POZ October/November 2021 by Smart + Strong

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H E A L T H ,

L I F E

H I V

Our Stories Matter Supporting Latinos living with HIV

IMPORTANT FACTS FOR BIKTARVY® 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.

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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 BEING YOU, 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. BVYC0467 06/21

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ESA

REAL

BIKTARVY

PAT I E N T S

KEEP BEING YOU. 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. Watch their stories at BIKTARVY.com Featured patients compensated by Gilead.

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

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CONTENTS

EXCLUSIVELY ON

POZ.COM

Add this pumpkin and arugula salad with hazelnuts to your fall menu.

#ADVOCACY

Fighting against HIV/ AIDS has always been a struggle. Much work remains to end the epidemic. POZ encourages you to get involved in advocacy. Go to poz.com/ advocacy to ﬁnd the latest news and learn how you can make a difference in the ﬁght.

#CRIMINALIZATION

#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 or go to poz.com/digital, to view the current and past issues online.

24 OUR STORIES MATTER Despite the fact that they are disproportionately affected by HIV, many Latinos living with the virus are thriving. BY CHARLES SANCHEZ 28 GUILT-FREE COMFORT FOOD This simple meal is low in calories yet rich in the flavors of fall. BY BOB BARNETT 3 FROM THE EDITOR

14 ASK POZ

Maybe This Time

How can I manage my diabetes?

4 POZ Q+A

16 BASICS

Miss Universe Andrea Meza visits the Oasis Latino L.G.B.T.S. Wellness Center and shares her passion for health, fitness and HIV awareness.

Latinos: a population disproportionately affected by HIV/AIDS

6 POZ PLANET David Zwirner galleries exhibit artists lost to AIDS early in the epidemic • HRC’s new generation Z program trains Latino and Black LGBTQ advocates to end HIV and stigma • Everyday AIDS milestones

11 VOICES In “My Heart,” long-term survivor and blogger Bob Leahy shares five lessons that a life-changing heart surgery taught him about HIV—and how it altered his activism. And in “Not Invisible,” AIDS United makes the case that plans to end HIV will not succeed if they omit sex workers.

17 RESEARCH NOTES

Long-acting PrEP • a twice-yearly injectable treatment • a new cure approach that uses antibodies • COVID-19 risk among people living with HIV

20 CARE AND TREATMENT

The fast lane to undetectable • getting mobile clinics to bring people back into care • a cardiovascular system on fire • have feminizing hormones, will PrEP

32 HEROES As president of the Latino Commission on AIDS, Guillermo Chacón hopes “Zero Transphobia, Zero Homophobia” will help address stigma in the Latinx community.

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, 157 Columbus Avenue, Suite 525, New York, NY 10023. Periodicals postage paid at New York, NY, and additional mailing offices. Issue No. 255. POSTMASTER: Send address changes to POZ/Smart + Strong, 157 Columbus Avenue, Suite 525, New York, NY 10023. 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.

COVER: ALL IMAGES ISTOCK; (SALAD) COURTESY OF COOK FOR YOUR LIFE/JOE GAFFNEY; (GAVEL/BOOKS, BARBED WIRE AND MAGNIFYING GLASS) ISTOCK

Opinions still vary on whether criminal law should apply to HIV disclosure, exposure and transmission. However, there is a growing consensus to make laws reﬂect current science. Go to poz.com/ criminalization for more on how you can get involved in reform efforts.

FROM THE EDITOR

Maybe This Time

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CAME OUT AS GAY TO MY parents and my sister 25 years ago. By then I had been living with HIV for four years, but I did not disclose my status to them until 2008. It took me a long while to accept being gay before I told them my orientation. It makes sense to me now that it took another long while to tell them about the virus. It didn’t make much sense to me back then. Or rather, my choice not to tell them about having HIV wasn’t about it making sense or not. I decided not to tell them out of practical concerns. Having been raised Roman Catholic, I figured my Latino family was going to have a difficult enough time accepting me as a gay. And I believed that I would be dead soon, so it didn’t matter. I wrote about this journey when I first joined the POZ staff in an article titled “Coming Out Again.” Over the years, I have had many people tell me how much they related to my story. I’m grateful that I had the opportunity to share it, but I am especially thankful to the folks who were kind enough to give me that feedback. I’d call that the best kind of win-win situation. Our stories matter. That’s true for all of us. However, in this special issue dedicated to Latinos, our cover story is focusing that lens on the experiences of Latinos with HIV. Go to page 24 to read stories of three Latinos with the virus, including activist and POZ contributing writer Charles Sanchez. As important as it is to uplift those of us living with HIV, we should also applaud the efforts of our allies who are HIV negative. The HIV movement would be much diminished without their efforts. We spotlight two of them: Guillermo Chacón, president and CEO of the Latino Commission on AIDS (LCOA), and Miss Universe Andrea Meza. Guillermo has led LCOA since 2010. In addition to not living with HIV, he is also heterosexual. Nonetheless, his predecessor, the late Dennis deLeon, brought him into the fold. Guillermo had done some HIV

work before joining LCOA, but it was his experiences working with Dennis and the HIV community at large that prepared him to lead LCOA. Go to page 32 to read more. Andrea is also not living with HIV and is heterosexual, but she makes it clear to all that she is no prude when it comes to being an ally to LGBTQs and people who have the virus. As the current Miss Universe, she uses her celebrity to raise HIV awareness. POZ caught up with her in New York City when she was touring LCOA and other HIV groups. Go to page 4 to read more about her HIV advocacy. In addition to HIV, Andrea is also passionate about general health and fitness. Those topics seem to be increasingly on the minds of those of us taking HIV treatment, especially in the past few years with the accumulation of studies showing that some HIV medications may themselves cause weight gain. As a result, POZ will regularly feature articles on nutrition and fitness. To get us started, we’re spotlighting recipes for healthy comfort foods. Go to page 28 for more. Last but certainly not least, we’re thrilled to publish another edition of POZ en Español. Go to the center of this issue to find it!

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.

poz.com OCTOBER/NOVEMBER 2021 POZ 3

POZ Q+A BY CHARLES SANCHEZ

Miss Universe 2020 Andrea Meza visited New York City to promote HIV awareness. She first went to GMHC to get tested for HIV then visited the Latino Commission on AIDS (LCOA). She spoke with POZ contributing writer Charles Sanchez (left) and Guillermo Chacón, president and CEO of LCOA, at the organization’s Oasis Latino L.G.B.T.S. Wellness Center.

BEAUTY, BRAINS AND HEART Miss Universe Andrea Meza shares her passion for health and fitness—and HIV awareness.

N MAY 16, 2021, MISS MEXICO ANDREA MEZA, AGE 26, WAS crowned Miss Universe 2020 at the 69th annual competition in Hollywood, Florida. (The event had been postponed due to the COVID-19 pandemic.) Undeniably beautiful, the raven-haired Chihuahua City native is much more than a smart sash and a fabulous crown. A women’s rights activist, Meza has a degree in software engineering and is a certified makeup artist and model. She’s passionate about fitness and health, consumes a vegan diet (her favorite dish is vegan ceviche made with cauliflower and texturized soy) and enjoys extreme sports in her spare time. The Miss Universe Organization spared no time in getting its glamorous representative to work. Barely a month after the pageant, Meza was touring New York City in stilettos in partnership with the Latino Commission on AIDS. She made several stops, including the LGBTQ rights landmark The Stonewall Inn, the HIV service center GMHC and God’s Love We Deliver, a nonprofit that delivers meals to people too sick to cook for themselves. Her mission was to spread awareness about HIV, including testing, and to promote sexual health overall. She even got an HIV test herself while at the GMHC Testing Center. POZ caught up with the charming Meza at the Oasis Latino L.G.B.T.S. Wellness Center in midtown Manhattan.

It’s so nice to meet you! What’s one of the most exciting and fun things that has happened since you were crowned?

Everything is new for me. Everything is exciting. I’ve been enjoying every single

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part of the journey. I think one of the most exciting things has been to get to know all the different people pursuing different objectives, like the Latino Commission on AIDS. One of the best experiences I’ve had was with God’s Love We Deliver, where I was able to prepare and pack food for people living with chronic illnesses. That was awesome because you get to see that the small work you do, combined with the work others are doing, is for a greater purpose. You see all these people going in and out of the building delivering food, and you feel that you’re part of this big thing. And you feel that your small contribution is helping someone. How did you get involved with the Latino Commission on AIDS?

Now that I’m Miss Universe, I have these great opportunities to work with different organizations and associations. [The Miss Universe Organization] has been working with GMHC and the

Latino Commission on AIDS for years and years. So I’m honored that I get to have this opportunity. The Miss Universe Organization is very steadfast in its work to spread awareness about HIV. Where else are you visiting to get the word out?

Before this meeting, I went to GMHC, and it was a great experience. All these people are working toward getting a healthier society and creating more awareness about HIV. I have to tell you, I come from a very Catholic country, and sometimes it is hard to talk about sex. It’s like a taboo. And when you don’t talk about these kinds of topics, then you are not really informed about them. For me, it’s great that I am surrounded by a Latin community that is not afraid to talk about [sex and HIV] and is encouraging people to know more, to be more informed and educated and to keep spreading the word. At GMHC, they gave you an HIV test. How was that experience for you?

It was actually pretty comfortable and a great experience. It was superfast also. I think there’s a lot of misinformation about testing. People don’t really know how it works, and they’re afraid to get tested. It was great. I mean, they ask you some personal questions, but everything is confidential, so I was perfectly fine with that. And in 20 minutes, I was out of there!

ALL IMAGES: COURTESY OF THE LATINO COMMISSION ON AIDS

Why is it important for Latinos to care about HIV and get tested?

It’s important because we have to take care of ourselves, and we have to know where we stand. Sometimes we don’t get tested because we are afraid of the results, but if we know if we are positive or negative, we can take action. That’s why I’m doing this. That’s why I want to encourage people to do it, to forget about the taboos and forget about all the stigma. The people who work in HIV and AIDS are doing it because they are passionate about it. They’re not going to think something negatively about you. They just want you to be healthy. I want to encourage people to get

tested for HIV. I know it can be scary because there is a lot of stigma and a lot of misinformation, but it is easy, it is fast and it’s confidential, and that’s the most important aspect of it, because I know people might feel embarrassed to share their personal life. It is not like that. [The people who perform the testing] are going to treat you in an incredible way—they are not going to judge you— and it’s for your own good. Besides HIV, I know that you also help spotlight other social issues, specifically violence against women. Tell me about your work with the Municipal Institute for Women in Mexico.

I started working with them a year ago. I became interested in gender-based violence because that is something that is

Andrea Meza

You feel the need to text your mom or someone to tell them that you’re going out and you send your live location because you don’t know if you’re going to be able to get back home. We started this campaign where we put up all these signs on the streets to encourage people to stop street harassment. Not only that, but we’re also working with the government to punish the people who are being violent in the streets. If you are catcalling a woman on the street, you are going to be punished. They’re not going to go easy on you. So that is one way we can start creating awareness and change. How does this work and your HIV activism overlap with your own thoughts and feelings about health and fitness?

“We have to take care of ourselves, and we have to know where we stand. Get tested for HIV.”

very sad in my country. It is not only happening in Mexico and not only in Latin America, but it happens worldwide. When I realized that for so many years, I’ve been blind and I didn’t see it as a problem, I wanted to do something about it. The first campaign I did with [the Municipal Institute for Women] was about street harassment. That’s one of the kinds of violence that we have normalized and don’t pay attention to. But when you are a woman outside, at least in Mexico, you feel you are in danger.

