Plus 124 May June 2018 by Pride Media

BECAUSE YOU’RE MORE THAN YOUR STATUS

JUST DIAGNOSED? 10 THINGS YOU NEED TO KNOW NOW

PROJECT RUNWAY ’S VIKTOR LUNA IS BACK

THE PROUD, POZ LATINO ON HIS NEW LIFE IN CALIFORNIA

MAY/JUNE 2018 www.hivplusmag.com

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WHAT’S YOUR STORY GOING TO BE? INTRODUCING BIKTARVY® Ask your healthcare provider if BIKTARVY is right for you.

To learn more, visit

BIKTARVY.com Please see Brief Summary of Patient Information with important warnings on the adjacent pages.

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Do not take BIKTARVY if you also take a medicine that contains: ` dofetilide

Brief Summary of Patient Information about BIKTARVY® BIKTARVY (bik-TAR-vee) (bictegravir, emtricitabine, and tenofovir alafenamide) tablets Important: Ask your healthcare provider or pharmacist about medicines that should not be taken with BIKTARVY. For more information, see “What should I tell my healthcare provider before taking BIKTARVY?”

What is the most important information I should know about BIKTARVY? BIKTARVY can cause serious side effects, including: ` Worsening of hepatitis B virus (HBV) infection. If you have an HBV infection and take BIKTARVY, your HBV may get worse (flare-up) if you stop taking BIKTARVY. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. • Do not run out of BIKTARVY. Refill your prescription or talk to your healthcare provider before your BIKTARVY is all gone. • Do not stop taking BIKTARVY without first talking to your healthcare provider. If you stop taking BIKTARVY, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking BIKTARVY. For more information about side effects, see “What are the possible side effects of BIKTARVY?”

What is BIKTARVY? BIKTARVY is a prescription medicine that is used without other anti-HIV-1 medicines to treat Human Immunodeficiency Virus-1 (HIV-1) in adults: ` who have not received anti-HIV-1 medicines in the past, or ` to replace their current anti-HIV-1 medicines for people whose healthcare provider determines that they meet certain requirements. HIV-1 is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).

` rifampin

What should I tell my healthcare provider before taking BIKTARVY? Before taking BIKTARVY, tell your healthcare provider about all your medical conditions, including if you: ` have liver problems, including hepatitis B virus infection ` have kidney 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 during treatment with BIKTARVY. Pregnancy Registry: There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk with your healthcare provider about how you can take part in this registry. ` are breastfeeding or plan to breastfeed. Do not breastfeed if you take BIKTARVY. • You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. • At least one of the medicines in BIKTARVY can pass to your baby in your breast milk. It is not known if the other medicines in BIKTARVY can pass into your breast milk. Talk with your healthcare provider about the best way to feed your baby. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, antacids, laxatives, vitamins, and herbal supplements. Some medicines may interact with BIKTARVY. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. ` You can ask your healthcare provider or pharmacist for a list of medicines that interact with BIKTARVY. ` Do not start a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take BIKTARVY with other medicines. Continued on next page.

BIKTARVY contains the prescription medicines bictegravir, emtricitabine, and tenofovir alafenamide. It is not known if BIKTARVY is safe and effective in children under 18 years of age.

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How should I take BIKTARVY? ` Take BIKTARVY exactly as your healthcare provider tells you to take it. BIKTARVY is taken by itself (not with other HIV-1 medicines) to treat HIV-1 infection. ` Take BIKTARVY 1 time each day with or without food. ` Do not change your dose or stop taking BIKTARVY without first talking with your healthcare provider. Stay under a healthcare provider’s care during treatment with BIKTARVY. ` If you take antacids that contain aluminum, magnesium, or calcium, take BIKTARVY on an empty stomach 2 hours before you take these antacids. ` If you take supplements that contain iron or calcium, take these supplements with food at the same time that you take BIKTARVY. ` Do not miss a dose of BIKTARVY. ` If you take too much BIKTARVY, call your healthcare provider or go to the nearest hospital emergency room right away. ` When your BIKTARVY supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to BIKTARVY and become harder to treat.

What are the possible side effects of BIKTARVY? BIKTARVY may cause serious side effects, including: ` See “What is the most important information I should know about BIKTARVY?” ` Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider right away if you start having any new symptoms after starting your HIV-1 medicine. ` New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys when starting and during treatment with BIKTARVY. Your healthcare provider may tell you to stop taking BIKTARVY if you develop new or worse kidney problems.

What are the possible side effects of BIKTARVY? (continued) ` Too much lactic acid in your blood (lactic acidosis). Too much lactic acid 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. In rare cases, severe liver problems can happen that 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, lightcolored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. The most common side effects of BIKTARVY are diarrhea (6%), nausea (5%), and headache (5%). These are not all the possible side effects of BIKTARVY. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

General information about the safe and effective use of BIKTARVY. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use BIKTARVY for a condition for which it was not prescribed. Do not give BIKTARVY to other people, even if they have the same symptoms you have. It may harm them. This Brief Summary summarizes the most important information about BIKTARVY. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about BIKTARVY that is written for health professionals. For more information, call 1-800-445-3235 or go to www.BIKTARVY.com. Keep BIKTARVY and all medicines out of reach of children. Issued: February 2018 BIKTARVY, the BIKTARVY Logo, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. © 2018 Gilead Sciences, Inc. All rights reserved. BVYC0004 02/18

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IN THIS ISSUE MAY/JUNE 2018

JUST DIAGNOSED? 18

DON'T PANIC If you've just learned you're HIV-positive, you may be freaking out, but you are not alone. We got this.

20 JUST THE FAQS You have lots of questions. Here are the answers to some of the most pressing ones: the good, bad, and ugly. 22

TO INFINITY & BEYOND You asked your doctor how long you had to stay on HIV meds. Now you have to process her answer. Our mental health editor tells you how.

TEN TO ONE 10 ways (beyond taking your meds) to stay healthy while living with HIV.

24 HIGH FIVE 5 treatments to add to your HIV regimen. Some might surprise you.

FEATURES

SHUTTERSTOCK (18, 26)

26 POSITIVELY STARVING What do you do when you have to decide between getting your meds or eating this week?

ON THE COVER 14

LUNA LANDING Project Runway's Viktor Luna was the quiet guy on season nine, but when he returned for Project Runway All Stars he was loud (and proud) about being HIV-positive. Then he withdrew from the public view. Now he's back and ready to take on HIV stigma.

Above left: Viktor Luna photographed by Lendon Flanagan Above, from top: Just diagnosed and full of questions? Food insecurity strikes people with HIV particularly hard. Cover: Project Runway's Viktor Luna is fighting HIV stigma with style. Photo by Alexis Iru.

HIVPLUSMAG.COM

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editor in chief DIANE ANDERSON-MINSHALL • svp, group publisher JOE VALENTINO associate publisher PAIGE POPDAN

creative director RAINE BASCOS deputy editor JACOB ANDERSON-MINSHALL senior editor SAVAS ABADSIDIS managing editor DAVID ARTAVIA associate editor DESIRÉE GUERRERO assistant to the editor DONALD STUART contributing editors KHAFRE ABIF, TYLER CURRY, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writers SAM PAGE, COLE HAYES, BORIS ABRAMS, BENJAMIN M. ADAMS creative director, digital media DAVE JOHNSON interactive art director CHRISTOPHER HARRITY online photo and graphics producer MICHAEL LUONG, TEVY KHOU front end developer MAYRA URRUTIA senior drupal developer NICHOLAS ALIPAZ, SR. traffic manager KEVIN BISSADA manager, digital media LAURA VILLELA svp, publishing, integrated partnerships GREG BROSSIA senior director, integrated partnerships STUART BROCKINGTON directors, integrated partnerships TARA DABUNI, ADAM GOLDBERG, NOREEN MURRAY director, integrated marketing BRANDON GRANT associate director, integrated marketing JAMIE TREDWELL managers, integrated marketing GRETA LIBBEY, CASEY NOBLE associate director, events JOHN O’MALLEY designer, integrated marketing MICHAEL LOMBARDO coordinator, integrated sales & marketing HAYLEY YATES senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director of social and branded content LEVI CHAMBERS editor, social media DANIEL REYNOLDS branded content producer LENNY GERARD branded content writer IAN MARTELLA senior fulfillment manager ARGUS GALINDO operations director KIRK PACHECO office manager HEIDI MEDINA print production director JOHN LEWIS

PRIDE MEDIA president LUCAS GRINDLEY executive vice presidents JOE LANDRY, BERNARD ROOK senior vice presidents GREG BROSSIA, CHRISTIN DENNIS, JOE VALENTINO vice president ERIC BUI ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions Fax (212) 242-8338 LOS ANGELES EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES 43430 E. Florida Ave. #F PMB 330, Hemet, CA 92544 • Phone (951) 927-8727 Email editor@HIVPlusMag.com FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To subscribe, visit HIVPlusMag.com/signup. There is a 10-copy minimum. FREE DIGITAL SUBSCRIPTIONS Plus magazine is available free to individual subscribers—a digital copy of each issue can be delivered to the privacy of your computer or reader six times per year. We require only your email address to initiate delivery. You may also share your digital copies with friends. To subscribe, visit HIVPlusMag.com/signup. NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, please email our circulation department at Argus.Galindo@pridemedia.com. Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc. Plus is a registered trademark of Here Publishing Inc. Entire contents © 2018 by Here Publishing Inc. All rights reserved. Printed in the USA.

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Twitter.com/ HIVPlusMag

MAY / JUNE 2018

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IN THIS ISSUE MAY/JUNE 2018 BUZZWORTHY 7

DON'T FORGET ABOUT ME Black people—and trans men—are still lagging behind when it comes to accessing care while HIV-positive.

THE BEATING HEART The award winning French AIDS film Beats Per Minute is now available on DVD in the U.S.

GIVE ME 5 Five ways to get healthier in less than five minutes each day.

ONE TOUGH MOTHER The late Dr. Mathilde Krim cofounded amfAR, did groundbreaking AIDS research, and mothered dozens of HIV activists.

CHILL 28

PAUSING PARTNER PROBLEMS Is your partner mothering (or smothering) you? Does your partner feel like they're dating your HIV? Here's advice from our mental health editor, Dr. Gary McClain.

RESISTANCE 35

GOOD RIDDANCE More proof a new drug will offer hope to those who have developed drug resistance—or kidney issues—on other medications.

TREATMENT/TASP 37

IS HIV HIDING IN YOUR PANTS? New study shows HIV can hide from medication in testicular tissue.

SWITCH HITTING Can you switch meds while being undetectable and still remain virally suppressed?

39 BABY, YOU'RE A STAR A new kind of starfish-shaped capsule could finally make a one-pill-aweek HIV regimen possible.

SHUTTERSTOCK (7, 40, 37); COURTESY OF ACHIM HOWARD (43)

40 SMALL PACKAGES A new HIV drug is the smallest of its kind. 41

RESEARCH UPS & DOWNS The latest findings about HIV are a mixed bag.

BACK TALK 43 BLACK, TRANS & #METOO Achim Howard came out about being poz and a sexual assualt survivor. Now he's helping other poz trans men of color.

DAILY DOSE 47 ARE WE POST-STIGMA? Is it still risky to come out about your status? Yes and no. HIVPLUSMAG.COM

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EDITOR’S LETTER

BY THE TIME you’re reading this

magazine, we’ll have passed a host of HIV and AIDS awareness days that recur each year, from Black HIV/AIDS Awareness Day in February to ones honoring women and girls, Native Americans (both in March), Youth and National Transgender HIV Testing Day (both in April), and, coming June 27th, National HIV Testing Day. There are plenty of awareness dates, including those aimed at long-term survivors, gay and bi men, Asian-Americans, and more. But what the awareness dates on a calendar don’t tell you

is the cycle of media information that happens for each one. Many TV news programs and local newspapers cover HIV only on one of those particular dates each year—whichever one they find most important. For a magazine like Plus, we cover it all, but we also hear about the aftermath. Take June’s National HIV Testing Day: everyone from pharmacies, community centers, and HIV organizations get the word out about HIV testing. Most will see a spike in the number of HIV tests done in the ensuing weeks until it drops off, and in most cases, goes back to the usual daily average. That’s where Plus comes in. When more people test, more people learn of their HIV status—negative or positive. Not all will test positive, but some will. If you have just been diagnosed, this issue is for you. While there can be no real answer to “Why me?” that’s anything near as deep or meaningful as most people are seeking, we assure you that becoming HIV-positive is a virological process, not God’s wrath for having sex or using drugs. We can offer you answers to the questions that others have asked when they were in your shoes. Sometimes the answers are easy, like the ones to these questions: Can I still have sex? Can I still have kids? Will anyone love me? Do I have to use plastic utensils from now on? In order, the answers are yes, yes, yes, and good god, no—and the environment thanks you for sticking with silverware. Each year as we compile our special Just Diagnosed section, we also attempt to dispel myths and confront stigma. What I’ve learned over the years from readers is that at some point this list won’t be for you. It will all have become old hat to you. If that’s the case, consider giving this copy to someone who can use it, whether they are a newly poz friend or your own relatives who still (quite ridiculously) believe they can contract HIV from sharing cups and forks, or kissing. (By the way, neither of those have ever been true.) What myths or stereotypes are you battling at home or at work? Tell us and let us explain why many people are still getting it wrong—and what we can all do about it. In the meanwhile, don’t forget it is summer. Get out in the sun and soak up some Vitamin D, get your body moving, and enjoy life a little bit more. The sun is finally out again!

DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM

Even the most infallible editors make mistakes. In our “20 Most Amazing HIVpositive People of 2018” (in our March/ April issue), we misattributed quotes about Abdul-Aliy Muhammad (right) to their Black and Brown Workers Collective cofounder, Shani Akilah Robin. You can read Robin’s actual profile of Muhammad at Bit.ly/AbdulAmz.

TONY DONALDSON (DIANE); LOUIE ORTIZ-FONSECA (ABDUL-ALIY)

OOPS, WE DID IT AGAIN

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BUZZWORTHY

STILL FALLING BEHIND Fewer black people and transgender men are reaching viral suppression—and the benefits of undetectability.

SHUTTERSTOCK

BY SAVAS ABADSIDIS & COLE HAYES

ecent studies underscore the fact that both HIVpositive African-Americans and transgender men are still being left behind other populations. According to the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, only 40.8 percent of black people living with HIV in 2014 had sustained viral suppression, a percentage lower than that among Hispanics (50.1 percent) and whites (56.3 percent). The 60.2 percent of black people who did not have viral suppression included 25.3 percent who were in care and 33.9 percent who had not had viral load testing in 2014. The latter is an indication that the person is not receiving adequate HIV care and therefore is unlikely to have a suppressed viral load. Not reaching sustained viral suppression means their immune systems will continue being impacted by HIV, and they won’t see the benefits of being undetectable, which means they will still be able to transmit HIV to sexual partners. Among people living with HIV who were in care, black people also experienced longer periods (six months out of a year) with viral loads over 1,500 copies/mL, which can also lead to poor health outcomes and higher risks of transmitting the virus. Although more black folks who received HIV care in 2013 were prescribed antiretroviral medication than in 2009, fewer received an ART prescription (92.9 percent) than did Hispanics (95.2 percent) or whites (95.2 percent). The racial and ethnic differences in sustained viral suppression existed regardless of gender, age, or transmission

HIVPLUSMAG.COM

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categories, although the lowest rates of sustained viral suppression were found among black people aged 13 to 24 years old. Lower viral suppression, combined with the higher prevalence of HIV among black people, can lead to greater risks of transmission (thus causing the epidemic among AfricanAmericans to intensify). The study noted barriers contributing to the situation included a lack of health insurance (particularly in southern states that refused Medicare expansion), limited access to health services, stigma, lack of health literacy, and a lack of trust in providers. “Reducing health disparities,” the study suggests, will take “tailored strategies that address barriers to achieving and sustaining viral suppression among blacks, especially those aged 13–24 years.” Transgender people also continue to face health disparities. Although research into HIVpositive transgender men is rare, the first national study of its kind suggests HIV-positive transgender men receiving medical care in the United States have unmet social and 8

healthcare needs. Published in the American Journal of Public Health, the research showed that approximately half of poz trans men are living in poverty and only 60 percent have reached sustained viral suppression. Compare that to a 2016 study by the National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention that showed men who have sex with men who were HIV-positive and 25 or older, had sustained viral suppression rates of 72 percent. The report published in AJPH found that many transgender men receiving care for HIV experienced poor health outcomes and unmet needs, with 69 percent having at least one unmet support need and a quarter reporting they were currently living with depression. “To decrease disparities and achieve health equity among HIV-positive men, HIV care models could incorporate transgender-sensitive health care and mental health services and health insurance inclusive of sex reassignment procedures and physical sex-related care,” concluded the study.

Dr. Jessica Rongitsch, a primary care doctor at Capitol Hill Medical, an LGBT clinic in Seattle, Wash., who has been providing care for the trans community for over 15 years, argues that trans men have specific risks that are not being addressed. “Many of my trans masculine patients have condomless penetrative sex with penises so are at risk of HIV infection. Testosterone causes thinning and dryness of vaginal mucosa, which increases risk of bleeding and tearing during sex. While there aren’t studies specifically looking at this, I believe trans men may be at higher risk of contracting HIV if exposed to the virus, compared to cisgender women.” The good news is that over the period of these studies (2009 to 2014), sustained viral suppression rates among all populations of people living with HIV have gone up. The bad news is that the current administration doesn’t have the same priorities, funding, or support of Obamacare that the previous one did—and that may increase disparities in the future.

SHUTTERSTOCK

BUZZWORTHY

MAY / JUNE 2018

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BEAT IT AIDS

Beats Per Minute tells the story of France’s ACT UP activists and their response to the epidemic during the early-1990s.

THE AIDS EPIDEMIC is cemented in American history as one of the most devastating periods for not only the LGBT community and for those living with HIV, but for the millions of families, friends, artists, and audiences who are still affected by it today. While many know the stories of early activists like Larry Kramer and Peter Staley, both staunch leaders in ACT UP New York, rarely do we hear about ACT UP’s international chapters. The film Beats Per Minute, directed by Robin Campillo, is a gripping drama that highlights the experiences of French activists in the early-1990s with ACT UP Paris. BPM takes us to the weekly meetings—inside tightlysqueezed lecture halls, bursting with dozens of activists debating how to move forward politically in their fight to save lives and draw attention to the AIDS epidemic. Campillo and his cowriter Philippe Mangeot were both involved with ACT UP Paris during those days, so they drew on memories to provide a compelling and authentic portrait of the times. Activists leading the Paris chapter were just as confrontational as ACT UP New York. As The Atlantic reports, volunteers would rush the stage at medical conferences and barge into pharmaceutical headquarters to fight against the capitalist approach they viewed as a central barrier stalling medical progress. The story is told through the eyes of Nathan (Arnaud Valois), who is HIV-negative and new to ACT UP Paris, and who eventually falls in love with a prominent member of the group, Sean (Nahuel Pérez Biscayart). The film quickly shifts from a dynamic story of community action to an intimate, personal tale of love amidst a backdrop of stigma, homophobia, and activism. With over 22 major award wins—including Best Foreign Language Film of 2017 by the Gay and Lesbian Entertainment Critics Association—this isn’t a film to be missed, and it is now available on DVD, Amazon, and iTunes through its U.S. distributor, Passion River Films. —DAVID ARTAVIA

5 WAYS TO CHANGE YOUR LIFE IN 5 MINUTES They might seem small, but these five daily rituals will help you become a better you.

PHOTO SHUTTERSTOCK CREDIT (MAN); PASSION RIVER FILMS (BPM)

BY SAM PAGE

MAKE YOUR BED: It takes less than five minutes and sends a message of order and tranquility to you, and anyone else who enters your home. MEDITATE: A five-minute morning meditation practice sets the tone for your day (try Meditation Oasis’s free podcast or the free Breathe app). LOG YOUR DAILY FOOD INTAKE. It takes five minutes or less and can help you lose and keep extra pounds off (try the apps MyNetDiary or MyFitnessPal). LIST POSITIVES. Write for five minutes, listing items you are grateful for or went well for you today. It will help keep you focused on the positive. Check out the 5 Minute Journal, (hardcover book or smartphone app). USE AFFIRMATIONS. Catch yourself being negative toward others and yourself? Catalog those nasty thoughts, determine their opposites, and write the affirmations on mirrors or post-it notes, or even record them to listen to while you exercise. Neuroplasticity is real and we can rewire our brains to be more positive, even when we have spent many years doing the opposite. Sam Page is a celebrity fitness guru and teacher of whole mind and body wellness, who often speaks on what it means to live HIV healthy today, to help eradicate stigma. (@SamPageFitness)

HIVPLUSMAG.COM

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In adults with HIV on ART who have diarrhea not caused by an infection

IMPORTANT PATIENT INFORMATION This is only a summary. See complete Prescribing Information at Mytesi.com or by calling 1-844-722-8256. This does not take the place of talking with your doctor about your medical condition or treatment.

What Is Mytesi? Mytesi is a prescription medicine used to improve symptoms of noninfectious diarrhea (diarrhea not caused by a bacterial, viral, or parasitic infection) in adults living with HIV/AIDS on ART. Do Not Take Mytesi if you have diarrhea caused by an infection. Before you start Mytesi, your doctor and you should make sure your diarrhea is not caused by an infection (such as bacteria, virus, or parasite).

Possible Side Effects of Mytesi Include:

Tired of planning your life around diarrhea?

Enough is Enough Get relief. Pure and simple. Ask your doctor about Mytesi. Mytesi (crofelemer): • Is the only medicine FDA-approved to relieve diarrhea in people with HIV • Treats diarrhea differently by normalizing the flow of water in the GI tract • Has the same or fewer side effects as placebo in clinical studies • Comes from a tree sustainably harvested in the Amazon Rainforest What is Mytesi? Mytesi is a prescription medicine that helps relieve symptoms of diarrhea not caused by an infection (noninfectious) in adults living with HIV/AIDS on antiretroviral therapy (ART). Important Safety Information Mytesi is not approved to treat infectious diarrhea (diarrhea caused by bacteria, a virus, or a parasite). Before starting you on Mytesi, your healthcare provider will first be sure that you do not have infectious diarrhea. Otherwise, there is a risk you would not receive the right medicine and your infection could get worse. In clinical studies, the most common side effects that occurred more often than with placebo were upper respiratory tract (sinus, nose, and throat) infection (5.7%), bronchitis (3.9%), cough (3.5%), flatulence (3.1%), and increased bilirubin (3.1%). For Copay Savings Card and Patient Assistance, see Mytesi.com

Please see complete Prescribing Information at Mytesi.com.

• Upper respiratory tract infection (sinus, nose, and throat infection) • Bronchitis (swelling in the tubes that carry air to and from your lungs) • Cough • Flatulence (gas) • Increased bilirubin (a waste product when red blood cells break down) For a full list of side effects, please talk to your doctor. Tell your doctor if you have any side effect that bothers you or does not go away. 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.

Should I Take Mytesi If I Am: Pregnant or Planning to Become Pregnant? • Studies in animals show that Mytesi could harm an unborn baby or affect the ability to become pregnant • There are no studies in pregnant women taking Mytesi • This drug should only be used during pregnancy if clearly needed A Nursing Mother? • It is not known whether Mytesi is passed through human breast milk • If you are nursing, you should tell your doctor before starting Mytesi • Your doctor will help you to decide whether to stop nursing or to stop taking Mytesi Under 18 or Over 65 Years of Age? • Mytesi has not been studied in children under 18 years of age • Mytesi studies did not include many people over the age of 65. So it is not clear if this age group will respond differently. Talk to your doctor to ﬁnd out if Mytesi is right for you

What Should I Know About Taking Mytesi With Other Medicines? If you are taking any prescription or over-the-counter medicine, herbal supplements, or vitamins, tell your doctor before starting Mytesi.

What If I Have More Questions About Mytesi? For more information, please see the full Prescribing Information at Mytesi.com or speak to your doctor or pharmacist. To report side effects or make a product complaint or for additional information, call 1-844-722-8256.

RELIEF, PURE AND SIMPLE

Mytesi comes from the Croton lechleri tree harvested in South America.

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BUZZWORTHY

HIV Burden on Youth

AmfAR’s founding chairman Dr. Mathilde Krim attends the organization’s annual New York Gala in 2011, the year amfAR celebrated its 25th anniversary.

40%

of new diagnoses are among young people between 13 and 29 years of age, despite them being only 23 percent of the U.S. population.

34%

of new diagnoses are in 22- and 23-year-olds, compared to 0.7 percent between 13 and 15.

AP PHOTO/EVAN AGOSTINI (KRIM)

Source: Morbidity and Mortality Weekly Report, February 23, 2018

MOTHER COURAGE

Dr. Mathilde Krim, a cofounder of amfAR—and dedicated HIV researcher—passes away at 91. Dr. Mathilde Krim, a cofounder of the American Foundation for AIDS Research (amfAR) passed away on January 15, at the age of 91. Responding to her death on Facebook, HIV activist Peter Staley wrote, “My greatest AIDS hero died a few hours ago. Dr. Mathilde Krim, founder of amfAR, warrior against homophobia and AIDS-related stigma, dedicated defender of science and public health, and mother-figure and mentor to countless activists, will leave a deep hole in the continued fight against AIDS—a fight she dedicated her life to.” According to amfAR, Krim received her Ph.D. from the University of Geneva, Switzerland, in 1953, after which she pursued research in cancer-causing viruses at the Weizmann Institute of Science in Israel. While there, she was on a team that developed the first method for determining the sex of a baby before birth. Krim moved to New York City, where, in 1958 she married Arthur B. Krim, then head of United Artists Motion Picture Company and later founder of Orion Pictures. She joined the research staff of Cornell University Medical School, and in 1962 worked at the Sloan-Kettering Institute for Cancer Research and, from 1981– 1985, she was the director of its Interferon Laboratory. “Soon after the first cases of AIDS were reported in 1981, Dr. Mathilde Krim recognized that this new disease raised grave scientific and medical questions, and that it might have important sociopolitical consequences,” notes amfAR’s bio of Krim. “She dedicated herself to increasing the public’s awareness of AIDS and to a better understanding of its cause, its modes of transmission, and its epidemiologic pattern. Dr. Krim also became personally active in AIDS research through her work with interferons—natural substances now used in the treatment of certain viral and neoplastic diseases.” In April 1983, Krim founded the AIDS Medical Foundation, the first private organization to support AIDS research. In Los Angeles in 1985, Elizabeth Taylor and Dr. Michael Gottlieb cofounded the National AIDS Research Foundation to research for a cure and help people living with HIV or suffering from AIDS-related illnesses. The two organizations merged soon after to form amfAR, which has since become an international leader in the field. The organization has supported trailblazing research studies, HIV prevention, and the development of sound, HIV-related public policies. Krim was amfAR’s founding chair, and from 1990 to 2004, served as the chairman of the board. She held 16 honorary doctorates and received numerous other honors including, in 2000, being awarded the Presidential Medal of Freedom—the highest civilian honor in the United States.—SAVAS ABADSIDIS HIVPLUSMAG.COM

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BY DESIRÉE GUERRERO

Project Fearless

BELOVED FASHION DESIGNER AND REALITY STAR VIKTOR LUNA KNOWS WHAT IT’S LIKE COMING OUT POZ ON TELEVISION. NOW HE’S TAKING IT A STEP FURTHER.

