Real Health Spring 2019

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Who’s Hit Harder by Stress: Males or Females? The Return of Cannabis as Medicine The Pros and Cons of Using Dogs to Detect Cancer

Bobby Brown

How Finding Happiness Led Him to Become an Advocate for Health

Keys to Breaking the Cycle of Illness and Poverty

Why Aren’t More Black Women Taking PrEP?


this month on REALHEALTHMAG.COM Thyroid disease has complicated the life of the popular TV talk show host and forced her to take an extended break from the air.

Health Basics A­—Z

5 3


Barbers and Blood Pressure


Cancer Care Burdens

What are the additional obstacles Black women face in accessing information to prevent and manage breast cancer as compared with most white women?

Digital Real Health

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editor’s letter


a whole new man

If time seems to move faster as you age, here’s a way to slow the clock.

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 home page.

One year later, Black men with previously uncontrolled hypertension still benefit from a barbershop intervention program that helped to lower their BP.


6 buzz

Poverty and health; HIV testing; interrupting ARV treatment; how to reclaim your vim and vigor; dogs that detect cancer; why hepatitis C infection rates are soaring


The best cardiovascular workouts; lose weight and build muscle with high-intensity interval training




healing foods

The nutrients in what we eat can be good medicine for the body.


PrEP solutions

Why aren’t more Black women taking pre-exposure prophylaxis?


cannabis for health

History repeats itself: Before the feds criminalized marijuana, the plant was prescribed for illnesses.


Healthy fats; good-for-the-belly bacteria; dine out despite allergies


After surviving a hellish nightmare of addiction and illness, Bobby Brown continues to thrive.


Cancer doesn’t have to end sexual intimacy; red flags that should never be ignored in a relationship


Unfair gender expectations that anger, annoy and exasperate women; expert suggestions for shaking off stress

Real Health Question of the Month

In your opinion, what is the best way to use cannabis as a medicine to treat patients?

It’s necessary to have the right approach, products and dosing to see what works best for each individual. After assessing a patient’s condition, I educate them on how cannabis works in their body and is specific to their disease or issue. —Susan Marks, RN

reach out & click!

At, 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!


Wendy’s Condition


What Time Is It?


Kate Ferguson-Watson MANAGING EDITOR

Make the most of the moments in your life.

Jennifer Morton DEPUTY EDITOR

Trent Straube COPY CHIEF

Joe Mejía


Alicia Green


Mark Robinson

eople say that as you get older, time seems to move faster, and research findings suggest a variety of explanations for why this may be so. But of all the theories scientists have presented, the ones that propose time can be slowed by exposing our brain to new stimuli intrigue me the most. After all, lifelong learning and personal growth can help to keep our minds and bodies healthy and fit. No matter how much we know and how accomplished we are, there is always room for improvement. One theory on the passage of time suggests that when we don’t open ourselves up to new information, we become stuck in a routine and time seems to speed up. That’s when our lives assume a monotonous pattern of waking, eating, working and sleeping. (Hopefully, somewhere in between there’s a little playtime too.) Sometimes life feels as it did for Bill Murray in Groundhog Day, in which he plays a TV weatherman constantly reliving the same day. One way to slow down the clock when



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Here’s to your health, JOAN LOBIS BROWN

Issue No. 57. Copyright © 2019 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.

we find ourselves in this type of rut is to seek out unique and exciting experiences. Of course, this means different things to different people. But such adventures stir up a fresh breeze in our lives that serve to reinvigorate a humdrum existence and decelerate the passing of time. Perhaps, the biggest issue for us is how to make good use of the seconds, minutes and hours of our lives. Here are a few suggestions: Overcome your fears, improve upon skills you have, find new inspiration in life, travel to places you’ve always dreamed of visiting, read new books, attend events of all kinds and introduce yourself to others. Step out of your comfort zone and accept life’s dare to grow. And though time may be of the essence, don’t feel pressured to do everything. Just one or two novel experiences may help you better appreciate life and renew your sense of purpose. Years ago, I enrolled in a summer workshop on the basics of writing a screenplay. I finished the course knowing much more about that craft. In addition, I met a host of people from a variety of backgrounds. We shared our work, stories, hopes and dreams, and I learned a lot about myself in the process. That summer seemed to pass slowly. As I watched the screenplay take shape, editing and revising the script became my sole reason to live. In anticipation of finally finishing my assignment, I’d forgotten that time existed. Now, I realize that just reliving the moments when we were happiest can help us recapture those past feelings of well-being and satisfaction. That’s when you may notice that time can, and will, stand still for you.

Kate Ferguson-Watson, Editor-in-Chief


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Living with a lung disease can be easier.

“I value the fellowship, education and support this group offers.” — Better Breathers Club member

American Lung Association Better Breathers Clubs are welcoming support groups offered at no charge for individuals living with lung disease – such as COPD, pulmonary fibrosis and lung cancer, and their caregivers. Led by a trained facilitator, learn better ways to cope with your diagnosis and live life to the fullest with chronic lung disease during these regularly scheduled educational programs. Plus, it’s fun and enriching to connect with others. Find a Better Breathers Club near you at or by calling 1-800-LUNGUSA.

Lung HelpLine 1-800-LUNGUSA |

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Poor Outcomes


What will it take to break the vicious cycle of poverty and bad health? IN A NUMBER OF RURAL COMMUNITIES in the South, pools filled with gobs of raw sewage from failing septic tanks and trenches seeping with scummy effluence crisscross backyards near areas where children play. There, diseases formerly found only in developing nations plague folks who share a trait that places them at a greater risk for illness: poverty. Among the conditions triggered by such unsanitary conditions are parasitic infections, such as hookworm, a disease that the introduction of indoor plumbing was thought to have all but eliminated. But today, the problem remains an issue in countrified areas of Alabama and likely other parts of the Southern United States, according to recent findings published in the American Journal of Tropical Medicine and Hygiene. “The depth and breadth of poverty and disease in Texas, the Gulf Coast and the Southern United States has been consistently underestimated,” says Peter Hotez, MD, PhD, the dean of Baylor College of Medicine’s National School of Tropical Medicine in Waco, Texas, and the lead author of the study. Hotez estimates that up to 12 million or more Americans currently live with neglected tropical diseases, the term used to describe a diverse group of

communicable illnesses prevalent in tropical and subtropical conditions. “The new findings of persistent hookworm infection among the poor living in the American South help to confirm my many concerns about neglected tropical diseases in the U.S.,” he says. “We still need to account for all the enabling factors responsible for tropical diseases in the U.S.—clearly, extreme poverty is an important factor.” According to Tom Boyce, MD, the chief of the University of California, San Francisco’s Division of Developmental Medicine, “Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality.” Research reveals that impoverished Americans face large and increasing disparities that shave years off their life expectancy. In addition, poor people are more likely than their wealthier counterparts to suffer from chronic mental and physical health problems. Trends show that income inequality in the United States has increased dramatically in recent decades, reports a brief by Half of Health Affairs, a leading U.S. kids live in journal about health policy or near and thought. What’s more, poverty. the summary also points

out that researchers are increasingly aware that such nonclinical factors profoundly influence health outcomes. “In a nearly step-wise fashion, lowincome Americans have higher rates of physical limitation and of heart disease, diabetes, stroke and other chronic conditions, compared to higher-income Americans,” report authors of the summary. “Americans living in families that earn less than $35,000 a year are four times as likely to report being nervous and five times as likely to report being sad all or most of the time, compared to those living in families earning more than $100,000 a year. These disparities emerge early in life and can be transmitted across generations.” This unequal distribution intersects with a variety of additional socioeconomic risk factors that include race, ethnicity, mass incarceration, sex, geography and educational status to create a complex relationship between poor health and poverty. Policies that support educational opportunities, affordable housing and social mobility can promote economic equity and better health for everyone. Conversely, policy moves that work against these benefits often trigger opposite results. —Kate Ferguson-Watson


