POZ January/February 2022

A SMART+STRONG PUBLICATION JANUARY/FEBRUARY 2022 POZ.COM $3.99

H E A L T H ,

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In the Limelight Broadway legend André De Shields retakes the stage

H I V

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.

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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 that may have been hidden in your body. 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. Your

healthcare provider will test you for HBV. 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, and may give you HBV medicine.

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: ` Have or have had any kidney or liver problems,

including hepatitis infection. ` Have any other health problems. ` 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.

Tell your healthcare provider about all the medicines you take: ` 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.

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. 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.

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.

GET MORE INFORMATION ` 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, GILEAD, the GILEAD Logo, and LOVE WHAT’S INSIDE are trademarks of Gilead Sciences, Inc., or its related companies. Version date: February 2021 © 2021 Gilead Sciences, Inc. All rights reserved. BVYC0370 04/21

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ZACH LIVING WITH HIV SINCE 2009 REAL BIKTARVY PATIENT

KEEP EXPLORING. 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 Zach’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.

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CONTENTS

EXCLUSIVELY ON

POZ.COM

Charles Sanchez, left, of the digital series Merce, with Broadway icon André De Shields

#ADVOCACY Fighting against HIV and 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 don’t transmit HIV sexually. In addition to keeping people healthy, effective HIV treatment also means HIV prevention.

Go to poz.com/undetectable for more.

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

18 INVITING DEATH TO TEA Broadway legend and long-term survivor André De Shields on life, career, COVID-19 and HIV. BY CHARLES SANCHEZ 24 HOW WELL DO COVID VACCINES WORK FOR PEOPLE WITH HIV? Overall, they’re effective, but some folks are at risk for poorer response. BY LIZ HIGHLEYMAN 28 HISTORY RECLAIMED Race, queerness, art and AIDS resonate in the work of Darrel Ellis. BY TRENT STRAUBE 3 FROM THE EDITOR

12 ASK POZ

The Impossible Dream

Who should get COVID vaccine boosters?

4 POZ Q+A

14 BASICS

St. Louis advocate Maven Lee shares his HIV story while promoting balls, serving runway and starring in the reality series The Kiki Show.

African Americans and HIV

6 POZ PLANET THRIVE SS, an Atlanta-based HIV service provider, launches the THRIVE 365 app for same-gender-loving men of color • Lil Nas X boosts morale and raises HIV funds

10 VOICES AIDS United’s working group of safety net providers says the federal 340B Drug Pricing Program ensures that vulnerable populations access HIV services. Plus, NMAC’s Paul Kawata remembers Michael Hirsch and stresses the importance of peer-provided services.

15 RESEARCH NOTES The first long-acting injectable PrEP may be approved soon • HIV treatment Biktarvy is now available for small children • a second woman appears to have naturally cleared her HIV • fewer people are getting treated for hepatitis C

16 CARE AND TREATMENT

Lost in translation: U=U • race, individual behavior and structural HIV risk • early treatment reduces anal cancer risk • Cabenuva works regardless of weight

32 HEROES Marlene McNeese is a proud ally in Houston and a cochair of PACHA.

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, 157 Columbus Avenue, Suite 525, New York, NY 10023. Periodicals postage paid at New York, NY, and additional mailing offices. Issue No. 257 POSTMASTER: Send address changes to POZ/Smart + Strong, 157 Columbus Avenue, Suite 525, New York, NY 10023. Copyright © 2022 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 AND THIS PAGE (DE SHIELDS) : BILL WADMAN; (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

The Impossible Dream

EDITOR-IN-CHIEF

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I

WAS IN MUSICAL THEATER when I was in high school. I played Mr. Applegate (aka the Devil) in Damn Yankees, Don Quixote in Man of La Mancha and El Gallo (the narrator) in The Fantasticks.

For a few years, I seriously considered becoming a professional actor.

There were plenty of reasons that didn’t happen, but the most pressing was my inability to remember the lines. It took way too long for me to memorize scripts. It’s the same reason why I usually don’t tell jokes.

Some would say it’s because I lack a sense of humor. But really it’s because I can’t remember how to deliver the punch lines.

Our cover subject, André De Shields, thankfully suffers from none of those concerns. The Broadway legend and long-term HIV survivor has a way with words. At 76, the actor, singer, dancer, director and choreographer has been wowing audiences most of his life—and he’s also been living with HIV for over 40 years.

Go to page 18 to read our interview with André conducted by POZ contributing writer Charles Sanchez, who found out firsthand how brilliantly André’s light shines.

We had planned to interview André over a year ago, but COVID-19 got in the way.

All’s well that ends well, as they say. Getting to share his return to the stage starring in the hit Broadway show Hadestown is perhaps an even better story than it would’ve been otherwise. But we could all have done without the trauma of COVID-19.

Indeed, the coronavirus continues to wreak havoc in our daily lives. For those of us living with HIV, there have always been added worries when it comes to SARS-CoV-2, the virus that causes COVID-19. Now that COVID vaccines are widely available, many of us question how well they work for people with HIV. Overall, they are highly effective, but some folks are at risk for poorer response.

Go to page 24 for more.

This special issue dedicated to African Americans also spotlights other Black advocates. Among them are Maven Lee, Marlene McNeese and the late Darrel Ellis.

Maven is the Midwest overseer of the House of Nina Oricci, which was featured in the reality show Legendary. He’s been living with HIV for a decade and has been involved in ballroom and kiki events across the nation.

Go to page 4 to learn more.

Marlene is cochair of the Presidential Advisory Council on HIV/AIDS (PACHA). As a longtime advocate working at the Houston Health Department, she has a front-row seat to the HIV epidemic. Go to page 32 to read about her advocacy goals for PACHA. Darrel was a mixed-media painter and photographer. He died of AIDS-related illness in 1992 at age 33, but the openly gay artist and his work were starting to get recognized. In recent years, his artwork has gained in popularity. Visual AIDS has published a monograph of his artwork. Go to page 28 to learn more about Darrel and view selected works.

To set the stage for the new year, please go to the back of this print issue for our 2022 HIV/AIDS Awareness Days poster.

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 JANUARY/FEBRUARY 2022 POZ 3

POZ Q+A

BY TRENT STRAUBE

Richard Hutchinson, Tori Cooper, Senator Tammy Baldwin, Maven Lee and Keiva Lei Cadena at AIDSWatch

KIKI WITH AN HIV ADVOCATE Maven Lee shares his HIV story while promoting balls, serving runway and starring on reality TV.

T

HE HOUSE AND BALL SCENE IS BACK IN VOGUE. ALTHOUGH they shot to world fame over three decades ago with the documentary Paris Is Burning and Madonna’s megahit “Vogue,” ballroom dance competitions and their communities have returned to the cultural spotlight by way of the reality show Legendary (Megan Thee Stallion is a judge) and the drama Pose, which was set in AIDS-ravaged 1980s and ’90s New York City.

Since balls remain popular among LGBTQ folks of color, the events offer a unique opportunity for HIV outreach. New diagnoses among Black Americans fell 10% between 2015 and 2019. But a closer look at the data reveals disconcerting trends. Gay and bisexual men, for example, accounted for 69% of the total 36,801 new HIV diagnoses in 2019. That same year, Black Americans represented 13% of the U.S. population ages 13 and older but 43% of all new HIV diagnoses. New diagnoses among Black gay and bisexual men ages 25 to 34 increased 12% between 2014 and 2018.

To learn more, we spoke with Maven Lee, 32, an HIV advocate in St. Louis who has been living with the virus for a decade and has been involved in ballroom and kiki events across the nation. (Kiki is a more youth-oriented twist on ballroom.)

Lee is the Midwest overseer of the House of Nina Oricci, which was featured on Legendary and has members in Missouri, Chicago, Detroit and Indiana. You can watch Lee in season 2 of the reality series The Kiki Show, now available (for free!) on Vimeo.

How did you get into HIV advocacy?

I was part of a house here in St. Louis called the House of Efficacy, and it was centered around HIV prevention and outreach more than on walking balls, which is a little bit

4 POZ JANUARY/FEBRUARY 2022 poz.com

unusual. I started volunteering at an HIV organization called Project ARK on behalf of my house, and I started learning about HIV. I ended up getting a job at the organization as a peer advocate.

I thought I knew it all and was protecting myself. I was dating around and things like that, and there was a situation when everything I knew went out the door. I trusted someone, and I was vulnerable, and, honestly, that’s how I ended up becoming positive.

It was an interesting situation, because I was working at an organization that tells you this is what you’re supposed to do [to stay HIV negative] and how you handle situations. But none of that mattered when my feelings and emotions and heart came into the conversation and I trusted someone. I then realized that I had to nuance what I was being taught when I said it to other people because it’s not that simple. We need to speak to folks like they’re real human beings because it’s not as easy as “Protect yourself. Use a condom.” When you

talk from real experience, you start to say things differently.

Did working in the HIV field prepare you for the diagnosis?

Absolutely. At one point, I was disappointed in myself and angry. And folks made me feel this way. They were like, “How dare you make this mistake?

You’re supposed to know better.”

I also felt like me becoming positive opened the door [for me to] be a positive light for so many people. I’m able to live a very healthy life, I’m undetectable and I’m doing well. Who’s to say this was not something I’m supposed to experience?

How long did it take before you started disclosing your status?

When I was told my results, the first thing I did was call my house father and call my grandmother and father—he’s my uncle but raised me as his son. But I don’t think my family understood. They didn’t necessarily judge me, but they haven’t talked about it since.

Like a week later, I participated in a retreat for Black and brown men who have sex with men, and we were all sitting around and sharing information, and for some reason, I felt compelled to say, “Hey y’all, last week, I found out I was positive.” This was 2011. So I disclosed that day. I saw how difficult it was for folks I know who have HIV—the hurt and confusion of having that conversation every time they met someone—so for me, I wanted to get that [over with] immediately. It was a relief to me.

BOTH IMAGES: COURTESY OF MAVEN LEE

You’re also a singer and auditioned for shows like The Voice. Are you open about your status in those situations?

