Real Health Spring 2018

YOUR GUIDE TO BLACK WELLNESS

Can Discount Cards for Prescriptions Really Save You Money?

Artificial Intelligence and Our Health Care System

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Not Even Multiple Illnesses Could Stop The Voice Singer

Janice Freeman

The Unique Ways That HIV Affects Women Common Human Foods Harmful to Pets

Pretty Flowers You Can Eat

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CONTENTS

this month on REALHEALTHMAG.COM Drama Off the Court

After tennis superstar Serena Williams gave birth to her daughter, she suffered major health complications that almost took her life.

Health Basics A—Z

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(COVER) COURTESY OF NBC/PAUL DRINKWATER; (WILLIAMS) LEONARD ZHUKOVSKY/SHUTTERSTOCK.COM; (PINNACE) MICHAEL HALLIDAY; (ROBOT, PILLS, FLOWERS, FEMALE REPRODUCTIVE SYSTEM AND BOY) ISTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY)

Findings show that Black women with a common form of permanent alopecia are at a higher risk of developing painful uterine fibroids.

Depression in Black Youth Compared with folks of other backgrounds and ages, AfricanAmerican teens are more likely to show signs of the blues in a number of unique ways.

Digital Real Health

Read Real Health magazine online exactly as it appears in print. Go to realhealthmag.com/ digital to view the current issue and the entire Smart + Strong digital library.

editor’s letter

18 COVER STORY

a winning tale

Sports and head injuries

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nutrition

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sex

blossom basics

Edible flowers may boost the taste, appearance and nutritional value of meals and beverages.

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fear of the dark

Findings suggest that women who use inky hair dyes may face a higher risk of breast cancer.

Food cravings by gender; foods toxic to pets; protein powders

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facts of life

HIV affects women differently than men.

fitness

How to rev up your routine; cycling can help kids with ADHD

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Janice Freeman lives with multiple chronic illnesses but doesn’t let any of them limit her life.

buzz

High-tech medicine; merging antibodies to target HIV; drugresistant HIV; prescription discount cards; psoriasis problems; hep C meds for prisoners; stick out your tongue; controlling chronic disease; measuring health risks

Want to lose weight, exercise smart, eat right, find good health care, sleep better or just get healthy? For tips, click on “Health Basics A–Z” on the realhealthmag.com home page.

Hair Loss and Fibroids

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Are your meds causing vaginal dryness?; Ask Dr. Dee tackles sibling rivalry

thoughts

Can too much togetherness ruin your relationship?

Real Health Question of the Month

What have you learned about the effects of HIV on women that surprises you?

Wow! I was totally amazed and shocked by how vulnerable the female anatomy is when under attack by the virus and also unaware that it’s easier for women, as compared with men, to acquire HIV. —Jeanette L. Pinnace, Real Health contributor

reach out & click!

At realhealthmag.com, you can read more articles; access exclusive, online-only special reports; and subscribe ($9.97 for four quarterly issues; or call 212.242.2163). Plus, sign up for the Real Health email newsletter to get the latest news on issues relating to Black health!

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JOMY, stroke survivor.

THIS IS WHAT HIGH BLOOD PRESSURE LOOKS LIKE. You might not see or feel its symptoms, but the results – a heart attack or stroke – are far from invisible or silent.

If you’ve come off your treatment plan, get back on it, or talk with your doctor to create a new exercise, diet and medication plan that works better for you.

Go to

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LowerYourHBP.org before it’s too late.

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EDITOR’S LETTER

Defensive Maneuvers

S

hortly after I learned that the New England Patriots and the Philadelphia Eagles were to face off in Super Bowl LII, I found an illustration depicting “Death” as a skeleton while doing some research online.

Death stands at the edge of a football field littered with bodies, holding a pigskin against the ground with one bony hand.

The image accompanied an old story published in The New Yorker about football and the sport’s capacity for injuring players.

The caption labeled Death as “The Twelfth Player in Every Football Game.”

The illustration’s morbid message may reflect a concern about findings showing that some hits sustained by football players can, in the long term, contribute to mortal injuries. A small but key study that examined the brains of a group of professional and nonprofessional football players found that a majority of them showed signs of a brain disease called chronic encephalopathy (CTE), which scientists have noted in some high school players.

Researchers published these results in the Journal of the American Medical Association. But additional findings about the condition and its link to sports-related head trauma have also been published in other authoritative scientific journals and support a reason to worry.

EDITOR-IN-CHIEF

Kate Ferguson-Watson MANAGING EDITOR

Jennifer Morton DEPUTY EDITOR

Trenton Straube COPY CHIEF

Joe Mejía

EDITORIAL ASSISTANT

Alicia Green

ART DIRECTOR

Mark Robinson ART PRODUCTION MANAGER

Michael Halliday ADVISORY BOARD

Goulda Downer, PhD, RD, CNS; Lovell Harris, MD; Dorothy Horton, PsyD; Jeanette L. Pinnace, DPM; Lee SaintMartin, MS, IIPA, CN, ND; Yuan Wan; Terrie M. Williams FEEDBACK

Real Health, 212 West 35th Street, 8th Floor, New York, NY 10001, or email info@realhealthmag.com

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JOAN LOBIS BROWN

Issue No. 52. Copyright © 2018 CDM Publishing LLC. All rights reserved.

No part of this publication may be reproduced, stored in any retrieval system or transmitted, in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. Smart + Strong® and Real HealthTM are trademarks of CDM Publishing, LLC.

According to reports, for the past few years, there’s been a marked decline in high school kids’ participation in football.

Although the causes of the downturn are unconfirmed, many believe that worries about head injuries voiced by the medical community contributed to the slump. If the trend continues, some wonder how this might affect the pool of talent from which professional football selects its most promising young players.

The evidence of degenerative disease found in the brains of significant numbers of athletes involved in rock-’em-sock-’em sports prompted folks like Jeff Miller, the National Football League’s top health and safety official, to affirm a link between football-related concussions and CTE. Those who want to preserve the game—whether for revenue or recreation— suggest that sports leagues and programs follow the lead of the Pop Warner football program, the country’s largest youth football organization, and focus on safety for players in comprehensive ways. (Pop Warner bans kickoffs, punts and head-on blocking and prescribes more training for coaches.)

According to sports injury statistics from the Johns Hopkins Health Library, more than 3.5 million children ages 14 and younger get hurt annually playing sports or participating in recreational activities. The highest rates of injury occur in sports that involve contact and collisions, and most injuries in organized sports occur during practice.

The stats also show that football consistently accounts for the largest number of catastrophic injuries as compared with other high school sports. Surely, this fact, combined with the tragic life-changing effects of such injuries, should stay on the brains of school officials, parents and folks in the NFL.

Kate Ferguson-Watson, Editor-in-Chief katef@realhealthmag.com

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BUZZ

High-Tech Medicine

Artificial intelligence can improve medical care, but can the health care industry guard against machines that may one day outsmart us?

ISTOCK

Future shock: The doctor may be a machine!

IT’S BEEN ALMOST 50 YEARS SINCE COMPUTERS BEGAN BEING WIDELY USED as an administrative tool in health care, but it’s only relatively recently that their artificial intelligence (AI) has been applied to patient care. How might this affect medical assistance for individuals?

Computer scientist Zeeshan Syed, PhD, the director of the clinical inference and algorithms program at Stanford Health Care defines artificial intelligence as, basically, getting computers to behave in smart ways by programming existing data into their systems. Ideally, AI could use this information to predict, prevent and treat disease. Innovative efforts to perfect these AI functions could help resolve current problems in medicine and help individuals reap huge benefits for better health and medical care overall.

“Algorithms and artificial intelligence are making it possible for doctors to rapidly apply relevant medical literature to their patients’ cases, while ‘natural language processing’ (that is, talking to computers) holds the promise of liberating them from keyboards during office visits,” writes cardiologist Eric Topol, MD, a professor of molecular medicine at The Scripps Research Institute, in an article for The Wall Street Journal.

Topol, a thought leader in individualized medicine, believes that AI will play an important role in keeping people healthy and out of hospitals. He sees a future in which sensors hooked up to smartphones and other wireless devices will allow people to track their vital signs and collect and transfer information to their doctors. This would permit physicians to diagnose and treat rapid-onset illnesses, injuries or chronic diseases that require constant monitoring.

In order to render computers capable of making such diagnoses, scientists employ a type of AI called “deep learning” that trains computers to evaluate information from medical records, sensors, images and language and make recommendations based on those evaluations. Experts believe artificial intelligence will enable machines to deliver more accurate disease diagnoses and develop better, more effective treatment plans for patients.

But some view the future of AI in digital medicine—and elsewhere—with fear. A key goal in the evolution of artificial intelligence is the development of programs that can resolve complex issues without human input. The ability of AI to think for itself in this manner is called “the singularity,” the point when machines become smarter than humans. This situation worries British physicist Stephen Hawking and other experts on the technology.

