AIDS 2018 COnference update REPORT FROM AMSTERDAM

POSITIVELY AWARE September+October 2018 Eric, Robert, Toni-Michelle, and NINA areg amon the advocates working to change the laws that criminalize People living with HIV

[DE]CRIMINALIZING HIV

HEPATITIS C Behind BarS BREAK PRISON HEALTH THE IS PUBLIC HEALTH CHAINS POSITIVELY AWARE For pagination purposes, this page has been intentionally left blank. ➤ F rrONT cove backstory Advocates assemble in Atlanta by Rick Guasco

No sooner had he gotten home to New York from the international AIDS conference in Amsterdam than Robert Suttle jetted down to Atlanta to be photographed with fellow HIV criminalization advocates Erik Paulk, Nina Martinez, andToni- Michelle Williams for the cover of P OSITIVELY AWARE.

T he 39-year-old engaging in private consen- Shreveport native has been sual conduct, without regard living with HIV for 15 years; to whether or not measures for him, HIV criminalization is are taken to prevent HIV a personal issue. exposure and transmission; “My life was nearly without harming anyone, or destroyed by a grossly unjust intending to harm anyone, I HIV prosecution and convic- could face up to 10 years of tion,” he says. “I served six imprisonment. months in a Louisiana state “This has consequences,” For pagination purposes, this page prison under an HIV non- Martinez adds. “Women liv- disclosure charge.” ing with HIV like myself are has been intentionally left blank. As assistant director of at increased risk of violence, the Sero Project, Suttle coor- sexual coercion, and can be exacerbated the epidemic. “Criminalization of HIV has dinates a nationwide network trapped in unsafe circum- As such, current practice is made it harder for people ➤ of HIV criminalization survi- stances because of HIV non- bad law and worse policy.” [living with HIV] to seek help vors, and makes the case for disclosure laws that are rife when they are the victim of why criminalization affects for abuse.” While the focus has been to a crime, because they risk everyone living with HIV. “modernize” HIV criminaliza- being arrested. We must chal- “Every person living with Eric Paulk, 38, is an HIV policy tion laws—that is, replacing lenge the state and utilize its HIV is just one misunder- organizer for the LGBT advo- current statutes or reducing resources to take care of the standing or disgruntled cacy organization Georgia penalties from a felony to a people directly impacted.” ex-partner away from finding Equality. “Black communities less serious misdemeanor, him or herself in a courtroom,” and other marginalized com- Toni-Michelle Williams An HIV and civil rights activ- he says. “A minor infraction of munities are more vulnerable wants to see these laws ist himself, photographer the law or negative encounter to being victimized by the removed altogether. “When Johnnie Ray Kornegay III pro- with law enforcement while criminal justice system than we modernize laws we leave duced the shoot and photo- HIV-positive could lead to a other communities,” he says. loopholes for the folks who graphed the cover. Kornegay felony conviction, a lengthy Paulk points out that laws are most marginalized and is founder of Staticc Art & prison sentence, public sham- criminalizing HIV don’t take impacted by them,” she says. Life, an arts company. Special ing and/or registration as a into account the medical The Atlanta-born thanks to the Center for Civil sex offender.” science surrounding HIV, and 27-year-old is a leader- and Human Rights museum have been ineffective in con- ship development and in downtown Atlanta, which “Georgia is a state in which taining the virus. “The CDC accountability coach at the served as the location. 54,000 people living with acknowledges that there is Solutions Not Punishment HIV are my neighbors,” says ‘effectively no risk’ of sexually Collaborative (SNaP Co). Nina Martinez, 35, a steering transmitting HIV when on “Transgender women committee member of the treatment and undetectable,” suffer from profil- more information T he Sero Project: seroproject.com Georgia HIV Justice Coalition. he points out. “These laws ing, exposing them to Georgia Equality: georgiaequality.org Martinez acquired HIV have failed to accomplish their sexual harassment and Georgia HIV Justice Coalition: through a blood transfusion intent of reducing the preva- undignified searches thegeorgiacoalition.wordpress.com when she was six weeks old. lence of HIV. In fact, there that could result in an Solutions Not Punishment Collaborative: snap4freedom.org “Our state’s HIV non-disclo- have been no significant pub- arrest if they are carry- Center for Civil and Human Rights: sure statute makes it a felony lic health benefits or reduc- ing condoms,” she says. civilandhumanrights.org crime for me not to disclose tion in the HIV epidemic—if Williams pointed out Staticc Art & Life: staticc.com my HIV positive status before anything, these laws have the need for change.

pso itively aware SEptember+OCtober 2018 3 POSITIVELY AWARE o JOURNALISM. INTEGRITY. HOPE. in in the expression of of expression the epidemic. 4 & f to share accurate, reliable, and and reliable, accurate, share to share information and support support and information share David Durán, Jim Pickett, Pickett, Jim Durán, David Johnnie Ray Johnnie D A timely treatment information SEpt Network, when 17 individuals individuals 17 when Network, ut N c ut r D Sub C with anyone affected by HIV. by affected anyone with SING rt A HIV HIV in response to the HIV/AIDS HIV/AIDS the to response in gathered in a living room to to room aliving in gathered S N was founded in 1987 1987 in founded N was TP C h o is wo dv [email protected] [email protected] I V C h icago as as icago NCE 1989. 1989. NCE asso positivelyaware.com A fax Andrew Reynolds, Andrew 5537 N. B N. 5537 t [email protected] re G p icag a N - e Jason Lancaster tr r e Michelle [email protected] @enidvazquezpa Lorraine Hayes Lorraine s ho Denise Crouch Denise nd re O pr di (773) 989-9400 (773) l Enid Vázquez W i Chris c : Rick Guasco a @rickguasco John Gress John (773) 989-9494 (773) b @PosAware i Posi e Jeff Berry Jeff t r re t editor @ b o t

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ER VE Y ISSUE Tis h ISSUE

3 BREAK THE CHAINS 28 Front cover Backstory [DE]CR IMINALIZING HIV Prison health HIV decriminalization is public health advocates assemble in Atlanta. The case for testing and 16 treating hepatitis C in prisons. Ending criminalization reby And w Reynolds 6 of HIV the conversation We are destined to win. ‘Deploy, or get out’ from an by ROBERt Suttle 35 Army doctor’s perspective. Learning to stay 2GETHER 18 How to have a good 7 He said, she said— relationship as a male couple. E ditor’s NOTE and what the law says Áby EnID V zquez HIV Is Not a Crime and me. A doctor who works with people with HIV who are incarcerated looks at two cases. 38 8 by Chad Zawitz, MD Howling out art Briefly through eyes of love The first single-tablet regimen Artist Michael Payne’s work containing a protease 20 gets published at AIDS 2018. inhibitor—Symtuza—is A matter of culture by EnID Vázquez approved by the FDA. PrEP and rights development guidance. CDC Two activists discuss struggles updates TB guidelines. Two in the U.S. and Mexico. Conference update: generic versions of Suboxone by Leonardo Bastida AIDS 2018 Amsterdam get FDA approval. New and Marco Castro- campaign aims to ‘Cut the Bojorquez Stigma.’ 40 Musings from Amsterdam 23 A brief recap of my week Resources at AIDS 2018. You care about HIV by Jeff Berrry criminalization—you just don’t know it yet. 45 Report roundup 26 A look at some of Crossroads: the findings presented. HIV and social justice Áby EnID V zquez Q&A with The Sero Project’s Sean Strub by Jeff Berry 48 S till kicking O N THE COVER: Eric Paulk, Mosaic HIV vaccine shows HIV policy organizer at Georgia immune responses one year Equality; Robert Suttle, assistant after final vaccination. director of The Sero Project; by Warren tong Toni-Michelle Williams, leadership development and IAS

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pso itively aware SEptember+OCtober 2018 5 THE CONVERSATION

Join US ‘Dpl e oy, or get out’ that patients with blood-borne Legal, to respond regarding the —An Army doctor’s diseases are generally considered military’s policies: Perspective non-deployable. Again, I enjoy your journal, but “That is but one of the justifications positivelyaware Fir st off, I am an active duty just wanted to make sure that for this discriminatory policy—one Army Infectious Disease provider statement was clarified as in this that is easily knocked down. While and a large portion of my time day and age, it seems that it will it would be ideal if all soldiers could @posaware goes towards care of HIV-positive be easily construed that this was donate blood, there are various soldiers. I wanted to start by a Trump administration policy, reasons a soldier could not do so saying I generally enjoy your which is technically inaccurate. (including if they are a man who Positively Aware journal but Thank you for your time and has had sex with another man in [email protected] wanted to clarify something in the hope you have a great day! Keep the past 12 months). The very small July + August issue. up the great work! percentage of deployed soldiers PSO ITIVELY AWARE On page 11, it states “Under — Aaron Farmer who are HIV-positive will not have 5537 N. the ‘Deploy or Get Out’ policy insti- Major, U.S. Army Physician any noticeable effect on the blood Broadway St. tuted by the Trump admin- supply at the front lines. Chicago, IL istration, people living We think it is likely the 60640-1405 with HIV are not allowed military will offer this as a to enlist nor be appointed justification for refusing to All letters, email, as officers.” Technically deploy people living with online posts, etc. this has been the policy HIV, but like other policies are treated as letters to the for years and goes back that have gone by the editor unless to Army Regulation (AR) wayside (women in the otherwise 600-110, which states that military; ‘Don’t Ask, Don’t instructed. We reserve the people living with HIV are Tell,’ etc.), it is time for this right to edit for not allowed to join the one to be re-examined length, style, or military, and this was last and reformed. That which clarity. Let us updated in 2014. I will HIV-positive soldiers have know if you prefer not to have your add a caveat that the new to offer is far greater than name or city policy does say if you are any minor limitations that mentioned. non-deployable, then the may affect their deploy- goal is to administratively ment in insignificant ways, S uBSCRIPTIONS separate you from the mili- such as the inability to and bulk orders tary, but most providers donate blood. We look for- T ell us how many taking care of these indi- ward to proving in court copies you want, where to ship viduals, myself included, that people living with HIV them, and who have advised our com- are as capable of serving should get them: mands of the error of this as anyone else.” distribution@ tpan.com policy and it is currently under review. On July 19 Lambda Legal Also, I should mention From the July+August issue and OutServe-SLDN, along that part of the reason with pro bono counsel for this policy is that all from Winston & Strawn soldiers are supposed to LLP, asked a federal court be considered blood donors due to Editor Jeff Berry responds: to halt implementation of a new the potential need for a “walking Thank you, Dr. Farmer, for the clari- Department of Defense policy result- blood bank” during deployment fications, and for your dedication. ing in the discharge of service mem- to austere and remote environ- We asked Scott Schoettes, Counsel bers living with HIV. Find out more at ments and it is because of this and HIV Project Director at Lambda lambdalegal.org.

© 2018 Positively Aware S(IS N: 1523-2883) is published bi-monthly by Test Positive Aware Network (TPAN), 5537 N. Broadway, Chicago, IL 60640. TPAN is an Illinois not-for-profit corporation, providing information and support to anyone concerned with HIV and AIDS issues. Positively Aware is a registered trademark of TPAN. All rights reserved. Circulation: 100,000. For reprint permission, email [email protected]. Six issues mailed bulk rate for $30 donation; mailed free to those living with HIV or those unable to contribute.

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6 SEptember+OCtober 2018 positively aware Eitorted ’s No JFEF BERRY

HIV Is Not a Crime and me

his past June I had the opportunity to attend my first HIV Is Not A Crime training academy (HINAC 3) in Indianapolis. I have wanted to do a deeper dive and learn more about HIV criminalization for some time, and this was my chance. Plus the conference was in the neighboring state of Indiana so it was just a short drive away. I also saw it as an opportunity to learn what is happening on the ground level with efforts to decriminalize HIV not only in the United States, but also around the world, and to introduce myself to other networks of people living with HIV.

TAs has been pointed out time and again, and you There was an incredibly moving and powerful will read about in this issue, the laws have not caught criminalization survivors’ panel with a call to action. up with the science when it comes to criminalization As one person pointed out, the impact lasts past of HIV. The indisputable fact that you can’t pass on prosecution, conviction and even incarceration—we the virus when you are on effective therapy and have need a focus on expungement and removal from the an undetectable viral load (U=U) means it’s time sex offender registry as much as a focus on repeal. to update or do away with these laws altogether. “What does it look like to embody a sense of Anyone who intentionally tries to infect another belonging in ourselves?” asked Toni Michelle-Williams, The indisputable person (which is rare and represents only a fraction who appears on the cover of this issue. “How do we fact that you of the people who end up getting prosecuted under let go of our shame, so others can walk beside us? can’t pass on the these discriminatory laws) is already covered under Invest in Black Trans Leadership!” she declared. non-HIV specific laws. One of the most moving parts of the conference virus when you “U=U has opened up this whole new discourse for me was when Sero board member Kerry Thomas are on effective on reproductive rights,” Naina Khana of Positive called in during a plenary session to talk about his therapy and have Women’s Network tweeted out during the meeting. experience as an advocate behind bars. According an undetectable “Because we don’t just have the right to reproduce, to Sero’s website Thomas is serving two consecutive viral load (U=U) we have the right to have pleasurable sex.” Read 15-year sentences for having consensual sex, with means it’s time more about U=U in our AIDS 2018 coverage begin- condoms and an undetectable viral load, with a female to update or do ning on page 40. partner without transmitting HIV, and has become In this issue Sean Strub, founder of the Sero active as an educator and advocate within the walls of away with these Project which organizes the biennial conference, the Idaho correctional facility where he is housed. laws altogether. talks about how Sero came about, and about the On the three-hour drive back to Chicago I was power that comes from networks of people living still processing the previous four days at the confer- with HIV when they join together. “Our strength ence in Indianapolis. I began to feel a shift in the way comes from each other, and working with networks I look at the world and my activism. As I wrote in my like The Reunion Project [for long-term survivors of Facebook post at the time, “We are in an incredibly HIV],” he told the audience. Robert Suttle talks more difficult and challenging time, but to know that hard- about the work they are doing on page 16. working advocates and policy makers are making I had, and still have, much to learn. Mayo Schreiber, significant advances and changes, and developing a Jr., deputy director at the Center for HIV Law and Policy, strategy and a movement to make change happen, pointed out how in the state of Missouri if you kill two gives me hope. And to begin to try to understand people while driving drunk, you’re convicted of a felony how that, and all my work, absolutely has to happen and sentenced to 5–15 years, and if you expose some- within a framework of social and racial justice, has one to HIV (with no transmission required), you serve me reinvigorated. Thank you to all of those who the same amount of time: 5–15 years. helped make this happen, my heart and my mind Edwin Bernard of HIV Justice Network said during have been opened.” his presentation that the U.S. used to be the world In the empowering words of HIV criminalization leader in HIV decriminalization, and now “they are survivor Monique, “HIV criminalization did not stop me the world leader against HIV decriminalization.” from anything my heart and mind was willing to do!” Read more about the expert consensus statement on HIV criminalization released at the Amsterdam Take care of yourself, and each other. conference on page 46. Ariel, an articulate young man from Honduras who attends college in Florida, described how he was threatened with HIV criminalization at his university and charged under Title IX for sexual misconduct after a man he was dating filed a complaint—despite there being no risk of transmission. @PAeditor

pso itively aware SEptember+OCtober 2018 7 Bieflr y Enidá V zquez @ENIDVAZQUEZPA Symtuza approved by the FDA T he first single-tablet regimen containing a protease inhibitor

