Real Health Winter 2016 by Smart + Strong

YOUR GUIDE TO BLACK WELLNESS

Sleepy Hollow â&#x20AC;&#x2122;s

Lyndie Greenwood Talks Self-Defense:

WINTER 2016 $2.99 US REALHEALTHMAG.COM

How to Make Holiday Dishes Healthier and Delicious!

A Key Skill Women and Girls Need for Empowerment

How Much Longer? An Update on HIV Vaccines

The Dangers of Being Too Clean

Big Worry #1 Health Insurance After the Election

YOU MATTER AND SO DOES YOUR HEALTH

That’s why starting and staying on HIV-1 treatment is so important.

What is DESCOVY ? ®

DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.

DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body ﬂuids. Never reuse or share needles or other items that have body ﬂuids on them.

What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: • •

•

Changes in body fat, which can happen in people taking HIV-1 medicines.

Changes in your immune system. Your immune system may get stronger and begin to ﬁght infections. Tell your healthcare provider if you have any new symptoms after you start taking DESCOVY. Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems. Bone problems, such as bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

IMPORTANT SAFETY INFORMATION

The most common side effect of DESCOVY is nausea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

DESCOVY may cause serious side effects:

What should I tell my healthcare provider before taking DESCOVY?

What is the most important information I should know about DESCOVY? •

•

Buildup of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

Serious liver problems. The liver may become large and fatty. Symptoms of liver problems include your skin or the white part of your eyes turning yellow (jaundice); dark “tea-colored” urine; light-colored bowel movements (stools); loss of appetite; nausea; and/or pain, aching, or tenderness on the right side of your stomach area. You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight, or have been taking DESCOVY for a long time. In some cases, lactic acidosis and serious liver problems have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without ﬁrst talking to your healthcare provider, as they will need to monitor your health.

•

All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis virus infection. All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take DESCOVY with all of your other medicines. If you are pregnant or plan to become pregnant. It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/ medwatch, or call 1-800-FDA-1088. Please see Important Facts about DESCOVY, including important warnings, on the following page.

Ask your healthcare provider if an HIV-1 treatment that contains DESCOVY® is right for you.

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IMPORTANT FACTS (des-KOH-vee)

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

MOST IMPORTANT INFORMATION ABOUT DESCOVY

POSSIBLE SIDE EFFECTS OF DESCOVY

DESCOVY may cause serious side effects, including:

DESCOVY can cause serious side effects, including:

• Buildup of lactic acid in your blood (lactic acidosis), which is a serious medical emergency that can lead to death. Call your healthcare provider right away if you have any of these symptoms: feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

• Those in the “Most Important Information About DESCOVY” section. • Changes in body fat. • Changes in your immune system. • New or worse kidney problems, including kidney failure. • Bone problems.

• Severe liver problems, which in some cases can lead to death. Call your healthcare provider right away if you have any of these symptoms: your skin or the white part of your eyes turns yellow (jaundice); dark “tea-colored” urine; loss of appetite; light-colored bowel movements (stools); nausea; and/or pain, aching, or tenderness on the right side of your stomach area. • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking DESCOVY. Do not stop taking DESCOVY without ﬁrst talking to your healthcare provider, as they will need to check your health regularly for several months. You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight, or have been taking DESCOVY or a similar medicine for a long time.

ABOUT DESCOVY • DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years of age and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. • DESCOVY does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.

The most common side effect of DESCOVY is nausea.

These are not all the possible side eﬀects of DESCOVY. Tell your healthcare provider right away if you have any new symptoms while taking DESCOVY. Your healthcare provider will need to do tests to monitor your health before and during treatment with DESCOVY.

BEFORE TAKING DESCOVY Tell your healthcare provider if you: • Have or had any kidney, bone, or liver problems, including hepatitis infection. • Have any other medical condition. • 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 you take: • Keep a list that includes all prescription and over-thecounter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. • Ask your healthcare provider or pharmacist about medicines that should not be taken with DESCOVY.

GET MORE INFORMATION HOW TO TAKE DESCOVY • DESCOVY is a one pill, once a day HIV-1 medicine that is taken with other HIV-1 medicines. • Take DESCOVY with or without food.

• This is only a brief summary of important information about DESCOVY. Talk to your healthcare provider or pharmacist to learn more. • Go to DESCOVY.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit DESCOVY.com for program information.

DESCOVY, the DESCOVY Logo, GILEAD, the GILEAD Logo, and LOVE WHAT’S INSIDE are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. © 2016 Gilead Sciences, Inc. All rights reserved. GILC0265 10/16

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CONTENTS

this month on REALHEALTHMAG.COM Tough Guys Hurt Too

Rapper Kid Cudi disclosed he suffered from depression and motivated other black men to start talking about their mental health issues.

Health Basics A—Z

7 5

COVER: PHOTO BY BLAKE BALLARD; HAIR AND MAKEUP: ERIKKA HART; STYLING: BLAIRE BALLARD (CUDI) JAIME RIVERA/SIKI MEDIA COMMONS; {WOMAN, BABY, FLAG/STETHOSCOPE, NUTS AND TEST TUBES) ISTOCK; (MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY); (SNORTLAND) COURTESY OF ELLEN SNORTLAND

If they’re to thrive, black women who survive breast cancer need health providers to address their physical, emotional, financial and sexual problems.

And Baby Makes Four

A controversial birth method that used genes from two moms and one dad stopped a baby from being born with a genetic disorder. Is this OK?

Digital Real Health

Read Real Health magazine online exactly as it appears in print. Go to realhealthmag.com/ digital to view the current issue and the entire Smart + Strong digital library.

editor’s letter

16 COVER STORY

empowering women

Women’s sexual health care

sex

Ask Dr. Dee: How can I stop stress from ruining my relationship?; the latest Pap smear guidelines

nutrition

Troubling treats; say yes to healthy high-calorie foods; what to have if you can’t drink milk

Actress Lyndie Greenwood is a believer in women learning how to protect themselves through self-defense training.

buzz

Obamacare: what happens now?; PrEP for women; HIV and affordable housing; flossing facts; when dirt isn’t so bad; a new and improved test for fibrosis

Want to lose weight, exercise smart, eat right, find good health care, sleep better or just get healthy? For tips, click on “Health Basics A–Z” on the realhealthmag.com home page.

Cancer Care

fitness

Most anyone can master doing a pull-up with the proper technique; health benefits of virtual fitness

stopping the virus

Researchers haven’t given up on a safe and effective HIV vaccine.

feasting made easy

Overhaul your ingredients list for a tasty and healthy holiday menu of your traditional favorites.

don’t dye yet!

Here’s the proper way to prep your tresses for color to avoid damage, breakage and hair loss.

thoughts

Easy ways to overcome the fear of humiliation and embarrassment

Real Health Question of the Month

What role does self-defense training play in empowering women and girls? Girls need to be given permission to have jurisdiction over their own bodies. We need to teach girls to deliver their own consequences, because it’s a fairy tale to think that someone is going to be there to rescue them. —Ellen Snortland, author and activist

reach out & click!

At realhealthmag.com, you can read more articles; access exclusive, online-only special reports; meet other health-minded black singles; and subscribe ($9.97 for four quarterly issues; you can also call 800.973.2376). Plus, sign up for the Real Health email newsletter to get the latest black health news!

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EDITOR’S LETTER

The High Cost of Womanhood

Women pay more but get less care for sexual health.

EDITOR-IN-CHIEF

Kate Ferguson-Watson MANAGING EDITOR

Jennifer Morton DEPUTY EDITOR

Trenton Straube

ecently, I researched the MonaLisa Touch Method, a laser vaginal rejuvenation therapy that treats a host of women’s sexual health issues. In particular, the treatment addresses the problem of vaginal atrophy: the thinning, dryness and inflammation of the vaginal walls that can lead to painful sex, chronic vaginal infections and urinary problems of varying severity. These unpleasant and uncomfortable symptoms are widespread among pre- and post-menopausal women and range from simply being troublesome to seriously affecting women’s physical, mental and sexual health and well-being. Interestingly, although the Food and Drug Administration (FDA) approved the procedure almost two years ago, the treatment has yet to be covered by insurance. Why? When I asked an ob/gyn, she said insurance companies consider the therapy plastic surgery, a reconstructive procedure that’s elective and medically unnecessary. Generally, health insurers make determinations about coverage based on whether a treatment is medically necessary. But when it comes to interventions that address sexual dysfunction in women, insurers refuse to cover options that maintain or restore their bodies’ ability

COPY CHIEF

Joe Mejia

ART DIRECTOR

Mark Robinson ART PRODUCTION MANAGER

Michael Halliday LEGACY ADVISOR

Megan Strub

ADVISORY EDITOR

Sean Strub

ADVISORY BOARD

Lee SaintMartin, MS, IIPA, CN, ND, naturopath; Goulda Downer, PhD, RD, CNS, and Nutrition Services Inc.; Yuan Wan, licensed acupuncturist and doctor of traditional Chinese medicine; Dorothy Horton, PsyD, clinical psychologist; Lovell Harris, MD, internist; Jeanette L. Pinnace, DPM; Terrie M. Williams, mental health advocate

SMART + STRONG PRESIDENT AND COO

Ian Anderson

CHIEF TECHNOLOGY OFFICER

Christian Evans

VICE PRESIDENT, SALES/PUBLISHER

Susan Mary Levey CONTROLLER

Joel Kaplan INTEGRATED ADVERTISING COORDINATOR

Jonathan Gaskell

CDM PUBLISHING LLC CHIEF EXECUTIVE OFFICER

Jeremy Grayzel SALES OFFICE

212-938-2051

Here’s to your health, JOAN LOBIS BROWN

Issue No. 48. Copyright © 2016 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 prior written permission of the publisher. If you are an individual or organization and would like to subscribe to Real Health, go to realhealthmag. com or call 800-973-2376. Send feedback to info@realhealthmag.com or Real Health, c/o Smart + Strong, 212 W. 35th St., 8th Floor, New York, NY 10001. Smart + Strong® and Real HealthTM are trademarks of CDM Publishing, LLC.

to function normally. For women especially, insurance companies often deny coverage of treatments that can relieve sexual problems, such as this vaginal rejuvenation procedure. Mean while, this is not usually the case for men. Reports show that it’s easier for men to get insurance to cover erectile dysfunction drugs like Viagra, penile implants and vacuum devices to stimulate erections. Is there a double standard at work? Many doctors believe there is. According to a CNN story, insurers typically cover testosterone for older male patients who wish “to boost their sagging sex lives. But when older women want treatments for vaginal dryness and atrophy, insurance companies usually balk.” Some experts believe that how men and women are socialized about sex is at the heart of this health issue. Women are perceived as having lower sex drives, while the sex urge in men is thought to be a biological imperative. And so women’s complaints and concerns about this aspect of their reproductive health tend to be dismissed. The rules for health care coverage of sexual dysfunction issues continue to favor treatment and relief for men at women’s expense. As far as the MonaLisa Method is concerned, though, there’s been talk that it may eventually qualify for health insurance coverage. Right now, however, there’s no processing code for the procedure under managed care. The message for women seems clear: Insurance companies don’t consider treatments for women’s sexual health issues a priority. According to Even the Score, a campaign for women’s sexual health equity, in early 2014 the FDA approved the 24th drug to treat male sexual dysfunction. For women, there’s just one med to use.

