HIV Plus Magazine #93 by Pride Media

FINDING THE RIGHT DOCTOR + SPOTTING & STOPPING ADDICTION + POSITIVE PRISONERS

H E A LT H + F I T N E S S + C U LT U R E + L I F E

celeb dj caroline D’Amore opens up about her mom’s Battle with AIDS

THE WOMEN’S ISSUE IS it OK to get pregnant? How to find Housing for families

THE COST OF CIGARETTES: IS SMOKING WORTH 15 YEARS OF YOUR LIFE?

falling in love

Hear Her

ROAR BLACK WOMEN’S INFECTION RATES ARE DROPPING, BUT singer and Jekyll & Hyde STAR DEBORAH COX SAYS THERE’S STILL MUCH MORE WORK TO DO

MARCH/APRIL 2013

www.hivplusmag.com

What is STRIBILD? STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. It combines 4 medicines into 1 pill to be taken once a day with food. STRIBILD is a complete single-tablet regimen and should not be used with other HIV-1 medicines. STRIBILD does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking STRIBILD. 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 STRIBILD? STRIBILD can cause serious side effects: t 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 (not normal) 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. t Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include 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. t You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking STRIBILD 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.

t Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking STRIBILD, your hepatitis may suddenly get worse. Do not stop taking STRIBILD without first talking to your healthcare provider, as they will need to monitor your health. STRIBILD is not approved for the treatment of HBV. Who should not take STRIBILD? Do not take STRIBILD if you: t Take a medicine that contains: alfuzosin, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, rifampin or the herb St. John’s wort. t For a list of brand names for these medicines, please see the Brief Summary on the following pages. t Take any other medicines to treat HIV-1 infection, or the medicine adefovir (Hepsera®). What are the other possible side effects of STRIBILD? Serious side effects of STRIBILD may also include: t New or worse kidney problems, including kidney failure. Your healthcare provider should do regular blood and urine tests to check your kidneys before and during treatment with STRIBILD. If you develop kidney problems, your healthcare provider may tell you to stop taking STRIBILD. t Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones. t Changes in body fat can happen in people taking HIV-1 medicines. t 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 STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea. 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 STRIBILD? t All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, bone, or liver problems, including hepatitis virus infection. t All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking STRIBILD without first talking with your healthcare provider. t If you take hormone-based birth control (pills, patches, rings, shots, etc). t If you take antacids. Take antacids at least 2 hours before or after you take STRIBILD. t If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. t If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in STRIBILD can pass into breast milk, and it is not known if this can harm the baby. 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 Brief Summary of full Prescribing Information with important warnings on the following pages.

STRIBILD is a prescription medicine used as a complete single-tablet regimen to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD does not cure HIV-1 or AIDS.

I started my personal revolution Talk to your healthcare provider about starting treatment. STRIBILD is a complete HIV-1 treatment in 1 pill, once a day.

Ask if itâ&#x20AC;&#x2122;s right for you.

Patient Information STRIBILDTM (STRY-bild) (elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg) tablets #SJFG TVNNBSZ PG GVMM 1SFTDSJCJOH *OGPSNBUJPO 'PS NPSF JOGPSNBUJPO QMFBTF TFF UIF GVMM 1SFTDSJCJOH *OGPSNBUJPO JODMVEJOH 1BUJFOU *OGPSNBUJPO What is STRIBILD? t STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. 453*#*-% JT B DPNQMFUF SFHJNFO BOE TIPVME OPU CF VTFE XJUI PUIFS )*7 NFEJDJOFT t STRIBILD does not cure HIV-1 or AIDS. :PV NVTU TUBZ PO DPOUJOVPVT )*7 UIFSBQZ UP DPOUSPM )*7 JOGFDUJPO BOE EFDSFBTF )*7 SFMBUFE JMMOFTTFT t Ask your healthcare provider about how to prevent passing HIV-1 to others. %P OPU TIBSF PS SFVTF OFFEMFT JOKFDUJPO FRVJQNFOU PS QFSTPOBM JUFNT UIBU DBO IBWF CMPPE PS CPEZ þ VJET PO UIFN %P OPU IBWF TFY XJUIPVU QSPUFDUJPO "MXBZT QSBDUJDF TBGFS TFY CZ VTJOH B MBUFY PS QPMZVSFUIBOF DPOEPN UP MPXFS UIF DIBODF PG TFYVBM DPOUBDU XJUI TFNFO WBHJOBM TFDSFUJPOT PS CMPPE

t %P OPU TUPQ UBLJOH 453*#*-% XJUIPVU ý STU UBMLJOH UP ZPVS IFBMUIDBSF QSPWJEFS t *G ZPV TUPQ UBLJOH 453*#*-% ZPVS IFBMUIDBSF QSPWJEFS XJMM OFFE UP DIFDL ZPVS IFBMUI PGUFO BOE EP CMPPE UFTUT SFHVMBSMZ GPS TFWFSBM NPOUIT UP DIFDL ZPVS )#7 JOGFDUJPO 5FMM ZPVS IFBMUIDBSF QSPWJEFS BCPVU BOZ OFX PS VOVTVBM TZNQUPNT ZPV NBZ IBWF BGUFS ZPV TUPQ UBLJOH 453*#*-% Who should not take STRIBILD? Do not take STRIBILD if you also take a medicine that contains: t BEFGPWJS )FQTFSB®

t BMGV[PTJO IZESPDIMPSJEF 6SPYBUSBM®

t DJTBQSJEF 1SPQVMTJE® 1SPQVMTJE 2VJDLTPMW®

t FSHPU DPOUBJOJOH NFEJDJOFT JODMVEJOH EJIZESPFSHPUBNJOF NFTZMBUF % ) & ® .JHSBOBM® FSHPUBNJOF UBSUSBUF $BGFSHPU® .JHFSHPU® &SHPTUBU® .FEJIBMFS &SHPUBNJOF® 8JHSBJOF® 8JHSFUUFT® BOE NFUIZMFSHPOPWJOF NBMFBUF &SHPUSBUF® .FUIFSHJOF®

t MPWBTUBUJO "EWJDPS® "MUPQSFW® .FWBDPS®

t PSBM NJEB[PMBN

What is the most important information I should know about STRIBILD?

t QJNP[JEF 0SBQ®

STRIBILD can cause serious side effects, including: 1. Build-up of lactic acid in your blood (lactic acidosis). -BDUJD BDJEPTJT DBO IBQQFO JO TPNF QFPQMF XIP UBLF 453*#*-% PS TJNJMBS OVDMFPTJEF BOBMPHT NFEJDJOFT -BDUJD BDJEPTJT JT B TFSJPVT NFEJDBM FNFSHFODZ UIBU DBO MFBE UP EFBUI -BDUJD BDJEPTJT DBO CF IBSE UP JEFOUJGZ FBSMZ CFDBVTF UIF TZNQUPNT DPVME TFFN MJLF TZNQUPNT PG PUIFS IFBMUI QSPCMFNT Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: t GFFM WFSZ XFBL PS UJSFE t IBWF VOVTVBM OPU OPSNBM NVTDMF QBJO t IBWF USPVCMF CSFBUIJOH t IBWF TUPNBDI QBJO XJUI OBVTFB PS WPNJUJOH t GFFM DPME FTQFDJBMMZ JO ZPVS BSNT BOE MFHT t GFFM EJ[[Z PS MJHIUIFBEFE t IBWF B GBTU PS JSSFHVMBS IFBSUCFBU 2. Severe liver problems. 4FWFSF MJWFS QSPCMFNT DBO IBQQFO JO QFPQMF XIP UBLF 453*#*-% *O TPNF DBTFT UIFTF MJWFS QSPCMFNT DBO MFBE UP EFBUI :PVS MJWFS NBZ CFDPNF MBSHF IFQBUPNFHBMZ BOE ZPV NBZ EFWFMPQ GBU JO ZPVS MJWFS TUFBUPTJT Call your healthcare provider right away if you get any of the following symptoms of liver problems: t ZPVS TLJO PS UIF XIJUF QBSU PG ZPVS FZFT UVSOT ZFMMPX KBVOEJDF

t EBSL iUFB DPMPSFEw VSJOF t MJHIU DPMPSFE CPXFM NPWFNFOUT TUPPMT t MPTT PG BQQFUJUF GPS TFWFSBM EBZT PS MPOHFS t OBVTFB t TUPNBDI QBJO You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time. 3. Worsening of Hepatitis B infection. *G ZPV IBWF IFQBUJUJT # WJSVT )#7 JOGFDUJPO BOE UBLF 453*#*-% ZPVS )#7 NBZ HFU XPSTF þ BSF VQ JG ZPV TUPQ UBLJOH 453*#*-% " iþ BSF VQw JT XIFO ZPVS )#7 JOGFDUJPO TVEEFOMZ SFUVSOT JO B XPSTF XBZ UIBO CFGPSF t %P OPU SVO PVU PG 453*#*-% 3Fý MM ZPVS QSFTDSJQUJPO PS UBML UP ZPVS IFBMUIDBSF QSPWJEFS CFGPSF ZPVS 453*#*-% JT BMM HPOF

t TJMEFOBý M 3FWBUJP® XIFO VTFE GPS USFBUJOH MVOH QSPCMFNT

t SJGBNQJO 3JGBEJO® 3JGBNBUF® 3JGBUFS® 3JNBDUBOF®

t TJNWBTUBUJO 4JNDPS® 7ZUPSJO® ;PDPS®

t USJB[PMBN )BMDJPO®

t UIF IFSC 4U +PIO T XPSU Do not take STRIBILD if you also take any other HIV-1 medicines, including: t 0UIFS NFEJDJOFT UIBU DPOUBJO UFOPGPWJS "USJQMB® $PNQMFSB® 7JSFBE® 5SVWBEB®

t 0UIFS NFEJDJOFT UIBU DPOUBJO FNUSJDJUBCJOF MBNJWVEJOF PS SJUPOBWJS $PNCJWJS® &NUSJWB® &QJWJS® PS &QJWJS )#7® &Q[JDPN® ,BMFUSB® /PSWJS® 5SJ[JWJS®

STRIBILD is not for use in people who are less than 18 years old. What are the possible side effects of STRIBILD? STRIBILD may cause the following serious side effects: t 4FF i8IBU JT UIF NPTU JNQPSUBOU JOGPSNBUJPO * TIPVME LOPX about STRIBILD?” t /FX PS XPSTF LJEOFZ QSPCMFNT JODMVEJOH LJEOFZ GBJMVSF :PVS IFBMUIDBSF QSPWJEFS TIPVME EP CMPPE BOE VSJOF UFTUT UP DIFDL ZPVS LJEOFZT CFGPSF ZPV TUBSU BOE XIJMF ZPV BSF UBLJOH 453*#*-% :PVS IFBMUIDBSF QSPWJEFS NBZ UFMM ZPV UP TUPQ UBLJOH 453*#*-% JG ZPV EFWFMPQ OFX PS XPSTF LJEOFZ QSPCMFNT t #POF QSPCMFNT DBO IBQQFO JO TPNF QFPQMF XIP UBLF 453*#*-% #POF QSPCMFNT JODMVEF CPOF QBJO TPGUFOJOH PS UIJOOJOH XIJDI NBZ MFBE UP GSBDUVSFT :PVS IFBMUIDBSF QSPWJEFS NBZ OFFE UP EP UFTUT UP DIFDL ZPVS CPOFT t Changes in body fat DBO IBQQFO JO QFPQMF XIP UBLF )*7 NFEJDJOF 5IFTF DIBOHFT NBZ JODMVEF JODSFBTFE BNPVOU PG GBU JO UIF VQQFS CBDL BOE OFDL iCVGGBMP IVNQw CSFBTU BOE BSPVOE UIF NJEEMF PG ZPVS CPEZ USVOL -PTT PG GBU GSPN UIF MFHT BSNT BOE GBDF NBZ BMTP IBQQFO 5IF FYBDU DBVTF BOE MPOH UFSN IFBMUI FGGFDUT PG UIFTF DPOEJUJPOT BSF OPU LOPXO t Changes in your immune system *NNVOF 3FDPOTUJUVUJPO 4ZOESPNF DBO IBQQFO XIFO ZPV TUBSU UBLJOH )*7 NFEJDJOFT :PVS JNNVOF TZTUFN NBZ HFU TUSPOHFS BOE CFHJO UP ý HIU JOGFDUJPOT UIBU IBWF CFFO IJEEFO JO ZPVS CPEZ GPS B MPOH UJNF 5FMM ZPVS IFBMUIDBSF QSPWJEFS SJHIU BXBZ JG ZPV TUBSU IBWJOH BOZ OFX TZNQUPNT BGUFS TUBSUJOH ZPVS )*7 NFEJDJOF