Prime among the many causes for alarm is that AI could create a new, more dominant form of life that threatens humans. Artificial intelligence could become “extremely good at accomplishing its goals, and if those goals aren’t aligned with ours, we’re in trouble,” Hawking says.

To address possible problems ASAP, seven high-tech companies—Microsoft, Amazon, Apple, IBM, Google, DeepMind and Facebook—teamed up to form an oversight organization called the Partnership on AI to Benefit People and Society. Their stated goal is to promote ethical and technical standards for the development of artificial intelligence and to minimize any potential adverse consequences of the technology.

In medicine, poor decisions can lead to patients dying. This is why some experts say that human and artificial intelligence must be merged in a mindful and balanced way.

—Kate Ferguson-Watson realhealthmag.com

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BUZZ

Troubling Mutations When the virus fights back

Scientists merge three antibodies that target almost all strains of HIV. LATER THIS YEAR, RESEARCHERS PLAN to start clinical trials to test a combination drug consisting of three antibodies that may work to prevent or treat HIV in humans.

The idea for this study flowered after investigators previously isolated three individual HIV antibodies, each of which neutralizes many strains of HIV in people. Scientists combined these substances into one entity that they tested on 24 monkeys injected with SHIV, a simian version of the virus.

Results from the findings, published in the medical journal Science, showed that the triple-threat antibody neutralized 99 percent of HIV strains among primates given the new drug.

Researchers tested a number of single antibodies to determine which ones performed most effectively together.

They called the most powerful grouping of three a “trispecific” antibody because each part of the combo latches onto a different location on the virus.

Antibodies that the body produces to help fight infection prompted scientists to take a harder look at these sub-

stances as a way to destroy HIV. Combinations of antibodies that each bind to a distinct site on HIV may work better to overcome the defenses of the virus in the effort to achieve effective antibody-based treatment and prevention, explains Anthony Fauci, MD, the director of the National Institutes of Allergy and Infectious Disease.

The trispecific antibody would work to stimulate the immune system to quickly create these antibodies when the body is exposed to HIV. According to reports, scientists also propose a separate study to test the combination antibody on people currently living with the virus. Other researchers say the trispecific antibodies may also qualify for use beyond HIV prevention and treatment as therapy for autoimmune diseases and cancers.

Gary Nabel, MD, PhD, one of the study’s authors, says that as potential HIV killers these antibodies “are more potent and have greater breadth than any single naturally occurring antibody that’s been discovered.”

—Kate Ferguson-Watson

THE PERCENTAGE OF INDIVIDUALS NEWLY DIAGNOSED WITH HIV WHO TEST POSITIVE FOR A STRAIN OF THE VIRUS THAT’S RESISTANT TO DRUGS Source: Centers for Disease Control and Prevention

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Hybrid Hope

In 2017, the World Health Organization (WHO) issued a report showing that in six of 11 countries surveyed in Africa, Asia and Latin America, more than 10 percent of people starting treatment for HIV suffered from drug-resistant HIV. Drug resistance refers to the ability of a pathogen to continue multiplying in the presence of medications that ordinarily would defeat this disease-causing agent. Despite many breakthroughs in HIV antiretroviral (ARV) medications, drug resistance persists as an obstacle to effective management of the virus. This is because the virus replicates rapidly and imperfectly, generating many mutations, some of which are able to block the ARVs that target HIV. Most individuals who develop resistance to ARVs do so because they are unable to adhere to treatment—whether because of an inability to access medications regularly or because of side effects— which increases the likelihood of drug-resistant mutations.

This negatively affects not only individuals but people everywhere because those with resistance will see their health decline. What’s more, they may transmit drug-resistant strains of HIV to others.

Therefore, WHO recommends that countries keep a close watch on their treatment programs and shift to alternative first-line ARV regimens when more than 10 percent of folks on ARV therapy develop a resistant strain of the virus.

The agency believes that early HIV treatment and undergoing drug-resistance testing can help abate this problem, which is also key to achieving the global target of ending AIDS as an epidemic by 2030.

—Joe Mejía

BUZZ

Superficial Appearances Sometimes psoriasis goes beyond the skin’s surface.

Compare and Contrast What’s the deal with cost savings cards for prescriptions?

YOU CAN FIND PRESCRIPTION DISCOUNT cards at drugstores and at doctors’ offices, in your mailbox, in magazines and even online. Convenient? Sure. But can they deliver meaningful savings on meds prescribed by your doctor?

“At the pharmacy level, these cards are treated just as prescription insurance is treated,” explains Todd Pendergraft, DPh, a pharmacist in Broken Arrow, Oklahoma.

How much individuals save on a medication with a prescription discount card depends on a number of variables, Pendergraft says. Chief among these factors is the cash price each drugstore charges for a specific medication, which can vary drastically because each pharmacy sets its own prices.

Still, cards may save consumers a few dollars, especially if folks shop around. Online price check tools and apps associated with discount cards can help to find the expected cost of medicines. (Note: Drug prices are always subject to change and may differ based on available pharmacy inventory.) This also allows shoppers with insurance to see whether a discount card might save them more money on prescription drugs.

But Pendergraft also urges folks to consider several issues prior to using these cards: Discount card companies might sell your personal information, there may be connected fees and some may require that you purchase a membership to receive the card.

—Kate Ferguson-Watson

Psoriasis is an autoimmune disease that affects nearly 7.5 million Americans. The illness commonly causes raised red patches to appear on areas of the skin, especially the elbows, knees or scalp. But psoriasis can cause more than just skin problems.

According to the National Psoriasis Foundation, people who suffer from the condition face a higher risk of developing other serious health illnesses. Nearly 30 percent of these folks will also be diagnosed with psoriatic arthritis, a condition that results in joint pain, stiffness and swelling.

Both psoriasis and psoriatic arthritis are linked to cardiovascular disease, diabetes and depression, among many other ailments.

What’s more, recent findings published in the Journal of Investigative Dermatology reported that individuals living with these chronic diseases experience a threefold risk for serious liver damage.

But there’s a way to reduce complications from psoriasis: Ask your doc to prescribe steroidal or anti-inflammatory medication.

—Alicia Green

THE PERCENTAGE OF U.S. ADULTS WHO DID NOT TAKE THEIR MEDICATION AS PRESCRIBED IN ORDER TO SAVE MONEY Source: National Health Interview Survey, National Center for Health Statistics

A Corrections Issue

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Newer hep C meds may give more prisoners access to the cure.

Previously released direct-acting antivirals (DAAs) shown to cure hepatitis C were too expensive for state prisons to purchase, especially without the price discounts available to federal prisons and some other government agencies.

But now, activists are excited about lower costs for two newer DAA regimens for hep C: Mavyret (glecaprevir/pibrentasvir), which costs $26,400 for eight weeks, and Vosevi (sofosbuvir/velpatasvir/ voxilaprevir), which costs $74,760 for 12 weeks.

Compare this with existing therapies that cost as

much as $94,500 for a full course of treatment for the viral liver infection, which affects one in three of the 2.2 million individuals currently imprisoned in U.S. jails.

Findings published in the journal Health Affairs revealed that less than 1,000 of the more than 106,000 inmates in state prisons diagnosed with hep C as of January 2015 were receiving treatment. To get access to expensive DAAs currently available, inmates in several states filed lawsuits.

Many hope that the newer, less expensive therapies will help to correct the problem.

—KFW

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BUZZ

Reminder: You Control Your Health

Measuring Health Risks WHAT TO CONSIDER BEFORE TAKING A GENETIC TEST AT HOME

Many chronic diseases and conditions are preventable.

Say Aah!

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Now, look in the mirror.

THERE’S A REASON DOCTORS ASK folks to stick out their tongue during office visits. That’s because this body part can reveal a lot about your health.

According to doctors, a healthy tongue should be pink and covered with small nodules, called papillae, and feel perfectly fine with no aches and pains. But when that’s not the case and this fleshy, muscular, hardworking organ is coated with a white film or spots, appears otherwise discolored (yikes!), or is sore or dotted with painful bumps for two weeks or more, it’s time to book an appointment with your health care provider.

Sometimes, the tongue is grooved with vertical fissures that resemble cracks on its surface. Researchers believe fissured tongues might result from underlying conditions, such as malnutrition or infection (the condition also affects about 80 percent of people with Down syndrome), so if your tongue is criscrossed with grooves, get that checked out.

Otherwise, practice prevention: Study your tongue each day when it’s teeth brushing time, experts suggest.

—Kate Ferguson-Watson

In the United States, chronic diseases and conditions such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis are among the most common, costly and preventable of all health problems.

This is because simple behavioral modifications can stave off these illnesses.

Yes, you read right. The causes for many of these health issues, such as lack of physical activity, poor nutrition, tobacco use and drinking too much alcohol, along with the suffering and early death that often accompany them, are yours to control.

According to the Centers for Disease Control and Prevention (CDC), it’s key that we rethink our approach to health care.

