BECAUSE YOUâ€™RE MORE THAN YOUR STATUS
OUR ANNUAL HIV DRUG TREATMENT GUIDE AIDS WATCH 2019
LIKE A PRAYER WHY TALES OF THE CITY STAR MURRAY BARTLETT IS THE PERFECT MAN TO TAKE US THERE
JULY/AUGUST 2019 www.hivplusmag.com
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IN THIS ISSUE J U LY / A U G U S T 2 0 1 9
ON THE COVER 18
MAD ABOUT MURRAY Australian actor Murray Bartlett plays the beloved Michael "Mouse" in Netflix's version of Armistead Maupin's Tales of the City, beautifully showing audiences what it means to be living with HIV in 2019
OUR 7TH ANNUAL HIV TREATMENT GUIDE 28
KNOW YOUR MEDS Our rundown of the most commonly-prescribed medication for HIV.
34 NEWBIES Could one of these recently approved drugs be right for you? 36 SIDE HUSTLE We need drugs with fewer side effects. When will we see them? 38
FUTURE FIGHTERS Research continues on new ways to fight HIV. Here are some of the drugs on the horizon.
40 TIME TO SWITCH Ten reasons why trading one medication for another may be a smart bet. 42 WELCOME TO CLASS An introduction to the drug classes that treat HIV. 44 MORE DRUGS TO KNOW These meds treat HIV-related conditions.
On the cover and right: Murray
Bartlett photographed for Netflix by Katrina Symonds
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IN THIS ISSUE J U LY / A U G U S T 2 0 1 9
DAVID WILLIAMS (VELEZ); COURTESY VICTORIA NOE (DR. MATHILDE KRIM & MR. LEATHER); DAVID ARTAVIA (AIDSWATCH)
BYE, ANGEL Andy Velez, an early AIDS activist, blazed a trail for us all.
THE PRICE IS RIGHT Companies now have to show the price of their drugs on TV. Will that lower the cost?
THE MAN WITH THE PLAN? Robert Redfield, the director of the CDC, on the plan to end the HIV epidemic by 2030.
DAILY DOSE 14
WE'RE IN THIS TOGETHER By coming together and raising our voices, we can change policy.
I AM THE FIRST
26 FIRST THRIVER Daniel Driffin founded Thrive SS and Undetectables Atlanta.
48 ALLIES FOREVER Never forget these straight women who fought HIV at the height of the crisis.
Above (clockwise from top left): The
late Andy Velez, AIDSWatch 2019, Dr. Mathilde Krim & Mr. Leather (from Victoria Noe's Fag Hags, Divas and Moms)
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editor in chief DIANE ANDERSON-MINSHALL • evp, group publisher JOE VALENTINO associate publisher PAIGE POPDAN
creative director RAINE BASCOS deputy editor JACOB ANDERSON-MINSHALL editor at large TYLER CURRY-MCGRATH managing editor DAVID ARTAVIA associate editor DESIRÉE GUERRERO assistant to the editor DONALD PADGETT contributing editors KHAFRE ABIF, DIMITRI MOISE, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writers JAY BLOTCHER, JEANNIE WRAIGHT interactive art director CHRISTOPHER HARRITY online photo and graphics producer MICHAEL LUONG front end developer MAYRA URRUTIA manager, digital media LAURA VILLELA assistant vp, integrated sales STUART BROCKINGTON executive directors, integrated sales ADAM GOLDBERG, EZRA ALVAREZ senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN senior coordinator MICHAEL TIGHE designer, branded partnerships MICHAEL LOMBARDO director, branded partnerships JAMIE TREDWELL associate directors, branded partnerships ERIC JAMES, MICHAEL RIGGIO senior manager, branded partnerships TIM SNOW editor, social media DANIEL REYNOLDS branded content writer IAN MARTELLA director of circulation ARGUS GALINDO office manager HEIDI MEDINA print production director JOHN LEWIS
PRIDE MEDIA chief executive officer ORLANDO REECE chief finance officer JANELLE MITCHELL evp, advertising and branded partnerships GREG BROSSIA corporate executive vice president BERNARD ROOK vice president ERIC BUI human resources ANTIOUSE BOARDRAYE 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 Retrograde Communications • 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 Pride Publishing Inc. Plus is a registered trademark of Pride Publishing Inc. Entire contents © 2019 by Pride Publishing Inc. All rights reserved. Printed in the U.S.A. Unless otherwise noted, all stock images are of posed models.
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ONE OF MY very best friends found out
he had HIV in the late 1990s. I was crushed but tried not to show it. After all, we had just watched dozens of friends, colleagues, and community leaders die of AIDS complications in the previous decade. “Don’t worry,” he told me, “they aren’t even starting me on medication yet.” In the late 1990s, antiretrovirals were quite new and there was a school of thought, at least among some San Francisco doctors, that you held off treatment until you really needed it—lest the drug cocktails impact your body adversely the way AZT had early users. I think now of how relieved I was to hear that from him—and how upset I’d be to hear the same response from someone today. Current treatment options for HIV are, well, miraculous compared to what they were in 1998. We now know everyone, regardless of viral load, should start on antiretroviral medication at the time of diagnosis. Indeed, with immediate treatment and persistent adherence, you can dramatically reduce HIV’s impact on your life. The idea that
you can now take medication and become undetectable and unable to transmit HIV to anyone else feels like absolute liberation to my poz friends. Now that people living with HIV have so many treatment options, it can sometimes be confusing figuring out which is right for you. That’s one reason we do this annual treatment guide. In part, it’s something to take to your doctor to discuss what’s going well and what isn’t with your current treatment regimen. If you’re experiencing side effects, for example, it might be time to switch to another med (there are more options than ever, and studies prove it’s safe to change which drugs you use to treat your HIV). If something is not right, bring it up. Make your doctor listen to your needs—and if they don’t, find a new doctor. Longtime ACT UP activist Andy Velez died in May at 80 years old (see page 6). In his eulogy, Jay Blotcher said that Andy “protested like a warrior. But he added irreverence to the mix. Andy dressed in pearls and jewels for demonstrations. His naughty jokes would easily defuse a stand-off with cops. When we were thrown into jail after a protest, Andy led us all in ‘60s girl group songs. Andy’s difficult past provided the fuel for his activism. A punishing childhood. Being jailed in 1964 after homosexual entrapment. Navigating a bitter divorce. Coming out at a time when gay was synonymous with AIDS. Andy possessed life lessons that most of ACT UP didn’t.” Andy made it to 80 years old. He wasn’t HIV-positive but thanks to him and his fellow protestors, people living with HIV today could surpass that age themselves—by decades. Heck, the oldest documented person living with HIV in the world just turned 100 (and his viral load is undetectable). You’ll need help to reach this century mark, but medication is a necessary part of that path; no person with HIV makes it to 100 without treatment. Andy Velez represents an entire generation of women, men, and gender-nonconforming folks who survived Stonewall and the early AIDS crisis, people who helped others along their way, pushing society to where it is now (including the push to get research on HIV and bring effective treatment to market). Those young (mostly queer) people pushing for PrEP access on Capitol Hill earlier this year? They’re standing on the shoulders of guys like Andy Velez. On the 50th anniversary of Stonewall and the 38th anniversary of the first reported cases of HIV and AIDS, I want people to remember that you need more than medicine and platitudes. You need to know your history. You need to see what paths have been trodden for you and what privileges they offer. We all need to be able to hear and amplify the voices that have been ignored, marginalized, or outright silenced, because those are often the folks (like trans women of color) whose lives have so much trauma that effective HIV treatment seems like a luxury. More than anything, to hit that 100 mark yourself and to honor those folks who made it so you can live to 100, you need other people. So take your meds, love your family, cherish your friends, surround yourself with support, and let the haters go by the wayside (and if you can, vote them out of office). If you have no people because of HIV stigma or trauma, reach out to a support group, a community center, an HIV organization, or a sliding-scale mental health specialist. Once you find your people, you can help and protect each other, as Andy would, like a warrior.
DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM
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WE MOURN THE LOSS OF THE BRONX-BORN ACTIVIST WHO PLAYED A HEAVY ROLE IN ACT UP’S MOST NOTORIOUS DEMONSTRATIONS. BY JAY BLOTCHER
BILL BYTSURA/THE AIDS ACTIVIST PROJECT (HEADSHOT); DAVID WILLIAMS (MARCH)
ndy Vélez, an internationally prominent AIDS activist whose three decades of advocacy work resulted in improved drug access and civil rights for people living with HIV, especially in the Latino community, died on May 14, 2019. He was 80 years old. His sons, Ben and Abe Vélez, confirmed the cause of death was complications arising from a severe fall in his Greenwich Village building in April. Until his recent accident and despite several health challenges, Vélez had remained consistently active in the HIV and social justice communities, taking part in protests for ACT UP and Rise and Resist. Vélez was a seminal member of ACT UP, joining the group in 1987—its first year of activity—and played a prominent role in its most notorious demonstrations over the past 32 years. Vélez was born on March 9, 1939 in the Bronx, N.Y., to Ramon Vélez and the former Dorothy Solomon. The family, including siblings Eugene and Raymond (“Al”), soon relocated to Aguadilla, Puerto Rico, where they lived a few years before returning to the Bronx The activist earned a Master’s degree in psychoanalysis in 1976 and worked with the Center for Modern Psychoanalytic Studies under Dr. Phyllis Meadow, and maintained his own therapy practice for two decades. Vélez had initially explored psychoanalysis for personal reasons, suspecting that he was gay. Then in 1964, he was entrapped by an undercover policeman and spent the night in the jail facility known as The Tombs, a traumatizing experience that would provide the impetus for his activism. Working for the Housing Authority at the time, Vélez lost his position when his boss learned of his arrest. He received a suspended sentence of six months, but when Vélez appealed with the help of a progressive lawyer, his conviction was ultimately reversed. Though Vélez initially hoped to become an actor—he appeared in several off-Broadway productions in the late 1950s and early 1960s— he found success in other careers. He entered book publishing in 1969. Over the course of 16 years, he worked his way up to the position of president of the prominent Frederick Ungar Publishing, managing the company until it was sold in 1985. Notable among his literary projects was a 1984 collaboration with screen star Marlene Dietrich to update her 1962 bestseller, Marlene Dietrich’s ABC.
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Andy Velez protesting with fellow AIDS activists from around the globe at the International Conference on AIDS in Florence, Italy in 1991.
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community publications, including POZ, Body Positive, and SIDA Ahora. He took part in aggressive and effective treatment access work with Treatment Action Group, and worked in a N.Y.C. HIV clinical trial unit, alerting affected communities to their vulnerability to tuberculosis. From the 1990s through the 2010s, Vélez returned to his first love of theater by covering the scene for several LGBTQ magazines, as well as by conducting interviews with jazz greats for All About Jazz and The New York City Jazz Record. He penned liner notes for the CD reissues of several Broadway musical classics, such as Finian’s Rainbow, The Pajama Game, and Saratoga. He also provided liner notes for vocal collections by legends such as Doris Day, Fred Astaire, Ella Fitzgerald, and Artie Shaw. From 1990 to 1992, he taught courses in musical theater at the New School. Among his in-class guests from the golden age of Broadway were Barbara Cook, Sheldon Harnick, Elaine Stritch, John Kander, and Fred Ebb. He was included in the anthology Cast Out: Queer Lives in the Theater, a collection focusing
on out lesbians and gays working on the American stage. Vélez was a prominent presence on the international AIDS scene for over 20 years, working with co-organizers of the International Conference on AIDS to guarantee the inclusion and active participation of people living with HIV. He also served for several conferences as the official liaison to the activist community. He served as a consultant to the Latino Commission on AIDS and was a guest speaker on HIV issues at high schools and colleges across America. Vélez is survived by his sons Ben and Abe, his daughter-inlaw Sarah, his granddaughter, his younger brother Eugene (“Gene”), as well as thousands of comrades in the global AIDS and LGBTQ activist communities. Years ago, when asked how he would like to be remembered, Vélez replied, “As someone who was able to help.” Donations in Vélez’s memory may be made to ACT UP New York, Broadway Cares/Equity Fights AIDS, and the Latino Commission on AIDS. Jay Blotcher is a veteran LGBTQ and AIDS activist and a member of the founding chapters of ACT UP and Queer Nation in New York City.