The most common side effects of STRIBILD include: t /BVTFB t %JBSSIFB Tell your healthcare provider if you have any side effect that bothers you or that does not go away. t 5IFTF BSF OPU BMM UIF QPTTJCMF TJEF FGGFDUT PG 453*#*-% 'PS NPSF JOGPSNBUJPO BTL ZPVS IFBMUIDBSF QSPWJEFS t $BMM ZPVS IFBMUIDBSF QSPWJEFS GPS NFEJDBM BEWJDF BCPVU TJEF FGGFDUT :PV NBZ SFQPSU TJEF FGGFDUT UP '%" BU '%"

EJHPYJO -BOPYJOÂ®

EJTPQZSBNJEF /PSQBDFÂ®

FTUB[PMBN FUIPTVYJNJEF ;BSPOUJOÂ®

Ã¾ FDBJOJEF 5BNCPDPSÂ® Ã¾ VSB[FQBN Ã¾ VUJDBTPOF 'MPWFOUÂ® 'MPOBTFÂ® 'MPWFOUÂ® %JTLVT 'MPWFOUÂ® )'" 7FSBNZTUÂ®

JUSBDPOB[PMF 4QPSBOPYÂ®

What should I tell my healthcare provider before taking STRIBILD? LFUPDPOB[PMF /J[PSBMÂ®

MJEPDBJOF 9ZMPDBJOFÂ®

Tell your healthcare provider about all your medical conditions, including: NFYJMFUJOF t *G ZPV IBWF PS IBE BOZ LJEOFZ CPOF PS MJWFS QSPCMFNT JODMVEJOH PYDBSCB[FQJOF 5SJMFQUBMÂ®

IFQBUJUJT # JOGFDUJPO QFSQIFOB[JOF t *G ZPV BSF QSFHOBOU PS QMBO UP CFDPNF QSFHOBOU *U JT OPU LOPXO JG Â® 453*#*-% DBO IBSN ZPVS VOCPSO CBCZ 5FMM ZPVS IFBMUIDBSF QSPWJEFS QIFOPCBSCJUBM -VNJOBM

JG ZPV CFDPNF QSFHOBOU XIJMF UBLJOH 453*#*-% QIFOZUPJO %JMBOUJOÂ® 1IFOZUFLÂ®

o 5IFSF JT B QSFHOBODZ SFHJTUSZ GPS XPNFO XIP UBLF BOUJWJSBM QSPQBGFOPOF 3ZUINPMÂ® NFEJDJOFT EVSJOH QSFHOBODZ 5IF QVSQPTF PG UIJT SFHJTUSZ JT UP RVJOJEJOF /FVEFYUBÂ® DPMMFDU JOGPSNBUJPO BCPVU UIF IFBMUI PG ZPV BOE ZPVS CBCZ 5BML SJGBCVUJO .ZDPCVUJOÂ®

XJUI ZPVS IFBMUIDBSF QSPWJEFS BCPVU IPX ZPV DBO UBLF QBSU JO UIJT SFHJTUSZ SJGBQFOUJOF 1SJGUJOÂ®

t *G ZPV BSF CSFBTUGFFEJOH OVSTJOH PS QMBO UP CSFBTUGFFE %P OPU SJTQFSJEPOF 3JTQFSEBMÂ® 3JTQFSEBM $POTUBÂ®

CSFBTUGFFE JG ZPV UBLF 453*#*-% TBMNFUFSPM 4FSFWFOUÂ® PS TBMNFUFSPM XIFO UBLFO JO DPNCJOBUJPO :PV TIPVME OPU CSFBTUGFFE JG ZPV IBWF )*7 CFDBVTF PG UIF SJTL PG XJUI Ã¾ VUJDBTPOF "EWBJS %JTLVTÂ® "EWBJS )'"Â®

QBTTJOH )*7 UP ZPVS CBCZ TJMEFOBÃ½ M 7JBHSBÂ® UBEBMBÃ½ M $JBMJTÂ® PS WBSEFOBÃ½ M -FWJUSBÂ® 5XP PG UIF NFEJDJOFT JO 453*#*-% DBO QBTT UP ZPVS CBCZ JO ZPVS 4UBYZOÂ® GPS UIF USFBUNFOU PG FSFDUJMF EZTGVODUJPO &% *G ZPV HFU CSFBTU NJML *U JT OPU LOPXO JG UIF PUIFS NFEJDJOFT JO 453*#*-% DBO EJ[[Z PS GBJOU MPX CMPPE QSFTTVSF IBWF WJTJPO DIBOHFT PS IBWF QBTT JOUP ZPVS CSFBTU NJML BO FSFDUJPO UIBU MBTU MPOHFS UIBO IPVST DBMM ZPVS IFBMUIDBSF 5BML XJUI ZPVS IFBMUIDBSF QSPWJEFS BCPVU UIF CFTU XBZ UP GFFE QSPWJEFS PS HFU NFEJDBM IFMQ SJHIU BXBZ ZPVS CBCZ UBEBMBÃ½ M "EDJSDBÂ® GPS UIF USFBUNFOU PG QVMNPOBSZ BSUFSJBM Tell your healthcare provider about all the medicines you take, IZQFSUFOTJPO including prescription and nonprescription medicines, vitamins, UFMJUISPNZDJO ,FUFLÂ®

and herbal supplements: UIJPSJEB[JOF t 453*#*-% NBZ BGGFDU UIF XBZ PUIFS NFEJDJOFT XPSL BOE PUIFS WPSJDPOB[PMF 7GFOEÂ®

NFEJDJOFT NBZ BGGFDU IPX 453*#*-% XPSLT XBSGBSJO $PVNBEJOÂ® +BOUPWFOÂ®

t #F TVSF UP UFMM ZPVS IFBMUIDBSF QSPWJEFS JG ZPV UBLF BOZ PG UIF GPMMPXJOH NFEJDJOFT [PMQJEFN "NCJFOÂ® &EMVMBSÂ® *OUFSNF[[PÂ® ;PMQJNJTUÂ®

)PSNPOF CBTFE CJSUI DPOUSPM QJMMT QBUDIFT SJOHT TIPUT FUD Know the medicines you take. ,FFQ B MJTU PG BMM ZPVS NFEJDJOFT BOE TIPX JU UP ZPVS IFBMUIDBSF QSPWJEFS BOE QIBSNBDJTU XIFO ZPV HFU B "OUBDJE NFEJDJOFT UIBU DPOUBJOT BMVNJOVN NBHOFTJVN OFX NFEJDJOF %P OPU TUBSU BOZ OFX NFEJDJOFT XIJMF ZPV BSF UBLJOH IZESPYJEF PS DBMDJVN DBSCPOBUF 5BLF BOUBDJET BU MFBTU IPVST 453*#*-% XJUIPVU Ã½ STU UBMLJOH XJUI ZPVS IFBMUIDBSF QSPWJEFS CFGPSF PS BGUFS ZPV UBLF 453*#*-% .FEJDJOFT UP USFBU EFQSFTTJPO PSHBO USBOTQMBOU SFKFDUJPO PS IJHI Keep STRIBILD and all medicines out of reach of children. CMPPE QSFTTVSF 5IJT #SJFG 4VNNBSZ TVNNBSJ[FT UIF NPTU JNQPSUBOU JOGPSNBUJPO BNJPEBSPOF $PSEBSPOFÂ® 1BDFSPOFÂ® BCPVU 453*#*-% *G ZPV XPVME MJLF NPSF JOGPSNBUJPO UBML XJUI ZPVS IFBMUIDBSF QSPWJEFS :PV DBO BMTP BTL ZPVS IFBMUIDBSF QSPWJEFS PS BUPSWBTUBUJO -JQJUPSÂ® $BEVFUÂ®

QIBSNBDJTU GPS JOGPSNBUJPO BCPVU 453*#*-% UIBU JT XSJUUFO GPS IFBMUI CFQSJEJM IZESPDIMPSJD 7BTDPSÂ® #FQBEJOÂ®

QSPGFTTJPOBMT PS DBMM PS HP UP XXX 453*#*-% DPN CPTFOUBO 5SBDMFFSÂ®

*TTVFE "VHVTU CVTQJSPOF DBSCBNB[FQJOF $BSCBUSPMÂ® &QJUPMÂ® &RVFUSPÂ® 5FHSFUPÂ® DMBSJUISPNZDJO #JBYJOÂ® 1SFWQBDÂ®

DMPOB[FQBN ,MPOPQJOÂ®

DMPSB[FQBUF (FO YFOFÂ® 5SBOYFOFÂ®

$0.1-&3" &.53*7" (*-&"% UIF (*-&"% -PHP (4* )&14&3" 453*#*-% UIF 453*#*-% -PHP 5367"%" BOE 7*3&"% BSF USBEFNBSLT PG (JMFBE 4DJFODFT *OD PS JUT SFMBUFE DPNQBOJFT "53*1-" DPMDIJDJOF $PMDSZTÂ®

JT B USBEFNBSL PG #SJTUPM .ZFST 4RVJCC (JMFBE 4DJFODFT --$ "MM PUIFS NBSLT SFGFSFODFE IFSFJO BSF UIF QSPQFSUZ PG UIFJS SFTQFDUJWF PXOFST NFEJDJOFT UIBU DPOUBJO EFYBNFUIBTPOF EJB[FQBN 7BMJVNÂ®

Âª (JMFBE 4DJFODFT *OD "MM SJHIUT SFTFSWFE 2$

MARCH/APRIL 2013

IN THIS ISSUE

healthy doses

6 both sides of the coin A new commemorative coin recalls the legacy of Nelson Mandela. 8 drugstore 2.0 HIV-specific pharmacies work to take the hassle out of your regimen. 9 shedding the shackles Alabama’s policy of segregating HIV-positive prisoners is a thing of the past. CASE STUDIES

12 WHY YOU NEED MENTAL AEROBICS Doing brain exercises could help combat cognitive delay.

13 ashes to ashes We know smoking is dangerous, but a new report shows it’s likely more deadly than HIV.

13 gone country A new project at Michigan State University aims to look at the effect of HIV on small-town America.

COLUMNS

36 MIND + MOOD by Gary McClain, Ph.D. 37 RELATIONSHIPS by Maria Mejia YOU 2.0

38 STEP, BELL, CHANGE Tighten your middle in three easy steps.

39 modern family Tips on how to spot and stop addiction to drugs or alcohol in a family member or loved one.

Hear Her Roar

Between recording albums, performing in musicals, and raising three kids, singer and Broadway star Deborah Cox reminds women that HIV hasn’t gone away.

30 Electric Youth

The group Advocates for Youth launches an effort to engage young people in sex education and HIV awareness.

WOMEN & HIV

20 Is the Worst Behind Us?

HIV numbers drop for African-American women, but it’s no time to stop fighting.

11 DAILY DOSE: FINDING MR. (OR MS.) RIGHT How to find the right doctor to keep you healthy for now and years from now.

18 News you can use All the latest news, studies, and more.

40 ask & Tell Q&A with celebrity DJ Caroline D’Amore.

22 Invisible Women

Why do transgender women have some of the highest HIV rates in the country?

26 Chicago’s Finest

Ambitious efforts in the Windy City help HIV-positive people find housing, transportation, and health care.

28 What to Expect When You’re Expecting

There’s no reason you can’t bring home your own healthy bundle of joy, but make sure to read this before you try to conceive.

courtesy subjec t

ALSO

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Diane Anderson-Minshall

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evp, group publisher

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Peter Di Maso Dave Johnson director, digital media Scott Ragan senior online producer Christopher Harrity web production coordinator Joe Okonkwo

lead web architect & developer

circulation Director

creative director, digital media

fulfillment manager

Jeff Lettiere Argus Galindo

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i am woman, hear me roar

t sometimes seems like

women are the forgotten ones when it comes to HIV care. Even though we've long struggled to get the world to understand that HIV/AIDS is not a "gay disease" but rather merely a human condition that affects all of us, the media's take on HIV is still often one that excludes women. Fortunately, a bevy of chicks are fighting back—and working to make sure that other women have their needs met. Whether it's an HIV-positive mom like LaVera Anom teaching other women how to negotiate condom use (p. 20) or someone like Kathie Hiers, who helps single moms in Alabama find housing (p. 31), women really are doing it for themselves. Our cover girl, R&B star Deborah Cox, who is headed to Broadway in April with Jekyll & Hyde, is even encouraging women to Break the Silence with a video that asks “Do you know that a woman tests positive for HIV every 35 minutes in this country?" My favorite line from her interview (p. 32) is “Honestly, if you don’t have anything higher than yourself in your life, it can be a very lonely place. I'm just an advocate for love on every level.”

