Plus 142 May June 2021 by Equal Pride

MAY/JUNE 2021 hivplusmag.com

BECAUSE YOU’RE MORE THAN YOUR STATUS

40 YEARS SINCE THE NEW YORK TIMES WARNED OF “RARE CANCER IN HOMOSEXUALS” A NEW U=U THEMED PORN BOTH EXCITES AND EDUCATES HOW TO SAFELY RETURN TO DATING—AND SEX

POSITIVELY POSITIVE

HOW POP STAR DIZZ TURNED AN HIV DIAGNOSIS INTO TRIUMPH

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contents

issue

142

ON THE COVER 40 DIZZ IS THE FUTURE Multitalented musician and activist Dizz is smashing stigma with his band rIVerse and bringing the conversation around HIV to a whole new generation.

FEATURES 18 THE EARLY REPORTS Revisiting the initial reports of a new "gay cancer" in the 1980s. 22 LOOKING BACK ON ACT UP Sarah Schulman's book reflects on how the radical grassroots group changed the world. 28 DEAR DIRECTOR Andrew Spieldenner is bringing positive change as the new head of MPact Global Action for Gay Men’s Health and Rights. 32 EDUCATIONAL PORN? Kayden Gray discusses his new hardcore adult film that also teaches about U=U. 39 U=U: JUST THE FACTS Learn the science behind undetectable equals untransmittable. And pass it on.

ON THE COVER & ABOVE Musician and activist Dizz photographed by Ryan MacDonald

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CONTENTS DAILY DOSE

TREATMENT

WELLNESS

WHERE WE'RE AT From injectables to patches, the 2021 CROI convention breaks down the very latest in HIV treatment and prevention.

46 BACK IN THE GAME? Tips to help stay safe and sane while navigating dating apps.

MIGHTY MERGER Four pharma companies unite to help underserved communities.

48 SEX DOC TALK Dr. Jess O'Riley gets real about your post-pandemic sex life.

TROUBLE IN TEXAS The state's budget issues could leave thousands without meds.

HISTORY ON THE GRAM An Instagram account honors many of the real lives lost to the AIDS epidemic.

INSTAG R AM (6); COU RTESY BALTIMORE AIDS WALK & M USIC FESTIVAL ( 13); COU RTESY DR . J ESS O ' RILE Y (4 8)

BUZZWORTHY 10

SALUTATIONS IN SEATTLE Art and history in the city's impressive new AIDS memorial.

PRICKLY SITUATION Halting a needle exchange program in West Virginia results in a spike in HIV cases.

NEW JERSEY JUSTICE The state makes a move to protect HIV-positive seniors.

AIDS WALK GOES VIRTUAL Baltimore revamps its annual AIDS Walk & Music Festival.

BACK TALK

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48 4/1/21 12:23 PM

chief executive officer & editorial director DIANE ANDERSON-MINSHALL

evp, group publisher & corporate sales JOE VALENTINO

editor in chief NEAL BROVERMAN

vp, branded partnerships & associate publisher STUART BROCKINGTON

EDITORIAL managing editor DESIRÉE GUERRERO editor at large TYLER CURRY senior copy editor TRUDY RING associate editor DONALD PADGETT contributing editors KHAFRE ABIF, MARK S. KING mental health editor GARY MCCLAIN staff writer MEY RUDE contributing writers JOHN-MANUEL ANDRIOTE, JOHN CASEY, CHARLES STEPHENS, JEANNIE WRAIGHT ART executive creative director RAINE BASCOS art director BEN WARD editor at large digital art CHRISTOPHER HARRITY PRINT PRODUCTION production director JOHN LEWIS production editor JACOB ANDERSON-MINSHALL PRIDE MEDIA EDITORIAL editor in chief, the advocate TRACY E. GILCHRIST digital editor in chief, advocate.com NEAL BROVERMAN editor at large, the advocate JOHN CASEY editor in chief, out DAVID ARTAVIA digital director, out.com MIKELLE STREET editor in chief, out traveler JACOB ANDERSON-MINSHALL editor in chief, pride RAFFY ERMAC deputy editor, pride TAYLOR HENDERSON digital director, pride & senior editor, advocate.com DANIEL REYNOLDS director of podcasts & special projects JEFFREY MASTERS SALES & MARKETING executive director, integrated sales EZRA ALVAREZ senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director, branded partnerships JAMIE TREDWELL creative director, branded partnerships MICHAEL LOMBARDO senior manager, branded partnerships TIM SNOW junior manager, advertising & branded partnerships DEAN FRYN coordinator, advertising & branded partnerships KEIGHTON LI DIGITAL vp, technology & development ERIC BUI digital media manager LAURA VILLELA social media manager CHRISTINE LINNELL social media editor JAVY RODRIGUEZ CIRCULATION director of circulation ARGUS GALINDO FINANCE/ACCOUNTING vp, finance BETSY SKIDMORE accounts receivable controller LORELIE YU accounting manager PAULETTE KADIMYAN ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions Fax (212) 242-8338 EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com

FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To subscribe, visit HIVPlusMag.com/signup There is a 10-copy minimum. FREE DIGITAL SUBSCRIPTIONS Plus magazine is available free to individual subscribers — a digital copy of each issue can be delivered to the privacy of your computer or reader six times per year. We require only your email address to initiate delivery. You may also share your digital copies with friends. To subscribe, visit HIVPlusMag.com/signup NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, please email our circulation department at Argus.Galindo@pridemedia.com Plus (ISSN 1522-3086) is published bimonthly by Pride Publishing Inc. Plus is a registered trademark of Pride Publishing Inc. Entire contents ©2021 by Pride Publishing Inc. All rights reserved. Printed in the U.S.A. FOLLOW US ON FACEBOOK AND TWITTER

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EDITOR’S LETTER

LU KE FONTANA

BY N E AL B ROVE R MAN

OV E R A D E C A D E ago, I had a boyfriend — let’s call him Dennis — I was head over heels for. He was handsome, funny, soulful. Sadly, we had a lot going against us — his professional life was in flux, he was in addiction recovery, I was overly eager to have a boyfriend. Another thing drove a wedge between us: his HIV-positive status. As an HIV-negative person, I was fi xated on the virus, regularly voicing anxiety over what sexual activity was risky and what wasn’t. I didn’t keep my worries to myself but often heaped them on Dennis, expecting him to assuage my fears. I didn’t think how my HIV paranoia affected Dennis; it made him feel tainted and undesirable. My ignorance, not his HIV, was our relationship’s death knell. Thoughts of Dennis sprung to mind when I recently interviewed Canadian musician Dizz, who was only diagnosed with HIV back in September (read Dizz’s cover story on page 40). When he told his partner the news, Dizz was accepted with open arms and a confirmation that HIV would not weaken their relationship in the slightest. I can’t know exactly why Dizz’s partner reacted so well, but I have to think it may have something to do with what’s changed since 2010, namely the concept of undetectable equals untransmittable, or U=U. Undetectable equals untransmittable is the scientifically proven consensus (supported by Dr. Anthony Fauci and the Centers for Disease Control and

Prevention) that people with HIV who are on treatment and have an undetectable level of the virus in their blood cannot transmit the virus to anyone, including sexual partners. As with his hair, body, and apartment, Dennis was meticulous about taking his HIV meds. Had I known about U=U, I wouldn’t have had anything to worry about. It’s hard not to think how our lives would have turned out differently if I had the tools to choose knowledge over stigma. People navigating serodiscordant relationships now — or searching for love online (read some great tips on digital dating on page 46) — are hopefully coming from a much more informed place than I was. There is still too little discussion about U=U happening, but things are changing. Adult film star Kayden Gray recently wrote and starred in a novel film, Undetectable Equals Fucking Untransmittable (page 32). Yes, there is hard-core sex, but the message of U=U is interspersed throughout the moans of pleasure. With a cameo from RuPaul’s Drag Race star Bianca Del Rio, UEFU is a perfect place to let everyone know that HIV is nothing to fear. It’s incredible to think how far we’ve come. Forty years after the first reports of a “gay cancer” began appearing in mainstream media, senior politics editor Trudy Ring spoke to some of the journalists, activists, and doctors active during that time about the scant news coverage and how homophobia may have played a part in the media’s response (page 18). Journalist Sarah Schulman painstakingly covered the ensuing years of the epidemic in her comprehensive book Let the Record Show: A Political History of ACT UP New York, 1987-1993. Jeffrey Masters, director of podcasts for Pride Media (parent company of Plus), recently sat down with Schulman to discuss her book and why women are so often left out of the HIV discussion (page 22). Then, in our Daily Dose column (page 6), editor at large John Casey wrote about the amazing AIDS Memorial on Instagram — a beautiful repository of photos and stories about people lost to AIDS complications. The online memorial forced Casey to look at his own troubled relationship with HIV and how he hid from anyone affected by the disease in the 1980s and ’90s, not only out of health fears but because of self-loathing and internalized homophobia. Reconciling with the past is one of the hardest parts of adulthood but a necessary one. I have apologized to Dennis previously for how I treated him, but I can’t say it enough: Dennis, I love you and I’m sorry. Be well,

NEAL BROVERMAN EDITOR IN CHIEF

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LIKE THEY NEVER LEFT A POWERFUL NEW INSTAGRAM ACCOUNT TRANSFORMS AIDS STATISTICS INTO THREE-DIMENSIONAL HUMAN BEINGS.

