Supplement to Real Health magazine
Becoming an Advocate Urging action by people living with HIV
Michelle Lopez
IMPORTANT FACTS FOR BIKTARVY®
(bik-TAR-vee)
This is only a brief summary of important information about BIKTARVY and does not replace talking to your healthcare provider about your condition and your treatment.
MOST IMPORTANT INFORMATION ABOUT BIKTARVY
POSSIBLE SIDE EFFECTS OF BIKTARVY
BIKTARVY may cause serious side effects, including:
BIKTARVY may cause serious side effects, including: ` Those in the “Most Important Information About BIKTARVY” section. ` Changes in your immune system. Your immune system may get stronger and begin to fight infections that may have been hidden in your body. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY. ` Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY. ` Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. ` Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. ` The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).
` Worsening of hepatitis B (HBV) infection. Your
healthcare provider will test you for HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to check your health regularly for several months, and may give you HBV medicine.
ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults and children who weigh at least 55 pounds. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS. Do NOT take BIKTARVY if you also take a medicine that contains: ` dofetilide ` rifampin ` any other medicines to treat HIV-1
BEFORE TAKING BIKTARVY Tell your healthcare provider if you: ` Have or have had any kidney or liver problems,
including hepatitis infection. ` Have any other health problems. ` Are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY. ` Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.
These are not all the possible side effects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088. Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.
HOW TO TAKE BIKTARVY
Tell your healthcare provider about all the medicines you take:
Take BIKTARVY 1 time each day with or without food.
` Keep a list that includes all prescription and over-the-
GET MORE INFORMATION
counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. ` BIKTARVY and other medicines may affect each other.
Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.
` This is only a brief summary of important information
about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more. ` Go to BIKTARVY.com or call 1-800-GILEAD-5 ` If you need help paying for your medicine,
visit BIKTARVY.com for program information.
BIKTARVY, the BIKTARVY Logo, GILEAD, the GILEAD Logo, GSI, and KEEP ASPIRING are trademarks of Gilead Sciences, Inc., or its related companies. Version date: February 2021 © 2022 Gilead Sciences, Inc. All rights reserved. US-BVYC-0008 01/22
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#1 PRESCRIBED
HIV TREATMENT * *Source: IQVIA NPA Weekly, 04/19/2019 through 05/28/2021.
DIMITRI LIVING WITH HIV SINCE 2018 REAL BIKTARVY PATIENT
KEEP ASPIRING.
Because HIV doesn’t change who you are. BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.
Ask your healthcare provider if BIKTARVY is right for you. ONE SMALL PILL, ONCE A DAY Pill shown not actual size (15 mm x 8 mm) | Featured patient compensated by Gilead.
Please see Important Facts about BIKTARVY, including important warnings, on the previous page and visit BIKTARVY.com.
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Scan to see Dimitri’s story.
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CONTENTS
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3 BUZZ
8 BASICS
Preventing HIV on Black campuses; R.I.P. Stephaun Elite Wallace; untold stories on the National Mall; U=U National Task Force launches
Shingles
9 NUTRITION Black bean breakfast burrito
6 CARE & TREATMENT 10 FEATURES HIV cases decline, but disparities remain; people with HIV can have a near-normal life expectancy
Advocates Michelle Lopez and Joyce McDonald share their stories of living long term with HIV.
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COVER AND THIS PAGE: (LOPEZ) BILL WADMAN; (COUPLE AND MEDITATION) ISTOCK; (FOOD) SHUTTERSTOCK.COM/RUTH KAY
Digital Real Health
10
Michelle Lopez
BUZZ
R.I.P. Stephaun Elite Wallace The late epidemiologist founded the House of Marc Jacobs.
