Plus 135 March April 2020

MARCH/APRIL 2020 hivplusmag.com

BECAUSE YOU’RE MORE THAN YOUR STATUS

DAVID & JOHNNY, A SERODISCORDANT COUPLE AND CELEBRITY INFLUENCERS, ARE SHOWING THE WORLD THAT LOVE KNOWS NO STATUS

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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.

(bik-TAR-vee)

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

MyDailyCharge.com

BVYC0102_BIKTARVY_A_7-875x10-5_Plus_KeepEmpowering_r1v1jl.indd All Pages 18927 Biktarvy Plus 132 Keep empowering.indd 2

} 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 EMPOWERING, 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 EMPOWERING. 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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IN THIS ISSUE MARCH / APRIL 2020

ON THE COVER

FEATURES

30 POWER COUPLE Newly married Atlantabased serodiscordant couple David and Johnny are continuing to remind us that love has nothing to do with one's status.

14 BODY LOVE Men over 60 open up about sex, love, and HIV. 24 AXING "AIDS" Since living with HIV has evolved, organizations are changing too.

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BUZZWORTHY 6 ANDRÉ THE GIANT Broadway star André De Shields is more than his HIVpositive status. He's a true trailblazer.

8 BE IN THE KNOW Get educated on some quick facts about HIV, PrEP, and stigma.

WELLNESS 12 NO BONES ABOUT IT How to keep your bones strong and healthy.

13 AGING GRACEFULLY Tips on thriving as you enter the next chapters of life.

BACKTALK 21 HELD TOGETHER, PUSHED APART Writer Craig Washington says Black gay and bisexual men have more healing to do.

SURVIVOR STORIES 38 PHILADELPHIA STORY Author Paul Lisicky reflects on early films about AIDS. 41 BRING SEXY BACK How HIV made writer Philipp Spiegel a better lover.

UNDETECTABLE 44 N'AWLINS VIBE Radio host Dorian-Gray Alexander talks about U=U in the South.

45 BIG EASY HIV resources and places to play while you're in the city of New Orleans.

TREATMENT 46 BOOTY CALLS Are rectal microbes the key to effective HIV vaccines?

47 SWITCHING MEDS Just a few of the many reasons to consider making a change.

48 NEW MEDS? A new peptide shows promise as a long-acting HIV treatment.

COVER & OPPOSITE: Newlyweds David and Johnny Lester-Massey, photographed by Laure Jacquemin

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editor in chief DIANE ANDERSON-MINSHALL • associate publisher STUART BROCKINGTON

creative director RAINE BASCOS deputy editor JACOB ANDERSON-MINSHALL managing editor DAVID ARTAVIA copy chief TRUDY RING associate editor DESIRÉE GUERRERO assistant editor DONALD PADGETT editor at large TYLER CURRY contributing editors KHAFRE ABIF, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writers CHRIS WASHINGTON, PHILIPP SPIEGEL, PAUL LISICKY, SCOTT STIFFLER interactive art director CHRISTOPHER HARRITY manager, digital media LAURA VILLELA executive directors, integrated sales EZRA ALVAREZ, MICHAEL RIGGIO, PATTY AGUAYO senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN designer, branded partnerships MICHAEL LOMBARDO director, branded partnerships JAMIE TREDWELL senior manager, branded partnerships TIM SNOW integrated ad sales and branded partnerships coordinator DEAN FRYN social media editor, OUT.com JAVY RODRIGUEZ director of circulation ARGUS GALINDO print production director JOHN LEWIS

PRIDE MEDIA chief executive officer DIANE ANDERSON-MINSHALL vice president ERIC BUI vice president, finance BETSY SKIDMORE vice president, branded partnerships STUART BROCKINGTON 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.

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Plus (ISSN 1522-3086) is published bimonthly by Pride Publishing Inc. Plus is a registered trademark of Pride Publishing Inc. Entire contents ©2020 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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LUKE FONTANA (ANDERS0N-MINSHALL), COURTESY NEAL BROVERMAN

EDITOR’S LETTER W H E N I F I R S T joined the company that publishes Plus magazine about a decade ago, I knew exactly one person on staff: Neal Broverman. The two of us had met on a press trip together in sunny Florida, where Neal wore these hip, David Carusostyle aviator sunglasses 90 percent of the the time. Though he appeared too-cool-for-school because of it, he was also the only man on the trip who understood why I—the only female in attendance—might not want to hear some of the guys’ antiquated ideas about women.

Neal and I forged a friendship through a decade of working together in different capacities at The Advocate and Plus magazines, which is why I’m happy to announce that with my recent promotion to CEO of Pride Media, I’ll be handing over the reins to Neal as he becomes Plus’s new editor in chief.

But don’t worry. I’m still here. Neal will take care of day-to-day operations along with our already great crew of editors and artists, including creative director Raine Bascos; editors Jacob Anderson-Minshall, David Artavia, Tyler Curry, Desireé Guerrero, Donald Padgett, and Trudy Ring; and contributing editors Mark S. King (blogger behind My Fabulous Disease), and Dr. Gary McClain.

It couldn’t come at a more exciting time, as Pride Media continues what began as a year-long initiative to inform the world about the scientific consensus that people with undetectable viral loads cannot transmit the virus to others. This issue, we meet a few people who personify this, including DorianGray Alexander, a radio host in New Orleans, and our cover stars David and Johnny LesterMassey, who are so popular in HIV activist circles (and among their many fans) that they just go by “David & Johnny.” They are a serodiscordant couple; David is living with HIV, while Johnny is not. As a couple, they teach us what it means to “live” with HIV and how it factors in today’s world of treatment as prevention. HIV doesn’t ever need to stop love, sex, or reproduction. David & Johnny, who met in 2013, took us inside their recent Italian wedding for our cover story. More than a look at the day of the wedding, David Artavia’s feature is a snapshot of a couple in love in 2020.

In addition to our cover stars, this issue we’ve got essays from Craig Washington, Philipp Spiegel, and Paul Lisicky (the latter is author of the brilliant new memoir Later: My Life at the Edge of the World). In his feature on sex, HIV, and aging, author Scott Stiffler speaks to a number of long-term survivors.

Since this is likely my last editor’s letter for Plus, I want to shout out some of the people who’ve been critical to our success over the past decade under my helm. Organizations

that have been vital partners include GMHC, NMAC, APLA, Black AIDS Institute, AIDS United, Transgender Law Center, Treatment Action Group, Prevention Access Campaign, Elton John AIDS Foundation, Elizabeth Taylor AIDS Foundation, and so many more. The Sero Project, Sean Strub, Tami Haught, and the HIV Is Not a Crime conference have trained not just me but several of our editors (and if you’ve never been to the conference of activists working to overturn stigmatizing and scientifically unsound HIV laws, consider it this year). Positive Women’s Network-USA staffer Jennie Smith-Camejo and executive director Naina Khanna helped us turn a publication with a lot of male readers into one that also speaks to the needs and accomplishments of women living with HIV. Tez Anderson’s AIDS survivor network, Let’s Kick ASS (AIDS Survivor Syndrome), helped push us to cover the lives of long-term survivors and people aging with HIV. Damon Jacobs taught us as much about PrEP and smoking cessation as any of the physicians we spoke to. As I write this, I’m flooded with folks I should thank but since this isn’t an Oscar speech, I’ll leave it by saying I should thank you, dear reader, most of all for making Plus a magazine that empowers anyone living with HIV to embrace life, care for your health, find love, enjoy family, and in all ways reach for the sky.

Each year we name 25 people of the year, and I can’t wait to see who makes 2020’s list. But honestly, you all deserve to be there: you’re amazing! Ciao!

DIANE ANDERSON-MINSHALL EDITORIAL DIRECTOR EDITOR@HIVPLUSMAG.COM

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buzzworthy buzz

LUST FOR LIFE

Irrepressible Broadway legend André De Shields, 74, proves that status is just a state of mind.

BY D O N A L D PA D G E T T 74 years of age is a good time to start taking it easy and relax a little. For dancer, singer, actor, director, choreographer, and Tony Award-winning entertainment legend André De Shields, it’s just middle age.

From choreographing Bette Midler concerts and starring in The Wiz on Broadway in the ’70s to recently singing the “Algebra Song!” in Netflix’s off-the-wall children’s special John Mulaney & the Sack Lunch Bunch, De Shields has done it all. The out performer hasn’t let his nearly three-quarters of a century on the planet slow him down one bit—or the fact that he’s been living with HIV for almost 30 years.

“That’s what you have to understand about HIV,” he told The Body’s Juan Michael Porter. “You can’t be fatalistic about it.”

Still, De Shields is no stranger to the devastation of HIV. His life partnership with playwright and mentor Chico Kasinoir lasted 17 years before Kasinoir died of AIDS-related lymphoma in 1992. Another partner died in 1995.

But after three decades of living with HIV, The Body reports De Shields remains in great health.

He’s just your average 74-year-old youngster doing eight Broadway shows a week, and lending his legendary presence to numerous other projects.

De Shields titled his autobiographical stage show Confessions of a P.I.M.P. with the acronym P.I.M.P. standing for “positive individual making progress.”

Embracing his poz status the motto also reflects De Shields’s approach to life: its less about the destination as it is about making the most of the ride.

De Shields told Porter he wasn’t about to let the tentacles of racism 6

and racial stereotyping stand in his way. Whether it was in the gay bar scene or dealing with deeply entrenched Broadway biases, De Shields was going to shine as brightly as he could.

And he has.

“Broadway has come around to diversity, equity, and inclusion, but it’s come around after we dragged them screaming and kicking,” he previously told The Daily Beast.

De Shields’s résumé proves he’s a true legend. His Broadway debut came in 1973 in Warp!, which was followed by such

ANGELA WEISS/AFP VIA GETTY IMAGES

FO R M O S T P E O P L E ,

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Broadway star André De Shields attends the 73rd Annual Tony Awards in New York City. The theater legend has been living with HIV for three decades

hits as The Wiz, Ain’t Misbehavin’, and Play On! He originated the role of Noah “Horse” T. Simmons in the musical adaptation of The Full Monty. His film and television credits include Law & Order, Another World, Sex and the City, and many more.

De Shields is currently appearing on Broadway as Hermes in Hadestown, for which his performance earned him his first Tony Award, for Best Performance by an Actor in a Featured Role in a Musical. He had previously been nominated for Play On! and The Full Monty.

Younger audiences or those not familiar with his stage work might

recognize him as the musical math tutor donning a sequined red suit and black eye patch who sings and dances his way through a song about how algebra caused the loss of his eye in John Mulaney & the Sack Lunch Bunch.

The song is intentionally silly, and the longawaited revelation about how his character lost his eye is perfectly in sync with the offthe-wall vibe of the show. And, of course, De Shields is absolutely fantastic in the number.

“Much has been made of my receiving my first Tony Award at 73,” De Shields told Porter. “I did an interview, and the interviewer said, ‘What does it feel like to get your first Tony Award so late in life?’ And I responded, “I think it’s perfectly timed, because I’m just hitting my middle age.”

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BUZZWORTHY BUZZ The Art of Care Callen-Lorde, a global leader in providing LGBTQ health care, is transforming a record $2.5 million donation by the Keith Haring Foundation into a groundbreaking program providing cultural competency to medical providers. The historic partnership will support further medical innovation in LGBTQ health care. The donation is the largest private gift ever made to Callen-Lorde, and the largest donation made by the Keith Haring Foundation in its three decades of operation. The gift will establish the Keith Haring LGBTQ+ Health Equity Endowment, which will fund Callen-Lorde’s Nurse Practitioner Postgraduate Fellowship in LGBTQ+ Health. The program will be housed in the organization’s new site in downtown Brooklyn, slated to open later this year.

