POZ September 2024 by Smart + Strong

HEALTH, LIFE & HIV

Bishop Stacey S. Latimer and Kane

HEALTH, LIFE & HIV

Bishop Stacey S. Latimer and Kane

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):

Talk to your healthcare provider

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

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. 1 3 2

Find out everything you can

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.

Maintain your sexual health

If your test result (reactive)

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

1 2

Talk to your healthcare provider

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

Find out everything you can

The more you HIV, the better. discover resources scanning the QR even ﬁnd helpful on your

Find out everything you can The more you HIV, the better. discover resources scanning the QR even ﬁnd helpful on your 1 2

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

Help l terms

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).

PrEP

Pre-Exposure Prophylaxis

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

with HIV start treatment as soon as possible. help you get to and stay at an undetectable others through sex. Here are some steps you can

everything can know about better. You can resources by QR codes, or helpful information own.

everything you can you know about better. You can resources by the QR codes, or helpful information your own.

Maintain your sexual health

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

terms to know

Undetectable

also

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.

taking prescription

reduce your chances available, some of which protect against other healthy sex practices.

taking prescription reduce your chances available, some of which protect against other sex practices.

Model

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POZ BLOGS

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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

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.

POZ DIGITAL

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

Hassan James Gibbs has lived with HIV for nearly 40 years.

22 NOW IS THE TIME Long-term survivor Bishop Stacey S. Latimer shares his advice on aging with HIV. BY TRENT STRAUBE

28 WHEN SURVIVAL ENDS We won’t always be HIV and AIDS survivors. That’s not how life works. BY MARK S. KING

4 POZ Q & A

The founder of the Shanti Project, Charles Garfield, PhD, talks with POZ contributing writer Mark S. King about 50 years of service to the HIV community.

6 POZ PLANET

Stigmavir to treat HIV stigma? • visualized data on stigma • Memphis area sees spike in HIV cases • ending discriminatory HIV prosecutions • court mostly upholds coverage of pre-exposure prophylaxis and preventive care • Everyday: HIV milestones

12 VOICES

Marvell L. Terry II highlights the far-reaching impact of HIV in the Black South and how to prioritize change • Connie L. Johnson shares her journey living with the virus and overcoming adversity along the way

14 SPOTLIGHT

Cielo Gala 2024 •

16 RESEARCH NOTES

Twice-yearly PrEP for women • longacting treatment and PrEP for homeless people • early treatment shrinks viral reservoir • CDC urges mpox vaccination

17 BASICS

HIV and your bones

18 CARE & TREATMENT

Novel HIV vaccine approaches • U.S. HIV incidence continues to decline • cannabis affects immune response in people with HIV • CDC finalizes doxyPEP guidelines

20 NUTRITION & FITNESS

Fusilli with vegetables • morning cardio

32 HEROES

HIV advocate Hassan James Gibbs

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One Moment in Time

IWAS RAISED ROMAN

Catholic. As a first-generation Cuban American, my religious background isn’t much of a surprise. I was baptized and even confirmed, a sacrament to express a recommitment to the faith.

Growing up, I often considered becoming a priest. As someone who was struggling to accept myself as gay, my interest in pursuing that path significantly diminished over the years the more I understood what such a life would mean for me. I just couldn’t do it.

Nowadays, many people from different spiritual traditions not only choose a life of religious leadership but also follow a path of living out and proud. What a blessing that must be for such individuals.

Case in point: Bishop Stacey S. Latimer. Our cover subject has been a lifelong member of many Christian denominations. He is now a bishop in the Church of the Everlasting Kingdom. His faith has helped him face being diagnosed with HIV in 1987 and Stage IV prostate cancer in 2019.

Stacey first appeared on the cover of POZ in 2007. At the time, he was an HIVpositive same-gender-loving reverend who performed HIV ministerial work within the Black church. We were curious to know more. So when we heard about his current challenge with cancer, we wanted to reconnect. For more, go to page 22.

As happens with many long-term survivors, me included, health challenges in addition to HIV await us as we age. In this special issue dedicated to aging with HIV, we check in with two other folks who know a thing or two about the topic: Charles Garfield, PhD, and Hassan James Gibbs.

As the founder of the Shanti Project in San Francisco, Charles recently marked 50 years of service. The organization was created as a volunteer-driven resource for people facing terminal illness. When the

HIV epidemic began, the group expanded to help those dying of AIDS-related illness. Charles and his colleagues became quick allies. Go to page 4 to learn more.

Hassan tested HIV positive in 1985. At the time, such a diagnosis often meant impending death. He turned to drugs and alcohol to cope. When he started seeing friends and others around him die, he got angry. Not only did he become an HIV activist, but he also became a mentor for HIV-positive folks in 12-step programs. Go to page 32 for more.

As human beings, we know that someday we’ll die. We just don’t like to talk about it. For long-term survivors aging with HIV, however, mortality is taking center stage yet again. Go to page 28 for an essay by POZ contributing writer Mark S. King exploring this conundrum.

Women of all ages living with the virus have additional health considerations when it comes to their HIV treatment. Go to the center of this issue for a POZ Focus pullout on this topic.

Copies of this issue distributed at the 2024 United States Conference on HIV/AIDS in New Orleans will have a city guide. Check it out!

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.

HUMAN CONNECTIONS

The founder of the Shanti Project reflects on 50 years of service.

ONE OF THE FIRST ORGANIZATIONS IN CALIFORNIA IN THE 1980s serving people living with HIV and AIDS wasn’t founded as an AIDS agency at all.

In 1974, psychologist Charles Garfield, PhD, founded the Shanti Project in San Francisco as a volunteer-driven resource for people facing terminal illness. Garfield had developed the Shanti model, which taught volunteers “compassionate presence” and “active listening” so that they could provide nonjudgmental support for cancer patients.

The Shanti Project in San Francisco turned its attention to people dying of AIDS in the early 1980s, and the Los Angeles Shanti Foundation was founded soon thereafter. Both agencies trained thousands of volunteers to simply be with people living with HIV and AIDS, listening to their fears and providing compassionate support during life’s final chapter. Clients came and went quickly, often falling to the disease within days or weeks.

Today, Garfield has a legacy of community service and several books to his credit. Although the Los Angeles organization closed its doors years ago, the Shanti Project is still open and maintains its core mission to provide “human connections to reduce isolation, enhance health and well-being and improve quality of life.”

This year, the Shanti Project celebrates its 50-year milestone of community service. At a recent special event, POZ contributing writer Mark S. King, one of the original staffers at the Los Angeles Shanti Foundation, interviewed Garfield. The following has been edited for length and clarity.

You began your career as a mathematician and worked on the NASA team that sent Apollo 11 to the moon. You are literally a rocket scientist Yes.

Your biography says that you didn’t find it satisfying. Sir, you sent a rocket to the moon.

What wasn’t satisfying was when it was all over, there was nothing to replace it. There was no mission that was worth all the time and energy that we poured into the moon landing project.

At the University of California San Francisco’s Cancer Research Institute, you were one of the first doctors responsible for the emotional wellbeing of cancer patients.

And in doing that, you discovered that all the other psychologists were

Clockwise from above: POZ contributing writer Mark S. King (left) in conversation with Charles Garfield, PhD, founder of the Shanti Project; covers of books authored by Garfield

overwhelmed, and you started wondering why you couldn’t train laypeople to provide the same services. You must have gotten a lot of raised eyebrows from the professionals. Yes, there were a few raised eyebrows. But I had the hunch that if you selected people well and if you trained them well, they could do this work as well as anybody. And it worked. The idea was viable. Now, it’s 50 years later. I started Shanti when I was 29 years old. Now I’m 79 years old. And we’re still here.

Shanti as an organization began in 1974. That was a decade before the AIDS crisis in San Francisco. Tell me about the transition to helping people who were dying of AIDS.

I started getting calls from my medical colleagues and physicians saying, “We have people with a kind of cancer. And it’s hitting mostly gay men. Are you available to take care of these folks?”

I held a meeting of the volunteers and the staff and said, “What do you think of the idea of us taking on this new challenge? And by the way, we don’t know how the disease is spread.” When we made that transition from cancer work to AIDS, almost nobody left. It was just common sense. We stepped up.

There’s a lot that comes with a patient population made up of primarily gay men. Was there any culture shock on your part?

There was a lot we had to learn. We got together four or five people with this new disease, and we asked questions, and we let them tell us what we needed to know. Turned the patients into teachers.

I want to tell you a little bit about my experience with the Shanti model and taking the training in 1986.

It was very intense, especially for someone living with HIV, which many volunteers were. But it got me out of my head. I was able to develop empathy for other people as opposed to being caught up in my own diagnosis.

My oldest friend, Lesley, was the first to die in my circle. I remember I kept trying to fix it. My attitude was,

“Just tell me what to do because I need to feel as if I’m helpful.” It was about me. It wasn’t about him. Shanti turned that around so that I could just shut up and listen to Lesley. You don’t fix people. You fix refrigerators.

