POZ March 2024

A SMART+STRONG PUBLICATION MARCH 2024 POZ.COM $3.99

H E A L T H ,

L I F E

Ray of Light

Madonna uplifts the HIV community

&

H I V

IMPORTANT FACTS 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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POSSIBLE SIDE EFFECTS OF BIKTARVY

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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 )02;(9=@ ^P[OV\[ ÄYZ[ [HSRPUN [V `V\Y OLHS[OJHYL 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 [OH[ JVU[HPUZ! ` dofetilide ` rifampin ` any other medicines to treat HIV-1

BEFORE TAKING BIKTARVY Tell your healthcare provider all your medical JVUKP[PVUZ PUJS\KPUN PM `V\! ` Have or have had any kidney or liver problems, including hepatitis infection. ` Are pregnant or plan to become pregnant. ` Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

Tell your healthcare provider about all the medicines `V\ [HRL! ` Keep a list that includes all prescription and over-thecounter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. ` Ask your healthcare provider or pharmacist about medicines that interact with BIKTARVY.

BIKTARVY” section. ` Changes in your immune system. ` New or worse kidney problems, including kidney failure. ` 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.

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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, ADVANCING ACCESS, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. © 2023 Gilead Sciences, Inc. All rights reserved. US-BVYC-0357 11/23

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Gilead is committed to helping you afford your medication no matter your situation.

If your healthcare provider has already determined that BIKTARVY is right for you, then the Gilead Advancing Access® program can help you explore potential coverage options.

If you’re eligible,

you may be able to pay as little as $0 for your co-pay.* *For commercially insured eligible patients only. See terms and conditions at GileadAdvancingAccess.com.

People featured take BIKTARVY and are compensated by Gilead.

If you do not have insurance, Advancing Access can help explore alternative support options. Call Advancing Access (1-800-226-2056) or go to HelpPayForBIKTARVY.com.

Scan here to learn more

Advancing Access specialists can help you understand your health insurance and Gilead medication costs.

Ask your healthcare provider if BIKTARVY is right for you.

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

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CONTENTS

EXCLUSIVELY ON

POZ.COM POZ BLOGS

Members of Positive Women’s Network– USA

Our roster of bloggers spans the diversity of the HIV community. Go to poz.com/blogs to read varying points of view from people living with the virus as well as from HIV-negative advocates. Join the conversation in the comments section. Visit the blogs to find hope and inspiration from others.

D

POZ OPINIONS Advocates, researchers, politicians, thought leaders and folks just like you all have ideas worth sharing.

Go to poz.com/ opinions to read about topics such as living with HIV, improving care and treatment, increasing prevention efforts and fighting for social justice.

#UNDETECTABLE

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

22 LIVE TO TELL Madonna continues to uplift the HIV community. BY MATHEW RODRIGUEZ 28 CENTERING THE VOICES OF WOMEN LIVING WITH HIV Naina Khanna bids farewell to the Positive Women’s Network–USA. BY ALICIA GREEN 3 FROM THE EDITOR

14 SPOTLIGHT

Take a Bow

2023 year-end highlights

4 POZ Q & A

16 NUTRITION & FITNESS

Andrew Spieldenner, the head of MPact Global Action, reacts to an uptick in anti-LGBTQ laws and actions worldwide.

17 BASICS

Olive oil banana bread • intensity matters HIV and pregnancy

6 POZ PLANET Vaginal ring is approved in Africa, but not in the United States • girls around the globe are at disproportionate risk for HIV • inside an HIV research van • playwrights with HIV debut works • Broward House welcomes Nicole Burrell as its new CEO • Everyday: Milestones in the HIV epidemic

18 CARE & TREATMENT

Last large HIV vaccine trial halted • HIV and long COVID • are new HIV cases rising or falling? • statins recommended for all people 40 and older living with HIV

20 RESEARCH NOTES

11 VOICES

PEP-in-pocket • longer-lasting treatment • 23 years of suppression • women’s health

Read about the winners of the POZ Awards 2023, as voted on by readers • women born with HIV face unique challenges

Meet Ukrainian HIV activist Tatyana Lebed.

32 HEROES

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. 274 POSTMASTER: Send address changes to POZ/Smart + Strong, 157 Columbus Avenue, Suite 525, New York, NY 10023. Copyright © 2024 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) KEVIN MAZUR/WIREIMAGE FOR LIVE NATION: (PWN-USA) COURTESY OF PWN-USA; (MEGAPHONE AND SPEECH BUBBLES) THINKSTOCK; (MAGNIFIER) ISTOCK

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.

FROM THE EDITOR

Take a Bow

EDITOR-IN-CHIEF

ORIOL R. GUTIERREZ JR. MANAGING EDITOR

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CAN’T SAY FOR sure when I first heard Madonna on the radio, but I do remember grooving to “Holiday” and “Lucky Star” in middle school.

Soon after those early days, she was everywhere—and over 40 years later, Madonna remains musically and culturally relevant. That’s not to say she hasn’t had her ups and downs. As a fan, I’ve personally cycled through adoration and disappointment over and over again. That said, I’ll always be thankful for her music and her unwavering support of the LGBTQ community and people living with HIV. So it comes as no surprise to me that during every stop of her ongoing Celebration tour, Madonna celebrates the lives of those lost to the virus. While she sings “Live to Tell,” images of her friends are projected all around her, followed by photos of people she never knew. The cover image of this issue of POZ captures a moment during the memorial when Madonna is elevated above the stage with those photos in the background.

Touted by many concertgoers as a highlight of the show, Madonna’s HIV homage surprised some folks. Without knowing about her connections to the virus, it’s understandable. In that spirit, we’ve set out to explore Madonna’s AIDS advocacy through the past four decades. Go to page 22 for more on how she uplifts the HIV community.

Over the years, POZ has spotlighted several celebrities who’ve advocated for the HIV community. In fact, two of Madonna’s dancers from her Blond Ambition tour and the “Vogue” video—Salim “Slam” Gauwloos and Carlton Wilborn—graced our July/ August 2016 cover. They promoted Strike a Pose, a documentary about their time dancing for Madonna, and disclosed that they were both living with HIV while on that tour.

So when we realized that in all this time, POZ had never featured Madonna herself on the cover, we jumped at the opportunity.

Madonna was a fitting cover subject for this special issue dedicated to women. We’re also pleased to highlight the many contributions of Naina Khanna, the co–executive director of Positive Women’s Network–USA (PWN-USA).

After more than a decade at the helm, she is moving on. Go to page 28 to read about her legacy and how PWN-USA has centered the voices of women living with HIV. As readers of POZ know all too well, HIV knows no borders. The virus remains a global threat. Enormous progress has been made in fighting HIV worldwide, but much is still left undone. And that’s under the best of circumstances. When unthinkable challenges surface, such as war, HIV often tends to regain the upper hand. That is the case in Ukraine.

Thankfully, activists such as Tatyana Lebed are on the front lines. Go to page 32 to learn more about her advocacy.

To read 10 ways you can become an HIV advocate, see the poster in the back of this issue.

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 MARCH 2024 POZ 3

POZ Q & A

BY TIM MURPHY

Andrew Spieldenner at IAS 2022

GLOBAL PUSHBACK

A

CCORDING TO HUMAN RIGHTS WATCH, IN THE UNITED STATES in 2023, state legislatures introduced more than 520 anti-LGBTQ bills, 220 of which specifically targeted transgender and nonbinary people.

What’s more, 74 of those bills were enacted, especially laws banning gender-affirming care for trans youth. It’s clear that a backlash to decades of LGBTQ progress is unfolding.

Despite this trend, the United States remains a haven for LGBTQ people relative to many countries. Human Rights Watch also notes that at least 67 countries— mostly in Africa, the Middle East and the Caribbean—criminalize same-sex relationships between consenting adults, and at least nine nations criminalize transgender and gender-nonconforming people.

Last year, LGBTQ rights advocates globally were outraged to see Uganda, which has made strides against HIV and AIDS in the past few years, pass one of the world’s most severe anti-LGBTQ laws—one that calls for the death penalty for “serial offenders.” Now, at least three other countries—Kenya, Ghana and Iraq—may pass similar laws. HIV and AIDS advocates have long said such laws work only against efforts to eliminate the epidemic in the countries that have passed them because they scare away folks in two groups most vulnerable to the virus—men who have sex with men and transgender women—from seeking prevention and treatment.

On the occasion of World AIDS Day, December 1, 2023, POZ talked with Andrew Spieldenner, PhD, a gay man living openly with HIV who heads MPact Global Action for Gay Men’s Health and Rights, which “advocates for equitable access to effective HIV prevention, care, treatment and support services for gay men and bisexual men, including those living with HIV, while promoting their health and human rights worldwide.”

In broad terms, how would you characterize what’s going on in multiple countries?

We’re seeing a rise in homophobia and transphobia across the world, but particularly

4 POZ MARCH 2024 poz.com

in countries like Uganda, with its new law that includes the death penalty. This rise has had a devastating impact on our [LGBTQ] communities. It drives queer people out of the country and excludes us from lifesaving health care services.

It’s due partly to social instability driven by economic instability, where scapegoating the LGBTQ community is easier than finding actual solutions to real problems. And these laws are coming at a time when groups like UNAIDS [the Joint United Nations Programme on HIV/AIDS] and PEPFAR [the U.S. President’s Emergency Plan for AIDS Relief] are talking about ending the HIV epidemic globally. With laws like these, that’ll be impossible, as more people go underground, lose their housing and jobs and are unable to access services.

What is driving these laws and attacks?

A lot of them are driven and funded by American right-wing Christian evangelical groups. The Arizona-based group Family Watch played a large role in laying the groundwork for getting the Uganda law passed. As little as $1 million in support can get these bills passed. The people pushing them prey on the economic instability of these countries and

COURTESTY OF MPACT

The head of MPact Global Action reacts to an uptick in anti-LGBTQ laws and actions around the world.

get them to say about LGBTQ people or about women who want to have abortions, “This is the problem.”

