A&u march 2014 by A&U: America's AIDS Magazine

MARCH 2014 • ISSUE 233 • AMERICA’S AIDS MAGAZINE

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DUBERMAN IN HIS NEW BOOK ON UNSUNG HEROES MICHAEL CALLEN & ESSEX HEMPHILL, THE WRITER & HISTORIAN REVISITS THE BATTLEFIELD OF AIDS

POSITIVE WOMEN’S NETWORK CREATES SISTERHOOD ACROSS THE U.S.A. RESEARCHERS TAKE ON THE HARD WORK OF THE END OF AIDS

ARTISTS HELP EMPOWER HIV-POSITIVE WOMEN HOW CAN WE COMPARE & CONTRAST HIV ERADICATION STRATEGIES?

What is STRIBILD? STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. It combines 4 medicines into 1 pill to be taken once a day with food. STRIBILD is a complete single-tablet regimen and should not be used with other HIV-1 medicines. STRIBILD does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking STRIBILD. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about STRIBILD? STRIBILD can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. • Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. • You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.

• Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking STRIBILD, your hepatitis may suddenly get worse. Do not stop taking STRIBILD without first talking to your healthcare provider, as they will need to monitor your health. STRIBILD is not approved for the treatment of HBV. Who should not take STRIBILD? Do not take STRIBILD if you: • Take a medicine that contains: alfuzosin, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, rifampin or the herb St. John’s wort. • For a list of brand names for these medicines, please see the Brief Summary on the following pages. • Take any other medicines to treat HIV-1 infection, or the medicine adefovir (Hepsera®). What are the other possible side effects of STRIBILD? Serious side effects of STRIBILD may also include: • New or worse kidney problems, including kidney failure. Your healthcare provider should do regular blood and urine tests to check your kidneys before and during treatment with STRIBILD. If you develop kidney problems, your healthcare provider may tell you to stop taking STRIBILD. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones. • Changes in body fat can happen in people taking HIV-1 medicines. • Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking STRIBILD? • All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, bone, or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Do not start any new medicines while taking STRIBILD without first talking with your healthcare provider. • If you take hormone-based birth control (pills, patches, rings, shots, etc). • If you take antacids. Take antacids at least 2 hours before or after you take STRIBILD. • If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in STRIBILD can pass into breast milk, and it is not known if this can harm the baby. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

STRIBILD is a prescription medicine used as a complete single-tablet regimen to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD does not cure HIV-1 or AIDS.

I started my personal revolution Talk to your healthcare provider about starting treatment. STRIBILD is a complete HIV-1 treatment in 1 pill, once a day.

Ask if itâ&#x20AC;&#x2122;s right for you.

Patient Information STRIBILDTM (STRY-bild) (elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information. What is STRIBILD? • STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD is a complete regimen and should not be used with other HIV-1 medicines. • STRIBILD does not cure HIV-1 or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses. • Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or reuse needles, injection equipment, or personal items that can have blood or body fluids on them. Do not have sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood.

• Do not stop taking STRIBILD without first talking to your healthcare provider • If you stop taking STRIBILD, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking STRIBILD Who should not take STRIBILD? Do not take STRIBILD if you also take a medicine that contains: • adefovir (Hepsera®) • alfuzosin hydrochloride (Uroxatral®) • cisapride (Propulsid®, Propulsid Quicksolv®) • ergot-containing medicines, including: dihydroergotamine mesylate (D.H.E. 45®, Migranal®), ergotamine tartrate (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), and methylergonovine maleate (Ergotrate®, Methergine®) • lovastatin (Advicor®, Altoprev®, Mevacor®) • oral midazolam

What is the most important information I should know about STRIBILD?

• pimozide (Orap®)

STRIBILD can cause serious side effects, including: 1. Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take STRIBILD or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: • feel very weak or tired • have unusual (not normal) muscle pain • have trouble breathing • have stomach pain with nausea or vomiting • feel cold, especially in your arms and legs • feel dizzy or lightheaded • have a fast or irregular heartbeat 2. Severe liver problems. Severe liver problems can happen in people who take STRIBILD. In some cases, these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis). Call your healthcare provider right away if you get any of the following symptoms of liver problems: • your skin or the white part of your eyes turns yellow (jaundice) • dark “tea-colored” urine • light-colored bowel movements (stools) • loss of appetite for several days or longer • nausea • stomach pain You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time. 3. Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take STRIBILD, your HBV may get worse (flare-up) if you stop taking STRIBILD. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. • Do not run out of STRIBILD. Refill your prescription or talk to your healthcare provider before your STRIBILD is all gone

• sildenafil (Revatio®), when used for treating lung problems

• rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • simvastatin (Simcor®, Vytorin®, Zocor®) • triazolam (Halcion®) • the herb St. John’s wort Do not take STRIBILD if you also take any other HIV-1 medicines, including: • Other medicines that contain tenofovir (Atripla®, Complera®, Viread®, Truvada®) • Other medicines that contain emtricitabine, lamivudine, or ritonavir (Combivir®, Emtriva®, Epivir® or Epivir-HBV®, Epzicom®, Kaletra®, Norvir®, Trizivir®) STRIBILD is not for use in people who are less than 18 years old. What are the possible side effects of STRIBILD? STRIBILD may cause the following serious side effects: • See “What is the most important information I should know about STRIBILD?” • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking STRIBILD. Your healthcare provider may tell you to stop taking STRIBILD if you develop new or worse kidney problems. • Bone problems can happen in some people who take STRIBILD. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones. • Changes in body fat can happen in people who take HIV-1 medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the middle of your body (trunk). Loss of fat from the legs, arms and face may also happen. The exact cause and long-term health effects of these conditions are not known. • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider right away if you start having any new symptoms after starting your HIV-1 medicine.

The most common side effects of STRIBILD include: • Nausea • Diarrhea Tell your healthcare provider if you have any side effect that bothers you or that does not go away. • These are not all the possible side effects of STRIBILD. For more information, ask your healthcare provider. • Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. What should I tell my healthcare provider before taking STRIBILD? Tell your healthcare provider about all your medical conditions, including: • If you have or had any kidney, bone, or liver problems, including hepatitis B infection • If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. – There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk with your healthcare provider about how you can take part in this registry. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take STRIBILD. - You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. - Two of the medicines in STRIBILD can pass to your baby in your breast milk. It is not known if the other medicines in STRIBILD can pass into your breast milk. - Talk with your healthcare provider about the best way to feed your baby. Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements: • STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works. • Be sure to tell your healthcare provider if you take any of the following medicines: - Hormone-based birth control (pills, patches, rings, shots, etc) - Antacid medicines that contains aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or after you take STRIBILD - Medicines to treat depression, organ transplant rejection, or high blood pressure - amiodarone (Cordarone®, Pacerone®) - atorvastatin (Lipitor®, Caduet®) - bepridil hydrochloric (Vascor®, Bepadin®) - bosentan (Tracleer®) - buspirone - carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegreto®) - clarithromycin (Biaxin®, Prevpac®) - clonazepam (Klonopin®) - clorazepate (Gen-xene®, Tranxene®) - colchicine (Colcrys®) - medicines that contain dexamethasone - diazepam (Valium®)

- digoxin (Lanoxin®) - disopyramide (Norpace®) - estazolam - ethosuximide (Zarontin®) - flecainide (Tambocor®) - flurazepam - fluticasone (Flovent®, Flonase®, Flovent® Diskus, Flovent® HFA, Veramyst®) - itraconazole (Sporanox®) - ketoconazole (Nizoral®) - lidocaine (Xylocaine®) - mexiletine - oxcarbazepine (Trileptal®) - perphenazine - phenobarbital (Luminal®) - phenytoin (Dilantin®, Phenytek®) - propafenone (Rythmol®) - quinidine (Neudexta®) - rifabutin (Mycobutin®) - rifapentine (Priftin®) - risperidone (Risperdal®, Risperdal Consta®) - salmeterol (Serevent®) or salmeterol when taken in combination with fluticasone (Advair Diskus®, Advair HFA®) - sildenafil (Viagra®), tadalafil (Cialis®) or vardenafil (Levitra®, Staxyn®), for the treatment of erectile dysfunction (ED). If you get dizzy or faint (low blood pressure), have vision changes or have an erection that last longer than 4 hours, call your healthcare provider or get medical help right away. - tadalafil (Adcirca®), for the treatment of pulmonary arterial hypertension - telithromycin (Ketek®) - thioridazine - voriconazole (Vfend®) - warfarin (Coumadin®, Jantoven®) - zolpidem (Ambien®, Edlular®, Intermezzo®, Zolpimist®) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking STRIBILD without first talking with your healthcare provider. Keep STRIBILD and all medicines out of reach of children. This Brief Summary summarizes the most important information about STRIBILD. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about STRIBILD that is written for health professionals, or call 1-800-445-3235 or go to www.STRIBILD.com. Issued: August 2012

COMPLERA, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, the STRIBILD Logo, TRUVADA, and VIREAD are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. © 2013 Gilead Sciences, Inc. All rights reserved. QC14549 02/13

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c o n t e n t s March 2014

40 Cover Historian Martin Duberman Talks to A&U’s Lester Strong About His New Book, Hold Tight Gently, Which Charts the Early Years of the Pandemic Through the Lenses of Two Cultural Icons—Michael Callen & Essex Hemphill

Departments

Features 36 Gallery String Theory: Artists Allyson Mitchell, Jessica Whitbread and L.J. Roberts Enrich the Dialogue & Activism Around Women and HIV 26 Imagine Me & You What Happens to HIV Prevention When Partners Test Together? 32 Sisters of Change Five Members of Positive Women’s Network Sit Down for a Candid Discussion About Surviving & Thriving 38 Three Researchers A Trio of AIDS Scientists Talk About Research—Past, Present & Future 46 Facing AIDS Through Fashion Natural Woman: Entrepreneur Dominique Drakeford Sews Prevention Awareness into the Fabric of Our Lives cover by Stephen Churchill Downes

Frontdesk

Mailbox

NewsBreak

Ruby’s Rap Mitchell Anderson

viewfinder 16

Fiction

Just*in Time

lifeguide 50

Treatment Horizons

Destination: Cure

Hep Talk

My Turn

Lifelines

The Culture of AIDS

Survival Guide

A&U Frontdesk

History Boys?

artin Duberman is a great man whose collected works of history, fiction, nonfiction, and biography have influenced thousands of writers, probably more than any other post-Stonewall thinker on the planet. But his intellectual rigor is not, and never shall be, the sole reason to read him. His take on the AIDS crisis puts him in the pantheon of living writers—Tony Kushner, Larry Kramer, Mark Doty, Felice Picano, Sarah Schulman, to name but a few who have appeared over the years in A&U— whose eyewitness accounts of the Plague Years have invigorated writers in both the halls of academia and social sciences, as well as popular culture, movies, and music. Their unblinking witness to the tragic events over the past thirty-five years have spurned many in this country, including myself, to seek ways to preserve and protect the legacy that is the culture of AIDS. Organizations like Visual AIDS in New York City and the NAMES Project/AIDS Memorial Quilt and popular forms of entertainment such as this year’s Dallas Buyers Club have continued the documentary nature of AIDS culture. Artists and writers, archivists and historians, find innovative ways to document the holocaust that is AIDS in this country. Mr. Duberman continues in this tradition of remembrance in his latest biography, Hold Tight Gently (which we excerpt in this issue). The lively retelling of two artistic lives from the early days of AIDS—Essex Hemphill and Michael Callen—reminded me of how much history has been lived, fought over, and has also been forgotten by today’s mainstream media. The genius of this dual biography is that it brings together several generations of AIDS history into one book. Altough I never met Essex, I was introduced to many of his colleagues when I was in the initial planning stages of launching A&U in 1989. As such, poets as dissimilar as Assotto Saint and Mark Doty were some of the earliest contributors to the poetry pages of the magazine. Their contributions of “elegiac poetry” are a direct result of the trailblazing verse of Essex Hemphill. As for Michael Callen, I remember fondly our meeting at his New York City apartment in the late eighties where he handed

A M E R I C A’ S A I D S M A G A Z I N E issue 233 vol. 23 no. 3 March 2014 editorial offices: (518) 426-9010 fax: (518) 436-5354

me a tape of his “activist music” called Living in Wartime, which was performed in Larry Kramer’s play The Normal Heart. As a member of the a cappella group The Flirtations, Michael’s activism was also a large part of his artistry. In his interview with A&U’s Lester Strong, Duberman reminds us that all pandemics are provincial in their beginnings: “I remember a trip to Fire Island very early in the epidemic to visit Larry Mass [co-founder of Gay Men’s Health Crisis, or GMHC] and Vito Russo [author of The Celluloid Closet] was staying there for a weekend, and he was up in arms that the gay community literally had their heads in the sand about AIDS, not mobilizing themselves, not raising money, not doing anything.” Such is the nature of denial. But after denial sometimes there is an epiphany. Enlightenment happens and then empowerment. Within a short period of time the LGBT community and its allies mobilized and the rest is history. I’m also reminded that some histories were rarely, or never, told. Women were affected by the early epidemic, yet their individual stories are still overshadowed. As A&U marks National Women and Girls HIV/AIDS Awareness Day this March, we offer a diverse group of movers and shakers. In Gallery, Alina Oswald leads a discussion with three artists—Allyson Mitchell, Jessica Whitbread, and L.J. Roberts—whose work interrupts the stigma around women and HIV/AIDS. In “Sisters of Change,” Chip Alfred interviews five members of Positive Women’s Network–USA, all of whom share their advocate perspectives on everything from trauma recovery to access to healthcare. Writer Jermane Graham interviews Dominque Drakeford, an upand-coming entrepreneur who seeks to stay on message about AIDS. This issue also features an in-depth discussion with longtime AIDS researchers, women who have been working on the science of our health for nearly three decades. As these women, and everyone else we feature in A&U month after month, prove, it’s never too late to make history.

DAVID WAGGONER

Editor in Chief & Publisher David Waggoner Managing Editor: Michael Needle Senior Editor: Dann Dulin Editors at Large: Chip Alfred, Sean Black Special Projects Editor: Lester Strong Literary Editor: Brent Calderwood Consulting Editor: Nick Steele Copy Editor: Maureen Hunter Contributing Editors: Sarah Churchill Downes, Reed Massengill, Kelly McQuain, Lesléa Newman, Robert E. Penn Contributing Writers: Noël Alumit, V. Anderson, Annie Buckley, Larry Buhl, Ruby Comer, Nancy Ellegate, LaMont “Montee” Evans, Diane Goettel, Sally Hessney, Angela Leroux-Lindsey, Sherri Lewis, Alina Oswald, Mark Rebernik, Dale Reynolds, Elizabeth Rodgers, Mariel Selbovitz, Justin B. Terry-Smith, Patricia Nell Warren, Chuck Willman, Jeannie Wraight Art Director: Timothy J. Haines Contributing Photographers: Jordan Ancel, Davidd Batalon, Mark Bennington, Tom Bianchi, Sean Black, Adam Bouska, Brian Bowen Smith, Fred Brashear, Jr., Tim Courtney, Stephen Churchill Downes, Greg Gorman, Francis Hills, Renée Jacobs, Tom McGovern, Nancy Perry, Annie Tritt National Advertising Director: Harold Burdick, Jr. Sales & Marketing: David L. Bonitatibus Advertising Sales Office: (518) 426-9010 National Advertising Representative: Rivendell Media (212) 242-6863 Subscription Info: (518) 426-9010 Circulation Manager: Robert Schelepanow Bookkeeper: Richard Garcia Board of Directors President: David Waggoner Vice President: Harold Burdick, Jr. Secretary: Richard Garcia Founding Board Members: Mark S. Labrecque, 1961–1992, Christopher Hewitt, 1946–2004, Mark Galbraith, 1962–2011 In Memoriam: Bill Jacobson, 1939–2005 Rhomylly B. Forbes, 1963–2011 Chris Companik, 1957–2012 A&U (ISSN 1074-0872) is published by Art & Understanding, Inc., 25 Monroe St., Suite 205, Albany, NY 12210-2743, USA. For A&U advertising information please call 518-426-9010; for subscriptions and address changes please call 518-426-9010; for letters to the editor and unsolicited manuscripts write A&U Magazine, 25 Monroe Street, Albany, New York 12210; fax 518-436-5354; or e-mail: mailbox@ aumag.org. All unsolicited manuscripts that do not have a S.A.S.E. cannot be returned and will not be acknowledged. ©2014 Art & Understanding, Inc. ALL RIGHTS RESERVED. A&U may not be reproduced in any manner, either in whole or in part, without written permission of the publisher. A&U and the graphic representations thereof are the registered trademarks of Art & Understanding, Inc., a 501 (c) (3) nonprofit organization. Individual Subscription rates: $24.95 (12 issues). Institutional rates: $80.00 (12 issues). For subscriptions outside the USA and possessions, $30.95/Canada, $49.95/international, payable in advance in U.S. currency. First North American serial rights revert to contributors upon publication. A&U retains the right to anthologize work in further issues, as well as in microform or reprinting on the Internet within the context of each issue. Statements of writers, artists and advertisers are not necessarily those of the publisher. Readers note: subjects and contributors to A&U are both HIV-positive and HIV-negative. In the absence of a specific statement herein concerning the serostatus of any individual mentioned in, or contributing material to, this publication, no inference is made with respect thereto and none should be implied. Letters written to A&U or its contributors are assumed intended for publication. Art & Understanding, Inc. assumes no responsibility or liability for unsolicited submissions and does not guarantee the return thereof. PostMaster: Please send address corrections to A&U Magazine, 25 Monroe Street, Suite 205, Albany NY 12210-2743, USA

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A&U Mailbox

“Behind the Candelabra is one movie that I can watch over and over again…. Cheyenne in part says, ‘This Liberace movie opened up the whole conversation about AIDS.’ And do we need more conversations about AIDS! I also recommend the movie Dallas Buyers Club. We really have to keep AIDS in the spotlight, otherwise people will forget, and that would really be tragic.”

Cheyenne Jackson is quite the hunk, but he is more than that [cover story, “Gentle Strength,” by Dann Dulin, January 2014]. He is a great actor, singer and now he is the amfAR International Ambassador on AIDS. I just like his commitment to fighting HIV and AIDS. He made a comment that was interesting: “There’s so much rampant bareback sex with menwho-have-sex-with-men, especially in New York. And whether you know it or not, we have all been affected by AIDS. Many people think they don’t know anyone positive, but most likely, they do.” I hope his career keeps moving on up. —Cassandra Michele Bynum Tonawanda, New York Behind the Candelabra is one movie that I can watch over and over again, thanks in part to the good actors in it. I’m pleased that Cheyenne Jackson was a part of it. And now the movie has won numerous awards. Cheyenne in part says, “This Liberace movie opened up the whole conversation about AIDS.” And do we need more conversations about AIDS! I also recommend the movie Dallas Buyers Club. We really have to keep AIDS in the spotlight, otherwise

people will forget, and that would really be tragic. —Brendan O’Brien Stratford, Connecticut

Cry Freedom! Thank you, thank you, A&U, for that wonderful tribute to Nelson Mandela by Sally Hessney [January 2014]. Mandela truly was a heroic human being, immortal and legendary. I can’t say enough about the man. He took on the administration of South Africa and took on Thabo Mbeki and the whole issue of HIV and AIDS. What Thabo Mbeki was saying was pure hogwash, but also criminal. Hundreds of thousands of South Africans died, and we can blame the policies of Thabo Mbeki. Nelson said, “We have to rise above our differences and combine our efforts to save our people. History will judge us harshly if we fail to do so now, and right now.” What a great man. —Tyler Manton Clinton, Iowa

Making a Change I am a transgender woman and just fell in love with Bamby Salcedo [“Transfiguration,” by Dann Dulin, January 2014].

How can you not love transgender people after reading what Bamby herself has gone through. It was for me quite the story; Bamby just has so much spunk and vitality in her. And she is right that people and especially the media think that we are weird. We are not weird! We are normal people, just like everyone else. I am so excited that she started Angels of Change that works with the Center for Transyouth and Development. Bamby is an excellent spokesperson for our people and the whole question of AIDS. Sadly, so many transgender people have become infected with HIV. Anyway, keep up the excellent work that you are doing, Bamby. —Stevie Meduska Senatobia, Mississippi

Send e-mail to: mailbox@aumag.org Send letters to: Mailbox, A&U, 25 Monroe Street, Suite 205, Albany, NY 12210 Or click on “Mailbox” on our Web site’s home page: www.aumag.org Tweet Us @au_magazine Facebook: http://on.fb.me/AUFANPAGE All correspondence requires name, address, and daytime phone number for confirmation. Letters may be edited for length and clarity.