ASHLEY GALLERANI PHOTOGRAPHY

When

Project Runway season 9 finalist Viktor Luna first appeared on the series in 2009, he was known as the “quiet one.” It’s not entirely surprising that since his time on reality TV, he has consciously moved away from the spotlight—the glare was a bit too harsh for the talented, yet humble, fashion designer. Still, Luna has recently reemerged in the public eye as he debuts his latest line of menswear, and joins the fight to eradicate HIV stigma. “I’ve been kind of hiding a little bit from the Project Runway public,” the poz designer admits. Luna, who followed fellow Project Runway star Mondo Guerra’s lead by coming out HIV-positive on screen, is quick to add that his retreat from the public eye was “not because I’m ashamed or anything. It’s just, I like my privacy. I really enjoy it.” Luna jokes that his newly grown beard and recent relocation from New York City to Los Angeles has helped him be more incognito. “It just happened to be perfect timing… I like my beard—and nobody recognizes me!” Before venturing to the West Coast, Luna spent the previous decade-anda-half immersed in New York’s fashion scene, but he is not new to Southern California. He grew up in L.A. after his family moved to the U.S. from Guadalajara, Jalisco, Mexico when he was a kid. It seems fitting that the gifted artist, designer, and photographer was born—along with tequila and Mariachi music—in the country’s cultural center. Luna says his mother, who worked as a seamstress in his youth, was an influence on his love of fashion, though his very traditional father was not exactly excited about his son’s choice of career direction. And Luna says it was his love and pursuit of fashion, not fame, which led him to the Project Runway franchise (after getting to the finals in season nine, he returned for the third season of Project Runway All Stars). And it paid off. The show, and his enormous talent, helped him launch a successful career in fashion, altering the elegant and charming 37-year-old’s life. HIVPLUSMAG.COM

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COURTESY OF LIFETIME

When Luna returned for All Stars in 2014, not only had his talents grown, but so had his ability to open up to others. Throughout the season, he was no longer the quiet one. During filming, he decided to share something he had been keeping from the world for more than seven years: he was HIV-positive. “For those who remember me during Project Runway season 9, I was very protective of my feelings and how I was portrayed on camera,” Luna wrote in an open letter after the episode. “Many thought I was just quiet, but in truth, I was just hiding from the world. This season, I wanted to let it all out and be myself. You’ve seen me laugh, cry, and openly share my feelings, but I haven’t shared everything… until now. To complete this process with myself and to truly feel free, I chose to reveal my HIV status. In doing this, I have come to accept the virus inside me, and I now know this little thing isn’t going to stop me anymore.” Though he describes this experience as unbelievably freeing, Luna says not all reactions were totally positive. “It was,” he pauses a moment, as if to find the right words, “it was very mixed. My partner [at the time] was definitely not happy with me disclosing it because to him it was very private, and he was very scared of the stigma. But that’s kind of why I did it—because I really wanted to speak out loud and just be free. It’s such a burden to carry, and when I spoke about it, I felt so free.” Luna says in the end, the benefits of coming out about his status have far outweighed any negatives. “I’m sure there’s negative people out there [who] probably see me or treat me different, but you know what? I really don’t even pay attention to them. I have no idea of what their thoughts are of me—and I really don’t care.” Perhaps the most difficult part of disclosing on the show was the fact that, after the filming of the episode, he only had a couple of months to tell his family before it aired. His mother’s reaction serves as a wonderful example to others of how to react when a loved one shares their status. “She was very positive and she said, ‘Nothing will ever change my love and who you are to me. You are my son.’ And that just broke me,” he recalls. “It made me feel so comforted. It just added to my freedom.” He adds his mother remained very calm as he told her, and she only wanted to know if he was MAY / JUNE 2018

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I think it’s a milestone for the Latino family, to accept something like that, because other families will probably not take it well. okay and if he was getting proper treatment. “She didn’t panic,” Luna recalls, which he says was enormously reassuring. However, Luna was not quite as eager to tell his “very machista” father who had initially disapproved of him going into fashion, and with whom his relationship was a little more “iffy.” “I’ve got to say, he knows now, and we never talk about it at all, but he has not changed his point of view towards me whatsoever,” Luna says, despite his father’s rigid old-school ways. “So, I appreciate that. I think it’s a milestone for the Latino family, to accept something like that, because other families will probably not take it well.” Today, Luna continues to evolve and reinvent himself. After the aforementioned relationship eventually ended and the two parted ways as friends (“we still keep in touch”), he decided to take a post-break-up vacation to L.A.—and ended up staying, adding, “It wasn’t ideal at first, but I’m having the best time of my life here. I’m at peace.” He has a new boyfriend now, who Luna says is very supportive and has no problem schooling others about what it means to love someone living with HIV. He recounts a particular instance when someone was questioning his boyfriend’s feelings about dating someone who is poz, to which his boyfriend responded that he “trusts a person who has been living with HIV for 10 years more than someone who doesn’t know anything about their status.”

This is especially true in light of current facts. Many people still don’t know of the recent scientific consensus that states once you achieve an undetectable viral load, you are unable to transmit the virus to others (dubbed U=U for undetectable equals untransmittable). The consensus has been endorsed by hundreds of world health organizations. Today, a large percentage of people living with HIV who are on regular treatment are able to lower their HIV to undetectable levels. So why now—after successfully moving away from the spotlight into a happy, peaceful life working and living in Southern California—has Luna decided to “come out of hiding?” After seeing fellow reality TV alum Ryan Palao (Ongina of RuPaul’s Drag Race) in amfAR’s Epic Voices campaign—an online video series featuring folks from different walks of life who are living and thriving with HIV—Luna decided to jump on board and become another voice helping to eradicate stigma by filming his own video. “I knew [Palao] from a long time ago actually, before he was on Drag Race… we actually met during the AIDS Walk in New York, and we were just walking and getting to know each other, but I had no idea that he was positive,” Luna remembers. “I was positive at that time, and I didn’t share it with anybody, but once I saw him on the video I was like, ‘Oh cool. Yeah, definitely!’ So, he kind of pushed me to do it.” Luna also credits Palao for his bravery, as one of the few reality stars since The Real World’s Pedro Zamora to disclose their status to the world. “He kind of opened the door for me and he encouraged me to speak out loud, so that’s the power of it. That’s why I did it, too.” Luna encourages people living with HIV to share their status (but stresses only if they are in a situation where they can do so safely)—not just to free themselves from the burden and shame, but also so they can help educate and reduce stigma. “It’s funny because when you are in the closet,” Luna says about being poz but not out, “people talk about HIV and they speak so badly about it, and it’s kind of like you almost want to say it out loud and be like, Bitch, I’m HIV[-positive], too! Stop saying that! It’s like the inside of me was screaming. So, for me, it’s to turn it into a positive. Turn it into an opportunity to reach out and teach people what it really is, and it’s not that serious. There is no stigma, and I am equal just like anybody else.” HIVPLUSMAG.COM

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JUST DIAGNOSED?

DON’T PANIC If you are newly HIV-positive, you are probably filled with concerns and questions. But don’t worry. We’ve got your back and will help you unravel the confusion. Here are some FAQs. BY PLUS EDITORS

Receiving an HIV diagnosis has never been less life-changing than it is today. Since the early days of the epidemic, treatments have been revolutionized, and with modern medications you can now look forward to living a long and healthy life, pursuing all the same dreams you had before you were HIVpositive. Perhaps even better, with treatment you’ll no longer have to worry about transmitting HIV to someone else. Medicine has made the virus a manageable condition—and breakthroughs continue to be made. Still, you naturally have questions and concerns. We’re here to answer them. HIVPLUSMAG.COM

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J U ST D I AG N O S E D?

I just found out I’m HIV-positive, what do I do now? First, don’t panic. You are the same person who walked into the clinic before receiving your test results. It may seem like everything has changed, but it hasn’t. Find a doctor who is highly knowledgeable about HIV and is the right fit for you. When should I start treatment? Right now. Ideally you should begin treatment as soon as possible, like the day you get your positive result. Early HIV treatment has been shown to provide long-term advantages. Even without symptoms, if your infection runs unchecked it can compromise your immune system. The sooner you’re on treatment, the sooner you can lower your viral load and reach undetectable levels where it becomes nearly impossible for you to transmit HIV to a partner. So get that prescription and start taking your meds right away. What’s next? During your first appointment, your doctor will do your initial lab work. This is to see what your CD4 count and viral load is. Your CD4 count is the number of diseasefighting white blood cells you have in your body, and your viral load is the number of copies of HIV in your blood. Your doctor will also determine whether the virus you have is resistant to any medications. This sounds scary, but it doesn’t have to be. No matter what your CD4 count may be, most people can bring their count up by simply taking a single-pill regimen. The same medication can also help reduce your viral load to an undetectable level. The key to staying healthy and keeping an undetectable viral load is to not miss a dose—just as you should with medication for any other condition. Am I going to die? Not from HIV. A person diagnosed today has roughly the same life expectancy as a person who is HIVnegative. However, your virus does make you more susceptible to other health problems that you need to be aware of. Some of these are cardiovascular disease, kidney problems, and bone density loss. But before you start to panic, know that these all can be prevented with lifestyle changes and the right medication. Being knowledgeable about what to look out for is the best way to ensure a long and healthy life. Am I going to get AIDS? Most people who are living with HIV will never be diagnosed with AIDS. HIV is a virus; AIDS is a diagnosis that a person receives once the virus reaches a certain point. When your CD4 count dips below 200 and your immune system is so damaged that common illnesses can be life-threatening, then your disease is classified as AIDS. As long as you stay on your medication and keep a healthy body and mind, you can keep your CD4 count in the healthy zone and far away from the level of AIDS. And if your CD4 count is already in the danger zone, the correct medication can bring you back up to healthy levels. AIDS is a stigmatized, outdated term that’s on its way out—these days the preferred terms are late stage HIV or stage 4 HIV. What’s the difference between compliance and adherence and why does it matter? Your doctor may talk a lot about the importance of staying compliant or adhering to your treatment regimen. What they mean is that studies show taking your medication as prescribed is the best way to maintain your health long-term. But words matter, as Gary McClain, Plus’s mental health editor, explains: “Compliance is 20

A PERSON DIAGNOSED TODAY HAS ROUGHLY THE SAME LIFE EXPECTANCY AS A PERSON WHO IS HIV-NEGATIVE. essentially doing what you are told to do. Whereas, adherence implies doing something out of a commitment you have made.” That’s why most people living with HIV prefer to use the term adherence, because you stay on your regimen for you. You’re not just “taking orders.” What is an undetectable viral load? Last year, the Centers for Disease Control and Prevention noted that research has shown antiretroviral therapy both keeps people living with HIV healthy and has a preventative effect: “When [antiretroviral treatment] results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission.” In other words, having one’s HIV suppressed to levels no longer detectable by blood tests prevents transmission. “Across three different studies, including thousands of couples and many thousand acts of sex without a condom or preexposure prophylaxis (PrEP), no HIV transmissions to an HIVnegative partner were observed when the HIV-positive person was virally suppressed. This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of transmitting the virus to an HIV-negative partner.” Undetectable equals untransmittable. Can I only have sex with other people who are also HIVpositive? Nope. There are ways to protect yourself and your partner, including Treatment as Prevention (TasP, or using your ART to remain undetectable), condom use, and PrEP (for an HIV-negative partner). Today, there are multiple ways to have safer sex. Staying compliant with your meds and maintaining an undetectable viral load is one of the best ways to ensure that you never transmit the virus. Can I still have kids? Yes, you can still have kids if you are HIV-positive. The great news is that if you have your viral load suppressed to undetectable levels you likely won’t have to do anything special, as you can no longer transmit the virus. Still, if you are planning to make a baby the old-fashioned way, you should speak with a specialist first. For those whose viral load isn’t suppressed, there are specialists who deal with HIV, fertility, and insemination. If you’re a woman who is living with HIV, additional medications can also decrease your chance of perinatal transmission. If you’re a man with detectable HIV, your sperm may need to be “washed” of HIV and then inseminated into your partner, wife, or surrogate. If you want to adopt, there are protections for HIV-positive parents-to-be that ensure you can’t be discriminated against.

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we Play Sure PP ep ep + + Condoms Condoms #PlaySure #PlaySure

BE HIV & STI Sure BE HIV & STI Sure If you are HIV negative, PrEP is a daily pill that protects you from HIV. Condoms add If youprotection are HIV negative, is a help dailyprevent pill thatother protects you from HIV. Condoms add more againstPrEP HIV and Sexually Transmitted Infections. more protection against HIV healthy and helpand prevent other Infections. Combine these tools to stay prevent theSexually spread ofTransmitted HIV and other STIs. Combine these tools to stay healthy and prevent the spread of HIV and other STIs. PLAY SURE: Call 311 or visit nyc.gov/health to design the right PLAY SURE: 311 or visit nyc.gov/health to design the right HIV and STI Call prevention combination for you. HIV and STI prevention combination for you.