Previously married, Vélez began to make active connections with the LGBTQ community after his divorce. He served as a leader for the Gay Circles Consciousness Raising Group for almost three years. One evening, after his group ended, Vélez walked past the first meeting of a new organization d e d i c a t e d t o a d d re s s i n g government inaction surrounding HIV. He was intrigued. The group soon had a name: ACT UP, the AIDS Coalition to Unleash Power. Vélez became involved in several ACT UP committees, including the Media Committee and Actions Committee. He was involved in high-profile demonstrations and civil disobedience arrest scenarios that showcased ACT UP’s signature street theater activism, such as chaining himself in the office of a pharmaceutical company, or covering himself in fake blood to symbolize the lives lost to AIDS because of government negligence. However, Vélez found his niche with the group’s Latino Caucus, which focused on the raging but neglected epidemic in the Latino community. Significantly, Vélez and his colleagues traveled to Puerto Rico to help organize a local ACT UP chapter in the commonwealth. He was also a founding member of Queer Nation in N.Y.C. in 1990. He was also involved in many AIDS educational and service organizations over the years, serving as an administrator and bilingual educator for AIDSmeds.com for more than a decade. His writing and activism intersected significantly when he moderated a community forum on AIDSmeds, where he often directed desperate, distraught people to lifesaving medical information. Vélez also wrote about the epidemic for numerous JULY / AUGUST 2019
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WILL TV ADS DRIVE DOWN DRUG PRICES?
This recent change is receiving bipartisan support and it may benefit those living with HIV.
n May, Health and Human Services secretary Alex M. Azar II announced that pharmaceutical companies will soon be required to include the price of prescription drugs in television advertisements, if the cost of those medications exceeds $35 per month, which includes most drugs used to treat and prevent HIV. The new policy is an attempt to address the rising cost of prescription drugs—a key issue for American voters and one that both Republicans and Democrats have vowed to address. The proposed policy is anticipated to be challenged by the drug industry, which argues that revealing the list price will confuse consumers and could violate the companies’ First Amendment rights. While the list price of some drugs can be thousands of dollars a month, consumers often pay far less. Those with insurance or Medicare coverage that includes prescriptions may see out-of-pocket copays of $50, $20, $5, or even $0. According to officials at the Department of Health and Human Services, to address those concerns, a
disclaimer will be displayed, stating: “If you have insurance that covers drugs, your cost may be different.” Azar promoted the new guidelines expected to take effect this summer, telling reporters, “We are moving from a system where people are left in the dark to a system where patients are put in the driver’s seat.” As anyone who watches TV these days knows, drug companies are already required to list common side effects in ads. Now, all direct-toconsumer TV ads for drugs covered by Medicare or Medicaid must also include the list price, also known as the wholesale acquisition price. A 2011-2014 study from the Centers for Disease Control and Prevention found that nearly half of all Americans (48.9 percent) had taken at least one prescription drug in the past 30 days, making this the first truly bipartisan issue the administration has addressed. The move has been pushed by patient advocacy groups, which have complained that televised drug ads often promote high-priced medications that people don’t necessarily need. In fact, many of the most heavily advertised drugs are the most expensive and literally cost thousands of dollars per month. Two dosing pens of AbbVie’s Humira, used to treat rheumatoid arthritis and other conditions, have an average retail price of $5,684 (according to drug pricetracking website GoodRx). Another heavily advertised drug, Xeljanz, a Pfizer arthritis medication, costs about $4,840 a month. The measure was applauded by Richard Durbin, a Democratic senator from Illinois, and Charles Grassley, a Republican senator from Iowa. Both have tried to pass similar legislation in the past. “Direct-to-consumer prescription drug advertisements are everywhere, and they tell you just about everything imaginable about the drug, other than its price,” the senators said in a joint statement. “We believe American patients deserve transparency.” Ultimately, this could help drive prices down on many medications— even those that are lifesaving, such as drugs used to treat HIV. —DESIRÉE GUERRERO
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ARE WE 10 YEARS FROM THE END OF HIV?
Can a well-meaning CDC director override a hostile administration and deliver an end of the HIV epidemic within a decade? BY DAVID ARTAVIA
hen it was announced earlier this year, Trump’s plan to end the HIV epidemic within a decade was met with mixed reviews. Heralded for good intentions, many advocates and policy makers still questioned its strategy (and the commitment of an administration that remains determined to dismantle the Affordable Care Act, which has had demonstrable positive impacts on slowing the epidemic and improving the lives of those living with HIV). But Dr. Robert Redfield, director of the Centers for Disease Control and Prevention insists, “It is a realistic plan. We’re in this to do it. We’re in this to get it done. This should not be equated with some pronouncement like we heard many years ago about the war on cancer or the war on poverty. This is an intentional program to build the important tools that have been developed.” As confident as Redfield is in the administration’s commitment, it will take time for many to be convinced. After all, in the two years since Trump took office, his administration continues to threaten access to health care, frequently undermines social services poz people rely on, and attacks the very scientific research that must underpin any effort to successfully address the complex issues (and social disparities) that continue to drive this epidemic. Redfield, himself a Trump appointee, stands behind the plan to reduce new diagnoses by 75 percent within five years, and 90 percent within 10 years. He says it starts in jurisdictions like Washington, D.C., and San Juan, Puerto Rico, where “over 50 percent of new diagnoses occurred in 2016 and 2017.” In a nutshell, the new plan will alter the way money is allocated, directing resources to the locations that represent the highest number of new diagnoses. In other words, it will build programs to deliver treatment and care to where the people are—rather than having people travel to where the treatment was. Redfield explains that making this change is going to “require innovation in care delivery systems,” specifically on the local end. “Concentrating resources and allowing [at-risk] communities to develop their own individual community plans,” rather than having “a set plan for everybody” is a key focus moving forward. “Some areas may find out that what they need is more expansion of, say, syringe programs,” Redfield explains, applauding the state of Georgia’s recent passing of the HB 217, a law that legalized needle exchange programs. “Other areas may find what they need is more innovative ways to deliver PrEP in nonclinical settings,” he adds.
“Another area may find they just don’t have a clinical space that transgender persons feel comfortable in, and they have to figure out how to create it… Each community is going to have to figure that out. This is not a program designed to implement a specific medical approach. This is a program that’s designed to bring new HIV infections to an end.” To ensure these efforts, the CDC plans on asking the people directly. “What we will be doing as part of the planning process is really asking each of the communities to identify what they consider to be key structural challenges that prevent them from doing the work they need to get done,” Eugene McCray, director of HIV/AIDS prevention at the CDC, explains. “In some cases, it might be just changing a policy or procedure that could make things work better. So we want to identify all of those, and then work with the community to really address it.” Working closely with at-risk communities to best address local needs may indeed help address the HIV epidemic, but activists point out that another, perhaps even more effective effort involves improving access to PrEP. And that raises significant questions about how the CDC has dealt with Truvada, currently the only drug the FDA has approved for use as PrEP. The Washington Post reported in March this year that, since 2015, the CDC has owned the patent for Truvada, but hasn’t requested any royalties from Gilead, which manufacturers the antiretroviral medication. Given that the pharmaceutical giant raked in over $1 billion last year from Truvada alone, the CDC could have invested millions (or even hundreds of millions) of dollars over the past five years back into the prevention of or treatment of HIV. (At a Congressional oversight hearing this spring, Gilead’s CEO, Daniel O’Day, insisted that the federal government’s patent on the drug isn’t valid.) While speaking at this year’s AIDS Watch in D.C., Redfield was jeered by activists following the Washington Post report. “Obviously, I would’ve rather not been heckled,” Redfield says now. “But we’re serious about engaging the community. In order to do that, we have to show up, and interact, and I wanted to hear from the community. It doesn’t mean I have to hear everything. I want to hear what the community says, and I heard them. And I hope people respected the fact that I was there to hear from the community.” Some of what he heard was that for many people high drug costs are one of the biggest barriers limiting access to treatment. “People are really striving to try figure out how continued on page
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IMPORTANT FACTS FOR BIKTARVY® This is only a brief summary of important information about BIKTARVY and does not replace talking to your healthcare provider about your condition and your treatment.
MOST IMPORTANT INFORMATION ABOUT BIKTARVY
POSSIBLE SIDE EFFECTS OF BIKTARVY
BIKTARVY may cause serious side effects, including:
BIKTARVY may cause serious side effects, including: } Those in the “Most Important Information About BIKTARVY” section. } Changes in your immune system. Your immune system may get stronger and begin to ﬁght infections. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY. } Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY. } Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. } Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. } The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).
} Worsening of Hepatitis B (HBV) infection. If you
have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without ﬁrst talking to your healthcare provider, as they will need to check your health regularly for several months.
ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS. Do NOT take BIKTARVY if you also take a medicine that contains: } dofetilide } rifampin } any other medicines to treat HIV-1
BEFORE TAKING BIKTARVY Tell your healthcare provider if you: } Have or have had any kidney or liver problems,
These are not all the possible side effects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY.
including hepatitis infection. } Have any other health problems. } Are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY. } Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch, or call 1-800-FDA-1088. Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.
HOW TO TAKE BIKTARVY
Tell your healthcare provider about all the medicines you take:
Take BIKTARVY 1 time each day with or without food.
} Keep a list that includes all prescription and over-the-
GET MORE INFORMATION
counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. } BIKTARVY and other medicines may affect each other.
Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.
Get HIV support by downloading a free app at
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} This is only a brief summary of important information
about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more. } Go to BIKTARVY.com or call 1-800-GILEAD-5. } If you need help paying for your medicine,
visit BIKTARVY.com for program information.
BIKTARVY, the BIKTARVY Logo, DAILY CHARGE, the DAILY CHARGE Logo, KEEP PUSHING, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. Version date: December 2018 © 2019 Gilead Sciences, Inc. All rights reserved. BVYC0102 01/19
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KEEP PUSHING. Because HIV doesn’t change who you are. BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.
Ask your healthcare provider if BIKTARVY is right for you. To learn more, visit BIKTARVY.com.
Please see Important Facts about BIKTARVY, including important warnings, on the previous page and visit BIKTARVY.com.
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D A I LY D O S E B Y D AV I D A R TAV I A
IS CONGRESS LISTENING NOW?
AIDSWATCH REMINDED ME THAT PROGRESS STARTS WHEN YOU MAKE YOUR VOICE HEARD.
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And in the weeks following AIDSWatch, New York’s high-profile congresswoman, Alexandria Ocasio-Cortez, rallied other representatives to hold an oversight hearing surrounding rising costs of Truvada as PrEP. There I was honored to bear witness to the initial meeting in which James Krellenstein and Nick Faust (activists at PrEP4All, the organization that spearheaded investigations into PrEP pricing), as well as other HIV activists from organizations like GMHC and Housing Works, sat down with Ocasio-Cortez’s chief of staff to discuss the lack of access to
LIBERATION OFTEN STARTS WITH ANGER. IT STARTS BY SHOUTING THE TRUTH SO LOUD THAT OUR LEGISLATORS CAN’T HELP BUT HEAR IT.