Are you afraid to die? Does the work that you do make you more comfortable with the dying process? God, I wish I could say to you, “No, I’ve solved it.” What did I learn from all of that, that might allow me some comfort in considering my own death? What I’m most afraid of is that I won’t use my potential. Am I afraid of dying myself? Me, personally? Probably. But I don’t think about it

it, whether dying imminently or later, and holding their hand and talking. It’s the two of us who are in this together, and we’ll do the best we can.

And it’s not that somebody’s a guru or a spiritual leader of some great merit. I’m not going to say anything about the people you mentioned. I’m sure they did useful work for people, but they were held in such high regard, as if there are people “up here,” and then there’s the rest of us. And I never saw it that way. Some of the greatest teachers I ever had were patients.

Where would you like to see Shanti in another 50 years?

I would love to believe that in 50 years

“Some of the greatest teachers

I ever had were patients.”

that much. But be cautious when somebody says to you, “I’m not afraid of dying.” It usually means it’s not yet real for them.

During Shanti’s work with people living with AIDS in the ’80s, spiritual leaders, like Marianne Williamson and Louise Hay, also emerged. They were very metaphysical, and they sort of became gurus within the HIV arena.

Shanti never went there. Do you see a difference between what you were doing and what they were doing?

Yes. I’m much more interested in you finding your own strength and your own power than I am being the source of it for you.

The most powerful spiritual experiences I ever had were sitting at the bedside of people who were up against

we will learn much more about empathy and compassion and what it really means to care for one another.

I don’t see some magical transformation over a 50-year period. I do think we’re going to learn a lot more about what it really means to love somebody.

That need is universal, right?

I can’t think of a more barren life than one that doesn’t include some substantial amount of caring for other people. It’s a lot more important than making a lot of money or having a lot of esteem.

Well, if it’s a barren life not to have helped somebody else, then you are living in a garden, my friend. And we thank you.

My pleasure. Q

Charles Garfield

Stigmavir to Treat HIV Stigma?

The fictitious drug is part of an awareness campaign.

HIV stigma in health care is real and harmful. Fortunately, health care providers can now take the antiviral drug Stigmavir to treat their stigma. Unfortunately, the drug is fictitious, but you can watch a real ad for it on YouTube.

back at my behavior, it should have been a crime.”

“I should have trusted science, grounded in reality. Instead I broke the trust that my patient had in me,” adds an anesthesiologist. “Now Stigmavir—it made things clear.”

“Smash Stigma” campaign

Casey House, an AIDS service provider in Toronto, created the commercial as a public service announcement. It’s the latest installment in the organization’s long-running “Smash Stigma” campaign. At first serious and straightforward, the Stigmavir ad morphs into a musical set to a version of “I Will Survive” by Gloria Gaynor—the legendary diva herself even provided the rights to the song, according to a press release about the campaign. Here’s a snippet from the PSA:

“First I was afraid, I was petrified,” sings a doctor midsurgery. “I knew the science, but I was scared, I was shook inside. Then I took a pill and researched all night long, and I grew strong, and I learned how to carry on.”

“I stigmatized, all the time,” a dentist chimes in. “Looking

“I’m finally cured now: no more HIV fear.”

Despite advancements in HIV treatment, stigma persists— including in health care settings. According to the Canadian AIDS service provider, one in five people living with HIV are denied health services because of stigma and discrimination.

“Stigma remains a significant barrier for individuals living with HIV seeking access to health care,” said Casey House CEO Joanne Simons in the press statement. “This year, we’re inviting other health care providers to join us in the mission to create positive health care spaces that are informed, sensitive, inclusive and inquisitive rather than assumptive. Everyone deserves health care that meets their needs, treats them with respect and maintains confidentiality.” —Trent Straube

VISUALIZED DATA ON STIGMA

Sexual behavior stigma affects HIV outcomes.

Aiming to track and reduce the stigmas that act as a barrier to HIV prevention, treatment and care—as well as a hindrance to better overall health outcomes—the interactive HIV data tool AIDSVu recently added a new online feature, the Stigma Dashboard, that offers visualized stigma-related data. Currently, the dashboard tracks sexual behavior stigma in Georgia, New York and Maryland. Specifically, it includes data on men who have sex with men in those states. Additional

data and geographic areas will be incorporated in future phases.

Johns Hopkins University Bloomberg School of Public Health researchers Amrita Rao, PhD, and Stefan Baral, MD, created the Stigma Dashboard to showcase progress to eliminating stigmas across different geographic regions in a tangible way.

Stigma comes in many forms and can negatively affect the way people living with and at risk for HIV interact with medical professionals and adhere to HIV treatment. It can also deter HIV-negative individuals from accessing prevention tools, such as pre-exposure prophylaxis (PrEP).

What’s more, many types of stigma can affect a person’s well-being and engagement in care. Racism, homophobia, transphobia and HIV stigma are but a few examples.

“Stigma is a central underpinning as to why somebody is at risk for being homeless and why a gay man may be

at risk for HIV and beyond,” Baral told AIDSVu. “It’s like you can follow this pathway along why some folks have worse addictions, why some folks have more dependencies and so on—it’s that stigmas have manifested in different ways.”

He continued: “We are trying to [measure] stigma in a very nuanced way—through anticipated stigma, perceptions of stigma, enacted stigma, intersectional stigmas and beyond. We want to understand the drivers that worsen health outcomes among certain communities structurally and then provide insights into how to respond to them.”

Researchers used qualitative survey data from cisgender gay, bisexual and other men who have sex with men throughout the United States. The dashboard provides information on stigma from family, anticipated health care stigma and general social stigma. —Laura Schmidt

Memphis Area Sees Spike in HIV Cases

A Tennessee county is concerned about newly diagnosed HIV.

In recent years, reported HIV and syphilis cases have surged in Tennessee’s Shelby County, which encompasses Memphis, prompting a response from the Shelby County Health Department (SCHD), reports WREG-TV News Channel 3.

According to the Tennessee Department of Health (THD), since 2018, HIV rates have increased by 36%, and syphilis rates have increased by 100% in Shelby. The individuals most impacted are between 14 and 35 years old, noted the county health department without citing specific figures.

HIV rates among those between ages 15 and 19 increased by 40% during this time. That same age group saw a 150% increase in syphilis rates, according to SCHD.

While the extent of the outbreak has not yet been quantified for the public, the SCHD shared the Shelby County ZIP codes with the highest incidence of sexually transmitted infections (STIs).

The ZIP codes most affected were located throughout the greater Memphis area (38103, 38107 and 38109).

To address the “alarming” increase in newly diagnosed HIV cases, SCHD is partnering with TDH, United Way of Greater Nashville and the Centers for Disease Control and Prevention to launch an outreach program to deliver HIV testing and treatment to communities with the highest rates of HIV.

“Knowing your HIV status is the first step to protecting your health,” said SCHD’s Michelle Taylor, MD, in a news release. “HIV can be successfully suppressed with medications, allowing HIV-positive persons to live long and healthy lives.”

To encourage countywide testing and treatment for HIV and STIs, SCHD offers a full list of locations in Shelby County where folks can get tested for free.

The HIV rate increase arrives less than two years after Republican leadership in the state, including the governor, rejected federal funding to help prevent HIV and after the Department of Justice sued Tennessee for enforcing state laws that discriminate against people with HIV. —LS

Ending Discriminatory HIV Prosecutions

Enforcement of a Tennessee state law will cease.

The Justice Department announced in May that the Shelby County, Tennessee, district attorney general has agreed to cease prosecution of individuals living with HIV under Tennessee’s aggravated prostitution law. The DA will also adopt reforms to correct discrimination against people living with HIV who were subjected to discriminatory and harsher penalties under the law.

This agreement resolves the Justice Department’s finding that the Shelby County DA violated the Americans with Disabilities Act (ADA) by enforcing Tennessee’s aggravated prostitution law that imposed enhanced criminal penalties based on a person’s HIV status. The prosecutions were carried out without consideration of risk of transmitting HIV, and the harsher penalties included being charged with a felony (as opposed to a misdemeanor) and being required to register for life as a sex offender.

“Living with HIV is not a crime and the continued enforcement of laws that criminalize a person based on their HIV status, regardless of risk, perpetuates bias, stereotypes and ignorance about HIV,” said assistant attorney general Kristen Clarke of the Justice Department’s Civil Rights Division. “We are pleased that [the] Shelby County District Attorney has agreed to cease enforcement of this discriminatory law, and that future prosecution decisions will reflect the significant advances made in HIV prevention and treatment, consistent with the ADA.”

Under this agreement, the DA will not prosecute individuals under the aggravated prostitution law or for violations of the sex offender registry requirements that have resulted from prior convictions under that law. The DA will also notify anyone eligible of their ability to petition for the vacating of their convictions, termination of the remainder of their sentences and elimination of fees owed.

