, there’s a whole spectrum. It could be strippers where you might not physically be having sex, but you’re exchanging the fantasy

You’re also one of the faces of New York state’s multimedia “HIV Stops With Me” campaign.

This is my third year on the “HI V Stops With Me” campaign. I’ve been undetectable for years. When we found scientifically that [people with an undetectable viral load] cannot transmit HIV to our partners—[a fact referred to as Undetectable Equals Untransmittable, or U=U]—it gave us more options on how to navigate our sexual encounters.

That’s not to say it’s an open door to do anything you want, but it did open doors. In the campaign, we’re telling our stories. It ’s similar to Impulse Group. We’re connecting and engaging the community to support one another, to get resources we need and to just be better. Q

poz.com APRIL/MAY 2021 POZ 5

POZ PLANET

BY TRENT STRAUBE

VISUAL MANIFESTO Impulse Group NYC’s art book is a queer Black family album and an unapologetic road map.

6 POZ APRIL/MAY 2021 poz.com

1

9

CREDIT

Open the art book Our Light Through Darkness and you’ll find beautiful photography, illustrations, essays and poems by and for LGBTQ Black artists. You’ll also see a gorgeous spectrum of body types and gender expressions, and you’ll read attention-grabbing titles, such as “I Hope You Catch AIDS and Die,” among the empowering HIV survivor stories.

LaQuann Dawson, a photographer who curated the book for Impulse Group New York City, an HIV nonprofit, says of the book’s title: “There is so much darkness in our lives and so much hiding we have to do as queer people and Black people and so much silencing and overall lack of visibility. But when you see us and we are visible and get to present ourselves and get to be ourselves, it’s so bright and beautiful and strong and powerful.”

Traditionally, Impulse Group NYC hosts an annual fall fundraising party to benefit two local HIV organizations, but because of the COVID-19 pandemic, the 2020 event couldn’t be held in person. After brainstorming, the group and Dawson decided to publish a fundraising art book (order a copy at OurLightThroughDarkness.com) that champions the queer Black creative community and encourages folks to embrace their bodies and sexuality—kinks, fetishes and all. “I wanted this book to confront the things we are Above: Impulse taught to be afraid of and hide,” Dawson Group NYC’s board tells POZ. “I wanted this book to be of directors 2020– a little louder about it, without a filter 2021; below: the or restrictions.” fundraising book “It was very pertinent to highlight Black and brown queer and trans people—and HIV—and even those who have disabilities,” says Impulse Group NYC president Drey Armbrister (read our interview with him on page 4). “And due to racial injustices,” he adds, “we wanted to speak on being revolutionaries. I describe the book as a visual manifesto for our resistance. In this book, we own our journey and road map unapologetically.”

2

3

5

8

1. Self-Portrait by LaQuann Dawson 2. Swim Good by Kendrick Daye 3. Cameron Cooper and Keimante Wright in Brown Skin by Vincent Marc 4. Ava Grey by Don Brodie 5. Once in a Blue Moon by Jacobi Myles 6. Portrait of River by Adam Chuck 7. Lovell Lykaon in Uninhibited by Kameo Entertainment 8. Jessica Ray

by Alex Webster 9. West Side Bathroom by Juniper Jones

CREDIT

7

6

OUR LIGHT THROUGH DARKNESS: IMPULSE GROUP NEW YORK CITY AND LAQUANN DAWSON

4

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

(bik-TAR-vee)

MOST IMPORTANT INFORMATION ABOUT BIKTARVY

POSSIBLE SIDE EFFECTS OF BIKTARVY

BIKTARVY may cause serious side effects, including:

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

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

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

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

ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults and children who weigh at least 55 pounds. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements.

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS. Do NOT take BIKTARVY if you also take a medicine that contains: ` dofetilide ` rifampin ` any other medicines to treat HIV-1

BEFORE TAKING BIKTARVY Tell your healthcare provider if you:

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

` Have or have had any kidney or liver problems,

including hepatitis infection. ` Have any other health problems.

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

` Are pregnant or plan to become pregnant. It is not

known if BIKTARVY can harm your unborn baby.

Tell your healthcare provider if you become pregnant while taking BIKTARVY. ` Are breastfeeding (nursing) or plan to breastfeed.

Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.

HOW TO TAKE BIKTARVY Take BIKTARVY 1 time each day with or without food.

Tell your healthcare provider about all the medicines you take:

GET MORE INFORMATION

` Keep a list that includes all prescription and over-the-

counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. ` BIKTARVY and other medicines may affect each other.

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

Get HIV support by downloading a free app at

MyDailyCharge.com

` This is only a brief summary of important information

about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more. ` Go to BIKTARVY.com or call 1-800-GILEAD-5 ` If you need help paying for your medicine,

visit BIKTARVY.com for program information.

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

BVYC0197 03/20

PZA522837.pgs 06.05.2020 14:55

ESA

DIMITRI LIVING WITH HIV SINCE 2018 REAL BIKTARVY PATIENT

KEEP ASPIRING.

Because HIV doesn’t change who you are.

BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.

Ask your healthcare provider if BIKTARVY is right for you.

See Dimitri’s story at BIKTARVY.com.

Featured patient compensated by Gilead.

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

PZA522838.pgs 06.05.2020 14:57

ESA

POZ PLANET

BY TRENT STRAUBE

SEX, DEATH & SHAME The hit British miniseries It’s a Sin tackles AIDS in the ’80s.

Above: a poster for It’s a Sin; clockwise from bottom right: Nathaniel Curtis and Lydia West, Olly Alexander, Neil Patrick Harris and Callum Scott Howells, and Omari Douglas

Guess How Many TV Characters Have HIV In the 2020–2021 TV season, out of a total of 773 series regulars, only three characters were living with HIV— and all three were on FX’s Pose, which follows the late Pose 1980s and early ’90s underground ball Mj Rodriguez scene in New York City. in Pose

10 POZ APRIL/MAY 2021 poz.com

This marks a “drastic decrease” from the previous year, which included nine characters with HIV, according to study findings from GLAAD, an advocacy group that focuses on LGBTQ representation in the media. The good news?

Programming saw an uptick

in LGBTQ people of color.

The importance of representation on television has grown exponentially in the past year, GLAAD notes, because more people are home watching TV during the COVID-19 pandemic and looking for on-screen connections.

(IT’S A SIN POSTER) COURTESY OF HBO MAX; (IT’S A SIN ACTORS) COURTESY OF HBO MAX/BEN BLACKALL; (TV) ISTOCK; (POSE) COURTESY OF FX

Another fab British import arrived stateside this year: the five-part miniseries It’s a Sin, which follows a group of young, mostly gay friends who arrive in London as the AIDS crisis unfolds in the early 1980s. The show, which streams on HBO Max, takes its name from a Pet Shop Boys song and is penned by hitmaker Russell T. Davies, who brought us the original Queer as Folk. It stars British pop star Olly Alexander and American actor Neil Patrick Harris, both of whom are gay.

It’s a Sin premiered in January on Britain’s Channel 4, becoming its most watched show ever while raising HIV awareness, boosting testing nationwide and, now, inspiring heated discussions across the globe about telling HIV stories (look up the must-read blog post “How’d You Get It?/Such a Shame” by Brian Mullin on Substack.com). Some AIDS advocates, however, have expressed concern that viewers might find the show scary and stigmatizing. Of course, in the 1980s, HIV was, in many respects, a death sentence. But we’ve come a long way. Effective treatment arrived in 1996, and now we know that people living with HIV who take medication and maintain an undetectable viral load cannot pass the virus sexually, a fact known as Undetectable Equals Untransmittable (U=U). HIV advocates at Prevention Access Campaign have worked to spread this hopeful message to coincide with the release of the miniseries. HBO, for its part, has a landing page with updated information about HIV. Is that enough? Long-term survivor Mark S. King writes that It’s a Sin “reinforces dangerous, stereotypical myths about gay men [as fixated on sex as a result of being shamed by their families] and people living with HIV.” By ignoring the “heroic history” of many gay men—like those who advocated for health care—Davies feeds into the trope of the AIDS monster who willingly spreads the virus, King writes, adding that the cliché has led to dangerous HIV crime laws that many advocates are still fighting to have repealed.