I HAD NEVER been to Washington, D.C., before April 2019, when alongside hundreds of other HIV activists, I stormed the Capitol for the 26th annual AIDSWatch, the nation’s largest annual HIV advocacy event. Presented by the Elizabeth Taylor AIDS Foundation and the U.S. People Living With HIV Caucus, it’s an opportunity for people to march directly into congressional offices to share personal stories with our elected leaders about how HIV impacts our lives, to demand better access to care and treatment, and to educate them about the impeding efforts to end this epidemic. And you know what? It works. Protecting our health care is up to us. We’ve always known that. Since the beginning of the AIDS crisis, it has been people living with HIV and those of us most at risk of becoming HIV-positive who have crowded the streets to demand government funding and research to end HIV. We’re continuing that fight today, but we’re no longer as alone as we once were. Where once we had to beg for support from politicians, AIDSWatch has been changing that.
affordable treatment—not just for HIV meds, but for all drugs on the market. After the hearings, Gilead agreed to give the Centers for Disease Control and Prevention up to 2.4 million bottles of Truvada each year to go to uninsured Americans at risk for HIV. The agreement goes through 2029, and if the Food and Drug Administration approves it for this use, the agreement will extend to its newest drug, Descovy, which in recent studies proved as effective as Truvada when taken as PrEP. The oversight hearing was just the first step in a very long journey to holding the pharmaceutical industry accountable for price inflation. For many of the legislators at the three-hour hearing, it was clearly the first time they’d spoken about HIV and PrEP. Rep. James Jordan from Ohio voiced a common confusion: “What’s the difference between PrEP and Truvada?” PrEP stands for pre-exposure prophylaxis, an HIV prevention protocol that relies on utilizing antiretroviral medication to prevent rather than treat HIV. Truvada was developed to treat HIV, but its almost miraculous nature as the first medication shown to prevent HIV when taken daily as PrEP (or even after sex as PEP, post-exposure prophylaxis) has been confirmed in numerous clinical trials. Although Truvada currently remains the only drug approved by the FDA for PrEP, others are in the pipeline (and Descovy will likely be approved this year or next). For me, what was even more remarkable than witnessing Congress speak about HIV was seeing familiar faces of HIV activists from around the country. Among them were HIVPLUSMAG.COM
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when I think about how far we’ve come and the fight still ahead of us. If ever there is a time to come together, it is now. Our health care is under attack by an administration that seems determined to undermine decades of progress. Throughout the world, and in our own country, people are dying not because appropriate medication doesn’t exist, but because they cannot access it (due to structural, systemic, or financial barriers). History shows that liberation often starts with anger. It starts by shouting the truth so loud that our legislators can’t help but hear it. The success of this year’s AIDSWatch and the subsequent congressional oversight hearings on drug pricing show our representatives are listening to the activists among us. Don’t stop now. Make your voice heard. This can be a turning point for America. Let’s come together and fight for access to care. Let’s seek rights that go beyond health insurance, but also include access to affordable medication. Keep talking to your representatives. Keep them on their toes. When people die because they can’t afford their medication in one of the richest countries in the world, it makes me angry. It makes me want to fight. How about you?
ABOVE: Speaker Nancy Pelosi greets AIDSWatch activists at the Supreme Court after a rally with Congressional Democrats. ACROSS: (clockwise from top) Prep4All activists James Krellenstein, Nick Faust, and Cameron Kinker; Positive Women’s Network N.Y.C. co-chair China Hunt; PWN’s N.Y.C. chapter treasure Yolanda Diaz (left) and two activists from GMHC speak with Alexandria Ocasio-Cortez’s chief of staff; HIV activists Tami Haught (left) and Kamaria Laffrey; activists from HIV organizations in the offices of Chuck Schumer; activists Yolanda Diaz and China Hunt; PWN N.Y.C. chapter member Nancy Duncan and PrEP4All’s James Krellenstein; HIV activists from North Carolina protesting during AIDSWatch.
TOM WILLIAMS/CQ ROLL CALL
renowned HIV activists whose work has already changed the world, including Tami Haught, the champion of anticriminalization efforts, and Peter Staley, a member of ACT UP NY in the 1980s and ‘90s who founded Treatment Action Group and held politicians’ feet to the fire to fund HIV treatment research. Actions by activists like Haught, Staley, and thousands of others—many who unfortunately didn’t survive to see this day— ultimately led to the modern HIV treatment we have now, where living with HIV is manageable and HIV transmission can be prevented by a once-a-day pill. Like all millennials, I’m not old enough to remember the early days of the AIDS crisis. Yet I’ve lived with the ghosts of a generation lost, as HIV stigma and AIDS phobia continue haunting gay and bi men. I’ve heard survival stories from those who live with HIV and related illnesses and those who suffered inconceivable losses. But I’m also lucky enough to have friends who teach me what being poz means in 2019—when one can become undetectable within weeks of being diagnosed HIV-positive, where being virally suppressed means it’s virtually impossible to transmit HIV to anyone else. That stigmabusting truth gives me hope for the future JULY / AUGUST 2019
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By David Artavia
In the latest installment of Tales of the City, gay actor Murray Bartlett offers a fresh look at living with HIV in 2019.
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Viewers can see Michael in a new light as he navigates the nuances of a serodiscordent relationship—including the fear and anxiety he harbors, which many real-life long-term survivors say never goes away. “Michael became HIV-positive at a time when it felt like a death sentence, in the height of the AIDS epidemic, and lost a lot of his friends,” Bartlett explains. “He went through that incredible period of loss and fear, and really facing your own mortality. He was able to move through that and see a future for himself again, which he hadn’t thought was a possibility. Then, coming into this new era of PrEP, LGBTQ people who have a completely sort of different perspective on sex and safe sex, and how to approach that.”
NETFLIX/ KATRINA SYMONDS (BOTH)
in the 1990s was a defining time for Australian-born actor Murray Bartlett. He was visiting the Bay Area at the time and came across VHS tapes of Tales of the City, the PBS miniseries that first aired in 1994. Bartlett “completely fell in love” with the characters, and quickly devoured the nine Armistead Maupin books the series is based on. Bartlett’s impressions of the city were forever “mingled” with the imagery of the novels and adaptions. And he isn’t alone. Maupin’s enduringly classic series is a benchmark for San Francisco’s LGBTQ community. Beginning as regular installments in the San Francisco Chronicle and the San Francisco Examiner, the gay author’s stories ultimately evolved into nine novels and three TV miniseries. Now, nearly 41 years since the first tale was published, the residents of 28 Barbary Lane are speaking to the next generation in a new adaption streaming on Netflix, executive produced by Maupin and Orange Is the New Black alum Lauren Morelli, who is also the showrunner. Revolving around a group of San Francisco residents and their tangled lives, the show centers on Mary Ann Singleton (played by Laura Linney in all installments), who visits the city from Cleveland and impulsively decides to stay. She finds an apartment managed by marijuana-growing landlady Anna Madrigal (played by Olympia Dukakis throughout the series), where she befriends a string of other zany tenants like the bisexual hippie Mona Ramsey, womanizer Brian Hawkins (who eventually becomes her lover), and perhaps one of the most memorable of all, Michael “Mouse” Tolliver, a gay man who is diagnosed with HIV early in the series. Michael holds a special place in the hearts of diehard Tales of the City fans. Played in the past by Marcus D’Amico and Paul Hopkins, the role is now Bartlett’s to tackle in the new interpretation, and he does so with such conviction and honesty that he reminds us of all the reasons why we fell in love with Michael in the first place. Bartlett, who grew up in Perth, Australia, and moved to the U.S. in 2000, got his big break playing Oliver Spencer, the sexy gay Aussie shoe distributor who becomes Carrie Bradshaw’s fast friend on Sex and the City. A year of theater touring with Hugh Jackman (in The Boy From Oz) and several guest and recurrent TV roles followed, including Farscape and Guiding Light, where he spent two years playing Cyrus Foley. Then came HBO’s groundbreaking gay series, Looking (and later, Looking: The Movie) where his character, Dom Basaluzzo, showed us what it’s like to be a gay middle-aged, career waiter. It’s safe to say he’s right at home on the modern Tales set. It’s been 20 years since we last saw Michael. Now he’s a long-term survivor. His much younger boyfriend Ben is HIV-negative, offering one of less than a handful of serodiscordant relationships ever shown on TV. And unlike in the books (where the character of Ben is white), the role in the Netflix version is played wonderfully by Charlie Barnett (a gay Black actor who also stars in Netflix’s Russian Doll and was previously in Chicago Fire). JULY / AUGUST 2019
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It’s been nearly 20 years since we saw Armistead Maupin’s iconic characters from Tales of the City brought to life. In the latest Netflix installment, Laura Linney (pictured above and left) revives her role of Mary Ann Singleton alongside Murray Bartlett’s Michael “Mouse” Tolliver. Viewers watch as Michael, who is HIVpositive, navigates the nuances of being in a serodiscordent relationship—a rarity for TV audiences who haven’t been exposed to positive HIV stories.
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Still, Bartlett says, while it’s wonderful exploring the new age of HIV prevention, for folks of his generation it’s still complicated to embrace. Michael and Ben represent the intersection of these two perspectives. Ben is a lot less apprehensive than Michael is when it comes to sex, which ultimately helps navigate for viewers the consensus that, with treatment, HIV is a chronic manageable condition. The books were themselves revolutionary for showing Michael living a prosperous life with HIV, rather than succumbing to a tragic death as was a common storyline throughout the ’80s and ’90s. Now that the character is living in the age of PrEP and U=U (undetectable equals untransmittable), Bartlett continues that tradition of never letting Michael’s status define him. But this time around, the scale is even larger. “One of the amazing things about a platform like Netflix is that it’s global,” says Bartlett. “I think we’re in sort of a golden age of television in that there are more risks being taken, and the platforms that we have are so far-reaching, and it’s so exciting. Particularly, telling stories like these can really change people’s lives in terms of people who are 22
living in a place where there aren’t the freedoms that we have. Just seeing the possibility of something else, and not feeling alone, the power of that is kind of overwhelming for all of us.” While the nostalgia of revisiting familiar characters is a predominant draw for some viewers, the new Tales offer a cast of entirely new residents to engage fresh audiences and reiterate the times we’re currently living in. Social media-obsessed twins, played by Christopher Larkin and Ashley Park, occupy the top floor of 28 Barbary Lane. Jake Rodriguez, a trans man, and his girlfriend Margot Park are the newest residents (played by nonbinary newcomer Josiah Victoria Garcia and High Maintenance star May Hong). Ellen Page plays Shawna, Mary Ann and Brian’s daughter, who, in the books, was eventually left behind with Brian as Mary Ann went to New York to pursue a career in broadcasting. When Mary Ann returns in the new installment to celebrate Anna’s 90th birthday, she is forced to face her now-adult daughter who resents her for leaving. Trans actress Daniela Vega (A Fantastic Woman), Looking star
Charlie Barnett (above and opposite with Murray Bartlett) plays Michael’s boyfriend Ben, who is HIV-negative. Their serodiscordent relationship offers an avenue for discussing PrEP and U=U, neither of which were around during the original series.
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It’s really important to make sure that we’re employing more women, employing more trans people, more people from the LGBTQ community.
NETFLIX/ KATRINA SYMONDS (ALL. BOTH PAGES)
Matthew Risch (as Mouse’s ex-boyfriend), and Caldwell Tidicue, a.k.a. Bob the Drag Queen (as the manager of the burlesque house where Shawna and Margot both work) round out the cast. Since Maupin began writing the series in the late 1970s, the once-queer eden of San Francisco has morphed into a tech-gentrified city that was recently crowned the most expensive place to live in the United States. All that change has pushed many queers, trans people, artists, and those living with HIV out of the city—and you’ll see some of that on Tales. But in many ways, San Francisco and the LGBTQ love affair with it (especially on screen) have simply matured with time. “You have the nostalgia of the old characters in Tales of the City and the same with [San Francisco],” says Bartlett. “You have the nostalgia of the mystery of it, the fog, the beautiful sense of community, the incredible echoes of the LGBTQ civil rights movement, the Castro and all of that wonderful stuff. And then you have this new generation of characters that are not all disconnected from the sort of old, more romantic San Francisco… There’s a wonderful sort of vitality in the new generations.” The demand for accurate representation of LGBTQ folks in TV and film has never been louder, which encouraged producers to enlist trans writer Thomas McBee and trans directors Silas Howard and Sydney Freeland to be part of the creative team for the Netflix version—another milestone for TV. One earlier revolutionary moment for Tales of the City was the character of Anna Madrigal, who, readers discovered only after several novels, is transgender.
