POZ June 2021

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H E A L T H ,

L I F E

&

H I V

Words and Wisdom Exploring poetry, passion and HIV

Jericho Brown

IMPORTANT FACTS FOR BIKTARVY®

(bik-TAR-vee)

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

MOST IMPORTANT INFORMATION ABOUT BIKTARVY

POSSIBLE SIDE EFFECTS OF BIKTARVY

BIKTARVY may cause serious side effects, including:

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

` Worsening of hepatitis B (HBV) infection. Your

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

ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults and children who weigh at least 55 pounds. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements.

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS. Do NOT take BIKTARVY if you also take a medicine that contains: ` dofetilide ` rifampin ` any other medicines to treat HIV-1

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

including hepatitis infection. ` Have any other health problems. ` Are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby.

Tell your healthcare provider if you become pregnant while taking BIKTARVY. ` Are breastfeeding (nursing) or plan to breastfeed.

Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

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

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

HOW TO TAKE BIKTARVY

Tell your healthcare provider about all the medicines you take:

Take BIKTARVY 1 time each day with or without food.

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

GET MORE INFORMATION

counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. ` BIKTARVY and other medicines may affect each other.

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

` This is only a brief summary of important information

about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more. ` Go to BIKTARVY.com or call 1-800-GILEAD-5 ` If you need help paying for your medicine,

visit BIKTARVY.com for program information.

BIKTARVY, the BIKTARVY Logo, GILEAD, the GILEAD Logo, KEEP LOVING, and LOVE WHAT’S INSIDE are trademarks of Gilead Sciences, Inc., or its related companies. Version date: February 2021 © 2021 Gilead Sciences, Inc. All rights reserved. BVYC0370 04/21

PZA529987_1-1.pgs 04.20.2021 01:56

ESA

NIKKI LIVING WITH HIV SINCE 2008 REAL BIKTARVY PATIENT

KEEP LOVING.

Because HIV doesn’t change who you are.

BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.

Ask your healthcare provider if BIKTARVY is right for you.

See Nikki’s story at BIKTARVY.com.

Featured patient compensated by Gilead.

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

PZA529987_2-2.pgs 04.20.2021 01:56

ESA

CONTENTS

EXCLUSIVELY ON

POZ.COM POZ BLOGS Our roster of bloggers spans the diversity of the HIV epidemic. Go to poz.com/ blogs to read varying points of view from people living with the virus as well as from HIV-negative advocates.

Join the conversation in the comments section. Visit the blogs to find hope and inspiration from others.

D

POZ OPINIONS

#UNDETECTABLE The science is clear: People who have an undetectable viral load can’t transmit HIV sexually. In addition to keeping people healthy, effective HIV treatment also means HIV prevention.

Go to poz.com/undetectable for more.

POZ DIGITAL Scan the QR code (left) with your smartphone camera to view the current issue, or go to poz.com/ digital to see past issues online.

Jericho Brown tells his truth about HIV through poetry.

22 HEART TO HEART In his Pulitzer Prize–winning poetry, Jericho Brown reveals how HIV, rage and rape can coexist with joy, lust and love. BY TRENT STRAUBE 28 A COMPLETE HISTORY OF HIV/AIDS WILL DEPEND ON YOU Preserving the stories of 40 years of the epidemic BY MARK S. KING 3 FROM THE EDITOR

14 ASK POZ

A Little Respect

How do I know if I have HIV?

4 POZ Q+A

16 CARE AND TREATMENT

In her new book, Let the Record Show, AIDS activist and author Sarah Schulman discusses the early political history of ACT UP.

Promptly starting HIV treatment works for teens • gender-affirming surgery linked to HIV suppression • redefining support for mothers who have HIV • community collaboration cuts HIV rates

6 POZ PLANET A book of portraits and stories of dogs and their humans fighting stigma • protections for LGBTQ people, including seniors, help fight HIV • getting the word out on the street about PrEP • Everyday AIDS milestones

18 RESEARCH NOTES

A yearly PrEP implant? • treatment that lasts two months • HIV comes back in a Brazilian man • liver fibrosis concerns

10 VOICES

20 BASICS

Jeremiah Johnson of Treatment Action Group asks: What if we treated COVID-19 the way we treat HIV? Plus: Singer and activist Sherri Lewis shares how she and her mother overcame COVID-19.

Monitoring your viral load and CD4 count to see how well treatment is working

12 SPOTLIGHT Transgender Day of Visibility

32 HEROES After leading New York City’s “Ending the Epidemic” initiative, activist doctor Demetre Daskalakis, MD, MPH, now heads national HIV prevention efforts at the CDC.

POZ (ISSN 1075-5705) is published monthly except for the January/February, April/May, July/August and October/November issues ($19.97 for an 8-issue subscription) by Smart + Strong, 1001 Avenue of the Americas, FL 12, New York, NY 10018-5460. Periodicals postage paid at New York, NY, and additional mailing offices. Issue No. 252. POSTMASTER: Send address changes to POZ/Smart + Strong, 1001 Avenue of the Americas, FL 12, New York, NY 10018-5460. Copyright © 2021 CDM Publishing, LLC. All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted, in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the written permission of the publisher. Smart + Strong® and POZ® are registered trademarks of CDM Publishing, LLC.

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Advocates, researchers, politicians, thought leaders and folks just like you all have ideas worth sharing.

Go to poz.com/ opinions to read about topics such as living with HIV, improving care and treatment, increasing prevention efforts and fighting for social justice.

FROM THE EDITOR

A Little Respect

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STILL FIND IT SURPRISING, even after all these years of being out as a gay man living with HIV, just how similar the journeys have been for my fellow LGBTQ folks, especially those of us who have HIV, no matter how different from one another our paths have been.

The journey our cover subject, Jericho Brown, has experienced is a case in point.

The Pulitzer Prize–winning poet tested HIV positive in 2002, at age 26. He kept his status private for many years. Although he came out to his parents, they struggled with his sexual orientation. He is now in a better place in his life because of being out about being gay and living with the retrovirus.

Apart from the Pulitzer Prize and poetry, I can relate to his journey. I’m sure many of us can. I was 22 when I tested HIV positive.

I kept my status to myself for ages. I had difficulty with coming out about being gay and living with HIV. I’m in a much better place now because of being out. These similarities give many LGBTQs a shared story.

Of course, even though relating to one another as fellow LGBTQ people provides us with a sense of community, we shouldn’t overlook that there are often significant differences that should be respected. To learn more about Jericho’s journey, go to page 22.

In this LGBTQ-themed special issue, we spotlight other LGBTQ advocates, such as Demetre Daskalakis, MD, MPH, the head of HIV prevention at the Centers for Disease Control and Prevention (CDC). He was previously at the New York City health department, where he helped to reduce HIV rates citywide. Go to page 32 to read about his HIV prevention goals at the federal level.

This year is the 40th anniversary of the first report about the disease that would eventually be called AIDS. Published on June 5, 1981, in the CDC’s Morbidity and Mortality Weekly Report, the account described unusual cases of pneumonia among five gay men. The rest, as the saying goes, is history. But whose history is it?

AIDS history belongs to everyone, but for those of us living with HIV and our allies, there is an undeniable sense of ownership when it comes to telling the stories of these four decades. As we’ve seen in the past few years, AIDS history is getting told and retold by an increasingly diverse group of people.

Mark S. King has been writing about AIDS history for decades. Go to page 28 to read his essay about preserving the stories from 40 years of the epidemic and how a complete history of HIV/AIDS will depend on you.

You’ll also find ways to preserve your stories.

As Mark argues in his essay, the benefit of each of us telling our tales is that we build a more complete version of events. Such is the intent of a new book by activist and author Sarah Schulman. Based on interviews with surviving members of ACT UP, the book tells the stories of a wide variety of people who rose up to fight HIV/AIDS. Go to page 4 for our Q&A. A heartwarming example of folks contributing to a more complete HIV/AIDS story is a new book profiling people living with HIV and their dogs. Go to page 6 to read more.

ORIOL R. GUTIERREZ JR. EDITOR-IN-CHIEF editor-in-chief@poz.com

Want to read more from Oriol? Follow him on Twitter @oriolgutierrez and check out blogs.poz.com/oriol.

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POZ Q+A

BY TERRI L. WILDER

Sarah Schulman is codirector of the ACT UP Oral History Project.

Activist and author Sarah Schulman discusses the early history of ACT UP New York in a new book.

S

ARAH SCHULMAN IS AN ACTIVIST, AUTHOR AND HISTORIAN. Spanning decades, her novels and nonfiction works explore LGBTQ themes, including HIV/AIDS. She has also produced plays and films, including the documentary United in Anger: A History of ACT UP, which she coproduced and was directed by Jim Hubbard.

So it’s no surprise that her newest book, Let the Record Show: A Political History of ACT UP New York, 1987–1993, arrives with great anticipation. Based on interviews with surviving members of ACT UP (AIDS Coalition to Unleash Power), it celebrates the extraordinary people who rose up to fight HIV/AIDS and changed the world.

How did you come up with the idea for the book? Why did you publish it now?

Jim Hubbard and I started the ACT UP Oral History Project in 2001 because the internet revolution had eclipsed ACT UP. Suddenly, everybody was online, and none of our stuff was digitized, and it was like we had disappeared.