TH E R E H A S B E E N a secret and often unsaid guilt that has hung over me through my life. I am old enough to have lived through and survived the AIDS crisis of the 1980s and ’90s. I was also left unscathed, with no scars, wounds, or grief from caring for, caring about, or losing a loved one. AIDS did not come near me, and I did not go near it. I never lost a partner or lover to the dreaded disease because there was intentionally no romance. I didn’t experience the loss of a community of gay friends, because I avoided anyone who was gay, like me. There were no losses of coworkers — that I know of — from the dreaded complications related to acquired immune deficiency syndrome. Vaguely, I knew one person who died, but not intimately. I went to see him once in the hospital. I was trying to be kind. And when I arrived at his room, I walked away, frightened at the sight of his withered body. That moment in time stings indelibly. I was a coward. During that era, there were rumors about some people who disappeared. Some were said to be sick, though it was never AIDS — cancer was usually the reason. Others had relocated, moved back home to be “closer to their families.” These obfuscated explanations seem obvious now, but back then I was too naïve to understand the real reasons why some men never came back. Thus, there is guilt that someone my age was never close enough to the horror and the sadness that so, so many in our community felt during that exceedingly difficult period of time and still feel today. And the culpability I still feel for leaving the shadow of a man I once knew to suffer alone in his hospital room. Many will say, “You should feel lucky.” And there’s a part of me that agrees. Certainly, I am profoundly lucky; however, 30 years after the fact, whether it’s from the guilt or an intense desire to know as much as I can about that time, I am now learning more about the devastation of the disease on a daily, almost on a one-by-one basis. I am able to see, and hear about, some of the beautiful souls who were lost and the joyous lives they lived.

IMAG ES VIA INSTAG R AM

D A I LY D O S E

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COU RTESY OF AUTHOR (C ASE Y )

BY JOHN CASE Y

A few weeks ago, The AIDS Memorial on Instagram (Instagram.com/theaidsmemorial) showed up in my feed as suggested content. At first I wondered why it was appearing in between all the happy, lively, and quirky people I follow. Then I took a moment to read one of the posts. It was more than a simple Instagram post. More than an image with a quick caption. More than a picture accompanied by creative hashtags or with fanciful emojis. What I began to see and read were stories with real emotion, complemented by dated photographs that showed individuals in their prime, who were once happy, lively, and quirky. Some of those images are contemplative, some with bare chests, some of good-looking men, frolicking on beaches and in Speedos, but all immeasurably thought-provoking. If you are on Instagram, you need to experience this humility, particularly if you are younger, or older like me and missed what happened during that tragic time. If you are older and survived, it might be difficult to wade through the daily posts, so I’m in no position to recommend that you do. I can’t begin to imagine the scars, wounds, and loss you suffered. Granted, some of the stories can be difficult to read, written by loved ones, that genuinely

try to reflect the life of someone close to them who died of AIDS. The stories can also elicit smiles and laughs, and that’s mainly due to the uproarious lives some of the deceased lived and the way they chose to be remembered. There’s heartache for sure. But for those who want to know what life was like during that time, the posts are poignant reflections. They are also about unlimited and endless love. Through the posts, you find that there are and were boundless ways to love. The photos and heartfelt stories written by family and friends of those who were lost are illustrative of love, more than anything else. There’s the preeminent love of someone’s child. The love of someone’s life. The love of a wife or partner or fiancée or husband. There’s fraternal and maternal love for survivors’ moms, dads, stepdads, or stepmoms. There are reflections of brotherly and sisterly love. There is unknown love of nieces and nephews for uncles they never met or knew. There are also stories of love for roommates — code at the time for lovers. There’s the platonic love of lost friends, acquaintances, coworkers. Neighborly love. Protective love. First love. Enduring love. Timeless love. What I didn’t want to do when I set about to write this column was to call out one story over another, because each of them is equally and vitally important. They all matter. Each picture tells a story and captures a life at a time and a place when the departed was living, breathing, and growing. The stories talk in the most personal terms and show how that growing was violently snapped in two and then snuffed out. It all seems so avoidable now. All those lives, all those pictures, all those stories. They all should be current and continuing. I’ll continue to carry this unavoidable survivor’s guilt, for lack of a more appropriate term. But in a very modest way, I will continue to follow, and look forward to seeing the AIDS Memorial on Instagram. I’m learning a lot about humanity each day, and also about the past and the lingering memories of those still present. It’s so easy to forget the carnage of the AIDS crisis. And we shouldn’t. We should constantly be reminded of all that senseless, inexplicable loss, and all the struggle and love that still lingers to this day, even if it’s within the bounds of our buoyant Instagram accounts. I am reminded of a line from one of my favorite plays, I Never Sang for My Father, that says, “Death ends a life, but it does not end a relationship, which struggles on in the survivor’s mind toward some final resolution, some clear meaning, which it perhaps never finds.”

JOHN CASEY is editor at large for The Advocate, a sister publication to Plus. H IVPLUS MAG .CO M

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buzzworthy

MODEL MEMORIAL

NO OTHER AMERICAN CITY IS BUILDING AN HIV MONUMENT AS EXPANSIVE AND AMBITIOUS AS SEATTLE’S. BY T R U DY R I N G

A volunteer-driven effort in Seattle is presenting the history of HIV and AIDS in Washington State through a sprawling public art project, the AIDS Memorial Pathway. The pathway extends through several blocks in the Capitol Hill neighborhood and will incorporate four artworks, two of which have already been installed. It is designed to share stories about the epidemic and serve as a call to action to end HIV and AIDS as well as the associated stigma. The first installation, In This Way We Loved One Another by artist Storme Webber, was completed in December. It features photos plus incorporates text from people directly affected by AIDS, with a focus on women and people of color. It is aimed at “restoring missing narratives of working-class activists, healers, leaders, witnesses, and ancestors lost to the AIDS crisis,” according to an AMP press release. It is located in the Cathy Hillebrand Community Room inside Community Roots Housing’s Station House building. The second, We’re Already Here by the Civilization design practice, consists of three groupings of sculptures shaped like protest signs and bearing messages that evoke historic moments in the crisis, such as “Dream Big End AIDS,” “Women ACT UP,” and “Stop the Stigma.” The title comes from a quote from Seattle activist Brian Day, who was leading a demonstration to build support for an AIDS care center in the area. A Seattle Times reporter asked him about neighborhood residents who feared having people with AIDS in the area, and he replied, “We’re already here.” Installed in February, the sculptures are located in the plaza above the Capitol Hill Link light rail station and on the adjacent corner of Cal Anderson Park. 10

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COU RTESY AIDS M EMORIAL PATHWAY

FROM TOP LEFT: Installation of We’re Already Here segment of the AIDS Memorial Pathway; artist Storme Webber with her work In This Way We Loved One Another; a poem from Webber’s installation

Two other artworks are scheduled for completion this spring and summer. Christopher Paul Jordan’s andimgonnamisseverybody will be a 20-foot-tall sculpture made of silent speaker equipment that he says “exists both to celebrate the lives of those no longer with us and to galvanize ongoing action.” The speakers form an X, or a positive sign on its side. It is meant to evoke the spaces created by Black, brown, poor, trans, queer, and otherwise excluded communities to take care of our own. It will be in the Central Plaza. Ribbon of Light by Horatio HungYan Law will be a series of three human-scale illuminated sculptures along a landscaped pathway adjacent to the main trail on the north edge of Cal Anderson Park. Inspired by the words of poets affected by the AIDS pandemic, the works will represent pieces of the sky that have broken

into sculptural fragments and fallen to the ground, highlighting the changing nature of grief and providing places of mourning, reflection, and contemplation. “The AMP will bring an important part of Seattle’s history to life,” Michele Hasson, steering committee chair for the AMP, said in a press release. “With each artwork’s public installation and as we get closer to the completion of the AIDS Memorial Pathway, the anticipation is building in the community. The artists have created powerful works that showcase the moving journey of the AIDS epidemic in our region. Thousands suffered, experienced discrimination, and died during this public health crisis, but a strong community came together to create organizations and services that are still in operation today. We’re excited to share the efforts of so many that made the AMP possible.” The project has been in development since 2015, when a group of volunteers came together to plan it. It is funded by community partners, public funds, and private donations. Learn more and see additional images at TheAMP.org. H IVPLUS MAG .CO M

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buzzworthy

A SHARP PAIN

WEST VIRGINIA OFFICIALS END NEEDLE EXCHANGES AND AN ALARMING HIV SURGE FOLLOWS.

