H E A L T H + S P I R I T + C U L T U R E + L I F E
THE ART OF AIDS A look at the people and creative efforts behind a growing body of virally inspired work
NOVEMBER/DECEMBER 2010 www.hivplusmag.com
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INSIDE N OV E M B E R / D EC E M B E R 2 0 1 0 | I S S U E 7 9
BOLD REFLECTION: Terrence Gore’s A View Into My Heart and Soul, a 2007 self-portrait that explores the sadness caused by his health-related challenges.
FEATURES 26 SPANNING THE GLOBE Ahead of the 30th year since the ﬁrst AIDS cases were identiﬁed, we take a look at the current state of the indelible imprint that HIV has left on almost every continent of our planet.
30 GOING VIRAL What began as a Day Without Art on the second World AIDS Day, in 1989, eventually morphed into a Day With(out) Art to highlight works inspired by HIVers’ experiences. We honor that still-growing body of inﬂuence and some of the creative people behind it in a special package on virally inspired arts.
DEPARTMENTS & VOICES 8 STATUS SYMBOLS Watch your friends. They might provide important clues about your ailments. Plus: Tips and news for living your life to the fullest.
20 H-EYE-V Eyewitnesses deliver events from around the globe in living color.
40 HAART BEATS Why does HIV evolve diﬀerently in blood versus in semen? Plus: Much more treatment news and insight.
44 MIND+MOOD If you ﬁnd yourself blowing your top a bit too often, Gary McClain has some advice that could help you mellow.
46 PERFECTLY FLAWED He starts to write about love and hope, but Corey Saucier ends up wondering about the risks of exposing one’s fragile emotions.
48 ASK & TELL Victor Mooney is ready to launch a new attempt to row across the Atlantic to raise awareness about HIV.
ON THE COVER
A self-portrait by artist, designer, stylist, and curator Terrence Gore.
NOV EMBER /DECEMBER 2010 HIV PLUS
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NOV EMBER / DECEMBER 2010 HIV PLUS | 7
8 | HI V PLUS NOV EMBER / DECEMBER 2010
STATUS SYMBOLS I N T E L F O R B E T T E R L I V I N G
SOCIAL ILLS Even though you might not be sick of your friends, you could very well be getting sick because of them
might not want to admit it, your friends are probably more popular than you are. But ultimately, knowing this fact could help you because a phenomenon called the “friendship paradox” might predict the spread of infectious disease. Two researchers—Nicholas Christakis, a professor of medicine, medical sociology, and sociology at Harvard University, and James Fowler, a professor of medical genetics and political science at the University of California, San Diego—have used the paradox to study the 2009 flu epidemic among 744 students. The researchers say their findings, which were reported online in September in the journal PLoS One, point to a novel method for early detection of contagious outbreaks. Analyzing a social network and monitoring the health of its central members is an ideal way to predict an outbreak. But such detailed information simply doesn’t exist for most social groups, and producing it is time-consuming and expensive. But the “friendship paradox,” first described by a sociologist in 1991, potentially offers an easy way around this. Simply put, the paradox states that, statistically, the friends of any given individual are likely more popular than the individual herself. Take a random group of people, ask each of them to name one friend, and on average the named friends will rank higher in the social web than the ones who named them. Just as they come across gossip, trends, and good ideas sooner, the people at the center of a social network are exposed to diseases earlier than those at the margins. As the 2009 influenza season approached, Christakis and Fowler, who are authors of the book Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, decided to put these basic features of a social network to work. They contacted 319 Harvard undergraduates who in turn named a total of 425 friends. MoniS MUCH AS YOU
toring the two groups—their original contacts and the named friends—both through self-reporting and data from Harvard University’s health services department, the researchers found that, on average, the friends group manifested the flu roughly two weeks prior to the random group using one method of detection and a full 46 days prior to the epidemic peak using another method. “We think this may have significant implications for public health,” Christakis says. “Public health officials often track epidemics by following random samples of people or monitoring people after they get sick. But that approach only provides a snapshot of what’s currently happening. By simply asking members of the random group to name friends and then tracking and comparing both groups, we can predict epidemics before they strike the population at large. This would allow an earlier, more vigorous, and more effective response.” “If you want a crystal ball for finding out which parts of the country are going to get the flu first,” Fowler adds, “then this may be the most effective method we have now. Currently used methods are based on statistics that lag the real world—or at best are contemporaneous with it. We show a way you can get ahead of an epidemic of flu—or potentially anything else that spreads in networks.” John Glasser, a mathematical epidemiologist at the U.S. Centers for Disease Control and Prevention in Atlanta (who was not involved in this research), says, “Christakis’s and Fowler’s provocative study should cause infectious disease epidemiologists and public health practitioners alike to consider the social contexts within which pathogens are transmitted. This study may be unique in demonstrating that social position affects one’s risk of acquiring disease. Consequently, epidemiologists and social scientists are modeling networks to evaluate novel disease surveillance and infection control strategies.”
NOV EMBER / DECEMBER 2010 HI V PLUS
INDICATIONS ISENTRESS is an anti-HIV medicine used for the treatment of HIV. ISENTRESS must be used with other anti-HIV medicines, which may increase the likelihood of response to treatment. The safety and effectiveness of ISENTRESS in children has not been studied. It is important that you remain under your doctorâ€™s care. ISENTRESS will NOT cure HIV infection or reduce your chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood.
IMPORTANT RISK INFORMATION A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when anti-HIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to treat the HIV infection and strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS. Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions muscle problems can be serious and can lead to kidney damage. When ISENTRESS has been given with other anti-HIV drugs, side effects included nausea, headache, tiredness, weakness, trouble sleeping, stomach pain, dizziness, depression, and suicidal thoughts and actions. Rash occurred more often in patients taking ISENTRESS and darunavir together than with either drug separately, but was generally mild.
I am outgoing. I am on the go. I am a newlywed. I am HIV positive. You are special, unique, and different from anyone else. And so is your path to managing HIV. When you’re ready to start HIV therapy, talk to your doctor about a medication that may ﬁt your needs and lifestyle. In clinical studies lasting 96 weeks, patients being treated with HIV medication for the first time who took ISENTRESS plus Truvada: Had a low rate of side effects — The most common side effect of moderate to severe intensity (that interfered with or kept patients from performing daily activities) was trouble sleeping — This side effect occurred more often in patients taking ISENTRESS plus Truvada (4%) versus Sustiva plus Truvada (3%) Experienced less effect on LDL cholesterol (“bad” cholesterol) — Cholesterol increased an average of 7 mg/dL with ISENTRESS plus Truvada versus 21 mg/dL with Sustiva plus Truvada
Ask your doctor about ISENTRESS. Not sure where to start? Visit isentress.com/questions
People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection. Tell your doctor about all of your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breast-feeding or plan to breast-feed. ISENTRESS is not recommended for use during pregnancy. Women with HIV should not breast-feed because their babies could be infected with HIV through their breast milk. Tell your doctor about all the medicines you take, including prescription medicines like rifampin (a medicine used to treat infections such as tuberculosis), non-prescription medicines, vitamins, and herbal supplements. 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. For more information about ISENTRESS, please read the Patient Information on the following page.
ISENTRESS is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Copyright © 2010 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. 21052250(8)(110)-11/10-ISN-CON Sustiva is a registered trademark of Bristol-Myers Squibb Truvada is a registered trademark of Gilead Sciences, Inc.
Disability Changes for HIVers? The Institute of Medicine has provided new guidance to the Social Security Administration on updating its Listings of Impairments, a tool that helps the agency to assess whether someone with HIV or another condition qualiﬁes for beneﬁts. The HIV-related listings, which were last updated in 1993, no longer adequately reﬂect medical reality, institute oﬃcials say, since over the past 15 years advances in therapy have changed the course of HIV infection. The listings could be amended to the following to determine if an HIVer is eligible for Social Security disability payments: h A CD4-cell count of 50 or below. “Because CD4 counts can change in response to antiretroviral therapy,” the institute’s report states, “claimants allowed disability in this way should be regularly reevaluated.” h Several rare but fatal or severely disabling HIV-associated conditions, including dementia and certain types of AIDS-related cancers. Beneﬁts for these diseases should be permanent, institute oﬃcials say. h Severe HIV-associated conditions, such as hepatitis or heart disease, which
are already covered by another section of the Social Security Administration’s full listing. These claimants too should be regularly reevaluated, according to the institute. h HIV-associated conditions, such as wasting syndrome, that are not included in another section of the listing. But these conditions must be severe and limit function. The institute suggests that claimants allowed in this way should be regularly reevaluated. The biggest change would be that HIV-positive applicants seeking disability would have to reapply to the Social Security Administration every three years. That policy pertains only to new applicants, though, not to those already receiving disability through the administration. Raeline Nobles, executive director of the Dallas-based nonproﬁt AIDS Arms, says the Social Security Administration currently allows disability for people with a CD4 count of 200. She says she sees many clients who get along ﬁne with a CD4 count of 100. “But politically, it might be a way to cut some expensive corners,” she says, adding, “50 seems awfully low to me.”