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Status Report Why HIV testing is key

What happens if individuals with HIV skip or stop antiretroviral therapy? MANY PEOPLE WITH HIV MAY THINK about how wonderful it would be if they didn’t have to take daily antiretroviral (ARV) medication. One man, Steve, age 53, who has lived with the virus for almost 30 years, fantasizes that his positive test result years ago was a mistake. “I hate taking all these meds every day!” he says. Steve’s biggest beef was the nausea and headaches his ARVs caused. But these side effects, as well as other common issues, such as diarrhea and dizziness, are often short-term and can be minimized with other meds.

For some, a daily pill regimen can become tiresome and depressing. But Steve knows that stopping therapy would have serious consequences. When an individual interrupts HIV treatment, the virus becomes harder to manage and more resistant to meds and can rise to a detectable level, leading to progression of the disease once his or her CD4 count drops. (CD4s are special cells that find and destroy harmful bacteria and viruses in the body.) Overburdened by HIV? Talk to your doctor now. —Kate Ferguson-Watson


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ARV Interrupted

According to findings, the sooner that individuals diagnosed with HIV begin treatment with antiretrovirals (ARVs), the better off they’ll be. This is because ARVs lower the level of virus in the blood—called viral load— which reduces the risk of developing illnesses related to HIV and the chances of transmitting the virus to others. But because no test can detect the virus immediately after transmission, the Centers for Disease Control and Prevention (CDC) recommends that everyone between ages 13 and 64 get tested for HIV at least once as part of routine health care. How soon a test can pinpoint infection depends upon different factors, including the type of exam used. If the test is one ordered by a doctor, a laboratory will check for antigens or antibodies. If these substances are found, the lab usually confirms the result with a follow-up exam on the same blood sample used for the first test. However, if someone undergoes a rapid test for HIV that’s determined to be positive, he or she is referred to a health care provider for a follow-up screening. Three types of diagnostic tests are employed to find HIV: exams that detect both antigens and antibodies activated by the immune system if the virus strikes; one that checks only for antibodies that the body produces against HIV; and expensive nucleic acid tests (NATs) that check for HIV in the blood. (NATs are usually used only if someone experiences high-risk exposure to the virus or early symptoms.) The CDC stresses that testing helps folks who are HIV negative make better decisions about sex, drug use and health care, which can protect them from the virus and stop the spread of HIV. —KFW


Going Up Why the recent surge in hep C infection rates?

Get Up and Go! How to reclaim your vim and vigor FATIGUE AFTER A TOUGH DAY AT WORK OR A PARTICULARLY GRUELING BOUT OF PHYSICAL activity is normal. But being consistently tired, weak to the point of exhaustion, moody or foggy mentally could be a signal from your body that something is wrong. First, find out what’s causing the energy drain. Are you getting enough sleep or battling depression? Focus on the quality of your diet and exercise, experts advise. For example, eat foods with sugars that the body absorbs slowly (also known as low-glycemic), such as whole grains, high-fiber vegetables, nuts and healthy oils, such as olive oil, suggest experts from the Harvard Medical School. If the tiredness lingers past two weeks, book an appointment with your doc to get tested for conditions that may be to blame, such as anemia or hormonal deficiencies. “There are many different diagnostic tests available today,” says Eva Cwynar, MD, an endocrinologist and author of the book The Fatigue Solution. “Some must be done in a doctor’s office, and some you can do at home.” These tests can determine whether you’re lacking key nutrients or suffer from chemical imbalances that rob the body of vitality. In addition, a checkup can help determine whether the problem is a side effect of medications you take to treat allergies, blood pressure or some other health issue. Don’t give up, Cwynar stresses. Look into the matter. —Kate Ferguson-Watson

The Centers for Disease Control and Prevention (CDC) cited a “disturbingly high” rise in the number of reported cases of hepatitis C virus (HCV) and blamed the trend on an increase in injection drug use. “The shadow of the opioid crisis puts our nation’s progress at risk,” says Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Tackling hepatitis C requires diagnosing and curing people living with the virus and cutting off new infections at the source.” Many people who became addicted to prescription painkillers transitioned to heroin or other cheaper injectable opioids. This prompted folks to share needles, which upped infection rates. “Effective treatment for hepatitis C has become even more relevant today in light of the recent surge in new cases due to rising opioid use,” writes Anna Suk-Fong Lok, MD, an assistant dean for clinical research at the University of Michigan Medical School, in an article published by the online journal The Conversation. According to Lok, a preventive vaccine for hep C would be key in helping to eliminate this blood-borne illness. —KFW


THE ESTIMATED NUMBER OF AMERICANS LIVING WITH HEPATITIS C Source: Centers for Disease Control and Prevention

Fido’s Smell Test Can canines detect cancer? Stories about dogs detecting cancer in people abound. These anecdotes are supported by a wealth of research showing that trained dogs can distinguish odors emitted by volatile organic compounds in cancerous cells in the breath, sweat, urine and other bodily fluids. Which is not surprising considering a dog’s sense of smell is 10,000 to 100,000 times sharper than that of a human. But researchers caution that as long as there’s a risk of false positives, a system must be established

to verify and validate these doggy diagnoses. In addition, some experts, such as Cynthia M. Otto, DVM, PhD, director of the University of Pennsylvania School of Veterinary Medicine’s Working Dog Center, caution that various factors can interfere with a dog’s olfactory sense and throw it off. Incidentally, it should be noted that no one breed of dog seems better at detecting cancer. Experts say the best canine cancer gumshoes are dogs that are friendly, easygoing and eager to learn. —KFW


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This is only a brief summary of important information about BIKTARVY and does not replace talking to your healthcare provider about your condition and your treatment.



BIKTARVY may cause serious side effects, including:

BIKTARVY may cause serious side effects, including: } Those in the “Most Important Information About BIKTARVY” section. } Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY. } Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY. } Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. } Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. } The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).

} Worsening of Hepatitis B (HBV) infection. If you

have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to check your health regularly for several months.

ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS. Do NOT take BIKTARVY if you also take a medicine that contains: } dofetilide } rifampin } any other medicines to treat HIV-1

BEFORE TAKING BIKTARVY Tell your healthcare provider if you: } Have or have had any kidney or liver problems,

These are not all the possible side effects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY.

including hepatitis infection. } Have any other health problems. } Are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY. } Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

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

Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.