Source: Callen-Lorde, November 2019

Opponents of PrEP have feared that relying on it as an HIV prevention strategy would lead to more condomless sex and cause already skyrocketing STI rates to climb even higher. Proponents have countered that if more frequent STI testing goes hand-in-hand with PrEP in clinics, it will bring higher-risk folks in to get checked and treated more quickly. That assertion has been granted new support by a Dutch study suggesting that widespread use of PrEP among queer men could lead to a 97 percent decrease in annual gonorrhea cases. Even when calculating a 75 percent rise in condomless anal sex among gay and bisexual men, the computer modeling showed gonorrhea rates would still plummet. The researchers examined what would happen over a 10-year period if 75 percent of Dutch gay and bisexual men eligible for PrEP would start taking it regularly. They also ran scenarios in which the adherence was reduced and with the total number of people on PrEP capped at 5,000. In the first scenario, the rates of HIV would fall 61 percent over the decade in those who practice PrEP, and almost as far among the gay community at large. In fact, the modeling indicates that even if PrEP failed 100 percent of the time (say, due to a lack of adherence), the increase in testing that PrEP programs entail would reduce HIV diagnoses by onethird to one-half in the LGBTQ community. Perhaps the most surprising finding suggested the nearelimination of gonorrhea. By the end of a decade, the number of those on PrEP who still needed to take it would drop by half simply due to the reduction of HIV and other STIs among the wider queer population.

Source: AIDS journal, December 2019

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Those willing to consider an HIV cure if its side effects (nausea, vomiting, muscle weakness, pain, or heart arrythmia) extended for the following time periods:

44% 73% 90%

one year

two months

two weeks

Source: AIDS and Behavior, January 2020.

ALEXAS_FOTOS/PIXABAY (SMILEY FACE); ANDREAS RENTZ/LIFE BALL 2018/GETTY (GALLERY); SHUTTERSTOCK (MAN)

CLAP BACK

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CURATED BY PLUS EDITORS

ADHERENCE IS ESSENTIAL TO THE EQUATION

GERD ALTMANN/PIXABAY (EQUATION); SHUTTERSTOCK (ALL OTHERS)

Drop-Kicking Stigma Late last year, gay rugby star Gareth Thomas chose to reveal he was living with HIV rather than submit to a blackmailer’s demands. The former British and Irish Lions captain is thought to be the first person in the U.K. pro sports world to come out as poz (even after retiring from the sport). He played professionally from 1995 to 2007, and ranks 13th on the list of alltime international scorers. In 2018, Thomas was assaulted in a violent, antigay attack but chose to push for restorative justice rather than imprisonment for his 16-year-old attacker.

Thomas was in the news again this January when he spoke out against the controversial decision by the Catalans Dragons to sign Israel Folau, who’d been kicked off Rugby Australia for posting on social media that “hell awaits” LGBTQ people. Thomas is also campaigning for the U.K.’s professional soccer association to actively fight homophobia, pointing out that there are no out players in all 96 professional clubs across England and saying the association currently responds only when a player is accused of racial abuse, not antigay actions.

Source: The Guardian and The Telegraph, January 2020.

A new study shows that adherence to HIV treatment is an essential element in the undetectable equals untransmittable (U=U) equation. Out of the 157 gay and bisexual men living with HIV in serodiscordant relationships, 20 percent said they had an undetectable viral load when their blood tests showed it was still detectable. Meanwhile, 7.5 percent believed their viral load was detectable when it was actually suppressed. The good news is that it still means almost threequarters (72.5 percent) accurately assessed their current viral load. It’s important to note that this research focused on men recruited to a program aimed at improving medication adherence and engagement in care, so the findings may not be representative of the broader poz community. However, it is a reminder for poz folks in relationships with HIV-negative partners to see their doctors regularly and take their medications faithfully.

Source: Journal of Acquired Immune Deficiency Syndromes, February 2020.

Black Needs Matter In February, the Southern Black Policy & Advocacy Network released the report HIV Advocacy Needs Assessment: Health Policy and Advocacy Opportunities for Black Communities in the South. Mining data from multiple sources, it is ultimately a response to the Trump administration’s Ending the HIV Epidemic plan, which aims to cut new HIV cases in the U.S. by at least 90 percent within 10 years. The new report addresses the needs of AfricanAmerican communities in nine Southern states that are heavily impacted by HIV. The administration’s plan “really necessitates a localized approach to improve health outcomes,” SBPAN cofounder and CEO Venton Hill-Jones said in a statement to press. “With this document, we are ensuring that communities have this incredibly timely and important information that they need in order to make their EHE plans and, ultimately, advance the end of HIV in the South.”

Source: Southern Black Policy & Advocacy Network, February 2020.

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WELLNESS

BY JACOB ANDERSON-MINSHALL

WORK THEM BONES BONE HEALTH IS A KEY ISSUE FOR ADULTS OVER 50 LIVING WITH HIV. HERE’S HOW TO KEEP YOURS STRONG. bone mineral density, which can lead to osteoporosis, frailty, and broken bones. This can prove deadly among those over 60.

Common antiretroviral drugs, like tenofovir disoproxil fumarate, have potential detrimental impacts on bone health.

However, research in the Journal of Acquired Immune Deficiency Syndromes shows that the bone loss associated with HIV treatment cannot itself account for the 22 percent increased risk of fractures that poz folks face.

“The increased fracture risk in people living with HIV is not caused by reductions in BMD [bone mineral

density] as these only explain a 15 percent increase in fragility fractures,” Dr. Jakob Starup-Linde noted. “These findings underline a bone deficiency in HIV besides what is reflected in BMD.” The study’s authors also point to comorbidities like hepatitis as possibly accounting for the differences. Performing a meta-analysis of published studies, Starup-Linde and his colleagues at Aarhus University Hospital in Denmark set out to evaluate bone fracture risks and bone mineral loss among people living with HIV—and potential prevention and treatment methods.

The researchers found that HIV-positive people (mostly men) in the studies were 50 percent more likely to experience any fragility fracture and four times more likely to experience a hip fracture. They also found that two drugs may combat or reverse bone mineral density loss: alendronate (associated with a 3.5 percent increase in BMD of lumbar spine) and zoledronate (associated with a 8.9 percent increase in BMD of lumbar spine).

“Besides antiosteoporotic treatment, efforts should aim at environmental risk factors, such as smoking cessation, decreased alcohol intake, optimal nutritional intake, including increased physical activity and screening for risk factors for falls,” the researchers concluded.

A 2018 study in AIDS Research and Therapy previously noted that nearly one-third (28 percent) of older people living with HIV are frail and exhibit three or more of the following: self-reported exhaustion, weak grip strength, slow walking speed, reduced physical activity, and unintentional weight loss of more than 10 pounds in the previous year.

That being said, the time to intercede and improve your bone health should be before you become frail. So here are some lifestyle changes you can make now to strengthen your bones: 12

Stop smoking tobacco and reduce alcohol consumption.

Since risk factors include smoking and chronic kidney disease or cardiovascular disease, addressing the issues that lead to disease can combat frailty and fracture risk.

Increase your calcium intake. Calcium is critical for bone health—but it’s also essential for heart health.

And without enough calcium intake, your body will leach calcium from your bones to meet the needs of that vital organ. Getting your calcium from foods like milk, cheese, tofu, kale, and sardines is ideal but if you’re not

able to get at least 1000 to 1200 milligrams a day, consider taking a supplement. And don’t forget Vitamin D, which is a crucial element in processing calcium. The vitamin will help your kidneys break down calcium while improving absorption so you get more out of the calcium you take in.

Eat a healthy diet. Bone growth takes energy, so you need to provide the body with enough fuel to remain strong. This means you need protein to build bones. Embrace a high protein diet, but don’t forget about your need for other nutrition requirements (i.e. don’t stop eating fruits and vegetables). The Mediterranean diet has been named the best diet overall for three years running, beating out other options like keto in the U.S. News & World Report 2020 rankings.

Move it or lose it. Like muscles, bones need to be used or they wither. When you stop actively loading your skeleton, calcium begins to leak out. While 20 minutes of weight-bearing exercises (like walking, push-ups, or lifting weights) a day can help maintain or even increase bone density, even small increases in physical activity can make a difference. The important thing is to move your body more.

Prevent falls. You want strong bones, but you also want to avoid the kind of injuries that can lead to broken bones. That doesn’t just mean rethinking extreme sports after 70. It can be as simple as clearing the clutter from floors, deicing slippery walkways, or putting a nonslip rug in your bathroom.

Or, it might be time to install railings and handles, or move heavier items to lower shelves.

Practice Yoga or Tai Chi. Another way to prevent falls is to improve your balance. Yoga, Tai Chi, and similar practices can help you do just that. They are also associated with other health benefits including pain reduction and increases in mental and cardiovascular health.

PIXABAY

P E O P L E L I V I N G W I T H HIV have been found to have lower

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AGING GRACEFULLY

CHRISTIAN BUEHNER/ UNSPLASH

HOW PEOPLE LIVING WITH HIV CAN CONTINUE TO THRIVE AS THEY GET OLDER. People living with HIV face specific hurdles beyond those that confront the general population as they enter the latter half of their lives. Living with HIV increases the risks of experiencing substance abuse, social discrimination, and stigma—which can lead to negative outcomes for those dealing with both HIV and comorbidities like cardiovascular disease, neurological issues, kidney problems, and cancer.

However, studies suggest that living with HIV may not be as disruptive to “successful aging” as we once had thought.

The Journal of Acquired Immune Deficiency Syndromes recently published results showing 82.5 percent of HIV-positive women aged 50-plus reported that they were aging well—compared with 83.7 percent of HIV-negative respondents. These results are particularly hopeful given that previous studies had been limited to white men and found greater disparities between poz and negative respondents—with 66 percent of poz men self-reporting successful aging versus 84 percent of HIV-negative men in a 2014 study.

Women living with HIV are known to have more negative health outcomes, with reduced access to care and quality of life, poorer adherence and viral suppression, and increased morbidity and mortality. Women living (and aging) with HIV are also disproportionately African-American and face wide-ranging health disparities and social inequalities.

Successful aging is generally defined as growing older while avoiding significant illness or disability. In a 2019 piece in the Journal of the Association of Nurses in AIDS Care, researcher David Vance reiterated what he considers the eight essential components of successful aging: length of life, biological health, mental health, cognitive efficiency (being able to learn and problem solve), social competence (ability to form and maintain close relationships), productivity, personal control, and life satisfaction.

Some people living with HIV have self-defined the concept differently. For many, physical fitness and even general health may be of less importance to their happiness and sense of aging successfully. Quality of life may reign over length of life, and continuing to engage in activities may have more value than one’s productivity in those activities.

A 2017 Canadian study found six themes that repeatedly came up when researchers spoke to people over the age of 50 who were living with HIV: accepting limitations, maintaining a positive outlook, fostering social support, taking responsibility for their health, adopting a healthy lifestyle, and engaging in meaningful activities.

Many of these themes are echoed in advice from the poz women’s group Well Project’s suggestions on how long-term survivors can age well by taking control of their health, finding support, speaking their truth, demanding a seat at the table, and committing to purposeful action.

Additionally, researchers from the Journal of Acquired Immune Deficiency Syndrome study found that spirituality was of particular importance to older Black poz women’s sense of wellbeing. It also found connections between aging well and higher levels of self-

reported psychosocial attributes, such as optimism, resilience, and personal mastery. Those who reported experiencing anxiety, depression, loneliness, or a lifetime of discrimination, were less likely to report they were aging well. Addressing these mental health (and societal) issues could help combat those impacts.