A&U • MARCH 2014

photo by Adam Bouska

Jack of All Trades

NEWSBREAK Play Smart IV Launched by Visual AIDS in 2010, Play Smart trading cards have become an annual campaign to encourage sexual-health empowerment. Redesigned each year, the trading cards go beyond the typical model-hunk-wants-to-talk-to-you-about-safer-sex messages by offering sexy and creative images by four different artists that embrace the complexity of desire. Four of the cards provide information and resources about harm reduction, HIV testing, pre- and post-exposure prophylaxis, while raising awareness about HIV/AIDS. The project also seeks to celebrate different types of bodies and engage diverse communities. The three-card packs come with with condoms and lube, and various cards have different sets of information. Some cards feature a fun Mad Libs-type game on the back so people can play together and “start the conversation.” The 2014 edition of Play Smart features four sero-diverse artists in collaboration. Although the artists created individual images, they also teamed up with another artist to produce an image. Benjamin Fredrickson worked with Silvia Prada, and Carmine Santaniello [A&U, February 2014] worked with Jayson Keeling. For each iteration, Visual AIDS works Top: Jayson Keeling and Carmine Santaniwith experts and service providers to help ello for Visual AIDS, Nightwing, 2013 develop and distribute the cards across the country. This year, the New York City-based Left: Jayson Keeling for Visual AIDS, non-profit worked with Streetwise & Safe Untitled, 2013 and Sero Project on a variety of topics such as: No Condoms as Evidence (a national advocacy movement and now New York State bill that seek to stop police and prosecutors from using condom possession as evidence of sex work), HIV is Not a Crime, Testing, and Prevention Beyond Condoms. Also, check out the Visual AIDS blog, where activists and writers Dee Borrego, Jim Eigo, and Ricardo Gambo offer personal essays in response to the project, delving into their own experiences with sex, HIV/AIDS, criminalization, risk, love, community, and prevention. Part of Visual AIDS’ Print+Edition series, Play Smart trading cards are available in bulk (at the cost of shipping and handling) for free distribution, while supplies last. To order, contact Ted Kerr by e-mail at tkerr@visualaids.org.

Denying Coverage Outcry from patients, advocacy groups, and the AIDS community emerged in response to Louisiana-based health-insurance providers’ decision to drop low-income, HIV-positive patients who relied on Ryan White CARE Act-funded programs from their rolls. The Ryan White CARE Act has been allowing many individuals living with HIV/AIDS to access health coverage they otherwise could not afford. Throughout the history of the AIDS epidemic, health insurance companies have often deliberately denied coverage to those individuals living with HIV/AIDS or charged exorbitantly high premiums. Health insurance companies, including BlueCross BlueShield of Louisiana (BCBS), Louisiana’s largest insurer, Louisiana Health Cooperative, and Vantage Health Plan, recently announced that they planned to no longer accept federally funded premium subsidies for current policyholders or new enrollees. These subsidies, namely, those provided under the Ryan White CARE Act, had allowed low-income individuals living with HIV in Louisiana, and elsehwere, to access health insurance. The three insurers are the only ones offering coverage around MARCH 2014 • A&U

ABOUT PREZISTA

PREZISTA® is always taken with and at the same time as ritonavir (Norvir ®), in combination with other HIV medicines for the treatment of HIV infection in adults. PREZISTA® should also be taken with food. • The use of other medicines active against HIV in combination with PREZISTA®/ritonavir (Norvir ®) may increase your ability to fight HIV. Your healthcare professional will work with you to find the right combination of HIV medicines • It is important that you remain under the care of your healthcare professional during treatment with PREZISTA® PREZISTA® does not cure HIV infection or AIDS and you may continue to experience illnesses associated with HIV-1 infection, including opportunistic infections. You should remain under the care of a doctor when using PREZISTA.® Please read Important Safety Information below, and talk to your healthcare professional to learn if PREZISTA® is right for you.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about PREZISTA®? • PREZISTA® can interact with other medicines and cause serious side effects. See “Who should not take PREZISTA®?” • PREZISTA® may cause liver problems. Some people taking PREZISTA,® together with Norvir ® (ritonavir), have developed liver problems which may be life-threatening. Your healthcare professional should do blood tests before and during your combination treatment with PREZISTA.® If you have chronic hepatitis B or C infection, your healthcare professional should check your blood tests more often because you have an increased chance of developing liver problems • Tell your healthcare professional if you have any of these signs and symptoms of liver problems: dark (tea-colored) urine, yellowing of your skin or whites of your eyes, pale-colored stools (bowel movements), nausea, vomiting, pain or tenderness on your right side below your ribs, or loss of appetite • PREZISTA® may cause a severe or life-threatening skin reaction or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. You should call your healthcare professional immediately if you develop a rash. However, stop taking PREZISTA® and ritonavir combination treatment and call your healthcare professional immediately if you develop any skin changes with these symptoms: fever, tiredness, muscle or joint pain, blisters or skin lesions, mouth sores or ulcers, red or inflamed eyes, like “pink eye.” Rash occurred more often in patients taking PREZISTA® and raltegravir together than with either drug separately, but was generally mild Who should not take PREZISTA®? • Do not take PREZISTA® if you are taking the following medicines: alfuzosin (Uroxatral®), dihydroergotamine (D.H.E.45,® Embolex,® Migranal®), ergonovine, ergotamine (Cafergot,® Ergomar ®), methylergonovine, cisapride (Propulsid®), pimozide (Orap®), oral midazolam, triazolam (Halcion®), the herbal supplement St. John’s wort (Hypericum perforatum), lovastatin (Mevacor,® Altoprev,® Advicor ®), simvastatin (Zocor,® Simcor,® Vytorin®), rifampin (Rifadin,® Rifater,®

Rifamate,® Rimactane®), sildenafil (Revatio®) when used to treat pulmonary arterial hypertension, indinavir (Crixivan®), lopinavir/ ritonavir (Kaletra®), saquinavir (Invirase®), boceprevir (Victrelis™), or telaprevir (Incivek™) • Before taking PREZISTA,® tell your healthcare professional if you are taking sildenafil (Viagra,® Revatio®), vardenafil (Levitra,® Staxyn®), tadalafil (Cialis,® Adcirca®), atorvastatin (Lipitor ®), rosuvastatin (Crestor ®), pravastatin (Pravachol®), or colchicine (Colcrys,® Col-Probenecid®). Tell your healthcare professional if you are taking estrogen-based contraceptives (birth control). PREZISTA® might reduce the effectiveness of estrogen-based contraceptives. You must take additional precautions for birth control, such as condoms This is not a complete list of medicines. Be sure to tell your healthcare professional about all the medicines you are taking or plan to take, including prescription and nonprescription medicines, vitamins, and herbal supplements. What should I tell my doctor before I take PREZISTA®? • Before taking PREZISTA,® tell your healthcare professional if you have any medical conditions, including liver problems (including hepatitis B or C), allergy to sulfa medicines, diabetes, or hemophilia • Tell your healthcare professional if you are pregnant or planning to become pregnant, or are breastfeeding — The effects of PREZISTA® on pregnant women or their unborn babies are not known. You and your healthcare professional will need to decide if taking PREZISTA® is right for you — Do not breastfeed. It is not known if PREZISTA® can be passed to your baby in your breast milk and whether it could harm your baby. Also, mothers with HIV should not breastfeed because HIV can be passed to your baby in the breast milk What are the possible side effects of PREZISTA®? • High blood sugar, diabetes or worsening of diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZISTA® • Changes in body fat have been seen in some patients taking HIV medicines, including PREZISTA.® The cause and long-term health effects of these conditions are not known at this time • Changes in your immune system can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden • The most common side effects related to taking PREZISTA® include diarrhea, nausea, rash, headache, stomach pain, and vomiting. This is not a complete list of all possible side effects. If you experience these or other side effects, talk to your healthcare professional. Do not stop taking PREZISTA® or any other medicines without first talking to your healthcare professional You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please refer to the ritonavir (Norvir ®) Product Information (PI and PPI) for additional information on precautionary measures. Please read accompanying Patient Information for PREZISTA® and discuss any questions you have with your doctor.

28PRZDTC0288R8

PREZISTA® (darunavir) is a prescription medicine. It is one treatment option in the class of HIV (human immunodeficiency virus) medicines known as protease inhibitors.

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Once-Da

Once-Daily PREZISTA® (darunavir) taken with ritonavir and in combination with other HIV medications can help lower your viral load and keep your HIV under control. The PREZISTA® Experience isn’t just an HIV treatment. It’s an HIV treatment experience as unique as you. Find out if the PREZISTA® Experience is right for you. Ask your healthcare professional and learn more at PREZISTA.com

Snap a quick pic of our logo to show your doctor and get the conversation started.

Please read the Important Safety Information and Patient Information on adjacent pages.

Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2014 01/14 006960-131202

IMPORTANT PATIENT INFORMATION PREZISTA (pre-ZIS-ta) (darunavir) Oral Suspension PREZISTA (pre-ZIS-ta) (darunavir) Tablets Read this Patient Information before you start taking PREZISTA and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or your treatment. Also read the Patient Information leaflet for NORVIR® (ritonavir). What is the most important information I should know about PREZISTA? • PREZISTA can interact with other medicines and cause serious side effects. It is important to know the medicines that should not be taken with PREZISTA. See the section “Who should not take PREZISTA?” • PREZISTA may cause liver problems. Some people taking PREZISTA in combination with NORVIR® (ritonavir) have developed liver problems which may be life-threatening. Your healthcare provider should do blood tests before and during your combination treatment with PREZISTA. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems. • Tell your healthcare provider if you have any of the below signs and symptoms of liver problems. • Dark (tea colored) urine • yellowing of your skin or whites of your eyes • pale colored stools (bowel movements) • nausea • vomiting • pain or tenderness on your right side below your ribs • loss of appetite PREZISTA may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. You should call your healthcare provider immediately if you develop a rash. However, stop taking PREZISTA and ritonavir combination treatment and call your healthcare provider immediately if you develop any skin changes with symptoms below: • fever • tiredness • muscle or joint pain • blisters or skin lesions • mouth sores or ulcers • red or inflamed eyes, like “pink eye” (conjunctivitis) Rash occurred more often in people taking PREZISTA and raltegravir together than with either drug separately, but was generally mild. See “What are the possible side effects of PREZISTA?” for more information about side effects. What is PREZISTA? PREZISTA is a prescription anti-HIV medicine used with ritonavir and other anti-HIV medicines to treat adults with human immunodeficiency virus (HIV-1) infection. PREZISTA is a type of anti-HIV medicine called a protease inhibitor. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). When used with other HIV medicines, PREZISTA may help to reduce the amount of HIV in your blood (called “viral load”). PREZISTA may also help to increase the number of white blood cells called CD4 (T) cell which help fight off other infections. Reducing the amount of HIV and increasing the CD4 (T) cell count may improve your immune system. This may reduce your risk of death or infections that can happen when your immune system is weak (opportunistic infections). PREZISTA does not cure HIV infection or AIDS and you may continue to experience illnesses associated with HIV-1 infection, including opportunistic infections. You should remain under the care of a doctor when using PREZISTA. Avoid doing things that can spread HIV-1 infection. • Do not share needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades.

• D o 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 semen, vaginal secretions, or blood. Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people. Who should not take PREZISTA? Do not take PREZISTA with any of the following medicines: • alfuzosin (Uroxatral®) • dihydroergotamine (D.H.E. 45®, Embolex®, Migranal®), ergonovine, ergotamine (Cafergot®, Ergomar®) methylergonovine • cisapride • pimozide (Orap®) • oral midazolam, triazolam (Halcion®) • the herbal supplement St. John’s Wort (Hypericum perforatum) • the cholesterol lowering medicines lovastatin (Mevacor®, Altoprev®, Advicor®) or simvastatin (Zocor®, Simcor®, Vytorin®) • rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®) • sildenafil (Revatio®) only when used for the treatment of pulmonary arterial hypertension. Serious problems can happen if you take any of these medicines with PREZISTA. What should I tell my doctor before I take PREZISTA? PREZISTA may not be right for you. Before taking PREZISTA, tell your healthcare provider if you: • have liver problems, including hepatitis B or hepatitis C • are allergic to sulfa medicines • have high blood sugar (diabetes) • have hemophilia • are pregnant or planning to become pregnant. It is not known if PREZISTA will harm your unborn baby. Pregnancy Registry: You and your healthcare provider will need to decide if taking PREZISTA is right for you. If you take PREZISTA while you are pregnant, talk to your healthcare provider about how you can be included in the Antiretroviral Pregnancy Registry. The purpose of the registry is follow the health of you and your baby. • are breastfeeding or plan to breastfeed. Do not breastfeed. We do not know if PREZISTA can be passed to your baby in your breast milk and whether it could harm your baby. Also, mothers with HIV-1 should not breastfeed because HIV-1 can be passed to the baby in the breast milk. Tell your healthcare provider about all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Using PREZISTA and certain other medicines may affect each other causing serious side effects. PREZISTA may affect the way other medicines work and other medicines may affect how PREZISTA works. Especially tell your healthcare provider if you take: • other medicine to treat HIV • estrogen-based contraceptives (birth control). PREZISTA might reduce the effectiveness of estrogen-based contraceptives. You must take additional precautions for birth control such as a condom. • medicine for your heart such as bepridil, lidocaine (Xylocaine Viscous®), quinidine (Nuedexta®), amiodarone (Pacerone®, Cardarone®), digoxin (Lanoxin®), flecainide (Tambocor®), propafenone (Rythmol®) • warfarin (Coumadin®, Jantoven®) • medicine for seizures such as carbamazepine (Carbatrol®, Equetro®, Tegretol®, Epitol®), phenobarbital, phenytoin (Dilantin®, Phenytek®) • medicine for depression such as trazadone and desipramine (Norpramin®) • clarithromycin (Prevpac®, Biaxin®) • medicine for fungal infections such as ketoconazole (Nizoral®), itraconazole (Sporanox®, Onmel®), voriconazole (VFend®) • colchicine (Colcrys®, Col-Probenecid®) • rifabutin (Mycobutin®) • medicine used to treat blood pressure, a heart attack, heart failure, or to lower pressure in the eye such as metoprolol (Lopressor®, Toprol-XL®), timolol (Cosopt®, Betimol®, Timoptic®, Isatolol®, Combigan®) • midazolam administered by injection • medicine for heart disease such as felodipine (Plendil®), nifedipine (Procardia®, Adalat CC®, Afeditab CR®), nicardipine (Cardene®) • steroids such as dexamethasone, fluticasone (Advair Diskus®, Veramyst®, Flovent®, Flonase®) • bosentan (Tracleer®) • medicine to treat chronic hepatitis C such as boceprevir (VictrelisTM), telaprevir (IncivekTM)

IMPORTANT PATIENT INFORMATION • m edicine for cholesterol such as pravastatin (Pravachol®), atorvastatin (Lipitor®), rosuvastatin (Crestor®) • medicine to prevent organ transplant failure such as cyclosporine (Gengraf®, Sandimmune®, Neoral®), tacrolimus (Prograf®), sirolimus (Rapamune®) • salmeterol (Advair®, Serevent®) • medicine for narcotic withdrawal such as methadone (Methadose®, Dolophine Hydrochloride), buprenorphine (Butrans®, Buprenex®, Subutex®), buprenorphine/naloxone (Suboxone®) • medicine to treat schizophrenia such as risperidone (Risperdal®), thioridazine • medicine to treat erectile dysfunction or pulmonary hypertension such as sildenafil (Viagra®, Revatio®), vardenafil (Levitra®, Staxyn®), tadalafil (Cialis®, Adcirca®) • medicine to treat anxiety, depression or panic disorder such as sertraline (Zoloft®), paroxetine (Paxil®, Pexeva®) • medicine to treat malaria such as artemether/lumefantrine (Coartem®) This is not a complete list of medicines that you should tell your healthcare provider that you are taking. Ask your healthcare provider or pharmacist if you are not sure if your medicine is one that is listed above. Know the medicines you take. Keep a list of them to show your doctor or pharmacist when you get a new medicine. Do not start any new medicines while you are taking PREZISTA without first talking with your healthcare provider. How should I take PREZISTA? • Take PREZISTA every day exactly as prescribed by your healthcare provider. • You must take ritonavir (NORVIR®) at the same time as PREZISTA. • Do not change your dose of PREZISTA or stop treatment without talking to your healthcare provider first. • Take PREZISTA and ritonavir (NORVIR®) with food. • Swallow PREZISTA tablets whole with a drink. If you have difficulty swallowing PREZISTA tablets, PREZISTA oral suspension is also available. Your health care provider will help decide whether PREZISTA tablets or oral suspension is right for you. • PREZISTA oral suspension should be given with the supplied oral dosing syringe. Shake the suspension well before each use. See the Instructions for Use that come with PREZISTA oral suspension for information about the right way to prepare and take a dose. • If your prescribed dose of PREZISTA oral suspension is more than 6 mL, you will need to divide the dose. Follow the instructions given to you by your healthcare provider or pharmacist about how to divide the dose. Ask your healthcare provider or pharmacist if you are not sure. • If you take too much PREZISTA, call your healthcare provider or go to the nearest hospital emergency room right away. What should I do if I miss a dose? People who take PREZISTA one time a day: • If you miss a dose of PREZISTA by less than 12 hours, take your missed dose of PREZISTA right away. Then take your next dose of PREZISTA at your regularly scheduled time. • If you miss a dose of PREZISTA by more than 12 hours, wait and then take the next dose of PREZISTA at your regularly scheduled time. People who take PREZISTA two times a day • If you miss a dose of PREZISTA by less than 6 hours, take your missed dose of PREZISTA right away. Then take your next dose of PREZISTA at your regularly scheduled time. • If you miss a dose of PREZISTA by more than 6 hours, wait and then take the next dose of PREZISTA at your regularly scheduled time. If a dose of PREZISTA is skipped, do not double the next dose. Do not take more or less than your prescribed dose of PREZISTA at any one time. What are the possible side effects of PREZISTA? PREZISTA can cause side effects including: • See “What is the most important information I should know about PREZISTA?” • Diabetes and high blood sugar (hyperglycemia). Some people who take protease inhibitors including PREZISTA can get high blood sugar, develop diabetes, or your diabetes can get worse. Tell your healthcare provider if you notice an increase in thirst or urinate often while taking PREZISTA. • Changes in body fat. These changes can happen in people who take antiretroviral therapy. The changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the back, chest, and stomach area. Loss of fat from the legs, arms, and face may also happen. The exact cause and longterm health effects of these conditions are not known.

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Call your healthcare provider right away if you start having new symptoms after starting your HIV medicine. • Increased bleeding for hemophiliacs. Some people with hemophilia have increased bleeding with protease inhibitors including PREZISTA. The most common side effects of PREZISTA include: • diarrhea • headache • nausea • abdominal pain • rash • vomiting Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all of the possible side effects of PREZISTA. For more information, ask your health care provider. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. How should I store PREZISTA? • Store PREZISTA oral suspension and tablets at room temperature [77°F (25°C)]. • Do not refrigerate or freeze PREZISTA oral suspension. • Keep PREZISTA away from high heat. • PREZISTA oral suspension should be stored in the original container. Keep PREZISTA and all medicines out of the reach of children. General information about PREZISTA Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use PREZISTA for a condition for which it was not prescribed. Do not give PREZISTA to other people even if they have the same condition you have. It may harm them. This leaflet summarizes the most important information about PREZISTA. If you would like more information, talk to your healthcare provider. You can ask your healthcare provider or pharmacist for information about PREZISTA that is written for health professionals. For more information, call 1-800-526-7736. What are the ingredients in PREZISTA? Active ingredient: darunavir Inactive ingredients: PREZISTA Oral Suspension: hydroxypropyl cellulose, microcrystalline cellulose, sodium carboxymethylcellulose, methylparaben sodium, citric acid monohydrate, sucralose, masking flavor, strawberry cream flavor, hydrochloric acid (for pH adjustment), purified water. PREZISTA 75 mg and 150 mg Tablets: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose. The film coating contains: OPADRY® White (polyethylene glycol 3350, polyvinyl alcohol-partially hydrolyzed, talc, titanium dioxide). PREZISTA 400 mg and 600 mg Tablets: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose. The film coating contains: OPADRY® Orange (FD&C Yellow No. 6, polyethylene glycol 3350, polyvinyl alcohol-partially hydrolyzed, talc, titanium dioxide). PREZISTA 800 mg Tablets: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose, hypromellose. The film coating contains: OPADRY® Dark Red (iron oxide red, polyethylene glycol 3350, polyvinyl alcohol-partially hydrolyzed, talc, titanium dioxide). This Patient Information has been approved by the U.S Food and Drug Administration. Product of Ireland Manufactured by: PREZISTA Oral Suspension PREZISTA Tablets Janssen Pharmaceutica, N.V. Janssen Ortho LLC, Beerse, Belgium Gurabo, PR 00778 Manufactured for: Janssen Therapeutics, Division of Janssen Products, LP, Titusville NJ 08560 Revised: December 2013 NORVIR® is a registered trademark of its respective owner. PREZISTA® is a registered trademark of Janssen Pharmaceuticals © Janssen Pharmaceuticals, Inc. 2006 007653-131217

NewsBreak

Louisiana through the federal marketplace, which was recently implemented by the Patient Protection and Affordable Care Act roll-out and was designed to expand coverage of individuals living with HIV/AIDS, not limit it. Lambda Legal, and LGBT and HIV civil rights advocacy organizations, filed a federal class action discrimination lawsuit against these three insurers in U.S. District Court for the Middle District of Louisiana, and sought an emergency injunction that would force all three insurers to accept the premium payments and to provide health insurance until the lawsuit is heard. Assisted by the New Orleans AIDS Task Force and AIDSLaw of Louisiana, and echoing earlier complaints filed with the U.S. Department of Health and Human Services Office of Civil Rights, Lambda Legal filed the lawsuit on behalf of John East, a part-time worker in the hospitality industry, and other lowincome Louisianans living with HIV, all of whom were denied coverage for which they had previously qualifed. East, who is fifty-nine, had been insured by BCBS for nearly thirty years. Fortunately, a federal judge has temporarily prohibited these three insurance companies from following through with their plans to drop individuals living with HIV/AIDS from their rolls and deny coverage to new enrollees. As this issue went to press, the judge had planned a hearing to consider a long-term prohibition. For more updates, log on to: www.lambdalegal.org.

