POZ April/May 2022 by Smart + Strong

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H E A L T H ,

L I F E

H I V

A Woman’s Journey Navigating life with HIV

Ivy Kwan Arce

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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.

Tell your healthcare provider about all the medicines you take: ` Keep a list that includes all prescription and over-the-

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.

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 Take BIKTARVY 1 time each day with or without food.

GET MORE INFORMATION ` 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, GSI, and KEEP LOVING are trademarks of Gilead Sciences, Inc., or its related companies. Version date: February 2021 © 2022 Gilead Sciences, Inc. All rights reserved. US-BVYC-0008 01/22

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D’EVA LIVING WITH HIV SINCE 2009 REAL BIKTARVY PATIENT

KEEP LOVING.

Because HIV doesn’t change who you are. BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.

Ask your healthcare provider if BIKTARVY is right for you. ONE SMALL PILL, ONCE A DAY Pill shown not actual size (15 mm x 8 mm) | Featured patient 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

Ivy Kwan Arce creates art to educate and empower.

POZ BLOGS Our roster of bloggers spans the diversity of the HIV community. Go to poz.com/ blogs to read varying points of view from people living with the virus as well as from HIV-negative advocates. Join the conversation in the comments section. Visit the blogs to find hope and inspiration from others.

POZ OPINIONS

#UNDETECTABLE The science is clear: People who have an undetectable viral load don’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 issue and read past issues online.

22 A WOMAN’S JOURNEY Connecting with others has helped activist and artist Ivy Kwan Arce navigate life with HIV. BY ALICIA GREEN 28 ENDING HIV CRIMINALIZATION STARTS WITH ME How HIV criminalization laws target women—and how women are fighting back BY HEATHER BOERNER 3 FROM THE EDITOR So Happy Together

4 POZ Q+A HIV activist Matthew Rose interviews Mackenzie Copley and David Schaffer, MD, the cofounders of One Tent Health.

6 POZ PLANET

A collection of over 8,000 AIDS posters • a solo art show from Kia LaBeija, who was born with HIV • a Visual AIDS Duets book on William Olander • hepatitis news • Everyday

16 CARE AND TREATMENT

Why are Black people more at risk for HIV? • taking the first step to walking more • 59% of trans women with HIV are undetectable • bones take a hit from menopause and HIV

18 RESEARCH NOTES An HIV vaccine trial uses mRNA technology • injectable treatment Cabenuva can be taken every other month • how HIV hides • concerns about fatty liver

19 BASICS Women and HIV

12 VOICES Shawn Decker points out the HIV stigma in Kanye West’s alleged outbursts. Plus, Andrew Spieldenner shares how testing positive for COVID-19 brought up feelings about living with HIV.

14 SPOTLIGHT A roundup of recent community events

20 ASK POZ Can aspirin prevent heart attacks and strokes?

32 HEROES Black transgender activist Iya Dammons leads Baltimore Safe Haven to provide housing, meals and much more.

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. 259 POSTMASTER: Send address changes to POZ/Smart + Strong, 157 Columbus Avenue, Suite 525, New York, NY 10023. Copyright © 2022 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 AND THIS PAGE: (KWAN ARCE) MEGAN SENIOR; (MEGAPHONE AND SPEECH BUBBLES) THINKSTOCK; (MAGNIFIER) ISTOCK

Advocates, researchers, politicians, thought leaders and folks just like you all have ideas worth sharing. Go to poz.com/ opinions to read about topics such as living with HIV, improving care and treatment, increasing prevention efforts and fighting for social justice.

FROM THE EDITOR

So Happy Together

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TESTED POSITIVE FOR HIV IN 1992, but it took me several years to connect with others living with the virus. I spent those years mentally preparing to die by age 30. In the thick fog of my depression, finding community seemed pointless to me. That all changed after effective treatment for HIV arrived in 1996. I was among countless others who had found new purpose in life. I went to graduate school for a master’s degree in publishing management. I took a few chances on publishing start-ups. I even had my first few truly long-term relationships. I dared to dream of what could be. Feeling better about my prospects finally led me to find connection with others living with HIV. I understand the privilege of that pathway to community. For so many of my fellow long-term survivors, finding such connection was essentially mandatory. Their hopes for survival depended on it. Case in point: HIV activist and artist Ivy Kwan Arce, this issue’s cover subject. In 1992, she saw a poster on the New York City subway that read, “Women don’t get AIDS—they just die from it.” Since Ivy had some cause for concern, she decided to get a test for HIV, which came back positive. As a first-generation Chinese-American woman living with HIV, Ivy struggled to find others like her. It wasn’t until she was introduced to the People With AIDS Health Group that she finally felt seen. The group’s director entrusted her with the creation and development of graphics and artwork. The rest is history. Go to page 22 to read more about her amazing journey. Ivy’s story is a wonderful example of the contributions of women to the HIV movement. In this special issue dedicated to women and youth, we explore additional examples, such as Iya Dammons, the executive director of Baltimore Safe Haven. The group provides resources to LGBTQ people at risk for homelessness, substance use and sex work. It provides housing to