The long-term survivors organization Let’s Kick ASS (AIDS Survivor Syndrome) suggests feedback loops, where stigma helps increase the isolation many older HIV-positive people face, which in turn adds to loneliness and depression, which can exasperate physical health problems. Therefore, even something like promoting the message that undetectable equals untransmittable (the consensus that shows when someone’s viral load has become undetectable, they are no longer able to transmit the virus to someone else) could improve the health of those living with HIV over 50 by reducing the stigma they may face in aging communities.

As the world changes, the future will undoubtably include new solutions and challenges to living well with HIV in the second half of one’s life. The ability to adapt to those changes or move to places with fewer challenges may play increasing roles in our experiences of aging.

Yet ultimately, what it takes to age well is a subjective evaluation that depends in part on what you value and prioritize. Is it a shorter life spent engaging in meaningful activities or stretching the goal post out longer, even if it comes with additional challenges? Either way there are some commonalities: it helps to have a support system and to stay as physically and mentally healthy as you can. And retaining control over decisions about your own life is essential. It helps to start now, at whatever age you are, to plan the future you’d like and to begin living well today. —J A M

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Blessings

&

Burdens: Aging with HIV Some long-term survivors have mixed feelings about finding themselves alive— and undetectable—decades after their original terminal prognosis.

HELENA IJE/PEXELS

BY SCOTT STIFFLER

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or gay men who received their HIV diagnosis decades ago, aging into Social Security retirement eligibility is a marker that once seemed as unimaginable as the prospect of U=U, or undetectable equals untransmittable. Strict adherence to the daily antiretroviral regimens first introduced in 1996 can itself be a burden, but long-term survivors must swallow other bitter pills as well.

Perry N. Halkitis, 57, author of Out in Time: The Public Lives of Gay Men from Stonewall to the Queer Generation, believes, “For older adults living with HIV, antiretrovirals bestow, potentially, a level of comfort with one’s [ability to transmit HIV].”

The fear of transmitting HIV to one’s partner is now history for those who are able to reduce their viral loads to the point that they can no longer pass the virus to others.

Still, Halkitis, who was diagnosed with AIDS in 1988 but is now currently undetectable, notes that for long-term survivors like himself, “An underlying trauma exists. The alienation, stigma, and loss associated with the epidemic is particularly pronounced, given they expected to die.”

Halkitis—dean, professor, and director at the Center for Health, Identity, Behavior and Prevention Studies at Rutgers School of Public Health— contributes to an emerging field of study dedicated to people with HIV and AIDS over 50.

That population is growing. As reported by the Centers for Disease Control and Prevention, “we can say that as of 2017, 50 percent of all PLWHA [people living with HIV/AIDS in the U.S.] were 50 and older,” explains Stephen Karpiak, Ph.D., senior director for research at the ACRIA Center on HIV and Aging at New York City’s Gay Men’s Health Crisis. Although the data isn’t in yet, Karpiak says that as of this year 16

that stat is expected to hit 55 percent nationally, and 62 percent in New York City.

Longevity was an unlikely prospect when Rev. Steve Pieters, now 67, was diagnosed first, in 1982, with what health professionals at the time called gay-related immunodeficiency; and later, in 1984, with two AIDS-related cancers.

“When they pronounced me ‘terminal’ in 1984, that’s when I began to think I wouldn’t live to see 1985,” Pieters recalls now. He spent 39 weeks that year in a clinical trial for Suramin, one of the first medications investigated as a potential HIV treatment. Most participants in the trial did not survive.

Many of the men Pieters had sex with during that era later died of AIDS-related illnesses. He recalls two muscled partners with whom he says enjoying mutual masturbation “contributed to my becoming sexual again” after his diagnosis.

They later proceeded to “protected oral and anal sex” using condoms. Pieters laments now, “I have to wonder if the condoms slipped or I didn’t do everything I should have.” Both men passed away from AIDS-related conditions, although he doesn’t know if they got HIV from him.

“Of course, there’s some level of survivor’s guilt.

But I hope that my activism and my ministry [as staff clergy at Los Angeles’s Founders Metropolitan Community Church] have been a tribute to all those friends who died.”

Grieving for friends as well as the loss of his own youth and vitality, Pieters says he occasionally succumbs “to my tendency toward depression,” but feels, with age, “I’ve acquired much more effective ways of dealing with it. I don’t sink as deeply, and it doesn’t last as long.”

Pieters finds support through his church, gym, the HIV service organization APLA Health, and sharing his story at public events, as a member of the Gay Men’s Chorus of Los Angeles, where many younger members regard him as “a tribal elder.”

DIRK BOLLE

Rev. Steve Pieters in his clerical robes in the 1980s, around the time he was diagnosed with what was then described as gayrelated immunodeficiency (later renamed AIDS)

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“I think a lot of that has to do with their awareness of all I survived in the worst of the ‘plague years,’” Pieters says, appreciative of their acknowledgement.

“There are [other] times when I feel I’ve entered ‘the age of invisibility,’” he adds. “Sometimes, when I walk into a room full of younger gay men I may not know, it feels as if no one even notices me.”

Living with HIV since the ’80s did give Pieters what he calls “an early start on developing coping skills that others might not have, because my long-term HIV infection and its treatments have sped up the aging process.”

Since his early 50s, Pieters has developed high cholesterol and triglycerides, coronary artery disease, arthritis, stenosis of the spine, neuropathy, cataracts, glaucoma, and problems with balance. Still, the 67-year-old is currently undetectable and considers himself “pretty healthy for a man who’s had GRID/ AIDS for decades.”

But he admits one or more of the 30 drugs in his medical regimen has rendered him impotent, leading to a 2003 decision to lead a celibate life.

“I could be joyfully sexual again, with the aid of Viagra or Cialis, if I fell in love and wanted to have a relationship,” explains Pieters. “But I’m not out looking for it. I am so much happier than I ever was when I was sexually active. I miss the intimacy, but I don’t dwell on that.”

Thom Kam learned of his positive status in 1992.

Now 64 and currently undetectable, he is “very certain” he actually seroconverted in 1987. “That puts me at 33 years living with HIV, and for 24 years on antiretroviral therapy,” says Kam, who recalls feeling “devastated” when he was told he was undetectable.

“I realized that I was going to survive, when so many others hadn’t. This was, and is, the hardest thing for me, about surviving,” Kam explains. “I think a lot about the countless friends I lost to AIDS. I do feel cheated, thinking that my life would have been richer if we had more time together for those friendships to have become deeper, as friendships do through the decades.”

That weight, says Kam, “seems to have become a bit lighter, as I start acknowledging that most of my years are behind me.”

But he’s not dead yet, nor are his desires. When his 14-year committed relationship ended in 2000, recalls Kam, “I found myself gravitating toward men who were HIV-positive, and taking care of themselves.”

That changed, he says, “about two years ago.”

That’s when the wider adoption of PrEP and his own undetectable status first made him feel “more comfortable being with guys who are negative.”

Kam is transparent about his HIV status with new sexual partners and gets tested for other sexually transmittable infections every quarter— as is recommended for all of those on PrEP. “So I feel fairly safe with them, regarding HIV and other [STIs],” he says.

Still, “hooking up is a low priority,” Kam says. He’s also experienced discrimination on dating apps.

“What surprises me,” he says, “is encountering guys my age and Gen Xers, that are interested in HIVnegative partners only. The self-loathing, stigma, and irrational fear that represents in 2020 makes me feel

really sorry for them. I’m delighted and encouraged to see that it’s a nonissue for the majority of millennials.”

A member of the leather community, Kam was crowned Mr. Eagle NYC 2019, and says that although it’s “segmented and not unified,” there is still a community “code of responsibility, whether you’re negative or positive, that I’m very proud of.”

Gregg Bruckno, 49, is program coordinator of GMHC’s Terry Brenneis Hub for Long-Term Survivors, which launched in June 2018 to provide resources and build support networks for those in need. Bruckno says that workshops and social programming, in partnership with St. John’s Lutheran Church, allow attendees to “connect socially, so it’s not all about the dating apps. And if it turns out to be love, then we become matchmakers.”

Bruckno, diagnosed HIV-positive in 1999 and currently undetectable, is sexually active, but was married (2001-2015) when “dating apps came out.”

Now, he says, “There’s more openness about it on apps, but there is still a stigma. If you have it on your profile, maybe they’ll shame you. So I tell people when we meet.”

For many long-term survivors, though, there’s still a fear of being rejected for having HIV, Bruckno acknowledges, “that is almost the same as it was back in the day.”

But he says, “If you have the confidence to convey [it], I would say being undetectable can be a good marketing tool for having sex.”

Thom Kam, who holds the title of Mr. Eagle NYC 2019, been living with HIV for over 30 years

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B AC K TA L K

B Y C R A I G WA S H I N G T O N

BREAK THE CHAINS

ZULMAURY SAAVEDRA/ UNSPLASH

IF BLACK QUEER MEN WANT TO BREAK FREE FROM MENTAL SLAVERY, WE MUST FIRST UNLOCK OUR OWN BIASES.

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B AC K TA L K

LOVE HAS NEVER BEEN A POPULAR MOVEMENT. AND NO ONE’S EVER WANTED, REALLY, TO BE FREE. THE WORLD IS HELD TOGETHER, REALLY IT IS HELD TOGETHER, BY THE LOVE AND THE PASSION OF A VERY FEW PEOPLE. —JAMES BALDWIN

I ’ M AT T H E Eagle, Atlanta’s oldest leather bar. House Godfather Ron Pullman is spinning for the gods and I am trying to pace my 50-plus self (well, more like 60-minus self).

I need to spare enough energy to traipse over to MIXX, where the House Mother Sedrick will soon minister. At the bar, I’m huddled near John Dennis, founder of Indigenous House, a major annual event that celebrates house music as an innovation of Black queer culture. John shares updates on the SGL (Same Gender Loving) Family Cruise, a well-known annual excursion, when one of his friends joins the clutch.

“There were too many queens up in there,” scowls the friend, who is well past 50. He’d survived the plague long enough to join an openly gay Black cruise party, yet his takeaway was “too many queens.” How ironic was the setting for this brand of shade.

We were four Black men indulging our freedom in a leather bar without having to know what that freedom cost—or who paid for it. Did he have an inkling as to how many queens living and dead made his very gay life in Atlanta possible? Not that it matters. He sees no connection to the men he trashes. In fact, it is in his troubled interest to set himself apart from them.

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I can’t help but notice a negativity among Black gay men that seems more virulent, more widespread than ever. We don’t have the luxury of overlooking this affliction. This is no blaming invective. Black gay men didn’t raise themselves to believe they are defective. That was the work of their families and communities of origin. This hate turned inward is not limited to disdain for the femme within us. It is a broad mindset that refutes our goodness and undermines our greater good. It is a resistance to our own self-love and acceptance. Like a religion designed for a traumatized people, it would not take root without our shame to feed upon. It resurrects the myths we were taught about our wholly unholy nature. It reminds gay men that we are not really men. We really are “perverse,” as they say.

Furthermore, it informs us that the queen in and among us is to blame for our people’s rejection.

It calls us to worship the butch and the hard-bodied, the straightadjacent, and the pinnacle of gay manhood: the revered top. The resistance scoffs that we are less accomplished, less “relationshiporiented,” and otherwise less than white gay men. It convinces us that we are less worthy—so much so that many of us think andact accordingly.

Social media, particularly hookup sites, give gay men the nerve to say things they wouldn’t dare say in person in front of wide audiences.