I’ve wondered if my HIV status has caused producers [not to put] me on the shows. I’ve gotten to the last stage of auditions on almost all the singing shows and never get past that round. To be honest, I’ve even been told that sharing my status has cost me certain opportunities in mainstream media. That was a pretty hard thing to hear someone say.

Do you discuss HIV on The Kiki Show?

I do. In the beginning, it’s what they

focus on. There are four others who are HIV positive on the show.

It was filmed in Philly—the first season was in Atlanta, when I lived there— the second season is individuals battling against each other, unlike regular balls, where it ’s house competing against house. And it’s folks from different regions competing in runway, vogue and tag-team performance.

While in Atlanta you also participated in AIDSWatch, the advocacy event for which folks travel to Washington, DC, to meet with elected officials. And you were going by the name Omar?

I identify by various aliases. That year I represented both Georgia and Missouri.

I was particularly excited to be an ally for trans issues that year.

Maven Lee

500 to 700 people in attendance. Our mainstream ballroom events get like 200 to 400 folks.

You organized a ball in St. Louis during Black Pride last summer, and you’re planning events at historically Black colleges and universities. Does this overlap with your HIV work?

I consult with several LGBTQ centers and HIV service centers here in St. Louis.

Some of the HIV agencies like to throw balls because lots of young LGBTQ folks of color come out to balls and pageants, so [it’s an opportunity] to get people tested for HIV and connected to services.

Has the ballroom scene changed during the past decade?

The community is evolving, and stigma

“We need to speak to folks like they’re real human beings.”

Tell us about your history in the balls.

I’ve been walking balls for 12 years. I’m legendary for the category of runway. To be a legend or icon, you have to be deemed as such. I’ve walked in every major ballroom city in the country and abroad. Ballroom is everywhere.

I’ve been to balls in Minnesota, Wisconsin, Kansas, Nebraska, Chicago and Detroit. We have had some very successful balls in St. Louis. We have a mainstream ballroom scene and a kiki ballroom scene—they’re a little bit different. In St. Louis, we treat the kiki ballroom scene more as a practice for the mainstream scene. Our kiki balls are like 50 to 70 people.

In some cities, the kiki scene is almost bigger than the mainstream ball.

New York’s kiki ballroom scene gets

is decreasing. Far more folks are open to sharing their HIV status.

Ballroom is beginning to shift into an era where even folks that are loved on the ballroom floor are being held accountable for stigma, bias and so on.

Have recent television shows such as Pose and Legendary affected the ballroom scene?

Honestly, some folks love the shows, and some in the scene feel the shows are inauthentic. It’s truly a mixture.

As far as influence, Legendary has elevated some folks in ballroom who weren’t known much before the show.

And I think Pose has certainly given some folks in ballroom a reminder of its roots. To me, it really told some honest Black queer stories. ■

poz.com JANUARY/FEBRUARY 2022 POZ 5

POZ PLANET

BY TRENT STRAUBE

Connect and Inspire Black Gay Men

Larry Walker remembers waking up one morning a few years back and logging into Facebook to connect with THRIVE SS, a support group for African-American gay men living with HIV, only to be confronted with random news items about the killing of yet another Black man. “Our members were being triggered and traumatized just trying to get to a space of support,” he realized. And after a mysterious Facebook glitch purged most of THRIVE SS’s members—“We went from 1,000 to 13 and had to rebuild!”—Walker and his fellow members knew they had to create their own network.

THRIVE SS became an incorporated nonprofit in 2015, thanks to funding from a community member who saw value in its online forum. The name stands for Transforming HIV Resentments Into Victories Everlasting Support Services, and the group provides numerous HIV-related services and programs, both online and at its headquarters in Atlanta.

In November, the group launched the THRIVE 365 app, offering samegender-loving men of color nationwide, regardless of HIV status, a way to connect and be affirmed. “Black lives revolve around love and art and connectivity—so much more than just health,” says Walker, the executive director of THRIVE SS who cofounded the group with Daniel Driffin and Dwain Bridges. “The last thing we wanted to do was create an app that hinges only on health.”

On the app, users will find original articles, forums (such as “I Love Beyoncé”), community groups, campaigns and empowering messages. “It’s not just an app to mindlessly scroll through,” Walker notes, adding that THRIVE SS partnered with Rutgers University in New Jersey to develop the app and include stress-reducing aspects. “We are intentional about putting in psychosocial messaging and stories that can bolster your resilience. You’re being fed while you’re inside the app.”

To build a safe and stigma-free space, THRIVE 365 requires potential users to sign up at Thrive365.ThriveSS.org, while online moderators ensure a polite and safe environment. What’s more, some forums and elements of the app are open only to users living with HIV. To be granted access, members must prove their status to the THRIVE SS team. “Our members like this extra level of vetting,” Walker says. “They feel safe and that people are not just there for the tea.”

The app allows users to create profiles and to chat, but at this stage, it isn’t a hookup or matchmaking site—though

6 POZ JANUARY/FEBRUARY 2022 poz.com

Walker envisions incorporating dating aspects into future iterations, hopefully later in 2022.

And yes, you can get connected to local care through the app, regardless of where you live. THRIVE SS has a trained team to help folks deal with myriad needs, including housing insecurity and access to pre-exposure prophylaxis (PrEP, an HIV prevention medication). The staff are trained in what THRIVE SS calls its undetectables support model, which combines A screengrab from online and in-person support with THRIVE 365. The “Judy support”—which, Walker exapp informs and plains, is akin to getting help from a bolsters resilience as it entertains. knowledgeable best friend.

Importantly, support is offered in a celebratory mode while honoring the fact that many folks are not open about their status or private lives. In this sense, “undetectables” also references flying under the radar, not just striving for an undetectable viral load.

THRIVE SS also operates on-the-ground networks in Washington, DC; Nashville; and Oakland, California; and new networks are coming soon to Birmingham, Alabama, and New Orleans. In each of these areas, Walker explains, “we galvanize at least 10 people living there with HIV and give them the tools and skills—as well as the financial support— to do what we did in Atlanta, to create an online Facebook network and train on the app. We’re starting with 10 but want to build up to the hundreds.”

It’ll take a small army to keep up with the diverse needs of growing membership. Already, THRIVE SS spearheads a number of popular programs, including the Silver Lining Project, a group for mature Black men living with HIV; Lotus, a group for women with HIV; Project Grio, a digital storytelling group that produces a documentary each year; and Project Innovate, a program funded by ViiV Healthcare through which THRIVE SS dispenses small grants to young innovators and pairs them with mentors and business owners.

Who would have imagined that all this could spring from a private Facebook group started in 2015? But those original Facebook members wanted to meet in person, Walker recalls, and that grew into founding the nonprofit. Once members started saying they wanted their own app, the launch of THRIVE 365 was inevitable.

“Everything we do,” Walker says, “is driven by our members and is member approved.”

(HAND WITH PHONE) ISTOCK; ALL OTHER IMAGES: COURTESY OF THRIVE SS

THRIVE SS launches an app for same-gender-loving men of color, regardless of their HIV status.

WHEN LIL NAS X PAYS YOU A VISIT “He’s our Beyoncé!”

Lil Nas X shows a whole lot of love for folks with HIV. First, his hit debut album, Montero, which dropped in September, is raising funds for 15 groups fighting the epidemic in the South—over $100,000 so far—then, during a trip to his hometown, Atlanta, the pop star paid a visit to AIDS service organizations, including the Ponce de Leon Center at Grady Health; He Is Valuable, Inc.; and the headquarters of THRIVE SS, which stands for Transforming HIV Resentments Into Victories Everlasting Support Services, a group for same-gender-loving men of color living with HIV. “It was so cool,” recalls THRIVE SS executive director Larry Walker. “It reminded me that yes, money does a lot, but visibility and representation are just as important, as is seeing yourself as real and valid and essential to culture.”

A bona fide Black gay pop icon—“He’s our Beyoncé!” Walker adds—Lil Nas X, né Montero Lamar Hill, ruled the past year with a steady stream of hit singles, controversial videos and click-worthy clapbacks to haters (earning him a spot on the 2021 POZ 100, which celebrates Black HIV advocates). Having someone of that caliber stop by your space and tell you and your staff that you’re doing a great job, Walker says, boosts morale and gives you the energy to persevere.

Lil Nas X visits HIV So what happened during the visit? service provider Folks—from long-term HIV survivors THRIVE SS in to young men new to the community— Atlanta. Top left: formed a big circle and introduced with founders themselves. They shared with Lil Nas X Dwain Bridges, left, details about themselves and also and Larry Walker. how much it meant that a pop star like Inset: Walker. him exists today, and Lil Nas X asked them about the work they do and how HIV impacts the community. “He was truly engaged in what we’re doing,” Walker recalls. “He wanted to learn and know why HIV plagues our community so much.”

For Montero, Lil Nas X created an online baby registry linking each album track to a nonprofit that fans can donate to. The HIV groups on the registry are grantees of Gilead Sciences’ COMPASS Initiative (the name stands for “COMmitment to Partnership in Addressing HIV/AIDS in Southern States”). The registry includes the Arianna Center, Bros in Convo, Central Alabama Alliance Resource & Advocacy Center, Ch-Pier, Compassionate Atlanta, The Counter Narrative, Happy Hippy, The Normal Anomaly, OLTT, Relationship Un-leashed, Samuel DeWitt Proctor Conference, THRIVE SS, Transinclusive Group and What’s in the Mirror?

poz.com JANUARY/FEBRUARY 2022 POZ 7

POZ PLANET

BY TRENT STRAUBE

“We Need Your Donations!”

Lifesaving combination therapy for HIV arrived in 1996. That year also saw the launch of Aid for AIDS, an international organization based in New York City that gathers unused, unexpired meds and distributes them to people living with HIV across the globe who don’t have access to treatment.