For me, it’s crucial to maintain a safe and healthy lifestyle. We only have one body in this life, and we only have this one life. If we don’t take care of it, we’re going to regret it at some point. That’s why I love working out, why I like to have healthy eating habits. That’s why it’s important to go to the doctor and to get tested, to just take care of yourself. It’s important that you are able to live a healthy lifestyle—not only you but also your partner—to enjoy all the great things that life can give you. Q

poz.com OCTOBER/NOVEMBER 2021 POZ 5

POZ PLANET BY TRENT STRAUBE

IN THE BEGINNING David Zwirner highlights artists lost to AIDS early in the epidemic. This year marks 40 years since the first published report of the disease now known as AIDS. To coincide with this milestone, David Zwirner galleries in New York City and London curated More Life, a series of solo exhibitions of artists who died of AIDS-related complications during the first half of the epidemic. Four exhibitions and various related events ran this summer, highlighting the works of painter and filmmaker Derek Jarman, photographer Mark Morrisroe, filmmaker Marlon Riggs and the Silence=Death Project, which created several iconic posters. Beginning this fall, four other artists will be exhibited, all painters: Ching Ho Cheng, Frank Moore, Jesse Murry and Hugh Steers. The show’s title, More Life, “is a reference to the last lines of Tony Kushner’s seminal play Angels in America,” says Alec Smyth, who is the

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associate director of sales at David Zwirner and one of the organizers of the AIDS art series. “[The title] speaks to what we hope the exhibition will do: bring more attention and life to this group of artists.” Don’t worry if you can’t visit a gallery

in person. DavidZwirner.com features images from the shows, along with the phenomenal resource “AIDS in the Art World: A Timeline,” which was created with help from the What Would an HIV Doula Do? collective. The website also includes a video conversation, “AIDS Counternarratives,” featuring Avram Finkelstein, Gregg Bordowitz, Joy Episalla and Pamela Sneed. To narrow their gallery exhibitions down to eight artists, More Life organizers combed through the Artists+ Registry at Visual AIDS (you can peruse this archive online as well!). “We gravitated toward artists who have not had as much mainstream notoriety as Keith Haring and Robert Mapplethorpe,” Smyth explains. “We hope that these exhibitions will be an entry point for more people to engage with this group and the many others who were lost.”

All artworks span the 1980s and ’90s, the first 20 years of the AIDS epidemic. 1. Yellow Pillow by Hugh Steers. 2. Act Up by Derek Jarman. 3. Everything I Own II by Frank Moore. 4. Untitled by Ching Ho Cheng. 5. Portrait of Jesse Murry holding one of John Constable’s brushes (photo by Richard Constable). 6. Production still from the film Tongues Untied by Marlon Riggs. 7. AIDSGATE by the Silence=Death Project. 8. Sweet Raspberry/ Spanish Madonna by Mark Morrisroe. Inset: Installation view of More Life: Silence=Death at David Zwirner, New York City.

poz.com OCTOBER/NOVEMBER 2021 POZ 7

ALL IMAGES: COURTESY OF DAVID ZWIRNER

POZ PLANET BY TRENT STRAUBE

Making Gen Z Free of HIV Growing up in Indiana’s public school system, Alejandro Rodriguez, now 23, didn’t learn much about HIV in sex ed. “Classes focused on abstinence and pregnancy,” he recalls, “and HIV was stigmatized as a gay disease.” A glimpse into the world of healthy LGBTQ youth arrived via the hit musical series Glee. “It was known as a gay TV show, and I didn’t want my sexuality to identify me,” Rodriguez says, “so I didn’t share that I watched the show. But it really helped me.” As Rodriguez became more comfortable as a queer person—he identifies as bisexual—he knew he was at risk for HIV and got tested regularly. But he engaged in condomless sex and struggled with sex addiction, a result, he says, of sexual abuse as a child, which he believes is common. In September 2020, he tested positive for HIV. “That’s when I realized how misin-

EVERYDAY October

formed everyone was,” Rodriguez says. “I thought it was a death sentence.” Today, he’s educated, undetectable and determined to be an HIV advocate. Young activists like him are much needed. In 2018, youth ages 13 to 24 made up 21% of new HIV diagnoses. Black and Latino gay and bisexual men are at especially high risk. One reason, as Rodriguez puts it, is: “We don’t hear the truth about sex.” Generate, a new program from the LGBTQ advocacy group Human Rights Campaign (HRC), aims to change that. It mentors and mobilizes young adults ages 18 to 24 who identify as Black or Latino LGBTQ to become peer facilitators by using “storytelling as a powerful tool for grassroots-level advocacy,” explains Vanessa A. Castro, HRC’s associate director of HIV and Health Equity. “Our goal is to combat HIV stigma and discrimination, mobilize

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

The first AIDS CANDLELIGHT VIGIL/RALLY is held by the AIDS/ KS Foundation in San Francisco. (1983)

In a 94–2 vote, the Senate adopts the HELMS AMENDMENT, which requires federally financed educational materials about AIDS to stress sexual abstinence and forbids any material that “promotes” homosexuality or drug use. (1987)

LGBTQ+ young people to elevate comprehensive HIV Vanessa A. prevention efforts, and Castro leads advocate for the dignity, HRC’s rights and well-being Generate of people living with program. and affected by HIV.” Generate is a component of HRC’s “My Body, My Health” HIV campaign, which also provides in-home HIV testing kits and created a sexual health directory for historically Black colleges and universities. Today, Rodriguez is a student at the University of Indiana who’s heading to Washington, DC, to work as a congressional intern. He plans to work in law or government and to maybe run for public office. Along the way, he’ll share his HIV story. “We need young people to talk about HIV,” he says. “Youth representation can make a difference.”

November

Pop music stars, including Ciara, Kelly Rowland, Common, Romeo and Lyfe Jennings, quiz young adults about sexual health and safer sex practices during the one-hour HIV/AIDS special WHAT U KNOW BOUT THAT? Rap-It-Up Sex Quiz on BET. (2007) Rowland, Ciara and Common

PHILIP REED—an openly gay Black man with HIV who was elected to the New York City Council in 1997—dies. He appeared on the March 1998 cover of POZ. (2008)

NATIONAL LATINX AIDS AWARENESS DAY

HIV/AIDS activist, blogger, author and speaker MARK S. KING releases A Place Like This: A Memoir. (2007)

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JACK MACKENROTH, of Project Runway fame, and the global LGBTQ social app Moovz launch the HIV Shower Selfie Challenge using the hashtag #weareALLclean to raise awareness of HIV and funds for Housing Works. (2014)

(CASTRO) COURTESY OF VANESSA A. CASTRO; (CANDLE, CAPITOL BUILDING AND PHONE) ISTOCK; (ROWLAND, CIARA AND COMMON) WIKIMEDIA; (MACKENROTH) INSTAGRAM/@JACKMACKENROTH

HRC trains Latino and Black LGBTQ advocates.

VOICES BLOGS AND OPINIONS FROM POZ.COM

MY HEART In a post titled “Five Things My Heart Surgery Taught Me About HIV,” advocate and blogger Bob Leahy shares how this life-changing experience altered the course of his HIV advocacy. Below is an edited excerpt.

spent eight days in the hospital undergoing open-heart surgery. It was one of the most challenging life events I’ve ever had to navigate. I’m well on the way to recovery, but the scars, real and emotional, remain. Here is what I learned:

ISTOCK

Glimpses of a previous era: the ’80s revisited While I was in the hospital, my HIV was not really an issue. All medical professionals I encountered were respectful and unconcerned that I was HIV positive, from the operating room down. Despite that, I had a highly triggering experience. Due to a potential infection unrelated to HIV, I was designated “no contact” for a while, pending investigation. My food was left outside my room. Extra protective gear appeared. I was devastated. The circumstances just seemed too reminiscent of something horrible in our collective past. Clearly, the impact of our history lies just under the surface for many of us. Our resilience is real and ready for its close-up. I learned of my HIV status in the era before effective treatment existed, when HIV was fatal. I remember thinking at that time that HIV was all I could handle. To be diagnosed with a subsequent illness was beyond my comprehension, well beyond my ability to manage. This was before comorbidities became a buzzword within our commu-

nity. Fast-forward to 2021, and here I am not only managing my HIV but also saddled with heart disease, not to mention diabetes. I’m coping (kind of) well. The truth is, though, that serious comorbidities are virtually inevitable as one ages. Listen up: Your resilience is about to be tested. It may be mightier than you think. My HIV is no big deal. (Your experience may vary.) While in the hospital recovering from surgery, I couldn’t help reflecting on the difference between the treatment of my HIV—one pill a day, as it is for many—and heart disease, the latter often requiring intrusive surgery with a prolonged recovery period. HIV is typically less dangerous. Sure, HIV-related stigma remains out there, but for many of us, the times have been right to “rise up to HIV,” as the T-shirts say. I certainly did, but then, I’m privileged. All in all, I’ve come to believe that the response to HIV hasn’t changed enough since it was mostly a life-threatening condition. Instead, we face the growing danger of HIV being overblown in relation to other diseases. That opinion won’t win me many friends, I know, but it’s the truth as I see it, born of lived experience that extends beyond HIV. Don’t knock lived experience. Heart disease recovery focuses on wellness; we can learn from that. I found the approach to heart disease

recovery to be fresh, engaging and people-centered, not number-centric. In contrast, our focus on HIV treatment has become maybe too centered around clinical numbers. We have become highly focused, for example, on the ability of people living with HIV to become undetectable and, as a community, to meet 90-90-90 objectives. True, that focus has come with tremendous benefit to people living with HIV, particularly with the advent of Undetectable Equals Untransmittable (U=U). We can’t abandon that—but we can add other objectives. I can’t help thinking that achieving wellness is as important as attaining an undetectable viral load. Recovery from heart surgery involves a holistic combination of exercise, rest, nutrition, breathing and mindfulness. Very little of that approach is seen in HIV circles. It’s a significant gap that is only just receiving some attention. I need to quit. At 74, I’ve been working independently in and out of the HIV sector for almost 30 years. I’m proud of what I’ve achieved, particularly around bringing U=U to Canada. But surgery has changed me. I need some time to myself now. I’d love to see a new generation of activists help fashion a response to HIV entirely different from the current one. It’s truly been an honor to share my musings on POZ.com and elsewhere with you! Q

poz.com OCTOBER/NOVEMBER 2021 POZ 11

VOICES BLOGS AND OPINIONS FROM POZ.COM

NOT INVISIBLE

ince being appointed as the director of the White House Office of National AIDS Policy, Harold Phillips has been inundated with requests for his help. He was appointed to the position on June 5, 2021, by Ambassador Susan Rice, the director of President Biden’s Domestic Policy Council. At the ceremony, Rice recognized the 40th anniversary of the identification of HIV/AIDS and “called upon the nation to recommit ourselves to ending HIV/ AIDS once and for all.” This recommitment will require a sharp turn from the current iteration of the Trump administration’s “Ending the HIV Epidemic” plan. With extraordinary will and work, Phillips has committed to producing an updated National HIV/AIDS Strategy (NHAS) by World AIDS Day 2021. However, there is not yet clarity on one aspect of the impending NHAS that will greatly impact our nation’s ability to end the epidemic: our nation’s acknowledgment and support of and health care provision for sex workers. In 2016, the Joint United Nations Programme on HIV/AIDS (UNAIDS) named five groups as particularly vulnerable to HIV and frequently lacking adequate access to services: 1. Sex workers 2. Transgender people 3. Incarcerated people 4. People who inject drugs 5. Men who have sex with men.