PrEP Peer Educators Help Prevent HIV on Black Campuses
(EDUCATORS) COURTESY OF HUMAN RIGHTS CAMPAIGN FOUNDATION; (WALLACE) COURTESY OF STEPHAUN ELITE WALLACE, PHD
Meet the Human Rights Campaign’s new class of students at historically Black colleges and universities trained in HIV prevention, education, stigma and more. AS STUDENTS RETURNED TO HISTORICALLY BLACK COLLEGES AND universities (HBCUs) this fall, many learned about HIV prevention thanks to a group of 12 student PrEP ambassadors trained by the Human Rights Campaign Foundation (HRCF), the educational arm of the LGBTQ advocacy group the Human Rights Campaign. PrEP, or pre-exposure prophylaxis, refers to daily pills and long-acting injectables taken by people at risk of contracting HIV. For the 2023–2024 school year, the 12 students will serve as PrEP Peer Educators and work to eliminate HIV- and AIDS-related stigma on HBCU campuses by educating fellow students about PrEP and HIV testing and treatment, according to an HRCF news release. “We are thrilled to welcome this dynamic cohort of HBCU students and take great pride in the work they’re doing to continue spreading the message of HIV awareness on the respective campuses,” Leslie Hall, director of HRCF’s HBCU Program, said in the news release. “As a Black gay man and HBCU alumnus, I’m aware of the hurdles college-aged youth face when it comes to knowing their status Stephaun and taking the appropriate measures to maintain their optimal health.” Elite Wallace About 13% of the 1.2 million people living with HIV in the United States are unaware of their status. Of all new HIV diagnoses in 2019, Black and Latino individuals accounted for 42% and 22%, respectively. What’s more, one out of every five new HIV cases are seen in young people ages 13 to 24. Yet 44% of those individuals do not know their status. Although HIV impacts young people—especially those in minority populations—at an alarming rate, over half of HBCUs lack formal HIV prevention policies. The ambassador program fosters safe environments throughout the country to educate college students about the realities of the HIV epidemic and necessary preventive care. “The creation of this ambassadorship program serves as an outlet for those who may be unfamiliar with the nuances surrounding HIV but want to take measures to ensure their community is educated on this impactful topic,” Hall added. Currently, health insurers must cover PrEP to prevent HIV, though a conservative Texas Court case may end that mandate. —Laura Schmidt
Stephaun Elite Wallace, PhD, an epidemiologist and social justice and HIV advocate who was also a legend of the house ballroom scene, died August 5, 2023. He was 45. A cause of death was not disclosed. The director of external relations for Fred Hutchinson Cancer Center’s HIV Vaccine Trials Network (HVTN) in Seattle, Wallace was also a staff scientist at Fred Hutch, a clinical assistant professor at the University of Washington and an affiliate professor at Yale, according to a statement from HVTN. Colleagues and friends noted his passing, posting condolences and remembrances on social media. During the COVID-19 pandemic, Wallace worked to address health disparities, promote vaccinations and improve health and science understanding in the Black community. His efforts, including those with the COVID-19 Prevention Network, earned him praise from Bill Gates, who interviewed Wallace for the book How to Prevent the Next Pandemic. “For many people, science is still very much a mystery; it still feels like there’s a veil over this process,” Wallace says in the video “Bill Gates’s Heroes in the Field: Dr. Stephaun Wallace.” “Part of my role is to take this veil off.... Often, I encounter myths and misinformation about COVID-19. The distrust in science and medicine is rooted in day-to-day-experience with systems that routinely show them that their lives don’t matter. Everyday experiences of racism and xenophobia contribute to people’s hesitancy and skepticism.” Wallace grew up in Los Angeles in the ’80s and ’90s and is revered as a legendary father in the ballroom community, notes a memorial to him on InCloudForever.com. He was preceded in death by his parents, according to the site, and he “leaves behind a brother, Jeremiah, a sister, Krystal, and a large and extended chosen family with children from many houses, including The House of Elite, which he reopened in 2004, The House of Blahnik, and The House of Marc Jacobs that he founded in 2021.” —Trent Straube
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BUZZ