This agreement also requires the Shelby County DA to adopt policies and train prosecuting attorneys on the ADA’s anti-discrimination requirements relating to HIV, a disability under the ADA. Under the agreement, the DA will also report its compliance with the agreement to the department. —HIV.gov

IMPORTANT FACTS FOR BIKTARVY®

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

MOST IMPORTANT INFORMATION ABOUT BIKTARVY

BIKTARVY may cause serious side e ects, including:

` Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without ﬁ rst talking to your healthcare provider, as they will need to check your health regularly for several months, and may give you HBV medicine.

ABOUT BIKTARVY

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

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS.

Do NOT take BIKTARVY if you also take a medicine that contains:

` dofetilide

` rifampin

` any other medicines to treat HIV-1

BEFORE TAKING BIKTARVY

Tell your healthcare provider if you:

` Have or have had any kidney or liver problems, including hepatitis infection.

` Have any other health problems.

` Are pregnant or plan to become pregnant. Tell your healthcare provider if you become pregnant while taking BIKTARVY.

` Are breastfeeding (nursing) or plan to breastfeed. Talk to your healthcare provider about the risks of breastfeeding during treatment with BIKTARVY. Tell your healthcare provider about all the medicines you take:

` 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.

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

POSSIBLE SIDE EFFECTS OF BIKTARVY

BIKTARVY may cause serious side e ects, including:

` Those in the “Most Important Information About BIKTARVY” section.

` Changes in your immune system. Your immune system may get stronger and begin to ﬁght infections that may have been hidden in your body. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY.

` Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY.

` Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

` Severe liver problems , which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

` The most common side e ects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).

These are not all the possible side e ects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY. You are encouraged to report negative side e ects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.

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

HOW TO TAKE BIKTARVY

Take BIKTARVY 1 time each day with or without food.

GET MORE INFORMATION

` This is only a brief summary of important information about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more.

` Go to BIKTARVY.com or call 1-800-GILEAD-5.

` If you need help paying for your medicine, visit BIKTARVY.com for program information.

People featured take BIKTARVY and are compensated by Gilead.

Ask your healthcare provider if BIKTARVY is right for you.

*Source: , 04/19/2019 through 05/19/2023. IQVIA NPA Weekly #1 PRESCRIBED HIV TREATMENT*

MORE TO LOVE

BIKTARVY® is approved for more people than ever before.

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

*This information is an estimate derived from the use of information under license from the following IQVIA information service: IQVIA NPA Weekly, for the period week ending 04/19/2019 through week ending 05/19/2023. IQVIA expressly reserves all rights, including rights of copying, distribution, and republication.

Scan to learn more about BIKTARVY.

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

Court Mostly Upholds Coverage of PrEP and Preventive Care

Most employers must continue to cover preventive services, but future coverage may still be at risk.

Following a federal appeals court decision, most health insurers must continue to cover certain preventive services and their related costs, including pre-exposure prophylaxis (PrEP) to prevent HIV as well as screenings for cancer. However, the court ruled against the system that decides which procedures must be covered, declaring that the agency behind the health coverage requirement operates unconstitutionally.

Only the eight businesses that brought the Texas lawsuit Braidwood v. Becerra will no longer be required to cover certain preventive health care services. Although the 5th Circuit Court of Appeals in New Orleans didn’t strike down the prevention coverage mandate that is part of the Affordable Care Act (ACA, or Obamacare) nationwide, the case was sent back to the lower court and could eventually land at the Supreme Court, potentially endangering robust prevention coverage in the future.

EVERYDAY

September

Under current ACA guidelines, a panel of experts called the U.S. Preventive Services Task Force (USPSTF) grades preventive services; those that receive an A or B must be covered by health insurance plans, Medicaid and Medicare.

In earlier rulings involving this case, a Texas judge said that because the USPSTF’s members are not appointed by the president and approved by the Senate, the panel is unconstitutional.

The case stems from a 2020 lawsuit challenging PrEP coverage that read in part: “The PrEP mandate forces religious employers to provide coverage for drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use. It also compels religious employers and religious individuals who purchase health insurance to subsidize these behaviors as a condition of purchasing health insurance. This substantially burdens the exercise of religion.”

PrEP refers to daily pills or long-acting injectables that are highly effective at preventing HIV. They are for anyone at risk for HIV, including heterosexual people and married couples in which one person is living with HIV.

“While we were predicting the worst, at the moment, insurers will still have to cover preventive services, including PrEP, except for the original plaintiffs. That is the good news,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in a statement.

“The bad news is, the court still finds the mandate to cover USPSTF recommended services unconstitutional and now asks the lower court to review both the [Health Resources and Services Administration] and [Advisory Committee on Immunization Practices] preventive services,” Schmid continued. “The case is not going to the Supreme Court at this time but back to the lower court. Coverage of preventive services continues.” —Trent Straube

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

THE WELL PROJECT launches a mobile app that includes treatment information and highlights the firsthand experiences of women living with the virus. (2012)

THE CONGRESSIONAL HIV/ AIDS CAUCUS is founded. (2011)

NATIONAL HIV/AIDS AND AGING AWARENESS DAY

RED HOT + BLUE, a compilation album that features contemporary pop performers reinterpreting the songs of Cole Porter, is released. The album sells over a million copies and raises nearly $1 million to benefit such groups as ACT UP and TAG. (1990)

Cole Porter 18 17 27 AIDS CAUCUS

The Centers for Disease Control and Prevention launches the HIV awareness campaign “HIV TREATMENT WORKS,” which encourages people living with HIV to get in care, start taking HIV medications, remain in care and stay on treatment as directed. (2014) 5 15 25

NATIONAL GAY MEN’S HIV/ AIDS AWARENESS DAY

SYSTEMIC BARRIERS

In an opinion piece titled “HIV in the Black South: Confronting Systemic Barriers and Inequities,” HIV advocate Marvell L. Terry II highlights the far-reaching impact of the virus. Below is an edited excerpt.

GROWING UP IN MEMPHIS— a city known globally for its vibrant culture, music and civil rights legacy—I’ve witnessed ﬁrsthand the alarming rise of HIV rates.

This issue is not unique to Memphis but reﬂects a broader crisis throughout the Southern United States.

Tragically, the Black community bears a disproportionate burden in nearly every category related to HIV—race, transmission category, and gender. According to HIV.gov, “By region, in 2021, the South accounted for more than half (52%) of the 32,100 estimated new HIV infections.”

The Black community continues to confront formidable social and structural barriers. These challenges encompass racism ingrained within the health care system, inadequate systems that devalue Black lives, public health strategies that overlook the complexities of pleasure and intimacy among Black individuals and community engagement efforts that fail to account for cultural nuances.

Why the disproportion? Systemic barriers and religious dogma frequently impede Black individuals from accessing and openly discussing the urgent need for expanded access and engagement with prevention strategies like preexposure prophylaxis (PrEP). In fact, the

Centers for Disease Control and Prevention found that PrEP uptake among Black individuals remains low. Of those for whom PrEP should be considered, a mere 11% of Black individuals were using PrEP in 2021, compared with 21% of Latino individuals and a staggering 78% of white individuals.

Compounding the challenges faced by the Black community in the South is the looming trifecta of threats: stricter and unfounded HIV criminalization laws; the passage of anti-LGBTQ legislation; and the alarming erosion of reproductive rights.

Fortunately, prioritizing the following can bring about change:

• Developing public health strategies tailored to the diverse range of sexual and romantic relationships that exist, ensuring no one is le behind;

• Advocating for comprehensive sexual education in classrooms that equips young people with the knowledge and resources they need to make informed decisions about their health;

• Demanding that colleges and universities, particularly minority-serving institutions, not only increase access to HIV testing but also provide condoms and lubrication, overcoming outdated religious objections that impede harm reduction efforts;

• Prioritizing the infrastructure and long-term sustainability of Black-led organizations, empowering them with the support they need to drive impactful change in their communities;

• Ensuring our HIV strategies are truly inclusive, addressing the unique needs of o en-overlooked groups such as Black cisgender heterosexual men, Black cisgender women and transgender women and men;

• Supporting the essential development of the HIV workforce, including frontline workers like HIV testers, community health workers and early intervention specialists, by providing them with livable wages and resources;

• Redeﬁning the boundaries of the Southern states impacted by HIV to include states like West Virginia, Arkansas, Kentucky and Oklahoma in our assessments and funding priorities, ensuring no region is le behind;

• Expanding our concept and implementation of mental wellness and harm reduction as part of the larger treatment and support methodologies;

• Advocating for and supporting political candidates who support HIV-related resourcing and awareness. The time for action is now. Let us stand united. Go to blkinthesouth.org for more information. Q

TIME TO FEEL

In a blog post by The Well Project titled “Good Morning, World!” HIV advocate Connie L. Johnson shares her journey living with the virus and overcoming adversity along the way. Below is an edited excerpt.

I’VE SPENT THE LAST SIX YEARS unpacking my past, settling in self and growing in grief. This journey of emotional upheaval has been the most arduous work I’ve ever done, including teaching high school remedial reading to teen girls from Chicago’s South Side. Without warning, life demanded that I shake the snow globe of my inner being and allow the ﬂakes to fall in their proper places.