Screening at-risk populations can detect problems early and help individuals better manage existing diseases and their related complications.

Effective screening, says the CDC, requires eliminating health care disparities with coordinated strategies targeting people of all ages.

—KFW

THE PERCENTAGE OF TOTAL MEDICAL CARE SPENDING IN THE UNITED STATES THAT’S FOR INDIVIDUALS SUFFERING FROM MORE THAN ONE CHRONIC CONDITION Source: Agency for Healthcare Research and Quality

Last spring, the Food and Drug Administration (FDA) allowed 23andMe, a private biotechnology company based in Mountain View, California, to market genetic health risk (GHR) tests for 10 diseases or conditions directly to consumers for the first time.

The agency noted that this would enable individuals to access information about their genetic risks for certain illnesses, including Alzheimer’s and Parkinson’s diseases, but counseled caution. “It is important that people understand that genetic risk is just one piece of the bigger puzzle,” says Jeffrey Shuren, MD, the director of the agency’s Center for Devices and Radiological Health.

“It does not mean they will or won’t ultimately develop a disease.”

Typically, direct-to-consumer (DTC) genetic tests analyze DNA from a sample of an individual’s saliva or blood or from a cheek swab that’s been sent to a lab.

According to the Federal Trade Commission, prices of these tests can range from less than $100 to a few thousand dollars. But because diseases are caused by complex interactions in the body, results shouldn’t be used to diagnose a condition or determine decisions about treatment.

Furthermore, users should consult a health care professional if they have questions or concerns about test outcomes, the FDA advises.

The agency recently relaxed its regulation of DTC genetic tests and now requires only a one-time review in order to ensure that screenings meet FDA requirements. After that, companies may enter the market with new GHR tests without further review, says Scott Gottlieb, the agency’s commissioner.

—KFW

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FITNESS

Ride On! How cycling can help schoolkids struggling with ADHD

Break through that rut!

OK, SO YOU’RE CONSISTENT WITH YOUR WORKOUT PROGRAM. THEN WHY DOES your body look pretty much like it did when you first started? The answer: “Maybe you’ve been doing the same workouts for a while but now aren’t getting as many benefits from them,” says Kelly James-Enger, an American Council of Exercise–certified personal trainer at TOPS Club Inc., a nonprofit network of weight-loss support groups and wellness education organizations in the United States and Canada.

James-Enger suggests you walk, run or bike as fast as you can for one or two minutes after you warm up and then recover for the same amount of time before resuming a blistering pace. Training this way forces your body to work harder than usual and burns more calories.

In addition, you can diversify workouts: Make sessions short and intense, vary the number of days you exercise each week, opt for outdoor activities or work up a sweat in the privacy of your home.

—Kate Ferguson-Watson

THE NUMBER OF CHILDREN AGES 4 TO 17 DIAGNOSED WITH ADHD, ACCORDING TO THE MOST RECENT REPORT ON THE DISORDER Source: Centers for Disease Control and Prevention and the Health Resources and Services Administration

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Rev Up Your Routine

Several years ago, scientists chose to study the effects of cycling on 47 kids ages 11 to 14 with attention deficit/ hyperactivity disorder (ADHD), a brain disorder that makes it hard for individuals to pay attention and control impulsive behaviors. Their findings showed positive effects on the children’s brain activity, attention span and mood as well as improvements to fitness and body mass index—a ratio of height to weight— after the youngsters began biking.

The results triggered the launch of a nonprofit group called Specialized Foundation, which created Riding for Focus. Now, the organization helps institutions implement the cycling program as a tool for middle schoolers—with and without ADHD—to use to improve academic skills and social, emotional and physical well-being.

According to Kim Price, PhD, a neuroscientist and director of research and school programs at the foundation, “You can see benefits on things like cognition, mood and attention after just a single 20-minute bout of activity.”

—KFW

NUTRITION Don’t Feed the Animals GRUB WE EAT CAN BE TOXIC TO PETS.

Gendered Tastes

Food cravings in men versus women IN A POPULATION SURVEY OF ALMOST 15,000 MEN AND WOMEN THAT TRACKED food-borne diseases and sex-based differences in food consumption published in the journal Clinical Infectious Diseases, researchers note that a higher proportion of men reported eating meat, certain types of poultry, runny eggs, pink hamburger and raw oysters. In comparison, a higher number of women ate fruits and alfalfa sprouts. In addition, study results have shown that people perceive specific foods as being either masculine or feminine.

Other findings showed that males and females ate different types of nourishment for comfort. Males mostly reached for steaks, casseroles and soups, while females chose to snack on chocolate, candy and ice cream. The takeaway is that gender—as well as expectations of what men and women should eat— may play a big role in the types of foods men and women crave.

Researchers from Yale University stress that it’s key to explore these differences in order to improve interventions and make sex differences “less likely to derail weight loss attempts and contribute to gender-related health disparities in obesity.”

—Kate Ferguson-Watson

Many foods humans chow down with impunity can mean death for a cat, dog or other beloved animal companion that shares our homes.

According to the ASPCA, individuals should avoid feeding all pets chocolate, coffee, caffeine, milk and dairy-based products, nuts, raw or undercooked meat, eggs, bones, salt or salty foods (such as potato chips, pretzels and popcorn), the stems, leaves, peels, fruit and seeds of citrus plants, and beverages, foods or products that contain alcohol.

Additional edibles that pose a danger to our animal friends include the sweetener xylitol and yeast dough.

Avocado is mainly a problem for birds, rabbits and more unusual and exotic pets, such as horses, cattle, goats, sheep, giraffes, yaks, deer and even some kangaroos.

What’s more, anything from a coconut—including flakes, flesh or water—may upset their stomach. Grapes and raisins can cause kidney failure in animals, and onions, garlic and chives can irritate their gastrointestinal tract and damage red blood cells.

The best bet is not to take any chances.

Give your animals food specifically created for them to eat.

—KFW

A Scoop of This...or That?

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Whether whey, soy, pea, rice or hemp, not all protein powders are equal.

Numerous brands and types of protein powders are currently available. But the right type of this manmade fuel for your body depends on a number of different factors. Here are three key points to consider: Bioavailability: How easily proteins in powders are absorbed by the body is ranked using an inexact measurement from zero to one called the protein

digestibility corrected amino acid score. Those closest to one are considered superior.

Your health goals: Do you want to replace a meal, boost protein intake or build or maintain muscle?

Dietary restrictions: Are you vegetarian, prone to allergies or suffering from digestive problems?

If so, choose your protein powder accordingly to meet your specific needs. —KFW

THE PERCENTAGE INCREASE OVER THE PAST SIX YEARS IN THE REPORTED NUMBER OF CASES CONCERNING PETS THAT HAVE INGESTED MARIJUANA Source: Pet Poison Helpline

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SEX

Ask Doctor Dee Dorothy Horton, PsyD, answers your questions.

Check Your Medicine Cabinets

Common meds can cause vaginal dryness.

AFTER MENOPAUSE, VAGINAL TISSUES may dry out because hormonal imbalances cause the body to secrete less natural fluid for hydration. But females of all ages may experience this dehydration as a result of over-the-counter cold and allergy drugs.

“Allergy medications and antihistamines can also dry out the body’s mucous membranes, causing dryness in the vaginal wall,” says Jennifer Berman, MD, a practicing urologist with specialized training in women’s urology and female sexual medicine based in Los Angeles.

What’s more, warnings on product packaging don’t mention this side effect, so many women are unaware of this potential problem.

Vaginal dryness affects many women during different phases of their lives.

According to the Women’s Health

Concern, “Around 17 percent of women ages 18 to 50 experience problems with vaginal dryness during sex, even before menopause takes place.”

The condition is common after menopause in women between ages 51 and 60 and causes a host of problems, such as pain during sex, loss of sexual desire and general discomfort in the vaginal area, that may interfere with a woman’s quality of life.

One possible solution is to find ways to treat sinuses with products that don’t contain antihistamines. In addition, a number of effective treatments can counteract the vaginal dryness associated with menopause and certain meds and medical procedures.

Health care providers who are knowledgeable about this issue can be very helpful.

—Kate Ferguson-Watson

THE ESTIMATED PERCENTAGE OF POSTMENOPAUSAL WOMEN WHO EXPERIENCE VAGINAL DRYNESS Source: Women’s Health Concern

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It’s normal for kids at home to compete.

That said, sibling rivalry can be aggravated when parents don’t spend enough quality time with each child, play favorites or put kids into categories.

Therefore, to reduce the frequency of brothers and sisters competing with one another, parents should strive to observe the following supportive behaviors.

Don’t label kids. Respect your children’s individuality, and don’t use limiting descriptions—such as “the smart one” or “the athletic one”—to define your kids. Labeling can generate negative attitudes and behaviors and prompt teens to compete for a parent’s attention.

Bestow attention equitably. Set aside quality time with each teen daily, as this can help to show kids it’s unnecessary for them to fight to get noticed.

Arrange frequent family meetings.