clients ranging from young adults to seniors. The organization also offers HIV testing and other prevention services. Go to page 32 to read more about the group and Iya’s journey as a Black transgender woman. Helping youth is one of Iya’s goals. The same is true for Mackenzie Copley and David Schaffer, MD, cofounders of One Tent Health, a youth-driven and youth-led nonprofit in Washington, DC, that provides HIV screening in the most underserved and lowest-income neighborhoods. Go to page 4 to read our Q&A with Mackenzie and David by HIV activist and former youth leader Matthew Rose. An increasing concern for women living with the virus is HIV criminalization laws. Though the public face of these laws has been gay men—particularly gay Black men—recent data show that such legislation also targets Black women. Go to page 28 to learn more. When it comes to overcoming the obstacles that HIV can put up, a great example is Kia LaBeija. Born with HIV in 1990, Kia lost her mom to the virus in 2004. She recounts her experiences in a new art exhibit, her first solo museum show. Go to page 10 for details.

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 APRIL/MAY 2022 POZ 3

POZ Q+A

BY MATTHEW ROSE

Left: One Tent Health volunteers serving the Washington, DC, community; right, from top: Mackenzie Copley, David Schaffer,MD, and Matthew Rose

The cofounders of One Tent Health discuss their HIV outreach to younger and older people alike.

OUNDED IN 2017, ONE TENT HEALTH IS A YOUTH-DRIVEN AND youth-led nonprofit in Washington, DC, that provides free HIV screening in the most underserved and lowest-income neighborhoods. The organization has thousands of youth volunteers. The group also provides free onthe-spot pre-exposure prophylaxis (PrEP) pills, COVID-19 PCR testing and voter registration. Cofounders Mackenzie Copley and David Schaffer, MD, both now 29 years old, were local students when the group launched. HIV activist and former youth leader Matthew Rose recently spoke with Copley and Schaffer about the importance of youth leadership and more. — Oriol R. Gutierrez Jr. Rose: One Tent Health is doing what a lot of people just talk about but can’t actually

seem to execute. By that I mean you have, functionally, a multiethnic organization that has intergenerational conversations about HIV. How’d you get there? Copley: Years ago, I was doing volunteer HIV screening in the community, similar to what we do now. The primary problem, though, was that even though we saw that about 60 people a day were getting tested in front of a grocery store, about 20 people who had waited in line got turned away. They didn’t have health insurance. It was a private testing company that was turning them away, so I asked the owners if we could test the people who didn’t have insurance. They said no. So I said, “I’m going to go start a nonprofit and test everyone.” Very soon after that, I definitely needed medical experience in the room. So enter Dr. Schaffer, or, at the time, medical student Schaffer. We went about trying to do everything that we could. We didn’t have any money, which was a great driver of our creativity to solve problems in a way that perhaps other organizations don’t need to because they have more of a budget.

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We started by using 10-by-10 canvas tents for screenings. We didn’t yet have money to pay a staff, so we thought maybe there’s an opportunity to loop in college students as volunteers. I remember training our first 12 volunteers at Georgetown University. In just a few years, that number grew to over 3,000 volunteers from five different schools, including Howard University, George Washington University, University of Maryland, American University and Georgetown. It’s been cool to see things blossom into exactly what you said, which are conversations that cross generations, from our 18- to 22-year-old volunteers speaking with people the same age to people in their 70s, if not older. Rose: Elders are still getting busy? Schaffer: As the data person, I can confirm we have had clients of that age. In retrospect, one of the most important things we do in addition to youth engagement is community engagement. Rose: Your approach differs from those who think we have to go to the clubs and bars to find people for screenings.

(TENTS) INSTAGRAM/ONETENTHEALTH; (COPLEY, SCHAFFER, ROSE) COURTESY OF THE SUBJECTS

INTERGENERATIONAL HEALTH

You’re figuring out where people are willing to let you have these conversations. How has that been? Copley: The local businesses have been quite open to it. I think it just has to do with people in the community knowing that HIV is an issue. Rose: In 2021, a research group led by faculty at Harvard Medical School conducted an analysis of One Tent Health’s program. Tell us about it. Schaffer: What I wanted to understand is how we’re doing. We’re getting great feedback from clients on the surveys that they fill out after screenings, but are we really accomplishing our goals? As our staff summarizes the paper: “Notably, the research team observed that One Tent Health found a newpositive rate of more than four times that of traditional testing models in Washington, DC. The research group also reported unique statistical findings from One Tent Health’s program, providing further evidence to suggest that factors such as residential segregation, social capital, stigma and psychological influences intertwine to explain why Black or African Americans are disproportionately affected by the HIV epidemic. Further, the research group found by a literature review that One Tent Health’s program is likely the first of its kind in the United States, and is positioned well to be both reproduced and applied to testing or other services related to the COVID-19 pandemic.” Rose: If you had more resources, what else would you like to achieve? Copley: Our goal right now is to crank up our volume. We’ve been doing COVID testing since December 2020 along with HIV screening, but the HIV screening has decreased a bit as the COVID testing has increased. We want to further leverage that big number of volunteers we have to do a lot more events per day. So up from one each day on Saturdays and Sundays to as much as five per day. If we did that, we could test about 200 people per weekend, which would translate into identifying one new HIV case every weekend. That would be a good way for us to keep using the model we currently have to make a bigger impact.