In 2016, I returned to my small but vibrant college hometown a er 20 years of living as a gypsy-like prodigal. In those 20 years, I had lived in Chicago, traveled to Kenya twice, wrote a book, earned a couple of degrees and established an impressive career in family and youth services. But I hadn’t managed to conquer the one thing that needed my undivided attention— my feelings. A er settling into the home my father was raised in, located less than a block from my maternal homestead and childhood home, every memory I ever subconsciously silenced came rushing to the forefront of my psyche.

So much of my childhood and adolescence were spent hiding and shushing the pain of my parents’ divorce, secret abuses and hustling for love. Add a

couple of AIDS diagnoses to the mix and you have a recipe for silent suffering. I now know that for a large swath of my adult life, I lived in a state of highfunctioning depression. The grief of losing my mom at 19 to AIDS- related illness and the distress of my being diagnosed with AIDS at 26 took a heavy mental toll. I distracted myself. In the early years, I smoked, I drank, I partied and sexed my pain away. In my quest to discover a higher power, I worked, I churched, I smiled, I prioritized the needs of others and ate my pain. Eventually, I had nowhere to hide. It was ﬁnally time to feel.

In 2016, I moved home with every intention of continuing the pattern of masking my darkness with “good work.” I started a tutoring business helping challenged learners. I became active in my community working parttime at an a er-school program. I jumped feet ﬁrst into the music ministry at my church. I did this all while taking on speaking engagements and vendor opportunities as an author. A year later, the bottom dropped out without warning. Suddenly, I found myself with no money, no functioning relationships, no car, no frilly amenities most of us take for granted. It was just

me, my memories and feelings. It didn’t take long to discover that fear was the chief emotion calling the shots. Next up was anger. The last adjective I would use to describe myself would be angry. For years, I refused to allow anger to enter my consciousness because I wasn’t sure I could control it if it ever surfaced.

So instead, I suffocated it by inﬂicting self-harm to avoid exploding on others. With the help of a therapist, I broke that festering emotional wound open and allowed it to ache.

A er six years of dissecting, confronting and investigating my feelings, I’m ﬁnally feeling something new—joy. I’m grateful for the dark places I’ve seen and experienced. Because of them, only light and love illuminate every step forward. As I learn to embrace and navigate joy, I’m rediscovering and redeﬁning my passions for creativity and service. I now have a certain clarity about my purpose that was once a vague haze of ideas. At church, we used to sing a song that says, “Weeping may endure for a night. But joy comes in the morning.” I didn’t fully understand what the older folks meant then. I do now. Good morning, world! Q

CIELO GALA 2024 AND AIDS/LIFECYCLE 2024

The annual Cielo Gala raises funds for the Latino Commission on AIDS (LCOA). Founded in 1990, LCOA spearheads health advocacy for Latinos, promotes HIV education, develops prevention programs for high-risk communities and helps community organizations scale up their capacity to fight HIV and AIDS. This year’s gala was held at Cipriani Wall Street in New York City and honored various individuals for their activism, health care advocacy and promotion of Latino visibility and representation. The gala also served to underscore LCOA’s commitment to reach Zero Homophobia and Zero Transphobia in the Latino community by highlighting its national ZERO Campaign. Since 1994, the 545-mile AIDS/LifeCycle bike ride from San Francisco to Los Angeles has raised funds for the San Francisco AIDS Foundation and the Los Angeles LGBT Center so that the two nonprofits can continue to provide free HIV and AIDS medical care, testing and prevention services. Riding from June 2 through June 8, this year’s cyclists raised $10,984,492; in total, the ride has raised more than $300,000,000 to fight the epidemic and provide services to those who need them most.

Community activist Valerie

for boosting

and trans Latino

Reyes-Jimenez, diagnosed with HIV in 1989, has worked since the early days of the epidemic to ensure that women with HIV and AIDS receive the same services and medical care as men. 2. Congressman Ritchie Torres (left) and LCOA president Guillermo Chacon (right) pose with honoree Mitchel Katz, MD, president and CEO of NYC Health + Hospitals, the nation’s largest public health care system, who was honored for his work ensuring that under-resourced communities and LGBTQ people have access to health care. 3. Transgender actor and model Laith Ashley, was recognized for his advocacy and

visibility for trans folks. 4. Former director of the White House Office of National AIDS Policy Harold Phillips (left), who is living with HIV, was recognized for his enduring commitment to fight HIV. Phillips is now the deputy director of programs for NMAC. Pose cocreator and coproducer Steven Canals was honored for his work on the groundbreaking show, which featured gay

characters and HIV storylines. 5. Actor and filmmaker Dominic Colón, known for his roles on Electric Company and Mr. Robot, hosted the event.

6. A delay due to an accident on Highway 101 (unrelated to the ride) wasn’t enough to dampen spirits; on the contrary, it was cause for an impromptu conga line dance party. 7. A logistical challenge, the weeklong AIDS/ LifeCycle would not be possible without the services of about 650 roadie volunteers who coordinate the transport of luggage, mark routes, set up camps and more. 8. At about the halfway mark, along California’s coast, cyclists rehydrate and regroup before pedaling on. 9. Brian Sims, Pennsylvania’s first openly gay elected state legislator, rode as part of team Lavender Scare. 10. Every year, the Sisters of Perpetual Indulgence lead a beachside vigil honoring those lost to AIDS.

PREVENTION

Twice-Yearly PrEP

Lenacapavir (Sunlenca), Gilead Sciences’ twiceyearly capsid inhibitor, demonstrated 100% e cacy for HIV prevention in a large study of young cisgender women in Africa. Oral PrEP is highly effective for people who can take it consistently, but additional options are still needed for people who have di culty using daily pills. The Phase III PURPOSE 1 trial enrolled more than 5,300 women in South Africa and Uganda. They were randomly assigned to receive injectable lenacapavir once every six months or the daily PrEP pills Descovy (tenofovir alafenamide/emtricitabine) or Truvada (tenofovir disoproxil fumarate/emtricitabine) in a 2:2:1 ratio. There were zero new infections in the lenacapavir group, 39 in the Descovy group and 16 in the Truvada group. All three PrEP methods were well tolerated, and no new safety concerns were identiﬁed. A parallel study (PURPOSE 2) is testing lenacapavir PrEP for cisgender and transgender men, trans women and nonbinary people in the United States and six other countries; results are expected in late 2024 or early 2025.

TREATMENT

Long-Acting Injectables

Long-acting injectable antiretrovirals can be a feasible treatment or prevention option for homeless and unstably housed people who have trouble using daily pills. A pilot study looked at 33 people who started HIV treatment or pre-exposure prophylaxis (PrEP) at the Maria X. Martinez Health Resource Center in San Francisco, which provides low-barrier care augmented by satellite sites and street medicine teams that deliver injections at syringe access programs, shelters and tent encampments. Most used drugs, primarily methamphetamine, and mental health problems were common. Of the 18 people with HIV—including 14 with a detectable viral load— most received Cabenuva (long-acting cabotegravir and rilpivirine) monthly or every other month, but four used injectable cabotegravir plus lenacapavir. All but one achieved or maintained viral suppression. In addition, 15 people started Apretude (injectable cabotegravir alone) for PrEP. All remained HIV negative. Adherence was good, with just 8% of scheduled injections delayed more than a week.

CURE

Smaller Reservoir

People who start antiretroviral therapy (ART) during acute HIV infection experience a faster decline in the viral reservoir in CD4 T cells. Within days a er infection, the virus inserts its genetic blueprints into the DNA of host cells and establishes a long-lasting reservoir that is unreachable by antiretrovirals. Using more than 500 blood samples from 67 people in the UCSF Treat Acute HIV cohort who started ART within 100 days a er infection, researchers developed mathematical models of HIV dynamics and control. The models showed a biphasic decay of integrated proviral DNA out to one year. During the first phase, lasting up to five weeks, there was a steep decrease in intact HIV DNA, followed by a slower decline during the second phase. For every week ART was delayed, the half-life of intact proviral DNA was about 14 hours longer during the first phase and eight days longer during the second phase. While even very early treatment usually doesn’t prevent viral rebound a er stopping antiretrovirals, a smaller reservoir could improve prospects for a functional cure.

CONCERNS

Mpox Vaccination

A growing outbreak of mpox (monkeypox) in the Democratic Republic of the Congo (DRC) raises concerns about wider spread. The virus has two subtypes, Clade I and Clade II, with the former having a higher fatality rate. Historically, mpox was an uncommon disease linked to contact with wild animals. In contrast, the Clade II global outbreak in 2022 was mainly driven by sex between men. Clade I mpox began rising in the DRC last year. There appear to be concurrent outbreaks, one largely affecting children and the other involving sexual transmission among men and women. Clade I mpox has not been detected in the United States, but low-level transmission of Clade II continues, with 750 cases reported this year. The CDC recommends two doses of the Jynneos vaccine— which protects against both clades—for people at risk, including sexually active gay men, transgender people, HIV-positive people and those on PrEP. Only about 25% of eligible individuals have received both doses, and most recent cases involved people who were not fully vaccinated.