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Our partners around the world agree with this assessment of the highest priorities and greatest needs when responding to the HIV epidemic—but not the United States government, which, at present, excludes sex workers entirely from our national HIV response. Those of us working to end the HIV epidemic are hoping to see several changes in U.S. policy with the Biden administration. This includes expanding consumer-centered services for people who use drugs, people of transgender experience and people aging with HIV. We are pressing for reasonable policy decisions on molecular surveillance and adequate health care resources, especially in Southern states. We are, rightly, centering folks like young Black men as one of the key populations with whom we must work to end HIV. Why, then, aren’t sex workers included in our current or future federal plans? To omit sex workers as a key population impacted by HIV in the United States is to deny the human rights and needs of a community as real as any of the other four named by our international partners. Juno Mac, a coauthor with Molly Smith of Revolting Prostitutes: The Fight for Sex Workers’ Rights, observed during a recent demonstration that “in America, tens of thousands of people are ‘arrested, prosecuted, incarcerated, deported

or fined’ for sex work–related offenses in the U.S. every year.” The Centers for Disease Control and Prevention (CDC), however, has no estimate of the number of “people who exchange sex” for resources in the United States. It merely acknowledges that “many social and structural factors make it difficult to prevent and treat HIV among persons who exchange sex for money or nonmonetary items.” The U.S. government is, in effect, insisting on public silence about sex work in America. Consequently, this has been used to justify the ongoing federal refusal to provide sex workers with the appropriate HIV-related services that are provided to the other communities most affected by HIV. In this federal silence, the CDC and other federal health agencies have been allowed to gather very minimal data regarding sex workers’ health. The government does not allocate funds for programs designed to help sex workers manage health care or to help prevent possible HIV acquisition. In fact, in most cases, the government continues to ignore the existence of sex workers altogether. We have no indication that the Biden administration—in line with its stated desire to end the HIV epidemic— will finally include sex workers as the fifth of the key populations impacted by HIV, as the rest of the world does. The new NHAS due in December has the opportunity to take that step. Q

ISTOCK

In a blog post titled “Ending HIV Means Ending Sex Workers’ Invisibility,” the advocacy group AIDS United questions why U.S. plans to fight HIV omit sex workers. Below is an edited excerpt.

LOWER YOUR VIRAL LOAD. AND MAKE UNDETECTABLE * A POSSIBILITY AGAIN. * Undetectable viral load is defined as fewer than 50 copies of HIV per mL of blood.

Ask your healthcare provider about TROGARZO® – A fully active HIV-1 treatment designed specifically for those with treatment failures

For more information, visit TROGARZO.com WHAT IS TROGARZO®? TROGARZO® (ibalizumab-uiyk) is a prescription medicine that is used with other antiretroviral medicines to treat Human Immunodeficiency Virus-1 (HIV-1) infection in adults who: • have received anti-HIV-1 regimens in the past, and • have HIV-1 virus that is resistant to antiretroviral medicines, and • who are failing their current antiretroviral therapy It is not known if TROGARZO® is safe and effective in children. IMPORTANT SAFETY INFORMATION Do not receive TROGARZO® if you have had an allergic reaction to TROGARZO® or any of the ingredients in TROGARZO®. TROGARZO® can cause serious side effects, including: • Allergic reactions. TROGARZO® can cause allergic reactions, including serious reactions, during and after infusion. Tell

your healthcare provider or nurse, or get medical help right away if you get any of the following symptoms of an allergic reaction: trouble breathing, swelling in your throat, wheezing, chest pain, chest tightness, cough, hot flush, nausea or vomiting. • Changes in your immune system (Immune Reconstitution Inflammatory Syndrome) can happen when you start taking HIV-1 medicines. Your immune system might get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your health care provider right away if you start having new symptoms after receiving TROGARZO®. The most common side effects of TROGARZO® include diarrhea, dizziness, nausea, and rash. These are not all the possible side effects of TROGARZO®. Before you receive TROGARZO® (ibalizumab-uiyk), tell your healthcare provider about all of your medical conditions, including if you are:

• Pregnant or plan to become pregnant. It is not known if TROGARZO® may harm your unborn baby. Tell your healthcare provider if you become pregnant during treatment with TROGARZO®. • Breastfeeding or plan to breastfeed. You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. Do not breastfeed if you are receiving TROGARZO® as it is not known if TROGARZO® passes into breast milk. Talk with your healthcare provider about the best way to feed your baby during treatment with TROGARZO®. Also tell your healthcare provider about all the medicines you take, including all prescription and over-the-counter medicines, vitamins, and herbal supplements. For more information or medical advice about side effects, ask your healthcare provider. You may report side effects to the FDA at 1-800-FDA-1088 or the THERA patient support® program at 1-833-238-4372.

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ASK POZ WELLNESS TIPS FROM POZ.COM

HOW CAN I MANAGE MY DIABETES? Weight loss, exercise and a healthy diet are keys to managing type 2 diabetes.

14 POZ OCTOBER/NOVEMBER 2021 poz.com

known as metabolic syndrome). The U.S. Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in people with overweight or obesity starting at age 35 (recently lowered from 40). Regular blood glucose monitoring, weight loss, exercise and a healthy diet are keys to managing type 2 diabetes and stopping prediabetes from advancing. Experts recommend eating a balanced diet low in sugar and fat, getting at least 150 minutes of moderateintensity physical activity each week and quitting smoking. Some people with type 2 diabetes may need oral medications or insulin. Unmanaged diabetes can lead to serious health problems, including heart disease, kidney disease and nerve damage, so it’s important to keep blood sugar under control. —Liz Highleyman

10 TIPS FOR LIVING WITH HIV: A SPANISH-LANGUAGE GUIDE Exercise and a healthy diet are among the top 10 recommendations from POZ for living with HIV. These practical tips include advice on health care and treatment, lessons on HIV and thoughts on support to help you on your journey with the virus. Go to the back of this issue for more tips in Spanish!

CONSEJOS PARA VIVIR CON EL VIH

1. ENCUENTRA UN MÉDICO

6. APRENDE SOBRE EL VIH

Siendo VIH positivo, puedes mantener tu salud y prolongar tu vida considerablemente accediendo el cuidado y tratamiento adecuado. Tu médico puede aconsejarte cómo mantenerte sano viviendo con el VIH y hablar contigo sobre varias opciones de tratamiento. No tengas miedo a hacer preguntas si no entiendes algo.

Conocer los datos reales sobre el VIH y su tratamiento puede empoderarte para tomar mejores decisiones acerca de tu propio cuidado y bienestar. Aprende la información básica y mantente al día con las últimas noticias sobre el VIH. POZ.com es un excelente lugar para empezar.

2. TOMA TUS MEDICAMENTOS El tratamiento para el VIH es más sencillo y seguro que nunca. Si bien es posible que haya efectos secundarios, el tratamiento protege tu salud y puede eliminar el riesgo de transmitir el VIH a otros. Saltarse las dosis o no tomarse los medicamentos como fueron recetados puede afectar tu salud y llevarte a desarrollar resistencia a los medicamentos. Si estás teniendo problemas con la adherencia, habla con tu médico.

3. SÉ HONESTO Habla con tu médico sobre lo que esté pasando en tu vida. ¿Qué ha cambiado desde tu última visita? ¿Estás deprimido o ansioso? ¿Bebes demasiado? ¿Tienes problemas para comer o dormir? Tu médico sólo puede ayudarte si eres honesto sobre tus problemas.

4. PIDE AYUDA ¿Necesitas ayuda para obtener seguro médico o vivienda o alguna otra cosa? ¿Estás buscando servicios de salud mental o ayuda con el abuso de sustancias? Pídele a tu médico que te refiera a un trabajador social o encargado de caso que pueda ayudarte a conectarte con los servicios que necesites.

5. BUSCA APOYO Rodéate de familiares y amigos con los que puedas contar, en las buenas y en las malas. Los grupos de apoyo y los chats online también son buenas maneras de conectarte con otros. Busca a otras personas que vivan con el VIH para aprender de sus experiencias.

7. PRACTICA EL AUTO-CUIDADO Ya sea que necesites recargar las baterías o relajarte, tomarte tiempo para ti mismo es esencial para mantenerte sano. Descansa y relájate practicando yoga, escribiendo un diario o tomando un baño de inmersión. Encuentra algo que funcione para ti.

8. MUÉVETE El ejercicio es fundamental para una buena salud general, sin importar tu estado de VIH. Tomarse el tiempo para practicar una actividad física casi todos los días es parte importante de una vida saludable. Elige una clase de ejercicio que disfrutes. El objetivo es encontrar actividades que encajen en tu rutina diaria para que te sientas motivado para hacerlas con regularidad.

9. COME ALIMENTOS SALUDABLES Una dieta equilibrada es importante para mantener la energía y la fuerza, promover una buena función inmunitaria, reducir el riesgo de desarrollar problemas de salud y mejorar la calidad de vida. Los expertos recomiendan consumir la mayoría de los nutrientes a traves de una dieta equilibrada que incluya una amplia variedad de alimentos.

10. DEJA DE FUMAR Fumar cigarrillos es un mal hábito para cualquiera, pero es especialmente dañino para las personas que viven con el VIH. Fumar aumenta los riesgos de desarrollar problemas de salud, como la enfermedad cardiovascular, el cáncer, el derrame cerebral y la enfermedad pulmonar. Si estás dispuesto a dejar de fumar, tu médico puede ayudarte.

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!

ISTOCK

IABETES IS A CONDITION IN which blood sugar (glucose) levels are too high. Type 1 diabetes, which usually arises during childhood, involves inadequate production of insulin, a hormone that enables cells to use glucose for energy. People with type 1 diabetes need to take insulin, administered via daily injections or a pump. Type 2 diabetes typically occurs later in life, when cells in the pancreas no longer produce enough insulin or cells are unable to use it, a condition known as insulin resistance. It may be preceded by a milder form called prediabetes, when blood sugar levels are higher than normal but not high enough to be classified as diabetes. Some people develop another form, gestational diabetes, during pregnancy. Risk factors for type 2 diabetes include overweight or obesity, lack of physical activity, older age, family history and being Black, Latino or Native American. This type of diabetes is often accompanied by abdominal fat accumulation, high blood pressure and abnormal blood fat levels (collectively

WHEN IT’S HARD BELLY (EXCESS VISCERAL ABDOMINAL FAT)

IT MAY BE TIME FOR EGRIFTA SV

IF YOU ARE LIVING WITH HIV AND LIPODYSTROPHY ASK YOUR HEALTHCARE PROVIDER ABOUT EGRIFTA SV TM.

FIND A SPECIALIST AT EGRIFTASV.COM Actual patient living with HIV.