Untold Stories on the National Mall Ashon T. Crawley’s Homegoing honored Black queer church musicians lost to AIDS. of the AIDS crisis, past and present, by channeling Black queer music as a spiritual practice. The artist achieves this, as he notes, ‘by staging an audiovisual memorial to queer musicians, choir directors and songs from Black church contexts. [These people were] often closeted, the fullness of their stories still untold.’ Crawley’s composition consists of three movements— Procession, Sanctuary and Benediction—performed in an open-air shrine. With sightlines to the Washington Monument and the Smithsonian National Museum of African American History and Culture, Homegoing Above: a rendering of Homegoing on the is situated in accordance with National Mall; inset: Ashon T. Crawley the National Mall’s legacy of important sites of mourning and resistance, including the first Chung, vanessa german, display of the AIDS Memorial Quilt in 1987 Paul Ramírez Jonasa and and the ACT UP protests of the late 1980s Wendy Red Star. Their works explored and early 1990s.” immigration, desegregation, Native The other artists who exhibited their work American treaties that have been ignored on the Mall were Derrick Adams, Tiffany or abrogated and more. —Trent Straube
U=U National Task Force Launches LGBTQ group joins HIV organizations to promote the prevention message of Undetectable Equals Untransmittable. During this year’s Pride season, a national LGBTQ advocacy group promoted more than queer equality. The Human Rights Campaign Foundation joined the U=U National Task Force as an inaugural member to help promote modern HIV prevention, notably the fact that people with HIV who take medication and maintain an undetectable viral load cannot transmit HIV via sex, often referred to as Undetectable Equals Untransmittable, or U=U. The task force’s efforts include educating policymakers, Congress members and the public not just
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about U=U but also about pre-exposure prophylaxis, or PrEP, the daily pills and long-acting injectables that prevent HIV. Beyond prevention, HIV meds known as antiretrovirals primarily offer benefits for those living with the virus. For example, people with HIV who have an undetectable viral load also experience slower disease progression, have a lower risk for opportunistic illnesses and enjoy better overall health. Organized by the Prevention Access Campaign (PAC), the U=U National Task Force also includes the HIV organizations NMAC, the Elton John AIDS Foundation, the Southern AIDS Coalition and The Well Project as well as the LGBTQ and social justice advocacy group Equality Federation. The Human Rights Campaign Foundation is the educational arm of the Human Rights Campaign. The U=U
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National Task Force was launched in collaboration with the Congressional HIV Caucus and was announced at the nation’s capital. According to a press statement, the U=U National Task Force will work toward the following goals: Educate policymakers and the public about U=U (and PrEP) as the path to transform lives and end the HIV epidemic in America; Q Educate policymakers about the social, economic and public health benefits of increasing access and removing the social, structural and legal barriers to HIV treatment, care and services; Q Move U.S. federal health departments to integrate U=U fully into the domestic HIV response; Q Secure commitments and accountability structures to take the actions outlined in the Multinational U=U Call to Action; Q Document and showcase the U.S. leadership’s scale-up as a model to move other governments. —TS Q
(MALL AND CRAWLEY) YOUTUBE/TRUST FOR THE NATIONAL MALL (ILLUSTRATION) ISTOCK
VISITORS TO THE NATIONAL MALL IN Washington, DC, had a rare opportunity in September to check out a series of temporary installations, including Ashon T. Crawley’s Homegoing, an audiovisual AIDS memorial that centered spirituality and the Black queer church musicians lost to the HIV epidemic. Crawley, an African-American artist, writer and professor based in Richmond, Virginia, is one of six artists who contributed works of art for Beyond Granite: Pulling Together, a pilot exhibition that sought to answer the question: What stories remain untold on the National Mall? The National Mall is famous for its permanent larger-than-life monuments, memorials and museums—often made of granite—spread across nearly 700 acres of parks near the U.S. Capitol. Beyond Granite marked the first time that curated, temporary works were displayed on the Mall, according to The Washington Post. The works were on view in September. You can learn more about the project on BeyondGranite.org. The site describes Homegoing as follows: “Ashon T. Crawley’s Homegoing mourns and celebrates those gone too soon because
New HIV Awareness Day for African Immigrants and Refugees #NAIRHHA Day is now officially recognized by the federal government. It’s official! National African Immigrant & Refugee HIV/AIDS and Hepatitis Awareness (NAIRHHA) Day has been recognized by the federal government. Advocates began promoting the awareness day in 2014 via citywide events in Boston. Now, thanks to the Department of Health and Human Services, their efforts can help raise awareness of HIV and hepatitis among African immigrants and refugees nationwide each September 9. NAIRHHA Day is led by the Hepatitis B Foundation, the Africans For Improved Access program at the Multicultural AIDS Coalition and the Coalition Against Hepatitis for People of African Origin.