Dukakis’s portrayals in the 1993, 1998, and 2001 miniseries were welcomed then, but might not have been if produced today, given that the actress is cisgender. In an interview with Vanity Fair, Morelli said if she were casting the role today, Anna “would have to be played by, rightfully so, a trans woman.” Still, it’s hard to find anyone who would argue that Dukakis’s iconic role ought to be played by anyone else after she has embodied it for over a quarter of a century. It should be noted, however, that trans actress Jen Richards now plays a young Anna during flashback scenes. Bartlett applauds activists for demanding Hollywood to be more inclusive and authentic. In fact, he encourages them to go even further in terms of beauty standards. “I think that there’s still in the U.S. a tendency to kind of stay within some sort of safe confines of what we’re familiar with in terms of the kind of characters we see, what they look like, what we should look like. Everyone has to have a great body, look a certain way, or whatever. A great body, whatever that means. Hollywood has sort of very fixed ideas about that.” Though Bartlett explains these types of beauty standards aren’t as prevalent in places like Australia and the United Kingdom, he is definitely noticing a healthier shift in America as he sees a larger demand for authenticity. In many ways, he credits streaming services like Netflix for that evolution. “In terms of what’s happening in the world of television at the moment, there are people taking more risks, taking really great creative risks,” he says. “Casting in a different way, and telling different stories, more diverse stories, and stories that are actually more reflective of life. They haven’t got [that] sort of Hollywood kind of fairytale fog over them.” It’s clear that Bartlett is well aware of the history he is making in Tales of the City. “It’s surreal how much I love this job,” the actor confesses. He understands this can be the beginning of a new way to tell queer stories—and he’s not taking that responsibility lightly. “It’s really important to make sure that we’re employing more women, employing more trans people, more people from the LGBTQ community—or at least giving them a shot at those roles playing trans and LGBTQ characters, and for trans actors to play cis roles,” he says. “We need to branch out and bring up this new wave of a real reflection of the world that we live in so that we can tell more stories and give [queer] people opportunities to become masters in what they do.” HIVPLUSMAG.COM
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I AM THE FIRST
Mr. Driffin’s Neighborhood This Atlanta-based activist is helping hundreds of samegender loving men learn to thrive in their lives. t’s been three years since Daniel Driffin nervously stood on stage at the Democratic National Convention, ushered in to the tune of Michael Jackson’s “Don’t Stop ‘Til You Get Enough.” The song could be a metaphor for Driffin’s network building ethos. Just a year prior, Driffin and two friends— Larry Scott-Walker and Dwain Bridges—founded THRIVE Support Services, a support network for Black same-gender loving men, which then had 44 members. Driffin was the first out person living with HIV to speak at the DNC in 16 years, and only the sixth to speak at either party’s national convention. Elizabeth Glaser and Bob Hattoy were the first, in 1992 at the DNC, at the urging of Bill Clinton. Mary Fisher came after, at the Republican National Convention the same year. Then again at the DNC was Phill Wilson in 1996, and Jesse Milan in 2000. Sixteen years without HIV being part of the conversation left a lot of responsibility on Driffin, who spoke of Hillary Clinton’s support of HIV causes as senator and later secretary of state, which included lifting the HIV travel ban in the U.S. and helping get antiretroviral meds to 6.7 million around the world. With HIV cases on the decline overall, Driffin added that Americans now know how to prevent, diagnose, treat, and suppress HIV—and “we learned all that within my lifetime.” But those still most at risk? “Young gay Black men like me,” he said, adding that Black transgender women are at high risk too. Driffin called for investing in more research, expanding treatment, and electing Clinton. THRIVE SS is still going strong today, with over 900 Black SGL men living with HIV in Atlanta, and more than 300 Black women 26
in an extended network. They also touch an additional 3,300 folks within national networks. “We see new conversations occurring that never happened before THRIVE SS being in existence,” Driffin says now. “We have more than 125 Black SGL men in national campaigns discussing thriving with HIV.” Even better? THRIVE’s annual engagement survey shows more participants reporting viral suppression of their HIV. It went from 86 percent in 2015 to 92 percent in 2018. In addition, Driffin says, the group has moved the community to be “centered around affirmation versus the negativity.” And it’s only the beginning. “Myself, Dwain, and Larry believed a new definition of support was needed for Black SGL men living with HIV,” he recalls of THRIVE’s founding. “We believe health is crucial, but if health isn’t supported through fun and family, than what one pill will fix [it]?” There is still need for “more work that is innovative and supportive of Black and Brown communities.” Driffin, 33, is the oldest of five kids and says he’s still deeply connected to his “family in South Carolina and my created family in Atlanta and across the nation.” Raised in Rochester, N.Y., Driffin spent six years in South Carolina before ending up in Atlanta about a decade ago, where he quickly became a committed activist. There he founded Undetectables Atlanta (a group of over 400 gay and bisexual men with HIV), chaired both the Young Black Gay Men’s Leadership Initiative and the Task Force to End AIDS in Fulton County, Ga., and served as the Georgia Equality Youth HIV Policy Advisor. Driffin has also been honored as one of Poz magazine’s Poz 100 and Plus’s Most Amazing HIV-Positive People. It’s a far cry from years ago, he admits. “I don’t think I could have imagined the life I lived a decade ago. I still remember how lonely I felt on June 19, 2008, when I tested positive in Columbia, S.C. To sit here in 2019, after creating and assisting large-scale community interventions to move Black SGL men to a healthier place is humbling—and I still feel like I have so much more to do.” He’s doing all he can too. Last year, he helped found the SPOT, an HIV testing center inside Atlanta’s Rush Center (where many nonprofit and LGBTQ orgs meet). According to continued on page
COURTESY DANIEL DRIFFIN
BY DIANE ANDERSON-MINSHALL
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JOSHUA COLEMAN ON UNSPLASH
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OUR 7TH ANNUAL HIV TREATMENT GUIDE A RUNDOWN OF THE MOST COMMONLYPRESCRIBED MEDICATIONS APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION FOR THE TREATMENT OF HIV AND ITS RELATED CONDITIONS. RESEARCH BY JACOB ANDERSON-MINSHALL, DAVID ARTAVIA, DESIRÉE GUERRERO, AND TRUDY RING
Editor’s note: This info was culled from the National Institutes of Health’s drug database, the FDA, and individual pharmaceutical companies.
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Unless otherwise noted, all dosages are traditional adult dose.
Atripla generic name: efavirenz, emtricitabine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults and children 12 years and older weighing at least 40 kg as an initial regimen. Should not be used for those with moderate or severe kidney or liver impairment, those with neuropsychiatric issues, or women who are pregnant or may become pregnant. traditional dosage: One tablet once daily. Tablet contains 600 mg efavirenz (Sustiva, a NNRTI), 200 mg emtricitabine (Emtriva, a NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, a NRTI).
Biktarvy generic name: bictegravir,
emtricitabine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults who have no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (less than 50 copies per mL) on a stable antiretroviral regimen for at least three months with no history of treatment failure and no known resistance to the components of Biktarvy. Not recommended for those with creatinine clearance below 30 mL per minute, those with hepatitis B, or those with severe liver impairment. traditional dosage: One tablet once daily. Tablet includes 50 mg of bictegravir (an INSTI), 200 mg of emtricitabine (Emtriva, a NRTI), and 25 mg of tenofovir alafenamide (a NRTI). Doesnâ€™t need to be taken with other HIV drugs.
Cimduo generic name: lamivudine and tenofovir disoproxil fumarate class of drug: combination of two nucleoside reverse transcriptase inhibitors maker: Mylan who is it for? For adults and children weighing at least 35 kg. Should not be used for those with creatinine clearance below 30
30 mL per minute or those on dialysis. traditional dosage: One tablet once daily in combination with other antiretrovirals. Tablet contains 300 mg lamivudine (3TC) and 300 mg tenofovir disoproxil fumarate (TDF).
those on dialysis.
generic name: emtricitabine, rilpivirine,
and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 and older who are new to antiretroviral drugs who have viral loads of 100,000 copies per mL or less; or as a replacement regimen for individuals with a viral load of 50 copies per mL or less and no resistance to any components. Use caution if also positive for hepatitis B. traditional dosage: One tablet once daily. Tablet includes 25 mg rilpivirine (Edurant, an NNRTI), 200 mg emtricitabine (Emtriva, a NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, a NRTI).
generic name: doravirine, lamivudine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Merck who is it for? For adults new to HIV medication. Not recommended for those with creatinine clearance below 50 mL per minute and should not be used by those with moderate to severe kidney impairment or severe liver impairment. traditional dosage: One tablet once daily. Tablet contains 100 mg doravirine (Pifeltro, a NNRTI), 300 mg lamivudine (3TC, a NRTI), and 300 mg tenofovir disoproxil fumarate (TDF, a NRTI).
Descovy generic name: emtricitabine and tenofovir alafenamide class of drug: two nucleoside reverse transcriptase inhibitors maker: Gilead who is it for? For adults and children who weigh at least 35 kg, as well as for children who weigh 25 to 34 kg when used with certain other antiretrovirals. Should not be used for those with creatinine clearance below 30 mL per minute or
traditional dosage: One tablet
per day in combination with other antiretrovirals. Each tablet contains 200 mg emtricitabine (Emtriva) and 25 mg tenofovir alafenamide (TAF). NEW
generic name: dolutegravir and
class of drug single-tablet regimen maker: ViiV Healthcare who is it for? For adults new to HIV
medication. Not recommended for those with severe liver impairment. traditional dosage: One tablet per day. Each tablet contains 50 mg dolutegravir (Tivicay, an integrase inhibitor) and 300 mg lamivudine (Epivir a nucleoside reverse transcriptase inhibitor).
Edurant generic name: rilpivirine class of drug: non-nucleoside reverse
transcriptase inhibitor maker: Janssen who is it for? For treatment of HIV-1 in adults and children 12 and older weighing at least 35 kg who havenâ€™t previously taken antiretroviral drugs and have a viral load of 100,000 copies per milliliter of blood or less. traditional dosage: One 25 mg tablet once daily with meal. It is always taken with other antiretrovirals. Is a component in single-tablet regimens Complera, Odefsey, and Juluca.
Emtriva generic name: emtricitabine class of drug: nucleoside reverse
transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children as component of initial regimen. Dosing needs to be adjusted for those with decreased kidney function. Use caution if also positive for hepatitis B. traditional dosage: One 200 mg capsule once daily.
Epivir generic name: lamivudine or 3TC class of drug: nucleoside reverse
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transcriptase inhibitor maker: ViiV Healthcare who is it for? For adults and children at least 3 months old, as component of initial regimen. Dosing needs to be adjusted for those with decreased kidney function. traditional dosage: One 300 mg tablet once daily, or one 150 mg tablet twice daily.
Epzicom generic name: abacavir sulfate and
class of drug: two nucleoside reverse transcriptase inhibitors maker: ViiV Healthcare who is it for? For adults and children weighing 25 kg or more as a component of initial regimen. Not recommended for those with decreased kidney function. traditional dosage: One tablet once daily. Tablet contains 600 mg abacavir sulfate and 300 mg lamivudine, both NRTIs.
Evotaz generic name: atazanavir and
for at least six months, with no previous virologic failure, and no drug resistance to the components of Genvoya. Not recommended for those who have a creatinine clearance below 30 mL per minute. traditional dosage: One tablet once daily. Tablet contains 150 mg of elvitegravir (an INSTI), 150 mg cobicistat (Tybost, a pharmacokinetic enhancer/booster), 200 mg emtricitabine (Emtriva, a NRTI), and 10 mg tenofovir alafenamide (a NRTI).