Founded by Jesús Aguais, who moved to New York City from Venezuela in 1989 and worked for 12 years at an AIDS program in the now-shuttered St. Vincent’s Hospital, Aid for AIDS has collected over $160 million worth of antiretrovirals and provided them to over 55,000 people in 70 countries.

The nonprofit also accepts and distributes meds for the treatment of comorbidities common among people living with HIV, such as hepatitis C and high cholesterol.

“Recycling unused and unexpired medication is a simple but very powerful way to save lives,” Aguais says. “Because HIV is now considered a chronic disease here in the United States, people actually are not aware of the potential that donating their surplus medication can have.”

The need for donated HIV meds has only grown during the COVID-19 pandemic—donations dropped nearly 70% over

the past two years—and humanitarian crises throughout the world put entire populations at risk for medicine and food shortages.

A campaign to For example, over 6 help Venezuelan million Venezuelans have fled refugees; inset: the country since 2014, and Jésus Aguais Aid for AIDS has been the main supplier of HIV meds, delivering over 500,000 antiretrovirals so far.

What’s more, Aguais says, “Many refugees perform sexual acts for survival. This phenomenon has to be addressed within the HIV response framework.”

Aid for AIDS receives its medications, Aguais says, from “people with HIV, case managers and HIV providers. We also have a very dedicated network of partner organizations that collect medicine donations from their communities and clients for us.”

Visit AidforAIDS.org to learn how you can help and contribute meds. “We need donations,” Aguais says. “We need your surplus medication to save lives.”

EVERYDAY January

February

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

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HIV/AIDS activist JEFF SHEEHY is named to San Francisco’s Board of Supervisors representing District 8, making him the first person living with HIV to serve as a supervisor. (2017)

PLUS

23

AIDS IS EVERYDAY launches on POZ.com. (2017)

Project Inform founder and longtime AIDS activist MARTIN DELANEY dies of liver cancer at age 63. (2009)

31

ANGELINA JOLIE stars in the television film Gia, about the life of supermodel Gia Carangi, who died of AIDS-related causes at age 26. (1998)

8 POZ JANUARY/FEBRUARY 2022 poz.com

7

NATIONAL BLACK HIV/AIDS AWARENESS DAY

13

The HIV Justice Network issues the OSLO DECLARATION ON HIV CRIMINALISATION. The declaration provides a clear road map to ending inappropriate criminal prosecutions for HIV nondisclosure, potential exposure and unintentional transmission. (2012)

17

An HIV-themed episode of THE GOLDEN GIRLS TITLED “72 HOURS” debuts on NBC. The episode centers on how Rose and her roomates deal with waiting for her HIV test results after a possible exposure to HIV through a blood transfusion. (1990)

(AGUAIS) COURTESY OF JESÚS AGUAIS; (VENEZUELA CAMPAIGN) FACEBOOK/AIDFORAIDS; (SHEEHY AND JOLIE) WIKIMEDIA; (TV) ISTOCK; ( GOLDEN GIRLS ) YOUTUBE

Aid for AIDS collects and distributes unused meds.

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

VOICES BLOGS AND OPINIONS FROM POZ.COM

THE 340B PROGRAM

A

s members of AIDS United’s 340B Working Group, we’re working to end the HIV epidemic by the end of the decade. That isn’t fantastical thinking— it is more than possible with today’s medical science.

For those of us living with HIV, there are medicines that can make the virus undetectable in our bodies. In addition to the many personal health benefits of reaching this undetectable level, it also means it’s impossible for us to pass the virus along to others. That’s what’s meant by Undetectable Equals Untransmittable, or U=U. And for those of us who are vulnerable to HIV, there is pre-exposure prophylaxis, or PrEP, a highly effective drug that prevents us from contracting the virus.

However, it isn’t science holding us back from ending the HIV epidemic.

The issue is the same problem that leads to so many terrible health outcomes in our society—systemic barriers to health care that disproportionately harm people of color, people with low incomes, LGBTQ people and people living at the intersections of these identities. These groups have always been the most harmed by the HIV epidemic; 40 years later, that has not changed. But it can.

10 POZ JANUARY/FEBRUARY 2022 poz.com

The AIDS United 340B Working Group is composed of 13 safety net providers working to advance health equity across the country by getting HIV services to the people in communities harmed by these systemic barriers.

Collectively, we provide care and services to over 100,000 people across 11 states and the District of Columbia.

We’re working to make a difference.

And one federal program in particular is helping us do it: the 340B Drug Pricing Program.

The 340B Drug Pricing Program is an essential program that allows eligible HIV service organizations like ours to give our patients living with HIV access to the medicines they need to live long, healthy lives. It allows us to get patients vulnerable to HIV access to PrEP and the testing they need to know their status.

But the funding we get from the 340B discount program allows us to do so much more than that.

What good is a prescription if you don’t have the transportation you need to make it to your doctor appointments?

How can people experiencing homelessness follow a consistent prescription schedule when every day they have to wonder where to get their next meal?

We cannot end the HIV epidemic without services like these that allow

those of us living with HIV to access care. We need transportation. We need nutrition programs. We need assistance finding health insurance. People facing systemic barriers need holistic care and support. We cannot provide these programs without the critical funding the 340B program provides.

Our organizations stretch every last dollar to get people the care they need.

And, with federal resources scarce, a huge percentage of those dollars come from our participation in the 340B program. It is no exaggeration to say that without the 340B Drug Pricing Program, we would be forced to substantially decrease the types of services we provide and the number of people we’re able to welcome through our doors.

Pharmaceutical companies are doing everything in their power to sidestep or outright destroy this program. 340B cuts into their bottom line.

[Clinics obtain steep discounts on meds, leaving them with extra cash.]

But Big Pharma—and the HIV community too—needs to remember how critical the 340B program is to our work and to the efforts to end the HIV epidemic in this country. AIDS United, and its 340B Working Group, will be doing everything we can to preserve this indispensable government program. ■

ISTOCK

In a blog post titled “Ending the Epidemic Requires a Comprehensive Approach to Health Care,” AIDS United’s working group of safety net providers weighs in. Below is an edited excerpt.

MORE THAN WORDS In a blog post titled “Yours in the Struggle,” NMAC executive director Paul Kawata pays homage to the late HIV activist Michael Hirsch, his friend and partner in crime. Below is an edited excerpt.

ISTOCK

“Y

ours in the Struggle” is how I close correspondence. The phrase is more than words—it’s an homage to my friend and partner in crime Michael Hirsch. I moved to Washington, DC, in 1985 to fight an epidemic that was killing my family and friends. To this day, I am not sure why they chose me, a twentysomething kid from across the country who knew nothing of politics. The serendipity of life meant that I had to find the courage to leave the comfort of home in Seattle and jump into the abyss of DC. Michael was one of the first people to take me under his wing. He was the quintessential New York City activist: outrageous, maddening and fun. He was also the first executive director of New York’s People with AIDS (PWA) Coalition and the first executive director of Body Positive. While at Body Positive, Michael came up with the wild notion of peer-provided services. His model using consumers changed the nature of HIV services.

Michael used to infuse meds while doing business at board meetings. He always wanted to remind us that HIV was about real people with real problems. It was because of Michael that I got accepted into the PWA

community. He insisted I attend the organizing meetings that would later give rise to the National Association of People with AIDS (NAPWA).

In those days, we didn’t have email.

Michael would write these long diatribes about life, the movement, his frustrations and joy. They were intimate letters between someone who was dying and someone who would remember. In many ways, those letters were the culmination of his life. He would close each letter with “Yours in the Struggle.”

The call from the hospital. A stranger telling you to come quickly because your friend is about to pass. When I got the call about Michael, I was in Washington and needed to rush to New York. I remember hopping on that shuttle and praying that he would hold on so I could say goodbye. The taxi ride from LaGuardia Airport to St. Vincent’s Hospital was one of the longest in my life. As I rushed down the hall, I saw Michael’s mother and sister sobbing.

My heart sank. I thought he was gone.

Just then, Rona Affoumado came up to me and said, “Oh God, you just made it. The family has just decided to pull the plug.” I wasn’t too late. Rona escorted me into Michael’s room. It was all pumps and whistles from the many machines trying to keep him

alive. It had that funny smell, the smell of death. Michael had been unconscious for the last 24 hours. The morphine had stopped the pain and allowed him to sleep. As they turned off the machines, there was an eerie silence. I held Michael’s hand and told him how much I loved him.

Just then, his eyes opened, and a single tear rolled down his cheek...and then he was gone. The nurse would later tell me that his opening his eyes was probably just a reflex, but to me, it was a sign. It was Michael saying goodbye. I close my letters and emails with “Yours in the struggle” to honor his life and the lives of so many we lost.

Our work has moved far from those early days. While we talk about patientcentered services, the reality is far more of a “medical model.” Why have so many people living with HIV fallen out of care and services? The Biden-Harris plan to end the HIV epidemic must prioritize retaining people in services.

I believe that starts with Michael’s radical notion of peer-provided services. Our movement needs to prioritize hiring people living with HIV to deliver HIV services. They have a unique understanding of the stigma and discrimination that continue to challenge too many people living with HIV in America. ■

poz.com JANUARY/FEBRUARY 2022 POZ 11

ASK POZ WELLNESS TIPS FROM POZ.COM

WHO SHOULD RECEIVE COVID-19 VACCINE BOOSTERS? Health officials say all adults could potentially benefit from an additional shot.

12 POZ JANUARY/FEBRUARY 2022 poz.com

those with advanced or untreated HIV. Some people with suppressed immune function do not produce enough antibodies after the first two doses. For some, a third dose does the trick, but others are still not fully protected.

The FDA and CDC later went further, recommending Pfizer-BioNTech and Moderna boosters for people ages 65 and older, younger adults with underlying health conditions and those at high risk for exposure due to their work or living situation as well as for anyone who received the J&J vaccine. Finally, on November 19, the agencies recommended boosters for all adults six months after the last Pfizer or Moderna shot or two months after the J&J shot. People do not need to get the same vaccine brand as a booster.