Another “finally” moment in HIV drug development have an important role given came in July: the FDA approved the first single-tablet the low rate of transmitted PI resistance, its high genetic regimen (STR) containing a protease inhibitor. barrier to resistance, and low rate of treatment-emergent T he HIV protease inhibi- Janssen to advertise Symtuza resistance during many tor class of drugs created as “help[s] protect against years of clinical experience.” the Lazarus effect in the resistance.” HHS uses bioequivalence epidemic, in the late 1990s. “In key Phase 3 clinical data comparing cobicistat- Back then, they were dif- trials, Symtuza success- boosted darunavir to ficult to take. Over the years, fully treated those who were ritonavir-based darunavir many protease inhibitors (PIs) starting therapy,” said Dr. to recommend cobicistat- dropped off in use. Some are Eron, “as well as those who boosted darunavir for initial no longer even available. were stably suppressed use. DRV/r does not have this Darunavir, first approved on antiretroviral (ARV) recommendation. in 2006 as a new-and- therapy—including patients Of note, the guidelines improved PI, has survived. It’s with more complex treatment immediately pointed out that not only powerful, but—for histories or previous virologic dolutegravir, an INSTI, may the most part—tolerable. It’s failure—demonstrating its also be considered for use for these two reasons that potential as an important new before resistance testing darunavir has become the top treatment option for a wide results are available. Symtuza gun of the protease inhibitors. variety of patients.” may also be used in this sce- The new Symtuza con- At this moment in time, nario, as long as people taking tains darunavir boosted with U.S. HIV treatment guidelines it have had undetectable viral Check for hepatitis B before a small dose of the blood recommend the newer inte- load for at least six months taking Symtuza. level enhancer cobicistat. It grase inhibitor (INSTI) drugs before going on it. Moreover, Another side effect is the also contains the two medi- for first-time therapy in “most unlike the other HIV drugs, price: around $40,000 a year, cations found in Descovy, people with HIV.” people with previous treat- the highest ever for an HIV pill. emtricitabine and tenofovir Only two PIs are recom- ment failure were allowed to There is a free 30-day start alafenamide. The dose is one mended for initial therapy, and enter into Symtuza clinical program for new Symtuza film-coated tablet once daily then “in certain clinical situa- studies. Approximately 15% users and the co-pay assis- with food. tions.” Of the two, darunavir is of participants had previous tance program has gone up to “Many people living with preferred over atazanavir. HIV treatment failure. $10,500. HIV struggle to adhere to The treatment guidelines The guidelines also point Darunavir is available their medication, which can from Health and Human out that “an observational under the brand name lead to the development of Services list reasons why the cohort study suggested that Prezista, and is also found drug resistance and poten- INSTIs are preferred for most DRV/ritonavir is associated in the co-formulated pill tially cause their medica- individuals. Then it states with increased rates of car- Prezcobix (with cobicistat). tion—or even an entire class that, “An exception is in those diovascular disease; data on Compared with tenofovir of medications—to stop individuals with uncertain DRV/cobicistat are too limited DF, found in Truvada, the working,” said Joseph Eron, adherence or in whom treat- to draw conclusions.” tenofovir alafenamide (TAF) M.D., Professor of Medicine ment needs to begin before Darunavir contains a sulfa in Symtuza is safer on kidney and Director, Clinical Core, resistance testing results are component, so it should be and bone health. Also as a University of North Carolina available (e.g., during acute used with caution by people result of the TAF, Symtuza Center for AIDS Research, HIV infection, pregnancy, with sulfa allergies. Diarrhea, can be taken by people Chapel Hill, N.C., in a press and in the setting of certain rash, and nausea were report- with more advanced kidney release from Janssen opportunistic infections). In ed in clinical research. Severe disease, down to a renal Pharmaceutical Companies. this context, DRV/r [darunavir rash with darunavir is rare but function (CrCL) of 30. Go to In fact, the FDA allowed boosted by ritonavir] may potentially life-threatening. positivelyaware.com/symtuza.

8 SEptember+OCtober 2018 positively aware itoS ockph to approved approved June A in e T Intelence medication e HIV T T Janssen Janssen ViiV Healthcare reported reported Healthcare ViiV one year compared with with compared year one at medications HIV two of opioid medica dependence cabotegravir, which is still is still which cabotegravir, cines are accessible to the the to accessible are cines entry of generic versions of entry 3 study included 618 men and and men 618 included 3 study steps to advance the develop the advance to steps antiviral regimen. a regular oral triple-drug a once-a-month injection approval came in July. See See July. in came approval the by approved able combination used ViiV’s ViiV’s used combination able and also facilitating market market facilitating also and development of better drugs, drugs, better of development kg). (10 (etravirine) has been finding similar efficacy for for efficacy similar finding positivelyaware.com/intelence Generic Suboxone Generic ment of improved treatments improved of treatments ment nucleoside reverse transcript nucleoside transcript reverse patients who need them. them. need who patients Intelence now for Monthly injection HIV for F F daily). twice mg 200 is inhibitor (NN irine. irine. in development, along with in along with development, women from around the world. two generic versions two dose adult (the daily twice pounds 22 least at weigh to make sure these medi these sure make to and disorder, use opioid for water. with whole tablets the swallow to unable those for tion Suboxone. label. Intelence is anon- is Intelence label. 5who 2to ages children by children 2–5 ages years approved by FDA h h h ol D “ at includes promoting the A reiterated instructions instructions A reiterated low on instructions the T F h T D e h F T e global A e global T D h h A is taking new new taking A is e dose is 100 mg mg 100 is e dose erapeutics’ rilpiv- erapeutics’ RT I ). F T T T D L

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Mavyret and HIV data

T he FDA in August added HIV data to the drug label for the hepatitis C medication Mavyret (glecaprevir and pibrentasvir). In the EXPEDITION-2 study, there was a 98% cure rate (a sustained virologic response, or SVR)— 150 out of the 153 participants living with HIV who were taking Mavyret. The ones who did not have cirrhosis took Mavyret for 8 weeks, while the ones with compensated cirrhosis (11%) took it for 12 weeks. Side effect information was also added. In the ENDURANCE-1 and EXPEDITION-2 HIV/hepatitis New campaign aims to ‘Cut the Stigma’ C co-infection studies, participants had a similar Lambda Legal, the national rights organiza- education to prevent such discrimination safety profile as that seen tion for the LGBTQ community, and Los from happening in the first place.” among those who only had Angeles-based Black AIDS Institute (BAI) “It was important for BAI to get involved hep C. Adverse reactions have teamed up for an education campaign in Nikko’s case because there’s no way to observed in at least 5% of called C ut the Stigma, focusing on black end the AIDS epidemic if we’re not fighting people taking Mavyret in communities to “dispel misconceptions sur- bigotry, discrimination, and bias,” said Phill the EXPEDITION-2 study rounding the transmission of HIV and reduce Wilson, CEO and founder of the Black AIDS (whether for 8 or 12 weeks) HIV stigma and its resulting discrimina- Institute. “In addition, as a Black organiza- were fatigue (10%), nausea tion.” The campaign was developed after the tion, we have to be ever vigilant in confront- (8%), and headache (5%). owner of an L.A. barbershop refused to cut ing injustice. It is a part of our survival. We Data were also added regard- the hair of a customer living with HIV. fight those injustices to survive—and this ing people who have had liver “My experience at the Leimert Park is a case about injustice. It’s about bias. It’s or kidney transplants. barbershop was not the first I have had with about bigotry. It’s about discrimination. We For more information, HIV discrimination. Today, I am speaking out have an obligation to be at the forefront of go to [email protected]. because I would like it to be my last,” said that effort; that’s essential.” Nikko Briteramos, 34, who has been living Wilson continued, “We are well aware with HIV since he was 19, in a press release. that HIV discrimination does not only occur “I want everyone to hear my story so they in the Black community. But Nikko’s experi- can better understand how harmful these ence highlights how Black people living with moments of discrimination can be to those HIV are often confronted with discrimination living daily with HIV. The stigma is a result of connected to stigma and misinformation misconceptions and it needs to end.” in public places of importance within our Scott Schoettes, Counsel and HIV Project community. The barbershop is a sacred Director at Lambda Legal, said, “The facts social space, where Black Americans debate of this case, as well as the legal claims, social, cultural, and political ideas. HIV are pretty straightforward: the owner of discrimination destroys such safe spaces. King of Kuts in Leimert Park refused to cut Through this partnership with Lambda Legal Nikko’s hair because he is living with HIV, on C ut the Stigma, Black AIDS Institute in clear violation of the federal Americans intends to engage barbers across the coun- Condoms and mistrust with Disabilities Act (ADA) as well as the try in an effort to end the harmful effects California Unruh Civil Rights Act. While we of HIV discrimination that stems from London-based researchers work within the legal system to remedy the misinformation.” surveying people in several dignitary harms Nikko suffered as a result African countries found that of this discriminatory encounter, we are To Learn more about the case, go to lamb- “condoms were often seen O also partnering with Black AIDS Institute dalegal.org/nikko. For more about the C ut as symbolic of infidelity and T H

to engage with Black communities nation- the Stigma campaign go to blackaids.org/ mistrust, and therefore only P K C

ally to do some critically important public CutTheStigma. appropriate in short-term O T

relationships,” according to ISO

10 SEptember+OCtober 2018 positively aware AIDSmap. They also looked at the attitudes around PrEP use. Genvoya, Stribild and Tybost with anticoagulants “Emerging interventions, New drug interactions were added to the labels for Genvoya, Stribild and Tybost. The FDA in whose symbolic meanings August added information on taking these HIV meds with a direct oral anticoagulant (DOAC). are being constructed anew, See chart below. may be uniquely positioned to infuse their ‘brand’ with Apixaban (brand name Eliquis) with Genvoya, Stribild, or Tybost/Reyataz: associations compatible with Genvoya, Stribild, Tybost/Prezista or Due to potentially increased bleeding love, commitment, respon- Tybost/Reyataz: risk, dosing recommendation for sibility, and sexual pleasure, Due to potentially increased bleeding risk, coadministration of betrixaban, dabigatran rather than those associated refer to apixaban dosing instructions for or edoxaban with a P-gp inhibitor such as with disease, danger, and dis- coadministration with strong CYP3A and Genvoya, Stribild or Tybost plus Reyataz trust,” Emily Warren and col- P-gp inhibitors in apixaban prescribing depends on the direct oral anticoagulant leagues at the London School information. indication and renal function. Refer of Hygiene and Tropical to the DOAC dosing instructions for Medicine wrote. “If interven- Rivaroxaban (brand name Xarelto) with coadministration with P-gp inhibitors in the tions have positive symbolic Genvoya, Stribild, Tybost/Prezista or DOAC prescribing information. meaning and are understood Tybost/Reyataz: to have fewer risks associ- Coadministration of rivaroxaban with Betrixaban, dabigatran or edoxaban with ated with them, uptake and Genvoya, Stribild or Tybost is not Tybost/Prezista: adherence may improve.” recommended because it may lead to No dose adjustment. Read Roger Pebody’s an increased bleeding risk. report ataidsmap.com/ page/3304079. Go to page 35 Betrixaban (brand name Bevyxxa); For more information, go to to read about HIV infection dabigatran (brand name Pradaxa); and [email protected]. among gay and bisexual male edoxaban (brand name Savaysa) with couples. get POSITIVELY AWARE. For yourself, For your agency.

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pso itively aware SEptember+OCtober 2018 11 G Of HI Of criminalization endING destined to win to destined are we believes adamantly ordeal, activist Having experienced his own THE BREAK CHAINS Collateral of a and consequences social 16 got allies today who only a few years ago we might ago years todayonlyafew got allies who from prison. Social stigma and mental tion don’t simply uponone’s end release allies fighting against stigma and injustice, was fighting allies was stigmaand injustice, against We’ve leaders. public policy and political and als, criminal justice, medical and scientific profession- scientific and criminal medical justice, advocates, and of activists of networks national in ending criminalization HIV coalescing the est and create change, challenging the status quo in every challenging quo increate status change, the every particularly people living with HIV, people with social along particularly professional conferences to community forums, it forums, to community conferences professional grossly unjust prosecution and convic movement willmovement continue to to grow build and power Iowa, Colorado, California, and North North and California, Colorado, Iowa, health one’s challenges affects day-to- Project, a network of people living with HIV and living and with HIV of people anetwork Project, difficult to cope. cope. to difficult day life making it, at times, all the more state across the country. It’s already starting to country. It’s the starting already state across destined to win! to destined justice groups; community organizers; public health, public organizers; health, groups; community justice have thought unlikely. thought have growing the inter- to witness remarkable been has happen. future,that the our optimistic about Iam issue, launched, leading me to believe that to me believe leading launched, SEpt Although HIV criminalization HIV remains amajor Although Much has changed since 2012, when the Sero Sero the 2012, since when changed Much has From hundreds from ofranging public events, e mb ing with HIV, the experience became the savingbecame grace for my survival. As a person livmy aperson survival. As ment to HIV end criminalization criminalization changes you. you. changes criminalization of by being HIV persecuted etting involved etting e r+OCt For example, several states— several example, For V

[ DE o b ] R ali CRI e r 2018 o M bert bert IN in the move the in Z p IN o S we are we are s G i u t HIV ivel ttle y

- a

- w - ar e

Photo:Pho to: Johnnie Ray kornegay III do this has done more to raise awareness and mobilize W hERE DeCRIMINALIzation efforts are Taking place grassroots action to change statutes than anything else. Absent our voices—and the many other PLHIV who have spoken up since—this movement would look very different today, certainly less robust and vibrant and more likely been created around PLHIV than by and with PLHIV. The difference would be profound. One of the Sero Project’s strategies is to build and strengthen networks of people living with HIV in a number of states. Networks are persuasive and powerful advocacy tools, and have led to the growth of organizing around HIV criminalization in many states. We are destined to win! That’s why today, I implore Many statewide coalitions or working groups have formed, since the inaugural every person living with HIV, 2014 HIV Is Not a Crime in Grinnell, Iowa, starting state-level strategic planning and reform every advocate, every activist efforts or demonstrating some level of interest in some of the following states: and ally, to join in the move- ment to getting to zero pros- S outhERN Region (CHAIN), Michigan Coalition for HIV Health ecutions. #HIVisNotaCrime! Alabama, Arkansas HIV Reform Initiative, and Safety, Missouri HIV Justice Coalition Get educated and active with- Florida HIV Justice Coalition, Georgia HIV (MHJC), Ohio Health Modernization in your state coalition and Justice Coalition, Kentucky, Louisiana Movement, Oklahoma learn why HIV criminalization Coalition on Criminalization and Health laws are ineffective, unwar- (LCCH), Mississippi, North Carolina, South Noearth st Region ranted, and discriminatory. Carolina, Tennessee, Texans Living with HIV HIV Is Not a Crime Pennsylvania Working You care about HIV criminal- Network (TLHIV), Virginia Group ization, you just don’t know Md i west Region Wern ste Region it yet. We need your support C olorado Mod Squad, Illinois, HIV Modernization C alifornia for HIV Criminalization Reform and involvement to make sure Movement - Indiana, Community HIV/ (CHCR), Idaho Coalition for HIV Health & we take the path that will Hepatitis Advocates of Iowa Network Safety (ICHHS), Nevada, Washington improve public health and deliver on the promise of jus- tice to every person, including those of us who have HIV.