Two new and innovative initiatives for women living in the Bronx at highest risk for HIV have been launched by that borough’s Health People: Community Preventive Health Institute. Established in 1990, Health People is a “peer education, prevention and support organization in the South Bronx whose mission is to train and empower residents of communities overwhelmed by chronic disease and AIDS to become leaders and educators in effectively preventing ill health, hospitalization, and unnecessary death,” according to its Web site. The initiatives will provide prevention and services to women who are most vulnerable. Out of the five New York City boroughs, the Bronx has the highest rate of new women’s HIV/AIDS cases. The Bronx has the most women living with HIV/AIDS of any borough as well as thirty-five percent of the city’s women’s AIDS deaths, according to the NYC Department of Health and Mental Hygiene. With lead partner Narco Freedom, a comprehensive Bronx drug treatment center, Health People will offer a peer-mentor program to treat women for trauma and abuse as an essential component of comprehensive HIV prevention and care. As mentors trained by Health People, women who themselves are in drug recovery will help other women who are substance users to stay in drug treatment and trauma recovery services while they receive prevention counseling. In 1990, Health People pioneered the peer education model in order to provide access to critical health information for New York City’s most underserved and difficult to reach clients. This new initiative continues Chris Norwood, executive its holistic approach practice by understanding the full range of challenges and abilities of clients director of Health People as a way to address health risk and encourage them to believe that positive change is possible. By addressing addiction, childhood sexual abuse, current abuse, domestic violence and social isolation, the initiative seeks to offer women a greater chance to lower their risk for HIV infection and/or transmitting the virus, and increase their overall health opportunities. The second initiative involves exploring the uses of social media to reach women with effective messages about HIV prevention and care. Working with Albert Einstein School of Medicine on this research project, Health People will seek answers about social-media messaging through field testing and interviews. The initiative hopes to find new ways to employ social media to help women living with HIV/AIDS to engage in care and treatment. “Health People was originally founded as a women’s AIDS peer organization to train the women most affected by AIDS as leaders and educators,” said Chris Norwood, executive director, in a prepared release. “We learned from the early days what extraordinary leadership women could show in this crisis. We’ve made a lot of progress in HIV prevention, but we have to look carefully at improving our strategies for women who remain at risk. These projects are enabling us to use the crucial leadership of women, themselves, to assist the women for whom it will make the most difference today.” The initiatives are expected to serve as models for other affected communities across the U.S. For more information, log on to: www.healthpeople.org.

A&U • MARCH 2014

photo courtesy Health People

Bronx Health

fiction

away. Afterward, Dad calmed and sulked. When we were leaving, Tico approached Dad. “Junior, I’m sorry.” He held his arms out for a hug. Dad stared, emotionless. “If you talk again, I will fucking kill you.” On the way home, Dad said we could talk to Tico, but he would not. In other words, “I will kick the shit out of you every time you say ‘Tico.’” Uncle Tico became a ghost not long before he died. We didn’t go to his funeral. Dad kept grudges to the grave. He was comfortable with death. As a nurse, he worked Intensive Care. He went out of his way to work with patients near dying. Cancer, no problem; he’d catch vomit with a towel when you threw up from chemotherapy and explain expected side effects. Stroke? He’d clean bedpans and talk about therapy’s benefits. He even kept a handful of hand exercisers, the ones that chronic masturbators use to increase intimacy. In the 1980s, he was in demand because he was willing to work with AIDS patients. In a profession filled with Filipinos, caring for someone suffering from “God’s Punishment” was equal to Father Damien tending lepers. He said there was nothing to fear if you were smart enough to wear gloves. The nurses that worked with him said he was helpful with coworkers and tender with patients. The doctors said he would do extra research to better care. Once, just once, he tried to explain the ghosts. He tried to say he’d lost too much to AIDS. He told Doran and I, when we were old enough to know about sex and sexuality, old enough to know that our actions, no matter the intent, could make us who we didn’t want to be, that Uncles Tico and Joe were dead because of their choices. I remember when he said it. The lights in the house were off. He was home early from the nightshift, sitting between our beds. “Dad?” Doran asked. “Are you okay?” “I miss them,” Dad said. “They were brothers.” “Who?” “Your uncles.” In the hallway’s dim light, I could see a smile touch his lips. “Tico got me his older brother’s examination books. His brother was a good engineer.” Doran asked, “Weren’t you a good

Where Ghosts Come From by Christian Hanz Lozada

he family knows Dad hated mahu, gays. After 20 years here, an American wife and kids, he still acted fresh off the boat to the core, haunted by a wife who hurt his machismo. But he hurt his masculine image when he changed from engineering to nursing, added a Freddie Mercury mustache and loved shirts so tight his nipples stared at you. Even I questioned his sexuality. But what in any of this explains a vibrant hate capable of turning the living into ghosts? Uncle Tico was one of the ghosts. He was nice to my brother, Doran, and me. Because he had done well in America, he kept a pocket full of Zippo lighters and gave them to us at reunions. All we could do with them was light Dad’s cigarettes or sell them to the smokers at school, but for an evening, that silver square was the American dream. Tico told us that when he was a kid, he and Dad would dream about the tricks they could do with that lighter. They wanted to flick it across their thighs: once to open the cover, twice for flame. They wanted fire to spring up with a snap of their fingers. In the hands of an expert, the Zippo was magical. But only at a distance. You see, only the kids with money could buy them from the GIs in the Philippines. Tico and Dad were too busy working in the coconut fields for Zippo magic. He said, “We needed the money to feed our siblings so they could get fat like you.” He’d pat my belly. “Only rich kids can have little bits of wonder.” Tico’s change to ghosthood was sudden. As the men were gathered around the barbecue, throwing insults at each other in Vasayan—so we didn’t know what was said—Dad shoved the grill. It fell over, lava rocks spilling and the propane tank stretching the hose to breaking. While the smart uncles ran for the fence, Dad ripped off his shirt and shouted, “You’re the fucking fag.” Some uncles struggled to hold him back while Dad burned his slippered feet trying to kick rocks at Tico, who stood at a safe distance, smiling, before eventually walking

engineer?” “Nah. I cheated for my degree.” He started crying. “Are you okay?” Doran repeated. Dad nodded. “What’s wrong?” “You didn’t know Joe. He was funny.” “What was funny about him?” I asked. “Stupid,” Doran said to me. “One time, we stole the mayor’s limo and smashed it against the gate around Magellan’s Cross.” Dad started laughing. “We could have died.” “From the car crash?” “From the mayor’s armed drivers!” I asked, “What happened to Uncle Joe?” “He and Tico would go clubbing,” Dad said. “They never invited me.” “Were they—” Doran asked. “And they never got caught,” he said. “They were untouchable, and when I was with them, I felt untouchable, too.” “What’s wrong?” Doran touched Dad’s shoulder. “I don’t.” Dad brushed Doran’s hand aside. “I didn’t.” “Don’t what? Didn’t what?” Dad threw a bag at Doran. “Take your clothes. Take your car. Finish school. I’ll pay.” “What’s this about?” Doran lowered his head, turned on the light, and started to fill the bag with clothes. “What’s happening?” I asked. “Stay out of it,” Doran said. “Out of what?” “Sleep,” Dad said. “Why do you have to leave?” “I get it.” “Get what?” Doran shook his head. “I’m mahu.” “So?” He nodded at Dad. “It’s Doran,” I said. “Who?” Dad asked. “See? I’m already a ghost.” I followed Doran to the front door and stood by as he backed out of the driveway, into the street, and headed to the place ghosts live. Christian Hanz Lozada spends his never-ending Southern Californian commute thinking of new poems, stories, novels, and solutions to other people’s problems. His fiction has been published in Spot Literary Magazine. His poetry can be seen in Spot Literary Magazine, Conceit, and Amulet. He is the cowriter of Pictures of America: Hawaiians in Los Angeles. He is a graduate of California State University, Long Beach, Master of Fine Arts program in Creative Writing and is currently teaching all over creation. A&U • MARCH 2014

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MITCHELL ANDERSON est reaction is, “Ever since I changed careers, I sometimes forget I had a former life!” Several weeks later, I’m parked across the intimate square blond-wood table from him in his mid-town restaurant, MetroFresh—a hi-tech, airy place decorated in lightwood and eggshell colored brick paneled walls, multi-contrasted stained wood floors, and splashed with neon lime and emerald chairs. Ruby Comer: Oh! Before I forget and before I take a nibble of this marinated kale salad (with roasted brussel sprouts, pears, and walnuts), lemme ask you something. You grew up in Lucille Ball’s hometown of Jamestown, New York; are you a Lucy fanatic like me?! Mitchell Anderson: I love Lucille Ball… you kinda have to, coming from Jamestown! [He flashes a full grin.] What do you think about when you think about the AIDS epidemic? [He rattles off, with many sighs in between] Life…death…fear…change…activism… care-giving…love…hate…hope…despair. When did you first hear about the disease? I had just moved to New York after graduating from Williams College in 1983. I was in a show that summer before my first semester at Julliard and was aware of this new horrible disease, but not many people were talking about it. At that time, I was completely in the closet and barely wanted to travel below 42nd Street. I was afraid of everything and Anderson in MetroFresh, the restaurant he coowns with his partner, Richie Arpino

AIDS was foremost in my mind. How has the epidemic affected you? Oddly, it both kept me in the closet and pushed me out. At first I was afraid, but then, after moving to L.A. in 1985 and having friends start to die, I came to see that we just couldn’t be in the closet any longer. I learned to be more comfortable with myself and learned that only by coming out—at least to friends and family—were we able to defend ourselves against the great scourge of bigotry that was coming our way. [He takes a spoonful of “Mitchili,” turkey chili soup he named after himself.] My first best friend in Los Angeles was the actor Timothy Patrick Murphy (who played Mickey Trotter in Dallas). Tim was the first person I knew who got sick and died. After that, about five or six of my friends from the New York days got sick and died. It was devastating, Ruby, time after time. So sorry to hear, Mitchell. Were you ever in an AIDS-themed production? I was in the L.A. premier of Love! Valour! Compassion! by Terrence McNally, which was an amazing experience. I also did a staged reading of The Normal Heart in Atlanta to raise money for Emory Vaccine Center and the AIDS Quilt.

ruby illustration by Davidd Batalon; photos by Richie Arpino

miss Karen Carpenter. Every time I hear her angelic voice on a recording it soothes and stimulates my whole being. The other night I watched The Karen Carpenter Story, with Cynthia Gibb and Mitchell Anderson, as my fireplace was roarin’ and my legs were propped up on my hot-magenta lounger couch. The two lead actors captured every single nuance of their characters. What stellar performances! Afterward, I began to wonder about Mitchell, who played Richard Carpenter. I remember watching him in the eighties and nineties on TV series like Doogie Howser, M.D., and Party of Five. He also made guest appearances on 21 Jump Street, Highway to Heaven, Melrose Place, Matlock, and even the Jaws sequel, Jaws: The Revenge, where the shark ate him. So what happened to this cutie-pie? The next day, I fasten on my Hollywood antennae and discover that he’s living in Atlanta with his longtime partner, Richie Arpino. They own a restaurant. Mitchell ended his two-decade rein in Hollywood in 2002 after appearing on the wildly popular Popular and Showtime’s Beggars and Choosers. His talent is now culinary and his stage is the restaurant. During our initial phone chat, I tell Mitchell that I want to do a story on him. The lad’s mod-

A&U • MARCH 2014

Tell me about your AIDS fundraising. I started working as a volunteer on the Los Angeles AIDS Walk in about 1988 and kept on as a key volunteer for many years. I participated in the San Francisco and Chicago Walks as well. It gave me a purpose and introduced me to many kind and loving people. Years later, after I worked on the 1992 Barbara Boxer and Clinton campaigns, I found a greater purpose than just booking the next acting job. Then, after I publicly came out in 1996, I went all over the country working for various organizations and political campaigns that were furthering the cause of equality, medical awareness, and liberal ideals. “You’ve got spunk, boy!,” as Mr. Grant would say to Mary on The Mary Tyler Moore Show. I like your enthusiasm and your humanity…. [He nods in appreciation.] This became my life, Ruby, and looking back…I believe the path I took was perfect. I was able to relate my story about being a closeted actor in the eighties and early nineties to speaking out and finding my voice as a man. Even my parents, who were slow to come around to having a gay son, saw my work as an activist as a means of teaching tolerance and acceptance in the world. My father [one of his heroes] said to me before I went to a huge gay Democratic convention in 1996 in Chicago, “Go out there and be a leader.” To have my father understand that my life had, at that time, a great purpose, was incredible. Touching. What keeps you volunteering? Volunteering and being involved in the community really comes from my parents, who, even though they vote on the other side of the aisle from me, taught me that the most important thing is community. If you have the ability, you have to give back. I stood on street corners as a young child collecting money for the local hospital. That was how it started. It’s really the only thing that matters in life—how you relate to those around you, how you find your place in the community, and how you give. Thank you Mom and Dad Anderson, and thank you for your contributions. How long have you and Richie been together? Do you guys get tested for HIV? We’ve been together for nearly seventeen years. We’re completely monogamous so our perspective about testing has changed. Now that we’re well into our fifties, we are much less “active” so we have much less to worry about. Understood! Briefly, tell me about your overall experience filming The Karen Carpenter Story. I have many great memories. This was my first major lead in a big movie. It put me on the map as an actor and gave me an entry MARCH 2014 • A&U

him and his family, but he was the executive producer so he could have the last word. Cindy [Cynthia Gibb] and I wore their [personal] clothes—right out of the warehouse. I remember one olive green leisure suit; I looked like the Jolly Green Giant with a giant “package.” Um…I want more backstories! Were any of the scenes shot in the real Carpenter’s Downey home? I went there in the early nineties just to see it in person. Yes—we shot for a few days at their house. I remember the shot of the ambulance pulling away [with Karen’s dead body] from the driveway just as Richard pulls up [not knowing his sister had just died]. That still gives me chills….

Anderson as Richard, with Cynthia Gibb as Karen, in The Karen Carpenter Story into bigger roles. The next part I got was Doogie Howser. What was it like working on that set? I loved it, but at that point in my life I was too freaked out to let anyone find out I was gay. I was playing a real skirt chaser and it was hard for me to feel comfortable on the set. Still, it was all part of the process of just growing up. So fascinating that you and your co-star on Doogie Howser, Neil Patrick Harris, are both gay…. I don’t keep in touch with Neil anymore, but I’m so impressed by his career and life. He has really made an incredible life for himself in the crazy world of show business. I watched him host the Emmy’s last year. How cool is that? If I ever do run into him again, I’m sure it will be great. Were you are a fan of the Carpenters’ music? I was! But back then when I was in junior high and high school, you weren’t really allowed to favor them. We were supposed to listen to America, Supertramp, and Queen! But I secretly loved Karen’s voice. “Rainy Days and Mondays” was my secret favorite song. Me too! It was so “white bread” and you were unpopular with your peers if you liked them— and The Osmonds, too. Now I’m proud that I did. I love “Rainy Days and Mondays,” Mitchell! I know Richard Carpenter had a firm hand in the making of the film. What was your impression of him? Richard was nice, but somewhat distant. I think the filming of the story was hard on

Oh, me too, Mitchell. In 2012, you performed on stage in Next Fall at Actor’s Express in Atlanta. Do you plan to act again? I’m sure I’ll act again, but I don’t know when. It has to be right and I have to feel like I’m not taking too much time away from my personal and business life. It’s a great feeling not to need it anymore. Next Fall was probably one of the highlights of my acting life, since I didn’t need anything from it and I could just enjoy the process of rehearsal and the joy of performing. Oh, those days of trying to break into show biz, I know. It’s the ultimate stressor. Wanting someone to like you….Oy! [I take a nip of green tea and look at him.] I’m thrilled to be here with you, Mitchell. Do you have any final words? I believe that my life has come full circle. There was an important time that I was out front. Now I live the quiet activism of everyday life with an openness and honesty that comes with age and confidence. I write a blog every day and include my partner, my family, and my life in the stories of the restaurant. My audience is a bit smaller, but I still believe that we make a difference just by living our lives with grace, honesty, and the confidence that we’re just as deserving of happiness as everyone else. My customers are part of the journey— wherever that takes us. [For a pensive moment he places his elbow on the table and rests his chin on his hand. Mitchell’s brownish-green eyes look into the distance, sparkling.] Today, I work seventy to ninety hours a week in our restaurant so time is short, but I use the restaurant as a conduit to my service work. We raise money for the high school across the street and we stay connected to the little non-profits that ask for help. Whenever we can, we do. Ruby Comer is an independent journalist from the Midwest who is happy to call Hollywood her home away from home. Reach her by e-mail at MsRubyComer@aol.com.

The

one

for me

Patient model. Pill shown is not actual size.

What is COMPLERA? COMPLERA® is a prescription HIV medicine that is used as a complete regimen to treat HIV-1 in adults who have never taken HIV medicines before and who have an amount of HIV in their blood (this is called “viral load”) that is no more than 100,000 copies/mL. COMPLERA contains 3 medicines – rilpivirine, emtricitabine and tenofovir disoproxil fumarate. It is not known if COMPLERA is safe and effective in children under the age of 18 years. COMPLERA® does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Avoid doing things that can spread HIV-1 to others: always practice safer sex and use condoms to lower the chance of sexual contact with body fluids; never reuse or share needles or other items that have body fluids on them, do not share personal items that may contain bodily fluids. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others.

IMPORTANT SAFETY INFORMATION What is the most important information you should know about COMPLERA? COMPLERA® can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold, especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. • Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. • You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. • Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking COMPLERA, your hepatitis may suddenly get worse. Do not stop taking COMPLERA without first talking to your healthcare provider, as they will need to monitor your health. COMPLERA is not approved for the treatment of HBV.

Who should not take COMPLERA? Do not take COMPLERA if you have ever taken other anti-HIV medicines. COMPLERA may change the effect of other medicines and may cause serious side effects. Your healthcare provider may change your other medicines or change their doses. Do not take COMPLERA if you also take these medicines: • anti-seizure medicines: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek) • anti-tuberculosis medicines: rifabutin (Mycobutin), rifampin (Rifater, Rifamate, Rimactane, Rifadin) and rifapentine (Priftin) • proton pump inhibitors for stomach or intestinal problems: esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), dexlansoprazole (Dexilant), omeprazole (Prilosec), pantoprazole sodium (Protonix), rabeprazole (Aciphex) • more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate • St. John’s wort (Hypericum perforatum) If you are taking COMPLERA you should not take other HIV medicines or other medicines containing tenofovir (Viread, Truvada, Stribild or Atripla); other medicines containing emtricitabine or lamivudine (Emtriva, Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir, Atripla, Stribild or Truvada); rilpivirine (Edurant) or adefovir (Hepsera). In addition, tell your healthcare provider if you are taking the following medications because they may interfere with how COMPLERA works and may cause side effects: • certain antacid medicines containing aluminum, magnesium hydroxide, or calcium carbonate (examples: Rolaids, TUMS). These medicines must be taken at least 2 hours before or 4 hours after COMPLERA. • medicines to block stomach acid including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine HCL (Zantac). These medicines must be taken at least 12 hours before or 4 hours after COMPLERA. • any of these medicines: clarithromycin (Biaxin); erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral) methadone (Dolophine); posaconazole (Noxafil), telithromycin (Ketek) or voriconazole (Vfend). • medicines that are eliminated by the kidneys like acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex) and valganciclovir (Valcyte).

COMPLERA.

A complete HIV treatment in only 1 pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and have no more than 100,000 copies/mL of virus in their blood.