Diane Anderson-Minshall Editor in Chief

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Both Sides of the Coin A new commemorative coin recalls the legacy of Nobel Peace Prize winner Nelson Mandela to help raise awareness and funding for HIV/AIDS. â&#x17E;¤

n november 29, 2003, Nobel Peace Prize winner and former South African president Nelson Mandela addressed the world from Cape Town at an AIDS-awareness concert dubbed “46664.” The concert, named after the prisoner ID number Mandela was assigned when he was imprisoned for more than two decades, became a recurring fundraiser for the fight to end AIDS in Africa. But what lasted long after the musicians’ final notes were Mandela’s words. “AIDS is no longer just a disease,” said Mandela. “It is a human rights issue.” Ten years later, the South African Gold Coin Exchange has immortalized Mandela’s words on a commemorative gold medallion, on sale now for the first time in the U.S. Following in the footsteps of Mandela’s simple but passionate advocacy, SAGCE hopes the set of coins will raise awareness about the global HIV/AIDS epidemic while simultaneously benefiting three U.S.-based organizations fighting to end the disease. “To date several million dollars have already been given to organizations from the sales of SAGCE commemorative medallions in South Africa and the United Kingdom,” says Melanie Nathan, LGBT human rights activist and SAGCE’s U.S. marketing director. “We hope the U.S. public will embrace the Mandela Red Ribbon Twin Set campaign, not only to raise money for the U.S. based organizations but also to foster the Mandela legacy while promoting the destigmatization of HIV/AIDS.” A portion of the proceeds from the collectible coins will benefit the Black AIDS Institute, a Los Angeles–based organization dedicated to eradicating HIV among African-Americans.

Proceeds from the limited-edition set will also benefit American Friends of the Phelophepa Train, a U.S.-based partnership with the Phelophepa Train of Hope, which uses the rail system in South Africa to bring affordable and accessible medical, dental, and mental health care to impoverished rural communities in South Africa. Doctors on the two Phelophepa Trains crisscrossing the country have treated more than 7 million people since the project began in 1994. The Elizabeth Glaser Pediatric AIDS Foundation will also receive a percentage of the funds generated through sales of the coins. Phillip O’Brien, vice president of communications, advocacy and development at the foundation, released a statement saying, “This type of support will help us eliminate mother-to-child transmission of HIV and ensure we see a day when every HIVpositive woman has the knowledge, access to care, and treatment services needed to give birth to a HIV-negative baby.” The coin set consists of a half-ounce gold coin and a one-ounce silver coin, both emblazoned with Mandela’s face on one side, and on the reverse, an AIDS ribbon and Mandela’s historic quote. On the silver coin, the AIDS ribbon stands out in brilliant crimson. The coins are produced by the Mint of Norway as part of its Nobel Peace Laureate Program and distributed by SAGCE, which holds the exclusive rights to the images of all Nobel Peace Prize winners embossed on coins. Only 2,500 sets featuring the U.S.-specific design will be minted, making the coins a true collectible. —Sunnivie Brydum Vis Man i

opposite page: getty images; this page: courtesy subject; getty images

“AIDS is no longer just a disease,” said Mandela. “It is a human rights issue.”

t del a Co to inUS A .c le a om mo r n re

Text Success for aids memorial grove Social media venues are opening up new fund-raising possibilities for AIDS-related organizations. Case in point: A text-to-donate campaign in December, said to be the first for an AIDS group, generated money and, perhaps even more important, awareness for the National AIDS Memorial Grove in San Francisco. Officials are still totaling up the donations, but they believe they reached their goal of $3,000 to $5,000 through the AT&T-sponsored campaign, which allowed supporters to make a $10 donation via text message. And the effort appears to have motivated others who wanted to make larger contributions—the AIDS Grove saw a roughly 25% overall increase in year-end donations compared to 2011, says executive director John Cunningham, and it led to a 25% spike in Facebook followers. He’d recommend campaigns involving texting and other social media to similar nonprofit groups, he says, as that’s where to find a new generation of donors. “We know that is where the current generation of young people is engaging,” he says. —Trudy Ring

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Drugstore 2.0 icking up prescriptions is no one’s idea of fun, but this errand can be fraught with confusion and judgment if you’re living with HIV. For those in the know, there’s an alternative to the usual drugstore experience: Walgreensoperated pharmacies that cater to those living with HIV. Walgreens now operates over 700 HIV-specialized pharmacies throughout the U.S. and Puerto Rico. Started three years ago and placed in areas identified by the CDC as greatly affected by HIV, the stores are close to nearly 90% of the HIV-positive U.S. population. The staff who run these locations are all trained in HIV care, including sensitivity and cultural training that Walgreens developed with the University of Buffalo and enhanced through the American Academy of HIV Medicine and the AIDS Education and Training Center. In fact, the pharmacists at these

denied coverage? the health care act can help HIV/AIDS now qualifies as one of the chronic conditions eligible for enhanced federal reimbursements through Medicaid. States adhering to the Affordable Care Act’s Health Homes program will find it easier to create care and support systems for people with HIV. About 90,000 people, including some HIVers, have already enrolled in the mandatory Pre-existing Condition Insurance Plan, which ensures they will not be locked out of the health insurance market just because of their health status. However, you’re required to prove that you’ve been denied coverage, and those with coverage of any sort, even if they have been denied treatment for their HIV under that provider, will not qualify.

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stores undergo 25 hours of HIV training, and patients can schedule confidential consultations with these experts to address concerns. “Our pharmacists are positioned to support patients in addressing issues they face, including side effects, emotional support, and motivation to take their medications as prescribed,” says Glen Pietrandoni, senior manager for HIV/AIDS and hepatitis pharmacy services at Walgreens. Helping with adherence is a big reason Walgreens established the pharmacies, he says. Their services include refill reminders, 24/7 online pharmacist access, education and testing, and automatic refill options. These medications at these stores cost the same as at regular Walgreens pharmacies. To protect patients’ privacy, the pharmacies don’t feature special signage. To find one near you, go to HIV.Walgreens.com. —Neal Broverman

AMP! It Up

With hilarious skits about condoms, STDs, and HIV stigma, AMP! is education disguised as entertainment. Performed by University of California, Los Angeles, students who call themselves the UCLA Sex Squad, AMP! travels to high schools around the country to teach teens about responsible sex. The Sex Squad kicked off its 2013 tour with a performance on World AIDS Day at UCLA. A show created especially for the day, 48 Hours to Action, featured special costars: students from an L.A. high school who formed their own sex squad. For more info go to www.facebook.com/ UCLASSquad.

this page from top: photos.com; members of the 2012-12 sex squad; opposite page from top: Courtesy the artist and Johann König, Berlin; photos.com

New HIV-specific pharmacies work to take the hassle out of your regimen

The Art of HIV

A still from “Raspberry Poser,” a digital video with CGI and hand-drawn animation by artist Jordan Wolfson

nternationally acclaimed New York–based artist Jordan Wolfson’s latest exhibition, “Raspberry Poser,” shown earlier this year at Los Angeles’s REDCAT arts center, is an ambitious blend of film, computer-generated images, and hand-drawn animation. Against a soundtrack of pop music and a backdrop of still and moving images, little characters called “Posers” bounce and float along the screen in the form of silvery, heart-filled condoms, mutating red blood cells, a sexually entangled lock and key, and a rubbery, almost-human incarnation of the HIV. Wolfson, 32, says his work is inspired by his experiences, the history of art and entertainment, and the awesome gravity of love, life, and death. —Sunnivie Brydum

What Else Does the Affordable Care Act DO? + AIDS Drug Assistance Program

benefits now count as contributions toward a Medicare beneficiary’s out-ofpocket spending limit for prescription drugs, easing the cost burden.

+ No matter where they live in the U.S.,

an individual or family whose income is less than 133% of the federal poverty level ($14,500 per individual) will be instantly eligible for Medicaid in 2014.

+ It closes the Medicare Part D prescrip-

tion drug benefit “doughnut hole,” giving beneficiaries a 50% discount on covered brand-name drugs.

24%

of HI V insura ers have no n privat ce, while 1 health e in 3 % ha ve receiv surance. T he r e cove est r ag e t gover hr nmen t prog ough rams.

Shedding the Shackles

Alabama’s prison policy segregating HIV-positive inmates is a thing of the past

ven in 2013, segregation is still is alive and well in some parts of the South. For more than 20 years, Alabama has been segregating its HIV-positive inmates from the rest of the prison population, but a recent court ruling should change that. About 250 HIV-positive male prisoners have been housed in a

converted warehouse at the Limestone Correctional Facility in Harvest, Ala. About a dozen female inmates with HIV were detained in Dorm E, a segregated facility at Julia Tutwiler Prison for Women, the only women’s prison in the state. Unlike the rest of the state’s prison population, these HIV-positive inmates were placed at Limestone and

Dorm E without regard to their mental health, the level of security needed, or (in the case of Limestone) proximity to family members (who may live so far away that visits create a hardship). At Limestone the inmates were forced to sleep in long rows of bunk beds in a room as long as a football field, where health complications such as pneumonia occurred frequently. At Tutwiler’s Dorm E, with fewer inmates, there were also bunk beds and little privacy, in an area described as resembling an isolation cell. In 2011 seven male and female prisoners banded together, representing all HIV-positive prisoners in Alabama, to sue the state for discrimination, with the help of the American Civil Liberties Union. Dana Harley, a female prisoner and plaintiff in the case, was automatically placed in Dorm E after testing positive for HIV. “We are in isolation from general population like we are contagious animals,” Harley said in a letter to the court. She continued, “We are confined and can’t

even participate in everyday activities such as trade schools or state jobs.… It’s like punishment three times over: Prison, the virus, then the denial of an education or trade.” U.S. District Court judge Myron Thompson ruled in December that such segregation was damaging to prisoners because it limited their access to work release, mental health care, drug rehabilitation, education, and vocational programs. He also ruled that positive prisoners would no longer have to wear white armbands to alert others to their HIV status. “It is evident that, while the [Alabama Department of Corrections’] categorical segregation policy has been an unnecessary tool for preventing the transmission of HIV, it has been an effective one for humiliating and isolating prisoners living with the disease,” Thompson wrote in his decision. One question remains now: Will South Carolina, the last state still segregating prisoners based on HIV status, follow suit? —Michelle Garcia

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THIS SUPERSTAR JUST BECAME AN HIV AMBASSADOR

greatest Bollywood stars, Aishwarya Rai Bachchan, has been appointed as international goodwill ambassador by the Joint United Nations Programme on HIV/AIDS. The actress, who’s also starred in crossover films such as Bride & Prejudice and The Pink Panther 2, says she wants to raise awareness about HIV, help stop mother-to-child transmissions (which UNAIDS hopes to do globally by 2015), and advocate for increased access to antiretroviral treatment in the 22 countries, including India, that account for 90% of all new HIV infections among children. “Spreading awareness on health issues, especially related to women and children, has always been a priority for me,” Bachchan said upon her appointment. “And now, as a new mother, I can personally relate to this––the joys and concerns of every mother and the hopes that we have for our children. I strongly believe that every baby should be born free from HIV. And I wish that every woman living with HIV stays healthy and has access to treatment. I promise that with UNAIDS, I will do my utmost to make this happen.”

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Finding Mr. (or Ms.) Right Finding the right HIV doctor now will affect your health for years to come. Here’s how to do it. —Michelle Garcia

or some people, establishing a solid relationship with the right doctor can be as important as keeping up a relationship with a good friend. For others, it’s about finding the right coach to get you through the best and worst situations, or just someone you see a couple of times a year to make sure your body is in good working order. In any case, finding a good doctor and working with him or her are important tasks for HIVers. Whether you are seeking a general practitioner who is especially experienced in HIV care or an HIV specialist to be a part of your medical team, there are several steps you can take to find the right fit. ask around.

Ask for referrals from your local HIV resource center, your current general practitioner, or other HIV-positive people you know. get online.

The American Academy of HIV Medicine (AAHIVM.org) and the HIV Medicine Association (HIVMA.org) both offer a database of doctors and medical services nationwide, allowing you to search for an HIV-knowledgeable doctor in your hometown. Both websites can help you find the right general practitioner, but AAHIVM will also match you doctors who focus on specialized HIV care in areas including nutrition therapy, dental care, or access to clinical trials.

from left: photos.com; courtesy subj

check the ratings.