These powwows give everyone a chance to voice their opinions and allow parents to add or delete rules.

Stay out of kids’ conflicts. Allow kids to resolve disagreements without your input, unless fights escalate. Even then, subtly lead them to negotiate their differences with suggested compromises. If no resolution materializes, parents should follow through with a neutral decision.

Lead by example. Children will do as you do—not as you say—so when parents squabble, they should be mindful to interact with each other in a respectful way.

(MEDICINE CABINET) ISTOCK; (HORTON) COURTESY OF DOROTHY HORTON, PSYD

How can I stop my teen children from always competing with one another?

Introducing the new and improved RealHealthMag.com WEBSITE FEATURES INCLUDE: • Responsive design optimized for smartphones and tablets • Faster site for quicker load times • Redesigned for easier readability y and navigation • Improved search function

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Janice Freeman delivers one of many dynamic performances during Season 13 of The Voice.

WHEN SINGER JANICE FREEMAN PERFORMED THE SONG “THE

Story” during the live Top 12 performances on The Voice, the moving lyrics could be likened to points along the path of her personal life. Her unwritten memoir is an account of pain, perseverance and hope in the face of the multiple chronic illnesses that she manages while being a wife, mother and entertainer who stands on the threshold of her big break. As a contestant on the popular American reality TV singing competition, Freeman walked into fame through a door she opened with tenacity and talent and a strong belief that—no matter what’s going on in your

A WINNING TALE ALTHOUGH SHE’S ONE OF 100 MILLION AMERICAN ADULTS WHO LIVES WITH SEVERAL CHRONIC ILLNESSES, JANICE FREEMAN DOESN’T PLACE LIMITS ON HERSELF.

COURTESY OF NBC/TYLER GOLDEN

By Kate Ferguson-Watson

life—you must pursue the things that make you feel happy and whole inside. She believes what’s most important is not to live your life in a box.

“If I’m alive, whether I’m hurting or mentally going through things, such as fighting depression, when you understand your mandate and what you’re supposed to do in this life, you’ve got to push through,” Freeman says.

When she got an opportunity to audition for the show, Freeman regarded the chance as an answer to her prayers.

She’d been in search of a platform that she could use “to touch a lot of people at once,” she says. “I just thought,

Maybe this is it.”

At age 32, Freeman, who is from Harrisburg, Pennsylvania, but is based in Compton, California, is no new jack to show business, and she has paid her dues. “I’ve worked from since before I was probably legally able to fi nd work,” she says. As an adult, Freeman held down a job as a customer service representative while trying to kick-start her music career. Then lupus struck, and she ended up losing her job. She shifted gears and became a data analyst specialist supervisor.

Lupus is an autoimmune disease of, basically, four realhealthmag.com

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different types that’s estimated to affect 1.5 million Americans, according to the Lupus Foundation of America.

The illness can range from mild to life-threatening and strikes mostly women of childbearing age, between 15 and 44.

Freeman first experienced flu-like symptoms and extreme weakness.

Then her kidneys shut down. “I started first having the signs right after I had my daughter in 2007,” she says. “But it took doctors two years to finally diagnose me, in 2009.”

AMONG THE BATTERY OF EXAMINATIONS

Freeman underwent for doctors to determine whether she was suffering from lupus is the antinuclear antibody (ANA) test. Although the ANA exam is a very sensitive diagnostic test that can indicate that an individual

has an autoimmune disorder, health providers usually perform additional defi nitive exams, such as an ANA panel, to check for antibodies to confi rm a specific diagnosis.

“With those tests along with the symptoms, they were fi nally able to diagnose me with lupus overall,” Freeman says.

Also in 2007, doctors diagnosed Freeman with Sjogren’s syndrome, another chronic autoimmune disorder.

Sjogren’s—a systemic disease that’s commonly associated with lupus and rheumatoid arthritis—interferes with the proper functioning of the body’s moisture-producing glands. For Freeman, the condition was like a giant sponge that robbed her body of water.

The dryness associated with Sjogren’s made life extremely unpleasant.

The illness triggered ulcers at the

root of Freeman’s teeth, causing them to break off. “I noticed that I never had enough enamel to protect my teeth and my eyes were dry all the time,” Freeman says. “My vision kept going bad and getting worse over time, so that’s how they were able to make the diagnosis for Sjogren’s syndrome.”

Four years later, a PAP smear detected abnormal cells in Freeman’s cervix, and she was diagnosed with cancer.

(Lupus increases a woman’s risk of cervical cancer.) After a year of trying to treat the disease, Freeman opted for a hysterectomy. “They had to take everything,” she says.

LIKE MANY OF THOSE WHO SUFFER

from multiple chronic conditions, Freeman learned to take life one day at a time. “My first illness was kidney failure when I was 7 years old; it’s like

FREEMAN SAYS THE BEST ADVICE MILEY CYRUS GAVE HER WAS NOT TO LIVE LIFE IN A BOX.

Janice Freeman performs on The Voice (left) and discusses a performance with competitor Katrina Rose and coach Miley Cyrus.

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(FREEMAN) COURTESY OF NBC/TYLER GOLDEN; (FREEMAN AND ROSE) COURTESY OF NBC/TRAE PATTON

every seven years something huge happens,” she says. “At 14, I contracted the [rare but serious] bacterial infection meningococcal meningitis. Literally, rigor mortis set in, and I almost lost my life in weeks.”

Perhaps that experience acted as a dress rehearsal to prepare Freeman for managing the current illnesses she lives with day in and day out. Living well with multiple diseases necessitated she organize a treatment plan with her doctors. In addition, she educated herself about the conditions and implemented changes to her lifestyle.

But when doctors suggested that Freeman stay on regimens to treat lupus and cervical cancer at the same time, she said no. “I wasn’t on chemo long because I had to make a decision,” Freeman says. “I couldn’t undergo both treatments together.”

Fortunately, the therapy quickly brought Freeman’s cancer into remission. Today, she still undergoes treatment for lupus with intravenous infusions of Benlysta (belimumab) once each month and takes Plaquenil (hydroxychloroquine) to relieve the symptoms caused

by Sjogren’s syndrome.

When lupus flares, also called flareups, occur, Freeman can experience draining fatigue, pain from fibromyalgia, skin problems (rashes and sores) or urinary tract issues. Medications help with pain management, but Freeman also relies on more holistic ways to stay healthy. She makes resting a priority and tries to find complementary approaches that might work for her. “For the last six months, I’ve been doing research on essential oils, different salts and a lot of baths and overhauled my eating habits,” she says.

FREEMAN CUT GLUTEN, DAIRY AND RED

meat from her diet and upped her intake of greens, such as spinach and kale; she also drinks alkaline water.

“As you grow and you learn, you find out what your body can and can’t take,” she says.

In the midst of juggling therapies, side effects from prescription meds and financial struggles, Freeman says she constantly thought about her goals while competing on a show viewed by millions. “I just wanted to be able to

MANAGEMENT TACTICS How to build a comprehensive plan to supervise your care The leading causes of death and disability in the United States are chronic diseases. One in four Americans have several such conditions, according to the Centers for Disease Control and Prevention.

The high rate of chronic illnesses has several underlying causes: the rapidly growing population of older adults, the increasing life expectancy associated with advances in public health and clinical medicine, and the high prevalence of some risk factors, such as tobacco use and physical inactivity.

With each additional chronic condition, an individual’s risk of dying prematurely, being hospitalized and even receiving conflicting advice from health care providers increases. People with multiple chronic conditions are also at greater risk of seeing a decline in their day-to-day functioning.

To manage these diseases, individuals must assemble a team of health care professionals who communicate regularly with patients and one another and whom they authorize to share medical information. Those living with chronic illness should schedule all their doctors’ appointments on one day if possible. If you are newly diagnosed with several diseases, ask doctors for referrals to other professionals they know and trust who specialize in specific conditions.

Experts advise folks suffering from diverse illnesses to educate themselves about their conditions so they fully understand what each disease entails. Another tip for handling chronic diseases is simply to be honest about your condition with family, friends and, if appropriate, employers who truly value you.

—KFW

capitalize off this platform, walk away from this, live comfortably and do the things that I’ve been wanting to do since I was little, namely share my music and have it be successful in all the ways that matter,” she says.

“I want to be able to inspire people because my heart’s desire is for people to have hope,” she adds. “So many people don’t live up to their potential. I want suicides to decrease and for people to choose life.”

The message is one that Freeman works hard to impress on her daughter, Hannah, age 11, whose father, Freeman’s first husband, died of cancer.

“There’s been times where I wanted to give up, and I know why God gave her to me,” Freeman says. “She’s taught me so many things, and for her to see me fight again, for her to see that in spite of what her mom goes through, she still stands tall and she’s always pushing, for her to see that nothing—from what color she is to being a woman—

can stop her, that there’s nothing that she can’t accomplish. That means the world to me.”