Ask your healthcare provider if it’s the one for you.

These are not all the medicines that may cause problems if you take COMPLERA. Tell your healthcare provider about all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take.

The most common side effects reported with COMPLERA are trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Some side effects also reported include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles) and pain.

Before taking COMPLERA, tell your healthcare provider if you: liver problems, including hepatitis B or C virus infection, or have abnormal liver tests • Have kidney problems • Have ever had a mental health problem • Have bone problems • Are pregnant or planning to become pregnant. It is not known if COMPLERA can harm your unborn child • Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their milk to the baby. Also, COMPLERA may pass through breast milk and could cause harm to the baby

This is not a complete list of side effects. Tell your healthcare provider or pharmacist if you notice any side effects while taking COMPLERA, and call your healthcare provider for medical advice about side effects.

• Have

COMPLERA can cause additional serious side effects: or worsening kidney problems, including kidney failure. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may need to do regular blood tests. • Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself. • Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may need to check your liver enzymes before and during treatment with COMPLERA. • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones. • Changes in body fat can happen in people taking HIV medicine. • Changes in your immune system. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting COMPLERA. • New

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch or call 1-800-FDA-1088. Additional Information about taking COMPLERA: • Always take COMPLERA exactly as your healthcare provider tells you to take it. • Take COMPLERA with food. Taking COMPLERA with food is important to help get the right amount of medicine in your body. (A protein drink does not replace food. If your healthcare provider stops COMPLERA, make certain you understand how to take your new medicine and whether you need to take your new medicine with a meal.) Stay under the care of your healthcare provider during treatment with COMPLERA and see your healthcare provider regularly. Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

Learn more at www.COMPLERA.com

Brief Summary of full Prescribing Information

COMPLERA® (kom-PLEH-rah) (emtricitabine, rilpivirine, tenofovir disoproxil fumarate) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information including Patient Information. What is COMPLERA? t

COMPLERA is a prescription HIV (Human Immunodeficiency Virus) medicine that is used to treat HIV-1 in adults – who have never taken HIV medicines before, and – who have an amount of HIV in their blood (this is called ‘viral load’) that is no more than 100,000 copies/mL. Your healthcare provider will measure your viral load.

(HIV is the virus that causes AIDS (Acquired Immunodeficiency Syndrome)). t

COMPLERA contains 3 medicines – rilpivirine, emtricitabine, tenofovir disoproxil fumarate – combined in one tablet. It is a complete regimen to treat HIV-1 infection and should not be used with other HIV medicines.

It is not known if COMPLERA is safe and effective in children under the age of 18 years old.

COMPLERA does not cure HIV infection or AIDS. You must stay on continuous therapy to control HIV infection and decrease HIV-related illnesses.

Ask your healthcare provider if you have any questions about how to prevent passing HIV to other people. Do not share or re-use needles or other injection equipment, and do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal fluids or blood.

Who should not take COMPLERA? Do not take COMPLERA if: t your HIV infection has been previously treated with HIV medicines. t

you are taking any of the following medicines: – anti-seizure medicines: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) – anti-tuberculosis (anti-TB) medicines: rifabutin (Mycobutin); rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) – proton pump inhibitor (PPI) medicine for certain stomach or intestinal problems: esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); dexlansoprazole (Dexilant); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) – more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate – St. John’s wort (Hypericum perforatum)

If you take COMPLERA, you should not take: – Other medicines that contain tenofovir (Atripla, Stribild, Truvada, Viread)

What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects, including: t Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – have stomach pain with nausea (feeling sick to your stomach) or vomiting – feel cold, especially in your arms and legs

– Other medicines that contain emtricitabine or lamivudine (Combivir, Emtriva, Epivir or Epivir-HBV, Epzicom, Trizivir, Atripla, Truvada, Stribild) – rilpivirine (Edurant) – adefovir (Hepsera) What should I tell my healthcare provider before taking COMPLERA? Before you take COMPLERA, tell your healthcare provider if you: t have or had liver problems, including hepatitis B or C virus infection, kidney problems, mental health problem or bone problems t

– feel dizzy or lightheaded Severe liver problems. Severe liver problems can happen in people who take COMPLERA. In some cases, these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis). Call your healthcare provider right away if you get any of the following symptoms of liver problems:

– your skin or the white part of your eyes turns yellow (jaundice) – dark “tea-colored” urine – light-colored bowel movements (stools)

are breast-feeding or plan to breast-feed. You should not breastfeed if you have HIV because of the risk of passing HIV to your baby. Do not breastfeed if you are taking COMPLERA. At least two of the medicines contained in COMPLERA can be passed to your baby in your breast milk. We do not know whether this could harm your baby. Talk to your healthcare provider about the best way to feed your baby.

– loss of appetite for several days or longer

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

– nausea

– stomach pain t

are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child. Pregnancy Registry. There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry.

– have a fast or irregular heartbeat t

Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider. – Do not let your COMPLERA run out. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone. – Do not stop taking COMPLERA without first talking to your healthcare provider. – If you stop taking COMPLERA, your healthcare provider will need to check your health often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA.

You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time.

COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works, and may cause serious side effects. If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help control your HIV infection. The HIV virus in your body may become resistant to COMPLERA or other HIV medicines that are like it.

Especially tell your healthcare provider if you take: an antacid medicine that contains aluminum, magnesium hydroxide, or calcium carbonate. If you take an antacid during treatment with COMPLERA, take the antacid at least 2 hours before or at least 4 hours after you take COMPLERA.

a medicine to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). If you take one of these medicines during treatment with COMPLERA, take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA.

abnormal dreams

headache

dizziness

diarrhea

nausea rash

– clarithromycin (Biaxin)

tiredness

depression

Additional common side effects include:

– fluconazole (Diflucan)

vomiting

– itraconazole (Sporanox)

stomach pain or discomfort

– ketoconazole (Nizoral)

skin discoloration (small spots or freckles)

– methadone (Dolophine)

pain

– telithromycin (Ketek) – voriconazole (Vfend) medicines that are eliminated by the kidney, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte)

What are the possible side effects of COMPLERA? COMPLERA can cause serious side effects, including: t See “What is the most important information I should know about COMPLERA?”

trouble sleeping (insomnia)

– posaconazole (Noxafil)

any of these medicines (if taken by mouth or injection): – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)

The most common side effects of COMPLERA include:

New or worse kidney problems, including kidney failure, can happen in some people who take COMPLERA. Your healthcare provider should do blood tests to check your kidneys before starting treatment with COMPLERA. If you have had kidney problems in the past or need to take another medicine that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of COMPLERA. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 (1-800-332-1088). How should I take COMPLERA? t

Stay under the care of your healthcare provider during treatment with COMPLERA.

Take COMPLERA exactly as your healthcare provider tells you to take it.

Always take COMPLERA with food. Taking COMPLERA with food is important to help get the right amount of medicine in your body. A protein drink is not a substitute for food. If your healthcare provider decides to stop COMPLERA and you are switched to new medicines to treat HIV that includes rilpivirine tablets, the rilpivirine tablets should be taken only with a meal.

Do not change your dose or stop taking COMPLERA without first talking with your healthcare provider. See your healthcare provider regularly while taking COMPLERA.

If you miss a dose of COMPLERA within 12 hours of the time you usually take it, take your dose of COMPLERA with food as soon as possible. Then, take your next dose of COMPLERA at the regularly scheduled time. If you miss a dose of COMPLERA by more than 12 hours of the time you usually take it, wait and then take the next dose of COMPLERA at the regularly scheduled time.

Do not take more than your prescribed dose to make up for a missed dose.

Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: – feeling sad or hopeless – feeling anxious or restless – have thoughts of hurting yourself (suicide) or have tried to hurt yourself

Change in liver enzymes. People with a history of hepatitis B or C virus infection or who have certain liver enzyme changes may have an increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease. Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA.

Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones.

Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known.

Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting your HIV medicine.

This Brief Summary summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals, or call 1-800-445-3235 or go to www.COMPLERA.com Issued: June 2013

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. ©2013 Gilead Sciences, Inc. All rights reserved. CPAC0041 07/13

Justin B. Terry-Smith has been fighting the good fight since 1999. He’s garnered recognition and awards for his work, but he’s more concerned about looking for new ways to transform society for the better than resting on his laurels. He started up in gay rights and HIV activism in 2005, published an HIV-themed children’s book, I Have A Secret (Creative House Press) in 2011, and created his own award-winning video blog called, “Justin’s HIV Journal”: justinshivjournal.blogspot.com. Now, with this column, Justin has found a way to give voice to the issues that people write to him about. Visit his main Web site at www.justinbsmith.com. He welcomes your questions at jsmithco98@hotmail.com.

I have seen your Web site and it looks like you are a knowledgeable person about HIV and HIV prevention. I had a possible exposure with another male; I was the bottom partner and condoms were used, but it was my first experience so I immediately got scared. Anyway, I went and got tested and was negative at three weeks and again at six weeks with a fourth-generation HIV test, which is conclusive at six weeks according to the clinic I went to. But just to be safe I tested at twelve weeks with the OraQuick oral swab and used your video to guide me and the result was negative again. So, do you believe that I should test again? —Miguel Let’s not go overboard here! I do believe in getting tested every three to six months. There are several questions that you might ask after your potential exposure. How do you think you were exposed? When people talk about exposure, a lot of times they are thinking about unprotected sex. Some people think it means having sex with a condom. I bring this up because you can’t assess risk unless this question is answered and it’s not clear from your letter. I see that you did use condoms, which is very effective when protecting yourself against HIV and other STIs (sexually transmitted infections). You are probably fine. You did a very good

thing in being proactive when getting tested for HIV. You’ve consulted your clinic and they advised you correctly. I understand the stress of having sex for the first time and the stress if you were exposed to HIV. But let’s think calmly and rationally about this. It was your first time. Things are confusing right now and you’re scared, but it will pass with time. We have all had scares like this and nobody is immune to fearing the unknown. But the best advice I can tell you that was given to me is: “Why stress about something you can’t do anything about?” My husband is the one who taught me that. Meaning, don’t stress yourself out about whether or not you are positive or negative. Keep living your life and get tested every 3 to 6 months. According to the San Francisco AIDS Foundation: “Antibody tests give a positive result based on antibodies to HIV, not the virus itself. 2-8 weeks (up to 2 months) after infection, most people will have enough antibodies to test positive. 12 weeks (3 months) after infection, about 97% of people will have enough antibodies to test positive “Antigen tests show a positive result based on the presence of the virus. These tests are more expensive than antibody tests, so are not offered in as many places. 1-3 weeks after infection, there will be enough viral material for a positive result. “Polymerase chain reaction tests also test for the actual virus. This type of test is often used for testing the viral load of HIV-positive people, as well

as testing babies born to HIV-positive mothers. 2-3 weeks after infection, there will be enough viral material for a positive result.” Justin, I was just wondering: Did your HIV provide additional problems when adopting a child? Just curious because this is something I wish to do. —Prince Good question! Being HIV-positive, I didn’t think I would become a biological father at all. So adoption was my option. I also did have the option of sperm cleansing and then going through an agency to find a surrogate to carry my child, but that costs thousands of dollars—so it wasn’t a true option for me. My husband and I decided on adoption. On January 30, we adopted our son, Lundyn, who is a seventeen-year-old LGBT ball of hormones. But to answer your question: No; I thought that having HIV would be an issue but it wasn’t. My husband and I went through the state of Maryland for our adoption. (Going through an agency would also cost money, but the state gives more benefits as far as education, food and clothing allowances, etc., for the child.) The only thing they checked for when it came to my HIV infection was to make sure I was undetectable. I believe that the state wants to make sure that my HIV is under control and being undetectable proves to them that I’m living healthy with HIV. ◊

A&U • MARCH 2014

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Imagine Me & You

Testing Together makes it safer to share serostatus, and may help prevent the spread of HIV in relationships

by Larry Buhl

ince the first HIV antibody test at San Francisco State University. In 2010 was licensed by the Food and Drug Hoff examined the relationship dynamics Administration nearly thirty years of gay male couples and found that couples ago, HIV testing has undergone an make “sexual agreements” or rules about evolution. From the two-step blood whether sex with outside partners is allowed. draw and second counseling session (with a They do this primarily in order to strengthen fraught two weeks waiting for the results) to and improve their relationship but not to the availability of rapid (twenty minute) tests, protect against HIV. Hoff also found that a it’s become easier than ever to learn one’s broken sexual agreement or one that isn’t serostatus. HIV testing is now provided in clear to either partner could make both a wide range of clinical and nontraditional partners vulnerable to HIV. Her findings, settings to reach more people, and, if the CDC she said, were “concerning,” because they recommendations are followed, HIV screensuggested HIV-negative gay men in couples ing will become a routine part of medical care. felt unduly protected from But one eleHIV simply because of ment of testing their relationship status. , n nt HIV infectio ve re p hasn’t changed “When there isn’t To : H T MY r off in a e tt much over the consensus on what the e b ys a lw a you’re , even lifetime of the agreement is, one parts relationship u o m a g o n o m . epidemic. Testing ner could be involved ve ti si r is HIV-po and counseling in risky behavior if your partne remains a one-onoutside of the rea is re e h one with the counlationship and the T : Y REALIT at th ce selor or medical other partner may n a ch t n forty-perce r practitioner. Bringing in your be unaware of e n rt a p ve ti partner to learn your results the resulting risk the HIV-nega g fected durin in e m is still not only discouraged, of unprotected co e b l il w A study has . ip but in some cases verboten. sex within the h rs e n rt a the p ry relationship,” a m ri p h But the paradigm of it w en shown that m individual-only testing is Hoff said in re more likely a finally changing. With Testing the study’s sex partners t sex with tha Together, a couples testing summary. She to have anal g the in w o n k program, gay men—and soon, added that the t u o h partner wit straight men and women— study suggests s. partner’s statu and their partners can not only that knowing learn their serostatus together, what motibut also have trained guides to vates gay couples to make sexual help them assess their risk, develop sexual agreements could help HIV prevention “agreements” and come up with strategies, programs tailor their efforts to be relevant together, to lower their HIV risk. to the whole relationship. “We in HIV prevention need to take Risky business • There’s been a shift ownership of the misunderstanding [of HIV in recent years to going beyond messages risk in monogamous relationships]” says about safer sex as part of HIV prevention. Patrick Sullivan, professor of epidemiology in Part of that shift is a growing understanding the Rollins School of Public Health at Emory that openness in sharing sexual histories University. Sullivan spearheaded the Testing and serostatus among partners in commitTogether initiative in 2010 and is an administed relationships is a crucial component in trator for a Testing Together site. risk reduction. “For many years the belief was that HIV risk One longtime proponent of what’s consid- was about promiscuity,” Sullivan says. “If you’re ered a “holistic” approach to HIV prevention in a monogamous relationship with a partner is Colleen Hoff, a professor of sexual studies who has HIV and doesn’t know it, being mo-

nogamous doesn’t protect you from acquiring HIV. Yet there’s a widespread belief that in a relationship it’s not important to be tested.” And that belief can be dangerous, Sullivan and an increasing number of HIV prevention experts say. In an abstract from a soon-to-be published study, Sullivan’s colleague, Dr. Rob Stephenson, associate professor in the Rollins School of Public Health at Emory University, writes that male couples represent a high priority group for HIV-prevention interventions, with “primary partners identified as the source of approximately one-third to two-thirds of HIV infections among MSM.” Sullivan points to another study conducted at Emory University in 2013 that showed men who have a primary sex partner perceive themselves to be at less risk and are less likely to get tested than single men. Conversations and “agreements” • HIV transmissions do occur within committed partnerships. But partnered men have far lower rates of routine HIV testing. One aim of Testing Together is to make couples testing normal, routine, and safe for both partners. Beyond that, it can provide a starting point for the conversation that both parties, especially those in newer relationships, are afraid to start. Testing Together’s model was developed and proven in Africa with male-female couples, Sullivan notes. “One of our colleagues at Emory in Africa, Susan Alan, was working on an NIH research project learning about HIV prevalence in Rwanda among women. When they received the results the women said, ‘thanks for helping us learn our status, now help our husbands learn their status.’” In 2008, when Sullivan was working with sites that were providing testing services for heterosexual couples in Kigali, Rwanda, and Lusaka, Zambia—he still works with these sites—he wondered why the U.S. couldn’t do couples testing for men to reduce the spread of HIV. He was funded by the NIH to conduct the early stages of adapting the Africa intervention to the U.S. in 2009. In 2011, Sullivan and colleagues approached MAC AIDS to scale-up the new service from its first site, Atlanta, to A&U • MARCH 2014

read of HIV is MYTH: The sp ncounters with al e driven by casu x partners. include two addianonymous se tional cities. ry Now the CDC ALITY: Prima E R has folded the ale-male partners in m Testing Together approach into account for the hundreds of organizations relationships irds of new that do HIV testing. Commuup to two-th nity-based organizations are s in the U.S. HIV infection increasingly offering Testing Together as an alternative to individual testing. Couples learn about Testing Together through word of mouth and a Web site (www.testingtogether.org). Jasper Barnes, who was the first Testing Together counselor in the U.S. and continues to counsel couples in Atlanta, says that over four years he’s been surprised at the widespread misconceptions of the men who participate. “Many men come in believing that their partners’ negative test means they must be negative too.” Though Testing Together is technically a formal program, counselors have some flexibility in administering the services. Sometimes a couple comes in and one is previously diagnosed and wants to use this mechanism to facilitate a discussion. In other cases one partner with HIV knows he is positive but he may want to use Testing Together to be there to support his partner. Whatever the couple decides, there is a lot of ground to cover over a thirty- to forty-five-minute session. There are eight steps according to Barnes: (1) An introduction and session overview and a chance to learn what the couple wants to get out of the session; (2) Performing the test; (3) A discussion of the relationship in general. An exploration of partners’ concerns about HIV; (4) Determining the “agreement.” Partners state whether their relationship is open, monogamous, or someMARCH 2014 • A&U

where in between. The counselor is there to help them develop this agreement, if there isn’t one already, through role-playing; (5) Preparation for the results; (6) Delivery of the results; (7) Creating a risk reduction plan; (8) Links to follow-up services and referrals. Coming up with the agreement takes up most of the session, Barnes says. “Many haven’t had a conversation about the boundaries of their sexual relationship. Often they’ll say they thought (monogamy) was just understood.” When couples say they’re monogamous or think they’re monogamous, in some cases they’re actually monogam-ish, making their own rules and conditions for if and when they do stray outside the relationship. “When a couple tells us they’re monogamous, we dig a little deeper and ask what does that really mean to them,” Sullivan says. “Then we ask what would it look like if one partner stepped outside of the relationship.” Barnes adds that there are fewer conflicts that arise than one might suspect. “Because the couples are choosing to be a part of this, they’re very open with the counselors,” Barnes says. “It’s very different than individual HIV counseling, where it’s often like pulling teeth.” But Barnes admits that the process does have the possibility of opening up deeper issues that go beyond the parameters of the session. In those cases, the counselor will refer the couple to skilled practitioners in couples therapy, substance abuse or whatever is needed. “In many cases couples have not always

communicated their serostatus, or that was based on testing that predated the relationship,” Barnes says. “When they decide they want to stop using condoms, that’s a good time for them to talk about it.” Sullivan says that having a counselor start a discussion about safe sex practices in and outside the relationship is liberating. “It helps to have a facilitator to say it’s okay to discuss these issues of monogamy and it is not a sign of weakness in your relationship to do so. It is hard for a person in a relationship to start that discussion without a suspicion or starting from a place of conflict. Conflict does happen, but it’s rare, Sullivan says. The leaders of Testing Together were sure of this from the start, when they conducted a randomized trial of 100 couples before launching the program. “We found there was no higher occurrence of break ups or violence between the group that tested separately and the group that tested apart.” In that same study Sullivan found another striking statistic: The seropositivity rate for couples who came in to test was higher than the rate of men who came in individually. This underscored the need for a service that would help burst the bubble of perceived safety from HIV for those in committed relationships. “One of the benefits of Testing Together is that it offers a relevant way for men to be tested in the context of a relationship, without undermining the relationship. Counselors emphasize that this is a way to strengthen the relationship, and as a result this may bring people in for testing who may think they’re not at great risk.” Sullivan says that in addition to potentially stopping the spread of HIV within couples, services like Testing Together can play an important role for men living with HIV. That continued on page 60

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engaged! A National Coalition Advancing Health & Healthcare Access for HIV Positive Communities

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Amplify the voice of PLWH in DC and around the country by joining the Pozitively Health Coalition at www.HealthHIV.org.

Engage Help us understand the needs of PLWH by taking the Pozitively Healthy survey at www.HealthHIV.org.