For Davies, It’s a Sin is largely autobiographical—and a chance to tackle a subject he avoided in Queer as Folk, which premiered in 1999. (The U.S. remake, which he didn’t write, did feature HIV storylines.) In defense of his choice, Davies has said he didn’t want gay men’s lives to “be defined by disease.” What’s more, he told the New York Times, “If you look at my work over the last 20 years, I was always telling the story of sex leading to death, which I do think was very profoundly molded into me during the ’80s.”

#BeGlowedAF Iris House encourages young people to get tested.

What makes you glow? For a diverse group of young social media influencers in a new awareness campaign titled “Simply Glow’d,” the answer is getting tested for hepatitis C, HIV and sexually transmitted infections (STIs) and then “keeping it 100” by making smart sexual choices and staying mentally healthy.

The campaign is spearheaded by Iris House, a New York City–based center for women and families fighting HIV/AIDS, substance misuse and STIs, with funding from the federal Substance Abuse and Mental Health Services Agency (SAMHSA) and creative assistance from the marketing team at AIDS Healthcare Foundation.

“We need to find innovative ways to engage young people using language they can relate to,” Iris House executive director Ingrid Floyd tells POZ. “Young people really like the Glow’d concept. They understand it.”

Glow’d targets young people ages 13 to 29 in East and Central Harlem and the South Bronx. In New York City, according to Iris House, nearly 10,000 people under 29 are living with

EVERYDAY

These dates represent milestones in the HIV epidemic. Visit poz.com/aidsiseveryday to learn more about the history of HIV/AIDS. BY JENNIFER MORTON

April

May

ACTIVIST KEITH CYLAR dies of AIDSrelated causes. Cylar helped create ACT UP’s Housing Committee and its spin-off organization Housing Works. (2004)

HIV activists kick off the CAMPAIGN TO END AIDS by leaving 8,500 pairs of shoes outside the White House to signify the daily number of global AIDS deaths. (2005)

5

9

PRINCESS DIANA, in an effort to end HIV-related stigma, shakes hands with a person living with AIDS on the new AIDS ward at Middlesex Hospital in London. (1987)

(GLOW’D) INSTAGRAM/@IRIS_HOUSE_; (DIANA) WIKIMEDIA; (SHOES AND ORCHID) ISTOCK

HIV. What’s more, over 40,000 young people The Glow’d campaign between 13 and 24 were diagnosed with an STI. stars young And alcohol continues to be the most widely social used substance among America’s youth. media To reach this youthful audience with mesinfluencers. sages promoting sexual and mental health, the campaign includes images and videos of local social media influencers—notably young people of color and those who are LGBTQ and nonbinary. The idea is to get youth to shine, to #BeGlowdAF, #GetThatGlow and #GlowUp by getting tested and encouraging awareness. Visit Iris House’s Instagram account to view some examples, and for more details, visit ProjectGlow-IrisHouse.org.

Other folks like the campaign too. As Floyd explains, “We have received many positive responses from persons over the target age of 29 who have asked, ‘How do I get a picture in the campaign?’ So we see that the message resonates with many different age groups.”

10

NATIONAL YOUTH HIV & AIDS AWARENESS DAY

18

NATIONAL TRANSGENDER HIV TESTING DAY

5

18

HIV VACCINE AWARENESS DAY

19

NATIONAL ASIAN & PACIFIC ISLANDER HIV/AIDS AWARENESS DAY

28

Actor, writer and director CHARLES LUDLAM dies of AIDS-related PCP pneumonia at age 44. His obituary is the first to appear on the front page of the New York Times to specifically list AIDS as a cause of death. (1987)

poz.com APRIL/MAY 2021 POZ 11

VOICES BLOGS AND OPINIONS FROM POZ.COM

Nushawn Williams was photographed at Clinton Correctional Facility for the August 2000 issue of POZ.

FIGHTING FOR NUSHAWN

I

remember the moment so clearly.

In 1997, I was coming to grips with an AIDS diagnosis. Thirteen years earlier, I’d been diagnosed with HIV. Back then, I couldn’t even say I had AIDS out loud to myself.

One evening, as my family and I watched the news, the words AIDS Monster screamed from the TV, and I became paralyzed. I was scared and thought everyone in the room was staring at me. But how could they know? I hadn’t shared my HIV status.

During the four-minute news segment, I listened to the story of Nushawn Williams, a 19-year-old, HIV-positive Black man who’d been accused of having unprotected sex with numerous female partners (some of them under 18). Nushawn claimed he was unaware of his status. Although the story was breaking, the news anchor’s tone made it sound as if Nushawn was already guilty before his trial. I felt the anchor’s voice was also speaking directly to me: “Bryan, now that you have this nasty, dirty disease, you’ll always be guilty.” In those few minutes, I felt totally broken. Those four minutes would define my mental prison for several years to come: I was an AIDS MONSTER. Nushawn’s story became sensationalized in the media and reflected ignorance about HIV and racial prejudice.

I’d think about his situation and become frantic. I didn’t want to be plastered

12 POZ APRIL/MAY 2021 poz.com

all over the news and labeled “the AIDS Monster of Ohio.” I knew I couldn’t endure a similar witch hunt.

For years, I was lost. I had no one to talk to or to show me how I could live with HIV. In the early days, there were few places to turn to for support. Up to that point, everyone I knew who had HIV had slipped away into the hereafter. After their deaths, they were shamed because of HIV-related stigma. I felt for certain I would also die a similar ugly, painful and embarrassing death. That I’d also be talked about as a monster in hushed conversations.

But the image of Nushawn in the courtroom stayed with me. I’d often wondered about the young guy whose spirit didn’t seem to be broken despite his fate or the nightmare of AIDS. Back then, I never would have imagined that I’d ever be open about my status and advocating for others with HIV. But Nushawn gave me the strength to fight. Watching him in the courtroom, with his head held upright, somehow assured me that I could also be strong.

In 1999, Nushawn pleaded guilty to statutory rape and reckless endangerment and was sentenced to a 12-year prison term. In 2010, four days before his scheduled release, Andrew Cuomo, the New York attorney general at the time, filed a motion to place Nushawn under indefinite civil confinement under a statute aimed at predatory sex

offenders. Nushawn has been locked up for more than 20 years—10 years more than his original maximum sentence—with no release date in sight.

Nushawn’s HIV status has consistently been used to portray him as a monster. Laws targeting people living with HIV only deter others from getting tested and further stigmatize those living with the virus. We know that effective treatment allows people with HIV to suppress their viral load to the point that they can no longer transmit the virus to a sexual partner (Undetectable Equals Untransmittable, or U=U). Nushawn has paid his debt to society—there’s no reason for him to remain under confinement.

A couple of years ago, I came across a social media post by Davina “Pozitively Dee” Conner, raising awareness about Nushawn’s plight. It was an aha moment for me. I could use the strength that Nushawn once gave me to help him. Dee and I formed a coalition of advocates to help free Nushawn.

We believe that Black Lives Matter and that mass incarceration is real and unjust. We believe that working to free Nushawn helps to combat the stigma that persists around HIV and AIDS. Hasn’t Nushawn endured enough?

Black lives are being taken every day.

Let’s fight for the living. Let’s fight to free Nushawn and give him his life back.

To join the Free Nushawn Coalition, visit FreeNushawn.com. Q

ANDREW LICHTENSTEIN

In an op-ed titled “Paying It Forward to Fight for Nushawn Williams,” Bryan C. Jones shares why he cofounded a coalition to help a Black man who was labeled an AIDS monster in the ’90s. Below is an edited excerpt.

PEER RECOVERY Luis Viera, a graduate of the Peer Recovery Education Program at The Alliance for Positive Change, testifies about living with HIV in an opinion piece titled “From Caterpillar to Butterfly.” Below is an edited excerpt.

(FLOWERS/BUTTERFLY) ISTOCK; (VIERA) COURTESY OF LUIS VIERA

I

n 2010, I tested HIV positive. From that moment, my world collapsed.

My new reality became even worse when, at the beginning of 2011, I got a call to start treatment, but that wasn’t all—my diagnosis was AIDS. I’d only been in New York City from Puerto Rico a short time. It was difficult to face all this without my family close by, without support, without a job and without a home. For weeks, I slept in train stations, until a person offered me his hand and his support.