According to an NAIRHHADay.org fact sheet, HIV and hepatitis B among African immigrants in the United States is a “hidden epidemic.” In fact: 40% to 70% of people living in the United States with hep B are foreign born, and African immigrants have among the highest chronic hepatitis B rates in the United States. What’s more, HIV diagnosis rates among African-born people in the United States are six times higher than those of the general population. The awareness day takes place in September, explains NAIRHHADAY.org, because the month had already been designated as National African Immigrant Heritage Month to celebrate the diverse and remarkable contributions—in spheres ranging from sports to writing to politics —through which African immigrants have enriched the United States. Advocates say they “aim to bring both national and local attention to the highly prevalent health issues of HIV/AIDS and viral hepatitis in the African immigrant
and refugee population in the United States, in a way that is culturally and linguistically appropriate. NAIRHHA Day provides a way for communities, families and individuals to: Raise awareness about HIV and AIDS and viral hepatitis to eliminate stigma; Q Learn about ways to protect against HIV, viral hepatitis and other related diseases; Q Take control by encouraging screenings and treatment, including hepatitis B vaccination; Q Advocate for policies and practices that promote healthy African immigrant communities, families and individuals.” Q
Visit NAIRHHADay.org for more, including fact sheets, resources and downloadable, sharable graphics in English, Kinyarwanda, Swahili, Somali, Amharic and French. —TS
Amida Care at 20
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The health plan specializes in coverage for people living with HIV. New York City’s largest Medicaid Special Needs health plan, Amida Care, which focuses on comprehensive health coverage for people with HIV, celebrates its 20th anniversary in August. Founded in 2003 by communitybased HIV and AIDS providers, the nonprofit currently serves more than 9,000 New Yorkers. Amida Care works in partnership with its members and clients, prioritizing their feedback to best address their needs and serve as a bridge between members and providers. “Two decades ago, no one believed that seven community-based health care organizations with no experience with Medicaid managed care could launch a health plan. But thanks to the vision of our provider founders, we have been able to help thousands of New Yorkers live healthy, fulfilling lives by creating an innovative model of care that puts the needs of people impacted by HIV first,” says Doug Wirth, president and CEO of Amida Care, in a news release. By working with Medicaid—a health
insurance plan for low-income and disabled Americans—Amida Care is able to provide communities most impacted by HIV with access to lifesaving care and resources. Amida Care offers primary care, gender-affirming procedures and mental health support services. What’s more, the health plan covers pre- and post-exposure prophylaxis— PrEP and PEP—the pills and long-acting injectables that prevent HIV. Amida Care was one of the first plans to advocate for gender-affirming care, including hormone therapy and surgeries, as well as hepatitis C testing and treatment, which is now covered for all Medicaid members. Two thirds of Amida Care members are living with significant mental health issues, 40% have experienced homelessness at least once since their HIV diagnosis and 90% have a history of substance abuse. Black and Latino members make up 55% and 32% of Amida Care’s current membership, respectively, highlighting the dispro-
portionate impact HIV has on communities of color. “We have grown and evolved,” Wirth says, “but our commitment to addressing health disparities, ending HIV, breaking down barriers to care for marginalized communities and addressing racism as a public health crisis remains steadfast.” —Laura Schmidt
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CARE & TREATMENT
People With HIV Can Have a Near-Normal Life Expectancy An international team of researchers estimated life expectancy for more than 200,000 adults living with HIV in North America and Europe.
New HIV Cases Decline, but Disparities Remain The drop is attributable in part to increased use of pre-exposure prophylaxis (PrEP) to prevent HIV. HIV INCIDENCE IN THE UNITED States declined by 12% in recent years, according to the latest surveillance report from the Centers for Disease Control and Prevention (CDC). The drop is attributable in part to increased use of pre-exposure prophylaxis (PrEP) to prevent HIV. While everyone did not benefit equally, all groups saw some improvement. New cases fell from about 36,500 in 2017 to about 32,100 in 2021. The decline was driven by a 34% drop among people ages 13 to 24. Young gay and bisexual men, who account for four out of five cases in this age group, saw new infections fall from about 7,400 to about 4,900. But the decline was not even: Cases fell by 45%, 36% and 27% among young white, Latino and Black gay and bi men, respectively. Just under
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20% of new cases in 2021 were among women, more than half of whom were Black. The South saw more new infections in 2021 (16,700) than the West (6,600), Midwest (4,400) and Northeast (4,400) combined. However, it was the only region to see a statistically significant decline, falling by 12%. “We see some bright spots in the data—our nation’s HIV prevention efforts are working, especially for young people,” says Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “A challenging task that once seemed impossible— to end the HIV epidemic in America— is possible. We need the will, the resources and the resolve to make it happen.” —Liz Highleyman