Connect E-mail or call Pozitively Healthy Staff: Joseph Jefferson: Joseph@HealthHIV.org Julio Fonseca: Julio@HealthHIV.org 202-232-6749 Facebook.com/PozitivelyHealthy @HealthHIV YouTube.com/HealthHIV

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A National Coalition Advancing Health & Healthcare Access for HIV Positive Communities A National Coalition Advancing Health & Healthcare Access for HIV Positive Communities

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A National Coalition Advancing Health & Healthcare Access for HIV Positive Communities Are you concerned how health care reform will affect you?

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Would you like to become a better informed consumer?

today! A National Coalition Advancing Health & Healthcare Access for HIV Positive Communities

A National Coalition Advancing Health & Healthcare Access for HIV Positive Communities

EMPOWERMENT through EDUCATION and ADVOCACY Empowered consumers are healthier consumers. Empowered consumers engage in a dialogue with their providers about their health goals and treatment plans. Consumer education helps PLWH recognize high quality, stigma-free health care and empowers them to take full advantage of health care reform. Educated consumers can effectively advocate for equitable treatment throughout the health care system. Effective advocacy by educated and empowered consumers helps ensure that competent, affordable, and effective health services and treatment are more accessible.

‘‘

Pozitively Empowering I am a 53-year-old Black gay man who has been HIV-positive for the past 25 years. I am dedicated to working with and advocating for youth, so that they may not have to endure the pain and hardships I have experienced. My involvement with Pozitively Healthy allows me to work with a diverse group of individuals on a personal, meaningful, and shared cause. I treasure the opportunity to be a positive influence and to help empower all HIV consumers. My passion for helping others has led me to join a number of advocacy groups, as well as found Brothers Reaching Others, Inc. (BRO), which provides resources, educates clients, empowers individuals, develops skills, engages others, and disseminates information to disenfranchised and impoverished communities.

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Edward Jackson, CEO, Brothers Reaching Others, Anniston, Alabama

Pozitively Healthy National Steering Committee

Brandon Aversano George Washington University Washington, DC

David Brakebill Florida Keys HIV Community Planning Key West, FL

Matthew Lesieur VillageCare New York, NY

Stephen Bailous Metropolitan Washington Regional Ryan White Planning Council Washington, DC

Robert Caldwell The Tauri Group, Biowatch Systems Program Office Washington, DC

Andrew Hartman Lt. Joseph P. Kennedy Institute of Catholic Charities Washington, DC

Judi Billings Targetted Alliances Puyallup, WA

Andrew Espinosa Midwest AIDS Training + Education Center Chicago, IL

Angel Hernandez Orocovis, PR

Mark Fischer Values in Action Washington, DC

Edward Jackson Brothers Reaching Others, Inc. Anniston, AL

leads to ACCESS to better care and improved health.

‘‘

Pozitively Educating and Advocating My involvement with Pozitively Healthy is rooted in understanding the history of the HIV movement, and my desire to diminish the emotional and social suffering PLWH experience due to ignorance and judgment. I see stigma as one of the largest barriers to testing and treatment. We need to change the way HIV is understood in public discourse; HIV is a virus and a public health issue. My long-term vision for Pozitively Healthy is to one day look back at the victory over stigma and judgment and see an enlightened and accepting society that recognizes HIV as a medical issue as opposed to a moral one.

ʼʼ

Ann Stuart Thacker, Executive Director, AIDSNET, Bethlehem, PA

‘‘

Pozitively Improving Access to Better Health As a gay man born during the height of the HIV/AIDS crisis, I never would have guessed that nearly 30 years later that stigma, barriers to quality heath care, and undue suffering would still exist for so many members of my community. Heroic efforts and huge advancements in science have been made; however, we have seen little progress in addressing not only the stigma of being HIV-positive, but also the legal and emotional ramifications of intolerance and misinformation. It is because of this uphill battle for PLWH that I have chosen to advocate on behalf of myself, my friends, and my community by joining Pozitively Healthy. It is because of those men and women who fought during the early days that I’m able to now lend my voice in support for those will come after me. Bryce Romero, Consumer Marketing Assistant, Human Rights Campaign

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Pozitively Healthy advocates and educates so that the HIV community is and remains Pozitively Healthy

Angel Lozada Pittsburgh, PA Randal Lucero National Quality Center, Consumer Advisory Committee New Mexico Aging & Long-Term Services Department’s HIV/AIDS Advocacy Network Albuquerque, NM Oliver Martin, III National United Church of Christ HIV and AIDS Network Green Bay, WI

Eric Martinez Positive Mind & Body Support Group Net Vero Beach, FL Butch McKay Okaloosa AIDS Support and Informational Services, Inc. (OASIS), Fort Walton Beach, Florida Mark Peterson Michigan Positive Action Coalition (MI-POZ) Detroit, MI

Bryce Romero Human Rights Campaign Washington, DC

Ann Stuart Thacker AIDSNET Bethlehem, PA

David Sheon Whitecoat Strategies, LLC Washington, DC

Tim Vincent California STD/HIV Prevention Training Center Oakland, CA

John Tenorio Pueblo Community Health Center EIS Program Canton City, CO

David Waggoner A&U, America’s AIDS Magazine Albany, NY Channing Wayne Larkin Street Youth Services San Francisco, CA

Sisters of

African-American women are more impacted by HIV than women of any other race or ethnicity in the U.S. Yet when it comes to addressing their plight, it’s mostly men who call the shots and set the agenda. Meet five positive women from across the country who are committed to being a part of the solution, fighting for gender equity. by Chip Alfred

A&U: Let’s start by talking about your earlier lives, coming of age as an African-American woman in a man’s world. Waheedah: I was raped when I was nine by one of my mom’s boyfriends. I didn’t feel comfortable sleeping in my own home. I was afraid of mom’s boyfriends crawling into bed with me. Mom could barely put food on the table or pay for heat. I wasn’t told that I was going to college; there was no message to

me that I was going to go somewhere. I had my first child at fourteen, and another one at sixteen. I converted to Islam at eighteen. Islam gave me structure—a sense of family and values. It calmed me down. I wasn’t that psychedelic party girl after that. Mary: I was born with HIV. My mother was a drug addict and not really fit to take care of me. I was raised by my dad and stepmom. In fifth grade I told my class I was HIV-positive during an HIV discussion, and that started a long trek of internalized stigma. My stepmom told me not to tell anybody. She said I would be kicked out of school; it wouldn’t be a good situation for me. Some kids were extremely insensitive, very standoffish. They didn’t want to eat with me at lunch anymore. I had a bully who would harass me every day in front of the whole class. I didn’t understand why I had to feel like I was guilty. I didn’t do anything wrong. Pat: I’ve been raped so many times. We get into relationships not knowing anything about abuse until we become abused. Then there’s the shame and guilt and not knowing what to do or who to share it with. I only

reported it once. That ended up being so traumatic; it was like I was the victim all over again. All of you have been living with HIV for more than a decade. Can you describe your situation when you received your diagnosis? Sharon: Before I was infected, I was in a marriage. He knew he was infected and never told me. He drank a lot and was abusive—physically and emotionally. After the abuse got more regular, I packed up me and my kids and left. When he got sick, I came back to help him and I got tested. My world just kind of stopped. I had the feeling that I was dirty, that no matter how many baths I took I just could never get clean enough. I thought, “Who’s going to want me with this? I’m tainted.” Loren: I grew up in North Philadelphia and went to Penn State. But in 1986 when I was diagnosed, there was no information out there for women. I was homeless and had no job at the time. I said to myself, “Now I’ve really screwed up. I’m not going to deal with this right now.” I needed to deal with other basic priorities [earning money, putting food on the table, finding a place to live]. A&U • MARCH 2014

photo courtesy Pat Kelly

hey call themselves “Sisters of Change.” As members of Positive Women’s Network-USA, they motivate women living with HIV to get involved in all levels of policy and decision-making. They’re raising their voices for women’s rights in the HIV-positive community, refusing to be counted out. In a no-holds-barred discussion, a group of female activists share their stories of surviving the past, embracing the present, and empowering themselves to change the course of the future. Mary Bowman, twenty-five, from Prince George’s County, Maryland, is a poet, singer, and peer navigator for people living with HIV/AIDS. Sharon DeCuir, forty-six, from Baton Rouge, Louisiana, is an HIV prevention program manager. Loren Jones, sixty-one, from Berkeley, California, is a member of the board of directors, Positive Women’s Network-USA. Pat Kelly, fifty-nine, from Orangeburg, South Carolina, is the president of “A Family Affair” HIV/AIDS Ministry, Victory Tabernacle Deliverance Temple. Waheedah Shabazz-El, sixty, from Philadelphia, Pennsylvania, is the regional organizing coordinator, Positive Women’s Network-USA.

photo courtesy Mary Bowman

f Change

Pat: It was 1985. I was serving time in prison for writing bad checks. They gave me an HIV test in jail without my knowledge. When I found out I was positive, I went a little crazy. I got more actively involved in drugs. I just threw everything out the window because I thought I was going to die tomorrow. l had intentions of going to law school. It didn’t make sense then to apply to law school. I didn’t think I would live long enough to do it. In my mind I started to have a hopeless life. MARCH 2014 • A&U

Clearly, you’ve all experienced hardships, but you managed to turn your lives around. How did you do it? Mary: I wrote a poem called “Dandelion” about my father being a drug dealer and my mom’s issues. Performing it was a really freeing experience for me because I wasn’t able to talk about it before that. After my performance, a young lady in the audience with tears in her eyes tapped me on my shoulder and said, “Thank you.” It was a life-changing

Above: Mary Bowman Opposite page: Pat Kelly

experience for me and I realized that I was on to something. Waheedah: I was married to a former IV drug user. I was educated and had a good job, but I didn’t know I had any risk of becoming HIV-positive through somebody else’s behav-

photo by Freedom G Photography

Waheedah Shabazz-El

A&U â&#x20AC;˘ MARCH 2014

photo courtesy Sharon DeCuir

ior or how to protect myself. We didn’t talk much about condoms; we talked about birth control. I was probably infected for a number of years before I got tested. At the time I was diagnosed with AIDS. I started in treatment and went to ACT UP meetings. I found people who wouldn’t judge me, people who were fighting for justice for everybody. HIV has taught me about the real spirit of the human being. It’s something that goes beyond color and ethnicity and what you have and where you come from. Sharon: I thought I was the only woman with this disease. I found a women’s support group and started to learn what HIV was. This became my safe place. I had to find out everything I could about this disease. The more I learned, the more I needed to know. I realized that I was the one who was willing to put a face to HIV/AIDS publicly in my town. Now that I’m working in prevention, it’s like full circle for me. I came to this agency ten years ago, when I was homeless and needed help. Now it feels great because I can help people who don’t have a voice and are afraid to speak up. I can empower them.

rights. It’s preventing women from wanting to get tested. Women are asking themselves, “Why should I get tested if automatically I’m a liar, I’m a criminal, I’m no longer allowed to have a life or romance?” Mary: I’m a lesbian. In lesbian circles,

As women involved in HIV activism and advocacy work, what do you see as the major challenges HIV-positive African-American women face? Pat: We have babies and Sharon DeCuir childcare issues. Women naturally are caregivers and nurturers and men are not. they don’t really talk about HIV much or at all. We try to take care of everybody and end up Lesbian women have been shunned by the putting ourselves last, so a lot of women are lesbian community because they’re positive; not getting the care they need. Disclosure is it means you slept with a man before or you another big issue for African American womused drugs. en. So many women have self-esteem issues before the diagnosis. Learning that you’re So how can we resolve the gender inequity HIV-positive just makes it worse. It makes us issue? feel ashamed. We feel as though we are not Sharon: We need to not be afraid to talk lovable. Nobody wants to be rejected, so rather about HIV in our schools, our communities, than fear that rejection, some women just vow our churches, and most importantly our to themselves, “I’m not going to tell.” kitchen tables. Waheedah: The new wave of criminal laws Loren: I don’t consider it improvement for HIV nondisclosure is a major challenge. until…poor African-American women are HIV criminalization cases usually come from not having to have survival sex or medicating a former partner after a breakup. If there’s a themselves on drugs or alcohol because their custody battle, an HIV-positive woman will lives are so stressful or miserable. We need lose her child because she’s seen as an unfit to make their lives worth living. We have mother. Incarcerated HIV-positive women are often denied their sexual and reproductive to address the poverty and the education MARCH 2014 • A&U

issues—starting with our children. We need to give them a sense of worth and self-esteem and the knowledge that women are valuable for things other than our perceived sexuality and our looks. Waheedah: I’d like to see HIV treated as a medical condition not a moral condition, so we can talk about health disparities among women, about putting women at the center of HIV prevention, planning, care and services. Pat: We need a champion—a woman champion. We need to groom women to become champions. We have to stand up and be counted. If we don’t, it will continue to be a male-dominated world. With each sexual encounter, African-American women face a higher risk of infection because of the high prevalence of HIV and other STDs in their communities. Endemic stigma, not knowing their status, and limited access to healthcare are other factors that increase HIV risk among black women. Nevertheless, there is some encouraging news. HIV incidence among African-American women decreased twenty-one percent from 2008 to 2010, based on CDC data. “Additional years of data are needed,” explains Dr. Donna McCree, Associate Director for Health Equity in CDC’s Division of HIV/AIDS Prevention. “However, we are cautiously optimistic that this could be the beginning of a longer-term trend.” For women like Waheeda, this may signal a light at the end of the tunnel. “Women haven’t had a place at the table. Activism gives me hope, and I’m never going to stop trying to change the world. This is a fight we all have to fight.” For more information about Positive Women’s Network, visit www.pwn-usa.org. For more information about Freedom G Photography, visit: www.freedomgphotography.com. For the CDC fact sheet on HIV and AIDS among African Americans, log onto http://1.usa.gov/1eZkFZf. Chip Alfred is an A&U Editor at Large based in Philadelphia.

Artists Allyson Mitchell, Jessica Whitbread and L.J. Roberts use art & activism to start a new dialogue about all self-identified women, their sexuality and HIV status by Alina Oswald

ruth is, the subject of women’s rights has always been a controversial one, but possibly never as much as it is today. Now, maybe more than ever, being a woman has become a political topic meant to score points especially on one side of the aisle, an issue able to split society (and, sadly, women as a part of society) along party lines, cultural differences, and religious beliefs. Mike Huckabee called women “helpless” without free, government-provided birth control. Wendy Davis stood for hours, filibustering in the Texas House to oppose a bill that would have almost eliminated the number of women-centered health clinics in the state. Malala Yousafzai faced death when she stood up to the Taliban in her quest to secure the right to education for girls. Marked by this duality, women’s issues today beg for a new kind of conversation, especially when it comes to HIV/AIDS. This conversation could be one that includes all self-identified women, their sexuality, and how it relates to their HIV status, among other concerns. This conversation becomes possible thanks to artists and activists who unite their voices to deliver a bold, yet necessary message, and open up a dialogue that wasn’t available before. In that sense, the “Queer Threads: Crafting Identity and Community” group show provides a stage on which to have this dialogue. Curated by John Chaich, a past A&U contributor, “Queer Threads” is on view at the Leslie-Lohman Museum of Gay and Lesbian Art, and features works by internationally recognized threadbased artists. L.J. Roberts is a Brooklyn-based artist whose works were included in “Not Over: 25 Years of Visual AIDS,” “40 Under 40: Craft

Futures” at the Smithsonian American Art Museum, and, together with Allyson Mitchell, in the upcoming “Alien She” show at The Miller Gallery at Carnegie Mellon University. Allyson Mitchell has spent the past twenty

years creating art, and has exhibited in galleries and festivals around the world. Together with her partner, she runs Feminist Artists Gallery in Toronto. For “Queer Threads” she contributed her Queer Un-Nation flag, and also a bold and sometimes considered controversial poster created in collaboration with Jessica Whitbread.

Jessica Whitbread is also a Toronto-based artist and activist, and global chair of the International Women Living with HIV. She’s been involved in the HIV community, among others, by organizing Tea Time events—traveling tea parties that offer HIV-positive women from around the world a safe space to talk about their issues without fear of judgment. Tea Time events involve teacup-and-letter exchanges among women from different corners of the world. Whitbread’s new book is Tea Time: Mapping Informal Networks of Women Living with HIV, which comes out this month. Part of “Queer Threads,” The Queer Houses of Brooklyn in the Towns of Brekelen, Boswych, and Midwout during the 41st Year of the Stonewall Era is an impressive art piece by L.J. Roberts, now part of the Smithsonian collection, which employs quilting, knitting and embroidery techniques, and was inspired, as explained by Roberts, by a map of the queer collective houses in Brooklyn, in itself a contemporary document of queer life. Also part of the group show is Fuck Positive Women, a poster created by Allyson Mitchell and Jessica Whitbread, and commissioned by Toronto’s AIDS ACTION NOW! poster/VIRUS, a project that combines HIV, art, and activism. Alina Oswald: What is the message of the work you show in Queer Threads? L.J. Roberts: It is a quilted object referencing the AIDS Quilt, the effects of gentrification of AIDS, in terms of how the pandemic has been a factor in the shifts in demographics and neighborhood. It is historical, and also contemporary. Allyson Mitchell: As the International Community of Women Living with HIV says [referring to the poster]: “This is the kind of messaging we wanted to have,” messaging that makes a debate, a conversation, elicits a response that isn’t apathetic or complacent. A&U • MARCH 2014

Opposite page: Allyson Mitchell with Jessica Whitbread, Fuck Positive Women, 2012, yarn on plastic and needle, 12 by 8 inches. Collection of Jessica Whitbread Above: Allyson Mitchell, Queer Un-Nation, 2011, yarn and felt, 36 by 48 inches. Courtesy of the artist and Katharine Mulherin Contemporary Art Projects, Toronto. Photo by Stanley Stellar (cropped) The message [of the poster] can help [women, especially HIV-positive women] be recognized, and be counted. Jessica Whitbread: We collaborated throughout the time [in creating the poster], but Allyson was the one who took the lead, and put it together. This particular piece is about the lack of representation of queer women living with HIV, and the fact that queer women are left out of any kind of discussions around HIV. Why is it necessary to make a bold statement with your artwork? LJR: I feel I’ve been talking about AIDS since I was in undergrad, which is thirteen years ago, [and yet] talking about [HIV] positive women stuff is still a new thing. It’s a dialogue that needs to be started. It’s a dialogue I want to be engaged in. AM: There’s a kind of stigma, culturally, around women taking an active position around being sexual and [having] sexual feelings, and desires, particularly [HIV] positive women. I think the language that MARCH 2014 • A&U

we chose to use [in the poster] is harsh, to the point. It’s rude. Direct. It’s not making it easily digestible. JW: [The poster] was meant to provoke, to start a dialogue and engage people in a different way. Drawing from my own experience as a woman living with HIV myself, I think that women living with HIV are often de-sexualized. A lot of times, the HIV movement frames women as victims, and women’s bodies as vessels for reproduction, and doesn’t take into account that women are sexual [people and] that they have sex regardless of their HIV status. Why do you believe there’s a lack of material about women living with HIV/AIDS? LJR: The lack of material addressing trans people [living] with HIV and AIDS also needs to be part of the conversation. I think it’s been unfortunate that it has been such a high hierarchy of who is addressed primarily. When you look at trans women who are HIV-positive, it very much follows how society is set up, [in terms of preferential treatment]. And so, there’s no conversation about [HIV-positive trans women], no prevention campaigns. We’re in tune to [this preferential treatment] in society. That, I think, really says something. AM: I think in part [it stems from] the masculinity attached to a kind of entitled sexuality. Men are sexual beings. When the AIDS crisis first began, it was absolutely necessary to teach people [in] the queer community about sex, and push into the public all these

conversations around practicing safer sex, and sexuality in general. JW: Women are often sidelined within the HIV movement. When it comes to HIV, feminism really dropped the ball. Especially in North America and the Western world, the epidemic is concentrated in [and around gay men]. It is true that gay men or men who have sex with men have higher rates of HIV [infection] but it doesn’t mean that [HIV] doesn’t exist in other places. Should women have the AIDS conversation in a different way than men do? LJR: I think we’re understanding now the effects of the epidemic. We’re seeing what happened when an entire creative class of people was wiped out, and how younger people are making creative work, and also how demographics of queer people are evolving post [AIDS] crisis. I hope that there is more dialogue. AM: There’s that concern of contamination [if we touch] people who are positive, in general. It gets amplified in relation to gender. As women, if you are already in a position where you don’t really have access to examples of being empowered sexually, then it becomes a problem. Queer and heterosexual positive women don’t have that literacy or that language [that gay men and MSM have] because of misogynistic and social control concerning women and women’s bodies. JW: To be quite honest, this [is] a bedroom conversation that generally happens behind closed doors. Fuck Positive Women is the public continued on page 62

Researchers

e know the drugs on the pharmacy shelves. We hear of the discoveries. We watch the pipeline. Unless we are lucky enough to travel to AIDS conferences, or sit down with some academic journals for some light reading, we rarely get a chance to hear from the creative forces behind the science that supports our health. Here’s our chance. Three scientists. Three sets of insights and inspirations. All three have made significant contributions to AIDS drug discovery, research and development. All three are still seeking answers and posing questions. All three have contributed to and continue to evolve the scientific lifeblood of Merck & Co., Inc., particularly in the field of HIV/AIDS. Meet Randi Y. Leavitt, MD, PhD, Executive Director, Clinical Research, Infectious Diseases, Merck & Co., Inc. After a long stint at NIAID, Dr. Leavitt joined Merck in 1993 and has since worked on clinical studies of Crixivan, Isentress, and HIV vaccine development. Meet Daria Hazuda, PhD, Vice-President and Therapeutic Area Head, Infectious Disease, Merck Research Labs. Trained as a biochemist, Dr. Hazuda has focused much of her energies on HIV and HCV antiviral research. Leading to the development of a new class of drugs, and first-in-class Isentress, her work on integrase inhibition earned her the Prix Galien prize in 2008. Dr. Hazuda’s lab first identified HIV-1 integrase inhibitors, established their mechanism of action, showed anti-HIV efficacy in vivo, and reported on basic mechanisms of resistance.

