With HIV, the Magazine’S Anti-Stigma with HIV Campaign That Captures a Single 24-Hour Period in the Lives of People Around the World Affected by HIV

One issue, four covers A DAY This issue of Positively Aware features four different covers, each one a snapshot taken on A Day with HIV, the magazine’s anti-stigma WITH HIV campaign that captures a single 24-hour period in the lives of people around the world affected by HIV.

6:00 AM: Pasadena, California 12:45 PM: Denver, colorado Charles McPeak: The discipline and goal-setting of D avina Conner: Living with HIV 18 years, and thankful triathlon training and masters swimming has helped for everyone who’s in my life. Let’s stop the stigma, me follow my pill regimen. I’m a man with HIV, and and love one another. I’m proud of who I am.

THE LOW-DOWN ON THE LOW-DOWN ON INFLAMMATION INFLAMMATION TALES FROM THE INSIDE TALES FROM A DOCTOR’S PERSPECTIVE THE INSIDE A DOCTOR’S PERSPECTIVE ICAAC UPDATE SWITCHING ICAAC UPDATE TO NEW SWITCHING POSITIVELY AWARE TO NEW HIV DRUGS THE HIV TREATMENT JOURNAL OF TEST POS POSITIVELY AWARE NOVEMBER+DECEMBER 2015 HIV DRUGS THETHE HIVHIV TREATMENT JOURNALJOURNAL OF OF TEST TEST POSITIVE POSITIVE AWARE AWARE NETWORK NETWORK SEPTEMBER+OCTOBERNOVEMBER+DECEMBER 2015 2015

12:45 PM: SAN FRANCISCO WALDIE MURRAY MARKS HIS FIRST YEAR OF LIVING WITH HIV

ADHERENCE ALL-STARS OVERCOMNG LIFE’S A DAY WITH HIV CHAOS AND STICKING 12:45 PM: DENVER, COLORADO TO YOUR MEDS Davina Conner: Living with HIV 18 years, and thankful for everyone who’s in my life. DISCLOSURE Let’s stop the stigma, and love one another. DISCRIMINATION ANDA THE DAY LAW WITH HIV ALSO6:00 AM: PASADENA, CALIFORNIA Charles McPeak: The discipline and IASgoal-setting 2015 of triathlon training and VANCOUVERmasters swimming has helped me CONFERENCEfollow my pill UPDATE regimen. I’m a man A DAY WITH HIV with HIV, and I’m proud of who I am.

POSITIVELY AWARE POSITIVELY AWARE THE HIV TREATMENT JOURNAL OF TEST POSITIVE AWARE NETWORK NOVEMBER+DECEMBER 2015 THE HIV TREATMENT JOURNAL OF TEST POSITIVE AWARE N SEPTEMBER+OCTOBER 2015

THE LOW-DOWN ON INFLAMMATION THE LOW-DOWN ON INFLAMMATION TALES FROM THE INSIDE TALES FROM A DOCTOR’S PERSPECTIVE THE INSIDE ICAAC UPDATE A DOCTOR’S PERSPECTIVE SWITCHING ICAAC UPDATE TO NEW SWITCHING HIV DRUGS TO NEW A DAY WITH HIV HIV DRUGS 4:30 PM: WASHINGTON, DC Aaron Burgess: Wrapping up another day as a Child Protective Services Investigations Social Worker in our nation’s capital. Three and a half years ago, I thought my life and career A DAY WITH HIV were over. Today, I have a master’s degree 12:45 PM: JERSEY CITY, NEW JERSEY and help keep safe the most vulnerable. Timothy Daniels: My partner and I decided to take this picture after he got in from work. I am HIV-positive; my partner has shown so much support. He’s not afraid to say or show that he is in love with me.

12:45 PM: Jersey City, new jersey 4:30 PM: Washington, DC Timothy Daniels: My partner and I decided to take this Aaron Burgess: Wrapping up another day as a Child picture after he got in from work. I am HIV-positive; my Protective Services Investigations Social Worker in our partner has shown so much support. He’s not afraid to nation’s capital. Three and a half years ago, I thought say or show that he is in love with me. my life and career were over. Today, I have a master’s degree and help keep safe the most vulnerable. The Low-down on INFLAMMATION Tales from The inside AO DOCT R’S PERSPECTIVE ICAAC UPDATE SITW CHING TO NEW POSITIVELY AWARE HIV DRUGS The HIV Treatment Journal of Test Positive Aware Network NOVEB M ER+DECEMBER 2015

A DAY WITH HIV 6:00 AM: pasadena, cALIFORNIA C harles McPeak: The discipline and goal-setting of triathlon training and masters swimming has helped me follow my pill regimen. I’m a man with HIV, and I’m proud of who I am. The- Low Down on INFLAMMATION Tales from The Inside AO DOCT R’S PERSPECTIVE ICAAC UPDATE SITW CHING TO NEW POSITIVELY AWARE HIV DRUGS The HIV Treatment Journal of Test Pos NOVEB M ER+DECEMBER 2015

A DAY WITH HIV 12:45 PM: Denver, colorado D avina Conner: Living with HIV 18 years, and thankful for everyone who’s in my life. Let’s stop the stigma, and love one another. POSITIVELY AWARE The HIV Treatment Journal of Test Positive Aware Network NOVEB M ER+DECEMBER 2015

The Low-down on INFLAMMATION Tales from The inside AO DOCT R’S PERSPECTIVE ICAAC UPDATE SITW CHING TO NEW HIV DRUGS A DAY WITH HIV 12:45 PM: Jersey City, new jersey Timothy Daniels: My partner and I decided to take this picture after he got in from work. I am HIV-positive; my partner has shown so much support. He’s not afraid to say or show that he is in love with me. POSITIVELY AWARE The HIV Treatment Journal of Test Positive Aware N SEPTEMBER+OCTOBER 2015

The- Low Down on INFLAMMATION T ales from The inside AO DOCT R’S PERSPECTIVE ICAAC UPDATE SITW CHING TO NEW A DAY WITH HIV HIV DRUGS 4:30 PM: Washington, DC Aaron Burgess: Wrapping up another day as a Child Protective Services Investigations Social Worker in our nation’s capital. Three and a half years ago, I thought my life and career were over. Today, I have a master’s degree and help keep safe the most vulnerable. COMPLERA is a prescription medicine for adults COMPLERA does not cure HIV-1 infection or AIDS. • Depression or mood changes. Tell your healthcare provider right away who have never taken HIV-1 medicines before and To control HIV-1 infection and decrease HIV-related illnesses you must keep if you have any of the following symptoms: feeling sad or hopeless, taking COMPLERA. Ask your healthcare provider if you have questions about feeling anxious or restless, have thoughts of hurting yourself (suicide) who have no more than 100,000 copies/mL of how to reduce the risk of passing HIV-1 to others. Always practice safer sex or have tried to hurt yourself. virus in their blood. COMPLERA can also replace and use condoms to lower the chance of sexual contact with body fl uids. • Changes in liver enzymes: People who have had hepatitis B or C, or current HIV-1 medicines for some adults who have Never reuse or share needles or other items that have body fl uids on them. who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. an undetectable viral load (less than 50 copies/mL) It is not known if COMPLERA is safe and effective in children under Some people without prior liver disease may also be at risk. Your and whose healthcare provider determines that 18 years old. healthcare provider may do tests to check your liver enzymes before they meet certain other requirements. COMPLERA and during treatment with COMPLERA. IMPORTANT SAFETY INFORMATION • Bone problems, including bone pain or bones getting soft or thin, combines 3 medicines into 1 pill to be taken once What is the most important information I should know which may lead to fractures. Your healthcare provider may do tests to a day with food. COMPLERA should not be used about COMPLERA? check your bones. • Changes in body fat can happen in people taking HIV-1 medicines. with other HIV-1 medicines. COMPLERA can cause serious side effects: • Changes in your immune system. Your immune system may get • Build-up of an acid in your blood (lactic acidosis), which is a serious stronger and begin to fi ght infections. Tell your healthcare provider if medical emergency. Symptoms of lactic acidosis include feeling very weak you have any new symptoms after you start taking COMPLERA. or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and The most common side effects of COMPLERA include trouble sleeping legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, • Serious liver problems. The liver may become large (hepatomegaly) rash, tiredness, and depression. Other common side effects include and fatty (steatosis). Symptoms of liver problems include your skin or vomiting, stomach pain or discomfort, skin discoloration (small spots the white part of your eyes turns yellow (jaundice), dark “tea-colored” or freckles), and pain. Tell your healthcare provider if you have any side urine, light-colored bowel movements (stools), loss of appetite for effects that bother you or do not go away. several days or longer, nausea, and/or stomach pain. • You may be more likely to get lactic acidosis or serious liver problems What should I tell my healthcare provider before if you are female, very overweight (obese), or have been taking taking COMPLERA? one COMPLERA for a long time. In some cases, these serious conditions • All your health problems. Be sure to tell your healthcare provider if have led to death. Call your healthcare provider right away if you have you have or had any kidney, mental health, bone, or liver problems, any symptoms of these conditions. including hepatitis virus infection. • Worsening of hepatitis B (HBV) infection. If you also have HBV and • All the medicines you take, including prescription and Just the for me stop taking COMPLERA, your hepatitis may suddenly get worse. Do nonprescription medicines, vitamins, and herbal supplements. not stop taking COMPLERA without fi rst talking to your healthcare COMPLERA may affect the way other medicines work, and other provider, as they will need to monitor your health. COMPLERA is not medicines may affect how COMPLERA works. Keep a list of all your approved for the treatment of HBV. medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking COMPLERA without fi rst Who should not take COMPLERA? talking with your healthcare provider. Do not take COMPLERA if you: • If you take rifabutin (Mycobutin). Talk to your healthcare provider • Take a medicine that contains: adefovir (Hepsera), lamivudine about the right amount of rilpivirine (Edurant) you should take. (Epivir-HBV), carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol- • If you take antacids. Take antacids at least 2 hours before or at least XR, Teril, Epitol), oxcarbazepine (Trileptal), phenobarbital (Luminal), 4 hours after you take COMPLERA. phenytoin (Dilantin, Dilantin-125, Phenytek), rifampin (Rifater, • If you take stomach acid blockers. Take acid blockers at least 12 Rifamate, Rimactane, Rifadin), rifapentine (Priftin), dexlansoprazole hours before or at least 4 hours after you take COMPLERA. Ask your (Dexilant), esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), healthcare provider if your acid blocker is okay to take, as some acid omeprazole (Prilosec, Zegerid), pantoprazole sodium (Protonix), blockers should never be taken with COMPLERA. COMPLERA is a complete rabeprazole (Aciphex), more than 1 dose of the steroid medicine • If you are pregnant or plan to become pregnant. It is not known if HIV-1 treatment that dexamethasone or dexamethasone sodium phosphate, or the herbal COMPLERA can harm your unborn baby. Tell your healthcare provider if supplement St. John’s wort. you become pregnant while taking COMPLERA. • Take any other medicines to treat HIV-1 infection, unless combines the medicines • If you are breastfeeding (nursing) or plan to breastfeed. Do not recommended by your healthcare provider. breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some in TRUVADA + EDURANT What are the other possible side effects of COMPLERA? medicines in COMPLERA can pass into breast milk, and it is not known Serious side effects of COMPLERA may also include: if this can harm the baby. in only 1 pill a day.* • Severe skin rash and allergic reactions. Call your doctor right away You are encouraged to report negative side effects of prescription drugs if you get a rash. Some rashes and allergic reactions may need to be to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. treated in a hospital. Stop taking COMPLERA and get medical help Ask your healthcare right away if you get a rash with any of the following symptoms: Please see Brief Summary of full Prescribing Information with severe allergic reactions causing a swollen face, lips, mouth, tongue important warnings on the following pages. provider if COMPLERA or throat which may lead to diffi culty swallowing or breathing; mouth sores or blisters on your body; infl amed eye (conjunctivitis); fever, dark may be the one for you. urine or pain on the right side of the stomach-area (abdominal pain). • New or worse kidney problems, including kidney failure. Your healthcare *COMPLERA is a combination of the provider should do blood tests to check your kidneys before starting medicines in TRUVADA (emtricitabine treatment with COMPLERA. If you have had kidney problems, or take other and tenofovir disoproxil fumarate) and medicines that may cause kidney problems, your healthcare provider may also check your kidneys during treatment with COMPLERA. EDURANT (rilpivirine).

Pill shown is not actual size.