59% OF BLACK
HIV Precursor Is Older Than Thought An ancestor of HIV that infects monkeys is thousands of years older than previously thought, according to a new study, suggesting that HIV is not likely anywhere near the end of its lethal path. Simian immunodeficiency virus is at least 32,000 to 75,000 years old—and likely much older—according to a genetic analysis of unique viral strains found in monkeys on Bioko Island, a former peninsula that separated from mainland Africa after the Ice Age more than 10,000 years ago. This new research, published in the September 17 issue of the journal Science, calls into question previous DNA sequencing data that estimated the virus’s age at only a few hundred years. The study has implications for HIV. The simian immunodeﬁciency virus, unlike HIV, does not cause AIDS in most of its primate hosts. If it took thousands of years for SIV to evolve into a primarily nonlethal state, researchers say, it would likely take a very long time for HIV to naturally follow the same trajectory. “HIV is the odd man out because, by and large, all the oth-
er species of immunodeﬁciency viruses impose a much lower mortality on their host species,” says Michael Worobey, a professor in the department of ecology and evolutionary biology at the University of Arizona. Worobey led the study in conjunction with virologist Preston Marx of Tulane University. “So if SIV entered the picture relatively recently as was previously thought, we would think it achieved a much lower virulence over a short timescale. But our ﬁndings suggest the opposite. If HIV is going to evolve to lower virulence, it is unlikely to happen anytime soon.” The study also raises a question about the origin of HIV, which scientists believe evolved from SIV. If humans have been exposed to SIV-infected monkeys for thousands of years, why did the HIV epidemic only begin in the 20th century? “Something happened in the 20th century to change this relatively benign monkey virus into something that was much more potent and could start the epidemic,” Marx says. “We don’t know what that ﬂash point was, but there had to be one.”
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The percentage of men who have sex with men—within their own racial or ethnic category—who are HIV-infected but unaware that they have the virus. In the same study, conducted by the federal Centers for Disease Control and Prevention in 21 major U.S. cities, researchers found that 19% of men who have sex with men are infected with HIV and 44% of those are unaware of their infection. “This alarming new data provides further evidence that prevention efforts for gay men have not been adequate to meet the growing epidemic and should be dramatically scaled up if we are going to prevent HIV infections in our country,” says Carl Schmid, deputy executive director of the AIDS Institute. “The severity of the impact of HIV in the gay community is nothing new. What has been missing is an appropriate response by our government—at the federal, state, and local levels—and the gay community itself.”
GWMs: TOO MANY RISKS Risky sexual behavior among young white gay men is still adding to the spread of HIV, according to research published in the journal BMC Infectious Diseases. And despite increased education and awareness of HIV in the Western world, the researchers say, the number of new infections among these men continues to rise each year. Comparing the genetic information of viruses isolated from more than 500 patients— male and female, gay and straight, Caucasian and non-Caucasian—who were newly diagnosed at an HIV screening clinic between 2001 and 2009, researchers from Ghent University in Belgium looked at factors that might contribute to the local spread of HIV so that they could help develop prevention strategies. “Using genetic proﬁling techniques, we were able to group viruses into ‘clusters’ of highly related variants,” lead researcher Chris Verhofstede says. “Clusters of viruses are indicative for the local onward transmission of this particular viral strain. We deﬁned more and larger clusters among the HIV subtype B viruses compared to the non-B viruses. We also found that clustered viruses are more frequently isolated from young Caucasian men who have sex with men and who have a high prevalence of other sexually transmitted diseases.” With this ﬁnding conﬁrming results of epidemiological studies, Verhofstede concludes that more targeted prevention programs need to focus on this group.
SIMIAN BY RYAN MC VAY/VALUELINE/THINKSTOCK ; MAN BY STOCKBY TE/THINKSTOCK
IN THE DARK
DID DOCS JUMP-START THE HIV PANDEMIC?
DOC BY STOCKBY TE/THINKSTOCK ; NATURE BY KIM CARSON/STOCKBY TE/THINKSTOCK ; DAD BY JUPITER IMAGES/THINKSTOCK
Two new studies suggest that there was a health care link to HIV’s evolution from a chimpanzee infection—possibly transmitted to bush-meat hunters by bite or blood—to its earliest human dissemination and global spread. Scientists have theorized that the pandemic was sparked after colonial-era urbanization fueled changes in sexual behavior. The new studies—by Jacques Pepin, of the Université de Sherbrooke in Montreal, and colleagues and reported in Clinical Infectious Diseases—propose that sexual transmission might have been secondary to initial blood-borne dissemination of HIV from a few isolated cases. Syringe reuse during early 20th century massvaccination campaigns against endemic diseases in equatorial Africa may have inadvertently spread HIV and jump-started the pandemic, they suggest. “For a long time the needles and syringes used to administer the intravenous drugs were not single use,” Pepin explains. “There were a lot of patients and not a lot of needles, so the sterilization of needles was not very eﬃcient. If HIV was present in one of these patients 50 years ago, we can assume that [that person] probably transmitted HIV.”
New Sperm-Freezing Technique Opens Up Fatherhood Possibilities A new technique for freezing sperm can dramatically increase its viability. In addition, since the technique does not involve the freezing of seminal plasma, it creates the possibility of allowing sperm from HIV-positive men to be used without the danger of transmitting the virus. Currently, sperm is frozen slowly and then stored in liquid nitrogen at 160 degrees Celsius. This technique allows recovery of around 30% to 40% activity. However, the current technique has drawbacks, including loss of motility and vitality as well as damage to the cell membrane. The new technique—sperm vitriﬁcation (egg and embryo vitriﬁcation are already in use in fertility clinics)—entails putting sperm in a centrifuge to remove the plasma components and then resuspending it in a sucrose solution before plunging it into liquid nitrogen to fast-freeze it. This gives several advantages over the existing
NATURE’S HEALING EFFECTS Forests and other natural, green settings can reduce stress, improve moods, reduce anger and aggressiveness, and increase overall happiness. But forest visits may also strengthen our immune system by increasing the activity and number of natural killer cells that ﬁght disease and destroy cancer cells. “Many people,” says Eeva Karjalainen of the Finnish Forest Research Institute, “feel relaxed and good when they are out in nature. But not many of us know that there is also scientiﬁc evidence about the healing effects of nature.” Studies have shown that after stressful or concentrationdemanding situations, people recover faster and better in natural environments than in urban settings. Blood pressure, heart rate, muscle tension, and the level of stress hormones all decrease faster in natural settings. Depression, anger, and aggressiveness are reduced in green environments,
and symptoms of attention deﬁcit hyperactivity disorder in children reduce when they play in green settings. Not only does nature enhance mental and emotional well-being; more than half of the most commonly prescribed drugs include compounds derived from nature— for example, Taxol, used against ovarian and breast cancer, is derived from yew trees, while Xylitol, which can inhibit caries, is produced from hardwood bark. Karjalainen says that for our health it’s important that we take care of the places that can help us stay well and help heal us. “Preserving green areas and trees in cities is very important to help people recover from stress, maintain health, and cure diseases,” she says. “There is also a monetary incentive to do so, since such space could aid in improving people’s working ability and reducing health care costs.”
method, including a signiﬁcant increase in motility of the rethawed sperm (77% motility versus 29%). In addition, sperm are damaged less by the vitriﬁcation technique.. As a by-product of the technique, the removal of the sperm plasma separates the sperm from many contaminating agents, such as HIV, hepatitis, and other viruses. “The great advantage of this technique is that it can eliminate potential sources of infection such as HIV or hepatitis B, which are present in seminal plasma,” says lead researcher Raul Sanchez of La Frontera University in Chile. “In this process we discard the seminal plasma, with the sperm being vitriﬁed in culture medium. It has the potential to allow HIV-positive men to have children without worrying about transmitting the virus.”