We thought that we would just do these long-form interviews and that other people, probably academics or others, would analyze the data, but we found as the years went on that nobody was really analyzing the data. I know what kind of treasures were in the interviews, but they never seemed to appear anywhere.

It was either because people weren’t reading them critically, or they were just searching for keywords. I don’t know exactly what the problem was, and, of course, Jim in the meantime had preserved about 2,000 hours of archival footage. We made all that available. We made everything available for free. We had open access. We had 14 million hits on our website, and yet the treasures were not being unearthed.

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It started to go really bad when work started to appear that really distorted the history, creating basically white male individual heroes and ignoring the actual functioning of the organization and what the AIDS coalition was really like, and it was very disturbing.

We kept trying to find somebody to do it, and I had always been a huge fan of Taylor Branch’s book Parting the Waters, which is a two-volume analysis of the civil rights movement’s strategies, and it just became clear that I was going to have to write it myself.

I spent about three years rereading interviews and trying to cohere large tropes. What were the themes? What did they show? What was revealed? I didn’t want to just reprint interviews. I wanted to really analyze the material.

After about three years, I had a manuscript, then we put it up for sale to major book publishers. I ended up getting a great editor, Jackson Howard, at Farrar, Straus and Giroux, who was 26 years old, and he helped me fashion

COURTESY OF SARAH SCHULMAN

FOR THE RECORD

it in a way that someone who’s 26 can understand.

Who do you hope will read the book?

What is the significance of the title?

The book is for everyone, but it’s mostly for people who want to make change right now. ACT UP was probably the most recent successful social movement in America. It’s important to understand that movements can win something, how they do it and what mistakes they make.

So it’s an anti-nostalgia book. It’s really about strateg y, and the title comes from a very early art event that ACT UP did at the New Museum that was called Let the Record Show—this was before the art collective Gran Fury was even formed—where they showed images of the Nuremberg Trials.

What was implied was that the people who were responsible for the neglect and indifference that caused the mass death experience of AIDS in the United States would someday be made accountable, and yet they never really have been.

In this book, I wanted to finally fulfill the wish of that early exhibit by showing who really were the problematic people and who really created the solutions.

COURTESY OF FARRAR, STRAUS AND GIROUX

The first sentence in the preface declares that this is a book in which all people with AIDS are equally important. Why did you start with that?

Because the popular historicization in recent years has narrowed and whitened the coverage of AIDS history to the point of parody.

It gave the impression that it was individuals, most of whom were white and male, who transformed the AIDS crisis, and that’s just simply not true.

The crisis was transformed by a very broad coalition of lots of different kinds of people.

Many of us have the wrong idea when we say the word coalition. Some people think of it like a Benetton ad with an Asian person and someone Puerto Rican, etc. That’s not what a coalition is. Coalitions are silos of likeminded people who work together in a way that is effective and that makes

sense to them, standing side by side with each other and having their work resonate with each other. That’s really what the AIDS coalition was.

In my book, I’m also including mothers, prisoners, Haitians, drug users, homeless people. If you’re not looking at all of these different kinds of groups, you will have no idea how change actually occurred.

The first chapter of the book focuses on Puerto Ricans in ACT UP. Why?

What I was not going to do was write a chapter on Latinos, a chapter on Asians, a chapter on women, etc. So there are three chapters that focus expressly on Latinos. There are Puerto R icans.

There’s a chapter on Patricia and Ray Navarro, and there’s a chapter at the end

Latinos who were in ACT UP. So I thought why not just start there?

Why did you put remembrance sections in the book?

So many people in ACT UP died. I never had a chance to interview them because I didn’t start interviewing until 2001.

There are so many of them that I did not include. If you look at our film United in Anger, you can see more of them. The deaths of our friends were overwhelming. People carry it with them the rest of their lives, so it had to be part of the story.

What do you want folks to take away from this book?

The most important idea is that successful movements do not use consensus. A truly effective movement will practice

“A truly effective movement will practice radical democracy.” on Cesar Carrasco, a Latin American gay man. There are other Latinos throughout the book, including Robert Garcia and Aldo Hernández.

However, the two Puerto Rican men that I focus on were very well-known leaders in ACT UP. Both were HIV posit ive. One of t hem is Rober t Vazquez, who is Nuyorican, Black Puerto Rican, born in New York. The other, Moisés Agosto, was from the island, so contrasting the two of them was absolutely fascinating.

In the process, I learned that there were four Latino committees in ACT UP. There was the Latino Caucus, the Spanish Translation Committee, the Immigration Committee and the Majority Action Committee. When I interviewed Cesar Carrasco, he named about 35

radical democracy. It will have a big tent in which people can respond simultaneously in the way that makes sense to them, because people can only be where they’re at—trying to force people into one analysis or one strateg y or even one vocabulary has historically always failed.

ACT UP succeeded to the extent that it did because it had so many different strategies and so many different communities acting in a way that made sense to them at the same time that there was a simultaneity of response. That is where I hope we can go next in our movement. Q

Terri L. Wilder, MSW, has written for TheBody.com since 2007. Her HIV activism was honored in the 2017 POZ 100.

poz.com JUNE 2021 POZ 5

POZ PLANET

BY TRENT STRAUBE

DOGS AND THEIR HUMANS FIGHT STIGMA Portraits and stories from an HIV fundraising book Whoever said laughter is the best medicine probably didn’t have a dog. Canine companions have the power to save lives. Just ask any of the people living with HIV who are beautifully photographed and profiled in the book When Dogs Heal.

“Each story and image showcase how a dog’s unconditional love [can restore] hope in the future, combat stigma and overcome much of the hardship that for many of us define an HIV diagnosis,” says Robert Garofalo, MD, MPH, a professor of pediatrics who codirects the Gender & Sex Development Program at the Ann & Robert H. Lurie Children’s Hospital Center of Chicago.

In 2010, Garofalo tested HIV positive.

Despite his medical expertise (he often works with HIV-positive youth), he became depressed and isolated. That is, until a 10-week-old Yorkshire terrier named Fred entered the picture. Inspired, Garofalo launched Fred Says, a nonprofit that raises money for young people with HIV. When Dogs Heal is the latest fundraising effort from Fred Says. It’s the result of a six-year collaboration with fine art dog photographer Jesse Freidin. Together, Garofalo and Freidin traveled across the country to meet and photograph

6 POZ JUNE 2021 poz.com

HIV-positive people and their dogs. Journalists Christina Garofalo (Robert’s niece) and Zach Stafford (MSNBC, The Advocate) compiled the stories that accompany the photos.

(To read examples of heart-wrenching and heartwarming stories and to order a copy, by Lerner Publishing imprint Zest Books, visit WhenDogsHeal.org.)

The people featured in the book represent the full range of those impacted by the HIV epidemic and span age, race, sexual identity and socioeconomic background. “The themes that you read about in this book are universal,” Garofalo tells POZ. “They transcend HIV. While these participants have their struggle grounded in the stigma and challenges that accompanied an HIV diagnosis, what you read in these pages are more universal struggles about substance use, or intimate partner violence, or depression, or a physical disability. People— regardless of their HIV status—have written to us because they see themselves in these pages, and they feel as though their stories have been seldom told or celebrated.”

For example, there’s the story of Lynnea, who in 1992, at age 7, learned that she had AIDS and who in her 20s “mistook acceptance for love” and found herself in an abusive relation-

WHEN DOGS HEAL (ZEST BOOKS)/JESSE FREIDIN

Clockwise from top left: Lynnea and Coconut, Julian and Papi, Amador and Bella, Richard and Stoli, and Rob and Fred (the doctor and doggie duo behind the HIV nonprofit Fred Says). Inset: the book’s cover.

ship. As she recounts in When Dogs Heal, her life changed when she brought home Coconut.

“Coconut showed me that I deserved more out of a partner—not just for me, but for the baby girl growing inside of me,” Lynnea says in the book.

“Being by myself felt really lonely at times. I cried a lot over what might come of my life after having a child. But Coconut made it better just by being there.

He wouldn’t let me sit around feeling depressed.

“Lately, I’ve found myself not hiding in silence anymore,” she continues. “I no longer look at HIV as something negative in my life, or as a reason to push people away.… Coconut has shown me I can be loved by another living thing—that I deserve a love that doesn’t hurt.”

Photographer Freidin says his aim was to create a “calm, clean, quiet, welcoming space for participants to feel seen—a blank canvas void of stigma or oppression, where their true selves could shine.

Visually, these portraits all feel like a moment of safety, as well as a moment of empowerment.”

Several of the photographs and stories appeared in a When Dogs Heal exhibit that traveled to several cities across the states. But now, thanks to the book, everyone can enjoy these gorgeous portraits and inspiring tales—and tails.

poz.com JUNE 2021 POZ 7

POZ PLANET

BY TRENT STRAUBE

Having a Senior Moment

Protecting LGBTQ equality helps fight HIV. Within a few hours of his January 20 inauguration, President Joe Biden signed 17 executive orders. One explicitly protects LGBTQ people from discrimination.

The order had been deemed necessary because after the Supreme Court ruled last year that employers could not discriminate against LGBTQ workers, the Trump administration stated that the ruling did not apply to other areas, notably health care.

Biden’s executive order clarified that, indeed, federal antidiscrimination regulations cover health care, education, housing and taxpayer-funded programs. Also in January, Biden rescinded the ban on openly transgender people serving in the military, a discriminatory policy enacted under President Donald Trump.

Protections are needed.