Tell your healthcare provider about all the medicines you take:

Take BIKTARVY 1 time each day with or without food.

} Keep a list that includes all prescription and over-the-

counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

} BIKTARVY and other medicines may affect each other.

Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.

Get HIV support by downloading a free app at

GET MORE INFORMATION } This is only a brief summary of important information

about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more.

} Go to or call 1-800-GILEAD-5. } If you need help paying for your medicine,

visit for program information.

BIKTARVY, the BIKTARVY Logo, DAILY CHARGE, the DAILY CHARGE Logo, KEEP MOTIVATING, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. Version date: December 2018 © 2019 Gilead Sciences, Inc. All rights reserved. BVYC0102 01/19

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Because HIV doesn’t change who you are. BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.

Ask your healthcare provider if BIKTARVY is right for you. To learn more, visit

Please see Important Facts about BIKTARVY, including important warnings, on the previous page and visit

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Have More Fun While Being Active The best cardiovascular workouts don’t really feel like exercise.

How high-intensity interval training helps folks whip themselves into shape quickly A PRIMARY REASON INDIVIDUALS CITE FOR NOT EXERCISING REGULARLY IS BEING short on time. But high-intensity interval training (HIIT), characterized by workouts that tax the body with short periods of vigorous activity followed by brief periods of rest, are an effective way to burn fat, torch calories and get fit, according to findings from a number of studies. Much of the research on HIIT has focused on aerobic exercise; as a result, the exercise program’s ability to help people quickly achieve cardiovascular health has been confirmed. But now, the results of a study conducted by the American Council on Exercise show that when applied to weight training, HIIT principles can also help individuals build muscle more rapidly. But observe this key bit of advice from experts for safe cardio and weight training: Before working out, learn the proper techniques for all exercises and activities in order to avoid injuries. —Kate Ferguson-Watson


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Hard HIIT-ing Principles

Have you ever danced, swum, roller skated or participated in other physical activities that you thoroughly enjoyed? All these pastimes qualify as cardio, or aerobic, exercise, but chances are not one of them made you feel like you were doing hard work. To qualify as cardiovascular exercise, an activity must raise your heart rate (beats per minute) to between 50 and 70 percent of the maximum you can endure during physical activity. (To calculate your maximum heart rate, subtract your age from 220.) Each of the previously mentioned activities meets this requirement. Aerobic exercise positively affects the entire body, boosts mood and energy levels, promotes better sleep, releases stress-taming hormones and builds a stronger immune system. To reap these head-to-toe benefits of cardio, experts suggest people walk, run, bike, row, climb stairs, jump rope and engage in circuit training. —KFW



A Big Lie Fat is bad for you. YEARS AGO, NUTRITIONISTS CAUTIONED individuals to steer clear of “fattening” foods on a list that included nuts, seeds, avocados and olives. But eventually, findings showed that these plant-based foods as well as oily fish, such as salmon, sardines, mackerel and tuna—all rich in omega-3 fatty acids—are good sources of healthy monounsaturated and polyunsaturated fatty acids, which lower the risk of cardiovascular disease and type 2 diabetes. According to the American Heart Association, the body needs dietary fats for energy, cell growth, regulation of body temperature, nutrient absorption, hormone production and protection of

the vital organs, such as the kidneys, heart and intestines. The avocado is the fattiest fruit. Nearly 85 percent of its total calories are from fat, surpassing the olive, which also contains healthy fat. “While fat is often regarded as a bad word, not so when it comes to the avocado,” says Ian K. Smith, MD, in his book The Clean 20: 20 Foods, 20 Days, Total Transformation. These fatty foods help lower levels of LDL, or bad cholesterol, and provide a host of vitamins, minerals, fiber and other phytonutrients, Smith adds. But to avoid excess calories, be sure to eat these healthy fats in moderation. —Kate Ferguson-Watson

People with allergies to certain foods can stay safe in a number of ways when eating at restaurants. But those who employ multiple preventive techniques at once experience the fewest problems, according to study findings presented at the recent American College of Allergy, Asthma and Immunology Annual Scientific Meeting in Seattle. For the study, researchers reviewed answers to a 25-question survey given to members of a food allergy network to identify the different methods individuals use to avoid allergic reactions. The top five tactics included alerting a waiter about their condition, ordering menu items with simple ingredients, examining food before eating, avoiding restaurants with a likelihood of contamination and checking menus online beforehand. Scientists noted that diners who used 15 strategies on average when eating out had fewer allergic reactions than those who applied an average of six techniques. —KFW


Foods that contain good bacteria Many people know that both good and bad bacteria inhabit the gut. But fewer folks may realize that certain foods can increase the number of the right microbial colony-forming units (CFUs) in their belly. According to experts, the best foods for a healthy gut are those rich in fiber or other nutrients and fermented fare. This is because they contain either beneficial bacteria known as probiotics or prebiotics, the stuff that fuels these good microbes. Found in certain fruits, veggies and whole grains, fiber is, perhaps, the best-known prebiotic. Two types of fiber, soluble and insoluble, provide gut bacteria with the energy, vitamins and special fatty acids needed to boost immune function, decrease inflammation and protect against obesity. Fermented foods include pickled cabbage, such as sauerkraut and kimchi, and other brine-soaked veggies (think cucumbers) as well as soybean products, such as miso and tempeh. (Beware their salt content, however.) In addition, cultured dairy products, such as plain yogurts and kefir (both available made from nondairy sources), and dandelion greens, seaweed, flaxseed, garlic and gum arabic offer a wide range of bacteria strains to boost the number of CFUs populating the gut. —KFW



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

Which qualities or behaviors are red flags not to be ignored in your relationship? In healthy relationships, partners are loving, sexually compatible, respectful, trustworthy, honest, communicative and emotionally available. But if folks exhibit any of the tendencies below, heed the handwriting on the wall:

Cancer doesn’t have to bring sexual intimacy to an end. SEX MAY BE THE LAST THING ON A person’s mind after a cancer diagnosis. But once the initial shock wears off and treatment commences, questions may arise about how soon patients can resume intimate activities. Any type of experience with cancer can affect a person’s body image, emotions and relationships, experts explain, and all these factors significantly impact what individuals— and their significant others—think about sexuality. In findings presented at the 2015 annual meeting of the American Society of Clinical Oncology, researchers found that younger patients diagnosed with ovarian or cervical cancer who received chemotherapy and were in committed relationships were at a high risk of sexual dysfunction. As a result,

the scientists concluded that doctors ought to provide people with information about the possible changes cancer treatment could have on their sex life. But if a physician doesn’t initiate this conversation, individuals should take charge and broach the subject. Folks should start by talking with their cancer specialist, experts suggest. The next step for patients is to visit either a clinical psychologist or sexual therapist to solicit support and advice about ways to continue being intimate in the face of a diminished sex drive, erectile issues, vaginal dryness or other difficulties related to cancer treatment. The good news is that many of these problems are temporary and generally improve once cancer therapy ends. —Kate Ferguson-Watson


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Untrustworthiness. Habitual behavior of this kind triggers credibility issues that render communication and honesty impossible in a relationship. Partners who don’t hold themselves accountable to loved ones are irresponsible and lack respect and integrity. Incompatibility. If individuals are total opposites sexually, morally, or in other key ways, this can create huge problems in a relationship. Constant insecurity. Those who allow fear and self-doubt to cultivate unwarranted suspicion, paranoia and jealousy in their hearts toward their mate can destroy a union. Codependency. This unhealthy condition smothers growth for both people in a relationship. Emotional immaturity. Individuals who display this characteristic aren’t yet adults emotionally, so they’re not ready for a grownup union. A lack of commitment. Significant others who cheat, become involved in illegal activities or lead double lives are essentially unavailable to their partners and cannot build or sustain solid relationships. Abusive behaviors. Verbal, emotional or physical violence perpetrated by a partner is never acceptable.