PALIO Date: 07.24.15 • Client: Gilead • Product: Complera • File Name: 32937_pgitvd_8.125_10.5_Master_C_lo3 copy PALIO Date: 07.24.15 • Client: Gilead • Product: Complera • File Name: 32937_pgitvd_8.125_10.5_Master_C_lo3 copy Ad Page 1 Positively Aware Mag Ad Page 2 Positively Aware Mag Trim: 8.0” x 10.5” • Live: 7.0” x 9.5”• Bleed: 8.5” x 11.0” Trim: 8.0” x 10.5” • Live: 7.0” x 9.5”• Bleed: 8.5” x 11.0” Brief Summary of full Prescribing Information • Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) • Depression or mood changes. Tell your healthcare provider right away Tell your healthcare provider about all the medicines you take, COMPLERA® (kom-PLEH-rah) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop if you have any of the following symptoms: including prescription and over-the-counter medicines, vitamins, and taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns herbal supplements: (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate – feeling sad or hopeless in a worse way than before. COMPLERA is not approved for the treatment of 300 mg) tablets – feeling anxious or restless • COMPLERA may affect the way other medicines work, and other HBV, so you must discuss your HBV with your healthcare provider. medicines may affect how COMPLERA works. Brief summary of full Prescribing Information. For more information, – have thoughts of hurting yourself (suicide) or have tried to hurt yourself – Do not run out of COMPLERA. Refill your prescription or talk to your • If you take certain medicines with COMPLERA, the amount of please see the full Prescribing Information, including Patient Information. • Change in liver enzymes. People with a history of hepatitis B or C healthcare provider before your COMPLERA is all gone. COMPLERA in your body may be too low and it may not work to help virus infection or who have certain liver enzyme changes may have an What is COMPLERA? – Do not stop taking COMPLERA without first talking to your control your HIV-1 infection. The HIV-1 virus in your body may become increased risk of developing new or worsening liver problems during healthcare provider. resistant to COMPLERA or other HIV-1 medicines that are like it. • COMPLERA is a prescription medicine used as a complete HIV-1 treatment with COMPLERA. Liver problems can also happen during – If you stop taking COMPLERA, your healthcare provider will need to treatment in one pill a day. COMPLERA is for adults who have never taken treatment with COMPLERA in people without a history of liver disease. • Be sure to tell your healthcare provider if you take any of the check your health often and do blood tests regularly to check your HIV-1 medicines before and who have no more than 100,000 copies/mL of Your healthcare provider may need to do tests to check your liver following medicines: HBV infection. Tell your healthcare provider about any new or unusual virus in their blood (this is called ‘viral load’). Complera can also replace enzymes before and during treatment with COMPLERA. – Rifabutin (Mycobutin), a medicine to treat some bacterial infections. current HIV-1 medicines for some adults who have an undetectable viral symptoms you may have after you stop taking COMPLERA. Talk to your healthcare provider about the right amount of rilpivirine • Bone problems can happen in some people who take COMPLERA. Bone load (less than 50 copies/mL) and whose healthcare provider determines (Edurant) you should take. Who should not take COMPLERA? problems include bone pain, softening or thinning (which may lead to that they meet certain other requirements. – Antacid medicines that contain aluminum, magnesium hydroxide, or Do not take COMPLERA if you also take any of the following medicines: fractures). Your healthcare provider may need to do tests to check your bones. • COMPLERA is a complete HIV-1 medicine and should not be used with calcium carbonate. Take antacids at least 2 hours before or at least any other HIV-1 medicines. • Medicines used for seizures: carbamazepine (Carbatrol, Equetro, • Changes in body fat can happen in people taking HIV-1 medicine. 4 hours after you take COMPLERA. Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); These changes may include increased amount of fat in the upper back • COMPLERA should always be taken with food. A protein drink does not – Certain medicines to block the acid in your stomach, including phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) and neck (“buffalo hump”), breast, and around the main part of your replace food. cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or • Medicines used for tuberculosis: rifampin (Rifater, Rifamate, body (trunk). Loss of fat from the legs, arms and face may also happen. You must stay on continuous ranitidine hydrochloride (Zantac). Take the acid blocker at least 12 • COMPLERA does not cure HIV-1 or AIDS. Rimactane, Rifadin); rifapentine (Priftin) The cause and long term health effect of these conditions are not known. HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses. hours before or at least 4 hours after you take COMPLERA. Some • Certain medicines used to block stomach acid called proton pump • Changes in your immune system (Immune Reconstitution Syndrome) acid blocking medicines should never be taken with COMPLERA (see • Ask your healthcare provider about how to prevent passing HIV-1 inhibitors (PPIs): dexlansoprazole (Dexilant); esomeprazole (Nexium, can happen when you start taking HIV-1 medicines. Your immune “Who should not take COMPLERA?” for a list of these medicines). to others. Do not share or reuse needles, injection equipment, or Vimovo); lansoprazole (Prevacid); omeprazole (Prilosec, Zegerid); system may get stronger and begin to fight infections that have been – Medicines that can affect how your kidneys work, including acyclovir personal items that can have blood or body fluids on them. Do not have pantoprazole sodium (Protonix); rabeprazole (Aciphex) hidden in your body for a long time. Tell your healthcare provider if you (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), sex without protection. Always practice safer sex by using a latex or start having any new symptoms after starting your HIV-1 medicine. • Certain steroid medicines: More than 1 dose of dexamethasone or valacyclovir (Valtrex), and valganciclovir (Valcyte). polyurethane condom to lower the chance of sexual contact with semen, The most common side effects of COMPLERA include: vaginal secretions, or blood. dexamethasone sodium phosphate – clarithromycin (Biaxin) • Certain herbal supplements: St. John’s wort • Trouble sleeping (insomnia), abnormal dreams, headache, dizziness, – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) What is the most important information I should know about COMPLERA? diarrhea, nausea, rash, tiredness, depression • Certain hepatitis medicines: adefovir (Hepsera), lamivudine (Epivir-HBV) – fluconazole (Diflucan) COMPLERA can cause serious side effects, including: Do not take COMPLERA if you also take any other HIV-1 medicines, including: Additional common side effects include: – itraconazole (Sporanox) – ketoconazole (Nizoral) • Build-up of an acid in your blood (lactic acidosis). Lactic acidosis • Other medicines that contain emtricitabine or tenofovir (ATRIPLA, EMTRIVA, • Vomiting, stomach pain or discomfort, skin discoloration (small spots can happen in some people who take COMPLERA or similar (nucleoside STRIBILD, TRUVADA, VIREAD) or freckles), pain – methadone (Dolophine) analogs) medicines. Lactic acidosis is a serious medical emergency Other medicines that contain lamivudine (Combivir, Epivir, Epzicom, Tell your healthcare provider if you have any side effect that bothers – posaconazole (Noxafil) that can lead to death. Lactic acidosis can be hard to identify early, • Triumeq, Trizivir) you or that does not go away. – telithromycin (Ketek) because the symptoms could seem like symptoms of other health • These are not all the possible side effects of COMPLERA. For more – voriconazole (Vfend) problems. • rilpivirine (Edurant), unless you are also taking rifabutin (Mycobutin) Call your healthcare provider right away if you get any of information, ask your healthcare provider. the following symptoms which could be signs of lactic acidosis: COMPLERA is not for use in people who are less than 18 years old. Know the medicines you take. Keep a list of all your medicines and • Call your doctor for medical advice about side effects. You may report show it to your healthcare provider and pharmacist when you get a new – feel very weak or tired What are the possible side effects of COMPLERA? side effects to FDA at 1-800-FDA-1088. medicine. Do not start any new medicines while you are taking COMPLERA – have unusual (not normal) muscle pain COMPLERA may cause the following serious side effects: without first talking with your healthcare provider. – have trouble breathing What should I tell my healthcare provider before taking COMPLERA? • See “What is the most important information I should know Keep COMPLERA and all medicines out of reach of children. – having stomach pain with nausea or vomiting Tell your healthcare provider about all your medical conditions, including: about COMPLERA?” – feel cold, especially in your arms and legs • If you have or had any kidney, mental health, bone, or liver problems, This Brief Summary summarizes the most important information about • Severe skin rash and allergic reactions. Skin rash is a common side effect – feel dizzy or lightheaded including hepatitis B or C infection. COMPLERA. If you would like more information, talk with your healthcare of COMPLERA but it can also be serious. Call your doctor right away if you provider. You can also ask your healthcare provider or pharmacist for – have a fast or irregular heartbeat • If you are pregnant or plan to become pregnant. It is not known if get a rash. In some cases, rash and allergic reaction may need to be information about COMPLERA that is written for health professionals, • Severe liver problems. Severe liver problems can happen in people COMPLERA can harm your unborn child. treated in a hospital. Stop taking COMPLERA and call your doctor or get or call 1-800-445-3235 or go to www.COMPLERA.com. who take COMPLERA. In some cases, these liver problems can lead to medical help right away if you get a rash with any of the following symptoms: – There is a pregnancy registry for women who take antiviral medicines death. Your liver may become large (hepatomegaly) and you may develop – severe allergic reactions causing a swollen face, lips, mouth, tongue during pregnancy. The purpose of this registry is to collect information Revised: May 2015 fat in your liver (steatosis). Call your healthcare provider right away if or throat, which may cause difficulty swallowing or breathing about the health of you and your baby. Talk to your healthcare provider you get any of the following symptoms of liver problems: – mouth sores or blisters on your body about how you can take part in this registry. – your skin or the white part of your eyes turns yellow (jaundice) – inflamed eye (conjunctivitis) • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed – dark “tea-colored” urine – fever, dark urine or pain on the right side of the stomach-area if you take COMPLERA. COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, – light-colored bowel movements (stools) (abdominal pain) – You should not breastfeed if you have HIV-1 because of the risk of HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of – loss of appetite for several days or longer • New or worse kidney problems, including kidney failure. Your healthcare passing HIV-1 to your baby. Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of – nausea provider should do blood and urine tests to check your kidneys before – Two of the medicines in COMPLERA can pass to your baby in your Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced – stomach pain you start and while you are taking COMPLERA. If you have had kidney breast milk. It is not known if this could harm your baby. herein are the property of their respective owners. • You may be more likely to get lactic acidosis or severe liver problems problems in the past or need to take another medicine that can cause – Talk to your healthcare provider about the best way to feed your baby. ©2015 Gilead Sciences, Inc. All rights reserved. CPAC0167 06/15 if you are female, very overweight (obese), or have been taking kidney problems, your healthcare provider may need to do blood tests COMPLERA for a long time. to check your kidneys during your treatment with COMPLERA.

PALIO Date: 07.24.15 • Client: Gilead • Product: Complera • File Name: 32937_pgitvd_8.125_10.5_Master_C_lo3 copy PALIO Date: 07.24.15 • Client: Gilead • Product: Complera • File Name: 32937_pgitvd_8.125_10.5_Master_C_lo3 copy BS Page 1 Positively Aware Mag BS Page 2 Positively Aware Mag Trim: 8.0” x 10.5” • Live: 7.0” x 9.5”• Bleed: 8.5” x 11.0” Trim: 8.0” x 10.5” • Live: 7.0” x 9.5”• Bleed: 8.5” x 11.0” Brief Summary of full Prescribing Information • Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) • Depression or mood changes. Tell your healthcare provider right away Tell your healthcare provider about all the medicines you take, COMPLERA® (kom-PLEH-rah) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop if you have any of the following symptoms: including prescription and over-the-counter medicines, vitamins, and taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns herbal supplements: (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate – feeling sad or hopeless in a worse way than before. COMPLERA is not approved for the treatment of 300 mg) tablets – feeling anxious or restless • COMPLERA may affect the way other medicines work, and other HBV, so you must discuss your HBV with your healthcare provider. medicines may affect how COMPLERA works. Brief summary of full Prescribing Information. For more information, – have thoughts of hurting yourself (suicide) or have tried to hurt yourself – Do not run out of COMPLERA. Refill your prescription or talk to your • If you take certain medicines with COMPLERA, the amount of please see the full Prescribing Information, including Patient Information. • Change in liver enzymes. People with a history of hepatitis B or C healthcare provider before your COMPLERA is all gone. COMPLERA in your body may be too low and it may not work to help virus infection or who have certain liver enzyme changes may have an What is COMPLERA? – Do not stop taking COMPLERA without first talking to your control your HIV-1 infection. The HIV-1 virus in your body may become increased risk of developing new or worsening liver problems during healthcare provider. resistant to COMPLERA or other HIV-1 medicines that are like it. • COMPLERA is a prescription medicine used as a complete HIV-1 treatment with COMPLERA. Liver problems can also happen during – If you stop taking COMPLERA, your healthcare provider will need to treatment in one pill a day. COMPLERA is for adults who have never taken treatment with COMPLERA in people without a history of liver disease. • Be sure to tell your healthcare provider if you take any of the check your health often and do blood tests regularly to check your HIV-1 medicines before and who have no more than 100,000 copies/mL of Your healthcare provider may need to do tests to check your liver following medicines: HBV infection. Tell your healthcare provider about any new or unusual virus in their blood (this is called ‘viral load’). Complera can also replace enzymes before and during treatment with COMPLERA. – Rifabutin (Mycobutin), a medicine to treat some bacterial infections. current HIV-1 medicines for some adults who have an undetectable viral symptoms you may have after you stop taking COMPLERA. Talk to your healthcare provider about the right amount of rilpivirine • Bone problems can happen in some people who take COMPLERA. Bone load (less than 50 copies/mL) and whose healthcare provider determines (Edurant) you should take. Who should not take COMPLERA? problems include bone pain, softening or thinning (which may lead to that they meet certain other requirements. – Antacid medicines that contain aluminum, magnesium hydroxide, or Do not take COMPLERA if you also take any of the following medicines: fractures). Your healthcare provider may need to do tests to check your bones. • COMPLERA is a complete HIV-1 medicine and should not be used with calcium carbonate. Take antacids at least 2 hours before or at least any other HIV-1 medicines. • Medicines used for seizures: carbamazepine (Carbatrol, Equetro, • Changes in body fat can happen in people taking HIV-1 medicine. 4 hours after you take COMPLERA. Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); These changes may include increased amount of fat in the upper back • COMPLERA should always be taken with food. A protein drink does not – Certain medicines to block the acid in your stomach, including phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) and neck (“buffalo hump”), breast, and around the main part of your replace food. cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or • Medicines used for tuberculosis: rifampin (Rifater, Rifamate, body (trunk). Loss of fat from the legs, arms and face may also happen. You must stay on continuous ranitidine hydrochloride (Zantac). Take the acid blocker at least 12 • COMPLERA does not cure HIV-1 or AIDS. Rimactane, Rifadin); rifapentine (Priftin) The cause and long term health effect of these conditions are not known. HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses. hours before or at least 4 hours after you take COMPLERA. Some • Certain medicines used to block stomach acid called proton pump • Changes in your immune system (Immune Reconstitution Syndrome) acid blocking medicines should never be taken with COMPLERA (see • Ask your healthcare provider about how to prevent passing HIV-1 inhibitors (PPIs): dexlansoprazole (Dexilant); esomeprazole (Nexium, can happen when you start taking HIV-1 medicines. Your immune “Who should not take COMPLERA?” for a list of these medicines). to others. Do not share or reuse needles, injection equipment, or Vimovo); lansoprazole (Prevacid); omeprazole (Prilosec, Zegerid); system may get stronger and begin to fight infections that have been – Medicines that can affect how your kidneys work, including acyclovir personal items that can have blood or body fluids on them. Do not have pantoprazole sodium (Protonix); rabeprazole (Aciphex) hidden in your body for a long time. Tell your healthcare provider if you (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), sex without protection. Always practice safer sex by using a latex or start having any new symptoms after starting your HIV-1 medicine. • Certain steroid medicines: More than 1 dose of dexamethasone or valacyclovir (Valtrex), and valganciclovir (Valcyte). polyurethane condom to lower the chance of sexual contact with semen, The most common side effects of COMPLERA include: vaginal secretions, or blood. dexamethasone sodium phosphate – clarithromycin (Biaxin) • Certain herbal supplements: St. John’s wort • Trouble sleeping (insomnia), abnormal dreams, headache, dizziness, – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) What is the most important information I should know about COMPLERA? diarrhea, nausea, rash, tiredness, depression • Certain hepatitis medicines: adefovir (Hepsera), lamivudine (Epivir-HBV) – fluconazole (Diflucan) COMPLERA can cause serious side effects, including: Do not take COMPLERA if you also take any other HIV-1 medicines, including: Additional common side effects include: – itraconazole (Sporanox) – ketoconazole (Nizoral) • Build-up of an acid in your blood (lactic acidosis). Lactic acidosis • Other medicines that contain emtricitabine or tenofovir (ATRIPLA, EMTRIVA, • Vomiting, stomach pain or discomfort, skin discoloration (small spots can happen in some people who take COMPLERA or similar (nucleoside STRIBILD, TRUVADA, VIREAD) or freckles), pain – methadone (Dolophine) analogs) medicines. Lactic acidosis is a serious medical emergency Other medicines that contain lamivudine (Combivir, Epivir, Epzicom, Tell your healthcare provider if you have any side effect that bothers – posaconazole (Noxafil) that can lead to death. Lactic acidosis can be hard to identify early, • Triumeq, Trizivir) you or that does not go away. – telithromycin (Ketek) because the symptoms could seem like symptoms of other health • These are not all the possible side effects of COMPLERA. For more – voriconazole (Vfend) problems. • rilpivirine (Edurant), unless you are also taking rifabutin (Mycobutin) Call your healthcare provider right away if you get any of information, ask your healthcare provider. the following symptoms which could be signs of lactic acidosis: COMPLERA is not for use in people who are less than 18 years old. Know the medicines you take. Keep a list of all your medicines and • Call your doctor for medical advice about side effects. You may report show it to your healthcare provider and pharmacist when you get a new – feel very weak or tired What are the possible side effects of COMPLERA? side effects to FDA at 1-800-FDA-1088. medicine. Do not start any new medicines while you are taking COMPLERA – have unusual (not normal) muscle pain COMPLERA may cause the following serious side effects: without first talking with your healthcare provider. – have trouble breathing What should I tell my healthcare provider before taking COMPLERA? • See “What is the most important information I should know Keep COMPLERA and all medicines out of reach of children. – having stomach pain with nausea or vomiting Tell your healthcare provider about all your medical conditions, including: about COMPLERA?” – feel cold, especially in your arms and legs • If you have or had any kidney, mental health, bone, or liver problems, This Brief Summary summarizes the most important information about • Severe skin rash and allergic reactions. Skin rash is a common side effect – feel dizzy or lightheaded including hepatitis B or C infection. COMPLERA. If you would like more information, talk with your healthcare of COMPLERA but it can also be serious. Call your doctor right away if you provider. You can also ask your healthcare provider or pharmacist for – have a fast or irregular heartbeat • If you are pregnant or plan to become pregnant. It is not known if get a rash. In some cases, rash and allergic reaction may need to be information about COMPLERA that is written for health professionals, • Severe liver problems. Severe liver problems can happen in people COMPLERA can harm your unborn child. treated in a hospital. Stop taking COMPLERA and call your doctor or get or call 1-800-445-3235 or go to www.COMPLERA.com. who take COMPLERA. In some cases, these liver problems can lead to medical help right away if you get a rash with any of the following symptoms: – There is a pregnancy registry for women who take antiviral medicines death. Your liver may become large (hepatomegaly) and you may develop – severe allergic reactions causing a swollen face, lips, mouth, tongue during pregnancy. The purpose of this registry is to collect information Revised: May 2015 fat in your liver (steatosis). Call your healthcare provider right away if or throat, which may cause difficulty swallowing or breathing about the health of you and your baby. Talk to your healthcare provider you get any of the following symptoms of liver problems: – mouth sores or blisters on your body about how you can take part in this registry. – your skin or the white part of your eyes turns yellow (jaundice) – inflamed eye (conjunctivitis) • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed – dark “tea-colored” urine – fever, dark urine or pain on the right side of the stomach-area if you take COMPLERA. COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, – light-colored bowel movements (stools) (abdominal pain) – You should not breastfeed if you have HIV-1 because of the risk of HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of – loss of appetite for several days or longer • New or worse kidney problems, including kidney failure. Your healthcare passing HIV-1 to your baby. Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of – nausea provider should do blood and urine tests to check your kidneys before – Two of the medicines in COMPLERA can pass to your baby in your Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced – stomach pain you start and while you are taking COMPLERA. If you have had kidney breast milk. It is not known if this could harm your baby. herein are the property of their respective owners. • You may be more likely to get lactic acidosis or severe liver problems problems in the past or need to take another medicine that can cause – Talk to your healthcare provider about the best way to feed your baby. ©2015 Gilead Sciences, Inc. All rights reserved. CPAC0167 06/15 if you are female, very overweight (obese), or have been taking kidney problems, your healthcare provider may need to do blood tests COMPLERA for a long time. to check your kidneys during your treatment with COMPLERA.