Even though same-sex marriage equality is the law of the land, 27 states don’t explicitly protect LGBTQ people from other types of discrimination. What’s more, a future president could undo Biden’s equality efforts, and countless bills

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across the President Joe Biden nation target signs an queer people executive (such as order. legislation banning transgender high school students from playing sports).

What does this have to do with HIV? First, LGBTQ people experience higher HIV rates than their heterosexual peers. In 2018, 69% of new HIV diagnoses in the United States were among gay and bisexual men (about 26,000 out of 37,968 total cases). And in 2017, the number of transgender people who tested HIV positive was three times the national average, and it’s estimated that

14% of trans women are living with HIV. Obviously, allowing discriminatory policies in health care settings will affect queer HIV-positive people’s access to care and treatment—not to mention their well-being.

Plus, people living with HIV who don’t maintain an undetectable viral load can transmit the virus to others. Discrimination harms LGBTQ people— how can you prioritize your health if you’re denied housing, for example?— while supportive environments foster better health outcomes. A case in point: A recent study showed that transgender people with HIV who received gender-affirming surgery were more likely to suppress the virus (see page 16 for details).

To ensure LGBTQ protections nationwide, the House of Representatives passed the Equality Act, a federal antidiscrimination bill. The Senate has yet to vote on it, but Democrats support the measure, and Biden has said he’ll sign it into law when it lands on his desk. Stay tuned.

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RAINBOW RIGHTS

Long-term care facilities in New Jersey cannot discriminate against seniors who are living with HIV or identify as LGBTQ, thanks to a law signed this year by Governor Phil Murphy.

Lawmakers for the District of Columbia approved a similar bill, but the legislation still requires congressional approval.

In a little more than a decade, as many as 4.7 million LGBTQ elders— many of them living with HIV—are expected to be seeking long-term care and services. A survey of those already in such facilities found that only 22% felt they could be open about their identity, and 89% expected they would be discriminated against; 43% already reported mistreatment.

To hold such facilities to account on their treatment of queer residents, two of the leading LGBTQ rights organizations—the Human Rights Campaign and SAGE (Services & Advocacy for LGBT Elders)—have collaborated to create the Long-Term Care Equality Index, a tool to score how fairly such facilities treat LGBTQ clients, visitors and employees.

PrEP Uptake Promoting HIV prevention among Latinos and African Americans The Boriken Neighborhood Health Center of East Harlem launched an HIV prevention campaign titled “I Matter Therefore I PrEP,” a reference to preexposure prophylaxis (PrEP), a daily pill that HIV-negative people can take to prevent contracting HIV. A response to research showing that the rate of new HIV diagnoses in East Harlem is two times that of the rest of New York City, the campaign targets Black and Latino men ages 20 to 39 and Black women ages 30 to 49 through ads on buses, local venues and social media.

Also in New York City, the nonprofit health plan Amida Care has been holding virtual town halls to help boost PrEP uptake among underserved communities, such as Black women in the Bronx (you can watch the events

EVERYDAY

on Amida Care’s YouTube channel).

Nationwide, African Americans represented 13% of the population in 2019 but accounted for 43% of new HIV diagnoses. Latinos represented 16% of the population and accounted for 26% of new HIV cases. Generally, HIV rates are higher among Black and Latino gay and bisexual men and transgender women of color.

Data presented at this year’s Conference on Retroviruses and Opportunistic Infections show that investing in local communities is a great way to improve HIV outcomes for these underserved groups. Specifically, researchers found that HIV rates among young Black same-gender-loving men decreased in cities where local community groups received federal PrEP funding through

Details from the THRIVE program, the “I Matter while the rates inTherefore I creased in similar PrEP” ads cities without those funds (see page 17).

The Boriken center’s PrEP outreach and Amida Care’s roundtables might further support the idea of investing in local prevention efforts. “Since the launch of [the ‘I Matter Therefore I PrEP’ campaign], we have had multiple walk-ins inquiring about our trans health services as well as messages on our social media platforms inquiring how to [get] HIV services and get on PrEP,” Paul Bolter, the HIV services coordinator at Boriken, tells POZ. “The word is out on the street about this campaign and how familiar and representative it is of our community.”

These dates represent milestones in the HIV epidemic. Visit poz.com/aidsiseveryday to learn more about the history of HIV/AIDS. BY JENNIFER MORTON

June

(PREP AD) COURTESY OF THE BORIKEN NEIGHBORHOOD HEALTH CENTER; (ACT UP AD) INSTAGRAM/@ACTUPORALHISTORYPROJECT; (COMPUTER) ISTOCK

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HIV IS NOT A CRIME, the national conference devoted to tackling HIV criminalization in the states, debuts in Grinnell, Iowa. (2014)

HIV LONG-TERM SURVIVORS AWARENESS DAY

The Centers for Disease Control and Prevention (CDC) relaunches “LET’S STOP HIV TOGETHER,” a campaign aimed at reducing stigma and raising HIV awareness. (2018)

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NATIONAL CARIBBEAN AMERICAN HIV/AIDS AWARENESS DAY

ACT UP runs a full-page ad in The New York Times that reads “Women Don’t Get AIDS. They Just Die From It” in large type. The smaller text details the CDC’s refusal to expand the definition of AIDS to include diseases that affect women. (1991)

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NATIONAL HIV TESTING DAY

A DIGITAL VERSION OF POZ becomes available for the first time so readers can view the magazine online just as it appears in print. (2010)

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VOICES BLOGS AND OPINIONS FROM POZ.COM

WHAT IF?

T

he COVID-19 pandemic has revealed that as a nation we are OK with mandating behavior change for the sake of public health in marginalized populations but not for society as a whole— and certainly not for privileged classes.

If we treated the new coronavirus in the same way we have treated HIV— and if we stigmatized straight white men the way we stigmatize literally every other population when they struggle disproportionately with health conditions—the narrative around masks and other preventive measures would be quite different in America right now.

As a gay man, when I struggled with preventing HIV infection, I solely was held responsible. I was given no credit for any of the preventive measures I had taken to avoid the retrovirus, and my challenges with accessing and successfully utilizing prevention options were continually dismissed.

I compare that to a recent New England Journal of Medicine podcast where I heard a doctor say that they didn’t think the Centers for Disease Control and Prevention should promote N95 masks or double masking because people might struggle with the discomfort. Hearing him say that, I couldn’t help but laugh. Not because I think that individual comfort should

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not be a factor in scaling up preventive measures for infectious diseases—it absolutely should.

I laughed because of how different the conversation around masks has been compared to barrier methods for HIV prevention and how unsurprising it is that, once again, the public narrative prioritizes the comfort of privileged groups while readily mandating behavior change for others.

Those of us fighting to avoid HIV didn’t have doctors and public health officials acknowledging that our barrier methods—primarily condoms— were uncomfortable and difficult to adhere to 100% of the time. In fact, there was a mass effort to gaslight almost anyone who dared to say that barrier methods were difficult to use.

Powerful individuals were not sympathetic to our challenges with condoms in the way that so many are sympathetic to challenges with masks. And I’m sorry, but for many of us, condoms are a hell of a lot harder to use all the time compared to masks.

Can you imagine if gay men had shown up with guns to a state capital building and threatened to kidnap a governor because we were being told to use barrier methods for sex and reduce our number of sexual partners, our equivalent of social distancing?

To be clear, I do not advocate for

stigmatizing conservatives and straight white men around their behaviors with COVID-19. And I do not advocate for overly authoritarian responses to epidemics and pandemics. I believe that any time we can reduce the level of stigma in relation to health conditions, it is better for society as a whole.

But for a year, as I’ve seen conservatives and straight white men whine and complain about even the smallest attempts to alter their behaviors (and, yes, I know #NotAllStraightWhiteMen), I just want to shake them.

I will not do that, but I do feel once again convinced after the past year (really the past five years) that the behavior of conservative white leadership has definitively shown just how little perspective they have.

More than ever, I feel we must fight for a renewal in this country—particularly through a revolution of Black, brown, female and queer leadership— lest we continue to follow behind a demographic that is decidedly less prepared for survival compared to those who have had to fight for their safety and protection.

We must follow those who, because of lived pain and suffering, understand the difference between real and imaginary threats, those who have walked through the fire and emerged more resilient and powerful than ever. Q

ISTOCK

In an opinion piece titled “What If We Treated COVID-19 the Way We Treat HIV?” Jeremiah Johnson, an activist living with HIV and the HIV project director for the Treatment Action Group, urges for a renewal. Below is an excerpt.

AFTER COVID-19 In an opinion piece titled “Recovering From COVID-19,” activist and singer Sherri Lewis, who is living with HIV, recounts how she and her mother confronted and overcame COVID-19. Below is an edited excerpt.

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’m a long-term HIV survivor. I know about terror, isolation, loneliness, loss, hazmat suits, false positives, asymptomatic spreaders, condom fatigue, virus variants and resistance— even getting cured of hepatitis C. Nonetheless, the onset of the first COVID-19 pandemic restrictions in California had me panicked.

I thought, I’m locked in with my 90-year-old mother in her assisted care! I just couldn’t leave her alone not knowing when I’d see her again.

Unable to afford private care for her, I became her caregiver. I took a photo of her sitting in her wheelchair in her dimly lit 400-square-foot room and posted it on my Facebook page.