After you find a couple of promising doctors in your area, you may want to check reviews on ZocDoc.com, RateMDs.com, HealthGrades, or Angie’s List for any red flags. More information on a particular doctor you are interested in may be available to you through your insurance provider. And if you want to be really investigative, the Federation of State Medical Boards (FSMB.org) can give you a report on any physician’s licenses, medical edu-

cation, any sanctions or disciplines, and location history. talk to her first.

Don’t hesitate to consult with your prospective doctor before you dive into his or her client pool. Many doctors will make time to speak with you before you put on the examination gown. Find out if you have a compatible philosophy about your HIV treatment: Do you want cutting-edge methods or consistent, conservative care? Do you like to supplement your health care with alternative therapies such as massage and acupuncture? Would you rather collaborate on your treatment plan with your doctor, or would you prefer him or her to take the wheel? pass the info along.

When you’re ready to become a patient, make sure your new doctor has as much of your medical history as possible to determine the right care plan. Transferring medical records is often as easy as calling your previous medical provider. When you talk to your doctor, try to be as honest as possible. At this point, you probably already know their philosophy on certain things, so you should feel comfortable talking about your sexual history, sleep patterns, and substance use. ✜

Could Your Phone Save Your Life? Problem: More than 700,000 people were hospitalized in 2008 because they skipped or took incorrect dosages of their prescribed medication. Even worse, every 19 minutes someone in the U.S. dies because of medication noncompliance. Solution: MediSafe Project is the first cloud-synced pillbox app. It reminds you when it’s time to take your medication and also lets your chosen caretakers if you miss a dose. What does that mean? You miss a dose and your husband gets alerted, for example, and he can help make sure you’re on track. Since the app is compatible with the Food and Drug Administration’s drug database, as you start to type in either the generic or brand name of a medication, MediSafe auto-completes it, and it stores the name of the medicine, its strength, and its manufacturer. You can also enter a medication by using your smartphone camera to take a picture of the National Drug Code number, which appears on all original drug packaging. Works on: iPhone and Android Cost: Free

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CASE STUDIES

Why You Need Mental Aerobics Brain exercises could help combat cognitive delay caused by HIV

t’s common knowledge that as we age, our brains slow down. But research shows that for HIV-positive adults, that forgetfulness—formally called cognitive impairment—can start to appear earlier and more severely than it does for the average person. “Thirty to 60 percent of adults with HIV experience cognitive problems, a condition known as ‘HIV-associated neurocognitive disorders,’ ” explains David E. Vance, an associate professor at the University of Alabama at Birmingham’s School of Nursing. He says it’s critical for people with HIV to be proactive in addressing cognitive problems, because “these issues can lead to difficulties in working and living independently.” But there’s hope. Vance led a 2012 study that found brain exercises dramatically improve intellectual function in HIVers over 50. That’s good news for the nation’s HIV-positive population, a majority of whom will be over 50 by 2015. “Just like when you exercise your muscle, it increases the size. The brain works similarly,” explains Vance. Vance’s study looked at 46 adults with HIV and randomly assigned participants to either 10 hours of computerbased “speed of processing”

training or no training at all. Vance found that nearly 90% of his subjects who received training saw an improvement in the scope of visual information their brains could understand. This is known as the visual field of processing, and it’s a mental process necessary in life. Vance says previous studies found that adults with a broader visual field of processing have fewer car accidents. “A split second when you’re driving can be the difference between life and death,” Vance explains. Participants in Vance’s study used an intellectual exercise set housed at BrainHQ.PositScience.com. But according to Vance, more important than the specific exercises is that the activities “make your brain sweat.” The newer the activity, the better, says Vance. “So if you are already doing crossword puzzles…why don’t you try Sudoku puzzles instead?” Training your brain doesn’t have to be a solitary activity, though. “Social interaction itself is a wonderful cognitive tool,” says Vance, noting that figuring out what to say next in a conversation is highly stimulating for the brain. “This is brain science,” says Vance, “but it’s not that complicated.” —Sunnivie Brydum

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Gone Country A new project at Michigan State University is one of the first to gather data on HIV outside urban areas

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Ashes to Ashes We know smoking is dangerous, but a new report finds it’s likely more deadly than HIV

ERIC PIERMONT/AFP/Getty Images

The average life expectancy of a 35-year-old with HIV who smokes

The average life expectancy of a 35-year-old with HIV who doesn’t smoke

fter being diag- 19% of all Americans. As antinosed, it’s hard not retrovirals help people live lonto wonder how HIV ger with HIV, many are having will affect your life their lives cut short not from expectancy. For HIV-positive their disease but from lifestyle people, though, the most impor- factors related to obesity, alcotant factor in how long you live hol, drug abuse, and smoking. may not be your positive status The Danish study found but whether you smoke. that a 35-year-old HIV patient A massive 15-year study who currently smokes has an of 13,500 Europeans recently average life expectancy of 62.6 released its startling findings: years, almost 16 years shorter There were three times as than a nonsmoker with HIV. many smoking-related deaths “The loss of years of life among people with HIV as in associated with smoking was the general population. Even twice as high as that associated more disturbing was the dis- with HIV among HIV-infected covery that positive smokers patients,” the researchers note. lost more years of life to their The researchers say their cigarettes than to HIV. Sur- findings prove you should quit prisingly, these patients were smoking now since “smokreceiving free and regular ing may impact life expecantiretroviral care—and tancy considerably more still dying at alarming than the HIV infecnumbers. tion itself.” —Neal F OR IN Q UI “More than 60% Broverman T TIN FO ON G S MO K EF , GO T O of deaths among HIV REE .GO patients are associV ated with smoking” rather than HIV, said researcher Marie Helleberg, MD, of Copenhagen University Hospital. Studies show that smoking is prevalent among people with HIV: about half of those with the virus light up, compared to

There’s a lot of information about people with HIV for scientists to study, but most of it is on people in cities, leaving rural America underrepresented. Michigan State University plans to change this. The East Lansing institution is setting up a voluntary, confidential database of HIV-positive people from rural areas in the state, which will help scientists determine how best to prevent HIV transmission among those populations and to treat those with the virus. These HIVers are different in some ways from those in urban areas, says Linda Dale, a member of the team working on the database. “With these patients, IV drug use plays much less of a role in transmission,” she says, adding that Ingham County, which includes East Lansing, has the state’s highest HIV rate per capita outside of Detroit, “but most transmission here is sexual. This is important when planning funding for prevention and management.” The university began assembling the database last fall. For privacy reasons, there are strict limits on which personnel are allowed to connect numbers with names. Studies planned by the researchers using the database will look at factors such as how marijuana use affects HIV-infected cells and how genetics influence immune cells. —Trudy Ring Naked activists, with slogans such as “AIDS CUTS KILL” painted on their bodies, protest inside the LOBBY OF House Speaker John Boehner’S CAPITOL HILL OFFICE November 27. WHY? BECAUSE OF THE THREAT OF POSSIBLE CUTS IN AIDS Funding Due to THE U.S.’s CURRENT ECONOMIC STRUGGLES.

The

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for me

Patient model. Pill shown is not actual size.

What is COMPLERA? COMPLERA is a prescription HIV medicine that is used as a complete regimen to treat HIV-1 in adults who have never taken HIV medicines before and who have an amount of HIV in their blood (this is called “viral load”) that is no more than 100,000 copies/mL. COMPLERA contains 3 medicines – rilpivirine, emtricitabine and tenofovir disoproxil fumarate. It is not known if COMPLERA is safe and effective in children under the age of 18 years. ®

COMPLERA® does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Avoid doing things that can spread 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, do not share personal items that may contain bodily fluids. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others.

IMPORTANT SAFETY INFORMATION What is the most important information you should know about COMPLERA? COMPLERA® can cause serious side effects: t 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 (not normal) 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. t Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include 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. t You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA 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. t Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking COMPLERA, your hepatitis may suddenly get worse. Do not stop taking COMPLERA without first talking to your healthcare provider, as they will need to monitor your health. COMPLERA is not approved for the treatment of HBV.

Who should not take COMPLERA? Do not take COMPLERA if you have ever taken other anti-HIV medicines. COMPLERA may change the effect of other medicines and may cause serious side effects. Your healthcare provider may change your other medicines or change their doses. Do not take COMPLERA if you also take these medicines: t anti-seizure medicines: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Tileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek) t anti-tuberculosis medicines: rifabutin (Mycobutin), rifampin (Rifater, Rifamate, Rimactane, Rifadin) and rifapentine (Priftin) t proton pump inhibitors for stomach or intestinal problems: esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), dexlansoprazole (Dexilant), omeprazole (Prilosec), pantoprazole sodium (Protonix), rabeprazole (Aciphex) t more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate t St. John’s wort (Hypericum perforatum) If you are taking COMPLERA you should not take other HIV medicines or other medicines containing tenofovir (Viread, Truvada, Stribild or Atripla); other medicines containing emtricitabine or lamivudine (Emtriva, Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir, Atripla, Stribild or Truvada); rilpivirine (Edurant) or adefovir (Hepsera). In addition, tell your healthcare provider if you are taking the following medications because they may interfere with how COMPLERA works and may cause side effects: t certain antacid medicines containing aluminum, magnesium hydroxide, or calcium carbonate (examples: Rolaids, TUMS). These medicines must be taken at least 2 hours before or 4 hours after COMPLERA. t medicines to block stomach acid including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine HCL (Zantac). These medicines must be taken at least 12 hours before or 4 hours after COMPLERA. t any of these medicines: clarithromycin (Biaxin); erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Iloson), fluconazole (Difulcan), itraconazole (Sporanox), ketoconazole (Nizoral) methadone (Dolophine); posaconazole (Noxifil), telithromycin (Ketek) or voriconazole (Vfend). t medicines that are eliminated by the kidneys like acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex) and valganciclovir (Valcyte).

COMPLERA.

A complete HIV treatment in only 1 pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and have no more than 100,000 copies/mL of virus in their blood.

Ask your healthcare provider if itâ&#x20AC;&#x2122;s the one for you.

These are not all the medicines that may cause problems if you take COMPLERA. Tell your healthcare provider about all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take.

The most common side effects reported with COMPLERA are trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Some side effects also reported include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles) and pain.

Before taking COMPLERA, tell your healthcare provider if you: liver problems, including hepatitis B or C virus infection, or have abnormal liver tests t Have kidney problems t Have ever had a mental health problem t Have bone problems t Are pregnant or planning to become pregnant. It is not known if COMPLERA can harm your unborn child t Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their milk to the baby. Also, COMPLERA may pass through breast milk and could cause harm to the baby

This is not a complete list of side effects. Tell your healthcare provider or pharmacist if you notice any side effects while taking COMPLERA, and call your healthcare provider for medical advice about side effects.

t Have

COMPLERA can cause additional serious side effects: t New or worsening kidney problems, including kidney failure. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may need to do regular blood tests. t Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself. t Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may need to check your liver enzymes before and during treatment with COMPLERA. t Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones. t Changes in body fat can happen in people taking HIV medicine. t Changes in your immune system. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting COMPLERA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch or call 1-800-FDA-1088. Additional Information about taking COMPLERA: t Always take COMPLERA exactly as your healthcare provider tells you to take it. t Take COMPLERA with a meal. Taking COMPLERA with a meal is important to help

get the right amount of medicine in your body. (A protein drink does not replace a meal). Stay under the care of your healthcare provider during treatment with COMPLERA and see your healthcare provider regularly. Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

Learn more at www.COMPLERA.com

Patient Information

COMPLERA (kom-PLEH-rah) (emtricitabine, rilpivirine, tenofovir disoproxil fumarate) tablets ®

Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information including Patient Information. What is COMPLERA? t

COMPLERA is a prescription HIV (Human Immunodeficiency Virus) medicine that is used to treat HIV-1 in adults – who have never taken HIV medicines before, and – who have an amount of HIV in their blood (this is called ‘viral load’) that is no more than 100,000 copies/mL. Your healthcare provider will measure your viral load.

(HIV is the virus that causes AIDS (Acquired Immunodeficiency Syndrome)). t

COMPLERA contains 3 medicines – rilpivirine, emtricitabine, tenofovir disoproxil fumarate – combined in one tablet. It is a complete regimen to treat HIV-1 infection and should not be used with other HIV medicines.

It is not known if COMPLERA is safe and effective in children under the age of 18 years old.

COMPLERA does not cure HIV infection or AIDS. You must stay on continuous therapy to control HIV infection and decrease HIV-related illnesses.

Ask your healthcare provider if you have any questions about how to prevent passing HIV to other people. Do not share or re-use needles or other injection equipment, and do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal fluids or blood.