Health experts have observed a disturbing spike in new cases of HIV among injection drug users in West Virginia, and many believe the 2018 cancellation of a needle exchange program may be at least partially to blame. The outbreak clusters have been centered around Kanawha and Cabell counties, with the region rivaling New York City in new cases despite having only a fraction of the population. Experts warned the situation will only get worse unless steps are taken to counter the threat. “It is possible the current case count represents the tip of the iceberg,” Dr. Demetre Daskalakis, chief of HIV prevention at the Centers for Disease Control and Prevention, said at a Kanawha County HIV task force meeting in February. “There are likely many more undiagnosed cases in the community. We are concerned that transmission is ongoing and that the number of people with HIV will continue to increase unless urgent action is taken.” Experts like Daskalakis expressed concern that local leaders ignored studies showing needle exchange programs reduce new cases of HIV among injection drug users. The Kanawha-Charleston Health Department shut down its program in Charleston, the state’s capital and largest city, due to complaints about discarded needles, and then police ran undercover operations against 12

an activist group offering its own program. Solutions Oriented Addiction Response initially offered clean needles from organizers’ cars, then grocery store parking lots until police made them leave, forcing them to migrate services to a church parking area. “We started doing our thing about 18 months ago because we knew [the crackdown] was coming,” SOAR cofounder Sarah Stone said. Despite the success of a similar program in the nearby city of Huntington, Kanawha County officials have no plans to resurrect their own shuttered needle exchange. Sherri Young, executive director of the KanawhaCharleston Health Department, told BuzzFeed News the canceled program was “very damaging.” She referenced a city survey of police, fire, and public works personnel showing 17 percent had been stuck by a needle on the job, with more than 80 percent saying they saw no need to expand syringe exchange programs and also wanted a one-for-one exchange of needles. The numbers cited by Young have been criticized since only one-third of those asked to complete the survey did so. Rather than offering needles to injection drug users in the effort to reduce HIV transmission, Young indicated the health department will instead expand testing and use a mobile clinic to locate hard-to-reach people.

THIRDMAN/PE XELS

BY D O N A L D PA D G E T T

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GOLDEN RULE

ONE STATE BOLDLY STANDS UP FOR SENIORS LIVING WITH HIV. BY NEAL BROVERMAN N E W J E R S E Y ’ S G OV E R N O R , Democrat Phil Murphy, signed legislation

50 Slightly over

percent of Americans living with HIV in 2018 were aged 50 or older; 66 percent of those newly diagnosed in that age group became HIV-positive through male-on-male sexual contact.

in March that protects LGBTQ+ and HIV-positive seniors from discrimination in long-term care facilities. Called the LGBTQI+ Senior Bill of Rights, the legislation not only bans discrimination based on gender identity, sexual orientation, and HIV status, it mandates training on those subjects for long-term care staff. It goes even further, banning misgendering of trans patients, allowing use of restrooms that comport with users’ gender identity, and lifting restrictions on who can share sleeping quarters. Studies conducted by the AARP and Services & Advocacy for LGBT Elders (SAGE) cite high levels of anxiety among LGBTQ+ people over possible discrimination at assisted-living facilities and nursing homes. The concern is easily explained — one study from SAGE and the Equal Rights Center found nearly half of same-sex couples applying for senior housing experienced some form of bias. “Through our work, we know LGBTQ older adults are at greater risk for social isolation, health issues, and poverty, and often have concerns about living in a long-term care facility,” Christian Fuscarino of Garden State Equality said in a statement.

THE CHARM CITY FINDS A WAY WORKING AROUND COVID-19, BALTIMORE’S AIDS WALK & MUSIC FESTIVAL REVAMPS THE ANNUAL FUNDRAISING EVENT WHILE HIGHLIGHTING HIV HISTORY.

SH UT TERSTOCK (SENIOR); COU RTESY BALTIMORE AIDS WALK & M USIC FESTIVAL ( WALKERS)

BY D E S I R É E G U E R R E R O

They say necessity is the mother of invention — and perhaps nothing has brought this point home more so than the ongoing global COVID pandemic. But as we begin to crawl out of the shadows and figure out new ways to move forward safely into the world, we’re seeing inspiring examples of human resilience and resourcefulness. One such example is the recent revamping of Baltimore’s AIDS Walk & Music Festival. The annual fundraiser is back on for 2021 and has creatively reinvented itself for a post-pandemic world. Presented by Gilead, the Baltimore AIDS Walk & Music Festival is a fundraising event benefiting Chase Brexton Health Care, a nonprofit health organization, and its community partners. Chase Brexton was founded in 1978 as a gay men’s health clinic and since grown into one of the area’s largest HIV services orgs, now seeing over 40,000 patients annually. The theme for this year’s AIDS Walk & Music Festival is “Pledge to End HIV/Working Together = Power to Stop It,” which asks supporters and participants “to fight for patients until HIV and AIDS is no longer. Every generation has the power to stop HIV. We can make this happen together.” Funds raised from this year’s event “will help strengthen and expand HIV and AIDS education, testing, prevention, and treatment programs,” according to the official website. The event

is anticipated to draw over 500 participants and has a goal of raising $165,000 to support local community partners with HIV and AIDS programming. As of press time the event had already raised over $100,000, so it’s likely it will exceed this goal. Proceeds raised directly by Chase Brexton Health Care will support the delivery of HIV medication to patients’ homes. In order to keep things fun yet safe, organizers have created several routes for participants to walk, run, or bike along, alone or in small socially distanced groups. Organizers have even created a tour route that covers sites steeped in Baltimore HIV history, including gay health clinics that date back to the 1970s. In addition, this year’s celebration event and musical performances will be virtual only, airing live on YouTube June 6 at 5 p.m. (The video link will be shared on the website the day before the event, or simply search for “Baltimore AIDS Walk” on YouTube that day.) Eze Jackson, Wendel Patrick, and Jasmine Pope will be performing. (BaltimoreAIDSWalk.org) H IVPLUS MAG .CO M

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A ZOOM TO REMEMBER THIS YEAR’S CONFERENCE ON RETROVIRUSES AND OPPORTUNISTIC INFECTIONS WAS VIRTUAL AGAIN, BUT IT DIDN’T LACK FOR HUGE NEWS ON HIV TREATMENT, PREVENTION, AND A CURE. BY NEAL BROVERMAN P O T E N T I A L H I V C U R E S and the advent

of long-acting HIV treatment, delivered via subcutaneous injection, slow-release patch, or even a pill, were among the biggest findings revealed at this year’s virtual Conference on Retroviruses and Opportunistic Infections. In a Facebook Live video, Drs. Hillary Hoffman and Carl Dieffenbach from the National Institutes of Health described CROI’s big takeaways. Dieffenbach started with the event’s plenary discussion, which centered on upcoming prevention options, especially for women. In addition to Truvada (the first drug approved as PrEP) and vaginal rings serving as successful HIV prevention tools for women, long-acting cabotegravir delivered via injectables was seen as similarly effective in recent studies. The positive prevention outcomes were mostly the result of increased adherence with injections of cabotegravir, which is being studied as a prevention option. Cabotegravir was recently approved by the Food and Drug Administration in combination with rilpivirine (sold as ViiV Healthcare’s Cabenuva) for the treatment of HIV. Depending on potency and scientific advances, injections of cabotegravir could be effective for a month, two months, six months, or even a year, freeing people with HIV — and those hoping to remain HIV-negative — from having to take a daily pill. Dieffenba ch c a l le d c ab ot eg r av i r ’s prevention power “incredibly effective,” and noted that adherence was good throughout the study. He also cited a study of about 4,500 participants; of those taking Truvada, 38 indiv iduals became HI V-positive, compared with 12 given cabotegravir. Hoffman and Dieffenbach also discussed the COVID-19 pandemic and how research on that disease might yield advances for HIV. “Can [COVID] antibodies be used in HIV prevention?” Dieffenbach asked. “Can we get to a long-acting antibody that could either be used independent of a medication for the treatment or prevention of [HIV]?” An antibody “cocktail” administered either as a pill or injectable could “allow people to live their truths of U=U [undetectable equals untransmittable] but not have to take a pill a day,” Dieffenbach said. “And I think that

is the ultimate goal of where we want to go with therapy in the next few years.” Dieffenbach also shared that he was impressed with lenacapavir, Gilead Sciences’ potential HIV inhibitor, calling it “pretty amazing.” Injected under the skin and effective for six months, the drug is aimed at reducing viral loads of HIV-positive people suffering from drug resistance. “It’s really exciting and gratifying to see something coming forward that was so strong and so safe for that population that could also be an anchor for prevention and other treatment,” Dieffenbach said. “We are not done in the drug discovery and development space in HIV; there’s always room for improvement. We’re getting to a point where treatment is accessible and easy for all. Some people just can’t take a pill a day. We need to meet their needs.” Hoffman took a question from an online participant who asked why the new injectables require a visit to a clinic or doctor’s office. Dieffenbach said we’re still a ways off from offering injectable treatment or prevention that’s available for selfadministration at home, like insulin, but he noted that even the required clinic visits are a step up from a daily medication. At this year’s CROI, more data was also presented on the IMPAACT 2010 study, which focused on pregnant women with HIV. Dolutegravir — previously seen as risky for pregnant women in preventing perinatal HIV transmission — was shown to be safe and effective, including when paired with tenofovir alafenamide (F/TAF). The combination was shown as especially beneficial to controlling outsize weight gain (or loss) among expectant mothers with HIV. “There were also some really interesting talks in the cure space...that give glimmers of hope,” Dieffenbach added. “We’re beginning to really understand the dynamics of the [HIV] reservoir in different ways.” The doctor expressed hope at research into elite controllers — people with HIV whose viral loads remain low even without the aid of antiretrovirals — and the increasing research into “how their [HIV] reservoirs look different than those who are virally suppressed [through medication].” Thanks to the pandemic, March’s CROI was the second virtual iteration of the event. Hoffman and Dieffenbach expressed uncer tainty about 2022’s conference occurring in person, while CROI cochair Sharon L. Hillier said, “We look forward to a time when we can gather in person again and do real live networking.”