Since the Adam4Adam days, profiles have grown more mean-spirited in rejecting the femme, the soft, round, and HIV-positive bodied.

Recently, I ran across this message and it stuck with me: “I am a total top. The Alpha and Omega. If u know you a bitch ass nigga don’t waste your time. Where the real niggas at?”

This Jack’d member refers to himself not merely as a top, but a “total top.” The “total” meaning, unlike other tops who may occasionally bottom (a disqualification according to the yet unwritten top/bottom etiquette playbook), he does not. He knows top purity bestows more than sexual allure. He has come to expect the reverence gay men often lavish on men like him. That may explain why he describes himself with a moniker Christians reserve for God. Also, the Jack’d top shifts focus to exclude any femme men who might hit him up. His name-calling (“bitch ass”) parrots the same homophobic men who would disown him without pause, despite his top credentials— at least in the light of day. “Where the real niggas at?” he concludes.

We know “real” is a definitive code for men who present as masculine, hard, thuggish. By contrast, femme (“bitch ass”) men are unreal and undesirable.

We must fully acknowledge this trauma and recognize these negative self-images as symptoms of untreated injury and pain. Contrary to popular myths of utopian white queerness, white gays also struggle with self-acceptance. But it is Black gay men who, I think, need most to be healed.

We activists talk a lot more about freedom than we do healing.

One cannot be set free with a shame-sickened soul. What do our symptoms reveal about our condition and the treatment required?

In the last four decades, the bulk of Black gay men’s community involvement has been focused on battling HIV. The plague snatched away our leaders and diverted attention and resources from other significant needs. If HIV/AIDS never happened, how many Black

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ALVIN AGARRAT

gay men would have concentrated on mental and spiritual health, or political advocacy fields? How many careers would have been centered in Black queer arts and culture? The neglect of those needs is yet another AIDS casualty. Today, we need more Black gay men engaged in spiritual and emotional health work without obligations to HIV-centered outputs.

James Baldwin once stated that the world is held together by the love and passion of very few people.

How might we apply Baldwin’s assessment to a Black queer world?

I know some of those rare souls. They perform poems, they memorialize the poets, they inform and enroll brothers into advocacy.

They confront HIV criminalization and challenge “HIV disservice” (a term coined by one of these angels, Daniel D. Driffin) organizations to do better. They organize Black queer film events and hold space for us to play in and outside of the club.

They love on us and we have never been more in need of this love, to be administered as a balm. Let this serve as a call for their collaborative attention to this matter. The very salvation of Black gay men depends on direct, hands-on leadership.

While writer Joseph Beam lamented how he could not “go home as who I am,” he and other forefathers left us blueprints to build a home of our own. As today’s visionaries carry his fallen spear, they must hold our healing as paramount. Where can Black gay men turn to unlearn the disabling beliefs they harbor about themselves?

We deserve to own real estate where we gather to learn about our histories and plot action for change.

Were we to mount a widespread profusion of art, another Black queer renaissance, might it set the stage for Beam’s self-loving revolution? Would it help more of us recognize our basic goodness, if not our greatness?

Instead of accepting our own difference, our deviations from sexual and gender majorities, so many of us in and out of closets downplay that difference. This resistance to our own remarkable nature distracts us from understanding our purpose. As children we are told that we are out of order and many of us spend a lifetime trying to get back in order.

I believe we are born to upend the order that binds us all, and not give in to it.

What transforming lessons might we model for our hetero brothers by resisting “normal”? How might we help them recognize the confines of their own mentality by breaking out of our own?

Asserting our fullest selves does not end at telling Mama what she already knows and walking up into Bulldogs, a white-owned, Black-patronized bar.

We are free when we can reenvision our difference as an expression of diversity, as part of a natural order.

When we understand the intentions of our creation, we know how natural we truly are. When we arrive at that understanding, we will no longer be ashamed or shame others for the desire to have another man inside of us. We will not see any brother as less of a man because of how he dresses, gets down, walks, or talks, as we ourselves have suffered. We will no longer silently collude with cisgender straights who are cool with us but “just don’t understand” trans and genderqueer sisters and brothers.

Craig Washington is a writer, HIV advocate, and public speaker living in Atlanta.

He is the cofounder of Southern Unity Movement and an organizer of the annual Rustin Lorde Breakfast, held each year on Martin Luther King Day

I’VE LEARNED TO HOLD MY HEAD UP HIGH, NOT IN SCORN NOR DISGRACE. —ARCHBISHOP CARL BEAN When we act, speak and live as free men, as opposed to passing, we destabilize, we disrupt, we catalyze, and we break free. And as we fully break free, we emancipate ourselves and other Black people at large from mental slavery.

When we realize the full value of our Black queer lives, we are fully motivated to organize and invest in our communities far beyond the bounds of HIV prevention. When we organize that consecrated movement for our very lives, we end up bashing the principalities of white supremacist patriarchy.

Let us look to the artists, the organizers, the leaders and the masses, our forgotten elders and our misunderstood young, the living and the dead who still speak, to uncover our power. There is a new order that only we can bring.

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MODERN MEDS AND AN EVOLVING CONSCIOUSNESS HAVE CHANGED WHAT IT MEANS TO LIVE WITH HIV. NOW OUR ORGANIZATIONS ARE PIVOTING, TOO.

BY DE SIR ÉE GU ER R ERO

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“Since 1983, we have been committed to delivering care to the people who need us most,” said APLA Health CEO, Craig E. Thompson, in a statement at the time. “Thirty-three years ago, that meant ensuring people with AIDS died with dignity. Today, it means much more…. Our mission is to achieve health care equity and promote well-being for the LGBT and other underserved communities, and people living with and affected by HIV.” That same year, on World AIDS Day and during the final days of the Obama administration, the federal government announced its decision to change its official HIV information website from AIDS.gov to HIV.gov, which went into effect the following spring.

Miguel Gomez, senior communications adviser for the Department of Health and Human Services’ Office of HIV/AIDS and Infectious Disease Policy, said the decision was based largely upon the preferences of people living with or affected by HIV, as well as current science.

“We want our program to reflect today’s science,” Gomez wrote in the announcement, “as well as the terms most of our visitors use to tell their stories about HIV or to search for information about HIV and AIDS on our website.”

“In the beginning of the epidemic, the term ‘AIDS’ became implanted in the public’s mind because it was used in the popular press before researchers identified the cause of AIDS and an international committee of scientists named it the human immunodeficiency virus (HIV),” notes Gomez, adding the decision was a practical one as well. “Today, twice the number of people who come to our website from internet searches use the term ‘HIV’ rather than ‘AIDS.’ In addition, the majority of the social media conversations we participate in focus on the term #HIV.” Dr. Richard Wolitski, a former director of the HHS Office of HIV/AIDS and Infectious Disease Policy who’s been working in HIV advocacy and policy for over 35 years, was very pleased with the decision.

“I started doing this work in 1985, when the reality of living with HIV was so very different than it is today,” Wolitski commented when the change was announced. “Now people with HIV can live just as long as their HIV-negative peers. I’ve been living with HIV for more than 20 years, and I don’t expect to ever develop AIDS.” Often, such rebranding isn’t just about changing language, but changing times and expanding programs. A lot of these organizations have grown immensely over the years and now include numerous other wellness programs such as dental,

COURTESY MEDICAL ADVOCACY & OUTREACH INC.

riginally called “gay related immunodeficiency disease” (GRID), AIDS quickly took over as the known acronym for the mysterious and deadly epidemic that arose in the early 1980s, killing gay and bi men in large numbers at an alarming rate.

Fear reigned as AIDS hit other communities, stars including Rock Hudson and Freddie Mercury died, and hundreds of thousands of others succumbed to the then-deadly affliction over the next decade.

Though it was soon made clear that no demographic is immune to HIV, AIDS had already been cemented as a stigmatized acronym associated with queer men—and death—and remained so throughout the ’80s and ’90s. While there is nothing obviously stigmatizing in the acronym (“acquired ummune deficiency syndrom), early reports tying the disease to queer men and intravenous drug users— and to death—cemented biases that remained entrenched through the 1980s and ‘90s.

“AIDS” has proven itself problematic over the years. The acronym only describes the advanced stages of HIV. It is not the name, nor was it ever, for the virus itself (human immunodeficiency virus). But unfortunately, AIDS stuck and has often been misused to describe someone who is simply living with HIV. When the first versions of the lifesaving antiretroviral drugs we use today were developed in the mid-’90s, quite suddenly, having HIV was no longer a death sentence. Now, one could simply be living with HIV—and no longer condemned to “dying of AIDS.” Although this medical revolution has drastically changed the lives of people living with HIV, in many ways, the rest of the world has failed to catch up with current science.

It’s not that AIDS is an erroneous term, as it was and still is a widely used medical jargon for the advanced stages of HIV. The problem, many experts and activists argue, is that due to its history of misuse and stigmatization, the term is now somewhat antiquated and actually promotes stigma. It also overemphasizes the fatal phase of the condition in a time when the life expectancy of those living with HIV is pretty much the same as anyone else’s.

This has led to a huge push, particularly in the last five years or so, to eradicate the term from the conversation around HIV as much as possible. Some of the first organizations to do so have been ASOs— an acronym that ironically stands for “AIDS service organization.” However, it makes sense that the orgs directly serving the actual people living with and affected by HIV would be first to lead the charge.

One of the first orgs to make this shift was Whitman-Walter Health in 2014, when they renamed AIDS Walk Washington to The Walk To End HIV. Then in 2016 another major ASO, AIDS Project Los Angeles, rebranded as APLA Health. When APLA’s cofounders first met in the early ’80s to try to combat the growing “GRID” issue (as HIV was still being called then), it was actually a bold move at the time to name their org AIDS Project Los Angeles—and was done so rebelliously to reinforce the fact that HIV was not just a gay man’s disease. But today, the virus and its related terminology continues to evolve.

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related services, MAO has an ever-expanding list of services designed to address hepatitis C, diabetes, behavioral health, and other health and wellness issues that are particular to these communities.

“The new name reflects our expansion of quality services to new healthcare issues facing rural Alabama,” says Michael Murphree, MAO’s chief executive officer, summing up the general philosophy behind rebranding. “The MAO team does not just see health conditions, we see human beings in need.”

Since then, this movement has only gained momentum. Over the past few years, dozens of other orgs have followed suit with their own AIDSfree rebranding. Among the more recent to do so is Vivent Health, which announced its new name just this past World AIDS Day. Originally the AIDS Resource Center of Wisconsin, the org took the opportunity to modernize its brand when it merged with Rocky Mountain CARES in Colorado and St. Louis Effort for AIDS in Missouri.

Michael J. Gifford, Vivent Health president and CEO, says it’s not only important and necessary to change with the times in terms of serving those living with HIV, but to also make things like HIV prevention and testing more accessible to all.

“As the need for PrEP [pre-exposure prophylaxis] increases and HIV continues to be a leading example of a health disparity, Vivent Health will be as committed as ever to expanding lifesaving programs to individuals with the greatest need,” Gifford said in announcing the change. “Together, we will continue to work toward a world without AIDS, ensuring accessibility and affordability of essential health care services.”

COURTESY ALLIANCE FOR POSITVE CHANGE

Above: Participants pound the pavement at MAO's annual Tread Red Walk & Fun Run in Montgomery, Ala. Below: Deborah Yuelles of Alliance for Positive Change and the org’s rebranded signage

vision, mental health, housing assistance, and addiction recovery. With health care in general moving in a more holistic direction, HIV testing, prevention, and treatment are now simply considered a part of general LGBTQ wellness (or for anyone in the community who is served). Removing “AIDS” from these orgs’ names not only creates a more welcoming environment for poz folks but more accurately reflects the range of services they provide—and for whom.