Experts disagree about whether most healthy younger adults need boosters. An additional vaccine dose raises antibody levels and reduces hospitalization in older people, but protection against severe disease seems to be holding up

well for younger people after two doses.

On a public health level, boosters can help curb transmission, but the increase in antibodies after a booster may also last only a few months.

It is not yet clear whether people will need boosters every year or even every six months. Some experts think that because the initial Pfizer-BioNTech and Moderna shots are given so close together (three or four weeks, respectively), a third dose with longer spacing could lead to stronger immunity and frequent boosters won’t be necessary.

New types of COVID-19 vaccines may be an option in the future. Current boosters are an extra dose of the same vaccines, but researchers are working on new vaccines tailored to the Delta variant and others that would work against multiple variants or different coronaviruses. Scientists are also testing nasal vaccines, which produce antibodies in the nose, in the hope that they will better prevent infection and transmission.

—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

N

OW THAT A MAJORITY OF Americans have received their initial COVID-19 vaccines, attention has turned to boosters. Two main factors determine whether additional doses are needed: Do the original vaccines still work against current SARS-CoV-2 variants? Does immunity wane over time?

The three vaccines authorized in the United States, from Pfizer-BioNTech, Moderna and Johnson & Johnson, remain active against the predominant Delta variant. However, while they still provide good protection against severe disease, hospitalization and death, they are less effective at preventing infection.

Immunity against SARS-CoV-2, either after infection or vaccination, does wane over time. But while antibody levels begin to decline after a few months, memory B cells are left behind to produce more antibodies if the virus is encountered again. T cells also play a role in fighting SARS-CoV-2.

In August 2021, the Food and Drug Administration (FDA) authorized and the Centers for Disease Control and Prevention (CDC) recommended an additional Pfizer-BioNTech or Moderna vaccine dose for immunocompromised people, including organ transplant recipients, people being treated for cancer and

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

BASICS

BY LIZ HIGHLEYMAN

AFRICAN AMERICANS AND HIV

T

HROUGHOUT THE UNITED States, Black people bear the greatest burden of HIV. While African Americans make up 13% of the U.S. population, they account for 42% of all new HIV diagnoses, with a total of about 15,300 new cases reported in 2019, according to the Centers for Disease Control and Prevention (CDC).

Stated another way, Black people are about eight times more likely than white people and about twice as likely as Latinos to be diagnosed with HIV. Of the estimated 1.2 million Americans currently living with HIV, about 40% are Black.

Among Black men, those who have sex with men account for the largest proportion of new HIV diagnoses. Just over a quarter of all newly diagnosed people in 2018 were Black gay, bisexual and same-gender-loving men. What’s more, over half of newly diagnosed young gay and bi men ages 13 to 24 are African American.

Black women make up about 60% of all new HIV diagnoses among women; their most common risk factors are heterosexual contact and injection drug use. Adequate data are lacking for transgender people, but Black trans women appear to have a disproportionately high HIV rate.

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The good news is that HIV diagnoses have fallen in recent years, dropping by 6% among Black men and 10% among Black women between 2014 and 2018.

New diagnoses have fallen for all age groups except young adults ages 25 to 34, who saw a 7% rise. HIV-related mortality has also declined, and HIV is no longer one of the top 10 causes of death for Black men or women.

The CDC estimates that six out of seven African Americans living with HIV have been tested and are aware of their status. Testing is important because people who know their status can start antiretroviral treatment, which halts disease progression and prevents HIV transmission, as people who achieve an undetectable viral load do not transmit the virus through sex.

Unfortunately, compared with HIV-positive people overall, African Americans are less likely to receive HIV care (63%), remain in care (48%) and achieve viral suppression (51%). These metrics are somewhat better for Black gay and bi men specifically (75%, 56% and 61%, respectively). African-American people are also less likely than whites to be taking pre-exposure prophylaxis (PrEP) to prevent HIV. While HIV does not progress faster among African Americans, and antiretro-

viral treatment is equally effective for this group, Black people are less likely than white people to receive adequate health care. Reasons include a higher poverty rate and a lower likelihood of having health insurance compared with the overall U.S. population.

In addition, African Americans are at greater risk for other health problems that can make managing HIV more difficult, including sexually transmitted infections, heart disease, kidney disease and diabetes.

Racism, stigma, homophobia and distrust of the health care system can negatively impact risk behavior, knowledge of HIV status, HIV care and other services for many African Americans.

Black people are also more likely to experience homelessness, incarceration and criminalization related to their HIV status.

Many AIDS service organizations offer assistance and programs specifically for Black people living with HIV. The CDC’s high-impact prevention approach aims to focus efforts and resources in communities with the greatest burden. The “Ending the HIV Epidemic in the U.S.” plan prioritizes more than 50 jurisdictions with high HIV rates, many of which are home to large African-American populations. ■

ISTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY)

Black communities are disproportionately affected by HIV and AIDS.

RESEARCH NOTES

BY LIZ HIGHLEYMAN

PREVENTION

TREATMENT

CURE

CONCERNS

Disparities across states in pre-exposure prophylaxis (PrEP) use appear to have worsened over time, according to a recent study.

Truvada (tenofovir disoproxil fumarate/emtricitabine) was first approved for HIV prevention in 2012, but states did not embrace it at the same pace. Some, including Massachusetts, New York and Connecticut, were early adopters, while others took a wait-and-see approach. Researchers used PrEP prescription data from AIDSVu.org and estimates from the Centers for Disease Control and Prevention of the number of people who could benefit from PrEP. The states with the lowest uptake in 2014—Wyoming, Montana, Alaska, Indiana and Idaho—started an average of 3% behind early adopters, and that disadvantage grew as they tried to catch up. Between 2014 and 2018, PrEP use rose by 17% in the Northeast, 9% in the Midwest and 7% in both the South and the West. By 2018, PrEP use in New York—the number one state—had increased by nearly 30%, but the number edged higher by only 2% in Wyoming.

Biktarvy, which has become a popular single-tablet HIV regimen since it was approved for adults in 2018, is now available for small children. Biktarvy, from Gilead Sciences, is a oncedaily pill containing the integrase inhibitor bictegravir, tenofovir alafenamide and emtricitabine. In October 2021, the Food and Drug Administration (FDA) approved the all-in-one pill for children who weigh between 14 and 25 kilograms, or about 30 to 55 pounds; 30 pounds is a typical weight for a 2-yearold child. The small pill contains lower doses of the three medications, taking into account children’s lower weight. The FDA approved Biktarvy both for children starting treatment for the first time and for those who already have an undetectable viral load on their current therapy and wish to switch to a new regimen.

Approval was supported by a study of 22 children, 91% of whom maintained viral suppression after six months on the pill. No new adverse events or laboratory abnormalities were observed, making the treatment as safe for children as it is for adults.

A second woman appears to have eliminated HIV naturally and may even be considered cured. Last year, Xu Yu, MD, of Massachusetts General Hospital, and colleagues reported that Loreen Willenberg, dubbed “the San Francisco Patient,” appears to be cured without a stem cell transplant. Willenberg has maintained control of HIV for decades without antiretroviral therapy. The researchers were unable to find any intact HIV blueprints in more than 1.5 billion of her blood and gut cells, suggesting that her immune system may have eliminated the viral reservoir. Now, Yu’s team has reported that a second woman, “the Esperanza Patient,” who received antivirals for only six months during pregnancy, had no intact viral genomes in more than 1.19 billion blood cells and 500 million placenta tissue cells. Yu suggests that a specific type of killer T-cell response common to both patients may be driving these outcomes. If these immune mechanisms can be better understood, researchers may be able to develop therapies that mimic them.

The number of people treated with direct-acting antiviral (DAA) therapy for hepatitis C has steadily declined, reaching a low point in 2020. According to the IQVIA prescription claims database, 843,329 people in the United States started treatment from 2014 through 2020. Just over 109,000 were treated in 2014—the first year nextgeneration DAAs were available—rising to more than 164,000 in 2015, reflecting a backlog of people awaiting simpler, more effective treatment. Between 114,000 and 134,000 people were treated each year from 2016 through 2019.

But the number fell to about 84,000 in 2020, the first year of the COVID-19 pandemic—far below the 260,000 people who would need to be treated annually to eliminate hepatitis C as a public health threat by 2030.

The proportion of baby boomers and those covered by commercial insurance or Medicare declined over time, while the proportion of younger people and those on Medicaid rose, reflecting a shift in the hepatitis C epidemic in conjunction with the opioid crisis.

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

PrEP Disparities

Biktarvy for Kids

Hep C Treatment

Natural Cure

poz.com JANUARY/FEBRUARY 2022 POZ 15

CARE AND TREATMENT

BY HEATHER BOERNER

LOST IN TRANSLATION: U=U When it comes to the news that an undetectable viral load prevents people from transmitting HIV through sex—a concept dubbed Undetectable Equals Untransmittable, or U=U—something is getting lost in translation between the science and society.

First, the LGBTQ advocacy group GLAAD recently released its State of HIV Stigma report, showing that only about two thirds of Americans know about pre-exposure prophylaxis (PrEP), or pills that prevent HIV. Fewer, 42%, know about U=U. Essentially, Americans get a D on PrEP and an F on U=U. Data presented at IDWeek 2021 show that American clinicians are especially guilty of not sharing the science with their patients. The Positive Perspectives 2 survey by ViiV Healthcare and U=U advocates surveyed 538 people in North America about their mental and sexual health as well as whether their providers had explained U=U. Verdict: The good news is that 75% of gay people, 88% of those who identified as queer or bisexual and 100% of trans and nonbinary people said a provider had told them about U=U. But the bad news is that American clinicians, unlike their Mexican and Canadian colleagues, picked and chose which patients they explained the science to. While providers told most gay, queer and trans people about U=U, they told just 65% of cisgender men, heterosexual people and people living in rural areas.

This gap may have real implications for people’s health. Survey respondents who learned about U=U from a provider were more likely to have an undetectable viral load. Just 45% of Americans who had never talked to a provider about U=U had viral suppression, but that number rose to 64% for those who did so.