Carolina—have made the importance of centering people living with HIV, who Foor inf rmation on HIV significant victories by the voices and leadership of are involved in state-level HIV criminalization in any spe- amending statutes and health people living with HIV and criminalization reform efforts. cific state, or on advancing codes related to HIV “criminal other communities dispropor- Any effort to abolish HIV crim- advocacy for criminalization exposure” and “HIV control tionately impacted by crimi- inalization that is authentic reform in your state, go to measures.” That’s solid nalization in all its forms. must center racial justice and seroproject.com or email progress. Recognizing that crimi- leadership by people living [email protected]. HIV Is Not a Crime train- nalization in the U.S. dispro- with HIV and people of color. ing academies—held in portionately impacts Black As people living with HIV 2014 in Grinnell, Iowa; in people, the first-ever Black (PLHIV) and survivors of R obert Suttle is the Assistant 2016 in Huntsville, Alabama; United Leadership Institute criminalization, our voices Director of the Sero Project. and earlier this year in (BULI), convened at HIV Is and participation in the move- He oversees community Indianapolis—urge us to use Not a Crime III in Indianapolis ment continue to have a pro- outreach and education, and an intersectional lens to con- this past summer, to elevate found impact. Our willingness coordinates the Sero Project’s nect with other social justice and support a robust network to shed our shame, speak HIV Criminalization Survivors struggles, and remind us of of Black leadership, especially up and share our stories—to Network.

pso itively aware SEptember+OCtober 2018 17 BREAK THE CHAINS [DE]CRI MINaliZING HIV He said, she said —and what the law says A doctor who works with people with HIV who are incarcerated looks at two cases By Chad Zawitz, MD

nacted in 1989, Illinois’ HIV Criminal HIV Criminal Transmission. was unaware, and had been Transmission Law has undergone minor During a slow day in clinic, he having unprotected sex for revisions since then, but remains no decided to share his version years. Despite not contract- of the allegations with me. ing HIV, she was able to have less controversial. In the era of U=U He had been in a long-term Xavier incarcerated. (Undetectable=Untransmittable), PrEP, relationship with his girlfriend. Xavier told me his girl- treatment as prevention (TasP, e.g., They have one child together, friend had always been aware HPTN 052 and other studies), as well as and he has two other children of his status. He said she even from a previous partner. The came with him from time to enlightenment about HIV in general, it two of them apparently got time to his medical appoint- is time to reconsider the consequences into a heated argument ulti- ments with his HIV specialist, of this law. mately leading to the end of as it was part of their family their relationship. However, planning to minimize her risk I have worked at the Cook but to provide real-world that was not the end of the while trying to conceive. He ECounty Jail in Chicago for 14 examples of how this law has fight’s consequences. was adherent to his medica- years. In that time, I have affected patients from the per- Xavier alleged that out of tion and had an undetectable provided HIV medical services spective of the incarcerated spite, his now ex-girlfriend viral load. Despite this, he to a number of patients who and those who care for them. called the police and stated has spent nearly four years were in custody awaiting trial Names and specific details of that he intentionally tried to behind bars awaiting trial. over alleged violation of the criminal allegations have been infect her with HIV by not During his lengthy incar- o HIV Criminal Transmission modified to protect privacy. disclosing his status. She ceration, Xavier has lamented t h

Law. The purpose of this alleged that she discovered not being there for his chil- p k c

article is not to suggest inno- Mr. Xavier has been in jail his medications, researched dren, particularly his then o t s

cence or guilt of the alleged, since 2014, charged with what they were, realized she three-, now seven-year-old, I o

18 SEptember+OCtober 2018 positively aware during her sentence for he obligated to notify the n In the era of PrEP, PEP, personal reasons, and had a Department of Corrections U=U, and treatment as pre- very high plasma viral load. in some manner to consider vention, does the science She was “ticketed” by the housing Angelica separately of HIV transmission still Department of Corrections from other inmates to align with real-world risk for having sexual relations minimize the risk of addi- warranting incarceration? with multiple partners during tional new sexual exposures? n How does one prove her incarceration. Should he have considered intent to infect a sexual One of her sex partners the possibility of inmate partner? Would wearing a had been in the system retaliation against Angelica? condom be proof of lack of since 2013. Max had been intent? Would taking one’s tested for HIV at least annu- T hese cases illustrate some medications and having ally during his incarceration, additional perspectives of an undetectable viral load? negative each time. In 2017 the impact of criminalizing Would an HIV-negative he tested positive. During being HIV-positive. However, partner taking PrEP be at an inquiry, he acknowledged they also bring up numerous inordinate risk? his most recent sex partner related points for discussion: n S hould the Criminal was Angelica. Max stated Transmission law be he was not aware of her HIV n If any intimate partner can revised again to reflect status, and denied being with report someone else’s HIV our current science any other partners since his status to the police, do all regarding the real risk of last negative test. All the sex HIV positive people need HIV transmission? Should was consensual, but due to to consider if they need the law be eliminated condoms being contraband at some sort of “evidence” altogether? this institution, it was unpro- to support their disclo- tected. PrEP was not offered sure? This would include I do not have answers to clear or available. everyone who has ever used the air, but I do understand The medical provider felt hook-up apps or the inter- the science behind disease he had an ethical dilemma. net to find sex partners. transmission. The way the law He knew both patients. He n W hat role/responsibil- currently exists, it may simply knew the infection most ity does a Department boil down to “He said, she likely resulted from Angelica of Corrections have said.” May the most compel- declining to take medications. in providing access to ling story to the judge and jury Max claimed he did not have HIV prevention during “win”? any discussion with any of his incarceration? partners about HIV or other n W hy is HIV singled out as Chadz Zawit , MD, is a Board son he had with his now sexually transmitted infec- the only sexually com- Certified Infectious Diseases ex-girlfriend. He told me the tions. Angelica stated she did municable disease that is specialist at Cook County Jail prospect of a felony convic- not disclose her HIV status criminalized for lack of dis- in Chicago. He received his tion would “destroy” his prior to or after sexual activity closure? Many if not most Infectious Diseases training future. He has lost his job, his with any of her partners. Max sexually communicable at Rush University Medical apartment, his car, and some and Angelica were not mar- diseases can cause lifelong Center in Chicago and of his friends. His reputation ried or civil partners (in Illinois, complications and even Internal Medicine training at in the community has been the AIDS Confidentiality Act death (e.g., hepatitis B and the University of Pittsburgh. damaged. His HIV status is gives a medical provider the C, human papillomavirus, He is the Director of the no longer private information right to disclose without con- herpes simplex, syphilis, Continuity of Care Clinic for among his family and friends. sent in the instances of mar- chlamydia, gonorrhea, HIV-positive detainees at both At times, he told me, he was riage and civil partnerships, MRSA). the jail and the nearby coun- so depressed he had consid- but not other relationships). n W ho is ultimately respon- ty-run CORE Center. He is ered suicide. Knowing the criminal sible for protecting one’s also a Certified Correctional transmission laws in his health? You? Your partner? Healthcare Provider (CCHP). In a different state cor- state, this doctor was torn The legal system? The Dr. Zawitz has worked exclu- rectional institution, another between strictly observing healthcare system? sively with the incarcerated example of HIV criminal trans- medical confidentiality, or n Is disclosing someone’s population in Chicago for mission occurred. In this case, informing Max of the law in HIV status without more than 10 years. His aca- Angelica, a 21-year-old trans- the context of his new infec- consent (e.g., calling the demic interests include virol- gender female who is HIV- tion. Moreover, was it even his police) a violation of the ogy (HIV/HCV), correctional positive, was incarcerated role to get involved in such a Illinois AIDS Confidentiality healthcare, public health, and for theft. She refused to take legal issue when his job was Act (or the laws of other LGTBQ health. antiretroviral medications to provide medical care? Was states)?

pso itively aware SEptember+OCtober 2018 19 BREAK THE CHAINS [DE]CRI MINaliZING HIV A matter of culture and rights Two activists discuss decriminalization efforts in Mexico and the U.S. By Leonardo Bastida and Marco Castro-Bojorquez

o urnALIST and historian Leonardo Bastida, based in Mexico City, and Marco Castro- Bojorquez, an activist and filmmaker of Mexican descent living in California, met at the HIV is Not A Crime (HINAC) activist train- ing academy, organized by the SERO Project and Positive Women’s Network-USA. Here, they discuss HIV criminalization, specifically against queer and other marginalized communities, here and in Mexico. Btdaas i Castro-Bojorquez JHIV criminalization in the U.S. of leaders in the community, and we marginalized, like women, transwomen, drafted a framework called A Declaration sex workers, people that use drugs, and Leonardo Bastida During the last HIV Is of Liberation: Building a Racially Just and people of color in general. There’s a Not A Crime (HINAC 3) training academy Strategic HIV Movement. With this frame- disruption in anyone’s life once you’re [in June], one of the issues brought to work, we hope to inspire other leaders criminalized because of your HIV status. light was that African Americans were of color working in HIV to demand racial Every aspect of your life gets negatively more likely to be prosecuted for criminal justice within our movement, and we are affected and it is something I don’t wish transmission of HIV than other racial working with organizations and research anyone to experience, and so my heart groups. How do ethnicity and race affect groups that are interested in adopting it goes out to our HIV criminalization survi- other groups such as Latinos, whose as they engage in HIV care, prevention, vors and their families! members grow up in another cultural research and advocacy so that they ana- context, many of whom have been denied, lyze and adjust their practices and create Bastida How difficult is it to modern- or do not have, legal immigration status? meaningful change in their communities. ize laws in a country that does not care about human rights, in fact, prefers to Marco Castro-Bojorquez HIV is a Bastida In most of the states that call them “civil rights,” and does not racial issue, an economic issue, and a belong to the American Republic, the law accept international recommendations cultural issue. For the longest time the punishes people living with HIV who do from global agencies and organiza- behavior or personality traits of people not reveal their status. Do these actions tions, such as the United Nations or the of color were blamed for the higher rates help to diminish new HIV infections or Organization of American States? of HIV and other STIs, when in reality the just control a person’s sexuality as a kind socioeconomic aspects of people’s lives, of biopolitics in order to relate sex to a Castro-Bojorquez It isn’t easy but racial discrimination, stigma, and geogra- reproductive matter? it is possible. I was a lead organizer in phy, to name a few, are factors that deter- California in the efforts to modernize HIV

mine how HIV affects a person in their Castro-Bojorquez These actions do laws and it was a monumental effort. We z lifetime. At HINAC 3 there was a Black not help anything or anyone! fought for over three years and there que United Leadership Institute (BULI) right Any law criminalizing someone’s were really difficult times, both internally r

before the conference and this event health condition is a bad law. in our work as a coalition and externally ojo B -

gave our colleagues of African descent We don’t need for the government in some of the reactions from the public’s o r

an opportunity to engage around a series to send us to jail because we’re sick. We lack of awareness, but we did it. It wasn’t t

of issues affecting black Americans, but Cas

need health care, housing, food, and perfect but I know that, for now, I don’t more importantly, they had the opportu- jobs, and we need for the government to have to worry about being sent to prison and nity to be among other black advocates. stop trying to kill us, that’s what we need. because of my HIV status. da i

People of color are disproportionately People living with HIV in the U.S. aren’t In my opinion, we need to abolish t affected by HIV in the U.S., especially going to be quiet or passive. We’ve been all these laws and not just “modernize” Bas f

women, young people, and LGBTQ folks. fighting for our lives since the beginning them, but I understand it is a process. All o

y

We lack access to testing, prevention, of the pandemic and we’ll continue to do people unjustly incarcerated right now s care, and accurate data due to lack of so. I would fight till the day I die so we should be freed and returned to their rte u

inclusion in research. That’s why recently can be treated equally and with respect. homes with their loved ones. Because o a group of national HIV/AIDS advocates HIV criminalization is not just an HIV is Not a Crime! c o

of color, myself included, created HIV HIV issue but affects all communi- When I participated in the so-called t

Racial Justice Now, a collaborative group ties, especially those that are the most “National HIV/AIDS Strategy” and the word Phos

20 SEptember+OCtober 2018 positively aware SAIPIRIT R SED: Castro-Bojorquez in front of an altar he created at HINAC 3, with friend and fellow activist Carrie Foote.

“immigrant” was nowhere to be found, I and brothers who died because of com- another for sex workers, another one realized that my work needed to be more plications with AIDS and to embrace the for young people and many for LGBTQ intentional and embrace human rights idea of celebration even in death. I loved persons. But these movements don’t principles as my personal framework in the connections I made during the eve- work together and just partially share any efforts in which I am involved. Just nings the altar was open and the stories some goals. recently I was invited into an important we heard as a collective. Universal access to antiretrovirals is fellowship, by the U.S. Human Rights partial; discrimination is still part of their Network, to their 2018 Fighting Injustice HIV criminalization in Mexico lives; more than 20 percent of new HIV through Human Rights Education (FIHRE) infections are not detected; co-infections program. As a USHRN FIHRE fellow, I Castro-Bojorquez When I was in are not treated at all; and there are special would more formally incorporate human Mexico City in 2017 and doing transfor- criminal laws for people living with HIV. rights principles into my work in HIV/AIDS. mative HIV work with you, among other brilliant people, I noticed a tremendous Castro-Bojorquez At HINAC 3 you BastidA Some of the activities at division among the LGBTQ community. were part of the Mexican delegation the HIV Is Not a Crime academy were I even heard a dear friend saying that and represented the newly formed Red related to art. What is the relevance “straight people living with HIV have less mexicana de organizaciones contra la crimi- of using artistic projects to sensitize rights than LGBTQ people living with HIV.” nalización del VIH (Mexican Network of populations about a problem such as HIV Can you speak to how these divisions in Organizations Against the Criminalization criminalization? our own queer community affect people of HIV). Why was it important for people living with HIV/AIDS in Mexico? here in the U.S. to learn about the HIV Castro-Bojorquez Diego Rivera said work done in Mexico and Latin America? that every Mexican child is born an artist. Bastida I think that Mexican society, as

e I love being an artist and an activist, and a diverse entity, is comprised of many Bastida Language represents a big bar- t I honestly feel that it is with my filmmak- opinions and thoughts. In fact, all people rier between Mexico and Latin America Foo

. ing that I better express myself and feel should have their own ideas and beliefs. and the United States and Canada. Many E e i the most connected to people. At HINAC 3 However, it is necessary to agree on times, it seems that the North and the r r we had different expressions of art, from general points of view when we talk about South are totally different so, apparently, Ca

f a poster contest, films, ballroom à la common agendas and goals. In this case, we cannot build common bonds in spite o

y “Indianapolis is burning”—and my altar! to improve the lives of people living with of the fact that we share many problems. s [In Mexican culture, an altar pays tribute HIV, their conditions and rights. At this One of them is HIV criminalization in rte

u to the dead.] time, we have not established a common our laws. The HIV Justice Network has o

c For the second time around, I was agenda on HIV. There are so many documented that the U.S. is one of the o t fortunate to create an altar at the confer- movements, focused on different goals. countries where most persons have been