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HIV-positive people on modern antiretroviral treatment who maintain a high CD4 T-cell count can expect to live nearly as long as their HIV-negative peers—but those with low CD4s do not fare as well. An international team of researchers estimated life expectancy for more than 200,000 adults living with HIV in North America and Europe who had been on antiretroviral therapy for at least a year from 2015 onward. For men, at age 40, life expectancy was estimated at 74.5 years for those who started treatment before 2015 and 77.0 for those who started later. For women, the corresponding estimates were 75.8 and 79.0. Life expectancy was longer for people with a CD4 count of at least 500: 79.2 years for men and 82.0 years for women who started treatment after 2015. These estimates are in line with those for the general population: about 81 years for men and about 86 years for women. But life expectancy was around two decades shorter for people with a very low CD4 count. People with a count below 50 had about a fivefold higher risk of death than those with 500 or more CD4 cells. However, even those with less severe immune suppression—a count between 200 and 350—had about twice the risk of death as those with the highest levels. “For people with low CD4 counts at the start of follow-up, life-expectancy estimates were substantially lower, emphasizing the continuing importance of early diagnosis and sustained treatment of HIV,” the study authors wrote. —LH
WHO Reaffirms Treatment Is Prevention The updated guidance is supported by a systematic review of evidence. In a move long encouraged by advocates, the World Health Organization (WHO) has reaffirmed that people living with HIV who consistently take antiretroviral treatment and have an undetectable viral load do not transmit the virus during sex, a concept known as Undetectable Equals Untransmittable, or U=U. According to a WHO policy brief released at the International AIDS Society Conference on HIV Science, people with an undetectable viral load—usually defined as below 50 or 200—who continue to take their medication “have zero risk of transmitting HIV to their sexual partner(s) and minimal risk of transmitting HIV vertically to their children.” People with a suppressed but detectable viral load (under 1,000) have “almost zero or negligible
risk” of sexual transmission. The updated guidance is supported by a systematic review of evidence that found sexual transmission of HIV did not occur when viral load was less than 600 and was very rare when it was below 1,000. There is not enough evidence about the link between viral load and transmission via shared drug injection equipment. “The brief is a game changer for equitable scale-up of viral load testing and clear messaging about transmission risk,” says Bruce Richman, executive director of the Prevention Access Campaign. “When the WHO’s new brief is translated from policy to implementation, millions more people living with HIV will have the assurance that their treatment is working to protect their health and their partners.” —LH
Statin Cuts Heart Risk for People Living With HIV
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Even those with low to moderate cardiovascular risk can benefit. People with HIV who are at low to moderate risk for cardiovascular events can reduce their risk even further by taking a daily statin medication, according to long-awaited results from the REPRIEVE study. The international Phase III trial enrolled nearly 7,800 HIV-positive people ages 40 to 75. Their demographics, comorbidities and laboratory values reflected low to moderate cardiovascular risk, so they ordinarily would not have been prescribed a statin. But standard risk scores developed for the general population tend to underestimate the risk for people with HIV, who are about twice as likely to develop cardiovascular disease. The study participants were randomly assigned to receive oral pitavastatin or a placebo. Statins reduce low-density lipoprotein (LDL) cholesterol and also have anti-inflammatory properties. The drugs have been shown to lower the risk for cardiovascular problems and death in
the population at large, but their benefits for people living with HIV were uncertain. The trial was stopped ahead of schedule in April after an interim analysis showed that pitavastatin reduced the risk for heart attacks, strokes, severe chest pains, heart surgery and cardiovascular death by 35%. The effect was consistent for men and women, across racial/ethnic groups and regardless of CD4 count or baseline LDL level. Pitavastatin was generally safe and well tolerated, but people who used the drug were more likely than placebo recipients to develop diabetes (about 5% versus 4%, respectively). “We would highly recommend that guidelines be changed” to include statin therapy for people with HIV, says lead investigator Steven Grinspoon, MD, of Massachusetts General Hospital. “Pitavastatin is effective, prevents major adverse cardiovascular events and will save lives.” —LH
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BASICS
Shingles Vaccination is recommended for people 50 and older and all adults living with HIV. SHINGLES IS A CONDITION CAUSED by varicella-zoster virus (VZV), which also causes chickenpox. It is characterized by a painful rash, sometimes accompanied by flu-like symptoms. In some cases, it can lead to long-term nerve damage. Like other viruses in the herpes family, VZV causes lifelong infection. Most people acquire VZV during childhood. Chickenpox was once very common, but its incidence has declined dramatically in the United States since the advent of childhood immunization in 1995. After recovery, the virus establishes latent infection in nerves and can reactivate later in life to cause shingles (herpes zoster). According to the Centers for Disease Control and Prevention (CDC), about one in three adults will develop shingles during their lifetime. This typically occurs in older individuals, but people living with HIV—especially those with a low CD4 T-cell count—and other people with weakened immunity are susceptible at any age.