Kate Ferguson-Watson, Editor-in-Chief katef@realhealthmag.com realhealthmag.com

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Haywood and his wife, Ellen Midlothian, VA

I made a plan. It wasn’t easy, but I did it. So can you.

It’s not easy, but it’s worth it. People who learn to manage their diabetes from the start have fewer health problems from diabetes years later. You can too. Learn how to better manage your diabetes. Order a free booklet, 4 Steps to Control Your Diabetes. For Life. from the National Diabetes Education Program to learn more.

For more information, visit www.YourDiabetesInfo.org or call 1-888-693-NDEP (6337); TTY: 1-866-569-1162. The U.S. Department of Health and Human Services’ National Diabetes Education Program (NDEP) is jointly sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) with the support of more than 200 partner organizations.

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BUZZ

What Happens Now?

Everyone is waiting to see how the new president will handle Obamacare.

ISTOCK

AT PRESS TIME, THE ELECTION HADN’T been decided. But one thing we’re sure about is that both Hillary Clinton and her opponent, Donald Trump, plan to tackle the Affordable Care Act. Early in the presidential campaign, Trump declared that on the first day of his administration, he’d ask Congress to immediately deliver a full repeal of Obamacare. Clinton said that if she won, President Obama’s health care legacy would be safe and she’d expand on the law, especially if she could get more Democratic support in Congress. On her website, Clinton called the Affordable Care Act (ACA) “a critically important step toward the goal of universal health care, offering coverage to 20 million more Americans, and ensuring all Americans will never be denied coverage on account of a pre-existing condition or their gender.” Trump said he wanted to repeal Obamacare essentially because he believes “no person should be required to buy insurance unless he or she wants to.” In addition, the GOP nominee stated that current laws prohibiting

the sale of health insurance across state lines should be modified. “As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state,” Trump said. “By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.” But when health insurance companies enjoyed this commercial prerogative, in general, their medical maintenance plans didn’t always provide better health care for individuals—in particular older Americans. “My goal would be to create a public option for people between 55 and 64 to buy into Medicare,” Clinton proposed. She planned to add this type of health insurance coverage—one that’s financed by the public and administered by the government—to the existing options. Under this system, everyone would have health care, there’d be no networks for different insurance The state of plans and people would our nation’s be free to choose any health care doctor, hospital or health

center they wanted to use. The goal of a public option is to provide people with access to primary care that reduces the number of those getting sick by allowing doctors to catch illness and injuries before they become too severe and expensive to treat. “I think it would save us money,” Clinton said, and “it would certainly save heartbreak.” Trump’s approach to overhauling the ACA stressed reforms that would “allow the free market to provide insurance coverage opportunities to companies and individuals.” And for those who couldn’t afford insurance, he suggested improving basic options for Medicaid and ensuring that states offer health care coverage to anyone who wants it. But, basically, the problem with this plan is that it would reestablish the previous health care system that the ACA replaced, a high-cost, inefficient, wasteful dinosaur that begged for a deathblow. This is why millions of previously uninsured Americans who currently have health insurance are justified in worrying about where we go from here.

realhealthmag.com

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BUZZ

Digging for Dirt Germs aren’t all bad.

To Floss or Not What do dentists say? RECENTLY, A HUGE NEW STUDY found that evidence supporting the benefits of flossing, at this point, is “weak, very unreliable” and of “very low quality.” But despite the findings, many dentists say they’ll keep recommending that people floss regularly, moving the string up and down between their teeth at least once each day, as a way to prevent cavities and gum disease. Researchers note that although the first use of floss is unknown, scientists have found items (think horsehair and twigs) for cleaning between teeth in the mouths of prehistoric humans. (Even back then, folks couldn’t stand having food particles trapped in these spaces.) As years passed, dentists endorsed the practice as a key to proper oral hygiene. Today, the advice of the American

Dental Association (ADA) remains as firmly fixed as dental implants cemented in place. The nation’s largest dentists’ association, which represents more than 159,000 members and is the leading advocate for oral health, suggests that flossing is an essential part of tooth and gum care. The ADA’s members stress that “cleaning between teeth removes plaque that can lead to cavities or gum disease from the areas where a toothbrush can’t reach.”

Remember the boy who had no defenses against germs and had to live his life in a protective bubble? Well, in extreme cases, scientists theorize, this can happen when kids are raised in an environment that is just “too clean.” And now, recent findings published in the journal Pediatrics show that kids who bite their nails or suck their thumbs are less likely to have allergic reactions to a wide variety of irritants, including pets and mites. These findings support a theory researchers call the “hygiene hypothesis,” which states that children’s early exposure to bacteria, viruses and allergens primes their immune systems to better defend against microbial attacks. The scientists caution that they’re not suggesting parents should be unconcerned with children possibly swallowing germs from sucking their thumbs or biting their nails. Says Malcolm Sears, a professor of medicine at McMaster University in Ontario, Canada, and one of the study’s coauthors, “What we are saying [to parents] is don’t be quite so afraid of a little bit of dirt.”

THE PERCENTAGE OF AMERICANS WHO NEVER FLOSS New Test Gets High Marks This blood exam makes screening easier for folks with a certain type of liver disease. Until now, the preferred method for detecting liver damage in people living with non-alcoholic fatty liver disease, or NAFLD, was an invasive biopsy, a surgical procedure that samples a small portion of the liver to determine its level of fibrosis (scarring and thickening). But recent studies showed that biopsies can lead to misdiagnosis in 20 to 40 percent of people with hepatitis and may cause pain and bleeding. Now, there’s a new blood test, called the enhanced liver fibrosis (ELF) test, that 8 RE A L H E A LTH WIN T E R 2016

helps doctors quickly discover and monitor advanced liver fibrosis among people diagnosed with NAFLD. The test requires only a blood sample and produces results within an hour. Docs now recommend the ELF test for all NAFLD patients. Adults with the condition are retested every three years; children and young people are retested every two years. With the ELF test, a primary care provider can include liver fibrosis monitoring

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among a patient’s routine blood tests. Experts say the test is less invasive, more accurate and far more convenient compared with liver biopsies or scans. Plus, the test is reliable for checking liver fibrosis scores in people with viral and alcoholic hepatitis. LIVER

- TES

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

Source: Delta Dental Oral Health and Well-Being Survey, 2014

BUZZ

Home Rules A new law makes housing more affordable for people with HIV/AIDS.

Gotta Get PrEP’d for Prevention

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

Why is pre-exposure prophylaxis for HIV still not a routine part of ob/gyn and family health care? YOU CAN’T TAKE SOMETHING YOU DON’T know exists. This is what Judith D. Auerbach, PhD, a professor in the University of California at San Francisco’s Department of Medicine, learned during a series of women’s focus groups on PrEP, or HIV pre-exposure prophylaxis, that her research team conducted in six U.S. cities. “Almost none of the participants across sites had ever heard of PrEP before the focus group session,” the researchers reported. What’s more, many of these individuals “expressed feeling upset, frustrated and even angry that they had not learned of it before.” And some women who had heard about PrEP thought the med (the daily antiretroviral pill also known by its brand name, Truvada) was only for men, not women. In addition, a number of participants in the focus groups “were concerned that they might have to educate providers, instead of the other way around,” researchers said. Indeed, findings show that some primary care clinicians were largely unaware of PrEP before and after the release of

trial results for the medication. Some couldn’t correctly define pre-exposure prophylaxis or didn’t think educating patients about PrEP was important, and many admitted that they were uncomfortable offering this information. But “if more family physicians and other primary care providers feel comfortable prescribing PrEP, this strategy for reducing HIV prevalence may reach more individuals who are vulnerable to infection,” say James Conniff, MD, and Ann Evensen, MD, in their report about PrEP in primary care settings. When providers don’t explore HIV prevention as part of the sexual and reproductive health services they offer patients, the result is a lost opportunity for doctors to help reduce transmission of the virus. Experts say the burden is on the health care industry. Med school graduates and physicians need continuing education; women require effective treatments for sexual concerns; and health facilities must foster an environment of care that builds trust between doctors and patients.

As a recent blog post by AIDS United pointed out, affordable housing is “one of the greatest unmet needs of people living with HIV.” This is why President Obama recently signed a law that updates the federal housing program for people with HIV. The act now factors local housing costs and poverty rates into the formula used to calculate benefits so that HOPWA (Housing Opportunities for Persons with AIDS) funds are distributed based on the current state of the epidemic. The U.S. Department of Housing created HOPWA to provide housing assistance and related support services for low-income individuals living with HIV/AIDS and their families. “Rates of HIV are 3 to 16 times higher among persons who are homeless or unstably housed compared to those living in stable housing,” says Rusty Bennett, PhD, a licensed social worker and cochair of the annual National Conference on Social Work and HIV/AIDS. When people are stably housed, they’re “more likely to be engaged in care,” he adds. Says Senator Jack Reed (D–R.I.), who along with Senator Susan Collins (R–Maine) introduced the legislation, “This bill provides a fairer and more accurate formula to meet the needs of those who really need assistance now and in the future.”