Who should not take COMPLERA? Do not take COMPLERA if: t your HIV infection has been previously treated with HIV medicines. t

you are taking any of the following medicines: – anti-seizure medicines: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) – anti-tuberculosis (anti-TB) medicines: rifabutin (Mycobutin); rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) – proton pump inhibitor (PPI) medicine for certain stomach or intestinal problems: esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); dexlansoprazole (Dexilant); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) – more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate – St. John’s wort (Hypericum perforatum)

If you take COMPLERA, you should not take: – Other medicines that contain tenofovir (Atripla, Stribild, Truvada, Viread)

What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects, including: t Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – have stomach pain with nausea (feeling sick to your stomach) or vomiting – feel cold, especially in your arms and legs

– Other medicines that contain emtricitabine or lamivudine (Combivir, Emtriva, Epivir or Eprivir-HBV, Epzicom, Trizivir, Atripla, Truvada, Stribild) – rilpivirine (Edurant) – adefovir (Hepsera) What should I tell my healthcare provider before taking COMPLERA? Before you take COMPLERA, tell your healthcare provider if you: t have or had liver problems, including hepatitis B or C virus infection, kidney problems, mental health problem or bone problems t

– feel dizzy or lightheaded Severe liver problems. Severe liver problems can happen in people who take COMPLERA. In some cases, these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis). Call your healthcare provider right away if you get any of the following symptoms of liver problems:

– your skin or the white part of your eyes turns yellow (jaundice) – dark “tea-colored” urine – light-colored bowel movements (stools)

are breast-feeding or plan to breast-feed. You should not breastfeed if you have HIV because of the risk of passing HIV to your baby. Do not breastfeed if you are taking COMPLERA. At least two of the medicines contained in COMPLERA can be passed to your baby in your breast milk. We do not know whether this could harm your baby. Talk to your healthcare provider about the best way to feed your baby.

– loss of appetite for several days or longer

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

– nausea

– stomach pain t

are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child. Pregnancy Registry. There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry.

– have a fast or irregular heartbeat t

Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider. – Do not let your COMPLERA run out. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone. – Do not stop taking COMPLERA without first talking to your healthcare provider. – If you stop taking COMPLERA, your healthcare provider will need to check your health often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA.

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

COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works, and may cause serious side effects. If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help control your HIV infection. The HIV virus in your body may become resistant to COMPLERA or other HIV medicines that are like it.

Especially tell your healthcare provider if you take: t an antacid medicine that contains aluminum, magnesium hydroxide, or calcium carbonate. If you take an antacid during treatment with COMPLERA, take the antacid at least 2 hours before or at least 4 hours after you take COMPLERA. t

a medicine to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). If you take one of these medicines during treatment with COMPLERA, take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA. any of these medicines (if taken by mouth or injection): – clarithromycin (Biaxin) – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Iloson) – fluconazole (Diflucan)

trouble sleeping (insomnia)

abnormal dreams

headache

dizziness

diarrhea

nausea

rash

tiredness

depression

Additional common side effects include: t

– itraconazole (Sporanox)

vomiting

– ketoconazole (Nizoral)

stomach pain or discomfort

– methadone (Dolophine)

skin discoloration (small spots or freckles)

pain

– posaconazole (Noxafil) – telithromycin (Ketek) – voriconazole (Vfend) t

The most common side effects of COMPLERA include:

medicines that are eliminated by the kidney, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte)

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of COMPLERA. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 (1-800-332-1088).

What are the possible side effects of COMPLERA?

How should I take COMPLERA?

COMPLERA can cause serious side effects, including: t See “What is the most important information I should know about COMPLERA?”

Stay under the care of your healthcare provider during treatment with COMPLERA.

Take COMPLERA exactly as your healthcare provider tells you to take it.

Always take COMPLERA with a meal. Taking COMPLERA with a meal is important to help get the right amount of medicine in your body. A protein drink does not replace a meal.

Do not change your dose or stop taking COMPLERA without first talking with your healthcare provider. See your healthcare provider regularly while taking COMPLERA.

If you miss a dose of COMPLERA within 12 hours of the time you usually take it, take your dose of COMPLERA with a meal as soon as possible. Then, take your next dose of COMPLERA at the regularly scheduled time. If you miss a dose of COMPLERA by more than 12 hours of the time you usually take it, wait and then take the next dose of COMPLERA at the regularly scheduled time.

Do not take more than your prescribed dose to make up for a missed dose.

New or worse kidney problems, including kidney failure, can happen in some people who take COMPLERA. Your healthcare provider should do blood tests to check your kidneys before starting treatment with COMPLERA. If you have had kidney problems in the past or need to take another medicine that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA. Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: – feeling sad or hopeless – feeling anxious or restless – have thoughts of hurting yourself (suicide) or have tried to hurt yourself

Change in liver enzymes. People with a history of hepatitis B or C virus infection or who have certain liver enzyme changes may have an increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease. Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA.

Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones.

Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known.

Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting your HIV medicine.

This Brief Summary summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals, or call 1-800-445-3235 or go to www.COMPLERA.com Issued: January 2013

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, and VIREAD are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. ©2013 Gilead Sciences, Inc. All rights reserved. CON15582 02/13

Ne w s You Ca n Use

The latest health breakthroughs include findings on diarrhea, vitamin D, and staph infections. — Christopher Rudolph ✚ Revolutionary Road Research on a rectal microbicide (ointment people could use during anal sex to prevent HIV transmission) gets a boost with a new educational video encouraging people with HIV to participate in clinical trials for the microbicide. The video, The Rectal Revolution Is Here, urges those living with HIV to be part of a trial testing a reduced-glycerin formulation of tenofovir gel.

✚ Viva Vitamin D A recent study in Medicine & Science in Sports & Exercise indicates that stronger muscles may be linked to higher levels of vitamin D. The study finds that vitamin D may be an effective measure against weakening muscles in older adults, helping prevent falls and injuries.

✚ Bathroom Break The Food and Drug Administration has approved Fulyzaq, the first medication for symptomatic relief of noninfectious diarrhea in people with HIV/AIDS who are on antiretroviral treatment. Fulyzaq, from Salix Pharmaceuticals, is the first botanical oral drug derived from plant materials. It’s expected to greatly improve the quality of life for HIVers because diarrhea remains a common side effect of anti-HIV drugs and often leads people to stop taking their medications.

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✚ Stopping Staph Antibiotic-resistant staph infections cause hundreds of thousands of hospital admissions every year, but the HIV medication Selzentry (generic name maraviroc) was recently found to fight such infections. Selzentry thwarts the ability of the staph toxin to attack the immune system, the same way it helps battle HIV.

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✚ History of Violence Melanne Verveer, the U.S. ambassador at large for global women’s issues, has announced $3 million in small grants to various grassroots organizations to combat gender-based violence around the globe. The announcement coincided with the International Day for the Elimination of Violence Against Women and World AIDS Day. Gender-based violence increases women’s risk of HIV infection, and the grants will assist efforts to reduce and prevent such violence.

✚ Up With Updates NeedyMeds, a nonprofit organization that offers information on programs that help with the cost of medications and health care, has begun a new service, the Patient Assistance Program Update Service. The program will provide patients with daily and weekly email updates pertaining to their health care, important since NeedyMeds records 10 to 50 changes to pharmaceutical patient assistance programs every day.

WOME N & HIV

WOMEN HIV I istockphoto

t wasn’t that long ago that many people believed HIV was a man’s disease. Even though public awareness of HIV’s universal reach is increasing, women are still contracting it at alarming rates. There’s good news, though, and not just in terms of lower infection numbers—science, medicine, and the government are making life better for women living with HIV. Read how on the following pages. m a r c h /a p r i l 2 0 1 3

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Is the Worst Behind Us?

HIV infections finally drop significantly among African-American women, but this is no time to stop fighting

ivil rights leaders, health care workers, and all those who battle against HIV and its dispropor tionate effect on people of color got a welcome surprise in December. In a lengthy report released at the end of 2012, the Centers for Disease Control and Prevention announced the first-ever decline in new HIV infections among African-American women. The number dropped 21%, from 7,700 to 6,100, between 2008 and 2010. It appears that African-American women have finally turned a corner with HIV, though 20

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at the moment it’s unclear if these numbers are anomalous or if targeted initiatives have finally taken root. The CDC itself focused in on this group of people last year with its “Take Charge. Take the Test” campaign, which advocated HIV awareness and testing in 10 cities where black women are particularly at risk. Leisha McKinley-Beach, director of stakeholder engagement at the Black AIDS Institute, believes the reduction is partly thanks to the federal government’s emphasis on black women (she has much praise for the CDC’s pro-condom Sista program) as well as an unwavering commitment to AfricanAmerican women from groups such as hers. “We have an African-American HIV university where we’ve trained people, including women, across the country to go back to their

communities and educate them about HIV,” McKinley-Beach says of the Black AIDS Institute’s initiatives. “So they train their neighbors and also build networks. There’s also been wonderful social media campaigns like Greater Than AIDS, which we partnered with the Kaiser Family Foundation on.” Teaming up pays dividends by helping campaigns reach a greater number of people, McKinley-Beach says. She points to the successful partnerships of the CDC’s current Act Against AIDS campaign, which utilizes TV and radio public service announcements, print and online advertisements, doctor participation, and nonprofit and private-sector organizations to reach the public about prevention and testing. The federal agency had 19 partner groups to help blast its message, including the Black Women’s Health Impera-

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By NEAL BROVERMAN

“I know we have a long way to go, but for now it’s nice to celebrate that our strategies are working for one of the hardest-hit populations with HIV.”

tive, the National Council of Negro Women, and the NAACP. Innovative thinking by other groups could also be behind the reduction, McKinley-Beach says. Officials in Florida, which in the past few years made it a priority to test and educate black women, sought assistance from an African-American–focused women’s motorcycle club. “When we think of HIV, that’s not a group we automatically think of,” McKinleyBeach says. Florida officials would have club participants take a pledge to get tested and educate other women about HIV, and then take another black woman to get tested. It was a success. “With all these interventions, I’m not surprised to finally see some progress,”

McKinley-Beach says, adding she hopes such initiatives serve as models for other groups greatly affected by HIV, like young gay and bisexual black men. “I know we have a long way to go, but for now it’s nice to celebrate that our strategies are working for one of the hardest-hit populations with HIV.” LaVera Anom is determined not to rest on any laurels. The HIV-positive mom is a graduate student in marriage and family studies and also a peer educator for AIDS Project Los Angeles. She speaks to everyone from high school students to mothers just like herself about healthy relationships, condom negotiation, coping mechanisms for living with HIV, and the importance of knowing your status. “I can’t tell you how many times when I’m open about my status and mention it in my graduate studies, women are shocked and say, ‘How did you get it? You’re educated and you’re this and you’re that.’ You can be as educated as you want to be, but it means nothing if you’re not educated about HIV,” Anom says. “I think there’s a growing awareness [among black women about HIV], but there still needs to be more.” To underscore Anom’s point, though the rate of new HIV infections among black women has dropped, it remains 20 times that of white women, the CDC reported. Anom believes the most effective messages for black women are those delivered by black women. “That’s another reason I’m so open about my status now,” she says. “I realize I have to be that face. I have to talk about it if I want to see a change and make a difference.” Anom views the CDC’s report with cautious optimism, knowing that good news can translate to a decrease in urgency. “Unfortunately, when we see things start to go well, we back off and it becomes a problem again,” she says. “[HIV discussion] needs to be a part of culture, part of daily life, part of our part of our education system on a longterm basis.” ✜

FEMALE TROUBLES While many HIV-prevention efforts rightly focus on black women and gay men, where does that leave other women in high-risk populations?

According to the Centers for Disease Control and Prevention, women make up nearly a quarter of the U.S. HIV-positive population. In 2009, the most recent year on record, women accounted for 23% of new HIV infections. Overall, one in every 139 women will be diagnosed with HIV in their lifetime. Although women are generally at a lower risk for HIV infection than men, HIV affects women of color at a disproportionate rate. Black women are at the greatest risk—they have 20 times the rate of new HIV infections that white women have. One in every 32 black women will contract HIV in their lifetime. According to data from the CDC, the situation is not as dire for all women of color:

☞ 1 in every 106 Latina women will be infected with HIV. ☞ 1 in every 182 Native Hawaiian or Pacific Islander women will be diagnosed HIVpositive. ☞ 1 in every 217 Native American or Native Alaskan women will be infected with HIV. Between 2000 and 2007, HIV was among the top 10 causes of death for black women aged 10-54 and for Latina women aged 15-54. Who has the least risk? AsianAmerican and white women; in those groups combined, just one in every 526 women will be diagnosed HIV-positive.