Scientists at Merck Weigh In on Work Done and Work Yet to Do by Chael Needle

Meet Sandi Lehrman, MD, Global Director for Scientific Affairs (GDSA) for Antivirals in the Office of the Chief Medical Officer at Merck. Joining the company in 2007, she provides scientific input into the Global Infectious Diseases Franchise strategy, focusing on Merck’s portfolio of HIV and HIV/HCV co-infection treatments. Her previous work included a tenure as Director of the Therapeutic Research Program in the NIH’s Division of AIDS, providing strategic leadership and direction to a staff responsible for clinical trials focused on the development of treatment of HIV/AIDS, associated co-infections, complications, and co-morbidities. These brief introductions barely do justice to the breadth and acuity of their work, but hopefully the following Q&A will help you understand just a little bit better some of the people behind the pipeline. A&U: What inspires you to commit (and recommit year in, year out) to improving the health of others, particularly when it comes to HIV/AIDS? Randi Y. Leavitt: As an infectious disease physician, I saw the impact of HIV/AIDS from early on in the epidemic. There was little we could do except treat the complications, but nothing really made a big difference. I was very lucky to join Merck when Crixivan was entering clinical trials. It was an amazing experience when we realized the impact of the drug on the disease and epidemic, and saw patients improving and planning to live. Similarly, I feel very lucky to have also worked on Isentress, which proved to be another incredible drug that positively impacted HIV-infected patients. I also had the opportunity to work on the HIV vaccine trials at Merck

and everyone involved was very disappointed that the vaccines that looked promising in animal models did not prevent disease in patients. Sandi Lehrman: I began working on HIV/AIDS in 1983 as part of the team at Wellcome that discovered and developed AZT. Over the three decades I have worked in the field I have seen survival of individuals with HIV infection go from six months to sixty years. Although HIV has been transformed into a chronic manageable disease there is still much work to be done. Our past successes motivate us to work toward a future that will provide research and medical insights that continually improve our knowledge of this infection with the goal of even better patient outcomes. As we learn more about the pathology/ biology of HIV infection and its role in driving cardiovascular and other complications we have recognized that this knowledge is also important in understanding the possible factors impacting these diseases in the uninfected population. These broader lessons learned are also important motivators. The science is fascinating and ever-evolving. Daria Hazuda: Knowing that you have the opportunity to contribute to something that has the potential to have a significant impact in the lives of others is a tremendous inspiration for me. Having been a part of the team that developed Isentress and meeting HIV patients who are alive in part because of something that I helped to create is among the most amazing and rewarding of experiences. But having seen what can be accomplished, this experience also helps me focus and remain committed to HIV, knowing that there is still so much more to do. A&U • MARCH 2014

photo courtesy Merck

The media often trumpets news of an “HIV cure,” and many in the general public are arguably left with an impression that a functional (or even sterilizing) cure is right around the corner. Yet, solid research advances have been made toward realizing a functional cure. Could a “functional cure” be imagined as a relatively stable 1,000-piece jigsaw puzzle, and, if so, how much would you say we’ve completed of it? Or is the puzzle too changeable that it’s hard to tell where we are? RL: For me, I would have to say the latter. The field has made incredible progress and we are all hopeful that a cure will be defined, but it is clear that the disease is very complicated. Although I am hopeful, it is hard to figure out how close to a cure we might be. What is clear is that the field is moving forward and I am optimistic. DH: I think we are still at the stage of defining whether the puzzle is 100, 1,000 or 10,000 pieces, or even if it is one puzzle or many that will have to be solved. Drug discovery research is always an iterative process and, until you begin, it is often difficult to define the issues and complexity of the challenge. HIV cure research is no different; we have hypotheses and need to develop the tools and methods required to better understand the issues. How do antiretrovirals, like raltegravir (Isentress); next-generation candidates like Merck’s MK-1439; HIV-preventive approaches like microbicidal candidates; or novel agents that activate HIV reservoirs fit into this puzzle? RL: I think every new advance and option is a step toward better control of the disease. Better-tolerated drugs, once-a-day drugs, and fixed-dose combinations have all had an important impact on making the disease easier to control. It is very clear that patients are more compliant with these better-tolerated, easier-to-use drugs. Effective microbicides would also be important in controlling the epidemic and providing additional options in preventing acquisition of HIV. SL: If we are to continually improve the outcomes for those infected, prevent new infections, and ultimately cure those infectMARCH 2014 • A&U

ed, the research community must be open to pursuit of new molecules for established modes of therapy and new approaches for prevention and cure. There are no magic bullets for any disease. For infectious diseases we must always think on a continuum of prevention, treatment, and cure. The changing nature of the infecting virus and the immune response to the infection requires that we not become complacent.

trials is really important. We really appreciate the participation of patients in trials. Without these trials, we cannot understand whether new drugs have the potential to impact patients. Additionally, encouraging others to participate in trials, get tested and take their HIV medications as prescribed can make a difference. Enthusiastic support of fundraising events is also important in raising community awareness. I think the HIV-infect-

Virologist in Virus and Cell Biology seeks a vaccine that will stop HIV/AIDS in its tracks.

DH: To address the global HIV epidemic requires a comprehensive approach including treatment, prevention and eradication. Improving therapy with new agents such as MK-1439, exploring different prevention approaches, including vaccine and microbicides, as well as research on eradication are all pieces of the puzzle that are needed to make progress towards the ultimate goal of global eradication. What role can individuals living with HIV take in the research (or any other) aspect of working toward the end of AIDS? RL: Willingness to participate in clinical

ed and at-risk communities have been very supportive of the community and involved in drug development, and this support has had a major impact. Community outreach to maintain awareness of the disease is really important. It is important that people, particularly teenagers, understand that everyone is at risk and also understand that HIV/AIDS is a serious disease. I worry that people think since there are drugs to control HIV that it is not a big deal. DH: The HIV community has always played an important role in the progress of continued on page 60

HOLDING TIGHTLY BUT GENTLY Historian Martin Duberman in His Latest Book on Singer Michael Callen and Poet Essex Hemphill Revisits the Early Battleground That Was AIDS by Lester Strong photographed exclusively for A&U by Stephen Churchill Downes

fter the introduction in the mid-1990s of protease inhibitors, the first class of drugs to successfully suppress HIV and inhibit the damage it causes to the human immune system, AIDS began to recede from the American consciousness as a major health concern. Gone were the mass protests by ACT UP and other organizations aimed at prodding government medical research agencies and pharmaceutical companies to come up with effective medicines to deal with the disease. Gone was the panic over the disease that led to calls for the quarantine of those infected by the virus. And gone— or at least diminished—was the rampant homophobia unleashed by the fact that AIDS in the United States first manifested itself in a big way among gay men. Times have definitely changed in regard to AIDS. But for anyone who lived through the epidemic in its early years, the memories are still there, and they’re not pleasant. Noted historian Martin Duberman has brought those years vividly to life again in his just-published book Hold Tight Gently: Michael Callen, Essex Hemphill, and the Battlefield of AIDS. His credentials for doing so are impressive: A Distinguished Professor Emeritus of History at the CUNY Graduate center in New York City (where he founded and was first Executive Director of the Center for Lesbian and Gay Studies), he is also a multi-award-winning biographer, playwright, and novelist. As a resident of New York City for many years and a gay activist, Duberman was aware of the AIDS epidemic from its start. As he explained in a recent interview with A&U about the book: “I was certainly aware early on. I was friends with Larry Mass [Dr. Lawrence Mass; co-founder of Gay Men’s Health Crisis, or GMHC], who wrote the first feature article about the disease in the New York Native in 1981. He was full of information on the subject, and we talked about it frequently. I also remember a trip to Fire Island very early in the epidemic to visit Larry, who had a house there. Vito Russo [author of The Celluloid Closet, published in 1981, a pioneering book on lesbian and gay themes in the movies] was staying there for a weekend, and he was up in arms that the gay community in Cherry Grove literally had their heads in the sand about AIDS, not mobilizing themselves, not raising money, not doing anything. I knew a lot of people who early on were already concerned about what would soon be labeled ‘Gay-Related Immune Deficiency,’ or ‘GRID.’” Aside from talking with people who were soon in the thick of dealing with the

AIDS crisis, Duberman over time came to have a more intimate acquaintance with the epidemic. A number of close friends were diagnosed with the disease and eventually died of it (including Vito Russo in 1990). Amid very busy academic and writing careers, he found the time to serve as a caregiver for many of those individuals, and after the founding of the People with AIDS Coalition (PWAC) in 1985, he volunteered several hours a week as a phone operator for that organization, as well as the proofreader of its newsletter. In the mid-1980s also he met the man who became his life-partner (with the advent of marriage equality they have since married). An HIV test for each revealed that Duberman was negative while his partner was positive. This was well before the introduction of protease inhibitors, and in Hold

Tight Gently he details both the upset over the diagnosis and the turmoil for years as his partner tried medicine after medicine, to no avail. In the interview, he described it more tersely: “He tested positive, and then it just became endless doctor’s visits, endless experiments. For one study he traveled back and forth to Boston for months, and was that a nightmare!” Nothing worked, and everything looked very bleak. “And then,” Duberman writes in the book, when his partner’s “T-cell count fell below 10, came the unbelievable release of protease inhibitors…and he’s reacted well to them down to the present day. In the end, we were among the lucky ones.” As a long-time supporter of progressive political and social causes, Duberman knew that in the United States medical care is skewed depending on where you’re placed on the racial, social, and educationA&U • MARCH 2014

al continuums. When it came to writing Hold Tight Gently, he wanted to track the early years of the epidemic in this country in their black and white dimensions. The virus and illnesses were the same for everyone afflicted by them, but the experience of having AIDS could be very, very different depending on who you were, where you lived, and what your racial or ethnic background was. As Duberman makes clear in the introduction to the book, the experience of having AIDS in this country “remains a profoundly gay one, with young, poor, nonwhite men disproportionately impacted….” It was his hope that a glance back might help those of us concerned about AIDS today in setting priorities for the future. To tell his story, Duberman decided to focus on two individuals: Michael Callen, a MARCH 2014 • A&U

white Midwestern transplant to New York City in the 1970s intent on pursuing a singing career; and Essex Hemphill, a black poet born in Chicago but raised in Washington, D.C., who became a central figure in a flowering of black lesbian and gay male culture during the 1980s that was compared to the Harlem Renaissance of the 1920s. Both were diagnosed with AIDS early on in the epidemic, and both died before the introduction of protease inhibitors—Callen on December 27, 1993, at age thirty-eight, and Hemphill, who was two years younger, on November 5, 1995, also at age thirty-eight. “Mike and Essex never met,” said Duberman during the interview. “I knew them both a bit, and I admired them both. As I began to research the book, I saw they played off against each other very well in terms of balancing the story. They tell the black and white

dimensions of the epidemic very well.” One of those dimensions: the differing reactions of Callen and Hemphill to the organized AIDS protest movement. According to Duberman, Callen jumped right in: “He was radical in his approach to AIDS, an important and very vocal activist. From the start he demanded that people living with AIDS have a say in their own treatment and care, and was one of the founders of the self-empowerment group PWAC. He battled the straight medical and political establishments when he felt that was called for, and battled the AIDS service and protest organizations—for example, GMHC or ACT UP [AIDS Coalition to Unleash Power]—when he felt that was needed. He was very courageous.” Callen continued his singing career, most prominently performing in different venues with the gay male a cappella group The Flirtations, leaving behind two albums as a member of The Flirts and two solo albums. But from the time of his diagnosis through most of the rest of his life, singing was subordinated to AIDS activism. Essex Hemphill, on the other hand, mostly avoided the white-dominated AIDS protest movement. Instead, he threw his energy into writing poetry and essays, editing a book of literary work by black gay male writers titled Brother to Brother, appearing in films and performance pieces aimed at exploring black gay identity and experience, and in general working to put black gay male and lesbian writers on the larger cultural map. He identified as gay, but he identified as black first. In Hold Tight Gently, Duberman quotes Hemphill directly on this point: “My race…even at the point of birth, was more important than my sexuality. That’s going to always be the case….I love my race enough to know that I’m a Black man first and foremost and that my sexuality falls in line after that.’” Another difference in the white/black dimensions of the epidemic: AIDS is, if left untreated, an acute, life-threatening, medical condition. But as Duberman notes in Hold Tight Gently, “While most white gay men were clamoring [before protease inhibitors were released] for admission to experimental drug trials, some African Americans were reluctant to enter them. Thanks to the notorious Tuskegee experiment (1932–72), distrust of the government was deeply entrenched….” (The Tuskegee experiment was the infamous decades-long study where the U.S.

Public Health Service tracked the “natural progression” of syphilis among 600 impoverished African American men in rural Alabama without ever treating them for it although penicillin as an effective cure was available for more more than half the duration of the study.) Duberman also notes another difference between the black and white responses early on during the epidemic: “Just as some white gays feared quarantine, some blacks feared that AIDS was a deliberate genocidal plot—‘just as the introduction of heroin had been’—to decimate minority communities.” There’s no indication in Hold Tight Gently that Essex Hemphill himself feared drug trials or thought AIDS was a genocidal plot by the government. But as the book makes clear, an important aspect of the black gay male mindset at the time was the perception of racist attitudes among many of the white professionals who made up the AIDS medical and services establishments and many of the white AIDS activists, including many of the white gay men who were themselves infected with the virus. That affected not just Hemphill in a big way, but the larger black community concerned about AIDS, the latter so deeply that the solution for many was to set up their own organizations to deal with the disease: the Black Coalition on AIDS (San Francisco), Gay Men of African Descent (GMAD; New York City), Black Gay Men United (Oakland), Spectrum (Washington, D.C.), the Minority Task Force on AIDS (multiple chapters), among others. The stories of Michael Callen and Essex Hemphill indeed reveal the differing white and black dimensions of the early AIDS epidemic, and in a startling way. Neither man had it easy, because the disease itself has never been easy to have. But their priorities could not have been more different. For Callen, once he had contracted AIDS, the main issue was medical: finding drugs that could cure the disease, or at least stop it in its tracks. Hemphill, on the other hand, certainly understood the consequences of having AIDS, but his own physical welfare was less important to him than something else. In Hold Tight Gently, Duberman quotes a black friend of Hemphill as

saying he “never really took a proactive stance with his own illness.” But he was proactive to the end in advancing his chosen cause: the creation, promotion, and visibility of black gay male and lesbian cultural accomplishments in the face of white indifference and even black hostility from conservative black cultural and religious leaders who denounced homosexuality as a threat to black survival. What do Callen’s and Hemphill’s stories tell us about dealing with AIDS today and tomorrow? One answer suggests itself in the title of Duberman’s book. Hold Tight Gently is taken from the title of the section in Hemphill’s Brother to Brother devoted exclusively to writings by black gay men on AIDS. Enter a warm embrace, it seems to say, one that is firmly protective but also reassuringly

friendly. But is that what Essex Hemphill and other African Americans stricken by AIDS in the 1980s and early 1990s felt about the medical establishment charged with their care? The AIDS crisis today is all encompassing in terms of race, gender, sexual orientation, age, and nationality. To meet that challenge, a paradigm of care must be achieved that is all-welcoming and that embraces everyone so as to meet each person’s needs as that individual perceives them. No doubt both Essex Hemphill and Michael Callen would have approved of that approach. To contact photographer Stephen Churchill Downes, visit: www.stephenchurchilldownes.com. Lester Strong is Special Projects Editor of A&U. A&U • MARCH 2014

[Book Excerpt] Hold Tight Gently Michael Callen, Essex Hemphill, and the Battlefield of AIDS Diseases relating to sex have long been viewed in Western culture as the result of divine retribution. As Peter Lewis Allen has demonstrated in his splendid comparative study, The Wages of Sin: Sex and Disease, Past and Present, the link between “debauchery” (variously defined) and punishment has a long history in the West, with “unbridled lust” widely cited by physicians and clerics alike as attributable to everything from leprosy to syphilis to bubonic plague. Allen makes the additional and crucial point that the latest plague would be marked—as none had been previously—by the afflicted banding together and beginning to see themselves as a “group of people defined by their illness and entitled to rights because of it.” In the same way that Mike Callen, Joe Sonnabend, and Rich Berkowitz were on the verge of combining their resources, others, too, were beginning to realize that they need not sit passively by while their country abandoned them. They could become proactive on their own behalf.

◊ In part to contrast the different perspectives of Michael Callen and Essex Hemphill, Duberman also includes their voices, resonating with different vibrations within the pre-HAART era. From Michael Callen: “There’s so much to do!” Mike lamented. He worried about his legacy. “It’s begun to dawn on me that some people misinterpret my message of hope to mean that everyone with full-blown AIDS won’t necessarily die of it. I have never said any such thing! Instead, what I’ve been trying to explain is that no one diagnosed with AIDS needs to die on cue! That’s a very different message. Long-term survival is possible; my own life proves it.” From Essex Hemphill: “Some of the T cells I am without are not here through my own fault. I didn’t lose all of them foolishly, and I didn’t lose all of them erotically. Some of the missing T cells were lost to racism, a well-known transmittable disease. Some were lost to poverty because there was no money to do something about the plumbing before the pipes burst and the room flooded. Homophobia killed quite a few, but so did my rage and my pointed furies, so did the wars at home and the wars within, so did the drugs I took to keep calm, cool, collected.…Actually, there are T cells scattered all about me at doorways where I was denied entrance because I was a faggot or a nigga or too poor or too black. There are T cells spilling out of my ashtrays from cigarettes I have anxiously smoked. There are T cells all over the floors of several bathhouses, coast to coast, and halfway around the world, and in numerous parks, and in countless bars, and in places I am forgetting to make room for other memories. My T cells are strewn about like the leaves of a mighty tree, like the fallen hair of an old man, like the stars of a collapsing universe.” Copyright © 2014 by Martin Duberman. These excerpts originally appeared in Hold Tight Gently: Michael Callen, Essex Hemphill, and the Battlefield of AIDS, published by The New Press. Reprinted here with permission.