Making Adjustments

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Bobby Brown believes everything he has lived through has helped mold him into a better man.


That’s why starting and staying on HIV-1 treatment is so important.


DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.

DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.


What is the most important information I should know about DESCOVY? DESCOVY may cause serious side effects: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to monitor your health. What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: • Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking DESCOVY. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems. • Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that

can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. • Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. The most common side effect of DESCOVY is nausea. Tell your healthcare provider if you have any side effects that bother you or don’t go away. What should I tell my healthcare provider before taking DESCOVY? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take DESCOVY with all of your other medicines. • If you are pregnant or plan to become pregnant. It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088. Please see Important Facts about DESCOVY, including important warnings, on the following page.

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

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IMPORTANT FACTS This is only a brief summary of important information about DESCOVY and does not replace talking to your healthcare provider about your condition and your treatment. ®



DESCOVY may cause serious side effects, including: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking DESCOVY. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to check your health regularly for several months.

DESCOVY can cause serious side effects, including: • Those in the “Most Important Information About DESCOVY” section. • Changes in your immune system. • 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. The most common side effect of DESCOVY is nausea. These are not all the possible side effects of DESCOVY. Tell your healthcare provider right away if you have any new symptoms while taking DESCOVY. Your healthcare provider will need to do tests to monitor your health before and during treatment with DESCOVY.

ABOUT DESCOVY • DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. • DESCOVY does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.

BEFORE TAKING DESCOVY Tell your healthcare provider if you: • Have or had any kidney or liver problems, including hepatitis infection. • Have any other medical condition. • Are pregnant or plan to become pregnant. • Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. 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 DESCOVY.

GET MORE INFORMATION • This is only a brief summary of important information about DESCOVY. Talk to your healthcare provider or pharmacist to learn more. • Go to or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit for program information.

HOW TO TAKE DESCOVY • DESCOVY is a one pill, once a day HIV-1 medicine that is taken with other HIV-1 medicines. • Take DESCOVY with or without food. DESCOVY, the DESCOVY Logo, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: September 2017 © 2017 Gilead Sciences, Inc. All rights reserved. DVYC0085 11/17

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“You only live once.” So goes the saying, but entertainer Bobby Brown, age 50, was able to relive his past during the filming and airing of a two-part miniseries he executive produced with his current wife and manager, Alicia Etheredge-Brown, through their company, Brown Ribbon Entertainment. THE BOBBY BROWN STORY AIRED ON Black Entertainment Television (BET) last year and drew more than 6.6 million viewers who traveled back in time with the iconic star to watch him experience the personal tragedies and triumphs that affected him both physically and mentally and helped mold him into the man he is today. “It was an experience to have to relive a lot of the things that, probably, weren’t so good, and it was kind of surreal to see all of the things that I’ve been through, and I’m able to still be here, standing strong and moving on with my life,” Brown says. “It’s just a great thing, and watching the movie was like therapy.” A few events that occurred in Brown’s life—such as the stroke he suffered in August 2001—surprised many of the singer’s fans. During the BET recap program Rewind That!, actress Gabrielle Dennis, who plays Whitney Houston in the miniseries, recalls the dramatic reenactment. “That was a very difficult scene,” she says. “It was difficult to watch and to be a part of, in the sense that I had to take myself out of it as a spectator because I’m in it and not supposedly knowing what’s going on. Bobby would come to the set, and some days were easier than others. This was definitely a scene that was hard for him to get through.” Dennis says Brown told her that her portrayal of his deceased wife during this crisis was amazing to him. He offered only one suggestion during the filming of the intense scene. “He said, ‘You gotta bend down and put your finger in front of my nose to see if I’m breathing. I remember her doing that,’” Dennis recalls. By this point in his life, Brown had slipped deeper into drug addiction. But this horrific incident wasn’t

enough to motivate him to put an end to his substance use. “Jail got me to stop taking drugs,” Brown said during an interview on The Dr. Oz Show. “I never wanted to go back to jail. I didn’t want to be incarcerated ever, ever again.” Thoughts of his children also acted as a sort of intervention. “I didn’t want my kids to grow up and see me in that type of light,” he

Above: Bobby Brown with his wife, Alicia Etheredge-Brown, and their three children. Below: Brown and Etheredge-Brown with officials from the City of South Fulton.

told the talk show’s host, Mehmet Oz, MD. “I’ve always been one to want to grow, to want to be better and better on the next day. If I’m bad yesterday, I want to be better the next day, especially for my children. I mean, my children mean everything to me, everything. I wouldn’t be here if it wasn’t for them, so I try to be as strong as possible for them every day. And it takes every day for me to do that.”

During another segment of the interview, Oz handed the entertainer a healthy brain to look at and feel. Then he had Brown compare the soft, folded sections of the organ’s tissue to cross sections of a brain damaged by stroke. Oz instructed Brown to press visibly blackened areas embedded in sliced sections of the organ and explained that this blackening, or scarring, occurs when a rise in blood pressure brought on by drug use causes blood to seep into the brain. Shuddering, Brown prodded the slices of brain and declared that these parts felt “rock hard.” In general, substance use can trigger strokes, heart attacks and respiratory failure as well as increases in blood pressure, heart and breathing rates, and body temperature. Oz explained to Brown that this brain scarring might have caused Brown’s mouth to droop on one side after his stroke. “The brain’s remarkable ability to recover will let it make new paths to make up for that problem,” Oz said. “You just can’t keep doing it over and over again; that’s the beauty of stopping the bad habit.” AFTER HIS STROKE, BROWN VOWED to live differently from how he had been. Today, he remains committed to personal growth in all areas of his life and leads a healthier lifestyle. He also has a line of products that includes healthy sauces made from tomatoes, herbs and peppers; blended seasonings; and a coating mix for frying and roasting poultry, meats, fish and veggies. “All of the Bobby Brown Foods products use all-natural ingredients with a focus on reducing sugar, sodium and preservatives from our diet,” Brown says. His efforts to cope with the death of