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VZV spreads primarily through contact with fluid from chickenpox or shingles sores. Shingles exposure doesn’t directly lead to shingles, but people with an outbreak can transmit the virus to others who have never been infected or vaccinated, and they can develop chickenpox. People having a shingles outbreak may first develop fever, fatigue, headache or other flu-like symptoms, and they may experience burning, itching or tingling—known as a prodrome— before breaking out in a rash. While chickenpox is characterized by an itchy rash that can occur anywhere on the body, shingles typically has a more limited distribution, often appearing on one side of the body or face in a band-like pattern following the path of a nerve. The rash consists of fluid-filled blisters that are itchy and painful. In some cases, shingles can also affect the eyes, inner ear, lungs and brain. Shingles blisters typically heal within a few weeks, but the rash may last
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Vaccination and Treatment A vaccine called Varivax prevents initial VZV infection and chickenpox. It is recommended for children under 13 as well as adolescents and adults who have never had chickenpox. A different vaccine, Shingrix, prevents shingles outbreaks in people who already carry the virus. It reduces the risk for shingles outbreaks and postherpetic neuralgia by more than 90%. The CDC recommends Shingrix for all adults ages 50 and older, including those who have already had shingles or previously received Varivax or an older shingles vaccine called Zostavax. It is also recommended for younger adults with compromised immunity, including those living with HIV. Shingrix is a two-shot series spaced two to six months apart. The vaccine can cause injection site soreness and flu-like symptoms, but serious side effects are rare. VZV cannot be cured, but antiviral medications can reduce pain, speed healing and lower the likelihood of recurrent outbreaks and postherpetic neuralgia. Three related nucleoside analog medications—acyclovir (Zovirax), valacyclovir (Valtrex) and famciclovir (Famvir)—are used to treat shingles. Treatment works best when started as soon as possible after the first symptoms or prodromal signs. These antivirals are generally well tolerated with few side effects. Beyond antivirals, over-the-counter medications and topical preparations can be used to relieve pain. Some people, especially those with postherpetic neuralgia, may need stronger prescription pain medications. During an outbreak, keep sores clean and dry, as this helps speed up healing and prevent bacterial infection. Researchers are studying new therapies that might be more effective for shingles and postherpetic neuralgia. Ask your doctor whether a clinical trial might be a good option for you. — Liz Highleyman
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longer in people with weakened immunity. Some people develop long-lasting nerve damage known as postherpetic neuralgia, which can lead to chronic pain or numbness.
NUTRITION & FITNESS
Black Bean Breakfast Burrito A great source of protein There’s something satisfying and comforting about being able to wrap everything up in a tortilla. This breakfast burrito is a filling meal, and the eggs and black beans are both great sources of protein, which helps you feel fuller longer. To save some time, use store-bought salsa instead of making the pico de gallo. Just make sure it contains minimal ingredients. SERVINGS: 2 / INGREDIENTS: 14 / PREP: 20 minutes Pico de gallo (salsa): 1 plum tomato, seeded and diced 1 tablespoon finely chopped white or red onion 1 tablespoon minced jalapeño, deseeded 1 tablespoon fresh lime juice 1 tablespoon chopped cilantro Salt, to taste
Burrito: 4 large eggs Salt and pepper, to taste Pinch cayenne pepper (optional) 2 teaspoons canola or grape seed oil ⅓ cup grated Monterey Jack or cheddar cheese 1 cup black beans, rinsed and drained 2 (9-inch) whole wheat tortillas ½ ripe avocado, peeled, pitted and diced
DIRECTIONS 1. In a small bowl, mix the diced tomato, onion, jalapeño, lime juice, cilantro, salt and pepper. Set aside.
Don’t Skip Breakfast By Craig Ramsay Here are some slim-down tips: Q
Eat before drinking coffee.
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Split your lunch into two portions.
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Cut out carbs in the evening.
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Space out your meals every two to three hours.
Q
Eat six small meals a day. This will increase your metabolic rate and help you burn more calories throughout the day.