AS THE VOICE NEARED THE CLOSE OF

its 2017 season, Freeman’s elimination from the competition shocked many fans. But even when her stint on the show came to an end, she continued to thank God for her blessings.

An emotional Freeman posted a video online in which she reveals that her coach on the program, Miley Cyrus, helped her and her family fi nd a new home just before she was scheduled to go on tour. “One thing is for sure, the bond she and I cultivated still holds strong to this day,” she says.

“Miley more than exceeded her statement, ‘I will do anything for you.’”

And so chronic illnesses be damned; they don’t define her. “I’m so overwhelmed,” Freeman says. “I need y’all to understand that it is time to go into 2018 believing God is for real.” ■

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Facts of

LIFE HIV AFFECTS WOMEN DIFFERENTLY THAN MEN.

By Jeanette L. Pinnace

FROM THE TIME A WOMAN IS BORN, HER BIOLOGICAL,

social, cultural and economic susceptibility to HIV is greater than a man’s, simply by virtue of gender.

The female body is more vulnerable to HIV infection because women have more mucosal tissues that may be exposed to seminal fluids during condomless sex with a male partner, and heterosexual sex is the primary way women acquire HIV. >>

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What is TRUVADA for PrEP?

Who should not take TRUVADA for PrEP?

TRUVADA for PrEP (pre-exposure prophylaxis) is a prescription medicine that is used together with safer sex practices to help reduce the risk of getting HIV-1 through sex. This use is only for HIV-negative adults who are at high risk of getting HIV-1. To help determine your risk of getting HIV-1, talk openly with your healthcare provider about your sexual health.

Ask your healthcare provider if you have questions about how to prevent getting HIV. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.

Do not take TRUVADA for PrEP if you: ® Already have HIV-1 infection or if you do not know your HIV-1 status. If you are HIV-1 positive, you need to take other medicines with TRUVADA to treat HIV-1. TRUVADA by itself is not a complete treatment for HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat over time. ® Also take certain medicines to treat hepatitis B infection.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about TRUVADA for PrEP? Before taking TRUVADA for PrEP: ® You must be HIV-negative before you start taking TRUVADA for PrEP. You must get tested to make sure that you do not already have HIV-1. Do not take TRUVADA to reduce the risk of getting HIV-1 unless you are confirmed to be HIV-negative. ® Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. If you have flu-like symptoms, you could have recently become infected with HIV-1. Tell your healthcare provider if you had a flu-like illness within the last month before starting or at any time while taking TRUVADA for PrEP. Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin.

While taking TRUVADA for PrEP: ® You must continue to use safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1. ® You must stay HIV-negative to keep taking TRUVADA for PrEP: ® Get tested for HIV-1 at least every 3 months. ® If you think you were exposed to HIV-1, tell your healthcare provider right away. ® To further help reduce your risk of getting HIV-1: ® Know your HIV status and the HIV status of your partners. ® Get tested for other sexually transmitted infections. Other infections make it easier for HIV to infect you. ® Get information and support to help reduce risky sexual behavior, such as having fewer sex partners. ® Do not miss any doses of TRUVADA. Missing doses may increase your risk of getting HIV-1 infection. ® If you do become HIV-1 positive, you need more medicine than TRUVADA alone to treat HIV-1. TRUVADA by itself is not a complete treatment for HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat over time.

TRUVADA can cause serious side effects: ® Worsening of hepatitis B (HBV) infection. TRUVADA is not approved to treat HBV. If you have HBV and stop taking TRUVADA, your HBV may suddenly get worse. Do not stop taking TRUVADA without first talking to your healthcare provider, as they will need to monitor your health.

What are the other possible side effects of TRUVADA for PrEP? Serious side effects of TRUVADA may also include: ® Kidney problems, including kidney failure. Your healthcare provider may do blood tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to stop taking TRUVADA. ® 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. ® Bone problems, including bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

Common side effects in people taking TRUVADA for PrEP are stomach-area (abdomen) pain, headache, and decreased weight. Tell your healthcare provider if you have any side effects that bother you or do not go away.

What should I tell my healthcare provider before taking TRUVADA for PrEP? ® All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis. ® If you are pregnant or plan to become pregnant. It is not known if TRUVADA can harm your unborn baby. If you become pregnant while taking TRUVADA for PrEP, talk to your healthcare provider to decide if you should keep taking TRUVADA. ® If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. If you become HIV-positive, HIV can be passed to the baby in breast milk. ® All the medicines you take, including prescription and over-thecounter medicines, vitamins, and herbal supplements. TRUVADA may interact with other medicines. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. ® If you take certain other medicines with TRUVADA, your healthcare provider may need to check you more often or change your dose.

These medicines include certain medicines to treat hepatitis C (HCV) infection.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch, or call 1-800-FDA-1088.

Please see Important Facts about TRUVADA for PrEP including important warnings on the following page.

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We're open, not unprepared.

We know who we are. And we make choices that fit our lives.

TRUVADA for PrEP™ is a once-daily prescription medicine that can help reduce the risk of getting HIV-1 when taken every day and used together with safer sex practices. ® TRUVADA for PrEP is only for adults who are at high risk of getting HIV through sex. ® You must be HIV-negative before you start taking TRUVADA for PrEP.

Ask your doctor about your risk of getting HIV-1 infection and if TRUVADA for PrEP may be right for you.

Learn more at truvada.com

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IMPORTANT FACTS

This is only a brief summary of important information about taking TRUVADA for PrEPTM (pre-exposure prophylaxis) to help reduce the risk of getting HIV-1 infection. This does not replace talking to your healthcare provider about your medicine.

(tru-VAH-dah) MOST IMPORTANT INFORMATION ABOUT TRUVADA FOR PrEP Before starting TRUVADA for PrEP: • You must be HIV-1 negative. You must get tested to make sure that you do not already have HIV-1. Do not take TRUVADA for PrEP to reduce the risk of getting HIV-1 unless you are confirmed to be HIV-1 negative.

• Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. Symptoms of new HIV-1 infection include flu-like symptoms, tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin. Tell your healthcare provider if you have had a flu-like illness within the last month before starting TRUVADA for PrEP. While taking TRUVADA for PrEP: • You must continue to use safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1.

• You must stay HIV-negative to keep taking TRUVADA for PrEP. Get tested for HIV-1 at least every 3 months while taking TRUVADA for PrEP. Tell your healthcare provider right away if you think you were exposed to HIV-1 or have a flu-like illness while taking TRUVADA for PrEP. • If you do become HIV-1 positive, you need more medicine than TRUVADA alone to treat HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat over time.

• See the “How To Further Reduce Your Risk” section for more information.

TRUVADA may cause serious side effects, including: • Worsening of hepatitis B (HBV) infection. TRUVADA is not approved to treat HBV. If you have HBV, your HBV may suddenly get worse if you stop taking TRUVADA. Do not stop taking TRUVADA without first talking to your healthcare provider, as they will need to check your health regularly for several months.

ABOUT TRUVADA FOR PrEP TRUVADA for PrEP is a prescription medicine used together with safer sex practices to help reduce the risk of getting HIV-1 through sex. This use is only for HIV-negative adults who are at high risk of getting HIV-1.

• To help determine your risk of getting HIV-1, talk openly with your healthcare provider about your sexual health.

Do NOT take TRUVADA for PrEP if you: • Already have HIV-1 infection or if you do not know your HIV-1 status.

• Take certain medicines to treat hepatitis B infection.

HOW TO TAKE TRUVADA FOR PrEP • Take 1 tablet once a day, every day, not just when you think you have been exposed to HIV-1.

• Do not miss any doses. Missing doses may increase your risk of getting HIV-1 infection.

• Use TRUVADA for PrEP together with condoms and safer sex practices.

• Get tested for HIV-1 at least every 3 months. You must stay HIV-negative to keep taking TRUVADA for PrEP.

POSSIBLE SIDE EFFECTS OF TRUVADA FOR PrEP TRUVADA can cause serious side effects, including: • Those in the “Most Important Information About TRUVADA for PrEP” section.

• New or worse kidney problems, including kidney failure.

• 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.

• Bone problems.

Common side effects in people taking TRUVADA for PrEP include stomach-area (abdomen) pain, headache, and decreased weight.

These are not all the possible side effects of TRUVADA. Tell your healthcare provider right away if you have any new symptoms while taking TRUVADA for PrEP. Your healthcare provider will need to do tests to monitor your health before and during treatment with TRUVADA for PrEP.

BEFORE TAKING TRUVADA FOR PrEP Tell your healthcare provider if you: • Have or have had any kidney, bone, or liver problems, including hepatitis.

• Have any other medical conditions.

• Are pregnant or plan to become pregnant.

• Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. If you become HIV-positive, HIV can pass to the baby in breast milk.

Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

• Ask your healthcare provider or pharmacist about medicines that should not be taken with TRUVADA for PrEP.

HOW TO FURTHER REDUCE YOUR RISK • Know your HIV status and the HIV status of your partners.

• Get tested for other sexually transmitted infections. Other infections make it easier for HIV to infect you.