After a few months staying in shelters, I began to realize that the process of understanding and accepting my status was harder than anything in my life.

I faced stigma and marginalization, not only for being HIV positive but also for being a homeless gay Latino.

I went through so many agencies and organizations that I felt like just another number, a statistic, just one more client.

I felt disappointed and scared, and I relapsed to behaviors that took me even further into depression, anxiety and panic attacks. I thought I would never get the chance to find myself again. I knew I needed to go back to therapy and start taking my mental health meds again, but I also knew it would be harder than the first time.

I finally got the courage to try, and I decided to look for health coverage that really met my needs as an HIV-

Luis Viera positive person with graduating mental health issues. from peer It was then that I was training linked to The Alliance for Positive Change.

There, I learned how HIV affects me emotionally, physically and socially as well as the importance of staying physically and mentally healthy. I was truly motivated to seek more spaces where I could develop as a human being and learn the skills I need to reach out and help others facing the same challenges as me.

I then learned about the organization’s peer training. During the fiveweek program, a healing process took place, and I saw in my classmates the same need to understand and validate others, respect their experiences and value their opinions.

I could see that I wasn’t alone and that I could take control of who I was

regardless of external factors that might try to bring me down. Every day, I had the opportunity to learn how actively listening and analyzing valuable information would help me take control of my health, my body and my life.

I learned how to communicate clearly, with tolerance and without judgment. I also learned the importance of knowing the risk of acquiring sexually transmitted infections if we do not practice safer sex. I found that knowing myself could help me empower others.

I learned the importance of setting personal and professional boundaries, recognizing the five stages of change, understanding the meaning of harm reduction, managing stress, healthy eating habits, self-esteem, preventing relapse and, above all, understanding and valuing the disclosure process.

The most important thing I learned is that I can do whatever it takes to help others without forgetting about self-care. Now that this step is over, I will follow the advice of my trainers and look for opportunities that can further train me to help others.

I want to be that someone who can offer assistance to that person who might now be sleeping on the train, lost, scared and lonely, like I was.

This amazing journey transformed me from a caterpillar to a butterfly. Q

poz.com APRIL/MAY 2021 POZ 13

SPOTLIGHT

BY JOE MEJÍA

R.I.P. Joseph Sonnabend As a researcher and clinician, Joseph Sonnabend, MD (1933–2021), was a trailblazer in the fight against HIV/AIDS. Indeed, he has been hailed by some as “the first AIDS doctor,” a title the humble Sonnabend, who died in London of complications from a heart attack, likely would have shunned.

Born in Johannesburg, he grew up in Zimbabwe, attended college in South Africa and studied medicine in Edinburgh, where he trained in infectious diseases. After working with investigators in London who discovered interferons, he moved to New York City in 1969 to continue his research. In 1978, he opened a private practice in Greenwich Village, catering primarily to men who, like him, were gay.

It was from this vantage point that Sonnabend became one of the first physicians to recognize the emergence of AIDS in the early 1980s. At a time when gay men were treated as outcasts, he worked late hours and made house calls to ensure that his patients received the compassionate care they deserved. He would go on to cofound the AIDS Medical Foundation (now amfAR) in 1983; he also cofounded the Community Research Initiative (now ACRIA), which pioneered community-based research. Sonnabend was a maverick in other ways too, cautioning against the use of the early, toxic AIDS drug AZT, promoting prophylaxis for opportunistic infections and helping author the first safer-sex manual for gay men.

His impressive résumé aside, Sonnabend will best be remembered for treating people with dignity at their most vulnerable, nurturing hope during fearsome times and preparing countless former patients to become today’s fighters and survivors.

14 POZ APRIL/MAY 2021 poz.com

Posts may be edited for clarity and/or space. poz.com APRIL/MAY 2021 POZ 15

ASK POZ WELLNESS TIPS FROM POZ.COM

WHAT ARE THE LATEST DIET AND NUTRITION GUIDELINES?

16 POZ APRIL/MAY 2021 poz.com

proteins (for example, beans and nuts), low-fat dairy products, fish and unprocessed lean meat and poultry. Nutrientrich foods and drinks should make up about 85% of daily calories, with little leeway for empty calories. The recommendation to limit foods and beverages high in added sugars, saturated fat and sodium is also expected.

The report emphasizes the health benefits of exclusive breast feeding for at least the first six months of life, and it recommends that children should have potentially allergenic foods, such as peanuts and eggs, introduced into their diet during the first year to reduce the risk of developing allergies.

But many experts are disappointed that the guidelines do not incorporate a scientific advisory committee’s recommendation to lower consumption of added sugars in food and drinks from 10% of daily calories to 6%. The new

guidelines do recommend, however, that children under age 2 should not consume any added sugars.

Along with candy and desserts, sweetened beverages are a major source of added sugars. Sugar contributes to obesity, which raises the risk of cardiovascular disease, diabetes, at least 13 types of cancer and more severe COVID-19. High-fructose corn syrup, in particular, can cause fatty liver disease.

The update also fails to include the advisory committee’s recommendation to lower the alcohol limit for men from two drinks to one drink per day, which would match the current recommendation for women. But the guidelines do clarify that the daily limits can’t be added up to permit binge drinking a couple of days a week. Alcohol can cause liver disease, raises the risk of several types of cancer and is linked to increased mortality. —Liz Highleyman

Ask POZ is an ongoing section on POZ.com dedicated to answering general wellness questions. Go to poz.com/ask to read more answers, and email ask@poz.com to submit your questions!

ISTOCK

O

N DECEMBER 29, 2020, THE federal government released its Dietary Guidelines for Americans, 2020–2025.

Produced by the United States Department of Agriculture and the Department of Health and Human Services, the guidelines are updated every five years based on the latest scientific evidence.

Noting that more than half of American adults have one or more diet-related chronic diseases, the authors state that “just about everyone, no matter their health status, can benefit from shifting food and beverage choices to better support healthy dietary patterns.”

A decade ago, the federal government scrapped the old food pyramid that recommended numbers of servings per day from each food group, replacing it with a more flexible approach. The latest revision—the first to provide guidance by life stage, from birth through old age— recommends developing a customized healthy eating plan by considering personal preferences, cultural traditions and budget constraints.

The guidelines hold few surprises about what to eat: more fruits and vegetables, whole grains, plant-based

Good For You Two!

“I’m on one pill a day for HIV and Undetectable”

“I’m on one pill a day for PrEP and negative”

You both take your meds daily. And there’s zero risk of passing along HIV. You’re protecting yourselves and others. So, while you might worry about what to wear on your next date, you don’t have to worry about HIV.

PlayButPlaySafe.org

PZA529067.pgs 03.05.2021 17:14

ESA

RESEARCH NOTES

PREVENTION

TREATMENT

CURE

CONCERNS

Monthly Oral PrEP

HIV Capsid Inhibitor

Another Cure?

Telemedicine Risk

Islatravir, the first nucleoside reverse transcriptase translocation inhibitor, reaches levels in the body that should protect against HIV for at least a month, researchers reported at the 2021 HIV Research for Prevention conference. The drug is highly potent and has a long half-life, suggesting it could be taken once weekly for treatment and even less often for pre-exposure prophylaxis (PrEP). In an animal study, none of the monkeys that received high doses of islatravir were infected with an HIV-like virus. In an ongoing Phase II trial, people who took islatravir tablets once monthly for six months maintained protective drug levels in peripheral blood cells and in vaginal and rectal tissues. The tested doses were well tolerated.

A pair of Phase III trials will now compare once-monthly islatravir versus oncedaily oral PrEP for women and adolescent girls (IMPOWER-022) and for men who have sex with men and transgender women (IMPOWER-024). Researchers are also studying an islatravir implant that could provide protection for a year.