So masks became the new condoms, in the hope of protecting ourselves from contracting the new coronavirus and possibly ending up on a ventilator in a hospital and dying. I no longer went to the market, avoiding the drama of the anti-mask protesters. I became a shut-in, feeling safer indoors than out.

I could hear ambulances racing to a hospital blocks away day and night.

This was going to take much more time—months, maybe more. My mom’s facility opened up only to shut down again. Frustrated, the voice in my head began screaming, “We need testing!

Where’s the testing?”

A few days later, there was a knock on our door. It was the nurse and her assistant. They had come to test us.

The nurse asked, “Could you please bring your mother to the door so we can give her a COVID test?” I pushed my mom’s wheelchair up to the door.

The nurse stuck a long cotton swab up her nose while my mom squeezed my hand.

Then it was my turn. I had a scratchy throat and was already sneezing. I was anxious about my COVID test. I had been confident taking my HIV test in 1987 because I had no symptoms, even though I was positive. My COVID fears were mounting.

A few days later, I got the call: “You tested positive for COVID.” Déjà vu. I felt numb. I thought, Is this it? Is this how I’m going to die? In a retirement home taking care of my mother? After 34 years living with HIV, is this how it ends?

The next day, my mother’s test came back positive. My heart broke. I was horrified. Both of us had COVID-19.

What a nightmare. I began to steel myself for what might lie ahead.

Thankfully, we got through that night and the next, counting those following days with a watchful eye.

As bad as I felt, I had a mild case. The virus made its way out soon enough, 10 days for both of us. Some residents moved out to be with their families.

Some went to the hospital sick.

I could see medical trays in front of several rooms on our floor. I felt stigmatized by the medical tray that sat outside our door, a remnant from my HIV past. We were quarantined in our room with COVID-19 for 15 days.

Sadly, COVID-19 did claim a few of the residents.

It has been a year since COVID-19 entered our lives. My mom and I are now both vaccinated against the new coronavirus, as is the entire facility. We celebrated her 91st birthday. It’s going to be an adjustment. We’re grateful for a new day and a compassionate new president. Q

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SPOTLIGHT

BY JOE MEJÍA

Trans Visibility 2021 Since 2009, March 31 has been observed as the International Transgender Day of Visibility (TDOV).

The awareness day is dedicated to celebrating transgender, gender-nonconforming and nonbinary (TGNCNB) people around the world while reminding folks of the work that lies ahead in the fight for trans justice and equality.

The confirmation of Rachel Levine, MD, as assistant secretary for health marked an especially notable victory for the TGNCNB community this year. On March 24, Levine, a trained pediatrician, became the first openly transgender person to be confirmed to federal office and the highest-ranking transgender official in U.S. history. But, as Senator Rand Paul (R–Kentucky) demonstrated during one of Levine’s confirmation hearings, when he challenged her support of hormone replacement therapy for minors and likened gender-affirming surgery to genital mutilation, ignorance on matters pertaining to the experience of trans people is commonplace— and can be dangerous.

Indeed, this year, 28 states have introduced antitrans bills, including legislation put forth in Alabama that would prohibit doctors from providing trans minors with hormone therapy. What’s more, adults who have completed their transition often face worse health outcomes than their cisgender peers, including higher rates of HIV. This is surely due in no small part to the fact that nearly one third of trans people report being refused care or being harassed by medical providers.

So as people across the globe celebrated trans visibility with positive images and uplifting messages, many of this year’s TDOV social media posts made sure to draw attention to the fact that, as Positive Women’s Network—USA put it, “until we are all safe and free, none of us are safe and free.”

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Posts may be edited for clarity and/or space. poz.com JUNE 2021 POZ 13

ASK POZ WELLNESS TIPS FROM POZ.COM

HOW DO I KNOW IF I HAVE HIV? The CDC recommends everyone ages 13 to 64 get a routine HIV test at least once.

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some time for the body to produce antibodies, it can take at least 23 days— and up to 90 days—after exposure before this type of test can show a positive result; this lag time is known as the window period.

Combined antigen/antibody tests look for both antibodies and antigens, which are proteins from the virus itself.

An antigen called p24 becomes detectable before antibodies are produced, so this type of test can show a positive result in as little as 18 days. These tests are done in a lab using a blood sample.

Nucleic acid tests look for HIV genetic material, usually RNA, in the blood. This laboratory test can detect HIV in as little as 10 days after exposure.

The test is expensive and not used for routine screening, but it may be used in

some cases to detect early infection.

This is the same type of test used to measure viral load and guide treatment for people living with HIV. Rapid antibody tests are available from many community-based organizations, some of which run mobile or pop-up test sites. Home antibody tests can be purchased at a drugstore or online. If an initial rapid test or self-test is positive, it is important to see a health care provider for a follow-up laboratory test to confirm the result.

If you get an HIV test soon after a potential exposure and the result is negative, you should get tested again after the window period ends to confirm your status. If follow-up tests are positive, explore your options for starting treatment promptly. —Liz Highleyman

Ask POZ is an ongoing section on POZ.com dedicated to answering general wellness questions. Go to poz.com/ask to read more answers, and email ask@poz.com to submit your questions!

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F YOU THINK THAT YOU MIGHT have been exposed to HIV, it’s very important to get tested promptly.

If you test positive, starting antiretroviral treatment quickly will minimize damage to your immune system and reduce the risk of transmitting the virus to others. The Centers for Disease Control and Prevention (CDC) estimates that around 14% of people living with HIV do not know they carry the virus.

The CDC recommends that everyone ages 13 to 64 get a routine HIV test at least once. People at risk for HIV should get tested more often. Guidelines recommend that people taking pre-exposure prophylaxis (PrEP) should be tested at least every three months.

The most common type of HIV screening test looks for antibodies against the virus; the ELISA test is most widely used. It may be done using blood drawn from a vein, a blood drop from a finger stick or an oral fluid sample collected from the gums with a swab.

Rapid tests can return results in as little as 20 minutes. Because it takes

Protect Against COVID-19.

Safe and effective COVID-19 vaccines are available for free for everyone living in the United States.

Get Vaccinated: cdc.gov/coronavirus/vaccines

PZA530073.pgs 04.21.2021 15:23

ESA

CARE AND TREATMENT

BY HEATHER BOERNER

PROMPT TREATMENT START WORKS FOR TEENS When you’re a teenager, two weeks seems like forever. So imagine getting back nearly two weeks of health, in the form of an undetectable viral load.

That’s what happened when teens at St. Jude Children’s Research Hospital in Memphis were offered a prescription for antiretroviral therapy at their first HIV appointment, according to data published in The Pediatric Infectious Disease Journal.

The report followed 124 young people who started HIV care between 2016 and 2020. Of this group, 54 began before the clinic switched to same-day antiretroviral prescribing in April 2018 and 70 did so afterward.

Most of the teens were young Black men with a median age of 19.

The researchers found that the teens had a similar high rate of continued engagement in care at six and 12 months, whether they started treatment at their first appointment or later. And nearly the same number of young people in both groups still had an undetectable viral load at one year.

But the teens who started treatment at their first appointments got there faster: After the switch, teens started treatment a median of 18 days earlier, and they reached an undetectable viral load 13 days earlier than their peers who received a prescription after their first appointment.

Transgender New Yorkers living with HIV who received gender-affirming surgery through Medicaid saw their viral load drop in the years following surgery, according to data presented at the Conference on Retroviruses and Opportunistic Infections.

Epidemiologist Cristina Rodriguez-Hart, PhD, of the New York City Department of Health and Mental Hygiene, and colleagues identified 185 HIV-positive transgender adults in New York City who had access to Medicaid between 2013 and 2017 and had available viral load results. Medical codes in their charts showed they’d received top or bottom surgeries during that time.

Viral suppression rose among transgender people with HIV on Medicaid overall between 2013 and 2017, reaching 75%. What’s more, rates of viral suppression were higher among those who also had gender-affirming surgeries through Medicaid. It was an impressive climb, from 66% two years before surgery to 77% one year before to 86% a year after surgery.

By two years out, 88% still had an undetectable viral load.

One year after surgery, 92% of people who received top surgery had an undetectable viral load. People who had bottom surgery had marginally higher rates of viral suppression before surgery but saw their rate dip to 84% one year after surgery. However, they were expected to reach 90% viral suppression by two years out.

The surgery itself didn’t necessarily lead to an undetectable viral load, according to RodriguezHart, who noted that any number of factors could contribute to viral suppression in people receiving surgery. For instance, it could be that receiving the care one needs from professionals trained to work with transgender people could have built trust in a health care system that has often misgendered and otherwise mistreated people of trans experience.

“This is all the more reason why [transgender people living with HIV] need more support,” she said, “so that they can obtain better overall health and obtain affirming surgeries.”

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ALL IMAGES: ISTOCK (MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY)

Trans Surgery Linked to HIV Suppression

Redefining Support for Mothers Who Have HIV For years, U.S. infant feeding guidelines shied away from even discussing breast feeding with women living with HIV, largely due to fear of mother-to-child transmission. But a new consensus statement from experts in the United States and Canada calls for open conversations about undetectable viral load and a reframing of what it means to support women living with HIV. Having an undetectable viral load prevents sexual transmission of HIV— the principle behind Undetectable Equals Untransmittable, or U=U—and it is expected to prevent transmission via breast feeding as well, but this has not been well studied.