Kenya and Uganda, for instance, owe China so much money. So much of the everyday discourse in Kenya is about the toll of these Chinese loans on the country and the corruption of the Kenyan government that caused these loans. Climates like this give rise to nationalist populist movements that blame everything on a minority group.

Are activists pushing back?

The World Bank, by halting new lending to Uganda in protest of its anti-LGBTQ law, has taken a more assertive stance than the United Nations or the U.S. government, and that’s a chilling realization.

The big AIDS relief funders like PEPFAR and the Global Fund [to Fight AIDS, Tuberculosis and Malaria] haven’t threatened to pull back services because of the Uganda law because they don’t want those lifesaving services to stop.

PEPFAR slowed their grantmaking process with Uganda over the law, but it still went through. The Global Fund wants to transition to funding services in Uganda directly to in-country providers, not via the government, but that’s difficult because in Uganda the line between the government and the private sector, or civil society groups, is very thin.

COURTESY OF ANDREW SPIELDENNER

So there hasn’t been a lot of success reversing or preventing these laws?

There has been success in raising the alarm, but we’ve been stymied in trying to have more influence. William W. Popp, the new U.S. ambassador to Uganda, is trying to figure out how to support LGBTQ groups in the country as well as maintain diplomatic relations. But Uganda is among countries that have said that such anti-LGBTQ laws are a rebuke of having Western “colonialist” values imposed on them. And if someone calls you a colonizer, people shut down.

But now more than ever, we need our allies to step up and not be chilled by this kind of name-calling.

In another move to pressure Uganda to get rid of its law, the United States removed the country from its list of nations that can access the U.S. African Growth

and Opportunity Act tariff-free trade program. The Biden administration said that Uganda, in passing its anti-LGBTQ law, had committed “gross violations” of internationally recognized human rights. The removal deprives Uganda of about $130 million worth of exports to the United States this year. It’s probably the strongest thing the Biden administration has done to Uganda on this issue so far. I sense that it puts other countries on notice that if they enact this or other kinds of human rights violations, they could lose trade privileges as well.

Is there any bright side to this story?

Yes. This handful of new bad laws are happening at the same time we’ve had an uptick in decriminalization of homosexuality in other countries—last year in St. Kitts and Nevis, Antigua and Barbuda, Singapore and Kuwait and, just this past October, in Mauritius, where the highest court rejected the criminalization as a remnant of colonialism.

Andrew Spieldenner

Nations High Commissioner for Refugees]. Increasingly, the United States and Canada are allowing LGBTQ people to be listed for migrant status. But the catch-22 is that if you’re living in a refugee camp, as soon as you document your LGBTQ status with UNHCR to help your case, everyone who works in the camp will see the file. Migrant centers in Uganda, Jordan and Guatemala are all facing problems being able to process LGBTQ applicants for this reason. A refugee group in Los Angeles has put up money to house LGBTQ Ugandans elsewhere.

Then your fate is at the discretion of the U.S. immigration judge reviewing your case. To its credit, the Biden administration is trying to make it less of a burden for LGBTQ folks to prove their hardship and to create a pathway that doesn’t involve a judge.

What is the status of the anti-LGBTQ bills in Kenya, Ghana and elsewhere?

Kenya recently introduced a copycat bill

“Now more than ever, we need our allies.”

How has the Uganda law affected LGBTQ people there on the ground?

A group called Strategic Response Team, which tracks hate crimes and discriminatory practices, has tracked more than 180 evictions in Uganda since the law went into effect as well as 18 cases of forced anal exams done by law enforcement. And we’ve seen no action from PEPFAR in terms of penalizing those clinics where the exams happened, even though the main PEPFAR office has said that they’re dealing with it.

We’ve also been in touch with Rainbow Railroad, a group that helps LGBTQ folks get out of dangerous countries, and with UNHCR [the office of United

modeled on Uganda’s law that activists are trying to kill. Ghana’s been trying to pass their bill for five years now. And while Iraq has been a hotbed of homophobic and transphobic violence, we are now seeing the introduction of a draconian law specific to LGBTQ persons.

How can people help?

Some nonprofits directly support grassroots organizations in-country, such as my own, MPact Global Action; GATE [Global Action for Trans Equality]; and Rainbow Railroad. For more information, keep an eye on Human Rights Watch and our social media, where we post regularly about events. Q

poz.com MARCH 2024 POZ 5

POZ PLANET UPDATES ON HIV & AIDS

Girls at Disproportionate Risk for HIV

Vaginal Ring Approved in Africa The HIV prevention method isn’t available in the United States.

The ring The dapivirine vaginal ring, an alternative HIV slowly prevention method for women, will soon be releases available in nearly a dozen countries in Africa. dapivirine.

This is welcome news, as adolescent girls and young women are among the groups most at risk in sub-Saharan Africa. But the ring is not available to women in the United States, who also need more prevention options.

The antiretroviral ring is now approved or authorized for use in 11 countries in East and Southern Africa, according to a November 30 announcement from the Population Council and the International Partnership for Microbicides (IPM) South Africa.

It is currently being offered through more than 30 implementation and pilot studies in Eswatini, Kenya, Lesotho, South Africa, Uganda and Zimbabwe, and it will soon be available in Botswana, Malawi, Namibia, Rwanda and Zambia.

More than 113,000 rings, marketed as DapiRing, have been sold as of September 2023.

The ring is currently produced by a company in Sweden, but Kiara Health, a South African pharmaceutical company, aims to set up local manufacturing capability, which should improve access and lower costs.

The flexible silicone ring, which is worn in the vagina for a month at a time, slowly releases dapivirine, a non-nucleoside reverse transcriptase inhibitor. Research has shown that the ring is safe and moderately effective. Studies suggest that effectiveness can reach 75% with optimal adherence.

However, as oral and injectable pre-exposure prophylaxis (PrEP) have raised the bar, vaginal rings and other topical microbicide products don’t appear to be in the same league.

For this reason, the IPM withdrew the dapivirine ring from Food and Drug Administration consideration in 2022, after receiving feedback that current data are unlikely to support U.S. approval.

Researchers and advocates stress that women need multiple HIV prevention tools—especially discreet options they can control themselves—as they now have for contraception. Some women find it difficult to take a PrEP pill every day, or they may not want to have pill bottles that could reveal that they’re concerned about acquiring HIV, potentially subjecting them to stigma or even violence. Others, especially those in poor or rural areas, may not be able to attend a clinic for PrEP shots every two months. —Liz Highleyman

6 POZ MARCH 2024 poz.com

In 2022, nearly 98,000 girls ages 10 to 19 contracted HIV, according to UNICEF’s latest Global Snapshot on Children with HIV and AIDS. That’s 1,900 new infections every week. What’s more, girls were more than twice as likely to test positive for HIV in 2022 compared with boys, according to a UNICEF news release.

But there’s also reason for hope: Total HIV cases among girls ages 10 to 19 have decreased by half since 2010 (from 190,000 cases to 98,000).

Of the estimated 1.54 million children living with HIV younger than 15 years old throughout the world, 87% live in sub-Saharan Africa.

“It is unacceptable that adolescent girls, who should be planning their futures, continue to bear the heaviest burden of HIV infection,” said Anurita Bains, UNICEF associate director of HIV and AIDS, in the news release.

“We—the [United Nations], communities, governments and organizations—must eradicate the obstacles that make HIV a threat to their health and well-being. This includes ensuring the sexual and reproductive health and rights of adolescent girls and young women are met.”

Last year, there were 270,000 new HIV cases among children and adolescents ages 0 to 19. The total number of young people living with HIV is now about 2.6 million, according to UNICEF. Experts attribute the disproportionate rate of HIV among girls to gender inequalities worldwide that cause girls to feel disempowered to negotiate safer sex. Stigma, low income and lack of access to HIV prevention and sexual and reproductive health education programs also contribute to the high rates of HIV among girls.

What’s more, across 54 countries, the report found that, on average, 59% of people had discriminatory attitudes toward people living with HIV, nearly six times higher than the 2025 global target (10%).

The report also found major gaps in basic HIV prevention and treatment services. For example, among adolescents ages 15 to 19 living with HIV, about 350,000 were not receiving antiretrovirals to suppress the virus in 2022.

In addition, adolescent girls are less likely to be virally suppressed and tend to have poorer adherence to treatment compared with adults living with HIV. —Laura Schmidt

(VAGINAL RING) COURTESY OF THE INTERNATIONAL PARTNERSHIP FOR MICROBICIDES/ANDREW LOXLEY; (MOTHER AND CHILD) COURTESY OF UNICEF/DEJONGH

But total HIV cases among girls have decreased.

Playwrights With HIV Debut Works Seven short plays were performed.

Inside an HIV Research Van

(CONNECT VAN) YOUTUBE/MILLER SCHOOL OF MEDICINE; (LOVE) TRENT STRAUBE

Florida doctors combat rising HIV cases.

A new mobile research van operated by doctors at the University of Miami Miller School of Medicine delivers information on HIV research to vulnerable South Florida communities to encourage HIV study participation, testing, treatment and prevention.

The CONNECT The mobile unit van will expand was launched on outreach to World AIDS Day, South Florida.

December 1, 2023.

The vehicle is the school’s fourth mobile unit offering HIV services.

Mobile clinic vans are transforming HIV care in Florida communities. For several years, University of Miami doctors have provided HIV care via two mobile clinics: the IDEA Exchange mobile clinic for safe syringe exchange and the Rapid Access Wellness mobile unit, which provides pre-exposure prophylaxis (PrEP) for HIV prevention.

A third mobile unit, the Sylvester Comprehensive Cancer Center Game Changer, operated as a partnership, includes HIV and hepatitis screenings, according to the University of Miami.

The newest van, CONNECT, aims to expand outreach to South Florida locations with rising HIV diagnoses, such as North Miami and Broward County, to make it easier for people to learn about and participate in HIV

studies, according to the Miami Herald.

Florida is among the top five states in the country with the highest rates of HIV. More than 117,000 people in Florida were living with HIV in 2021, according to AIDSVu data. Miami-Dade and Broward counties house more than 50,000 people living with HIV. “We want to go out in the community and let the community know what research studies are ongoing in terms of both treatment and prevention as well as understanding how it’s affecting our community,” Maria Alcaide, MD, an infectious disease professor and director of clinical research at the University of Miami, told the Herald.