HIV AND YOUR BONES

Eating right, exercising and cutting back on alcohol and smoking can slow bone loss.

STRONG BONES HELP MAINtain mobility and enhance quality of life. People with HIV are more prone to bone loss and fractures, but you can take steps to improve bone health.

Bone is living tissue largely made up of minerals and collagen. Cells called osteoblasts continually add new bone tissue, while osteoclasts dissolve old bone. As people age, bone resorption starts to outpace bone formation, and bone mass naturally declines. Osteopenia is an earlier stage of bone loss, which can progress to osteoporosis.

Older age is the biggest risk factor for osteoporosis. Bone density in women decreases dramatically a er menopause, while men experience a slower decline. White and Asian people are more prone to develop osteoporosis, but Black and Latino people are also at risk. Other risk factors include family history, low estrogen or testosterone levels, poor nutrition, heavy alcohol use, smoking, certain medications and inadequate physical activity.

HIV and its treatment can increase bone turnover. People living with HIV are more likely to develop osteoporosis and sustain bone fractures, and they tend to do so at an earlier age. The virus

can alter metabolism, hormone production and cytokine levels and cause chronic inﬂammation, all of which can lead to bone loss.

Some HIV meds also have adverse effects. Tenofovir disoproxil fumarate (TDF), a component of Truvada and older single-tablet regimens, is most o en associated with bone loss. A newer formulation, tenofovir alafenamide (TAF), a component of Descovy and Biktarvy, is easier on the bones.

PREVENTION AND TREATMENT

Bone loss is o en asymptomatic, and osteoporosis may only be diagnosed a er a person sustains a fracture a er a minor fall or even normal activity. Guidelines recommend that HIV-positive postmenopausal women and men 50 and older should receive dual energy X-ray absorptiometry (DEXA) scans to screen for low bone mineral density.

Some osteoporosis risk factors— like age and sex—can’t be changed, but people can take steps to slow bone loss, including quitting smoking and limiting alcohol consumption, both of which suppress bone formation.

A balanced diet is key to maintaining bone health. Getting enough calcium is particularly important. Foods rich in

calcium include milk, cheese, canned fish and leafy green vegetables. Vitamin D is necessary for calcium absorption. The skin produces vitamin D when exposed to sunlight, but many people don’t make enough. Food sources include fortified dairy products, egg yolks, some fish and liver. Calcium and vitamin D supplements are widely available, but too much can be harmful.

Physical activity builds bone mass, strengthens muscles that support the skeleton and improves balance and coordination, which helps prevent falls. Both weight-bearing activities and resistance exercises are beneﬁcial.

There is no cure for osteoporosis, but several medications can slow, halt or partially reverse bone loss. Some drugs, including bisphosphonates, work by decreasing bone resorption, while others promote bone formation. For postmenopausal women, hormone replacement therapy can help stave off bone loss; testosterone can do the same for men with low levels.

Many of these meds have not been studied in people with HIV, but alendronate (Fosamax) and zoledronic acid (Reclast or Zometa) have been shown to improve bone density in HIV-positive people in randomized clinical trials. Q

NOVEL HIV VACCINE APPROACHES

Traditional vaccine approaches have not been able to prevent HIV, but researchers are exploring more sophisticated strategies. One novel approach, known as germline targeting, trains the immune system to produce broadly neutralizing antibodies (bnAbs) that target parts of the virus that don’t change much as it evolves. Only about 15% of people with HIV produce these bnAbs naturally, but most have rare immature B cells that have the capacity to do so. To overcome HIV’s ability to hide, scientists build immunogens, artiﬁcial constructs of viral proteins designed to provoke a robust immune response. A series of different primer and booster immunogens are used in a stepwise manner to encourage maturing B cells to produce bnAbs.

Scientists at the Scripps Research Institute created an immunogen dubbed eOD-GT8 60mer, designed to spur production of bnAbs similar to VRC01. The IAVI G001 trial demonstrated that most people who received an eOD-GT8 60mer primer vaccine developed specialized precursor B cells. Two follow-up studies showed that an mRNA version of the eOD-GT8 60mer vaccine (which Moderna calls mRNA-1644) primed immature B cells in mice, and boosters encouraged them to produce bnAbs that neutralize an HIV-like “pseudovirus.”

Two other studies evaluated a different immunogen called N332-GT5, designed to elicit production of a bnAb known as BG18. Researchers showed that an N332-GT5 primer vaccine activated rare precursor B cells in monkeys. Two booster immunogens drove further maturation of these cells in mice, leading to production of bnAbs with increased a nity for HIV.

Meanwhile, researchers at the Duke Human Vaccine Institute tested another vaccine candidate that targets MPER, a hidden part of HIV’s envelope that is brieﬂy exposed as the virus prepares to enter a cell. Most of the 20 participants in the HVTN 133 trial developed antibody responses against MPER peptides a er just two doses, and the most potent bnAbs neutralized various strains of HIV in the lab.

“To get a broadly neutralizing antibody, a series of events needs to happen, and it typically takes several years postinfection,” says Duke’s Wilton Williams, PhD. “With this vaccine molecule, we could actually get neutralizing antibodies to emerge within weeks.”

Although study results to date have been promising, they are early steps in a long process before vaccines can be tested in large clinical trials.

U.S. HIV Incidence Continues to Decline

New HIV infections in the United States continue to fall, with the greatest declines seen among gay and bisexual men, young people and people in the South, according to a new surveillance report from the Centers for Disease Control and Prevention (CDC). Estimated incidence fell from 32,700 infections in 2021 to 31,800 in 2022. Since 2018, overall HIV incidence has declined by 12%, driven by a 30% drop among those ages 13 to 24.

HIV testing and care indicators were about the same as last year. An estimated 87% of people living with HIV had been tested and knew their status, and 65% of those diagnosed were on treatment and had an undetectable viral load in 2022. But not all groups beneﬁted equally: Viral suppression rates ranged from 61% for Black people to 71% for white people.

“Overall, data from these reports demonstrate that expanding the reach of HIV testing, PrEP and treatment have been effective—but our reach must extend even further, and progress must be faster, to achieve our national goal of ending new HIV infections in the United States,” CDC’s Robyn Neblett Fanfair, MD, MPH, and Jonathan Mermin, MD, MPH, wrote.

HOW DOES CANNABIS AFFECT IMMUNE RESPONSE?

Marijuana and cannabidiol (CBD) have anti-inﬂammatory properties and may improve gut health, but smoking can lessen the beneﬁts, according to recent studies. Around a third of people with HIV have recently used marijuana, but its effects on immune function are not fully understood.

In one small study, cannabis users had fewer exhausted or senescent T cells and reduced expression of immune activation biomarkers compared with nonusers, but cannabis was not linked to HIV-specific CD8 T-cell responses or changes in the viral reservoir in CD4 T cells. Another study showed that HIV-positive people who took capsules containing CBD with or without THC showed reduced impairment of the gut lining, less T-cell exhaustion, fewer senescent CD4 and CD8 cells and a reduction in inflammatory biomarkers. Again, there was no change in the viral reservoir. A third study likewise showed that cannabis was associated with less immune activation and inflammation, perhaps because users had enhanced mucosal immunity in the gut and differences in their microbiome.

In two other studies, however, HIV-positive people who smoked marijuana showed evidence of both pro-inﬂammatory and anti-inﬂammatory effects on immune cells and

biomarkers. Smoking can damage the lungs and may increase the risk of cancer, so using edible forms of cannabis or CBD may be a healthier choice.

While randomized controlled clinical trials are still lacking, these findings add to the evidence that cannabis and CBD are anti-inflammatory in the setting of HIV, in part due to stabilization of the gut lining. “Cannabis may provide a beneficial intervention to reduce morbidity related to inflammation in people with HIV,” Ronald Ellis, MD, PhD, of the University of California San Diego, and colleagues wrote in a review of the research.

CDC Finalizes DoxyPEP Guidelines

The Centers for Disease Control and Prevention (CDC) has issued clinical guidelines for using doxycycline as post-exposure prophylaxis a er sex to prevent sexually transmitted infections (STIs). DoxyPEP involves taking a single dose of the antibiotic within 72 hours a er anal, vaginal or oral sex.

The new guidelines are supported by ﬁndings from the DoxyPEP trial, which enrolled more than 500 gay and bisexual men and transgender women at public

health clinics in San Francisco and Seattle. Taking doxycycline a er sex signiﬁcantly reduced the risk of gonorrhea, chlamydia and syphilis. But this approach failed to lower STI incidence in a similar study of cisgender women in Africa, likely due to poor adherence. Concerns about doxyPEP include antibiotic resistance and its effect on the gut microbiome.

The CDC recommends that health care providers should discuss doxyPEP with gay, bisexual and other men who have sex with men and transgender women who have had a bacterial STI within the past year. For other groups, providers are urged to use their clinical judgment and shared decision-making with patients.