Intelence generic name: etravirine class of drug: non-nucleoside reverse
transcriptase inhibitor maker: Janssen who is it for? For treatmentexperienced HIV-1 patients with viral strains resistant to an NNRTI and other antiretroviral agents. For adults, children 6 years or older weighing at least 16 kg. traditional dosage: One 200 mg tablet (or two 100 mg tablets) twice daily following meal. Pediatric patients (6-18 years old) should be dosed by medical professionals based on body weight.
class of drug: a protease inhibitor and a pharmacokinetic enhancer/booster maker: Bristol-Myers Squibb who is it for? For those initiating treatment as a component of a regimen. Not recommended for those with liver impairment. Use with caution if you have heart or kidney problems; diabetes; hemophilia; or are pregnant, plan to become pregnant, or are using hormonal birth control. Do not breastfeed. traditional dosage: One tablet once daily, in combination with other antiretroviral drugs. Tablet includs 300 mg atazanavir (Reyataz, a PI) and 150 mg cobicistat (Tybost, a PKE).
treatment or treatment experienced, as a component of a regimen. For adults and children weighing at least 2 kg. Tell your doctor if you have tuberculosis, or liver problems or phenylketonuria. traditional dosage: One 400 mg tablet twice daily for those with treatment experience. Those new to treatment or with undetectable viral loads may either take one 400 mg tablet twice daily or two 600 mg tablets once daily.
generic name: elvitegravir, cobicistat,
generic name: dolutegravir and
emtricitabine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older who weigh at least 35 kg and are new to antiretroviral therapy; or as replacement therapy for those virologically suppressed
generic name: raltegravir class of drug: integrase inhibitor maker: Merck who is it for? For those new to
class of drug: single-tablet regimen who is it for? For adults who are virally
suppressed for at least six months. maker: ViiV Healthcare traditional dosage: One tablet once daily, with a meal. Each tablet contains 50
mg dolutegravir (Tivicay, an II) and 25 mg rilpivirine (Edurant, a NRTI).
Norvir generic name: ritonavir class of drug: protease inhibitor maker: AbbVie who is it for? For adults and children,
used only in combination with other antiretrovirals, as a component of initial regimen. Reduced dosage recommended for people taking other protease inhibitors. traditional dosage: Six 100 mg tablets taken twice daily.
Odefsey generic name: emtricitabine, rilpivirine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults and children 12 years and older weighing at least 35 kg who are new to antiretroviral drugs, who have a viral load of 100,000 copies per mL or less; or can be used as a replacement regimen for individuals with a viral load of 50 copies per mL or less, who have been virologically-suppressed for at least six months. traditional dosage: One tablet once daily. Tablet conains 200 mg of emtricitabine (Emtriva, a NRTI), 25 mg of rilpivirine (Edurant, a NNRTI), and 25 mg of tenofovir alafenamide (a NRTI).
generic name: doravirine class of drug: nonnucleoside reverse
transcriptase inhibitor maker: Merck who is it for? For adults as part of an initial regimen. traditional dosage: One tablet, 300 mg, once daily, taken in combination with other antiretrovirals.
Prezcobix generic name: darunavir and cobicistat class of drug: protease inhibitor and a
boosting agent maker: Janssen
who is it for?:For both treatment naive and treatment-experienced adults HIVPLUSMAG.COM
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with no darunavir-related resistance. Should be used in combination with other antiretroviral medicines. Use with caution if you have liver or kidney problems; or if you are pregnant, breastfeeding, or plan to become pregnant. traditional dosage: One tablet once daily with food. Tablet contains 800 mg of darunavir (Prezista, a PI) and 150 mg of cobicistat (Tybost, a PKE/boosting agent).
Prezista generic name: darunavir class of drug: protease inhibitor maker: Janssen who is it for? For treatment of HIV-1
both those initiating treatment and those who have previously been on antiretroviral therapy, including those with some drug resistance to PIs. For adults and children 3 years or older weighing at least 10 kg. May reduce effectiveness of birth control pills. traditional dosage: One 800 mg tablet once daily with 100 mg Norvir or 150 mg Tybost for those without resistance. One 600 mg tablet with 100 mg Norvir taken twice daily for pregnant women and those with Prezista-related resistance. Must be taken with a booster like Norvir or Tybost. Pediatric patients (3 years to less than 18 years old and weighing at least 10 kg) should be dosed by a medical professional based on body weight. Should always be taken with food.
Reyataz generic name: atazanavir class of drug: protease inhibitor maker: Bristol-Myers Squibb who is it for? For both treatment naive
and treatment-experienced individuals. traditional dosage: 300 mg capsule, taken with 100 mg of Norvir or 150 mg Tybost, once daily.
Selzentry generic name: maraviroc class of drug: entry inhibitor maker: ViiV Healthcare who is it for? For the treatment of
only CCR5-tropic HIV-1 infection in adults and children 2 years or older, weighing at least 10 kg, and having a creatinine clearance of at least 30 mL per minute. Not recommended as a component of an initial regimen. Tell your doctor if you have 32
heart or kidney problems, or if you have low blood pressure or take medication to lower it. traditional dosage: 300 mg twice daily; or 150 mg twice daily if taken with CYP3A inhibitors; or 600 mg twice daily if taken with CYP3A inducers.
once daily, on an empty stomach. Symfi contains 600 mg efavirenz (Sustiva, an NNRTI), 300 mg lamivudine (Epivir, a NRTI) and and 300 mg tenofovir disoproxil fumarate (TDF, a NRTI). Symfi Lo contains 400 mg efavirenz, 300 mg lamivudine, and 300 mg TDF.
generic name: elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older, who weigh at least 35 kg, and are new to antiretroviral therapy; or as a replacement regimen for those virologically suppressed on their current regimen for at least six months, who have no previous virologic failures, and no drug resistance to Stribild components. Not recommended for those with a creatinine clearance below 70 mL per minute or for those with severe liver problems, or during pregnancy. traditional dosage: One tablet once daily. Tablet contains 150 mg of elvitegravir (a INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, a NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, a NRTI).
generic name: darunavir, cobicistat, emtricitabine, and tenofovir alafenamideÂ class of drug: single-tablet regimen maker: Janssen who is it for? For treatment-naĂŻve or those with a suppressed viral load on a stable HIV regimen for at least six months with no known resistance to darunavir or TAF. Not for those with severe liver or kidney impairment. traditional dosage: One tablet, once daily, with food. Each tablet contains 800 mg darunavir (Prezista a protease inhibitor), 150 mg cobicistat (Tybost, a pharmacokinetic enhancer), 200 mg emtricitabine (Emtriva a nucleoside reverse transcriptase inhibitor), and 10 mg TAF (a NRTI).
Sustiva generic name: efavirenz class of drug: nonnucleoside reverse
transcriptase inhibitor maker: Bristol-Myers Squibb who is it for? For adults and children 3 months and older weighing at least 3.5 kg as a component of initial regimen. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures. traditional dosage: One tablet of 600 mg once daily. It is a component in the single-tablet regimen Atripla
Tivicay generic name: dolutegravir class of drug: integrase inhibitor maker: GlaxoSmithKline who is it for? For both those new
to treatment and those who have taken integrase inhibitors previously and may have resistance to such drugs. For adults and children at least 30 kg. Take during pregnancy only if potential benefits outweigh risk.
One 50 mg tablet, once daily for those new to antiretrovirals; twice daily for those who take certain other antiretrovirals or have taken integrase inhibitors and may have resistance.
generic name: efavirenz, lamivudine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Mylan who is it for? For adults and children weighing at least 40 kg (those weighing at least 35 kg can take Symfi Lo). traditional dosage: One tablet,
generic name: abacavir sulfate, dolutegravir, and lamivudine class of drug: single- tablet regimen maker: ViiV Healthcare who is it for? For adults and children weighing at least 40 kg as initial regimen. Not recommended for those with a creatinine clearance below 50 mL per
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minute or those with liver impairment. traditional dosage: One tablet once daily. Tablet contains 600 mg abacavir sulfate (Ziagen, a NRTI), 50 mg dolutegravir (Tivicay, an INSTI), and 300 mg lamivudine (Epivir, a NRTI).
generic name: ibalizumab class of drug: post-attachment
maker: Theratechnologies who is it for? For heavily treatmentexperienced adults with multidrug resistant HIV-1 infection who are failing their current antiretroviral regimen, as a component of a regimen. traditional dosage: A loading dose of 2,000 mg, administered as an injection, followed by a maintenance dose of 800 mg every two weeks.
Truvada generic name: emtricitabine and
tenofovir disoproxil fumarate class of drug: two nucleoside reverse transcriptase inhibitors maker: Gilead Sciences who is it for? For those with HIV or at high risk of becoming HIV-positive. As treatment for HIV, for adults and children weighing at least 17 kg. As HIV prevention, for adults and and adolescents 15 or older weighing at least 35 kg. Dosing adjustments necessary for those with decreased kidney function. for hiv treatment: One tablet once daily, in combination with other HIV medications. Tablet includes 200 mg emtricitabine (a NTRI) and 300 mg tenofovir disoproxil fumarate (a NRTI). for hiv prevention: One tablet once daily. Must be paired with regular HIV tests and safer sex practices.
with the breakdown of these HIV drugs, increasing the blood levels of these drugs and making them more effective. maker: Gilead traditional dosage: One 150 mg tablet daily with food, with either 300 mg atazanavir or 800 mg darunavir.
Viread generic name: tenofovir disoproxil
class of drug: nucleoside reverse transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children at least 2 years old and weighing at least 10 kg, used in combination with other antiretrovirals to treat HIV-1 infection. Dosage adjustments recommended for those with kidney problems. traditional dosage: One 300 mg tablet once daily.
Ziagen generic name: abacavir class of drug: nucleoside reverse
transcriptase inhibitor maker: GlaxoSmithKline who is it for? For adults and children at least 3 months old, as a component of initial regimen. Dosage adjustments not needed for those with kidney problems. traditional dosage: One 300 mg twice daily or two 300 mg once daily. Individuals with mild liver impairment should take 200 mg twice daily.
Tybost generic name: cobicistat class of drug: pharmacokinetic
enhancer/CYP3A inhibitor/ booster who is it for? For adults taking atazanavir (Reyataz) or darunavir (Prezista). Tybost is not an HIV medicine and does not treat HIV: it interferes HIVPLUSMAG.COM
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NEW KIDS ON THE BLOCK BY DAVID ARTAVIA
THESE MEDICATIONS, FDA-APPROVED IN THE PAST YEAR, OFFER NEW WAYS TO MANAGE HIV.
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One of the latest FDA-approved drugs is Delstrigo, a single-tablet regimen containing doravirine, lamivudine, and tenofovir disoproxil fumarate. Made by Merck, it is designed to treat HIV in adults who have never taken HIV medication before. The drug’s approval was a direct result of two randomized, double-blind, activecontrolled phase 3 trials called DRIVEAHEAD and DRIVE-FORWARD. These studies are notable because not only did researchers see a lower discontinuation rate with Delstrigo (3 percent, compared to the 6 percent taking a different treatment), but also a higher percentage showed viral suppression after 48 weeks of treatment with Delstrigo versus the alternative treatment option. Researchers also found that Delstrigo can be co-administered with a wide range of nonantiretroviral agents. However, it cannot be co-administered with enzalutamide, carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifapentine, mitotane, or St. John’s wort. In light of the FDA approval of both Delstrigo and Pifeltro (below), Dr. George Hanna, vice president and therapeutic area head of infectious diseases at Merck, said in a statement: “As part of Merck’s 30-year commitment to the care of people with HIV, we are pleased to now bring forward these two new antiretroviral treatment options, Delstrigo and Pifeltro, which we believe offer a compelling clinical profile for clinicians and people living with HIV. We are thankful to the researchers as well as those living with HIV and their communities for the collaboration that made today’s approval possible.”