IMPORTANT INFORMATION FOR PATIENTS ABOUT EGRIFTA SV (TESAMORELIN FOR INJECTION) TM

What is EGRIFTA SV (tesamorelin for injection)? • EGRIFTA SV is an injectable prescription medicine used to reduce excess abdominal fat in adult patients living with HIV and lipodystrophy. EGRIFTA SV is a growth hormone-releasing factor (GHRF) analog. • EGRIFTA SV is not for weight loss management. • The long-term safety of EGRIFTA SV on the heart and blood vessels (cardiovascular) is not known. • It is not known whether taking EGRIFTA SV helps improve how well you take your antiretroviral medications. • It is not known if EGRIFTA SV is safe and effective in children, do not use in children. TM

Before using EGRIFTA SV , tell your healthcare provider if you: • Have or have had cancer. • Have problems with blood sugar or diabetes. • Have scheduled heart or stomach surgery. • Have breathing problems. • Are breastfeeding or plan to breastfeed. • Are taking any other prescription and non-prescription medicines, vitamins, and herbal supplements. TM

EGRIFTA SV may cause serious side effects including: • Increased risk of new cancer in HIV positive patients or your cancer coming back (reactivation). Stop using EGRIFTA SV if any cancer symptoms come back. • Increased levels of your insulin-like growth factor-1 (IGF-1). Your healthcare provider will do blood tests to check your IGF-1 levels while you are taking EGRIFTA SV . • Serious allergic reaction such as rash or hives anywhere over the body or on the skin, swelling of the face or throat, shortness of breath or trouble breathing, fast heartbeat, feeling of faintness or fainting, itching and reddening or flushing of the skin. If you have any of these symptoms, stop using EGRIFTA SV and get emergency medical help right away. TM

You should not take EGRIFTA SV if you: • Have a pituitary gland tumor, surgery, or other problems related to your pituitary gland, or have had radiation treatment to your head or head injury. • Have active cancer. • Are allergic to tesamorelin or any of the ingredients in EGRIFTA SV . • Are pregnant or become pregnant. If you become pregnant, stop using EGRIFTA SV and talk with your healthcare provider. • Are less than 18 years of age. TM

• Swelling or fluid retention. Call your healthcare provider if you have swelling, an increase in joint pain, or pain or numbness in your hands or wrist. • Increase in blood sugar (glucose) or diabetes. • Injection site reactions. Injection site reactions are a common side effect of EGRIFTA SV , but may sometimes be serious. • Increased risk of death in people who have critical illness because of heart or stomach surgery, trauma of serious breathing (respiratory) problems has happened when taking certain growth hormones. TM

The most common side effects of EGRIFTA SV include: • Pain in legs and arms • Muscle pain These are not all of the possible side effects of EGRIFTA SV . For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or to THERA patient support® toll-free at 1-833-23THERA (1-833-238-4372). This information is not intended to replace discussions with your doctor. For additional information about EGRIFTA SV , go to: www.egriftasv.com for the full Prescribing Information, Patient Information and Patient Instructions for Use, and talk to your doctor. For more information about EGRIFTA SV contact THERA patient support® toll-free at 1-833-23THERA (1-833-238-4372). TM

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BASICS BY LIZ HIGHLEYMAN

LATINOS AND HIV

ATINOS IN THE UNITED STATES are a diverse group that includes people of Cuban, Mexican, Puerto Rican, Central American and South American origin. Collectively, Latino communities have been hit hard by the HIV epidemic. While they make up about 19% of the U.S. population, Latinos accounted for 27% of all new HIV cases in 2018, according to the Centers for Disease Control and Prevention (CDC). Only African Americans have a higher rate of new HIV diagnoses. Among the estimated 1.2 million Americans living with HIV that year, around 274,000 were Latino. According to the Ofﬁce of Minority Health at the Department of Health and Human Services, Latino men and women are about four times more likely to have HIV than their non-Hispanic white counterparts. Among Latino men, those who have sex with men account for the largest proportion of new diagnoses (85%); 30% of gay and bisexual men diagnosed with HIV in 2018 were Latino. Among Latina women, the most common risk factors are heterosexual contact (87%) and injection drug use (12%). Overall,

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the rate of new cases among Latinos has remained stable in recent years, but it has risen among young men ages 25 to 34. The CDC estimates that ﬁve out of six Latinos living with HIV have been tested and are aware of their status. Testing is important because those who know their status can start antiretroviral treatment, which halts disease progression and prevents transmission of HIV, as people who achieve an undetectable viral load do not transmit the virus. Unfortunately, compared with HIVpositive people overall, Latinos have a lower likelihood of receiving HIV care (61%), remaining in care (49%) and achieving viral suppression (53%). Latinos are also less likely to be taking pre-exposure prophylaxis (PrEP) to prevent HIV. In addition, Latinos are at a greater risk for other health problems that can make it more difﬁcult to manage HIV and increase the likelihood of complications. The three leading causes of death for Latino men in the United States are heart disease, cancer and unintentional injuries; for Latina women, these are cancer, heart disease and stroke. Latinos

are twice as likely as non-Hispanic whites to have diabetes, or elevated blood sugar, which can cause a host of health problems. (See Ask POZ, page 14.) Although Latinos do not have higher rates of hepatitis B or C, they are more prone to fatty liver disease, which can lead to cirrhosis and liver cancer. While HIV does not progress faster among Latinos, and antiretroviral treatment is equally effective for this population, Latinos are less likely to receive adequate health care than non-Hispanic white people. Reasons include lower average income and education level, lack of health insurance, language barriers, concerns about immigration status, discrimination and stigma. What’s more, according to the CDC, Latinos may have a high level of distrust of the health care system. Many AIDS service organizations offer services speciﬁcally for Latinos living with HIV. In addition, some clinics and hospitals have Spanish-speaking staff, including doctors, nurses and social workers, or can provide translators to help patients communicate. Don’t hesitate to ask for this kind of help if you need it. Q

ISTOCK (MOELS UESED FOR ILLUSTRATIVE PUROSES ONLY)

Latino communities are disproportionately affected by HIV and AIDS.

RESEARCH NOTES

ALL IMAGES: ISTOCK

BY LIZ HIGHLEYMAN

PREVENTION

TREATMENT

CURE

CONCERNS

Long-Acting PrEP

Twice-Yearly

New Approaches

COVID-19 Risk

Long-acting injections given every two months could soon offer a new option for HIV pre-exposure prophylaxis (PrEP). Results from the HPTN 083 trial showed that cabotegravir injections every other month were more effective than daily tenofovir disoproxil fumarate/ emtricitabine (Truvada or a generic equivalent) for cisgender men and transgender women who have sex with men. The study found that 13 people randomly assigned to the cabotegravir group acquired HIV, compared with 39 in the Truvada group (0.41 versus 1.22 cases per 100 personyears), indicating that the injections were 66% more effective. This is remarkable given that the daily pill reduces HIV risk by about 99% for gay and bisexual men who use it consistently. The parallel HPTN 084 trial showed that long-acting cabotegravir also works better than daily Truvada for cisgender women in Africa. In that study, the difference was even greater—the injections were 92% more effective—as women appear more likely than men to have difficulty taking daily PrEP pills consistently.

Lenacapavir, a twice-yearly injectable, suppresses viral load in people with highly resistant virus, and it also shows promise for previously untreated people. In the Phase II/III CAPELLA trial, 36 adults with resistance to multiple antiretrovirals were first randomized to add oral lenacapavir or a placebo to their current failing regimen for two weeks; 88% and 17%, respectively, had at least a half-log reduction in viral load. Next, they received lenacapavir injections every six months plus an optimized background regimen. Interim results at 26 weeks showed that 81% had a viral load below 50. This was accompanied by an average gain of 81 CD4 cells. The Phase II CALIBRATE trial enrolled 182 previously untreated participants who were randomized to receive injectable or oral lenacapavir plus two other antiretrovirals or a standard three-drug regimen for 28 weeks. At that point, approximately 94% of lenacapavir recipients had an undetectable viral load. Going forward, they will receive lenacapavir injections every six months with just one other drug.

Starting antiretroviral therapy very early shrinks the latent viral reservoir and improves the prospects for attaining a functional cure; however, most people with HIV are diagnosed and start treatment later, during chronic infection. But now, researchers have shown that a combination of antibodies that block interleukin 10 (IL-10) and PD-1 may help control the virus even at this later stage. IL-10 is an antiinflammatory cytokine that suppresses T-cell activity. PD-1 is an immune checkpoint that acts as a brake on CD8 “killer” T cells. Researchers analyzed 28 monkeys with an HIV-like virus. They started antiretrovirals six weeks after infection and stayed on them for more than a year. After stopping the antiretrovirals, all the monkeys experienced viral rebound, but virus levels were lower in those that received IL-10 antibodies. Nine of the 10 animals that received both IL-10 and PD-1 antibodies experienced viral suppression below 1,000 copies at some point. What’s more, a majority maintained viral control for several weeks after stopping the antibodies.

Studies of COVID-19 risk among people with HIV continue to reach different conclusions. An analysis from the World Health Organization looked at data from more than 15,000 people with HIV, mostly in South Africa, who were hospitalized with COVID-19. Having HIV was associated with a 13% higher risk for severe illness and a 30% higher risk for death. Another analysis from the United States included more than 21,500 adults hospitalized with COVID-19, of whom 220 were HIV positive. HIV was not independently associated with mortality: 16% of HIV-positive and 15% of HIV-negative people died. Having HIV also was not associated with severity of illness or length of hospital stay. Both analyses were limited by lack of information about HIV treatment or CD4 count. But another study found that a lower CD4 count and a detectable viral load were associated with more severe COVID-19. In August, U.S. health officials recommended a third COVID-19 vaccine dose for immunocompromised people, including those with advanced or untreated HIV.

poz.com OCTOBER/NOVEMBER 2021 POZ 17

CARE AND TREATMENT BY HEATHER BOERNER

Getting Mobile to Bring People Back Into Care

To win a race, it helps to have a pit crew for support and a coach to help you get off the blocks fast. When people participating in a supportive program left their HIV diagnosis appointment with a 30-day supply of HIV meds and a first care appointment scheduled with an outside provider through the help of a navigator, they achieved an undetectable viral load three times faster than those who did not receive that level of support. The program, JumpstART, ran in New York City public sexual health clinics between 2016 and 2019 and provided free or low-cost HIV treatment, HIV prevention services, sexually transmitted infection (STI) testing and treatment and pregnancy testing, along with navigation services, case management, adherence counseling, partner testing, connection to external HIV providers and follow-up care. A total of 230 people were diagnosed with HIV and treated through JumpstART. Their viral load results were compared with a control group of 36 people diagnosed with HIV previously through a private provider. Researcher Preeti Pathela, DrPH, of the New York City Department of Health

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and Mental Hygiene, and her colleagues found that one third of JumpstART participants didn’t connect with a provider within 30 days and returned for a second starter pack of HIV medications. The rest successfully linked to care outside the clinic. Although by the end of the first 30 days, the same proportion of people in JumpstART and in the control group were linked to care, by three months after diagnosis, 85% of JumpstART participants had achieved viral suppression, compared with just 45% of those in the control group. By the end of the study period, 92% of JumpstART participants had an undetectable viral load, compared with 86% of people not in the program. After controlling for viral load at the time of diagnosis, people in JumpstART achieved viral suppression three times faster than those in the control group. “When newly diagnosed individuals have to be referred elsewhere to start [antiretroviral treatment], they are often faced with multiple disjointed steps and a complex system,” wrote Pathela and colleagues. And “that can delay time to viral suppression, or effectively impede it altogether.”

(RACEWAY) ISTOCK

THE FAST LANE TO UNDETECTABLE

What does it take to bring back people with HIV who have been out of care for a while? According to data presented at the 11th International AIDS Conference on HIV Science, traditional HIV care is not the answer. This cross-sectional study asked 50 people which of six different models of care would make HIV treatment doable for them. The participants, largely Black same-gender-loving men with an income below $10,000 a year, gave mobile clinics the biggest nod, with 70% ranking that model as their first or second choice, followed by communitybased peer navigators and telemedicine. Traditional clinics were less popular. Only 14% of participants ranked traditional clinics as their first choice, while 24% ranked them second to last. Still, traditional care tied with telemedicine as the third most popular option. Care at homeless shelters and substance use clinics came in last.