In 2017, AIDS Service Center NYC formally changed its name to the Alliance for Positive Change. This shift came as the nonprofit expanded to help more New Yorkers with substance use and mental health issues, and program participants with chronic illnesses such as hepatitis, diabetes, and heart disease.

“We used to be the AIDS Service Center of Lower Manhattan, and then AIDS Service Center of New York City—and as the epidemic evolved, so did we, as an agency,” says Deborah Yuelles, peer program director at The Alliance for Positive Change. “At our core, we are an AIDS organization but because there are so many other connected issues like substance abuse, like chronic illnesses and mental health…and high rates of trauma within our population—we’re addressing HIV [and] we’re addressing chronic conditions.”

Also in 2017, Montgomery AIDS Outreach, while retaining its original acronym for recognizability, rebranded as Medical Advocacy and Outreach. For over 30 years MAO has been primarily serving communities of color in rural Alabama—where words like “AIDS” can be especially stigmatizing. In addition to its HIV-

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GOING TO THE CHAPEL

Well it was more like an Italian villa where David and Johnny Lester-Massey, the popular serodiscordant relationship influencers and hosts of the Poz series Table Talk, tied the knot and reminded those living with HIV that love truly knows no status.

BY DAVID A RTAVIA PHOTOGR A PHY BY L AURE JACQUEMIN AT THE CA’ SAGREDO HOTEL IN CAMPO SANTA SOFIA IN VENICE, ITALY

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March 2013, David LesterMassey gave an interview that would change his life forever.

At the time, Atlanta-based marketing professional and producer Johnny Lester was casting a reality show and searching for potential talent. Following a brief phone call, Johnny informed David that he’d call him back. He did.

That call lasted for hours—as did the next one, and the next one, and the next one. Eventually, David raked up the courage to ask Johnny if they could meet in person. Admittedly, Johnny says now, he thought it was going to be a business dinner.

David, however, knew it was something more.

At this point, the two had hours of conversation under their belts and understood a genuine connection was forming. After having a “really good time” at dinner, David, knowing his feelings for Johnny were building, decided to make an even more courageous move. Only this time, it was something deeply personal.

“I need to let you know that I am HIVpositive,” he told Johnny, expecting what many people living with HIV dread after disclosing their status: fear, rejection, and isolation. But what happened next took David by surprise.

Johnny, who is HIV-negative and was not fully educated about the virus at the time, responded with compassionate and concerned questions: 32

“Are you OK? How are you? What does that mean? Are you healthy?”

David began to share with Johnny about his health, his numbers, and HIV in general. What really moved him, he says, was that Johnny never lost romantic interest after learning David was living with HIV. “[ Johnny] took the time to get educated,” explains David now. “When he left my house, he called his doctor and he had conversations about what it means to date or be in a relationship with somebody who is living with HIV. [The doctor] was like, ‘OK, so I want you to know something…. First of all, if they disclosed that information to you this early on, please consider yourself special, because it’s not easy to do, it’s not easy to hear, and he chose to disclose to you.’”

Those wise words from Johnny’s doctor, who is also his uncle, brought the issue into a broader perspective for the young producer. It wasn’t the first time someone disclosed their positive status to Johnny, but this time was different.

“Atlanta’s very fast-paced,” Johnny explains.

“There’s a lot of hits and misses here.”

According to the Centers for Disease Control and Prevention, the Southern city has one of the highest rates of new HIV diagnoses in the U.S. “I was at a point of time in my life where I was open and ready for a relationship. I wanted something different. Being from a small town…

David and Johnny, a popular Atlanta serodiscordant couple, celebrated their love last fall when they wed in Italy

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coming out as gay, being in front of a Baptist minister in the Bible Belt, you have all of these layers of stigmas and hang-ups that you have to walk through and deal with. I gave myself two years to really work on myself, to be my openly Black gay self, because I had never had the opportunity to do that. I was always terrified to do that. I said, ‘A relationship that’s meant to be will come.’ And it did.”

Six years later, David and Johnny LesterMassey have become leading content creators and relationship influencers specializing in building content for people living with HIV. As contributors for Poz and Real Health magazine, and hosts of Poz’s web series Table Talk and Real Health’s “Perspectives” column, the duo (branded as “David & Johnny”) give advice and insight to couples who, like them, are in serodiscordant relationships—where one person is living with HIV and the other is not.

The couple owns Hiclass Management, a boutique branding and imaging firm providing services for high-profile clientele and awareness marketing around HIV. Recently, they launched two ventures: Hiclass Blends, a luxury loose-leaf tea company, and SirHiclass Footwear, a luxury footwear line with products made in Italy.

By far, the most extravagant project they’ve curated to date was their own 2019 wedding in Venice, Italy, a country that holds a special place in their hearts.

A few years ago, David had started touring in Italy, singing and directing a gospel choir, and spending two to three weeks at a time traveling across the country. In 2017, he received a call from singer and Insta-celebrity Cheryl Porter, who’d been invited to perform at “Christmas at the Vatican” for Pope Francis.

“She said, ‘I can’t imagine doing this without you. Would you be able to come over?’” remembers David, who jumped at the chance.

Johnny joined him for the tour, and the duo fell in love with all things Italy. When the time came for choosing wedding destinations, the choice was obvious.

“We said, ‘Italy is a big country, where will we do it?’” David says. He explains. “I’d been to Venice, but he hadn’t. And so, I was like, ‘I would really enjoy being in Venice with you, and if we could make our wedding happen, I think you would be blown away.’”

The couple started the planning immediately.

Porter also sang at the intimate ceremony, which was performed in the music hall of the Ca’ Sagredo Hotel in Campo Santa Sofia. And the private setting was intentional on their part.

“We talked about the money we were investing and we said, ‘We don’t want to invest all of this money for people to come and just spectate,’” Johnny explains. “We want people [there] who are going to be rooting and cheering for us. [In Italy], they already invested to get themselves there, so I know they weren’t there to spectate.”

Wedding guest Rashian Boyd (above) smiles for the camera on the big day. Renowned singer and vocal coach Cheryl Porter (below) joined the celebration with her rendition of “Ave Maria.”

If there’s one attribute defining David and Johnny’s relationship, it’s authenticity. Checking in with each other to make sure they’re both good and being honest about their feelings will always be a top priority.

“We have this thing called maintenance time,” David explains. “Maintenance time itself is to take an hour of uninterrupted time. There’s no television, no radio, no cell phones, no computer, no devices. Just you and your partner, and you actually talk. You actually talk about the things that are going well. You talk about the things that you want to improve. You talk about things that you couldn’t talk about because you were too heated to talk about them. You save it for that one hour you’ve dedicated, every week.”

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Admittedly, David says they got to that point through therapy, which is another thing they encourage couples to partake in.

“Get someone with an unbiased voice that can hear both of you at the same time, because what we find is that if I’m saying something in a language my partner can’t understand, it’s just like me not talking at all,” David argues. “Learn to listen in a language your partner understands.”

“When David and I first started using [maintenance time], it’s because we couldn’t communicate effectively,” Johnny says. “I had a whole iPad note of stuff I was ready to talk about during maintenance time, so I was ready. I came to maintenance time ready to read and ready to just tell him everything I wanted to. [But] it became, ‘No, we need to go over this because of that’ and ‘This is going to be because of that.’

Eventually, we didn’t need maintenance time anymore because we just started to deal with stuff as it came.”

“That’s what you would hope for,” Johnny adds. “You really hope that you won’t need [maintenance time] as a long-term situation.

I think that’s one of the beautiful things I learned out of it. And when David talks about therapy, I laugh because I always say we were in therapy within the first six months. But then, we did therapy again a few years into the relationship, and we just kind of used therapy as a maintenance tool. I think it’s something

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that’s really contributed to the success and communication of our relationship.”

Without a doubt, David and Johnny’s love has grown stronger over the years as they continue breaking down their inner walls. For countless fans, many of whom are living with HIV, their story is one of triumph and trust. That sharing their experience as a serodiscordant couple is highly relevant now, in a world where many people still don’t understand that undetectable equals untransmittable, has not passed them by.

They’re also fully aware that in order to fight stigma within a relationship, those involved must equip themselves with knowledge.

“I can understand that there are a lot of people who don’t have the education [about HIV] because I didn’t either,” Johnny says. “David didn’t know that he was the main reason I was comfortable being in that moment with him the first night he told me [his status], because he was calm. If he would’ve came to me freaking out and all over the place, I probably would’ve naturally reacted and been as freaked out as he was. But he was very calm. He had a conversation with me.... People are not dumb. They know what’s going on. And you can tell if somebody’s kind of rushing things along…that doesn’t make somebody who’s unsure be OK.” David’s advice to anyone choosing to disclose their poz status to their lover: “The person that’s sharing the information, they really are

Below: The happy couple saying their vows in the music hall of the Ca’ Sagredo Hotel in Campo Santa Sofia, Venice, Italy.

Across: Family and friends bearing witness to the couple’s intimate ceremony

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the gauge on that thermometer, because how they deliver it is probably how they’re going to get a response.”

David adds, “I was educated about my own status enough to share it with somebody else, when they felt comfortable hearing the information. So, just imagine what it would have been like if I was not educated and Johnny had questions, and then I either gave him misinformation or just said ‘I don’t know.’ That would make me seem less credible.”

“The onus of your status still belongs to you,” David explains. “You can choose to share it. You can choose not to share it. But you do have a responsibility to ensure that you protect yourself and you protect the other person that you’re with. Whether you plan to be with them for a week, a night, or a lifetime, you still have to protect yourself.”

He continues, “The way to do that is to make sure that you have as much education in your tool belt that you can be able to share with somebody else. So when they leave you, for whatever reason, they’re more educated just by meeting you— not hooking up with you, not being in a relationship. Whenever they come into somebody else’s presence, they can give that education to somebody else.”

That education certainly helped when David disclosed his status publicly for the first time at a conference—after he’d already told Johnny.

“I didn’t know at that time, but somebody was recording it and they had hit share,” David remembers. “There were people in my hometown that got the information through social media, not me. There were people that were in Johnny’s [circle] that got the information over social media and not through him.”

“And so now all of these questions are forming,” he adds.

“They’re like, ‘Wait a minute, did you know that David is living with this? Did Johnny know? Did you see him?’ All of these things. I really wanted to control our message, and once

we couldn’t, it was like, OK, now that it’s out there, we still have a responsibility to let people know that, ‘Yes, this is a part of our story, but it’s not the entire story. It’s just the backdrop.’

This was more than HIV.” That was the moment they both realized their stories could actually help others, and they answered the call.

“I told him this from the beginning,” explains Johnny. “I was like, ‘I want people not only to see you living with HIV, but they need to see you live well.’ They don’t need to just see you and say, ‘Oh, he looks healthy, he’s eating.’ No. They need to see you be a rock star, because they need to see something that they’ve never seen before.”

Alternatively, they also understand that Johnny’s voice is equally as important as an HIV-negative person who is in a healthy long-term relationship with someone who is poz—a narrative we often don’t see in mainstream TV and film.

“I’m negative, he’s positive, we know what our regimen is, we know what the doctors have told us, and we know how we operate,” Johnny says. “It was like a revelation or an aha moment for me in that instance. I also told David, since we’ve never seen this before, since there is no template, my thing is, if we’re going to do anything, we’re going to do it fabulous.”

Recently, they have pieced together a mini e-book, which is a collection of quotables and small insights (or “David & Johnnyisms”) their fans will be able to download and use if ever they need a jumpstart of inspiration.