Bill de Blasio Mayor Bill deT.Blasio Mary Bassett, MD, MPH Mayor Commissioner Mary T. Bassett, MD, MPH Commissioner

J U ST D I AG N O S E D?

FOREVER AND A DAY

LEARNING YOU’LL HAVE TO BE ON HIV MEDS FOR THE REST OF YOUR LIFE SOUNDS DAUNTING. HERE’S HOW TO TAKE IT ONE DAY AT A TIME. BY GARY MCCLAIN

Talk back to catastrophic “What if?” thinking. When you’re first starting on an HIV regimen, it’s only human nature to think about what your life might be like in the future as you travel this road. But keep in mind that, when there is a lack of information, our minds have a way of filling in the gaps—with the worst possible outcomes. Remember you don’t know what living with your regimen is going to be like going forward. While you may indeed need to take HIV medication for the rest of your life, new treatment options are being developed all the time, and many revolve around long-acting injectables. In a few years your HIV treatment might require one shot every three months instead of a daily pill. Anything is possible, including the best possible outcome. Break your regimen down into daily tasks. Your doctor has just given you a lot of information about what pills you have to take, what tests you’ll need, and how your lifestyle may have to change. It can sound overwhelming. It’s all too easy to focus on the new responsibilities having HIV will now demand of you. Take a step back and dig into the details in terms of what your HIV regimen actually means on a daily basis. Sure, it could make new demands on you in the future, with unwelcome changes ahead. But don’t get ahead of yourself. Think of any potential changes in terms of small steps, not big leaps. While you’re at it, also identify what aspects of staying on top of your regimen may be most challenging. Be realistic here. Your HIV regimen may pose some challenges for you, even just having to take your medication at a particular time of the day. Get specific: Is it just the idea of daily medication that bothers you? Or having to carry a pill container around, or needing to set up some kind of pill reminder? Or are you worried what might happen to your health if you miss a dose? Be specific about what bothers you. Find a strategy for maintaining adherence. Consider everything you need to do to maintain adherence with your HIV regimen. And then map out a strategy for keeping your regimen on track. There are apps, timers, pill containers, and lots of other devices that can help you remember what to take and when. You might 22

want to get some advice from your doctor or pharmacist, as well as family members and friends whose judgment you trust. Identify the benefits. What will adhering to your daily HIV regimen get you? Sure it helps you to avoid symptoms and feel better now. But get more specific. Can you name 10 things your regimen makes possible? Here are some ideas: Keeping up with your kids. Getting through the day at work. Being there for your partner for many years to come. Not being at risk of transmitting HIV to someone else. Being physically able to travel or do something else you value and enjoy. You might want to keep a list of benefits around to review when that “forever” question hits you. Stay informed. Learn everything about your HIV regimen. Jump on the Internet. Ask your doctor questions. Talk to other HIV-positive people and find out what their regimens are like. Knowledge is power. Don’t go through this alone. Ask for help if you need it— emotional support, reminders, gentle accountability, or a place to vent when you’re having an especially frustrating day. Chances are, your loved ones want to help. They may be waiting for you to let them know what you need. Get a support team in place so that you aren’t traveling alone on the road ahead. Support is power! Chronic conditions like HIV do require ongoing treatment. Embrace your regimen as the key to helping you live the life you have envisioned for yourself. The truth is, by taking your medication you can pursue all the same dreams you had before you were diagnosed. Keep your focus on making the best of your regimen today. The future will unfold one day at a time.

GARY MCCLAIN, PHD, is a therapist, patient advocate, and author in New York City, who specializes in working with individuals diagnosed with chronic and catastrophic medical conditions, their caregivers, and professionals. (JustGotDiagnosed.com)

SHUTTERSTOCK (MAN AND PILL); MAXIMILIAN IMAGING (MCCLAIN)

I was just diagnosed with HIV. I asked my doctor how long I was going to have to take antiretroviral medication every day. She answered: Forever. Are you really saying I’ll have to take a pill every day until I die? You are surely not alone in having concerns about potentially being on medication for the rest of your life. I have this conversation a lot with my clients, who share your concerns. Here’s what I say to them first: Forever seems like a long time. But the road to forever is traveled a single day at a time. Here’s how to cope with the idea of being on your regimen indefinitely:

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J U ST D I AG N O S E D?

STAY POSITIVE Studies have shown a positive outlook can actually improve health, lower one’s viral load, and extend your life. Judith T. Moskowitz’s 2014 University of California, San Francisco study showed that people newly diagnosed with HIV who used coping skills to stay positive carried a lower viral load, were more likely to take their medication correctly, and were less likely to need antidepressants. NURTURE YOUR GUT The lymphoid tissues in a person’s stomach are filled with T cells. Because HIV affects T cells, many people with HIV have gastrointestinal problems, but a healthy GI tract is crucial to proper absorption of antiretroviral medication. Eat yogurt or take probiotics to replenish your healthy gut bacteria and embrace a high-fiber diet. MOVE THAT BODY Exercise helps control your weight, fights cardiovascular disease, and can help boost your T cells. Brian Risley, the manager for treatment education at AIDS Project Los Angeles, says some studies have shown that moderate activity, even in short bursts, spurs an uptick in T cell counts, even when it doesn’t have a serious effect on viral load.

WAYS TO STAY HEALTHY + BEYOND JUST TAKING YOUR ANTIRETROVIRAL MEDICATION. BY PLUS EDITORS There are a lot of things besides your meds that can keep you healthy despite living with HIV. Here are some of our favorites:

DRINK COFFEE Drinking three cups of coffee a day increased treatment success by 80 percent and reduced side effects by more than 80 percent in one study of people living with HIV and hepatitis C. BRUSH YOUR TEETH HIV can cause sores in your mouth. Brushing can help prevent cavities, which could allow an infection into your bloodstream. Plus, you’re sexier when you have all your pearly whites. GET IT ON Orgasms can be wonder drugs in themselves: They help you sleep, boost your immunoglobulin levels (which fight infections), and reduce stress and depression. HAVE A LITTLE FAITH No matter if you worship in a cathedral, mosque, temple, or on the sofa, most physicians believe that some form of spirituality can help people better cope with their health problems. This can also help you build a social circle and feel generally more positive. CALL SOMEONE WHO CARES Each state has its own tollfree HIV and AIDS hotline, and Project Inform has the full list at ProjectInform.org/hotlines. If you call the Project Inform HIV Health InfoLine (800-822-7422), you can talk to nonjudgmental people (in English or Spanish) who will listen, share their experiences, offer you accurate information, and help you navigate health care obstacles.

SHUTTERSTOCK

MAKE FRIENDS Having strong relationships can be a matter of life or death. A joint review by Brigham Young University and the University of North Carolina at Chapel Hill found that people with stronger social relationships had a 50 percent increased likelihood of survival regardless of age, sex, or health status. Simply put: people with friends live longer. STOP SMOKING According to a study in the Journal of the American Medical Association Internal Medicine, people living with HIV who smoke are far more vulnerable to side effects than people not living with HIV, and are now more likely to die from lung cancer than HIV. Indeed, researchers found, “those who continued to smoke were six to 13 times more likely to die from lung cancer than from traditional AIDSrelated causes.” HIVPLUSMAG.COM

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J U ST D I AG N O S E D?

FIVE THINGS YOU MIGHT WANT TO ADD TO YOUR TREATMENT REGIMEN IT HAPPENED: YOU TESTED POSITIVE FOR HIV. WHAT’S NEXT? BY BORIS J. ABRAMS

The doctor has told you that you must start taking antiretroviral medication right away. The longer you wait, the greater the risk of complications. They may elaborate, telling you that without pills your CD4 count will drop and your viral load will escalate. Amidst all the jargon, it is easy to bow down to the physician’s command to take the pills and move on with your life. You certainly should, but you can also top those meds off with additional complementary therapies. Some of these treatments can mitigate side effects from HIV drugs, while others may help keep your immune system in top shape. A note of caution: They are called “complementary” because they are meant to complement, or add to, your treatment. They are not meant to replace your antiretroviral medications—even though there are individuals who refuse to take antiretroviral drugs, and quacks who insist they can cure HIV with alternative medicine. Have some time to kill? Read up on the ridiculous Manto Tshabalala-Msimang, a.k.a Dr. Beetroot. No, she’s not a New Age vegan hippie. She was the health minister of South Africa between 1999 and 2008. Her approach to addressing the AIDS epidemic? Forget the pills! Instead, indulge in garlic, olive oil, and lemon. Oh, and plenty of beetroot. Then presto, you will be cured. According to her obituary in The New York Times, Msimang, who died in 2009, was responsible for policies that led to the deaths of hundreds of thousands of South Africans. (A Harvard study put the number around 365,000 premature deaths.) Suffice it to say, she has been accused of committing genocide. Fortunately, there is an enormous difference between such quackery and most alternative therapies (many of which have research to back up

their health claims). I encourage you to enjoy the beauty of medical autonomy and choice. You can stick to one treatment regime and then move to the other. Feel free to dabble, but never replace your antiretrovirals. Remember when Charlie Sheen stopped meds to test alternative therapies? His viral load spiked dangerously.That kind of thing threatens your long-term health and can lead to the development of drug resistance down the road. Still, the Highly Active Antiretroviral Therapy (HAART) that has saved millions of lives can also take a toll on your physical wellbeing (but so can Advil). HAART can lead to nasty side effects including kidney failure, pancreatitis, fatty liver disease, and bone density loss. HIV-positive folks also have an increased chance of developing depression and anxiety, both of which weaken the immune system, and can make you sicker, which can make you more depressed. So really, if there are additional means of helping the body and mind deal with the virus, why wouldn’t you want to test the waters? Besides, the following complementary treatments are fun, affordable, and easy to incorporate in your daily routine. STICK PINS IN YOU Quite frankly, who isn’t having needles pierced into their skin these days? If you haven’t realized yet, HAART can cause serious stomach upset, from nausea to diarrhea. There are drugs designed specifically to target HIV-related diarrhea, but acupuncture comes with additional benefits like relieving stress. Acupuncture dramatically improves your gastric intestinal health, allowing you to maintain adherence to your meds. HIV can cause peripheral neuropathy. That’s essentially pain and weakness in hands and feet, which acupuncture can counteract.

GET STONED. Not that you need an excuse to get high, but marijuana is leading the way in alternative HIV treatment opportunities. HIV-positive people have heightened risks of developing certain neurological disorders. HIV can spur chronic inflammation in the brain. Tetrahydrocannabinol (THC) is known to reduce the number of inflammatory white blood cells circulating in the blood, reducing the inflammatory process. Researchers at Michigan State University found that inflammatory reduction could delay or prevent cognitive decline in those living with HIV. Cannabinoids (chemical compounds found in pot) have also been shown to inhibit the viral replication of HIV and, some say, may prevent HIV from progressing to stage 3 HIV (or AIDS). EMBRACE THE MUNCHIES. For all Dr. Beetroot’s nonsense, there is something to be said for the power of food and nutrition in the battle against HIV. Focus on using food and nutritional substances to raise CD4 counts. While it is important to keep your viral loads down (and ideally, undetectable, which means it’s near impossible to transmit to another person), some scientists believe that increasing CD4 counts is of greater importance. We need CD4 cells to help fight infections. Research found that in Tanzania, consumption of probiotic yogurt significantly increased CD4 counts and reduced the prevalence of gastric infections. Yogurt is cheap to purchase and easy to make at home! GOT MILK? Another thing to watch out for is decreases in bone mineral density, a common side effect of HIV medication. Try adding a good portion of calcium and vitamin D to your diet (through foods like dairy products, CONTINUED ON PAGE

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I AM, I SAID THE ONLY THING STANDING BETWEEN YOU AND KNOWLEDGE IS FEAR. BY DAV ID A RTAV I A

SHUTTERSTOCK

I almost went in disguise the first time I was tested for HIV. It felt like I was about to pull the trigger in a game of Russian Roulette. Was this the moment everything would come to a halt? Did I make a “mistake” along the way that I would regret forever? I could hear the voice of my youth pastor in my ear: “You have no one to blame but yourself, David.” Where I’m from in the South, people don’t talk about HIV or sexually transmitted infections unless you’re in health class. Even then, it’s linked back to sex with an overlay of shame—the idea being that if you have lots of sex, you will catch an STI, so either lock the legs or prepare for a lifetime of damnation. It wasn’t until after I had lived in Los Angeles for a year that I started to understand what being aware actually means. It didn’t matter if I was afraid to get tested (that’s not going to stop the virus). What mattered was my willingness to find out my status, then to act on it—whatever the results were. After all, it was certainly better than the alternative.

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START HIV TREATMENT. HELP PROTECT YOUR HEALTH.

There is no cure for HIV, but find out how treatment helps make it possible to live a healthy life. See Inside

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A HEALTHIER LIFE CAN START WITH HIV TREATMENT. Starting HIV treatment right after diagnosis can help stop the virus in your body. Because treatment helps lower the damage HIV causes to your immune system. Plus, doctors and scientists have found that it can help lower the risk of heart disease and certain cancers.