In addition to arguing that clinicians should provide birthing parents who have HIV all the data on the risks and benefits of breast feeding, the statement recommends that clinicians “recognize, account for and advocate to change” policies that impact HIV-positive women who might want to breast-feed, such as systemic racism, economic disparities and misogyny. The statement also recommends that clinicians uphold HIV-positive women’s bodily autonomy along the entire sexual and reproductive health continuum and life span and calls for more education for clinicians, resources to help women with HIV understand all their options and more research on breast feeding and HIV. “Insistence on a ‘zero-transmissionrisk’ choice concerning breast feeding is also at odds with the autonomy of parents living with HIV and their fundamental right to make informed choices about their children’s care without judgment or interference from providers or government,” write the authors of the statement.

COMMUNITY COLLABORATION CUTS HIV An interesting thing happened when public health departments and clinicians listened to Black and Latino communities about how to roll out pre-exposure prophylaxis (PrEP): HIV rates went down.

These are the results from seven cities that participated in the Centers for Disease Control and Prevention’s THRIVE program, including Birmingham, Alabama; Washington, DC; and New Orleans. The five-year program formed community collaboratives between Black and Latino community groups, public health departments and health providers to craft and roll out PrEP programs for Black and Latino people.

The program also paid for increased HIV testing; PrEP screening, counseling, education and navigation services; services to help people stay on PrEP if they wanted to; and training for local providers on how to prescribe the HIV prevention pill.

Through THRIVE, a total of 9,494 Black and 3,528 Latino gay and bisexual men received PrEP. Between 2014 and 2018, HIV diagnoses among Black same-gender-loving men were 4.2% lower than they were for similar men in jurisdictions that qualified for THRIVE but didn’t receive funding.

For Latino gay and bi men, HIV diagnoses rose 1.7% in THRIVE-eligible but unfunded jurisdictions. But in the THRIVE jurisdictions, diagnoses dropped by 2.7%.

While lots of things could have contributed to the drops in HIV cases, the program seems to have had a beneficial effect, noted CDC researcher Kashif Iqbal, MPH. “Barriers still exist,” he said, “and highlight the need to better engage with the Hispanic community and the African-American community to identify better ways to engage these populations.”

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RESEARCH NOTES

PREVENTION

TREATMENT

CURE

CONCERNS

Yearly PrEP?

Every Two Months

HIV Comes Back

Liver Fibrosis

An islatravir implant that can be replaced just once a year could one day be a convenient new option for HIV pre-exposure prophylaxis (PrEP). While daily oral PrEP and every-other-month injections are highly effective, longer-acting methods could be an attractive alternative. Merck scientist Randolph Matthews, MD, PhD, presented findings from a study of an implant containing three doses of the experimental nucleoside reverse transcriptase translocation inhibitor at the Conference on Retroviruses and Opportunistic Infections.

The study included 36 men and women at low risk for HIV. The matchstick-sized implants were inserted under the skin of the upper arm and left in place for 12 weeks. The highest-dose implant produced protective drug levels for 16 weeks, including four weeks after its removal. The researchers projected that this implant should release adequate levels of islatravir for almost all individuals for more than a year. Merck plans to start a Phase II trial to further evaluate the implant.

Cabenuva administered every other month suppresses HIV for at least two years. The regimen consists of an extended-release formulation of ViiV Healthcare’s integrase inhibitor cabotegravir plus an injectable version of Janssen’s non-nucleoside reverse transcriptase inhibitor rilpivirine. The Food and Drug Administration (FDA) recently approved Cabenuva as a monthly regimen, but European regulators also gave the nod to an everyother-month schedule. The ATLAS-2M trial showed that once-monthly and every-other-month dosing are equally effective. After 96 weeks, 90% of people in the once-monthly group and 91% in the every-othermonth group maintained viral suppression. But sticking to the schedule is especially important for those using Cabenuva every other month. Studies showed that delaying cabotegravir or rilpivirine injections by up to a week should have little impact, but longer delays could be a problem. ViiV has requested FDA approval of the everyother-month regimen.

A Brazilian man who last summer had no evidence of remaining HIV after more than a year off antiretroviral treatment once again had a detectable viral load a few months later. As part of a clinical trial, the São Paulo man, who had stable viral suppression, added two more antiretrovirals (dolutegravir and maraviroc) to his three-drug regimen along with nicotinamide, a form of niacin (vitamin B-3) for 48 weeks. In March 2019, he started a closely monitored treatment interruption.

More than 15 months later, he still had undetectable HIV RNA and HIV DNA, and his HIV antibodies fell to a very low level. But in September 2020, the man was diagnosed with secondary syphilis; two months later, his viral load exceeded 6,300 and his HIV antibodies started to rise. He resumed treatment, and his viral load again became undetectable.

The emerging HIV strain had substantial genetic differences from the original strain. Further analysis is underway to determine whether this is a case of viral rebound or reinfection.

Liver fibrosis, or buildup of scar tissue, is more common among people with HIV than HIV-negative individuals, according to recent research.

Liver fibrosis and cirrhosis (the most advanced stage of fibrosis) can be caused by hepatitis B or C, heavy alcohol use or fatty liver disease, but HIV infection and antiretroviral treatment may also play a role. Danish researchers compared 342 people with HIV and 2,190 HIV-negative individuals between 50 and 70 years old; none of them had hepatitis B or C. Almost all of the HIV-positive people were taking antiretroviral therapy, and most had an undetectable viral load.

Transient elastography (FibroScan) was used to assess liver stiffness, an indicator of fibrosis. Elevated liver stiffness was more common among people with HIV (12%) compared with HIV-negative people (7%). Greater liver stiffness was also linked to older age, higher body mass index, elevated ALT liver enzyme levels and exposure to ddI (Videx), an older HIV drug known to cause liver problems.

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(ISLATRAVIR) COURTESY OF MERCK; ALL OTHER IMAGES: ISTOCK

BY LIZ HIGHLEYMAN

SHARE YOUR POZ STORY Our stories can inspire, educate and empower others.

Our stories can provide hope and offer strength. Our stories can make people laugh and cry.

When people living with and affected by HIV share their stories, it breaks down the shame, silence and stigma surrounding the virus. Together, our stories can change the way the world sees HIV.

To share your story or to read other stories, visit POZ.com/stories.

BASICS

BY LIZ HIGHLEYMAN

MONITORING YOUR HEALTH Monitoring viral load and CD4 count can show how well treatment is working.

VIRAL LOAD Measuring the amount of virus in the blood is the mainstay of HIV monitoring.

The goal of treatment is to keep viral load as low as possible for as long as possible. Viral load tests can indicate whether your treatment is failing and your immune system is at risk before your CD4 T-cell count drops.

Viral load tests measure the number of copies of HIV RNA, or viral genetic material, in a small amount of blood.

They typically measure down to 50 or 20 copies. Below this level, the result will come back as “undetectable.”

Federal HIV treatment guidelines recommend getting a viral load test when you seek HIV care, when you start treatment or change your regimen and again two to eight weeks later. Once viral load falls below 200, it should be monitored every three to six months.

Sometimes temporary increases known as “blips” can occur; these are usually nothing to worry about. But a trend of rising viral load over time is

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a bigger concern. This could indicate that HIV is resistant to drugs or that a person is struggling with adherence or having trouble getting prescription refills.

CD4 COUNT There are two main types of T cells: CD4, or helper, cells coordinate the immune response, while CD8, or killer, cells attack virus-infected cells.

CD4 cells are the primary targets of HIV. Left untreated, the virus kills off these cells and the CD4 count declines.

The normal CD4 range for HIV-negative people is 500 to 1,500. Once the level falls below 200, a person is susceptible to opportunistic illnesses and is considered to have AIDS. CD4 counts were previously used to determine when to start treatment, but now antiretroviral therapy is recommended for everyone diagnosed with HIV. The CD4 percentage is the proportion of all T cells that are CD4 cells. The normal range for HIV-negative adults is 30% to 60%. People with HIV often have a lower percentage; below 14% indicates an AIDS diagnosis. The CD4/CD8 ratio gives a fuller picture of immune health. HIV-negative people usually have one to four CD4 cells for every CD8 cell. People with HIV may have fewer CD4 cells than CD8 cells, indicated by a ratio less than 1.0.

Federal guidelines recommend getting a CD4 count when you first seek

care and when you start antiretrovirals, then every three to six months during the first two years on treatment. After two years with stable viral suppression, CD4 tests can be done once a year if your count is between 300 and 500 and are optional if it’s above 500.

OTHER LAB TESTS Other lab tests should be done periodically to monitor your overall health. A chem screen measures the amount of various chemicals in the blood. It may include glucose, cholesterol and electrolyte levels as well as biomarkers of liver function (such as bilirubin, ALT and AST) and kidney function (including creatinine and blood urea nitrogen).

A complete blood count (CBC) is an inventory of different types of blood cells. It includes a red blood cell count and hemoglobin level. Lymphocytes (T cells and antibody-producing B cells), neutrophils and monocytes are white blood cells. Platelets are cell fragments that enable the blood to clot.

Federal guidelines recommend getting a chem screen, CBC and urinalysis when you first seek HIV care and when you start or switch treatment. The chem screen should be repeated two to eight weeks later to check for drug toxicities.

If everything looks good, these tests can usually be done every six or 12 months—ask your doctor which monitoring schedule is right for you. Q

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ITH TODAY’S EFFECTIVE and well-tolerated antiretrovirals, people living with HIV don’t require ongoing monitoring as often as they used to.