“Doxy PEP represents the ﬁrst new STI prevention tool in decades, at a time when innovation in the nation’s ﬁght against STIs is desperately needed,” says Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention.

FUSILLI WITH ROASTED VEGETABLES & ROMESCO

Roasting the vegetables intensifies their sweetness to perfection.

PASTA SALADS CAN BE DULL, but this one is quite tasty. Roasting the vegetables intensifies their sweetness to perfection, and the delicious romesco sauce made with roasted pepper and almonds brings the whole dish together. Despite the number of ingredients, the prep and cooking are easy, so this is really worth putting together.

SERVINGS: 6 / INGREDIENTS: 14 / PREP: 30 MINUTES

INGREDIENTS

3 cups diced eggplant (about 1 medium eggplant)

3 medium red peppers, deseeded

½ cup halved cherry tomatoes

1 medium shallot, sliced

DIRECTIONS

1. Preheat the oven to 425°F.

4 cloves garlic, kept in their peel

1 tablespoon olive oil

Salt and pepper, to taste

6 ounces whole-wheat fusilli

6 cups baby spinach leaves

3 tablespoons almonds

By Craig Ramsay

Here are some slim-down tips: Add morning cardiovascular exercise to your fitness routine. After breakfast, hit the streets for a jog or step onto a Stairmaster or similar stationary fitness machine at home or the gym. Getting your heart rate up quickly and down slowly is the ideal cardio interval.

2 tablespoons red wine vinegar

3 tablespoons Parmesan cheese

¼ cup olive oil

6 small fresh mozzarella balls

halved, or half of 1 large ball cut into a ½-inch dice

2. In a large bowl, toss the eggplant, red peppers, cherry tomatoes, shallot and garlic with 1 tablespoon of olive oil, salt and pepper. Spread onto a baking sheet in a single layer. Roast for 20 minutes or until tender and well browned. When the vegetables are done, allow them to cool slightly. Set aside half of the peppers for the dressing.

3. Meanwhile, bring a large stockpot full of water to a boil. Add the fusilli. Cook for 3 minutes less than stated on the package instructions, add in the spinach and cook for 1 more minute. Drain well, drizzle with olive oil and let cool at room temperature, turning every so often.

4. To make the romesco dressing, take the cooled roasted red peppers you set aside and puree them with the almonds, red wine vinegar, Parmesan cheese and olive oil. Taste for seasonings.

5. Toss the cooled pasta, spinach and roasted vegetables with the dressing. Stir in the fresh mozzarella. Eat at room temperature or cover and keep in the refrigerator until ready to eat.

CHEF TIPS

If you are on a low-fiber diet, you can lessen the amount of fiber in this salad by using 8 ounces of white pasta instead of 6 ounces of whole wheat and 2 cups of eggplant instead of 3.

NUTRITION FACTS (per serving)

Calories: 463; fat: 28 g; saturated fat: 10 g; polyunsaturated fat: 3 g; monounsaturated fat: 14 g; carbohydrates: 33 g; sugar: 7 g; fiber: 5 g; protein: 21 g; sodium: 576 mg

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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.

Matthew McConaughey Stand Up To Cancer Ambassador

Photo by John Russo Background

Photo by Bobby Altman

“LIVE YOUR HIGHEST AND BEST LIFE,” URGES LONG-TERM SURVIVOR BISHOP STACEY S. LATIMER, WHO SHARES HIS EXPERIENCES AND ADVICE ON AGING WITH HIV: “YOU ARE STILL GROWING. YOU ARE YET WHO YOU SHALL BE.”

BY TRENT STRAUBE

WADMAN

y S. Latimer was diagnosed with HIV in 1987 while in the Army.

Stace

MUCH HAS CHANGED IN THE WORLD SINCE STACEY S. LATIMER FIRST appeared on the cover of POZ in 2007. For some context: The iPhone debuted that year, MySpace was more popular than fledgling Facebook and a junior senator from Illinois named Barack Obama announced his candidacy for president. Modern HIV treatment was also emerging: The first one-pill-once-a-day HIV treatment, Atripla, was approved the previous year, while pre-exposure prophylaxis (PrEP) to prevent HIV wouldn’t be available for another five years, and the fact that Undetectable Equals Untransmittable (U=U) wouldn’t be scientifically proved for almost a decade.

In 2007, Latimer was a 45-year-old, HIV-positive, same-genderloving reverend at the Unity Fellowship Church in Brooklyn who performed HIV and AIDS ministerial work within the Black church and advocacy within the larger community. Although he tested HIV positive in 1987 while in the Army, he had enjoyed good physical health and a rewarding life, thanks in part to treatment, care, his faith and a solid support system.

But as happens with many long-term survivors, other health challenges awaited. In 2019, Latimer was diagnosed with Stage IV prostate cancer, meaning it had already spread throughout his body. Although chemotherapy helped shrink the tumors, it eventually stopped working. Today, he’s participating in a New York University clinical

trial involving targeted radiation to kill cancer cells.

For this issue of POZ, which is focused on aging with HIV, we wanted to check in with Latimer, age 61, who is now a bishop with the Church of the Everlasting Kingdom. Our discussion, edited for length and clarity, covers clinical trials, the Black church, LGBTQ issues, life wisdom and, of course, an introduction to Kane, his larger-than-life canine companion and daily health champion.

Latimer participates in a clinical trial to treat his prostate cancer.

Thanks to modern HIV treatment, many people living with the virus enjoy normal life spans with few side effects from the meds. That’s amazing. But emerging data show that long-term survivors experience aging-related health challenges earlier than their HIV-negative peers and that they’re at higher risk for certain comorbidities. For example, people living with HIV are at greater risk for cardiovascular disease and may beneﬁt from starting cholesterol and blood pressure meds at an earlier threshold. And a recent study found that men with HIV had more advanced

MAN’S BEST FRIEND—AND HEALER

GROWING UP, BISHOP STACEY S. LATIMER always had dogs, and he always wanted an Italian mastiff (also known as a cane corso). Alas, it wasn’t to be—that is, until a few years ago, when the image of one popped up on Latimer’s Facebook feed, spurring him to research breeders. In 2019, he put down a deposit; then, two months later, he was diagnosed with Stage IV prostate cancer.

“I didn’t know what to do,” he recalls. “I didn’t want to have him orphaned. I decided to discuss it with my doctor. He said, ‘Mr. Latimer, you get your dog. People with pets generally do better.’”

A dog makes you feel good!

In fact, a recent survey by Cancer Care’s Pet Assistance & Wellness Program found that 92% of respondents said their pet was extremely important throughout their cancer diagnosis. Some respondents (15%) valued their pets so much that they considered ending or pausing cancer treatment in order to keep them.

Latimer followed the advice, and today, he and Kane are virtually inseparable. “He’s a gentle giant,” Latimer says. “He draws a lot of attention and is known as the mayor of Brooklyn. He has been a life changer. Before I got him, the doctor said to me one day, ‘Mr. Latimer, I want you to do at least 7,000 steps a day.’ It was a struggle. But once I got him—10,000 steps, 15,000 steps. Getting a dog just starts to make you feel good!”

prostate cancer at diagnosis, which was the case with you. Do you feel you were informed about these issues before your cancer diagnosis?

I strongly feel that I had some knowledge about the prevalence of cancer in HIV patients, but I do not think I was adequately informed. By this, I mean we retain information and develop good habits through repetition. So I believe the information was not provided to me frequently enough. More needs to be done to inform at-risk individuals of the possible dangers [and] that higher-risk populations can request speciﬁc screenings as a part of their routine care, for we know early detection is key to better outcomes. There need to be more efforts in getting the message out to the masses, and there is a need for diverse messaging that meets target populations where they are.

You’re currently in a cancer clinical trial. You have also participated in HIV studies, dating back to the 1980s when you were in the AIDS ward at Walter Reed National Military Medical Center in Washington, DC. Can you tell us about that?

I remember in 1987, the research team at Walter Reed came to the ward looking for subjects to volunteer to become part of research. Fear hindered my participation. I was much

healthier then and not as knowledgeable. I declined but witnessed very ill people volunteer, willing to sacriﬁce themselves for the greater good of others. As life afforded me the opportunity to live beyond what was predicted, the experience made me wiser. I began to understand the importance of research, trials and the need for Black participation for future treatment and care outcomes as well as a cure.

Since 1988, I have been a participant in HIV research through the military, by way of the Henry M. Jackson Foundation along with the Veterans Administration. In the beginning, I was seen every three months. As health outcomes for people living with HIV and AIDS improved, that time was adjusted to every six months. Since reopening after COVID-19 restrictions, I am now seen once a year in person and once via video. I’ve had the privilege of participating in so many studies, I’ve lost count.

What advice would you like to impart to other folks aging with HIV?

There’s no better time than now to live your highest and best life! Each person must take the time to ﬁgure out what that means for them. And don’t forget, you are still growing. You are yet who you shall be. As we age, there’s no time for being too upset, so depressed or so broken that we cannot or will

not take the time to love and take care of ourselves. We must be actively involved in our health care. We must be our own best advocate. Maintaining a good support system that understands where you are is also helpful.