Race, Individual Behavior and Structural HIV Risk Need more proof that individual behavior isn’t the only thing that determines whether you acquire HIV? Talk to the 14,716 people who inject drugs included in a recent study by researchers at the Centers for Disease Control and Prevention (CDC), published in Morbidity and Mortality Weekly Report.

In 2018, 36% of white participants reported using a needle that someone else had already used—a major risk factor for acquiring HIV—more than twice the rate of Black people (16%) and about a third higher than Latino people (22%). When it came to sex, Black participants were less likely than whites to report having had condomless vaginal or anal sex.

Meanwhile, Black participants were slightly more likely than white people to report having been tested for HIV in the last year (59% versus 53%, respectively). In addition, they were more likely to report having participated in an HIV prevention program in the previous year (34% versus 29%, respectively).

Based on individual behavior, you’d think that white people who inject drugs would acquire HIV more often. But the opposite happened: More than 1 in 10 Black people who inject drugs (12%) acquired HIV, compared with 5% of white people and 7% of Latino people.

So what was different? CDC scientist Senad Handanagic, MD, and colleagues reported that just 40% of Black people received sterile syringes from a needle exchange, compared with 63% of both white and Latino participants. And Black participants were least likely to access medication-assisted treatment for opioid use disorders.

The bottom line: Everyone in the study engaged in activities that could expose them to HIV, but Black participants bore the brunt of transmission despite more conscientious behavior.

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CARE AND TREATMENT

BY LIZ HIGHLEYMAN

(DOCTOR’S EXAM) COURTESY OF ANCHOR; ALL OTHERS: ISTOCK

Early Treatment Reduces Anal Cancer Risk Treating abnormal anal cell changes early can reduce the risk of progression to anal cancer in people living with HIV, according to long-awaited results from the ANCHOR study. This suggests that screening to detect precancerous anal lesions should be part of routine care.

Anal cancer, like cervical cancer, is caused by human papillomavirus (HPV). Men who have sex with men are especially prone to anal cancer, but women get it too. People with HIV have more types of cancer-causing HPV and experience more rapid progression from low-grade abnormal cell changes to precancerous lesions (high-grade squamous intraepithelial lesions, or HSIL) to invasive cancer.

While widespread screening has dramatically cut the risk of cervical cancer, anal cancer screening is currently not standard care for people with HIV. In the ANCHOR study, 4,446 participants were screened for HSIL using anal Pap smears and anoscopy (examination of the anal canal with a scope). Those with precancerous lesions were randomly assigned to either receive immediate treatment or undergo active monitoring. The most common treatment was electrocautery, which uses an electric current to remove abnormal lesions.

The trial was halted early after an interim analysis showed that early treatment offers a clear benefit: Removing HSIL significantly reduced the chances of progression to anal cancer.

“ANCHOR data show for the first time that, like cervical cancer, anal cancer can be prevented even in high-risk populations, such as people living with HIV, who often have HSIL that can be difficult to treat,” says Joel Palefsky, MD, of the University of California at San Francisco.

Advocate Jeff Taylor suggests the results may make it easier for HIV-positive people to get their insurance to cover anal cancer screening.

CABENUVA WORKS REGARDLESS OF WEIGHT Long-acting injectable Cabenuva works well in people with obesity, according to research presented at the European AIDS Conference. Cabenuva consists of an extendedrelease formulation of ViiV Healthcare’s new integrase inhibitor, cabotegravir, plus an injectable version of the NNRTI rilpivirine. It involves two separate shots in the buttocks administered by a health care provider.

The Phase III ATLAS and FLAIR trials showed that more than 90% of people who received Cabenuva maintained viral suppression at 48 weeks. The follow-up ATLAS-2M study found that every-other-month administration works as well as once monthly.

Some drugs can be metabolized and distributed differently depending on body weight, so ViiV scientists conducted a pooled analysis of the three trials, stratifying participants by body mass index (BMI); 154 people who received Cabenuva once monthly and 59 of those treated every other month had a BMI of 30.0 or greater (classified as obesity).

Among participants with obesity, 92% had an undetectable viral load at 48 weeks, similar to the rate for those classified as normal or overweight. However, people with obesity were more likely than people with normal weight or overweight to have a viral load above 50, especially on the every-other-month regimen. No participants with obesity experienced severe side effects.

Looking at drug levels, cabotegravir and rilpivirine trough concentrations (the lowest level between doses) remained above the target level known to suppress HIV, regardless of BMI. But the researchers found that using a longer 2-inch needle led to higher cabotegravir trough concentrations for people with obesity.

poz.com JANUARY/FEBRUARY 2022 POZ 17

BROADWAY LEGEND ANDRÉ DE SHIELDS ON LIFE, CAREER, COVID-19 AND HIV

BY CHARLES SANCHEZ • PHOTOGRAPHY BY BILL WADMAN

A

NDRÉ DE SHIELDS KNOWS HOW TO MAKE AN ENTRANCE. At the beginning of the Broadway show Hadestown, which won the 2019 Tony Award for Best Musical, the house lights dim as the cast and musicians take the stage; that is, all but one of them. There’s a pause, and then the fi nal cast member makes his entrance to applause afire, slinking and sexily meandering through the company, weaving his way across the entire stage, every eye on him.

André De Shields outside the Walter Kerr Theatre, home of Hadestown

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Lean and lithe with a mass of gray hair slicked back, De Shields is decked out sweet and sharp in a silver suit, perfect for his role as the god Hermes, who leads the audience on the glorious and tragic love journey of Orpheus and Eurydice.

When De Shields reaches his place downstage right, he straightens his collar, fusses a bit and flashes the audience a smile as bright as the lights of Broadway itself. It’s magic, and the audience knows it’s in good hands with this master performer as he kicks off the show.

When POZ met De Shields for this interview, he made an equally impressive entrance at an elegant Manhattan restaurant. He was snazzily dressed in the fabulous red tuxedo—with a matching COVID-19 mask, of course—that he wears on the current cover. As he descended the grand staircase into the belly of the bistro, it was apparent that even if you didn’t know who De Shields was, you definitely knew by how he carries himself—the expressive dancer’s gait, the majestic air—that he is someone.

When told that his arrival at the restaurant resembled the big entrance in Hello, Dolly!, De Shields replies, “I do not want to do Hello, Dolly!” He pauses before turning back to say, “I do want to do Gypsy. ‘Rose’s Turn,’” he adds, referring to the number sung by the ultimate musical theater stage mother, a role originated by Ethel Merman and more recently played by Patti LuPone. “I want to do that.”

No doubt that De Shields could be a brilliant Mama Rose. At 76, the Baltimore-born actor, singer, dancer, director and choreographer has been wowing audiences most of his life. He was the Wiz in the original Broadway production of The Wiz and was in the original Broadway casts of Ain’t Misbehavin’, the Mitchell Parish musical Stardust, Play On!, The Full Monty and many others.

What’s more, he’s had roles in numerous Off Broadway and regional theater productions, television, movies and, most recently, podcasts. And that’s not to mention his directing and choreographing credits, which include staging two Bette Midler musicals. Among his awards and accomplishments, he earned the 2019 Tony Award as Best Featured Actor in a Musical for his role in Hadestown, which is once again playing on Broadway after a hiatus due to coronavirus pandemic restrictions.

De Shields is a long-term HIV survivor, having been diagnosed early in the AIDS crisis. Yet he never missed a step, never let the diagnosis get him down. It seems nothing can stop this charming powerhouse.

How does it feel to be back in the show after Broadway was dark for so long?

It’s wonderful.

How long did you have to rehearse?

Two weeks. When former Governor Andrew Cuomo announced that Broadway was coming back, everyone thought, It is? He didn’t talk to Broadway about it. When it was asked, “How are we coming back?” no one had any answers. We are still discovering what those answers are,

20 POZ JANUARY/FEBRUARY 2022 poz.com

André De Shields particularly because of the very strict has lived with HIV COVID-19 protocols. for over 40 years and In the case of the Walter Kerr [the won a Tony for his role theater where Hadestown plays], 900 in Hadestown. people are coming to the theater. We are not doing physical distancing. The audience members have to show proof of vaccination. They must wear masks during the performance. The musicians are all wearing masks—with the exception of the trombone player, because obviously you can’t play the trombone with a mask.

What other precautions is the cast taking?

We are all in masks until we are onstage. When we leave the stage, we are in masks. We have to do the RNA PCR tests twice a week, and we get our temperatures checked every day. It’s a necessary precaution, but it adds a level of experience to what is traditionally thought of as a very family community in the theater. The first day we were back, we all wanted to grab each other and kiss and hug, and then it was like, Oh no, we can’t do that. It’s not wise to do that.

You have to manage your affection.

Exactly. But in terms of performing, it is wildly joyful. The script is flipped, because it’s the audience who is in charge.

They’re so excited that we’re finally back, not where we had started but at a new place that is even more valuable, more revelatory, more precious because we have been away from it for 18 months.

It was a celebration when we initially opened in 2019, but now it’s like a nightly baptism. It’s a ritual. I know this is going to sound over the top, but it’s the way we all feel. It’s sanctified.

If you think of going to a healer for therapy and you come away feeling cleansed and emptied out, that’s what I’m experiencing at the theater now, because we have so much that we want to share with one another. We are luxuriating in every moment, the expressions of overwhelming joy every night. Now, when Hermes starts that monstrously slow entrance from stage left, the audience is on its feet.

The magic and power of the theater. Emotions were so tough during the lockdown. You have to know that you are experiencing the emotions before you can make it better.

These should be life lessons that we are learning from this experience with the new pandemic, because it’s a wake-up call for humanity. We needed something shockingly, stunningly, differently, amazingly fearful to cause us to stop in the name of love.

Why did that big pause not happen when HIV was discovered?

Because that was the pandemic of the other. That was a pandemic—this is going to sound ugly, but it’s exactly what happened—that was killing the people who were considered parasites and needed to die. We now understand how misguided and evil those thoughts were.