Lenacapavir, the first HIV capsid inhibitor, reduces viral load in people who have used several prior antiretrovirals and have multidrug-resistant virus, according to Gilead Sciences. Lenacapavir disrupts the HIV capsid, the cone-shaped shell that surrounds the viral genetic material. Because it works differently than existing antiretrovirals, it remains active against virus that has developed resistance to other types of drugs. In the Phase II/III CAPELLA trial, 36 adults with highly resistant HIV added oral lenacapavir or a placebo to their current failing regimen. After 14 days, 88% of people in the lenacapavir group had at least a half-log reduction in viral load, compared with just 17% in the placebo group. The treatment was safe and well tolerated. At that point, all participants were offered lenacapavir injections every six months plus an optimized combination regimen. Prior studies showed that lenacapavir injections led to sustained drug concentrations for several months. Researchers are also testing lenacapavir as a twice-yearly injectable PrEP option.

A woman in Argentina may represent a unique case of posttreatment control of HIV after stopping antiretroviral therapy. Now in her late 50s, the woman was diagnosed with HIV in 1996 after developing wasting syndrome and toxoplasmosis. She started an early combination regimen, which was modified several times. In 2007, she stopped treatment entirely due to side effects, but her viral load has remained suppressed ever since, and she continues to maintain a normal CD4 count. Intensive testing revealed that her blood plasma viral load was below the limit of detection of the most sensitive tests, and HIV RNA was not detected in lymph node or gut biopsies. HIV DNA—the form of genetic material in the viral reservoir—was not detected in immune cells in the blood or in gut tissue but was present at a very low level in lymph node tissue.

The woman shows only weak HIV-specific CD8 T-cell responses and no longer tests positive for HIV antibodies, suggesting she doesn’t harbor enough virus to trigger an ongoing immune response.

People receiving HIV care at a safety-net clinic in San Francisco were 31% less likely to have an undetectable viral load after the city imposed its COVID-19 shelter-in-place order in March 2020 and the clinic shifted to telemedicine.

After the shift, 54% of scheduled visits at Zuckerberg San Francisco General Hospital’s Ward 86 HIV clinic, which serves a largely disadvantaged population, were done by telephone.

Although the overall number of no-shows remained similar, homeless people were more likely to miss appointments after the transition, while younger people were less likely to do so—possibly reflecting greater comfort with telehealth. Viral suppression rates fell substantially, especially among homeless people. While telemedicine may facilitate retention in care for those with reliable access, it is unlikely to compensate for the loss in clinic-based social services and support for HIV-positive people with vulnerabilities, the researchers concluded.

Ward 86 has since made a push to bring people back for in-person care.

18 POZ APRIL/MAY 2021 poz.com

ALL IMAGES: ISTOCK

BY LIZ HIGHLEYMAN

Have questions about COVID-19?

Visit COVIDHealth.com, your trusted source for coronavirus prevention, vaccine and treatment news.

Follow us on:

A SMART + STRONG PUBLICATION Award-winning consumer health care information

COVID_Health_House_Ad_2020_HY.indd 25

12/1/20 8:22 AM

POZ19603-00_CovidHouseAd.pgs 12.02.2020 09:08

CARE AND TREATMENT

BY HEATHER BOERNER

Broadly Neutralizing Antibodies Show Limited Success

MONTHLY INJECTABLE CABENUVA APPROVED How’s this for a shot in the arm—er, butt? In January, the Food and Drug Administration (FDA) approved the monthly injectable antiretroviral regimen Cabenuva to replace daily pills for maintenance of viral suppression. The United States now joins Canada and Europe in approving the first complete long-acting injectable treatment for HIV. Cabenuva combines an extended-release formulation of the integrase inhibitor cabotegravir plus an injectable version of the non-nucleoside reverse transcriptase inhibitor rilpivirine (sold in pill form as Edurant).

The FDA approved the shots for people with a long-term undetectable viral load, no history of treatment failure and no known or suspected resistance to either cabotegravir or rilpivirine.

Approval was based on positive results from the Phase III ATLAS and FLAIR trials, which found that monthly Cabenuva injections maintained viral suppression as well as standard daily oral regimens. What’s more, the ATLAS-2M study showed that once-monthly and every-other-month injections are equally effective, with 94% of people in both groups maintaining viral suppression. For now, the FDA has approved only the once-monthly schedule, but ViiV Healthcare has requested approval for the every-other-month regimen.

Before switching to the shots, there will be pills—at least at the beginning.

The FDA also approved a tablet version of cabotegravir, called Vocabria, which people switching to Cabenuva will need to take along with Edurant for a month to ensure that the new combination agrees with them. After that, they will receive two injections in the buttocks administered by a health care provider once a month. Vocabria and Edurant pills may also be used as a complete short-term regimen—for example, if someone has to miss a planned Cabenuva injection appointment.

20 POZ APRIL/MAY 2021 poz.com

The broadly neutralizing antibody (bnAb) VCR01 cut HIV acquisition by 75%—but only for the fraction of viral strains it was designed to target, according to interim results from the Antibody Mediated Prevention trials.

Lawrence Corey, MD, of the Fred Hutchinson Cancer Research Center in Seattle, and his colleagues recruited 1,924 cisgender women and 2,699 gay and bisexual cisgender men and transgender adults without HIV into two separate trials. In each study, participants were randomly assigned to receive a placebo or VRC01 antibodies via IV infusion, for a total of 10 infusions administered every eight weeks.

Overall, VRC01 had little effect on HIV acquisition, as the antibodies were active only against 30% of virus strains.

But for those 30%, the rate of HIV acquisition was 0.20 per 100 personyears among people who received the antibodies, compared with 0.86 per 100 person-years among those who received the placebo. That’s a 75% drop in new cases.

“This is the first study to demonstrate the concept that bnAbs can prevent acquisition of infection,” Corey said during a press conference at the HIV Research for Prevention conference.

However, he added, “We’re going to need cocktails of antibodies.

Maybe that shouldn’t be surprising, since we’ve needed cocktails of drugs [for HIV treatment].”

ALL IMAGES: ISTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY)

Updated Pregnancy and Perinatal Guidelines It’s official: Dolutegravir is the preferred antiretroviral for women with HIV who are trying to conceive. For HIV-negative women, that designation goes to Truvada pre-exposure prophylaxis (PrEP).

These are the key recommendations in the December 2020 update to the Department of Health and Human Services’ Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States.

The update recognizes new findings out of Botswana showing that dolutegravir (sold alone as Tivicay and included in the Triumeq, Dovato and Juluca singletablet regimens) is far less likely than suspected based on earlier data to result in neural tube defects among infants born to women who used the medication around the time of conception. This moves dolutegravir from an alternative to the preferred option.

For HIV-negative women looking to become pregnant with HIV-positive partners, the guidelines list Truvada (tenofovir disoproxil fumarate/emtricitabine) as the recommended PrEPception option across the reproductive life cycle, from preconception to breast feeding.

Descovy (tenofovir alafenamide/emtracitabine) isn’t a preferred option because the FDA approval of Descovy for PrEP excludes people exposed to HIV through vaginal sex.

HIV TREATMENT FOR ALL COULD END THE EPIDEMIC FASTER By reallocating $37.5 billion in public and private funds, new HIV cases could drop from 37,000 a year to just 2,000 by 2027. That’s a 94% reduction, according to a new modeling study from the Centers for Disease Control and Prevention (CDC).

Doing so would require scaling back programs for pre-exposure prophylaxis (PrEP) and dramatically expanding HIV treatment to every U.S. resident living with the virus, demonstrating the power of an undetectable viral load to prevent transmission.

With no change in the annual public and private spending or how those funds are allocated for HIV care and prevention, another 330,051 people would be expected to be diagnosed with HIV by 2027—an average of 33,100 new cases per year, which is lower than the current HIV diagnosis rate, which hovers around 37,000 per year.

If current funding were reallocated from PrEP for high-risk heterosexuals to gay and bisexual men and significantly increased for syringe services, among other things, HIV acquisition could drop by 69% by 2027, to an average of 10,400 new cases per year. In this scenario, not every U.S. resident living with HIV would receive treatment.

But by allocating six times more funding for linkage-to-care programs, increasing funds for antiretrovirals by one and a half times and doubling funds to help people maintain viral suppression, those rates could plummet to just 2,000 new cases a year, the model suggests.