TREATMENT ALSO HELPS YOU PROTECT OTHERS. HIV treatment can help lower the amount of virus in your body. It can get so low, it can’t be measured by a test. It’s called being undetectable. And it helps lower the chance of passing HIV on to others by more than 90%.

TALK TO YOUR HEALTHCARE PROVIDER. Have an open conversation. When you work together it helps your healthcare provider find the treatment that’s right for you.

Watch HIV: “Treat 2 Prevent” See how staying on treatment can help protect you and the people you care about. YouTube.com/HelpStopTheVirus

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STOPPING THE VIRUS CAN START WITH YOU. Here are two resources that can help.

Watch videos, share information, and see how we can all help stop the virus. HelpStopTheVirus.com YouTube.com/HelpStopTheVirus

Get the answers you need, privately, on your phone. HIVanswers.com/app

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Refusing to get tested out of fear invites more fear. I learned that the hard way. Eventually it morphs into anxiety, paranoia, guilt, and shame—a vicious cycle that can easily be broken in the 15 minutes it takes for a full checkup for HIV and other STIs. I finally realized the obvious truth: I wasn’t afraid of getting tested, but rather the idea of testing positive. In that moment, it felt much easier not to know. But ignorance never supplies much protection, especially when most people living with HIV can take one pill a day, get to undetectable, and live a life almost exactly like anyone who is HIV-negative in terms of sex, relationships, and careers. Living in a state of unawareness is like viewing the world inside a fish bowl. It might be blissful, but your perspectives turn distorted. In today’s Grindr-obsessed, sex-on-the-go, instant gratification world we live in, knowing your status is the most responsible thing we can do to protect ourselves and our future partners. The only thing standing between us is the fear of HIV stigma, and that needs to end today. Getting tested every three to six months, like the Centers for Disease Control and Prevention suggests, can be daunting when it incites our biggest worry (what if today is the day I get a positive result?). But you know what? It’s okay to hate HIV stigma; because it’s a bully. It has no benefit other than to puncture the progress of millions of lives fighting against being labeled as “dirty,” “unsafe,” or “slutty.” But like all bullies, stigma does have a weakness. When you look stigma directly in the face, it runs away. It disappears because all bullies are

cowards. Afterwards, you realize it wasn’t the stigma that had power over you, but rather the fear of facing it. The willingness to discover the truth becomes a springboard to courage. In the end you learn that the stigma was a lie. HIV stigma corners us inside a box of fear. The more we tell ourselves it’s better “not to know,” the heavier our shame weighs. Getting tested should never feel like we’re walking the green mile. We are taking control of our health by allowing ourselves to know, and knowledge is powerful—more powerful than fear alone. That is something to be proud of. The first person you need on your side is you—not your sex partner, not your doctor, not your counselor, not your therapist, and not your friends or loved ones. You are the one who needs to stay on top of your health. And these days that’s really not hard to do. But to get started you have to know your status. Testing is an essential element. Without it, you cannot take the next steps you need to stay healthy. When we fight against ourselves, we’re always going to lose. It doesn’t matter what the results of a test might bring. The important part is being aware, because trust me it’s much better than living in a state of panic. Life itself is a game of Russian Roulette. Every time we we get in a car, we are taking a risk. The same goes for when we have sex. We are never going to control everything, but the one thing we can control is our awareness. With that, fear has no reason to exist. There are things we can do to stay on top of our health. Having PrEP as an option to avoid getting HIV is a major leap forward in prevention, and it should be adopted unapologetically. HIV has not disappeared. According to the CDC, if current diagnosis rates continue, one in six gay and bisexual men overall will be diagnosed with HIV in their lifetime and for black and Latino men it’s more than twice that. It’s also estimated that in today’s world, one in seven gay and bisexual men already have HIV but don’t know it because they aren’t getting tested. Due to their lack of knowledge, they are unknowingly putting other men at risk for contracting the virus. But the good news is that getting on treatment and lowering your viral load to undetectable levels makes it virtually impossible to transmit HIV. (The sooner you get tested, and if positive, treated, the easier that process is.) Sleeping with an HIV-positive person who is undetectable is much safer than sleeping with a guy who doesn’t know his status. Getting tested impacts more than one person. It produces a ripple effect in our community that encourages men to be empowered about our sexual health, thus breaking free of the fish bowl. As a result, we invite clarity into our lives. And with clarity, fear has no power. Get tested today. Proudly.

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5 REASONS YOU SHOULD GET AN HIV TEST TODAY IT’S NOT JUST ABOUT KNOWING YOUR STATUS ANY MORE. BY SAVA S A BA D SI D I S Of course, you know that getting tested for HIV is the only way to know your status, which has a great value in and of itself. But if that hasn’t motivated you to go to a clinic yet this year, here are some more reasons why testing is great for your health—and your community.

You can get back to having fearless sex. After testing positive for HIV, immediately beginning treatment with antiretroviral therapy can lead to quick viral suppression and—once you’ve reduced your viral load to undetectable levels—it becomes nearly impossible to transmit the virus to an HIV-negative partner. Think about that. Even if you’re HIVpositive, you’ll never have to worry about transmitting HIV to someone you love (or screw). That’s huge. It can save your life. Knowing that you are HIV-positive means you get on treatment. Without treatment, people who are HIV-positive risk developing deadly complications if the virus isn’t controlled and instead progresses to stage 3 (also known as

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AIDS). While it was ubiquitious in the 1980s and early ‘90s, the majority of people today living with HIV and on treatment will never develop AIDS or its complications. Treatment can enable HIV-positive people to live as long and healthy lives as their non-poz peers. In that sense, HIV is becoming no different than any other chronic condition, such as diabetes (which now kills more people each year than AIDS). Testing keeps HIV on the run. The rate of new HIV infections nationwide has steadily dropped in recent years. HIV prevention and screening efforts are finally paying off. Why? When HIV-positive folks on medication are completely virally suppressed and unable to transmit HIV to someone else (i.e. undetectable equals untransmittable), that essentially turns treatment itself into an HIV prevention strategy. That’s what doctors call Treatment as Prevention (TasP). To take full advantage of the preventative effect of treatment, San Francisco pioneered efforts to get those who test HIV-positive into treatment the same day. Other cities and states like New York have also

dedicated themselves to reducing the time between when someone tests positive and when they start treatment, which is crucial given the fact that people are more likely to transmit the virus soon after acquiring it (in most cases, that’s before they learn their status). Testing helps your whole community. Here’s another reason to get tested: It’s good for your community. Marginalized communities continue to bear the brunt of new diagnoses in this country, even while the overall rate of HIV among the broader (especially white, cisgender, straight) population is going down. People of color, transgender people, and gay and bisexual men are disproportionately impacted; having higher new diagnoses and worse health outcomes. Those with intersecting identities are particularly affected by HIV. As individuals, we may not be able to cure some of the systemic issues (racism, poverty, environmental injustice, mass incarceration) that disadvantage marginalized communities, but we can protect others in our communities by getting tested and embracing either TasP or PrEP to stop HIV in its tracks.

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If you’re negative, you can stay that way. The sooner you know you are HIVpositive, the sooner you can start treatment. But testing is also good for your health if you test negative. That’s because there is now an HIV prevention strategy known as PrEP, which is medication taken daily that prevents HIV-negative people from contracting the virus. (Condom use is still recommended given that PrEP doesn’t protect against other STIs.) And here’s the clincher: In order to start PrEP, you have to first take an HIV test. So regardless of the outcome of getting tested, doing so will give you the power to improve your health. You get tested so you can avoid getting HIV or so you can get treatment for HIV. Either way, testing is a win-win.

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almonds, or vegetables including broccoli and kale). Supplements work too. Taking 4000IU of a daily vitamin D supplement in combination with 1000mg of calcium was shown to reduce bone loss by a whopping 50 percent during the first year of ART treatment. If you don’t fancy taking supplements, stock up on sardines (an absolute favorite of mine). They’re cheap and, when canned, have long shelf-lives.

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BECOME A YOGI. Stress damages the immune system. For people living with HIV, mitigating anxiety is even more important. If only we could talk ourselves into being “calm’.” As anyone who has suffered from depression can attest, this is no easy task. Yoga forces your body into a state of relaxation. Just one month of integrated yoga for HIV-positive individuals was shown to raise CD4 counts. Cardiovascular risk is another cause for concern among those living with HIV. The reasons are varied, from chronic inflammation to side effects of certain drugs. Incorporating yoga into your daily schedule is a cost efficient (and relatively simple) means of keeping your heart healthy. A recent study confirms that yoga could “lower blood pressure in pre-hypertensive HIV-positive adults with mildmoderate CVD risk factors.” Some options here require no medical supervision (no one will stop you from enjoying a good old sardine sandwich). However, always speak to your health care provider about any complementary therapy you may choose to explore. Sometimes, even something as innocent as garlic supplements can be risky. (Garlic supplements can actually cause levels of ART to drop.) In other words, feel free to explore—and even go off trail. But don’t trek into the wilderness alone without a compass. Your doctor can help show you the way. HIVPLUSMAG.COM

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3/21/18 12:25 PM

MANY HIV-POSITIVE PEOPLE HAVE TO CHOOSE BETWEEN FOOD AND THEIR MEDICATION. BY Boris ABrams

“You just have to find a way,” quotes David Brathwaite-Hill. His apartment is cluttered, evidence of a lifetime spent in the East Village scattered between exposed brick walls. But the space is welcoming, pulling guests into a tender embrace. Although I have never been here before, the environment is somewhat familiar, comforting. A mocking nostalgia seeps forth, the soul pleading a return to a life yet lived under these worn wooden beams. “How are you meant to ‘find a way?’” he laughs, recalling one provider’s worthless advice. Such had been the solution offered to his conundrum about how to consume healthy food on a limited budget. I lose him in thought, his fingers tugging on the nipple rings that dangle from his bare chest. Since being diagnosed with HIV in 2013, Brathwaite-Hill, now 62, exists as yet another ignored statistic in the murky world of HIV and food insecurity. Too “rich” to qualify for SNAP (food stamps) and too poor to afford a healthy balanced diet, he lives week to week. This month, he is forgoing part of his treatment in order to buy nutrient-dense foods. For people living with HIV, consuming nutritious foods and adhering to antiretroviral therapy work in symphony, fortifying and protecting the immune system. Often, for those of a lower socioeconomic status, a group disproportionately affected by HIV, this 26

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Insufficient food access torments many of those living with HIV (and, for some, struggling with the complications of AIDS). Worse, for those those facing food insecurity, any assumption that HIV has become a manageable condition is rendered obsolete.

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symphony shatters. Sacrifices are made, while immune systems are left vulnerable and exposed. Food insecurity, be it chronic or intermittent, disrupts adherence to antiretroviral therapy. Taken in the absence of food, ART can upset the stomach. To avoid this, many people miss doses when food supplies dwindle. The hunger and stress associated with food insufficiency, also increases the probability of simply forgetting to take medication. Erratic adherence to ART is troubling. Drug resistance can develop, creating future treatment challenges. Studies also show that poor ART adherence allows viral loads to escalate and CD4 counts to plummet. A rep from the New York nonprofit God’s Love We Deliver notes that many of its HIV-positive clients facing food insecurity aren’t able to get their viral loads down to undetectable levels—which means they remain capable of transmitting HIV to others. For those dealing with food insecurity, even perfect adherence to their drug regimen may be in vain. To reach full efficiency, certain drugs must be taken with food. The non-nucleoside reverse transcriptase inhibitor, rilpivirine, must be consumed with at least 500 calories, a challenging daily requirement for those with limited calorific access. The drug plasma concentration of atazanavir increases 70 percent when taken with a light meal. Ritonavir is equally dependent on food. In a sample of 400-plus food insecure HIVpositive

individuals in Atlanta, Ga., researchers found that over half the participants were on meds that required food. Individuals on food-dependent ART regimes were also more likely to have to choose between the purchase of food or medication. Unsurprisingly, those on food-dependent regimes were significantly more likely to display lower CD4 counts and higher viral loads. This situation is unlikely unique to Atlanta. It is very likely happening all across America. Food insecurity has no face. Unless an individual expresses difficulty in accessing food, it is nearly impossible for providers to make necessary medical adjustments. Confronting and admitting difficulties in food procurement is not easy. Many don’t recognize the importance of revealing their food insecurity when establishing ART. This is especially true for those experiencing intermittent insecurity. This will not last; this is just a phase; others are in greater need need, they tell themselves. Stigma and shame affect those living with both HIV and food insecurity. Eradicating this is paramount at the Keith Haring Food Pantry, one of the many services provided by New York City’s Gay Men’s Health Crisis. Situated above the streets of Manhattan, the room is hidden. There are no windows and no branded grocery bags. Individuals choose their food in near privacy, under the watchful care of a registered dietician. Canned foods and other non-perishables line the walls, while a large fridge offers fresh fruits and vegetables, organic where possible. Sadly, on this particular day, only bulbs of garlic remain for the taking. Yet, there is a certain pride to be felt. That the Keith Haring Food Pantry even exists is reason for celebration. In 2016, GMHC served over 120,000 meals through both the pantry and its in-house meal program. Popular handson cooking classes are also offered, along with general nutrition and food safety training. Similarly, each client of God’s Love We Deliver completes a comprehensive nutrition assessment with one of seven registered dietitians. Advice on cooking with limited access and resources enables individuals to make informed decisions. In an insecure world, education fosters greater stability. Despite the positive roles these organizations play, food insecurity remains a significant problem for people living with HIV, even in resource-rich locations. The Keith Haring Food Pantry has historic waitlists. Owing to the nature of the federal grants received by God’s Love We Deliver, clients are required to provide eligibility documents every six months. This creates challenges for those who struggle to constantly access updated records. As a result, delays in care and diet may result. A recent study in New York City found that out of 2,118 HIV-positive people receiving federal nutrition-based assistance, only 14 percent were constantly food sufficient. With ever-escalating food prices, the situation is only set to worsen. Unfortunately, the current administration is showing no signs of increasing funding that’s so vitally needed. For now, all we can do is raise awareness. Recognizing the relationship between HIV and food insecurity should encourage individuals to seek culinary education. Understanding the importance of ART adherence and nutritional intake must foster dialogue between providers and clients, for it is the responsibility of both to ensure optimistic treatment outcomes. For instance, while ART may not feasibly be switched to less food-dependent regimes, specific nutritional care programs could be enforced for specific individuals. So long as we bring food access to the forefront of HIV discourse, we will begin to find ourselves in a far more optimistic position. HIVPLUSMAG.COM

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CHILL

BY GARY MCCLAIN

DATING YOUR BOYFRIEND’S HIV OUR RESIDENT MENTAL HEALTH EXPERT OFFERS ADVICE ON NAVIGATING TWO DIFFERENT, BUT VERY COMMON, ISSUES FACING SERODISCORDANT COUPLES. IS SHE DATING YOU OR YOUR HIV?