ARTEM PODREZ /PE XELS

t r e at m e n t

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T R E AT M E N T

THE INTEGRATION OF FOUR MAJOR PHARMACY COMPANIES PROVIDES EXPANDED SERVICES FOR UNDERSERVED PEOPLE LIVING WITH HIV.

National HIV-focused pharmacy services BY DESIRÉE GUERRERO organization Avita has merged with three other major pharmacy companies and will move forward with an increased concentration on assisting underserved communities. Avita (officially, Longs Pharmacy Solutions/Avita Pharmacy) completed its union with Paramount Specialty Pharmacy, PharmBlue, and PharMedQuest in March, resulting in an entity with a “unified focus on vital 340B pharmacy services,” according to an Avita news release. Avita has been a longtime supporter of Section 340B programs — run under a provision of the Public Health Service Act that requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for uninsured and low-income patients. With 60 locations throughout the country, Avita is also the largest independent nationwide provider of pharmacy services for Ryan White HIV/AIDS Program grantees, AIDS service organizations, and federally qualified health centers. In a statement to the press, company officials said the merger will give Avita an even greater ability to “ensure access to critical medications 16

for underserved communities and for patients with complex conditions, including HIV.” In addition to helping folks living with HIV receive treatment and care, Avita has been a leader in providing access to PrEP and other LGBTQrelated health care services. It also offers personalized and confidential med delivery, 24/7 pharmacist access, financial assistance, and ongoing patient outreach programs, among many other services. “I am so proud that we built our brand around our core values, which celebrate our commitment to compassionate care for our patients, our covered entity partners, and for each other,” Avita CEO Lorrie Carr said in the press release. “At Avita, we share a sense of community and we treat and respect our patients as individuals because we believe everyone should have the care they need, delivered with the compassion they deserve.” In celebration of the merger, Avita unveiled a new logo of interlocking hearts, which the company says represents a “shared sense of community and commitment to delivering compassionate care. Under one company, Avita is building its culture based on a vision to unlock the full potential of health. Avita’s mission is to provide individually focused pharmacy services, support, and advocacy for patients and partners.”

SH UT TERSTOCK

A MERGER FOR THE PEOPLE

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t r e at m e n t

TEXAS TURMOIL

SH UT TERSTOCK

TENSIONS MOUNT WITH THOUSANDS LIVING WITH HIV IN PERIL OF LOSING ACCESS TO THEIR MEDS.

While Texas state of ficials struggle to replenish an enormous budget deficit worsened by the pandemic, the health of thousands of people living with HIV hangs in the balance. The state-run HIV Medication Program is buckling under increased, pandemic-related demand, and administrators there asked the legislature for more than $100 million over the next two years to help combat the looming financial crisis, according to a report by Houston Public Media. Texas already has some of the strictest requirements in the country for such programs, and if the additional funds are denied it could tighten eligibility and force thousands off their meds and reduce HIV prevention efforts throughout the state. With supplies of drugs for PrEP and treatment for people living with HIV at risk, a denial in funding could also fuel a spread of HIV. Though the Texas Department of State Health Services claimed that limiting eligibility “was already under consideration before budgetary shortfalls were identified,” demand for the program has escalated heavily due to job losses during the pandemic. Enrollment in the state-funded HIV program has recently increased by approximately 30 percent, to more than 21,000 people. “People who are losing their jobs, they may have gone to a private doctor or had insurance,” Januari Fox, policy director at PRISM Health of North Texas, told Houston Public Media. “They no longer have that and they’re looking for alternatives.”

Fortunately, the DSHS was able to temporarily pause enrollment cuts in February and asked state lawmakers to allocate $103 million from the funds it gets from the federal government to keep the program going through 2023. The request is heavily dependent on the new stimulus package signed into law by President Biden in March. The requested funds would be in addition to the $34 million in pandemic relief awarded to the program for 2021. However, as of December, the program had already begun to end coverage for some enrollees — and has received harsh criticism from HIV activists for doing so. “It really caught folks off guard,” Fox said. “Agencies are now forced to scramble. Where do these folks go now? How are they being informed? The last thing that we want as providers is for people to not be compliant with their medications.” Houston Public Media also spoke with several people living with HIV who were on the program, bringing to light the dark reality of what could be. “It’s just astronomical,” said Josh Mica, who is currently on treatment and undetectable thanks to the assistance program. “Like, who can afford $1,500 to $2,000 a month for medication?” “If I go six months without my medication,” he added, “there’s no telling that the medication I was on previously will work. It decreases my health. [I’ll] end up in the hospital with no insurance. So my body will just deteriorate because the government is trying to play politics with my life.”— D G H IVPLUS MAG .CO M

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The early ‘80s summer scene on Fire Island, New York, just as news of a mysterious new disease began to surface

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40 Years Later

“Rare Cancer” Article Was Prelude to a Pandemic The summer of 1981 saw the first media reports about mysterious diseases in gay men. What did they get right — and wrong?

J IM PEPPLER /G E T T Y IMAG ES

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rare diseases that were killing gay and bisexual men. No one could know then that the events heralded a global pandemic, but fear was there in the early days — fear both of disease and of the stigma it would bring to an already marginalized population. The story that made the biggest impression, although it wasn’t the first, was in The New York Times, considered the “paper of record” in the U.S. “Rare Cancer Seen in 41 Homosexuals,” the headline read in the article by Lawrence K. Altman, published July 3, 1981, on page 20 of the front section. That rare cancer was Kaposi’s sarcoma, usually seen in people over 50, but these cases were in younger men, many of them under 40. They were sexually active gay and bi men, although the paper didn’t use the term “gay” at the time. The men often reported having multiple partners and using recreational drugs to enhance their sexual pleasure. And they were dying quickly — eight of them within 24 months of their KS diagnosis. The same day Altman’s article came out, the Centers for Disease Control and Prevention published coverage of the outbreak in one of its newsletters, Morbidity and Mortality Weekly Report. A month earlier, the CDC 20

newsletter had carried a story about another rare disease, pneumocystis pneumonia, or PCP, seen in five gay men in Los Angeles. The Los Angeles Times also reported on the pneumonia cases. And in May the New York Native, a paper geared to the gay community, had run what’s recognized as the first article on what came to be known as AIDS, with its medical columnist, physician Larry Mass, reporting on the PCP cases. The coverage was largely cautious. A CDC spokesman quoted by Altman downplayed the possibility of contagion, as the KS outbreak had been confined to gay men. A doctor with the New York City Department of Health told Mass that PCP wasn’t all that rare; a new and deadlier strain could be emerging, but no one knew. The L.A. Times story had a quote from Dr. Wayne Shandera of the CDC, though, that was sure to stoke fears of both disease and stigma: “The best we can say is that somehow the pneumonia appears to be related to gay life style.” Reactions in the gay community were all over the map. “I think we were really terrified, especially at first,” says Charles Kaiser, a New York City-based journalist, author, and activist. There were some who foresaw a pandemic, along with some who took comfort in the fact

NY T/G E T T Y IMAG ES

FORTY YEARS AGO this summer, the first news emerged about

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JOE STOUTER (K AISER)

OPPOSITE: AIDS activist and gay rights advocate Larry Kramer, cofounder of ACT UP and the Gay Men’s Health Crisis RIGHT: Charles Kaiser, New York City-based journalist, author, and activist