“The current allocation spends a large proportion of prevention funding on testing low-risk heterosexuals and on PrEP for high-risk [gay and bisexual men],” Stephanie Sansom, PhD, of the CDC’s Division of HIV/AIDS Prevention, and colleagues wrote. “Models comparing interventions show that [PrEP] is less effective in reducing new HIV cases nationally than ensuring that those already infected cannot transmit to others by achieving and maintaining viral suppression with effective [antiretroviral therapy].”

poz.com APRIL/MAY 2021 POZ 21

BASICS

BY LIZ HIGHLEYMAN

VIRAL HEPATITIS

H

EPATITIS, OR INFLAMMATION of the liver, can be caused by viruses, heavy alcohol use, fat accumulation in the liver and several other factors. Over time, this inflammation can lead to the buildup of scar tissue (fibrosis) and impaired liver function.

Hepatitis A virus is transmitted through food or water contaminated with feces. It causes an acute form of hepatitis, meaning it doesn’t lead to chronic, or long-term, infection. Hepatitis A usually resolves on its own with supportive care, but in some cases, it can cause fatal liver disease. A person who has had hepatitis A once cannot get the virus again.

Hepatitis B is a blood-borne virus that can be transmitted through sex, from mother to child during pregnancy and via shared needles or personal items, such as razors. About 90% of people infected as infants develop chronic disease, but most adults clear the virus naturally and recover. Hepatitis B can be treated with antiviral drugs or interferon, but it is seldom cured. A person who has had hepatitis B once cannot get it again.

Hepatitis C is another blood-borne virus that is transmitted in similar ways,

22 POZ APRIL/MAY 2021 poz.com

although sexual transmission is less common. About a quarter of adults clear the virus naturally, but the rest develop chronic infection. Hepatitis C can be treated with well-tolerated direct-acting antiviral medications for two or three months, and almost everyone can be cured. However, it is possible to acquire hepatitis C again after natural clearance or successful treatment.

Hepatitis D, or delta, is a defective virus that occurs only in people with hepatitis B, and it is transmitted in similar ways. Coinfection with both hepatitis B and D can lead to more severe liver disease. There are no approved treatments for hepatitis D, but controlling hepatitis B with antivirals can keep it in check.

Hepatitis E, which is uncommon in the United States, is transmitted through contaminated food or water, like hepatitis A. It usually resolves on its own without treatment, but it can cause more serious illness in pregnant women and immunocompromised people.

Regardless of the cause, hepatitis symptoms can include fatigue, nausea, loss of appetite, pain in the upper right abdomen, yellowing of the skin and whites of the eyes (jaundice), dark urine, pale stools and elevated ALT

and AST liver enzymes.

All types of viral hepatitis can be detected using blood tests for antibodies against the specific virus. Hepatitis B screening is recommended for anyone at risk, including people who inject drugs, men who have sex with men, people who have sexual or household contact with a person with hep B, people living with HIV, pregnant people, those with potential occupational exposure and those born in countries with a high prevalence of the virus.

Hepatitis C screening is recommended at least once for all adults.

Many people with hepatitis B or C have no early symptoms and are not aware that they carry the virus. However, they can still transmit the virus even if they feel well. Over years or decades, chronic infection can lead to serious liver disease, including cirrhosis, liver cancer, liver failure and the need for a liver transplant.

Hepatitis A and B can be prevented with vaccines. Vaccination is recommended for all babies and for adults at risk. Combination vaccines can prevent both hepatitis A and B, and preventing hepatitis B also prevents hepatitis D. There is no vaccine for hepatitis C, but this is an active area of research. Q

(HEPATITIS C VIRUS) ISTOCK

If left untreated, hepatitis B and C can lead to cirrhosis and liver cancer.

The Philadelphia Trans Wellness Conference is Going Virtual

Join the largest free trans-specific health conference in the world for its first virtual conference.

featuring Join hundreds of others attendees and professionals in live virtual sessions for both our general track and professional track. Learn the latest in transgender health and wellness.

Visit trans, non-binary, and gender-variant vendors, health and wellness organizations, and other vendors in our first ever virtual exhibition. Visit all of the virtual booths in attendance during the conference!

www.transphl.org PZA529068.pgs 03.05.2021 17:17

ESA

RAISING HIV AWARENESS AMONG YOUNG PEOPLE YOUTH ADVOCATES SEEK INCLUSIVE SEX EDUCATION FOR THEIR PEERS.

BY ALICIA GREEN

“Because I thought I was in a monogamous relationship, I didn’t think I needed to get tested,” says Moore, who is now 26 and works as an HIV advocate in Dallas. “But I did it to lead by example so that my friends would get tested as well.”

After receiving an oral swab, Moore got his results in 15 minutes. To his surprise, he tested HIV positive. “I kind of spaced out,” he recalls. “I just remember [the person who told me] saying, ‘You should get blood work done.’”

24 POZ APRIL/MAY 2021 poz.com

When Moore went to a clinic for blood work, his results were the same. A doctor confi rmed his status and left him alone in his office to come to terms with the news.

“I remember looking out through the window in the doctor’s office,” Moore says. “There were these little butterfl ies on the windowpane. I remember wishing that I was one of those butterfl ies and I could just fly away.”

MOORE’S STORY IS A COMMON ONE. IN THE UNITED STATES, NEARLY 45% of young people between ages 13 and 24 who are HIV positive don’t know they are living with the virus, according to the Centers for Disease Control and Prevention (CDC).

Inadequate sex education, low HIV testing rates and stigma are a few of the reasons some young people are unaware of their status.

LYNN LANE

D

EONDRE MOORE HAD NO IDEA THAT A THURSDAY NIGHT out with friends in Houston in 2014 would end with him testing positive for HIV. At 19 years old, the African-American college student was hanging out at a local hot spot when he noticed the venue was offering HIV testing.

Deondre Moore is a youth advocate living with HIV in Dallas.

ACCORDING TO A 2019 PAC SURVEY, MANY MILLENNIALS AND members of Generation Z across the United States lack extensive knowledge about sexual health, HIV and U=U. Survey findings also revealed disparities in HIV awareness and education among African-American youth. An estimated 80% of HIV-negative Black young adults reported being highly confident they aren’t at risk of contracting HIV, despite research showing this population faces the greatest risk.

When it came to U=U, 31% of young Black people with HIV believed that being undetectable meant they were incorrectly diagnosed and didn’t have HIV. “As Dr. Anthony Fauci says, ‘U=U is the foundation of ending this epidemic,’” Moore explains, referring to the director of the National Institute of Allergy and Infectious Diseases.

“It’s liberating and removes HIV stigma.”

With these findings, Moore helped develop the campaign “Owning HIV Presents: HIV in Young Black America” in collaboration with the drug company Merck. Initially, the project was supposed to address HIV-related disparities and raise

26 POZ APRIL/MAY 2021 poz.com

awareness on historically Black college A Human Rights Campaign ad; and university campuses. However, due to Armonte Butler COVID-19, it became a virtual webinar to (left) and J. Maurice discuss HIV in the young Black community.

McCants“When you don’t provide the education Pearsall to folks and continue with misconceptions and myths, that’s what folks are going to believe,” Moore explains. “But when you start to debunk those myths and misconceptions and provide the necessary education, that’s when we begin to change the narrative and trajectory of what HIV looks like.”

Moore is intentional about the messaging and language he uses when it comes to reaching young people of color about HIV and U=U. Through his role at PAC, he selects specific partners around the country who can help ensure that youth feel empowered to get on treatment and to take control of their sexual lives. “HIV does not have to be a death sentence,” Moore says. “You can live a healthy, happy and long life—and date—with HIV.” ONE OF PAC’S PARTNERS IS THE HUMAN RIGHTS CAMPAIGN (HRC), a national LGBTQ advocacy group that understands the importance of promoting HIV awareness and sex positivity among young people.

“It’s OK to have sex,” says J. Maurice McCants-Pearsall, MBA, director of HIV and health equity at HRC. “Who you have sex with is nobody else’s business. Just as long as when you’re having sex, you’re doing everything that you need to protect your body.”

In 2020, HRC created the “My Body” campaign to raise

(“MY BODY” CAMPAIGN) COURTESY OF HRC; (BUTLER AND MCCANTS-PEARSALL) COURTESY OF SUBJECTS

At the time of his diagnosis, Moore didn’t know all the facts about HIV. He just knew that he needed to do everything possible to live.