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his and Houston’s daughter, Bobbi Kristina, at age 22 prompted another development in Brown’s life. IN MEMORY OF HIS DAUGHTER, Brown founded the Bobbi Kristina Serenity House, a nonprofit organization that currently offers help and support via its website,, to individuals who experience or are affected by domestic violence. “I know my daughter is always with me, and I know she’s very proud of what we are doing in her name,” Brown says. The official cause of Bobbi Kristina’s death was reported as pneumonia caused by the immersion of her face in water in a bathtub and drug intoxication from a mix of meds. Her estate filed a lawsuit that alleged Bobbi Kristina was physically abused by her boyfriend, Nick Gordon, and Brown later joined the suit. (Gordon lost by default.) “On the days that they were shooting those scenes [focusing on Bobbi Kristina], I really couldn’t be on the set, so my wife was always there and I would stay home with the kids,” he says. “She made sure that everything was accurate. But it was kind of difficult; it’s always difficult when you’re dealing with something like that.” Last summer, Brown and his wife received a proclamation from Bill Edwards, the mayor of South Fulton, 2 0 RE A L H EALT H S P R ING 2019


Georgia, and other local officials, for the couple’s plans to launch a 24-hour crisis intervention hotline and emergency transitional center for male and female domestic abuse survivors. Brown says his family lives every day

BOBBY BROWN SAYS WATCHING HIS LIFE UNFOLD ON TV WAS LIKE THERAPY. with the pain of losing Bobbi Kristina under these circumstances. “She was just this funny little girl who could sing, dance; she was just a beauty to be around—my baby. I loved her smile because she smiled just like her father. But she’s in my heart. She follows me everywhere I go, and my two little daughters are just like her. I see Bobbi

Kris in both of my daughters, and that’s the beautiful part. It’s like she was reincarnated into my daughters, and they look just alike.” Brown’s two little girls—Bodhi Jameson Rein and Hendrix Estelle Sheba—and son Cassius are the singer’s children with Etheredge-Brown. Brown also has two older sons, Landon and Bobby Brown Jr., and an older daughter, LaPrincia. “They are the most beautiful kids that I ever could ask for,” Brown says. “My older children were there for each other and their younger siblings, and they grieve too. We all grieve, but we have to get through it because life must go on, and they realized that. They’re always together, so it’s funny to just sit down at the table with six kids and two granddaughters and know that this is my family.” Brown says the most difficult thing for him was having to let go of Bobbi Kristina. “I know that she is safe now. She’s not in harm’s way and I’m glad for that,” he says. “She doesn’t have to suffer any more. She’s not suffering, and, like I said, she’s always with me, so just knowing that I have her here in my heart is everything for me.” A message from Brown on the organization’s site states its mission. “We seek a world without Domestic Abuse, Bobbi Kristina’s Serenity


Veteran entertainer Bobby Brown has been performing for almost 40 years.

House is that forum…our collective voices will be heard. We may not know what the future holds, but we do know that it lies in the hands of our children. Thus, the decision is not whether we should invest in the future of our children, but how soon we can make the commitment.” Brown says he’s still waiting to build a home for abused women, men and children. “Domestic violence is a disease; it’s something that we need to get the cure for and the Bobbi Kristina Serenity House is a safe haven for those who are in that situation,” he says. He asks that people visit the Serenity House website and donate to support the organization and help fund construction of a shelter in Atlanta and others elsewhere. “We’re trying to build homes in different cities for domestic abuse survivors,” he says. “We’ve got a lot of people who are helping out.” TO THOSE WHO KNOW INDIVIDUALS who are enduring domestic violence in one form or another, Brown says, “Just lend them your ear and be kind because they are going through something that is hard for them,” he says. “Domestic abuse affects the whole community; it affects the whole family, so just be there for them.” Today, Brown is proud of his resilience. He believes the bad times that tested him strengthened his character. The loss of his daughter also changed

him in another positive way. “I think it helped me grow to want to be a better man,” he says. “Life throws you curveballs sometimes, but you have to know that some things are meant to be. Sometimes you have to take the bad with the good and be able to move on.” ULTIMATELY, WITH HIS NEW FAMILY, perhaps it can be said that Brown received a second chance, an opportunity to create a new life that allows him to apply all the lessons he’s been taught. “I learned that I’m a lot stronger than I look and my heart is a lot heavier,” he says. “But with the help of my wife and my family, I’m able to get over some of the bad days,” he says. “Sometimes I wake up and don’t want to get out of bed. But I know there’s so much to do and so little time. Life’s not promised to you tomorrow. But if you live healthy and you love strong, there’s no telling how long you can be here.” Once known as the “Bad Boy of R&B,” Brown now subscribes to a totally different outlook on life. “Bobby today is definitely a family man who’s content with being that,” he says. “I’m content with staying for real with my kids and with my wife. I used to be out partying and all types of things. I don’t do that anymore. Now it’s about respecting the life I live with my wife and my kids and respecting myself as a man, a husband and a parent.” ■

GOOD GRIEF Take baby steps to help you heal. When individuals lose loved ones, or weather some other life-altering experience, they need time to mourn the loss, recover and move forward with their lives. But everyone processes these events very differently, as the healing process for each person is unique. Nevertheless, folks can effectively negotiate such trying times in a number of ways. Below are a few suggestions from experts: Allow yourself to grieve. Be patient, and take things one day at a time; it takes time to mourn your loss. Remember the happy times you spent with your loved one and celebrate those moments, which will keep that person alive in your heart. Seek support. Don’t be afraid to turn to family and friends. Make them aware of your loss and ask them to lend a sympathetic ear if you need to talk.


Keep living your life. Stay active and take care of yourself. Don’t withdraw from the world. Continue to make plans for the future; focus on goals you want to achieve and new skills you want to learn.

Actor Woody McClain, center, plays Bobby Brown in the BET miniseries.

Appreciate the little things. Learn to stop, look and listen so you can find the beauty in your surroundings. See the humor in life and don’t forget to laugh. —KFW


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he growing area of research known as

nutritional psychiatry examines how the food choices we make influence our mental state and behavior. In addition, because studies have shown a connection between food, inflammation and mental illness, this rapidly evolving science also focuses on how doctors can use food and supplements to help treat mental health disorders. A related area of inquiry is the exploration of the equilibrium between good and bad bacteria in our digestive system, or gut, which scientific evidence confirms can affect digestive function, inflammation in our bodies and mood and energy levels. Elisa Shankle, co-owner of HealHaus, a wellness center and café in Brooklyn, learned this fact the hard way. She now knows that healthy bacteria benefit the gut, which regulates many bodily functions. “If bacterial balance in the gut is off, toxins can seep into your organs and bloodstream,” says Shankle. “This is why it’s important to keep your gut bacteria under control and as neutral as possible.”

and the foods I ate,” she explains. Certified nutritionist Mindy Lu, founder of the website, agrees that taking antibiotics may lead to depression. “These medicines have a tendency to wipe out our gut microbiome, which is where most of our neurotransmitters related to mood are created,” she explains. “Lately, there has been significant research about just how responsible neurotransmitters—such as serotonin and dopamine—which are produced largely by our gut microbiome are for mood. That’s why it’s really important to have a healthy gut system.” Lu advises people to avoid strict eating regimens. “In my

experience, [these kinds of] diet plans increase anxiety for people and often lead to disordered eating,” she says. “I try to encourage people to listen to their bodies and mood.” Additionally, she believes food deprivation can contribute to depression. “Without nourishment, our brains and bodies have difficulty processing information, finding motivation and functioning in a way that feels balanced and healthy,” she says. “Food cannot be reduced to ‘what we eat equals how we feel,’ but it is a very layered relationship,” Lu continues.