drug companies, that the illnesses seemed and more. K ramer ’s t o be c onc ent rat ed confrontational style in men w ith a large was legendary and earned number of partners. And him some enemies, but it some definitely worried Charles Kaiser got public attention and led that, at a time when gay sex to breakthroughs in treatment was still criminalized in many and prevention. “Mostly, what states and when few states or cities Larry Kramer did was definitely on the banned antigay discrimination, reports of right track,” Mass says. a new disease found mostly in gay men could Mass likewise doesn’t think much of the lead to further oppression, even quarantine early Times reporting on AIDS or LGBTQ+ concentration camps. issues in general, saying the paper in that era Mass recalls being both “very concerned “was hostile still to gays” and “very inadequate and very cautious.” As a doctor and journalist, in its coverage.” Kaiser, however, describes he didn’t want to jump to conclusions about himself as a “dissenter to the conventional the disease, but he understood the fears wisdom that the Times did a bad job.” Altman, about the illness itself and the possibility he says, was and is “an extremely serious, that it could increase stigma. “This was a conscientious, and not homophobic reporter.” potentially dangerous situation,” he says. As Both the media and gay activists were worried the story of the new disease developed, he about creating a panic, Kaiser adds. continued covering it, striving to be accurate Altman, a now-retired physician and but not alarmist, he notes. occasional Times contributor, says he simply Soon medical exper ts grouped the focused on science in his reporting, and the outbreaks under the umbrella of a syndrome science surrounding AIDS developed quickly they first called gay-related immune and furiously. Scientists had long expected deficiency, but switched to the more neutral another pandemic like the 1918 influenza acquired immune deficiency syndrome, or outbreak, but “I don’t know that anyone AIDS, once it became clear the disease wasn’t could have predicted AIDS per se,” he says. confined to gay and bi men. Under either And in the 1980s, the U.S. had a conservative name, it was a deterioration of the body’s president, Ronald Reagan, whose response immune system that caused vulnerability to to AIDS — largely ignoring it — was as a variety of deadly infections. It wasn’t until problematic in its own way as Donald Trump’s 1984 that a recently discovered virus — the spreading of misinformation during the human immunodeficiency virus, or HIV — COVID-19 crisis. “The stupidity and bigotry would be identified as the cause of AIDS. and small-mindedness of the government Until the news about HIV, there were cannot be overstated,” Mass says. alternative theories about what caused AIDS; With 20/20 hindsight, it’s clear the press the predominant one in the gay community, could have sounded a louder alarm, Kaiser Mass says, was that multiple factors were notes. But no one could have predicted in involved — a large number of sexual partners, 1981 that AIDS complications would take the drug use, poverty. But that didn’t really make lives of nearly 700,000 Americans and more sense for other groups, he notes. than 30 million people worldwide. To Mass, the greatest thinker of the To Mass, the greatest heroes of the AIDS AIDS epidemic is writer Larry Kramer, one story are Kramer and those who joined him of the men who joined Mass in founding in demanding action. “The gay community’s Gay Men’s Health Crisis in 1982. Kramer response to the AIDS epidemic under Larry believed the new disease was likely due Kramer was as glorious and heroic as to an infectious agent and “was the sort anything in American history,” he says. of Cassandra voice in saying this is really, “There are things we all could have done really serious,” Mass says. better,” he adds, “but in the end things had Kramer, who died last year, was highly to be done on the front lines. … There was a critical of The New York Times’ coverage of lot of heroism, a lot of good things done by a the epidemic, as he was of the response by lot of good people.” mainstream media in general, government, H IVPLUS MAG .CO M

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ACT UP protest at the headquarters of the Food and Drug Administration on October 11, 1988

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The accomplishments of

ACT UP are staggering. Over the course of six years, from 1987 to 1993, the direct-action HIV organization designed a fast-track system where those who were sick could access unapproved experimental drugs, ran a four-year campaign to force the Centers for Disease Control and Prevention to change its definition of those at risk for AIDS to include women, made needle exchange legal in New York City, started Housing Works, a service for homeless people with HIV that exists to this day, ended insurance exclusion for people with AIDS, reconceptualized what effective HIV treatment looks like, and in the process redefined how the world thought about people living with HIV and the larger LGBTQ+ community. But how did ACT UP do it? Let the Record Show: A Political History of ACT UP New York, 1987-1993, the new book by queer historian Sarah Schulman, explores just that. Drawing from 188 interviews with surviving ACT UP members, Let the Record Show is an utterly crucial guidebook for effective activism. In the book, I was struck by how massive and complex of an organization ACT UP was. Is it a common misunderstanding that the group was just a small group of people?

The whole history of AIDS and AIDS activism has been narrowed and whitewashed down to a handful of individuals. So this is the first really accurate history. One of the great successes of the movement is that it was so flexible. It didn’t work on consensus. There was simultaneity of response. And it was a real coalition. What it really is, is little silos of groups of like-minded people working together on things that really matter to them in an effective way. And those different groups standing side by side and trading in and out and supporting each other’s projects. That was the open structure, the radical democracy of ACT UP. You write that 500-800 people would show up to the Monday meetings and the biggest action drew about 7,000 people.

Yes, but that’s actually quite small when you think about it, because mass movements or very effective movements have hundreds of thousands of people, but this was really more like a vanguard movement.

Most of what was accomplished was not accomplished in the meeting itself. It was accomplished in these small groups called affinity groups that had 10 to 20 people who would meet separately from the Monday night meetings and would plan actions. So the Monday night meeting was just a gathering of all of these different functional entities that were doing their own projects at the same time. Was there an approval process for affinity groups who wanted to execute an action?

Affinity groups were not accountable to the Monday night meeting; they would plan often illegal or civil disobedience actions to support larger actions that the group was officially organizing, but they worked privately. And the larger group did provide legal support for them. But there was no consensus in ACT UP. The only point of 24

MARK PE TERSON/G E T T Y IMAG ES

How did you ever get anything accomplished in a meeting with 500-800 people?

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A crowd of ACT UP activists march in front of St. Patrick’s Cathedral during the 25th anniversary celebration of the Stonewall uprising

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ACT UP stages a die-in on 5th Avenue during a Pride parade

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unity was direct action to end the AIDS crisis, that’s it. So that meant you couldn’t be doing social service provision, for example; it had to be direct action, and it had to be to end the AIDS crisis. If you were doing those two things, you could really do anything. The group did not have to all agree. For example, if you wanted to do a needle exchange on the Lower East Side to provoke an arrest for a test case, and if I thought that was a terrible idea, I wouldn’t try to stop you from doing it. I just wouldn’t do it. If instead I wanted to interrupt Mass at St. Patrick’s Cathedral, and you were against that, you just wouldn’t go. Was it understood by all members that there wouldn’t be consensus on everything?

No, because ACT UP never theorized itself. So it just evolved that way, without any sort of discussion. There was very little theory in ACT UP. And as Maxine Wolfe said, “Theory emerges from action.” So if you put action first, then you have to make decisions about how to do your action. And that’s where your values come to surface. But if you’re debating theory before you act, you’ll end up in very polarized positions, and you won’t have anything on the table.

DRE W STE VENS (SCH U LMAN); MACMILL AN PU B LISH ERS (BOOK )

Larry Kramer was seen externally as the sole creator and leader of ACT UP. You write he was influential but not in charge.

take them to the photo editors at Time magazine or U.S. News & World Report or whatever. And she would be bringing in these photos and they’d say, “No, we want people with AIDS. We want people who are emaciated, covered with [Kaposi’s sarcoma lesions], lying in bed.” And she would say, “These are people with AIDS.” And finally, after ACT UP disrupted Mass at St. Patrick’s Cathedral in 1989, they turned around and they started wanting activist photos. But it’s really about the individual who’s up against the institution. Having that conversation with the person in power, sometimes jeopardizing their own ability to earn a living, and it helps people change their minds. Let The Record Show comes out May 18. The full interview with Sarah Schulman is available on the LGBTQ&A podcast, through Apple Podcasts or Spotify.

I interviewed 188 surviving members of ACT UP, and not one person considered Larry Kramer to be the leader of ACT UP. ACT UP in its time was represented inaccurately in the media. Because when we go back to the ’80s, we have to remember that media, government, and private corporate life were all controlled by white males. And gay men among those white males were closeted. It’s nothing like it is now. So the white male media would come to ACT UP, and they would only see white men, they would interview white men, they would use photographs of white men. Other people were there doing things, but it wouldn’t be covered. And this was debated openly. I had a public conversation with Larry Kramer at OutWrite, which was the gay and lesbian writers’ conference, in 1990. And I said, “Well, Larry, what about the next time the media calls you? Why don’t you pass them on to a woman or person of color in ACT UP?” And he said, “But Sarah, shouldn’t we use our best people?” So there was this kind of sifting going on. And it’s only when you look at ACT UP’s own media that you actually see a more accurate representation. Media during this time liked to portray people with AIDS as male-only and in hospital beds. Women were nly seen as caretakers, not people on the front lines or who could also get AIDS.

That’s a complete distortion. That’s a sexist distortion. My interviews show that there was no gender differential in terms of who was a caretaker in ACT UP. Men and women were both caretakers and activists. Donna Binder is a very important person in this whole story. And I’m happy to introduce her to history. She was a photographerjournalist who was photographing ACT UP. In those days, you’d go home to your darkroom, develop the photos, and you’d physically H IVPLUS MAG .CO M

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Andrew Spieldenner, the new executive director of MPact Global Action for Gay Men’s Health and Rights, has as many ideas as he does challenges. BY NEAL BROVERMAN or someone as accomplished as Andrew Spieldenner, Ph.D., it’s refreshing how candid and down-to-earth he remains. The current communications professor at California State University, San Marcos, and new executive director of MPact Global Action for Gay Men’s Health and Rights — the Oakland, Calif.-based organization that focuses on the needs of gay and bisexual men living with HIV — spoke to Plus on his first day on the job. “People are trying to hide that they’re still sexually active,” Spieldenner says, referencing the complications of sex during COVID. “I don’t think people should hide it, but I know why they do; there’s a lot of public shaming. We ought to create our sexual bubbles however we can. For us to pretend we don’t have sexual needs, that’s also a problem.… I do think we need to be more open about our sexual needs and be able to negotiate them.” Spieldenner is taking the reins of MPact at a time when the coronavirus continues to upend life, especially for people living with HIV. It’s not only the risks inherent in having sex when COVID vaccinations have not reached everyone in the country, and certainly not everyone globally, but also the interruption of in-person doctor’s visits and, for some people with HIV, disruptions in their regimens. 28