MARCH 2014 • A&U

Facing AIDS Through Fashion Entrepreneur Dominique Drakeford Uses Her Talent to Spread Awareness by Jermane Graham

icture this; you’re at the first ple who are living with HIV/AIDS. Each annual World AIDS Condom contestant was given 900 expired conCouture Fashion Show hosted doms and a three-week period of time to by the student-run organization create a condom couture dress. Face AIDS NYU. Your expecThe competition’s theme was remtations aren’t skyscraper high; neither iniscent of multiple Grammy-winning are they below sea level. A few models R&B/hip hop female trio TLC’s method of walk down the runway with dresses that promoting safe sex through fashion in the have condoms strategically placed on early 1990s by attaching condoms to their them. But then the next model appears, clothing. The designers in the Condom snatching your breath away. She struts Couture contest took it to the next level, down the runway covered in nothing but it was taken even further by Drakeford. but condoms, and condom wrappers. Even though the competition didn’t have The only casual piece of clothing that any strict guidelines Drakeford was the she has on are high heels; other than only designer who took it upon herself to that she exemplifies the true meaning glue, sew, and staple condoms together in of condom couture. The person who’s order to create her first dress ever, responsible for grabbing your attention fully made out of condoms. is Dominique Drakeford. Completed in roughly two Drakeford is a twenty-five-year-old days, Drakeford’s dress “Confounder and the CEO of sustainable dom Nation” exposes the arms fashion PR and community developand back of the model. The front ment company Drake Natural. On forms a V shape composed of December 6, 2013, she attended and bare condoms, while the shoulparticipated in the first annual World der pads are made up of cut-up AIDS Condom Couture Fashion Show. condom wrappers. Lines of This platform gave her and a few other bare condoms were suspended designers the chance to simultaneously from the bottom of the waist-high showcase their talents and promote skirt portion of the dress. PossiAIDS awareness. bly the most significant part of Cash votes, which were sent toward the dress was the five-foot-long raising awareness for AIDS treatment train, which was latched onto in Rwanda, were taken from the audithe top of the skirt’s backside. ence to choose the winning dress. The Drakeford said, “The train winner received a gift card to Housing was kind of a bold statement, Works’ thrift store, which donates their a very Dominique edition to proceeds to serCasandra Rosario models Drakeford’s creation. vices toward peo-

the dress to kind of give it some sass and pizzazz.” As if layered condoms weren’t enough to stress the importance of safe sex, the train immediately diverts the mind back to wedding dresses, which is the usual garment that is known to have a train. The train on “Condom Nation” symbolizes Drakeford’s belief in safe sex even during marriage to prevent the possibility of transmitting HIV if one of the partners happens to have the disease. It would prevent them from bringing children into the world with the disease. Drakeford is familiar with some of the HIV/AIDS statistics in Africa. “When [Face AIDS NYU] gave us the condoms I had learned that even though the AIDS epidemic in Africa is ridiculous right now with about seventy percent of HIV-positive people living in Sub-Saharan Africa,” recalls Drakeford. “The usage of condoms has definitely increased, but that goes away when a couple wants to conceive a child which increases the chances of the disease multiplying.” With advancements being made in the medical field, HIV-positive women can now take a course of antiretroviral drugs during pregnancy which severely decreases the chances of their fetus being infected with the virus. It reduces the unborn baby’s chance of infection to two percent, but unfortunately not A&U • MARCH 2014

condom couture photos by Dominique Drakeford; hair & makeup by Dominique Drakeford

photographed exclusively for A&U by Alina Oswald

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A&U • FEBRUARY 2014

everyone has access to obtaining those drugs. All in all Drakeford stands behind various ways of decreasing widespread HIV transmissions. She supports abstinence as well as HIV/AIDS testing. “I would encourage partners to keep one another accountable for getting tested even if you practice safe sex. My dad always told me, ‘it’s better to be safe than sorry.’” The absence of female condoms from the show was something that went over Drakeford’s head and most likely the rest of the designers who participated as well. “To be honest I have no idea what a female condom looks like,” said Drakeford who found humor in trying to grab memories of its existence. “Female condoms are not acknowledged by the public. It’s funny because I remember taking my Sex Ed class and I don’t even recall talking about diaphragms. Maybe reading a passage in a book but never having a discussion about it. They’re almost obsolete in sex education today. Maybe it’s an alternative that we should look into.” In the beginning Drakeford didn’t receive the type of support that she would have hoped for. She states, “When I first proposed the idea to my family and to a couple of my friends there was a lot of skepticism, questioning, and sarcastic encouragement. Showing people that I can go against the odds, beat the status quo, was kind of exciting. Their reactions were a lot more fulfilling than the actual competition itself.” Even though Drakeford supports HIV/ AIDS awareness, she believes that the work that is currently being done could be improved. Since she’s an advocate for it herself in the fields of social and economic awareness and youth development, she sees where it is lacking. She says, “I never feel like community centers and even marketing agencies are doing enough. There’s always ways to do more and push the idea further.” As far as the methods used to spread awareness goes, Drakeford believes in heightening awareness through social media outlets, and forms of art can be extremely effective. “There was an exhibit at the Fashion Institute of Technology Museum with regards to fashion and LGBT awareness, which was interesting, so I think the idea Mark Bashian of infiltrating creative platforms to bring about AIDS awareness such as condom MARCH 2014 • A&U

couture are slowly seeping in…but it’s definitely not mainstream enough, not only for the LGBT community but for other communities as well.” She goes on to say, “I also think that HIV and AIDS awareness does focus on the LGBT community a little more when it needs to be clear that anybody, any race, ethnicity, and sexual orientation can contract HIV. Not just blacks, not just LGBT, not just in Africa, anybody.” Drakeford is originally from Oakland, California, where she obtained her BA in Environmental Management at the University of California, Riverside. She’s been a resident of New York City for about three years and has been attending NYU for a majority of her stay. During the spring of 2013 she completed her Master’s in Sustainable Entrepreneurship and Fashion, a program that she created herself. Drakeford’s company, Drake Natural, is a public relations and community development business. She states, “It is a startup company so it’s in the very beginning stages. Its purpose is to publicize this idea of sustainable fashion from an environmentally and ethically conscious point of view…and spark change in the social elements as well, [and] under that category is HIV/AIDS awareness, protecting yourself, people becoming individuals,

and making sound decisions.” Through her business agenda she shows how important environmental awareness is to her. Being grounded in environmentalism it has become somewhat of a way of life for the young entrepreneur. Drakeford says, “I’ve always had this philosophy that how we live is embedded in the natural world and the earth is not going to be the same years from now so we have to take care of it and nurture it and be able to live in unison with it. I’m not a tree hugger per se, but I definitely think that we need to cherish our natural resources and the beauty within them.” But besides the fact that she is aware of how much attention topics such as AIDS awareness and environmentalism deserve, she also has a goal for herself. “I really want to make a name for myself in the press in media outlets in publications. I want to be known, not only in New York, but in California. Those are like my two pinpoint areas to focus on and then eventually spread the company to London.” Winning the Condom Couture Fashion show opened the door for Drakeford to connect with NYC’s Department of Hygiene’s Director of Condom Distribution. The director didn’t hesitate to offer Drakeford more condoms to create dresses if she ever happened to join future condom dress contests. It was a beneficial proposal to Drakeford, who plans on seeking out more condom dress competitions for the sake of challenging her own talents and spreading HIV and STD awareness. When it comes to the future of condom dress competitions Drakeford claims, “I would never restrict myself to ‘I made this one dress and this is all I can make.’ I always tell people that fashion-forward change is limitless so I have no boundaries when it comes to creating change, instilling awareness, and doing good for a community. Yeah, I’m ’bout that life.” For more information about Dominique Drakeford, Condom Nation, and her Sustainable Fashion PR and Community Development company, Drake Natural, visit drakenatural.com. Photographer Alina Oswald is also a contributing writer for A&U (www.alinaoswald.com). Jermane Graham is currently a student at Medgar Evers College, CUNY. He will receive his bachelor’s degree in English with a concentration in Professional Writing this spring. He plans to become a music journalist.

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Mighty Mouse

a humanized blt mouse model creates a vital platform for drug discovery

n the early stages of drug discovery, many candidates that show promise of effective anti-HIV activity may be in the running. But which ones deserve to move on? That question is answered in part by those researchers who can help make visible and measure the anti-HIV effects of these candidates before consideration of a human clinical trial is even broached. At this stage of research, in other words, it’s all about the launching pad. One of those launching pads is the humanized BLT (bone marrow-liver-thymus) mouse model, which uses human cells within the animal to simulate how human virus interacts with both the body and HIV-specific agents that seek to target it. While the humanized BLT mouse model can be used to test many treatment and prevention approaches, it is especially important in a new wave of research into HIV eradication strategies, many of which seek to “kick” HIV out of its reservoir hiding spots, where it persists, despite antiretrovirals, in tissues and peripheral blood cells, in stable fashion, competent enough to replicate if it ever is given a chance. Activating this latent HIV is necessary in order to eradicate the virus completely. Of course, there’s little reason to activate the virus if one doesn’t have a strategy to recognize it and then kill it. Researchers know that stopping antiretrovirals often prompts latent HIV to start replicating, but, as this approach might create new rounds of infection, they want to see if latent HIV might be induced and attacked by an adjunctive agent even when an individual is on antietroviral therapy. Researcher J. Victor Garcia, PhD, Division of Infectious Diseases, Department of Medicine, UNC Center for AIDS Research, University of North Carolina School of Medicine, worked with a collaborative team across multiple sites on a study, whose results were recently published in the journal PloS Pathogens, that examined the effects of an adjunctive immunotoxin, 3B3-PE38, on latent HIV. 3B3 is an antibody that recognizes a specific HIV protein on infected cells, and then attaches to them, allowing PE38, a toxin, to enter and kill the virus-producing cells and spare, for the most part, others. The compound was developed by co-authors Edward Berger, PhD, and Ira Pastan, MD, from the National Institute of

Allergy and Infectious Diseases (NIAID). Both the distribution of, and the antiretrovirals’ and this targeted cytotoxic agent’s effects on, persistent HIV-infected cells were able to be measured because the mouse model is humanized; that is, it’s not an animal model that is merely similar to a human subject. It’s a step closer—an entire immune system made up of human cells, which can be infected by human virus and which can be treated with human antiretrovirals. Notes Dr. Garcia, who pioneered the mouse model and is a senior author of this study, which he helped conceive and design: “The translation from our model into clinical application is facilitated by the fact that we’d be using exactly the same reagent.” In the study, the mice were infected with HIV, the virus was then suppressed by antiretroviral therapy to the greatest degree possible, and then were given the immunotoxin. The goal was to see if an agent could target the virus-infected cells that remain ultimately out of reach of antiretrovirals. Notes Dr. Garcia, the first surprising result the team observed was viral RNA in the tissues of humanized mice undergoing the same antiretroviral therapies that would be administered to humans and remove the virus from the blood. “Viral RNA is an indication of the potential of the virus to replicate.…We found that there was this second reservoir of RNA-producing cells in virtually every tissue we examined—in the lungs, the liver, the thymus, the spleen. Everywhere we looked there was viral RNA. So we had an opportunity to test the new approaches to kill the cells, because we identified them as present.” He explains: “We saw that, when we put the animal on antiretroviral therapy, there was an expected reduction in the viral RNA in those tissues, but then, when we added the adjunctive immunotoxin therapy, we saw further reduction in the amount of viral RNA produced in individual tissues. So we found an effect on top of what the drugs were doing.” Garcia’s colleagues at the University of Minnesota, Stephen W. Wietgrefe and Ashley T. Haase, were able to “essentially go in and count how many cells in different tissues were

actually producing viral RNA. And, remarkably, after the addition of the immunotoxin, the numbers of cells making RNA were dramatically reduced in virtually every tissue that we looked at. That was proof that the immunotoxin could go in and kill infected cells in the animal that was already well suppressed by antiretroviral therapy.” The research team noted a six-fold drop in the number of infected cells throughout the immune systems. It’s not the agent’s effects but moreso the visibility of those effects that emboldens Dr. Garcia’s work toward a functional cure. “The biggest advance was not that we tested 3B3-PE38. It’s that we developed a platform in which we can evaluate different novel approaches to HIV eradication. So you can exchange the immunotoxin for another, or you can exchange the immunotoxin for a different type of antiviral or anti-HIV infected cell therapy, and then we can decide which one is the best. That could lead to prioritizing which approach to eradicating HIV could translate into clinical application.” A mode of comparison is now possible. “There might be other approaches that investigators have that might be better or more well suited and we need to have a platform in order to compare them head-to-head,” he says. “If you think about it, if the goal is to eradicate, we might have Agent A, being an immunotoxin; Agent B, a bifunctional antibody; Agent C a cytotoxic T lymphocyte approach; or a gene therapy approach; and so on, then we don’t really know which one is going to work the best but we need to demonstrate which one actually works, which ones are effective, and this is what we can do with the BLT model.” Chael Needle wrote about HPV-complication immunotherapy candidate Multikine in the January 2014 issue. A&U • MARCH 2014

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News of the Day

ere’s a look at some of the HIV cure headlines over the past couple months. The ever-growing momentum towards a cure, particularly funding for cure initiatives, is encouraging. Obama redirects $100 million towards HIV cure research At a White House gathering commemorating the 25th World AIDS Day on December 1, President Obama announced a $100 million dollar redirection of National Institute of Health (NIH) funds to be used for HIV cure research. The funds will be redirected from existing projects and resources that have expired, or will be expiring shortly, and will be used over the next three years. A substantial amount of the funds will be granted towards continuing the current objectives of cure researchers worldwide, including research on viral reservoirs, viral latency and viral persistence. “Beyond HAART: Innovative Approaches to Cure HIV-1” The National Institute of Allergy and Infectious Diseases (NIAID) and The National Heart, Lung and Blood Institute (NHLBI) have announced a new funding opportunity aimed at facilitating research of novel therapies to eliminate HIV. Guidelines from the grant announcements state: “Research topics of interest are as follows: cell therapies, including those based on hematopoietic stem cells; novel gene therapy approaches; and the development and delivery of non-traditional antiviral strategies (e.g. miRNAs, siRNAs, gene-editing enzymes). Applications are expected to include basic science/preclinical research as well as translational activities such as test-of-concept studies in animal models or humans. Applications must be designed as collaborative efforts between academia and the private sector.” Several grants through each institute will fund projects for a total of $11.2 million per year for five years. It is unclear whether these funds are a part of the $100 million redirected cure research dollars. Wistar Institute receives funding for largest randomized HIV cure trial Wistar Institute announces a large,

multi-institutional research project studying the effects of interferon alpha on HIV latent reservoir size. Wistar was awarded a NIAID based research grant of $6.2 million over six years, following positive results of a prior clinical trial on interferon-alpha. In the initial twenty-person study, half of the participants maintained viral load reductions under 400 copies/ml with interferon-alpha and saw a reduction in the size of latent reservoirs while ARVs were temporarily discontinued. The funding will expand current research to include a Philadelphia-based, 54 person, twenty-week, randomized, multi-site study of interferon. “An HIV cure will require going beyond current therapies, and our strategy has shown that it can do that. With this funding, Philadelphia will hold the largest randomized trial anywhere focused on testing an easily accessible strategy to advance an HIV cure,” stated Luis Montaner, Wistar Institute professor and research team leader, in an article on the Wistar Institute’s Web site. T-memory stem cells discovered Research conducted at Massachusetts General Hospital (MGH), The Ragon Institute of MGH, MIT, and Harvard have discovered a new type of cell which may help explain, or partially explain, how HIV persists long term in viral reservoirs, offering a clue to eradicating HIV from the body. HIV can be nearly cleared from the blood with the use of effective ARVs. It survives by infiltrating cells which then revert into a resting state and are impenetrable by ARVs. Scientists have long questioned how these cells persist when T cells, the main target of HIV, are short-lived and should eventually die off on their own. A report published in the January 12 online edition of the journal Nature’s Medicine, details the discovery of these long-lived T-memory stem cells that survive for decades and give rise to other types of T cells, possibly providing a sustainable source of HIV production.

amfAR launches “Countdown to a Cure for HIV/AIDS” On February 5, The Foundation for AIDS Research (amfAR) launched “Countdown to a Cure” at their recent New York gala. The new campaign aims to find a “broadly applicable cure” for HIV by the year 2020. amfAR plans to invest $100 million dollars over the next six years in this effort. AmfAR should be applauded for its efforts and supported in any way possible. However, the Web site description and cheesy video, to me, are a bit concerning and maybe even misleading. Among my concerns is the use of the phrase “broadly applicable cure,” which is widely stated, as its primary goal. In its campaign FAQ’s they state, “We might start by curing some of the people some of the time. It might be that there won’t be a single cure for all, but at this stage we can’t say for certain.” It’s completely reasonable to assume that a broadly applicable cure may not be possible within six years. However, with this being the case, should the non-profit be touting this as the primary goal of the campaign or was this a term chosen for its PR appeal when the campaign should stand as a respectable effort on its own? Jeannie Wraight is the editor-in-chief and co-founder of HIV and HCV Haven (www.hivhaven.com) and a blogger and writer for TheBody.com. She is a member of the Board of Directors of Health People, a community-based organization in the South Bronx and an advisor to TRW (Teach me to Read and Write), a community-based organization in Kampala, Uganda. She lives with her husband in the Bronx, New York. A&U • MARCH 2014

illustration by Timothy J. Haines

the latest reports on hiv cure research show momentum

FEBRUARY 2014 • A&U

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Race to the Cure

eyond the implementation of the Affordable Care Act, one of the biggest healthcare stories of 2013 was the emerging race of pharmaceutical companies to bring new drugs to the market to cure hepatitis C. The advent of direct-acting antiviral agents in 2011 started a revolution in hepatitis C treatment, but many people with hepatitis C and their providers are awaiting all-oral regimens that avoid the difficult side effects of interferon and ribavirin. By the beginning of 2014, four biotech leaders had emerged in the race to bring the simplest, easiest-to-tolerate HCV treatment regimen to the market. Gilead Sciences appears to be the front-runner now. In December, Gilead’s Sovaldi (sofosbuvir) became the first alloral treatment for certain hepatitis C genotypes 2 and 3 when it was approved by the U.S. Food and Drug Administration (FDA) as a component of a combination antiviral treatment regimen. The Sovaldi ribavirin-free regimen only requires patients to take one pill once a day. Though Sovaldi is highly effective for genotypes 2 and 3, the big prize is an oral regimen for genotype 1, which accounts for two-thirds of all hep C patients. Gilead has some impressive mid-stage results for Solvadi combined with both ribavirin and its own ledipasvir on genotype 1 HCV patients: a ninety-five percent cure rate after eight weeks of treatment. In even better news for patients who don’t want to take ribavirin, a dual oral regimen of daclatasvir (Bristol-Myers Squibb) plus Sovaldi cured more than ninety percent of chronic hepatitis C patients without interferon or ribavirin, according to a report in the January 16, 2014 issue of The New England Journal of Medicine. A series of new studies of this combination in difficult-to-treat groups including HIV/ HCV coinfected people and liver transplant recipients are underway. Janssen Pharmaceuticals is another in the pack. In November the FDA approved simeprevir (Olysio), an oral, direct-acting antiviral agent used for treating HCV as part of an antiviral treatment regimen in combination with interferon and ribavirin

in genotype 1 infected adults with compensated liver disease, including cirrhosis. Janssen (part of Johnson & Johnson) says Olysio may benefit patients with chronic hepatitis C, including those who are treatment naïve or who have failed prior interferon-based therapy. Bristol-Myers Squibb is preparing to offer an all-oral regimen including daclatasvir, asunaprevir, and BMS-791325. Last April, Bristol-Myers Squibb announced positive Phase II results for the combo. Up to ninety-four percent of patients were cured of hepatitis C after twenty-four weeks of treatment. Bristol-Myers Squibb is now in Phase III testing of the three-drug combo, and the company expects the regimen to reach the market sometime in 2014. This, in addition to the aforementioned positive results from the combination of daclatasvir and Sovaldi (Gilead) puts Bristol-Myers Squibb in contention to grab a big share of the HCV drug market, analysts say. AbbVie Inc. announced in December that its all-oral HCV therapy cured ninety-six percent of difficult-to-treat genotype 1a patients in a late-stage clinical trial after twelve weeks. However, its ability to compete could be hampered by a larger number of pills that must be taken: three experimental direct acting antiviral drugs that each attack a different target necessary for virus replication, plus the ribavirin. The drugs are the protease inhibitor ABT-450, whose effect is boosted by a widely used antiviral called ritonavir; the polymerase inhibitor ABT-333, and ABT-267 from a highly promising new class known as NS5A inhibitors. The company has four more Phase III trials underway, and is also testing its drugs without ribavirin. But other companies are shooting for combination

regimens that involve just one or two pills a day, giving them a big advantage over AbbVie in the race. Alliances and combinations also make for a crowded market. Right now, the race to be the first with a simpler, all-oral regimen for HCV looks more cooperative than competitive as companies test their drugs with other companies’ offerings. As an example, now that sofosbuvir has been approved by the FDA, Bristol-Myers Squibb is able use it in combination studies with daclatasvir. Three such Phase III trials are now underway, though not yet recruiting participants. Then again, which drug maker wins market share for HCV drug regimens matters less to HCV patients than who can provide the easiest and most tolerable—and most affordable—regimen. The global need for hepatitis C therapies is big and growing. More than 170 million are infected worldwide, according to the World Health Organization and up to 30,000 more are likely to be diagnosed with the disease each year in the United States. Those projections have drug wholesaler Express Scripts expecting the spending in the U.S. on hepatitis C to quadruple over the next three years. No matter who “wins” the market share, the amount of attention and money spent on treating HCV should be good news for the millions of infected people around the world. Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His young adult novel, The Genius of Little Things, debuted last year. A&U • MARCH 2014

illustration by Timothy J. Haines

who are the biggest players now in eradicating hepatitis c

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L A É R T N O M 2 .1 T C O Y A D N N I U A M T: S EVEN

IN ASSOCIATION WITH MANY THANKS TO

BBCM.ORG FACEBOOK.COM/FONDATIONBBCM

Condom Cutting Room does the adult film industry have a responsibility to promote safer sex?