NOV EMBER /DECEMBER 2010 HI V PLUS
ATRIPLA Important Safety Information and Indication INDICATION ATRIPLA® (efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate [DF] 300 mg) is a prescription medication used alone as a complete regimen or with other medicines to treat HIV-1 infection in adults. ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others. The long-term effects of ATRIPLA are not known at this time. People taking ATRIPLA may still get infections that develop because the immune system is weak or other conditions that happen with HIV-1 infection. Do not stop taking ATRIPLA unless directed by your healthcare provider. See your healthcare provider regularly.
•Have ever had seizures: Seizures have occurred in patients taking a component of ATRIPLA, usually in those with a history of seizures. If you have ever had seizures, or take medicine for seizures, your healthcare provider may want to switch you to another medicine or monitor you. •Have ever had mental illness or use drugs or alcohol. Contact your healthcare provider right away if you experience any of the following serious or common side effects:
•Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby. •Have liver problems, including hepatitis B or C virus infection.
ATRIPLA is one of several treatment options your doctor may consider.
Serious side effects associated with ATRIPLA: •Severe depression, strange thoughts, or angry behavior have been reported by a small number of patients. Some patients have had thoughts of suicide, and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness. IMPORTANT SAFETY INFORMATION Contact your healthcare provider right away if you get the following •Kidney problems (including decline or failure of kidney function). If you have had kidney problems, or take other medicines that may side effects or conditions associated with ATRIPLA: • Nausea, vomiting, unusual muscle pain, and/or weakness. These cause kidney problems, your healthcare provider should do regular blood tests. Symptoms that may be related to kidney problems include may be signs of a buildup of acid in the blood (lactic acidosis), a high volume of urine, thirst, muscle pain, and muscle weakness. which is a serious medical condition. • Light-colored stools, dark-colored urine, and/or if your skin or the •Other serious liver problems. Some patients have experienced serious liver problems, including liver failure resulting in transplantation whites of your eyes turn yellow. These may be signs of serious or death. Most of these serious side effects occurred in patients with a liver problems. chronic liver disease such as hepatitis infection, but there have also • If you have HIV-1 and hepatitis B virus (HBV), your liver disease been a few reports in patients without any existing liver disease. may suddenly get worse if you stop taking ATRIPLA. •Bone changes. Lab tests show changes in the bones of patients treated Do not take ATRIPLA if you are taking the following medicines with tenofovir DF, a component of ATRIPLA. Some HIV patients treated because serious and life-threatening side effects may occur when with tenofovir DF developed thinning of the bones (osteopenia), which taken together: Vascor® (bepridil), Propulsid® (cisapride), could lead to fractures. Also, bone pain and softening of the bone Versed® (midazolam), Orap® (pimozide), Halcion® (triazolam), (which may lead to fractures) may occur as a consequence of kidney or ergot medications (for example, Wigraine® and Cafergot®). problems. If you have had bone problems in the past, your healthcare In addition, ATRIPLA should not be taken with: provider may want to check your bones. ® ® ® Combivir (lamivudine/zidovudine), EMTRIVA (emtricitabine), Epivir ® ® Common side effects: or Epivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), SUSTIVA® (efavirenz), Trizivir® (abacavir sulfate/lamivudine/zidovudine), •Dizziness, headache, trouble sleeping, drowsiness, trouble TRUVADA® (emtricitabine/tenofovir DF), or VIREAD® (tenofovir DF), concentrating, and/or unusual dreams. These side effects tend to go because they contain the same or similar active ingredients as ATRIPLA. away after taking ATRIPLA for a few weeks. These symptoms may be ® ATRIPLA should not be used with HEPSERA (adefovir dipivoxil). more severe with the use of alcohol and/or mood-altering (street) drugs. If you are dizzy, have trouble concentrating, and/or are drowsy, Vfend® (voriconazole) or REYATAZ® (atazanavir sulfate) with or without avoid activities that may be dangerous, such as driving or operating Norvir® (ritonavir) should not be taken with ATRIPLA since they may lose their effect and may also increase the chance of having side effects machinery. from ATRIPLA. Fortovase® or Invirase® (saquinavir) should not be used •Rash is a common side effect that usually goes away without any as the only protease inhibitor in combination with ATRIPLA. change in treatment, but may be serious in a small number of patients. Taking ATRIPLA with St. John’s wort or products containing St. John’s wort •Other common side effects include: tiredness, upset stomach, vomiting, is not recommended as it may cause decreased levels of ATRIPLA, gas, and diarrhea. increased viral load, and possible resistance to ATRIPLA or Other possible side effects: cross-resistance to other anti-HIV drugs. This list of medicines is not complete. Discuss with your healthcare •Changes in body fat have been seen in some people taking anti-HIV-1 medicines. The cause and long-term health effects are not known. provider all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take. •Skin discoloration (small spots or freckles) may also happen. Tell your healthcare provider if you: •If you notice any symptoms of infection, contact your healthcare provider right away. •Are pregnant: Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping ATRIPLA. Serious birth defects •Additional side effects are inflammation of the pancreas, allergic have been seen in children of women treated during pregnancy with reaction (including swelling of the face, lips, tongue, or throat), one of the medicines in ATRIPLA. Women must use a reliable form of shortness of breath, pain, stomach pain, weakness, and indigestion. barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control, while on ATRIPLA and for 12 weeks You should take ATRIPLA once daily on an empty stomach. Taking ATRIPLA at bedtime may make some side effects less bothersome. after stopping ATRIPLA.
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 Patient Information on the following pages. © 2010 Bristol-Myers Squibb & Gilead Sciences, LLC. All rights reserved. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, VIREAD, and TRUVADA are trademarks of Gilead Sciences, Inc. SUSTIVA and REYATAZ are registered trademarks of Bristol-Myers Squibb. All other trademarks are owned by third parties. 697US09AB07036/TR6101 07/10
“My entire HIV regimen in one pill daily. For me, that’s great.” Phil li p
on ATRIPLA for 2 years
ATRIPLA is the #1 prescribed HIV regimen.* About ATRIPLA: • Only ATRIPLA combines 3 HIV medications in 1 pill daily. †
• Proven to lower viral load to undetectable in approximately 7 out of 10 patients new to therapy, and also raise T-cell‡ (CD4+) count to help control HIV through 3 years of a clinical study.§ •ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others.
Selected Important Safety Information: Some people who have taken medicine like ATRIPLA have developed the following: a serious condition of acid buildup in the blood (lactic acidosis), and serious liver problems (hepatotoxicity). For patients with both HIV-1 and hepatitis B virus (HBV), hepatitis may suddenly worsen if ATRIPLA is discontinued. Please see detailed and additional Important Safety Information, including the bolded information to the left. †
Defined as a viral load of less than 400 copies/mL. Average increase of 312 cells/mm3. § In this study, 227 patients took the meds in ATRIPLA. ‡
Patient model. Individual results may vary.
Your doctor may prescribe ATRIPLA alone or with other HIV medications.
Talk to your doctor to see if ATRIPLA is right for you. * Synovate Healthcare Data; US HIV Monitor, Q1 2010.
To learn more, visit www.ATRIPLA.com
Controversial Vision South African artist Yuill Damaso’s HIV-themed painting has provoked outrage in his country. The image depicts South Africa’s ﬁrst black president, Nelson Mandela, lying on an autopsy table as the late Nkosi Johnson, a child AIDS activist who died at 12, cuts into his ﬂesh and
prominent political ﬁgures surround them. The ruling African National Congress party calls the painting “racist” and has criticized the artist for depicting Mandela as dead, saying it is considered an act of witchcraft in African society. However, Damaso says his work is a tribute to the iconic leader.
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PABALLO THEKISO/AFP/GE T T Y IMAGES
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Service Interruption A barbed wire fence surrounds an AIDS clinic being shuttered in Kiev, Ukraine, to make room for a luxury hotelâ€”although HIV prevalence in the nation has risen to 1.11% among the adult population, making it one of the European states hardest hit by the pandemic. The closing
gave rise to protests and demonstrations across the country. For years the virus was spread in the former Soviet republic mainly by injection-drug users, but the trend has changed. Since 2008, more Ukrainians have been contracting the virus through heterosexual sex than through drug abuse.