I often talk to clients about the importance of taking responsibility for their health, but I also understand that as the HIV-negative partner, you can feel sidelined. This is one of the challenges of being in a serodiscordant relationship, where one partner is poz and the other isn’t. Here are some ideas to get the communication back on track: Think, before you react. Take a step back and get some perspective on the situation. Consider your boyfriend’s position. Living with HIV and staying healthy means staying on top of your treatment regimen and everything that goes along with it. Having a partner living with a chronic condition like HIV means being in a supportive role where his HIV regimen is concerned. 28

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When a poz partner’s efforts to stay healthy leaves the other partner feeling left out in the cold. Since my boyfriend received an HIV-positive diagnosis, he’s become a health nut. He works out every morning and his counters are lined with bottles of supplements. He says I can’t understand what he’s going through. I feel like he’s got this new life that he won’t share with me. It’s like HIV is the third wheel in our relationship. How do I tell him I’m dating him, not his HIV?

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CHILL

BY GARY MCCLAIN

If he was recently diagnosed he may still be figuring it all out. Of course, so are you. In that way, you share the diagnosis. Talk about that. Get specific about what you need most from your partner. How can he support you while you support him? What do you miss the most when your partner is focused on his regimen and self-care, and how could you get more of what you need? Getting together with friends, or spending quality time together? It can be hard to sit down and have a conversation about needs and expectations. These conversations can veer into dangerous territory, and nobody wants to walk into a conflict—especially when you or your partner may experience some raw feelings. But also keep in mind that talking about your relationship can make it stronger. Make that your goal. Avoid accusations. Use “I” statements. Give examples. Start on a positive note: “I really care about you. And I know you are dealing with a lot.” That’s a good way to not make your partner feel defensive. Follow this with: “I want to be your teammate in this. I want to support you in taking good care of yourself. I want to understand your treatment regimen.” Follow this by affirming what you would like to have more in your relationship: “I would really like it if we spend more time just being a couple and getting together with friends.” Lay out the specifics with each other, as well as what your boyfriend needs from you and what you need from him. No elephants in the room, okay? Most of all, be patient. Learning to live with HIV is an ongoing process—adjusting to the drug regimen, making healthy lifestyle changes, and coping with the emotions that come up, as well as issues like disclosure. All of this requires lots of patience with your boyfriend and yourself. If you can keep the line of communication open, without accusations or defensiveness, you will be more able to avoid hurt feelings and resentment. While life may feel out of balance right now, the two of you will find your new normal as your boyfriend gains his footing on the road ahead. Remind each 30

other every day who number one is, then back up your words with action.

ARE YOU MY BOYFRIEND OR MY MOTHER? Sometimes a well-intending partner can turn into a mothering, micromanager when it comes to their poz partner’s health. My boyfriend has been incredibly supportive since I got my HIV diagnosis. He got educated on HIV, he has gone to doctor’s appointments with me, and he’s always there to listen. The problem is, he’s sometimes too helpful. He’s treating me like a child who can’t be trusted to make sound decisions. Being watched that closely is disempowering, even though I know he means well. And his constant hovering is stressing me out. I already have a mother. What can I do to get him to lighten up without hurting his feelings? Your question is ironic in a way. I talk with clients who have unsupportive partners, who don’t give them much help at all. And then I have clients who, like you, would like it if their partners would back off and not be so micromanaging. Let’s start with this thought: Coping with parental behavior begins with understanding your partner. Be patient. It’s easy to feel on edge emotionally when you aren’t at your best physically. And what you may wish for the most is to be left alone. However, you and your partner are a team, and your teammate wants to be by your side. Recognize what’s behind all that parenting— in a word: helplessness. One of the hardest things in life is to watch someone we love suffering and not be able to make it better. Your boyfriend is feeling helpless, and he is trying to manage his helplessness by hovering over you. So all that excess attention is about you, but it’s also about your boyfriend. Let him know how you’re feeling and that his support feels like a lack of trust in your ability to take care of yourself or speak up for yourself. Even something as simple as, “I know you’re worried about me and I really appreciate that. But you’re coming across as kind of parental. And that makes me feel like you don’t trust me.”

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Be gentle, but also firm and specific. Follow up by letting your boyfriend know what he doesn’t have to do to help you, and what he can do. Try to find a balance between doing what you want—and need— to do for yourself, and letting him give you a hand: Say something like, “Please know you don’t have to worry about ________. I am on top of that. But you could help me a lot if you would _________.” It might also help to do a little more verbalization than you might normally do: “I took my meds on schedule this morning” or “I feel up to getting out for awhile.” This may keep you from having your boyfriend subject you to what feels like an interrogation, while also helping him to feel less worried. By the way, if you’re reading this and you’re the one in the relationship who may be guilty of all that parenting, I suggest taking a step back and asking yourself, What’s going on with me emotionally? Am I creating calmness or stress? Recognize your own helplessness. Cope with helplessness by first admitting to it. You’re feeling helpless because you are helpless, helpless to make

what your partner is dealing with go away. While your heart’s in the right place, this is one of those things you aren’t in control of. But there are things you can do and places where you can help. Put yourself in your partner’s shoes. How would you like it if you weren’t feeling well and someone was standing over you and treating you like an irresponsible child? What would you find helpful? Ask and listen. Yes, it’s that simple. “Honey, I know you’re having a rough time. It’s hard to watch you not feeling well and so I’m feeling kind of helpless. Can you let me know what I can do to help?” Listen to their response and try to act accordingly, even if it means biting your tongue a few times to keep from jumping in with a question—or an order. It’s hard to watch someone we love not feeling well, and it’s also hard to not feel well and have someone treat you like you need supervision. Let’s try to be more aware of each other’s needs. Along with being more patient. And let’s communicate with compassion and clarity. We’re all in this together. HIVPLUSMAG.COM

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3/19/18 1:12 PM

C H I L L . U S • # C H I L L • @ C H I L LT H E M A G

R E S I S TA N C E

BY BENJAMIN M. ADAMS

ONE-A-DAY WONDER

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THE LATEST RESEARCH SHOWS THAT A NEW SINGLE-PILL HIV REGIMEN FIGHTS RESISTANCE WHILE INCREASING TREATMENT ADHERENCE.

DRUG RESISTANCE IS a growing problem for people living with HIV. As antiretroviral medications have extended the lives of HIV-positive people and turned living with the virus into a manageable chronic condition, it has meant more poz folks are taking drugs for longer periods. Current HIV regimens involve taking daily medication (longer lasting treatments are in the works), something that is difficult for anyone to adhere to seven days a week for years or even decades at a time—without missing a dose or two. Combined, these truths are a recipe for the development of drug resistance. Particularly when there are breaks in treatment, the virus is able to mutate, and it can develop genetic immunities to particular classes of drugs (which all share a common method of attack). “Despite significant progress, clinical challenges remain in the management of HIV [as it is] related to adherence and the risk of developing HIV drug resistance,” Kimberley Brown, a medical director at Janssen Scientific Affairs, a pharmaceutical company of Johnson & Johnson, tells Plus. “In the treatment of HIV, adherence is critical, because missing just a few doses can lead to drug resistance, which can stop a person’s medication from working. However, people living with HIV often miss doses of their treatment due to a variety of factors, including pill burden, convenience, stigma, and tolerability of therapy over time.” Resistance is a significant concern, but so too is the fear that taking some HIV medications long-term may be detrimental to poz folks in other ways. Some of the worst side effects from combination drug therapies can include bone density and kidney-related problems. The end goal is to come up with new treatments that minimize these problems. Earlier this year, at the annual Conference on Retrovirues and Opportunistic Infections, researchers unveiled further positive results from Phase 3 trials of a new once-daily, single-tablet regimen from Janssen that hopes to do just that.

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presented at CROI are consistent with the pivotal data previously presented and are relevant to the real-life clinical challenges physicians face in treating diverse patients with various levels of treatment experience.” If approved, the drug would be the only complete regimen delivering the benefit of a once-daily singlepill HIV cocktail with darunavir, a drug that has proven to be less at risk for the development of drug resistance, and tenofovir alafenamide, which has been less detrimental to kidneys and bone density than other HIV drugs. EMERALD has been examining whether people whose HIV is already under control with the help of antiretroviral medication could switch to the new drug without negative consequences. Brown says one of the things that makes the study unique is the number of participants who had resistances to multiple drugs (and thus are in most need of finding a new regimen to switch to). “Unlike other HIV switch studies,” Brown says, “EMERALD had more inclusive entry criteria and may be more representative of the treatment-experienced patients in clinical practice since the study included patients with previous non-darunavir virologic failure, prior experience with multiple antiretroviral and known baseline resistance-associated mutations to agents other than study drugs. Yet, we saw high response rates and low rebound rates in both our pivotal trials, even with these more inclusive criteria.” These analyses demonstrate the potential of the drug as an important treatment option for patients regardless of previous treatment history. It could receive FDA approval later this year.

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Submitted to the U.S. Food and Drug Administration for approval last year, Brown says, darunavir, cobicistat, emtricitabine, and tenofovir alafenamide (D/C/F/TAF) is currently under review. “If approved in the U.S.,” Brown explained, “D/C/F/TAF could give clinicians a simplified treatment option that offers the benefit of a once-daily [single-tablet regimen] with the durability and high barrier to resistance of darunavir coupled with the bone and renal safety profile of TAF for those living with HIV who may be at risk for drug resistance.” The application was filed for the treatment of HIV-1 in adults and pediatric patients ages 12 and older and was based on the results from the ongoing EMERALD and AMBER Phase 3 trials, which Brown says “demonstrate the potential of D/C/F/TAF as an important treatment option for a wide range of patients regardless of previous treatment history, including those with previous virologic failure, experience with multiple [antiretrovirals], and in some cases, unknown baseline [resistance-associated mutations] to agents other than study drugs.” Those are important distinctions, since many new HIV treatments unveiled in the past few years have been specifically for those who had never been on HIV treatment before. That’s been a boon for those just diagnosed with HIV, but those who’ve experienced treatment failures—particularly due to developing resistance to multiple antiretroviral medications— haven’t gotten a lot of new options. Previous findings already suggested D/C/F/TAF offers new hope for those facing drug resistance or concerned about kidney issues. Brown says the latest “analyses MAY / JUNE 2018

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3/20/18 9:05 AM

TREATMENT WHAT’S HIDING IN YOUR HUEVOS?