Four judges had a hand in selecting the covers. D uane Cramer was diagnosed 18 years ago with HIV, and POSITIVELY AWARE is an activist and professional photographer who has used his creative skills to raise awareness. Illinois state representative G reg Harris is one of a handful elected public officials in the U.S. who is open about his JOURNALISM. INTEGRITY. HOPE. HIV status. G ina Brown has been HIV-positive for more than 20 years, and is a medical case manager at NO/AIDS Task Force. HIV-positive since 1984, H unter Reynolds was an early member of ACT UP in New York, where he co-founded ART+ Positive to push back against gay and HIV stigma in the arts.

6:00 AM: Pasadena, California 12:45 PM: Denver, colorado Jeff Berry Charles McPeak: The discipline and goal-setting of D avina Conner: Living with HIV 18 years, and thankful edi tor-in-Chief triathlon training and masters swimming has helped for everyone who’s in my life. Let’s stop the stigma, @PAeditor me follow my pill regimen. I’m a man with HIV, and and love one another. “I don’t always get it right, but I’m proud of who I am. it’s always from the heart.”

THE LOW-DOWN ON THE LOW-DOWN ON Enid Vázquez INFLAMMATION INFLAMMATION a tssocia e editor TALES FROM THE INSIDE TALES FROM A DOCTOR’S PERSPECTIVE THE INSIDE @enidvazquezpa A DOCTOR’S PERSPECTIVE ICAAC UPDATE “Having had the pleasure SWITCHING ICAAC UPDATE TO NEW SWITCHING of meeting Patricia Douglas, POSITIVELY AWARE TO NEW HIV DRUGS THE HIV TREATMENT JOURNAL OF TEST POS I know that she has truly found POSITIVELY AWARE NOVEMBER+DECEMBER 2015 HIV DRUGS THETHE HIVHIV TREATMENT JOURNALJOURNAL OF OF TEST TEST POSITIVE POSITIVE AWARE AWARE NETWORK NETWORK a measure of peace SEPTEMBER+OCTOBERNOVEMBER+DECEMBER 2015 2015 and happiness.”

Rick Guasco Cetr a ive director @rickguasco “It’s the stories behind the photos that give A Day with 12:45 PM: SAN FRANCISCO WALDIE MURRAY MARKS HIS FIRST YEAR OF HIV its impact. It’s a reminder LIVING WITH HIV that you are not alone.” ADHERENCE ALL-STARS Jason Lancaster OVERCOMNG LIFE’S A DAY WITH HIV CHAOS AND STICKING 12:45 PM: DENVER, COLORADO TO YOUR MEDS Davina Conner: Living with HIV 18 years, p roofreader and thankful for everyone who’s in my life. DISCLOSURE Let’s stop the stigma, and love one another. DISCRIMINATION contributing writers ANDA THE DAY LAW WITH HIV ALSO6:00 AM: PASADENA, CALIFORNIA Charles McPeak: The discipline and Dar vid Du Án IASgoal-setting 2015 of triathlon training and VANCOUVERmasters swimming has helped me Carlos A. Perez CONFERENCEfollow my pill UPDATE regimen. I’m a man A DAY WITH HIV with HIV, and I’m proud of who I am. Jim Pickett Andrew Reynolds

poh tographers John Gress Chris Knight POSITIVELY AWARE POSITIVELY AWARE THE HIV TREATMENT JOURNAL OF TEST POSITIVE AWARE NETWORK NOVEMBER+DECEMBER 2015 THE HIV TREATMENT JOURNAL OF TEST POSITIVE AWARE N a dvertising SEPTEMBER+OCTOBER 2015 L orraine Hayes L [email protected]

Di istr bution and THE LOW-DOWN ON INFLAMMATION Subscription services THE LOW-DOWN ON INFLAMMATION TALES FROM [email protected] THE INSIDE TALES FROM A DOCTOR’S PERSPECTIVE THE INSIDE ICAAC UPDATE A DOCTOR’S PERSPECTIVE SWITCHING ICAAC UPDATE TO NEW SWITCHING HIV DRUGS TO NEW A DAY WITH HIV HIV DRUGS 4:30 PM: WASHINGTON, DC SINCE 1989. PUBLISHED BY Aaron Burgess: Wrapping up another day as a Child Protective Services Investigations Social Worker in our nation’s capital. Three and a half years ago, I thought my life and career A DAY WITH HIV were over. Today, I have a master’s degree 12:45 PM: JERSEY CITY, NEW JERSEY and help keep safe the most vulnerable. Timothy Daniels: My partner and I decided to take this picture after he got in from work. I am HIV-positive; my partner has shown so much support. He’s not afraid to SUITE 300 say or show that he is in love with me. 5050 N. Broadway St. Chicago, IL 60640-3016 phone: (773) 989-9400 fax: (773) 989-9494 12:45 PM: Jersey City, new jersey 4:30 PM: Washington, DC email: [email protected] Timothy Daniels: My partner and I decided to take this Aaron Burgess: Wrapping up another day as a Child Protective Services Investigations Social Worker in our positivelyaware.com picture after he got in from work. I am HIV-positive; my partner has shown so much support. He’s not afraid to nation’s capital. Three and a half years ago, I thought @PosAware say or show that he is in love with me. my life and career were over. Today, I have a master’s degree and help keep safe the most vulnerable.

4 NOVember+DECEMber 2015 POSITIVELY AWARE NOV +Dec 2015 VOLUME 27 NUMBER 7

FET A URes IN EVERY ISSUE

6 The Conversation Raising T-cells. Treatment ups and downs. Few resources for hep C.

ditor 7 E ’s Note What can I say?

RILY8 B EF TAF easier on kidneys and bones than TDF. HIV treatment and STIs. Needle exchange 16 curbs HIV while saving Inflamed millions. The low-down on inflammation e36 R aders poll from an HIV doctor. Do you believe you will by JoaNNA Eveland, MD see an HIV cure in your lifetime?

41 My kind of life My day with HIV. 14 38 37 B y CaRLOS A. Perez T ales from Der a Switching to the inside Doctor new HIV drugs An HIV doctor finds his W hat about cancer? And A look at Triumeq and calling helping people who other questions answered the new “son of Stribild.” Spi ec al section are incarcerated. B y JoEL Gallant, MD, MPH B y EnID Vázquez Bady Ch Zawitz, MD y23 A Da with HIV A selection of photos taken on September 22, 2015, capturing the lives of people around the world affected by HIV.

Also insidE RRY

E 40 The ANNUAL B

FF PA reader survey E Getting to know you. : J ON I T C A O T

L 18

L ONLY ON A C A call to action by the POSITIVELYAWARE.COM A

CK transgender community O T Using USCA as a platform, activists HIV NEWS FROM IS : discuss invisibility and violence. THE ID WEEK Conference E B y EnID Vázquez

M B y DaVID DurÁn a l INF D

P OsiTIvely AWARE NOVember+DECEMber 2015 5 The conversation [email protected]

COLLECR TO ’S ITEM taking Sustiva and Epzicom. How can we know straight men who have been LET ’s I have been collecting your annual I get my CD4 to rise? infected via heterosexual activity and CONNECT HIV Drug Guide since your first issue. —Robert A. Truby their reality should not be discounted. All com- I used to go to a doctor who had the Florida State Prison, Raiford, FL munications magazine in the lobby. Unfortunately, F ew resources for Hep C (letters, Editor’s note: email, online I’ve had to move to a less than toler- You should be happy I am a peer posts, etc.) ant part of the U.S., and my new doc- to hear that HIV specialists believe educator at the are treated as tor’s office does not carryPsitively o the viral load is more important than Arizona State letters to the Aware. the T-cell count. Many people are in Prison Complex, editor unless I was wondering if you might the same boat you’re in, so we under- Meadows Unit. otherwise instructed. We know of a way to find two copies of stand your concern and frustration. Our main focus reserve the the P oSITIVELY Aware 2015 Drug It’s great that you have undetectable is hepatitis right to edit for Guide? It’s nice to look back at the viral load and your lack of OIs proves A, B, and C; length, style, old issues and see how many more it. As for survival, it’s estimated that HIV, STDs, or clarity. Let us know if you meds are available and how many people on successful antiviral treat- and hygiene. prefer we not better tolerated meds have come ment will have a normal lifespan. Last week I use your name along. Makes one think there may be received a and city. even more in the future. I had no idea Tre n aTMe t ups and downs copy of the I’d live long enough to see a 19th I am on Prezista, Norvir, Viread, July+August issue—what a great Write to: Positively drug guide. and lamivudine. My CD4 count is source and wealth of information. I Aware, Thank you so much for the work 882 and my viral load is less than have been able to share it in our HCV 5050 N. you do. It is greatly appreciated. You 20—undetectable—since 2010. and HIV classes on this yard. Thirty Broadway St., have no idea. I’ve slept with your I was diagnosed in November 2009. percent of our peers have HCV and Suite 300, Chicago, IL magazines by my bed. They provide I am 63 years old and thanks to PA about 5% have co-infection with 60640-3016 such hope. Cheers. magazine and staff I am doing well. HIV. There is little or no treatment —G.B.D. My biggest problem is abdominal pain, for infected peers. We have a private, EAM IL: via email excessive gas, and bloating. The info for-profit health care provider! HIV- inbox@ I get from PA has been very helpful positive peers never get to see a virolo- tpan.com I n print to me. It helps me understand a lot gist. They get a viral load and CD4 cell Tw eet: I would like to thank all of you at PA about my treatment and how to best count maybe once a year. There are @PosAware for still providing prisoners with free, cope with it. I want to be an advocate no wellness protocols in place. There printed treatment information on HIV, and volunteer for clinical trials and are over 1,200 inmates on this yard AIDS, and hep C. Prisoners in most research in the near future. and just one doctor. This yard is a states do not have Internet access. —John R. Hernandez medical and mental health yard. They I’m sure I speak for thousands of HIV- Terrell Unit, Rosharon, TX use the cheapest and oldest medica- positive inmates when I say thank you tion to treat HCV, peginterferon and for providing this most helpful service Boye me ts girl ribavirin, which also have the most to positive prisoners. We seem to First, thank you for the subscription. side effects, so severe most peers be the forgotten minority with most It’s a very informative guide and mag- stop treatment. The hep C drug issue all other AIDS service organizations. azine. I pass it along for others to read issue gave us so much information on Please keep up this great service. and even get certain articles copied all the new medications with far fewer Thank you! and posted wherever the prison allows side effects and those that treat co- —Johnny C. Smith me to post it. infection of HIV. We are told that co- Coffield Unit, Tennessee I believe the most arguable topic infected patients must have their HIV Colony, Texas is how the virus enters the body for under control first. They forget that the male who engages the female. most HIV peers have been on meds Ra ising T-cells Most people cannot conceive that for years and have their HIV as well as I’ve been diagnosed with AIDS since notion. Please have someone elabo- can be under control. Secondly, they March 2003. I’m wondering how rate on that. just want to save money. What they long one can survive taking medica- Thank you again for keeping us fail to realize is that at some point tion? My CD4 count was 6 in 2003 informed. You are actually saving lives. most of these peers will be released and to date the highest it has been —Di av d Gant and will have relationships and need is 259. As of April, it was 238. I am Frackville, Pennsylvania to be as healthy as they can be. I sur- undetectable and have been for more vived HCV. I have an SVR [sustained than 10 years now. My viral load was Editor’s note: Thank you for the virologic response] and am cured. I 367,000 in 2003 and when I found opportunity to say that absolutely, share my treatment openly with my out my condition, I had acute TB and men can get HIV from women! It’s peers, to let them know there is hope. MAC. No opportunistic infections known to be a very limited route of —Wm ay an Walker since then. Praise the Lord! I am transmission for several reasons, but Florence, Arizona

6 NOVember+DECEMber 2015 POSITIVELY AWARE Photo:Pho tO: CHRIS KNIGHT I vely si P in 1989, Iwasn’t even sure that older was getting in the being diagnosed meout. For manyHIV—hear after years will open. burst of inspiration will andthe curse the floodgates lifted, be what selfishly, that if Iput out maybe it there, in hopes the floating around I’mnowin So my head. telling you,some what’s accurate, been butit’s necessarily not it’s I know thought. writing,on tell scary Ican you that that’s avery nothing left to say and the only thatmeare, to words screen Ihave come alwaysbut it’s the heart. from another day. eyes of set fresh Idon’t always getit right, at it with it on look to sleep to a and alwaysworkers, try wordsmith, times, it several my solicitco- from feedback paper.ontoout the flow to I’ll start the words rewrite then click to write, it Idon’t,begins other times butonce me for whatI have of Iwant asense saywhen to Isit down to Often sorts. of block” experiencing a“writer’s been I’ve somethingand when there. out for we only can “put” hope thewhich timewill of we writers as most never about, hear with them in amultitude profoundly, ways, of sometimes and resonate move can others words of power The often. happen which doesn’t anyoneoccurs, knows who writes by my I’m story. always incredibly so humbled when that what and tell to Ihad they were written mehow touched Center, many up came meand to thanked people mefor living Medical people for with HIV organized by Northstar published, while the annual at of one gatherings in Chicago it was it). after (I when Iread still how shortly Irecall cry do to with little HIV, me for very personal it but was very mother, who died in June 1998. of column The really had titled “ by how muchstruck Ihad say. to particular One column O I think part of it for me is the fact that meisI think it for the fact I’m of aging part with at ablank few months Istare past computer These to me for admit whyThat’s difficult that, it’s of late, I look back at some of myand of earlier I’m backat some editor notes I look T I n 2004 n not. Aresponsibility hope, to offer and provide information in away that’s easy to understand. the larger HIV community, including providers and by those HIV, affected whether positive or a certain sense of responsibility. Responsibility to the readers of the magazine, as well as to HIV. It is arole that Ihave never taken lightly, and I’ve always understood that with it comes tremendous opportunity that few others get, aplatform to avoice be for others living with W h o will my of us?” for there dealt with the be loss A W A R when Istepped up as interim editor of E . As someone whose livelihood whose depends someone . As W T O EDI T R hat ’ S