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SERGEI SUPINSKY/AFP/GE T T Y IMAGES
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Sending a Message Tanzanian HIVer Fortunata Kasege and her daughter, Florida Mwesiga, use 1,000 balloons to highlight the number of children born with HIV worldwide every day. The two are part of advocacy group One Campaign’s
effort to remind world leaders—who were gathered at the U.N. in New York City in late September to discuss the Millennium Development Goals—of their pledge to ensure that no child is born with HIV by 2015.
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GARY HE/AP IMAGES FOR ONE CAMPAIGN
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WORLD AIDS DAY 2010
On the verge of the year that will mark 30 years since the ﬁrst cases of AIDS were identiﬁed, HIV Plus takes this World AIDS Day—observed on December 1 each year since 1988—to take a look at the effects one microscopic virus has made in three short decades. While by their very nature statistics are cold facts, we urge you in the spirit of World AIDS Day to take the opportunity to raise awareness about HIV, commemorate the people who’ve been lost, yet still celebrate the victories achieved in this battle
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h An estimated 33.4 million people worldwide are now living with HIV. In the United States there are approximately 1.1 million people living with the virus. h It’s estimated that 2.7 million people were newly infected with the virus in 2008, the most recent year for which statistics are available. That’s just under 7,400 people who contracted HIV every day. Roughly 56,300 of those new infections occur annually in the United States. h Since the beginning of the pandemic, almost 60 million people worldwide have been infected with HIV and 25 million people have died of AIDS-related causes. There were roughly 2 million AIDSrelated deaths in 2008 alone. h Globally, a third of people living with HIV are coinfected with TB. Tuberculosis is a leading cause of death among people living with HIV and yet is mostly curable and preventable. h Globally, men who have sex with men are 19 times more likely to be infected with HIV than the general population. Men who have sex with men accounted for 53% of all HIV cases diagnosed in 2006. A third of these men were younger than 30. h African-Americans accounted for 46% of new HIV infections diagnosed in 2006, although they represent only 12% of the U.S. population. h The number of HIV-infected women has increased so rapidly over the past three decades that, worldwide, women now make up half of all people living with HIV. The number of women living with HIV in the United States has tripled in the past two decades. h Around the world, the percentage of HIV-positive pregnant women who received treatment to prevent transmission of the virus to their child increased from 33% in 2007 to 45% in 2008. h In 2008 around 430,000 children were born with HIV, bringing to 2.1 million the total number of children under 15 living with the virus. h Young people account for about 40% of all new adult (older than 15) HIV infections worldwide. h Less than 40% of young people have basic information about HIV, and less than 40% of people worldwide living with HIV know their serostatus. h The number of new HIV infections continues to outstrip the number of people on treatment—for every two people starting treatment, a further ﬁve become infected with the virus. h The region most affected is sub-Saharan Africa, home to 67% of all people living with HIV worldwide and 91% of all new infections among children. In sub-Saharan Africa the epidemic has orphaned more than 14 million children. h Despite considerable progress, global efforts to treat HIVers remain insufﬁcient. Only 42% of people in need of antiretroviral medications in 2008 had access—but that’s compared to 35% in 2007. h More than 4 million people in low- and middle-income countries had access to HIV treatment at the end of 2008, up from only 3 million who had access at the end of 2007—a 36% increase in one year and a 10-fold increase over ﬁve years. h Only 38% of children in need of treatment in low-and middle-income countries in 2008 received it. h An estimated 700,000 people received treatment in high-income countries in 2008, bringing the global total for those who had access to 4.7 million people. SOURCES: UNAIDS, “AIDS EPIDEMIC UPDATE, 2009”; UNAIDS, “TOWARDS UNIVERSAL ACCESS: SCALING UP PRIORITY HIV/AIDS INTERVENTIONS IN THE HEALTH SECTOR: PROGRESS REPORT 2009”; WHO/UNAIDS/UNICEF, SEPTEMBER 2009; U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION; “AMFAR, MSM, HIV, AND THE ROAD TO UNIVERSAL ACCESS—HOW FAR HAVE WE COME?” AUGUST 2008
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GLOBAL SNAPSHOT: The Joint United Nations Programme on HIV/AIDS estimates that the total population living with the virus has reached between 31.1 million and 35.8 million and that there were between 2.4 million and 3 million new infections in 2008. The positive news is that the number of new infections is down by nearly half from four years ago
Wester West ern n& Cent Ce ntra rall Eu Euro r p pee
Tot l HIV ca Total cases: 850,000 New in infec fectio tions: 30,000 AIDS-r AID S ela e ted deaths: 13,000
Total HIV cases: 1.4 million New infections: 55,000 AIDS-related deaths: 25,000
C riibb Ca bbea ean n Total HIV cases cases:: 240 240,00 ,000 0 New infec ecttioons: 20, 20,000 000 AIDS-rela latedd de death aths: s 12, 12,000 000
Latin America Total HIV cases: 2 million Ne infections: 170,000 New AIDS-related deaths: 77,000 000 00 0
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WORLD AIDS DAY 2010
Eastern Europe p & Central Asia Total HIV cases: 1.5 million New infections: 110,000 AIDS-related deaths: 87,000
Middle Eastt & North Afri riica ca Total HIV cases: 310,00 ,0 00 0 00 New infections: 35,000 00 0 AIDS-related deaths: 20,000 000 00 00 0 0
Sub-Saharan Africa Total HIV cases: 22.4 4 million New infections: 1.9 mi million AIDS-related deaths: 1.4 million on n
East Asia Total HIV cases: 850,00 00 00 New infections: 75,000 AIDS-related deaths: 59 59, 9,,000 9 00
South & Southeast Asia Total all HIV H cases: 3.8 million New N e in nfe fec e tions: 280,00 00 00 AIDS-relaated t deaths: 27 27 70,00 0 0
Occea O ceeaaani nia ni Total HIV caasess: 59, 59 9 000 0 New infecctioons: 3,900 0 AIDS-related ted deeath aths: s:: 2, 2, 00 2,0
SOURCE: UNAIDS, “AIDS EPIDEMIC UPDATE, 2009”
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Art OF AIDS THE
Ahead of World AIDS Day and the corresponding Day With(out) Art, HIV Plus takes a look at the art, in its variety of forms, that has been created in the name of this virus. From emotional and physical therapeutic efforts to the outright documentation of the AIDS crisis, we had no idea when we started this project of just how immense the body of works had grown. And while we were barely able to scratch the surface here in these pages, we are gratefulâ€”and awedâ€”that there is not only a universe of creativity that speaks of the past three decades of struggle, of success, and yes, of loss, but also an army that is growing to preserve this history.
IMAGES © JOE AVERAGE INC. REPRODUCED WITH PERMISSION OF THE ARTIST. ALL RIGHTS RESER VED. W W W.JOEAVERAGE.CA
WHEN VISUAL ARTIST Joe Average was sitting with a doctor in Vancouver, Canada, at the age of 27 in 1985, he says when he asked what the diagnosis meant he was told, “You could last six months. You could last a year, ﬁve years, 10 years, or forever. We just don’t know.” His response: “I’ll choose forever.” And 25 years after that conversation, he is still going. A few years later, after being let go from “a crappy job,” he says, he decided to make an eﬀort to make a living as an artist. Since art had been part of his life since childhood, it made sense. “I started making art and having little shows in my apartment,” he told The Positive Side in 2005. “I priced things according to my rent so that if I sold a piece, I could pay a month’s rent. HIV saved my life in that I decided to make art my life.” The work that Average went on to produce—much of it infused with HIV-related themes—garnered critical acclaim and has even been sought out by celebs and royalty. In fact, he’s been credited with having given a face to AIDS in Canada when in 1991 he created the ﬁrst national HIV awareness poster. He created British Columbia’s annual AIDS walk poster each year for more than a decade, and one of his existing pieces was requested for use as the symbolic artwork for the XI International AIDS Conference when the biennial meeting was held in Vancouver—although he did decide it was important to rework the piece specially for the IAC. The image also became Canada’s ﬁrst AIDS-themed postage stamp.
My Thinking Cap, 1997: This piece (above) is a bald head with the brain sectioned out like diagrams of cuts of meat, says Average (above, top), and each section has different words like hope, love, courage, sex—what’s in the forefront of your brain to keep you going. The person has no nose; instead the pills 3TC, d4T, and AZT are strapped to the head like a nose. One World, One Hope, 1994: This image (opposite page) was for the XI International AIDS Conference in Vancouver in 1996. The conference organizers asked if they could reprint the image I did in 1991 that became Canada’s ﬁrst AIDS awareness poster, Average says. I said I wanted to rework it. The ﬁrst image was just different faces, different people, and there was a heart in the center to suggest that we’re all joined together as a race—because we are—and to get through this we have to do it with love and compassion. When I reworked it, I decided to change it into stained glass to show the fragility of humankind, the face of AIDS, and that we are all connected. I kept the heart in the center.