• Get information and support to help reduce risky sexual behavior, such as having fewer sex partners.

• Do not share needles or personal items that can have blood or body fluids on them.

GET MORE INFORMATION • This is only a brief summary of important information about TRUVADA for PrEP. Talk to your healthcare provider or pharmacist to learn more, including how to prevent HIV infection.

• Go to start.truvada.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit start.truvada.com for program information.

TRUVADA FOR PREP, the TRUVADA FOR PREP Logo, the TRUVADA Blue Pill Design, TRUVADA, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners.

Version date: April 2017 © 2017 Gilead Sciences, Inc. All rights reserved. TVDC0127 07/17

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During sex, the virus in semen can gain access to the mucosal tissues in the vagina or rectum, where it may remain for several hours. If HIV is present in bodily fluids, the virus may enter the bloodstream through tiny abrasions in the vaginal or rectal lining that occur during sexual intercourse.

What’s more, if a woman has a sexually transmitted infection (STI) or damage to the tissues that line these body parts, those areas become more vulnerable to HIV transmission.

Women are affected by STIs in different ways than men and are more likely to suffer long-term harm from an STI, especially one that goes untreated.

This may occur because women are less likely than men to have symptoms of common STIs such as chlamydia and gonorrhea; furthermore, symptoms of STIs such as syphilis may not be easily visible for women.

ONCE A WOMAN HAS CONTRACTED

HIV, the virus affects her menstrual cycle. Many women living with HIV who aren’t pregnant or undergoing menopause may notice changes in the frequency, duration and amount of

However, the primary worry for many women of childbearing age is passing the virus to their unborn children. But the good news is, there are ways for moms-to-be living with HIV to plan for healthy pregnancies that can reduce the risk they’ll transmit the virus to their babies.

Today, people with HIV live much longer lives because of ARV medicines.

For women, advancing age and menopause means more bone loss (osteoporosis), and because a woman has smaller bones than a man, these effects are amplified. When older women living with the virus are on treatment, there’s an even higher risk their bones may weaken and break easily because some ARVs might increase some individuals’ risk of osteoporosis.

In addition, some HIV medicines, such as Viramune (nevirapine) and Norvir (ritonavir), may cause different side effects in the sexes. Findings show that women on HIV treatment are more likely than men to accumulate fat buildup throughout the body and face problems with their pancreas.

Then there’s stigma, which has shadowed the lives of men and women living

HIV-related stigma are even greater for females. “These effects occur both for women and girls at risk of getting HIV and those already living with it,” say advocates writing about the issue for The Well Project, a nonprofit organization dedicated to providing information about women and HIV. ACROSS THE GLOBE, THE LIVES OF

women and girls are shaped by a number of gender-based inequities, such as less power in sexual decision-making and earning or controlling income as well as policies that deny women their rights pertaining to inheritances, education or reproduction. Even in the United States, women are at an increased risk for HIV as a result of such injustices.

According to the Centers for Disease Control and Prevention, poverty can act to limit women’s access to HIV testing and medications that lower the level of virus in the blood to undetectable, which reduces the risk of transmission to effectively zero. In addition, those who cannot afford the basics in life may end up in circumstances that increase their risk for HIV infection.

PREVIOUS PAGES: ISTOCK (MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY)

FINDINGS SHOW THAT WORLDWIDE, THE NEGATIVE EFFECTS OF HIV STIGMA STRIKE WOMEN AND GIRLS HARDER. blood they pass or may not menstruate (amenorrhea) for more than three months. But menstrual irregularities are less common if women have a high CD4 count and are on antiretroviral (ARV) treatment.

What’s more, women with HIV are likely to experience more frequent and severe gynecologic illnesses, such as genital herpes and HPV (human papilloma virus, which can lead to cervical cancer), than women who don’t have HIV. Additionally, women with HIV are more likely to develop pelvic inflammatory disease and vaginal yeast infections and may experience menopause at an earlier age.

with the virus since the beginning of the epidemic. “I was diagnosed with HIV 20 years ago,” says Maria Davis, a music industry promoter and HIV advocate who in 2014 became a spokesperson for I Design, a national HIV education campaign launched by Merck, a pharmaceutical company. “I am surprised that there are still misconceptions about HIV. I was recently asked if HIV is spread through saliva or if someone can get the virus by using a bathroom after someone with HIV has used it.” Editor’s note: It’s not, and you can’t.

Findings and stories about women all over the world who live with the virus show that the negative effects of

This description uniquely defines the economic status of many of the almost 16.3 million American women living in poverty in 2016, notes the National Women’s Law Center. (Poverty rates were highest for Black women followed

by Native American and Latina women.)

Globally, too, social factors that predominate in different places combine with poverty to doubly burden women. The financial cost of having HIV triggers a cascade of progressively worse effects. For instance, when a woman is the sole breadwinner and she becomes ill, her family is affected. In some areas of the world, she may also be unable to see a doctor.

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These circumstances can destroy the financial base for her family. Children might miss school or, in some cases, be forced to become caregivers, which can limit their potential to secure future employment opportunities.

WOMEN EVERYWHERE FACE ANOTHER

problem that raises risk for HIV: genderbased violence (GBV).

According to a United Nations paper on reducing HIV, “One in three women has been beaten, experienced sexual violence or otherwise abused in their lifetime. One in five will be a victim of rape or attempted rape.”

GBV can include sexual, physical or emotional abuse. What’s more, these assaults on women take many forms and are predominantly perpetrated by their intimate partners.

But no matter what guise acts of violence assume, they’re all proven drivers of HIV transmission for females.

“Trauma related to childhood physical trauma—as well as sexual abuse and intimate partner violence in adulthood—is related to increased risk for HIV infection among women,” explain psychologists Lily D. McNair, PhD, and Cynthia M. Prather, PhD, in their report on factors that influence AfricanAmerican women’s risk and reaction to HIV and AIDS published in the Journal of Black Psychology.

The authors add that a scarcity of African-American men available for romantic partnerships is yet another inequity that uniquely affects Black women’s risk of acquiring HIV. This imbalance makes them less likely to ask about their partner’s HIV status or demand that a man with whom they’re involved use condoms.

“A lot of women I talk to don’t feel comfortable having that conversation with their partner—whether they just started dating or are in a committed relationship,” Davis says.

“They think it will bring up trust issues,” she adds. “It’s not easy to have this kind of conversation with your partner, but it’s important.”

In an effort to make women less vulnerable to HIV exposure, activists and advocates worldwide continue to work to empower women in all aspects of their lives. Part of the solution is to 2 8 RE AL H E A LTH SP R IN G 2018

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FOR WOMEN, ACTS OF ABUSE AND SEXUAL VIOLENCE ARE PROVEN DRIVERS OF HIV INFECTION.

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ensure that women can engage in their societies’ decision-making processes.

IN 2016, AMONG BLACK WOMEN IN

the United States, new rates of HIV dropped by 21 percent. Although experts called this decrease an “encouraging trend,” African-American women continue to be affected by the virus far more often than women of other races and ethnicities.

Still, Davis is optimistic that educating individuals about the virus will eventually help end the epidemic as well as strengthen self-determination among women and the ability to achieve their full potential.

“Get tested and know your status,” she advises. “Go with your partner to the clinic if you need to. Love yourself enough to have an open and honest conversation to help protect your health, and your partner’s health.” ■

Better Treatment for Her ANTIRETROVIRALS CAN KEEP WOMEN HEALTHY REGARDLESS OF THEIR HIV STATUS. Although males and females are alike in many ways, they differ in key aspects of their biology and behavior.

This is why researchers worked hard to address women’s needs in HIV prevention, management and therapy.

The result? Medications and drug formulations that help females in more effective ways.

For example, treatment as prevention, or TasP, refers to the use of antiretroviral (ARV) medications to prevent HIV. This protocol is used by mothers-to-be living with the virus to stop them from transmitting HIV to their babies during pregnancy, birth and breast feeding.

Another TasP therapy, Truvada (tenofovir disoproxil fumarate/ emtricitabine) as pre-exposure prophylaxis, or PrEP, reduces a woman’s chances of contracting HIV by 90 percent—99 percent for men—if the medication is taken daily.

(Note: PrEP doesn’t protect against other sexually transmitted diseases,

such as syphilis and gonorrhea, but condoms do.)

In addition, the Food and Drug Administration recently approved Descovy (emtricitabine and tenofovir alafenamide), an ARV, for use as pre-exposure prophylaxis.

Now, scientists want to study Selzentry (maraviroc) to determine whether the med is an effective alternative to Truvada as PrEP. In a small study, scientists found that the drug was safe and well tolerated among women.

Meanwhile, advocates support continued research on ARV microbicide gels or creams that could be applied vaginally or anally to help stop HIV transmission despite debate about whether studies for these drugs— sometimes called “topical PrEP”— should continue to get funding.