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“THIS JOURNEY HAS TAUGHT ME THAT DEATH IS NOT TO BE FEARED. IT’S TO BE MANAGED.”

Tell us about your HIV journey.

I had taken Ain’t Misbehavin’ from Broadway to the West End [in London] in 1979. I got a telephone call from one of my colleagues back in the States saying that the gentleman who had been the hairstylist for the show had just died. I asked, “From what?” and the response was, “We don’t know.”

He took a day off because he got a cold, but he didn’t come back.

Then it happened a second time. A colleague of mine caught the flu and died. It’s something we hadn’t heard of before: the instantaneous death from rhinovirus or influenza in adults, in normally healthy people.

Then, of course, the phenomenon continued until the best educated guess was GRID [gay-related immune deficiency], which made all of us whose sexual orientation was same-sex start to scratch our heads.

I returned from London to rejoin the original Broadway company to take Ain’t Misbehavin’ on its first national tour.

By the spring of 1980, we were in Los Angeles for six months.

One day, I’m preparing for the matinee, and I’m shaving.

And I’m noticing that there are certain parts of my face that are tender to the touch of the razor. But then sometimes your face is just tender from having to shave so much. Then I begin to investigate, and, because I know my own anatomy, I say to myself, These are my lymph nodes. What could that be?

I saw a medical practitioner whose mind was as boggled as mine. Then certain questions that seem ridiculous were being asked. “Have you been kissing a cat?” I didn’t own a cat! Ultimately, the decision was to biopsy one of my lymph nodes. I said, “No, if you don’t have a clue as to what this is, I don’t want you cutting me to find out.”

I returned to New York and saw my primary care provider, but the story was the same. “We don’t know what this is.

We have to biopsy one of your lymph nodes.” I went forward with the international tour. We started in London, came back and did the States and then were on our way to Paris.

I saw a doctor in Paris, same response.

I said no to the French doctor, and then, as quickly as it came, the tenderness went away. It’s the early ’80s, so we have some information. We didn’t know it’s caused by a virus yet, but we did know the indicators: fever, swollen lymph nodes, that kind of thing. I thought that perhaps it was GRID. When we finally had the acronym HIV, I knew then that’s what I had.

It was the first conversation I had with death about myself.

I come from a family of 11 children, and I was 17 when my father died at age 50. I didn’t know how to even experience his death because I was uninformed and unformed. I have now experienced the death of nine of my siblings, plus my father, plus three of my life partners. Each time, I’d become more conversant with death. Each time death has said to me,

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“What about you? Are you ready to join me?” No, I’m not.

What this journey has taught me, metaphysically, is that death is not to be feared. It’s to be managed, because we’re all dying. Some of us are actively dying. Others of us are unaware of our dying until something catastrophic happens, and then it’s always too much for us to even handle. Now when death makes a visit, I invite it in for tea.

When I had the clinical diagnosis of HIV, which wasn’t until 1991, it wasn’t a shock, because my eyes are open. I’ve lived with HIV for over 40 years.

Has HIV affected any of your life choices or career?

Of course it has. In terms of romantic relationships [before HIV], one never had to say, before we become intimately involved, “You should know that I have a cold. You should know that I had the flu last week.” But there was a time when it was absolutely necessary to say, “You should know that I’m HIV positive.” But even that has morphed, because after years of testing and the advances in medication, I can’t pass it on to anyone. I’m not contagious.

It’s still intelligent to say to someone I am HIV positive. But the metaphorical response now is: “Isn’t everyone?”

How would you like to be described?

Do not describe me as a Black gay man. If you find yourself wanting to use a variation of that description, you may say, with my blessing, a Black man who is queer. That is because I learned this early in my life: I am thrice judged for punishment. First, for the melanin in my skin. Second, for the hubris in my character, because melanin should not have hubris. Third, for the expression of my sexuality, that I’m a Black man who loves other men.

But I am fortunate in my career and how people approach me. I was just in Colorado at the newly refurbished Colorado Academy [a pre-K through grade 12 school]. It’s for young people who pursue careers in the arts. Before I performed, there was a dinner, and the children—they’re free, they’re honest. They’re not suspicious of anything. The children just run up to hug you, grab you around the legs. The children love Hermes. One of the things that’s great about Hermes is he’s not a liar. He’s authentic. That’s the way I play him.

Your performance is a revelation.

I would like to conclude with a word from the network of Bantu languages that are spoken in the southeastern areas of the continent of Africa, and the word is ubuntu. It’s related to the yoga salutation namaste, which I understand to mean “the Divinity in me recognizes and salutes the Divinity in you.” Ubuntu means “I am because you are.” So that’s my final word: ubuntu. ■

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ESA

OVERALL, VACCINES ARE HIGHLY EFFECTIVE, BUT SOME FOLKS ARE AT RISK FOR POORER RESPONSE.

BY LIZ HIGHLEYMAN

24

S

TUDIES OF COVID-19 OUTCOMES AMONG PEOPLE LIVING WITH HIV have yielded conflicting results, but some show that HIV-positive people are at greater risk for severe illness and death. Many people with HIV are older and have other chronic health conditions, and experts stress that they should get vaccinated—and boosted—as soon as possible.

(SHIELD AND COVID-19) ISTOCK

“All of the authorized vaccines are safe and effective for people with HIV,” says Melanie Thompson, MD, of the AIDS Research Consortium of Atlanta. “Vaccination should be a very high priority.”

But how well do the vaccines work for people living with HIV? Once vaccinated, can they fi nally ease up on some precautions and start to resume their normal activities?

We know that people with compromised immunity are at risk for more severe COVID-19 and can have slower and weaker immune responses after infection or vaccination. Studies show, for example, that organ transplant recipients and cancer patients treated with immunosuppressive medications may not be fully protected.

Vaccine research involving people with HIV mostly looks good so far, but some individuals are at risk for poorer response, including those who are not benefiting from antiretroviral treatment.

“Vaccines remain the most important intervention for preventing morbidity and mortality from COVID-19, including among people living with HIV,” says Matthew Spinelli, MD, of the University of California at San Francisco. “The limited data available suggest that people with higher CD4 counts have robust immune responses to COVID-19 vaccines, but there is some concern that people with lower CD4 counts or with unsuppressed viral load could have diminished responses.”

VACCINE RESPONSE IN PEOPLE WITH HIV A majority of people with HIV produce an adequate natural immune response against SARS-CoV-2, the coronavirus that causes COVID-19. A small study presented at this summer’s International AIDS Society Conference on HIV Science showed that 73% of HIV-positive people on antiretroviral therapy who had recovered from COVID-19 had detectable SARS-CoV-2 antibodies, compared with 94% of people who are HIV negative.

But current antibody levels don’t tell the whole story. Antibodies normally decline after infection or vaccination, but memory B cells are left behind to produce more if the virus is encountered again; T cells also play a role. In this study, all HIV-positive people had memory B cells and both groups had similar levels of virus-fighting T cells.

The ability to mount a natural immune response bodes well for a good vaccine response, and this is indeed what studies have generally seen.

Advocates fought to get people with HIV included in clinical trials of the vaccines, but the numbers were small and limited to those with good immune function. The pivotal trials of the Pfizer-BioNTech (BNT162b2, or Comirnaty) and Moderna (mRNA-1273, or Spikevax) vaccines included 196 and 179 HIV-positive people, respectively, among their tens of thousands of participants. No safety concerns were reported for people with HIV, but there were too few of them to draw conclusions about effectiveness.

More recent studies have shed more light on vaccine safety and efficacy in this population.

First, subsequent studies have shown that COVID-19 vaccines are safe for people with HIV. Side effects are similar to those of HIV-negative people, mostly temporary soreness at the injection site and mild to moderate flu-like symptoms.

The Pfi zer-BioNTech, Moderna and Johnson & Johnson vaccines do not contain live virus, so they do not pose a risk to immunocompromised people.

Turning to vaccine effectiveness, John Mellors, MD, of the University of Pittsburgh School of Medicine, and colleagues analyzed vaccine response in 107 healthy health care workers and 489 immunocompromised individuals, all fully vaccinated with one of the three authorized vaccines. While only 37% of organ transplant recipients and 55% of blood cancer patients produced antibodies against SARS-CoV-2, 95% of people with well-controlled HIV did so—similar to the 98% response rate for healthy participants.

Two small studies by researchers at Johns Hopkins University School of Medicine looked at responses in people with HIV who received the Pfi zer-BioNTech or Moderna messenger RNA (mRNA) vaccines. Almost all of the 26 combined participants had an undetectable or very low viral load and a CD4 count well above 200. After the second dose, antibody levels and T-cell responses were comparable to those of an HIV-negative control group.

In a larger study, Galia Rahav, MD, of Sheba Medical Center in Tel Aviv, and colleagues compared vaccine response in 143 HIV-positive people on antiretroviral treatment and 400 HIV-negative health care staff. Most had an undetectable viral load, and the average CD4 count was around 700. Here, 98% of people with HIV produced antibodies after two doses of the Pfi zer-BioNTech vaccine, and antibody levels were similar in HIV-positive and HIV-negative people.

The four people with HIV who did not respond were older

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and had other underlying health conditions.

There has been less research on the Johnson & Johnson vaccine, but the pivotal clinical trials included more than 1,200 people with HIV. Among them, there were five cases of COVID-19 in the vaccine group and five in the placebo group, but these numbers were too small to draw conclusions about effectiveness.

RISK FACTORS FOR POOR RESPONSE Experience with vaccines for other diseases shows that some people with HIV, including older people and those with a low CD4 count, do not have as strong or as durable a response as HIV-negative people, and this is true for COVID-19 vaccines as well.

“As is the case with some other common vaccines, people with CD4 counts below 200 and those whose virus is not controlled may not respond as robustly to vaccination against COVID,” Thompson explains.