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POIGNANT METAPHOR took the traditions of New York’s bohemian art scene and spun them into pop culture. All along, artist Marguerite Van Cook has remained true to the spirit of the underground and carried on those splendid visions of the avantgarde. Indeed, she has lived, so to speak. As central ﬁgures in the East Village artistic community, she and husband James Romberger survived and thrived at the epicenter of the New York City AIDS crisis of the 1980s. Trained as an artist in her native England, Van Cook says she had an intellectual curiosity and yearning for public forms of expression that have propelled her to try on various colorful hats. Her band, the Innocents, once toured with the Clash. After Sid Vicious killed his girlfriend, Nancy Spungen, in the Chelsea Hotel in 1978, the Sex Pistols front man called her house to look for his manager. A few days later the Innocents and some of the Clash, she says, “played the gig that was like the Sid Vicious defense,” a beneﬁt concert for his defense fund. In addition to producing their own work, she and Romberger ran the Ground Zero art gallery in the East Village in the mid 1980s, and the two of them have curated together over the years. More recently she ran New York City’s Howl Festival, the ad hoc tradition that keeps alive the spirit of beat poet Allen Ginsberg’s revolutionary 1955 poem. She also completed a bachelor’s degree in English at Columbia University and has gone on to master’s work in European studies at the university. The 1980s were so traumatic, she says, that she found it “almost impossible not to make art” about AIDS. Her most HIV-speciﬁc work was a collaborative eﬀort between her, her husband, and renegade HIV-positive artist David Wojnarowicz: a three-part comic book called Seven Miles a Second. Wojnarowicz, a former child street hustler whose provocative work was held up by conservatives as an example of why the U.S. government should cut funding to the National Endowment for the Arts, died of AIDS-related complications in 1992. Afterward, Van Cook and Romberger took Wojnarowicz’s diaries, which chronicled his death, and used them for the story of the series’ ﬁnal installment. She and Romberger learned of their own respective HIV infections in 1997. They have a 25-year-old son, who is HIV-negative. After her diagnosis, Van Cook says she suﬀered through seven years of often poor health, including a bout of meningitis, the need for a hysterectomy, and complications from hepatitis C coinfection. Today, she has found inspiration, both for her own physical perseverance and for her artistic vision, in her community gardening eﬀorts. “I was watching these things grown and just hanging on,” she says. “It was the idea that if I could live through this bulb cycle, I can get through this.” She’s also examined the physical changes HIV and antiretroviral treatment has brought onto her body—through an exploration of amphibians, which she feels serve as a poignant metaphor. “This disease changes you and you’re in between two worlds, more or less,” she says. “Because there is a really strange sensation to being in a diﬀerent place to those people who are healthy. You start to live in this very amorphous condition. So I made these images of women as frogs: growing ﬂippers and tails. Because your body really does change. And it is really diﬃcult to cope with.” At the end of the day Van Cook is a dyed-in-the-wool social activ-
FIFTEEN YEARS AGO THE MUSICAL RENT
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Van Cook’s (from top) Blossom, Frog Girl, and Candelabra: The artist (opposite page) ﬁnds some of her inspiration in her community gardening efforts as well as in the physical changes that HIV and antiretroviral treatment have brought to her body.
ist but “always with a twist, if possible,” she says. “I’ve always tried to keep a fabulous edge to it!” After reading recently released data from the U.S. Centers for Disease Control and Prevention on the high prevalence of HIV among urban gay men, she felt the age-old call to action. “I’m horriﬁed. It’s terrifying,” she says. “I feel personally delinquent. I should’ve been back out in the trenches. I’m already thinking, What’s the slogan that goes on the street now?” —Benjamin Ryan
A MAN REMADE TERRENCE GORE ’ S RÉSUMÉ
is a collage of his diverse interests. The 46-year-old Philadelphia native has worked as a hairstylist with models and celebrities, he’s excelled in interior design, he’s curated gallery shows and sold artwork by well-known AfricanAmerican artists like Allen Stringfellow and Frank Louissaint, he’s studied modern dance, and to top it all oﬀ he’s accomplished in the culinary arts. An insatiable curiosity has taken him and a pair of trusty Rollerblades to the four corners of the globe, where he’s sped through various cultures and picked up many varied treasures along the way. “I just gained more and more momentum, becoming inspired with beauty,” he says of his peripatetic days, “whether with a singlepanel painting or a building or a person dressed nicely.” Then suddenly it seemed all his rich aesthetic pursuits—and quite possibly his life as well—would come to an end. In 2005 he was in a dance class when he felt a numbness in the big toe of his right foot. The numbness spread over the right side of his body and aﬀected his vision. He was soon diagnosed HIV-positive, and subsequent tests showed he was suﬀering from a typically fatal nervedegeneration disorder known as progressive multifocal leukoencephalopathy. A biopsy identiﬁed a lesion on the left hemisphere of his brain that has caused widespread numbness and paralysis on the right side of his body to this day. Initially given a short time to live, he was in the hospital for a year and a half and spent nine days in a coma. But he managed to speed by the stop sign before him, Rollerblades or not. When Gore was well enough, a friend took him some art supplies. Using his left hand (Gore is right-handed), he began to experiment with watercolors. Now living on disability, he’s remade himself as a ﬁne artist and, in doing so, has found his voice. HIV, he says, is the best thing that ever happened to him. “It appeared that I had everything in the past: traveling the world, being able to acquire whatever I wanted. But there was some sort of void inside me. I just decided that once I came out of the coma and I realized that I was alive, I asked God, ‘What is it for me to do?’” Gore has devoted much of his work to collages, in which he brings elements of his travels home to his canvas. The very act of
My goal for A Look Into My Past, 2007 (opposite page) was an interpretation of my exploring the past, present, and future—the ignorance and disproportion of racism and classism as it relates to HIV infection, says Gore (self-portrait above and on our cover). The black-and-white maze exempliﬁes the confusion and stigma associated with the disease process. Both the Maasai tribe of Kenya and Tanzania as well as artist Keith Haring, who died of AIDS, are some of my inspiration for creating this piece.
artistic creation, he says, in turn communicates the hopeful message of his survival to others. In addition, his dedication to juicing and homeopathic herbs as a source of rejuvenation lends an added beneﬁt to his work; he often takes skins of fruits he’s consumed— like a banana or mango—preserves them, and applies them to his artwork so that they resemble, for example, human skin. “There isn’t anything that goes to waste,” he says.
“Everything has a new life, even after it’s consumed.” His own new life as an artist, he says, provides not just occupational and physical therapy, but an emotional and spiritual release as well. “I think we’re all going to die from living, ultimately,” he says. “And if in fact I die from PML, or whatever, I still have to live well. I have to do what I can right now. That’s why I live my best life.” —Benjamin Ryan
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SAVING HISTORY is an organization that campaigns for HIV prevention and AIDS awareness through producing visual art projects, while also assisting artists who are living with HIV. One of its major functions is to preserve the work of HIVpositive artists as well as the artistic contributions of the AIDS movement through its repository of images of all types of pieces created by HIVers over the years so that their legacy is not lost. Working to turn attention to the often overlooked females who are aﬀected by HIV, a section of the agency’s website, Women of Visual AIDS, pays tribute to those who’ve incorporated their HIV status into their works. And each January the agency holds the Postcards From the Edge fund-raiser, in which the public can purchase one-of-akind creations on postcards. The creative twist to the beneﬁt is that when a buyer selects a purchase from the several hundred available, no one knows until after the transaction is complete if it was created by one of the many HIVers represented by the agency or by a celebrity. And unlike in earlier years, buyers can even do their shopping for the postcards online now. VISUAL AIDS
A Wishful Gargoyle, 2001 by Rene Capone is one of the images preserved in the Visual AIDS catalog.
IN YOUR FACE YOU ’ LL FIND THEM HANGING IN BARS AND CLUBS ,
displayed on bus stops and subway platforms, and even warning you from magazine pages and billboards. Wherever you go, it seems, they’re in your face. And there’s a reason for that. They’re public-service ads that warn you about drug and alcohol abuse, communicating with your intimate partners, and protecting yourself from a range of sexually transmitted diseases—but all with the goal of keeping HIV infections down. Whether promoting smart decisions so that readers don’t become the newest statistics, HIVers who don’t know what might be going on in their own bodies get tested, or moms get the prenatal care and medication they need to help keep their unborn children from becoming infected, eﬀorts toward prevention and care have created a whole spectrum of work—some of which truly must be called art— for a world on the go.