“I didn’t know enough then because in Texas they don’t teach comprehensive or inclusive sex education, which is part of the work I’ve been doing to change that narrative,” says Moore, the U.S. partnerships and community engagement manager at Prevention Access Campaign (PAC).

PAC is the health equity initiative behind the concept of Undetectable Equals Untransmittable (U=U), meaning a person with HIV who achieves and maintains an undetectable viral load cannot transmit the virus to others through sex.

Inclusive sex education is vital to reducing HIV rates and raising awareness among youth. Young people account for 21% of new HIV diagnoses annually, and most of those cases (83%) are among men who have sex with men (MSM). What’s more, Black adolescents account for 42% of all new diagnoses among young MSM. Transgender youth are also at greater risk for HIV. Despite scant data regarding HIV among transgender people, including trans youth, CDC findings reveal that trans women—especially Black and Latino trans women—have alarmingly high rates of HIV. Young trans people could face similar risks.

“Our state legislatures are going into session this year,” Moore says. “My plan is to work with state legislatures on the LGBT caucus to start enforcing that school boards of education begin to implement comprehensive and inclusive education.”

It won’t be an easy feat in a state like Texas, where people, Moore says, are more closed-minded and often unwilling to embrace the LGBTQ community. “But it’s imperative that we get that, because it was having sex with another male that resulted in my HIV diagnosis,” Moore says.

HIV awareness and education among Black and Latino LGBTQ people between ages 16 and 35. “My Body” also encourages young adults to embrace their bodies and sexuality.

“We developed a campaign that laid out the numbers as it relates to those who are disproportionately impacted by HIV,” McCants-Pearsall says. “But in addition to that, we also wanted to provide safer-sex tips because we understand that people are still having sex during the COVID-19 pandemic.”

To ensure that young people were practicing safer sex, HRC offered free “My Body” gift boxes containing condoms, lubricant, a pill case, a face mask, hand sanitizer and other goodies.

The boxes also included fact sheets and how-to instructions.

More than 1,000 “My Body” boxes were requested, according to McCants-Pearsall. HRC fulfilled all orders.

For McCants-Pearsall, who tested HIV positive as a young adult, the campaign is personal. He remembers having no such resources as a young Black man.

“I was told not to talk about my sexuality,” he recalls. “No one had conversations about sex with me. It caused me to be misinformed as it relates to sex and sexual health.”

Now McCants-Pearsall wants to ensure that young Black and brown people exercise agency over their own sexual health. His goal is to mitigate HIV risk among this demographic by helping expand access to prevention.

“I was told HIV was a death sentence,” he says. “But every year, I get to see one more year around the sun. So live your best life. Live it stigma-free and without reservation.”

LIVING STIGMA-FREE BEGINS WITH SHARING ONE’S STORY AND experiences, says Armonte Butler, senior program manager of LGBTQ health and rights at Advocates for Youth, an organization based in Washington, DC, that partners with young people in the fight for sexual health, rights and justice. It is responsible for National Youth HIV/AIDS Awareness Day (NYHAAD), which is observed every year on April 10.

“You are your best advocate,” says Butler, who is 25 years old, African American and HIV negative.

For most young people, stigma determines whether they will get tested for HIV or seek treatment. And it’s not just self-stigma that affects this population. Negative health care experiences also contribute to young people’s fear of addressing concerns around HIV and other sexual health issues.

When doctors shame young people for their sex life or risky behaviors, it pushes youth further away from seeking the help they need to live healthier lives.

“If I was at a facility that is five minutes away from my house, but I experienced something stigmatizing, I might have to go to a city that is more inclusive and 30 minutes away,” Butler says. “That includes money and travel, but I’m probably not going to do that because of that one experience I had.”

Butler believes doctors don’t show enough appreciation and encouragement to young people for taking charge of their health and seeking care. If they did so, perhaps more young people with HIV would start on or better adhere to treatment.

“Any negative interaction could mean that folks aren’t going to return or be interested in returning,” Butler explains.

“And if they’re going to return, it’s going to take some type of motivation to get them to go back.”

HRC’s McCants-Pearsall encourages young people to have open and honest conversations with their health care providers. “If they can’t have a conversation with you about your sexual health, then you need to find a new doctor,” he says.

He wants young people to make the most of available resources, whether that means frequenting local health departments or community-based organizations.

ONE UNDERUTILIZED WAY YOUTH CAN TAKE ADVANTAGE OF HEALTH care services is to ask providers about pre-exposure prophylaxis (PrEP), a daily pill that can prevent HIV-negative people from contracting the virus. “PrEP is a key HIV prevention tool, just like condoms,” Butler says. “It’s a remarkable tool that has allowed people to have another option.”

Daily oral Truvada (tenofovir disoproxil fumerate/emtricitabine) is estimated to be about 99% effective among men who have sex with men and about 90% effective among heterosexual men and women; indeed, further studies may reveal the latter figure to be even greater. New options are being studied, including a monthly injection.

Despite PrEP’s remarkable ability to reduce the risk of HIV transmission, most young people still don’t know about or have access to the medication, according to Butler.

In addition, PrEP use continues to be stigmatized.

“All those stigmatizing ideas that people have about birth control are the same ones they have about PrEP,” Butler explains. “It’s the same thing when thinking about access.”

Many young people aren’t aware of PrEP because their providers may not discuss the pill with them. In addition, other barriers, such as cost and availability, might prevent youth from accessing PrEP. For those in the South, especially in rural areas, PrEP can be hard to come by. Even college students in these communities don’t have equal access to PrEP. “There are some colleges that offer PrEP, but there are some that don’t even offer condoms,” Butler says. Those that don’t provide these services tend to be religious institutions that push for abstinence rather than promote safer sex among their students.

Butler believes that college campuses can play a crucial role in offering students medically accurate and inclusive sexual health information and services, such as PrEP. “Colleges have the opportunity to streamline the information and make it concrete and tangible for all students,” he says.

As a result of COVID-19, Butler is working with young people on college campuses trying to ensure that PrEP is offered through school telehealth services.

“What we really need right now is targeted or prioritized outreach campaigns that are really educating folks about PrEP,” Butler says. “But also making sure that sex education includes information about PrEP.” Moore echoes those sentiments. “It all goes back to education,” he says. “Providing education and ensuring that folks have the tools they need to overcome HIV is how we change the trajectory of HIV.” Q

poz.com APRIL/MAY 2021 POZ 27

A SHOT in the

DARK

WE GOT COVID-19 VACCINES IN RECORD TIME. WHY ARE HIV VACCINES TAKING SO LONG?

BY LIZ HIGHLEYMAN

IN MARCH 2020, AS A NEW PANDEMIC SWEPT ACROSS THE GLOBE, National Institutes of Allergy and Infectious Diseases (NIAID) director Anthony Fauci, MD, predicted that a COVID-19 vaccine could be available in 12 to 18 months. A year later, three highly 28 POZ APRIL/MAY 2021 poz.com

effective vaccines are authorized in the United States, and over 50 million Americans have received their first dose.

In April 1984, Health and Human Services Secretary Margaret Heckler predicted an HIV vaccine could be ready for testing in two years; 37 years later, we’re still waiting.

Many people have speculated that if the same level of focus and resources we’ve seen with COVID-19 had been devoted to HIV, we’d likely have an HIV vaccine by now.

But while the early response to AIDS was painfully— some would say criminally—slow, that’s no longer the case.

A generation of scientists have devoted their careers to HIV science, and HIV now receives more research funding than most diseases.

“My annual budget is $1 billion a year,” says Carl Dieffenbach, PhD, director of the NIAID’s Division of AIDS. “Over the course of 20 years, it’s been about $15 billion. Easily a third of that has gone to HIV vaccine research.”

(ILLUSTRATION) DORIOT KIM; ALL IMAGES: ISTOCK

A WILY FOE Yet brainpower and money have not been enough. Unlike the quick home runs in COVID-19 vaccine development, dozens of HIV vaccine candidates have shown promise in laboratory and animal studies, only to fail in clinical trials.

There are many reasons why it’s harder to develop vaccines for HIV than for the SARS-CoV-2 coronavirus.

First, a brief immune system overview. The innate immune system kicks in first, launching a nonspecific attack against invaders. Then, the adaptive immune system comes into play to respond to specific pathogens. B cells produce billions of different antibodies, which bind to foreign proteins called antigens like a lock and key. CD4 helper T cells coordinate the immune response, while CD8 killer T cells attack invaders.