Pho ence to honor the legacy of our sisters For example, a special group for women, prosecuted in the whole world. Mexico

pso itively aware SEptember+OCtober 2018 21 BREAK THE CHAINS [DE]CRI MINaliZING HIV

does not appear on that list, but 30 of issues that benefit directly people living amendment. It was removed some days the states that belong to the Mexican with HIV into a database in order to apply later. Republic have legal frameworks similar them if it is needed or as a guide in mak- In San Luis Potosí, the governor tried to the American ones. ing new prevention strategies. to punish HIV transmission, but the We could see during the training ses- House of Representatives rejected it after sions that many delegates didn’t know Castro-Bojorquez I am so grateful some months. that, or of the existence of a Mexican for the human rights work for and with In Quintana Roo, laws were amended movement. In addition, they didn’t know people living with HIV in Mexico by in a negative manner. that in Mexico the Supreme Court has people like you and our dear friend and After some protest from NGOs, some ruled that laws which punish people colleague Patricia Ponce from Grupo representatives agreed to modify legal living with HIV are not constitutional Multi, and many others. Can you share texts, but their deadline is almost here because they are discriminatory. the biggest issues affecting people living and they have not done it yet. In the sessions, we explained how with HIV in Mexico? And also, how is it These propositions are a result of persons who belong to different NGOs that HIV criminalization has been a topic huge ignorance about HIV and AIDS. [non-governmental organizations] and that has resonated with the Mexican Many people, including legislators and are from different cities and countries, people? government officials, still think that HIV such as you, could gather together and is synonymous with death and they have implement a strategy, at several levels, Bastida For many years, Patricia other prejudices as well. Therefore, dis- that could reach public and political Ponce has been interested in HIV social crimination against people living with HIV spaces where decisions and changes can research and in public incidence to help is a big challenge to defeat. Some figures, be made. improve the political situation in Veracruz. shown by the National Council to Prevent We shared our experience in the Part of her work is making visible the Discrimination, show that almost 40 per- Veracruz case, a Mexican state that in needs of people living with HIV and cent of Mexican society would not agree 2015 changed its law to criminalize HIV. the injustices against them. That is the to live with a person living with HIV. As a result of that, Grupo Multisectorial reason Grupo Multisectorial questioned That is the reason why I believe the en VIH-SIDA del Estado de Veracruz [the Mexican HIV criminalization laws. biggest challenge in Mexico is to eradi- Multisectorial Group in HIV-AIDS in the During the last two years, our states cate prejudices and discrimination, with State of Veracruz] asked the National proposed legislation that punish a pos- sexual education in elementary schools, Human Rights Commission to declare the sible HIV transmission. In Veracruz, it was more informative campaigns, positive law an unconstitutional action because presented as a solution to diminish rates messages in media, training in medical it affects the rights of people living with of HIV in women. Fortunately, it was can- and public services, focused strategies to HIV. That action was submitted to the celled by the Supreme Court. prevent new infections, and normalized National Supreme Court and discussed in Another case occurred in Chihuahua, HIV testing. 2018, three years later. The result was a where a representative proposed a similar declaration that the law was invalid. We think that this experience can help our brothers and sisters create their own Statements from the writers interdisciplinary strategy and reach a law modernization in their state, and why not Leonardo Bastida: For several years Marco Castro-Bojorquez: I consider in the whole country? I have focused on the oral history of my film work to be contracorriente, Mexican immigrants in the United or countercultural. My philosophy is Castro-Bojorquez “Molecular States and the social networking of inspired by the efforts of the “Third Surveillance” was an important topic I MexAmerican communities in border- Cinema,” coined by filmmakers and first heard about at HINAC 3. What were lands. In addition, I have worked as a thinkers of the movement of the New some of the lessons you learned at the journalist at La Jornada newspaper Latin American Cinema of the ’70s, conference? following human rights, LGBTQ and where the main purpose was to resist, gender issues, migration, and HIV. mobilize, agitate, and promote social Bastida One of the most important les- During the last two years I have been consciousness to counter the prac- sons I learned was that we need to keep involved in a social movement against tices of the American film industry, on together, no matter the languages, HIV criminalization in Mexico, after as mainly Hollywood. I advocate for the nationalities, health condition, race, an investigative journalist I learned civil and human rights of LGBT people sexual orientation, gender identity or that 44 people have been prosecuted and people living with HIV/ AIDS, as expression, to improve life conditions because of possible HIV transmission. a convener for Venas Abiertas (Open and guarantee human and civil rights of In not one case could it be demon- Veins), a network of Latinx immigrant people living with HIV. strated that the person was guilty. people living with HIV/AIDS in the Molecular surveillance means that However, judges considered their U.S., as a steering committee member there is a collection of HIV data to attitudes and actions a felony. As a of The U.S. People Living with HIV support health systems in monitoring person interested in human and civil Caucus, and as a lead organizer with trends on new HIV infections, the use of rights, I believe that no one should be the coalition of Californians for HIV antiretroviral therapies, and co-infections. prosecuted or discriminated against Criminalization Reform. See more Socially, molecular surveillance could because of a health condition. about my filmwork at about.me/ mean that we can join together our expe- castro-bojorquez. riences in modernizing laws and other

22 SEptember+OCtober 2018 positively aware What you need to know about HIV criminalization HIV-specific criminal charges have been filed in the United States more than 1,500 times since the first HIV-specific laws were introduced in 1986. Thirty-four states currently have HIV- specific criminal stat- utes in effect. The majority of these laws criminalize HIV non-disclosure, and incarceration for consensual activity if they do not notify their partner of their HIV status. These prosecutions disregard condom use, viral load, or the actual risk of transmission. Other statutes enhance sentences for crimes relating to sex work, heightening mis- demeanors to felony status when the defen- dant is HIV-positive— aeci site-sp fic project by Avram Finkelstein for Visual AIDS, created for the 2018 New York City Pride March even in solicitation cases where there is no allegation of sexual activity. Many of these HIV-specific laws were passed in the early Organizations and resources years of the epidemic, on HIV criminalization: An updated annotated bibliography on HIV and ignore current criminalization was published in August. (An Center for HIV Law & Policy scientific knowledge annotated bibliography is a list of citations to hivlawandpolicy.org about the effectiveness books, articles, and documents. Each citation of condoms, antitretro- is followed by a brief—usually about 150 HIV Is Not a Crime vals, and pre-exposure words—descriptive and evaluative paragraph, the National Training Academy prophylaxis (PrEP) for annotation.) First published in 2012, “Bibliography hivisnotacrime.com preventing the trans- on Criminalization of HIV Non-Disclosure, mission of HIV. Exposure, And Transmission” was curated by HV Justice Network 25 states criminalize Dini Harsono, M.Sc., Assistant Director of the hivjustice.net one or more behaviors Clinical and Health Services Research (CHSR) that pose low or negli- Core and coordinator of the Criminalization of Lambda Legal gible risk for HIV trans- HIV Exposure Work Group at CIRA. The document lambdalegal.org/know-your-rights/article/ mission, such as biting systematically highlights the literature consisting hiv-criminalization or spitting. Spit does of summaries of criminal laws, empirical research, not transmit HIV. legal and public health analyses, fact sheets and Positive Women’s Network Even states without guidance documents, consensus statements, and pwn-usa.org/issues/know-your-rights-guide HIV-specific statutes other relevant references on criminalization in have prosecuted the context of the United States and Canada. The Po z magazine people living with HIV, bibliography is a working document and will be poz.com/criminalization charging them with updated periodically. bit.ly/2MP7T8M aggravated assault, T he Sero Project attempted murder, and seroproject.com bioterrorism.

pso itively aware SEptember+OCtober 2018 23 BREAK THE CHAINS [DE]CRI MINaliZING HIV

How did the Sero Project come about?

I have been focused on helping to support and strengthen PLHIV networks for many years. It was clear that the voices of people living with HIV [PLHIV] were what would drive the anti-criminalization movement. When NAPWA [National Association of People With AIDS] shut down, it seemed like a good time to start a network focused on supporting other networks and combatting criminalization. That’s what Sero does. Our entire board is comprised of PLHIV as is most of our staff.

How has HIV stigma changed over the last 30 years, and what is the link between stigma and criminalization?

Mn a y people remember when one had to wear a spacesuit to visit someone with HIV in the hospital, or when people were afraid to shake hands with someone with HIV or go to a gay restau- rant or whatever. Since most people know more about HIV today, and that fear of casual contagion isn’t as bad, people think stigma has lessened. CROSSROADS: But stigma, as experi- enced by the stigmatized, is HIV and about much more than fear of casual contagion. It is about having our moral worth social justice judged when someone finds out we have HIV, about being Q &A with The Sero Project’s Sean Strub marginalized and “othered,” having our words discounted before they are even spo- ken. By those measures, stigma is worse today than s an early AIDS activist and a long-term survivor, Sean Strub ever before. has taken on many roles throughout the HIV epidemic. In 1990, he We don’t have a broad became the first candidate openly living with HIV to run for Congress. LGBT and HIV community He was among the ACT UP protesters in 1992 who placed a giant that recognizes the epidemic

as a collective responsibility, Strub condom over the home of then-Republican U.S. Senator Jesse Helms. n as we once did. HIV is no a Strub founded POZ magazine (like Poitiv s ely Aware, published for e

longer a fashionable cause. f S o

people living with HIV), and produced an off-Broadway play, The Night It can no longer be seen in y s Larry Kramer Kissed Me. At 60, he is executive director of The Sero Project, a singular terms and therefore rte A divorced from the inter- u nationwide network of people living with HIV and their allies, combatting stigma Co

secting realities of racism, o

and social injustice. Strub recently took time out to talk about HIV criminaliza- homophobia, sexphobia, pov- t

tion, and what it’s like to be mayor of a Pennsylvania town, population 974. erty, addiction, mental illness, Pho

26 SEptember+OCtober 2018 positively aware homelessness, and other fac- those who are incarcerated. W hat is a normal day for dishes when the restaurant tors that drive the epidemic. If there’s anyone who you as mayor of Milford, gets unexpectedly slammed Very important, a diagnosis is thinks of themselves as a Pennsylvania? or changing light bulbs or much more isolating today. “single issue” activist on HIV doing other maintenance That’s partly because criminalization, they just don’t Hh a , every day is different. work. Working with my hands those newly diagnosed can get what it is that we are try- But I’m usually up around 6 at the hotel is therapeutic for choose to keep it a secret; ing to accomplish. HIV crimi- am, do the New York Times me and I enjoy it. they don’t have to assume that nalization is a point of entry mini-crossword puzzle on my others will ultimately find out issue into radical changes to phone—it’s easy, but I keep Anything else you’d like because they will lose weight improve the lives of PLHIV trying to better my best time, people to know about? or show other symptoms. and affected communities. I which is 56 seconds—and Years ago, when diagnosed, use the word “radical” inten- have my first calls or meet- Onla y th t as awful and one worried about survival, tionally, because the vision ings around 7:30. In a given dangerous as the Trump presi- not the long-term impact on we have is very different than day, I’m involved with Sero dency has been, don’t person- one’s career. That isolation the reality so many of us must work, obviously, speaking alize our battle too much to denies a person of peer sup- live, but it is not a fantasy. with legislators, activists, and being just about the revolting port, becoming part of a com- Even amidst the nightmare policy leaders. I’m lucky to person Donald Trump has munity, and fuels loneliness. of the Trump administration, we are making tremendous W hat was your biggest progress and laying a strong takeaway from the HIV Is foundation for change. HIV is no longer a fashionable cause. Not a Crime 3 conference in It can no longer be seen in singular terms and Indianapolis in June? W hat do you see as the therefore divorced from the intersecting realities biggest challenges or oppor- of racism, homophobia, sexphobia, poverty, Theemen mov t to end HIV tunities facing the HIV com- criminalization is growing munity that the Sero Project addiction, mental illness, homelessness, and rapidly and has become a can help address and raise other factors that drive the epidemic. defining cause in HIV policy awareness about? work. Leaders and agencies who aren’t contributing to 1. HIV service and policy anti-criminalization work are organizations and leadership have a great Sero team, with shown himself to be. We all not serious about addressing that talk the talk about PLHIV Cindy Stine here in Milford, want him to go and the sooner stigma, not serious about HIV empowerment but don’t walk Robert Suttle and Ken Pinkela the better, but the truth is that prevention, and are not seri- the walk; in New York, Tami Haught he exploited an ugly, racist, ous about the quality of life in Iowa, Kamaria Laffrey in dangerous, and greedy under- for and rights of PLHIV. 2. Inspiring PLHIV to under- Florida, and Allison Nichol in current in the nation that will What I found especially stand and take hold of the Washington. still be there after he is gone. exciting is the huge number tremendous power they have, I’ve also got a great team That doesn’t mean everyone of new activists finding their as individuals, to affect their with my mayoral work in who voted for him is all of voices through this work, lives and the lives of other Milford as well, including a those things—I know that isn’t especially young people. I PLHIV. I think often of the supportive borough council the case—but it does mean alternate between feeling quote sometimes attributed and dedicated borough the sentiment, the distorted weird about being one of the to Harriet Tubman, in refer- employees and many vol- values, ignorance, and intoler- oldest in the room—I turned ence to her work freeing unteers. Right now we’re ance that elected him isn’t 60 in May—and being so enslaved people, “I could updating our comprehensive going away when he does. thrilled to see all the new have saved a thousand more plan, organizing a big ben- The real change—and I energy, as well as the interest if they had only known they efit for our garden club, and believe the most important in the history that brought us were slaves”; getting started on a major work any of us can do—is in to this point. streetscape improvement our neighborhoods and with We have seen at the 3. Getting those who are project. As mayor, I oversee our families and friends. It HINAC gatherings how HIV newly diagnosed connected the police department, which might not be glamorous, but criminalization is a crossroads to PLHIV social, recreational, is interesting and sometimes the grassroots—the real for work in a wide range of educational, and advocacy challenging, but has given grassroots—is where we need intersecting social justice and networks. me a greater appreciation for to create change, neighbor- human rights movements. what community policing can to-neighbor. That’s how I got The HIV criminalization How can people get involved be. One of the first priorities elected mayor in a community reform work has created or find out more? for our new chief was to get a that also went for Trump. stronger ties with those com- police bicycle so our officers The kind of change we batting racism, poverty and G et conNECted with a can patrol on bikes. Finally, need in our politics, in our mass incarceration, those P LHIV network [seroproject. Xavier Morales, my partner, society, and in the world working for drug and com- com/state-networks] or start my sister Megan and I run a will come from the bottom mercial sex policy reform, one. Sero is glad to provide small hotel and restaurant in up, with millions of people those fighting for the rights guidance to anyone interested Milford and I spend a lot of working in small ways on their of people of trans experience, in starting a network in their time on that as well. It isn’t home turf, not from the top immigrants, migrants, and community. unusual to see me bussing down.

pso itively aware SEptember+OCtober 2018 27 Prison health IS public health T he case for testing and treating hepatitis C in prisons By Andrew Reynolds