A WISHFUL GARGOYLE COURTESY OF VISUAL AIDS; GUERRA COURTESY OF LIFE TIME T V
FABRIC OF OUR LIVES BACK IN 2007 Jack Mackenroth kept no secrets about the fact that he is HIVpositive while he was a contestant on Project Runway. But even after his run on the show was cut short before the season’s end because of health reasons, the star continues to shine. In the fall of 2008 Mackenroth put his two decades of experience of life with the virus to work when he helped launch the Living Positive by Design project with drugmaker Merck. As the face of the campaign, he travels around the country talking about dispelling the myths that bolster the stigma surrounding people who are HIV-positive. This year Mackenroth completed a Living Positive by Design panel for the AIDS Memorial Quilt. (The quilt, started in 1985, incorporates panels contributed by family and friends of people lost to AIDS; it’s reported to be the largest piece of community art in existence, weighing in altogether at an estimated 54 tons.) The quilt panel completed by Mackenroth is composed of several smaller designs created by people he’s met while traveling the country on his outreach eﬀorts. And Project Runway was back in the HIV news spotlight again in October, when contestant Mondo Guerra designed a fabric pattern that incorporated a plus sign. “This print is also just symbolism for who I am now,” he explained to the judges during deliberations. “It’s just very, very personal, and it tells a story.” But real-
izing he left the judges puzzled by not explaining more, he eventually decided on air to share that the symbolism was his own 10-year journey of being HIVpositive. The plus-symbol fabric pattern and his design that incorporated it won him that week’s challenge, and at press time, Guerra was a front runner to take the top designer prize.
Making It Work: Designer Mondo Guerra—who revealed on season 8 of Project Runway that he has been HIV-positive for 10 years—begins one of the shows fashion challenges.
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HOME MOVIE FILMMAKER IRA SACHS ’ S 2010 documentary short, Last Address, presents a look at a set of creative individuals who’ve been lost to AIDS. In roughly eight minutes of footage, the ﬁlm moves from street view to street view of 20-plus New York City houses and apartment buildings where artists, writers, and performers lived when they died—their last address. Yet with little more than the ambient sounds of the city and the names and addresses of the lost superimposed on frames, the ﬁlm is riveting. Among the sites visited are the former homes of Keith Haring, Robert Mapplethorpe, Vito Russo, David Wojnarowicz, Assotto Saint, and Reinaldo Arenas. With all of the individuals whose homes are shown having died from 1983 to 2007, Sachs has memorialized in a quiet, beautiful way, as he describes it, “the disappearance of a generation.”
Last Address, 2010: The documentary short by ﬁlmmaker Ira Sachs (at right) visits the ﬁnal homes in New York City of a generation of famed creative individuals who died of AIDSrelated complications.
part of the Alliance for the Arts, works to not only preserve and document a variety of works of art—visual, ﬁlm and video, musical scores, dances, and manuscripts—by HIV-positive artists as a cultural legacy of the AIDS crisis but also to provide ﬁnancial planning to artists. The organization is currently working on projects that include an iniative for preserving works associated with live theater performances as well as creating a National Registry of Artists With AIDS.
THROUGH WHAT IT CALLS
THE ESTATE PROJECT FOR ARTISTS WITH AIDS
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the “intersection of advocacy, art, community, and spirit,” the HIV Law Project has been holding an annual exhibition and silent auction of works of contemporary artists in order to raise money to help the agency provide service to disadvantaged and low-income HIVers. At this year’s event, to be held November 4, there will be 18 works of art up for auction.
COLOR BLIND for Play Me, I’m Yours—an installation of pianos on city streets and in public buildings across the globe “for the public to enjoy,” including 60 placed throughout all ﬁve boroughs of New York this year—British artist Luke Jerram is all about sculptures, installations, and live art projects that he hopes excite and inspire people, that he says “explore the edge of perception.” And that’s precisely the motivation behind his creation of transparent glass sculptures of microbes that are having a major eﬀect on our planet, including an HIV cell (below). Jerram believes there’s a need to contemplate the global impact of each disease and to consider how the artiﬁcial coloring of scientiﬁc imagery aﬀects our understanding of phenomena. The question of pseudocoloring in biomedicine, he says, and its use PERHAPS BEST KNOWN STATESIDE
for communicating science is a vast and complex subject. “If some images are colored for scientiﬁc purposes,” he asks, “and others are altered simply for aesthetic reasons, how can a viewer tell the difference? How many people believe viruses are brightly colored? Are there any color conventions, and what kind of ‘presence’ do pseudocoloured images have that ‘naturally’ colored specimens don’t? How does the choice of diﬀerent colours aﬀect their reception?” Working with virologists from the University of Bristol, Jerram used a combination of scientiﬁc microscopic photos and models to create his works—including swine ﬂu, smallpox, and SARS viruses as well as an untitled future mutation—and now images of Jerram’s color-free art are being distributed as alternative representations of each virus.
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HAART BEATS T R E AT M E N T A N D R E S E A R C H N E W S
SEMINAL CHANGE In a potential clue about transmission, researchers ﬁnd that HIV may undergo important changes in a man’s genital tract
I V M IGH T U N DE R GO changes in the genital tract that make the HIV-1 strain in semen different from what it is when it’s in the bloodstream, according to a study led by researchers from the University of North Carolina at Chapel Hill. Worldwide, much of the transmission of HIV-1 is through sexual contact, men being the transmitting partner in the majority of cases. The new findings are significant because the nature of the virus in the male genital tract is of central importance to understanding the transmission process and the selective pressures that might affect the transmitted virus. Ultimately, it is the transmitted virus that must be blocked by a vaccine or microbicide. “If everything we know about HIV is based on the virus that is in the blood— when in fact the virus in the semen can evolve to be different—it may be that we have an incomplete view of what is going on in the transmission of the virus,” says Ronald Swanstrom, Ph.D., a professor of biochemistry and biophysics and of microbiology and immunology at the UNC School of Medicine. In the study, published in August in the online journal PLoS Pathogens, Swanstrom and his colleagues compared viral populations in blood and semen samples collected from 16 men with chronic HIV-1 infection. Using single genome sequencing, they analyzed the gene coding for the major env protein, located on the surface of the virus, in the samples. The differences between the viruses from the two sources were striking, Swanstrom says. “The sequence differences between the blood and the semen were like a flashing red light; it was a big hint about the biology of virus in the seminal tract,” he explains. “In some men the virus population in semen was similar to that in the
blood, suggesting that virus was being imported from the blood into the genital tract and not being generated locally in the genital tract. However, we found two mechanisms that significantly altered the virus population in the semen, showing that virus can grow in the seminal tract in two different ways.” In the first, he says, one to several viruses are rapidly expanded over a short period of time so that the viral population is relatively homogeneous compared to the complex population in the blood. In the second the virus replicates in T cells in the seminal tract over a long period of time, creating a separate population of virus that is both complex and distinct from the virus in the blood. To find out why these mechanisms are at play, the researchers then measured the levels of 19 cytokines and chemokines— proteins secreted by cells that control the immune system—in both the blood and semen samples. They discovered a significant concentration of these immunesystem modulators in the semen relative to the blood, which could boost viral replication by creating an environment where target cells are kept in an activated state. Swanstrom’s laboratory is now exploring whether evolutionary selection for some special property of the virus is occurring in the seminal tract that does not happen in the blood. “While [we don’t know] how these differences change the biology of the virus or if these changes are important for the transmission process,” study author Jeffrey Anderson says, “it is clear that the virus in the blood does not always represent the virus at the site of transmission.” Knowing how the virus in the semen is different, the researchers say, could be an important part of understanding the puzzle of how HIV is transmitted.