n recent months, a number of popular all-male adult entertainment video production companies, including Lucas Entertainment, have opted to delve into the production of bareback films. This has sparked heated responses from both the pro and con camps on a variety of matters. Some have pointed out that straight adult videos have almost always been condom-free and no one has said a word. Perhaps they have; but two wrongs don’t make a right. Others have said that there is plenty to choose from—safer sex productions or raw films—so if you don’t like it, don’t watch. I insist on the use of condoms in my own intimate life and most certainly prefer to see that level of responsibility in my adult entertainment. Falcon Studios has tossed their hat into the bareback ring as well. While keeping condoms in use, they have announced that they will digitally remove condoms from the productions, prompting some to cry false advertising. Falcon has always been one of the major studios promoting condom use in the gay porn industry, and, while I commend them for remaining a studio that films safer sex productions, digitally removing the condoms from the films still glamorizes unsafe activity in its own way. If you ask any of the major players in the health field, such as the NIH, CDC or GMHC, you will find that each and every one, plus countless more, advocate the use of condoms. A document released by the CDC called “Condoms and STDs: Fact Sheet for Public Health Personnel” states the following: “Latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS. In addition, consistent and correct use of latex condoms reduces the risk of other sexually transmitted diseases (STDs), including diseases transmitted by genital secretions, and to a lesser degree, genital ulcer diseases. Condom use may reduce the risk for genital human papillomavirus (HPV) infection and HPV-associated diseases, e.g., genital

warts and cervical cancer.” No matter what reputable source you consult, the percentages of HIV and STI prevention are considerably higher when condoms are used correctly and consistently. It seems time that someone not only reminds the adult film industry of that fact, but of the impact they have on their viewers and fans. It’s no secret that the demand for raw

films is alive and well. In my Internet travels I often see “raw” and “bareback” as the top search words. This demand, along with the onset of PrEP, seems to have wooed adult film companies to produce more bareback films. “PrEP” stands for pre-exposure prophylaxis. The word “prophylaxis” means to prevent or control the spread of an infection or disease. The goal of PrEP is to prevent HIV infection from taking hold if you are exposed to the virus. This is done by taking a pill that contains two HIV medications every day. These are the same medicines used to stop the virus replicating in people who are already infected. Michael Lucas, the self-proclaimed human rights activist, owner and often performer in adult films for his own adult entertainment company, Lucas Entertainment, was one of the last hold-outs on producing bareback films; throughout his career he has been a staunch advocate of condom use. Not too long ago he had a change of heart after discovering PrEP and singing its praises in an interview with Out magazine. Lucas states: “I am advocating that we look at both the

social and medical science, and [to] begin responding accordingly….I’m now 41 years old, and have been sexually active for at least 23 years. I’ve lived through the horrific period when AIDS was untreatable. It’s a memory that will never go away. But since this disease is no longer a death sentence, our daily fear of it has diminished, and we have become more likely to slip up. That’s why the possibility PrEP offers our community is one we need to be talking about.” While I agree with the concept that HIV is no longer the death sentence it used to be, I would urge readers to make note of the statement “our daily fear of it has diminished, and we have become more likely to slip up.” Indeed. Should we live in fear? No. But we should thrive in awareness. By glamorizing unsafe sex, whether it be truly raw or a digitally manipulated fantasy, aren’t we giving people more of an opportunity to “slip up”? In addition, Lucas tells AVN: “It is mandatory for our models to undergo full panel testing no more than two weeks prior to a shoot regardless of the type of scene. A full panel test covers syphilis, gonorrhea, chlamydia and of course HIV. We don’t shoot unless the models have a clean bill of health. Models can verify their partners’ results if they desire. In addition, as a second level screen, we provide rapid HIV tests on the day of the shoot if the models request this additional verification. “We don’t discriminate against HIV-positive models. We pair HIV-positive models in condom free shoots as long as both are comfortable. Obviously we do not pair sero-discordant models in condom free shoots.” To add insult to injury, Lucas Entertainment goes so far as to put HIV-positive men in a place where re-infection or super-infection is possible. While I commend Lucas Entertainment for not discriminating against HIV-positive performers, Lucas might have lost sight of the fact that there are many different strains of the virus and pairing positive models with positive modA&U • MARCH 2014

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els in raw films puts both parties at further risk and may make an already difficult situation worse. In 2011, former adult entertainer Jack Ryan had a commentary published on Advocate. com. It began: “Someone just messaged me on Facebook to say I am a role model to them, and that excites me and scares me at the same time. I did porn to rebel and not be normal, but even in rebelling, you gotta keep boundaries. Safe sex is a must. “For those of you who don’t know, I did a bareback movie in 2008. I’m not gonna even mention the studio or the title, because I do not want anyone to purchase it, and I don’t want to promote it.” It was the only raw film he ever did. Later in the commentary he continued: “But promoting bareback sex, which I was outspoken against throughout my porn career, could have possibly caused one gay man to replicate my on-screen behavior, resulting in them contracting HIV.” Kudos, Mr. Ryan. Adult film entertainers are often revered as celebrities. In a world that often places perfect bodies and sexual prowess on a pedestal, is it

any wonder that many try to emulate those who seem to stand out above the rest? They have the kind of lives, at least from what we see on film and in their public personas, which many long for. They are beautiful, well built men living an arousing and exciting life in the spotlight. They are seen as stars. That being said, what message does appearing in a bareback film send? Does it sway the most vulnerable and impressionable of our community? When the mighty in the adult entertainment industry remove their condoms, do our young or impressionable view that action as they would their favorite superhero donning a cape? What prompts a production company to produce bareback films; a new customer base, taking hold of a new genre, higher sales? What leads a performer to appear in these films; higher rate of pay, new fans in a different category? Perhaps, but my concern is what sways viewers. What happens to the impressionable who want to be just like their heroes? Celebrities are used to promote and sell everything from cell phones to life insurance to their adoring public. Hair styles, fashion, fragrances, gyms and gadgets alike; we strive to be like those we admire. Consumer see, consumer do. Does it not stand to reason that

celebrities in the adult industry equally impact their followers and that indulging in raw sex may be just another way to be like those they look up to? What is the outcome of emulation if you are wooed to put your condoms aside by the actions of these men you admire? An article published in USA Today in January states: “The rate of HIV increased 22% among gay males ages 13 to 24 from 2008 to 2010, according to the Centers for Disease Control and Prevention in Atlanta. Teens and young adults accounted for more than a quarter of the 47,500 new infections recorded in 2010, the latest year for which statistics are available.” It takes a village, my friends. Each of us, in our own way and in any way we can, including the adult entertainment industry, should be promoting safer sex to our young and impressionable and reinforcing self preservation to all the members of our community. Rob Zukowski, a New York native, has spent twenty-five years in LGBT activism, both personally and professionally. He is a published writer and photographer and is currently pursuing a degree and licensing in complementary and alternative medicine.

A Calendar of Events

photo by JD Urban

nfold a napkin on April 24, when Dining Out For Life hosted by Subaru will be the special of the day at restaurants in cities across North America. Twenty-three-years-strong, Dining Out for Life gives you the chance to make sure AIDS awareness has a place at the table. More than 3,000 participating restaurants will donate “a generous percentage of the day’s proceeds to support service providers in their region to fund care, prevention, education, testing, counseling and other essential HIV/AIDS services,” according to the organizers. All you need to do is find a participating restaurant, place your order, and enjoy your meal, big or small. Organizers hope to raise an estimated $4 million. Cities from A&U’s hometown of Albany, New York, to Vancouver, British Chef Daisy Martinez playfully takes a bite out of Columbia, are represented by red ribbons on AIDS apathy as a spokesperson for Dining Out for an interactive map on Dining Out for Life’s Web site. It’s easy to link to information about a Life hosted by Subaru. participating city or region near you. longtime supporters of AIDS and Dining Out for Life hosted by Subaru has also enlisted the sup- nutritional services. port of celebrity spokespeople: designer Mondo Guerra, winner Visit www.diningoutforlife.com for of Project Runway All-Stars [A&U, January 2013], Ted Allen, host more info, and, for updates, follow the of Food Network’s Chopped, actor Pam Grier [A&U, April 2o13], event on Twitter and Facebook: and chef Daisy Martinez from Food Network’s ¡Viva Daisy! All are Facebook/DiningOut4Life.

MARCH 2014 • A&U

E R U T CUL S THE

AID OF

BOOKS

Body Counts by Sean Strub Simon & Schuster

Even those intimately familiar with the darkest days of the AIDS crisis might not know Sean Strub. Diagnosed with HIV in 1985, Strub protested with ACT UP at St. Patrick’s Cathedral and and was part of the group that covered Sen. Jesse Helms’ house with a giant condom. He was the first openly HIV-positive man to run for Congress. He started POZ magazine and founded the Sero Project, an organization dedicated to decriminalizing HIV/AIDS. All the while Strub was taking names and taking notes. Part personal struggle with AIDS, part chronicle of early public policy fights, Sean Strub’s Body Counts ensures that we never forget that frightening and infuriating time and who we should still blame. Comparisons will be made to Paul Monette’s personal, tear-jerking Borrowed Time or the fury-stoking documentary film, How to Survive a Plague. But Strub is more interested in a dispassionate and objective travelogue of the terrain of AIDS, death, inaction, and medical revolution in the trenches of the first decade of the crisis. There are takedowns of the usual suspects—Ronald Reagan, Anthony Fauci, NIH, Jesse Helms and closeted Washington insiders—as well as a bit of gratuitous name dropping of Strub’s celebrity friends like Andy Warhol and Bianca Jagger. Strub devotes a considerable amount of time on direct mail and donor appeals for fundraising campaigns. That’s more interesting than it sounds, because Strub wraps up the nuts and bolts of campaigns in the frustration of engaging those who could do a lot to help but fear sticking their necks out and jeopardizing their image. If Strub’s account lacks immediacy and passion it’s only because he’s writing from a

perspective two decades after the height of AIDS activism. Still, Body Counts is an important perspective to add to the canon of literature documenting the Plague Years. —Larry Buhl

Ethel Merman, Mother Teresa… and Me by Tony Cointreau Prospecta Press

Ethel Merman and Mother Teresa? Both were “other mothers” to Tony Cointreau whose family had made a fortune from the liqueur of the same name. He grew up well-off in New York City, with regular visits to France. But his family was not a happy one and he was subjected to sexual abuse by a teacher at his posh elementary school, abuse kept hidden for years. He does eventually get professional help, spurred by the emotional intensity of his volunteer work at Gift of Love, the residence for men with HIV operated by the Missionaries of Char-

ity, Mother Teresa’s order. Readers concerned with HIV will find this the most interesting part of the book. Cointreau writes about the early 1990s, a time before effective treatments. The men he encounters are mostly young and destitute and none will live very long. This period was one of intense controversy and heated activism around HIV, and it would be interesting to know how much Cointreau attended to the debates and frenzy of this era, but this is not the story he wants to tell. Rather, Cointreau offers the reflections of a volunteer in service to the dying. He finds great meaning in peeling potatoes, scrubbing floors, and helping with personal care activities while befriending residents. Cointreau offers several tender recollections of those lost to HIV and of Mother Teresa, whom he meets in New York and later spends time with in Calcutta. This book is not a typical literary memoir. Cointreau isn’t skilled in the techniques of fiction and too often tells us more than he shows us. However, the work is artfully organized and flows well, with chapters crafted mainly around particular events or figures. Of particular note are memories of Ethel Merman. Cointreau knows her from the time of her triumph in Gypsy to her death and shows us a more spiritual, giving, and complex woman than the confident, brassy singer of popular memory. Interestingly, we learn that Merman herself spent many hours as a volunteer at New York’s Roosevelt Hospital. Like the three people noted in its title, Ethel Merman, Mother Teresa and Me is a big-hearted book. —Nancy Ellegate Larry Buhl is the writer of A&U’s monthly Hep Talk column. Nancy Ellegate is a sometime book reviewer for A&U. A&U • MARCH 2014

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TESTING TOGETHER continued from page 27

is, having a third party start the dreaded HIV conversation with a new partner. “When we brought in focus groups of HIV men in each city, they said, ‘I knew I was positive when I met this guy but I didn’t tell him because I didn’t know it would go anywhere. One morning I woke up and said, ‘We had sex last night and how do I deal with this?’’’ They didn’t have a way to tell their partner and set the reset [button] in the relationship. For people living with HIV, as with coming out, the disclosure is a process that never ends. It’s challenging to find the right time to tell a relationship prospect.” Future plans • The CDC is supporting and expanding Testing Together around the country. Trainings are scheduled for El Paso, St. Louis, and Brunswick, New Jersey, and a few other cities this spring. Sullivan says it is likely that places already providing HIV testing and counseling will add Testing Together to their offerings.

3 RESEARCHERS continued from page 39

HIV research; HIV patient advocates have been key in increasing public awareness, providing forums for education and support, partnering with the government and pharmaceutical companies to facilitate drug development and supporting the need to make HIV research a priority for government and other funding agencies. In the current economic environment, these activities are as important today as in the past. We have made such great strides with therapy that the same sense of urgency is no longer apparent, but, given the enormity of the issues that still remain, we must continue to work together to make progress. From the beginning of AIDS research, Merck has been a generative environment for HIV-related research advances. In 1984, Merck launched a comprehensive AIDS research program. In 1988, its research team was the first to show that HIV replication could be interrupted by inhibiting the protease enzyme; and then its team was the first to determine the 3-D structure of protease. In 1996, Crixivan (indinavir) was approved as one of the first protease inhibitors. In 2007, Isentress (ralte-

er in a

artn Nancy men—both by society and MYTH: If a p nship o ti la re s Mahon, global u o gay men themselves—inmonogam er n rt a p executive dir e th fluenced testing practices. o “cheats,” the rector for MAC At the start of the AIDS said in would tell. crisis in the eighties a prepared r u fo sex between men in e statement that REALITY: On was criminalized a have the organization partners who y in many places, sa t emen will continue to invest onogamy agre m and there was no at in Testing Together and ped outside th ep st ey Americans With th that she is “gratified that the last year, Disabilities Act. in h it w t en em the CDC is now bringing agre of them didn’t HIV testing was set this program to scale and five in six . it t u o b a er to reach more people up with protectn rt tell their pa nationwide.” ing confidentiSullivan adds that ality—gay sex there is interest in explorwas shameful and HIV was shameful ing the possibility that couples testing and deadly—and it was a given that you actually helps HIV-positive partners link wouldn’t test with another person present. into care, and suppress their viral load Sullivan hopes the increased societal sooner. A study to be conducted in Bosrecognition of male couples and their legitton, Atlanta, and Chicago this year will imacy and respect for those partnerships test this theory. will encourage many more male couples, A comprehensive approach to testat whatever stage of whatever kind of relaing gay male couples may seem like a tionship they’re in, to test together. no-brainer now. So what took it so long for the idea to gain traction? Sullivan points to the societal changes since the Larry Buhl interviewed writer, editor, and advocate early eighties, and how attitudes about gay Khafre Kujichagulia Abif for the February issue. gravir) hit the shelves. Next-generation NNRTI candidate MK-1439 is now in Phase II. Sincerely, what do you believe accounts for such a productive track record? What are the special ingredients—the values or best practices—beyond attracting top researchers? RL: I think Merck has incredibly bright and committed basic researchers developing new drugs. The company has committed its resources toward drug discovery and development. SL: I came to Merck after working at Wellcome and also serving as the head of the Therapeutic Research Program for the Division of AIDS at NIAID. Merck is committed to advancing the best science to enable continually improving outcomes for patients. The integrase program, with which I have been highly involved, is an example of commitment to new molecules and mechanisms that make a difference in HIV. This began with the first non-nucleoside reverse transcriptase inhibitor (NNRTI), efavirenz, and progressed to the first protease inhibitor, Crixivan. The ongoing “cure” work at Merck, in collaboration with many academic investigators, is an additional example of Merck leading the field. In my entire career I have been privileged to be part of the teams leading the field. In coming to Merck I felt that I would have continued opportunity to advance science. DH: I am biased, but I believe Merck HIV

research has some of the best scientists in the world. We are all driven by a passion to make a difference and commitment to a mission that we believe supersedes us as individual scientists. HIV provides a compelling mission that is a deeply and personally unifying force. It is that common mission and the ability to work collectively as one team utilizing the strengths and skills of each individual to tackle the most difficult and sometimes seemingly insurmountable challenges that makes us successful and also makes it both fun and a privilege to come to work every day. We are not afraid to take on these challenges or learn from failure because we believe in the mission and trust each other, and we all love what we do. Is there anything you would like to add that we haven’t covered? DH: Drug discovery is incredibly challenging, fraught with failure and disappointment and many people who work in drug discovery research never participate in a project that makes a drug. I have been very fortunate to have been a part of the team that discovered Isentress and I wish everyone could experience the amazing feeling it is to know that the work you do has had a significant impact in the lives of patients. Chael Needle is Managing Editor of A&U. A&U • MARCH 2014

A&U Gallery continued from page 37

art about AIDS that we’re still censored. That’s really telling about how powerful art about AIDS is, and that there’s still censorship happening. AM: I think there’s always a battle. It requires activists to be vigilant and fight for maintaining rights and access. JW: I do a social practice called No Pants, No Problem through which I create activism banners. A favorite one says, “HIV is not a crime. HIV prosecuting is.” I love the merger between art and activism. Art allows you to push more. Art is about starting dialogue, and also creating pretty things.

L.J. Roberts,The Queer Houses of Brooklyn in the Three Towns of Breukelen, Boswyck, and Midwout during the 41st Year of the Stonewall Era, (based on a 2010 drawing by Daniel Rosza Lang/Levitsky with 24 illustrations by Buzz Slutzky on printed pin-back buttons), 2011 Poly-fill, acrylic, rayon, Lurex, wool, polyester, cotton, lamé sequins, and blended fabrics, 138 by 114 by 108 inches. Courtesy of the Smithsonian American Art Museum, Gift of Elaine Reuben. Photo by the Smithsonian American Art Museum performance of that private conversation. We should be able to have [it] in a way that feels good to us. There’s not one way to [have] it, but silencing more provocative ways is not really fair. We see things with this piece that we don’t generally see—women living with HIV being assertive in their sexuality, taking action and owning it. That’s a big deal.

alized materials, to address marginalized populations—women, people of color, working class people. Because textiles have been marginalized in society. And the more marginalized you are, the less [your issues are] addressed. AM: I think textiles can work as a device to bring people closer to a different kind of message. It’s something that’s connected to the body, one of our most intimate materials. As a piece of art, that material makes people put their guard down in terms of fear of touching someone with HIV. JW: There are many layers to it. This is a topic talking about a population against which there is a lot of stigma. [Sometimes people] don’t want to touch or even get close to [people living with HIV]. [And yet they] want to get close to this piece that looks like it should be hanging in [their] grandma’s house.

The material used to create the artwork shown in “Queer Threads” is made of fiber and thread. Textiles. Why is that important? LJR: There’s a mirror-effect that’s set up with choosing textiles, traditionally margin-

Where does this kind of art activism leave us in terms of the ongoing fight against AIDS? LJR: I hope that people will look at contemporary work as a way to really encourage dialogue and activism. We are still so frightened by

What are a few contemporary issues we need to address relative to HIV/AIDS? LJR: There are a lot of issues about AIDS and HIV that are very much of immediate concern, like criminalization and prevention, the dialogue about women and AIDS, trans issues and AIDS. I hope art will be made to address these issues. AM: I made a flag, Queer Un-Nation, to carry in an alternative [grass-roots] Pride [event] called Stonewall TO. It is critical about queer politics being taken in the direction of nationalist politics, where [marriage and adoption rights, serving in the military are perceived] as the only and most important rights for queer people, watering down the revolutionary politics, and sexualities. JW: There’s an automatic assumption that women living with HIV almost always [are straight]. Queer women are not even part of the discussion. Criminalization of HIV, nondisclosure, not being able to talk openly about your sexuality, HIV status, sex for pleasure... it’s detrimental for the HIV movement, and I think it perpetuates patriarchy, heteronormative ideas, and silences women and people living with HIV, and that’s a huge problem. And it’s hard because, globally, over half of the people living with HIV are women. Young women, in particular in some places, make up seventy-five percent of people living with HIV. It’s mind-blowing. “Queer Threads: Crafting Identity and Community” is running from January 17 – March 16, 2014, at Leslie-Lohman Museum of Gay and Lesbian Art in New York City. Jessica Whitbread and L.J. Roberts will give a talk on Queer Craft and AIDS at the museum on March 13. Visit www.leslielohman.org for more information. For more information about the artists, visit Allyson Mitchell: www.allysonmitchell.com; Jessica Whitbread at: www.jessicawhitbread.com; and L.J. Roberts at www.ljroberts.net. Alina Oswald is a writer, photographer, and the author of Journeys Through Darkness: A Biography of AIDS. Contact her at www.alinaoswald.com. A&U • MARCH 2014

MARCH 2014 • A&U

Survival Guide

[a portrait by sean black]

[

Daniel Pearce Palm Bay, Florida Living with HIV, he has served his community for over twenty years. He is currently the president of Project Response, a Central Florida ASO.

“In giving back, I discovered my life again.”

Sean Black is an Editor at Large of A&U.

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A&U • DECEMBER 2013 A&U • MARCH 2014

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