Invisible Women Why do transgender women have some of the highest HIV rates in the country?

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By Sunnivie Brydum

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transgender women are the fastest-growing population of HIV-positive people in the country, according to Miss Major, a 70-year-old transgender woman of color and the executive director of TGI Justice Project, a San Francisco– based advocacy organization that fights for the rights of transgender, intersex, and gender-variant people who are in prison or have served jail time. Most experts agree with Major’s assertion, but hard data backing up that reality is hard to come by since HIV data collection methods often either mistakenly categorize transgender women as men who have sex with men, or don’t distinguish between transgender and nontransgender women. This kind of systematic mislabeling and ignorance is a grim reality for many trans women, says Major. Medical professionals, police officers, and even gay and lesbian communities “go out of their way to crush us so that we feel ignored and rejected, and that our wishes and desires don’t count,” Major says. “There is no care for who we are and what we do.” The data validates Major’s concerns. A 2009 report from the National Institutes of Health found that nearly a third of transgender Americans are

HIV-positive. The study also indicated that many transgender women may not know their HIV status, due to a series of cultural, social, and economic barriers. Transgender women of color are at an even greater risk for HIV infection than their white peers. The NIH study noted that African-American and Latina transgender women had the highest infection rates; among those transgender women of color surveyed, more than 56% of black trans women were HIV-positive, and Latina trans women had an HIV infection rate of 16%. Transgender women often require regular hormone therapy, and many of those who can afford the out-of-pocket expense undergo various forms of gender-reassignment surgery. But with multiple medications necessary already (such as estrogen, which must be taken weekly), HIV-positive trans women are less likely to regularly use antiretroviral medication than are their nontransgender peers. The NIH study, which focused on a clinic in New York City, reported that transgender women were often concerned that HIV medication would interfere with their hormone therapy. One woman told NIH researchers that many

of her fellow HIV-positive trans women prioritized hormone therapy over HIV medication: “They feel that the HIV meds would mess with the hormones, and by them being transgender, they want the hormones to work OK.” A great deal of the medication and treatment these women need is not covered by insurance, and is often costly and difficult to obtain. To make matters worse, antidiscrimination laws rarely cover transgender women. “In the majority of the states in the U.S., it’s legal to discriminate on the basis of gender identity,” says JoAnne Keatley, director of the Center of Excellence for Transgender Health at the University of California, San Francisco. “You can deny a person employment or you can terminate someone who is transitioning on the job merely because they are transgender.” That kind of discrimination has a devastating effect on the economic well-being of transgender people. According to a 2011 report from the National Center for Transgender Equality, transgender people were four times more likely than the general population to live in extreme poverty, with a household income less than $10,000 a year, and more than twice as likely as the general population to be homeless. A staggering 90% of the 6,450 transgender people surveyed nationwide reported being the target of harassment, mistreatment, or discrimination at work. This complex web of intertwining oppression and discrimination leaves many transgender women with no option to support themselves but to turn to underground employment—most frequently by engaging in sex work. “We have to scrounge for housing, and it puts us in the street at night to cover what we need to cover during the day,” explains Major. “It’s kind of like a merry-go-round that we’re

56%

of black trans women queried in one study were found to be HIV-POSITIVE

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“Trans women are disproportionately profiled and targeted by law enforcement for harassment and arrest…because of policies like [using] condoms as evidence, trans women often face a choice between protecting themselves and their partners from HIV and risking arrest.” on, and it’s difficult to stay [HIV-] negative.” Cyd Nova, the harm reduction coordinator at San Francisco’s St. James Infirmary, a clinic for current and former sex workers, agrees that trans women are often forced to turn to sex work to support themselves. “Sex work is a form of labor available to people who may not have many other options,” says Nova. “Sex work is also a means of empowerment for a community that often has high financial needs.” But the effort to meet those needs runs into problems with the criminalization of sex work, which hits transgender women particularly hard. Police officers sometimes target trans women, and in several major U.S. cities, use the presence of multiple unused condoms as evidence of prostitution. “Trans women are disproportionately

profiled and targeted by law enforcement for harassment and arrest,” says Nova. “And because of policies like [using] condoms as evidence, trans women often face a choice between protecting themselves and their partners from HIV and risking arrest.” Incarceration also plays a role in the high HIV rates. When a trans woman is arrested and jailed for prostitution—or any other crime—many prisons will house her with male inmates. Other jails keep trans prisoners in solitary confinement, often only releasing the inmate from her cell for an hour or so each day, presumably for her protection. “Once a trans person becomes part of that cycle of criminal injustice, it’s hard to break out of that,” says Keatley. While sex workers in general are more likely to be HIV-positive than those who do not engage in sex work, transgender female sex workers are at four times greater risk for contracting HIV than other female sex workers, according to an international analysis published in 2008 in the Journal of Acquired Immune Deficiency Syndromes. Further complicating efforts to combat HIV among transgender people is that population’s basic lack of access to medical care. The 2009 NIH study examined one community-based health clinic in New York City and identified a number of reasons that transgender women aren’t seeking preventive health care, including limited access to low-cost care and safe, trans-inclusive medical environments, along with the incompetence of many doctors about basic transgender health care, which results in trans women feeling unsafe to disclose their HIV status. The combination of social stigma, insti-

JoAnne Keatley, director of the Center of Excellence for Transgender Health at the University of California, San Francisco

tutional discrimination, economic hardship, and distrust of medical professionals creates a major barrier to connecting transgender women with HIV-related care. “Not much HIV-prevention messaging is aimed toward or accessible to trans people,” says Nova. Noting that most HIV-prevention programming is for gay and bisexual men, Nova argues that current prevention efforts don’t meet the needs of HIV-positive trans women. When this reality is layered with the medical profession’s lack of understanding around transgender health care, the result is an identity that is stigmatized and often treated as psychiatric illness. Given that, Nova says, “it is no wonder that trans people are hesitant to come into contact with HIV care, which in turn multiplies the risk of transmission.” ✜

Connect the Dots

Matching transgender women with the care they need

COURTESY SUBJEC T

ransgender women of color form one of the most at-risk but least served groups when it comes to HIV, but a new federally funded initiative aims to do something about the situation. The Health Resources and Services Administration, part of the U.S. Department of Health and Human Services, points out that not only are women in this category at high risk of contracting HIV, many are already HIV-positive and either don’t know it

or are not receiving treatment for it. Transgender women often don’t seek health care or drop out of care, as they fear discrimination or have already experienced it. Also, some health care providers lack the knowledge and sensitivity needed to deal with these women. The new initiative, called Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color, seeks to encourage testing and treatment and to connect these women with

appropriate care. HRSA has made five-year grants, beginning last year and extending through 2016, to organizations in several cities for the project; the organizations will design, implement, and evaluate programs to bring transgender women of color into ongoing HIV care. “This has been a desperately needed initiative,” says Stan Sloan, chief executive officer of Chicago House, whose TransLife Project is one of the grantees. “It’s very exciting, and it’s very much needed.”

Other grantees are another Chicago organization, Howard Brown Health Center; Bienestar, Los Angeles; the city and county of San Francisco; Community Healthcare Network, New York City; Friends Research Institute, Baltimore; the Public Health Institute, Oakland, Calif.; Research Foundation of the State University of New York, Albany; Tri-City Health Center, Fremont, Calif.; and the University of California, San Francisco. —Trudy Ring m a r c h /A P R I L 2 0 1 3 •

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Lack of stable housing is a problem for many single moms, but groups around the nation are offering HIVaffected families a home

By Trudy Ring

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Hiers. Her organization also administers federally funded vouchers under the Housing Opportunities for People With AIDS law, allowing HIVers statewide to find housing on the open market. “We’ve always known that people have better health outcomes when they have safe, affordable housing,” says Hiers. That knowledge was initially based strictly on informal observation, but once researchers undertook some scientific studies, they generated enough evidence to fill an entire issue of the journal AIDS and Behavior, she says. AIDS Alabama’s experience has been similar to Chicago House’s in that most of its family households have consisted of a single mother with children. Women with families have a particular need for housing and other supportive services, says Hiers: “Nine times out of 10, they’re going to be putting those children ahead of their own health needs.” These organizations and other housing providers for people with HIV offer additional services to their residents, such as case management to coordinate their health care; transportation; and tutoring and recreational programs for children. “Prior to our families getting here, there’s so little hope for them,” Sloan says, but stable housing and related services help improve their quality of life. The goal of supportive housing providers is to allow residents to stabilize their health and finances to the point that they can move on to housing available on the general market. For some this process takes a few months, for others several years. Sloan sums it up this way: “People can stay,” he says, “as long as they need to build a whole life.” ✜

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There’s I No Place Like Home

t’s difficult enough being a mother with HIV or the mother of an HIV-positive child—or both. It’s even more difficult if you don’t have stable housing, a situation faced by many people with HIV. “If they don’t have any place to live, they’re not going to be adhering to their medications,” says Kathie Hiers, CEO of AIDS Alabama and president of the National AIDS Housing Coalition. To address the problem, AIDS Alabama and similar organizations around the nation are now providing housing to families in which at least one member is HIV-positive, but the demand still often exceeds the available space. And, more often or not, the families served tend to be headed by single moms. The threat of homelessness, or the reality, results from a variety of factors, including discrimination and lack of resources. Chicago House and Social Service Agency was founded in 1985, when it was common for people with HIV to be kicked out of their homes. Initially, it largely served individuals, but in 1992 it opened an apartment building dedicated to serving families, the first such facility in the Midwest. It added a second family building in 2009 and now also has scattered-site units for families, on the whole housing about 25 families at any given time, says CEO Stan Sloan. He estimates that Chicago House has provided homes to 300 families since 1992, and in most of them the mother has been the only parent in the household. The story is similar at AIDS Alabama, which got into the housing business in the early 1990s, serving individuals, then recognized the need to expand its mission. In 1993 the group built its first family complex, which was also the first in the South, says

Women’s Work

(Left) The South Side Help Center’s Vanessa (left) and Betty Smith; children served by the Chicago organization

A second generation of Smith women is helping Chicago’s South Side Help Center care for African-Americans with HIV By Trudy Ring

courtesy subjec t

ack in 1987, the public perception was that AIDS was a disease of white gay men. But Betty Smith, who was working as a respiratory technician in a Chicago hospital, knew that wasn’t accurate. She had seen the inroads the disease had made among African-Americans but had also witnessed heartbreaking hostility to those suffering from it. In one instance, she encountered a minister wouldn’t enter the hospital room where one of his congregants lay dying of AIDS complications. “She knew that was something she would not want the religious community to do,” says Vanessa Smith, Betty’s daughter and executive director of the South Side Help Center, the organization her mother founded in 1987 to address the AIDS crisis among Chicago’s African-Americans. Betty Smith, with help from her husband and daughters, set out to educate other African-Americans about

HIV and AIDS, including what the risks are and how to prevent the spread of the disease. “We were the only African-American organization in the 1980s to address HIV prevention,” says Vanessa Smith, and it is still one of the largest. Each year, it performs nearly 4,000 HIV tests and provides about 10,000 people with HIV prevention information. And it has about 300 HIVpositive clients in its case management program, which started in 1995. “We’ve reached at least a million people over our 25 years of service,” says Smith, who became executive director when her mother retired four years ago. The Help Center now has 29 full-time employees in three locations. A point of pride with the group is making sure its messages are culturally appropriate, whether the recipient is female or male, gay or straight. For example, Smith says, for many women, it’s not enough to

“A lot of people are still so closed-minded, But we’re making inroads, and that’s a success for us.” hear that condoms prevent HIV transmission when used by men, as some men are not willing to use them. So it’s important to emphasize that a female condom is available. Given that the Help Center was founded and is led by women, does that reflect women’s traditional role as nurturers? Well, women’s experience in this role helps, says Smith, but many men are terrific nurturers too. Of the staff as a whole, she says, “you have to have people who reflect the population which you’re serving,” whether that’s women, people recovering from substance abuse, or anything else. Also, adjusting to changes in the epidemic is crucial. “What we’ve seen is people are living longer,” Smith says, and that has created more demand for

case management, which involves coordinating all the medical care and other services, such as housing, that a client might need. “We used to have more HIV test counselors,” she says. “Now we have more medical case managers.” The group recently received funding to provide linkageto-care services, connecting people who are newly diagnosed or who have dropped out of care with the treatment they need. “Our ability to really adapt to the changing environment has been a success for us,” says Smith. As long as AIDS exists, there will undoubtedly be more need to adapt and challenges to be met. “A lot of people are still so closed-minded,” Smith says when asked about challenges. “But we’re making inroads, and that’s a success for us.” ✜ m a r c h /a p r i l 2 0 1 3

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WHAT TO EXPECT

BEFORE YOU’RE

EXPECTING There’s no reason you can’t bring home your own healthy bundle of joy by Michelle Garcia

With better medication and keener understanding of the virus, people with HIV who want to be parents are finding ways to make it happen safely. With proper care, you can reduce the risk of transmitting HIV to your baby to less than 2%. Here is a road map for moms (and dads) to-be.

how do you want to grow your family 9 If you’re a woman who wants to get pregnant, there are options for you. But remember, if you’re a man, woman, or couple

(even a same-sex couple) with HIV, adoption is always an option. Though agencies used to deny requests from HIVers, the Americans With Disabilities Act now prohibits adoption agencies from discriminating against couples or individuals with HIV or AIDS.

before you get pregnant: Find and consult with an obstetrician who specializes in HIV care and pre-conception counseling. General obstetricians may not have the knowledge to properly care for an HIV-positive person who is trying to conceive. Likewise, HIV specialists may not have much experience in gynecology or childbirth.

while in labor:

HIV-positive men may consider the option of sperm scrubbing. Since HIV occupies the seminal fluid and

not the sperm itself, the process essentially separates the sperm from the seminal fluid. The sperm is then deposited in the woman’s body during a peak period of fertility.