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New study shows HIV can hide inside testicles for years, remaining protected from your immune system, even while on treatment. New research suggests HIV reservoirs might be able to evade drug treatment by finding a home in male testes (or testicles), where they can remain protected from the body’s immune system for years. Studies around testes are difficult to undertake, mainly because the tissue itself is hard to collect without removal of the testes—and most men aren’t willing to make that sacrifice for science! But, according to Scientific American, Jean-Pierre Routy, an infectious disease clinician and researcher at McGill University in Montreal, Canada, found a unique way around that roadblock. Dr. Routy, a surgeon who performs gender-affirming surgeries at GRS Montreal (a plastic surgery clinic) collected samples from transgender women who were undergoing bottom surgery. The women gave consent for their tissues to be used for research after removal. Routy has collected nearly 100 samples, about a tenth of which were HIV-positive, offering him an unprecedented opportunity to examine HIV in testicular tissue. And his research is breaking new ground. Data shows that inside the testes is what’s known as an “immune-privileged” site, where HIV can find protection from the immune system. Immune privilege allows foreign invaders the same protection from the immune system as sperm. “This is because antigens from invaders also do not seem to set off an inflammatory response, unlike elsewhere in the body,” according to Scientific American. The same idea of immune privilege was evident in the recent Zika and Ebola outbreaks. Traces of these viruses were found in semen months after it had been cleared elsewhere in their bodies. For one man in Italy, Zika virus was detected in his semen nearly 134 days after his symptoms stopped. Meanwhile, his blood and saliva samples showed no trace of the virus. Researchers have known that HIV can remain detectable in certain tissues (like the lymphatic system) and organs, while lowering to undectable levels in the blood. In these latent HIV reservoirs, the virus can remain dormant while a person is being treated with antiretrovirals, and it can exist even after the person living with HIV has become virally suppressed. If the HIV-positive person stops treatment, the latent virus can reawaken and reactivate, and viral loads can rebound. After examining testicular tissues and blood samples from HIV-positive donors, Routy and his team found lingering viral DNA in at least one testicle of each donor, even though all the poz donors were on treatment and undetectable at the time. It’s important for scientists to study testicular tissues, even if they are hard to come by. Routy stated, “If we don’t learn how [viruses] persist in the testes, then patients will continue to transmit the virus to others and put people at risk.” Studies like this show how including transgender subjects in scientific research can offer new avenues for investigation and groundbreaking insights that have broad applications. —DAVID ARTAVIA HIVPLUSMAG.COM

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TREATMENT IS SWITCHING WHILE UNDETECTABLE SAFE? Discovering whether virally supressed folks can switch to certain treatment regimens A new study launched by ViiV Healthcare aims to see if HIVpositive adults who are virally suppressed will be able to maintain suppression after switching from a three drug, tenofovir alafenamide fumarate (TAF)-based regimen to a two-drug regimen of dolutegravir and lamivudine. The TANGO study will enroll 550 adults living with HIV in North America, Europe, Australia, and Japan. Researchers will be monitoring participants’ health and satisfaction during the 48-week drug trials. Since the introduction of antiretroviral therapy 20 years ago, most people living with HIV have had regimens that include three drugs. This was, in part, to reduce the risk of failure even if someone developed a resistance to one of the meds. Those treatments have changed HIV into a chronic, manageable

condition. But that now mean growing concern about what impact a lifetime of these drugs will have. Reducing the number of drugs reduces the risk of developing long-term toxicity issues. “We are asking a simple question in the TANGO study,” Dr. John C. Pottage, Jr., the chief scientific and medical officer at ViiV Healthcare (ViiVHealthcare.com), said in a statement. “Can virally suppressed people with HIV reduce the number of medicines in their HIV treatment regimen while maintaining viral suppression? If the data show the answer to be yes, this may allow healthcare providers to address issues of long-term toxicity by reducing exposure to antiviral agents over a lifetime of treatment.” The importance of maintaining viral suppression has grown as we’ve learned that being undetectable means one cannot transmit HIV to partners. Therefore, people living with HIV need to make sure any changes to their treatment (even those that will be beneficial long-term) don’t cause short-term setbacks. In previous studies, ViiV Healthcare showed that dolutegravir and rilpivirine are strong enough as a duo to suppress HIV. Now it is pairing dolutegravir and lamivudine to see if they get similar results while keeping participants virally suppressed, which would be particularly good news for anyone resistant to or suffering with side effects from rilpivirine. “We believe that with its high barrier to resistance, dolutegravir has the right clinical profile to be a core part of 2DRs for the treatment of HIV-1 and look forward to seeing the results of TANGO in 2019,” Pottage said.

SHUTTERSTOCK (BOTH PAGES)

—DAVID ARTAVIA

MAY / JUNE 2018

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ONE PILL TO RULE THEM ALL

Scientists discover a new way to deliver HIV meds via a once-a-week capsule, and it just might change the world. Researchers at the Massachusetts Institute of Technology and Boston’s Brigham and Women’s Hospital, in conjunction with Lyndra, a Bill & Melinda Gates Foundation-backed biomedical startup, have developed a way to deliver a week’s worth of medication in a single dose. This advanced technology can potentially revolutionize the way antiretroviral drug regimens are delivered to people living with HIV, drastically improving a patient’s adherence. The revolutionary delivery system is a small, six-pronged, starfishshaped “backbone” that is encased in a capsule. Once the capsule dissolves in the stomach, the arms expand out to form the star-shaped configuration—too large to be passed from the stomach into the digestive tract, but still safe enough to remain in the stomach. The backbone of the device is made of a polymer, designed to maintain its integrity for one week before breaking apart and passing safely through the intestines. Each arm contains a week’s dosage of medicine, each within a different polymer designed to dissolve at a set rate. By matching the drug with the correct rate at which the chosen polymer will dissolve, researchers were able to combine drugs that used different schedules and doses within a single pill. Previous efforts had been unable to solve this problem. “Because people with HIV require lifelong antiretroviral therapy, a longacting oral option that could be taken at home would make it easier for patients to adhere to their treatment regimen,” said Andrew Bellinger, cofounder and chief scientific officer at Lyndra, in a press release. “By fitting into a patient’s regular routine, an ultra-long-acting therapy would be taken consistently, improving therapeutic success and helping avoid viral resistance.” The key is the “versatility of a variety of polymer matrices to formulate and deliver controlled release of three highlypotent antiretrovials for a week after a single dose.”

For many HIV-positive people on combination therapies, proper drug adherence can be an issue day by day. As of now, all combination therapy drugs on the market must be taken daily, which can lead to medication fatigue. Missing doses can increase the risk of drug resistance while decreasing the chances of remaining undetectable, whereby your viral load is so low that it becomes near impossible to transmit to an HIV-negative person. Without proper adherence, poz people can also become more susceptible to infections or other health issues. The importance of adherence— and the potential benefits of this new delivery system—aren’t limited to HIV-positive people. The National Center for Biotechnology Information estimates there are nearly $100 billion in avoidable medical expenses directly resulting from people not taking medications on time, and as prescribed. This new delivery system is designed to not only save money, but to save lives. As Bellinger said in the statement, the goal is to “dramatically improve the probability of treatment success for patients who often forget to take their medicine on time.” For now, Lyndra plans to limit their areas of focus; one of these areas is a partnership with Allergan to explore its use in Alzheimer’s and other neurological disorders. That could also benefit people living with HIV, as they can be more susceptible to neurological issues as they age. Moving forward, Lyndra hopes to also examine its potential for use in developing long-acting treatments for cardiovascular disease and diabetes. In much the way once-daily dosages of drugs revolutionized the treatment of HIV-positive people, so too does Lyndra’s new weekly capsule. No longer may it be “an apple a day to keep the doctor away,” but simply a once-weekly pill.—DONALD STUART HIVPLUSMAG.COM

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TREATMENT

FDA APPROVES SMALLEST NEW DAILY HIV PILL

The U.S. Food and Drug Administration recently approved a once-daily, three-combination drug, Biktarvy, which, according to the drug’s maker, Gilead, is the smallest pill of its kind. Biktarvy combines the integrase strand transfer inhibitor (INSTI) bictegravir, with Descovy, which is a combination of two nucleoside reverse transcriptase inhibitors (NRTIs): tenofovir alafenamide and emtricitabine. The single pill is a complete regimen for HIV treatment in adults who have had no previous antiretroviral treatment history. It is also approved as treatment to replace the current antiretroviral regimen for those who are undetectable and on a stable regimen for at least three months, with no history of treatment failure and no known resistance to the individual components of the drug. Biktarvy has no food intake requirements and has no baseline viral load or CD4 count restrictions. According to Biktarvy’s prescribing information, prior to or at the time of treatment initiation, your healthcare provider should test you for hepatitis B and check your renal (kidney) function. Furthermore, your kidney function should be checked regularly while you are taking the drug. If you have hepatitis B, this may not be the drug for you, as it carries a risk of post treatment acute exacerbation of hepatitis B—in otherwords, when you stop taking Biktarvy, your hep B could worsen. During the 48-week clinical trials, no participants developed drug resistance to the individual components, according to a statement by Paul Sax, MD, clinical director 40

of the division of infectious diseases at Boston’s Brigham and Women’s Hospital, and a lead clinical trial investigator. “In addition, the clinical data show that the regimen’s antiviral efficacy, tolerability profile, and limited drug interactions offer an effective new treatment option for a range of people living with HIV.” The FDA approval of Biktarvy is supported by data from four ongoing Phase 3 studies involving over 2,400 participants, including people reflecting a wide range of adult age groups and races/ethnicities. During the 48 weeks of study, no participants failed Biktarvy with treatment-emergent virologic resistance, and none discontinued Biktarvy due to kidney-related issues. The most common side effects from the drug were diarrhea, nausea, and headaches. “Gilead is committed to improving care and simplifying therapy for people living with HIV,” said Gilead’s president and CEO, Dr. John F. Milligan. “We continue to invest in research in next-generation treatments, including therapies that could potentially cure HIV patients. We are pleased to offer Biktarvy, our latest triple-therapy treatment, which brings together the potency of an integrase inhibitor with the most prescribed dual-NRTI backbone in a once-daily single tablet regimen.” Additional clinical trials of Biktarvy are ongoing, including a dedicated study of its effects on women, as well as in adolescents and children living with HIV. Gilead plans to present data from these studies at this year’s scientific conferences.—SAVAS ABADSIDIS

SHUTTERSTOCK (BOTH PAGES)

A new drug has been approved for HIV-positive people, and this one might go down easier.

MAY / JUNE 2018

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PLUSES AND MINUSES THE CONFERENCE ON RETROVIRUSES AND OPPORTUNISTIC INFECTIONS REVEALED BOTH PROMISING, AND CONCERNING, STUDY RESULTS. THIS SPRING, 4,000 researchers from 76 countries descended on Boston for the annual Conference on Retroviruses and Opportunistic Infections to share important developments in HIV research. The event is known to deliver new insights, treatment options—and hope—for healthcare professionals and people living with HIV. And this year was no different. HIV researchers presented the conclusions of their studies—some of which are ongoing, and others that took months or years to compile—and much of the information has potential to lead to further research. Here are some of the key takeaways: ORGAN TRANSPLANTS FOR HIV-POSITIVE PEOPLE ARE BECOMING MORE PROMISING

As we reported last year, surgeons are finally able to transplant organs donated by HIV-positive people into others of the same status (thanks to the 2013 HIV Organ Policy Equity Act). According to a CROI presentation by Dr. Christine Durand of Johns Hopkins University, so far, 286 people with HIV have consented to receive an HIVpositive donor organ, and there have been 77 transplants from 22 donors. Another study at Hopkins also looked at 10 hepatitis C-negative people who received organs from those living with hep C. After a year, those who had received the donated organs remained hep C free. Both studies offer hope for the thousands of people waiting for organ transplants due to the shortage of available donors. TRANSGENDER WOMEN ARE MORE LIKELY TO BE INCLUDED IN HIV CLUSTERS

A study of HIV cases in Los Angeles found that transgender women are more likely than any other risk group to be in genetically-connected clusters of cases. In other words, they were more likely to share a strain of HIV, due to shared risks; particularly, the study found, a shared pool of sexual partners (out of the 167 transwomen in clusters, 147 had sexual contact as their only risk factor, while the other 20 also used injection drugs). Manon Ragonnet-Cronin of the University of California, San Diego, pointed out that this study shows there is a distinct population of cisgender men who

primarily or occasionally have trans women as sexual partners. That’s a group of men who are likely not being reached by traditional HIV prevention efforts. A LONGER LASTING PREP PILL IS IN THE WORKS

An investigational drug called MK-8591 (or EFdA), is being developed by researchers for Merck & Company, and could become a once-a-week extended release PrEP pill. The drug blocks HIV from making a DNA copy of its genes (which it can then insert into a human cell), while also blocking integrated HIV DNA inside cells from being converted back into viruses. These findings, reported on by Martin Markowitz of the Aaron Diamond AIDS Research Center, could also lead to improvements to current HIV meds. PREGNANT WOMEN HAVE A HIGHER RISK OF CONTRACTING HIV

Renee Heffron of the University of Washington presented a study finding women’s risks of contracting HIV through sex with a male partner increases during pregnancy—and peaks at four times as high during the postpartum period. Of course, that increases risks of vertical (or in utero) transmission of HIV. Fortunately, there are steps HIV-positive people can take to avoid transmitting HIV to a partner or child (including using antiretroviral medications). ANTIRETROVIRALS DECREASE THE EFFICACY OF CONTRACEPTIVE RINGS

The National Institute of Allergy and Infectious Diseases has been funding ongoing studies looking at the use of a two-in-one prophylaxis vaginal ring that prevents both HIV and pregnancy. The need for such a duo-purpose ring (and for using the right combination of drugs) was reiterated in findings presented by Dr. Kimberly Scarsi of University of Nebraska Medical Center, who found that the antiretroviral medication, efavirenz, interfered with the contraceptive hormones in standard birth control rings. Efavirenz reportedly caused an 80 percent decrease in levels of the contraceptive in the blood stream. —BENJAMIN M. ADAMS & DAVID ARTAVIA

HIVPLUSMAG.COM

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CHILL CHILL

URBAN DICTIONARY DEF: COOL, TIGHT, WICKED, SICK, SWEET, NICE, EASY GOING, SEX URBAN DICTIONARY DEF: COOL, TIGHT, WICKED, SICK, URBAN DEF: COOL, TIGHT, WICKED, OUR DEF: DICTIONARY A NEW MEN’S MAG THAT’S ALL SEX THAT ANDSICK, MORE SWEET, NICE, EASY GOING, SWEET, NICE, EASY GOING, SEX PREMIERING A P R I L / M AY 2018 OUR OUR DEF: DEF: A A NEW NEW MEN’S MEN’S MAG MAG THAT’S THAT’S ALL ALL THAT THAT AND AND MORE MORE . UI LS/ M A Y 2 0 1 8 P R E M I E R I NCGH IALPL R P R E M I E R I N G A P R I L / M AY 2 0 1 8 CHILL.US CHILL.US