Their ultimate goal is to be the first gay Black male couple to host a talk show. Given their shared drive and passion for change, they might achieve that goal sooner rather than later.

“I do believe there is a space for thought leaders and people that want to take themselves, their relationships to the next level,” Johnny says. “Us being men of color, by being open and vocal about who we are and what we do, I think it resonates with a lot of people.”

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Survivor Stories

In the decades since HIV took hold of our lives, stories of ALEXEY SKACHKOV/SHUTTERSTOCK

survival continue to mold the fabric of who we

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are and what we stand for. Harrowing tales of love, loss, and discovery are a reflection of the human strength we all share. Each of us has a story to tell, if only we had the platform to do so. Here are two of those stories:

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By Paul Lisicky

STORY

Has the world’s view on gay men living with HIV actually changed since 1993?

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SHUTTERSTOCK

My Philadelphia MARCH / APRIL 2020

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The town filled the theater.

If it wasn’t the whole town, it certainly felt like it. It was winter, in Provincetown, 1993. Crusts of dirty snow lined the parking lot, and it was the time of year when people didn’t leave their houses unless they had to.

We were here for the first showing of Philadelphia, which was no small thing for a town that functioned as a safe haven for people with HIV and AIDS. While neither my boyfriend and I believed we were HIV-positive, many people in the audience had struggled with chronic illness, or with the deaths of partners and friends. And yet, in the minutes before the curtain went up, there was a jovial mood in the room. People were excited to be together in one place. Everyone walked around telling dumb jokes, hugging one another and laughing as if we were all celebrating a birthday.

Then the curtain fell and the mood shifted.

I felt the crowd’s absorption almost bodily.

Every sound and action on the screen was scrutinized and taken in like no other movie I’d ever seen. My boyfriend squeezed my hand at every moment he was touched or disturbed. I was involved too, but I was aware of the lawyer story as a framing device.

I wanted to get to the heartbreaking parts, between the lovers, or at the hospital, where affection could be up front and visible. I wanted to get past the scenes in which the straight male characters expressed their homophobia.

The actors expressed their homophobia with such relish they almost snapped off the heads of their words. My whole body tightened each time they got going. They didn’t sound like they detested gay men for how they walked across the room, or for how they dressed, or shaped their vowels. Their disgust focused purely on sex.

“OK, I’m prejudiced. I don’t like homosexuals,” says Denzel Washington’s character in a manner that assumes agreement, and until that moment I was in the dark about why people supposedly hated us.

By giving so much air space to that disgust, the movie told the viewer, we can’t stand who you are at heart. If we’re your ally, it’s only testament to our generosity, to how much we’re willing to overlook.

This observation troubled me to such a degree that I shut down. And just when I thought there was nothing more for me to see and learn up on the screen, a man a few rows behind us, on the far side of the theater, stood up and stumbled past the people in the seats.

He was crying, and crying in such a way that demanded to be seen, which wasn’t a small thing, as he was tall, sinewy, determinedly masculine, not the type you’d associate with displays of emotion. I’d seen him around town, at the bars or at the A&P, either in a white T-shirt, or in flannel with the sleeves hacked off, a man of about 40, though it was hard to tell anyone’s age back then when sickness could scour people decades ahead of their years.

His face told us he knew he wasn’t going to live much longer. He had to get out of there. And in his outburst it felt as though he drew the movie into himself. He became the movie, and we were all in it, and once we saw ourselves as actors, the horrible dream of AIDS was not just a dream anymore. It was real. And it destroyed us.

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even his once-beloved sister. He was strong, shining, and real, not contorted to be some representation of an idea. And maybe that was why my mother’s face went dark and inscrutable. The man on the screen captured her son and put him up there in his place. She wanted her world back. She wanted her son again, or at least the story she’d always carried of her son, which was the story of someone who’d live a very long time, free of prejudice and illness, a person who didn’t make others flinch when he held out his hand to shake. What stranger had stolen him from her?

Yet she stayed in that room with me, for as long as she could bear it. And though I can’t say we talked about any of this—it would take years before we could get to that place—I could say a curtain lifted in the atmosphere between us.

Thirty-five years have gone by since that run of An Early Frost. My mother is gone, I am no longer young, and though you’d expect that movie to feel antiquated by now, it isn’t that way at all. It feels as though the roles were performed not just for that moment, but outside of time, which I suppose is true for any representation that succeeds, regardless of genre.

These days, I sit on the 3 train and look up at an ad featuring two women together, see a gay male couple on a situation comedy speak with such queeny abandon that worries about stereotypes are out of the question.

We’re oh so evolved, or too sophisticated for such worry—at least that’s what we’ve been directed to think. All of it still feels a little false somehow, too knowing, too engineered.

Maybe what I really want is a world in which representations of me, of all queer people, could matter less, could be in the background, or in the middle, as much as the foreground. For example: See those two guys holding hands as they cross Atlantic Avenue? Let’s put them in the background of a scene in a movie that has nothing to do with them at all. Let’s let them be unchartable for a while, and turn up the spotlight on them in a different film where something between them is actually at stake.

Only then will I know that we’ve changed the world.

Paul Lisicky is an award-winning author and associate professor at Rutgers University-Camden, living in Brooklyn, N.Y. His sixth book, Later: My Life at the Edge of the World (Graywolf Press) was just released.

BEOWULF SHEEHAN

Why hadn’t the churches or the government helped? Why were we all on our own when 306,000 people—in the United States alone— were living with HIV that year? These were not new questions, of course, but I felt them freshly, into my blood.

On the drive back home through the woods, my boyfriend and I were too upset to talk.

I felt an agitation in the space between my throat and my chest, a corral of two conflicting desires: the desire to be seen and the desire to be completely uncaptured—an uncharted wilderness, like the woods flying by outside the window.

I knew it was a paradox I’d never resolve, but if given the choice between the two, I wanted to be seen. I knew it was crucial to get our stories on the screen. People weren’t going to attend to our rage unless a big Hollywood movie was willing to say we existed.

In truth, I craved representation of queer life so badly that my hopes contorted whatever it was I saw. Everything on the screen usually felt so wrong. Something was usually off. A character was typically too polished or too careful, but the queer world I knew was alive with contradictions, full of people who couldn’t be shoehorned into any category or style, people who were just as messy as anybody. Every time I saw one of us on the screen it was to make some kind of point, and the heaviness of that crushed our individuality.

Was that why the man pushed his way out of the theater? Had the movie’s good intentions failed him to the point where he couldn’t stand it? Or, conversely, did he in fact see himself on trial once the Tom Hanks character was asked to take off his shirt to reveal his KS lesions to the courtroom?

Eight years before, my mother and I happened to be in the same room at the same time, in the house of my childhood. I’d heard a little bit about An Early Frost, the made-for-TV movie about to air. It had run up against some controversy (as they say).

I knew it was a movie with gay characters, and I knew it was about a character with AIDS, played by a handsome actor I’d seen in other movies, a guy with a deep voice and hard, athletic body whom I certainly had a crush on.

I had an urge, a molten urge, to bolt from the room the instant I saw his face on-screen—but I stayed.

I stayed even when I knew I couldn’t hide my deep interest in the actor, even when my mother lifted her face from the magazine in her lap, even when I felt her watching my reactions with such pressure that my face went red hot. It already mattered less to me that this was a story of a man taken down by AIDS, a man who loses his job, his boyfriend, his relationship with his family, MARCH / APRIL 2020

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By Philipp Spiegel

How HIV Improved My Sex Life

SHUTTERSTOCK

Don’t get me wrong.

Having HIV sucks.

It really does. Not that it affects me tremendously anymore. My viral load is minimal, my immune system is top-notch, and I generally feel slightly superhuman and awesome. But that is now, after long years of therapeutic confrontation. HIV took away a few years of my life.

Stuck in depressions, doubts, insecurity, and masturbatory loneliness, I was quite the pathetic personification of self-pity. Of course, future consequences are unknown. And it simply is a constant company—especially when getting to know women (that is a much funnier story to tell another day).

So to double down, HIV sucks…but this essay is not about HIV. This is about the joys of sex and how HIV has made sex so different—and so much better—for me.

I’ve always seen sexuality as one of my main sources of joy and happiness—the fun, laughter, giggles, and playfulness accompanying those lustful games. I was a womanizer—an artist, charming with poetry and prose, never wanting to commit, but never misleading either. Brief encounters were always welcomed, and I was curious about women in all shapes and sizes.

All in all, they were happy, sweaty, and mischievous times, in which erotic entanglements were aplenty. Until I learned I was HIV-positive.

Part I: In Full Retreat In those first days, weeks, and months of being diagnosed, I felt venomous, like my blood and my semen were infected with an alien entity. As I tried adjusting to this new life of mine, the sexual trauma had taken an ugly and monstrous shape in the back of my head.

In the cold and clouded grays of Vienna’s winter, my fear of intimacy reached unknown heights. I had already started taking my medication.

According to medicine, I was safe. According to medicine, I couldn’t infect anyone. According to medicine, the viral load was suppressed. According to medicine, I was “clean.” But according to me, I was poisonous.

What I used to associate with the joys of aimless wandering in the night—a glass of wine here, a glance and a smile there—had become a myth of distant lands. I stood in galleries, in bars, and in clubs on my own, disconnected from the surroundings, trapped in my own head. A fearful tension occupied my eyes, my mind, and my body language. Orifices and emotions clenched shut.

All I did was observe from a distance those women in their big smiles and shining, happy eyes in their elegant strides and delicate movements. They were so close to me, and yet so unbearably far away. It could have been easy to walk up, to say something, to smile. But it became impossible.

I was carrying invisible scars in the open. A simple conversation would mean a simple confrontation. What can I tell her? What can I say? That my life HIVPLUSMAG.COM

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is in shambles? That I am used and infected? That I am dirty? That my cock is a poisonous weapon?

A new darkness was taking hold of my life. I simply stared, having the imaginary conversation in my mind. Say this, say that, small talk, and superficial. The panicking drunk in my head was screaming violently: Can she see this? Can she see me hiding something? Can she see I’m not telling her something?! Can she see my poison?

Still, I remained silent.

At even the slightest chance of an intimate encounter, my mouth flooded with a dry excuse to escape. I didn’t dare talk to her. I made up stories, anything that kept me from having to confront the situation of telling her about my status. I shielded myself from the horrors of someone’s affection and interest.

I’ve always been a shitty liar. Some scars are simply too deep to hide, to make over, or to brush aside as if they weren’t a big deal. And so, I retreated.

Even if I was able to sway through a jungle of avoiding phrases and any personal details, even if things would move toward the tiniest bit of intimacy, I had installed more roadblocks.

And so, controlled by my fear, shame, and selfloathing, I ran to safety.

I retreated from the joys of life and sex. This was a typical fear of commitment I had embraced in my past. For now, my association with sex was fear. And danger. The trauma had taken hold.

Part II: Enter the Incel Loneliness leads to anger, leads to hate, leads to violence.

I was scared of intimacy. I was feeling ugly, unloved, and poisonous. To escape from that sick state of mind, I started blaming women for it. I blamed them for ignoring me, for not finding me attractive, for my failure to catch their attention.

I started seeing fewer and fewer women as attractive. Ugliness took hold of me.

When frustration and unhappiness dominate your days, the world’s color shifts into a shade of ugliness that started covering everything I saw: women, nature, moods. Of course I still craved for desire, sex, and intimacy, but I started separating my corporal needs from the emotional insecurities that were plaguing me.

As I was becoming slightly more confident with my health and status, I noticed a difference in my approach. The desire for satisfying women fell short. My frustration would reduce sex to a simple act of penetration—passive-aggressive grunts and snorts, instead of passion.