If a woman is on HAART, there is not much need for a cesarean birth. Once doctors discovered that HAART reduced the mother-to-child transmission rate by 70%, the need for cesarean births for HIV-positive mothers diminished.

An IV drip of AZT is administered to the woman as a way to pre-load the baby with the drug to prevent transmission during labor.

Women or couples may also opt to use a sperm donor, either through a sperm bank or by asking some-

after the birth:

one they know.

9 Breast-feeding

9 Couples in which both people have HIV may be tempted to get pregnant the old-fashioned way: through unprotected sex. However, these couples also share the risk of reinfection or superinfection (where you get a second strain of HIV), even if both members have a low or undetectable viral load. In either case, you may be reinfected with a more drug-resistant form of the virus.

is not recommended for HIV-positive women. If an HIV-positive woman does breast-feed, she puts her child at a 14% risk for transmission. Reliable formula, using clean water, is much better for your newborn.

After the baby is born, he or she will be tested several times to ensure there was no HIV transmission. An HIV pediatrician may also prescribe a medication plan to cut the infant’s risk of HIV infection by 50%.

A 2004 Spanish study found that serodiscordant couples (couples with one HIV-positive person) who had unprotected sex only during high-fertility days, were closely monitored by a doctor, and in which the positive partner took highly active antiretroviral treatment without fail and had consistently low viral loads were able to have a baby without transmitting HIV to the child. Talk to your obstetrician about what this means for you. 9

9 Don’t forget the issue of money. In addition to HIV treatment, pregnancy and delivery are expensive, but HIVers may be able to use Medicaid to help cover costs, depending on your state.

during pregnancy: Women should take extra folic acid supplements, in addition to any folic acid that may be in prenatal vitamin packs.

photos.com (2)

Avoid taking too much vitamin A. Though some doctors recommend high doses of vitamin A for HIVpositive women, it could actually cause birth complications if more than the standard 5,000 milligrams are taken per day.

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Electrifying T Youth By Christopher Rudolph

The State Department’s Office of U.S. Global AIDS Coordinator, along with the Eunice Kennedy Shriver National Institute of Child and Human Development, has just announced plans to award $7.5 million in grants over the next two years to help prevent mother-to-child transmission of HIV. The grants will fund, among other things, antiretroviral therapy for HIV-positive pregnant women, working toward the goal of erasing pediatric HIV infections by 2015. —Christopher Rudolph

PHOTOS.COM

A new effort is launched to get young people to pay attention to HIV

o help wake up teenagers and 20-somethings to the realities of HIV, April 10 will be the first National Youth HIV & AIDS Awareness Day. The day will highlight the epidemic’s impact on people between the ages of 13 and 24, as 26% of new HIV infections occur in this group, according to a recent report from the Centers for Disease Control and Prevention. On top of that, 60% of HIVpositive people in this age group don’t know they have the virus. Advocates for Youth, an organization that educates young people on how to make smart choices about sexual and reproductive health, is organizing the day. The plan came about when the Advocates for Youth team realized too many young people were not aware of HIV or how to prevent it, says Sarah Audelo, senior manager of domestic policy. “People are coming out younger and younger, and what happens when there is a lack of family acceptance?” Audelo asks. “Or when the sex-ed classes don’t cover HIV or anal sex or condom usage? We wanted to bring awareness to all of those things. People keep talking about an AIDS-free generation, but the only way we are going to achieve that goal is by reaching out to young people, and we hope this day will help people recognize that.” Advocates for Youth has assembled a team of youth ambassadors who will help with the events planned for National Youth HIV & AIDS Awareness Day. For more information and to get involved, visit AdvocatesForYouth.org. ✜

Adrian Steirn/The Global Fund via Ge t t y Images

SPOTLIGHT

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HEAR HER Between recording

albums, performing in musicals, and

raising three KIDS,

singer and Broadway star Deborah Cox reminds women that HIV hasn’t gone away By NEAL BrOVERMAN 32

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eborah Cox is in North Carolina. She’s been in

Durham for a few days and just bounced from California to Texas to Florida to New York to Raleigh, N.C., to D.C., back to Texas, then to Philadelphia, Rhode Island, and now Durham. The Grammy-nominated singer and theater actress is on tour with Jekyll & Hyde, playing a lady of the night in the dark musical, which begins a Broadway run in April. Before getting to New York, Cox needs to finish the show’s tour, which means trekking through Oklahoma, California, Iowa, and finally West Palm Beach, Fla., not far from her home in Miami. “Life on the road is drama,” Cox says. She’s tired but friendly and engaged. “The pace is really intense. We have to keep up an eight-show-a-week schedule, a Broadway schedule, while we’re traveling. There’s a day off, and the day off is a travel day and you try to get whatever you have to do outside of theater done. It’s very much a juggling act.” The stress of the tour is made harder by the fact that Cox has to go weeks without seeing her three kids: Isaiah, age 9; Sumayah, 6; and Kaila, 4. “Luckily, with technology I’m able to Skype and iChat and text and stay very present in their dayto-day,” she says. “I tend to worry a lot, but I have an amazing support system. My husband is amazing, my mother and mother-in-law help. We have a real family structure that helps tremendously.” Even though the Canadian-born Cox starred as Aida on Broadway, is a multiplatinum-selling recording artist with 11 number 1 hits on Billboard’s dance charts (including “Beautiful U R”), has won a Soul Train Award and a Lady of Soul Award, and has been nominated for Billboard and American Music awards, it’s easy to see an everyday, 30-something working mom dimension to Cox. That relatability may be why she was asked to be part of the Break the Silence campaign, which works to bring HIV back into the national conversation. “Did you know that a woman tests positive for HIV every 35 minutes in this country? It’s the leading cause of death for black women ages 25 to 34, and we make up for 66% of the new cases of HIV,” Cox says in the 2012 Break the Silence video. “I was shocked when I learned of this recently, because I thought for sure that with all the information that’s out there, for as long as we’ve been talking about this, that we would have been moving in a different direction. But instead women are at a greater risk. I’m Deborah Cox and I’m a mother and I was a friend to three beautiful souls who have

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“We have to get many, many types of women out there, so people can see a different range talking about AIDS” passed away from HIV.” Cox has chosen HIV awareness as her charitable mission, devoting her time to educating women about the disease. Aside from Break the Silence, Cox recently participated in public service announcements for Lifebeat, a music industry–affiliated nonprofit that educates people about HIV. “Get educated, get tested, and get involved,” Cox says in the promo. For the message of testing, safe sex, and drug adherence to stick, people need to relate to the messenger, Cox says. Many black women still see HIV as a white gay man’s disease, she believes, and that will only change if a more diverse group of people continue to speak out. “We have to get many, many types of women out there, so people can see a different range talking about AIDS,” Cox says. “Any time I have the opportunity to bring more awareness [to HIV] I’m there. I’ve been an advocate for a very long time for the fight. A lot of times I do things off the radar. It’s not important for me to get accolades.” Her first experience with AIDS was when a friend of hers, alone and scared, succumbed to the disease—and that experience cemented her commitment to the cause. Cox’s friend was gay, and she saw his family and friends, many of whom were religious, turn from him in his final moments. “A big part of it was that he was AfricanAmerican and in the closet and had just come out, not only about being gay but also about being HIV-positive,” she remembers. “There’s still a huge stigma in the AfricanAmerican community about being gay.

from left: ge t t y images; COURTESY Cbs; ge t t y images

From left: Deborah Cox performs as Lucy in the musical Jekyll & Hyde, now touring; Cox in character with Jekyll costar Constantine Maroulis; Cox sings in 2009 at the inaugural Cinema Against AIDS Toronto.

There are still a lot of people living in shame because they lose their family, they lose everyone who once supported them.” That loss causes physical as well as emotional damage, Cox says. “When people find out they’re alone, that contributes to the illness too,” she says. “When you don’t have that emotional support it’s a downward spiral. That’s what happened to my friend. I never want to see that again.” When asked whether churches should get involved in trying to change the conversation about both HIV and gay rights, Cox is not convinced that will be useful. “I would consider myself—if you need

to put a label on it—a very spiritual liberal Christian,” she says. “I find that a lot of faiths have way too much judgment and that stops people from coming out. It’s more hindering than supportive. For the churches to get involved—I really don’t think that’s the way to go.” Cox enjoys talking about her faith and how her belief in a higher power sustains her. “Honestly, if you don’t have anything higher than yourself in your life, it can be a very lonely place,” she says. “It’s very sad, and I don’t think that’s how God wants us to live. I’m just an advocate for love on every level.” Messages of positivity are found in much

of her music, maybe most notably in her uptempo 2008 single “Beautiful U R.” A hit on the Canadian pop charts and in U.S. dance clubs, the song stresses courage, self-love, and perseverance. Cox, who heads back into the studio in the spring and hopes to release new music this year, says she’s constantly reminded how “Beautiful U R” has helped people face down their challenges. “People post pictures on Instagram and talk about how they’re feeling today,” she says. “They listen to ‘Beautiful U R’ and it becomes their mantra. I really feel that this gift I have is to inspire and motivate people. I’m trying to do work that will change the world in some small way.” ✜

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COLUMNS

Wait Until Dark

Uncertain times give us an opportunity to remember our resiliency

ife is full of many twists and turns, some dreaded, others hoped for, and still others that seem to just fall out of the sky. For those of us who got hit with Hurricane Sandy last year, falling out of the sky has a special meaning. I live in New York City, lower Manhattan to be exact. If you were watching the news on October 29 and in the days and weeks that followed, you know that this area got slammed with what meteorologists call “the perfect storm.” I was sitting in my apartment alternating between trying to read a book and looking out the window at the howling wind and rain. My lights dimmed a few times but kept coming back on. And then it was dark. And it stayed that way. The next morning I sat on my couch, kind of half asleep. The storm wasn’t so strong, but my apartment was cold, and there was definitely not going to be any hot coffee. “This can’t last more than a few more hours,” I said to myself. “I’ll read my book and shiver until the power comes back.” And it did. Five days later. During the days that I was without electricity, I received a lot of email messages and texts from friends asking me if I had my

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• M A R C H /A P R I L 2 0 1 3

“power” back or if I was still “powerless.” Now, I guess this is what members of my profession tend to do, but I couldn’t help but think about the use of that word power. It’s a loaded word, right? Especially for someone like me, who is often talking to people who are feeling powerless for reasons that have nothing to do with electricity. Clients who are facing a situation that they can’t make go away. Like being diagnosed with HIV. The week before Hurricane Sandy socked us in, I met with two new clients who had recently been diagnosed. “I would like to make this go away, but I know I can’t,” one of my clients said. “I sat and cried for a while, and I kind of stayed alone for a couple of days. Then I decided I needed to start doing things to take care of myself. I got up and started moving.” Hurricane Sandy was a reminder of the lessons we have learned from the other perfect and not-so-perfect storms that we encounter: We don’t have control over everything that happens in life. We don’t always have the “power” to keep bad things from happening. We like to think we do, but life shows us otherwise. But I was also reminded of what it means to be resilient.