THE PERCENTAGE BY WHICH THE RISK OF GETTING HIV FROM SEX IS REDUCED WHEN PREP IS USED CONSISTENTLY Source: Centers for Disease Control and Prevention

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What is TRUVADA for PrEP (Pre-exposure Prophylaxis)?

uYou may be more likely to get lactic acidosis or serious liver problems

TRUVADA is a prescription medicine that can be used for PrEP to help reduce the risk of getting HIV-1 infection when used together with safer sex practices. This use is only for adults who are at high risk of getting HIV-1 through sex. This includes HIV-negative men who have sex with men and who are at high risk of getting infected with HIV-1 through sex, and malefemale sex partners when one partner has HIV-1 infection and the other does not. Ask your healthcare provider if you have questions about how to prevent getting HIV-1. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.

Who should not take TRUVADA for PrEP?

IMPORTANT SAFETY INFORMATION What is the most important information I should know about TRUVADA for PrEP?

Before taking TRUVADA for PrEP to reduce your risk of getting HIV-1 infection: uYou must be HIV-negative. You must get tested to make sure that you do not already have HIV-1 infection. Do not take TRUVADA for PrEP to reduce the risk of getting HIV-1 unless you are conﬁrmed to be HIV-negative. uMany HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. If you have flu-like symptoms, you could have recently become infected with HIV-1. Tell your healthcare provider if you had a flu-like illness within the last month before starting TRUVADA for PrEP or at any time while taking TRUVADA for PrEP. Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin. While taking TRUVADA for PrEP to reduce your risk of getting HIV-1 infection: uYou must continue using safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1. uYou must stay HIV-negative to keep taking TRUVADA for PrEP. uTo further help reduce your risk of getting HIV-1: • Know your HIV-1 status and the HIV-1 status of your partners. • Get tested for HIV-1 at least every 3 months or when your healthcare provider tells you. • Get tested for other sexually transmitted infections. Other infections make it easier for HIV-1 to infect you. • Get information and support to help reduce risky sexual behavior. • Have fewer sex partners. • Do not miss any doses of TRUVADA. Missing doses may increase your risk of getting HIV-1 infection. • If you think you were exposed to HIV-1, tell your healthcare provider right away. uIf you do become HIV-1 positive, you need more medicine than TRUVADA alone to treat HIV-1. TRUVADA by itself is not a complete treatment for HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat over time. TRUVADA can cause serious side effects: uToo much lactic acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, nausea, vomiting, stomach-area pain, cold or blue hands and feet, feeling dizzy or lightheaded, and/or fast or abnormal heartbeats. uSerious liver problems. Your liver may become large and tender, and you may develop fat in your liver. Symptoms of liver problems include your skin or the white part of your eyes turns yellow, dark “tea-colored” urine, lightcolored stools, loss of appetite for several days or longer, nausea, and/or stomach-area pain.

if you are female, very overweight (obese), or have been taking TRUVADA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. uWorsening of hepatitis B (HBV) infection. If you also have HBV and take TRUVADA, your hepatitis may become worse if you stop taking TRUVADA. Do not stop taking TRUVADA without ﬁrst talking to your healthcare provider. If your healthcare provider tells you to stop taking TRUVADA, they will need to watch you closely for several months to monitor your health. TRUVADA is not approved for the treatment of HBV. Do not take TRUVADA for PrEP if you already have HIV-1 infection or if you do not know your HIV-1 status. If you are HIV-1 positive, you need to take other medicines with TRUVADA to treat HIV-1. TRUVADA by itself is not a complete treatment for HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat over time. Do not take TRUVADA for PrEP if you also take lamivudine (Epivir-HBV) or adefovir (HEPSERA).

What are the other possible side effects of TRUVADA for PrEP?

Serious side effects of TRUVADA may also include: uKidney problems, including kidney failure. Your healthcare provider may do blood tests to check your kidneys before and during treatment with TRUVADA for PrEP. If you develop kidney problems, your healthcare provider may tell you to stop taking TRUVADA for PrEP. uBone problems, including bone pain or bones getting soft or thin, may lead to fractures. Your healthcare provider may do tests to check your bones. uChanges in body fat, which can happen in people taking TRUVADA or medicines like TRUVADA. Common side effects in people taking TRUVADA for PrEP are stomacharea (abdomen) pain, headache, and decreased weight. Tell your healthcare provider if you have any side effects that bother you or do not go away.

What should I tell my healthcare provider before taking TRUVADA for PrEP?

uAll your health problems. Be sure to tell your healthcare provider if you

have or have had any kidney, bone, or liver problems, including hepatitis virus infection. uIf you are pregnant or plan to become pregnant. It is not known if TRUVADA can harm your unborn baby. If you become pregnant while taking TRUVADA for PrEP, talk to your healthcare provider to decide if you should keep taking TRUVADA for PrEP. Pregnancy Registry: A pregnancy registry collects information about your health and the health of your baby. There is a pregnancy registry for women who take medicines to prevent HIV-1 during pregnancy. For more information about the registry and how it works, talk to your healthcare provider. uIf you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. The medicines in TRUVADA can pass to your baby in breast milk. If you become HIV-1 positive, HIV-1 can be passed to the baby in breast milk. uAll the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. TRUVADA may interact with other medicines. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. uIf you take certain other medicines with TRUVADA for PrEP, your healthcare provider may need to check you more often or change your dose. These medicines include ledipasvir with sofosbuvir (HARVONI). You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch, or call 1-800-FDA-1088.

Please see Important Facts about TRUVADA for PrEP including important warnings on the following page.

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The once-daily prescription medicine that can help reduce the risk of getting HIV-1 when used with safer sex practices. • TRUVADA for PrEP is only for adults who are at high risk of getting HIV through sex. • You must be HIV-negative before you start taking TRUVADA. Ask your doctor about your risk of getting HIV-1 infection and if TRUVADA for PrEP may be right for you.

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IMPORTANT FACTS (tru-VAH-dah)

This is only a brief summary of important information about taking TRUVADA for PrEP (pre-exposure prophylaxis) to help reduce the risk of getting HIV-1 infection. This does not replace talking to your healthcare provider about your medicine.

MOST IMPORTANT INFORMATION ABOUT TRUVADA FOR PrEP

POSSIBLE SIDE EFFECTS OF TRUVADA FOR PrEP

Before starting TRUVADA for PrEP to help reduce your risk of getting HIV-1 infection: • You must be HIV-1 negative. You must get tested to make sure that you do not already have HIV-1 infection. Do not take TRUVADA for PrEP to reduce the risk of getting HIV-1 unless you are conﬁrmed to be HIV-1 negative. • Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. Symptoms of new HIV-1 infection include flu-like symptoms, tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin. Tell your healthcare provider if you have had a flu-like illness within the last month before starting TRUVADA for PrEP.

TRUVADA can cause serious side effects, including: • Those in the “Most Important Information About TRUVADA for PrEP" section. • New or worse kidney problems, including kidney failure. • Bone problems. • Changes in body fat.

While taking TRUVADA for PrEP to help reduce your risk of getting HIV-1 infection: • You must continue using safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1. • You must stay HIV-1 negative to keep taking TRUVADA for PrEP. • Tell your healthcare provider if you have a flu-like illness while taking TRUVADA for PrEP. • If you think you were exposed to HIV-1, tell your healthcare provider right away. • If you do become HIV-1 positive, you need more medicine than TRUVADA alone to treat HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat over time. • See the “How to Further Reduce Your Risk” section for more information. TRUVADA may cause serious side effects, including: • Buildup of lactic acid in your blood (lactic acidosis), which is a serious medical emergency that can lead to death. Call your healthcare provider right away if you have any of these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, nausea, vomiting, stomach-area pain, cold or blue hands and feet, feeling dizzy or lightheaded, and/or fast or abnormal heartbeats. • Severe liver problems, which in some cases can lead to death. Call your healthcare provider right away if you have any of these symptoms: your 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, and/or stomach-area pain. • Worsening of hepatitis B (HBV) infection. If you have HBV and take TRUVADA, your hepatitis may become worse if you stop taking TRUVADA. Do not stop taking TRUVADA without ﬁrst talking to your healthcare provider, as they will need to check your health regularly for several months. You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight, or have been taking TRUVADA for a long time.

ABOUT TRUVADA FOR PrEP (PRE-EXPOSURE PROPHYLAXIS) TRUVADA is a prescription medicine used with safer sex practices for PrEP to help reduce the risk of getting HIV-1 infection in adults at high risk: • HIV-1 negative men who have sex with men and who are at high risk of getting infected with HIV-1 through sex. • Male-female sex partners when one partner has HIV-1 infection and the other does not. To help determine your risk, talk openly with your doctor about your sexual health. Do NOT take TRUVADA for PrEP if you: • Already have HIV-1 infection or if you do not know your HIV-1 status. • Take lamivudine (Epivir-HBV) or adefovir (HEPSERA). TRUVADA, the TRUVADA Logo, TRUVADA FOR PREP, GILEAD, the GILEAD Logo, and HEPSERA are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: April 2016 © 2016 Gilead Sciences, Inc. All rights reserved. TVDC0050 09/16

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Common side effects in people taking TRUVADA for PrEP include stomach-area (abdomen) pain, headache, and decreased weight. These are not all the possible side effects of TRUVADA. Tell your healthcare provider right away if you have any new symptoms while taking TRUVADA for PrEP. Your healthcare provider will need to do tests to monitor your health before and during treatment with TRUVADA for PrEP.

BEFORE TAKING TRUVADA FOR PrEP Tell your healthcare provider if you: • Have or have had any kidney, bone, or liver problems, including hepatitis infection. • Have any other medical conditions. • Are pregnant or plan to become pregnant. • Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you become HIV-1 positive because of the risk of passing HIV-1 to your baby. Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. • Ask your healthcare provider or pharmacist about medicines that should not be taken with TRUVADA for PrEP.