Through the mobile clinic, doctors inform community members living with HIV about various studies they can participate in. For example, the University of Miami MACS/WIHS Combined Cohort Study investigates the impact of chronic health conditions, such as heart and lung disorders, in people with HIV. Another study is seeking women ages 18 to 45 living with or at risk for HIV and who may be pregnant.

University of Miami doctors teach Floridians of all ages about the importance of HIV testing, prevention and treatment through community events, such as yoga classes, dance contests and HIV Jeopardy. —LS

After a 10-week virtual workshop, participants in the fourth annual Write It Out! playwriting program for people living with HIV debuted new works at a December 2, 2023, event at the LGBT Community Center in New York City in honor of World AIDS Day, marked annually each December 1.

Write It Out! (WIO!), in partnership with the National Queer Theater, announced Matty Mahoski as the 2023 recipient of the WIO! Prize for playwrights living with HIV. WIO! founder Donja R. Love selected Mahoski’s work UN(IN)SURE from four finalists.

For the event at the LGBT Community Center, actors directed by Dane Figueroa Edidi performed seven short plays created by the WIO! virtual workshop participants, giving the writers a chance to hear their words onstage and in front of an audience.

“The first in-person sharing for Write It Out! exceeded my wildest imagination,” Love told POZ. “The level of love and joy that manifested was so palpable. It bounced off each body in the space, creating something so magical.”

People in the HIV community have faced shame and stigma, he said, “but this was a night in which there were no traces. Instead, what we cultivated was joy and pride. The wonderful writers of the 2023 WIO! cohort used their words to offer love and healing. It was one of the most transformative nights of my life.”

The lineup for Write It Out!’s 2023 final sharing included: First Nigga to Cry written by Aaliy Abdullah Muhammad; 8,900 written by Kodee Stephens; Speak Yo Truth (SYT) written by a playwright who prefers to remain anonymous; Tiger, Max & the Donja R. Angel of Death written by Love David Anzuelo; Present Tense written by Mark S. King; Awake written by Ted Sod; and You Lived It written

by ZM. As the recipient of this year’s Write It Out! Prize, Mahoski will receive $5,000 and a year of support to develop a new work.

—Trent Straube

POZ PLANET UPDATES ON HIV & AIDS

Broward House’s New CEO Envisions Bright Future for Care

Nicole Burrell

Broward House, an HIV service provider in Florida, welcomes Nicole Burrell as its new chief executive officer.

Broward House, a leading organization in inclusive HIV care, has announced Nicole Burrell as its new chief executive officer. She’ll lead the organization in bringing HIV care and support to communities in Florida’s Broward County, which includes Fort Lauderdale and is part of Miami’s northern metropolitan region.

“I’m humbled to be able to lead such a wonderful organization and team with a rich history in the community,” Burrell said in a news release. “Community service is my passion, and being at Broward House allows me to mesh both my finance and service skills.”

For over 35 years, Broward House has worked to improve the quality of life for Floridians of all backgrounds impacted by chronic health conditions, including HIV. The nonprofit aims to expand access to care for those living with HIV while combating stigma and promoting HIV education,

longstanding goal of 100% of people living with HIV in care and zero new infections.”

“I want to increase our presence in the community and continue to advocate and educate individuals about HIV, housing insecurity, homelessness, prevention and care,” Burrell said. “With my background in finance, we can also expand our fundraising efforts and find opportunities to bring in additional funds to best serve our clients and community.”

In related news, Broward House received a $5,000 grant earlier this year after one of its assisted living facilities suffered major flood damage. It was one of 11 service providers in southern Florida to receive a Holiday Hug grant from Fort Lauderdale–based The Campbell Foundation, which funds unique evidence-based research in the treatment and prevention of HIV and AIDS. —Laura Schmidt

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

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Longtime POZ reader MICHAEL HONIOUS, who lives in Dayton, Ohio, commemorates his 40th anniversary of living with HIV. (2024)

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“RETROVIRUSES AS CARCINOGENS AND PATHOGENS: EXPECTATIONS AND REALITY” by Peter Duesberg, PhD, appears in the peer-reviewed journal Cancer Research. The article challenges the hypothesis that HIV causes AIDS, launching the AIDS denialist movement. (1987)

amfAR, The Foundation for AIDS Research, holds a virtual gala benefit to raise money for the amfAR Fund to Fight COVID-19. The fundraiser honors Anthony Fauci, MD, and actress Glenn Close for their contributions in fighting HIV. (2021)

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NATIONAL WOMEN AND GIRLS HIV/AIDS AWARENESS DAY

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NATIONAL NATIVE HIV/AIDS AWARENESS DAY

The television film SOMETHING TO LIVE FOR: THE ALISON GERTZ STORY (aka Fatal Love), starring Molly Ringwald as the AIDS activist, airs on ABC. (1992)

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(DUESBERG, CLOSE, FAUCI AND FATAL LOVE POSTER) WIKIPEDIA; (BURRELL) COURTESY OF BROWARDHOUSE.ORG; (HONIOUS) COURTESY OF MICHAEL HONIOUS

EVERYDAY March

prevention and more.

“Treating our clients like they are our family is one of our strengths,” Burrell added. “I aim to build on the legacy and culture that is already so well-defined here. Dignity and quality care are at the foundation of everything we do, and I will continue to lead with those principles and exemplify our core values: authentic, consistent, adaptable and resolute.”

Broward House’s previous CEO, Stacy Hyde, recorded a touching farewell video to commemorate her 21 years with the organization.

“The future for Broward House is bright with the board of directors’ choice in Nicole Burrell,” Hyde said.

“Broward House and the staff who make the lifesaving work happen will always have a special place in my heart.

I have full faith in Nicole Burrell’s skill to lead the staff and agency to both reach their fullest potential in reaching our

VOICES BLOGS AND OPINIONS FROM POZ.COM

POZ AWARDS 2023 In an article titled “POZ Awards 2023: Winners,” the POZ editors compiled the winners, as voted on by readers, of the 8th Annual POZ Awards, which spotlighted HIV and AIDS in media and culture. Below is an edited excerpt.

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BEST CELEBRITY ADVOCATE Adam Lambert Those who have followed Adam Lambert’s career know that he is not afraid to be out and proud, even on a show like American Idol, a favorite of the heartland. Since Lambert’s time on Idol, he has become the stand-in front person for the band Queen and taken on acting roles, including in Fairyland, the film adaptation of Alysia Abbott’s 2014 memoir about her relationship with her father, a gay man living with AIDS. While promoting the film, Lambert spoke openly about his own experiences growing up queer in a world with AIDS. “The history that the queer community has been through is really important now, more than ever, considering what’s going on in the country,” he told Collider.com early in 2023. “We [have] got to make sure everyone knows what’s happened already so that we cannot repeat our mistakes.”

BEST IN FILM OR TELEVISION Fairyland Almost a decade after the 2014 publication of Alysia Abbott’s Fairyland, the film version of her memoir found its way into theaters. Directed by first-time director Andrew Durham and produced

by Academy Award winner Sofia Coppola, the film traces the story of Alysia’s move, at age 5, to San Francisco after

the death of her mother. Her father, writer Steve Abbott, comes out after his wife’s death and begins to live as an out gay man while raising Alysia.

However, later, as he is diagnosed with AIDS, the tables are turned, and Alysia must care for him. The film, which stars SAG Award winner Scoot McNairy as Alysia’s father and CODA actress Emilia Jones as Alysia, debuted at Sundance in January 2023; sadly, it is not yet available to stream.

BEST IN LITERATURE World Made of Glass by Ami Polonsky At a time when LGBTQ books meant for young adults are being pulled from library shelves, World Made of Glass is a story for young people about activism and breaking silence. In the novel, Iris is facing the death of her father, who is living with HIV, though she feels she cannot talk about it due to stigma.

As she wrestles with the silence surrounding the virus, she confronts the misinformation and prejudice around AIDS. The book, which earned a starred review in the magazine Kirkus Reviews, has been called a “poetryfilled, inspiring call to activism.”

BEST IN VISUAL ARTS HIV Science as Art Science and art represent two drastically different methods of understanding

the world around us, including the AIDS epidemic. Featuring 12 original works, HIV Science as Art was the official art exhibit at the 12th International Conference on HIV Science, held in Brisbane, Australia, in July. The exhibit brought scientific advancements in HIV to life via collaborations between artists and scientists. It spanned various media, including fashion design, photography and sculpture, and the art was for sale, with proceeds supporting communitybased HIV programs and services.

BEST REASON TO KEEP ACTING UP Trans Rights As we know, transgender people have often been counted last in the fight for the rights of the LGBTQ community.

That made them an even bigger target in 2023, as state houses around the country have moved to ban and criminalize aspects of trans life, including removing information about gender identity from school library shelves and preventing trans youth from accessing gender-affirming care. AIDS activism is a health care movement, one that demands that people be allowed to access lifesaving medication and make the best decisions for their own health.

As trans youth face a system looking to block them from flourishing, this fight is a clear continuation of what AIDS activism is all about. Q

poz.com MARCH 2024 POZ 11

VOICES BLOGS AND OPINIONS FROM POZ.COM

WOMEN SURVIVORS

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ECENT DECADES HAVE SEEN great progress in HIV research and treatment; testing, especially of pregnant women; screening of donated blood products and organs; and the continued expansion of access to these advances worldwide.

As a result, rates of HIV transmission to babies during pregnancy, birth, breast/chest feeding or through medical interventions have dropped significantly overall.

Still, many adults living with HIV today acquired HIV at birth or as young children. They are lifetime survivors of HIV, meaning they have lived with HIV for their entire lives. They may have medical and other issues similar to those of older adults who have lived with HIV for many years as well as their own unique concerns.

At the end of 2021, nearly 13,000 people in the United States were living with early acquired HIV; fewer than 2,000 were under 13 years old. (That number globally is more difficult to gauge.) But very little information is available about their lives and experiences, particularly about women.