When she was in her 20s and worked in a stressful corporate setting, Shankle suffered from depression and anxiety. “I was also dealing with something called candida, an overgrowth of yeast that happens in your gut,” she explains. “It’s usually a reaction to a lot of your healthy flora being killed off. It happened to me because of antibiotics I was taking at the time. These meds really messed up my gut bacteria, but I didn’t really know what was happening. I was just having all these digestive issues.” In addition to getting therapy for her depression, Shankle

started going to a naturopathic doctor who advised her to begin an elimination diet. The objective was to stop consuming any substances, such as gluten, sugar and alcohol, that might be overloading her system with yeast. “That was when my life changed,” she recalls. At the same time, Shankle began to study healing herbs. “I started making my own teas and tinctures for anxiety and depression,” she says. “But when I changed my diet, that’s when my depression started to lift.” Shankle hasn’t suffered from chronic depression since. “I owe a lot of that to changing my lifestyle, my work environment 2 4 RE A L H EALT H S P R ING 2019


“Oftentimes, it’s not just about what we eat but how and when we eat it and what else we eat it with. For example, caffeine’s impact on the body is quite complicated. When consumed throughout the day in large amounts, this stimulant can increase anxiety and depressive symptoms—from the inevitable crash—and influence sleep quality. However, an individual’s body will respond to caffeine differently depending on their tolerance for it, if they ingest it with other foods, how active they were that day, what their stress level was, etcetera. That said, I have noticed that caffeine and sugar seem to impact people’s moods the most.” While Shankle eliminated such inflammatory foods as dairy, she incorporated fermented foods and probiotics into her diet to increase healthy gut bacteria. “Generally, individuals have experienced an improvement in mood when incorporating probiotics into their diet,” Lu says. “Probiotics as a whole food can include miso, live-culture yogurt, sour cream or kefir, or fermented veggies, such as sauerkraut or kimchi. In addition, you can find probiotics in supplement form in grocery stores.” Lu has discovered that probiotics seem to help lessen the effect of antibiotics on people’s moods. “If individuals go



the supplement path, I encourage them to rotate different brands to diversify the probiotic strains in their digestive systems,” she says. “The reason for this is because most of our neurotransmitters are created by the microbiome that lives in our gut and is essential to nurturing people’s moods.” Additionally, Lu suggests incorporating prebiotics, in the form of fruits and vegetables, which probiotics need in order to thrive. Sugar can also put folks at risk for depression and anxiety, says Trudy Stone, a certified culinary nutritionist. “People who are depressed have low levels of the hormone serotonin, 90 percent of which is produced in your gut,” she says. “If you have poor gut health due to eating too much sugar, you’ll run into issues with important gut functions, such as serotonin production, in addition to digestion and immune cell formation. “Also fluctuating blood sugar, especially when your blood sugar crashes, can trigger anxiety attacks,” she adds. Stone recommends eating certain foods to reduce cravings for sweets. “Avocados are a great source of healthy fat that will help to beat sugar cravings and also help to improve your mood,” she says. “As for food that’s added to help with moods, I just ask people to make sure they are getting grains and proteins in all their meals throughout the day,” Lu says. “I have noticed a large improvement in people who integrate an afternoon snack that includes both a grain and protein.” In addition, Lu advises eating meals and snacks that include all food groups throughout the day. For example, consuming proteins and grains at all three meals (breakfast, lunch and dinner) and as part of snacks may help with anxiety—particularly in the afternoon. “Depression can often feel like fatigue—or vice versa—so

I also encourage people to make sure they are well-nourished throughout the day,” Lu says. “One nutrient that I focus on is protein because neurotransmitters are all made from amino acids, which are proteins. To make sure our bodies have everything they need to make neurotransmitters, we need to make sure we supply the protein they need.” Lu doesn’t believe any foods should be completely eliminated from one’s diet. “I’ve found that that is not sustainable,” she cautions. “Who wants to cut sugar out of their lives completely?” Still, the standard American diet (the acronym, appropriately, is SAD) is “lacking in many vitamins, minerals and nutrients that are important for the brain to function well,” Stone observes. She notes that a study in the British Journal of Psychiatry found that consuming processed foods, such as refined carbohydrates, increases the risk of depression by 60 percent. Other findings show that a good quality diet is key to preventing mental disorders. Lu suggests that people simply notice how their bodies feel after they ingest foods with ingredients such as caffeine and sugar. “Then make decisions based on the data you collect,” she says. “This is a way for us to have ownership over these foods, not the other way around.” ■

Meals and Moods Some nutrients affect how we feel.

Trudy Stone, a certified culinary nutritionist, believes certain foods, such as eggs, fish and dark leafy greens, are key to brain health and can help regulate our mood. “Our brain cells depend on certain nutrients, and when we don’t get them, we don’t function as well,” she says. The following are some of the powerhouse substances found in the foods we consume:

B Vitamins

“Vitamin B-12 and others in this family of nutrients help to produce brain chemicals that affect mood. A B-12 deficiency causes irritability and depression,” Stone says. “Vitamin B-6, in particular, helps manufacture neurotransmitters, such as serotonin, which aids in the body’s ability to cope with depression, stress and anxiety.”


“Known as the antistress mineral, magnesium eases your nerves and mind and has been used to treat clinical depression. A deficiency can lead to fatigue, insomnia, anxiety and depression. Almost 70 percent of the U.S. population is deficient in magnesium,” Stone says. “Studies show that there is a greater prevalence of magnesium deficiency among African Americans compared with other populations.”

Vitamin D

Also called “the sunshine vitamin, this nutrient helps improve mood and relieves anxiety and depression.”


“Iron is vital for creating the mood-regulating neurotransmitters serotonin and dopamine,” Stone notes. “An iron deficiency can cause extreme fatigue, irritability and mood swings.”

Omega-3 Fatty Acids

An omega-3 deficiency has been associated with bad mood, cognitive decline and poor comprehension.


Findings show that lower levels of zinc are associated with mood disorders, including depression. —GES


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especially white gay men, but Black women? Not so much. And it makes me so mad because I’m the one sitting in the room when they’re being diagnosed thinking to myself,

contract HIV than white women. Just a few years ago, in 2014, Black women living with the virus had a higher death rate than women of all other races and ethnicities. Translation: Among women, African-American females bear the brunt of the HIV epidemic. But if we already know this to be true, why aren’t more Black women, especially those living in the South—the hotbed of new HIV infections—taking PrEP in droves? Well, you can’t take what you don’t know exists. ACCORDING TO A RECENT CDC INVESTIGATION, OUT OF 258,080

heterosexually active adults who could potentially benefit from PrEP, 68 percent (176,670) were women. However, separate data from Emory University in Atlanta found that out of 61,298 active PrEP prescriptions, men were 10 times more likely to be the recipients than women. Researchers also concluded that men were four times more likely than women to get a PrEP prescription when needed. In 2017 alone, only 2,695 women in the U.S. had active PrEP prescriptions, compared with 58,603 men. That’s pretty disheartening—but all is not lost. Anar Patel, MD, a physician who worked as a researcher on the Emory study, says findings from one study she conducted showed that once women were told about PrEP and understood how it worked and its potential side effects, the majority of those who were eligible for the prevention pill said they were willing to take the medication as long as it was safe and effective. “They really liked the idea of having more control over their prevention methods, especially since more than half of the respondents said they didn’t trust their sexual partners. Others also admitted to not even knowing if their partner had HIV,” she says. “This is also why we have to educate women on their own HIV risk. Too many are unaware of their vulnerabilities and therefore won’t really be open with their health care providers about their need for PrEP,” she adds. But why don’t need, awareness and willingness translate into equal access when it comes to PrEP?