Spinelli and colleagues analyzed stored samples from 100 HIVpositive adults at the Ward 86 HIV clinic at Zuckerberg San Francisco General Hospital and 100 HIV-negative patients receiving care for other chronic conditions who got two doses of the Pfi zer-BioNTech or Moderna vaccine. In the HIVpositive group, the median CD4 count was 511 and five people had a detectable viral load.

As reported at IDWeek 2021, people with HIV were more than twice as likely to have a poor vaccine response: 12% did not produce antibodies, compared with 5% of HIVnegative people. What’s more, antibody levels were 43% lower in the HIV-positive group, and their antibodies were less able to neutralize SARS-CoV-2. People with detectable HIV had fewer antibodies, and each 100-cell increase in CD4 count was associated with a 28% rise in antibody levels. All seven people with a CD4 count below 200 were nonresponders.

In another study, presented at the 2021 European AIDS Conference, Andrea Antinori, MD, of the National Institute for Infectious Diseases in Rome, and colleagues compared immune responses to the mRNA vaccines in 32 HIV-positive people with severe immune deficiency (CD4 count below 200), 56 with moderate immune deficiency (CD4 count between 200 and 500) and 78 with a normal CD4 count (above 500). All were on antiretroviral therapy. A month after the second dose, five people—four of whom had

fewer than 250 CD4 cells—had no detectable SARS-CoV-2 antibodies. Antibody levels, neutralization responses and T-cell responses were substantially lower in people with a CD4 count below 200.

Finally, Zabrina Brumme, PhD, of Simon Fraser University, and colleagues looked at vaccine response in 100 HIV-positive people in Vancouver, all of whom were on antiretroviral treatment with an undetectable viral load; the median CD4 count was 710. People with HIV had somewhat lower antibody levels and neutralization responses than an HIV-negative control group after their fi rst dose, but they mostly caught up after the second shot. In fact, after controlling for other factors, HIV itself was not associated with weaker vaccine response, nor was current or lowest-ever CD4 count (though only a couple of people had a count below 250). However, older people and those with more underlying health conditions had less robust responses.

“ALL OF THE AUTHORIZED VACCINES ARE SAFE AND EFFECTIVE FOR PEOPLE WITH HIV.”

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ADVICE FOR PEOPLE LIVING WITH HIV U.S. health officials now recommend that all adults and many children should get COVID-19 vaccines, but this is even more important for people with HIV. And it’s essential to get both doses.

Studies showing poor vaccine response among people with a detectable viral load or a low CD4 count are a concern, given that around a third of people living with HIV in the United States are not in care, and about 40% have not achieved viral suppression. What’s more, many are older and have other chronic health conditions.

For HIV-positive people who are not on treatment, starting antiretroviral therapy is a key step toward protection against COVID-19 and better overall health. Those who still have a detectable viral load or a low CD4 count while on treatment should talk with their doctor about optimizing their regimen.

“Starting HIV treatment is the most important way to boost vaccine responses, suppress HIV and prevent HIV transmission,” Thompson emphasizes.

For those who don’t have adequate CD4 recovery despite treatment, COVID-19 pre-exposure prophylaxis (PrEP) may help. Monoclonal antibodies and antiviral pills, such as molnupiravir and Paxlovid, when taken during the early stage of COVID-19, can prevent severe illness. Researchers are now testing whether monoclonal antibodies—and potentially oral antivirals—can be used even earlier as periodic PrEP for immunocompromised people.

“There are likely millions of immunocompromised people, including some with HIV, who cannot mount an

COURTESY OF RESHMA RAMACHANDRAN

immune response to the vaccines,” says Dorry Segev, MD, PhD, of Johns Hopkins University. “Pre-exposure prophylaxis with monoclonal antibodies could be the miracle they have been waiting for.”

Even people who respond well to the vaccines can still get breakthrough infections, and some of them will develop severe illness or long COVID— though the risk is much lower compared with unvaccinated people.

Now that a majority of Americans have received their initial vaccines, attention has turned to boosters in an effort to reduce that risk even further as well as to curb transmission.

In August 2021, the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) recommended an additional dose of the Pfi zer-BioNTech or Moderna vaccine for moderately to severely immunocompromised people, including those with advanced or untreated HIV. (For such individuals, the extra shot is considered part of the initial series needed to achieve full protection, not a booster.)

Patients at Spinelli’s HIV clinic are now receiving third doses, and his team will evaluate responses after the additional shot. “Given higher risk of severe disease, I think people living with HIV should be prioritized for vaccination and, when available locally, for boosters,” he says. “There are data showing that boosters for other immunocompromised populations can boost responses and reverse antibody nonresponse.”

The FDA and CDC later went further, recommending boosters for all Pfi zer-BioNTech and Moderna recipients six months after their last dose and for Johnson & Johnson recipients two months after their initial dose. Immunocompromised people who received an additional dose can also receive a booster six months later, for a total of four shots.

While this is good news for residents of the United States, many people in low- and middleincome countries still do not have access to fi rst vaccines (see “Vaccine Equity” sidebar). For countries where vaccines are in short supply, medical experts and advocates urge that people living with HIV should be among those prioritized for vaccination.

“Advocates should be insisting on equitable and convenient access to vaccines for all HIVpositive people, and people with HIV should feel confident about rolling up their sleeves to get the jabs,” says Thompson. “We have two pandemics to fight now, but at least we have effective vaccines for one of them.” ■

VACCINE EQUITY Equitable access to COVID-19 vaccines is critical in the United States and worldwide. As we saw with HIV, the burden Reshma of the new pandemic is not distribRamachandran uted equally, nor are the vaccines. and Zoey Thill call for While HIV-positive people and global vaccine equity outside the United the LGBTQ community in the United Nations General States generally have high vaccinaAssembly meeting on tion rates, Black and Latino people September 20, 2021. and frontline workers—who have borne the brunt of the pandemic— have been less likely to get vaccinated in some states. But this is changing thanks to the combined efforts of community leaders, health officials and advocates. The COVID-19 response is drawing upon community networks, trusted providers and harm reduction services that many people living with HIV already turn to.

“Maybe one of the few silver linings that came from the reckoning on systemic racism within the general white American community from the George Floyd summer was awareness of the impact of systemic racism on health care outcomes,” says Ace Robinson, cochair of the Federal AIDS Policy Partnership. “From the public to the private health care sector, there’s been an intentional focus on the historical and present-day factors that lead to disparate uptake of newer prevention and treatment options. We saw Black HIV public health leaders and trusted Black community leaders speaking with one voice. What was the result? I saw a real-time elimination of the gap in uptake of vaccines between Black and white, proving yet again that culturally responsive public health messaging saves lives.”

Worldwide, the lack of access to COVID-19 vaccines is all too familiar to advocates who recall the fight for global access to antiretroviral medications. In response, they are urging governments of wealthy countries to donate more vaccines and putting pressure on pharmaceutical companies to waive patents and share technology so vaccines can be produced where they’re needed.

“Now we’re in a sort of 1996 situation, where we have vaccines that work for us, but people around the world are dying for lack of access to them,” says ACT UP and TAG veteran Gregg Gonsalves, PhD, now an assistant professor of epidemiology at the Yale School of Public Health.

“We’re again seeing the same medical apartheid we screamed about 20 years ago with AIDS drugs.”

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History

Reclaimed RACE, QUEERNESS, ART AND AIDS RESONATE IN THE WORK OF DARREL ELLIS.

BY TRENT STRAUBE

WEEKS BEFORE DARREL ELLIS WAS BORN IN 1958, HIS FATHER, a Black portrait photographer in the Bronx, was beaten to death by police.

His father’s absence and artwork would profoundly influence Ellis, who grew up to become a mixed-media painter and photographer.

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(BIRTHDAY PARTY AND MOTHER) COURTESY OF VISUAL AIDS AND CANDICE MADEY; (SELF-PORTRAIT AND BROOKLYN PHOTO) COURTESY OF VISUAL AIDS

Clockwise from top: Untitled (Birthday Party), 1990, gelatin silver print; Untitled (Self-Portrait after Museum Guard Photograph), ca. 1990, gelatin silver print; Untitled (Mother), ca. 1989–90, oil, ink, gouache and graphite on paper mounted on canvas; Ellis at his Brooklyn apartment, ca. 1987–91

Ellis died of AIDSrelated illness in 1992 at age 33, but the openly gay artist and his work were already being recognized—Ellis was photographed by Peter Hujar and Robert Mapplethorpe, and he died just months before an exhibition at the Museum of Modern Art (MoMA) in New York that included his work. Luckily, his friend Allen Frame, a writer and photographer, archived Ellis’s art, notebooks and other personal items, and he and Ellis’s family helped preserve his legacy.

For a time, Ellis worked as a security guard at MoMA, a job that he ultimately found demeaning but afforded him the chance to study contemporary works; during his later career, he lived in a studio in Greenpoint, Brooklyn.

In recent years, Ellis’s artwork— mostly reworkings of portraits his father made of his own family in the 1940s and ’50s—have gained popularity.

Last spring, he was the subject of solo shows at Candice Madey, a gallery in New York City, as well as at a gallery in Switzerland. And now we have the publication of Darrel Ellis, a monograph

by Visual AIDS, an organization that

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(SELF-PORTRAIT, GRANDPARENTS AND LAURE) COURTESY OF VISUAL AIDS AND CANDICE MADEY; (SELF-PORTRAIT WITH ORANGE INK) COURTESY OF VISUAL AIDS/GALERIE CRONE; (DAY WITHOUT ART POSTER AND BOOK COVER): COURTESY OF VISUAL AIDS

Clockwise from top left: Untitled (Self-Portrait), ca. 1990–92, ink and wash on paper; Untitled (Grandparents Dancing), ca. 1981–85, gouache and ink on paper; Untitled (Self-Portrait after Allen Frame Photograph), ca. 1990, gelatin silver print with orange ink; Visual AIDS’s 1994 Day Without Art poster uses Ellis’s Self-Portrait after Photograph by Robert Mapplethorpe (1989); cover of the Darrel Ellis monograph; and Untitled (Laure on Easter Sunday), ca. 1990, gelatin silver print with orange ink

uses art to raise HIV awareness and preserves the work of HIV-positive artists (scroll through the nonprofit’s amazing digital collection, including over 100 works by Ellis, at VisualAIDS.org).