Some would prefer that the limited research dollars go to studies on injectable meds as PrEP, such as cabotegravir and rilpivirine.

—JLP

CAN15703-00_HouseAd.pgs 12.20.2017 13:18

BLOSSOM EDIBLE FLOWERS MAY BOOST THE TASTE, APPEARANCE AND NUTRITIONAL VALUE OF MEALS AND BEVERAGES.

By Gerrie E. Summers

SOME FLOWERS, SUCH AS FIERY, SPICY nasturtium, can add bright color and a dose of nutrients—like vitamin C and lutein—to a salad. Other blossoms might embellish a plate or party platter but taste rather insipid.

“When using edible flowers, think about why you are using the particular flower,” advises Katie Hess, author, flower alchemist and founder of the floral apothecary Lotuswei. “Is it for the aroma, visual beauty or the flavor?”

“For example, the elusive aroma of lilacs can be infused into organic cane sugar or coconut sugar to appreciate the fragrance in teas or baking,” Hess says. “Another heavily aromatic flower like night-blooming jasmine can be infused into maple syrup and then drizzled over fresh fruit or folded into the foam of a homemade dairy-free cappuccino. Rose petals can be infused into honey, teas or added to cakes, frostings and mousses, where the soft floral aroma can be appreciated.”

Hess’s new book, Flowerevolution: Blooming into Your Full Potential with the Magic of Flowers, is a guide to using flowers in everyday life. “When using edible flowers for visual beauty, they can be placed on top [of foods], chopped up and folded in for color or frozen into ice cubes. In some cases, flowers can even be the serving dish: Tulips can be used as cups for mousse, sorbet, chia pudding or other fun desserts,” she says. >>

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And here’s more practical advice from a number of other experts: • Make sure that the flavor of the flower complements the dish. One should not overpower the other.

• Don’t use flowers from a florist, as they will likely contain harmful chemicals or pesticides.

• Check the produce section of specialty grocery stores for edible flowers.

• Never use flowers growing by the road or in public parks, as they are likely to be tainted by pesticides, herbicides or fumes from vehicles.

• If you have ragweed allergies, avoid chamomile and carnation. If you you’re allergic to composite flowers (those in the daisy or sunflower family), skip calendula, chicory, chrysanthemum and marigold.

• Use petals sparingly; some can cause digestive problems.

TIP: GROW YOUR OWN FLOWERS FOR EATING. When picking flowers from a garden, pluck them early in the day. “Always rinse the flowers, remove any insects and gently dry the flowers with a paper towel,” Hess advises.

You can also order edible flowers online. If you do, “opt for hardy, long-lasting flowers like dianthus and karma orchids and use them as soon as they arrive,” Hess says.

In addition, it’s best to use flowers right away because they wither quickly and petals will start to dry out after two hours.

If you’re not going to use them immediately, keep flowers fresh for up to 10 days by placing them on moist paper towels inside an airtight container and refrigerating them—but it’s best to use them within a week. (Tip: A sprinkle of ice water will revitalize wilted flowers.)

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Although some flowers can be eaten whole, only the petals of some others are edible. (The pistils and stamens can be bitter, so these ought to be removed before eating.)

Certain flowers have parts that aren’t good to eat and can even be poisonous.

For example, some species of lilies are edible, while the ones that contain alkaloids shouldn’t be eaten. Research all flowers you want to consume.

Easy Edible Flower Recipes Lilac Sugar Rinse fresh lilac petals. Once completely dry, remove the petals from the stems.

Use equal portions of granulated sugar

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and lilac petals. In an airtight glass jar, alternate layers of sugar with layers of lilac petals. Gently shake the jar to mix, and store in a dark, dry place for a week to one month. Shake periodically (daily if you plan to infuse only for a week or two). Sift and remove the petals before use if you prefer. The dried petals and sugar can also be blended in a food processor. The infused sugar will last three months.

Decadent Crystallized Gardenia Petals* Use only organic flowers or flowers from a garden.

1 egg white 2 tablespoons water 1 handful gardenia flower petals** 1 teaspoon organic cane sugar Using a fork, mix the egg white and water in a bowl. With a small paintbrush or pastry brush, apply the mixture on both sides of each petal. Sprinkle sugar on both sides of the petals, and let dry for a couple of hours.

The crystallized petals can be eaten as a snack or used to decorate cakes or treats. Petals will keep in an airtight container for several days. (**You can also use other sweet florals, such as roses, violets, pansies and Johnnyjump-ups.)

Jasmine-Infused Maple Syrup* Use this jasmine-infused maple syrup as a sweetener for coffee drinks. To make it at home, you need a jasmine plant that flowers every morning. If you don’t have one, buy one from a nursery in your area. Note that there are many varieties of jasmine. Some, such as star jasmine or pink jasmine, may bloom only for two weeks at a time, but two weeks should be enough time to make the syrup.

Each morning, pick the jasmine blossoms that have bloomed the night before.

Remove dirt or bugs, and place the flower clusters in a glass jar. Completely

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“Flowers with a strong flavor, such as lavender, can be used in baking cookies or cakes,” she continues. “They can also be obtained dry, which also makes them appropriate for high heat, whereas when you’re working with fresh flowers, it’s best not to cook them, using them instead for beverages, desserts or garnish.”

For best results, experts recommend choosing fresh flowers and petals from organically grown blooms or plants from your own garden or a local farmers market. The type of flowers available will depend on the time of year and your location. If you’re using flowers from a local farm, make sure that they’re sourced from soil that hasn’t been fertilized with manure for at least four months, Hess warns. In addition, pick plants not sprayed with chemicals so that they’re safe to eat.

cover the petals with maple syrup. Seal the jar and refrigerate. The next day, using wooden chopsticks, remove the blossoms and replace them with freshly collected flowers. Repeat this step as many days as you like, according to your desired intensity of fragrance and flavor. For heavily scented syrup, Hess recommends infusing for 20 to 30 days.

Jasmine Foam Cappuccinos* Heat 1 cup of dairy or nut milk in a small saucepan over medium-high heat.

After heating the milk, use a handheld milk frother to create bubbles in the liquid.

Brew the espresso or coffee and pour the foamy milk over it. Gently fold 1 teaspoon of jasmine maple syrup into the foam.

Delightful Golden Nasturtium Salad* To make the nasturtium vinaigrette: Fill 3/4 of a jar with fresh nasturtium blossoms. Top with 1/2 cup of white rice vinegar or white wine vinegar.

Store in a dark place for three weeks.

After three weeks, add a sprig of fresh rosemary, a handful of fresh chives or a couple of crushed garlic cloves to the jar to enhance the flavor.

Rinse fresh nasturtium flowers and leaves with water and dry with a paper towel.

Combine the nasturtium vinaigrette with 1/2 cup of olive oil. Then add 3 tablespoons of maple syrup, 2 teaspoons of Dijon mustard and 1/2 teaspoon of pink Himalayan salt, and 2 large handfuls of nasturtium flowers and leaves. Shake well. Allow the flavors to marry for a couple of minutes. Refrigerate and use within five days.

To make the salad: Combine a large handful of salad greens and eight nasturtium flowers and leaves in a large bowl. Top with nasturtium vinaigrette and toss. ■ *Adapted from Flowerevolution: Blooming into Your Full Potential with the Magic of Flowers (Hay House) by Katie Hess.

FLOWER

FLAVOR

USE

Arugula (Eruca sativa or vesicaria)

Peppery, milder than the leaves

In salads and savory dishes

Bachelor’s Button (Cornflower) (Centaurea cyanus)

Cucumber or clove-like

As a garnish

Eat only the petals.

Borage (Borago officinalis)

Cucumber

In salads or as a garnish

Avoid if pregnant or lactating.

Chrysanthemum (Chrysanthemum morifolium or indicum)

Sweet to peppery

In salads, salad dressing and stir-fries

Remove white base.

Daylily (Hemerocallis)

Melon, sweet lettuce, asparagus or zucchini

In desserts and other dishes; can be stuffed and fried

Cut out white base; eat in moderation, as it can act as a diuretic.

Geranium (Pelargonium)

Lemony, fruity to spicy, like nutmeg)

As a garnish

Hibiscus (Hibiscus rosa-sinensis)

Sweet and tart, like cranberries

In salads, teas, cocktails and desserts

Impatiens (Impatiens walleriana)

Sweet

As a garnish

Jasmine (Jasminum sp.)

Sweet

In teas, ice cream and desserts

Johnny-Jump-Up (Viola tricolor)

Wintergreen and minty

As a garnish; with soft, mild cheese

Lavender (Lavandula)

Minty, citrus

In teas, cocktails and desserts

Lemon Verbena (Aloysia triphylla or citriodora)

Lemony, comparable to lemon zest

In marinades, teas, sorbets, desserts; can be added to fish or chicken for lemon flavor

Lilac (Syringa vulgaris)

Lemony to pungent

In salads, jellies, liqueurs, ice cream; crystallized with egg whites and sugar

Nasturtium (Tropaeolum majus)

Peppery

In salads and savory dishes

Buds, flowers and leaves are edible.