28 SEptember+OCtober 2018 positively aware Istock T This argument is sometimes stated outright, but outright, but stated argument issometimes This YODO — e degree civilization of in asociety judged be can by entering prisons.” its “ and mental health issues, as wellhigh as rates issues, health mental and group in the U.S. who have a constitutional group in U.S. have the who aconstitutional ages in jail are roughly the same as they are in are they as in jail roughly same are the ages that percent the to it issafe assume but data, though jail or prison each year in U.S. the year each jailthough prison or (with approxi 18% around rangingfrom states than arrest them and put them away.) them put and them arrest than rather outside the on services social and tion, but place, in first the into them prison notput treating HCV, and testing, U.S. the helping put that policymakers, prison officials, and the gen the and officials, prison that policymakers, of people who pass through criminal the justice pass who of people numbers sheer The addiction. and of use drug on track to eliminate HCV by 2030 per World per to eliminate track on by 2030 HCV any day on given on (see 1). Box 1.5 around With eral public have won’teral but loud. out say 270,000 as the generally accepted number, accepted generally the with as 270,000 people with hepatitis C pass through the crimi throughthe pass C hepatitis with people of 30%, that It’s or one-third, estimated prisons. people in prison living with HCV can vary, with with vary, can living with HCV in prison people provide them with medical care, harm reduc- harm care, with medical them provide make prisons an ideal location for preventing, for location ideal an make prisons will return to of state prisoners 95% released: more often than not, it’s a quiet assumption not, it’s than aquiet assumption often more nal justice system each year. each system justice nal mately 10% tomately 41%), 10% of of number the estimates preva HCV overall the in prisons, million people Health Health with theirhigh of HCV, rates combined system, days. ofstay 2–5 ayear, than less average for with an sentences incarcerated in jail typically are People society. systems do not screen for HCV or have or available HCV for notscreen do systems Specific 500,000. over thinking be it could some for shorter stays, either awaiting trial or serving awaiting serving or either trial stays, shorter for way to keep people who use drugs healthy is healthy drugs use who way people to keep in jail pris or persons transgender and women jail numbers are hard to come by, jail to hard are come jail numbers most as important to keep inwill to mind keep that be most important inmates million in2.3 with world, over the men, hand. The U.S. has the largest population of population largest the U.S. has The hand. Prisoners are notworthy are Prisoners lence (people infected with HCV) in prisons in prisons with HCV) infected (people lence of HCVtreatment Myth #1: Myth T F O Ironically, people in prisons are the only the are inIronically, prisons people People in prison often have other medical have medical other often in prison People Hepatitis C (HCV) and prisons go hand in hand go prisons and C(HCV) Hepatitis h f t he 2.3 million 2.3 he it’s in jail prison, or O r r D ganization goal. (A caveat: The best best The (A caveat: goal. ganization United States today: “The degree of degree United States “The today: the U.S.to C the commitment hepatitis easily be adapted to Cin hepatitis the adapted be easily elimination can be judged by its com- by its judged elimination be can mitment in to prisons.” treating HCV R uot hi u s q o ssian novelist of the 1800s can can of 1800s novelist the ssian s t o O y v e er 11 million people pass 11er pass million people e v from the famous classic classic famous the from sky

------“Treatment is recommended for all for patients “Treatment isrecommended This is a myth based on old HCV regimens— HCV old on based isamyth This Technically, this isn’t Yes, amyth: need we do Association for the Study the of for Association another directed therapy.” directed another addition Arecent therapy,ated by HCV or transplantation, liver remedi- be that cannot life expectancy a short an injection once per week, and had severe severe had and week, per once injection an in out and those both at of risk infection, those that people clear makes guidelines to these tion was very long, lasting 48 weeks, required required weeks, 48 lasting long, very was tion do of America, Society Diseases Infectious the for aren’ttreated who in prison to people get of prisons. incarcerated: are notthey or whether on other. both. do should and We can people who are not in prison receive. notin are who prison people as just treatment, and linkage and to care port, the same rights to access healthcare as she/he as healthcare rights to access same the in included this notbe should to healthcare punishmentthe have whatever they crime for prison. It doesn’t have to be one versus the the versus one have to It doesn’t be prison. cases, such a failure may actually produce afailure such may produce actually cases, pegylated interferon and ribavirin—that were and interferon pegylated all for HCV treat and to screen made be must sup- and education prevention and reduction not distinguish who should be treated based based not distinguish treated be should who medical or mental health illness, side effects, effects, side illness, health mental or medical physical torture or alingering or death.” torture physical Supreme In alandmark right to healthcare. must rely on prison authorities to his treat [or authorities prison on rely must AC the As ment. punishment. A person in prison should have should in prison punishment. Aperson HCV. We also need to treat people who are who HCV. to people treat We need also ration from free society and loss of liberty is of liberty loss and society free from ration side effects. Active drug use, co-occurring co-occurring use, drug Active effects. side very difficult to take. The treatment combina- The treatment difficulttake. to very so, those needs will not be met. In the worst In will worst the met. notbe needs so, those Estelle v. that case, ruled Gamble, it was Court with chronic HCV infection, except those with those except infection, with chronic HCV was the equivalent of cruel and unusual and punish- of cruel equivalent the was in prison should receive HCV testing, harm harm testing, HCV shouldreceive in prison would outside. have the on to inmate an care denyingmedical or ignoring in prison, we have a moral one, too: The sepa- too: The one, we have amoral in prison, to fail do authorities if the needs; her] medical been convicted of, and the removal of access of, of access removal convicted the and been their HCVproperly won’tPrisoners manage We need to focus our treatment efforts ourWe to treatment focus efforts need on people who aren’t who in people on prison Myth #3 Myth #2 Myth

In order to eliminate HCV, a concerted effort toIn eliminate order effort HCV, aconcerted Guidelines, established by the American Beyond the legal rationale for treating HCV treating HCV for rationale legal the Beyond L U s ummarizes: “anummarizes: inmate

L i s p ver Diseases and and Diseases ver o i t ivel y a in in w ar e S Ept j ails and prisons each year people pass through through pass people SON P SON P e 2.3 million 2.3 r r mb i i 11 million11 are in jail or prison or jail in are people in the the in people e r+OCt Poli Poli c c y y I I o n n b i i t t e i i r 2018 a a t t U i i v v . S e 2 e 2 . U

018 018 . S 29 . T he War on Drugs, Prisons and Hepatitis C: and length of treatment all posed significant liver-related deaths. Patients with HCV who are barriers to treating HCV in prisons and jails. cured have improved quality of life and utilize W e can’t incarcerate That said, even in the days of interferon, people fewer health resources. Finally, when prisoners our way out of this in prison who received treatment were cured at are cured inside of prison, there are benefits to problem rates similar to those on the outside. the larger community, as there would be fewer In today’s HCV treatment landscape, newer new infections there too, and less cost for n Social policy decisions medications known as direct-acting antivirals medical care upon release. can have far-reaching (DAAs) have a shorter treatment duration (8–12 effects and unintended weeks), have fewer side effects, and have a cure Beyond the myths: consequences. Rather rate of over 95%. They are safe and effective for Doing what’s right than taking a public health people in prison to take, and the shorter dura- approach to address illegal tions make them ideal for people in jail to take Anne Spaulding and colleagues from the Rollins drug use, the U.S. chose as well. There is no medical or clinical reason to School of Public Health, Emory University, have to deal with the issue by deny treatment to people in jails or prisons. suggested an “opt-out” model of HCV screen- declaring a “war on drugs” ing in U.S. jails. An opt-out system automati- that began in the 1970s. Myth #4 cally includes a test among a battery of routine In choosing to incarcerate Inmates will get reinfected tests done with a general consent, while still drug users rather than allowing a person to refuse the test. In a brief provide drug treatment This one is a little more complicated: People model put forth in the New England Journal of and other harm reduction living in prison are at greater risk of HCV Medicine, Spaulding states that if there are 1 interventions, arrest rates reinfection, both inside prison walls and upon million people with HCV in jails, and 70% are soared, and the U.S. prison release, but that’s mainly because they do not offered an HCV test and 70% of those accept population exploded in the have access to all the things that we know the offer, then 500,000 new HCV infections can decades to follow. can reduce reinfection. All the risks that exist be uncovered in the first year alone (Spaulding n Injection drug use is outside of prison—sharing injection equipment 2012). The public health impact of jail screening the most common mode and condomless anal sex—also happen within can have wide-ranging impacts on the health of of HCV transmission, prison walls. The major difference is that peo- the community as a whole. accounting for approxi- ple in prisons have no access to sterile syringes Once new HCV infections have been mately 70% of new infec- and injection equipment or other harm reduc- identified in correctional settings, the need tions. People who inject tion services. In the U.S., there are no prisons for support, education, care, and treatment is drugs (PWID) are also or jails that offer syringe exchange services and the responsibility of the system, as referenced arrested and incarcerated safe injection supplies, none that offer safer above. Hepatitis C care and treatment in the at rates well above the tattooing options, and very few that offer medi- DAA era is easier than ever, but it can still be average. cation-assisted therapy. Related to myths 1 and very complicated and may require the work of n Initiated by President 2, there are few options for HCV treatment, and specialists who may not be readily available in a Richard Nixon, the war the more people who get treated in prisons and correctional setting. on drugs is now nearly jails, the less likely reinfection will occur. That said, successful treatment of people 50 years old, and has not in corrections is possible. Today’s HCV treat- resulted in reductions Myth #5 ments are shorter, easier to take with fewer in drug use, but rather, It’s too expensive to treat side effects, and more effective in curing increased our country’s people in prison people. This not only increases the options for prison population, dis- successful treatment of people in prison, but it proportionately targeted This is the same myth we’ve heard since the also opens the door for people serving shorter people of color (especially DAAs were first used in late 2013. It is true that sentences in jails. African Americans) and HCV treatment can be expensive. The high cost widened health disparities of prescription drugs in the U.S. is a problem P rIMARy care providers will play a central in infectious diseases like beyond HCV, but HCV drugs have attracted role in treating HCV, in both community and HIV and HCV. some of the most media attention, as well as in correctional settings, but they will need n A public health the attention of insurance carriers, both private support and training to do so. To address this approach, where we and public, including prisons. need, the University of New Mexico (UNM) decriminalize personal That said, the days of the $1,000 pill are well initiated “The Extension for Community drug use, expand harm behind us. With several medications on the Healthcare Outcomes” (Project ECHO) to train reduction programs like market and competition, as well as lower nego- and improve the capacity of primary care syringe access services tiated drug prices among several pharmaceuti- providers in rural areas and prisons to manage and safe consumption cal companies and insurance carriers, both HCV. They employ telehealth technology, case- spaces, and replace public and private, the cost of medications has based training, and ongoing training to medical incarceration with drug dropped dramatically. providers. This evidence-based model has been treatment and medication- At current prices, HCV treatment is cost- shown to improve the care and treatment, and assisted therapy, would effective. It is true that there will be an initial consequently the cure rates, of patients in cor- be a far more effective jump in spending to pay for the testing and rectional settings, and the expansion of this approach to drug use. treatment of people in prison, but this short- model can serve the treatment needs of people term cost is more than made up for in the in jails and prisons across the country. reduction of new infections, prevention of In addition to supporting the training of advanced liver disease such as cirrhosis, liver medical providers, there is a strong need to cancer, or liver failure, and a reduction in HCV provide patient support and education in jails

30 SEptember+OCtober 2018 positively aware and prisons. Peer support models have been shown to be effective interventions for patient support. The Centerforce peer health model, “Peer Health Education Program (PHEP),” was identified by the CDC in 2009 as a model pro- gram in HCV service delivery in prison settings. HC V Risks in PHEP develops a variety of educational materi- Jails and Prisons als, presentations, and training, as well as videos and support group guides to HCV pre- vention and care. They train peer educators to ost inmates with HCV enter hold workshops, provide one-on-one counsel- jails or prisons already infected ing, and outreach to prisoners to raise aware- with the disease, but there are ness. Similarly, the New Mexico Department Ma number of risk factors that, of Corrections partners with UNM’s Project when combined with the closed setting ECHO and uses telehealth to train and develop and poor access to drug treatment and peer educators to both provide health educa- harm reduction services, may exacerbate tion and support for people living with HCV, but risk and lead to new infections among also to prepare for a career as a community previously HCV-negative persons. health educator upon release from prison. Soon, we’ll have a real-world example of the 670 out of These risk factors include the following: impact of treating all people in prison for HCV. California has embarked on such a program. every 100,000 n sharing of syringes and other injecting The state’s 2018 budget allocates $105.8 million people in the U.S. equipment per year for three years to pay for treatment of are incarcerated n sharing of intranasal snorting all HCV-infected prisoners in the state. In the See nt nciNG Project 2018 equipment (straws, Visine bottles) for first year, they will focus on treating the sickest non-injectable drugs inmates—those with advanced liver scarring n Limited access to drug treatment, and cirrhosis—while scaling up their treat- including medication-assisted therapy ment programs and capacity. In years two and 36.5% n Limited access to HCV treatment three, all remaining HCV-infected inmates will of those in state and (treatment as prevention) be treated and cured, with ongoing screening federal prisons are n unsterile tattooing and piercing and monitoring for new infections, reinfections, African American men n Condomless sex among inmates living and other liver-related medical issues. See nt nciNG Project 2013 with HIV (HIV-positive individuals are ‑at greater risk of sexual transmission Conclusions of HCV)

Ieall d y, the U.S. would not have the world’s Although needle and syringe access largest prison system with epidemic levels of programs (SAPs) remain a controversial HCV, and have a society where we are able to issue in many parts of the U.S., it is well screen, care for, and treat HCV patients before established that these programs are an they enter prison. Until then, we are legally and effective, evidence-based intervention morally obligated to take care of prisoners’ HCV for preventing HIV and HCV infections in screening, prevention, and treatment needs. people who inject drugs (PWIDs). If PWIDs With new testing technologies, improved treat- are incarcerated, they then no longer ment regimens, and innovative, evidence-based have access to these prevention tools. harm reduction interventions, we have the Internationally, however, prison and public means at our disposal. We need to dispel the health officials have introduced prison- myths that serve as barriers to HCV care and based needle exchange programs that treatment behind bars, and shift both public have had similar benefits as they do on the policy and political will that will lead to dramatic outside. Over 60 prisons in 10 countries implications for both prison and public health. operate SAPs in prisons; research and As researchers state: …”we can help to change evaluation of these programs have found the perception of the HCV epidemic in the that needle-sharing is decreased, HIV criminal justice system, transforming infections are reduced, and there was no it from a legal liability to a critical increased injection drug use or increases opportunity to change the course in levels of drug use. In over 30 years of of HCV in the United States.” operation, there have been no reports of syringes used as weapons. A ndrew Reynolds, who compiles the Positively Aware and Project Inform Annual Hepatitis B and C o t Drug Guide, is the Hepatitis C and Harm h p Reduction Manager at Project Inform, and k c

o facilitates several HCV support groups in the t s

I o San Francisco Bay Area.

pso itively aware SEptember+OCtober 2018 31 POSITIVELY AWARE For pagination purposes, this page has been intentionally left blank. ➤ Larninge to

“We had observed in our stay 2gether studies that the most com- How to have a good relationship mon predictor of whether or as a male couple not someone becomes HIV By Enid Vázquez positive is being in a serious romantic relationship,” said Newcomb, PhD, Assistant Professor, the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University’s Feinberg School of Medicine, in Chicago. “At first when we first started to see this it was very surprising because the predominant idea as to where most HIV infections were coming from was from hook- ing up; people that you met at a bar or online or something like that, people you don’t know. The truth is, our pre- vention message got across that if you meet somebody, if you don’t know anything For pagination purposes, this page about them, that you should be more careful with those has been intentionally left blank. partners and use condoms or other prevention methods. So, people were doing that ➤ very well. “erOur oth message at the time was if you are in a rela- tionship, then that’s a place where you can let your guard down, enjoy sex without a condom. Unfortunately, what often happens is that, par- ticularly among young people, many if not most young people who are HIV-positive don’t know that they are HIV-positive, because they haven’t been tested recently,” explained Newcomb. “What that leads to, when they get into a relationship and they Ah, love. So much heartache. and keep a boyfriend, and have a healthy rela- stop using condoms with What’s the secret to a good relationship? tionship, not just hear about HIV. their partner, is the potential What’s a smart researcher to do? Combine for HIV transmission. So we the interests of the men with the imperatives started to think, ‘Wow, what More than a decade into HIV prevention of HIV prevention and—voilà! The 2GETHER is the prevention message work, Michael Newcomb and his colleagues Couples Project study was born. Funded by here?’ It’s not easy to con- found that romantic relationships among the National Institutes of Health, the program vince couples to use condoms, gay men were actually driving infections. Not helps men, whether HIV positive or negative, because one of the benefits Grindr, not MISTER, not gay bars. It seemed work on their relationship together, both as a of being in a relationship in o t strange, but other researchers were finding the couple and in a group with other male couples. terms of sexual pleasure and h

p same thing. It helps them learn skills for intimacy, enjoy intimacy is having sex without k c

o Yet in his work, what gay men told healthy sexuality, and work through a relation- a condom. That’s not a great t s

I o Newcomb they wanted was to learn how to get ship agreement to guide their future. prevention message.” >>

pso itively aware SEptember+OCtober 2018 35 ‘ There are so many things that can’t be answered by a 15-minute doctor’s visit. We need behavioral approaches to help increase the uptake of our biomedical interventions.’