2. In a medium bowl, whisk the eggs with 1 teaspoon of water, cayenne pepper (if using) and salt and pepper. 3. In a medium nonstick skillet, heat 1 teaspoon of oil over medium heat. Add the eggs and cook, stirring to scramble just until set. Stir in the cheese and cook until it has melted. Remove from heat.
(BURRITOS) NATALIYA ARZAMASOVA/SHUTTERSTOCK.COM; (RAMSAY) COURTESY OF CRAIG RAMSAY
4. Wipe the skillet clean. Heat the remaining 1 teaspoon of oil over medium-high heat and add the drained black beans. Cook just until heated through, about 1 minute. Remove from heat. 5. Wipe the skillet clean again and heat the tortillas just until warmed. 6. Fill the tortillas with the pico de gallo vertically down the center, about an inch away from the edges. Then top with even amounts of beans, scrambled eggs and diced avocado. Fold over the top and the bottom of the tortilla, then fold over the sides, overlapping them. Serve folded side down. CHEF TIPS To get your meal on the table quicker, you can substitute a store-bought pico de gallo. NUTRITION FACTS (per serving) Calories: 834; fat: 33 g; saturated fat: 10 g; polyunsaturated fat: 8 g; monounsaturated fat: 13 g; carbohydrates: 93 g; sugar: 6 g; fiber: 21 g; protein: 45 g; sodium: 862 mg
©2023 Fred Hutchinson Cancer Research Center, a 501(c)(3) nonprofit organization. Used with permission.
Craig Ramsay is a fitness expert, an author and the winner of season 8 of The Amazing Race Canada. Follow him on Instagram at @craigramsayfit.
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“THERE ARE THINGS WE CAN DO. THERE ARE THINGS WE CAN FIX.”
(POGUE) DUSTIN FENSTERMACHER; (CHILDREN) COURTESY OF ERIC POGUE
Michelle Lopez
Becoming an HIV Advocate A LONG-TERM SURVIVOR URGES PEOPLE LIVING WITH HIV TO GET INVOLVED. By Mike Isbell
BILL WADMN
Over the years, Michelle Lopez, a bisexual woman living with
HIV, has shown how resilient, empowered individuals and communities can serve as agents for positive change. She would know. The daughter of a Black mother and a Latino father, the long-term survivor has overcome racial and ethnic health disparities. Lopez moved to New York City from her native Trinidad in 1979, when she was 16 years old. In 1990, she gave birth to a daughter; soon thereafter, she began to feel sick. When she took her baby to a hospital, a doctor advised Lopez to get tested for HIV. She was taken aback, since at the time, she thought only men who had sex with other men could get the virus. She and her daughter both tested HIV positive. “The man I was with at the time was beating me morning, noon and night,” she says. “I eventually wrapped my baby up in a blanket and left the house and started riding the trains.” Her subway ride that day started in Queens and ended in Brooklyn, where she saw an ad welcoming immigrant women to call a helpline for support. “When I called that number, a voice answered, not a machine. It turned out I was literally standing five blocks away from that person. She directed me how to get to the Community Planning Family Council.” That agency proved to be Lopez’s door to health care for her and her baby. The agency placed them in a shelter for battered women, where they stayed for 11 months. “There weren’t a lot of services being offered to me as an undocumented immigrant. I came down with PCP [pneumocystis pneumonia] and had to be hospitalized. That diagnosis made me eligible for AIDS services from the city.” While living in the shelter, Lopez started doing street outreach to raise awareness of the importance of HIV testing. Soon, the number of people seeking HIV testing at the council surged. Her case manager told her one day that the organization’s executive director wanted to meet with her. “She offered me a job on the spot, and she asked me to tell all the directors in the room what I was doing through outreach to get so many people to come in for testing.” Lopez was proactive about getting the help she needed, and her efforts paid off. The Partnership for the Homeless got her out of the shelter and into a place of her own. The legal department at Gay Men’s Health Crisis, now known simply as GMHC, helped Lopez and her sister become naturalized citizens.