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BERR Y a - n Is mer of hope, to someone who it. may need tosomeone hope, mer of even aslim glim- offer to and all,bare, warts in an effort right whonow. is struggling other person Laying ourselves that maybe in there, out it willtruth the hopes help one may be).wrong, asthe case print, of you’ve chance one got horror getit to right—or (that’s error andunretractable the simultaneous beauty in my head, in and made whichI’ve an egregious case this could alling course to. with just Of be youit as used something maybe my In too. writing case wasn’t resonat- like saying. Ifelt Iowedit you, itto needed you felt in case I’m closet. block writer’s only sure it’s temporary, butIfeel design. sand-castle majestic grand, whichof HIV is only asmall atiny part, grain in sand of a I’m discovering that there’s awhole new world there, out beginning widen, to the HIV haze begining dissipate. to fall to my blinders vision off, and are now starting those ing blinders kind had or narrowing of some vision, of like It’s wear- at acost. been that come I’ve probably it’s like. mightlook what that think toseriously andstarting my about retirement years, and bone, mental health).exercise, and heart, I’m also who’s agingthink to needs (for about example diet and are additional there 60s, things consider to that anyone manyit had so for my of Now, friends. asIapproachmy that methanhope itfor would maybe turn differently out just figuringstay somehowout howalive, to hoping against back then was possibilitiesme.realm concern My for of SITIVELY P Take yourself, of and other. care each that’sBut the chance we all take, right? our Putting of the out come said I’ve there, it. officially I’ve So in long, HIV so immersed for pointMy isbeen I’ve o Aw a are y , Iwas with blessed a ? NOV e mb e r+ D ECE @ there. new world out there’s awhole that discovering to dissipate. I’m begining haze widen, the HIV to beginning off, my vision starting to fall blinders are now vision, and those of narrowing of or had some kind blinders wearing It’s like I’ve been come at acost. that it’s probably HIV for long, so immersed in I’ve been J follo M PAEDITOR b e w r 2015 e ff 7 Briefly Enid Vázquez

HIVtmn trea e t and STIs TAF beats TDF in kidney and bone safety PouldrE sh be offered The value of HIV treatment in A new version of an older HIV drug has met its The Lancet of September 9 helping to curb new infections, primary research objective for safety and efficacy. published final results of an “on average,” doesn’t seem to In September, Gilead Sciences announced important study with PrEP be affected by STIs, accord- the results of an advanced Phase 3 study (pre-exposure prophylaxis, or ing to a review of 14 studies comparing tenofovir DF (TDF) with the new prevention). The pilot phase with nearly 3,000 individuals. tenofovir alafenamide (TAF). At one year, of the PROUD trial looked Historically, STIs are recognized there were similar rates of efficacy shown in at real-world effects of using as causing greater infectivity. undetectable viral loads (under 50 copies), once-daily Truvada for PrEP Read the report published 94% for TAF takers vs. 93% for those on (see May+June 2015). “In June 30 in BMC Infectious a TDF regimen. this high incidence population, Diseases at biomedcentral. There was, however, a statistically daily [Truvada] conferred even com/1471-2334/15/249. significant difference in bone mineral higher protection against HIV density (BMD) at the hip and spine than in placebo-controlled N eedle exchange and change in a measure of kidney trials, refuting concerns that curbs HIV while function (estimated glomerular fil- effectiveness would be less saving millions tration rate, or eGFR). TDF has the in a real-world setting,” the That’s the conclusion of a potential for toxicity to bone and research team concluded. George Washington University kidneys, and TAF was created to overcome “The time for caution- study looking at syringe these problems. ary speculation is over: HIV exchange in Washington, DC, “For more than a decade, Truvada [con- prevention services should published online September taining TDF] has been a cornerstone of HIV be expanded worldwide by 3 in AIDS and Behavior. The therapy, and the results of this and other offering PrEP routinely to those study estimated that the pro- recent trials demonstrate the potential of F/ who could benefit,” concluded gram, started in 2007, cut new TAF [the new version of Truvada] to become two U.S. doctors in a separate HIV cases by 70% in two years a next-generation backbone,” said Norbert commentary providing an and saved $44 million to boot. Bischofberger, PhD, Executive Vice President, overview of PrEP history Read the HealthDay News Research and Development and Chief Scientific (Kenneth H. Mayer, MD, of story about the study at nlm. Officer for Gilead Sciences, in a press release. Fenway Health and Harvard nih.gov/medlineplus/news/ “The results from this study reinforce the effi- Medical School in Boston and fullstory_154470.html. cacy, as well as the renal and bone safety advantages of TAF for Christopher Beyer, MD, of patients who face a lifetime of treatment.” Johns Hopkins University and Tg i ers and hemophilia There were 663 patients in the ongoing study, some of whom president of the International Listen to the interview “Growing were switched from a TDF-containing regimen to one using TAF AIDS Society, or IAS). o

Up with Hemophilia, HIV and instead. See more on switching to TAF on page 37. Go to thelancet.com/ t o

Tigers” on public radio, in which A newer version of Stribild containing TAF instead of TDF (E/C/F/ journals/lancet/article/ h p

Craig McLaughlin talks about TAF) is awaiting approval and is expected to arrive in early November. PIIS0140-6736(15)00056-2/ ck o his new memoir, Passing on abstract. t Curves While Death Rides WHOmm reco ends universal HIV treatment es: is g

Shotgun. Go to wcqs.org/post/ In September, the World Health Organization updated its HIV treat- P rE and apps a growing-hemophilia-hiv-and- ment guidelines to recommend antiviral therapy for all as soon Half of gay men in the United m

tigers#stream/0 er i . after diagnosis as possible. In a press statement, the organization States using dating apps have h

reported that, “With its ‘treat-all’ recommendation, WHO removes all interacted with a man using Ot

PrE for Canada limitations on eligibility for antiretroviral therapy (ART) among people daily Truvada for HIV preven- t igh

In August, Gilead Sciences living with HIV; all populations and age groups are now eligible for tion—read the aidsmap report n applied to Canadian authori- treatment. The expanded use of antiretroviral treatment is supported by Roger Pebody at K ris ris

ties for approval of Truvada by recent findings from clinical trials confirming that early use of aidsmap.com/ h C for PrEP. To date, the United ART keeps people living with HIV alive, healthier, and reduces the page/2996161/?utm_ States is the only country that risk of transmitting the virus to partners.” The organization also now source=NAM-Email-

makes the medication available recommends providing prevention with PrEP to people at “substan- Promotion&utm_ Á V for HIV prevention in addition tial” risk of HIV. Go to who.int/mediacentre/news/releases/2015/ medium=aidsmap-news&utm_

to HIV treatment. hiv-treat-all-recommendation/en. campaign=aidsmap-news. ENID zquez:

8 NOVember+DECEMber 2015 POSITIVELY AWARE follow ENID @ENIDVAZQUEZPA

Edurant pediatric dose and new side effect info Pa ss it on In August, the FDA added a pediatric dose for Edurant (rilpivirine). People with HIV can It can now be used by pediatric patients ages 12 to 18 who have share words, pictures, or never taken HIV therapy before. As with adults, their viral load can- videos on the website Your not be above 100,000. TDF and low bone mass Story, Your HIV Wisdom. “Depressive disorders” (depressed mood, depression, dysphoria, in newborns Launched in September major depression, mood alterations, negative thoughts, suicidal Infants exposed in the womb by Janssen Therapeutics, ideation, and suicide attempt) are a known side effect of Edurant. to the HIV medication tenofovir the site donates money The FDA reported that, “Patients with severe depressive symptoms DF (TDF, brand name Viread, to AIDS United and the should seek immediate medical evaluation to assess the possibility also found in Truvada, Atripla, Black AIDS Institute for that the symptoms are related to Edurant, and if so, to determine Complera, and Stribild) may contributions that are whether the risks of continued therapy outweigh the benefits.” have lower bone mineral con- made. Guy Anthony, Maria Advanced Phase 3 studies found a 9% rate of depressive disorders tent than infants exposed to Mejia, and Josh Robbins (vs. 8% for Sustiva, found in Atripla), but the study of pediatric other antivirals, the National serve as advisors to, and patients found a rate of 19.4% (seven out of 36 participants). As Institutes of Health (NIH) moderators of, the site. Go with adults, most cases were considered mild or moderate. reported in September. “At this to ShareHIVWisdom.com. There was also information added to the drug label about adre- point, we can say that those nal changes of unknown clinical significance. who care for pregnant women with HIV and their children No new HIV W hAT is high risk? should be aware that pre- Health care provider Kaiser Groups with behaviors that are high risk for scribing tenofovir to pregnant Permanente reported seeing HIV transmission do not necessarily have women could be a concern no new HIV infections in real- a higher rate of infection. In San Francisco, for their infants’ bones,” said world medical practice after researchers looked at MSM (men who have sex with men), people George K. Siberry, MD, the more than two years of provid- who inject drugs (PWID), and “high-risk” heterosexuals (HRH): lead author of a study finding ing PrEP, in one of the first and women of color and people living in poverty. The heterosexuals had that a 12% lower bone min- largest published evaluations a greater number of high-risk behavior compared to the two other eral content in babies whose of the prevention strategy groups, but the lowest HIV prevalence. “Focusing on risk behavior mothers received TDF in their outside of a clinical trial. This alone to label populations without considering the background third trimester. The study was was despite the fact that PrEP HIV prevalence in communities, the types of risks engaged in and published in Clinical Infectious users experienced other STIs. actual HIV infections may obscure which populations truly merit Diseases. Read more at nih. “Our study is the first to extend the label ‘high-risk’ for HIV infection,” wrote the research team in gov/news/health/sep2015/ the understanding of the use AIDS and Behavior. Go to link.springer.com/article/10.1007%2 nichd-30.htm. of PrEP in a real-world setting Fs10461-015-1181-0. and suggests that the treatment Author’s note: HIV prevention activist Jim Pickett says that words Oy l sio approved may prevent new HIV infections like “at risk” and “high risk” are stigmatizing in and of themselves, in HIV, genotype 4 even in a high-risk setting,” said and thus separate people from prevention efforts. He suggests using In October, the FDA approved lead author Jonathan Volk, MD, the word “vulnerable.” The HIV service organization Test Positive the hepatitis C medication MPH, a physician and epide- Aware Network (TPAN), the publisher of P oSITIVELY Aware, long Olysio for use by patients with miologist at Kaiser Permanente ago gave up using the terms (when promoting PrEP, for example) HIV as well as those who have San Francisco Medical Center, because people could not identify with them, and were lulled into a genotype 4 hep C virus. Prior in a press release. “Until now, false sense of security. Moreover, the idea that it’s your community— to the approval, these patients evidence supporting the effi- not necessarily your behavior—that can put you at risk, a concept could use Olysio off label (with- cacy of PrEP to prevent HIV that is bolstered by research, appears to be widely unrecognized by out official approval). The dose infection had come from clinical people who are particularly vulnerable to HIV. for these patients, however, is trials and a demonstration proj- with interferon and ribavirin, a ect.” The study was published Mc an infe ted with tainted blood combination that is not recom- September 2nd in Clinical A jury awarded an 85-year-old man and his wife $4 million mended by hepatitis C treat- Infectious Diseases. Read the after he was infected with blood containing HIV during open- ment guidelines. Most people full text at cid.oxfordjournals. heart surgery. Read more at montgomeryadvertiser.com/story/ take Olysio with another hep C org/content/early/2015/09/01/ news/2015/09/09/couple-awarded-million-husband-given-hiv- medication, Sovaldi. For more cid.civ778.abstract. tainted-blood/71963566/. information, go to olysio.com.

P OsiTIvely AWARE NOVember+DECEMber 2015 9 E s L T An 14 Infectious Diseases fellowship Diseases to Infectious est. Iwas hired my of right out est. By care, includingcare, HIV. for Butto health of standards community say I specifically chose to work to work chose say Ispecifically rections population to receive population receive to rections cor the for underserved need was my calling is totally not hon- fill I there. a vacancy imagined there because Ithought ajail because there is aclearthere and recognized Ch

I work atI work the jail because a HIV NOV a d e Zaw doc mb e i r+ tz, M tz, c and difficult answers. there?” questions These have both easy are some of the things crazy you must see there?”, “Aren’t you scared?”, and “ I’ve heard questions like “ ver since e ialist at the CountyJail Cook in Chicago, D t ECE o D r finds his c M b e r 2015 I - working started as an HIV spe -

from a calling at the jail. jail The finds at the time said, “You don’t find gracious, thankful, and interest and thankful, gracious, patients are generally patients the most Cook County. Butlike Cook my boss you.” only afew months on After ing people I have served in my Ihaveing people served ing the citizens for elsewhere of it was to work a stepping-stone the right place. right the the job, Iknew Ihad at arrived As for being scared? My My being for scared? As a W l h ling hel y do you work W h at p - - - i ng

ally does not result in result not amean- ally does engaged andengaged arich provide career. No. are Butscary? There changed privacy). for Svetlana or intimidatingor gener behavior points in theirpoints Threatening lives. at the lowest are often patients place on the compound andplace the on compound clin- in measures numerous security was acommercial worker sex head. Butall me them keep of leave mescratchingSome my are funny. areSome tragic. Some encounter. productive or ingful ical areas. More importantly, More ical areas. my jail, “Svetlana” Imet (names that mehumble. keeps the human of existence tapestry i e M th y v p And the stories? Endless. theEndless. And stories? e r o y f p r l s e who t e I w e ek at the the at a r ns - e inc addiction. She was also HIV- and going to be the norm for the rest the rest for going the norm be to er. him a Ihad seen at least shock. herthe to point of strangled her, her “john” raped stated struggling with depression and withstruggling depression of myof career? Iliterally cried. patient who was a repeat offend repeat a was who patient me she was arrested for public for me she was arrested unconsciousness, then threw her unconsciousness, were obvious finger marks. After obviouswere fingerAfter marks. her medical history, she told C-positive. hepatitis ing bruises around thating her neck bruises half-dozen times over a two-year half-dozen over atwo-year times indecency. that encounter, Iwas simply in then pulled back her hair, reveal limp into a dumpster. body She a “Larry” was another HIV “Larry” r cer W i e re stories like stories re hers W d he a t P n I pressed, she she n Ipressed, O e SI d e T W I VELY h ile taking ile taking A W A R - E -