There’s a control arm to also the effectiveness of viral It’s the same set of skills, just could make women promiscu- the study, providing couples suppression on reducing HIV applied to each couple’s indi- ous! And, It could make sex in that part of the study par- transmission, we’re at the vidual needs. about pleasure! And that, ticipation in a program that’s point where we can talk to “Ultimately, at the end of They’re going to have more well-established in showing everybody at the same time, the program, we help the partners! It actually turned improvements in people’s rather than segmenting pre- couples build what we call a out not to be case. It just mental health and wellbe- vention into either prevention relationship agreement. That gave them more options. So I ing. So whether couples are for negatives or prevention agreement details first the present PrEP much the same randomized to the 2GETHER for positives.” conditions under which it’s way, especially considering program or its control arm, This also means they get acceptable to have sexual it’s mainly more higher-risk they are receiving the same to talk to everyone about partners outside of the rela- individuals that are likely to amount of time and atten- adherence to medication, tak- tionship—if at all—and then, take it. It’s actually designed tion. Yes, the study is aimed ing the pressure off of those depending on the agreement for that population. Most of at showing reductions in new living with the virus. “That’s that they have with their the time they’re probably not HIV infections and STIs. really what’s the same in partner, we layer on top of using any other prevention “I love the fact that these the HIV field as it is in every that specific prevention meth- method to begin with, so we are programs that are open other health condition—that ods that are tailored to the should give them more tools to anyone regardless of HIV there’s no magic bullet to fix agreement that they have,” to put in their toolbox. It’s like status,” said Jim Carey, MPH, things,” said Newcomb. “We Newcomb said. “So those a lifejacket. You could wear a the 2GETHER lead facilita- can’t just provide someone prevention methods could be lifejacket to prevent anything tor and a Research Project with a medication and using PrEP. If folks are HIV from happening or you could Coordinator at the Institute. assume that it will go per- positive, then reducing viral say, ‘Oh, if you fall in the “A lot of RCTs [randomized fectly after that. In order for load so that people are virally water, that’s your own prob- controlled trials, or studies] medical interventions to be suppressed, as well as things lem. You’ll just have to deal have been focused on HIV- effectiveFor they pagination need to be purposes,like condom this use and page more with it.’ That makes no sense negative people and how paired, for many people, with frequent use of HIV and STI whatsoever.” to help them stay negative, behavioralhas interventions been intentionally as testing and left things blank. like that.” Added Newcomb, “So which is fantastic, but I feel well that address those barri- many people don’t think like that’s leaving an entire ers. It’s about things like stig- For whatever couples need they’re at risk.” He knows, piece of the population out of ma, but it’s also addressing ➤that is outside the realm of however, that HIV preven- the equation. So the fact that access to resources, access the project, they receive refer- tion education may change people can participate regard- to PrEP, improving people’s rals, such as for HIV testing community standards—what less of HIV status, regardless knowledge about what PrEP or PrEP prescriptions. Study people believe is acceptable of how they identify their rela- actually does. There are so staff finds that the men are and expected. tionship—whether they are many things that can’t be happy to receive information “We know norms have a open or not or somewhere in- answered by a 15-minute doc- about PrEP and referrals for big influence on people’s between—I think it’s a more tor’s visit. We need behavioral other services. behavior,” Newcomb said. comprehensive approach approaches to help increase Carey recalls the day “It’s easier to play the blame to meeting the population the uptake of our biomedical when, as an undergrad, he game and point the finger at where they are.” interventions.” made a presentation on HIV someone else. The truth is prevention that included a that norms have an influence 2GE THER reviews the current Theram prog finds that large bin of condoms for on older people as well as biomedical prevention meth- among other things, couples student use. He was happy to younger people.” ods used against HIV, most come in thinking that they find the bin empty the next specifically PrEP use by men know how to communicate day—until someone told him National videoconfer- who are HIV-negative, and well with one another—and another professor had thrown encing for love and the use of TasP (treatment then discover that they don’t. the condoms away so that wellness: The 2GETHER as prevention) by men living “The truth is that people students wouldn’t be tempted program has a national with HIV. are very different in the way into having sex. component available to “We’re integrating both that they communicate. “People are not having sex gay male couples across primary and secondary HIV People can be effective at because they have a condom,” the country, operating via prevention, so prevention communicating if they are said Carey. “You’re giving videoconferencing. For for negatives and positives quiet, if they are very ver- them the option of using a more information, email into the same program,” said bose—you can be effective no condom if they do have sex. I the team at 2gether@ Newcomb. “It’s so important matter what your communica- always compare the stigma northwestern.edu or text particularly in the context of tion style is,” said Newcomb. conversation around PrEP to 2GETHER to 773-340- the big shift to biomedical “We just try to improve the the exact same conversation 9825. Follow 2GETHER prevention strategies. With manner in which each couple when birth control pills were Couples Project on both all that we know now with is communicating based on released in the ’60s. The argu- Facebook and Instagram. the effectiveness of PrEP and what they bring to the session. ment back then was that, It

36 SEptember+OCtober 2018 positively aware POSITIVELY AWARE For pagination purposes, this page For pagination purposes, this page has been intentionally left blank. has been intentionally left blank. ➤ ➤ H t owling Ou art through eyes of love Artist Michael Payne’s work gets published at AIDS 2018 By Enid Vázquez

n international conference provides people around the world responded that he should exhibit it at the with the opportunity to meet and share important ideas and group’s annual art show at Las Manos support. This year, the HIV Howler was created to bring art Gallery in the Chicago’s Andersonville neighborhood, near TPAN. with a message, created by people living with the virus, to “I said, ‘Jessie, no!’ ” Payne recalled. the International AIDS Conference in the form of a newspaper. “He was nervous and thought it was Its motto is “Transmitting Art and Activism.” too risqué,” said Mott, “but of course, A that’s the kind of work I love the most. “Artists have and continue to play a think that they are born losers. They don’t [Laughs.] I said, ‘No, this is going to be fundamental role in shaping broader realize that there are movie stars who big.’ ” She sees the painting as “whimsical societal understandings of HIV and work- made millions of dollars who’ve become and yet really sensuous at the same time.” ing within the communities that are most homeless.” “Jessie told me, ‘Just do it [the exhibit]. impacted by the virus, such as people Artists are supposed to do in-your-face who use drugs, sex workers, people of Peidayn sa his work has turned more stuff.’ I thought about that,” said Payne. “I color, indigenous peoples, trans folks, political of late, particularly after the 2016 have to stop being afraid to express my and LGBQ+ people,” notes the project’s U.S. presidential election. He said some art, whatever it is. If people get offended call for art submissions. of that work was so angry, he threw it in by it, I have to say that’s probably a Michael Payne, a member of the art the garbage. good thing. Because it’s supposed to be therapy group at TPAN (publisher of He was thrilled at having his artwork provocative. If it didn’t offend you, it’s not Positively Aware), submitted works to accepted for the HIV Howler. “For some- powerful enough.” the HIV Howler for consideration. Three one who doesn’t even know you to look “Eyes of Hatred” brings out much more of his paintings, focusing on pleasure at your work and say ‘I like it,’ that is so in Payne. While the eyes of the Klansman and criminalization, were accepted for huge to me. You never know what kind peep through the holes in his sheet, the publication. of opportunities will pop up when you’re eyes of the black man and of the white “Blown Away,” “Erotica,” and “Eyes of doing this kind of thing.” policeman are blocked by sunglasses. The Hatred” represent the development of Although he had stopped creating work holds different meanings for Payne. both his art and his politics. art more than a decade ago, he kept a Payne spent two years at a liberal arts closet full of his work. But he was reborn Hrvee obse s that people use sunglasses, college, but after losing his job, became as an artist after attending art sessions even on a cloudy day. “So my thought is homeless. After a week of hitting the at TPAN. “To have this happen this late in … people don’t want to be seen or maybe pavement looking for work, he received my life, to me it’s God saying ‘I had your they’re hiding something.” He’s noticed two full-time job offers. “Young people back all along.’ I do believe in God. I think that individuals caught on video making need to look at that. They’re so used to He’s doing this as a bucket list [fulfill- racist rants that went viral over the sum- ‘give me’ and ‘I’ll just go home and live ment] sort of thing.” mer were also wearing sunglasses. He with my parents,’ ” he said. Payne gave up explaining his artwork thought it was interesting that they didn’t He was estranged from his family. a long time ago, when he saw that oth- bother to remove the glasses. Early on, his parents discouraged his ers were judging the work from their “Maybe they’re ashamed. I’m not a psy- dreams of becoming an artist. While own perspectives. To him, that was fine, chologist or anything, but I wonder if part he now believes that they were trying whether they liked it or not. For the of that is, ‘Even though I tell you I hate you, to protect him, they in fact destroyed pieces accepted by HIV Howler, however, I know when I’m alone, when I go to sleep his confidence. When hanging out with he was happy to elaborate. at night, that it’s not good to harbor this friends, more than one person told him “Blown Away” represents illicit drug hatred, but I can’t help it.’ You don’t want he was like “a scared little boy.” He began use, which led to an episode of homeless- to look a person in the eye when you’re to change when a friend said, “Michael, ness in his life. “This to me looks like filled with that much hatred. It can’t be a you’re not a little boy anymore.” Still, he madness. That’s what the drugs mean happy thing. It’s how we hide our hatred had gone into music as a young adult and to me, it’s total chaos. I put Superman in too, and how we may not be proud of it. had a song stolen by an agent. He then there because when you’re on drugs you And I think everybody is capable of hatred. gave up all creativity and spiraled even feel like Superman.” I don’t care what color you are. deeper into depression. “Erotica” is perhaps the strangest piece “Police use the sunglasses, in my mind, “I don’t really fit in the profile of home- he’s ever produced. Filled with orgiastic because it’s intimidation. They don’t want lessness,” Payne said. ““I came from an scenes from a freer time decades ago— you to see whether they’re looking at you,” upper middle class black family from a not all of which he engaged in himself—it he said. very nice neighborhood. My family was shocks those who know him. Those who He remembers walking out of TPAN full of high achievers. When I was out don’t have reacted with approval. one day and the eyes of another black there I found that there were a lot of Which is strange to him because it’s a man looking at him with hatred. He people like me. piece he never wanted to show, and sent thought that with TPAN being known as a “It’s just like drugs,” he continued. to the artist in charge of the art therapy place serving gay people or people living “People have a misconception of what that group just for fun. Jessie Mott, who led with HIV, or both, the man objected to means and who those people are. They TPAN’s art therapy group until recently, his being.

38 SEptember+OCtober 2018 positively aware ‘I think people have become too complacent and I want people to get upset, get angry, become active and do something about it. Don’t just look at a painting and look remorseful.’

active and do something about it. Don’t just look at a painting and look remorse- ful. ‘I don’t want to think about that.’ You need to think about it.” Said Jessie Mott, “To have that kind of reach, at the conference, is going to be just wild.” She said that from the start of the art therapy group, Payne was committed to his art and obviously very talented. He was also an unofficial leader of the group. “He’s kind. He’s really helpful to the other people. He has lots of empathy.” “Ultimately, the group is about creating social connections and building a commu- nity,” said Mott. “We check in and we talk about their week. But there’s lots of joking and laughter. It’s like a family, especially for the people who come in week after week. Everyone can find two hours of peace and creativity that week. For some people, it’s their only two hours out of the house. You come in and play. Mostly it’s about a safe place to be creative.”

P ayne’s confidence is really showing through now, said Mott. “He has so much PA YNE’s ‘Eyes of Hatred’ work and he gets a lot of response.” “He’s a real survivor,” Mott said. “He’s a “You can just see hatred in some- But there’s much more to his percep- real joy to be around.” body’s eyes. They say when you look in a tion of racism. The HIV Howler, funded in part by the person’s eyes, they either smile or they Toronto Arts Council, was envisioned by frown. When you look in the eyes of a per- “ WHEN people say racist things, I try to queer couple and project collaborators son who’s nice, there’s a warmth. When play devil’s advocate. Can people change? Anthea Black and Jessica Whitebread, you look in the eyes of hatred, there’s a George Wallace [an Alabama governor in who are based in that city. This is a lim- coldness. You know if a car ran over a the 1960s and ’70s who was an outspo- ited edition project they see as allowing puppy dog, they would look like that. ‘I ken segregationist and racist] atoned at art to be easily distributed. “We loved his don’t care. I don’t feel nothing about the end of his life. That’s something that [Payne’s] vibrant illustrative works,” said it.’ So people like that, I find them really you have to process over time. I’ve been Black via e-mail. “We felt they could be disturbing. I’m just at a point where I’d in the car with my father when the traffic interpreted to show a lot of important like them to just stay away from me. I just gets bad and he says. ‘Look at that stupid ideas that impact people living with HIV, want to be safe.” so-and-so.’ It was just the anger in the and also the international advisory com- The supposed “victim,” however, is moment. When you’re angry with some- mittee was very interested in showing also wearing sunglasses in the painting. “I one you pick a word that hurts them. drawings, paintings, and other creative originally was going to have him as just “I’m not perfect either. I have had works by HIV-positive artists and folks the innocent victim. But then I thought periods in my life when I got angry at who might not be getting mainstream about how I walked out of here and had someone and used a racial slur. I’ve done recognition in the art world.” this black guy look at me in just a hate- it. And I’m not proud of it. We’re all human Forty artists publishing in five lan- ful way. It can be an equal opportunity. beings. As long as you are aware that— guages are represented in the HIV Howler Black people have been largely victimized. that’s ... not … good. As long as it bothers editions. They include an “in conversation” e But there are black people who are full your conscience, then you are redeem- piece between New York mixed-media Payn

of hatred too, for gay people. Me being able. But when you do it and think ‘I’ve artist Frederick Weston and Nancer l e black and gay, trust me, I’ve been around done nothing wrong,’ that some Nazis are Lemoins of San Francisco, who does a h

c enough black people that hate gay people good, that’s disturbing. That’s Hitler-like.” printmaking and bookmaking as well as

Mi and hate me because I’m gay. That’s why I He said that with a greater bent to drawings and paintings; writing by Ed f o decided to include a black person in there. being more political in his art, his work Moreno of Brazil; photography by Kairon s And I think that’s fair. [Pause] You can’t is meant to be disturbing. “I think people Liu of Taiwan; paintings by Manuel Solano say one race has a lock on hatred, though have become too complacent and I want of Mexico; and drawings by L’Orangelis u

Co y rtewhite people probably take the cake.” people to get upset, get angry, become Thomas of Puerto Rico.

pso itively aware SEptember+OCtober 2018 39 C ONFereNCE UPDATE AIDS 2018: REPORT FROM AMSTERDAM

Mo nDAy’s Community March through amsterdam. Msingsu from Amsterdam A brief recap of my week at AIDS 2018 By Jeff Berry @PAeditor

n a whirlWINd week of workshops, dem- T here was a touching moment in the opening session when Dr. onstrations, presentations, and meetings, Joep Lange, his partner Jacqueline van Tongeren, and four others who were headed to the 2014 conference were remembered and this year’s international AIDS conference in honored. They were all aboard Malaysian Airlines flight 17 on that Amsterdam brought home the fact that while fateful day in 2014 when it was shot down and 298 lives were lost. we have made incredible progress and much The conference co-chair Peter Reiss became choked up as he was has changed since the conference was first talking about his friends who were murdered on the flight, and I and thousands of others were in tears as well. It was because of a held here in 1992, including the recent approval conversation with Joep before he was killed that they decided to of PrEP by the Dutch government, incredible chal- bring the conference back to Amsterdam after 26 years. I Go to the online program at for webcasts, lenges remain—since 2010 HIV infections have AIDS2018.org increased by 30% in Eastern Europe, largely due to slides, and rapporteur summaries of the conference. Videos are also available on the IAS YouTube channel at youtube.com/ intravenous drug use. iasaidsconference.