After the threat subsides, a subset of memory B cells and T cells remain on guard to fight the same invader in the future.

Preventive vaccines teach the immune system to fight an invader it hasn’t yet encountered. Traditionally, they contain a weakened version or pieces of a pathogen. A vaccine can either confer sterilizing immunity, which prevents a pathogen from gaining a foothold in the body, or it can work soon after infection to stop the pathogen from causing illness.

HIV mutates frequently as it replicates, producing countless variants. Over time, distinct HIV subtypes have emerged in different regions of the world—for example, subtype B in North America and subtype C in Africa. What’s more, the HIV spike protein, which attaches to cells, is covered with sugar molecules that provide camouflage.

“HIV is a very wily adversary,” says Susan Buchbinder, MD, director of Bridge HIV at the San Francisco Department of Public Health and a member of the HIV Vaccine Trials Network (HVTN) executive committee. “It mutates rapidly, so there’s quite a bit of variability. It has a glycan shield that protects the viral envelope. And once it becomes established, it creates a chronic, lifelong infection that can’t be cleared.”

But perhaps most important, people usually don’t develop strong natural immunity against HIV. A small number, known as elite controllers, do mount a robust immune response, but this is rare, and researchers have not figured out how to mimic it in others.

People with HIV do produce antibodies, but they usually target parts of the virus that are highly variable, so they don’t recognize new mutations. A few people naturally produce broadly neutralizing antibodies (bnAbs) that target hidden, conserved parts of the virus that don’t change much.

Researchers are developing bnAbs for HIV prevention and treatment, but the holy grail is a vaccine that can teach the immune system to produce its own bnAbs. “A vaccine generally mimics the body’s natural immune reaction to a virus, which usually results in it being cleared,”

poz.com APRIL/MAY 2021 POZ 29

Fauci says. “But with HIV, it doesn’t. So a vaccine has to elicit an immune response that’s better than nature, and that’s hard to do.”

MULTIPLE APPROACHES Many strategies have been explored in the quest for an HIV vaccine. The earliest candidates took a traditional approach, injecting viral proteins to trigger antibody production.

AIDSVAX, the first vaccine tested in Phase III clinical trials, contains gp120 envelope proteins from different HIV strains. In 2003, researchers reported that the vaccine offered no significant protection compared with a placebo, and there was no difference in viral load among those who did become infected.

Some researchers then turned to T-cell strategies. Although using weakened HIV is too dangerous, other viruses can be engineered to carry HIV genes or proteins to trigger T-cell immunity.

The Phase IIb STEP trial (HVTN 502) evaluated a vaccine that uses an inactivated adenovirus type 5 common cold virus to deliver three subtype B HIV proteins. After early studies showed that the vaccine triggered HIV-specific T-cell responses, STEP enrolled more than 3,000 volunteers in North America, South America and Australia.

But the study was halted ahead of schedule in 2007, after an interim analysis found that the vaccine did not reduce the risk of acquiring HIV. Even worse, uncircumcised men and people with higher levels of preexisting antibodies against adenovirus 5—which is common worldwide—were more likely to contract the virus. The Phambili trial (HVTN 503), which tested a similar vaccine with subtype C HIV proteins in South Africa, was also discontinued.

As with HIV treatment, many experts thought a combination approach would work better, using one type of vaccine as a primer and a different type as a booster.

The RV144 trial in Thailand tested a modified version of AIDSVAX plus ALVAC-HIV, which uses a canarypox vector to deliver DNA for HIV proteins. This was a controversial approach, since neither component worked well alone. But in 2009, researchers reported that this prime-boost combination reduced new infections by 31%—the first, and so far only, direct evidence that a vaccine can prevent HIV. The RV144 results left many questions unanswered and sent researchers back to the drawing board to design modified

Carl Dieffenbach, PhD (left), and Susan Buchbinder, MD

vaccine components and delivery methods.

The Uhambo trial (HVTN 702), which enrolled more than 5,400 men and women in South Africa, tested ALVAC-HIV plus a gp120 protein vaccine, both adapted to HIV subtype C. This study was halted in February 2020 after an interim review found that the HIV infection rates were similar in the vaccine and placebo groups.

The closure of Uhambo leaves just —Anthony Fauci, MD two large vaccine trials underway: Imbokodo (HVTN 705) and Mosaico (HVTN 706). Both are testing a primer vaccine dubbed Ad26.Mos4.HIV that uses an adenovirus type 26 vector. After the failure of STEP, researchers turned to a less common adenovirus that most people have not yet been exposed to. The virus carries a computer-designed mosaic of antigens derived from multiple HIV strains found around the world.

A set of preparatory studies tested Ad26.Mos4.HIV plus various boosters, finding combinations that induce strong antibody and T-cell responses. One of them showed that the best regimen was 67% effective at protecting monkeys exposed to SIV, HIV’s simian cousin.

Imbokodo, started in 2017, has recruited more than 2,600 young women at high risk for HIV in southern Africa. Mosaico, started in 2019, aims to recruit 3,800 cisgender gay and bisexual men and transgender people in North America, South America and Europe. Participants will receive either four injections of Ad26.Mos.HIV plus two gp140 protein booster shots or an equal number of placebo injections.

After hitting some snags in 2020 due to COVID-19, Imbokodo is now fully enrolled, and Mosaico has resumed recruitment. Results are expected in 2022 and 2024.

HIV vaccine trials have always offered condoms and riskreduction counseling, but pre-exposure prophylaxis (PrEP) adds a new wrinkle. It would be unethical to deny participants proven prevention tools, but they make it harder to tease out the effects of a vaccine. Prospective Mosaico participants will be offered PrEP, and only those who decline will be enrolled. The idea, according to Buchbinder, is that the trial will select participants who are looking for a different kind of prevention method.

A bigger issue is that the availability of effective biomedical prevention and antiretroviral therapy, which prevents HIV

30 POZ APRIL/MAY 2021 poz.com

(DIEFFENBACH, BUCHBINDER) COURTESY OF SUBJECTS

“AN HIV VACCINE HAS TO ELICIT AN IMMUNE RESPONSE THAT’S BETTER THAN NATURE, AND THAT’S HARD TO DO.”

transmission when viral load is undetectable, have led some to question whether expanding access to these might be a better investment than more vaccine research.

(JACOBS) COURTESY OF SUBJECT

HIV LAYS THE FOUNDATION Further back in the pipeline, researchers are exploring novel ways to make HIV vaccines more effective. These include alternative viral vectors such as cytomegalovirus; stabilized versions of the HIV spike protein, known as SOSIP trimers; and naked DNA vaccines delivered with electroporation, a small shock that opens cell membranes.

The messenger RNA (mRNA) technology used in the Pfi zer-BioNTech and Moderna COVID-19 vaccines is also being developed for HIV. One experimental vaccine triggered production of neutralizing antibodies and prevented or delayed SIV infection in monkeys.

Several efforts focus on encouraging the immune system to make its own broadly neutralizing antibodies. Most people possess specialized B cells capable of producing bnAbs, but they’re rare. An approach known as germline targeting uses a series of vaccines to train immature B cells to generate bNAbs. Other researchers are using viral vectors or mRNA to deliver genetic blueprints that instruct other types of cells to build bnAbs, such as VRC01.

The mRNA approach is an example of how basic science can lead to unexpected breakthroughs.

“Advances in HIV vaccine science have literally paved the way for SARS-CoV-2 vaccines,” says Fauci. “What goes around comes around, and I expect this to feed back into HIV vaccine development.”

The success of the Pfi zer-BioNTech and Moderna mRNA COVID-19 vaccines builds on decades of research. And the Johnson & Johnson COVID-19 vaccine employs the same adenovirus platform used in the HIV vaccine being tested in Imbokodo and Mosaico.

“To make a better mousetrap, we have focused on developing really good platforms to deliver viral antigens,” says Dieffenbach. “So the adenovirus vectors, the messenger RNA, direct injection of DNA—all of these platforms got their start in HIV.” Just as HIV research has laid the groundwork for COVID-19 vaccines, lessons learned from the new coronavirus could further the quest for HIV vaccines.