ILLUST TRA IONS: ISTOCK period. During one encounter, I and eloquent thank you letter, Provider (CCHP). Dr. Zawitz His academic interests include asked Larry if he could pinpoint telling me how grateful she was has worked exclusively with virology (HIV/HCV), correctional the moment in his life when that I had not given up on her. the incarcerated population in healthcare, public health, and “it went bad” for him. Larry While I have received many Chicago for more than 10 years. LGTBQ health. described a childhood of repeat- letters and cards over the years, ed sexual abuse by his father there was something special and uncles, followed by living about this one, and I decided to homeless on the streets by age tell Patricia a personal story in 11. He described getting hooked hopes she would be inspired. Ay Ra of Hope and Light on heroin by age 13, selling his iBy Patr cia Douglas body to support his habit and When I was in high school, I for food. But then he said none would have been best categorized I was a frequent flyer helped me to connect with of that was what turned his life as the “King of the Nerd-Herd.” I at the Cook County Jail in him. Maybe it was his genu- wrong. I was dumbfounded. He longed for social acceptance, to Chicago (CCJ), in and out on ineness and warmth, maybe then described in vivid detail be able to hang with the cool a regular basis. I was a hard- it was because I did not feel witnessing the murder of another kids. At the end of my senior core heroin addict for most judged. commercial sex worker right in year, as yearbooks were being of my life. I started injecting On one of our meetings, front of his eyes, her head liter- passed around for farewell wishes different drugs at about 12 the words he said to me still ally cut off. To this day, I still get from classmates, I approached years of age, everything from ring in my ears and bring goose bumps. someone I had idolized from afar. pills to cocaine, and then tears to my eyes. “You don’t I was consulted to see anoth- I figured he didn’t even know who I found heroin. As a result even know your own greater patient in the jail infirmary I was. He took my book, wrote of the addictive qualities of ness.” I can hear it like it was for a fever. After the encounter, something, and handed it back. heroin, I started stealing and yesterday. “Oh my goodness,” the patient stated, “Doc, I want The inscription stated simply, prostituting to support my I thought, “someone actually to thank you. You are the only “You don’t even know your own habit. Hence, my frequent believes in me.” Simply put, person since I’ve been here greatness.” Here I was, thinking visits to CCJ. that was all I needed to hear. who’s been nice to me.” Another that my classmate probably didn’t On one of these stopovers, A seed of hope had been head-scratcher. He seemed like even know me, and if he did, felt I ended up in Cermak Health planted and I began my jour- an ordinary guy. He was polite, I was beneath him. But here was (the jail’s clinic) where I met ney to find my “greatness”! cooperative, and otherwise did one of the most inspiring things a very kind man named Dr. That was four years ago. not seem to have any ‘red flags’. I had ever read. He actually had Z. Meeting him saved my life Today I am a thriving woman I asked him why the others were observed my achievements as in many ways. I had been so who is getting ready to gradu- not treating him well, and he a scholar, student athlete, and sick from abusing my body ate college with an A.A. in replied, “Because I’m a tree- student leader, and noticed that I with drugs, my CD4s were Psychology and my CADC jumper.” I had not heard the did not even appreciate the gifts I 50 and my body was overrid- (certified drug and alcohol term before, so I had to ask. “A already had. den with abscesses. I was in counselor). I have worked my tree-jumper is a child molester.” I repeated this story to a very bad state. Mentally, I way up from the very depths While I appreciated his honesty, Patricia. I saw greatness in her believe (if this was possible) of hell! There are ways out I quickly realized why he per- that she either never knew or that I was in even worse and I thank goodness ceived the others around him to had long forgotten. Sometime shape. I saw no other life for treat him with less regard. thereafter, she was released. me but the one I had been Fast forward to today: Patricia living. I truly believed that I On a positive note, not every has found her greatness, and was born to be a junkie, and encounter made me question soared. We still keep in touch, that was the way I was going why I continue to work at the and she wished to share her to die. jail. Many of my patients actually perspective with the readers of On our very first meeting I come from supportive families, P oSITIVELY Aware. knew Dr. Z cared, something that have a good education or a good I had not felt from another I finally job. And once in a blue moon, Ch ad Zawitz, MD, is a Board human being in a long time. found mine. someone like Patricia comes Certified Infectious Diseases I’m not sure if I can pinpoint It’s funny the along, who reminds me of what specialist at Cook County Jail one thing or the other that way things work. working at the Cook County Jail in Chicago. He received his Who would have is all about. Infectious Diseases training at thought that in a place Patricia is also an HIV patient Rush University Medical Center like CCJ, a person like me like Svetlana, who struggled in Chicago and Internal Medicine could find a ray of hope, with addiction and depression. training at the University of and a ray of light like Dr. Z. She had multiple incarcerations Pittsburgh. He is the Director of For those who are still and her health had deteriorated the Continuity of Care Clinic for struggling, the moment you to the point I felt she would HIV-positive detainees at both feel even an ounce of hope, probably die sooner rather than the jail and the nearby county- run with it. It just may save later. One day, Patricia wrote run CORE Center. He is also a your life. It saved mine. me a letter. It was a heartfelt Certified Correctional Healthcare

P OsiTIvely AWARE NOVember+DECEMber 2015 15 16 The low-down on infl A inf fro o b

NOV J a m e nn mb

a a e r+ E n ve D ECE l HIV a nd, M M b l doc e r 2015 D t

o r m a mmat ED i on

infl When do area. the injuredimmune system—to warrior cells the of cells—the white blood attract to the blood also circulate in messengers to theChemical flow to area. wound dilate to andblood more the near causing vessels blood locally, act chemical messengers chemicalsignals.out SOS These send edge paper the offending Injured skin cells by sliced open cut,you instance. getapaper for inflammation. chronic stand mation helps works to under allturned the way up. the volumebeing stuck—with volume astereo on knob control Chronic inflammation is like a injury is gone, is problematic. the initial evencontinues after tion, immune activation that healing. Butchronic inflamma and self-limited, for is essential immune activation that’s rapid signals. inflammation, Acute cells of and chemicalnetwork acomplicated system—activates defense body’s system—our injury. During injury, the immune to response the body’s for term this process is healing. this process theto injury. of endresult The immunea cascading response signals,create to chemical own cells arrive, their out they send to the next injury. theto next respond to immune free system leavingthe immune the response turn off chemical messengers other At this the endof process, down and is prevented. infection is laid tissue clot scar is formed, effects can be. effects long-lasting its what and why inflammation happens about understand really captures just how little we you talk to and it really the same no matter who inflammation—it’s for language sign international talk. Ilike to call this the our hands around as we ally end up wildly waving Here’s what happens when Knowing how acute inflam Inflammation is the generic a W mma he c n the white blood t t ion, ors dis P we usu we O SI T c I u VELY ss ss

A blood Ablood - A W - A - - R E

Photo: ISTOCK Chronic inflammation hap- suggested these reasons dur- So if you’re worried about medications work even better to pens when the immune system ing a presentation made at inflammation, what can you do? prevent HIV replication and stop doesn’t turn off after an injury or an International AIDS Society inflammation? Unfortunately, triggering event is over. We don’t Conference: Q uit smoking. Just about every most of the studies looking at have a cohesive, comprehensive study shows that inflammatory adding additional drugs to an way to measure inflammation n T here’s ongoing viral rep- markers go up in people who already suppressive regimen as a whole yet, but we can lication. Even people with smoke. have not shown to improve CD4 measure separate “inflamma- undetectable viral loads still count or reduce inflammation. tory markers,” or chemicals have virus in the body at very P ay attention to your Some studies have shown released by cells during the low levels. This small amount diet. Try and get at least that you can increase CD4 process of inflammation. Some of virus may stimulate the 5 servings per day of fruits counts with immune-boosting of the main ones being studied immune system and cause and vegetables. Reduce the therapies—also called “thera- right now include C-reactive inflammation. amount of refined sugar that peutic vaccines”—or the HIV protein (CRP), D-dimer, fibrino- you eat. You can get some drug maraviroc. Other stud- gen, Interleukin-6 (IL-6) and n Imm une regulatory cells recommendations on how to ies have tried to “turn down” Interleukin-8 (IL-8), but there are are dysfunctional. W hen eat an anti-inflammatory diet at immune system activation using many, many more. HIV infects white blood cells, drweil.com/drw/u/ART02012/ chemicals like interleukin-2. Inflammation is linked to just it disrupts all parts of the anti-inflammatory-diet. Unfortunately, none of these about every bad thing that can immune response including studies have produced signifi- happen to our body—cancer, the cells that direct and turn G et plenty of exercise. If cant health benefits for people. heart disease, liver and kidney off inflammation. This might we had a drug that had all the failure, dementia and autoim- lead to the failure of the “vol- benefits of exercise, it would be To sum up, inflammation is mune disease (just to name a ume control” of the immune a best seller. beneficial when it’s part of the few). A few years ago, HIV spe- system. body’s early response to injury cialists and researchers started M aintain a healthy weight. and problematic if it never goes talking about inflammation more n Mi crobes translocate Obesity promotes inflammation away. For many reasons, people and more. We noticed that across the gut. This is independently from HIV. with HIV have higher levels of people living with HIV—even also known as the “leaky gut inflammation than people who those successfully treated with syndrome,” an interesting Cut out recreational are HIV-negative, and this is combination antiretroviral thera- theory that HIV found in parts psychostimulants. Cocaine, linked to health issues like can- py (ART)—had higher levels of of the immune system tissue methamphetamine and cer and heart disease. We still inflammation than HIV-negative surrounding the intestines ecstasy all appear to promote have a lot to learn about what people. And, even though our causes the intestines to leak inflammation, especially within causes inflammation and how patients weren’t getting oppor- bacteria across the wall of the the brain. best to treat it but, in the mean- tunistic infections anymore, they gut. These bacteria are then time, people with HIV can lower still had higher rates of heart responsible for activating the Kee p your HIV well-con- their risk by eating healthily, disease and non-HIV-related immune system and causing trolled. HIV treatment also staying active and taking good cancers higher than the general ongoing inflammation. plays a role in reducing inflam- care of themselves. population. mation. While many people This isn’t to say that ART n T here’s another viral worry about the toxicity of HIV R eprinted with permission has no effect on inflamma- infection. W e know that medications, it’s important to of BETA. Read more online tion for people with HIV. We people with HIV have higher keep in mind that the virus itself at betablog.org. know from the SMART study rates of hepatitis B, hepatitis is toxic to every organ in the that people with HIV are able C and cytomegalovirus (a body. Early treatment also helps, Jon an a Eveland, MD, is an to reduce the levels of some herpes virus). It’s possible too. We know that the lower a HIV treatment specialist in inflammatory markers, like CRP, that these other viruses are person’s CD4 count is before San Francisco. She oversees with continuous ART. ART can responsible for activating the they begin treatment, the more HIV and homeless services as decrease inflammation—it just immune system and contrib- slowly and less well it bounces the Clinical Chief for Special doesn’t make it completely go uting to inflammation. back when ART is started. Low Populations at the Mission away. We also know from the CD4 counts are correlated with Neighborhood Health Center, is a SMART study and the recent n T he thymus is dysfunc- an increased risk of sickness faculty member at the University START study that continuous tional. The thymus is a and death from non-HIV related of California, San Francisco ART treatment decreases risk small organ under the breast causes. Clinician Consultation Center, of both HIV-related events and bone. It’s where certain and leads a bi-monthly health non-HIV-related events such as types of white blood cells The theory that low-level HIV education group for HIV-positive cancer and heart attacks. go to develop and learn to replication, even when a person men through the San Francisco While we’re still not com- tell which cells are part of is undetectable, is responsible AIDS Foundation. Dr. Eveland pletely sure why people with HIV the body and which cells are for inflammation has led some received her M.S. and M.D. have chronic inflammation even foreign invaders. In some people to wonder about the at the University of California, when their viral load is under people with HIV, the thymus benefit of taking an additional Berkeley-UCSF Joint Medical control, Steven Deeks, MD, an turns into scar tissue—it HIV medication. In other words, Program and completed her resi- HIV researcher at the University becomes “fibrosed”—and if taking three HIV medications dency at the Contra Costa Family of California, San Francisco, doesn’t work as well. works well, will taking four HIV Medicine Residency Program.

P OsiTIvely AWARE NOVember+DECEMber 2015 17 A Call to action by the TRANSGENDER COMMUNITY U sing USCA as a platform, activists discuss invisibility and violence By David DurÁn

his past September the annual United attention needs to be given funding as well as pharmaceuti- States Conference on AIDS (USCA) took place toward the needs of the trans- cal companies,” said Salcedo. in Washington, D.C., and the attendance out- gender community and chose “The [updated] National HIV/AIDS numbered previous years with representation to disrupt a plenary luncheon Strategy just came out and we to stage a protest. At the invita- thought it was an opportunity to from all fifty states. tion of Paul Kawata, Executive call out the office for a lack of T Director of the conference trans inclusion.” At this year’s USCA, leaders a workshop which highlighted organizer, NMAC (formerly the According to Salcedo, in the of the transgender community how the city of San Francisco is National Minority AIDS Council), initial strategy the transgender used the prominent, community- utilizing the spectrum of preven- and led by activist Bamby community was mentioned and based conference as a platform tion to advance trans health Salcedo, the transgender activ- there were some things that were to raise awareness around soci- within a high-impact prevention ists and their allies took the supposed to be implemented, ety’s treatment of trans people. framework. A plenary session on stage to protest and voice their and in the new one recently Specific programming at women and HIV included a trans concerns. released, it appears that trans- the conference dealing with woman of color, Valerie Spencer, “The primary reason why we gender issues were no longer a transgender issues included a as a speaker. Additional time was decided to interrupt the session priority. “For a lack of a better workshop on aging in the trans allotted for transgender-focused was because, as we know, the word, we felt erased. The name community, a roundtable discus- sessions; in addition, many of the USCA is a national conference of the session that we interrupted sion on holistic engagement sessions throughout the four-day where many individuals attend, was called Mind the Gap, and RRY solutions for trans women living conference could have techni- including people from the gov- we thought it was perfect that if E with HIV, a seminar on a trans cally applied to someone from ernment, people from different people really wanted to ‘mind the B women of color initiative aimed the transgender community. federal agencies that provide gap’, that they should realize that E o at enhancing engagement and But transgender activists services to people with HIV, in there was a huge gap between t

retention in HIV care, as well as and attendees feel that more addition to people who provide trans people and society.” Pho : J ff

18 NOVember+DECEMber 2015 POSITIVELY AWARE “ We need more transgender inclusion, especially in the HIV field; we don’t ask for anything more than what other groups have, we just want the same as others.”