Women lifetime survivors may face challenges stemming from their child-

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hood, and growing into adulthood, as people with HIV. These may include managing medication adherence (taking medicines as prescribed) at a young age and for the entirety of their lives; shifting care from pediatric to adult settings; dating, sexuality and reproductive health; and the visible and invisible impacts of lifelong medication on their bodies.

Many lifetime survivors have been taking HIV drugs for most or all of their lives. Adolescence (roughly the time between ages 10 and 19) is an especially rough time to have to think about taking medications of any kind.

There are many reasons young people may not take their HIV drugs at the times or in the amounts prescribed. These pertain to structural factors around systems and access, the person themselves or their provider, the drugs or HIV itself or a combination of these—and these factors may change over time.

A key reason HIV drug adherence is so important for staying healthy is that levels of HIV drugs in a person’s body can drop too low when they are not taken as prescribed, causing their virus to change and the drugs to become less effective against it (known as developing drug resistance). Resistance

to HIV drugs can keep a person’s HIV regimen from controlling the virus and reduces a person’s options for HIV drugs in the future.

Lifetime survivors over 18 are more likely to have drug resistance than those under 18 who were born with HIV. HIV drug regimens have become easier to take and pose a lower risk of resistance, and those who are under 18 living with HIV are more likely to have been taking these newer regimens all along. When their virus is not controlled, it is more likely due to low levels of the drugs in their bodies because of low adherence, not because of drug resistance.

Lifetime survivors of HIV who were born earlier in the epidemic may have treatment histories as complex as those of long-term survivors who acquired HIV as adults, often involving outdated and more toxic HIV drugs.

They also may have been exposed to HIV treatment in the womb, increasing their chances of resistance.

Luckily, today’s many classes of HIV drugs allow for designing powerful regimens that can be relatively easy to take and can work well even for young people with long treatment histories and drug resistance. Q

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A blog post from The Well Project titled “Medical Concerns for Women Lifetime Survivors of HIV” explores the challenges of women living with HIV who acquired the virus early in life. Below is an edited excerpt.

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SPOTLIGHT

BY JOE MEJÍA

2023: HIGHLIGHTS FROM THE END OF THE YEAR In 2020, Juilliard-trained playwright and onetime POZ cover subject Donja R. Love (December 2021) formed a playwriting program titled Write It Out! (WIO!) specifically to nurture the work of playwrights living with HIV via workshops. Then, in 2021, with sponsorship from actor Billy Porter and GLAAD, Love launched the inaugural WIO! Prize. On December 2, 2023, with sponsorship from Broadway Cares, the Terrence McNally Foundation, ViiV Healthcare, the Each Other Project and GLAAD, WIO! awarded $5,000 to one lucky writer. The award was presented during a staged reading of the short plays from workshop participants in partnership with the National Queer Theater. (For more, see Planet, page 7).

On December 13, Housing Works held a ribbon-cutting ceremony at its new Westside Community Health Center on 48th Street in Manhattan’s Hell’s Kitchen neighborhood.

The center, the organization’s sixth in New York City, offers primary care, behavioral and sexual health services, case management, adult day health care and services for youth.

Through its health centers and partner pharmacies, Housing Works serves the needs of thousands of low-income New Yorkers with HIV as well as those at risk of contracting the virus. Meanwhile, its thrift shops employ many of its clients while raising funds for its mission.

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1. WIO! founder Donja R. Love (sporting a signature chapeau) was visibly moved at the WIO! presentation of staged readings of plays by various writers living with HIV. The title of Love’s best-known play, one in two,refers to the statistic that one in two gay or bisexual Black men are projected to test HIV positive in their lifetime. 2. Writer and actor David Anzuelo, previously profiled in POZ (October/November 2023), fine-tuned his entry, the play Tiger, Max & the Angel of Death, during WIO!’s 10-week workshop.

3. Actor Malik Childs was one of the professionals who gave voice to the written words of the showcased playwrights at the presentation at New York’s LGBT Community Center. 4. Anna Polodak (left) and Reed Northrup showed their range as they performed various roles before a packed audience of community members.

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(1, 3, 4, 6) NATIONAL QUEER THEATER/FACEBOOK; (2) DAVID ANZUELO/FACEBOOK; (5) LUCA MILONA/PLAYBILL.COM’; (7, 8, 9) HOUSING WORKS

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5. Winning playwright Matty Mahoski, a graduate of NYU’s Tisch School of the Arts, said, “Receiving the Write It Out! Prize is a powerful affirmation of my personal progress as well as a recognition of the heart and effort I have poured into this play.” Their play, UN(IN)SURE, addresses some of the more absurd moments of navigating the health care system.

6. Actress Celeste Sena narrated the WIO! presentation. 7. Housing Works’ new health center boasts a bright and welcoming facade.

8. Housing Works medical director G. Placide Vassall, MD (left), and executive director Jessica Diamond helped do the honors at the ribbon cutting. 9. NYC Council Member Erik Bottcher shared words of gratitude and encouragement with event attendees.

Send your event photos to POZ at website@poz.com or tag us on Facebook, Instagram or Twitter. For a list of community events, visit poz.com/calendar.

poz.com MARCH 2024 POZ 15

NUTRITION & FITNESS ADVICE ON DIET AND EXERCISE

INTENSITY MATTERS

By Craig Ramsay Here are some slim-down tips:

Know your limits, but intensify your workouts.

If you are feeling the burn, you are doing it right.

OLIVE OIL BANANA BREAD For the best results, use very ripe bananas.

OLIVE OIL DOESN’T BELONG ONLY in salads and savories—it makes great cakes too. This dense, moist bread is intensely banana-y. For the best results, use very ripe bananas. Their sugars will add to the cake’s overall sweetness, not to mention its taste.

Aim for a 40-minute weight resistance program and 20 minutes of interval cardio.

SERVINGS: 12 / INGREDIENTS: 9 / PREP: 30 MINUTES

¾ teaspoon baking soda ½ teaspoon salt 1⁄3 cup olive oil 2 large eggs, lightly beaten

2 cups mashed ripe banana (about 4 large bananas) ¼ cup plain Greek yogurt 1 teaspoon vanilla extract

DIRECTIONS 1. Preheat the oven to 350 degrees. Grease a 9-by-5-inch loaf pan and set it aside.

2. In a large bowl, sift together the flour, sugar, baking soda and salt.

3. In a separate medium bowl, mix the olive oil, eggs, mashed banana, Greek yogurt and vanilla until well blended.

4. Make a well in the dry ingredients and pour in the banana mixture. Stir together with a wooden spoon.

5. Pour the batter into the prepared loaf pan. Bake for 50 minutes or until a toothpick inserted in the center comes out clean. Let cool on a rack for 20 minutes, and then remove from the pan to finish cooling.

CHEF TIPS When bananas get too ripe, peel and freeze them. Frozen bananas may be used straight from the freezer to thicken and sweeten smoothies or slowly thawed in the fridge to use in baking and desserts.

NUTRITION FACTS (per serving) Calories: 204; fat: 23 g; saturated fat: 1 g; polyunsaturated fat: 1 g; monounsaturated fat: 5 g; carbohydrates: 33 g; sugar: 14 g; fiber: 4 g; protein: 4 g; sodium: 194 mg

k )UHG +XWFKLQVRQ &DQFHU 5HVHDUFK &HQWHU D F QRQSURƓW RUJDQL]Dtion. Used with permission.

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One hour at the gym max!

Craig Ramsay is a fitness expert, an author and a winner of season 8 of The Amazing Race Canada. Follow him on Instagram at @craigramsayfit.

(BREAD) COURTESY OF COOK FOR YOUR LIFE/CFYL STAFF; (BOARDS) ISTOCK; (RAMSAY) COURTESY OF CRAIG RAMSAY

INGREDIENTS 2 cups whole wheat pastry flour ¾ cup dark brown sugar

BASICS

BY LIZ HIGHLEYMAN

HIV AND PREGNANCY Women living with HIV can have healthy HIV-free babies, but this takes planning.

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HANKS TO HIGHLY EFFECTIVE antiretroviral treatment, many people with HIV are living healthy lives and pursuing long-term goals, such as starting a family. Women with HIV—as well as some transgender men and nonbinary people—can have problem-free pregnancies and give birth to healthy babies, but this requires planning before conception, during pregnancy and after delivery.

One concern for serodiscordant heterosexual couples is how to prevent HIV transmission during condomless sex. Fortunately, antiretroviral treatment and pre-exposure prophylaxis (PrEP) dramatically lower the risk, making natural conception very safe. People who consistently take antiretrovirals and maintain viral suppression do not transmit the virus during sex, and PrEP further protects HIV-negative partners.

Women on modern antiretroviral therapy with well-controlled HIV do not appear to be at greater risk for complications during pregnancy, premature delivery or having infants with birth defects, and pregnancy does not seem to worsen HIV disease progression.

To maximize the chances of a healthy pregnancy, all pregnant people should receive prenatal care. But some women with HIV have poor access to health care. They may not be aware of their HIV status until after they learn they are

pregnant—or even until delivery. Lack of HIV testing before and during pregnancy and lack of prenatal care are major barriers to the elimination of mother-tochild HIV transmission.

Perinatal, or vertical, transmission can occur during gestation, during delivery or after birth via breastfeeding. Without treatment, an HIV-positive woman has about a 25% chance of passing HIV on to her baby. But for a woman on antiretroviral therapy with an undetectable viral load, the risk falls to 1% or less.

People who test positive for HIV during pregnancy should start antiretrovirals as soon as possible. Those who are already on a suppressive regimen when they become pregnant can often keep using the same drugs. Treatment should continue throughout pregnancy and during delivery. Pregnant people should not delay treatment or stop taking antiretrovirals due to concerns about fetal exposure, according to the federal government’s HIV treatment guidelines.

The guidelines designate several antiretrovirals as preferred, meaning they have good efficacy, acceptable side effects, no known risk of pregnancy complications or birth defects, are easy to use and have pregnancy-specific pharmacokinetic data available to guide dosing. Various alternative regimens are also acceptable options. However, the newest antiretrovirals have insufficient

data on pharmacokinetics and safety for the mother and baby.