WHEN BLACK WOMEN LEARN ABOUT PrEP AND KNOW HOW THE DRUG WORKS, MANY OF THEM ARE WILLING TO TAKE THE MEDICATION. This could have been prevented,” says Gina Brown, the community engagement manager for the Southern AIDS Coalition, who does PrEP outreach in New Orleans and is living with HIV. “Folks keep talking about getting to ‘zero new HIV infections,’ but how’s that going to happen if we keep ignoring Black women?” Brown makes a great point. According to the Centers for Disease Control and Prevention (CDC), in 2016, among all women who received an HIV diagnosis in the United States, 60 percent were Black. In addition, Black women are 20 times more likely to 2 8 RE A L H EALT H S P R ING 2019



given to addressing HIV risk among men who have sex with men (MSM) since PrEP first secured FDA approval. Indeed, this focus makes sense since MSM account for roughly 67 percent of new HIV diagnoses nationally each year. But LaQuandra Nesbitt, MD, MPH, the director of Washington, DC’s department of health (DC Health), adds that for far too long the faulty notions that women don’t want PrEP or that it may not work for them have prevailed.


magine there were a magical little blue pill that HIV-negative people could take every day to protect them against HIV. Now think about how big an impact this tiny wonder could have if those who needed it most in Black America, especially women, could get their hands on it. Guess what. Such a drug already exists. In 2012, the Food and Drug Administration (FDA) approved Truvada, the oral antiretroviral medication, as pre-exposure prophylaxis (PrEP), to prevent HIV. Studies have shown that among women, using Truvada daily reduces the risk of HIV via sexual intercourse by more than 90 percent. Thanks to this biomedical intervention, new infections around the country have decreased. Exciting news, right? Well, when you lean in and look a little closer at who’s benefiting from PrEP and who’s being left behind, the news isn’t quite so encouraging.

As a result, in 2016, DC Health launched #PrEPHer. The city’s first PrEP campaign targeting African-American women sought to let Black women know that the HIV prevention method isn’t only for gay and bisexual men. “We let our community know that PrEP is for anyone at risk for HIV. We needed Black women—the second most affected group to be diagnosed with HIV in DC—to know that not only is it appropriate for them, but it’s effective too,” Nesbitt stresses. Surprisingly, in spite of medical mistrust and other concerns, the community responded positively to the campaign— especially in initial focus groups—despite expressing anger that no one had told them about PrEP before. “Honestly, they were pissed—excuse my language,” she says. “They didn’t understand how if PrEP had been around for years, why this was the first time they were hearing about it.” Linda Blount, the president and CEO of the Black Women’s Health Imperative, also wants that question answered. “We know PrEP works; we know that the drug is expensive but you can get it at little or no cost at Planned Parenthood and other community clinics,” she says. “There is no legitimate reason why Black women continue to get left behind on this issue.” Clearly, doctors must also do their part to help educate African-American women about PrEP. But many medical professionals—especially ob-gyns and providers at women’s clinics in the South—don’t know enough about PrEP themselves to prescribe it to their clients. Or they may not fully understand the tests associated with monitoring its use. So awareness efforts must target potential eligible patients as well as providers. “See, for Black women, getting PrEP isn’t the problem. The problem is getting a prescription,” says Blount. “We don’t have enough primary care providers who prescribe PrEP to women, and, to be honest, that’s about sexism,” she continues. “Although HIV is an equal opportunity infection, providers still focus more on MSM and just don’t think about women.” Patel adds that even when health care workers are aware of PrEP, many of these professionals may not assess women’s risk factors accurately enough to prescribe the medication. “THE EXISTING CDC GUIDELINES MAY NOT BE SPECIFIC ENOUGH

to target those at risk,” Patel says. “They don’t take into consideration other factors linked to HIV transmission, such as local HIV prevalence, history of partner or sexual violence, or transactional sex (exchanging sex for drugs, money, housing or other commodities).” Blount notes another reason women are falling through the cracks: stigma. “I saw a study that found that medical students were less likely to prescribe PrEP to women and people of color because they didn’t think they would adhere to it or would engage in risky sexual behavior,” she says. “So people who need it aren’t getting it. Right there, we’re talking about bias and shame.” Brown agrees. “Some providers associate PrEP use with

being promiscuous or being a sex worker, so they don’t want to offend anyone by bringing up PrEP,” she explains. “And then sometimes, the patient doesn’t want to bring it up out of fear of being judged or asked, ‘Why do you need PrEP?’” She adds that if individuals are truly serious about ensuring that Black women are a vital part of the discussion about PrEP, folks must let go of these outdated hang-ups and start having the tough conversations with their providers, patients and partners. “I know taking a pill every day is not ideal, but if you can take a birth control pill or a vitamin every day, why not PrEP?” asks Brown. “It’s just one tool in our box to help bring us closer to ending this epidemic.” Brown sums it all up like this: “As someone who’s been living with HIV for 24 years, I know had PrEP been offered to me, I definitely would have taken it.” ■

HIV and Parenthood PrEP helps during pregnancy. When you’re an HIV-negative woman in a relationship with an HIV-positive man (meaning you are a serodiscordant couple) and you have dreams of having a baby together, can you conceive safely? The answer is simple: Absolutely. Women who take PrEP can drastically reduce their risk of contracting HIV as well as that of their baby. Here’s what you need to know: Each serodiscordant couple is different, so it’s crucial that individuals schedule a consultation to get prescribed, tailored treatment that fits their particular medical needs. If a man with HIV has an undetectable viral load, which means the amount of virus in his blood is so low that he cannot transmit the virus, a woman does not have to use PrEP. But that’s a personal decision the couple and the doctor must make together. Having condomless sex while on PrEP is one way to conceive. A common method is to undergo artificial insemination either at a clinic or at home. Studies have shown that PrEP is relatively safe among pregnant women, but there aren’t any data showing its long-term effects on children. We do know, however, that the drug doesn’t increase the risk of birth defects. PrEP is effective, but it doesn’t come with a 100 percent guarantee against HIV, and it doesn’t protect against other sexually transmitted infections. PrEP is only one tool women have if they want to start a family with a man living with HIV. —KT