could do to improve the experi- bring attention to the crimes suicide attempts, because their ence for transgender attendees, being committed against me and erasure from the gay community Salcedo said, “Providing more my sisters. Not only hate crimes, reduces their risk of HIV by isolat- scholarships for trans people murder, mutilation, and beating them from their community, would definitely be a great start.” ings that we face every day, but and that isolation is often fatal. She also stressed that the plan- structural damage that makes “As integration into gay men’s ning of the conferences could be our lives a living hell,” she said. cultural spaces improves and we more of a collaborative effort. “I Vidal expressed that many of the become more visibly accepted think next year since it’s going to agencies receiving “millions of and welcomed by other gay men, be in [Hollywood, Florida], and dollars” to work with and for the I expect we’ll see HIV incidence we will have a representative transgender community had no among gay trans men increase from the TransLatina Coalition, it transgender employees. accordingly. I don’t see anyone would be a good opportunity for On a more serious note, Vidal proactively discussing that much. us to collaborate with NMAC, so compared the fear that transgen- To be clear, trans women are we can include more people.” der women go through on a daily currently facing a legitimate crisis Arianna Lint is a transgender basis to those fears felt by peo- with regard to HIV right now, so woman who attended the confer- ple in the United States after the I want to emphasize that they ence, and was concerned about September 11th attacks. “When need all the support they can get, the lack of roles and positions we would walk past tall buildings and I think it’s obscene to divide available for transgender indi- wondering if someone was going HIV resources for ‘trans people’ viduals in the agencies that send to target them, is the same exact between trans men and trans people to attend the conference. fear my sisters and I go through women equally.” “The transgender programs every single day of our lives…not Next year’s USCA will be in the United States work only if knowing if we will return home held in South Florida near you have transgender individuals at night without getting beat up Fort Lauderdale, a city making as staff or in management posi- or killed.” She continued, “We massive efforts to include trans- tions,” she said. “We need more will keep on protesting, in acts of gender visitors. Various news transgender inclusion, especially public disobedience, and I have outlets have recently recognized in the HIV field; we don’t ask for a vision that soon this won’t be the Greater Fort Lauderdale anything more than what other necessary, but until then, we’ll Convention and Visitors Bureau groups have, we just want the make our voices heard.” for launching its Transgender same as others.” It’s unsure exactly how many Travel Initiative, the first of its Lint also stated that many attendees identified as transgen- kind. Furthering its efforts to agencies group transgender der, and there was no specific best cater to all segments of As for USCA, Salcedo felt that women within the men who programing geared towards trans- the LGBT market, the CVB will although transgender issues were have sex with men (MSM) group gender men. Brandyn Gallagher focus on delivering an authentic discussed during the conference, when applying for grants, but of Gender Justice League did welcoming experience for trans- they were mostly focused at an then don’t deliver the appropriate not attend the conference but gender visitors. organizational level and not as services which are desperately heard from friends who did and Awareness about transgender much on a personal level. “It was needed by her community. commented on the exclusion of individuals has grown signifi- educational for other people but Maritxa Vidal, Executive the transgender community from cantly in the past few years, and it would have been good if it was Board Member of the TransLatina society in general. perceptions have already begun a collaboration between other Coalition and employee of the “I think the exclusion and to change. With allies like NMAC organizations instead of just the Puerto Rican Cultural Center erasure of transmasculine people and USCA by their side, activ- one local organization they part- in Chicago and its HIV group, from society is a much larger ists will continue to forge even nered with,” she said. Vida/SIDA, noted that USCA this systemic issue,” he said. “The stronger and more effective part- Kawata continued to support year offered a hospitality lounge physical invisibility that protects nerships to create change and the activists as the protesters for transgender individuals and trans guys from street harass- inform individuals, and society exited the stage, telling the audi- gender non-conforming indi- ment …is the same invisibility as a whole, about the unique ence, “We’re a vast community viduals, as well as sessions and that leads researchers to exclude issues and challenges facing the of diverse people who don’t workshops geared towards her us from HIV research and forget transgender community. always understand, but love any- community. that we’re part of the MSM risk “USCA remains commit- way. It’s that courage to stand up Vidal was part of the group pool, and it leads cisgender gay ted to all communities highly to put your ass on the line [that of transgender women who men to presume we don’t exist in impacted by AIDS,” Paul Kawata matters]. If you’re not willing to disrupted the Creating Change their community at all.” told P oSITIVELY Aware. “NMAC put your ass on the line, this is 2015 conference, as well as this According to Gallagher, what stands in solidarity with the trans not the movement for you.” year’s USCA. “The demonstra- gay transmasculine people lack in community in the fight to end the When asked what USCA tion was and is necessary to HIV prevalence is made up for in HIV epidemic.”

P OsiTIvely AWARE NOVember+DECEMber 2015 19 ISENTRESS® (raltegravir) has been available to help people manage their HIV since 2007 and has been tested in long-term clinical trials. ISENTRESS has been available for previously treated patients since 2007 and for ﬁ rst-time patients since 2009 A long-term clinical study lasting more than 4 years (240 weeks) of patients being treated with HIV medicine for the ﬁrst time showed that ISENTRESS plus Truvada may help: – Lower viral load to undetectable – Raise CD4 cell counts ISENTRESS may not have these effects in all patients.

INDICATION right away if you have any of pain, tenderness, or weakness the following signs or symptoms while taking ISENTRESS. These ISENTRESS is a prescription of liver problems: yellowing may be signs of a rare serious HIV-1 medicine used with other of your skin or whites of your muscle problem that can lead to antiretroviral medicines to treat eyes, dark or tea-colored kidney problems. human immunodeficiency virus urine, pale-colored stools These are not all the possible (HIV-1) infection in people (bowel movements), nausea or side effects of ISENTRESS. For 4 weeks of age and older. HIV vomiting, loss of appetite, pain, more information, ask your is the virus that causes AIDS aching or tenderness on the doctor or pharmacists. Tell your (Acquired Immune Deficiency right side of your stomach area. Syndrome). doctor if you have any side effect Changes in your immune that bothers you or that does It is not known if ISENTRESS system (Immune Reconstitution not go away. is safe and effective in babies Syndrome) can happen when Tell your doctor about all your under 4 weeks of age. you start taking HIV-1 medicines. medical conditions, including Your immune system may get The use of other medicines if you have any allergies, are stronger and begin to fight active against HIV-1 in pregnant or plan to become infections that have been hidden combination with ISENTRESS pregnant, or are breastfeeding in your body for a long time. Tell may increase your ability to or plan to breastfeed. your doctor right away if you fight HIV. ISENTRESS is not recommended start having new symptoms for use during pregnancy. Do ISENTRESS does not cure HIV-1 after starting your HIV-1 not breastfeed if you take infection or AIDS. medicine. ISENTRESS. Women with You must stay on continuous HIV People taking ISENTRESS may HIV should not breastfeed therapy to control HIV-1 infection still develop infections or other because their babies could be and decrease HIV-related conditions associated with infected with HIV through their illnesses. HIV infections. breast milk. IMPORTANT RISK The most common side effects Tell your doctor about all the INFORMATION of ISENTRESS include: trouble medicines you take, including, Some people who take sleeping, headache, dizziness, prescription and over-the- ISENTRESS develop serious skin nausea, and tiredness. Less counter medicines, vitamins, reactions and allergic reactions common side effects include: and herbal supplements. that can be severe, and may depression, hepatitis, genital Some medicines interact with be life-threatening or lead to herpes, herpes zoster including ISENTRESS. Do not start taking death. If you develop a rash with shingles, kidney failure, kidney a new medicine without telling any of the following symptoms, stones, indigestion or stomach your healthcare provider. Your stop using ISENTRESS and call area pain, vomiting, suicidal healthcare provider can tell you your doctor right away: fever, thoughts and actions, and if it is safe to take ISENTRESS generally ill feeling, extreme weakness. with those other medicines. HIV Positive Model tiredness, muscle or joint aches, Tell your doctor before you take You are encouraged to report blisters or sores in mouth, ISENTRESS if you have a history negative side effects of blisters or peeling of skin, of a muscle disorder called prescription drugs to the FDA. Hey Birthday! redness or swelling of the eyes, rhabdomyolysis or myopathy Visit www.fda.gov/medwatch, or swelling of the mouth or face, or increased levels of creatine call FDA at 1-800-FDA-1088. problems breathing. kinase in your blood. It’s always great to see you. Please read the adjacent Patient Sometimes allergic reactions Tell your doctor right away if Information for ISENTRESS and can affect body organs, such you get unexplained muscle discuss it with your doctor. I wanted to know more about my HIV treatment options. So I as your liver. Call your doctor spoke with my doctor and we chose ISENTRESS as part of my HIV regimen. My doctor told me it could fight my HIV and may Having trouble paying for your Merck medicine? fit my needs and lifestyle. Merck may be able to help. www.merckhelps.com I have so many plans for what’s next. Talk to your healthcare professional about ISENTRESS and visit isentress.com.

Brands mentioned are the trademarks of their respective owners. Copyright © 2015 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. INFC-1141321-0000 03/15 ISENTRESS® (raltegravir) has been available to help people manage their HIV since 2007 and has been tested in long-term clinical trials. ISENTRESS has been available for previously treated patients since 2007 and for ﬁ rst-time patients since 2009 A long-term clinical study lasting more than 4 years (240 weeks) of patients being treated with HIV medicine for the ﬁrst time showed that ISENTRESS plus Truvada may help: – Lower viral load to undetectable – Raise CD4 cell counts ISENTRESS may not have these effects in all patients.

A DAY WITH HIV

Patient Information ISENTRESS® (eye sen tris) (raltegravir) film-coated tablets

Read this Patient Information before you start taking ISENTRESS and each time you get a refill. Sometimes allergic reactions can affect body organs, such as your liver. Call your doctor right There may be new information. This information does not take the place of talking with your away if you have any of the following signs or symptoms of liver problems: doctor about your medical condition or your treatment. ° yellowing of the skin or whites of your eyes What is ISENTRESS? ° dark or tea colored urine ISENTRESS is a prescription HIV medicine used with other antiretroviral medicines to treat ° pale colored stools (bowel movements) Human Immunodeficiency Virus (HIV-1) infection in people 4 weeks of age and older. HIV is the ° nausea or vomiting virus that causes AIDS (Acquired Immune Deficiency Syndrome). ° loss of appetite It is not known if ISENTRESS is safe and effective in babies under 4 weeks of age. ° pain, aching, or tenderness on the right side of your stomach area When used with other HIV medicines to treat HIV-1 infection, ISENTRESS may help: • Changes in your immune system (Immune Reconstitution Syndrome) can happen • reduce the amount of HIV in your blood. This is called “ viral load”. when you start taking HIV-1 medicines. Your immune system may get stronger and • increase the number of white blood cells called CD4+ (T) cells in your blood, which help begin to fight infections that have been hidden in your body for a long time. Tell your fight off other infections. doctor right away if you start having new symptoms after starting your HIV-1 medicine. • reduce the amount of HIV-1 and increase the CD4+ (T) cells in your blood, which may The most common side effects of ISENTRESS include: help improve your immune system. This may reduce your risk of death or getting • trouble sleeping • nausea infections that can happen when your immune system is weak (opportunistic infections). • headache • tiredness ISENTRESS does not cure HIV-1 infection or AIDS. • dizziness You must stay on continuous HIV therapy to control HIV-1 infection and decrease Less common side effects include: HIV-related illnesses. • depression • kidney stones • hepatitis • indigestion or stomach area pain Avoid doing things that can spread HIV-1 infection to others: • genital herpes • vomiting • Do not share needles or re-use needles or other injection equipment. • herpes zoster • suicidal thoughts and actions • Do not share personal items that can have blood or body fluids on them, including shingles • weakness like toothbrushes and razor blades. • kidney failure • Do not have any kind of sex without protection. Always practice safe sex by using a latex or polyurethane condom to lower the chance of sexual contact with any body Tell your doctor right away if you get unexplained muscle pain, tenderness, or weakness while fluids such as semen, vaginal secretions, or blood. taking ISENTRESS. These may be signs of a rare serious muscle problem that can lead to kidney problems. Ask your doctor if you have any questions on how to prevent passing HIV to other people. Tell your doctor if you have any side effect that bothers you or that does not go away. What should I tell my doctor before taking ISENTRESS? 10:00: aM 12:54 PM: 6:00 PM: Before taking ISENTRESS, tell your doctor if you: These are not all the possible side effects of ISENTRESS. For more information, ask your Los ANgeles, California Amersfoort, Utrecht; the Netherlands Las Vegas, Navada • have liver problems doctor or pharmacist. David Durán: I crave new experiences and thrive Eliane Becks Nininahazwe: I feel great today, Deral Takushi: If you lived every day as beautiful • have a history of a muscle disorder called rhabdomyolysis or myopathy Call your doctor for medical advice about side effects. You may report side effects to FDA on setting foot on new lands. Three letters are and the world should know that HIV is no longer as you are on the inside, you will always • have increased levels of creatine kinase in your blood at 1-800-FDA-1088. a small part of who I am, but those letters don’t a death sentence! This is how I can break exude glamour. • have phenylketonuria (PKU). ISENTRESS chewable tablets contain phenylalanine as part How should I store ISENTRESS? define the man I truly am. I’m an explorer, a stigma, by letting everyone see the face of a of the artificial sweetener, aspartame. The artificial sweetener may be harmful to people wanderer, a writer....and I’m also HIV+. woman who has been HIV-positive 12 years, and with PKU. Film-Coated Tablets: is still looking good! • have any other medical conditions • Store ISENTRESS Film-Coated Tablets at room temperature • are pregnant or plan to become pregnant. It is not known if ISENTRESS can harm your between 68°F to 77°F (20°C to 25°C). unborn baby. Keep ISENTRESS and all medicines out of the reach of children. Pregnancy Registry: There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information General information about ISENTRESS about the health of you and your baby. Talk to your doctor about how you can take Medicines are sometimes prescribed for purposes other than those listed in a Patient 24ur Ho s in the lives of people affected by HIV part in this registry. Information Leaflet. Do not use ISENTRESS for a condition for which it was not prescribed. by Rick Guasco • are breastfeeding or plan to breastfeed. Do not breastfeed if you take ISENTRESS. Do not give ISENTRESS to other people, even if they have the same symptoms you have. ° You should not breastfeed if you have HIV-1 because of the risk of passing It may harm them. HIV-1 to your baby. ositively Aware’s anti-stigma campaign every day I draw my strength 25th birthday. My daughter was Talk with your doctor about the best way to feed your baby. You can ask your doctor or pharmacist for information about ISENTRESS that is ° written for health professionals. captures a single 24-hour period in the lives and passion from him.” born free of HIV, thanks to HIV Tell your doctor about all the medicines you take, including, prescription and over- “My best friend, my brother, medications I took during preg- the-counter medicines, vitamins, and herbal supplements. Some medicines interact with For more information go to www.ISENTRESS.com or call 1-800-622-4477. of people affected by HIV. Since 2010, A ISENTRESS. Keep a list of your medicines to show your doctor and pharmacist. What are the ingredients in ISENTRESS? died of HIV—mere months nancy. She and I have so much Day with HIV has used pictures to convey its • You can ask your doctor or pharmacist for a list of medicines that interact with ISENTRESS film-coated tablets: before the first drugs which fun together!” ISENTRESS. • Do not start taking a new medicine without telling your healthcare provider. Your Active ingredient: raltegravir message that everyone, regardless of their have helped saved the lives of It was Zakk Marquez, of Los healthcare provider can tell you if it is safe to take ISENTRESS with other medicines. Inactive ingredients: calcium phosphate dibasic anhydrous, hypromellose 2208, lactose so many others,” said Stanley Angeles, who summed up A Day monohydrate, magnesium stearate, microcrystalline cellulose, poloxamer 407 (contains 0.01% status, is affected by HIV. On September How should I take ISENTRESS? butylated hydroxytoluene as antioxidant), sodium stearyl fumarate. Rutledge, of Chicago. “All I have with HIV: “Whether positive or • Take ISENTRESS exactly as prescribed by your doctor. 22, nearly 200 photos were submitted to the campaign’s The film coating contains: black iron oxide, polyethylene glycol 3350, polyvinyl alcohol, red P left of Paul is this lamp of his.” negative, straight, gay, bi, or • Do not change your dose of ISENTRESS or stop your treatment without talking with your iron oxide, talc and titanium dioxide. website and dozens more were posted on social media, doctor first. The photo submitted by the otherwise identified, every day is • Stay under the care of your doctor while taking ISENTRESS. This Patient Information has been approved by the U.S. Food and Drug Administration. accompanied by the hashtag #adaywithhiv. • ISENTRESS film-coated tablets must be swallowed whole. Heartland Men’s Chorus (HMC) always a day with HIV, a day of • ISENTRESS chewable tablets may be chewed or swallowed whole. in Kansas City recalled the early shared humanity.” • ISENTRESS for oral suspension should be given to your child within 30 minutes of mixing. See the detailed Instructions for Use that comes with ISENTRESS for oral In addition to people living of photos taken in previous days of the epidemic, before new The following eight pages suspension, for information about the correct way to mix and give a dose of ISENTRESS with HIV, the anti-stigma cam- years. Also helping out this year, medications marked a turning contain a selection of photos for oral suspension. If you have questions about how to mix or give ISENTRESS for oral suspension, talk to your doctor or pharmacist. paign attracts participants who the AIDS Clinical Trials Group point. “Now in its 30th season, taken on A Day with HIV. Note • Do not switch between the film-coated tablet, the chewable tablet, or the oral have friends or loved ones who mentioned A Day with HIV in its many of HMC’s early perfor- that some pictures were cropped suspension without talking with your doctor first. • Do not run out of ISENTRESS. Get a refill of your ISENTRESS from your doctor or are HIV-positive; activists, health internal newsletter, prompting mances were at funerals for for layout purposes. pharmacy before you run out. care providers, and staff from a number of selfies and group friends and members who died • If you miss a dose, take it as soon as you remember. If you do not remember until it is AIDS service organizations also photos from ACTG offices. of AIDS-related diseases. Today, time for your next dose, skip the missed dose and go back to your regular schedule. Do To view photos uploaded not double your next dose or take more ISENTRESS than prescribed. take part in A Day with HIV. While the images are often over 30 of the 169 chorus mem- to the campaign’s • If you take too much ISENTRESS, call your doctor or go to the nearest hospital For the third consecutive eye-catching, the stories behind bers are HIV-positive.” online gallery, go emergency room right away. to adaywithhiv.com. What are the possible side effects of ISENTRESS? year, the Centers for Disease them are what often give the Sharing her story of life usppi-mk0518-mf-1502r026 Pictures will be posted ISENTRESS can cause serious side effects including: Control and Prevention’s Let’s photos their power. “I took this with HIV, Jennifer Jako of throughout the year on • Serious skin reactions and allergic reactions. Some people who take ISENTRESS Issued: 02/2015 Stop HIV Together campaign picture in honor of my uncle,” Portland, Oregon, wrote, “Being Instagram and Twitter develop serious skin reactions and allergic reactions that can be severe, and may with the hashtag be life-threatening or lead to death. If you develop a rash with any of the following partnered with Psitivelyo said Tyrell Manning of Saint a mother to a healthy daughter #adaywithhiv. For symptoms, stop using ISENTRESS and contact your doctor right away: Copyright © 2007, 2013 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. Aware to promote A Day with Louis, Missouri, his uncle’s por- is a gift I did not expect when I information about the ° fever ° muscle or joint aches ° redness or swelling of the eyes generally ill feeling blisters or sores in mouth swelling of the mouth or face INFC-1141321-0000 03/15 HIV. Let’s Stop HIV Together trait appearing in the background became infected at age 18, 25 traveling exhibit, or to ° ° ° host the exhibit, email ° extreme tiredness ° blisters or peeling of the skin ° problems breathing also sponsors a traveling exhibit of his photo. “He lost his life to years ago. In fact, I was told I [email protected].