Pregnant women with HIV used to routinely receive intravenous AZT during labor and delivery, and cesarean section was recommended to prevent the baby from coming into contact with the mother’s blood during vaginal delivery.

These interventions are no longer necessary if the mother maintains good treatment adherence and has a viral load below 50 around the time of delivery, but they are still recommended if viral load is above 1,000 or unknown.

Whether to breastfeed can be a difficult decision for mothers living with HIV. Earlier in the epidemic, HIV-positive women were advised not to breastfeed if clean water and safe formula were readily available. Today, antiretroviral therapy that leads to full viral suppression lowers the risk of transmission via breastfeeding to less than 1%. Whether they choose to breastfeed or opt for formula feeding, mothers with HIV should be supported in their choices.

Beyond reducing the risk of perinatal transmission, staying on antiretroviral treatment after pregnancy is important for the mother’s own health. Some women may have trouble maintaining good treatment adherence and finding time for health care appointments amid the whirlwind of caring for a newborn. Just remember—your health matters too! Q

poz.com MARCH 2024 POZ 17

CARE & TREATMENT

BY LIZ HIGHLEYMAN

LAST LARGE HIV VACCINE TRIAL HALTED PrEPVacc, the last of several large HIV vaccine studies, was halted ahead of schedule in early December after an interim review showed that there was little or no chance of the trial demonstrating vaccine efficacy.

Only one large vaccine study—the RV144 trial in Thailand—has shown any effectiveness for HIV prevention. That trial tested a vaccine (AIDSVAX) containing HIV’s gp120 envelope protein plus a second vaccine that delivered DNA instructions for HIV proteins. In 2009, researchers reported that this regimen reduced new infections by 31%.

The PrEPVacc trial, which enrolled more than 1,500 men and women in Africa, used a similar approach. Participants were randomly assigned to receive AIDSVAX plus a DNA vaccine, a three-vaccine regimen or placebo injections. In addition, the study compared two PrEP pills; the oral PrEP component will continue.

As of October, more than 1,000 participants had received the full vaccine regimen, and most also received one of the PrEP pills. The study’s independent data monitoring committee found no safety concerns but determined that the trial probably would be unable to show whether the vaccine prevents HIV. This is not surprising: PrEP pills alone are highly effective, making it challenging to show that a vaccine offers additional protection.

“We have come so far in our HIV prevention journey, but we must look to a new generation of vaccine approaches and technology to take us forward again,” says PrEPVacc chief investigator Pontiano Kaleebu, MD, PhD.

Studies suggest that people living with HIV may be more susceptible to long COVID, the widely varying symptoms that can persist for months or years after SARS-CoV-2 infection.

In 2022, Michael Peluso, MD, of the University of California San Francisco, and colleagues reported results from a small study showing that people with HIV were about four times more likely to have long COVID symptoms along with lower levels of CD8 T cells targeting SARS-CoV-2 and higher levels of certain inflammatory biomarkers. A larger study by the same group found that HIV-positive people were about twice as likely to have neurocognitive symptoms, and Epstein-Barr virus (EBV) reactivation was linked to fatigue. In a review of data from more than 3 million people in the TriNetX health research database, people with HIV were more likely to experience persistent symptoms and had increased odds of developing multiple health conditions after a bout of COVID, but vaccination lowered the risk.

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Peluso and Annukka Antar, MD, PhD, of Johns Hopkins University Medical School, suggested several reasons why people with HIV might be more prone to develop long COVID, including chronic inflammation, impaired immune function that leads to persistent SARSCoV-2 infection, reactivation of EBV and other latent viruses, abnormal blood clotting, a leaky gut and a higher prevalence of comorbidities.

What’s more, a recent study found that HIV-positive people are more likely to experience SARS-CoV-2 reinfection, raising the odds of long-term consequences.

Scientists are exploring a wide variety of therapies to prevent and treat long COVID. Some studies suggest that COVID vaccines, the antiviral drug Paxlovid and the diabetes drug metformin may lower the risk, but data are mixed.

Peluso and Antar stress that HIV-positive people must be included in this research. “Attention needs to be paid to contributors that might be unique or more important in driving long COVID among people living with HIV,” they wrote.

ALL IMAGES: ISTOCK

Are People Living With HIV at Greater Risk of Contracting Long COVID?

ARE NEW HIV CASES RISING OR FALLING? New HIV diagnoses declined slightly in San Francisco and New York City in 2022, suggesting that things have gotten back on track after disruptions related to COVID-19, but other areas are seeing increases. At the start of the pandemic, there was a steep reduction in HIV testing. This led to fewer diagnoses in 2020, followed by a rise in 2021 as testing caught up.

San Francisco saw a 13% uptick in new HIV diagnoses from 2020 to 2021 but resumed its downward trajectory in 2022, with cases falling from 166 to 157. For the first time, Latinos—who make up 16% of the city’s population— accounted for the largest share of new diagnoses (43%). People who inject drugs accounted for 19%, and people experiencing homelessness accounted for 17%; both groups were less likely to achieve viral suppression. Nearly one in five deaths among people with HIV were due to drug overdose.

In New York City, 1,624 people were newly diagnosed in 2022. Here, too, the city saw a dip in new diagnoses in 2020 followed by a rise to 1,645 in 2021; before that, cases had fallen steadily since 2000. Most new cases were among Black (43%) and Latino people (40%). In New York, 8% of deaths in 2021 were due to COVID, making it the third most common non-HIV-related cause of death after cancer and heart disease.

Some areas, however, are not seeing a decline in new HIV cases. In Arizona, there were 975 newly diagnosed cases in 2022—a 19% increase since 2020—and the number was comparable to peak incidence in the late 1980s. The rise coincides with a steep increase in HIV testing in 2022, but Ricardo Fernandez, MD, of the Arizona Department of Health Services, said the 2022 numbers reflect more new infections as well as increased testing.

U.K. Experts Recommend Statins for HIVPositive People 40 and Older The British HIV Association (BHIVA) now recommends that all people living with HIV ages 40 and older should be offered a daily statin medication to reduce their risk of cardiovascular disease (CVD).

As people with HIV live longer, CVD has become a leading cause of morbidity and mortality. Statins reduce LDL cholesterol levels and may have additional benefits, including reduced inflammation and blood clotting.

These medications generally are not recommended for people with low CVD risk scores unless they have certain comorbidities, but scoring systems developed for the general population tend to underestimate the risk for people living with HIV. The new guidance, released in November, is supported by findings from the large REPRIEVE trial, which showed that HIV-positive people with low to moderate CVD risk reduced their likelihood of heart attacks, strokes and other major cardiovascular events by 35% if they took daily pitavastatin.

The BHIVA guidelines recommend baseline lipid assessments and optimization of antiretroviral therapy. HIV-positive people ages 40 and older should be offered a statin regardless of their lipid profiles or estimated CVD risk.

Pitavastatin (Livalo) is preferred, but atorvastatin (Lipitor) can be used as an alternative. The authors emphasize that statins should be part of a holistic hearthealthy lifestyle that includes smoking cessation, a healthy diet, exercise and weight management.

poz.com MARCH 2024 POZ 19

RESEARCH NOTES

PREVENTION

TREATMENT

CURE

CONCERNS

PEP-in-Pocket

Long-Lasting Meds

23-Year Remission

Women’s Health

Having antiretrovirals on hand for post-exposure prophylaxis after potential HIV exposure—an approach called PEP-in-pocket—is a feasible prevention option, especially for people who have sex infrequently. PEP involves taking a monthlong course of antiretrovirals after exposure. It should be started as soon as possible, and definitely within 72 hours.

PEP is typically provided on an emergency basis, but this can be difficult if, for example, a condom breaks on vacation or a person lives in a rural area or lacks transportation.

Researchers evaluated PEP-in-pocket at two HIV clinics in Toronto. After counseling, individuals with infrequent but high-risk exposures were prescribed a course of antiretrovirals to keep on hand. Among 112 people prescribed PEP, 35 self-initiated antiretrovirals after sexual exposure, including 19 who did so more than once, for a total of 69 courses. No one acquired HIV. However, there were 22 cases of sexually transmitted infections, suggesting that some recipients might also be candidates for doxycycline post-exposure prophylaxis (doxyPEP).

HIV treatment has come a long way, but people still need longer-lasting options.

Researchers at the University of Washington developed an extended-release injectable formulation of tenofovir disoproxil fumarate, lamivudine and dolutegravir, the most widely prescribed antiretroviral regimen worldwide. They used novel drug combination nanoparticle technology that makes it possible to combine agents with differing physical and chemical properties.

They were able to stabilize and assemble the three drugs into a formulation suitable for subcutaneous injection, which they dubbed TLD-in-DcNP. When given to monkeys, all three antiretrovirals exhibited long-acting profiles. Drug levels above predicted effective concentrations were maintained in blood plasma for four weeks after a single injection, and levels were even higher in cells. Tenofovir and lamivudine are also active against hepatitis B virus (HBV), making this regimen suitable for people with HIV/HBV coinfection. What’s more, the subcutaneous formulation, injected under the skin, might allow for self-administration.

A man in the Netherlands who started HIV treatment very early has maintained viral suppression for 23 years after stopping antiretroviral therapy. The man, then age 49, was diagnosed with acute HIV infection in 1998.

He had a high viral load at diagnosis and does not have the rare CCR5-delta-32 mutation, so he is not a natural elite controller. He started treatment two weeks after diagnosis using an intensive five-drug regimen and achieved viral suppression in seven months. The man decided to discontinue his antiretrovirals after two years but agreed to join a research study. For more than two decades, he maintained an undetectable plasma viral load according to standard tests and has shown no clinical signs of HIV disease. However, HIV RNA was detectable at very low levels (under 5 copies) using ultrasensitive tests, and he has detectable HIV DNA in CD4 cells. He continues to exhibit CD8 T-cell responses, especially against HIV’s gag protein. While the man’s HIV has not been eradicated, such cases of long-term remission provide clues in the search for a functional cure.