HOW TO TAKE TRUVADA FOR PrEP • Take 1 tablet once a day, every day, not just when you think you have been exposed to HIV-1. • Do not miss any doses. Missing doses may increase your risk of getting HIV-1 infection. • You must practice safer sex by using condoms and you must stay HIV-1 negative.

HOW TO FURTHER REDUCE YOUR RISK • Know your HIV-1 status and the HIV-1 status of your partners. • Get tested for HIV-1 at least every 3 months or when your healthcare provider tells you. • Get tested for other sexually transmitted infections. Other infections make it easier for HIV-1 to infect you. • Get information and support to help reduce risky sexual behavior. • Have fewer sex partners. • Do not share needles or personal items that can have blood or body fluids on them.

GET MORE INFORMATION • This is only a brief summary of important information about TRUVADA for PrEP to reduce the risk of getting HIV-1 infection. Talk to your healthcare provider or pharmacist to learn more, including how to prevent HIV-1 infection. • Go to start.truvada.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit start.truvada.com for program information.

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SEX

Ask Doctor Dee Dorothy Horton, PsyD, answers your questions.

How can I keep a super stressful job from putting the kibosh on my romantic relationship?

Pap Smear Guidelines

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This sexual health exam is key in the early detection of cervical cancer. WHEN JANETTE, A CARDIOLOGY NURSE, received confirmation that her Pap smear showed cervical abnormalities, she was frightened because she’d lost her mother to cervical cancer. Doctors referred her for a test called a colposcopy, which provides a more detailed look at the cervix. “[The medical staff] explained that as the abnormalities had been detected early, before cancer could develop, that I was going to be fine,” she says. According to the American Cancer Society (ACS), if it’s detected early, cervical cancer is one of the most successfully treatable cancers. Indeed, most cervical cancers are found in women who have never had a Pap test or who have not had one recently, the agency says. In general, the ACS suggests that all

THE ESTIMATED NUMBER OF NEW CASES OF INVASIVE CERVICAL CANCER DOCTORS DIAGNOSED IN 2016 Source: American Cancer Society

women get screened for cervical cancer every three years beginning at age 21. Then, starting at age 30, women should get the Pap smear exam along with an HPV test every five years and continue to do so until age 65. In addition, the agency advises that women older than age 65, who’ve been regularly screened in the previous 10 years, should stop cervical cancer screening as long as they’ve had no serious precancers in the last 20 years. Women at high risk of cervical cancer because they suffer from an immune system disorder, such as HIV infection, organ transplant or long-term steroid use, or because they were exposed to diethylstilbestrol (DES), a synthetic form of the female hormone estrogen, may need more frequent screenings. (Between 1940 and 1971, doctors prescribed DES to pregnant women to stop miscarriages, premature labor and pregnancy complications.) ACS says that women shouldn’t get screened for cervical cancer each year, but those with abnormal screening results may need to have a follow-up Pap test (sometimes with an HPV test) done six months or a year afterward. Says Janette, “I am living proof that cervical screening saves lives, and I often wonder if my mum had attended her routine smear, whether she would still be here today.”

It’s key to first understand that difficulties at work can damage your relationship with your partner. Once you’re aware, you can make a conscious effort to control the problem. Before you leave work, begin to mentally prepare for your return home. You can also use your commute to de-stress. Listen to some soothing music to help you relax and mellow out. Once you’re home, get comfortable, focus on your partner and ask about his or her day. Most likely, your partner will reciprocate and ask you about yours. If so, take a few minutes to share anything that stressed you out during the day. But know when to stop venting so you can refocus on your time together as a couple. Also, get into the habit of turning off your electronic devices. Reserve your evenings at home for enjoying your partner and relaxing with other loved ones. In addition, take some time for yourself. Soak in a tub of warm water infused with scented oils or bath salts, or stand under a soothing spray in the shower. You can also read, practice yoga, take a short walk, go for a jog, meditate or sip on a beverage of your choice. The key is to totally unwind. Anything that relaxes you will help to alleviate the stressors that can sour intimate relationships if you’re not careful.

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NUTRITION

Troubling Treats

Purple-colored slush and other verboten victuals

Source: Center for Science in the Public Interest Xtreme Eating 2016 picks

BELIEVE IT OR NOT! Some high-calorie foods can be very good for you.

have in one serving. But if you just can’t say no to fast food, follow these damage control techniques the CSPI suggests: Order from a “light” menu if available, skip appetizers, replace beef with grilled chicken or veggies, don’t eat the buns and bring home half of your portion to enjoy the next day.

Lactose Intolerant? How to get your full quota of calcium each day if you can’t drink milk It’s true that milk and other dairy products are some of the best sources of calcium, a key nutrient that builds strong, healthy bones and teeth and governs many other functions in the body. But if you can’t drink the cool, creamy beverage, don’t worry. Many other foods can help you get the recommended daily allowance of this body builder. One food people overlook as a great source of calcium is such fish as canned sardines and salmon with their soft, chewy bones intact. Other excellent sources of calcium are dark leafy greens, almonds and Brazil nuts, beans, oatmeal and calcium-fortified foods of all kinds.

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Many people think that foods high in calories and fat are automatic no-no’s. But this rigid view of what’s good and bad for us to eat doesn’t take into account that many of these foods also contain healthy nutrients the body can use. For example, consider the creamy (or crunchy) richness of peanut butter. Despite packing 200 calories into two tablespoons, this very affordable food is a great source of quality protein (as long as you’re not allergic to the tasty nut). What’s more, according to findings, eating peanuts and peanut butter daily can cut the risk of heart disease in half. Avocados, another high-calorie food, are also loaded with good fats and fiber. In addition, the nutrient-dense fruit contains minerals, such as potassium and magnesium; phytonutrients, such as lutein; and nearly 20 vitamins, including B6, C and E. Other healthy high-calorie foods include cheese, hummus, bananas, nuts, yogurt and olive oil, among many others. We certainly can’t eat these foods to our heart’s content, nutritionists advise, but we can—and should— indulge in moderation.

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IF YOU’RE THE HEALTH-CONSCIOUS type, you may not want to indulge in—even just one time—any of the following foods, all of which were winners in the Center for Science in the Public Interest’s (CSPI) annual Xtreme Eating awards. Among those winning dishes that “seem engineered to promote diabetes, obesity, heart disease and stroke,” says Lindsay Moyer, a CSPI dietitian, are the following high-calorie meals: Sonic’s RT 44 Grape Slush with Rainbow Candy, Uno Pizzeria & Grill’s Whole Hog Burger, Applebee’s Build Your Sampler meal, The Cheesecake Factory’s Fried Chicken & Waffles Benedict, Dave & Buster’s Short Rib & Cheesy Mac Stack, Buffalo Wild Wings’ Dessert Nachos, Jersey Mike’s Subs’ Giant Chipotle Cheese Steak, Romano’s Macaroni Grill’s Cremini Pork Shank and Maggiano’s Little Italy’s Marco’s Meal for Two. Although they may be scrumptious, these meals combine ingredients that break records for the number of calories and amount of sodium, saturated fat and sugar anyone should

THE NUMBER OF MILLIGRAMS OF SODIUM IN ONE UNO PIZZERIA & GRILL’S WHOLE HOG BURGER (6X THE RECOMMENDED DAILY ALLOWANCE)

FITNESS

Exercise Games With virtual workouts, folks can get fit without feeling like they’re exercising.

Hang Tough

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Practice these basic steps to perform a pull-up. “WHEN APPROACHED PROPERLY, A PULL-UP ISN’T NEARLY AS INTIMIDATING AS IT may seem,” says Jill Franklin, an aerial artist and creator of Aerial Physique, a unique airborne workout that sculpts and strengthens the body. To master this exercise, you can use a pull-up bar at the gym, or you can buy one for the home and securely install it in a doorway. Have a sturdy box or chair on hand to help you step up to reach and grasp the bar with your hands. Place your hands shoulder-width apart with your palms facing you (a chin-up grip) or spread your hands wider than shoulder-width apart with your palms facing away (a pull-up grip). Lift yourself so your chin is above the bar, and allow your body to hang. Then bend your knees so your heels move toward your butt. Hold for about 20 seconds, and then slowly, in a controlled manner, lower yourself to the floor and stand. Alternatively, bring your knees to your chest, and hold the position for 10 to 20 seconds before finishing the movement as before. “Make sure your abdominals are in, and as you lower yourself down, make that movement just as important as pulling your chin above the bar,” Franklin advises. “That negative pull-up is eventually going to give you more strength and power to be able to do a full chin-up or pull-up in the opposite direction.”

Although Pokémon GO motivated millions of people around the world to walk more in order to catch, train and battle different types of monsters, this virtual game wasn’t the first to boost the activity levels of both children and adults in a healthy way. A few years ago, Nintendo’s interactive Wii Fit games also coaxed people to get moving and participate in activities such as bowling, golf and tennis. Now it’s clear there are more games of this kind to come. Offering virtual cycling and adding illuminated sensors to standard gym fitness programs can create exciting and challenging interactive elements that pump up the health benefits of traditional workouts. One exercise game company makes a bike that prompts gamers to pedal to activate an attached controller so they can play their favorite Xbox games on the equipment. Research supports the theory that the best cardio workouts get people moving without making them aware they’re exercising. Like its virtual fitness program predecessors, Pokémon GO confirmed this principle. Says one diabetes researcher about the popular game, “If there is something out there that is getting people off the sofa and pounding the streets, then this game could be an innovative solution for rising obesity levels.”

THE PERCENTAGE OF CONSUMERS WHO USE A FITNESS GAME ON A MOBILE DEVICE OR GAME CONSOLE TO STAY IN SHAPE Source: The Digital Consumer Report 2014, Nielsen

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Lyndie Greenwood believes that being empowered also means having confidence in your ability to defend yourself physically.