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

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CARE AND TREATMENT BY HEATHER BOERNER

The first data from the much anticipated REPRIEVE trial on statin medications for people with HIV are out, and they suggest that a fire is brewing in the vascular system of about half of people living with HIV. The study, published in JAMA Network Open, details the heart health of 755 people living with HIV who were on antiretroviral treatment with an undetectable viral load as they began the trial. None had started taking statins, cholesterol-lowering medications used to prevent cardiovascular disease. According to traditional screening guidelines from the American Heart Association and the American College of Cardiology, all the participants had low to medium risk for atherosclerotic cardiovascular disease—that is, abnormalities in the arteries that can lead to heart attacks and strokes. The participants received a test of cardiovascular function called coronary computed tomography angiography and had blood drawn to look for inflammatory markers and the

amount of arterial plaque—buildup of fats, cholesterol and other substances that harden the arteries and impede the flow of blood. Nearly half of the participants (49%) had some level of plaque in their arteries—more than the traditional screening test would have suggested. And 7% of the participants had enough plaque to obstruct blood flow. Another quarter had vulnerable plaques, which are associated with heart attacks. Participants also had a 71% increased risk for the inflammatory marker interleukin 6, which is associated with plaque and coronary artery disease. “Data from REPRIEVE connect inflammation and immune activation to coronary artery disease in a large study of people with HIV under good virologic control and with low traditional risk...even in young people with HIV with low traditional [atherosclerotic cardiovascular disease] risk,” Udo Hoffmann, MD, of Massachusetts General Hospital, and colleagues concluded.

Have Hormones, Will PrEP A study presented at the 11th International AIDS Society Conference on HIV Science suggests that pre-exposure prophylaxis (PrEP) pills work at full potency in women of trans experience who use feminizing hormones—in fact, the data showed that women taking feminizing hormones were more likely to take the HIV prevention pills. Thirty-eight Brazilian trans women agreed to be divided into two groups: 14 took tenofovir disoproxil fumarate/emtricitabine (Truvada or a generic equivalent) without using feminizing hormones for 12 weeks; the other 24 women started PrEP while also taking a specified hormone regimen. Twelve weeks later, all the women could use the feminizing hormone regimen of their choice. The researchers checked their blood for any differences in levels of PrEP drugs depending on whether or not the women were concurrently taking hormone therapy. The verdict was that there was a difference—but it wasn’t what many transgender people had feared. Instead of feminizing hormones blunting the potency of PrEP, women using hormone therapy plus PrEP in the first part of the study had higher PrEP drug levels. This wasn’t because feminizing hormones boosted the power of the pills but because the women taking hormones were more likely to follow through on taking PrEP. At 12 weeks, 79% of women in the PrEP plus hormone therapy group had drug concentrations consistent with taking four or more pills a week, compared with 64% in the PrEP-only group. By the time the second measurements were taken at week 48, only 17 women were still on PrEP, but 93% of them had drug levels consistent with taking the pills at least four days a week. “Oral PrEP is clinically effective among trans women with HIV risk on hormones,” said Vitória Berg Cattani, MSc, a pharmacist at Instituto de Pesquisa Clinica Evandro Chagas in Rio de Janeiro.

22 POZ OCTOBER/NOVEMBER 2021 poz.com

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POZ533115.pdf 08.26.2021 09:52

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DESPITE BEING DISPROPORTIONATELY AFFECTED BY HIV, MANY LATINOS LIVING WITH THE VIRUS ARE THRIVING. BY CHARLES SANCHEZ

LATINOS ARE ABOUT 18% OF THE U.S. POPULATION, but they represented almost 30% of all HIV cases nationwide in 2019, according to the Office of Minority Health at the Department of Health and Human Services. So of the nearly 1.2 million people in our country with the virus, about 300,000 are Hispanic/Latinx. I am one of them. I’m a 53-year-old Mexican-American gay man living in New York City. In November 2003, I was living in Little Rock, Arkansas, sick with what I thought was a stubborn case of bronchitis. I had a dramatic cough so violent that my roommate Cassie could hear it from her bedroom at night. One afternoon, Cassie came home from work at lunchtime to check in on me and found me lying on the floor. My face was blue, and I was gasping for breath. She carried me to her car and sped me to the emergency room, where I was intubated and put into a drug-induced coma.

poz.com OCTOBER/NOVEMBER 2021 POZ 25

CHRISTINA (NOT HER REAL NAME) IS A STYLISH 29-YEARold transgender woman who lives in Birmingham, Alabama. Because she doesn’t speak English and I don’t speak Spanish, Alexander Bautista from the group AIDS Alabama graciously sat in as a translator.

26 POZ OCTOBER/NOVEMBER 2021 poz.com

Daniel G. Garza (above) and Charles Sanchez

Christina was born in New Mexico but was raised in Veracruz, Mexico. “I had a very terrible childhood,” she says. She grew up with her mother and three siblings. She says, “I was very lonely because I wasn’t a normal kid and wasn’t allowed to play with anyone.” Christina also suffered sexual abuse as a child. “It was from someone in the household,” she says, “from when I was 6 to when I was 8.” Christina always knew that she was female, even though she didn’t know what a trans woman was. When she was 7, she started to question her gender. “I wondered, Why do I feel like a girl and I’m a boy?” Christina recalls. She began to honor her true self at age 13 by wearing more feminine clothing; at 14, she began medically transitioning. Her family disapproved. “I come from a very Catholic religious family,” she says, “and they still believe that the whole LGBTQ community is going to hell!” When I asked Christina to tell me about her HIV journey, a look of sadness came over her, and she took a deep breath. “It all started with my family’s disapproval,” she says. “I was never a rule follower. I always just did what I wanted,” she says. Christina felt as though she had to choose between two terrible options: to stay at home with her family and become what they wanted her to be, a “real man,” or to leave and be vulnerable to the unknown. She ran away at age 12. Life away from home was not so easy. “In Mexico, when you are an innocent, away from home, you are like a target [for predatory men]. Easy to exploit,” she says. She intimates that she was repeatedly abused. She found work at a discotheque. At the club, Christina was tested for HIV and other sexually transmitted infections every six months. When she tested HIV positive, she was 15 years old. She didn’t know what HIV was or what testing positive meant. She thought that death was imminent. “I went out of my head,” she says, “I drank and did drugs. I wanted revenge on those guys [who gave me HIV]. I had unprotected sex without caring. I was a very irresponsible 15- and 16-year-old.” Her attitude didn’t change until she was 20 or 21. “I started to see that my situation was not the worst. I realized I had to change,” she says. Three years ago, in 2018, she and her mother moved to the United States.

PREVIOUS PAGES: (ALL IMAGES) ISTOCK; (GARZA) COURTESY OF DANIEL G. GARZA; (SANCHEZ) BILL WADMAN

I woke up three weeks later with my parents, my brothers and my sister—along with a very serious-looking doctor—all standing around my hospital bed. I was getting my bearings when the doctor told me my diagnosis: AIDS. I’d had pneumocystis pneumonia, thrush and histoplasmosis. My viral load was through the roof, and my CD4 count was 4. I looked at my family in horror, worried about what they were thinking. My sister took my hand and said, “Don’t worry about us; we’ve known for three weeks.” I left the hospital on Thanksgiving Day, the best Thanksgiving of my life. I was lucky, in more ways than one. That I lived was the big miracle, but there were practical considerations too. I had been fired from my waitering job days before my hospitalization (“You just haven’t been yourself lately,” my snotty boss had said), and I didn’t own a house or even have my name on an apartment lease. Uninsured and lacking any assets, I was considered indigent by both the hospital system and the government. That made me eligible for a lot of benefits. While I was in my drug-induced bliss, my parents took care of the paperwork, signing me up for every benefit possible. By the time I was released from the hospital, I had disability benefits, including Medicare and Medicaid. I was connected to case management and services at the Arkansas AIDS Foundation. I was streamlined into the systems already in place and slid right from hospital care into regular HIV care. I quickly regained health and went from having an extraordinarily high viral load to having undetectable virus in mere weeks. Although I almost died, I’m very aware that my HIV experience oozes privilege. I’m a fifth-generation U.S. citizen. I speak English. I have support from family and friends. It was and continues to be relatively easy for me to navigate finding the care and support I need, whether that means dealing with the social security system or pharmaceutical issues or finding medical care, mental health support or anything else. The barriers to my treatment and overall care have been few. That is not the case for many Latinos living with HIV. According to the Centers for Disease Control and Prevention (CDC), compared with all people in the country with HIV, Latinos have lower viral suppression rates. Sixty-one percent of U.S. Latinos with the virus receive some HIV care, 49% remain in care and only 53% make it to an undetectable viral load. The CDC cites several causes for these numbers: racism, discrimination, homophobia, HIV stigma, poverty, lower education levels, language barriers, mistrust of the health system and fear of disclosing immigration status, among others. These barriers can seem insurmountable. Yet, many in the Hispanic/Latinx HIV community who’ve faced and continue to face such challenges are living full, joyous, healthy lives with HIV. I had the pleasure of speaking with two of them.

Christina moved here seeking more opportunities. She settled in Alabama, where she first saw a doctor who insisted that she start antiretroviral treatment immediately. She had not been on HIV medication before. Fortunately, she hasn’t experienced any side effects from her HIV treatment. Christina relies on AIDS Alabama and other HIV organizations for support and is involved with the group Trans Latinx Alabama. Christina says that, although the HIV treatment in the United States has been great, she has had some problems with medical providers. “They’re not very accepting of my situation,” Christina says. “It feels like some doctors are just treating me because they are getting a paycheck, not because they care. They see me as just another patient. They don’t try to make a connection with me, with who I am.” She feels that some medical care providers have a strong phobia against trans people living with HIV. Also, language poses some challenges. “Sometimes I call, and I ask for someone who speaks Spanish, and they get annoyed with me or just hang up,” she says. “It’s so frustrating, but it’s not an obstacle for me,” Christina adds, “I’m still going to get my treatment and my care.” Despite such hurdles, she is happy to be living in the states. Christina married her longtime boyfriend on June 9. “Oh my God! It was the most beautiful day of my life,” she smiles. “It was the happiest day. I think of myself as such a strong independent woman, and now, I’m also a housewife!” THE HILARIOUS AND SMART DANIEL G. GARZA WAS born to a Mexican mother and Texan dad in Monterrey, Mexico. “I’m the original Tex-Mex,” he says. His family was very conservative and very Catholic. When Daniel was 3 years old, he and his parents moved to the states, settling in Dallas. He knew he was gay from an early age. “I don’t remember ever not having ‘I like boys’ thoughts. You don’t know it’s gay,” he says, “you just know you like boys.” To escape the bullying he faced as a kid in Texas, Daniel returned to Mexico to attend high school and lived with his older sister. He was outed as gay when he was 17. “I had this moment with this boy over the summer. Summer lovin’! But word got around and to my parents,” Daniel says. “It was very dramatic, even for Mexicans. It was over Thanksgiving, so it was like, ‘Pass another turkey tamal, Daniel’s gay!’” At 18, he moved back to Dallas, fell in love with his first boyfriend and tried drugs for the first time. The romance

“THESE BARRIERS CAN SEEM INSURMOUNTABLE.”