In April, the Food and Drug Administration
approved ViiV Healthcare’s Dovato, a single-tablet regimen of 50 mg dolutegravir and 300 mg lamivudine for treatment of HIV in adults with no antiretroviral treatment history and with no known resistance to either component. As a two-drug regimen, Dovato reduces exposure to the number of antiretrovirals from the start of treatment while maintaining the effectiveness and high
barrier to resistance of traditional threedrug dolutegravir regimens. Because it contains only two drugs (dolutegravir and lamivudine), rather than a traditional three, there is one less drug to worry about— while seeing the same viral load control and reduction. That’s an added bonus for people worried about or experiencing side effects or long-term toxicity from multiple drugs. Like a typical three-drug regimen, Dovato uses its component drugs to inhibit the viral cycle at different sites. Integrase inhibitors, like dolutegravir, inhibit HIV replication by preventing the viral DNA from integrating into the genetic material of human immune cells (T cells), according to a press release from ViiV Healthcare. This step is essential in the HIV replication cycle and is also responsible for establishing chronic infection. Lamivudine is a nucleoside reverse-transcriptase inhibitor that works by interfering with the conversion of viral RNA into DNA, which in turn stops the virus from multiplying. Dovato’s approval was supported by the landmark studies GEMINI 1 and GEMINI 2, which included over 1,400 people living with HIV. “One thing that surprised us in a very pleasant way was really how well it performed in individuals with high viral loads,” Kimberly Smith, head of global research and medical strategy for ViiV Healthcare, told Plus. “We made a point of enrolling individuals with viral loads above 100,000, and it ended up being that around 20 percent of the individuals in the trial were above 100,000. And when you looked at those individuals on D3 compared to the three-drug regimen, dolutegravir with Truvada, there was no difference in the outcomes in the high viral loads. And that was really exciting for us because I think a lot of folks had speculated that maybe a two-drug regimen wouldn’t do as well in individuals who had high viral loads, but this shows quite clearly that that’s not the case.” The benefits of a two-drug regimen rather than three-drug regimen, Smith explains, go beyond adherence. It’s also bringing hope for fewer side effects in the long term. “That’s where some of your kidney troubles and your bone trouble, those types of things, can come up after being on medicine for a long time,” Smith says.
“And so what was done with Dovato is taking away one drug, and in particular we took away in comparison to the threedrug regimen that we looked at here in the GEMINI study, which was tenofovir, FDC, and dolutegravir, we took away the tenofovir basically. Tenofovir is the drug that has been associated with bone damage and renal disease, so we’ve taken that out of the picture altogether. It’s one less thing for patients to have to worry about down the road.”
Merck’s newest nonnucleoside reverse transcriptase inhibitor (NNRTI), Pifeltro is a single 100 mg tablet of doravorine, which is to be used in combination with other antiretroviral medications. Pifeltro has several advantages over existing NNRTIs on the market. Clinical studies have shown it to have few drug interactions (particularly with acid-reducing agents), can be taken with or without food, has a more favorable lipid profile, and has lower incidence of rash. “A new HIV medication that is effective and well-tolerated and has a relatively high barrier to resistance and can be co-formulated with other HIV medications is to be welcomed,” David Alain Wohl, M.D., a professor in the Division of Infectious Disease at the University of North Carolina at Chapel Hill and site leader of the university’s AIDS Clinical Trials Unit, told Infectious Disease News. “Doravirine is a nice addition to the nonnucleoside class, and it is active even against virus that is resistant to older agents in this class. The coformulation with TDF and 3TC may allow some people on two or more pills to switch to a single tablet a day.” When tested in clinical trials, researchers found that people demonstrated sustained viral suppression after 48 weeks of being on Pifeltro. The drug also met its primary endpoint of non-inferior efficacy as those taking alternate treatment options. “As a result of the remarkable strides made in the fight against HIV, clinicians and their patients have the opportunity to work together to identify treatment regimens that may be best for each individual, taking into account other aspects of that person’s health, including other medicines they may be taking,” Wohl noted. HIVPLUSMAG.COM
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FEWER SIDE EFFECTS, PLEASE WILL WE EVER SEE HIV TREATMENTS WITH FEWER LONG-TERM IMPACTS? BY JEANNIE WRAIGHT
it’s commonly known that HIV is a manageable condition, serious side effects from antiretrovirals can substantially limit or greatly affect a person’s quality of life. While toxicities, pill burden (the number of cumulative pills one has to take), and the possibility of developing drug resistance are significantly lower with newer drugs than those approved in the 1990s and the first decade of this century, most ARVs (including the latest drugs) still have significant toxicities in long-term use, can cause life-threatening conditions, and carry side effects that severely impact quality of life and limit treatment options. Although ARVs are essential to living a healthy and longer life with HIV, there is a widespread belief that they are harmless, with little to no negative effect on those taking them. Many leaders in the HIV sphere downplay the side effects and complications people living with the virus experience. But that only prevents a greater demand for more tolerable drugs. This sentiment is particularly damaging when it comes from those in positions that influence public opinion. Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, told the Washington Blade in March the side effects of ARVs are “close to that of water” and that the medications allow for a high quality of life. In researching, testing, and approving HIV drugs, certain criteria are essential. By today’s standards, the ability to virally suppress HIV quicker and better than (or at least as well as) other approved ARVs, once-a-day dosing, and limiting side effects are the main criteria to demonstrate “superiority” over other ARVs on the market. Several of the “new” therapies approved last year by the U.S. Food and Drug Administration
for HIV treatment were fixed-dose combinations of previously approved drugs that satisfy the need for viral suppression and once-a-day dosing. However, these therapies and/or their components are linked to many adverse events, even life-threatening ones, and therefore do not fulfill the criteria for limiting side effects. Side effects, both bothersome and serious, can be temporary or have longlasting consequences. These include diarrhea, lipodystrophy, fatigue, bone pain and/or disease, nausea, and depression. Symtuza, Delstrigo, and Trogarzo (all of which are among the drugs approved in 2018) and some of their components are also linked to complications such as immune reconstitution inflammatory syndrome, and liver and kidney disease. Some of these conditions are related to a higher risk of cardiovascular disease. Despite FDA approval, the extent of the effects of Trogarzo are largely unknown due to the speed of its approval. The drug was approved for those with limited treatment options based on a 24-week, single-arm (not compared to other drugs) study of 40 patients. Most HIV drugs are studied in thousands of individuals and compared to numerous other HIV drugs before receiving FDA approval. The process used to approve Trogarzo, called fast track designation, was created early in the U.S. HIV pandemic to make drugs available quickly for those in desperate need. Although very necessary for some individuals, fast track designation severely limits our knowledge of the effects of a drug. As long as HIV medications have to be taken indefinitely—from both a personal and a public health standpoint (the latter because treatment prevents transmission of HIV)—there needs to be greater regulatory attention to ensure that adverse events are rigorously limited and not affecting adherence. Priority in publicly sponsored clinical trials and National Institutes of Health-funded grants should be given to therapeutics that are specifically designed with a great attention to reduce side effects. This would provide pharmaceutical and biotechnology companies that develop ARVs a strong incentive to invest the research and development dollars, time, and effort in making drugs that have much less of a negative effect on health and quality of life. Some drugs by their very nature are thought to produce fewer toxicities and thus much fewer side effects. ABX464, a Rev inhibitor currently in phase 2a studies, BIT225 a Vpu inhibitor in phase 2, and baricitinib, a Jak inhibitor being studied as a functional cure, all demonstrate superior toxicity profiles to current regimens. Although baricitinib is associated with some serious side effects, such as shingles in those who have been prescribed the drug for rheumatoid arthritis, it is an anti-inflammatory, and lowering HIV-related inflammation is essential for lowering the risk of many comorbidities, including heart disease, HIV-associated neurological disease, and nonalcoholic fatty liver disease. Another new drug in early development thought to have low toxicity is the RNA helicase DDX3 inhibitor being developed by a European pharmaceutical company, First Health Pharmaceuticals. DDX3 inhibitors are being considered for a list of infectious diseases including HIV, hepatitis C, Ebola, dengue, and Zika, as well as for several forms of HIV-related cancers. Thus far, these compounds have been found to have low toxicities both in vitro and in vivo testing. The DDX3 inhibitor for HIV is being studied as both a therapeutic and part of a functional cure, but like ABX464 and BIT225, it still hasn’t received any funding from the NIH. RNA helicase DDX3 inhibitors target RNA helicase DDX3, a human protein that is hijacked by HIV and is essential for the replication of HIV and the assembly of active viral material to enable HIV to replicate. In addition to offering low toxicity, a major advantage of targeting a human protein versus targeting HIV itself is that drug resistance cannot occur as with current therapies where HIV can mutate to overcome attack. This lack of resistance has been observed during in vitro studies where there was no selection of mutated resistant strains long after treatment at active doses. DDX3 inhibitors have been shown to be active against all strains of HIV. New drugs with reduced side effects and toxicity that improve quality of life and drug adherence for those who suffer with persistent ARV side effects should be prioritized in the HIV pipeline when considered for federal support. Only when this becomes the standardized norm will we see more drugs developed from conception that possess these qualities. HIVPLUSMAG.COM
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THE FUTURE IS BRIGHT THE HIV TREATMENTS OF TOMORROW PROMISE TO LAST EVEN LONGER. BY PLUS EDITORS
EXPECTED TO BE APPROVED IN 2019:
CABOTEGRAVIR/RILPIVIRINE LONG-ACTING INJECTABLE (NAME TBA): Consisting of ViiV Healthcare’s integrase inhibitor cabotegravir and Janssen’s NNRTI rilpivirine, this long-acting injectable can be administered every four to eight weeks. Clinical trials used a cabotegravir injection of 400 mg plus 600 mg rilpivirine injection. The dose consisted of two 2-mL injections. While oral rilpivirine must be taken with food, this injectable does not. Researchers found there was an induction phase with oral medication, which is also expected to be used when the drug goes to market. A tablet form of cabotegravir tablet may not be available for other use. FOSTEMSAVIR: An entry inhibitor currently under development by ViiV Healthcare and GlaxoSmithKline, fostemsavir is a prodrug, which means it’s an inactive drug. Once taken, it does not work until the body converts it into an active form. In the body, fostemsavir is converted to temsavir. In clinical trials, participants took the drug after eating and in combination with one or more other antiretrovirals. It is recommended for heavily treatment-experienced patients with a history of resistance to three classes of antiretrovirals who also have a background therapy of other active antiretroviral drugs. It has not been studied in treatment-naïve patients, pregnant women, or people under age 18.
GS-6207: Currently in a phase 1b proof-ofconcept study, GS-6207, developed by Gilead Sciences, is a first-in-class capsid inhibitor that interferes with the transport of the viral genetic material and replication of HIV’s genetic blueprint into a host cell’s nucleus. It is given subcutaneously. At CROI 2019, researchers noted, based on an early clinical trial, that they believed it could be safely administered every three months. DISULFIRAM: This drug, currently FDAapproved for helping in the management of alcohol use disorder, is being tested as a latency-reversing agent, a substance that draws HIV out of hiding so the body’s immune system and antiretroviral drugs can attack the virus. A recent study showed promise in this area. LEFITOLIMOD: Currently in phase 1b/2a development as an HIV therapeutic, lefitolimod is a type of latency-reversing agent called a toll-like receptor agonist. Researchers believe it may also improve the body’s immune response to HIV in addition to its effect on latent virus cells. Researchers in Denmark tested lefitolimod in the TEACH study, which showed it to be safe in early phase trials.