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MARIJUANA PRESCRIPTIONS A BRIEF MEDICAL HISTORY OF CANNABIS AS MEDICINE Cannabis seeds and oil were used as food in China as far back as 6000 BCE. In 2737 BCE, Emperor Shen Neng of China consumed the plant as medicine, marking the first recorded such use. And in his encyclopedia Natural History, completed in the year 77 CE, the Roman philosopher and author Pliny the Elder cited the analgesic effects of cannabis. Much later, in 1800, marijuana plantations flourished in America’s Southern states, including Mississippi, Georgia, South Carolina and Kentucky. In 1840, medicines made with a cannabis base were easily available. Until 1915—shortly after the Harrison Act of 1914 criminalized the use of marijuana—the medicine could be purchased in pharmacies. Then, in 1919, Congress ratified the 18th Amendment of the U.S Constitution, which banned alcohol and triggered a rise in the manufacture and sale of marijuana as people sought an alternative recreational drug to liquor. In 1936, the propaganda film Reefer Madness attempted to stop American youth from smoking pot by using scare tactics. One year later, Congress passed legislation that criminalized the drug. Interestingly, in 1942 scientists working for the Office of Strategic Services, the precursor to the CIA, laced cigarettes with cannabis and administered the drug as a truth serum to prisoners of war during interrogations. Finally, in 1976, a federal government research program allowed some patients to receive nine pounds of marijuana from the government for medical use. Twenty years after that, California became the first state to legalize medical marijuana again for people with AIDS, cancer and other life-altering illnesses. A number of other states followed. —JLP


UMAN BEINGS HAVE A LONG HISTORY WITH cannabis, aka marijuana. The plant’s origins trace back to the ancient world, and there’s evidence of its use more than 5,000 years ago in what is now Romania. Cannabis was described in the United States Pharmacopoeia (USP)—a publication that compiles legally recognized standards of identity, strength, quality, purity, packaging and labeling for drug substances—for the first time in 1850. In the 19th and 20th centuries, cannabis was widely used as an ingredient in tinctures and extracts intended to alleviate such ills as stomachache and nausea. But in 1937, the federal government restricted both the use and sale of marijuana by passing the Marihuana Tax Act. Five years later, cannabis was dropped from the USP. The Boggs Act of 1951 and the Narcotic Control Act of 1956 criminalized marijuana with increased legal penalties for its possession. Then the Controlled Substances Act of 1970 prohibited the use of cannabis, which, in turn, limited the extent to which scientists could procure it for academic research. But all that changed when in 1996 California enacted the Compassionate Use Act and became the first state to allow legal access to marijuana for medical purposes. By the end of 2018, 33 states and Washington, DC, allowed legal access to medical marijuana while a number of others decriminalized possession of the plant for either medical or recreational use. Currently, cannabis is near to completing a cycle as the controversial botanical transitions from illegal substance to a therapeutic medicine embraced by much of the public. Now, ads touting the medicinal benefits of THC and CBD, two of marijuana’s chemical components, or cannabinoids, are appearing everywhere. THC is the psychoactive agent in cannabis, and CBD, is the non-psychoactive component of the plant, which is found in many pain medications. Of the two ingredients, CBD has a tamer legal profile; as a result, sales of products containing this cannabinoid—for pain, sleep, anxiety and more—are thriving. “The future for CBD is very bright,” says Justin Amesbury, the director of research and development at Lazarus Naturals, an industrial hemp company based in Portland, Oregon, that produces a line of CBD products. “As we continue to uncover more of the potential benefits of CBD and how CBD interacts with the human body, we will be able to provide targeted therapies for those in need. “I think the public is beginning to understand that there is a tangible value to these products and is very supportive of us in our efforts to bring affordable, high-quality and effective products to market,” he adds. “We will continue to push the boundaries of what is possible with cannabinoid therapies for as long as we have that support.” Medically, cannabinoids from cannabis are being used to alleviate the nausea and vomiting that accompany chemotherapy for cancer; the involuntary weight loss (anorexia) and resultant malnutrition (cachexia) associated with HIV/AIDS; and the chronic neuropathic pain, stiff muscles and spasms experienced by those with multiple sclerosis and spinal cord injuries. Many such therapeutic indications were discovered through the personal experiences of patients. But as more formal, academic research on cannabis paves the way for doctors to prescribe cannabinoid therapies for other illnesses, societies will also have to grapple with the emerging legal and ethical issues related to using marijuana. Meanwhile, further studies must be conducted to identify any currently unknown risks associated with the medical use of cannabis. A recent report, published in Pharmacy and Therapeutics, a peer-reviewed journal for managed care and hospital management, noted that health care providers will also need to figure out how to deal with these developments. “Ultimately, as the medicinal cannabis landscape continues to evolve, hospitals, acute care facilities, clinics, hospices and long-term care centers need to consider the implications, address logistical concerns and explore the feasibility of permitting patient access to this treatment,” scientists stressed. ■

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Stop Fussing How one mom prompted her adult son to help out at home

Childcare and Other Undervalued Work Gender expectations add to women’s stress levels.

Several years ago, my 35-yearold younger brother moved back home with our mother after he was laid off from his job. He and my mom had totally opposite housecleaning habits. She was a neatnik, and I recalled him being a total slob, so I worried about how this arrangement would work. When I visited them, I was amazed to see my sibling wash the dishes after dinner and tidy his space without needing to be coerced. Finally, I asked my mom to tell me the secret to her success in getting him to share in the housework. She said she had learned to stop comparing my brother’s cleaning habits with her own. Instead of being critical of him like she used to be, she had simply thanked him for helping. —As told to Kate Ferguson-Watson

LAST YEAR, THE AMERICAN PSYCHOLOGICAL ASSOCIATION’S STRESS IN America Survey announced that women are more likely than men to report money and family responsibilities as significant sources of stress. What’s more, females are held accountable for keeping a household running smoothly. Essentially, women are unpaid servants who are expected to feel honored by these gender expectations, which adds to their emotional distress, suggests Silvia Federici, author of the book Revolution at Point Zero: Housework, Reproduction, and Feminist Struggle. “Many of us still have the illusion that we marry for love,” Federici writes. “A lot of us recognize that we marry for money and security; but it is time to make it clear that while the love or money involved is very little, the work that awaits us is enormous.” The Organization for Economic Cooperation and Development (OECD) notes that, in the United States, women spend almost 243.2 minutes each day performing unpaid housePsychologists suggest three easy and effective ways to hold work. This uncompensated time handle even the most heavy-duty stress: women spend toiling at home includes transporting and caring for family Join a support network. Understand why. Practice self-care. members, cooking, cleaning and many In order to better man- Community groups It’s OK to lavish some other household chores. and online forums of the love and attention age your responses to “Women typically spend disproprovide a place where stressful situations, you give to others on portionately more time on unpaid think more specifically people can gather to yourself. Eat well, stay care work than men,” notes an OECD talk about issues, listen active, get plenty of rest about the kinds of overview about this issue. “This is to the problems of oththoughts and actions and reach out for help in addition to their paid activities, thus ers and offer potential that trigger pressure, from health and wellcreating the ‘double burden’ of work ness professionals if you worry, anxiety, nervous- solutions to consider. for women.” —KFW ness or tension. need it. Wouldn’t this stress you out? —Kate Ferguson-Watson 3 4 RE A L H EALT H S P R ING 2019



Experts Say



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