IS SELF-DEFENSE THE MISSING ELEMENT IN THE EMPOWERMENT OF WOMEN AND GIRLS? By Kate Ferguson-Watson

FOR LYNDIE GREENWOOD THE NOTION

that women are the weaker sex is not reflected in either her role as the tough, combat-trained, monster chaser Jenny Mills on the TV series Sleepy Hollow or in what she says is her “natural affinity for kung fu.” Greenwood trained in the martial art for almost 10 years and says it helped her prepare for the role as one of several warrior women in the series, which has developed a cult following among fans of action-packed supernatural thrillers. As a teenager, Greenwood, who was

born in Toronto, was intrigued by the lifestyle of an old boyfriend’s sister. “She studied tai chi, and she was a jeweler who went all over the world to search for rare gems she used to make jewelry. I just thought she was the coolest person,” Greenwood says. “And because I thought she was so awesome, I wanted to follow in her footsteps and start training in martial arts. But I thought tai chi might be a little slow for me, so I chose kung fu.” Greenwood adds that her former boyfriend also signed up to study kung fu.

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BUT THE FOCUS OF MOST ADVICE TO

women and girls concerns doing things to avoid being attacked. “Our country’s attention has mostly been focused on what happens before an assault takes place. The intent is to change women’s behavior, to reduce the chance of being attacked. This typically includes advice

such as walk with a buddy, don’t drink or if you do don’t leave your drink unattended,” says Ellen Snortland, the author of Beauty Bites Beast and the producer of a same-name documentary. Snortland, a trained lawyer, is an activist for the empowerment of women, girls and other at-risk groups. “If you play a little gender switch and give the same advice to males, it sounds patronizing, which it is when directed at females,” she says. “Why do we place the responsibility for not being raped on the target? We keep hiding the perpetrators by focusing on the people who are their targets.” This year’s presidential campaign sparked a discussion of nationwide sexual abuse of women when the media placed a spotlight squarely on GOP nominee Donald Trump, who was heard bragging on a tape about his predatory actions. “Yes, there are males who diminish women simply because they are women. These behaviors range from annoying all the way to dangerous and damaging,”

Lyndie Greenwood as Jenny Mills with her castmates on the set of the supernatural TV drama Sleepy Hollow.

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Snortland says. “Trump’s behaviors resulted in a massive outpouring of women comparing notes on just how many of us have dealt with unwanted touch, groping, vulgar language and assault. We can no longer unsee just how pervasive this kind of abuse and harassment is and has been.” LAURA ANN KAMIENSKI, A THIRD-

degree black belt in tae kwon do and author of the book Training Women In the Martial Arts: A Special Journey, created and taught a course called Empower at several major universities, women’s shelters and schools. She says, “Breaking down gender roles was extremely important in my courses, as well as recognizing emotional abuse.” Kamienski contends that there’s “an alarming disconnect between what is being taught and the reality of assaults women and girls experience.” A report she wrote explores the main characteristics she believes women’s self-defense programs need to be effective. A successful self-defense program for women should reflect the reality that the sexual violence females experience is most often committed against them by men they know and trust. “The reality that women are usually assaulted by a known assailant means that self-defense skills for women should primarily include learning skills to recognize and defend against assaults committed by a trusted friend, neighbor or intimate partner,” Kamienski stresses. She believes classes should account for the emotional and psychological dynamics of the typical relationships between acquaintances. She adds, “Some martial artists teaching self-defense for women, even while acknowledging that assailants are typically not strangers, tend to ignore the relationships and emotional dynamics that exist between victim and perpetrator.” A potent program for women should also support the idea that females have “value over and beyond that of an attacker,” Kamienski says. Therefore, self-defense programs for them should include “activities that promote and increase a woman’s self-esteem and worth.” This is particularly crucial in a male-dominated society.

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“But he didn’t really have an affinity for it,” she says. “I think he really got frustrated seeing me excel. He dropped out, but I kept going.” Greenwood believes martial arts training gives women a sense of their body’s power and also instills confidence in those who learn and practice these fighting styles; others share her viewpoint. Indeed, many people who take self-defense classes report that practice drills in how to defend themselves when attacked can empower them to act if a dangerous situation arises. These safety courses offer women the kind of training that may save their lives or protect them against physical abuse or assault.

At a very early age, little girls, unlike little boys, are discouraged from displaying anger and participating in the kind of aggressive play and behavior that would afford them opportunities to learn self-defense skills. Snortland says dog breeders allow both male and female puppies to “growl, roll around, get dirty or fight back if attacked.” In nature, when most animals play, their interactions are very much like dress rehearsals for protecting themselves should they ever feel threatened. “I maintain that self-protection and the desire to be safe and set boundaries are universal and non-gendered. And by the way, getting their way all the time also damages the male puppies,” Snortland observes. “Aggressive male puppies are not born that way but trained that way.”

is one of many entries in a cavalcade of contemporary television shows, children’s programs and films that feature strong, independent women who can protect themselves—and often even protect the male heroes. “Jenny Mills is powerful in the sense that she’s a survivor,” Greenwood says. “She’s been on her own for a long time and had to find strength within herself to survive day to day. She’s extremely intelligent and found a place for herself in the world by looking for rare artifacts and having a purpose in life and pursuing that through all the difficulty that’s thrown her way. Plus, she’s physically and mentally strong.” FOR

GREENWOOD,

PHYSICAL

AND

mental strength are what keep her sane. “I love to run, and I love to work out. And when I do run, I leave all my

MANY EXPERTS OFFER THIS KEY PIECE OF ADVICE TO WOMEN AND GIRLS: DON’T WAIT UNTIL AFTER SOMEONE ATTACKS YOU TO LEARN THE SKILLS THAT MIGHT ONE DAY SAVE YOUR LIFE. Kamienski also recommends that self-defense training for females build on women’s existing capabilities to negotiate, resist and fight back against male violence. Some methods women employ to safely extricate themselves from threatening situations don’t necessarily involve using physical force to escape unharmed. Self-defense training should acknowledge and elaborate on the strategies women already naturally use, she stresses. In addition, these programs should provide a caring community of encouragement that helps restore and build women and girls’ self-esteem and confidence. “We need multifaceted thinking— all the approaches—that addresses changing male behavior and knowing what to do with the creep who didn’t get the ‘don’t grope or rape women’ memo, as well as aftercare,” Snortland says. A popular TV series, Sleepy Hollow

PROTECT YOURSELF!

Recommended reading for learning women’s self-defense Back Off! by Martha J. Langelan Street Smarts by Louise Rafkin Beauty Bites Beast by Ellen Snortland Domestic Violence for Beginners by Alisa del Tufo Exploding the Myth of Self-Defense by Judith Fein Fear Into Anger by Py Bateman Girls Fight Back! The College Girl’s Guide to Protecting Herself by Erin Weed Her Wits About Her: Self-Defense Success Stories by Women edited by Denise Caignon and Gail Groves In Defense of Ourselves by Linda Tschirhart Sanford and Ann Fetter Lifelines by Marcia Hall

technology at home,” she says. “I think doing something that makes you feel powerful, such as physical activity, and then simultaneously not connecting with the world of social media is a nice break; it gives me a lot of strength.” Snortland believes the idea that women and girls are mentally and physically strong has suffered from an imbalance when compared to these attributes in men. “Power has been out of balance for so long, we begin to think that certain characteristics are cemented [as components of gender],” she says. “Men aren’t inherently violent, nor are women inherently weak and helpless.” Certainly, neither Greenwood nor Jenny Mills fits that description. “I consider myself a strong woman,” she says. “I’ve had hardships, and I’m grateful for that, because it’s created a drive within me to keep going.” ■

Real Knockouts: The Physical Feminism of Women’s Self-Defense by Martha McCaughey Self-Defense: Steps to Success by Joan Nelson Self-Defense: Steps to Survival by Katy Mattingly Self-Defense: The Womanly Art of Self Care, Intuition, and Choice by Debbie Leung Self-Defense From the Inside Out: A Women’s Workbook for Developing Self-Esteem and Assertiveness Skills for Safety by Nadia Telsey Smile at Strangers: And Other Lessons in the Art of Living Fearlessly by Susan Schorn The Gift of Fear by Gavin de Becker Training Women in the Martial Arts: A Special Journey by Jennifer Lawler and Laura Kamienski Source: National Women’s Martial Arts Federation

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When infectious disease specialists first identified HIV, doctors thought a vaccine to stop its progression to AIDS would be ready within two years.

POINTING

WAY ALTHOUGH 30 YEARS HAVE PASSED SINCE RESEARCHERS FIRST ISOLATED HIV, THERE’S STILL NO SAFE, EFFECTIVE VACCINE TO STOP THE VIRUS. BUT SCIENTISTS ARE MAKING PROGRESS. By Kate Ferguson-Watson

MANY PEOPLE DON’T UNDERSTAND WHY RESEARCHERS HAVEN’T

yet developed a vaccine for HIV. But the fact is, the virus is a wily opponent adept at self-preservation. For starters, this complex pathogen encodes itself into cellular DNA. What’s more, HIV can quickly mutate to produce a variety of strains, or subtypes, that allow it to outwit any defenses the body’s immune system mounts against it. This is why the methods researchers used to produce the harmless but potent vaccines against viral diseases such as polio, measles, mumps and chicken pox haven’t resulted in an HIV vaccine. >>

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causing virus or bacteria to develop vaccines. This prompts the immune system to generate antibodies, special proteins that work to defend the body against disease. But researchers can’t use weakened HIV and inject it into the body, because the virus might mutate and cause illness. In addition, because of the virus’s ability to produce so many strains, using a killed or inactive version

been a statistically significant result from the testing of an HIV vaccine showing any level of protection,” Dieffenbach says. Eventually, researchers noted a downside to RV144. The vaccine wasn’t potent enough, and its effects rapidly waned until it offered no further degree of protection against the virus. In addition, the vaccine targeted only HIV subtypes B and E, strains of