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EARLY HIV TREATMENT HELPS TO FIGHT OTHER DISEASES
Researchers say they have discovered how HIV-1 is able to achieve resistance to AZT, a nucleoside reverse transcriptase inhibitor that was the ﬁrst approved antiretroviral. They say their ﬁndings, reported in Nature Structural & Molecular Biology, could lead to an understanding of how other anti-HIV meds eventually fail. Two drugs, decitabine and gemcitabine, that are currently used in precancer and cancer therapy, have been successful in mice in eliminating HIV infection by causing the virus to mutate itself to death, according to research published in the Journal of Virology. The drugs did not cause toxic side effects, and since both are already approved by the federal Food and Drug Administration, the researchers hope it will be easier to expedite research in humans.
groups of HIV-infected men responded to inﬂuenza vaccination at the start of the study and one year after beginning treatment. At the one-year point a signiﬁcantly greater proportion of B cells made anti-inﬂuenza antibodies in the early treat-
ment group compared with the late treatment group. This suggests that starting therapy early in the course of HIV infection enables individuals to ﬁght oﬀ other pathogens better than if they start it later, when the infection has become chronic.
DEVELOPMENTS IN MEDICAL STUDIES
ed men was signiﬁcantly lower than the number of B cells in the blood of the uninfected men. Once the two groups of HIV-infected men began treatment, however, the number of B cells in their blood increased signiﬁcantly and to similar degrees. However, the composition of B cells in the two groups of HIV-infected men diﬀered notably throughout the study. Scientists say early treatment restored resting memory B cells to the same level as that in HIV-uninfected men, but late treatment did not. Resting memory B cells remember how to make antibodies to a pathogen and can last a lifetime. Early treatment also reduced the proportion of immature B cells to the same level as that in HIV-uninfected men, but late treatment did not. In addition, after one year the late-treatment group had a signiﬁcantly greater proportion of so-called exhausted B cells—those that have shut themselves oﬀ and resist doing their usual pathogen-ﬁghting activities—compared with the other two groups of participants. To check their immune responses, the team examined how the two
Clinical trial data demonstrate that experimental anti-HIV drug KP-1461, from Koronis Pharmaceuticals, resulted in increased HIV mutations consistent with Viral Decay Acceleration. VDA is a mechanism used by a new class of drugs that, unlike other antiretrovirals, selectively disrupt the HIV genome and increase its rate of mutation to lethal levels for the virus, eventually causing the collapse of the viral population.
Beech Tree Labs has announced initiation of a Phase I/IIa clinical evaluation of its novel therapeutic agent for treating recurrent oral herpes infections.
HIV-infected children in South Africa who were exposed to the drug nevirapine at birth to help prevent motherto-child transmission and then received
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a protease inhibitor for viral suppression achieved lower rates of viremia if they were switched to nevirapine, compared to children who continued on the PI-based regimen, according to a study in the September 8 issue of The Journal of the American Medical Association.
Pﬁzer has entered into an agreement with Katholieke Universiteit Leuven in Belgium to develop compounds called ledgins, which have been shown to inhibit the interaction between HIV integrase and the cellular protein LEDGF/p75, in an effort to create a new class of antiretroviral that blocks HIV without cross-resistance with existing anti-HIV meds.
Researchers at the University of Pittsburgh are developing a quick-dissolving vaginal microbicide ﬁlm (similar to
those that deliver breath fresheners) that contains a drug that reduces the risk of HIV infection. Unlike gels, the researchers say, the ﬁlm would not require refrigeration and could release the drug faster and more efﬁciently.
A new study conducted by the AIDS Healthcare Foundation is looking at the role probiotics might play in increasing CD4-cell counts in HIVers.
In a double-blind trial published in PLoS Medicine, researchers report they could detect no signiﬁcant reduction in viral load after people with low-level HIV viremia had the integrase inhibitor raltegravir added to their regular treatment regimen. The researchers say their ﬁndings suggest that residual viremia might be due to the release of HIV from stable reservoirs.
JUPITER IMAGES/POLKA DOT/THINKSTOCK
HIVers who begin antiretroviral therapy soon after acquiring the virus may have stronger immune responses to other pathogens than infected individuals who begin treatment later, a new study from the National Institutes of Health has found. This ﬁnding suggests that early initiation of treatment may prevent irreversible immune system damage and adds to the body of evidence showing signiﬁcant health beneﬁts from early antiretroviral therapy. Scientists from the National Institute of Allergy and Infectious Diseases measured the quantity and qualities of B cells in blood samples taken from three groups of study volunteers: men who had been infected with HIV for less than six months, men who had been infected with HIV for six months or more (often for several years), and men who were not infected with HIV. The HIV-infected men began taking antiretroviral meds for the ﬁrst time once they entered the study. At the outset of the study the number of B cells (which make antibodies against pathogens) in the blood of both groups of HIV-infect-
HAART BEATS LACK OF FUNDS STALLS PROMISING MICROBICIDE Despite very promising results earlier this year from a microbicide candidate, donors have not committed enough money for further research needed to conﬁrm the efﬁcacy of the vaginal gel to prevent HIV transmission in women. Only about $58 million of the $100 million needed for two follow-up studies has been pledged, according to the Joint United Nations Programme on HIV/AIDS, and that would not be enough money for even one trial. The original study of the gel, reported at the International AIDS Conference in July, found that women who used it before and after sex were 39% less likely to become infected with HIV compared with women who used a placebo. And women who used the
gel most regularly reduced their risk of infection by 54%. Researchers had planned to lead one study in South Africa, where about 5.7 million people are HIV-positive, and a second in ﬁve other southern African nations. But potential donors have shifted their global health goals away from HIV toward other issues and tightened their budgets. The U.S. and South African governments have pledged a majority of the money so far, while the British Department for International Development has committed nothing. Ofﬁcials with the British agency, which had been a major supporter of microbicide research, say its government’s current priorities are maternal and child health, malaria, and tuberculosis.
Researchers are also concerned that the Bill and Melinda Gates Foundation has not committed major funding for the trials, despite being one of the largest philanthropic supporters of microbicide research. Stefano Bertozzi, head of the foundation’s AIDS programs, says the foundation was excited about the results of the ﬁrst trials but plans to focus on riskier, longer-term research. Public health advocates say that any delay in starting the trials could be deadly. A majority of the 22 million people living with HIV in subSaharan Africa are women, and an effective microbicide could protect women whose partners refuse to use condoms.
A GREATER NEED—FOR WOMEN There are no signiﬁcant gender-based differences in response to some anti-HIV drugs, according to a new study published September 21 in the Annals of Internal Medicine, and this demonstrates that it is possible to recruit large numbers of women into a clinical trial evaluating treatments for HIV infection. At the same time, though, the report also revealed that women dropped out of the Gender, Race, and Clinical Experience study at higher rates than men for reasons other than drug failure. This shows a need, the study’s authors conclude, for more effort to retain women in clinical trials that shed important light on the effectiveness of drugs in devel-
MICROBICIDE BY SAMUEL KUBANI/AFP/GE T T Y IMAGES; COUPLE BY HEMERA TECHNOLOGIES/THINKSTOCK
opment or those already on the market.
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MIND+MOOD BY GA RY McCL A I N, P h. D .
ALL THE RAGE If feelings of anger come up often in your life, it’s time to put in the effort to ﬁnd out what you are really getting so mad about
ET ME TELL YOU how angry I was. I went oﬀ !” I don’t think a day goes by when I don’t encounter someone using similar words—my clients, people I pass on the street, somebody in the media. A lot of people have something to be angry about, and they are feeling justiﬁed in making sure everybody else knows. Let’s be honest, though. Who doesn’t get mad sometimes? Anger is an emotion, and like any emotion, you can hold it in for only so long. Sooner or later it gets expressed, for better or worse. The longer you hold it in, the more likely it will come out at the wrong time—and with more force than you probably intend for it to. We’ve all been there. Anger can be a positive emotion. It can motivate you to cry out against injustice, protect someone in need, and change your life for the better. So I am not suggesting that you shouldn’t get mad. But expressing anger—as well as holding it in—can drive a wedge between you and the people you care about. In addition, anger releases stress chemicals that can have a negative impact on your health. Not always sure what to do with your anger? The next time you ﬁnd you’re about to boil over, consider an alternative approach to handling the situation. hBreathe! Listen to yourself as you inhale and exhale a few times. Breathing helps you regain your rational mind when you’re about to be overwhelmed with a rush of emotions. Breathing can have a great calming eﬀect. hTurn on the camera. Mentally take yourself out of the action for a moment and imagine that you are watching yourself in a movie. How is your acting? You may be right in sync with the other actors, or you may be chewing up the scenery when a calmer response—or no response at all— might be called for. And by the way, you know yourself better than anybody. Are you acting in or out of character?