But it’s still important to get the recommended tests on a regular basis to keep tabs on your health and make sure your treatment is working.

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IN HIS PULITZER PRIZE–WINNING POETRY, JERICHO BROWN REVEALS HOW HIV, RACE AND RAPE CAN COEXIST WITH JOY, LUST AND LOVE.

BY TRENT STRAUBE

J

ericho Brown’s third collection of poems, The Tradition, won the 2020 Pulitzer Prize for poetry. The Pulitzer website described his work as “a collection of masterful lyrics that combine delicacy with historical urgency in their loving evocation of bodies vulnerable to hostility and violence.” Casual readers might think Brown’s poetry focuses on racism and Trump’s America. Yet there’s much more in his work in terms of subject matter and historical sweep—joy, eros, nature, same-gender love, poets from the past. Brown also writes of being raped and subsequently diagnosed with HIV. As he tells POZ in this lightly edited interview, he kept his HIV status a secret for years, until poetry helped him accept his truth and use his voice to help others.

Jericho Brown is also a professor at Emory University in Atlanta.

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We now have a new administration. Are you optimistic about the future?

Am I optimistic about a change in the way police treat Black people? I don’t think so. But I am optimistic about the resistance people have to that. I’m not one of these people who think things are just like they were in 1964. They’re not! So I do believe in progress. I wish progress were not as slow.

And I do not like being called a liar. I don’t like seeing

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generation after generation after generation of Black people being called a liar over how we are treated by the police. We are not making this up!

And yes, it is a tradition in Black families to talk to your sons and daughters about how to deal with the police in certain ways, which really have to do with: Be prepared to be humiliated, and take the humiliation so that you might be able to live.

You now live in Atlanta, where you’re a professor at Emory University and the director of its creative writing program.

But where did you grow up, and how would you describe it?

I’m originally from Shreveport, Louisiana, [from] a bluecollar, violent, religious home. It was very Louisiana in that my parents thought it was important that my sister and I know how to play spades. There were always gatherings where people were eating food that was very spicy. I sang in choir growing up because we had to be active in the church.

But there was also a lot of stuff that’s traditional that I’d like to get rid of. My parents and grandparents were amazing, some of the hardest-working people I’ve ever met. They loved us, and education was important to them. And they were mean! Which I think parents were, by the way. I don’t think that’s special to my parents.

Have they changed their attitudes now that you’ve got a Pulitzer?

They don’t care. My dad, he’s the kind of guy who thinks if I

PREVIOUS PAGES; (BROWN) ELEY/@ELEY_PHOTO

You won the Pulitzer Prize last May, right as COVID-19 struck and racial tensions roiled the nation. When you were doing press for The Tradition and the Pulitzer, did people bring up the HIV or same-sex elements in your work?

It comes up when queer people interview me. Otherwise, it’s all about Black stuff. But when I’m talking about the poems, it’s impossible not to talk about the thread of disease or the thread of queerness. So yeah, it does come up but because I bring it up.

References to things like “a virus” or “the virus” come up in my work a great deal. The interesting thing the COVID pandemic has done for my work is, it has broad- Jericho Brown’s three books of ened the facts of those refpoetry. The erences, and, I think, it has first, Please, was published changed our judgment about in 2008. them. Something you write can change over time given other people’s circumstances. So many people have had COVID and so many people have died that I think it might change our understanding of health disparities among communities.

Poetry is always waiting for its moment.

Things that have been written a very long time ago make an impact now because the moment has been waiting for that. It takes a long time to write a poem—I’d give a poem four years on average—and many of my poems we think call out to the current moment were written long before the current moment. I wrote a book, yes, that has a lot to do with the Trump era if you think of the Trump era, and that has a lot to do with police if you think about police, or trees if you think about trees. But I really just wrote the poems of my heart. It turns out to be the saddest thing and the most fortuitous thing [that soon after the] Pulitzer was announced was the murder of George Floyd. There were several [similar murders] that summer. So obviously, people think, Oh, this book is about that summer.

write about him, he should get a cut of the money. Do you know what I’m saying?

POEM REPRINTED FROM THE TRADITION (COPPER CANYON PRESS)

How did they respond to your coming out as gay and HIV positive?

They don’t like it. We have a relationship based on the fact that I did everything in my power to be as independent as possible. I think other people have a hard time coming out, and part of the reason is that they still have dependency with their family. If I go to my mom and dad’s house and things get crazy, I can get in a car and leave.

But I have to say, one thing about the pandemic is, I’ve felt I should be living closer to my mom and dad. I want to be there—because they’re older and I don’t trust them. [Laughs] I want to make sure they’re staying in the house!

It’s interesting how things change. Since the pandemic, we talk now more than we ever did even when I lived there.

Finding Truth, Line by Line Jericho Brown is not the sort of poet who knows what he’s going to write about before he sits down and gets to work. “No. No! I would never do that,” he says.

“When I’m writing, I get a line. I write that line down because it sounds beautiful to me, and then I follow that with other beautiful-sounding lines. And when that gets spent, I look at what I’ve written, and it doesn’t make any sense, so I have to ask that mess of text a bunch of questions: What are you about? You sound good, but you don’t make any sense.” Having started at a particular point, Brown hopes to arrive at a surprising end that transforms the original idea, like in his poem “The Tradition,” below. He says it takes an average of four years for a poem to crystallize.

Doing the work has given Brown a deeper understanding of the world—and himself. “I grew up thinking and being told there was something wrong with me—being gay, an artist, Black—and that my job was to fix or get rid of that thing. But poems will teach you a certain logic if you read and write them enough. And I now know that there is nothing wrong with me.”

References to domestic violence and an abusive father appear in your poems, as do same-sex rape and HIV, all of which are autobiographical. If you’re “THE TRADITION” comfortable with it, can you recount Aster. Nasturtium. Delphinium. We thought this latter narrative?

I was a late bloomer when it comes to gay sex. I Fingers in dirt meant it was our dirt, learning was one of those people who thought if you do Names in heat, in elements classical everything except penetration, then you aren’t Philosophers said could change us. Stargazer. actually gay. But then I moved to Houston [for Foxglove. Summer seemed to bloom against the will college] and started having sex. I was very careOf the sun, which news reports claimed flamed hotter ful, actually. At that time, there weren’t apps to On this planet than when our dead fathers be had. It must have been 2002, and I was 26. I met a guy online, something like Adam4Adam Wiped sweat from their necks. Cosmos. Baby’s Breath. but for Black guys. Anyway, this guy came over.

Men like me and my brothers filmed what we I remember thinking that we were going to do Planted for proof we existed before all those things except penetration and him Too late, sped the video to see blossoms clearly wanting to do penetration. I remember Brought in seconds, colors you expect in poems telling him, “Oh, never mind,” and then he raped me. Which, you know, it’s in the book Where the world ends, everything cut down. now. And then he left. I knew I had been raped John Crawford. Eric Garner. Mike Brown. because of how he left, not because of what had happened. I remember lying there and thinking, I better get in the shower in case something is positive. I was so lucky to have him and to be living in wrong—as if, if I had HIV, I could wash it out, you know what Houston instead of a small town. He told me my numbers I mean? I kept thinking, I fucked up. I felt like I had given the were good enough that I didn’t need to be on medication, wrong idea to someone, in spite of having said no. but he wanted to keep me under observation.

And then some time passed, and I had shingles, a rash The other part of the story is that when you find out you that wasn’t painful across my ribcage. I went to a doctor, and have HIV in 2002, you feel like you’re going to die. My doctor he asked me, “Are you gay?” and gave me a test. A few days assured me I wasn’t, but that didn’t get rid of the feeling. later, he called to tell me I was HIV positive. I was like, “Oh.” And this is a little bit narcissistic, but I remember feeling like He’s like, “Do you have a doctor?” I said, “No, but I’ll get a this was really just to make sure that I stay lonely forever: doctor.” I started seeing a doctor named Gary Brewton Now, I’ll never have a boyfriend. who had a long history of working with men who are HIV

poz.com JUNE 2021 POZ 25

HIV appears in various contexts in Jericho Brown’s Pulitzer Prize– winning 2019 poetry collection, The Tradition (Copper Canyon Press).

In “The Virus,” Brown personifies HIV by giving it a taunting and destructive voice. “That poem,” he tells POZ, “is ultimately about how I could not allow myself to feel joy even at the sight of something beautiful in the natural world.” When you’re under the impression that you’re going to die or always be alienated, he says, no matter what you do to find joy—from watching The Golden Girls to making love—it will be tarnished by your thoughts of HIV. “Cakewalk,” which appears later in The Tradition and represents Brown’s more recent attitude toward HIV, is lighter and playful.

“I was trying to write a sweet poem without being sentimental,” Brown says. “And I thought you could have two lovers walking, and they’re making fun of each other’s HIV. One man could say to the other, ‘My HIV is better than yours’—which is automatically funny but also strange. The poem shows that a smile can also coexist alongside HIV.”

“THE VIRUS” Dubbed undetectable, I can’t kill The people you touch, and I can’t Blur your view Of the pansies you’ve planted Outside the window, meaning I can’t kill the pansies, but I want to.

I want them dying, and I want To do the killing. I want you To heed that I’m still here Just beneath your skin and in Each organ The way anger dwells in a man Who studies the history of his nation.