that features poster-size prints AIDS-related complications, and shouldn’t expect to reach my

P OsiTIvely AWARE NOVember+DECEMber 2015 23 A DAY WITH HIV

7:00 AM > TalLahassee, Florida Paula Kiger: I am not HIV-positive myself, but I was a volunteer and supervisor on the original Florida AIDS Hotline, so it’s been a part of my life for a long time.

7:05 AM >> Woking, London; England Paul Atkinson: I’m not afraid to talk openly about my HIV status. If that helps to break the stigma, then it’s worth it. Making the most of a gap in the weather earlier this morning for A Day with HIV.

8:04 AM > Prague, Czech Republic Michael: HIV and LGBT Slovenian activist Tanja with Michael, a Czech HIV-positive social and prevention worker. We are strong!

8:24 AM >> Chicago, Illinois John Peller: Starting off A Day with HIV biking to work at AIDS Foundation of Chicago.

9:08 AM > Rocks Beach, Florida Mario Ferri: Twenty-one years HIV-positive—and thriving. I am a veteran employed by the Veterans Administration, serv- ing other veterans who are overcome by the stigma and the self-stigma of severe mental illness.

9:30 AM >> Boston, Massachusetts Rob Quinn: Yoga teaches us practical skills to eliminate stress and support immune function for enhanced health and greater quality of life. Namaste!

24 NOVember+DECEMber 2015 POSITIVELY AWARE << 10:00 AM Cologne, Germany Markus Stein: We are not dirty. We are all clean! So, please change your mind, and don’t forget that stigma has a cure—EDUCATION!

< 10:00 AM Los Angeles, California Zakk Marquez: I work full-time at the Elizabeth Taylor AIDS Foundation. I couldn’t be more proud to be immersed in HIV/ AIDS advocacy and activism. Whether positive or negative, straight, gay, bi, or otherwise identified, every day is always a day with HIV, a day of shared humanity.

<< 10:02 AM CHicago, Illinois Elijah M.: I am the future of an AIDS-free generation.

< 10:21 AM St. Louis, Missouri Tyrell Manning: I took this picture in honor of my uncle (see the picture on the wall). He lost his life to AIDS-related complications, and every day I draw my strength and passion from him.

<< 11:15 AM Pisa, Italy Kevin Kelland: Standing in front of the Leaning Tower while on holiday from the UK with my partner Steve. We are celebrating the fourth anniversary of our civil partnership and being together for 10 years. I have been living with HIV for 29 years come December 5th. It took me a long time to get my confi- dence and grow into the person I am today.

< 11:16 AM Houston, Texas Venita Ray: Volunteering for National Voter Registration Day at Legacy Community Health.

P OsiTIvely AWARE NOVember+DECEMber 2015 25 A DAY WITH HIV

11:30 AM > Brooklyn, New York Krista Martel: On a conference call with some fierce women advocates preparing for our upcoming HIV treatment advocacy webinar series, “A Place at the Table.”

11:41 AM >> TEXAS Morénike Giwa Onaiwu: HIV stigma sucks!

12:00 PM > Tuskegee, ALABAMA Bernice L. Frazier: Helping to share HIV awareness at a youth empowerment conference at Tuskegee University.

12:00 PM >> Atlantic City, NJ Leanza Cornett: I’m holding a picture of my first press conference as Miss America 1993. I was able to use my title to champion the platform of AIDS, and I am still a passionate advocate.

12:30 PM > Los Angeles, California Tambusi: I’ve been living with HIV for 20 years, and have been on my meds successfully for 10 years. This photo was taken to show my continual belief in Him, the ultimate healer.

12:31 PM >> Atlanta, Georgia Ninda Martinez: Day 11,739— 32 years, one month and 20 days— of living with HIV. In another 33 days, I’ll be running the Marine Corps Marathon!

26 NOVember+DECEMber 2015 POSITIVELY AWARE << 12:37 PM Washington, DC Mark Byrd: In between classes at Gallaudet University, the world’s only university for the deaf. Twenty-three- year long-term survivor. College dream coming true!

< 12:40 PM Baltimore, Maryland Cedric Derrel Gum: Fierce and positive! I woke up with a purpose.

<< 12:50 PM Cleveland, Ohio Kinsey Roberts: Working with HIV is a part of living with HIV. I was at work when I saw a friend’s #adaywithhiv photo, so I decided to take and post my own from my cubicle.

< 12:53 PM Pacific City, Oregon Abram Heald: This is what it’s like to fly. We all must fly.

<< 1:02 PM NORTH LAS VEGAS, NEVADA John: My classroom. I’m a school teacher, on my 30-minute lunch break. Fifteen months ago, I had a heart attack; triple bypass surgery. My partner of 19 years was diagnosed with AIDS on March 5, 1989; he died seven days later, on March 12th. During those seven days, I received my own HIV diagnosis.

< 1:13 PM Houston, Texas Luvvie Ajayi: We have no time for stigma in this epidemic. Along with The Red Pump Project, I’m committed to seeing an AIDS-free generation.

P OsiTIvely AWARE NOVember+DECEMber 2015 27 A DAY WITH HIV

1:56 pM > Lincoln, Nebraska Andy Dillehay: I tested HIV-positive on November 17, 2011. A close friend intro- duced me to Nebraska AIDS Project. NAP has been an invalu- able resource. I am now a certifiedHIV testing counselor.

2:00 PM >> San Francisco, California Liz Highleyman: Covering HIV, hep C, and hep B news. In the background, my two rescue beagles, Beaker and Penny, and a poster from the 1996 International AIDS Conference, which marked the advent of effective HIV treatment. 2:00 PM > Greenfield, Massachusetts Teo Drake: Twenty years into living with HIV. Treasure ordinary days and working on plumbing. Watson the corgi offered his help.

2:03 PM >> Cleveland, Ohio Staff of the ACTG and Special Immunology Unit show their support for fighting HIV stigma.

2:25 PM > Plainview, New York Lisa Savyon: My daughter and I at a farm fest. I am living proof that HIV is survivable. I’ve had HIV my whole life; 33 years and counting. My daughter, age 3, is HIV-negative and the love of our lives. Live strong. Live long.

2:50 PM >> Leila, Pennsylvania Jen Glass: As a case manager, today I was out transporting a client to an appoint- ment and visiting clients.

28 NOVember+DECEMber 2015 POSITIVELY AWARE << 3:06 PM Seattle, Washington The clinicians and staff members of the University of Washington AIDS Clinical Trials Unit in Seattle ended our staff meeting early today to take a moment to take this picture. The future we may want depends on what we do today.

< 4:06 PM Philadelphia, PennsylavNIA Mark A. Davis: Robert Indiana’s AMOR sculp- ture was put on display atop the Philadelphia Art Museum’s “Rocky” steps as a backdrop for the Papal mass.

<< 4:35PM Atlanta, Georgia Carlos del Rio (right of banner): We are excited about the Emory HIV/AIDS Clinical Trials Unit as a Clinical Research Site with the AIDS Clinical Trials Group in finding a cure for HIV.

< 4:35 PM Palm SPrings, California Nicholas Snow takes a selfie as he broadcasts his second podcast of the day, live from his home at the Vista Sunrise Apartments, part of and adjacent to Desert AIDS Project: “I’m living powerfully with HIV.”

<< 4:41 PM Wilmington, Delaware Mark A. Warriner: Just enjoying the end of the summer!

< 5:09 PM Fayetteville, north carolina Art Jackson: A day in my life with HIV is a day of hope! A day to begin anew and to stand up to dispel stigma, bias, and shame.

P OsiTIvely AWARE NOVember+DECEMber 2015 29 A DAY WITH HIV

6:00 PM > Eugene, Oregon Kelsang Phunrab: As an American Buddhist monk, I want to show that you can still care for and inspire others, even if you have HIV. Let’s add more love into the world.

6:39 PM >> Portland, oregon Jennifer Jako: I became HIV-positive at age 18; I wasn’t expected to live past 25. That was 25 years ago. My daughter was born free of HIV, thanks to HIV medications I took during pregnancy. We have so much fun together! My 9-year-old daughter knows mom has HIV/AIDS and that it’s OK to talk about it. 7:00 PM > OKLAHOMA City, OKLAHOMA Luke Thomas: Retiring from the Air Force this year, I found myself smitten by a guy I met online. This man was HIV-negative, but refused to let my status get in the way of our undeniable chemistry. This picture was taken as I surprised him for his scheduled surgery this month.

7:12 PM >> WINCHESTER, WEST VIRGINIA The AIDS Response Effort Team, who serve people living with HIV, fight stigma, and provide crucial services in our community!

7:31 PM > Haddon TOwnship, New Jersey The Ritz Theatre Company’s cast of Rent—Michael Hogan, Jonathan Davenport, Joshua Bessinger, Krysten Genesius Cummings, and Eric Lawry (not pictured)— take five from rehearsal.

8:15 PM >> Kansas City, Missouri A few of the HIV- positive members of the Heartland Men’s Chorus at rehearsal. Now in its 30th season, many of our performances were at funerals for friends and members who died of AIDS-related diseases. Over 30 of the 169 chorus members are HIV-positive.

30 NOVember+DECEMber 2015 POSITIVELY AWARE << 8:48 PM Sitges, Spain Simon: In Sitges at the Santa Tecla fiesta fireworks in the street. I contracted HIV more than 30 years ago when living in Sitges, and am now back living here.

< 9:18 PM Boston, Massachusetts Steven Grinspoon: Thanks to the HIV community, researchers have developed effective treatment for HIV; the REPRIEVE trial is exploring prevention for long-term complications of HIV such as cardiovascular disease.

<< 9:20 PM Federal Way, Washington Kate Eling: I’ve been HIV-positive for 26 years. I’m healthy, and have a healthy 23-year- old son. I’ve been an advocate, served on planning councils, and I volunteer. I am the face of HIV, though it doesn’t define me!

< 9:30 PM Sarasota, Florida Debbie Sergi-Laws September 22, 2015— just one of the 9,714 days since being diagnosed with HIV.

<< 10:56 PM Chicago, Illinois Stanley Rutledge: My best friend, my brother, died of HIV—mere months before the first drugs which have helped saved so many lives. All I have left of Paul is this lamp of his. I plan to run in a marathon to raise money for AIDS Foundation of Chicago and for people living with HIV. And for Paul.

< 11:38 PM Russellville, Kentucky Josh: I was diagnosed with HIV on Dec. 25, 2012. It’s been a long, hard struggle to stay healthy, but I’m gonna keep on living and never give up hope in finding a cure.

P OsiTIvely AWARE NOVember+DECEMber 2015 31 R lleaders Po Yes. I think the cure is already Yes, if there is financial complex problems—the around, but curing people incentive. HIV/AIDS epidemic will end. INE TH doesn’t make money. Selling SEPTEMBER+OCTOBER medicine does. Yes. I’ve been poz since ’85 and No. I wish for a cure every day. ISSUE WE ASKED am doing much better on newer Yes, I am confident of seeing an meds. Great things happening Doe you b lieve you HIV cure in my lifetime. every day! will see an HIV cure T hIS issue’s question in your lifetime? No. It’s quite possible that we No, not a sterilizing cure, but D nid you k ow that could come close to eradicat- a functional cure looks like a half of the people ing HIV if everyone who was possibility. living with HIV YES: infected got on the appropriate around the world 60% NO: antiretroviral drugs. But at the Yes. I was infected in September are women? 40% age of 56, I think a genuine cure of 2014, and I have a lot of hope. in not going to happen in my Technology changes quickly. It is VOTE AT lifetime. in human nature to solve some positivelyaware.com

© 2015 Positively Aware (ISSN: 1523-2883) is published bi-monthly by Test Positive Although Positively Aware takes great care to ensure the accuracy of all the information it Aware Network (TPAN), 5050 N. Broadway St., Suite 300, Chicago, IL 60640. TPAN is presents, Positively Aware staff and volunteers, TPAN, or the institutions and personnel an Illinois not-for-profit corporation, providing information and support to anyone concerned who provide us with information cannot be held responsible for any damages, direct or with HIV and AIDS issues. Positively Aware is a registered trademark of TPAN. All rights consequential, that arise from use of this material or due to errors contained herein. Opinions reserved. Circulation: 100,000. For reprint permission, send email to [email protected]. Six expressed in Positively Aware are not necessarily those of staff or TPAN, its supporters issues mailed bulk rate for $30 donation; mailed free to those living with HIV or those unable and sponsors, or distributing agencies. Information, resources, and advertising in Positively to contribute. Aware do not constitute endorsement or recommendation of any medical treatment or product. TPAN recommends that all medical treatments or products be discussed thoroughly We accept submission of articles covering medical or personal aspects of HIV/AIDS, and and frankly with a licensed and fully HIV-informed medical practitioner, preferably a personal reserve the right to edit or decline submitted articles. When published, the articles become the physician. property of TPAN, Positively Aware, and its assigns. You may use your actual name or a pseudonym for publication, but please include your name, email address, and phone number A model, photographer, or author’s HIV status should not be assumed based on their with your story. appearance in Positively Aware, association with TPAN, or contributions to this journal.