The delicate romanticism of my past was dissolving in a testosterone-driven desperation.

Cheap, pornographic fantasies dominated my imagination. Fucking for fucking’s sake. My sex became brutal—the only one I wanted to satisfy was myself. I was becoming angry and violent in bed. And I didn’t care. It was the only place I could exercise a little bit of power.

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Eventually, I noticed where the source of my frustration was. HIV had taken away the awareness of my own sexuality, of my own desires and abilities, of what I can, of what I want, and of what I love.

Sexual awareness is my ultimate freedom, and I decided to seek that again. I wanted to overcome the trauma and to confront myself with the joys of sex.

Part III: Sticky Sweet Fountains of Joy Oh, Vienna…why? Yes, the city is nice but it’s also one of the most unsexual places in Europe.

Nobody talks. Nobody laughs—especially about themselves.

Generally, a lack of openness, friendliness, and approachability oppress this city, which makes its faces as gray as the sky. And so everyone is glued to the blue iridescence of their phones seeking online shortcuts to happiness.

The saddest thing of all is that to have sex, people seem to have to be drunk—or on drugs. Or both. To overcome shyness, inhibition, or some other emotional clogs that are blocking any sense of lightheartedness. Two-dimensional Tinder lives seeking two-dimensional Tinder wives. The third dimension—of taste, of emotion, of touch and smell—is tossed overboard. Considering the viral mess I was trying to step out of, these surroundings would be the end of me.

I met Mara at a fair in Barcelona over 10 years ago. She was selling ridiculous plastic dolphins.

What followed was a roller coaster. A heartwrenching relationship, challenging emotional and sexual limits—ending in borderline insanity.

We needed to stop the madness, so she took the courage to end it. Yet we had grown together—and over a few trying years, a bond had developed.

A familiar feeling of love, trust, and friendship that had outgrown any ambitions for relationships or sexual tensions. We were family now. Despite being in different cities—and sometimes different continents—we would partake in all of life’s joyous and horrid events.

When she told me she was pregnant, the poetry continued. In instances like these, life unravels too fast to keep track. After the hesitant decision to keep her child, the uncertain biological father faced certainty and ran back to Argentina.

For me it was obvious what would follow. I needed a change of heart, pace, and location.

Vienna was oppressing me in its icy heart, and since misery loves company, I packed my things and left. I might have been worthless for my own good at the time, but I knew Mara could use my support. I knew she needed me.

I fled back to the winter in Barcelona, where I would find a rhythm of living and loving that I was more comfortable with. I would start the next adventure living with my best friend—in her father’s garage.

A makeshift wooden board separated our “rooms.” She slept next to the kitchen, and I slept

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COURTESY PHILIPP SPIEGEL

next to the car. Occasional sleeping-on-the-bed battles ensued with the dog (I won, most of the time).

Sunny days and freezing nights of sharing— one pregnant with a child and a mountain of responsibilities, the other pregnant with a virus he would have to start living with. Both pregnant with thoughts and fears of uncertain futures and plights.

Still, the sharing helped. I reassured her that she would be able to manage the tasks at hand, and I was right. She reassured me of the reasons she fell in love with me all those years ago, and she was right.

With reluctance, she helped me reopen the box in which I hid all my attributes, desires, passions, and the sexuality I always saw myself to have— the same qualities I had blamed for my HIV in the first place.

While her belly got bigger, I used the time to dust off and study the treasure I was rediscovering again. To read and write and find inspiration. Biographies of artists and their muses, of literary masterpieces and pulpy junk.

And especially of sex.

Once again, a shift of light occurred—but this time it revealed beauty. Reading of the strength of the tongue, the abilities a mouth can have over the orgasmic pleasures of women, a desire awoke again. There was a beat again—a slow but steady beat of the heart, pumping creative blood through my veins and my seriously underused penis.

Spring had arrived.

I started remembering things I had almost forgotten from a long time ago, before the end of my life, before the virus covered me with doubts and fears. I remembered what it was like to satisfy. Not with brutal, violent power, but with the real, heartfelt, and delicate power of pleasure.

I remembered that sex is the most boring part of sex.

Passionately. Delicately. Honestly. In contrast to the plight that Mara was going through (the biological father’s abandonment and the challenges she faced), I felt ashamed of my dark and violent episodes. But being the sexual woman that she was, she encouraged me to re-explore the beautiful bars and ladies of Barcelona. And I followed her order.

A new smile took shape. Women started looking at me. My head couldn’t stop turning with excitement. Instead of the brutish grunts in my eyes when seeing beauty around me, my eyes would smile in their direction, sparkling with a curious passion. Instead of boasting testosterone, I laughed at myself and charmed with traveled anecdotes. Humble, kind, and occasionally funny (not trying too hard, nor too little).

Our lives ended shifting. Mara was feeling more confident, more secure. The dark, steelguttered garage was being transformed into a bright wooden-floored loft, with functioning kitchen and proper bedroom. And the dog finally had its own bed. A new home for Mara was becoming more real, so I moved out to give her

the last weeks to herself. With my moving, and her new confidence, the emotional curse of the virus had been broken.

Soon I was spending sober Sunday afternoons under white covers with a lover—sweaty bodies entwined in embraces, laughs, giggles, and hours of lip-smacking acrobatics. Very often, penetration wasn’t even involved.

I was more in the moment than I had ever been, more present than ever before, more grateful for being aware of what I had lost and found again.

Not only this closeness, but the ability to give in and let go of the world around me.

I had lost over two years to anger, to depression, to my venom. To HIV. To the struggle, and the ugly approach I had to life, to love, and to women.

The beauty of life and its sexual encounters, I used to take all of that for granted. It was so easy.

So simple and so wasted. A new appreciation for sex dawned on me. I bowed to life, to friendship, to love and to a new joy of intimacy I feel every time I’m with a woman now.

I became aware of the changes that had happened. Of my sexuality. Of what I wanted and what I didn’t want. Of how I wanted to be and how I wanted to be seen. As did Mara.

Once again, our lives danced in synchronicity.

Seeing Mara a few hours after she gave birth, looking at that beautiful son of hers, she knew she could manage anything—smiling with peace, tranquility, and the ultimate happiness of unconditional love.

This virus has given me a strange superpower and a second chance. HIV has given me a sexual awareness of my partners—of their tact and rhythms, of their movements and strides. I feel them more, I hear them more, I adapt more to the rhymes of our bodies, react to their unspoken yeses and noes. So much more pleasurable. No more aggressions, no more things to prove.

I am free again…except when I have to babysit.

This essay was originally published in German and reprinted with permission by Philipp Spiegel.

Philipp Spiegel is a writer, photographer, artist, and public speaker based in Barcelona, Spain, and Vienna, Austria. Spiegal started his career in photojournalism and fashion photography, but his HIV diagnosis shifted his main focus to subjects affiliated with sexuality and HIV. (Philipp-Spiegel.com)

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UNDETECTABLE

U=U ON THE AIRWAVES DORIAN-GRAY ALEXANDER AIMS TO MAKE UNDETECTABLE A HOT TOPIC IN THE BIG EASY. I N 2 0 0 5 , A F T E R Dorian-Gray Alexander experienced a series of illnesses and was eventually diagnosed with Stage 3 HIV, otherwise known as AIDS, he felt lucky to have health insurance as a selfemployed person.

“I was going to be OK, right?” he recalled, before his health insurer ultimately rescinded his coverage.

That’s when he turned to NO/AIDS Task Force, the oldest HIV organization in New Orleans (which later became CrescentCare).

“I learned I could receive my care there and get not just my clinical care, but also wraparound services,” he says. Alexander’s medication has a sticker price of $2,300 per month, but he pays no out-of-pocket cost.

“That one bottle saves my life.”

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The activist dove into HIV issues, and he learned about 340B discounts on medications through the federal Ryan White program.

These 340B savings have allowed CrescentCare—where Alexander now sits on the board—to nearly double its client population. In fact, over 80 percent of its clients living with HIV have achieved viral suppression, rendering them undetectable, which means it’s impossible for them to transmit the virus to others.

“The goal of HIV care is to have the virus become undetectable,” explains Alexander. “I plan to live a long life.” Like most poz folks today, he’s unlikely to die from complications related to HIV. “I’m so darn proud of the work

CrescentCare does,” he says of the organization, which implements stellar care including a gender clinic and syringe access programs that are “truly inspirational and unique to our city and in the South.”

“The legacy of HIV and support services are remarkable given the backdrop of Hurricane Katrina and all the changes we’ve endured,” he adds. “Our new 65,000-square-foot [headquarters] provides primary and specialty care as well as a safety net to a community that struggles with access to better health. We know some people will die younger just because of the zip code they live in. CrescentCare wants to change that and bring more equity in health care. Every day has its rewards and disappointments.”

Alexander also produces the Proof Positive Show on the community radio station FM 102.3 WHIV (We Honor Independent Voices).

Launched on World AIDS Day 2014, the program is a talk show with local guests raising awareness about HIV and other health concerns through music, protest songs, and programming dedicated to human

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BY JACOB ANDERSON-MINSHALL

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rights and social justice.

“Mine is a single yet important voice for my brothers and sisters of all molds who are living with HIV,” he says proudly of the program. “Each show hopes to empower us with HIV, especially [those] hiding in shadows, and to inform everyone.”

Alexander (right) is also on the board of the nonprofit media outlet Bayou Brief.

“A free press and an informed public are vital,” he emphasizes. “Nothing seems more important, especially right now with current politics. We need investigative reporting and nonprofit journalism like we need community radio. These are not obliged to advertisers but to the public to reveal the facts wherever they lead. Bayou Brief is another way to keep a transparent eye and those accountable for what they promise and what they deliver, or don’t.”

While Alexander says New Orleans has come a long way, he argues that there remains a need for getting out factual information about undetectable equals untransmittable (U=U).

“New Orleans is way behind on U=U,” he says. “Some of my frustration is [that] it’s

been hard to get initial buy-in still and they want to muck it up and conflate it, for example, mixing it with STIs. Having syphilis does not diminish the effectiveness of being undetectable, nor the fact we cannot pass it on. We need to stop this madness.” As Alexander says, we can all do a little bit more.

“I wear many hats in the community and volunteer on and off boards, and in many ways, it can be confusing,” he says. “In time I hope to pull back and look to other projects, maybe help mentor others to be more engaged, to speak out and call out others.

My approach is confrontational and can certainly be improved. But it’s never personal. It’s about those who cannot or don’t feel empowered to use their voice.”

This article is part of U=U & U, Pride Media’s initiative to get the word out about HIV prevention, treatment, and testing, especially the groundbreaking news that people living with HIV who have undetectable viral loads cannot transmit HIV.

SHUTTERSTOCK (CRAWFISH), COURTESY SUBJECT (ALEXANDER)

HIV RESOURCES IN THE BIG EASY Bordering Lake Pontchartrain and built on a curve along the Mississippi River, the city of New Orleans is located near the bayous of southern Louisiana’s Delta region. Its history and geography have always shaped the culture. Precariously placed and vulnerable to flooding (most dramatically demonstrated by the aftermath of 2005’s Hurricane Katrina), the port city is also a vibrant gumbo of diversity. The Crescent City faces high HIV rates, but the numbers are beginning to decline due to the advent of PrEP and U=U (undetectable equals untransmittable).

Currently, 87 percent of people living with HIV in New Orleans have been diagnosed, and 97 percent of those who are on medication are virally suppressed. But only 66 percent of those diagnosed in New Orleans are on antiretroviral medications, bringing the percentage of people living with HIV in the city who are virally suppressed down to a paltry 56 percent.