Resilience, as defined by mental health professionals, is the ability to recover or adjust to misfortune or change. To get up and start moving, as my client described it so well. My clients who are facing chronic conditions such as HIV often talk about how their diagnosis helped them to recognize their own resilience. They were able to move beyond feeling powerless. To tap into sources of strength. To be resourceful. And in ways they never thought possible. Being a resilient person starts with believing in your potential to face a challenge. If you’ve faced up to an HIV diagnosis, you know what I mean. Focusing not on your “powerlessness,” in whatever form that takes, but where you do have power, and taking action. For me, that started with getting up off the couch. The hurricane also reminded me that I can’t do it all on my own. I had to call friends and ask for help with the basics, like a place to take a shower and get on the Internet. I needed some human contact, especially during those long evenings in my cold, dark apartment. Optimism helped me get through the storm. I tried to focus on what was going right in my life. I found a new appreciation for the simple pleasures, like a cup of hot coffee and a few words of encouragement from someone whose life had also been turned upside down. It reminded me of how a stressful event can be an opportunity to see life in a new way. Life never stays the same, and refusing to accept uncertainty and change is setting up a battle that is not only unwinnable but also unnecessary. Accepting that life is about change helps you see more clearly what you do have control over and to take action. So, my lesson from Hurricane Sandy: Recognize your ability to solve problems. Get connected with your support network. Stay optimistic. Resilience is power. And the real power is in your hands. ✜

Gary McClain, Ph.D. is a counselor in New York City with a specialty in coping with chronic health conditions. His books include The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy.

Coming Out & Falling in Love

op p o si t e page: ge t t y im ages ; t his page: t hinks tock p hoto s

Maria Mejia is a Miamibased social media activist who blogs for TheBody, the Well Project, and Until There’s a Cure. A part of Gilead’s Advocate Network and a founder of English and Spanish international HIV support groups on Facebook, Mejia has many bilingual vlogs that can be found on YouTube.

For this Latina activist, finding love has been almost as good as a cure

nce you fall in love, you realize how beautiful being in love actually is, especially for anyone who is HIVpositive. It’s critical to have someone who loves you for you and can see past your illness. After years of thinking I would never marry, in part because I am HIV-positive, I found a loving and caring partner. The longer we were together, the more I realized she is a key element in my health, because when you are loved and cared for, your heart and soul fill up inside. You are happier and feel complete, all things that strengthen your immune system. This benefit comes not just from the love of your partner, wife, or husband. It actually comes from anyone who shows you love and cares for you, including friends and family members. Often people who are HIV-positive just don’t know how important it is for us to love and be loved. I’ve learned a lot from my relationship with my partner, Lisa. Almost all my adult life I have been with serodiscordant partners. I’ve only had one partner who was also positive, and that was actually my worst relationship. I learned early on that HIV status doesn’t tell you much about a person. What does is open communication. It has never been easy to disclose my positive status. My method for handling disclosure, which I recommend for anyone in a new relationship or on the dating market, is always to first get to know the person and feel them out before you come out about your status. If things are getting deep, spiritually and mentally deep, you

must disclose and give them the opportunity to choose the relationship. It is not an easy thing to do. I would get so scared. I would fear rejection by this person who I had connected with on so many levels, and I knew that they could tell me they couldn’t deal with the situation. Loving someone with HIV is loving someone with a communicable chronic medical condition that requires regular care, protection, and medication. While Lisa and I were dating, I realized, Wow, I found my soul mate after all these years. I feel so much for her, and now I have to tell her about me. I realized I had to tell her everything about my life, including my HIV, and risk the rejection I so feared. I said to myself, You are a strong woman. Tell her, but make her feel comfortable either way. I actually disclosed through our Internet chats. And, I have to be honest, I beat around the bush for an hour before I came out with it. “Lisa, I have something very serious to say about me before we move forward.” She wrote back, “Tell me! I don’t care what it is!” I answered, “Well, it is something very, very serious.” I just couldn’t say it, even though I kept urging myself to get it over with. Finally, I wrote, “I am HIVpositive.” After waiting for what seemed like an eternity, I clicked and hit “send,” and anxiously anticipated the response. There was a momentary pause. I worried I would throw up. Then, a blip on my computer screen: “OK. And?” she had written. “So,” I quickly wrote back, “That is my secret.”

She responded, “I don’t care. I already love you.” I was relieved but at the same time worried that I had put her on the spot. I wrote back, “You know, if you need time to think or just want to be friends, I am OK with that also.” She responded quickly: “No! I love you!” Those were the sweetest words to my ears. All my fears were gone. Finally, my soul mate knew everything about me, and it was such a wonderful moment. I felt so free. That was five years ago. Today, we are happily married, and Lisa has supported my work as an HIVpositive Latina activist. My work requires me to be out and visible and to educate people, and that exposes Lisa to stigma as well, as an HIV-negative person married to a positive person. But she doesn’t care what people think. She is supportive, compassionate, and loving, and I am blessed to be a part of her life. I have told her that if being cured of HIV meant having to leave her, I would choose living with her because that is my happiness, which is ultimately what we are all looking for. We all need to love and be loved, and when you’re HIV-positive, it’s good for your health. ✜

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YOU 2.0

Fitness

STEP, BeLL, CHANGE

Tighten your middle in three easy steps

he figure 8 is one of my favorite (and one of the most fun) movements for strengthening the core—the abdominal and lower back muscles. Building a strong core is foundational and essential to all athletic activity. To perform the movement: 1. Start in a squat position, lower back tucked in, holding a kettlebell out to one side. 2. Swing the kettlebell around the back of your leg and switch to the other hand as it passes between your knees. 3. Swing the bell around the back of the other leg, switching hands again as you pass between your knees.

This completes one rep. Perform three to four sets of 10–15 repetitions each. —Sam Page

Trainer to the stars Sam Page can be found at SamPageFitness.com or on his mobile fitness app, PocketSAM (Pocket-Sam.com).

We Also Recommend Kettlebells are all the rage, and the instructor who taught Hollywood’s hottest trainers has his own workout DVD. Paul Katami’s Ultimate Kettlebell Workout for Beginners ($17, AcaciaLifestyle.com) provides three 25-minute workouts. Snag Empower Fitness’s adjustable 3-in-1 Kettlebell ($42, Target.com), which can be used at five, eight, or 12 pounds.

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Photography by BRADFORD ROGNE

Health

How Will I Know? A drug or alcohol addiction isn’t always obvious. Here’s what to look for if you’re having suspicions about someone’s use, according to Komrad and Boyd.

Modern Family

ERIC PIERMONT/AFP/Getty Images

Cutting back on alcohol and quitting any illegal substances is a must for HIVers. But what if a loved one can’t do the same?

f the thought of confronting a loved one’s alcohol or drug use conjures up images of the A&E reality show Intervention, with its tears, fights, and relapses, take a breath. Talking to a friend, spouse, or family member about their substance abuse is never easy, but it doesn’t have to be as dramatic and scary as it’s usually depicted on TV. “The first thing you should do if you suspect that someone is abusing drugs is open a dialogue with them, presenting them with the facts of what you’ve observed and trying to withhold judgment,” says Wesley Boyd, an assistant clinical professor of psychiatry at Harvard Medical School and the author of Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem? “This reduces the likelihood of pushback and denial.” Mark Komrad, a psychiatrist at Johns Hopkins University and the author of You Need Help! A Step-byStep Plan to Convince a Loved One to Get Counseling, also stresses a light touch when addressing the problem. The key is to make the problem about you and your worries, so you don’t reprimand and heap accusations on your loved one. “Talk about your concerns,” Komrad says. “Frame your approach by discussing your feelings, worries, and concerns in the face of the specific behavioral or emotional prob-

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Altered sleep patterns

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Trouble waking in the morning

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Daytime sleepiness

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Increased irritability or moodiness

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Missed workdays

lems you are observing and how they ✚ Clumsiness are affecting you. This is far easier for the other person to hear than scold✚ Unexplained weight loss or gain ings. So keep the focus on your own distress and concern.” ✚ Other physical complaints, without It’s OK to suggest, rather than clear explanations demand, that your loved one make an appointment with a mental ✚ Money that’s spent without an health professional “just to see” if there really is a problem with drugs explanation or alcohol, Komrad says. If he or ✚ Disheveled appearance she doesn’t take you up on the offer, don’t give up; just continue to gently ✚ Deterioration of personal hygiene suggest this as an option. ✚ Slurred speech Both Boyd and Komrad recommend immediately seeking out your local Al-Anon F ind a gr group for help. n e ar y oup A l-A n ou at o n Fa “Al-Anon, an intermily Gr ou or Na p s .o national group with lots r -A n rg on.o rg . of meetings in many cities, is specifically for individuals who have a loved one abusing [alcohol],” Boyd says. “Al-Anon offers support to such people and sage advice about what to do and not do.” The group was founded in 1951 by the wife of an alcoholic who realized it wasn’t just the addict who needed support and treatment; spouses and children do as well. It’s given rise to a network of groups, including Nar-Anon, for families of drug addicts. Other people you could turn to, says Boyd, might include a primary care physician, a therapist knowledgeable about drug abuse, or a clergy member. —Neal Broverman m a r c h /a p r i l 2 0 1 3 •

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ask & t e l l

Pump Up the Volume

aroline d’amore made her debut as an L.A. “It” girl years ago, appearing on the scene with her famous pals Paris Hilton and Kim Kardashian. Eventually the model and actress made her debut as a DJ in West Hollywood’s dance clubs, leading to a residency at the Hard Rock Hotel, Las Vegas, and her single “Kill the Clock.” Now D’Amore is concentrating on her Billboard.com Web series, DJ Diaries, where she tags along with big-name DJs like Steve Aoki. D’Amore spoke to us about her mother’s AIDS-related death and her thoughts on Hilton’s recent remarks about gay men and HIV. —Savas Abadsidis and Alexander Hatzidakis

You used to run with a high-profile crowd, including Paris Hilton. How did you guys know each other? I started DJ-ing about eight years ago. I used to hang in the booth with DJ AM and he really inspired me. I loved watching how happy he was while making other people so happy. He really was my inspiration and motivation. He was the one that told me I could do it. Paris hired me to DJ all of her record release parties around the world. This was before it was “cool” to be a chick DJ. We actually had a lot of fun. How do you feel about the remarks she made a while back about gay men having AIDS? I was shocked and did not believe it. She’s always known how my mother passed and always had many gay friends. When I heard the recording, I was very disappointed. I know she didn’t mean what she said and was just joking with some gay friends. However, it’s time to grow up and always think about what you say and how it can affect others. I’m always the first to snap at someone who makes a negative remark about anyone because of how they were born.

stephen garne t t

What was it like growing up in Los Angeles? Growing up in L.A., for me, was a lot different than you’d think. I was the daughter of a hardworking pizza man who ended up kicking it with the rich kids. I lived in Malibu because we opened a D’Amore’s Pizza there. I’d make just enough money delivering pizzas so I could pay for gas and valet at the hottest clubs. I worked to party. I must have been

fired from D’Amore’s 100 times. But being the owner’s daughter had perks. And, of course, free pizza for life, so I never starved. Your mother died of AIDS when you were very young. How did that affect your life? I was raised by my pops. It made me super strong, maybe too strong at times. I was the only kid who didn’t cry for their mommy at sleepovers. Which turned into not really needing anyone. Which made it hard to date me. I’m so lucky I met someone who could handle me. My husband [rocker Bobby Alt] changed me for the better, but he loves me for the tough bitch I am. If he’s not happy, even for a moment, I will totally cry. My mother contracted the AIDS virus when I was very young. [Doctors] gave her a precautionary blood transfusion and did not check the blood they gave her. It was a total fluke. I was lied to for 15 years about it. I always thought she died from toxic shock. I was very angry that my father lied to me, but I now understand that he did not want the stigma of the disease to affect my friendships at school. As we all know, kids can be mean. The stigma of this disease has always been something I’d like to help remove. Anyone at any time can contract this disease—gay, straight, a mom of four with no drug history. Everyone needs to educate themselves on how to be protected and also about how to discuss this disease without adding to the stigma. It shaped my outlook on life by reminding me that life is so precious and can be very short. You have a significant fan base in the LGBT community. What does that stem from? My sister and best friend, Christie, came out at age 15—to only me. I always had to stick up for her within the family and outside of it, so I’ve always had an open heart from a very young age. My first club experience ever was Ultra Suede and I totally fell in love with the culture and scene. One of my first gigs as a singer was at Cherry Pop, and my sisters and I do the AIDS Walk every year in honor of my mother, under the name Team Bonnie Major. These walks are always eye-openers because even in West Hollywood there are people spreading hate on the sidelines. I literally have to stop myself from kicking some ass when I see these hate-filled people with demeaning signs. ✜

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