“One thing we’ve seen with COVID is that where there’s a will there’s a way, and you can cut through a lot of the red tape that sometimes bogs down these trials,” says Buchbinder. “We also saw a tremendous outpouring of altruism on the part of study volunteers who wanted to participate in COVID vaccine research. My hope is that this will transfer over to HIV vaccine research. We need more volunteers who are willing to roll up their sleeves and participate.” Q

HIT ME WITH YOUR BEST SHOT Participating in HIV vaccine research can help end the epidemic.

Before he became known as a proponent of preexposure prophylaxis (PrEP), Damon Jacobs, a licensed marriage and family therapist in New York City, put his body on the line to help develop another HIV prevention tool. In 2006, he volunteered for STEP, a study of an experimental HIV vaccine (see page 30).

Jacobs, 49, learned about the trial because his partner at the time was a participant. “It made a big difference that I knew someone who had done it and that he could tell me about his experience,” Jacobs says. He later applied that lesson when he started the PrEP Facts Facebook group in 2013: “You need that personal connection.”

Jacobs received three injections of the vaccine. “The experience was a little scary,” he recalls, “but I was just so grateful to be part of the Damon Jacobs solution.” The drawbacks?

“There were a lot of appointments, and that got a little tedious after a while.” Plus, the vaccine triggered antibody production, so he tests positive on standard HIV screening tests and instead needs HIV RNA tests.

Unfortunately, not long after he got his third shot, the study was stopped ahead of schedule after a preliminary analysis showed that the vaccine did not reduce the risk of contracting HIV. “It was really disappointing, but we had been told that this was possibly going to happen,” Jacobs says. “Every vaccine we take for granted today was the result of clinical trials, many of which failed. I don’t even think failed is the right word. They had to find out what didn’t work to help them find out what did work.”

His advice for people thinking about a vaccine study? “Learn the facts; learn the science. There haven’t really been any adverse side effects among people participating in HIV vaccine trials.

If you care about helping the world and ending HIV, this is a very meaningful way. Literally, your body can help end HIV in our lifetime.”

poz.com APRIL/MAY 2021 POZ 31

HEROES

BY ALICIA GREEN

At age 16, Derek Canas, of Brunswick, Georgia, stood 4 foot 1 and weighed 55 pounds and was much smaller than his peers. For years, his parents voiced concerns about his size, but doctors never seemed alarmed. It wasn’t until 2001, when a medical student suggested he take an HIV test, that Canas learned that he had AIDS. “My only knowledge of HIV at that point was a Nick News episode,” says Canas, referring to the episode of the children’s news program that featured basketball icon Magic Johnson. “I knew the word, knew it was medical and extremely deadly,” recalls Canas, an HIV advocate and a DJ who performs as D-REK. “I found out that I had wasting syndrome and was within months of death,” he recalls of his teen health challenges. “I had no immune system.”

At 3 months old, Canas had open-heart surgery.

He was required to wear a pacemaker and received a blood transfusion. That’s how he contracted HIV. Luckily, Canas was diagnosed before it was too late, and he immediately began treatment. Prior to his diagnosis, Canas was taking a growth hormone.

He grew to only 5 feet, and he continued experiencing problems with his weight.

Now 36 years old, Canas eats between 3,500 and 4,000 calories a day to maintain his weight and try to put on additional pounds. “I know people joke like it’s so difficult to lose weight,” he says. “But it’s equally difficult to gain. I struggle with that daily.”

HIV isn’t his biggest health threat—his heart is.

Canas is now on his fifth pacemaker. His heart has been shocked back into rhythm multiple times.

“My heart is one of those things that can just start acting up,” Canas explains.

In his early 30s, Canas read about people diagnosed with HIV later in life who seemed to be healthy. But that wasn’t the case for him. As a result, he created the #EndTheStigma campaign in the hope that his story could give a voice to people with HIV who didn’t feel seen or heard.

Despite his circumstances, Canas continues to push forward. His diagnosis has helped him take risks, such as becoming a DJ. He has even advocated from the DJ booth. Before the COVID-19 pandemic, he wore his #EndTheStigma campaign shirts and wristbands while deejaying.

“A lot of friends knew my story,” he explains.

“They would explain to people that would come in and might ask a question about it. I’m not a big dude, and it’s clearly visible when you meet me that I have health problems.”

With the help of his street team, Angels and Warriors, D-REK’s goal is to initiate discussions about HIV to educate people and eliminate stigma.

Canas encourages people to read his memoir, Operation D-REK, for a more detailed perspective on his unique life and health.

“You are not the words that are written in the medical folder,” Canas says. “You still get to choose what happens next. You still have the ability to fight and take it on headfirst. It doesn’t matter if every doctor you’ve seen says it’s not possible. I’m proof that you can break every rule in the book.” Q

32 POZ APRIL/MAY 2021 poz.com

Derek Canas raises HIV awareness from the DJ booth.

CHAD DENNIS

Operation D-REK

SURVEY

11

If you haven’t gotten a COVID-19 vaccine, will you get one?

T Yes T No T Maybe 12

Do you think people living with HIV should be prioritized for the COVID-19 vaccine?

T Yes T No

YOU AND COVID-19 More than a year into the pandemic, COVID-19 vaccines are being administered nationwide, but the coronavirus continues to take a toll on all of our lives. POZ wants to know how COVID-19 has affected you and your health.

1

Moderate

What year were you born? __ __ __ __

17

What is your gender?

T Male T Female 18

Are you still experiencing symptoms of COVID-19?

19

Has anyone in your family had COVID-19?

Do you know anyone who has died of COVID-19?

Have you used telemedicine to connect to health care services during the pandemic?

Have you had any difficulty accessing health care services during the pandemic?

T Yes T No 9

Have you had any difficulty refilling your HIV medications during the pandemic?

ISTOCK

T Yes T No T I don’t take HIV meds.

10

Have you gotten a COVID-19 vaccine?

T Yes (Skip to question 12.)

T No

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

20 What is your current level of education?

T Yes T No 8

What is your sexual orientation?

T American Indian or Alaska Native T Arab or Middle Eastern T Asian T Black or African American T Hispanic or Latino T Native Hawaiian or other Pacific Islander T White T Other (Please specify.): ___________________

T Yes T No 7

T Transgender T Other

T Straight T Bisexual T Gay/lesbian T Other

T Severe

T Yes T No 6

Have you experienced stress due to COVID-19?

16

T Yes T No 5

T Fair T Poor

T Yes T No

How were your symptoms of COVID-19?

T

How would you describe your mental health during the COVID-19 pandemic?

T Excellent T Good

Have you had COVID-19?

T Mild 4

14

15

T Yes T No (Skip to question 5.)

3

How much have you struggled during the COVID-19 pandemic?

T A lot T Somewhat T Not at all

How long have you been living with HIV?

T Less than one year T 1–5 years T 5–10 years T 10–15 years T 15–20 years T 20 years or more T I’m not HIV positive.

2

13

T Some high school T Some college T High school graduate T Bachelor’s degree or higher 21

What is your annual household income?

T Less than $15,000 T $15,000–$34,999 T $35,000–$49,999 T $50,000–$74,999 T $75,000–$99,999 T $100,000 or more 22 What is your ZIP code? __ __ __ __ __

Please fill out this confidential survey at poz.com/survey. Or scan or take a photo of your completed survey and email it to website@poz.com.

If you are living with HIV, ask yourself the following questions: Have I lost weight?

Have I lost weight without trying?

Does the change in my weight impact how I feel about myself or my health?

Is my clothing looser than before because I have lost weight without trying?

Have those I know mentioned that my appearance has changed?

Do I have less energy?

Are any of my usual activities more difficult to perform?

Am I exercising less than in the past?

Do I need to take a break more often?

Do I tire more easily after certain activities?

If you answered “yes” to any of these questions, take this questionnaire to your next appointment with your healthcare provider to start a conversation about HIV-associated wasting and to inquire about treatment. Together you can discuss next steps. To learn more about HIV-associated wasting, visit: AmIWasting.com

EMD Serono is a business of Merck KGaA, Darmstadt, Germany ©2020 EMD Serono, Inc. US-NONE-00026

PZA527808.pgs 01.22.2021 18:40

ESA