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B AC K TA L K B Y S AVA S A B A D S I D I S

BUILDING A NEW MOVEMENT

COURTESY ACHIM HOWARD

ACTIVIST ACHIM HOWARD BATTLES THE RISING HIV EPIDEMIC IN HIS COMMUNITY. ACHIM HOWARD , the Washington, D.C.-based founder of the social activist group Trans Men Rising, is an advocate for black transgender men living with HIV. As a sexual assault survivor, Howard also identifies with the #MeToo movement, though he faces different headwinds as a black, trans man. After he sought care for the assualt he received a call from his doctor saying he needed to come in right away. Howard worried that the assault left him with an STI, or worse, pregnant. He recalls, “[The doctor] told me I wasn’t pregnant, but she said, ‘I’m sorry to tell you that you have HIV.’” Howard began treatment at Whitman-Walker Health in Washington, D.C., where his care included a therapist and providers who called and checked on him, even on their days off. After the assualt Howard recalls, “I couldn’t sleep at night. So, to make sure I’d be able to sleep, I’d bring a bottle of wine to [my brother’s] house... and drink until I passed out. I didn’t want to think about anything. I just wanted to sleep.” Howard’s brother, who is gay, grew increasingly concerned, and eventually confronted him, saying that they should be able to talk about anything. “I ended up telling him I was positive—and that’s when my brother told me he was positive, too,” Howard recalls. After hearing someone at a support group talking about taking a huge number of pills for his HIV, and the medications’ side effects, Howard was shaken, and told his brother he “wasn’t going back.” But the two poz brothers tackled HIV together, going to support groups and doctors, and attending retreats, and conferences. “I was learning about myself. I was learning about HIV, and I was

learning how to live with HIV,” Howard says. But he noticed event organizers would often lump trans people and gay men together in groups. And they would often misgender him. So, he attempted to educate folks. Howard would explain what being a trans man was, as opposed to being a trans woman. “It was like they were missing the whole point.” He also realized most HIV support groups were tailored to gay men and trans women, without addressing the needs of trans men. “I became an advocate for trans men living with HIV when I became positive,” Howard says now. Along with other HIV-positive trans men of color, Howard founded Trans Men Rising (@TransMenRising), to help educate people. He’s also disturbed by the alarming HIV rates in the black community. “It’s getting out of hand,”

he laments, fearing efforts to address those disparities will fall short. “It’s hard because there’s limited funding and the current administration is not on any of our sides. Look at the proposed bill Trump has put out,” he says of the administration’s intentions to slash funding for HIV-related programs. If funding wasn’t a barrier, Howard would like to raise awareness around HIV for trans masculine individuals, whether they are men, women, or young people. “I want to educate the children, like from the get-go. There are trans men who are becoming comfortable with who they are at a younger age,” he says, and they need HIV education “starting as early as middle school.” Maybe then, he says, “we can end the rise of HIV transmission rates in my community.” HIVPLUSMAG.COM

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YOU MATTER AND SO DOES YOUR HEALTH Thatâ&#x20AC;&#x2122;s why starting and staying on HIV-1 treatment is so important. WHAT IS DESCOVYÂŽ? DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.

DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance QH UGZWCN EQPVCEV YKVJ DQF[ Ć&#x192;WKFU 0GXGT TGWUG QT UJCTG PGGFNGU QT QVJGT KVGOU VJCV JCXG DQF[ Ć&#x192;WKFU QP VJGO

IMPORTANT SAFETY INFORMATION What is the most important information I should know about DESCOVY? DESCOVY may cause serious side effects: â&#x20AC;˘ Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY YKVJQWV Ć&#x201A;TUV VCNMKPI VQ [QWT JGCNVJECTG RTQXKFGT CU they will need to monitor your health. What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: â&#x20AC;˘ Changes in your immune system. Your immune U[UVGO OC[ IGV UVTQPIGT CPF DGIKP VQ Ć&#x201A;IJV KPHGEVKQPU Tell your healthcare provider if you have any new symptoms after you start taking DESCOVY. â&#x20AC;˘ Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems. â&#x20AC;˘ 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. â&#x20AC;˘ 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 â&#x20AC;&#x153;tea-coloredâ&#x20AC;? urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. The most common side effect of DESCOVY is nausea. Tell your healthcare provider if you have any side effects that bother you or donâ&#x20AC;&#x2122;t go away. What should I tell my healthcare provider before taking DESCOVY? â&#x20AC;˘ All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection. â&#x20AC;˘ All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take DESCOVY with all of your other medicines. â&#x20AC;˘ If you are pregnant or plan to become pregnant. It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. â&#x20AC;˘ If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Important Facts about DESCOVY, including important warnings, on the following page.

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

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POSSIBLE SIDE EFFECTS OF DESCOVY

+,:*6=@ TH` JH\ZL ZLYPV\Z ZPKL L LJ[Z PUJS\KPUN! â&#x201A;&#x201D; >VYZLUPUN VM OLWH[P[PZ ) /)= PUMLJ[PVU DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking DESCOVY. Do not stop taking DESCOVY without Ă&#x201E;YZ[ [HSRPUN [V `V\Y OLHS[OJHYL WYV]PKLY HZ [OL` ^PSS ULLK to check your health regularly for several months.

+,:*6=@ JHU JH\ZL ZLYPV\Z ZPKL L LJ[Z PUJS\KPUN! â&#x201A;&#x201D; ;OVZL PU [OL Â¸4VZ[ 0TWVY[HU[ 0UMVYTH[PVU (IV\[ DESCOVYâ&#x20AC;? section. â&#x201A;&#x201D; *OHUNLZ PU `V\Y PTT\UL Z`Z[LT â&#x201A;&#x201D; 5L^ VY ^VYZL RPKUL` WYVISLTZ PUJS\KPUN RPKUL` MHPS\YL â&#x201A;&#x201D; ;VV T\JO SHJ[PJ HJPK PU `V\Y ISVVK SHJ[PJ HJPKVZPZ 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. â&#x201A;&#x201D; :L]LYL SP]LY WYVISLTZ ^OPJO PU YHYL JHZLZ JHU SLHK [V death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns `LSSV^ KHYR Â¸[LH JVSVYLKÂš \YPUL SPNO[ JVSVYLK Z[VVSZ loss of appetite for several days or longer, nausea, or stomach-area pain. ;OL TVZ[ JVTTVU ZPKL L LJ[ VM +,:*6=@ is nausea. ;OLZL HYL UV[ HSS [OL WVZZPISL ZPKL L LJ[Z VM +,:*6=@ Tell your healthcare provider right away if you have any new symptoms while taking DESCOVY. @V\Y OLHS[OJHYL WYV]PKLY ^PSS ULLK [V KV [LZ[Z [V TVUP[VY `V\Y OLHS[O ILMVYL HUK K\YPUN [YLH[TLU[ ^P[O +,:*6=@

ABOUT DESCOVY â&#x201A;&#x201D; +,:*6=@ PZ H WYLZJYPW[PVU TLKPJPUL [OH[ PZ \ZLK together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is UV[ for use to help reduce the risk of getting HIV-1 infection. â&#x201A;&#x201D; +,:*6=@ KVLZ UV[ J\YL /0= VY (0+:. Ask your healthcare provider about how to prevent passing HIV-1 to others.

),-69, ;(205. +,:*6=@ ;LSS `V\Y OLHS[OJHYL WYV]PKLY PM `V\! â&#x201A;&#x201D; Have or had any kidney or liver problems, including hepatitis infection. â&#x201A;&#x201D; Have any other medical condition. â&#x201A;&#x201D; Are pregnant or plan to become pregnant. â&#x201A;&#x201D; Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. ;LSS `V\Y OLHS[OJHYL WYV]PKLY HIV\[ HSS [OL TLKPJPULZ `V\ [HRL! â&#x201A;&#x201D; Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. â&#x201A;&#x201D; Ask your healthcare provider or pharmacist about medicines that should not be taken with DESCOVY.

.,; 469, 05-694(;065 â&#x201A;&#x201D; This is only a brief summary of important information about DESCOVY. Talk to your healthcare provider or pharmacist to learn more. â&#x201A;&#x201D; Go to DESCOVY.com or call 1-800-GILEAD-5 â&#x201A;&#x201D; If you need help paying for your medicine, visit DESCOVY.com for program information.

/6> ;6 ;(2, +,:*6=@ â&#x201A;&#x201D; DESCOVY is a one pill, once a day HIV-1 medicine that is taken with other HIV-1 medicines. â&#x201A;&#x201D; Take DESCOVY with or without food. DESCOVY, the DESCOVY Logo, LOVE WHATâ&#x20AC;&#x2122;S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: September 2017 ÂŠ 2017 Gilead Sciences, Inc. All rights reserved. DVYC0085 11/17

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D A I LY D O S E BY TYLER CURRY

POSITIVELY EMPOWERED

SHUTTERSTOCK (ILLUSTRATION); COURTESY OF TYLER CURRY (SELFIE)

YOU CAN’T CHANGE YOUR STATUS, BUT YOU CAN CHANGE HOW YOU LIVE YOUR LIFE WITH IT. PEOPLE OFTEN SAY that everyone’s problems are relative, but in the grand scheme of viruses and diseases, they are not all created equal. HIV used to be one of the meanest sons of bitches on the block. The suffering people endured from AIDS-related illnesses in the ‘80s and ‘90s left a stain on the world many still feel today. But unlike other more perilous foes, the physical impact of a new HIV diagnosis has lost the weight of its punch, despite its bitch of a reputation lingering. When it comes to treating a new patient with HIV today, it’s a fairly simple, straightforward route to achieving a suppressed viral load. With treatment, most HIV-positive people will never experience AIDSrelated illnesses. Instead, it’s a simple pill-a-day solution to keeping your health in check, with even more innovative treatment options on the way (like long-lasting injectables). So, now that HIV isn’t the omnipresent medical nightmare it

once was, why does it still seem like such a big deal? An HIV diagnosis has always had an impact far beyond the medical risks involved with the virus. From shame and stigma, to isolation and fear, poz people suffer from psychological symptoms that have the ability to manifest into real, physical illness and pain. It’s emotional trauma that keeps them in the closet, remaining silent and often feeling unable to reach out for support. Even though HIV has been reduced to a chronic, highly manageable disease for those on treatment, it’s sometimes seen as the mark of shame and embarrassment. But in the age of PrEP, proof that undetectable means unable to transmit HIV, and in an increasing sex-positive movement, is it still a risk to come out about your status? The answer is both yes and no. There is always a risk of judgment from ignorant people who spew negativity and see someone as lesser than themselves. For them, HIV is an easy target, a big red button to push if they are looking to inflict pain (often because they are in pain themselves). You may not be able to escape haters, but you don’t need to allow their hatred, judgment, and toxic bullshit to become your reality. In 2018, demand people to accept your status, and accept only love, understanding, and support. If this changes the landscape of your social network, it will be an improvement. When you open up about your status,

it’s hard to notice people disappear from your life because you’ve allowed new people in. This process of acceptance starts with you. Stop judging your past or seeing yourself differently just because life happened. Don’t let a chronic illness get in your way, or stop you from achieving goals. In fact, make bigger goals. Demand no less than love and acceptance from the people around you, and live your life accordingly. For an otherwise healthy newly diagnosed person, what your HIVpositive status means is an increased responsibility to maintain your health, take your treatment, and be proactive about your increased health risks. It means being an advocate in your own healthcare and staying on top of the latest in medical advances, insurance changes, and state and federal funded assistance programs. Yes, there is always a possibility for medical complications and changes in coverage. Because of that, it’s up to you to stay on top of your health and make sure to monitor a few risk factors that you are now more susceptible too. But hey, that’s just life, babe, and you got this. Editor at large Tyler Curry is also a contributing editor at The Advocate magazine and the author of A Peacock Among Pigeons (@IamTylerCurry) HIVPLUSMAG.COM

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Your pharmacist can make a

real difference People may know their neighborhood pharmacist as someone in a white coat who fills pill bottles. In reality, pharmacists can also be great sources of personal support and medication guidance. They are close by and able to answer questions without an appointment. Whether you are newly diagnosed or have been living with HIV for years, he or she can help you manage, afford and get the most from your medications.

Helping you stay on track Taking your medications on time, in the correct dose and in the right way can be big factors in making sure they stay effective. Your pharmacist can help you identify any barriers that may keep you from staying on track. Walgreens has convenient digital tools that can help, such as pill reminders and the ability to set up refills by email or text.*

Helping you afford your medications

Helping you manage multiple medications

Many medications, including those for HIV, can be costly with high copays, which can make it hard to stay on your treatment plan. The good news is that there are copay assistance sources and even manufacturer programs that can help bring costs down. Ask your Walgreens pharmacist about these programs. He or she can help you find them and even help you apply.

Pharmacists can help you manage medications for all health conditions, and can even work with you to arrange a same-day refill so you can pick up all your medications at the same time.

To learn more about Walgreens HIV services, visit HIV.Walgreens.com.

*Message and data rates may apply. Ongoing texts may be sent using an automatic telephone dialing system when prescriptions are ready for pickup and refill. Consent not required for purchase. Reply STOP to cancel or HELP for help. ©2018 Walgreen Co. All rights reserved.

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Expert support, every step Let’s Grow Old Together

Specially trained pharmacists like Andrew know that care means providing customers like Gregg with the personalized, compassionate support they need to work toward a healthy future.

Find your HIV-specialized pharmacist at HIV.Walgreens.com.

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