“THE FUNDAMENTAL PROBLEM IS ONCE YOU’RE INFECTED WITH HIV, YOU’RE INFECTED FOR LIFE, BECAUSE THE VIRUS BECOMES A PART OF YOU.” of one subtype of the virus wouldn’t be effective against other strains. Another challenge scientists face in creating an HIV vaccine is the ability of the virus to hide in places in the body from where it can strike without warning. TODAY, SCIENTISTS ARE USING

two major approaches—empirical and theoretical—in human studies to find an HIV vaccine. For the empirical approach, researchers observe the response of volunteers in a vaccine study to see whether they get “any degree of protection and then try and build upon and improve that,” explains Anthony Fauci, MD, NIAID’s director. “An example of that is the now well-known RV144 trial that was done in 16,000 participants in Thailand, which resulted in a very modest degree of efficacy to the tune of 31 percent.” Findings from this study showed that the vaccine blocked HIV infection without reducing the viral load (the amount of HIV in the blood) in those infected with the virus. “The significance of this is that previously there had never

the virus most commonly found in Thailand. Scientists followed up their Thai trial results with a series of additional studies. One of them, HVTN 505, tested whether the vaccine regimen could reduce the viral load of people who were vaccinated but later developed the virus. In addition, researchers were able to gather more crucial information about the vaccine regimen’s safety and effectiveness. But the results of this study were disappointing. Findings showed that this vaccine didn’t stop HIV infection or reduce viral load among those who were vaccinated and later contracted the virus. Consequently, researchers stopped this clinical trial. Then, last year, the NIH launched another study, HVTN 100. The study’s design featured improvements to boost the vaccine’s strength and effectiveness in the long term to provide protection from HIV subtype C, the strain dominant in Southern Africa. This November, researchers launched a trial named HVTN 702 to test a newer, improved version of the HVTN 100 vaccine regimen. The trial is being conducted in the African countries that are

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“If you take a step back and take a look at the field of vaccinology, just in general, you realize that most of the vaccines that we have today are for diseases that sicken people who eventually get better,” explains Carl Dieffenbach, PhD, director of the AIDS division of the National Institute of Allergy and Infectious Diseases (NIAID), an agency that’s part of the National Institutes of Health (NIH). “There are 70 million people in the world who have been infected with HIV,” Dieffenbach continues. “But there has never been a documented case of somebody getting an HIV infection and clearing that infection. The fundamental problem is that once you’re infected with HIV, you’re infected for life, because the virus becomes a part of you. It inserts its DNA into your cells, and then it is permanently within your body, no matter what you do. That’s what we’re currently fighting against.” In general, scientists use a harmless, weakened or killed form of disease-

COURTESY OF NIAID/NIH

among those with the highest rate of HIV infection and ongoing transmission in the world.

this approach “involves establishing an understanding of the immune response to HIV infection and finding ways to generate and enhance that ACCORDING TO THE MOST RECENT response through vaccination.” statistics, from 2015, an estimated 7 Although bNAbs don’t eliminate million individuals living with HIV the virus in those who have HIV, rereside in South Africa. “So we’re searchers have observed that about going into the teeth of the epidemic 25 percent of people with HIV natuto see if this vaccine could poten- rally develop broadly neutralizing tially blunt that ongoing epidemic,” antibodies after months or years of Dieffenbach says. infection. “These bNAbs have been Additionally, the NIH is collabo- shown in the laboratory to stop most rating with several major pharmaceu- HIV strains from infecting human tical companies and a group of re- cells,” NIAID notes. searchers from Beth Israel Deaconess Fauci says HVTN 702 is a continMedical Center, a hospital affiliated uation of the concept used in the with Harvard University, on a vaccine Thailand trial. “To now proceed that has “shown pretty powerful into a large efficacy trial in Southern activity in monAfrica is going keys,” Dieffenbach to hopefully conexplains. “We are firm the results still working out the of RV144 and kinks on [study] dedo better than sign, so it’s a little 31 percent; that’s premature to talk the critical issue,” about. But that’s he says. “We want just over the horito get to the zon. Our stated goal point of 50 to 60 is to try to launch percent efficacy. that in the third Hopefully, we’ll quarter of 2017.” get there, but we A group of rewon’t know until Carl Dieffenbach, PhD searchers at Oregon we see the results Health & Science of the trial.” (The University tested another vaccine, NIH expects results from HVTN this one based on a herpes virus. The 702 in late 2020.) vaccine didn’t prevent HIV infection, Dieffenbach is guardedly optimistic. but it promoted the clearance of HIV He says the HIV vaccine strategies infection in about 50 percent of the currently in various stages of discovery monkeys used in the study. Compared and development could pan out in the with the mechanism used in the next 10 to 15 years and fundamentally RV144 study, this approach was change how researchers tackle the slightly different, Dieffenbach says. HIV pandemic. Another path to controlling the In addition, very early studies of virus that scientists are exploring is broadly neutralizing antibodies created the creation of a vaccine that would in a laboratory were shown to kill cause people to produce special anti- HIV, so scientists are eager to continue bodies, called broadly neutralizing exploring this strategy. But the pressing antibodies (bNAbs), that could ren- issues for them are how to take these der many strains of HIV harmless, molecules and figure out what part of despite the ability of the virus to mu- the virus can trigger their existence tate rapidly. and how to design a vaccine based on These broadly neutralizing anti- their structure and the makeup of bodies figure prominently in the the- the virus. oretical approach to HIV vaccine “I’m not promising success,” Diefdevelopment in human studies that fenbach cautions. “I’m promising an Fauci describes. According to NIAID, answer to these questions.” ■

CONQUERING HIV HOW VACCINES COULD TRIUMPH OVER THE VIRUS Currently, scientists are testing two main types of HIV vaccines: preventive and therapeutic. But Carl Dieffenbach, PhD, the director of the division of AIDS at the National Institute of Allergy and Infectious Diseases, doesn’t differentiate between the two. His goal as a researcher is to find a vaccine to stop people from acquiring the virus, period. Still, the distinction between the two is that a preventive vaccine would stop HIV-negative individuals from developing the virus, while a therapeutic vaccine would help control the infection and delay the progression of the disease in those already living with HIV. But to prevent initial infection, when would an HIV vaccine be administered? “In my mind, I think what we will do is continue to test vaccines in young adults. As we get a vaccine that is more and more effective, we will move into younger and younger populations,” Dieffenbach proposes. “Then, if we found something that really works, we’d get parents to vaccinate their children. Of course, this will require a further breakdown in how we deal with the stigma associated with HIV. That’s the kind of problem I’d like to have. But you don’t want to wait until somebody is sexually active, because at that point, it could be way too late.” Dieffenbach says he doesn’t see an HIV vaccine being administered to very young children. “I think it would be more like an adolescent vaccine,” he explains.

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TASTY CELEBRATIONS TIPS TO MAKE TRADITIONAL HOLIDAY MEALS MUCH HEALTHIER AND STILL DELICIOUS! By Gerrie E. Summers

When you think about spending time with friends and family this holiday season, are you gripped with joy and dread about creating those savory special-occasion dinners and sweet desserts that can throw off months of sticking to a diet? If so, don’t worry. You can cook familiar dishes in new ways that will allow you the guilt-free enjoyment of eating some of your favorite meals of the season.

The Culprit: Sugar

Reduce or replace this refined sweetener with spices, such as cinnamon, allspice and nutmeg, or use extracts, such as vanilla, peppermint or almond. You might also try adding sweetness with a plant-based sugar substitute, such as stevia. The Culprit: Whole milk

Replace this high-fat liquid in desserts with fat-free or skim milk or low-fat buttermilk. Depending on the recipe, you can also substitute whole milk with soy milk or nut milks, such as almond, or use plain yogurt. The Culprit: Heavy cream

Use fat-free half-and-half or evaporated skim milk instead of full-fat cream to keep dishes rich and satisfying. 3 0 R E AL H E A LTH WIN T E R 2016

The Culprit: Butter, margarine, oil or some other shortening

If you must use fats, opt for a vegetable oil, such as olive oil. Bowden suggests you “choose from non-hydrogenated [no trans fat] oils that are great for cooking, such as grass-fed butter, ghee, coconut oil and certified sustainable palm oil.” Another option? Apply cooking spray or opt for nonstick pans. If you’re using shortening to bake desserts, use half of the butter or other

The Culprit: Chocolate chips and assorted candies

Replace these sugary calorie-boosting extras with dried fruit, such as cranberries or cherries. The Culprit: Alcoholic drinks

If you don’t want to skip the boozy beverages, sip still or sparkling water between each drink to prevent overindulgence and to lower the amount of alcohol and calories.

YOU DON’T HAVE TO SACRIFICE TASTE TO MAKE HOLIDAY MEALS AND DESSERTS HEALTHIER, JUST REDUCE OR REPLACE SUGAR, SALT AND UNHEALTHY FATS. shortening, and replace the other half with some unsweetened or cinnamon- flavored applesauce, mashed banana, prune puree, plain Greek or soy yogurt or even mashed avocado. The Culprit: High-calorie dessert

Apple pie on average is 360 calories per slice; pecan pie is a whopping 503. Switch to either sweet potato or pumpkin pie, which, depending on how they’re made, are usually lower in calories and have more nutritional value. The Culprit: Piecrusts

Crusts add extra calories to pies. Double crusts can add a hefty 240 calories. Instead, make a crust-free dessert, for example, apple crisp instead of apple pie.

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And if you’re not indulging but still need a glass in your hand, fetch a flute of sparkling water. Downing more H2O will keep you from drinking and eating too much. Substitute alcohol and sugary sodas in mixed drinks with cool, refreshing club soda. Instead of sugar in cocktails, use freshly squeezed juice (like lemon or lime) or 100 percent fruit juice. In dairy-based drinks, replace the whole milk and heavy cream with lowfat or skim milk. For example, you can still savor the rich taste of eggnog without the surplus calories. Fill the glass with one half to three quarters low-fat or skim milk and one part nonalcoholic eggnog.

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“What makes holiday dishes so terribly unhealthy and fattening is not the fact that they contain fat. It’s that they contain the wrong kind of fat and a ton of sugar, an absolutely lethal combination from the point of view of health,” says Jonny Bowden, a board-certified nutritionist and author of The 150 Healthiest Foods on Earth. “High-calorie, high-fat [the wrong fats] and high-sugar meals are a trifecta for diabetes, obesity and heart disease.” But the good news is, you can make healthier holiday meals and desserts by reducing or replacing sugar, salt and unhealthy fats without sacrificing taste. You can significantly cut back on starches and other unhealthy ingredients by using smart substitutions and making healthier choices.