didn’t last, but Daniel started on a 16-year path of addiction. Cocaine, alcohol, acid, ecstasy and crack were his drugs of choice. In the summer of 2000, he was living in Houston. “I was still doing a lot of drugs, and that summer, I started to feel a little sick.” He noticed that he was feeling chills, experiencing night sweats and losing weight. “But I thought, Cool!” he says, “I fit into a size 28 jeans—I’m hot!” That fall, the manager of the restaurant where he worked took him aside and expressed concern. “She told me that I looked really sick and I had to go to the doctor.” The next day, a friend took him to a clinic. “They took one look at me and pushed me to the front of the line,” he says. “They really didn’t think that I was going to make it. I went to the hospital for three weeks.” He was diagnosed with AIDS. “I didn’t really get it. I was selectively naive. I knew that it was sexually transmitted. And I knew there was medication, but that was it.” Daniel says his naiveté, mixed with cockiness, is what saved him at that serious moment. “I never thought of myself as a victim. It’s like when I was a kid and getting bullied. I needed to change direction, and I did. The same with AIDS,” he says. “I thought, Nope! I’m not going to fall for the fear tactics. You’re not going to put fear in my head because of AIDS.” Once he was discharged from the hospital, Daniel moved to McAllen, Texas, a border town, to recuperate and started volunteering at the Valley AIDS Council. “That’s when I started my advocacy. I would go and do the typical condom packets for them, just pack them up,” he says. “Then I was given the job to order pamphlets.” One of Daniel’s first projects came about after he noticed that there weren’t enough informational pamphlets in Spanish. “I would call up the companies and say, ‘Hey! Why don’t you translate this?’ So my first advocacy job was getting more stuff in Spanish.” From there, Daniel seized every opportunity—whether it meant furthering his education, manning a booth or agreeing to do a speaking engagement. “I started realizing that I knew more than I thought I knew.” In the years since his diagnosis, Daniel has become an amazing HIV advocate. He started by working at local service organizations in Texas, and his opportunities grew. He has been able to use his story, humor and skills as a bilingual advocate to teach people about HIV and push for more information and assets geared toward Spanish speakers. Daniel got sober in 2007 and now lives in California with his partner, Christian. Daniel’s work as a champion for HIV issues has earned him national attention. He has worked with HealtheVoices, a social media leadership program developed by Johnson & Johnson, as well as the “Positively Fearless” campaign launched by Janssen Pharmaceuticals. As if that weren’t enough, he has a YouTube channel and broadcasts live on social media. He has also acted and directed and performs stand-up comedy. “God, the universe—they spoil me. I am definitely blessed,” Daniel says. “I am a 50-year-old successful HIVpositive Latino gay man, and I have earned my name.” Q

poz.com OCTOBER/NOVEMBER 2021 POZ 27

ISTOCK

THIS SIMPLE FALL MEAL IS LOW IN CALORIES YET RICH IN THE FLAVORS OF FALL.

BY BOB BARNETT

COOL WEATHER WHETS THE APPETITE. But hearty autumn meals can also pile on calories. Pandemic-related weight gain is a real thing, and for people who are HIV positive, certain antiretrovirals and other drugs may contribute to weight gain as well. So as we head indoors, careful about COVID-19 again, we want comfort food—without the guilt. Wouldn’t it be great to rediscover the pleasures of home cooking without overindulging? Welcome to our table. This delicious and nutritious menu comes from Fred Hutch’s Cook for Your Life, a UHFLSH ZHEVLWH ODXQFKHG E\ $QQ 2JGHQ *D; QH\ D passionate cook and three-time cancer survivor. Her aim is to make nutritious and delicious food that’s simple to prepare. Every recipe is created by chefs and reviewed by a registered dietitian. On the menu tonight: Spicy Indian-Style Chicken/ Turkey Burgers, Pumpkin & Arugula Salad With Hazelnuts and Baked Apples With Rosemary & Honey. 7KH Á DYRUV DUH ULFK DQG KHDUW\ WDNLQJ DGYDQWDJH RI fall’s harvest. The whole meal is less than 800 calories, including the burger bun, and it’s nutritious too: low in saturated fat and sodium, moderate in sugar and KLJK LQ VDWLDWLQJ SURWHLQ DQG À EHU 'LJ LQ

Spicy Indian-Style Chicken/Turkey Burgers These spicy Indian-style chicken/turkey burgers are really a healthy and delicious version of kofta, the ubiquitous Indian and Middle Eastern version of meatballs. Adding dark turkey meat gives these burgers extra depth. If you happen to be outside grilling, shape the mixture into patties to make healthy, rich-tasting burgers, or roll it into little meatballs to broil or sauté for a party appetizer or to eat with pasta. It’s all good—and all good for you. 30 minutes prep; 8 servings; 11 ingredients

DIRECTIONS 1. Beat the egg, yogurt, parsley, red pepper, coriander, ginger, salt and pepper together in a large bowl. Add the ground chicken and turkey and mix well together. Add the breadcrumbs and mix until well combined. Shape the mixture into roughly 8 balls slightly flattened into thick patties. 2. Grill on a barbecue or a ridged iron grill pan until firm, about 5 minutes on each side, depending on the thickness of the patty. When cooked, the burgers should be firm to the touch with no bounce. Garnish with parsley. 3. Serve in toasted buns with lettuce or spinach and a side of Pumpkin & Arugula Salad With Hazelnuts.

30 POZ OCTOBER/NOVEMBER 2021 poz.com

NUTRITION FACTS PER SERVING* Calories: 195; Fat: 10g; Saturated fat: 3g; Polyunsaturated fat: 2g; Monounsaturated fat: 4g; Carbohydrates: 4g; Sugar: 1g; Fiber: 1g; Protein: 23g; Sodium: 326g *not including bun

CHEF TIPS Taste test the chili pepper first to make sure you’re comfortable with the heat you’re adding to your burgers. Cut off a tiny piece and see just how hot it really is. A mouthful of milk will take the heat away. Make sure not to add any of the seeds or the white pith from inside the pepper—that’s where most of the heat is stored. If you can’t find fresh red chilies, add a ½ teaspoon of cayenne, or to taste. To make your own bread crumbs, take any bread that’s gone a little stale, dice the slices and grind them on a coarse setting in a food processor. ©2021 Cook for Your Life, a 501(c)(3) QRQSURƓW RUJDQL]DWLRQ 8VHG E\ SHUPLVVLRQ

BOTH IMAGES: COURTESY OF UCSF ARCHIVES & SPECIAL COLLECTIONS

INGREDIENTS 1 large egg 3 tablespoons Greek yogurt WDEOHVSRRQV ƓQHO\ FKRSSHG SDUVOH\ SOXV PRUH IRU JDUQLVK VSLF\ UHG FKLOL SHSSHU SRG FD\HQQH RU 7KDL ELUG RU WR taste WHDVSRRQ JURXQG FRULDQGHU WHDVSRRQ IUHVKO\ JUDWHG JLQJHU 1½ teaspoons salt WHDVSRRQ IUHVKO\ JURXQG EODFN pepper SRXQGV JURXQG FKLFNHQ ½ pound ground turkey, preferably dark meat FXS EUHDGFUXPEV

Pumpkin & Arugula Salad With Hazelnuts

ALLIMAGES: COURTESY OF COOK FOR YOUR LIFE/JOE GAFFNEY

This recipe makes for a delicious addition to your fall salad rotation. Meatier squash cultivars—pumpkin, kabocha, butternut—are the best. (Nutty-tasting kabocha is my personal favorite.) This simple yet delicious salad tosses roasted pumpkin in a tangy maple vinaigrette dressing with the peppery cruciferous salad green arugula. 30 minutes prep; 4 servings; 9 ingredients INGREDIENTS 1½ pounds sugar pumpkin or butternut squash or kabocha squash, peeled, deseeded and cut into 1-inch cubes 4 tablespoons olive oil, divided cup hazelnuts salt to taste ¼ cup Pecorino or Parmesan cheese, cut with a vegetable peeler IUHVKO\ JURXQG SHSSHU WR WDVWH

1 tablespoon cider vinegar WHDVSRRQV PDSOH V\UXS or to taste 5 cups arugula

DIRECTIONS 1. Preheat the oven to 400°F. 2. Spread the cubed pumpkin or squash onto a baking sheet and drizzle with 1 tablespoon olive oil and salt. Toss to coat. Bake for 30 minutes, turning occasionally, until tender and browned. Let cool slightly. 3. While the pumpkin is baking, spread the hazelnuts onto a baking sheet and toast in the oven for 10 to 15 minutes or until the skins are well browned and cracking. 4. Remove the hazelnuts and let cool slightly. Rub the skins off the hazelnuts with a kitchen towel. Discard the skins and roughly chop the nuts. Set aside. 5. Make the maple vinaigrette: In a small bowl whisk the vinegar, salt, pepper and maple syrup together.

Gradually beat 3 tablespoons of the olive oil until well blended. Taste for sharpness and adjust seasonings if necessary. 6. Pour the vinaigrette over slightly cooled pumpkin, arugula, pecorino and toasted hazelnuts. Toss when ready to serve. NUTRITION FACTS PER SERVING Calories: 287; Fat: 23g; Saturated fat: 4g; Polyunsaturated fat: 3g; Monounsaturated fat: 16g; Carbohydrates: 17g; Sugar: 8g; Fiber: 3g; Protein: 8g; Sodium: 551mg ©2021 Cook for Your Life, a 501(c)(3) QRQSURƓW RUJDQL]DWLRQ 8VHG E\ SHUPLVVLRQ

Baked Apples With Rosemary & Honey These baked apples are a quick way to make a healthy dessert, hot or cold. All you need are some tart/sweet apples, like Braeburns or Pink Ladies, and an oven. Try to buy small apples and allow one per person.

(RALLY) LIZ HIGHLEYMAN; (GONSALVES) CROI 2021 SCREENSHOT

20 minutes prep; 8 servings; 6 ingredients INGREDIENTS 2-3 tablespoons almond slices or chopped walnuts 2 teaspoons melted butter WHDVSRRQ ƓQHO\ FKRSSHG URVHPDU\ leaves 4 tart/sweet apples, peeled and cut in half, cores scooped out FXS KRQH\ RU WR WDVWH 1 tablespoon water DIRECTIONS 1. Preheat the oven to 375°F. 2. Dry roast the sliced almonds or walnuts in a heavy pan until they just begin to color. Set aside in a bowl.

3. Generously smear a baking dish or cookie sheet with butter and sprinkle with rosemary. Take the apples and roll them around on the pan to coat with a little bit of the butter and herbs. 4. Place them cut side down in the dish or sheet. Drizzle them with the honey and add the water to the bottom of the dish. 5. Bake in the center of the oven for about 30 to 40 minutes. About halfway through, carefully flip the apples over and baste them with the pan juices. Continue to bake until the apples are soft and a bit caramelized on top. Let them cool for at least 10 minutes before serving. 6. Serve sprinkled with the toasted almonds; if desired, top with thick yogurt or ice cream. NUTRITION FACTS PER SERVING Calories: 135; Fat: 3g; Saturated fat: 1g; Polyunsaturated fat: 1g; Monounsaturated fat: 1g; Carbohydrates: 30g; Sugar: 27g; Fiber: 2g; Protein: 1g; Sodium: 2mg ©2021 Cook for Your Life, a 501(c)(3) nonSURƓW RUJDQL]DWLRQ 8VHG E\ SHUPLVVLRQ