In addition to featuring a rich variety of Ellis’s work, the book includes essays by Derek Conrad Murray, Steven G. Fullwood and Tiana Reid; a 1991 interview with Ellis by David Hirsh; and a 2000 discussion of Ellis’s work moderated by Ariel Goldberg with Black artists Sadie Barnette, Alanna Fields, S*an D. Henry-Smith and Paul Mpagi Sepuya.

Ellis worked primarily in photography, pencil, ink, watercolor and gouache (a thicker, more opaque type of watercolor). The foundation of his work is a vast collection of negatives from his father’s photography as well as from portraits of Ellis (often selfportraits). Careful never to alter the negatives, Ellis transformed and deconstructed the photos. He projected images on varying surfaces, repeated

elements, blocked out faces and painted over details, mostly in grays and browns.

He described his work as ephemeral and light, cerebral but soulful.

Ellis didn’t address issues like AIDS, racism and queerness directly in his work, gallery director Candice Madey told POZ last spring. “However, in his journal, he was thinking deeply about them. He questioned the Eurocentric history of art that was handed down to him and explored how to exert a Black identity that was true to himself. He presented us with beautiful, personal, intimate moments of a family—something that everyone can understand and relate to.”

“These images, like memories themselves, are warped, distorted, and obscured by the artist, as if to say, ‘You can look, but you cannot know,’’ writes Derek Conrad Murray, a Black art historian and theorist, in the Visual AIDS book. “This struggle between transparency and opacity is at the heart of Darrel Ellis’s work.” ■

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HEROES

BY ALICIA GREEN

Marlene McNeese traces her career in public health back to 1992, when, at age 21, she helped educate and test young women of color for HIV as a street outreach worker in Houston.

“I was really struck by the level of compassion and resilience I found in the HIV community,” recalls McNeese, who is cochair of the Presidential Advisory Council on HIV/AIDS (PACHA).

Now 50 years old, McNeese, who is HIV negative, has supported and advocated for some of the most vulnerable populations in Texas. Over 12 years, she worked variously with women, people with substance use disorders and formerly incarcerated people.

Then, in 2004, she joined the Houston Health Department, where she served as chief of the Bureau of HIV/STD and Viral Hepatitis Prevention for 13 years.

She proudly recalls the department’s Hip Hop for HIV program (aka Hip Hop 4 HIV), which gave away free concert tickets as an incentive to young people who got tested for HIV. “We did that intervention for 10 years,” McNeese says. “As a result, we were able to test over 63,000 youth and young adults.”

In 2018, McNeese was promoted to assistant director of disease prevention and control. In her current role, she oversees intergovernmental affairs as well as community and childhood environmental health.

She reviews programs and policies that the health department is considering supporting. “This can sometimes mean educating and recommending local and state policies that advance the science of public health,” she explains. And when it comes to developing HIV programs, that can sometimes mean fighting to reverse policies already in place.

Since August, McNeese has served as a member and cochair of PACHA. For nearly 27 years, PACHA has made recommendations on HIV policies, programming and research to the Department of Health and Human Services (HHS) and the White House.

“One of the bigger focus areas for PACHA is understanding that ending the epidemic is broader than a public health intervention,” McNeese says, emphasizing that it will require a whole government approach.

To that end, PACHA is hard at work establishing new intergovernmental partnerships.

The group is also dedicated to learning more about molecular HIV surveillance, which examines data collected from people during routine HIV testing to pinpoint HIV clusters and respond to outbreaks.

“We want to better understand the science as well as the experiences and implementation,” McNeese explains. PACHA hopes to encourage HHS to safeguard the use of these data to ensure the protection of individual rights.

McNeese believes that although people living with HIV should be leading conversations about ending the epidemic, they shouldn’t have to do all the work alone.

“As an ally, it is my responsibility to show up and be accountable and bold in what I think is effective and will support this community,” McNeese says. “I should be lending all of my gifts and talents to help see a better quality of life for all of them.” ■

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COURTESY OF MARLENE MCNEESE

Proud Ally

Marlene McNeese is cochair of the Presidential Advisory Council on HIV/AIDS.

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2022 HIV/AIDS AWARENESS DAYS Awareness days help educate the general public and specific communities about HIV/AIDS. Display this poster as a reminder of upcoming awareness days, and use the hashtags shown to promote them on social media.

FEBRUARY

MARCH

APRIL 10

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7 National Black HIV/ AIDS Awareness Day

National Native HIV/AIDS Awareness Day

#NBHAAD According to the Centers for Disease Control and Prevention (CDC), Black people made up 42% of new diagnoses in the United States in 2018.

NBHAAD raises awareness about HIV prevention, care and treatment within Black communities.

10 National Women and Girls HIV/AIDS Awareness Day #NWGHAAD According to the CDC, in 2019, women made up 16% of new U.S. HIV diagnoses. This awareness day recognizes the impact of HIV/ AIDS on women and girls.

#NNHAAD This day, which falls on the first day of spring, honors American Indians, Alaska Natives and Native Hawaiians and is intended to empower these groups to get tested and bring HIV/AIDS awareness to their communities.

National Youth HIV & AIDS Awareness Day #NYHAAD This awareness day encourages those under age 25 to speak out about HIV/ AIDS. According to the CDC, about 21% of new U.S. HIV diagnoses in 2019 were among 13- to 24-year-olds.

MAY 18

19 National Asian & Pacific Islander HIV/AIDS Awareness Day

HIV Vaccine Awareness Day #HVAD Led by the National Institute of Allergy and Infectious Diseases, HVAD showcases the progress in the search for a safe and effective HIV vaccine. It also serves as an opportunity to educate communities about the importance of vaccine research.

#APIMay19 Stigma is one of the biggest barriers to discussing HIV in many Asian and Pacific Islander communities. This awareness day aims to break down that stigma by highlighting how HIV uniquely affects these populations and encouraging HIV testing, prevention and treatment.

HIV Long-Term Survivors Awareness Day

Hepatitis Testing Day #HepTestingDay Approximately 25% of people living with HIV nationwide also have hepatitis C, and people who are at risk for HIV are also at risk for hepatitis B. Hepatitis Testing Day aims to encourage testing, but it also increases awareness of the various types of viral hepatitis and provides support and resources for those who are affected.

AUGUST

JUNE 5

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Southern HIV/AIDS Awareness Day

National Faith HIV/ AIDS Awareness Day

#SHAAD About half of new HIV diagnoses are in the

#NFHAAD

National Transgender HIV Testing Day #TransHIV The virus disproportionately affects people who are transgender. This awareness day calls for local events and campaigns promoting HIV testing and awareness in trans communities.

communities. This awareness day aims to break down that stigma by highlighting how HIV uniquely affects these populations and encouraging HIV testing, prevention and treatment.

progress in the search for a safe and effective HIV vaccine. It also serves as an opportunity to educate communities about the importance of vaccine research.

but it also increases awareness of the various types of viral hepatitis and provides support and resources for those who are affected.

2022 HIV/AIDS AWARENESS DAYSMARCH20National

AUGUST

JUNE 5 HIV Long-Term Survivors Awareness Day #HLTSAD This awareness day honors all long-term survivors of HIV. HLTSAD highlights the stories and needs of long-term survivors and advocates for community resources on their behalf.

are transgender. This awareness day calls for local events and campaigns promoting HIV testing and awareness in trans communities.

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Southern HIV/AIDS Awareness Day

National Faith HIV/ AIDS Awareness Day

#SHAAD About half of new HIV diagnoses are in the South. SHAAD raises awareness and provides an opportunity to advocate for the necessary resources to address the HIV crisis in the region.

#NFHAAD HIV affects people of all faiths across the United States. The goal of NFHAAD, which is held the last Sunday in August, is to bring together Buddhists, Christians, Hindus, Jews, Muslims and members of other religions to fight HIV together.

SEPTEMBER 18

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National HIV/AIDS and Aging Awareness Day

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(AFRICAN AMERICANS, SNEAKER, RAINBOW FLAG, WOOD HEART AND COLORED FLAGS) ISTOCK

National HIV Testing Day #HIVTestingDay According to the CDC, one in seven people living with HIV don’t know they have it.

This awareness day is a call to people of all ages to learn the facts about HIV and get tested for the virus.

#HIVandAging It’s estimated that more than half of people living with HIV in the United States are age 50 and older.

This day promotes HIV awareness for seniors and encourages HIV testing among older adults.

National Gay Men’s HIV/AIDS Awareness Day #NGMHAAD According to the CDC, one in six gay and bisexual men living with HIV are unaware they have the virus. NGMHAAD is a time to raise awareness, encourage testing and to support dialogue about HIV prevention and treatment and the unique needs of this population.

DECEMBER OCTOBER 15 National Latinx AIDS Awareness Day #NLAAD According to the CDC, one in six Latinos living with HIV are unaware they have it. NLAAD aims to unite and mobilize the community to raise awareness and promote HIV testing and education.

1 World AIDS Day #WorldAIDSDay About 37.7 million people across the globe have HIV, according to UNAIDS. Every December 1, the world comes together to show solidarity.

HEALTHIERLIFE LIFECAN CANSTART START AAHEALTHIER WITHHIVHIVTREATMENT. TREATMENT. WITH It’s important to start HIV treatment as soon It’s important to start HIV treatment as soon as possible and stick with it. When you do, as possible and stick with it. When you do, it helps stop the damage HIV causes. Plus, it helps stop the damage HIV causes. Plus, doctors and scientists have found that it doctors and scientists have found that it can help reduce the risk of some infections, can help reduce the risk of some infections, certain cancers, and even AIDS. certain cancers, and even AIDS.

TREATMENTHELPS HELPSPREVENT PREVENT TREATMENT THESPREAD SPREADOFOFHIV. HIV. THE

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

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

HIV to others through sex.

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

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

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