The Culprit: Ham hocks or bacon fat for seasoning

Use low-fat, low-salt chicken or vegetable broth. For diehard fans of ham hocks, “You don’t need to replace the ham hocks if you can find pastured pork,” Bowden says. “Otherwise, collard greens are a great vegetable. Try using just a bit less salt and a lot more flavorful spices.” The Culprit: Table salt or seasoning salt

Try mixing a combination of herbs or spices with salt-free seasoning, lemon juice, rice vinegar and pepper to flavor foods. “Use turmeric, oregano, basil, sage, rosemary,” Bowden suggests. “All have remarkable health benefits and will reduce the amount of salt you need.” The Culprit: Bread and pasta

Instead of processed white bread, pasta and flour, select their whole-grain counterparts. If you don’t like the taste of whole-wheat baked goods, measure and mix one-half white flour with onehalf whole wheat flour for cakes, muffins and other goodies from the oven. The Culprit: Macaroni and cheese

Again, reach for whole-grain pasta. For the creamy texture of butter and cream—without the fat—replace butter and cheese with nonfat Greek yogurt and either reduced-fat, fat-free or 2 percent milk and cheese, or simply use less cheese. The Culprit: Predinner noshing

Arrive late to miss cocktails and snacks. If you can, make a dip at home with low-fat or nonfat plain Greek yogurt or nonfat sour cream and bring your own crudités, such as raw carrots, cauliflower and broccoli florets, slices of bell peppers and other crunchy veggies. Other ways to make food healthier:

Try this no-brainer: Cook with less of the offending ingredient. ■■ Instead of frosting, jams, syrup and other sugar-laden toppings, use fresh or frozen fruits. ■■ Increase the amount of vegetables in meat dishes and sides. ■■ For dishes and desserts usually made with whole eggs, separate out the yolks and use only the whites. ■■

Baste cooked meats with vegetable juice, fat-free veggie broth or even a small amount of wine instead of fat-laden drippings. ■■ Having turkey? Eat the white meat without skin (160 calories) versus the dark meat with skin (230 calories). “If a turkey is at the center of your table, order an organic pasture-raised bird from a local farmer,” says Bowden. “Most store-bought frozen turkeys have been injected with up to 12 percent of a solution containing added sugar, salt and artificial flavorings. These birds must be labeled as ‘basted,’ ‘marinated’ or ‘injected.’ Additives are not allowed on fresh turkeys.” ■■ Choose smaller portions of all dishes, including traditional stuffing. A serving size is three ounces, the size of a deck of cards. Then fill the rest of the plate with more vegetables and healthy side dishes. ■■ Select baked or grilled meats and steamed vegetables. ■■ For gravy and other sauces, allow yourself just one tablespoon to cut down on fat, calories and salt. ■■ Strain and rinse canned goods, such as cooked beans and chickpeas, with water before using to wash off excess salt and starch. ■■ If using processed packaged goods, compare labels to find lower-salt and sugar-free items. Better yet, try to avoid them altogether. “Nix all the prepackaged dishes,” Bowden advises. Many of these foods contain partially hydrogenated oils, a primary source of trans fats and other unhealthy ingredients. ■■ Skip the dinner rolls. Refrigerated dough products, including crescent rolls, often contain trans fats, Bowden says, “as well as emulsifiers such as monoglycerides and diglycerides.” ■■ Say no to whipped cream on desserts, such as pie, and in drinks, such as eggnog, a seasonal favorite. ■■ When buying apple cider, carefully read the label to spot added sugars. Choose low-sugar or sugar-free versions, or make the tasty drink yourself with spices, such as cinnamon sticks, cloves, nutmeg and cardamom. Don’t forget to add tart whole cranberries and sweet orange slices for an Instagram-worthy beverage. ■ ■■

MORE SUBSTITUTIONS FOR YOUR FESTIVE FOODS Modify these top 10 foods to create healthier counterparts and save a ton of calories this holiday. 1. Gravy Skim the fat from drippings, or make gravy with fat-free or low-fat turkey broth, flour and seasonings. 2. Stuffing Skip the packaged kind, and make your own using whole-grain bread, or replace bread with wild-rice stuffing. 3. Candied yams Roast the yams instead of pairing with marshmallows or tossing in brown sugar. 4. Cranberry sauce Make a relish from scratch with fresh cranberries. 5. Greens In this otherwise healthy choice for a meal, don't diminish the nutritional value of collard and other greens by overcooking and adding unhealthy extras, such as salt, ham and bacon. Instead, gently sauté in low-fat and salt-free broth. 6. Creamy soups Use coconut milk instead of heavy cream. 7. Mashed potatoes You can either use reduced-fat butter and skim milk to lower the fat content, or swap the spuds with mashed cauliflower or mashed cannellini beans. 8. Dinner rolls Ditch the store-bought rolls. Reach for whole grain bread, and skip the butter. 9. Holiday pies Start a new tradition and serve fresh fruit. 10. Alcoholic and high-calorie beverages Choose cider instead of eggnog. If you drink wine, exchange for a fruity sangria made with spiced teas infused with fruit slices.

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COLOR CONSCIOUS WHAT YOU SHOULD KNOW BEFORE YOU SAY DYE! By Jeanette L. Pinnace

Color is a wonderful way to spice up your look. But because black hair is so fragile, for many sistas, the potential for damage when coloring their tresses is real. Dye affects moisture, the very thing our hair needs most. This means that before you decide to reinvent yourself with >>

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W IN TER 2016 RE A L H E A LTH 3 3

HEALTHY HUES MANY SUBSTANCES CAN COLOR HAIR NATURALLY. HERE ARE A FEW… These ingredients for creating hair color can be found in your very own kitchen.

Coffee:

Use this popular breakfast beverage to cover gray or to help your hair go darker. Simply brew strong coffee, mix your cup of Joe with leave-in conditioner and let it cool. Then apply the mixture to your hair and wait an hour. Rinse

3 4 R E AL H E A LTH WIN T E R 2016

several different textures? For example, coarse hair takes long to absorb color compared with finer strands. This affects the amount of time needed for your hair to hold on to dye. If your mane is healthy enough for color, the next step is to determine your hair color goal. Do you want to temporarily or permanently change the color? If you simply want to change your hair color for a short time, you can use easyto-apply rinses, mousses, spray-ons, hair mascaras and tinted shampoos and conditioners to deepen your hair color right at home. OTHER SHORT-TERM HAIR COLORS ARE

available in semipermanent products, which don’t contain ammonia and peroxide. Demi-permanent dyes also coat the hair gently with color and don’t include ammonia among their ingredients, but they are formulated with a small amount of peroxide. Both types of hair color gradually wash out with each shampoo. To make these temporary colors last longer, however, some colorists suggest you use controlled heat from a dryer to seal in the color. According to color experts, another

it out with a mix of water and apple cider vinegar to help the color stay in longer.

Black tea:

This anytime drink is good for darkening hair color and also helps to cover gray hair. The tea should be highly concentrated. Place three to five tea bags in two cups of hot water and let them steep until the liquid is a muddy brown. Add sage (fresh or dried) to the tea to help open up the hair cuticles. Apply the cooled tea to your hair, and leave it on for at least one hour or overnight. Rinse out in the morning. H erbs: These botanicals can also be used to color tresses. The particular

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difference between these two types of temporary color is the size of their molecules. In semipermanent dyes, molecules aren’t small enough to penetrate the cortex of the hair. But molecules in demi-permanent hair color products do make their way into the cortex. (This makes them very effective at covering gray hair.) Typically, semipermanent dyes last between six to 12 shampoos, while demi-permanent colors can last through nearly 24 shampoos. As for permanent color, the peroxide in dye will first remove your hair’s original color. This happens when the ammonia in permanent color opens the cuticle and allows the hair’s cortex to absorb the new shade. To avoid damaging tresses, colorists assign a color level number corresponding to how light or dark your hair is and then calculate the degree of lightness or darkness and tone (how warm, cool or neutral a color is) of a shade that’s needed to yield the desired hue. These calculations can be fraught with peril. That’s why experts strongly advise that if you want to permanently color your hair, the wise thing to do is consult a professional colorist. ■

herb you use will depend on the color you want. Use calendula, marigold, rosehips and hibiscus to deepen a red color or add warm highlights. The more you use this mixture the deeper the color becomes. Simmer the flowers in water, strain and cool. Pour into a spray bottle, apply and let your hair dry in the sun.

Bright juices:

Beet and carrot juice (who knew?) can also add red tints to your current color. Juice the veggies and use alone or mix. Apply about one cup of juice to your hair, work into the strands, wrap the hair and leave on for at least one hour. Then rinse out the juice and seal tresses with a spritz of apple cider vinegar.

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an amazing new hue, you must ensure that your hair is in great shape and can handle the new shade. One key test to see whether your hair is ready for color is to check its porosity. This quality refers to your hair’s ability to absorb and hold moisture. To determine your hair’s porosity, remove strands from a comb or brush and drop them into a bowl of water. If after two to four minutes, your strands rise to the top, your hair’s porosity is most likely low. But if they sink, it’s a safe bet that your hair is highly porous. This type of hair absorbs color quickly, so it’s easy to overprocess tresses. Conversely, hair that’s low in porosity isn’t as receptive to the chemical compounds in dye and can be more difficult to color. Other tactile tests include checking wet hair to see how much stretch your strands have. If your hair is more elastic than normal or the texture of your tresses is too “gummy,” says one colorist at a salon in New York City, “it is not safe to dye.” Another measure of your tresses’ receptiveness to color is what type of hair you have. Is your mane wavy, curly, coily, coarse, or a combination of these

FANIGHT Jacket (men’s and women’s styles, sizes XS to 2XL) Slip on this lightweight athletic jacket made with material that absorbs light from outdoor or indoor sources and emits it in the dark to ensure that you’ll be visible when you exercise at night. Preorder Fanight at indiegogo.com/projects.