A DAY WITH HIV

24 hours in the lives of people affected by HIV. adaywithhiv.com #adaywithhiv.com

36 NOVember+DECEMber 2015 POSITIVELY AWARE CONFERENCE UPDATE IcAAC 2015 SAN DIEGO Si w tching to new HIV drugs A look at Triumeq and the ‘Son of Stribild’ By Enid Vázquez

here was good news about switching The study is ongoing, with all kidney function: proteinuria, to newer HIV drugs from the 55th ICAAC people on their original therapy albuminuria, and RBP:Cr. (Interscience Conference on Antimicrobial being switched to Triumeq after The research team for study Agents and Chemotherapy), held week 24, another reason for GS-US-292-0112 reported that some to not discontinue their the one year results support September 17 to 21 in San Diego. medication. a switch to the new tablet for (See Briefly for the results of another people with a GRF between 30 switch study.) Switi ch ng to ‘Son of and 50. Stribild’ for people The new medication more TSwiti ch ng to Triumeq headache (5% each); diarrhea, with kidney impairment commonly goes by the initials fatigue, and upper respiratory of the drugs it contains, E/C/F/ Triumeq is the newest HIV super- tract infection (7% each); and There’s a new and improved TAF (for elvitegravir, cobicistat, star on the market, approved nausea (10%). The only side version of Stribild expected on emtricitabine, and TAF). by the FDA last year. The single effect experienced by more than the market before the end of the tablet regimen has a great track 5% of the people staying on year. Stribild contains tenofovir Switi ch ng from Atripla record in clinical trials, beating their original therapy was upper DF (TDF), which has the poten- to the new Stribild the best drug regimens out there. respiratory tract infection, per- tial for kidney and bone toxicity. The STRIIVING study reported haps because they had already The remake of Stribild, however, Study participants who were that people switching from their dealt with any side effects previ- replaces TDF with tenofovir alaf- switched from Atripla to E/C/F/ HIV therapy to Triumeq did well. ously or the side effects had enamide (TAF), which has been TAF stayed undetectable longer Individuals were randomized been transient. shown to be kinder to the kid- than those who were kept on to stay on their treatment or Of the 10 who discontinued neys and the bones than TDF. Atripla. They also saw improve- switch to Triumeq. These were Triumeq, however, only one A study found that patients ments in their lab values for early (24 week) results. experienced a Grade 3 or 4 who had kidney dysfunction, as kidney function and bone mass. Of those who switched, 85% (serious) adverse event, and one shown by having less than 50 Results are from the largest maintained their undetectable discontinuation occurred as the glomerular filtration rate (GFR), randomized switch study in HIV, viral load (less than 50 copies) result of being the victim of a did not experience a worsening GS-US-292-0109. Of 1,436 vs. 88% of the individuals stay- homicide. The rest of the discon- of this condition when taking people enrolled, 959 were ing on their therapy, and no one tinuation events (which included the TAF version of Stribild. They switched off Atripla. At one year experienced treatment failure. insomnia, diarrhea, abdominal were able to either maintain their after the switch, 96% remained At least 5% of the people pain, headache, and flu-like GFR or to increase it. undetectable compared to 90% on Triumeq experienced the fol- symptoms) were considered mild Moreover, improvements of those randomized to stay lowing side effects: cough and or moderate. were seen in other signs of on Atripla.

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P OsiTIvely AWARE NOVember+DECEMber 2015 37 D oear Doct r... Wuhat abo t cancer? And other questions answered By Joel Gallant, MD, MPH

ancer, the cure, side effects, a qualitative jump for for tenofovir-related kidney remains higher even among those treatment. Dr. Gallant provides understandable and bone toxicity. These are on effective antiretroviral therapy, answers to questions from his readers at effects that can be monitored, it is dramatically reduced com- hivforum.tumblr.com. allowing us to switch drugs pared to those not on treatment, C if problems develop. Could so the overall risk is quite low. we discover unexpected As for non-AIDS-defining can- Q uestion: I’ve read that supplements when I first got long-term side effects? That’s cers (the kind everyone else gets), Stribild may cause fat redistri- cold symptoms. Whether or always a possibility over time, it’s true that people with HIV are bution, but I’ve been reassured not these supplements actually but it doesn’t happen very more likely to develop a number by your blog that fat redistri- work at speeding up cold recov- often. We learn about most of cancers. But that’s due mainly bution no longer occurs with ery time, are there any compli- drug toxicities during the to a greater background risk: modern medicines. Why do cations I should worry about? development phase before People with HIV are more likely manufacturers and other web- I’ve heard magnesium is bad approval. to smoke, drink and to have HPV, sites still list fat redistribution (I’m on Truvada and Isentress, HBV, and HCV infection than as a possible side effect? for reference). 3. You won’t be on Stribild for HIV-negative people. If you’re a 50 years (unless you have non-smoker who doesn’t drink Ans: wer It’s an FDA require- Vitamin C is not a problem, but one of those “If it ain’t broke, heavily and who doesn’t have one ment. In a clinical trial, just avoid taking zinc and Isentress at don’t fix it” kind of doctors of those co-infections, then those about anything that happens to the same time. Take zinc at least who never changes any regi- statistics don’t apply to you. anyone on an experimental drug 4 hours before Isentress, since it men that keeps the viral load Whether HIV increases in a clinical trial gets listed as can interfere with absorption. undetectable). Treatment the risk of non-AIDS-defining an “adverse event,” even if it’s evolves and improves over cancers independent of the unlikely to have been caused by I have a question about the time. Stribild is a perfect established risk factors remains the drug. For example, you may effects of long-term treatment. example: By November we controversial. Prolonged periods see “common cold” or “arm frac- I am 28 years old, been taking should have a new version of time with untreated HIV ture” listed, though no one really Stribild for 6 months and have that contains TAF instead infection—including immuno- believes there’s a connection. a CD4 of 677 and undetectable of TDF. TAF is probably less suppression and unsuppressed In the case of lipodystrophy, viral load. I know if I am adher- toxic to bones and kidneys viral replication—could certainly there are two possibilities. First, ent I should have a normal life than TDF. increase the risk. But what about someone taking the drug may expectancy, but how do doctors people who get diagnosed and have complained of weight gain know that taking HAART [highly Finally, you need to aim high- treated right away and do well on and a bigger belly—a com- active antiretroviral therapy]/ er. You can do better than 78! treatment, with consistently high mon occurrence as people get Stribild for 50 years (if I am to CD4 counts and undetectable healthier—and the doctor may reach 78!) doesn’t have terrible My doctor tells me, and I read viral loads? Theoretically, they have recorded it as lipodystrophy. effects on the body over such a all the time, that I should have could still be at greater risk for Second, this is listed as a side long period of time? Fifty years a lifespan the same as someone cancer because of slightly higher effect of many antiretroviral is a long time to take medica- without HIV, but then I read levels of chronic immune activa- agents just because they’re in tion every day! things like this on reputable web- tion and inflammation compared a class of drugs that cause it, sites and really start to worry: to HIV-negative people. [See page even if there’s no clear evidence Your question is a good one, but “the older HIV-positive individu- 16 for more on inflammation.] linking that particular agent to let’s try to put your mind at ease: als get, the more disproportion- However, their levels are far lower the complication. ately cancer tends to strike them than they would be without treat- In general, the package 1. Even in the days when HIV than those without HIV. People ment, and we don’t have good insert or prescribing information therapy was difficult and with HIV who are in their 30s are evidence yet that the difference for a drug is the least helpful toxic, it was still a lot better at twice the risk of developing matters in optimally treated source of information about side than the disease itself. That’s NADC [non-AIDS defining can- people. effects. Better sources include even more true today, now cers].” This seems incongruous Finally, be careful when you Epocrates, the Johns Hopkins that therapy is easy and safe. to my doctor’s advice. read about a “doubling of risk.” HIV Guide, Medscape, or the Even if what you read about the DHHS Guidelines, which tell you 2. we know a lot about the W hat you read is a bit alarmist. risk of cancer in your 30s were what the likely side effects are. short- and medium-term People with HIV are definitely true–and I don’t think it is–what effects of Stribild and of at higher risk for AIDS-related ultimately matters is your abso- I ’m HIV-positive and I have my the other drugs we use to cancers (lymphoma and Kaposi lute risk, not your relative risk. If first cold. Prior to my diagnosis, treat HIV infection. In the sarcoma) than people in the you double a very low risk, what do I would take vitamin C and zinc case of Stribild, we watch general population. While the risk you get? A very low risk of cancer.

38 NOVember+DECEMber 2015 POSITIVELY AWARE So what should you do to Aware from the years 1999- approved that made effective W hat is your opinion about prevent cancer? 2004, I have just realized how treatment possible for people a possible cure? Is there any fortunate today’s patients are with extensive drug resistance. hope that we will see a cure in 1. K eep your HIV suppressed in comparison with just 15 There is less room for a decade? with antiretroviral therapy. years ago. Like TDF, approved improvement today. Most people 2. D on’t smoke. in 2001, now will be replaced can be treated with highly I believe there will be a cure. 3. If you drink alcohol, drink in by TAF, or Atripla this year even effective, simple, well-tolerated Whether it will occur in the next moderation. lost its “recommended” status regimens. Ongoing drug develop- decade is harder to predict, 4. G et your hepatitis C cured and maturation inhibitors are ment provides us with incremen- since we don’t know yet what a if you have it. underway, do you think the tal improvements rather than cure will entail. 5. G ccnet va i ated against same qualitative jump is fore- paradigm shifts. We welcome To search my blog for prior hepatitis B and make sure seeable in the next 15 years, the incremental improvements, answers on cure, go to: you’re immune. If you already or will it slow down? but until there’s a cure, I don’t hivforum.tumblr.com cure have chronic hepatitis B, expect anything earth-shattering. or go to bit.ly/1iZvl41. make sure it’s suppressed. The qualitative leaps we saw in 6. If you’re young enough, 1996 and again in 2007 would get the HPV vaccine. Get be hard to achieve again…short Joell Gal ant, MD, MPH, is Medical Director checked and treated for cer- of a cure. In 1996 HIV infection of Specialty Services at Southwest CARE vical and anal dysplasia. was transformed from an inevi- Center in Santa Fe, New Mexico, adjunct 7. G et the standard screen- tably fatal disease to a chronic, professor of medicine at the Johns Hopkins ings for breast, colon, and manageable one with the devel- School of Medicine, and clinical professor of prostate cancers. opment of protease inhibitors and medicine at the University of New Mexico. NNRTIs. Over the next decade He treats patients and conducts clinical trials After having read all your blog, we saw steady improvements on the treatment of HIV. He authored 100 then out of curiosity browsing in the toxicity and tolerability of Questions and Answers about HIV and AIDS. in older issues of Positively drugs. In 2007, new drugs were

Carol Potok with some of theGED womenT at theA TutweilerN PrisonGIVE for Women, P duringOSI an TeducationalIVELY event. AWARE.

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POSITIVELY AWARE MY KIND OF LIFE CARLOS A. PEREZ

My y Da with HIV

e’ve come a long way, baby. We have over 35 HIV medications. We’ve learned more about the immune system, thanks to HIV and AIDS, than we may have ever known had it not come along. We’ve created or found medications that treat opportunistic infections and we have implemented a plethora of prevention and treatment programs from harm reduction and needle exchanges to myriad styles, Wcolors, and tastes of condoms and other barriers for safer sexual practices. The huge purple gorilla in the room that no one can everyday people in every shape, color, gender, and age A Day with HIV yet deal with is the fear and stigma associated with HIV range in your face telling you how normalized and perhaps puts everyday and AIDS. This is why A Day with HIV is so important. wonderful their lives are today living with HIV and AIDS. people in Ghirardelli was the original manufacturer of chocolate in When I received my diagnosis I was also in so much every shape, America but Hershey’s was the first to mass produce it, fear and felt the societal stigma so fiercely that I, along color, gender, and their name is and always will be the most commonly with many friends, went underground and had sex in and age range associated with chocolate. In this same manner, once HIV clandestine places in the dark and under the roofs of in your face (or GRID back then) arrived in this country cloaked in fear, bathhouses, bookstores, and sex shops where we could telling you how stigma, and shame, associated with “those people” who go and not even have to share names or phone numbers normalized were “carriers,” the wheels of unscientific ideas about HIV with anyone. A few years later the Internet made this even and perhaps and people living with it were set in motion and destined easier by creating an entire specialized virtual space where wonderful their for a collision course with everything science tried to we could meet with each other one-on-one or in groups lives are today explain. As human beings we learn things best through and with every type of fetish under the sun. This only living with HIV trauma and fear, and once ideas are set in place, our created mini-communities where syphilis, gonorrhea, chla- and AIDS. entire society needs to be re-educated. mydia, HIV, hepatitis and now, more recently, meningitis The more we show people how normal it is today to can flourish. If we could have been more comfortable with live with HIV and even AIDS, the more we help tear down ourselves and with being HIV-positive, we may have been the fear and stigma machine. Even the CDC has tried able to keep our health in a better place and space, but to undo the sense of fear and panic fueled by our own we have needs like anyone else and we had to do what we government via the Reagan administration’s reluctance to had to do to feel the touch of another person close to us. even mention “GRID” or “HIV” during the epidemic’s first A Day with HIV shows the world that we are carpenters five or six years, and therefore today they still struggle to and teachers; case managers, doctors, and nurses. We quash the early fears that touching and kissing or sharing are firemen, athletes, and policemen and we are everyday eating utensils might cause HIV to spread. people. And we don’t care what opponents care about I speak with people every day in my work as an HIV HIV, AIDS, or anything else that’s linked to sexual activity medical case manager to retrain them on what transmits because life happens and sex is part of life. If diabetes or the virus and what doesn’t. To assure people that they can Alzheimer’s was spread through sexual activity or needle have sex with other people regardless of HIV status by sharing, we would be scared of diabetics and people expe- reducing their viral load to undetectable, by taking either riencing Alzheimer’s. It’s all about how the virus is spread PEP or PREP and by using safer sex techniques. And at and, as a country, we still have issues. least once a week I hear things like “but I can go to jail This is my example of what fear and stigma can do. It if…” And at the end of the day all this fear and anxiety can create a barrier higher and stronger than the wall of keeps people from getting tested. Until we’re able to China, and only as a community can we raze this wall convince people that if you get tested for HIV you will not down to the ground and not care how we got HIV. We only go to jail or wind up in any legal trouble, we will have to need to show our smiling faces today and let the world

T continue mass educational efforts. A Day with HIV puts know we have other fish to fry. KNIGH

CHRIS o: t Pho

P OsiTIvely AWARE NOVember+DECEMber 2015 41 ™

I am a best friend, a blogger, I am a friend, a dreamer, and an advocate. and an activist.

Mark has lived with HIV since 1985. Hydeia (left) has lived with HIV since 1984.

I am a partner, an editor, I am a colleague, a cook, and a runner. and a music lover.

Oriol (left) has lived with HIV since 1992. Nina (right) has lived with HIV since 1983.

More than one million people are living with HIV in the U.S. Get the facts. Get tested. Get involved. www.cdc.gov/Together