Fortunately, resources are available to combat the city’s challenges in getting people with HIV into care (and undetectable), while getting those who are most at risk on PrEP.

WHILE YOU’RE THERE New Orleans is famous for Mardi Gras, Jazz Fest, and Essence Fest celebrations—and the year-round bacchanal atmosphere of the French Quarter. But there’s so much more to experience here.

Take in the music, the voodoo, and the ghost stories. Guzzle frozen daiquiris in takeout cups the size of Big Gulps or sip Hurricanes and sing along at Pat O’Brien’s piano bar. Indulge in unforgettable food and drinks from beignets at Café Du Monde to muffulettas at Central Grocery & Deli, gumbo at Mother’s, po’ boys at Adams Street Grocery, Crevettes Rémoulade at Antoine’s Restaurant, and crawfish almost everywhere. LGBTQ folks have always been a part of the mix in the Big Easy and the city celebrates with annual LGBTQ events: Saints + Sinners LGBTQ Literary Festival (March 27-29), New Orleans Pride (June 12-14), and Southern Decadence (September 3-7).

There are plenty of queer-owned or LGBTQ-friendly accommodations in the city, including The Bourbon Orleans, Bon Maison Guest House, Ace Hotel, and the Old No. 77 Hotel.—JAM

CRESCENTCARE The organization was founded over three decades ago as the NO/AIDS Task Force. It has since transformed into a clinic offering a broad range of health and wellness services. (CrescentCareHealth.org) CHEVRON WALK TO END HIV Every year in September, hundreds join the three-mile walk-athon that benefits HIV services at CrescentCare.

(CrescentCareHealth.org/the-walk-to-end-hiv) NEW ORLEANS REGIONAL AIDS PLANNING COUNCIL This council oversees the distribution of federal Ryan White Part A funds in maintaining a comprehensive system of care for people living with HIV in the Greater New Orleans Area. (NORAPC.org) PROJECT LAZARUS This network provides transitional housing to people living with HIV who have no other place to stay. (ProjectLazarus.net)

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treatment

BOOTY RULES Is the secret for potential HIV vaccines hiding in our butts?

— DAV I D A R TAV I A

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SHUTTERSTOCK

Findings published in the journal mSphere show that microbes living in the rectum may have benefits when it comes to the effectiveness of experimental HIV vaccines.

Researchers at the University of California, Davis, sought to figure out whether microbes living in the rectum and vagina interacted with experimental HIV vaccines similarly to the HVTN 111 vaccine, an HIV DNA and protein vaccine currently in early-stage clinical trials. To test their theory, researchers studied vaginal and rectal microbes before and after adult female rhesus macaques were vaccinated—while noting their effectiveness at producing antibodies.

According to Smita Iyer, an assistant professor at UC Davis, vaccines that produce antibodies at the mucosal membranes where HIV transmission takes place (the rectum and vagina in this case) are crucial in preventing HIV contraction.

Iyer’s team discovered that while vaginal microbes didn’t show much of a difference, rectal microbes revealed that Bacteroidetes-type bacteria, like Prevotella, decreased upon vaccination.

Subjects with high levels of the gut bacteria Lactobacillus or Clostridia were shown to make more antibodies to the HIV proteins gp120 and gp140. The opposite was true with Prevotella bacteria. The data showed it to be correlated with weaker immune system responses.

Furthermore, evidence suggested that Lactobacillus supplements were able to boost production of these antibodies, while antibiotics can actually inhibit positive immune responses.

However, it’s still not clear what needs to happen for some bacteria to boost immune responses, but targeting these bacteria might be a way to get the best possible results from HIV vaccines that fail to produce a strong immune response.

As the authors conclude in the study, the microbiome could be an important factor to consider when evaluating vaccines—and it should not be overlooked.

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SWITCHING GEARS The top 10 reasons for long-term survivors to change medications.

There are numerous reasons that those living with HIV may wish (or need) to change meds. Fortunately, numerous studies have indicated it is safe to switch medications. Here’s when to consider it.

Your current treatment has failed When your viral load suddenly climbs or you start experiencing a new HIV-related illness, it’s likely that you have developed resistance to one or more of the drugs in your HIV regimen. Today, there are other medications available to those who become resistant to one drug, a whole class of drugs, or even multiple classes of drugs. For example, Trogarzo (ibalizumab), approved in 2018, is a long-acting injectable that fights multidrug-resistant HIV when added to a previously failing antiretroviral regimen.

You are worried about developing drug resistance HIV is always mutating, which is how it develops resistance to drugs, but some drugs are more susceptible to those mutations than others. Nonnucleoside reverse transcriptase inhibitors (NRTIs like nevirapine, efavirenz, rilpivirine, and etravirine), integrase inhibitors (IIs like raltegravir), and some nucleoside analogs (NAs like 3TC and FTC) have higher risks of resistance.

Other drugs offer protection: the ODIN trial found that darunavir (a component of Prezista and Prezcobix) stops the virus from multiplying and mutating.

You’re experiencing treatment fatigue Long-term survivors can develop treatment fatigue (a physical or emotional weariness with taking HIV drugs) simply from having had to take multiple pills every day for decades at a time. But rather than taking an ill-advised “medication vacation,” talk to your doctor about the possibility of switching to a one-a-day combo drug. There also may be a possibility of joining a clinical trial, like the Long-Acting Therapy to Improve Treatment Success in Daily Life, or LATITUDE. Funded by the National Institute of Allergy and Infectious Diseases, LATITUDE is testing whether two long-acting, experimental injectable antiretrovirals are better than daily pills for those who struggle to maintain adherence to a daily medication.

SHUTTERSTOCK

You want to take fewer drugs Maybe it’s not the number of pills, but the number of individual drugs you want to reduce. While three-drug regimens were once considered the only way to prevent HIV drug resistance, new two-drug regimens have proven to be just as effective.

Their advantages can include fewer side effects, and a reduction in toxicity associated with long-term drug therapies. Juluca (dolutegravir/rilpivirine) is the first two-drug regimen approved by the FDA for adults already on treatment and virally suppressed.

Your pharmacist is worried about interactions Some drugs react poorly when combined with other drugs, or supplements, or even certain foods (like grapefruit juice).

Many long-term survivors (like many older adults) can end up

taking a dozen pills (or more) a day, when you add up all their drugs for HIV and other health conditions as well as additional vitamins, supplements, hormones, pain relievers, and overthe-counter medications. Most pharmacists can look over your list of drugs and supplements and determine if you are at risk of negative interactions, and they may be able to recommend other formulations that won’t have the same problems. Take their advice to your doctor and talk about options.

You have co-morbitities (or want to prevent having them) Many people managing their chronic HIV are also combating heart disease, diabetes, or obesity. Others are at risk of developing those conditions and need to avoid drugs like Triumeq that come with certain cardiovascular risks; or switch from a protease inhibitor to a an integrase inhibitor (either raltegravir or dolutegravir) to reduce risks of developing diabetes, obesity, or heart disease.

You are starting to have kidney problems Long-term use of numerous drugs including anti-inflammatory meds (like ibuprofen) and certain HIV medications—particularly tenofovir disoproxil fumarate (Viread, which is a component in the single-tablet regimens Truvada, Atripla, Complera, and Stribild)—have been linked to kidney problems. Other chronic illnesses can also cause kidney issues, and many older people living with HIV therefore may need to consider regimens that replace TDF with tenofovir alafenamide (TAF), such as Genvoya, Odefsey, and Descovy.

You can’t stand the side effects Almost all medications come with potential side effects— some minor, some life-threatening. For example, diarrhea is a common side effect of HIV drugs, and impacts about 17 percent of those living with HIV. Not everyone taking a particular medication will experience the same side effects, and some people experience them more intensely, while others simply aren’t bothered by the side effects they experience. Only you can decide if the benefits of a particular medication outweigh the side effects that you are (or could be) experiencing. Talk HIVPLUSMAG.COM

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treatment

You want to cure your hep 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. Those rates are particularly high for baby boomers, who may have been unwittingly exposed by older medical practices. Today there are medications that can cure hep C, but many HCV drugs can interact with HIV

drugs, so it’s important for your doctor to carefully consider which medications you can take to treat the two conditions simultaneously.

You’re worried about bone health As we age, bone loss can become life threatening, both directly and due to the fact that older people aren’t always able to recover from broken bones (particularly damage to their hips or pelvises). Frailty is more common among those over 50 who are living with HIV, so preventing bone loss is a real concern. Certain drugs, particularly tenofovir disoproxil fumarate (a component in Truvada, Atripla, Complera, and Stribild) have a negative impact on bone health, and should be avoided by those already at increased risk. —JACO B A N D E R S O N - M I N S H A L L

PEPTIDE POWER The latest research reveals that a new scientifically engineered peptide may be used as a long-acting HIV medication.

According to recent study results published in the medical science journal PLOS Pathogens, a newly engineered peptide shows potential to be used as a long-acting HIV treatment and prevention drug.

Peptides are smaller versions of proteins that are currently used in numerous health and cosmetic products for anti-aging, anti-inflammatory, or muscle-building properties.

Over a decade ago, scientists discovered certain peptides that occur naturally in the body are also able to fight off HIV and prevent the virus from invading cells. Since then, researchers have been working hard to engineer peptides to be used as a treatment for HIV. The newly engineered peptide is called IBP-CP24, and it has the poten48

tial to be further developed as a long-acting antiretroviral drug that can be used alone or in combination with a broad neutralizing antibody.

The research team—led by Lu Lu and Shibo Jiang of Fudan University in Shanghai, China, and Lishan Su of the University of North Carolina at Chapel Hill—discovered that IBP-CP24 exhibited a prolonged halflife as well as potent and broad antiHIV activity. A half-life of a drug is the point in time when the concentration of medication in the body reaches half of what it was when the initial dose was given. Drugs with longer half-lives remain effective longer.

Another very promising discovery was that the peptide was also effective in suppressing drug-resistant strains of HIV.

Enfuvirtide was the first antiretroviral peptide drug approved by the U.S. Food and Drug Administration (in 2003).

Unfortunately, its clinical application has been very limited due to its short half-life, and because enfuvirtideresistant HIV strains already exist.

In this new study, researchers were able to prolong the half-life of another antiretroviral peptide, CP24, by fusing it to the human Immunoglobulin G Fc-binding peptide (IBP).

The resulting IBP-CP24 proved successful in blocking a large variety of HIV strains, including those resistant to enfuvirtide. Even more importantly IBP-CP24’s half-life in the blood of rhesus monkeys was 46.1 h—approximately 26-times longer than CP24 alone, and 14-times longer than enfuvirtide. It now stays in the system long enough to be an effective treatment.

When the injectable IBP-CP24 was given to rhesus monkeys, researchers found no significant IBP-CP24-specific antibody response—which could have caused resistance to the drug. And there were no signs of toxicity in the monkeys.

Furthermore, mice that had been pretreated with IBP-CP24 were found to be protected from HIV. Cotreating mice with chronic HIV with IBP-CP24 and normal human IgG, resulted in a major decrease in their viral loads.

One more promising finding from the study was that the combination of IBP-CP24 and a broad HIV neutralizing antibody resulted in a strong antiretroviral effect against HIV. Looking ahead, this could be crucial because it might reduce the dose needed of the antibody and the peptide, potentially reducing costs of the final product.

—DESIRÉE GUERRERO

PIXABAY

to your doctor if side effects are impacting your daily life. A new study in the The Journal of Infectious Diseases shows even those with failing regimes can switch from nucleoside reverse transcriptase inhibitors (NRTIs)—a class of drugs associated with more side effects—provided they still have three alternative drugs available.

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