If I can’t leave you Dead, I’ll have You vexed. Look. Look Again: show me the color Of your flowers now.

Scenes from POZ’s Zoom interview with Jericho Brown

“CAKEWALK” My man swears his HIV is better than mine, that his has in it a little gold, something he can spend if he ever gets old, claims mine is full of lead: slows you down, he tells me, looking over his shoulder. But I keep my eyes on his behind, say my HIV is just fine. Practical. Like pennies. Like copper. It can conduct electricity. Keep the heat on or shock you. It works hard, earns as much as my smile.

26 POZ JUNE 2021 poz.com

Did you disclose your status to anyone?

I didn’t tell people I had HIV. It was hard enough having people understand I was gay.

The thing I didn’t know then that I know now is that because of the meds that I did eventually get on, the likelihood of me passing HIV on to somebody else is effectively zero. I didn’t know that.

You’re referring to U=U, or Undetectable Equals Untransmittable. That was not widely accepted until a few years ago. People with HIV say that learning about U=U is transformative.

Exactly. For me, I had felt like there was something in me that I could put into somebody else, and that thing was a stain, and therefore, I needed to stay away from folks. But I also wanted to be a person in the world. I wanted to be a poet. I was a graduate student at the time.

I was learning so much. I was living in Houston, the biggest city I’d ever seen in my life! So I would never tell anybody. And I wasn’t comfortable bringing it up in my writing until my second book [The New Testament] came out in 2014. I wrote about being raped in my first book [Please, 2008].

How did you get to that level of comfort with disclosing these facts?

My writing is my religion. It is the thing I go to to figure out what I’m thinking and what I really believe about myself and if I’m in love. Writing for me is about investigation and discovery.

POEMS REPRINTED FROM THE TRADITION (COPPER CANYON PRESS)

A Tale of Two Viruses

What did you discover?

Maybe I’ll sound cliché or New Age–y, but I was brought back to the fact that I’m a child of God. [Laughs]

ELEY/@ELEY_PHOTO

Are you a religious person, in the Christian sense?

Maybe a little bit but not all the way. I do believe that there is ultimate human value. I know it sounds crazy to say there is something lifted about us when we had the last president that we had, and we saw how his supporters were willing to watch other people die for no reason. And yet, I still believe that there is this ultimate human value, and if I can believe that about everybody else, then why is it that I refuse to believe it about myself?

Also, I felt like there were people who had HIV that turned to AIDS and they died. But I didn’t die. I was able to write about HIV because I thought of it as a responsibility.

Jericho It becomes my reBrown’s next sponsibility as a poet project is a collection of to tell the truth, and essays and as long as there’s cultural something I know criticism.

I’m keeping from the page, not from people—fuck people—if I’m not addressing it on the page, in my poems, then I’m not facing it myself and being honest about it. When I finally started writing about that, it changed my mind about it, and I began to understand that I’m still Jericho Brown—a better Jericho Brown. Suddenly, I was glad. I had survived something that my idols didn’t.

“POETRY GIVES ME ENERGY. POETRY CHANGES MY MIND. POETRY HAS KEPT ME ALIVE AND KEPT ME GOING.”

Your work name-checks queer Black artists like poet Essex Hemphill and filmmaker Marlon Riggs, both of whom were lost to AIDS. Is that artistic lineage at the forefront of your mind?

I’m always thinking about tradition. I think a great deal about the fact that there are people who walked this earth and could not experience the freedoms I now experience, and yet they did things just so I could experience those freedoms and privileges. It’s hard for me to talk about [these artists] without getting emotional. I think I would have had a better understanding of how to move forward in the world if some of those people had lived through the ’80s and ’90s. Now it’s a lot to assume they would have been my best friend. [Laughs] And yet I do have this belief

in the community of artists and, specifically, a belief in the community of queer Black artists.

Do you believe poetry and art can change people?

Yes, because I know it affects me, and I know I’m not special in that regard. Writing has changed my life. Poems have kept me alive and kept me going. Poetry gives me energy.

Poetry changes my mind. Poetry wakes me up. When people talk about poetry making change, it’s like they’re expecting poetry to make some sort of governmental change. But poetry happens in your heart, to you, the individual.

Poetry is a love language. Poetry is from one person to one person. It’s not like a film or a pop song, which is from one person to many people. Poetry really happens from heart to heart. Q

poz.com JUNE 2021 POZ 27

A Complete History of HIV/AIDS Will Depend on

YOU

PRESERVING THE STORIES FROM 40 YEARS OF THE EPIDEMIC

(PHOTO ILLUSTRATION) NINA UY; IMAGES: (PROTEST) DREAMSTIME; (ALL OTHERS) ISTOCK (MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY)

BY MARK S. KING

And when you’re gone, who remembers your name?

Who keeps your flame?

Who tells your story?

Who tells your story?

Who tells your story?

— From the musical Hamilton

I

N MARCH OF 1985, I STOOD IN THE KITCHEN OF MY WEST HOLLYWOOD CONDO. The phone was attached to the wall, and I can remember how I nervously wrapped the cord up and down my fingers.

I was listening to a friend tell me the results of my HIV test. He was a nurse. Weeks earlier, he had secretly drawn my blood after his clinic had closed so we could keep the test results out of my medical records.

He told me my test was positive, and he wished me luck and hung up. I stepped toward my boyfriend, who had been watching the call, and he held me as I cried.

That’s the story I have been telling for more than 30 years. It’s not true. poz.com JUNE 2021 POZ 29

OUR HIV/AIDS CHRONICLE BEGAN 40 YEARS AGO, when Michael Gottlieb, MD, and colleagues published a write-up in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention.

The article outlined unusual cases of pneumonia among five gay men. It was dated June 5, 1981.

You would be forgiven if you thought that the first article was in The New York Times or The New England Journal of Medicine, as many do. Because memory. See? It can trick anyone.

Forty years. That’s a long time for history to drift by. To chronicle it, there have been books, movies, plays, musicals, television shows, paintings and iconography, all created to tell the story. Most of it has been driven by dominant culture,

30 POZ JUNE 2021 poz.com

“TELLING OUR STORIES IS AN ACT OF EMPOWERMENT. IT CAN UNLEASH A SOURCE OF ENORMOUS STRENGTH.” meaning, in this case, that it has been largely funded by white guys to amplify the stories of other white guys. The nature of popular culture isn’t exactly democratic.

That’s a problem that we, as HIV advocates, must work to correct. Who gets to tell their story, and who, if anyone, is telling yours?

Case in point: Gregg Gonsalves, one of the profile subjects of the award-winning documentary How to Survive a Plague, recently expressed his growing discomfort with that film. The film’s portrayal of ACT UP New York as a collection of privileged white gay men troubled him greatly, he wrote in a post on his Facebook page, and it didn’t reflect his own experience of the group.

Activist Peter Staley, another of the film’s subjects, strongly objected to Gonsalves’s viewpoint, pointing out that the film simply reflected who made up the coterie of ACT UP’s activists at the time. The comment string that followed was a fascinating debate about whether or not ACT UP had a real diversity problem during those years or whether the film portrayed it that way by focusing on these men and overlooking the contributions of ACT UP members who weren’t white and gay.

Gonsalves and Staley were actually on the scene at the same time, and they strongly differ about how an Oscarnominated film depicted their life experience. The only remedy to their debate is the inclusion of stories from others who were also there, like the women and Black activists who joined the Facebook string to provide their perspective.

Now is a good time to point out that the lack of prominent stories of our history from women and racial minorities isn’t for a lack of their trying. Their stories largely haven’t pierced through the bubble of popular culture for many reasons. An often-cited cause is that those stories committed the sin of

ISTOCK

I talked to that former boyfriend recently. He said we didn’t move into that condo until several months later, so I couldn’t have received the call there. Then he told me he doesn’t remember watching me get the results, wherever we lived, and that maybe he wasn’t actually there during the call.

I clearly remembered his loving embrace. I was certain of it.

Then I called my oldest friend. He remembers things like people and dates much better than I do.

He confirmed that I was living in a previous apartment when I got the HIV results. He also remembers me calling him right away because I was alone when I got the news.

At long last, I have a memory based on truth, pieced together from the recollections of three different people.

Criminologists say witness testimony tends to become more confident the longer it has been since the incident; memories become baked in, regardless of their accuracy. It never occurred to me to reexamine what actually happened when I got those results.

That cake has been baked and frosted for more than 30 years.

My mistaken memory is a little embarrassing to admit.

Storytelling is kind of my thing. Maybe I romanticized the experience, or my memory placed my boyfriend nearby because his presence soothed the trauma of the moment.

We’re not just selective in filtering our recollections. We can be reparative too.

Individually, we are all unreliable narrators, soaked as we are in ego and our singular perspectives. History teaches that we need multiple points of view to cobble together a clear picture of past events. If it took three of us to piece together one of the most significant days of my life, how many narrators will it take to create a reliable chronicle of the HIV epidemic as a whole?

The short answer: a lot. We need more people telling their stories to create a historical tapestry that is panoramic, revealing the entire picture. You, dear reader, are a part of the fabric of this tapestry, and you have a role to play in getting that history right.

taking place outside of major metropolitan areas. Books and other works from these folks will gratefully reveal themselves in a Google search of HIV, along with any demographic group that interests you.