Mint (sensor device and app, $99.99) This small, sleek unit fits easily in your handbag or pocket and syncs up with your smartphone to check your breath and oral health by testing for any sulfur compounds present in your mouth. breathometer.com

Stuff We Love A ROUNDUP OF THE LATEST MUST-HAVE FINDS FOR HAIR, SKIN, HEALTH, BEAUTY AND MORE. THESE PRODUCTS ARE WORTH EVERY CENT.

Stocking Stuffers 1. Milk & Cookies Kids Spa & Salon Splat collection features nail polishes in whimsical colors and textures that lets little ones express themselves, 14 shades, $9.75 each, milkandcookieskidsspa.com

The Booty Belt System (sizes X-small to X-large, $99.99; instructional DVD included) This easy-to-use adjustable Velcro belt with attached resistance bands for beginner, intermediate and advanced training uses your body weight to help you tone and sculpt your glutes at home or on the go. bootybelt.com

2. Withings Activité Steel is a fitness and activity health tracker watch that syncs up with your smartphone, $149.95, withings.com

Juicepresso Cold Press Juicer (available in two styles, several colors, $499 to $549) Extract the most nutrients from fruits and veggies with this powerful, compact juicer that’s quiet, easy to clean and dishwasher safe. juicepressousa.com

3. White Sands Curl Up in Silk Firm Hold Mousse can give you silky, soft, longer-lasting curls that resist moisture, 7 oz., $19.50, whitesandsproducts.com 4. Fizz & Bubble Artisan Bath Fizzies are fragrant bubble bath treats made from a balanced base of eight natural moisturizing oils, blended fragrances, and safe coloring that won't stain tubs or skin, $6 apiece, fizzandbubble.com

WHAT IS GENVOYA®? GENVOYA is a 1-pill, once-a-day prescription medicine used to treat HIV-1 in people 12 years and older. It can either be used in people who are starting HIV-1 treatment and 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. These include having an undetectable viral load (less than 50 copies/mL) for 6 months or more on their current HIV-1 treatment. GENVOYA combines 4 medicines into 1 pill taken once a day with food. GENVOYA is a complete HIV-1 treatment and should not be used with other HIV-1 medicines. GENVOYA does not cure HIV-1 or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking GENVOYA. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body ﬂuids. Never reuse or share needles or other items that have body ﬂuids on them.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about GENVOYA? GENVOYA may cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. • Serious liver problems. The liver may become large and fatty. Symptoms of liver problems include your skin or the white part of your eyes turning yellow (jaundice), dark “teacolored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. • You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight, or have been taking GENVOYA for a long time. In some cases, lactic acidosis and serious liver problems have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. • Worsening of hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking GENVOYA, your HBV may suddenly get worse. Do not stop taking GENVOYA without ﬁrst talking to your healthcare provider, as they will need to monitor your health.

Who should not take GENVOYA? Do not take GENVOYA if you take: • Certain prescription medicines for other conditions. It is important to ask your healthcare provider or pharmacist about

medicines that should not be taken with GENVOYA. Do not start a new medicine without telling your healthcare provider. • The herbal supplement St. John’s wort. • Any other medicines to treat HIV-1 infection.

What are the other possible side effects of GENVOYA? Serious side effects of GENVOYA may also include: • Changes in body fat, which can happen in people taking HIV-1 medicines. • Changes in your immune system. Your immune system may get stronger and begin to ﬁght infections. Tell your healthcare provider if you have any new symptoms after you start taking GENVOYA. • 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 GENVOYA. • Bone problems, such as bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones. The most common side effect of GENVOYA is nausea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking GENVOYA? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and overthe-counter medicines, vitamins, and herbal supplements. Other medicines may affect how GENVOYA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take GENVOYA with all of your other medicines. • If you take antacids. Take antacids at least 2 hours before or after you take GENVOYA. • If you are pregnant or plan to become pregnant. It is not known if GENVOYA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking GENVOYA. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Important Facts about GENVOYA including important warnings on the following page.

Ask your healthcare provider if GENVOYA is right for you, and visit GENVOYA.com to learn more.

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

(jen-VOY-uh) MOST IMPORTANT INFORMATION ABOUT GENVOYA

POSSIBLE SIDE EFFECTS OF GENVOYA

GENVOYA® may cause serious side effects, including:

GENVOYA can cause serious side effects, including:

• Build-up of lactic acid in your blood (lactic acidosis), which is a serious medical emergency that can lead to death. Call your healthcare provider right away if you have any of these symptoms: feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. • Severe liver problems, which in some cases can lead to death. Call your healthcare provider right away if you have any of these symptoms: your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. • Worsening of Hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking GENVOYA. Do not stop taking GENVOYA without first talking to your healthcare provider, as they will need to check your health regularly for several months.

You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight, or have been taking GENVOYA for a long time.

• Those in the “Most Important Information About GENVOYA” section. • Changes in body fat. • Changes in your immune system. • New or worse kidney problems, including kidney failure. • Bone problems. The most common side effect of GENVOYA is nausea. These are not all the possible side effects of GENVOYA. Tell your healthcare provider right away if you have any new symptoms while taking GENVOYA. Your healthcare provider will need to do tests to monitor your health before and during treatment with GENVOYA.

BEFORE TAKING GENVOYA Tell your healthcare provider if you: • Have or had any kidney, bone, or liver problems, including hepatitis infection. • Have any other medical condition.

ABOUT GENVOYA

• Are pregnant or plan to become pregnant.

• GENVOYA is a prescription medicine used to treat HIV-1 in people 12 years of age and older who have never taken HIV-1 medicines before. GENVOYA can also be used to replace current HIV-1 medicines for some people who have an undetectable viral load (less than 50 copies/mL of virus in their blood), and have been on the same HIV-1 medicines for at least 6 months and have never failed HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements. • GENVOYA does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others. Do NOT take GENVOYA if you: • Take a medicine that contains: alfuzosin (Uroxatral®), carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), cisapride (Propulsid®, Propulsid Quicksolv®), dihydroergotamine (D.H.E. 45®, Migranal®), ergotamine (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), lovastatin (Advicor®, Altoprev®, Mevacor®), lurasidone (Latuda®), methylergonovine (Ergotrate®, Methergine®), midazolam (when taken by mouth), phenobarbital (Luminal®), phenytoin (Dilantin®, Phenytek®), pimozide (Orap®), rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®), sildenafil when used for lung problems (Revatio®), simvastatin (Simcor®, Vytorin®, Zocor®), or triazolam (Halcion®). • Take the herbal supplement St. John’s wort. • Take any other HIV-1 medicines at the same time.

• 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 you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. • Ask your healthcare provider or pharmacist about medicines that should not be taken with GENVOYA.

HOW TO TAKE GENVOYA • GENVOYA is a complete one pill, once a day HIV-1 medicine. • Take GENVOYA with food.

GET MORE INFORMATION • This is only a brief summary of important information about GENVOYA. Talk to your healthcare provider or pharmacist to learn more. • Go to GENVOYA.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit GENVOYA.com for program information.

GENVOYA, the GENVOYA Logo, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks are the property of their respective owners. Version date: September 2016 © 2016 Gilead Sciences, Inc. All rights reserved. GENC0089 09/16

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THOUGHTS

The Expert Says Three effective ways to conquer the fear of failing in front of others Distract yourself. Take a walk, listen to your favorite music or watch an interesting movie. When we stop focusing on our faults and foibles, we can help reduce obsessive self-awareness. Squelch your desire for other people’s approval. Realize that you and your opinions and experiences have value despite any criticism you face. What’s more, take care to distinguish between constructive and destructive comments. Be realistic about how severe any damage might be to you socially. Evaluate objectively what might be the worst that could happen if you lose status in the eyes of others. Sometimes, by imagining worst-case scenarios, you can defuse feelings of anxiety because you’ve already dealt with these possibilities and understand that your life can and will go on.

ISTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY)

Feeling Foolish HIV positive, humiliated and embarrassed When word spread that Trevor had contracted HIV, a lot of folks he considered true friends shunned him. Some relatives stopped calling, and a few old girlfriends posted mean messages on his Facebook page. But the humiliation didn’t end there. Someone phoned Trevor’s job anonymously to report his status. Shame dogged Trevor. Besides losing his self-esteem, he was embarrassed.

Shrug Off Your Fears How one woman overcame her anxiety about speaking in public THREE YEARS AGO, I WAS REQUIRED TO GIVE A PRESENTATION IN CLASS ON findings from a scientific study of my choice that had to last five minutes. I was petrified. The days just before my presentation were especially difficult. I imagined all sorts of mishaps as I stood in front of my classmates and teacher. I imagined them yawning, staring or, even worse, sneering at me as I fumbled for words with my knees shaking. Then, the night before my imagined humiliation, I asked my sister to time my talk and give me a critique. We did several run-throughs, and a funny thing happened. Each time I spoke, I started to feel much more comfortable. The practice sessions helped me get progressively better at describing the study and its results. The next day in class, as I looked at everyone’s faces and began to speak, I experienced a sense of confidence that gradually replaced my initial nervousness. After all, hadn’t I just done this very same thing the night before? —As told to Kate Ferguson

He’d made a huge relationship blunder and trusted someone too soon. He was an HIV/AIDS educator and activist who spoke on panels encouraging everyone to practice safer sex, but he’d ignored his own advice. Eventually, Trevor came to understand that everyone makes mistakes. But when painful, ego-bruising, spirit-crushing moments occur, how can we recover our self-esteem? Robert J. Sternberg, PhD, a professor of human development at Cornell University, shared in an online article that he’d suffered numerous career challenges and “three serious crises” that so

humiliated him that he was ready to “jump down a rabbit hole.” After a time, just like Trevor, Sternberg recovered. Both men used the following tips to bounce back: Don’t think you alone make mistakes; learn from your crises; don’t take rejection or failure personally; cultivate resiliency to bounce back fast; find a support network; treat yourself well; if you feel wronged, don’t seek revenge; use setbacks as opportunities to do better; don’t withdraw and hide; and skip obsessing and move on. Now, when he speaks at events, Trevor shares his story without shame, embarrassment or regret.

realhealthmag.com

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