But Spieldenner, who currently serves as vice-chair of the United States People Living With HIV Caucus and as a North American delegate to the UNAIDS Program Coordinating Board, views the upcoming challenges with resolve rather than anxiety. “One of the things we learned in COVID was how communities take care of each other; how do we manage to communicate without being face-to-face,” he says. “Those lessons [we learned] around how to still build community and still thrive in these spaces as well as what we learned about who was the most marginalized and vulnerable. It’s exciting because we can take those lessons forward.” In particular, Spieldenner says, “One of the lessons with HIV for us as queer people is to really understand what risk we’re comfortable with. As queer people, we’re actually better adapted to COVID because we’ve already managed risk. As gay men we manage risk all the time. Will this trick beat me up? Will I get HIV? Will I get syphilis? We already have the skills to survive a pandemic. We did, and we’re doing it. We’re flexible; we adapt.” It’s helpful for people to give credit to themselves for how much they’ve endured this past year and a half, Spieldenner says. Not many people in January 2020 would have been able to wrap their heads around the fact that we’d have to socially isolate for over a year and that all our routines would be completely altered. “There are so many dimensions of our relationships that have changed, including to the clinic,” Spieldenner says. “Many of us haven’t seen our doctor in a year, physically. Getting back into the practice of going in, getting your PrEP, your meds, all of it will be adapted to whatever happens next. I know there’s concern, particularly around PrEP. As a person with HIV, I feel it; I get tired of getting my pills.” Part of Spieldenner’s new position leading MPact will be harnessing the incredible energy invested in fighting

COU RTESY M PACT

Deep Impact

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C AITLYN GAU R ANO

COVID and redirecting some of it to HIV, a pandemic that’s been around for at least 40 years and still lacks a vaccine or cure. “There is a larger investment in COVID and the vaccine, which was fast-tracked,” Spieldenner says. “That’s partially about who’s impacted. HIV clearly impacts certain populations more. Last year, we saw most new diagnoses globally were gay and bisexual men, people of trans experience, sex workers, people who use drugs. The machine works the way it was meant to.” Though MPact is based in California, much of its advocacy focuses on gay and bisexual men outside the U.S., with the organization working to end impediments to HIV and STI prevention and treatment, especially in nations hostile to men who have sex with men. “We’re dealing with a lot of issues globally,” he said. “The uneven impacts of [COVID and HIV] and uneven distribution of the COVID vaccine during a time of uprisings happening all over the world for many issues, whether it’s social justice or uprisings against fascist states. It’s an extraordinarily frightening time but also an exciting time.” Spieldenner’s first weeks will center on research and data collection; then he’ll go to MPact’s board of directors to advise where he wants to focus the organization’s efforts and funding. He envisions expanding the group’s global reach — with the awareness that international travel will be complicated for the foreseeable future — and its grassroots efforts. “I’d like every politically active person living with HIV, and gay and bisexual men especially, who wants to build community [to know] that MPact is the place they find in three clicks,” Spieldenner says. “We can provide them resources, help them build a community group, help them raise awareness and build advocacy. I want to increase our communications so people know who we are and that they want to be part of our community.” The board has already expressed confidence in the choice of Spieldenner to move MPact through the next decade. “Andy is an inspiring and energetic leader. His passion for elevating the voice

of the global LGBTI community and his intersectional approach to public health policy has earned Andy the esteem of advocates around the world,” MPact board chair Don Baxter said in a statement. “The board and staff are excited to work with Andy as our new executive director and confident that MPact will be well positioned under his guidance to thrive in the years to come.” Aside from the COVID crisis eventually coming to an end, Spieldenner finds other reasons for optimism. He sees opportunities to spread the message of undetectable equals untransmittable (U=U), the finding that a person with HIV who maintains his or her medication regimen and has an undetectable viral load cannot transmit the virus to another person. “When we see messaging like U=U, the structures that keep people undetectable need to be upheld,” he said. “They don’t work right now. They don’t work for people who are trans, they don’t work for people who are sex workers, don’t work for people who use drugs, and they don’t work very well with mental health issues, they don’t work well for people who are homeless.” The answer, he says is getting doctors and institutions “to embrace the U=U message. We still see a slow uptake in clinicians giving sex-positive messages. Our own HIV service organizations don’t give sex-positive messages, not for people with HIV.” Then there’s the advent of long-term injectable treatments for those living with HIV, swapping the necessity of daily pills for shots that are effective for 30 or 60 days. Spieldenner sees benefits with not just convenience and adherence but also mental health. “For those of us who are comfortable with [needles], it will take away a lot of the everyday reminder [of living with HIV],” Spieldenner says. “It will present a different kind of culture change in our community. Every technology advance has created a culture change, and I think injectables will too. I organize my day around my meds; I have to take them with meals, which meal, this and that. I’ve had HIV for 25 years, and not having to organize my day like that will be huge.” H IVPLUS MAG .CO M

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LET’S TALK ABOUT

SEX

(During Sex)

A new adult film seamlessly incorporates sex-positive messaging about U=U. BY NEAL BROVERMAN

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dialogue and storylines aren’t usually memorable, but Undetectable Equals Fucking Untransmittable isn’t your average adult film. Written, starring, and conceived by British adult star Kayden Gray, UEFU is a hybrid public service announcement and gay romantic dramedy that just happens to feature full-on gay sex. Gray released the two-part movie in February on his JustForFans page for free, with the intention of educating as many as possible on U=U, the concept that people with HIV who maintain an undetectable viral load by taking antiretroviral therapy cannot sexually transmit the virus to others. The movie follows Gray — basically playing himself — hooking up with a newly out man, played by fellow adult film star Bishop Black. The movie’s first half, subtitled “Dirty?,” mostly follows the porn playbook for the first two-thirds; two guys text on Grindr, meet at Gray’s apartment,

Kayden Gray (right) and Bishop Black view a U=U video by RuPaul’s Drag Race winner Bianca Del Rio in their new film

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and get down to business. After the, um, climax, the story gets more complicated once the men discover a condom slipped off Gray. Repeating a question he asked during texting, Black’s character inquires if his lover is “clean,” something that clearly irritates Gray, who is HIV-positive in the film and in real life. After Gray discloses his status, Black grows panicky and accusatory, angrily asking why Gray didn’t announce he was HIV-positive earlier. “There’s nothing to tell. Because it’s fine, you’re safe,” Gray’s character says, struggling to keep his cool. When Black’s character asks if he has AIDS, Gray’s character responds, “No, no. I’m undetectable.” Menacing internal voices hissing homophobic statements about HIV bounce around the head of Black’s character, who promptly storms out of the apartment. It isn’t until Black is on a lonely London street that an email from Impulse Group — a real-life organization Gray is affiliated with that aims to help gay men make informed health decisions — changes

his perception. RuPaul’s Drag Race winner Bianca Del Rio, who just happens to emblazon Black’s T-shirt, appears in an explainer video that pops up on Black’s phone, hilariously yet accurately describing the realities of U=U. Black’s character returns to Gray’s apartment, and a touching conversation occurs about HIV stigma and disclosure as well as the pressures gay and bi men face during dating and hooking up. “[UEFU] is based on many, many situations I’ve experienced and people I know,” Gray says. “One thing that is unusual about this scenario is that I have a bad-ass drag queen who has my back, appearing out of nowhere as a notification. What are the odds, right?” In real life, not very good, Gray acknowledges, but, “That’s a fantasy I’ve always dreamt of; someone could explain it to this person, who I didn’t maybe have the courage to tell. It’s not usually a broken condom that makes me talk about [U=U], but I eventually want to talk about it. I wouldn’t necessarily think it was appropriate or have the time or courage to say it in advance, so eventually, I wanted to make things right. I don’t really think I owe this to anyone, but I try to educate people.” The post-sex discussion in UEFU also includes Gray’s character explaining how the word “clean” is triggering for people with HIV. If someone without HIV is clean, what does that make someone with the virus? “The only logical antonym to clean is ‘dirty,’” Gray says. “A lot of people have an image of what good means and clean means. We use those words to say, ‘I’m not a whore. I’m not having that much sex, so I wouldn’t have HIV.’ We operate with these very basic, stock images, not through any fault of our own, because we haven’t been educated to do otherwise…. In your formative years, you absorb information very well; then when you’re an adult, with the fear and stigma that prevails around HIV, you’re resistant to alternative information. There’s a lot of shaming around sex. It’s been going on forever. I think we like this clear idea of what someone is and we use HIV status to make a judgment on who that person is.” UEFU’s second “episode” is a happy epilogue, where Black’s character has released his ignorance and lustily embraces a sexual escapade with Gray’s character. After the encounter, the men are shown comfortable and happy, able to revel in their satisfaction in a way they were denied previously because of shame and fear; it’s more romcom ending than the nonverbal heaving and heavy breathing that usually close out most adult movies. Produced by erotic filmmaking company altShift and made in conjunction with Jose Ramos of Impulse Group, UEFU is a passion project of Gray's, who learned about U=U not long after his HIV diagnosis eight years ago. H IVPLUS MAG .CO M

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UEFU could be a blueprint for future films that combine messaging with sex. It’s easy to imagine adult films that seamlessly incorporate conversations on consent, chem hookups, sex work, and sexual racism. “Mainstream porn can be really good, but we all have learned behaviors from it. I suppose you can argue it’s the responsibility of the consumer to know better, that it’s a fantasy, but to be honest, how many people do know better when they watch porn at a young age?” Gray asks. Gray, buoyed by his first foray into screenwriting and producing, has plans to film more PSAs about U=U and PrEP, which would appear before any of his condomless sex scenes. A matter-of-fact realist, Gray knows his hardcore work will always receive more attention than any informational messages he puts out to the world. With UEFU, he may have found the perfect recipe for delivering some of his life lessons to the public. “Even if you do an interview about a porn, it’s never going to get as much traction, interest, or demand as the porn itself,” Gray says. “I discovered when I started working as an activist, working for Impulse, there’s no comparison between the interest porn gets and the activism I’ve done…. The only way to dive into that is to put it into porn.” Find UEFU at Kayden Gray’s JustforFans page or on Twitter (@KaydenGrayXXX).