poz.com OCTOBER/NOVEMBER 2021 POZ 31

HEROES BY CHARLES SANCHEZ

“When you ask people I work with about me, they will say that Guillermo is always thinking from the micro to the macro.” The Guillermo in question is the president of the Latino Commission on AIDS (LCOA), Guillermo Chacón. The nonprofit group advocates for HIV/AIDS prevention and overall health care for Latinos. He has been its leader since 2010. Chacón began working with LCOA in 1995. “The second president of the agency was Dennis deLeon, a giant. He honored his last name: ‘the lion.’ He was not only a leader but also someone who was doing amazing work,” Chacón says. “He brought me on. I had done some work in the HIV field before, but it was Dennis who really got me involved.” Chacón grew up in El Salvador. “I come from a very socially active family,” he says. “Both my parents encouraged all of us—there’s another brother and two sisters—to do community organizing through our parish.” Although they were a middle-class urban family, they understood their responsibility to the larger community. Chacón’s brother works on migration issues, his older sister works in a local parish and his baby sister is a teacher. “All of us are in the social, education or health services sectors,” Chacón says. “I think it is wonderful.” Chacón’s Uncle Antonio was also a big influence on him and his work. “He was the uncle who would give you the best time. My uncle was a gay man, and he was in the closet. I learned about him more as I reached my 20s. And then he passed.” Chacón, who is straight, credits his gay uncle with helping him to be more thoughtful, loving and caring. “When I started to do more work around HIV and sexual health work with the commission, I connected the dots,” Chacón says. “How important it is to validate and embrace and understand who we are as a person, yes, but also who we are as a community.” This compassion for others and sense of community responsibility are central to Chacón’s work at the commission. “You always have to pay attention to who is less visible,” he says. “I always try to elevate the trans community and gay and bi men and women but also native folks and Black folks. If you look at history, those folks remind each of us to learn more about them and at the same time be better partners to make a difference.” LCOA will honor its 30th anniversary on National Latinx HIV Awareness Day, which is marked each October 15, and Chacón is focusing on the agency’s future. To that end, he recently became a member of the Presidential Advisory Council on HIV/AIDS. “I want to go deeper in doing a better job,” he says. “We have a campaign called ‘Zero Transphobia, Zero Homophobia,’ and I want to go deeper in addressing stigma in the community as a whole, especially the Hispanic/Latinx community, because there’s nothing worse than homophobia and transphobia in our society.” Chacón is adamant that any person of any gender identity should be able to get care without judgement. When we talk about public health and HIV, he says, we must remove barriers that keep people from accessing care. “Because it’s not just about you, it’s about who we embrace in this journey,” Chacón adds. “Life is a oneway ticket, and we better take advantage of this ride.” Q

32 POZ OCTOBER/NOVEMBER 2021 poz.com

Guillermo Chacón leads the Latino Commission on AIDS.

BILL WADMAN

Honoring Community

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TOMA TUS MEDICAMENTOS contigo sobre varias opciones tratamiento protege tu que nunca. Si bien es posible que haya efeces más sencillo y seguro tratamiento. No tengas miedo a VIH ElNo tratamiento para el tratamiento. tengas miedo a salud ymás puede eliminar el posible que efectos secundarios, elalgo. que nunca. Sihaya bien es hacerpreguntas preguntas si nosencillo entiendes algo. es y seguro hacer si no entiendes riesgo de transmitir el VIH a otros. tosnunca. secundarios, el tratamiento tu posible queprotege haya que Si bienefeces Saltarse las dosis o no tomarse tratamiento protege tu salud y puede eliminar el tos secundarios, posible que haya el efec2. TOMA TUS MEDICAMENTOS 2. TOMA TUS MEDICAMENTOS los medicamentos como salud puede eliminar el riesgo de transmitir el VIHfueron a otros. tratamiento protege tos y secundarios, el tu El tratamiento para el VIH El tratamiento para el VIH recetados puede afectar tu salud y riesgo de transmitir el VIH a otros. 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básica y mantente al día con las últidecisiones acerca de tu propio cuidado yempoderbienearte para tomar mejores miento puede mas noticias sobre el VIH. POZ.com propio cuidado ymejores bienestar. Aprende latomar información decisiones acerca de tu arte para 6.APRENDE APRENDE SOBRE EL VIH 6. SOBRE EL VIH es un excelente lugar para empezar. star. Aprende la información básica y mantente al día con las últipropio cuidado y bienedecisiones acerca de tu Conocer los datos reales Conocer los datos reales básica y mantente al día con las últimas noticias sobre el VIH. POZ.com star. Aprende la información propio cuidado y bienesobre elel VIH su tratasobre el yysu tratamas noticias sobre POZ.com es un excelente lugar para empezar. básica y mantente alVIH día con las últistar. Aprende laVIH. información 7. PRACTICA EL AUTO-CUIDADO miento puede empodermiento puede empoderes un excelente lugar para empezar. mas noticias eldía VIH. 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POZ.com relájate practicando yoga, para tipara mismo es esencial para mantenerte relajarte, tomarte tiempo esun unexcelente excelente lugar para empezar. recargar las baterías o es lugar empezar. escribiendo sano. un diario o tomando un cial para mantenerte Descansa y para ti mismo es tiempo esenrelajarte, tomarte baño de inmersión. Encuentra algo sano. relájate practicando yoga, cial para mantenerte para tiDescansa mismo esy esen7. PRACTICA EL AUTO-CUIDADO 7. PRACTICA EL AUTO-CUIDADO que funcione para ti. relájate practicando escribiendo un diario omantenerte tomando un sano. Descansa y yoga, cial para Yasea seadiario que necesites Ya que necesites escribiendo un o tomando baño de relájate inmersión. Encuentra algo sano.practicando Descansa y yoga,un recargar lasbaterías baterías recargar oo baño derelájate inmersión. Encuentra algo que funcione para ti. las escribiendo un diario o tomando un practicando yoga, 8. MUÉVETE relajarte, tomarte tiempo relajarte, tomarte tiempo que de funcione para ti.o baño inmersión. Encuentra algo escribiendo diario un El un ejercicio estomando fundamental paratitimismo mismo esesenesenpara es que funcione para ti. baño de inmersión. Encuentra algo para una buena salud 8. MUÉVETE cialpara para mantenerte cial mantenerte que funcione para ti. sin general, importar tu 8. MUÉVETE El ejercicio es fundamental sano. Descansa sano. Descansa yy estado VIH. Tomarse El ejercicio es fundamental para unade buena salud 8. MUÉVETE relájate practicando yoga, relájate practicando yoga, el tiempo para practicar para una buena salud general, sin importar tu El ejercicio es fundamental escribiendo un diario o tomando un 8. MUÉVETE escribiendo un diario o tomando un una actividad física casi general, sin importar estado de VIH. Tomarse una buena salud bañode deinmersión. inmersión. Encuentra algo tu Elpara ejercicio es fundamental baño Encuentra algo todos los días es parte im-tu estado de VIH. Tomarse el tiempo para practicar general, importar quefuncione funcione para ti. sin para una buena salud que para ti. portante de una vida saludable. Elige el tiempo para practicar actividad física casi estado de Tomarse general, sinVIH. importar tu una clasetodos de ejercicio que disfrutes. una actividad física casi los días es parte imel tiempo para practicar estado de VIH. Tomarse 8.objetivo MUÉVETE 8. MUÉVETE El es encontrar actividades todos los es parte importante de una vidadías saludable. Elige una actividad física casi el tiempo para practicar El ejercicio es fundamental El ejercicio es fundamental que encajen en tu rutina diaria para portante de una vida saludable. Elige una clasetodos deuna ejercicio disfrutes. los díasque es física parte imactividad casi para una buena salud para una buena salud que teclase sientas motivado para hacerlas de ejercicio que disfrutes. Eluna objetivo encontrar actividades portante dees una vida saludable. Elige todos los días es parte imgeneral, sin importar tu general, sin importar tu con regularidad. El objetivo es encontrar actividades que encajen en tu rutina para una clase deuna ejercicio quediaria disfrutes. portante de vida saludable. Elige estado deVIH. VIH. Tomarse de Tomarse que en tu rutina diaria para que teencajen sientas motivado para hacerlas El objetivo esestado encontrar actividades una clase de ejercicio que disfrutes. el tiempo para practicar el tiempo para practicar que te sientas motivado para para hacerlas con regularidad. que encajen tu rutinaactividades diaria El objetivo esen encontrar 9. COME ALIMENTOS una actividad física casi una actividad física casi conteregularidad. que sientas motivado para hacerlas