My philosophy, starting in 2023, the ﬁrst time I was told that my cancer treatment was no longer working, has been: “I refuse to worry about and fear that which has not happened, for it will rob me of the joys of today.” And a motto that we share in Kingdom is: “Life has only lessons and blessings to offer, if we are open and receptive to believe.”

We must seek options and solutions to our fears, worries and doubts as we plan for favorable outcomes and a glorious end. Let nothing stop you from living your best life, not even the hard work of reconciling your faith. One of my favorite songs this season is by gospel artist Brent Jones, who [in the song “Live Your Best Life”] sings, “It’s good to be alive, but it’s best to live!” Also, don’t be afraid to prepare for death. Come to terms with the fact it’s a road we all must travel. Preparing does not mean you have given up. It means you are responsible.

“LIFE HAS ONLY LESSONS AND BLESSINGS TO OFFER IF WE ARE OPEN AND RECEPTIVE.”

Finally, as my ﬁrst oncologist said to me early after my cancer diagnosis, “It’s time to focus on what really matters to you.” As I (we) do this, let’s not forget about the “inner me”: the essence of who we are, which is housed in our physical frames (bodies). We are spirit. To have a whole, balanced life, both the physical and the spiritual must be

Latimer is a bishop in the Church of the Everlasting Kindgom.

properly cared for and aligned. It’s never too late to begin one’s spiritual journey. I am a living witness that if the spirit is well taken care of, the physical part of you will thrive.

Your spiritual journey has been quite the trek. You were raised Southern Baptist in Laurens, South Carolina. You’ve also been an independent Pentecostal and a member of the gay-affirming Unity Fellowship Church in Brooklyn. You founded and were the pastor of Love Alive International Sanctuary of Praise Worship Center, and then you moved to liberation theology and became a bishop with the Church of the Everlasting Kingdom. How does faith impact your outlook and your health?

As scripture says, “We move from faith to faith and glory to glory.” For me, religion has always given me hope. Faith always provided that God is going to make a way. If you believe you are divinely made by God in God’s image for a divine purpose, it does something to you and for you. All of that says, “I have no time to sit around and die, nor is doing that going to fulﬁll me or my purpose.” I think of how my life has been used to educate the Black church about HIV and AIDS and now cancer. I feel this need to herald and scream because doctors are not telling us about the things we have to stay on top of [like cancer screenings].

You turn 62 this fall, and the Bishop’s Council of Love Alive International Sanctuary of Praise is throwing a Red Party on October 4 to honor not only your birthday but also your HIV and LGBTQ advocacy. You’ve spoken before about earlier struggles to accept your sexuality—including a suicide attempt—and your work to meld that with your faith. Have you witnessed improvements on these fronts in the Black church, and what challenges remain? Oh, yes, I have experienced and witnessed improvements [in attitudes] toward LGBTQIA people over the years as outreach and education continues to meet people, houses of worship and institutions where they are. The truth of love is not always easily received— that love overcomes all things, that love heals all things.

Even though we continue to make great strides concerning attitudes toward LGBTQIA people and people living with HIV and AIDS, our remaining challenges—religion, outdated cultures and customs, along with greed and hate—will more than likely continue to hinder HIV and AIDS education, prevention and access to care and treatment. This also blocks efforts to end AIDS and to solve our mental health crisis. The wheels of equality tend to move very slow. Yet in this volatile climate saturated with hate, everyone’s voice is important. Every vote counts. Every life matters!

I knew I was same-gender-loving at 6 years old, but I didn’t have words to [describe the experience or my identity]. There wasn’t even information to help my parents understand.

My family was not perfect, but their love and support allowed me to freely grow and become me without most of the hateful biases that ﬁll a child with brokenness and unanswered questions.

There is so much power found in self-love. Living your truth positions you to receive all the good that was meant for you. It provides you a peace the world cannot take away. Q

INFORMATION AGE

“WE MUST SEEK OUT INFORMATION to stay informed,” says Bishop Stacey S. Latimer, a long-term survivor also dealing with cancer. “Ask questions so that you might have the answers to make informed decisions concerning your life that line up with your desires and your vision.” He’s planning a November event with the New York State Health Department to educate faith leaders on issues of HIV and cancer.

Today, over 50% of people with HIV are 50 or older. If you are aging with HIV, check out these resources:

HIV+ Aging Research Project—Palm Springs (HARP-PS) aims to improve the lives of people with HIV by studying the impact of HIV and treatment on the natural aging process. The group also spearheads research projects.

HIV Long-Term Survivors Awareness Day (HLTSAD) is observed each June 5, but related information is available year-round.

Let’s Kick ASS—AIDS Survivor Syndrome is a nonproﬁt that aims to empower long-term survivors and enhance quality of life.

National HIV/AIDS and Aging Awareness Day (NHAAD), observed September 18, highlights issues and organizations focused on this topic.

POZ.com continues to post related news, science, proﬁles and more. Click the hashtags #Aging and #Long-Term-Survivors for a collection of headlines, including “HIV & Aging: The Basics.”

The Reunion Project, an alliance of long-term survivors, offers national and regional gatherings, bimonthly webinars and an email newsletter.

SAGE (Advocacy & Services for LGBTQ+ Elders) offers resources for older queer people living with HIV.

WE WON’T ALWAYS BE HIV AND AIDS SURVIVORS. THAT’S NOT HOW LIFE WORKS.

BY MARK S. KING ILLUSTRATION BY NINA UY

HE CASKET OF MY FRIEND JESSE

Peel, an elderly longtime HIV survivor who died in 2023, was crafted of gorgeous wood—oak, I think. As I stood admiring it in the alcove of the church prior to his memorial, a powerful sense of déjà vu brought suppressed emotions rushing back.

The smell of the wooden pews, freshened with lemonscented cleanser. The sight of the ushers greeting people and handing out programs. Whispered voices gathering and tumbling over one another. The encouragement from the pulpit to celebrate Jesse’s life joyfully because “that’s what he would have wanted,” even if our broken hearts refused to play along.

The scene was so familiar, like an old, plaintive song I had not heard in years. And just underneath it, a lingering, unsettling feeling: I thought I escaped all of this.

Something in my psyche, scarred by the trauma of so many funerals in my 20s and 30s, stubbornly believed they had been left in the past. After all, after testing HIV positive in 1985, I had made it out of those plague years alive. Once effective treatment arrived in the mid-1990s, funerals in my social circle slowed and then essentially stopped decades ago.

The questions stopped too, the ones I had been forced to confront when I was terribly young and diagnosed with a death sentence: Why am I here? What happens when I die? How in the world do I prepare for it?

Those questions, like the funerals, have returned. Long-term survivors in their 60s and beyond are getting a taste of late-life mortality, the kind we once never imagined for ourselves. And that means, with increasing regularity, that our survival ends.

It makes me question my own lifelong ﬁxation on survival. The very word survivor denies a basic human condition: We are mortal.

For long-term survivors, mortality takes center stage again.

MAYBE IT’S THE FACT THAT THE NATURAL ORDER of things—one generation ages and dies, followed by the next—was upended by AIDS. The wrong generation died. It threw us out of whack. As I enter late age, I ﬁnd myself contemplating the realities of death for the second time. It just feels off. We don’t like talking about this.

Our HIV organizations, support groups and media are in the business of providing hope. It’s awkward when something runs counter to that uplifting narrative. Death is depressing. And when we’re all engaged in triumphant public messaging about thriving with HIV, acknowledging death feels like admitting failure.

The irony is that most everyone working in HIV and AIDS has experience with uncomfortable conversations. For 40 years, we have fostered public dialogue on condoms, bodily ﬂuids, sex, gender identity, homophobia and racism. There was no time to be coy when it came to saving lives.

Silence equaled death. Now we’re silent about death.

I am convinced we are ready to talk a lot more about this renewed wave of mortality because I hear it from longterm survivors all the time. We are a stout bunch. Do not

PLANNING AHEAD

underestimate our willingness to face this topic.

Fellow survivors tell me about their growing list of ailments and physical decline and their confusing anger about growing frail when we’re supposed to be grateful for having survived at all. Or the loss of friends and family and how relieving it is to outlive our parents. They describe stepping discreetly into funerals to sign the guest book and slipping out again, so paralyzing is the posttraumatic stress when the pipe organ moans and the eulogies begin.

I may not be at death’s door, but I’m not far down the hall. It’s little things that remind me, like watching an actress play an elderly woman and realizing I saw her movie debut a half century ago. Or the grocery store clerk who asked whether I needed help getting my things to the car when I had exactly two bags containing a dozen eggs, three potatoes and a bottle of MiraLAX.

TO HELP GROUND ME AND FOCUS ON TANGIBLE ways to prepare for the inevitable, I ﬁrst spoke with my friend Ronda Goldfein, an attorney with the AIDS Law Project of Pennsylvania. Ronda is very capable and exacting—desirable

USE THE FOLLOWING DOCUMENTS to spell out your wishes and ensure that they’re honored. Laws regarding these documents vary by state, so do your research or work with a legal expert. Your local HIV and AIDS agency or Legal Aid Society may offer help completing these.