In another half-century, historians will have examined and absorbed the chronicles at their disposal, the popular and the obscure, and their analysis will stick. If we want to rescue HIV/AIDS history from simplistic narratives that erase rather than include, those historians will need more artifacts to fill in the blanks. Any verdict that history might eventually levy about HIV/AIDS will be inaccurate as long as it is incomplete.

SO NOW YOU HAVE A JOB TO DO. First, search out the stories of people unlike yourself.

Buy the book, rent the movie, listen to the podcast, watch the webinar, soak in the art. Give some oxygen to the stories of underrepresented people. Attention must be paid.

Next, be a witness. Find a way to add your story to the spectrum. New forms of media have exploded in recent years, providing multiple opportunities. If you like to write, there are online outlets, including nearly all the HIV sites, that welcome first-person stories.

Or make an audio recording of your story—an oral history—on your phone and preserve it via social media or your local HIV/AIDS service organization or archive.

You could host a Zoom meeting with other survivors and trade stories about your lives as people living with or affected by HIV. Record it, and submit it to an HIV/AIDS archive or post it on social media.

You don’t need to wait until the release of a book or movie that purports to tell your story. You lived it. Tell it yourself.

The benefits are greater than simply leaving something for posterity. Telling our stories is an act of empowerment. It can unleash a source of enormous strength.

Not everyone will be able to do this. Storytelling can bring up painful stuff that you haven’t yet processed, or perhaps sharing such stories might risk your personal safety. That makes it all the more important for the rest of us to step up if we are able.

Documenting our stories gives us an opportunity to reclaim the narrative of our own lives and turn it outward, using it as a tool to help other people. It transforms something tragic into a gift offered to others.

Time continues to drift by us. Every day, we are losing elders in our community, many of whom never had the opportunity to use the media tools now available to preserve their personal history. You do.

We all have our stories. Don’t let someone else be the unreliable narrator of yours. Q Mark S. King won a 2020 GLAAD Award for My Fabulous Disease, an ongoing blog that serves as his personal chronicle of his life as a gay man living with HIV.

FIVE WAYS TO PRESERVE YOUR STORY SUBMIT A FIRST-PERSON STORY. POZ is one of several outlets that welcome first-person accounts from people living with HIV. The Well Project, The Body and others offer similar opportunities. If you think your story would fit in these brief (1,000 words or less) formats, this is the way to go.

SAY IT THROUGH ART. Visual AIDS has been curating the work of people living with HIV for decades. It’s another kind of storytelling that might be right for you.

FIND AN HIV/AIDS ARCHIVE. Do you have historical artifacts, like ACT UP gear or your 1987 test results or personal diaries? Several notable archives around the country might welcome your materials and take care of them for you. Some examples are the ONE Archives at the University of Southern California and the LGBT archives at Yale and Cornell. Publicly curated archives, like the African American AIDS History Project, are also great to browse online.

WRITE YOUR MEMOIR. You don’t need a book agent in this century, and self-publishing doesn’t have the stigma it once did. Print-on-demand companies will charge you as much as $1,000 to set up your manuscript, but it will get published and listed on Amazon and other bookselling sites just the same.

STORYCORPS WANTS YOU. StoryCorps has recorded the stories of more than a half-million people, including many people living with HIV and their care providers. Most stories are conversations between two people, so grab a friend and check out the easily navigated site.

—MSK

poz.com JUNE 2021 POZ 31

HEROES

BY ALICIA GREEN

Demetre Daskalakis, MD, MPH, remembers the day he felt called to become an HIV doctor: April 23, 1995.

He was a college student working on a display for the AIDS Memorial Quilt when he witnessed people paying homage to their lost loved ones.

“I remember saying, ‘My job is to not let anybody get sick or die from HIV/AIDS,’” says Daskalakis, age 47, the director of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC).

But Daskalakis is not your average doctor—he’s also a gay activist with strong ties to the LGBTQ community.

“When I realized that the single largest health threat to my community was HIV, the intersection became really clear for me,” Daskalakis explains. “It’s important and possible to be both a physician and an activist and to work in government and have an activist heart.”

For eight years, he was an attending physician at the New York University School of Medicine before serving as the medical director of three HIV clinics at Mount Sinai hospital.

In 2014, Daskalakis joined the New York City health department as assistant commissioner of HIV/AIDS prevention and control, his first job in public health.

Daskalakis was promoted to deputy commissioner of disease control in 2017. During his three years in that role, he led NYC’s “Ending the Epidemic” initiative and helped reduce HIV diagnoses to a historic low.

Having effectively reduced HIV transmissions and deaths in America’s largest city, Daskalakis is now tackling HIV at the national level. Since December 2020, Daskalakis has led HIV prevention efforts at the CDC. He aims to apply what he learned in New York City to the epidemic across the country.

Health equity is top of mind for Daskalakis. He plans to identify ways to improve HIV outcomes for all by interrupting racism, sexism and other isms. Additionally, as the senior COVID-19 data and engagement equity lead at the CDC, he has been tasked with ensuring a fair and equal distribution of COVID-19 vaccines.

“We also want to really identify ways that we can cross-link HIV with STDs [sexually transmitted diseases] and viral hepatitis as well as mental health and drug user health to be able to achieve a more global approach to addressing syndemics,” he explains.

Daskalakis also hopes to eliminate the divide between people living with HIV and those who could benefit from prevention strategies through what he calls “status-neutral care”—giving patients the same initial treatment and care regardless of HIV status.

“The status-neutral framework is addressing stigma at its root,” he says. “Let’s not worry about building a service based on a test result. Let’s worry about who the people are and what we can do to make them comfortable getting services and care.”

Despite being called a “radical doctor” (for doing outreach at sex clubs, for example), Daskalakis insists that what makes him stand out in the fight against HIV is his love for the communities affected by the virus.

“All I’ve ever done is listen and learn,” Daskalakis says. “When you listen to the community and the science and figure out how to marry them, really good things happen.” Q

32 POZ JUNE 2021 poz.com

Demetre Daskalakis, MD, MPH, is tackling HIV prevention nationally.

COURTESY OF DEMETRE DASKALAKIS, MD, MPH/TATE TULLIER

The Activist Doctor

SURVEY

9

How often does your mental health interfere with your ability to get work done?

T Most of the time T Often 10

11 According to the National Institute of Mental Health, people living with HIV are at a higher risk for mental health conditions, especially depression. POZ wants to know about you and your mental health. If you are experiencing mental health issues, it’s important to recognize the signs and seek help.

1

How would you rate your overall mental health?

T Excellent T Average 2

3

ISTOCK

T Yes

T No

15

What is your gender?

T Occasionally T Not at all

During the last two weeks, how often have you felt nervous, anxious or on edge?

T Male T Female 16

T Occasionally T Not at all

During the last two weeks, how often have you had trouble sleeping or slept too much?

17

T Occasionally T Not at all

T Occasionally T Not at all

How often does your mental health interfere with your health care?

T Most of the time T Often

18

T Occasionally T Not at all

What is your ethnicity? (Check all that apply.)

What is your current level of education?

T Some high school T Some college T High school graduate T Bachelor’s degree or higher

T No

How often does your mental health interfere with your personal relationships?

T Bisexual T Other

T American Indian or Alaska Native T Arab or Middle Eastern T Asian T Black or African American T Hispanic or Latino T Native Hawaiian or other Pacific Islander T White T Other (Please specify.): ___________________

T Occasionally T Not at all

Do you ever have suicidal thoughts or feel like you want to harm yourself?

T Transgender T Other

What is your sexual orientation?

T Straight T Gay/lesbian

During the last two weeks, how often have you had trouble concentrating or paying attention?

T Most of the time T Often 8

Have you ever had difficulty accessing mental health services?

T Most of the time T Often

T Yes 7

13

T No

What year were you born? __ __ __ __

T Most of the time T Often 6

Have you ever undergone treatment for a mental health condition?

T Yes

T Good T Poor

T No

14

T Most of the time T Often 5

Is there a history of mental health conditions in your family?

T Yes 12

T No

During the last two weeks, how often have you felt sad or depressed?

T Most of the time T Often 4

Have you ever been diagnosed with a mental health condition (such as depression, anxiety or bipolar disorder)?

T Yes

HEALTHY MIND

T Occasionally T Not at all

19

What is your annual household income?

T Less than $15,000 T $15,000–$34,999 T $35,000–$49,999 T $50,000–$74,999 T $75,000–$99,999 T $100,000 or more 20 What is your ZIP code? __ __ __ __ __

Please fill out this confidential survey at poz.com/survey. Or scan or take a photo of your completed survey and email it to website@poz.com.

If you are living with HIV, ask yourself the following questions: Have I lost weight?

Have I lost weight without trying?

Does the change in my weight impact how I feel about myself or my health?

Is my clothing looser than before because I have lost weight without trying?

Have those I know mentioned that my appearance has changed?

Do I have less energy?

Are any of my usual activities more difficult to perform?

Am I exercising less than in the past?

Do I need to take a break more often?

Do I tire more easily after certain activities?

If you answered “yes” to any of these questions, take this questionnaire to your next appointment with your healthcare provider to start a conversation about HIV-associated wasting and to inquire about treatment. Together you can discuss next steps. To learn more about HIV-associated wasting, visit: AmIWasting.com

EMD Serono is a business of Merck KGaA, Darmstadt, Germany ©2020 EMD Serono, Inc. US-NONE-00026

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