hAsk yourself, Have I been here before? Chances are, you have. Maybe it was last week, last year, 20 years ago, that time you were disrespected or punished unfairly or bullied or your needs weren’t met. If you couldn’t do anything to protect yourself in the moment, how did you feel? While you’re safely behind the camera, ask yourself, Did somebody just push a button that brought all those feelings back for me? hLean into the angry feelings and get out of the story. This is the hard part. Stop telling yourself the story (“He should have done this.” “I should do that back.”) and let yourself feel your emotions. All of them. Identify them as they come up. While it probably feels a whole lot better to be empowered and energized by rage (therapists love that word), your anger may be covering up uncomfortable feelings like sadness, fear, or disappointment. Or the anger you’re feeling right now may be a stand-in for a pain in your past that you’re still angry about but can’t go back and ﬁx. In other words, the real battle may be the one inside of you. hJump back into the action with a new perspective. Yes, I understand that in the midst of a tense situation it seems impossible to go into observer mode. But what about those times when you could—but don’t—stop yourself from ﬁring oﬀ an angry e-mail or calling someone up to unleash the demons? Through practice, you can train your mind to think and get perspective on a situation before you react—or not even feel the need to react at all. It’s worth a try. As you look at your anger, don’t be afraid to reach out for help in getting a new perspective on the old issues and feelings that keep popping up. Open up to what’s possible in the here and now. McClain 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.
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PERFECTLY FLAWED BY C OR E Y SAU CI E R
MEASURABLE DANGER When it comes to love and relationships, perhaps HIV isn’t the always the scariest thing in the room
BRAND X PIC TURES/THINKSTOCK
Y P U B L I S H E R A S K E D M E to “write about something other than Jesus for a change,” and rather than tell him to go fuck himself, I thought I’d do the Christian thing and be humble and kind. So instead, I asked him, “What would you like me to write about?” He suggested I spend some time on “love and the pursuit of happiness regardless of status.” I thought that was a beautiful and noble subject—with which I have lots of experience. Who better to talk about living in a healthy, loving, long-term, partnered HIVpositive relationship than me? So here goes… Last week I broke up with my boyfriend. He said he was “scared.” This, now, is me breathing deeply to compose my darker emotions. This is me resigning myself to being single again and to the indeterminate time of loneliness that comes with it. And this is me sagely relegating the year of oﬀ-again, on-again pseudo-relationship stagnation to a lesson well-learned. I guess I should be heartbroken or angry or forlorn. And I am. But not over him; it has very little to do with him. He’s just the person I decided to hitch my wagon to, and I knew better. I’m kind of pissed at myself. I played the martyr. I played the benevolent HIV-positive partner willing to compromise and concede on behalf of someone who was ill-equipped, incapable, and terriﬁed to engage in the type of emotionally mature relationship that I required. He was unwilling to risk falling in love with me because he didn’t quite know what it might entail—or if he would be up for the challenge. I think I forget that for some people, being in a relationship with me represents a real and measurable danger. And I’m not talking about HIV. HIV is never the issue—no more than my having green eyes, being unable to watch
violent blockbuster ﬁlms, or having a propensity for public displays of aﬀection is an issue. Relationships are complicated and diﬃcult; they are fragile and rare. And any number of things could be the reason why two inﬁnitely diﬀerent strangers might not work out as a couple. In my experience HIV has never weighed any heavier than my race, economic standing, age, education, dick size, intellectual capacity, or religious aﬃliation. HIV is just one out of a thousand reasons why the precariously sensitive balance of a relationship may topple over and crumble into rubble at one’s feet. He is HIV-positive too, newly diagnosed. I think I was the place where he learned to get his conﬁdence back. Where he learned that someone could accept him, disease and all. Where he practiced playing the role of boyfriend and not just anonymous fuck-buddy friend. Where we ﬂeshed out the idea that the true virus is solitude—that loneliness is the pathogen that makes strangers reach for strangers without protection or guard, hoping against hope to ﬁnd connection on any level. And because so many of us are alone, there will always be others who are also alone to ﬁnd. Yet if we are willing to be vulnerable and risk the small—but very real—chance that the world will stop spinning on its axis, then perhaps that one special person will be brave enough to accept us…regardless. Because the alternative is worse. No one wants to be alone. And so here I am—alone again, a victim of the lonely, searching for another soul who I can help feel less alone, just doing my best… to be continued… Saucier is a writer, blogger, and performance artist based in Los Angeles. Find more of his writing online via our website.
NOV EMBER / DECEMBER 2010 HI V PLUS
ASK & TELL Q & A W I T H V I C TO R M O O N EY
Queens, N.Y.’er Victor Mooney will launch an attempt on World AIDS Day, December 1, to solo a rowboat from the east coast of Africa to Brooklyn in a mission to raise HIV awareness and funding for AIDS research. Mooney’s ﬁrst two attempts at the transatlantic crossing, dubbed the Gorée Challenge, failed. In May 2006 the craft he constructed in his garage was unknowingly damaged at launch and sank after only a few hours at sea, and in April 2009 the second eﬀort also required a rescue mission. But neither failure has dampened Mooney’s enthusiasm. Now at 45, with a high-tech boat donated by a French rower, he says he’s just as committed to the challenge he’s created for himself as we was his ﬁrst time out. —Michael W.E. Edwards
My central focus has always been to increase awareness about HIV prevention and to encourage testing so that people get into care if they need it. The number of new infections diagnosed each year isn’t decreasing, and many people who are infected live unaware of their HIV status until their health reaches a critical point. With your earlier attempts ending with some harrowing results, does that give you any second thoughts or heighten your fear now? No. I’ve
dedicated a considerable amount of time and resources for this undertaking—nearly seven years. I’ll make it because I refuse to give up in the ﬁght against AIDS. What’s the route that you plan to travel? I’m departing from São
Vicente, one of the islands of the Republic of Cape Verde. The country spans an archipelago of 15 islands located in the central
Atlantic Ocean. Cape Verde is about 300 miles west of Senegal, [where Gorée Island, the previous launch for the mission, was]. From Cape Verde to Brooklyn, where I’ll complete the trip at the Brooklyn Bridge, is about 5,000 miles. And that’s without any breaks on land? I’m prepared to go nonstop
to Brooklyn; however, if a resupply or any other circumstance is warranted, my support team will direct me to the nearest port of call. As I approach the Caribbean, I’ll head north toward Puerto Rico, then farther west toward the Bahamas, where I’ll enter the Gulf Stream— the strong northward moving ocean current—near Florida and work my way to Brooklyn. How long is all of this going to take?
And how is the fund-raising going?
Our goal is $50,000, and we have reached nearly half of this in pledges. This eﬀort seems to never stop, once you make the decision to go forward. Thanks to over 80 companies that have provided products and services, the cost of this particular undertaking is considerably lower. Without their support, this mission couldn’t proceed.
Six to eight months. Your boat—how technologically advanced is it? It’s not the typical rowboat that might spring to people’s minds, is it? Yeah, that’s
right. On board I’ll have a satellite phone, a wind turbine and solar panels to generate energy, GPS tracking, radar equipment, a computer, VHF radio, and an iPod.
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Is there anything else that you’d like to share with HIV Plus readers? In
Wolof, a traditional language spoken in Senegal and some other African countries, one often hears the phrase “amoul bayi.” It translates as “never give up.” Well, Never Give Up (my boat) and I hope to see you at the Brooklyn Bridge— rain or shine.
“I’ve dedicated a considerable amount of time and resources for this.… I’ll make it because I refuse to give up in the ﬁght against AIDS.”
Check out Mooney’s boat and track his transatlantic progress, at HIVPLUSmag.com
SEYLLOU/AFP/GE T T Y IMAGES
Initially you planned the challenge in honor of your brothers—one who died of AIDS and another who is HIV-positive—and you launched from Gorée Island to highlight the spot where slaves were taken from Africa. Has that focus evolved any?
Updated guidelines* include starting HIV medicines at 500 or less T-cells.
I used to think just eating right would be enough.
Now I know, for me
TREATING HIV SOONER, IS BETTER.
Considering HIV treatment earlier may improve your chances of living a healthier life. Starting HIV medicines when your T-cell count is 500 or less is one of several factors to consider, because it may help preserve your immune system and possibly avoid some long-term complications. Talk to your doctor today about a plan that may lead to a longer, healthier life. TAKE THE NEXT STEP. GO TO
hivtreatmentispower.com * Depar tment of Health and Human Ser vices ( DHHS )
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