Lopez developed a taste for activism. She testified before the Food and Drug Administration to successfully open up HIV clinical trials to the participation of women and children. She worked with the New York State AIDS Institute to form the Leadership Training Institute, which has now trained thousands of people living with HIV on self-care and how to become involved in the AIDS response. Lopez has served as a community adviser for the AIDS Clinical Trials Group and today is working with the Albert Einstein College of Medicine in New York City on research regarding the needs of people aging with HIV as well as young adults born with the virus. Actively participating in your own health care is essential, Lopez says. “You are aging. You are a long-term survivor. You have cognitive issues. I tell my doctors they can’t sit back on this. I probe. I ask questions. If I don’t understand something, I ask. If I don’t feel I have a real partnership with the doctor, then I know that doctor can’t work with me.” Lopez has accomplished a lot and is recognized as a pioneer and leader in her community, both in New York and nationally. But she knows there is a lot more to do. “When I’m around these decision-making tables, I speak about immigrants. I speak about women of color. I speak about the LGBTQ community. And I speak about being a mom and a grandmother. But it is so concerning that there aren’t more men and women of color around these tables. “When I look at communities of color, I know there are things we can do. There are things we can fix. My plea is that people of color recognize that you don’t have to be a rocket scientist to become involved.” Lopez has at times bristled at the tokenism she has encountered when it comes to her community engagement and advocacy. “I’m not just [at these health policy tables] because I am living with HIV or because I have Medicaid. I am here because I have a brain, and I need to be respected because I have ideas about how we can make things better.” As a mother and a grandmother, an adviser on important scientific studies and a tireless advocate, Lopez is doing her part to reduce racial and ethnic disparities in health. HIV prevention is everyone’s responsibility. To find out more about HIV prevention and how to access free home HIV tests, visit the Centers for Disease Control and Prevention’s “Let’s Stop HIV Together” website at Together.TakeMeHome.org. Q
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(POGUE) DUSTIN FENSTERMACHER; (CHILDREN) COURTESY OF ERIC POGUE
Joyce McDonald
Aging With HIV A LONG-TERM SURVIVOR SHARES HER JOURNEY. By Alicia Green
PHOTOGRAPHY BY DAYMION MARDEL; STYLING BY JOHN SLATTERY
In the beginning of the AIDS crisis, the idea of aging with HIV
was, at best, a distant dream. Indeed, an AIDS diagnosis in the very early days of the epidemic was a death sentence for many people. Despite the fact that effective treatment in the mid-1990s changed that reality, the general public still seems surprised by the aging of people living with the virus. The stigma attached to HIV and the misbelief that a positive diagnosis remains a death sentence help explain why folks have trouble accepting a long life with the virus. As a result, it remains necessary to uplift the stories of long-term survivors. More than half of people living with HIV in the United States today are 50 or older. By 2030, 70% of folks with the virus nationwide will be 50 or older. HIV prevention efforts and access to health care and treatment have helped transform the face of HIV and AIDS from young to old. Meet Joyce McDonald, a long-term survivor with a unique story to tell. When she was diagnosed with HIV in 1995, life had already thrown many challenges her way. The mother of two had experienced loss and trauma and battled substance use. “By the time I took the HIV test, I had accepted Christ,” says McDonald, an artist and minister from New York City. “I got detoxed and was in a better place.” Even after her diagnosis, McDonald, who is now 72, remained faithful. She remembered how God had helped her through all the other trials in her life. It would take McDonald 14 years to start on HIV meds. Her doctor would offer
them, but she would say she was already on them—healing Bible scriptures. Nowadays, the recommendation is to start early. In 2009, McDonald became an ordained minister. She was set to take on a bigger role at church when she got shingles (see page 8). The shingles attacked her body. After talking to her doctor, she knew it was time to get on meds. “I started taking medication then, and I prayed about side effects,” she says. “I haven’t felt any yet.” McDonald has an undetectable viral load. Although her HIV is under control, she suffers from neuropathy and heel fat pad syndrome. That’s when the pads that cushion your heels shrink or lose elasticity, giving rise to pain. But her faith continues to guide her. She reads the Bible and shares it with others. She also makes art, including sculptures and paintings, to help people heal. “My art not only explores the pain and hurt of my former life but also the joy and triumph of my present one,” McDonald says. Last year, McDonald was one of the first artists to join West Elm’s new ceramics residency in Brooklyn. Her art has also been featured in the New York Times and on the New York City cable news channel NY1. “It’s just beyond my wildest dreams,” she says. For McDonald, living this long after her diagnosis has been a blessing. It also has allowed her to fulfill her purpose as an artist and minister. Long-term survivorship has given her the opportunity to watch her daughters, grandchildren and great-grandchildren grow up. Q
“I PRAYED ABOUT SIDE EFFECTS. I HAVEN’T FELT ANY YET.”
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