A sex scene from the adult PSA Undetectable Equals Fucking Untransmittable

COU RTESY K AYDEN G R AY ( THIS PAG E); JOE MCCORNICK (PRE VIOUS SPRE AD)

“Cut to 2017, I came out about my status and that was a very pivotal moment and I finally started processing and healing from my diagnosis,” Gray says. “I ended up at an Impulse summit in 2018 and someone from New York, from Impulse, suggested we do a porn together. I started thinking about how that would go but it was an exciting idea and then sometime later, I ended up writing it myself, along with the collaboration and support of Impulse and Jose Ramos.” Gray lauds Del Rio’s participation, saying the high-profile drag queen refused payment for their participation. Black was initially going to play a role only in the film’s second episode, but his role was changed and expanded after a different adult film actor booked for the first half dropped out four days before the shoot. While speaking about your HIV diagnosis or being part of any HIV-themed project carries risks even for gay porn performers like Gray — who was blocked from working with some studios after coming out about his HIV status — it’s even more complicated for crossover performers like Black, who appears in both queer and straight adult films. Awareness of U=U is “not in a good state in the straight porn industry — they still treat it as a gay plague,” Gray says of HIV, adding that his costar Black “has it harder because of that [ignorance] from the straight industry.” MAY / J U N E 202 1

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Important Facts About U=U By Jacob Anderson-Minshall

JOE MCCORNICK

Undetectable equals untransmittable is the scientifically proven consensus supported by the Centers for Disease Control and Prevention that people with HIV who are undetectable cannot transmit the virus to someone else. Let’s break that down in five points: • Undetectable refers to people living with HIV who are on antiretroviral treatments that are keeping their viral load so low that it is not detectable in a blood test. • What does reaching and staying in this undetectable range take? For most poz folks, it simply requires getting on and staying on antiretroviral treatment, which suppresses the virus to undetectable levels. • You must get regular blood tests to verify that your viral load remains undetectable (and change medications if the amount of HIV in your blood creeps back up). • Study after study shows that when HIV cannot be detected in the blood, it also cannot be transmitted to someone else through blood, semen, or other bodily fluids (which is how the virus is transmitted). • As the CDC spells out, those who are undetectable have “effectively no risk of sexually transmitting HIV to HIV-negative partners.” The agency is now promoting this truth: “undetectable is prevention.” Being undetectable prevents the spread of HIV.

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Full Disclosure Canadian musician DIZZ beautifully demonstrates how to change an HIV diagnosis from personal breakdown to public breakthrough. BY NEAL BROVERMAN + PHOTOGRAPHY BY RYAN MACDONALD

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pop/R&B star Dizz walked out of a Canadian health clinic in September, after finding out he was HIV-positive, he was consumed with dark thoughts, imagining himself as “dirty,” “worthless,” and “complete and utter scumof-the-earth trash.” Less than five months later, the Toronto resident and member of the overtly queer music group rIVerse (pictured here) came out about his diagnosis in a YouTube video and spoke of his recently discovered wells of strength, saying, “I feel like I love myself more than I did before.” Dizz’s journey over the past year is familiar to many people newly diagnosed with HIV. As he describes it in both his conversation with Plus and in his coming-out video, his test result was a “blessing” because it made him take a hard look at his life and decide what’s important and worth devoting headspace to. Like most people who have a life-changing health diagnosis, he has good days and bad, but for Dizz, there are more of the former. “My own resilience coupled with the love and strength and compassion that I found 42

within my circle really allowed me to get to this place and tell my story,” Dizz said on his YouTube channel (rIVerseLive), which counts over 550,000 subscribers. Dizz’s HIV diagnosis happened as the pandemic was still raging unabated, without a vaccine in sight. For his band, that time also brought an abrupt halt to its upward trajectory. Consisting of Dizz, Monroe, Khadija, and Zak, rIVerse has built a steady following in Canada and beyond since the members met almost a decade ago after appearing in a stage production of High School Musical. The group has brought its infectious sound to Pride festivals across Canada, to South Korea for a 2018 tour, and directly to fans through two albums, including its recently released second album, Poison IV. A live performance of the album’s K-pop-inf luenced single, “BaeBeeBoo,” has racked up over 300,000 YouTube views as of March. Dizz says his self-esteem took a hit with the abrupt cancellation of rIVerse’s live shows and appearances in 2020, leading him to self-destructive behavior. Those behaviors were long his coping methods, especially as a teen, when he came out at 14

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and nearly his entire family disowned him. Dizz recalls his father saying, “I knew [he] was never mine.” “Despite the sadness and emptiness I feel over [the abandonment] — especially being in a band where the majority of my bandmates are very close to their family — it is something that motivates me,” Dizz says. “I hope that through my success with the group, one day I’ll be able to bring my family back together.” A former dancer for pop star Hilary Duff, Dizz recalls how his estranged family reached out after images of him were plastered on billboards across Canada. “If the band becomes successful and they want to reach out, I would love to use that to somehow bring my family back together,” he says. “If that’s what it’s going to take, I’ll be that g u y. My f a m i l y is phenomenal. I can’t blame them for falling prey to these stories that we as Black people have been taught since we were babies. I have to be understanding of their journey and what they w er e t a u g ht or brainwashed into believing and allow there to be space for reconciliation, because we deserve it. We all deserve family.” How Dizz ’s disclosure about his diagnosis will affect his relat ion ship with his family is unknown. But any potential negatives connected to coming out about his status was outweighed by the singer’s increasing desire for honesty and transparency. In his “I have HIV” video, Dizz says that before his diagnosis his attention was veering too much

toward keeping up appearances. He doesn’t want to go back there. “The discussion of my HIV status, there was a duality to it. It was easy in the sense that I’ve grown to be the type of person who values truth tremendously,” Dizz says. “It’s very important to me to live in my truth and to just be around authenticity. I can’t mess with anything other than that because it just doesn’t feel right in my soul.” Then there is the hard part, which is shedding the lifetime of preconceived notions he had about his sexuality and HIV. “Just knowing the world in a lot of different ways, there’s still a lot of stigma [about HIV] and people don’t understand it fully, despite the advancements,” Dizz says. “People don’t really know what we heard in the past.

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There’s a lot of fear about how I was going to be perceived. It wasn’t easy, but I’m very fortunate to have a loving and supportive group of people around me — not just my bandmates but my partner [and] a lot of chosen family I’ve been blessed to have.” Dizz’s experiences immediately after his diagnosis highlight the importance of quickly surrounding yourself with positive people who love and support you. He credits his partner with giving him a lot of the strength he’s developed since then. “‘I’m absolutely not going to leave you,’” Dizz recalls his partner telling him. “He embraced me and said, ‘You’re beautiful and nothing has changed. We’re going to go through this together.’ That was the first piece of healing I received.” Next he reached out to a longtime friend who had been living with HIV for years. “The first thing he told me was, ‘I want you to know whatever you’re telling yourself in your head, throw it out. Any fear, any stories, throw them out. You’re going to be fine. What we need to do is get you a doctor and get you on medication.’ By the next morning I had obtained a new family doctor and my medication the next day.” Now, less than a year after his diagnosis, Dizz is diving headfirst into advocacy, speaking out against stigma and for the importance of loving yourself. Serendipitously, Dizz’s new mission fits in perfectly with rIVerse’s. The band’s goal is “to use their music and their mission to bring true representation to the music industry,” as the members note in an online statement. With all four members of the band being queer and with their mix of races and body shapes, the bandmates quickly decided to center their diversity. On rIVerse’s YouTube channel and social media pages, fans regularly share stories of how the band has inspired them. “Seeing how many people see themselves in each member of rIVerse — full-figured women, LGBTQ+ people, people of color — is incredible,” Dizz says. “So many different types of people, backgrounds, cultures, [and] genders message us and let us know, ‘I’ve never seen myself represented or seen anyone who looks like me or seen a similar background like me. You’re giving me the strength and courage to follow my own dreams, because if you can do it, I can do it.’ That was really the goal.” With his embrace of his HIV status and a possible end to the pandemic in sight, Dizz and the rest of rIVerse see brighter days ahead. With most live venues still closed, though, the band is busy prepping for a live online concert on May 29. “We’re going to keep doing what we do in terms of creating content and bringing joy to our fans’ faces while we’re still in this place,” Dizz says. 44