Women living with HIV are more likely than men to have age-related conditions that can affect their overall health and quality of life. Researchers did a cross-sectional analysis of nearly 4,000 HIV-positive U.S. adults in the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study in the era of modern antiretroviral therapy. The median age was 51 for women and 56 for men.

Most were on antiretrovirals, and more than 80% had viral suppression. The unadjusted comorbidity burden was higher for women compared with men: an average of 3.4 vs. 3.2 conditions. Women were more likely to have bone problems (42% vs. 19%), lung disease (38% vs. 10%) or diabetes (24% vs. 17%), but less likely to have hypertension (68% vs. 75%), psychiatric illness (55% vs.

58%), abnormal blood lipids (41% vs. 64%), liver problems (34% vs. 38%), kidney disease (14% vs. 15%) or cancer (7% vs. 12%). Both groups were equally likely to have cardiovascular disease (15%). The study highlights the need for prevention and management of age-related health problems tailored according to sex.

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

BY LIZ HIGHLEYMAN

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MADONNA CONTINUES TO UPLIFT THE HIV COMMUNITY, AS SHE HAS DONE SINCE THE EARLY DAYS OF AIDS.

NINA UY

BY MATHEW RODRIGUEZ

N WORLD AIDS DAY 2023, WITH A PHOTOmontage depicting some of the many loved ones she has lost to the epidemic as a backdrop, Madonna cried onstage at Amsterdam’s Ziggo Dome during a rendition of the hit midtempo ballad “Live to Tell.” The first photo shown was of the artist Martin Burgoyne, who managed Madonna’s first tour and whose friendship predated her fame. Another was of her first dance teacher, Christopher Flynn, who died of an AIDSrelated illness in 1990. poz.com MARCH 2024 POZ 23

But among those pictured were also individuals Madonna did not know personally—the tour included images offered up by the families and friends of those who had died. The photos were provided with assistance from the Instagram account @theAIDSmemorial.

“I would have cut off my arms if I could’ve found a cure for them to live,” she told the audience at this stop of the European leg of Celebration, her 12th concert tour, which also serves as a career retrospective and living autobiography.

The moment occurred early in the show, reminding the audience that Madonna’s career and AIDS share a similar timeline. “I watched so many people die—male and female, children, straight, gay,” she continued. “It was a devastating time for me.”

Indeed, when Madonna signed her first record contract, HIV was floating, undetected, in many of the spaces she frequented. The illness we now know as AIDS was discovered in June 1981 when the Centers for Disease Control and Prevention (CDC) first identified a cluster of gay men experiencing pneumocystis pneumonia.

The CDC wouldn’t use the term “AIDS” for another 18 months, on September 24, 1982, just 12 days before Madonna released her first single, “Everybody,” which the singer performs on the Celebration tour.

It’s the first time she’s included the song on a tour since The Girlie Show three decades ago.

FEATURING A LIVING MEMORIAL TO PEOPLE who died of AIDS in the middle of a show titled Celebration underlines the fact that even the bounciest, danciest of Madonna’s pop oeuvre has been shaped and influenced by the epidemic. Although most people might read Madonna as a bubblegum pop queen, loss is an essential part of the Material Girl’s ethos, according to Mark Snyder, cohost of the podcast All I Wanna Do Is Talk About Madonna.

Her entire discography is informed by loss. Those who have seen her landmark film Truth or Dare know that the death of her mother when the singer was just 5 years old affected her deeply, as did the AIDS epidemic and its attendant losses. “That was kind of the first wave of loss after her childhood loss,” he says. “And that’s colored everything she’s ever done since.” Similarly, Snyder’s cohost, Kenny Finkle, says, “The death of her mother and the impact of AIDS on her life are the two defining events of her life. It’s in the thread of who she is. It’s not something she’s doing like, ‘Oh, I have to do my service.’”

More than simply nodding to AIDS as a part of her own life, Madonna seems to be pleading that her life and career be seen through the lens of AIDS. Mary Gabriel’s recent biography of the Material Girl, Madonna: A Rebel Life, includes an extensive index entry for AIDS. An AIDS activist who recently formed a book club for the 900-page tome described the book as a de facto cultural history of the epidemic.

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“I WOULD BE MORE AFRAID OF HOW SOCIETY WOULD TREAT ME FOR HAVING THE DISEASE THAN THE DISEASE ITSELF.” In an early chapter set in 1987, Madonna returns to New York City on her Who’s That Girl world tour in support of her third album, True Blue, to find the city transformed by AIDS, Gabriel notes. Andy Warhol is dead, influential queer clubs Danceteria and Funhouse are closed and the dance floor at Paradise Garage is “decimated by AIDS,” Gabriel writes.

Madonna responds by making her Madison Square Garden concert the first large-scale AIDS fundraiser put on by a major American pop star. “Madonna wasn’t afraid” of potential backlash for associating herself with AIDS, Gabriel writes.

“She thought it was her duty.”

To finish the chapter, the reader must first thumb through several glossy pages featuring photos of a young Material

Girl—including pictures of her as a cheerleader—placing her early history right in the middle of a chapter about AIDS, as if to announce that AIDS is as formative to her as her home state of Michigan or her high school education.

GIVEN THE CENTRALITY OF AIDS TO MADONNA’S career, it’s fitting that her current retrospective tour commemorates the epidemic. During her performance of “Live to Tell,” the appearance of the faces of people who died of AIDS visibly affects not only the singer but also the fans in the audience.

The first images include people Madonna knew personally.

These mammoth portraits unfurl from the concert’s ceiling and often directly above the audience. The photos then subdivide and proliferate until hundreds of faces share the space as Madonna is transported through the air in a metallic cage, as if communing in the heavens directly with those lost to the virus. The ethereal number illustrates how AIDS has touched both her and her fans—personally, politically and culturally.

Even Matthew Hodson—who has been working in HIV for 25 years, is living with the virus and is the executive director of aidsmap, a U.K.–based AIDS information charity—was touched when he attended the opening night of the tour in London. Hodson has spoken extensively about both HIV and Madonna; in fact, he contributed interviews to Gabriel’s book and is listed in the index.

Hodson experienced the “Live to Tell” moment without

Clockwise from left: any prior knowledge that it would AIDS information happen. “It was a very sincere, insert in the Like a very heartfelt and very appropriPrayer CD; cover of the Madonna ate tribute, not only to the people biography; image for that she personally lost but the proposed Madonna whole communities of people jukebox musical taken from us,” he says.

One of the faces onstage is that of a woman named Debbie, the mother of Crystal Gamet, who was unsure at first whether she should submit her mother’s photograph but ended up feeling “really grateful” that concertgoers saw her mother and

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FORCING UNCOMFORTABLE CONVERSATIONS about AIDS and sexuality is par for the course for the superstar, whose embrace of her sexuality has always been political.

In 1991, while speaking at an amfAR gala, Madonna re-

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BOTH IMAGES: @THEAIDSMEMORIAL

celebrated her. “It felt strange to see her in this setting that was so far removed from anything she’d ever done,” Gamet says.

Gamet doesn’t know whether her mom was a Madonna fan. And although she hesitated when the director of the AIDS Memorial asked her to participate, she is glad she did.

“My mom kept the biggest secret for 17 years from the moment she was diagnosed until right before she died,” she says.

“She’d be very into it. I’m sure of it. She would love it. She would be bragging.”

Gamet has received messages from people an ocean away who have seen her mom’s portrait. “Part of my healing is always the sharing,” she says. “I’ve kept this a secret for all these years. At first for both of us but eventually just for [her]. For me, I don’t want to keep it a secret anymore.”

sponded to the rumor that she was HIV positive herself, a speculation fueled by her forthright attitude toward sex and outspokenness about the virus.

“What if I were? I would be more afraid of how society would treat me for having the disease than the disease itself,” she told guests that evening.

She would go on to embrace sexual taboos with her charged 1992 album, Erotica, which included songs dedicated to those lost to AIDS during some of the bleakest days of the epidemic.

“So many people used AIDS as an excuse to be moralistic or judgmental about people’s sex lives,” Hodson says, praising Madonna’s unceasing sex positivity, even as other stars endorsed an abstinence message. “She was like, ‘I’m not going to put it away. Sex is good.’”

Madonna’s own knowledge of AIDS and the incorporation of the disease into her work, particularly her tour stagecraft, has evolved alongside the epidemic. During her 2006 Confessions tour in support of her album Confessions on a Dancefloor, Madonna sang “Live to Tell” while a clock tolling the deaths of people with AIDS in Africa ticked above her.

It was during rehearsals for that tour that Madonna first visited Malawi, after admitting that she knew nothing about the country or its specific epidemic.

Rather than shy away from learning about AIDS in Africa, she became an adroit student of the topic.

The small country, which at the time had some of the world’s highAbove: photo of Madonna’s est infant and maternal mortality friend Martin rates as well as poverty rates, was Burgoyne; right: a promotional the ninth most affected by AIDS image from globally, with one out of every 12 @theaidsmemorial people testing HIV positive.

When Madonna visited Malawi, according to Gabriel’s book, she saw children orphaned by AIDS, and she held sick babies who, at 1 year old, weighed as little as three pounds. “It was like history repeating itself,” she said of her visit, alluding to New York in the early 1980s.

Gabriel points out that for Madonna, the orphans spoke to her as a daughter who lost a parent and the children spoke to her as a young person who had lost friends as well as a mother.

What separates Madonna’s activism from that of many other performers is that it is intertwined with her artistry. As is clear from her Confessions tour, her 1980s tours and her most recent one, she wants her audience to think of her music and

AIDS as coexisting in the same sphere of conversation.

CELEBRATION KICKED OFF later than expected because the singer was battling a bacterial infection, but had the tour started when planned, it would’ve been one of two summer stadium tours from some of the biggest names in popular music to have featured a nod to the role that AIDS has played in culture over the past 20 years.

During her Renaissance tour, Beyoncé discussed her uncle Johnny, whom she has previously acknowledged died of AIDS in the early days of her career.

In fact, the final image shown on the jumbo screens as fans left her shows is a several-stories-tall rendering of Johnny with his sister Tina, Beyoncé’s mother.