40 SEptember+OCtober 2018 positively aware MARCH: ©Matthijs Immink-IAS • Photos this page: Jeff Berry Alison Alison of the Swiss Statement Statement Swiss the of and treatment, effective on men gay of partners the of with untransmittable), equals conference was the promi showing zero new infections infections new zero showing and endorsements from and endorsements pre-conference all-day an C message that people who are are who people that message landmark the of presentation includnumerous speakers, of nence P ing Dr.ing P for for groundwork the laid which severalworkshop, sessions, this about me for things E One A i amp U Equals U Equals U etro Vernazza,co-author R P of t of T r evention Access Access evention N aign’s empowering R T E o o R h ny ny U dger during her her during dger S 2s = most notable notable most F U a (undetectable (undetectable uci of NIAID, NIAID, of uci tudy results results tudy - - Alex Schneider is aGerman- is Schneider Alex on effective HIV therapy do do therapy HIV effective on Vernazza, fighting back tears. back fighting Vernazza, the about spoke campaign, of of ovation given by those in the the in those by given ovation controlling the message. “It’s “It’s message. the controlling of on work groundbreaking early by cre youth vulnerable other out that that out sented with an award for his his for award an with sented going on here, but it’s always always it’s but here, on going William William are increasingly rolled out as as out rolled increasingly are a young boy, now advocates advocates boy, now a young as positive HIV testing after ating opportunities for them them for opportunities ating and the negligence ofpeople adherence called Life4me+ Life4me+ called adherence improve help to designed app high were globe the around visibly moved by the standing standing the by moved visibly vital that campaigns like like campaigns that vital (available on Google Google on (available not transmit the virus. transmit not reach HIV-negative people prevention technologies that new dynamic as erased, not nialism, ignorance, and the room. “I’m shocked at what is is what at shocked “I’m room. U people to start to think about about think to start to people U Love to Love, a partner of the the of apartner Love, to Love in the global HIV response response HIV global the in M ing the message of of message the ing HIV and co-creator of a mobile a mobile of co-creator and HIV R B from campaigns Innovative ing call to action and admoni- and action to call ing including those from communities. own their in factors that hinder spread the silvery-blue bullet many many bullet silvery-blue the tion of those in power who are are who power in those of tion was and Statement, Swiss the and orphans of rights the for family his by shunned was the science, and not the fear.” the not and science, the have been seeking… keep centering the voices voices the centering keep pointed He Store). App the been about emotions,” said said emotions,” about been his presentation with arous- with presentation his living with HIV. with living for support financial of lack lighted throughout the day, u . g el e K., just to name a few. Dr. afew. name to just K., “Whatever you call it: it: call you “Whatever P T ssian activist living with with living activist ssian anda, including HIV colo- HIV including anda, lbourne, Australia, ended ize, Australia, and the ize, Australia, During the workshop Nic Holas, co-founder co-founder Holas, Nic P h L i e Institute of of e Institute HIV and ensure we are are we ensure and HIV etro Vernazza was pre- was Vernazza etro M U = a tovu of of tovu U is about “getting “getting about is M a M tovu, who who tovu, U U g P a R = anda’s anda’s l ny in in ny ay or or ay ussia, U in in U U = - = - U U , -

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41 C ONFereNCE UPDATE AIDS 2018: REPORT FROM AMSTERDAM

many of who are long-term survivors of HIV. In a poster by University of Greenwich’s Jacqui Stevenson and col- leagues, 14 women aged over 50 participated in a life story interview. Participants were recruited to reflect the diver- sity of women living with HIV in the UK, and included: Five white British women, one white other, one black British woman, and seven black African women. Twelve were aged 50–60, and two aged 60–70. Two bisexual women and one trans woman participated. One woman was diagnosed less than 5 years, Sveete De ks (left) looks on as Clark Hawley talks about participating in the cure study. three for 6–10 years, one for 11–15 years, two for 16–20 years, two for 21–25 years and U s VL, Ta P, call it loud and was ready for love. Hawley Jones concluded with an five for 26–30 years. proud. It is not enough to end is thought to be the earliest empowering analogy of how Some of the comments the HIV epidemic with PrEP adult who initiated treatment past epidemics can sow the from participants included, and leave us isolated, crimi- after being exposed to HIV seeds for future cures. The nalized, and stigmatized. No (probably around 10 days; he Delta 32 mutation that makes “Maybe we need something longer can we accept gate- was only on PrEP for four days cells resistant to HIV, and new to define this keeping from CEOs and board and was immediately put on contributed to the one known experience of loss of self, chairs of PLHIV and AIDS ART). He now takes two pills cure to date (that of Timothy loss of future, loss of organizations. No longer can a day instead of one, he says. Ray Brown), came from a past identity, loss of...” we allow this life-changing, “When you get covered in the epidemic such as the plague life-saving information to be magazine as one of the poster or smallpox, we don’t know “I survived something withheld from us. boys for HIV, this was not one for sure, said Jones. “But we that I wasn’t supposed “Zero risk equals zero of the things I aspired to be.” should also know that the to and I did..., I don’t excuses. If you are part of an Says Hawley, “If seeds of discovery that we have a problem with the organization that is sitting people knew how much the generate in the process [of term survivor, but I don’t on this information, you are researchers care for study discovering a cure] will drift identify with the word killing us.” participants, they would be into the future and will have guilt, I don’t feel guilt.“ much less fearful [about par- positive benefits on human HIV cure ticipating in a cure study].” health long after the HIV “…coin that one, survivor The HIV Cure Community In the Wednesday morn- epidemic is over. That will be conflict” pre-conference workshop ing plenary session, R. Brad the enduring legacy of the took place on Saturday, two Jones, PhD, of The George special community that we’ve “I think that’s a more, days before the official con- Washington University, gave built—and it will emerge from much better descriptive ference opening. See Karine an eloquent overview of HIV the altruism of people living term than the guilt one, Dube’s blog at positivleyaware. cure research, one of the with HIV, including those because you’re right, you com for more about the work- most understandable and who continue to participate do go between…” shop. One of the highlights for entertaining presentations on in research after they them- me was getting to hear Clark the topic that I’ve ever seen. selves are healthy. People like “You go between positive Hawley, who was featured In his talk Jones used the [Timothy Ray Brown] and so and negative feelings, a in the Posiy tivel Aware analogy of the story of the many of you whom I’ve had sense of confusion, a Summer 2018 issue on HIV little Dutch boy, who spots a the honor to speak to today.” sense of, it’s very difficult cure, tell his story about how leak in the dam and saves his to make sense of it, or to he came to participate in a town by plugging it with his Bee sur to check out the have a rational, logical, cure study. finger until help can arrive, to entire presentation at completely like, being In an interview of Hawley categorize the different cure aids2018.org. very happy about it. I am by Dr. Steven Deeks of USCF, strategies currently being grateful, on a good day.” who heads up the cure study pursued, either by draining Long-term survivors he is in, Hawley spoke of how the reservoir (sterilizing “Survivor Conflict” was Stevenson told Posiy tivel after coming out later in life cure) or by “reinforcing the the preferred term used to Aware that women with HIV and having gone through dam” (boosting the immune describe what’s often referred often feel excluded because a “slut” period, he decided response to HIV, also known to as “survivor’s guilt” by a they are not a “community” to go on PrEP because he as a functional cure). group of women in the U.K., affected by HIV (such as gay

42 SEptember+OCtober 2018 positively aware All Photos this spread ©Steve Forrest-Workers’ Photos-IAS ‘normal’ types of dying.” of types ‘normal’ Justice Network, led a panel apanel led Network, Justice Justice Network pre- Network Justice o The . B N E AIDS AIDS challenge of reconciling to to reconciling of challenge cated by feelings of gratitude, gratitude, of feelings by cated and emotional an is diagnosis of‘survival.’ constructs that experience evolving diagnosed before effective “Women that, concluded of activists and people who who people and activists of conference workshop was Wilding of the the of Wilding Surviving is just the begin- the just is Surviving mundane mortality, and the the and mortality, mundane meaning of HIV changes with with changes HIV of meaning and reached milestone new with decades, for Living, ning. Global Global psychological challenge psychological that adequate- not are that riences ment from Laela and Naomi Naomi and Laela from ment men), so they have to seek out out seek to have they so men), HIV is negotiated with each each with negotiated is HIV is the prospect of ordinary, ordinary, of prospect the is ongoing, an is HIV with Living inalization. inalization. decrim HIV involvement with time and age. age. and time external and internal the for many women is compli- is women many for treatment became accessible community. their loss, and fear for the future. future. the for fear and loss, simple with reconcile to hard be can that challenges brings addressed. or understood ly have unique needs and expe- and needs unique have kicked off by a moving state- amoving by off kicked d HIV criminalization HIV “Surviving a terminal aterminal “Surviving w T B h i F e e study authors authors e study J ou y C o ndation their about nd ordinator of the HIV HIV the of ordinator e E rnard B dwin dwin B l E ame e l izabeth izabeth yond this this yond B

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- criminaliza “We’ve made great advances advances great made “We’ve T T Amsterdam facingAmsterdam horrible A dancing in the streets. streets. the in dancing on planes herpes lesions with ers of A of ers calling upon the International International the upon calling are HIV with living people of of said that in one sense every sense one in that said some ofthe horrible inequities get food. Kate Kate food. get all over their face, thrush in conference 1992 the at another nothing has changed. nothing hasanother changed. activism going on at the same same the at on going activism Switzerland spoke about how how about spoke Switzerland Nutland. “Do not go back to to back go not “Do Nutland. aspace demanded and IAS Nutland of of Nutland E in treatment, a pill for preven for apill treatment, in went to Jonathan Jonathan to went their over all KS mouth, their tion, tion, in and changed, has thing the Global Global the and rest could they where that werethat happening.” William Activist about. written been yet haven’t that time to continue and were, there body, or or body, because people were getting holding our heads in shame at at shame in heads our holding be should we back, looking the how be, other, quieter forms of of forms quieter other, be, human rights issues again. again. issues rights human in later years 26 are we here u r n r #AIDS2020ForAll ump’s America in 2020!” in America ump’s berculosis and ic Sawyer, one of the found the of one Sawyer, ic “I make a call to IAS,” said said IAS,” to acall make “I U

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F UP P o we should be be should o we n s p u A lounges started started A lounges r , a of members members of nd to to nd o . E , t T P nd activists activists nd alked about about alked h i s t omson of of omson ter in the the in ter M ivel M F a a i laria in ght AIDS, AIDS, ght nn of of nn y B a u w t t U ar - . K. K. - - e

S Ept AIDS 2020 in in 2020 AIDS AIDS Society to immediately to immediately Society AIDS of individuals and organiza and individuals of during a conference main floor floor main aconference during out of the the of out 2020. allies appeared at AIDS 2018 2018 AIDS at appeared allies about the grassroots move the grassroots about administration making it it making administration announce their decision to unsafe and unethical to hold hold to unethical and unsafe press conference. Hundreds conference. Hundreds press ment to move the conference conference the move to ment rights violations of the the of violations rights relocate AIDS 2020 outside outside 2020 AIDS relocate F tions have signed on to No No to on signed have tions hivpowershift.wordpress.com the conference here in San San in here conference the the the Fo banner drop and a people’s apeople’s and drop banner r ancisco in and Oakland r m e re-distributes it re-distributes been wasted and then have would otherwise that medication life-saving ers unused, unexpired - recov Program Recycling living with HIV in the the in HIV with living everyone If help? you can How treatment. access to countries other to fled have 10,000 medications; in Venezuela need thousandEighty people needlessly. dying are HIV with people inregime Venezuela AID the through countries developing in access without be saved. saved. be thousands of lives would Aguais, says medications, would donate their unused Program. Access T aidforaids.org trash. the of out $140,000,000 taken has organization U F AID of Aguais Jesus AIDS for AID Activists, advocates, and and advocates, Activists, U mb reatment reatment o = . r AID S. due to the human human the to due S. U U o e audience that his his that audience re n r+OCt der the current ’s HIV Medicine Medicine ’s HIV A U S S in F . (A

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. S - - . 43

. C ONFereNCE UPDATE AIDS 2018: REPORT FROM AMSTERDAM

Am a sterd m travelogue

PhotoS by Steve Forrest-Workers’ Photos, Matthijs Immink, and Marcus Rose for IAS; and Jeff Berry 44 SEptember+OCtober 2018 positively aware Partner 2 study—Lots of sex, no transmission By EniD VÁzquez @enidvazquezPA

he PARTNER 2 study found zero The study team wanted to expand wrote lead author Alison J. Rodger, MD, transmissions of HIV in 972 male on the findings of the PARTNER 1 trial, of the University College London and couples where one partner has where most of the couples enrolled were colleagues in their conclusion. the virus and the other doesn’t, straight. That study also found zero “I think it’s very clear, the time for despite 75,000 acts of condom- linked transmissions. excuses is over,” she said during her Tless sex acts and no use of PrEP or PEP. “PARTNER 2 provides a similar presentation. “If you’re on suppressive The men living with HIV all had undetect- level of confidence for gay men as for therapy, you’re sexually uninfectious.” able viral load. heterosexual couples in PARTNER 1,”

More from Enid:

On-demand HIV acquisition, no break- PrEP succeeds through HIV infection was Vvei la France! The ANRS reported so far with either Prevenir community-based daily or on-demand PrEP, sup- study, which took place in porting continuing use of both the Paris area, found no HIV dosing regimens in their popu- transmission in men using lation,” they concluded. either PrEP or on-demand PrEP in sex with other men. PrEP levels with PrEP prevents HIV. The female hormones Prevenir (or “prevent”) trial Tran swomen who use built on the international feminizing hormones IPERGAY study that also have worried about drug found successful results with interactions with the use on-demand PrEP in men who of Truvada for PrEP, noted have sex with men. Akarin Hiransuthikul and At this time, PrEP requires colleagues of the Thai Red Ak ranarIN Hi suthikul, MD PE hndro Ca , MD a daily pill of Truvada. The Cross AIDS Research Center. on-demand PrEP used in this Not for nothing. The team’s earlier this year. It is a two- Fundacion Huesped in Buenos study consisted of: iFACT study found that the drug single-tablet regimen Aires, and colleagues report- plasma levels of the tenofovir of dolutegravir (brand name ed that patients are inter- n two pills of Truvada within DF (TDF) in Truvada were Tivicay) and rilpivirine (brand ested in two-drug regimens to 24 to 2 hours before first affected by feminizing hor- name Edurant). avoid greater drug exposure sexual intercourse, then mone therapy. Plasma levels In combined data from the over their lifelong therapy, as n one Truvada pill every of TDF were slightly lower. SWORD 1 and SWORD 2 stud- well as minimize potential 24 hours during the period This suggests that Truvada ies, 456 of the 513 individuals side effects. “DTG’s potency, of sexual activity, with for PrEP may be less effec- (89%) on Juluca continued to safety, and resistance bar- n one Truvada pill after the tive for transwomen on the have undetectable viral load. rier make it an optimal core last sexual intercourse, hormone treatment, although agent for two drugs while and one last Truvada pill Hiransuthikul said the levels Two-drug therapy 3TC’s safety, tolerability, and 24 hours after that. were still high enough to be non-inferior to 3-drugs efficacy make it an attractive effective for HIV prevention. as initial regimen partner for initial HIV-1 treat- “On-demand PrEP with More research is needed to One th coattails of ment,” they wrote. TDF/FTC [Truvada] has been see if the lower levels are Juluca, Tivicay’s maker, ViiV After one year in each recommended as an alterna- clinically significant. Healthcare, reported more study, dolutegravir plus 3TC tive to daily PrEP for MSM The hormone levels, on the good news with using it as a was found to be non-inferior [men who have sex with men] other hand, were unaffected two-drug regimen, combined to dolutegravir plus Truvada.