2020 AND BEYOND:
Leronlimab (PRO 140): After four years of trials, drugmaker CytoDyn now has the data to submit to the Food and Drug Administration for approval. This CCR5 antagonist would be dosed weekly and delivered subcutaneously. This would be the first in a new class of therapeutics called viral-entry inhibitors. It works by masking CCR5, thus inhibiting HIV’s ability to enter healthy T cells. PGT121: A small study showed that an experimental monoclonal antibody called PGT121 led to viral suppression that lasted for up to six months in HIV-positive people who started with a low viral load. Being developed by a collaboration that includes the International AIDS Vaccine Initiative, the Bill & Melinda Gates Foundation, the Scripps Institute, and Theraclone Science, the recombinant monoclonal antibody targets the V3 glycan site on the outer envelope of HIV. At the 2019 Conference on Retroviruses and Opportunistic Infections, researchers reported that two participants with low viral loads experienced treatment-free viral suppression, which for one lasted over five months and for the other was still ongoing at six months. PGT121 could eventually become a very long-acting HIV medication. UB-421: In a phase 2 trial, this broadly neutralizing antibody targeting domain 1 of CD4 was shown to maintain viral suppression after antiretroviral therapy ended. Weekly or biweekly intravenous infusions of UB-421 kept the viral loads of all 29 participants suppressed after they stopped taking oral HIV meds. 38
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WHY CHANGE THE HIV DRUGS YOU’RE TAKING? BY TYLER CURRY-MCGRATH & JACOB ANDERSON-MINSHALL
10 REASONS YOU SHOULD SWITCH MEDICATIONS
Numerous studies have confirmed that it is safe, and sometimes highly important, to switch from one antiretroviral therapy to another. If you are already undetectable, you can switch without risking your viral suppression. If you are struggling to take your HIV medication as prescribed, having disconcerting side effects, dealing with a comorbidity (like high cholesterol or liver disease), experiencing certain health concerns, or have changing lifestyle issues (unusual work hours, use of certain drugs) then reevaluating your medications can be a smart choice—especially with so many new options available. Take our Annual Treatment Guide with you to your next appointment and talk with your doctor about medications that may be right for you. A simple switch could be what you need to live your best and healthiest life. Here are some reasons why you might switch, and which drugs you might consider:
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IF YOU WANT TO REDUCE THE NUMBER OF DRUGS YOU TAKE. Although three-drug regimens were once considered essential in preventing the development of HIV drug resistance, new two-drug regimens have proven to be just as effective. Their advantages include fewer side effects, and a reduction in toxicity associated with longterm drug therapies. “Limiting the number of drugs in any HIV treatment regimen can help reduce toxicity for patients,” Debra Birnkrant, M.D., director of the Division of Antiviral Products in the Food and Drug Administration’s Center for Drug Evaluation and Research, told Endpoints News. Juluca (dolutegravir/rilpivirine) is the first two-drug regimen approved by FDA for adults already on treatment and virally suppressed.
IF YOU DON’T TAKE YOUR MEDS WITH FOOD. A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (protein or a hearty meal, rather than a snack). So if you’re the kind of person who either doesn’t eat that way or forgets your meds until later, you should consider a drug that has no food intake requirements, such as Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) or Truvada (emtricitabine/ tenofovir disoproxil fumarate).
IF YOU ARE CONCERNED ABOUT GAINING WEIGHT. At the 2019 Conference on Retroviruses and Opportunistic Infections in Seattle, researchers from the North American AIDS Cohort Collaboration revealed that among people just starting treatment, taking integrase inhibitors (dolutegravir or raltegravir) was associated with greater weight gain than taking nucleoside reverse transcriptase inhibitors. If you are already struggling with your weight, avoid drugs like Triumeq (abacavir/ dolutegravir/lamivudine) and opt for something like Truvada.
IF YOU NEED TO BE MORE HEART HEALTHY. Some drugs, like Triumeq, come with certain cardiovascular risks, so those with higher risks of heart disease should instead consider tenofovir-based medications, such as Stribild (elvitegravir/ cobicistat/emtricitabine/tenofovir disoproxil fumarate) or Genvoya (elvitegravir/ cobicistat/emtricitabine/tenofovir alafenamide).
5 6 7 8 9
IF YOU ALSO HAVE HEPATITIS C. According to the Centers for Disease Control and Prevention, approximately 25 percent of people with HIV in the United States also have hepatitis C. There are new, curative hep C treatments available, but many HCV drugs interact with HIV drugs, so it’s important for your doctor to carefully consider which medications you can take while treating them simultaneously. IF YOU WORK ODD HOURS, DRINK HEAVILY, OR USE RECREATIONAL DRUGS. People with unusual schedules, who binge-drink, or who use recreational drugs run the risk of missing their daily dose by time specified or altogether. Avoid medications that must be taken at the same time or with a meal, or are prone to drug resistance. Prezcobix (darunavir/ cobicistat), Truvada, and Biktarvy are potential choices, but if you’re a heavy drinker, note that the latter two can both impact renal function. IF YOU HAVE KIDNEY OR LIVER PROBLEMS. Tenofovir disoproxil fumarate (TDF, brand name: Viread, and a component in the single-tablet regimens Truvada, Atripla, Complera, and Stribild) has been linked to kidney problems in susceptible individuals, so those with kidney issues might consider regimens that instead use tenofovir alafenamide (TAF), such as Genvoya, Odefsey, and Descovy. Juluca, which overall promises fewer side effects, has seen some users develop worse or new liver problems.
IF YOU CAN’T DEAL WITH THE SIDE EFFECTS. Every medication has potential side effects—some minor, some life-threatening. Not everyone taking the medication will experience the same side effects, and some people experience them more intensely. Only you can decide if the side effects aren’t worth the benefits you’re getting from a particular medication. With so many treatment options now available, don’t hesitate to talk to your doctor if you feel side effects are impacting your daily life. IF YOU ARE WORRIED ABOUT DEVELOPING DRUG RESISTANCE Some drugs have a higher risk of resistance and only need one mutation for the virus to gain complete resistance. This is particularly true with nonnucleoside reverse transcriptase inhibitors (nevirapine, efavirenz, rilpivirine, and etravirine), integrase inhibitors (raltegravir), and some nucleoside analogs like 3TC and FTC. Other drugs offer more protection against HIV developing resistance. For example, the ODIN trial found that darunavir (a component of both Prezista and Prezcobix) stops the virus from multiplying and mutating. (Symtuza also offers a high barrier to resistance, but it’s only for those just starting treatment, not folks looking to switch).
IF YOU ALREADY ARE DRUG-RESISTANT. Just because you’ve developed a resistance to one drug, or even a whole class of drugs, doesn’t mean that other HIV meds won’t work for you. For example, Trogarzo (ibalizumab) a newly approved long-acting injectable, fights multidrug-resistant HIV when added to a previously failing antiretroviral regimen.
NOTE: You may have noticed from above that some of these seem a bit contradictory—for example, although Biktarvy includes tenofovir alafenamide like Descovy, the former is not recommended for those who have kidney problems while the latter is. Studies aren’t always conclusive, combination drugs can come with different recommendations than their individual elements, and if you have more than one health concern (like most of us) you and your doctor will have to decide which is most important in picking the right HIV medication to use. Keep in mind that if the antiretroviral therapy you and your doctor choose doesn’t turn out to be ideal, you can always switch again. HIVPLUSMAG.COM
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Drugs that treat HIV, known as antiretroviral medications, are grouped in various classes based on the methods the drug uses to attack the virus. HIV treatment regimens include drugs from multiple classes, to improve their combined effectiveness and help prevent the development of drug resistance. Here are brief descriptions of the classes and how they work. ENTRY AND FUSION INHIBITORS (EIs) Drugs in this class help block HIV from binding, fusing, and entering T cells. They are always taken with other HIV medication.
DRUG CLASSES COMBAT HIV IN DIFFERENT WAYS. HEREâ€™S HOW.
INTEGRASE STRAND TRANSFER INHIBITORS (INSTIs) Drugs in this class block integrase, an enzyme HIV needs in order to reproduce. HIV uses integrase to insert its viral DNA into the DNA of T cells. Blocking the integration process prevents HIV from replicating. They are always taken with other HIV medication. NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs, also known as nukes) Drugs in this class block reverse transcriptase, an enzyme that HIV needs in order to reproduce. HIV uses reverse transcriptase to convert its RNA into DNA, blocking the reverse transcription process prevents HIV from replicating. They are always taken with other HIV medication. NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs, also known as nonnukes) Drugs in this class also block reverse transcriptase, as NRTIs do, but in a different way. They are always taken with other HIV medication. PHARMACOKINETIC ENHANCER/ CYP3A INHIBITORS (PKEs, also known as boosters) Drugs in this class boost the effectiveness of antiretroviral medication. When the two are taken together, the pharmacokinetic enhancer slows the breakdown of the other drug, which allows the drug to remain in the body longer at a higher concentration. They are always taken with other HIV medication. POST-ATTACHMENT INHIBITORS (PAIs) Drugs in this class bind to CD4 cells after HIV has attached to them, but still inhibit the HIV virus from successfully infecting those cells. They are always taken with other HIV medications. PROTEASE INHIBITORS (PIs) Drugs in this class block activation of protease, an enzyme HIV needs to develop. Blocking protease prevents immature forms of HIV from becoming a mature virus capable of infecting other T cells. They are always taken with other HIV medication. SINGLE-TABLET REGIMENS (STRs) These are fixed-dose pills that combine multiple anti-HIV medications (often from more than one class of drug) into a single tablet, which is usually taken just once a day. They do not need to be taken with other HIV medication.
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OTHER DRUGS TO KNOW
THESE MEDS TREAT HIV-RELATED CONDITIONS.
ANDROGEL, FORTESTA, TESTIM generic name: testosterone gel makers: AbbVie, Endo Pharmaceuticals cautions: For menâ€™s use only. Women and
children should avoid skin-to-skin contact with application area. Tell your doctor about all your health conditions, especially if you have breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. traditional dosage: Amount and frequency determined by physician. Applied topically. what it treats: Treats low testosterone, which can be a complication of HIV, especially for men over 50.
generic name: tesamorelin maker: Theratechnologies cautions: Do not take if you have or had pituitary gland issues, if you have active cancer, or if you are pregnant or breastfeeding. traditional dosage: 2 mg injected 44
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subcutaneously (just below the skin), once daily. what it treats: Reduces HIV-related excess belly fat by encouraging the body to produce natural growth hormones.
generic name: anidulafungin maker: Pfizer cautions: Effects on women who are pregnant
or breastfeeding have not been studied, discuss possibility of pregnancy with your doctor. traditional dosage: For esophageal candidiasis 100 mg by injection the first day, followed by 50 mg daily dose thereafter for 14 days; for candidemia and Candida infections, 200 mg by injection first day, followed by 100 mg daily. what it treats: Treats esophageal candidiasis, candidemia, and other Candida infections.
generic name: dronabinol maker: AbbVie cautions: Do not use if you have a psychiatric
history, are pregnant or may become pregnant. Use caution if you experience seizures or have a cardiac disorder. traditional dosage: One 2.5 mg capsule taken twice daily. what it treats: A man-made form of cannabis, it is used to stimulate the appetite of people living with HIV.