tratamiento protege tu tratamiento protege medicamentos. Si estás teniendo problemas con laafectar adherencia, habla llevarte a desarrollar resistencia atu recetados puede tu salud ylos salud y puede eliminar el salud y puede eliminar el problemas con la adherencia, habla con tuHONESTO médico. medicamentos. Si estás teniendoa los llevarte a desarrollar resistencia 3. SÉ riesgo de transmitirel elVIH VIHaaotros. otros. riesgo de transmitir con tu médico. problemas con la adherencia, habla medicamentos. Si estás teniendo Habla con tu médico Saltarselas lasdosis dosisoono notomarse tomarse sobre Saltarse con tu HONESTO médico. problemas con la adherencia, habla lo que esté pasando 3. losSÉ medicamentos como fueron en los medicamentos como fueron con tu médico. tu vida. ¿Qué cam3. SÉ HONESTO Habla con tu médico sobre recetados puede afectar tuha salud recetados puede afectar tu salud yy biado desde tu última Habla con tu médico lo que esté pasando en 3. SÉ HONESTO llevarte a desarrollar resistencia a los llevarte a desarrollar resistencia asobre los visita? ¿Estás deprimido lo que esté pasando en tu vida. ¿Qué ha camHablaSi tu médico sobre medicamentos. Sicon estás teniendo 3. SÉ HONESTO medicamentos. estás teniendo olo ansioso? ¿Bebes tu ¿Qué cambiado desde tu ha última que esté pasando en problemasHabla con lavida. adherencia, habla con tu médico sobre problemas con la adherencia, habla demasiado? ¿Tienes probdesde tu camúltima visita? ¿Estás deprimido tubiado vida. ¿Qué ha contu tumédico. médico. lo que esté pasando en con lemas para comer o dormir? Tu visita? ¿Estás deprimido obiado ansioso? ¿Bebes desde tu vida. ¿Quétu haúltima cammédico sólo puede ayudarte siproberes o ansioso? ¿Bebes demasiado? ¿Tienes visita? ¿Estás biado desde tudeprimido última 3. SÉ HONESTO 3. SÉ HONESTO honesto sobre tus problemas. demasiado? ¿Tienes lemas para comer o¿Estás dormir? Tu probovisita? ansioso? ¿Bebes deprimido Habla con tu médico sobre Habla con tu médico sobre lemas sólo para comer o ¿Tienes dormir? Tu médico ayudarte siproberes demasiado? opuede ansioso? ¿Bebes lopuede queproblemas. esté pasando en lo que pasando en médico sólo ayudarte si eres honesto sobre tus lemas para comer oesté dormir? Tuprobdemasiado? ¿Tienes 4. PIDE AYUDA tu vida. ¿Qué ha camtu vida. ¿Qué hasicamhonesto sobre tusoayudarte problemas. médico sólo puede eres lemas para comer dormir? Tu ¿Necesitas ayuda para biadodesde desde tuúltima última biado tu honesto sobre tus problemas. médico puede ayudarte si eres o obtener segurodeprimido médico 4. PIDEsólo AYUDA visita?¿Estás ¿Estás visita? deprimido honesto sobre tus problemas. vivienda alguna otra 4. PIDE AYUDA ¿Necesitas para ansioso?oayuda ¿Bebes ooansioso? ¿Bebes cosa? ¿Estás buscando ¿Necesitas ayuda para o obtener seguro médico 4. PIDEdemasiado? AYUDA demasiado? ¿Tienes prob¿Tienes probservicios de salud menobtener seguro médico vivienda o alguna otra o ¿Necesitas ayuda para lemas para comer dormir? Tu 4. PIDE AYUDA lemas para comer oodormir? Tu tal o ayuda con el vivienda o alguna otrao cosa? ¿Estás buscando obtener seguro médico médicosólo sólo puede ayudarte siabuso eres ¿Necesitas ayuda para médico puede ayudarte si eres de sustancias? Pídele a tu o cosa? ¿Estás buscando servicios salud menvivienda ode alguna otra honestosobre sobre tusproblemas. problemas. obtener seguro médico honesto tus médico que te refiera a un trabajador servicios de salud mental o ayuda el abuso cosa? ¿Estás buscando vivienda o con alguna otra social o encargado de caso que tal o ayuda con el abuso de sustancias? Pídele a tu servicios de salud mencosa? ¿Estás buscando 4. PIDE AYUDA 4. PIDE AYUDA pueda ayudarte a conectarte con de sustancias? Pídele alos tu médico que te refiera ade un trabajador tal o ayuda con el abuso servicios salud men¿Necesitas ayuda para ¿Necesitas ayuda para servicios que necesites. médico que te refiera a un trabajador social o encargado de caso que de tal sustancias? Pídele a tu o ayuda con el abuso obtener seguro médico obtener seguro médico socialayudarte o encargado de caso que pueda a conectarte con losoo médico que te refiera a un trabajador de sustancias? Pídele a tu vivienda o alguna otra vivienda o alguna otralos pueda ayudarte a de conectarte servicios que social o que encargado quecon médico tenecesites. refiera acaso un trabajador 5. BUSCA APOYO cosa? ¿Estás buscando cosa? ¿Estás buscando servicios que necesites. pueda a conectarte conylos social oayudarte encargado de que Rodéate de caso familiares servicios de saludmenmenservicios de salud servicios que necesites. pueda ayudarte a conectarte con los amigos concon los que 5. BUSCA APOYO tal o ayuda el abuso tal o ayuda con el abuso servicios que necesites. puedas contar, en las 5. BUSCA APOYO Rodéate de familiares y de sustancias? Pídele tu de sustancias? Pídele aatu buenas yde en las malas. Rodéate familiares y amigos los que 5. BUSCA APOYO médico quete te refieracon un trabajador médico que refiera aaun trabajador Los grupos de apoyo y amigos con los que puedas en las Rodéate decontar, familiares y social encargado de caso que 5. BUSCA APOYO social ooencargado de caso que los chats online también puedas contar, en las buenas y en las malas. amigos con los que puedaayudarte ayudarte conectarte conlos Rodéate de familiares ylos pueda aaconectarte con son buenas maneras de buenas y en las malas. Los grupos de apoyo puedas contar, en las servicios que necesites. con los que y servicios queamigos necesites. conectarte con otros. Busca aen otras Los grupos detambién apoyo los chats online buenas en las malas. puedas y contar, las y personasson quebuenas vivan con el VIH paray los chats también maneras de Los grupos de apoyo buenas y online en las malas. 5. BUSCA APOYO 5. BUSCA APOYO aprender de sus experiencias. son buenas maneras de y conectarte con otros. Busca a otras los chats online también Los grupos de apoyo Rodéate de familiares Rodéate de familiares yy conectarte con otros. Busca a personas que vivan con el VIH para sonlos buenas deotras chatsmaneras online también amigos con los quepara amigos con los personas vivan con el que VIH aprender deque sus experiencias. conectarte con otros. Busca a de otras son buenas maneras puedas contar, enlas las puedas contar, en aprender de sus experiencias. personas que vivan con el VIH para conectarte con otros. 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el tiempo para practicar para una buena salud general, sin importar tu Elun ejercicio es fundamental escribiendo un diario o tomando un 8. MUÉVETE escribiendo diario o tomando un una actividad física casi general, sin importar estado de VIH. Tomarse una buena salud bañode deinmersión. inmersión. Encuentra algo tu Elpara ejercicio es fundamental baño Encuentra algo todos los días es parte im-tu estado de VIH. Tomarse el tiempo para practicar general, importar quefuncione funcione para ti. sin para una buena salud que para ti. portante de una saludable. Elige elvida tiempo para practicar actividad física casi estado de Tomarse general, sinVIH. importar tu una clasetodos de ejercicio que disfrutes. una actividad física casi los días es parte imel tiempo practicar estado depara VIH. Tomarse 8.objetivo MUÉVETE 8. MUÉVETE El es encontrar actividades todos los es parte importante de una vidadías saludable. Elige una actividad física casi el tiempo para practicar El ejercicio es fundamental El ejercicio es fundamental que encajen en tu rutina diaria para portante de una vida saludable. Elige una clasetodos de ejercicio disfrutes. los díasque es física parte imuna actividad casi para unabuena buena salud para una salud que te sientas motivado para hacerlas una clase de ejercicio que disfrutes. El objetivo es encontrar actividades portante todos de unalos vida saludable. Elige días es parte imgeneral, sindiaria importar tu general, sin importar tu con regularidad. El objetivo es encontrar actividades que encajen en tu rutina para una clase de ejercicio que disfrutes. portante de una vida saludable. Elige estado de VIH. Tomarse de VIH. Tomarse que en tu rutina diaria para que teencajen sientas motivado para hacerlas El objetivo esestado encontrar actividades una clase de ejercicio que disfrutes. el tiempo para practicar el tiempo para practicar que te sientas motivado para hacerlas con regularidad. que encajen tu rutinaactividades diaria para El objetivo esen encontrar 9. COME ALIMENTOS unaactividad actividadfísica físicacasi casi una con regularidad. que te sientas motivado para hacerlas que encajen en tu rutina diaria para SALUDABLES todos los días es parte imtodos los días es parte imcon regularidad. que te sientas motivado para hacerlas Una dieta equilibrada es 9. COME ALIMENTOS portantede deuna unavida vidasaludable. saludable.Elige Elige portante con regularidad. importante para man9. clase COME SALUDABLES una clasede deALIMENTOS ejercicioque que disfrutes. una ejercicio disfrutes. tener la energía y la es SALUDABLES Una dieta equilibrada 9. COME es ALIMENTOS Elobjetivo objetivo esencontrar encontrar actividades El actividades fuerza, promover unaes Una equilibrada importante para manSALUDABLES que encajen en tudieta rutina diaria para 9. COME ALIMENTOS que encajen en tu rutina diaria para buena función inmuniimportante para tener laequilibrada energía y manlaes Una dieta quete tesientas sientas motivado para hacerlas SALUDABLES que motivado para hacerlas taria, reducir el riesgo de tener la energía y la fuerza, promover una importante para manconregularidad. regularidad. Una dieta equilibrada es con desarrollar problemas de fuerza, promover una buena función inmunitener la energía ymanla importante para salud y mejorar la calidad de vida. buena función inmunitaria, reducir el riesgo fuerza, tener lapromover energía y una la de 9.COME COME ALIMENTOS 9. ALIMENTOS Los expertos recomiendan consumir taria, reducir el riesgo desarrollar problemas de de buena inmunifuerza,función promover una SALUDABLES SALUDABLES la mayoría de loslanutrientes a traves desarrollar problemas de salud y mejorar calidad vida. taria, reducir elde riesgo de buena función inmuniUna dieta equilibrada es Una dieta equilibrada es de una dieta equilibrada que incluya salud y mejorar la calidad de vida. Los expertos recomiendan consumir desarrollar problemas dede taria, reducir el riesgo importante para manimportante para manuna amplia variedad de alimentos. expertos recomiendan consumir laLos mayoría de los nutrientes a traves salud y mejorar la calidad de vida. desarrollar problemas de tener laenergía energía yla la tener la y la mayoría de los nutrientes a traves de una dieta equilibrada que incluya Los expertos recomiendan consumir salud y mejorar la calidad de vida. fuerza, promover una fuerza, promover una de una dieta equilibrada que incluya una amplia variedad de alimentos. la mayoría derecomiendan los nutrientesconsumir a traves Los expertos 10. DEJA DE FUMAR buena función inmunibuena función inmuniuna amplia variedad de alimentos. de una dieta equilibrada que incluya la mayoría de los nutrientes a traves Fumar cigarrillos es un de taria, reducir el riesgo taria, reducir el riesgo de una amplia variedad de alimentos. de dieta equilibrada que cualquiincluya mal hábito para 10.una DEJA DE FUMAR desarrollar problemas de desarrollar problemas de una variedad dees alimentos. era, especial10.amplia DEJA DE FUMAR Fumar cigarrillos un salud mejorar lapero calidad dees vida. salud yymejorar la calidad de vida. mente dañino para las Fumar cigarrillos es un mal hábito para cualqui10. DEJA DErecomiendan FUMAR Losexpertos expertos recomiendan consumir Los consumir personas que viven mal hábito para cualquiera, pero es especialFumar cigarrillos es uncon lamayoría mayoría de los nutrientes traves 10. DEJA de DE FUMAR la los nutrientes aa traves elmal VIH. Fumar aumenta era, pero es especialmente dañino para hábito para cualquideuna unadieta dieta equilibrada que incluya Fumar cigarrillos es unlas de equilibrada que incluya los riesgos de desarrollar mente dañino para las personas que viven con era,hábito pero especialunaamplia ampliavariedad variedad dees alimentos. mal para cualquiuna de alimentos. problemas de salud, como lapara enferpersonas viven con elmente VIH. Fumar aumenta dañino las era, pero esque especialmedad cardiovascular, el cáncer, el el VIH. de Fumar aumenta los riesgos desarrollar personas que viven con mente dañino para las 10.DEJA DEJA DE FUMAR 10. DE FUMAR derrame cerebral y la enfermedad los riesgos de desarrollar problemas de salud, como la enferelpersonas VIH. Fumar queaumenta viven con Fumar cigarrillos es unel Fumar cigarrillos es pulmonar. Si estás dispuesto a un dejar problemas de salud, como la enfermedad cardiovascular, el cáncer, los riesgos de desarrollar el VIH. Fumar aumenta mal hábito para cualquimal hábito para cualquide fumar,cardiovascular, tude médico ayudarte. medad el cáncer, derrame cerebral y lapuede enfermedad problemas salud, como la enfer-el los riesgos de desarrollar era, pero es especialera, pero es especialderrame cerebral y la enfermedad pulmonar. Si estás dispuesto a dejar medad cardiovascular, el cáncer, el problemas de salud, como la enfermente dañino para las mente dañino para las pulmonar. Si estás dispuesto a dejar de fumar, tu médico puede ayudarte. derrame cerebral y la enfermedad medad cardiovascular, el cáncer, el personas que viven con que viven con de fumar, tupersonas médico puede ayudarte. pulmonar. Si estás a dejar derrame cerebral y dispuesto la enfermedad elVIH. VIH.Fumar Fumaraumenta aumenta el de fumar, tu puede ayudarte. pulmonar. Simédico estás dispuesto a dejar losriesgos riesgosde dedesarrollar desarrollar los de fumar, tu médico puede ayudarte. problemasde desalud, salud,como comola laenferenferproblemas medadcardiovascular, cardiovascular,el elcáncer, cáncer,el el medad derrame cerebral y la enfermedad derrame cerebral y la enfermedad pulmonar.Si Siestás estásdispuesto dispuestoaadejar dejar pulmonar. defumar, fumar,tu tumédico médicopuede puedeayudarte. ayudarte. de

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TREATMENT HELPS PREVENT THE SPREAD OF HIV. If you’re living with HIV, a major goal is to get your viral load to undetectable. This means that there is so little virus in the blood that a test can’t measure it. How can you get to and stay undetectable? By taking HIV treatment every day. Current research shows that getting to and staying undetectable prevents the spread of HIV to others through sex.

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TALK TO YOUR HEALTHCARE PROVIDER. Have an open conversation. There’s no cure for HIV, but when you work together it helps your healthcare provider find the treatment that’s right for you.

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HELP PROTECT YOUR HEALTH. There is no cure for HIV, but find out how treatment helps make it possible to live a healthier life.

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