Pansy (Viola × wittrockiana)

Lettuce-y or minty

As a garnish

Eat only the petals; remove the pistils and stamens.

Peony (Paeonia lactiflora)

Sweet

In salads, lemonade, punches and teas

Use to decorate cakes.

Rose (Rosa rugosa or gallica officinalis)

Depends on the variety

As a garnish

Snip off bitter white part at base of petals.

Squash or Zucchini Blossom (Curcurbita sp.)

Zucchini, yellow squash

In salads and soups, fried, stuffed with cheese

Violet (Viola odorata)

Sweet

In desserts, jams, jellies

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TIP

Freeze in ice cubes to decorate drinks.

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FEAR OF THE

DARK FINDINGS SUGGEST THAT INKY HAIR DYES MAY POSE A HIGHER RISK FOR CANCER.

By Alicia Green

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nent dyes, hair coloring is so popular that analysts say hair color products account for 20 percent of the overall hair care market. However, researchers continue to speculate about the effects these products have on health.

According to the National Cancer Institute, more than 5,000 chemicals are used in hair dyes. These include ingredients such as formaldehyde (classified as cancer-causing to humans and animals), paraphenylenediamines, ammonia and coal tar, which can irritate the skin and cause rashes.

These consequences are some reasons why scientists continue to study hair dyes. But their ultimate goal is to determine whether there’s any connection between these pigments and an increased risk for cancer.

Although some investigations have linked use of hair dyes to breast and bladder cancer as well as certain cancers of the blood and bone marrow, others have found no such associations. Thus far, then, fi ndings still remain inconclusive.

A recent study of more than 4,000 African-American and white women assessed the prevalence and patterns of use of hair dyes and chemical relaxers and their link with breast cancer.

Researchers noted that Black women who used dark brown or black hair dye registered a 51 percent increased risk for breast cancer overall.

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ADDITIONALLY, PROFESSIONAL HAIR

coloring is associated with fewer health risks. Unlike less expensive doit-yourself dyes that may contain cheaper ingredients, salon dyes include components that help protect a person’s tresses as well as their skin.

Temporary and semipermanent dyes don’t contain ammonia to open the cuticle so the colorants in them cannot penetrate the hair shaft.

For this reason, experts consider these types of sprays, pastes and mousses, which wash out after a few shampoos, less damaging than permanent dyes.

Educate yourself and stay informed, Llanos advises. “It’s important that we are all aware of the hair products, cosmetics and other personal care products that we use and whether they contain chemicals that may be harmful to our health. ■

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CHEMICAL REACTIONS What to consider before coloring your hair after chemo According to experts, individuals should wait six months after chemotherapy to color their hair.

The reason? Dyes contain strong chemicals that can further damage the hair and scalp.

In addition, some professionals recommend waiting until the hair grows about an inch.

Folks with short manes who are newly recovered from cancer may want to experiment with different tinting techniques, including highlights, or try out natural colors.

But ask your hairdresser to administer a sensitivity test before taking a seat in that salon chair and having a plastic cape draped around your shoulders.

Having this patch-test assessment conducted in advance can help determine whether you’re allergic to certain ingredients in hair dyes. Always have an evaluation done before using permanent or semipermanent dyes—even if it’s a brand you’ve previously used.

In addition, consider natural vegetable and plant-based dyes, such as henna and indigo, that don’t contain the harsh chemicals usually found in regular hair color products. Many believe these are healthier as well as more gentle on fragile tresses compared with traditional dyes.

Finally, experts advise, always consult a physician before subjecting your hair to chemical treatments or processes following cancer therapy. —AG

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breast cancer risk rose by 74 percent.

(Black women who dyed and relaxed their hair were also at higher risk for breast cancer.)

“It is unclear why the association between hair product use and the risk for breast cancer differs by race,” says Adana Llanos, PhD, MPH, an assistant professor of epidemiology at Rutgers School of Public Health and Cancer Institute of New Jersey and the study’s lead author.

One possible explanation, she suggests, is that there may be a difference in the chemical composition of hair products that are marketed to and used by African-American women compared with those geared toward white women.

But “future research is needed to describe the associated risks in relation to specific products more completely,” Llanos explains.

Llanos, who is Black, occasionally colors her hair and takes precautions when doing so. She uses lighter dyes instead of darker ones, since more vivid hues don’t seem to be connected with a greater cancer risk.

Th is may be because dyeing locks a lighter hue lifts pigment from tresses with bleach whereas strands absorb the darker shades that are applied onto hair, according to Llanos.

Ethique Beauty Bars (from $8 to $32) These solid shampoos, conditioners, body washes, moisturizers and other personal care items are made from sustainable, ethically sourced, naturally derived ingredients and sold in com compostable packaging. amazon.com

Stuff We Love Pachy Natural Deodorant (2 oz., $9.99; .75 oz., $3.99) A natural formulation of rich, plant-based butters, powders, oils and extracts that nourish the skin while effectively fighting bacteria that causes odors. rusticmaka.com

Blue Copper 5 Firming Elasticity Repair (1.7 oz., $86, 1 oz. $58); Anti-Aging Body Lift (5 oz., $95); Lip & Tuck (.17 oz., $35) All are formulated with copper peptides, proteins that can improve the tone, firmness, texture and radiance of targeted areas on the face and body. osmotics.com

A ROUNDUP OF THE E LATEST MUST-HAVE FINDS NDS FOR HAIR, SKIN, HEALTH, BEAUTY AND MORE. THESE PRODUCTS ARE WORTH EVERY CENT.

Niucoco Luxury Hair Care Hydrating Shampoo (8.5 fl. oz., 250 ml, $22); Smoothing Conditioner (8.5 fl. oz., $22); Renewing Hair Serum (1.7 fl. oz., $29) Made with extra virgin, cold-pressed, unrefined coconut oil, these products are for all hair types and contain no sulfates, parabens, phthalates or gluten. niucoco.com

ARIIX PureNourish Natural (32 oz., $87.07) This plant-based dietary supplement contains high-quality protein, essential vitamins and minerals, probiotics, enzymes and natural sugars. Add eight ounces to water to replace a meal or to make a nutritious portable snack. ariix.com

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THOUGHTS

The Expert Says Psychologists say that in a relationship, it’s key to find ways to balance being together yet separate from a partner. Here are a few of their suggestions:

Why partners need to spend some time apart EXPERTS WARN THAT SOMETIMES TOO MUCH TOGETHERNESS CAN RUIN a relationship. Although spending time with a significant other contributes to building a solid union, constantly being in each other’s company may lead to one party or another feeling suffocated, and love may suffer as a result. The key, say experts, is for couples to strike a balance between making time for each other and enjoying periods apart.

Often, individuals equate how much time they’re in the company of their partner as a measure of how much each loves the other. In addition, sometimes fear of abandonment or thoughts of keeping a loved one safe can fuel an individual’s efforts to keep a partner in his or her sight. Such insecurities can become obsessive and trigger resentments that eventually create conflicts and cause individuals to withdraw. Paying attention to your mate and showing concern about his or her well-being shows love. But when excessive, these expressions of affection can be smothering.

Each person in a relationship needs a certain degree of space, which is different for everyone. Experts suggest that partners occasionally disconnect and then reconnect with each other to nurture their growth as a couple while also fulfilling themselves as individuals.

—Kate Ferguson-Watson

A Paradox of Love

While doing research for an article about love and relationships, I found excerpts from Mating in Captivity: Unlocking Erotic Intelligence, a book by New York City–based psychotherapist Esther Perel. One of the relationship topics the best-selling writer tackles is the tension between maintaining one’s individuality and being

Thoughts on two people being together yet separate

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Nurture all aspects of your life.

Maintain the separate interests and friendships that were important to you prior to your relationship and encourage your partner to do the same. Also, talk—and listen—to each other about your hopes, dreams, goals and other matters that are important to you both.

Balance independence with interdependence.

Understand that you are a whole person without your mate and vice versa. View your relationship as a team of two individuals with separate identities who share love and support each other in big and small ways.

—KFW

part of a couple.

In this constant ebb and flow of intimacy “our quest for love and security conflicts with our pursuit of adventure and freedom,” Perel writes.

Her words echo those of other well-known authors who have examined these seemingly contradictory desires.

Poet and artist Kahlil

Gibran, author of The Prophet, his masterpiece of philosophical insights on life, influenced Perel’s thoughts on romantic relationships. She described love as resting on two pillars— surrender and autonomy—that reflect the need for humans to merge yet remain separate.

It’s a deep mystery of life worth considering.

—KFW

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Space Considerations

Keep your sense of self.

Individuals should celebrate and respect each other’s differences as a way to remain connected without being consumed by a partner. These distinctions can help two people become closer by recognizing each other’s strengths as well as weaknesses.

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Take an active role in your health.

Ask your doctor if an HIV medicine made by Gilead is right for you.

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