IAS by the European AIDS Clinical by the Truvada. Yay! Twenty with its Epivir (3TC). (The In the participants taking the - s Society following the results women enrolled in the study. Edurant in Juluca is from two-drug regimen, 91% (655 ber i of clinical studies, but data are Janssen Pharmaceuticals.) out of 716) had undetectable

Hu limited on real-world experi- Juluca 2-year data In two separate studies, viral load, compared with 93% b o ence,” the research team ValiiV He thcare reported GEMINI-1 and GEMINI-2, (669 out of 717) of those tak- R

© ing the three-drug regimen. : noted in their study summary. that, at two years out, the Tivicay (dolutegravir, or l u Nearly 1,500 HIV-negative results of switching to Juluca DTG) plus Epivir (3TC) did There were more than 700 ik h men enrolled in the study. continued to be non-inferior as well as the combination persons in each study, all tak- u “In this ongoing PrEP cohort compared to staying on a of dolutegravir plus Truvada ing HIV medication for the first

a in the Paris region, enrolling three- or four-drug regimen. (tenofovir DF/FTC). time. More than 20% of them r i

H t mainlyNS MSM at high risk of Juluca was FDA approved Pedro Cahn, MD, of started out with a high viral

pso itively aware SEptember+OCtober 2018 45 C ONFereNCE UPDATE AIDS 2018: REPORT FROM AMSTERDAM

load of greater than 100,000 and upper respiratory tract taking dolutegravir compared copies per mL. There were infections (13%). These rates with those taking efavirenz. more drug-related adverse were about the same for the The 60 women in the events with dolutegravir plus Prezista group. study started HIV therapy Truvada, as to be expected There was, however, a sta- in their third trimester. due to the TDF it contains. tistically significant increase According to the report, start- in LDL cholesterol and triglyc- ing HIV therapy this late in the Doravirine update erides with Norvir-boosted game has been associated Mc er k upDAted its 48-week Prezista. Norvir is known to with an inability to achieve data with doravirine to 96 increase these levels, even at undetectable viral load as well weeks, from the DRIVE- lower booster doses. as increased transmission. FORWARD study. Doravirine is an NNRTI There were no HIV transmis- Doravirine continued medication (non-nucleoside sions in this study. to show non-inferiority to reverse transcriptase inhibi- “DTG transfer across Norvir-boosted Prezista. Both tor). The FDA has accepted a the placenta (122%) and in drugs were taken along with New Drug Application (NDA) breast milk (3%) coupled either Epzicom or Truvada. for both doravirine and a with delayed elimination R ebECCA Zash, MD At 96 weeks, 73% of the doravirine single-tablet regi- resulted in significant infant doravirine group had unde- men (combining it with Epivir exposures potentially persist- and delayed elimination.” tectable viral load compared and tenofovir DF). An FDA ing during breast-feeding,” The women, all in Uganda with 66% of the boosted decision is expected soon. the research team reported. and South Africa, took dolute- Prezista group. The average “Both regimens were well- gravir or efavirenz along with CD4 T-cell count increase was Dolutegravir tolerated. A total of 10 SAEs two HIV NRTI medications. 224 for the doravirine group in pregnancy [serious adverse events] were Dolutegravir is found in and 207 for the Prezista group. Di esp te low exposure reported in 5 mothers and 3 Tivicay, Juluca, and Triumeq. The 766 participants in the levels of dolutegravir (DTG) in infants, with no significant Efavirenz is found in Sustiva DRIVE-FORWARD study were pregnant women living with differences between arms and Atripla. all taking HIV treatment for HIV, the medication managed [the two medications].” Birth defects have the first time. to bring their viral load down The DolPHIN-2 study will recently been associated with Side effects in the rapidly. That’s good news. look at the impact of “sig- dolutegravir. See the following doravirine arm of the study The DolPHIN-1 study found nificant infant DTG exposures item, as well as the B riefly included diarrhea (17%), nau- a more rapid decrease in related to intrauterine trans- section of the Posiy tivel sea (12%), headache (15%), viral load in pregnant women fer, continued breastfeeding Aware July + August issue.

Dolutegravir and birth defects Flwngol o i recent warn- ings of the potential for neural tube defects to newborns of women taking dolutegravir at the time of conception, Rebecca Zash, MD, of the Beth Israel Deaconess Medical Center, provided an update. In the earlier report, pre- liminary data showed that four out of 426 infants born

to women who were taking S A I dolutegravir at the time of - s r

conception experienced neu- e b

ral tube defects. This was less ui H

than one percent (0.94%), but b

higher than the 0.12% found Ro : ©

among women taking a non- h s

dolutegravir regimen at the a

time of conception (14 infants • Z y

out of 11,300). r r However, not one infant out

of 2,812 whose mother started ff Be e Central Asian and Eastern European activists at AIDS 2018 promoted the campaign “Chase the virus, dolutegravir during pregnancy J not people!” Their logo consists of a pair of handcuffs with one locked on the virus, but the one had a neural tube defect. representing people left wide open. They called it “a symbol of limited freedom and actions.” Go to Researchers are looking t c

chasethevirus.org. to further surveillance to A ivists:

46 SEptember+OCtober 2018 positively aware confirm any link between dolutegravir and this potential side effect, which consists of birth defects of the brain, Expert panel: HIV criminalization spine, or spinal cord. is discriminatory and at odds with science The Amsterdam Affirmation: People, Politics, Power For every international AIDS conference, the organizer, the International AIDS Society “...these misconceived (IAS), and its partners create laws exacerbate a sign-on declaration. The the spread of HIV...” declarations focus on needed —LG inda- ail Bekker changes to end the pandemic. This year’s declaration was “The Amsterdam Affirmation: People, Politics, Power.” “Much has changed since the global HIV com- munity convened at the previous International AIDS Conference in Durban in 2016. Advances in science have been significant, including widespread acceptance that HIV is untransmittable with an An international team of 20 prominent Overall, the detailed report notes that undetectable viral load, medical providers and researchers struck criminalization laws ignore the science while increased PrEP rollout, inno- a blow against HIV criminalization with a perpetuating ignorance, stigma, and irrational vative treatment delivery detailed expert consensus statement in time fear. methods, and promising for AIDS 2018. “It is the hope of the Editors that this docu- developments in cure and “Simply put, HIV criminalization laws are ment will better inform readers about the rea- vaccine research. But while ineffective, unwarranted, and discriminatory,” sons why criminalization will not help reduce there have been success said co-author Linda-Gail Bekker, MD, of the transmission, but only fuel the epidemic,” stories, prevention efforts Desmond Tutu HIV Foundation in Cape Town, wrote JIAS Editor-in-Chief Kenneth Mayer, continue to lag and new and out-going president of the International MD, of Fenway Health in Boston, along with HIV infections are still on AIDS Society (IAS), which organizes the colleagues, in an accompanying editorial. “We the rise among key popula- international AIDS conferences, in a press therefore hope that governmental authorities tions and young women and release. “In many cases, these misconceived will view this Expert Consensus Statement girls. These groups continue laws exacerbate the spread of HIV by driving as a resource to better understand the actual to experience high levels people living with and at risk of infection into rather than the perceived risks posed by of structural violence and hiding and away from treatment services.” exposures to individuals living with HIV, and to stigma. Coupled with a rising The statement stresses that: create societies that encourage engagement tide of populism, question- and not fear.” able political commitment There is no possibility of HIV transmission The report concluded that, “The applica- and leadership, and declin- via saliva, including kissing, biting, or tion of up-to-date scientific evidence in ing financial resources, the spitting. criminal cases has the potential to limit unjust HIV response is operating The risk of transmission from a single act prosecutions and convictions. The authors in a fragile environment. of unprotected sex is very low, and there is no recommend that caution be exercised when People, politics, and power possibility of HIV transmission during vaginal considering prosecution, and encourage lie at the heart of the or anal sex when the partner living with HIV governments and those working in legal and AIDS epidemic. How these has undetectable viral load. judicial systems to pay close attention to IAS - intersect will continue to It is not possible to prove HIV transmission the significant advances in HIV science that ijl

D be critically important in from one person to another, even with the have occurred over the last three decades to achieving the agreed global ensure current scientific knowledge informs van most advanced scientific tools.

n targets and universal health application of the law in cases related to HIV.” te r coverage.” The consensus statement was published in a

M the scientificJournal of the International AIDS Radee th full consensus statement Rade the suggestions of Society (JIAS). In its detailed report, it notes at onlinelibrary.wiley.com/doi/full/10.1002/ er this declaration and sign on that such laws also seem to be punitive mea- jia2.25161. —EV kk e

B at aids2018.org © : . sures against certain groups of people.

pso itively aware SEptember+OCtober 2018 47 C ONFereNCE UPDATE AIDS 2018: REPORT FROM AMSTERDAM TO EVERYONE WHO HELPED GET US HERE: Sillt kicking M osaic HIV vaccine shows immune responses one year after final vaccination By Warren Tong @warrentong THANK YOU! IV vaccine regimens continued to show immune would protect against HIV in than the responses in the responses in monkeys and humans up to a year after the humans. This early phase only monkeys at the time that they last vaccination, according to results presented at AIDS tested for safety and immune were protected from the SHIV 2018 in Amsterdam. The vaccine in this study is called responses. challenges,” Dr. Tomaka said. a mosaic-based vaccine because it contains various That being said, all of the Although the results are Hcomponents that are designed to bring about immune responses vaccine regimens showed promising, actual effective- against many different HIV strains. similar durability in immune ness or protection against HIV responses. For the leading remains to be seen. T he results, which Thi s study used a prime- regimen (Ad26 prime + Ad26 were presented by Frank boost approach, which and high-dose gp140 boost), Next steps L. Tomaka, M.D., of Janssen consists of a multi-part 100% developed an antibody T o date, there has been only Pharmaceuticals, highlighted vaccination schedule. The response, which was main- one HIV vaccine candidate 96-week data from the initial vaccination known as tained for the whole study that has shown efficacy in APPROACH study, which the prime is followed by a period, including a year after humans. That was the RV144 builds on the promising second vaccination known as vaccination. study, also known as the Thai 48-week results reported last the boost. In the APPROACH The researchers also test- trial, which showed a moder- year at IAS 2017 and recently study, there were two primes ed to see if participants would ate 31% efficacy back in 2009. published in The Lancet. and two boosts. develop immune responses RV144 also used a prime- Notably, the vaccine regimens The study participants to a panel of nine gp140 boost strategy, but used a were safe and well tolerated, were split into eight groups. antigens. For the leading regi- different vaccine regimen. with no vaccine-related seri- All groups received the same men, 100% responded to the Because of the promising ous adverse events. prime vaccinations using antigens at week 52 and 80% results from the APPROACH “The APPROACH data adenovirus 26 (Ad26), which responded to the antigens at study, researchers started presented in Amsterdam is based on a flu virus, as a week 96. a phase-2b study, known as provides additional data with vector to deliver the vaccine. The vaccine regimens Imbokodo, in November 2017. longer-term follow-up of this After the primes, participants continued to be safe and well The Imbokodo study will run vaccine regimen. This mosaic received different boost regi- tolerated for the entire study for five years and enroll up to vaccine proved safe and mens. The boost regimens period. 2,600 young women in South prompted a broad and durable contained Ad26 again; modi- Africa. Researchers expect immune response to HIV in fied vaccinia Ankara M( VA), Parallel monkey study first results in 2021. this trial and further supports which is based on a pox virus; The researchers also the decision made last year to no viral vector; or a placebo. conducted a parallel study What level of effectiveness advance the candidate into a The boosts also may have in monkeys known as NHP would make the vaccine larger efficacy trial,”M itchell included a low or high dose 13-19. This study used the successful? Warren, executive director of gp140 protein, which is a same vaccine regimens and “ bTHE Im okodo study is of AVAC (formerly the AIDS structure typically found on followed a similar dosing looking at safety and efficacy, Vaccine Advocacy Coalition), HIV’s envelope. schedule as the human study. so there is no single efficacy told Posiy tivel Aware. The eight groups received The leading vaccine regimen number or result that would one of the following vaccine provided a 94% risk reduction mean success, and this trial Who was studied? regimens: per exposure of HIV, and com- is just one of a couple that The study followed n Ad26 prime + Ad26 and plete protection against SHIV would likely be required for about 400 healthy individu- high-dose gp140 boost (an engineered simian-HIV actual licensure of the vac- als who were randomized to n Ad26 prime + Ad26 and hybrid virus) in 67% of the cine,” said Warren. receive one of eight different low-dose gp140 boost monkeys after all six weekly “That said, it is hoped that regimens (seven variations n Ad26 prime + Ad26 boost challenges. we would see efficacy over of vaccines or a placebo). n Ad26 prime + MVA and Although animal results 50% and ideally durable for Among the participants, 54% high-dose gp140 boost don’t often translate into more than a year or two as were male and 46% were n Ad26 prime + MVA and humans, Dr. Tomaka noted the basis for a vaccine that female; while 56% were black, low-dose gp140 boost that the immune responses we could imagine delivering 26% were white, and 16% n Ad26 prime + MVA boost compared favorably between as part of a comprehensive Asian. In terms of geographic n Ad26 prime + high-dose the two species. “In general, HIV prevention program,” he demographics, 38% were in gp140 boost the human responses are added. the U.S., 33% were in Eastern n P lacebo high overall with improved Africa, 14% in South Africa, persistence. One of the most Warren Tong is a freelance and 15% were in Thailand. How did the encouraging observations health and science journalist, vaccine perform? is that after the third with an extensive background What was the vaccine To be clear, the study did vaccination, the responses writing about HIV and hepa- regimen? not test whether the vaccines seen in the humans are higher titis C.

48 SEptember+OCtober 2018 positively aware TO EVERYONE WHO HELPED GET US HERE: THANK YOU!

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