MEGACE ES, MEGACE ORAL SUSPENSION
generic name: megestrol acetate maker: Strativa, Bristol-Myers Squibb cautions: Do not use if you are pregnant. If you
have a history of blood clots, check with your doctor before taking. traditional dosage: 625 mg (one teaspoon), once daily. what it treats: Treats appetite loss, severe malnutrition, or unexplained, significant weight loss.
generic name: crofelemer maker: Napo cautions: Get tested to make sure your diarrhea is not caused by an infection.
traditional dosage: One 125 mg delayed-
traditional dosage: Single-use vial injected into the skin. what it treats: Treats facial fat loss (lipoatrophy) and stimulates the bodyâ€™s collagen production to combat HIV-related facial wasting.
generic name: injectable poly-L-lactic acid maker: Dermik Laboratories cautions::If you have an active skin
infection or inflammation in or near the treatment area, do not use until this condition is under control. traditional dosage: Amount and frequency varies by patient; delivered by subcutaneous injection. what it treats: Helps restore or correct signs of facial fat loss (lipoatrophy).
generic name: somatropin maker: EMD Serono cautions: Do not use if you are critically ill,
following surgery, have serious injuries, or a severe breathing problem, or have cancer. Do not use if you have eye problems caused by diabetes. traditional dosage: 0.1 mg per kg of body weight daily (up to 6 mg), injected subcutaneously at bedtime. what it treats:Treats wasting (HIV-related weight loss).
generic name: itraconazole maker: Janssen cautions: Use caution if you have heart, lung,
or kidney disease, or take certain antiretrovirals. Do not take capsules if you have or had congestive heart failure. traditional dosage: 200 mg daily, in oral solution, without food (if possible) for 1 to 2 weeks for oral candidiasis; 200 mg daily in capsule form, for other fungal infections. what it treats: Treats fungal infections. The oral solution only treats the fungal infections of oral candidiasis (thrush) and esophageal candidiasis. Sporanox capsules are a different preperation than Sporanox Oral Solution and should not be used interchangeably.
release tablet, twice daily.
what it treats: Formerly named Fulyzaq. Relieves HIV-related diarrhea that is a side effect of many antiretroviral drugs
have a heart arrhythmia.
generic name: calcium hydroxylapatite maker: Merz Aesthetics cautions: Users of blood thinners or aspirin may have bleeding or bruising at the injection site.
generic name: voriconazole maker: Pfizer cautions: Use with caution if you
traditional dosage: 200 mg in tablets or oral solution, every 12 hours. what it treats: Treats fungal infections, such as esophageal candidiasis. HIVPLUSMAG.COM
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i am the first, continued from page 26
around rides to and from and hours we will be able to touch more people instantly.” The activist says that a culture of indignity that can be present at an organization, and the ability to treat someone living with HIV with respect, has to come from every person they deal with—from the security guards and front desk worker to the case managers and executive director—or it can be an impediment to access. And just as access to food and housing can be barriers to care, Driffin says that both current political administrations and the media play vital roles in whether people live their healthiest lives. As media outlets (including Plus) rushed to share quotes from an Emory HIV expert last year who likened the HIV rates in downtown Atlanta to that of Zimbabwe, Driffin says they missed a key component. “Good reporting must start with someone being connected and willing to do the work of touching the people on the ground most impacted,” he says. “I think many felt this was not the case concerning this article… I [also] think the media has to be willing to not always sell HIV from a doom and gloom perspective but showing people living and thriving with HIV.” With his plate so full it’s hard to believe Driffin still has a clinical medical degree in his future, though he is currently determining if that is as a nurse, physician’s assistant, or as a medical doctor. And besides that medical degree and impacting the lives—hell, perhaps saving the lives—of people living with HIV, Driffin says he’s got dreams like everyone else: buying a house, travelling, a long-term relationship. What he’s not interested in, though, is bragging about his own firsts, saying the question seems egocentric to him. “I don’t think I do this work to say, ‘I am the first at this and that.’ I hope to be the first person to remind people, especially Black SGL men living with HIV, that they deserve quality, culturally-affirming care regardless of ability to pay.”
Daniel Driffin speaks during the Democratic National Convention at the Wells Fargo Center in Philadelphia in 2016. He was the first out speaker in 16 years who was living with HIV.
SAUL LOEB/AFP/GETTY IMAGES
Project Q, THE SPOT is “a joint venture of the Rush Center, THRIVE SS, Georgia Equality, AbsoluteCARE Medical Center & Pharmacy, and Atlanta Harm Reduction Coalition. It’s funded through a $75,000 grant from the pharmaceutical company Gilead.” The SPOT, says Driffin, can reach people who aren’t always comfortable at traditional service agencies. He thinks that happens because there’s “a level of shame and stigma wrapped up within all of our healthcare settings.” Organizations need to actively reduce stigma and negative interactions, he says, which is why the SPOT is “sex-positive, HIV-accepting, and trust-inspiring, regardless if they are needing HIV testing or PrEP.” Today, the SPOT has grown to three locations with STI testing and are in the final stages of adding housing opportunities for people vulnerable and living with HIV. “But so much need is still being requested,” says Driffin. “We can have a SPOT at every organization in and around Atlanta to serve as the ultimate peer navigator for the perspective of living with HIV. People living with HIV are experts on how to navigate systems when they work and have always helped other friends living with the virus to be the healthiest.” In addition to cofounding THRIVE SS and the SPOT (a collaboration of THRIVE and partners), Driffin has a new day job too, as deputy executive director of Living Room. Living Room, an organization that helps people living with HIV find and keep stable housing, serves a 29-county region including Atlanta area and parts of rural Northwest Georgia region. According to the organization’s own website, over 90 percent of their clients “are defined as ‘extremely low income,’ so finding and maintaining affordable housing is essential to preventing homelessness.” It’s also the state’s largest facilitator of emergency and transitional housing for people living with HIV. Driffin says as the new role will allow him “to think of innovative strategies to bring housing opportunities and medical care closer for people living with HIV in and around Atlanta metro. The Living Room has served people living with HIV for more than two decades through Housing Opportunities for People With AIDS (HOPWA) projects. I am excited since I am relatively new to creating housing solutions for our community, but I am a firm believer of using models and methods that have worked in HIV prevention, research, and care.” “Here in Georgia, we have several issues around access,” Driffin says. “Access shows up at the primary level of ensuring people can get to and from their medical appointments. This also includes providing for working people to have places to access care [after] 4:30 pm and even on the weekends. I believe fixing simple things JULY / AUGUST 2019
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Dr. Robert Redfield (far left), director of the CDC, and Eugene McCray (left), director of the CDC’s HIV/AIDS prevention program.
continued from page
to solve” the issue of drug inflation, Redfield says. “We’re all trying to do the same thing.” Another issue he’s trying to solve is how to extinguish HIV outbreaks in early stages, and he thinks the answer may lie in new innovations in delivery systems—and in getting more services involved early. “We need to help the public health community— and more importantly, the community where those clusters are occurring—to understand when interventions need to be augmented to be able to bring those clusters to an end. And ultimately, this is going to be done by developing a much more robust HIV workforce.” That workforce includes an increase in public health types, as well as “more encouragement” in the broader health community—including from social workers, providers, and nurses. “It’s a program that I anticipate will have 57 different plans,” he says, referring back to the administration’s initiative. “We’re looking forward to the communities working together over the next several months ahead to begin to put together what they think is an [appropriate] plan.” Though the plan to virtually eradicate HIV in the next 10 years seems like a stretch, Redfield says we should all be excited for the research currently in place in regard to functional cures “where people can maintain bio-suppression, independent of antiretrovirals… I think you’re going to see more and more progress in that area.”
“There’s a lot of movement in the pharmaceutical industry to make longacting drugs that will allow people different options to be able to maintain it, both for treatment and prevention,” he adds. “And I do think there’s going to be advancement in allowing people access to diagnostics in nonclinical settings, which will improve it.” “Long-acting preparations,” McCray chimes in, “like an injection you can take once every six months, would be great both for prevention and treatment. And then, of course, point of care diagnostics to ensure that we’re getting diagnostics to rural areas and to communities that don’t have access to a clinic and so forth. Home testing is one example. But also, having finger stick technology where you can do a blood spot and get it done.” Ending new HIV transmissions in the U.S. within a decade seems a high bar to reach, particularly given this administration’s ongoing efforts to undermine the health and wellbeing of the very communities most at risk of becoming HIV-positive (including African Americans, gay and bi men, undocumented immigrants, and transgender people). But one cannot doubt Redfield’s personal commitment to the cause. “I started my career in 1980 and was full-time in HIV from ‘83 on,” he recalls. “There’s a lot of us that have been in the arena for a long time who have no intention other than succeeding. And we’re going to only succeed if we have the full engagement and the leadership of the community as the key partner.” HIVPLUSMAG.COM
5/30/19 1:40 PM
B AC K TA L K BY D O N A L D PA D G E T T
THE LEGACY OF STRAIGHT WOMEN IN THE EARLY FIGHT AGAINST THE AIDS EPIDEMIC. VICTORIA NOE may have arrived at the front lines via a circuitous route, but, like other straight women fighting in the early battles of HIV, she was determined to do something significant during those darkest of days when the deadly epidemic raged—and most Americans gave little more than a shrug. “I knew I did not want to look back on that time and realize that I hadn’t done a damn thing,” says Noe, the author of the critically acclaimed self-help Friend Grief series, about coping with the death of friends. She’s also the author of Fag Hags, Divas and Moms: The Legacy of Straight Women in the AIDS Community, an effort to bring recognition to the heterosexual women who fought HIV in those early days. Noe went from fundraising for the Chicago arts community to working almost exclusively with AIDS service organizations. And she wasn’t alone. Of course, some straight women were themselves
mothers into some of the most driven early fighters. “All of them shared one trait: They deeply loved their sons,” the writer says. “And when your child is sick or dying, you will fight anyone and everyone to help them.” In Fag Hags, Divas and Moms, Noe introduces mothers like Willie Barrow (below), an ordained minister who marched with Dr. Martin Luther King Jr.; after losing her son to AIDS, she turned that same passion to the fight for people living with HIV. Another is Trudy James, who (when churches refused funerals to those who died of AIDS), created a “buddy program” through the Regional AIDS Interfaith Network in Arkansas to connect poz folks with volunteers recruited by churches. During one 11-week stretch, Noe lost a friend every week to AIDS. “The deaths were just relentless,” she recalls. The last was the cruelest of all for her personally: Steve Showalter, her assistant. Though Noe took time off of work, she didn’t stay away long. “When you’re in a state of war—because that’s what it always felt like to me—you don’t have the luxury to stop and take the time to grieve.” Noe is the first to say that the women depicted in the book weren’t driven by a hope for recognition. They were doing it because of the need to honor their children, or because it was the right thing to do. While much of the spotlight has focused on the male-dominated activism of the time, Noe’s book reminds us there were plenty of straight women in the trenches too. Women warriors (below): Nancy Pelosi and Elizabeth Taylor testifying before the House Budget Committee on HIV funding (left); Rev. Willie Barrow gives an impassioned speech (right)
COURTESY PUBLIC IMPACT PR (PELOSI, TAYLOR, BARROW)
impacted by the disease while others were driven by grief over the loss of a loved one to AIDS complications. Others simply saw a need to join the fight. The most visible of these early contributors were Elizabeth Taylor and Princess Diana. Taylor was perhaps the most famous actress of her time when she got involved in funding and supporting HIV research. Diana was one of the most beloved women in the world when she became a self-appointed HIV ambassador. Both women famously shook hands with people dying of AIDS. News outlets around the world featured photos of them not wearing gloves—immediately combating stigmas against touching people living with HIV. “I think it’s hard for people in 2019 to understand not just the importance of their involvement in the early days of the epidemic, but what they were risking,” Noe explains. “They were arguably the two most recognizable women in the world—and they had nothing to gain with their involvement—but both decided to leverage their celebrity status to do something that could change the world.” Another woman who helped do that was Dr. Mathilde Krim, a researcher at the Sloan-Kettering Institute in New York City who founded the AIDS Medical Foundation, which later merged with the National AIDS Research Foundation to become the American Foundation for AIDS Research (amfAR). Krim became the honorary “mom” of many poz gay men. Homophobia and ignorance around the virus also made it difficult for survivors to grieve. “The people who were dying— mostly gay men at that time—were close to us,” Noe remembers. “We could grieve with others in the AIDS community, but if we mentioned what we were going through to someone on the outside, the reaction could be hateful.” In many ways it was this hateful response that transformed grieving
JULY / AUGUST 2019
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