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LOVE IS IN THE AIR (AND ON YOUR PHONE) WITH WARMER WEATHER AND THE EMERGENCE OF COVID VACCINES, MANY ARE JUMPING BACK INTO ONLINE DATING. HERE IS HOW TO ACTUALLY ENJOY THE PROCESS. BY GA RY M CC L A I N I S P E N D A lot of time talking with my

clients about relationships. Specifically, people to date, with the goal of finding that one special person. And, of course, online dating comes up. My clients have experienced the broad spectrum of outcomes with cyberdating. Some have met the person of their dreams through the magic of the internet. But there are also those who have struck out repeatedly, to the point that they have given up on finding love and companionship in cyberspace, if not in life. Through their experiences, I have learned quite a bit about online dating. Here are some suggestions to help you have fun with the process and let it play out organically and in as stress-free a way as possible: Be honest in your profile description. Write a description of yourself that you feel encapsulates who you are and why you are looking to date. Use your

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WILLIAM FORTU NATO/PE XELS (OPPOSITE ); MA XIMILIAN IMAG ING (MCCL AIN)

wellness

own language. You don’t have to emphasize your shortcomings, but also don’t present yourself, for example, as a glib hipster when you aren’t. Post some candid shots that show you at your best, living the truth of your life. Feature shots of you doing something you enjoy or on a vacation. Avoid shots that you might use for a business bio or those that have been digitally manipulated. Showing the real you will help you avoid having potential dates feel like they got the bait and switch. Present yourself in the best but also the most realistic light. If you have a chronic condition, disclosing your diagnosis is up to you. If you feel better about including your chronic condition in your profile so that you don’t have to bring it up later, that’s up to you. On the other hand, your chronic condition doesn’t define you. You are a whole lot of qualities, interests, and experiences beyond your medical diagnosis. Some of my clients who are HIV-negative want that to be clear in their profile and want to limit their contacts to others who are also HIV-negative. While I find this to be an outdated attitude and one that potentially prevents them from meeting some great people, it’s their decision. On the other hand, I have HIV-positive clients who include their status in their profiles to get the disclosure thing out of the way, or they may even seek out HIV-positive dates on the sites and apps they choose to use. And I have others who choose to keep their HIV status to themselves, with the intention of disclosure if and when that first meeting leads to a deeper connection. I’ll leave you with the operative word: choice. At some point, hopefully, your dating efforts in cyberspace are going to result in a few connections. When that happens, you are faced with the first steps of courtship. Don’t get caught up in endless texting. It’s all too easy to fall into a routine where you and the person you met through the app start to develop a nice messaging relationship. The danger here is that you may create a persona that is not actually who you are. And the person you are texting or emailing may be doing the same. Encourage meeting up sooner rather than later. If they are hesitant or keep canceling, this tells you a lot. Consider a phone call before you meet. I know we live in the age of texting, but you can learn a lot about someone by hearing their voice. You may find that talking to them makes you even more eager to meet, or you may find the opposite. Coffee dates (or park dates) are a low risk and low-cost meeting option. Meeting in a café for that first meeting has worked well

for my clients. And no, I don’t own stock in Starbucks. However, with many coffee shops open only for takeout during the pandemic, a meetup at a public park is a good alternative. Even better if there’s a coffee kiosk nearby! Remember to make it fun. Not only your first date, but the whole process of online dating. Focusing on the fun factor will help you to not only make this process more enjoyable but also to have a positive perspective on the dates that don’t work out. Keep the stakes low. Don’t make online dating all about finding that right person to spend your life with. Online dating is a way to meet people. That’s all. What happens after that is totally unpredictable and can’t be forced. Avoid placing a deadline for when you need to be in a relationship. This will help you to avoid putting unrealistic expectations on your online dating as well as the people you meet. Don’t take anything personally. It bears emphasizing that chemistry is unpredictable. If the chemistry simply isn’t there, recognize it as such and move on. This is supposed to be fun, right? A caution. Many people on online dating sites or apps think they want to be in a relationship, but they don’t really want to be in a relationship. They aren’t willing to step out of their comfort zone and take the risk to actually meet people to date. Or they just have a lot of baggage that they need to deal with before they try to get in a relationship, and they haven’t admitted that to themselves yet. Be prepared to meet a lot of people who seem to be OK with occasional or even regular communication but can’t quite commit to meeting. Be aware of when it’s time to move on. If someone puts up a wall, that doesn’t mean you need to be banging your head against it. Here’s what I advise my clients: Stay connected with your friendship network. People to date will come and go until you meet that right person, but your friends are always there for you. Having a strong emotional support system helps you to keep your perspective and maintain your objectivity as you meet people in cyberspace. Sure, having a significant other brings additional quality to your life — but that person doesn’t give you a life. And being immersed in your life makes you that much more attractive out there in the dating world. The right person for you is out there. In my opinion, there are numerous people out there with whom you could have a satisfying relationship. So swipe away and see what happens next. Keep it fun, real, and sane.

Mental health editor GARY MCCLAIN, PH.D. is a therapist, patient advocate, and author in New York City who specializes in working with individuals diagnosed with chronic and catastrophic medical conditions JustGotDiagnosed.com H IVPLUS MAG .CO M

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B A C K TA L K

BY N E AL B ROVE R MAN

BRINGING SEX(Y) BACK

DR. JESS O’REILLY OFFERS TIPS FOR HOW PEOPLE LIVING WITH HIV CAN SAFELY RESUME THEIR SEX LIVES AS THE COVID-19 PANDEMIC WINDS DOWN.

Once someone living with HIV is vaccinated for COVID, can they feel safe engaging in sex with people they haven’t been quarantined with? Do they still need to steer clear of places like bars, nightclubs, and bathhouses?

The [Centers for Disease Control and Prevention] notes that you are not fully vaccinated until two weeks after your final dose and you should still take steps to protect yourself (e.g. wearing masks, physical distancing, avoiding group gatherings). It’s important to note that none of the vaccines offer 100 percent protection. We can anticipate that they will continue to update these guidelines as more people are vaccinated and they learn more about the potential of transmission post-vaccine. Of course, some people will opt to have sex, as the risk of COVID transmission is greatly reduced once fully vaccinated. The guidelines for gatherings vary from jurisdiction to jurisdiction, so you’ll want to check your local restrictions. How can some HIV-positive people who may have been unable to maintain their drug regimen during quarantine ensure their viral loads are still undetectable?

Spea k to your hea lth care practitioner about options for viral load testing and discuss your options for restarting your meds. Your local Walgreens pharmacist 48

has specialized training in HIV care, so you can stop in and ask to speak to them privately or chat with them online 24/7 (Walgreens.com/rx-utility/pharmacychat). For those who’ve abstained from sex during the COVID pandemic, do you have advice on how to return to their sexual lives in a healthy manner?

You might start by considering your current sexual values: 1. Why do you want to have sex? 2. What appeals to you about sex — physically, emotionally, relationally, practically? 3. What hesitations do you have when it comes to sex? 4. What tends to turn you on as of late? 5. What turns you off ? 6. How do you want to feel before, during, and after sex? 7. What do you want from a sexual partner? 8. What do you want to offer to a sexual partner? 9. What have you fantasized about lately? 10. What makes sex fulfilling for you? Reflecting upon your own sexual values can help you to better understand your own needs — and communicate them to your partner(s). You might also want to spend some time engaging in solo sex — not just for maintenance but to mindfully explore your body. Try taking your time and avoiding orgasm for a few extra minutes to tune in to the sensations in your body. The more connected you are with your body, the more open you may be connecting with others. Plan for safer sex. This might involve condoms, testing, lube, other barrier methods, as well as testing your viral load. If you have a partner, discuss safer sex in advance.

COU RTESY J ESS O’ REILLY

A LOT OF people call themselves “sexperts,” but Dr. Jess O’Reilly is the real deal. With best-selling books, a Ph.D. in human sexuality, and doctoral research focused on sexual health and HIV education training for teachers, O’Reilly is well-versed in all things pleasure. Between her speaking gigs and television appearances, O’Reilly took time to speak with Plus about how people living with HIV can reawaken their sex lives if they’ve been lying low for the past year.

@SexWithDrJess

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Callen-Lorde provides affirming and supportive healthcare to LGBTQ+ communities and people living with HIV/AIDS, regardless of ability to pay. We are proudly welcoming patients at our new Brooklyn location for in-person and virtual care! Learn more at callen-lorde.org/brooklyn

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TWO WAYS TREATMENT CAN HELP STOP HIV.

Starting HIV treatment as soon as possible and sticking with it every day helps you get to and stay undetectable. That means there is so little virus in the blood that a test can’t measure it. And that’s a good thing, because:

BEING UNDETECTABLE HELPS STOP THE DAMAGE HIV CAUSES.

CURRENT RESEARCH SHOWS GETTING TO AND STAYING UNDETECTABLE PREVENTS THE SPREAD OF HIV THROUGH SEX.

There’s no cure for HIV, but if you stick with treatment, you can protect yourself and the people you care about. Talk to a healthcare provider and watch It’s Called Treatment as Prevention at YouTube.com/HelpStopTheVirus

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