As their own type of retrospectives, Renaissance the album and Madonna’s Celebration tour fulfill similar cultural and critical roles. But Renaissance is also an album built around the idea of archiving queer history, specifically the house music created and popularized

by Black and brown queer people, populations hard hit by HIV. Thus, Beyoncé asks us to understand her discography through the lens of AIDS. So, too, does Madonna, albeit more directly.

Of course, Madonna has not been the only one to make that connection.

Brian Mullin, a U.K.-based playwright, turned his experience living with HIV into a theatrical production—titled Live to Tell, naturally—that is both a jukebox musical and a manifesto about living with AIDS in modern times.

While most AIDS narratives are marked by Greek-style drama and conflict befitting the early days of the AIDS epidemic, Mullin asks us to consider life with HIV today, including everything from taking daily pills to living with an illness still mired in stigma. Mullin uses Madonna as a metaphor throughout. He admits that the metaphor is “not the most charitable,” but it is a useful one. Madonna, like HIV, posits Mullin, adapts, mutates and, most of all, survives.

“I use Madonna as a symbol of constant adaptability,” he says. Brian, the character in the show based on the real-life Mullin, aches to adapt and evolve and, to paraphrase Madonna in the song “Music,” not think of yesterday, look at the clock and boogie-woogie. “It’s the idea that there’s a past experience that you had that you can put aside. You can reinvent yourself

with each new iteration, each new album,” says Mullin.

Live to Tell the musical ends with Madonna speaking to Brian as the voice of God, telling him that his obsession with Madonna is misplaced. Instead, God/Madonna says he should be obsessed with himself, including taking care of himself, acknowledging what’s happened in the past and moving into the future.

In a way, that sums up the moment when Madonna cried onstage on World AIDS Day in Amsterdam. Even at 65, she is still looking toward the future while acknowledging the past and the virus that continues to shape not only her own life but also the world we all inhabit. Q

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Naina Khanna is a founding member of PWN-USA.

CENTERING THE VOICES OF

Women Living With HIV NAINA KHANNA BIDS FAREWELL TO THE POSITIVE WOMEN’S NETWORK–USA.

BY ALICIA GREEN

COURTESY OF PWN-USA

I

N JUNE 2008, 28 DIVERSE WOMEN LIVING with HIV flew from around the country to San Francisco and gathered at the Hotel Kabuki for a special retreat. The women were all leaders of projects catering to people living with HIV, ranging from nutrition gardens to health care organizations.

They had decided to form a new national organization dedicated to women living with HIV. Its name: Positive Women’s Network–USA (PWN-USA).

“We spent a lot of time at that first gathering articulating what we were seeing impacting our communities and what we thought the solutions were,” says founding member Naina Khanna, the group’s co–executive director. “We developed a set of values and principles that continue to guide our work today.”

Khanna became an advocate a few years after being diagnosed with HIV in 2002, but a 2007 trip to Nairobi, Kenya, for a conference catapulted her work to a new level.

“There were about 300 women living with HIV from all different countries,” Khanna says. “There were all these powerful women living with HIV. But when it came to the

North American and United States representation, I was really disappointed.”

KHANNA NOTED THAT THOSE SPEAKING ON behalf of women living with HIV in the United States were mostly white. Missing were the voices of those most impacted by HIV: Black women. Something needed to change. Khanna had just learned about a global network for women living with HIV that was shaking the table— the Positive Women’s Network.

“There were these badass women all over the world who had organized formations and civil society mechanisms to hold their governments accountable,” she says. “They were demanding different kinds of guidance on breastfeeding and what type of medications were available to people living with HIV who were pregnant.”

This inspired Khanna and a few other American women living with HIV to establish their own PWN organization back home.

Today, PWN-USA is one of the largest HIV organizations in the United States, boasting 4,000 members nationwide. It

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KHANNA REMEMBERS PWNUSA’s first project. It was around the time of the 2008 presidential Above: Khanna election. HIV advocates wanted the (left) and next president to commit to a national advocates in AIDS strategy, but PWN-USA realWashington, DC; below: ized that women were missing from Venita Ray (left) the conversation. and Khanna “We said, ‘You can’t have a national AIDS strategy without women,’” Khanna says. “We needed to make sure that our voices were being represented. Otherwise, we were going to have a national AIDS strategy that didn’t address the issues that matter to cisgender and trans women.”

The all-volunteer group was spread across the country without much structure. Although it had a national steering committee, its members had little experience in writing policy recommendations. In a pre-Zoom era, they composed a document of their demands for the next administration via old-school conference calls.

“Our first-ever policy document was a memo that went to the transition team for the Obama administration in November 2008 that said, ‘Here’s what women living with HIV around the United States are asking for from you,’” Khanna recalls.

PWN-USA’s memo caught the administration’s attention.

The Obama White House used its recommendations, along with those of other HIV groups, to develop the first National HIV/AIDS Strategy.

PWN-USA also succeeded in getting the Obama administration to add an addendum to the strategy that included the word reproductive in reference to women’s reproductive health care needs vis-à-vis HIV and accounted for how trauma and violence intersect with HIV, particularly for women.

“I’m really proud of our contributions to the National HIV/ AIDS Strategy,” Khanna says. “PWN-USA is the organization that really helped push a gender lens on the strategy.”

OVER TIME, PWN-USA GREW TO INCLUDE PAID staff. Its work also continued to grow. It began to address stigma by centering the voices and expertise of women living

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with HIV and policy experts via blogs, articles and op-eds.

The group also pivoted its focus to HIV criminalization and training people on addressing HIV within the frameworks of human rights and reproductive justice.

In 2012, PWN-USA separated from WORLD (Women Organized to Respond to Life-threatening Disease), the group that had provided the structural umbrella for PWNUSA to establish itself. It was time for PWN-USA to form its own autonomous network led entirely by women living with HIV. Someone needed to lead the group as its first executive director. Khanna was chosen for the job, and the steering committee evolved into a board of directors.

“It was definitely a tremendous honor and a responsibility I took very seriously,” Khanna says. “I was really grateful to be entrusted by so many women that I respect and look up to, to serve in that capacity and also understand that it comes with a lot of obligation.”

For Khanna, it was important to be honest about the privilege that she, as a non-Black woman of South Asian descent, benefited from. To that end, as executive director, she endeavored to create avenues for accountability and transparency.

One of PWN-USA’s great accomplishments has been

BOTH IMAGES: COURTESY OF PWN-USA

has changed the lives of cisgender and trans women living with HIV through mobilization, empowerment and policy changes at the federal, local and state levels.

Khanna, who started as a coordinator of the network, became PWN-USA’s first executive director in 2012 and has been co–executive director since 2020.

But now Khanna is moving on. As she prepares to leave the organization she helped found, she and other PWN-USA members reflect on how far it’s come and where its heading.

to center the voices of women most affected by HIV, notably Black and Latina cisgender and transgender women.

VENITA RAY CAN ATTEST TO THAT. RAY WAS diagnosed with HIV in 2003. As she navigated life with HIV, she discovered PWN-USA online. But she didn’t connect with the group until 2013. Then Ray met Khanna at an event in Los Angeles.

“It’s interesting because I never would have thought I’d work with Naina,” she says.

Ray eventually started her own PWN-USA chapter in Houston and began attending PWN-USA summits. In 2015, she joined the organization’s board of directors and later became deputy director. From 2020 to 2022, she served as co–executive director alongside Khanna.

PWN-USA was the first place Ray worked where she could be her authentic Black self, and she’s been happy to help uplift PWN-USA’s Black staff and members.

“We really leaned into racial justice work, fighting antiBlackness and dismantling white supremacy,” Ray says. “We started the annual event called Celebrate and Honor Black Women. When I left, I was proud that Black staff were able to say that they felt affirmed and empowered in the space.”

For Ray, working with Khanna was one of the richest relationships she’s ever had. “As co-E.D., I felt like I’d been invited into somebody’s home. They had raised the money, built this, and I didn’t want to break anything, but something needed to be broken.”

Khanna always implored Ray to share her honest opinions about PWN-USA and its direction. And despite their 20-year age gap, the two hit it off.

“As two women of color, it was one of the greatest experiences,” Ray says.

them to take on a big role. Instead, she encouraged Cardell to consider what they could do in their home state of Colorado to help women living with HIV and fight criminalization.

CARDELL BELIEVES THAT KHANNA HAS BEEN instrumental in shaping the women living with HIV movement in the United States.

“When we talk about the mobilization, the organization, the empowerment, the centering voices of those most impacted, the elevation of Black liberation and trans liberation,” Cardell says. “All of that—that comes from this inherent sense of justice and pushing back against injustice that Naina has led the way for.”

Similarly, Ray believes that Khanna’s leadership, commitment, skills and passion have made PWN-USA the organization it is today.

“She created something out of nothing, and she will tell you she didn’t do it,” Ray says. “She took the reins and made this real. Naina took PWN-USA into places I don’t think it would have gone unless she did that. That’s from a fiscal and reputation standpoint to the type of work PWN-USA did.”

But through it all, Ray says, Khanna never takes all the credit, which is especially impressive considering she’s dedicated almost a third of her life to PWN-USA. “I just think we all owe her a lot,” Ray adds. “I just want so much for her because she gave not only to PWN-USA but to the whole HIV movement. Her contribution to the movement, PWN-USA and to thousands of people changed the game.”

“I AM SO PROUD OF HAVING HAD THIS OPPORTUNITY TO LEAD THIS ORGANIZATION.”

BARB CARDELL, WHO USES THEY/THEM PROnouns, is PWN-USA’s program director. Cardell joined PWN-USA’s steering committee in 2009. But in 2019, they became a full-time staffer.

Cardell has seen firsthand how Khanna’s leadership has centered those most affected by HIV through racial and gender justice lenses.

“Naina is a stone,” Cardell says. “You know how you toss a stone into a lake and the ripples move out? You see the obvious pieces about how she lifts up and elevates people, how she asks the difficult questions, how she has the analysis around the impact of policy on communities that are vulnerable.”

Cardell continues: “That’s the first big splash. That’s beautiful and obvious. But then there’s this ongoing ripple that I’m not sure Naina is aware of.”