A WILL states who inherits your assets when you die. Without a will, state law decides who gets your property. You can even handwrite your own will if you’re of sound mind and 18 or older. Be sure to name an executor, name which persons or groups you want to inherit your property and sign it. It’s best to have the will notarized and witnessed by two people over 18.

AN ADVANCE HEALTH DIRECTIVE , or a living will,

is a legal document stating your wishes for end-of-life medical treatment. The document allows you to choose the kinds of medical care you want—or do not want. The living will becomes effective only when there is a “triggering event” that is an end-stage medical condition. You must be of sound mind and age 18 or older when you create the document and must sign and date the written directive in the presence of two witnesses over 18.

A DURABLE HEALTH CARE POWER OF ATTORNEY, also known as a medical power of attorney, names someone to make medical decisions for you. This person is known as your “health care agent.” This goes into effect as soon as it is signed. You can revoke this decision at any time.

From “AIDS Law: Your Life, Your Decisions” by the AIDS Legal Project of Pennsylvania. Go to aidslawpa.org for more information.

traits in a lawyer—but I trust her even more because she also knows how to have fun. I once ﬂoated with her through an underground water cave in Mexico. She loves adventure.

Ronda said she tries to dig deep when counseling a client about end-of-life wishes. When they say they want everything possible to be done to keep them alive, they might not understand what that looks like, so Ronda gently and clearly explains it to them. For example, some resuscitation methods are invasive and even violent.

Ronda strongly believes that everyone should have a few basic documents prepared, like wills and powers of attorney. “You might live somewhere with a great care provider and where you are respected,” Ronda told me. “But what if you’re traveling and end up in some horrible place that doesn’t honor your wishes or your legal marriage or partnership? These documents matter. Complete them and share copies with loved ones, with your case manager, whoever should have it.”

While Ronda’s advice was reassuring, my emotional and spiritual fears still linger. Those anxieties have been constant since the beginning of AIDS. I remember looking into the eyes of dying friends as if they might reveal something about the cosmic destination they were quickly approaching. No clues were ever surrendered, and I am not particularly proud of using their ﬁnal days to try to resolve my fearful curiosities.

I assure you I live with joy and gratitude most of the time, as morbid as some of this might sound. I just know how much I will miss all of this, this life, this gorgeous chaotic world, my favorite streaming shows, all the friends and strangers reading this—even if my belief system tells me that death means it’s lights out and I will miss, well, nothing at all.

I said as much to my brother-in-law David Lanzillotti recently. We were on an afternoon walk to admire the lush forest in my neighborhood. David is a therapist, so he always listens patiently to my existential questions. “I can’t comprehend that I will be dead, that I won’t even exist, for the rest of all eternity,” I told him as we strolled along, a sunny breeze in our faces. “That kinda drives me crazy when I think about it.”

“Well,” David replied matter-of-factly, “you weren’t alive for all eternity before you were here. That doesn’t seem to have bothered you much.” I was dumbfounded. The truth of it, so maddening in its simplicity, made me want to stomp my feet.

My friend Bridgette Picou knows something about the intimacies of death and dying. She is an HIV survivor, a community liaison for The Well Project and a licensed nurse. She has seen some things.

“Loss is loss,” Bridgette told me when we discussed the topic. “But not all loss is equal. As a person living with HIV, losing a client to HIV complications has a profound effect on me. As a Black woman and mother, when I hear about Black men murdered on the street, I think of my son. That death is scary in a very different way.”

Bridgette brings real clarity to how race changes the dynamics of death. “Black men and women might die of illness like anyone else,” she explained, “but that death, from HIV or diabetes, was probably avoidable. Health care plays a role in that.”

I assumed Bridgette was talking about a lack of access to health care, but she corrected me right away. “There are inequities beyond the fact that we have less access to health care,” she contended. “My clinical care will be different from yours. I can go to the same doctor as you do and not get the same health care. Even with the same insurance.”

Bridgette’s point extends beyond doctors and patients, of course. Look at the high death rates of Black mothers during childbirth, the horriﬁc murders of trans women, the continued drumbeat of AIDS deaths among the marginalized and you are a witness to disparity. A just death, a natural death, might be the least everyone deserves, but it isn’t promised to anyone. The impact of inequity extends to the very end of our lives.

When it comes to the actual end of life, Bridgette has this observation: “There are people who approach death more easily than others,” she told me. “They feel like they have done what they were here for. Others are more anxious because they feel like they have more to do. They don’t feel ready.”

If we’re all going anyway, I thought to myself, I hope I have conﬁdence that I have done enough. Maybe more than enough.

AND THAT BRINGS US, AFTER ALL THE WORRY

and advice, to a basic truth. We must hold close to the life we have and to the moments lived in the here and now, when we can set aside eternal questions about the future and enjoy the glorious sights right in front of us.

The grin on Ronda’s face as we ﬂoat through a Mexican water cave. My brother-in-law David with a warm breeze in his hair as we stroll through the forest. The clarity of Bridgette’s wisdom as she speaks of death and justice. The chorus of voices singing hymns at Jesse’s funeral while the hairs on my arms stand up, as if I might believe in something after all.

Moments. Moments. Moments.

My husband, Michael, and I sat on the back porch late in the day recently, after hours of planting shrubs and creating a yard to enjoy in our rapidly approaching elder years. Then I said something that occurs to me more often these days.

“I love my life,” I told him. “And look at the yard. Isn’t it beautiful?”

“Sure,” Michael agreed, “but I do think we need a tree there, and I would like it more if we added more plants to…”

“Stop,” I gently chided him. “I mean it’s beautiful right now. Right now.”

Michael heard my point and smiled at me. “OK,” he admitted. “Everything is great. I love all of this.”

We lifted our gaze as the sky turned to night, taking in its deepening colors and unknowable mysteries.

“Yes,” I said, after a while. “Things are just right at this very moment.”

I reached for Michael’s hand, feeling released from questions and answers, as we quietly watched the gathering, inﬁnite stars. Q

Mark S. King is a GLAAD Award–winning writer and the author of My Fabulous Disease: Chronicles of a Gay Survivor

A Sense of Purpose

It’s been nearly 40 years since Hassan James Gibbs, 67, learned he was living with HIV. It’s a moment he still vividly recalls.

“It was March of 1985,” says Gibbs, a Philadelphia native. “I was selling some blood. I’d gotten out of the service honorably, but I was broke. The blood bank sent a letter a few days later—I thought it was a check—but it was a letter saying my blood was unacceptable, that I was HIV positive and that I needed to see a physician as soon as possible.”

Instead of seeking treatment, Gibbs turned to drugs and alcohol to cope with a diagnosis that, at the time, usually meant impending death.

“I didn’t seek care right away,” he explains. “I sought care when I got thrush patches in my mouth. That’s when I saw a doctor.”

The seeds of activism took root in Gibbs when he noticed that HIV was disproportionately affecting those on society’s margins: trans folks, sex workers, injection drug users, prisoners and poor people.

“I got mad because so many people were dying,” he says. “Everyone in the club that I went to—they died. They’re all gone. So I was mad. That anger about not having su cient treatments and not having people getting tested and admitting that they got it, it sparked up my enthusiasm to do something.”

Ultimately, that rage propelled Gibbs to ﬁnd his own voice. It’s a journey that has included a lot of listening along the way.

“My early days at ACT UP would be at St. Luke’s Church in Philly,” Gibbs explains. “I sat back, and I listened because I knew nothing about this activism thing. We went to Washington, DC [for a march]. I became one of the guards, meaning that I kept the crowd on the sidewalk and not straggling into the street where they could be arrested.”

Gibbs learned that the key to activism is showing up, again and again. He also spent time buttonholing lawmakers on Capitol Hill and demanding more AIDS funding.

“And then I found my niche through teaching, through lecturing, through staying clean, through sharing at Narcotics Anonymous meetings when they did not want talk about AIDS. They told me HIV was not a recovery issue.”

But for many people, HIV and addiction are inextricable. Most recently, Gibbs—who has abstained from substances for more than ﬁve years— has become a leader and mentor for HIV-positive folks in 12-step programs.

“This work gave me a sense of purpose,” Gibbs adds. “My head is now clear. I’m not using; I’m not drinking. I really feel like I’m doing something important with my life.”

He’s got advice for anyone newly diagnosed with the virus. “If you’re having substance use or mental health issues, address them,” he says. “And talk with your doctor about places that you can go to talk about depression, even if it’s absent of substance abuse.”

Gibbs also has some tips for longevity. “Stay social, stay involved and stay ﬁt,” he advises. Q

Hassan James Gibbs is a long-term survivor and an HIV advocate.

Sexual health is a crucial aspect of one’s overall health and well-being. A positive and holistic approach to sexuality respects individual rights, helps foster healthy relationships and contributes to one’s quality of life. Please take our conﬁdential survey and let POZ know about your sexual health.

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