When Cardell joined PWN-USA, Khanna never pushed

FOR HER PART, KHANNA KNOWS THAT SHE OWES her successful leadership—not to mention her survival as a woman living with HIV—to those who came before her.

“My role as the steward of PWN-USA has been to really honor all the folks who made it possible for me to be here and to leverage my privilege to create more safety, opportunity, dignity and rights for all the other women who come next,” Khanna says.

Her advice for the next executive directors is simple: Trust yourself, and trust PWN-USA’s members.

As she bids farewell, Khanna offers some parting words for the members who will help usher in a new era at PWN-USA. “I am so proud of having had this opportunity to lead this organization,” she says. “I have learned so much from every single one of you. It has made me a better leader. We already have everything we need to create the world we want to live in, and we must continue to be unapologetic about that.”

What’s next for Khanna? She’ll spend time with her family and her dog. But she’ll also prepare for the 2024 election. She will keep fighting because she knows what’s at stake for the HIV community. Q

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HEROES

BY JAY LASSITER

Tatyana Lebed is a warrior. As the CEO and executive director of the All-Ukrainian Association of Women who Use Drugs, she works to protect her clients from HIV in a country ravaged by war.

Helping marginalized populations can be challenging in the best of times. But Lebed’s work with female drug users, some of whom engage in survival sex, got a whole lot harder when Russia invaded her country in February 2022. Russia has occupied parts of Eastern Ukraine since 2014, but its illegal full-scale attack in 2022 left Ukraine’s transportation and health care infrastructure severely compromised.

When it comes to addressing the needs of women who use drugs, Lebed draws on her own experience.

“I learned about HIV when I decided to become a participant in an opioid substitution therapy program in 2005,” Lebed tells POZ. “At that time, international organizations had only begun to carry out such interventions in Ukraine. People who inject drugs and live with HIV could receive opioid substitution therapy on the pilot project. I found out about my HIV-positive status during testing in 2005.”

Despite Ukraine’s increasingly Western-leaning sensibilities, Soviet-era laws governing drug policy remain on the books.

“In Ukraine, people who inject drugs are also a stigmatized population group,” Lebed says. “Ukraine is a patriarchal country, so the most stigmatized group are women who use drugs and live with HIV.” What’s worse, drug use is on the rise in Ukraine, increasing the burden on harm reduction groups.

Lebed notes that “people who used to use light drugs or used them sporadically began to use drugs by injection during the war due to prolonged stress.”

Ukraine’s drug policy, Lebed says, was a work in progress when Russia’s full-scale invasion began.

“The strategy is currently under development,” she explains. “We have provided our suggestions.”

Lebed also often works to change Ukraine’s punitive laws governing women and families.

“Unfortunately, there is a discriminatory article in the Family Code of Ukraine in which a woman can be deprived of her maternal rights solely because of a diagnosis of drug addiction, even when the woman is in remission,” Lebed says. “Our group is currently fighting for the rights of such women who use drugs.”

Lebed briefly considered emigrating to Germany after the invasion but reconsidered when she learned that her antiretroviral therapy wasn’t available in parts of Western Europe. “Now I’m in my place,” Lebed says. “I pay taxes and wait for victory at home, and I help those who cannot help themselves.”

And in her work helping others, she employs the same indomitable spirit with which the Ukraine Army has dueled its powerful neighbor to a stalemate.

“Russia has started an unjust war of occupation against Ukraine,” Lebed says. “However, we hold on and fight. We continue to provide HIV prevention and treatment services for people who use drugs. And we continue to implement reforms, even under fire.” Q

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Tatyana Lebed advocates for people with HIV in Ukraine.

IGOR KUZMENKO

A Work in Progress

n

If your test result is positive (reactive) Today, it’s recommended that people living with HIV start treatment as soon as possible.

Starting and staying on today’s treatment can help you get to and stay at an undetectable status and prevent transmission of HIV to others through sex. Here are some steps you can take for yourself and your sexual partner(s):

1

2

3

Talk to your healthcare provider

Find out everything you can

Maintain your sexual health

Ask what your test results mean for you and find out about HIV treatments that could best fit your personal routine.

The more you know about HIV, the better. You can discover resources by scanning the QR codes, or even find helpful information on your own.

Use condoms, practice safer sex, and start and stay on the treatment discussed with your healthcare provider.

Helpful terms to know

TasP

Undetectable

Treatment as Prevention

A major goal of HIV treatment is getting your viral load to undetectable. Undetectable means that there is so little virus in the blood that a lab test can’t measure it. If you have questions about your lab results and what it means to be undetectable, talk with your healthcare provider.

If you’re living with HIV, current research shows that taking HIV treatment as prescribed and getting to and staying undetectable prevents transmitting HIV to others through sex. This is also known as U=U (undetectable=untransmittable).

PrEP Pre-Exposure Prophylaxis PrEP (pre-exposure prophylaxis) means routinely taking prescription medicine before you’re exposed to HIV to help reduce your chances of getting it. There are different PrEP options available, some of which are 99% effective. Just remember, PrEP doesn’t protect against other STIs, so be sure to use condoms and other healthy sex practices.

10 WAYS TO BE AN HIV ADVOCATE GET EDUCATED

Getting educated about HIV is often the first step toward advocacy.

Knowing how the virus is transmitted and how it can be treated can help you make better decisions about your own care and well-being. It will also empower you to help others more effectively.

KNOW YOUR RIGHTS

The rights of people living with HIV are protected under a wide array of laws that extend to housing, medical care, public facilities, education, transportation and more.

Understanding these laws can help stop those who may discriminate against people living with HIV.

VOLUNTEER

Consider assisting HIV organizations by volunteering once a week or once a month— whatever works for you.

You can help out in many different ways. Examples include providing administrative assistance or doing community outreach.

BE A MENTOR

Consider joining a

TALK ABOUT HIV

Discussing HIV with your family, friends and other people in your social circle isn’t just a good way to find support—it’s also a way to put a face to the epidemic and educate your loved ones about living with HIV today. You can also post about HIV and AIDS on social media.

SHOP—AND GIVE BACK

There are many opportunities to fight HIV through your fashion and other purchases. Buying merchandise from HIV organizations—local, national or global— supports their cause and can also bring awareness to the epidemic and help end stigma.

SPEAK OUT

Standing up against injustice is as important as ever, and joining a network of people living with HIV is an effective way to do so. Such groups can help focus your HIV advocacy and link you to powerful people in your community, which will give your words more weight.

PROMOTE HIV TESTING

different ways. Examples include providing administrative assistance or doing community outreach.

BE A MENTOR

Consider joining a support group or becoming a oneon-one mentor for others living with HIV. Helping people who are newly diagnosed navigate the health care system, secure housing or obtain other supportive services can help them live longer, healthier lives.

RAISE MONEY

Donating to HIVrelated causes is also a form of advocacy. Plus, it’s tax-deductible and may take only minutes of your time. Strapped for cash?

Help raise money in grassroots ways. For example, participate in an AIDS Walk or organize a bake sale or other fundraising event.

HIV advocacy and link you to powerful people in your community, which will give your words more weight.

PROMOTE HIV TESTING

If you know your HIV status, you are better able to protect your health and the health of your sex partners. If you’re HIV negative, get tested regularly.

If you’re living with HIV, talk to your friends about why getting tested is so important.

SHARE YOUR STORY

Sharing your HIV status, whatever it is, isn’t always easy, but doing so helps normalize HIV, which in turn combats stigma.

Whether or not you’re living with HIV, we’re all fighting the virus together.

Go to POZ.com/Advocacy for more information.

If your test result is negative (non-reactive) When it comes to HIV prevention, the Centers for Disease Control and Prevention (CDC) recommends that ALL sexually active adults and adolescents be informed about PrEP (pre-exposure prophylaxis). PrEP means routinely taking prescription medicine before you’re exposed to HIV to help reduce your chances of getting it. Here are some steps you can take for yourself and your sexual partner(s):

1

2

3

Talk to your healthcare provider

Find out everything you can

Maintain your sexual health

Have a conversation with your healthcare provider about all of your HIV prevention options, including PrEP.

Scan the QR codes and explore resources on your own to get tips on how to be proactive about protecting your sexual health, including understanding your HIV prevention options, like PrEP medications.

Regularly test for HIV and other sexually transmitted infections (STIs), use condoms, and communicate honestly with your partner(s). If you have been prescribed PrEP, continue to take it exactly as prescribed.

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Today, it’s recommended that people living with HIV Starting and staying on today’s treatment can help status and prevent transmission of HIV to others th take for yourself and your sexual partner(s):

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Whatever your results may be...

Speak with a healthcare provider: 1. How can I help protect myself and others?

2. How often should I get tested and retested?

3. How can I talk to my partner(s) about my status and theirs?

Share your status with partner(s) It may not be easy, but having a conversation with your partner(s) about your HIV status can help: • Normalize the conversation around status, sexual health, and testing • Empower others to make informed decisions about their sexual health • Encourage all people to have conversations and stay engaged with their healthcare providers

HEALTHYSEXUAL, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc. All other marks are the property of their respective owners. © 2022 Gilead Sciences, Inc. All rights reserved.

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Helpful term

TasP Treatment as Prevention If you’re living with HIV, current research shows that taking HIV treatment as prescribed and getting to and staying undetectable prevents transmitting HIV to others through sex. This is also known as U=U (undetectable=untransmittable).

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PrEP (pre-exposure prophylaxis) means routinely taking medicine before you’re exposed to HIV to help reduce of getting it. There are different PrEP options available, are 99% effective. Just remember, PrEP doesn’t protect STIs, so be sure to use condoms and other healthy sex

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Resources for you

Undetectable A major goal of HIV treatment is getting your viral load to undetectable. Undetectable means that there is so little virus in the blood that a lab test can’t measure it. If you have questions about your lab results and what it means to be undetectable, talk with your healthcare provider.

g prescription e your chances some of which t against other practices.

www.Healthysexuals.com

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Visit the link above for more information and educational resources about PrEP.

Visit the link above for more information and educational resources about HIV treatment.

If you are living with HIV, talk to your healthcare provider about treatment options.