We’d also like to expand our PrEP services. In 2019, we launched what we believe is the nation’s first same-day PrEP program. We started offering seven-day sample packs to those who tested HIV negative, instead of just referring them to somewhere else, decreasing the probability of them actually getting PrEP. In the paper, it said what percentage of people had never heard about PrEP before interacting with us. Schaffer: About 70%. Rose: It’s only been out for a decade! Copley: I know, right? And the percentage of people interacting with us who said that they would want same-day PrEP is about 30%, so it’s just a matter of finding the financing for us to do more. Rose: Two questions for you. What do you wish other young people knew that

and who were interested but then said, “No, that’s not going to work.” Have determination and grit to jump over the hurdles that come your way. Rose: What do you want the HIV field to know right now? Schaffer: I hope that people who are either working in this space or in the peripheral spaces will be careful not to isolate their work to just HIV and not recognize all of the other factors and the people who are doing other work that is so intertwined. We’re not going to achieve, in my opinion, the UNAIDS 90-90-90 goals without also addressing the opioid pandemic and needle sharing and making sure people have good access to medication-assisted treatment for opioid use disorder and homelessness

“We’re thinking of new ideas all the time.” you’ve figured out, that you wish someone would’ve told you when you were starting all this? And what do you wish the older generations understood about the work you’re doing? Copley: Every generation is charged with the goal of filling in the gaps that they’ve inherited. The fact that we’re even able to create a same-day PrEP program would never have been possible if the advocates in the ‘80s didn’t take the steps that they took. It’s so cliché, but we’re standing on the shoulders of giants. To the younger generation, imagine what the world would look like if everybody spent their time helping people. Schaffer: The only thing I would add is something along the lines of the quickest way to kill an idea is to bring it to a meeting. I just think about the number of times we brought the idea for One Tent Health to people with more experience

and stigma, all that kind of stuff. People who work specifically on those other things need to remember HIV. And the same goes for people like us who work on HIV—we need to improve our programs to account for all those other considerations. Copley: I would ask everybody to keep their minds open to new solutions coming from anyone, but especially from the younger generation. We’re thinking of new ideas all the time. For example, at One Tent Health, we added voter registration onto our model while people are waiting in line. A seemingly crazy idea can sometimes be one that changes the world. Not all crazy ideas work, but hardly any ideas that change the world aren’t a bit crazy at first. Keeping your ears and eyes and hearts open is my primary request. Doing so could lead us all to a place we’d like to be. ■

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POZ PLANET BY TRENT STRAUBE

View Over 8,000 AIDS Education Posters!

A new exhibition and book showcase 165 posters selected from a vast online collection.

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4 (UP AGAINST THE WALL BOOK) COURTESY OF RIT PRESS, (BRICK WALL) ISTOCK; (POSTERS) COURTESY OF THE UNIVERSITY OF ROCHESTER AIDS EDUCATION COLLECTION

On a Boston subway car around 1990, during the early days of the AIDS crisis, Edward C. Atwater, MD, noticed a poster depicting two hands unwrapping a condom packet. Fascinated by the illustration’s ability to clearly inform the public about sensitive topics—especially considering the prevailing discourse of 35 years earlier, when he attended medical school and it was illegal to teach contraception—Atwater procured his own copy of the AIDS poster. Over the years, he would acquire more than 8,000 others spanning 130 countries and 76 languages. Before Atwater died in 2019 at age 93, the rheumatologist and medical historian donated his posters to the University of Rochester in New York, where they make up the AIDS Education Poster Collection within the River Campus Libraries’ Department of Rare Books, Special Collections, and Preservation. Amazingly, the entire collection has been digitized and can be viewed online (aep.lib. rochester.edu/browse). For the first time, an exhibition and accompanying book cull from the collection to explore the myriad themes, narratives and histories found Above: The book; in the images. Up Against the Wall: Art, right: posters from Activism, and the AIDS Poster runs through the University of June 19 at the University of Rochester’s Rochester collection Memorial Art Gallery. It includes 165 posters, ranging from 1983 to 2018 (though the collection continues to grow, thanks in part to Jessica Lacher-Feldman, a special projects manager at the university). Throughout the HIV epidemic, posters have remained one of the most popular, direct and cost-effective methods to educate the public, inspire compassion, incite protests and, when misused, to frighten and stigmatize—just think of all the images that associated an HIV diagnosis with death, a link no longer tolerated. Posters make an “immense and profound impact,” says Donald Albrecht, the exhibit’s curator, adding that he was astonished by “the wide range of content and styles represented in the posters, from slick advertising-style graphics to simple hand drawings, from expressions of grief to humor and irony.” The show organizes the posters into topics such as “AIDS Is a Women’s Issue,” “AIDS—Hidden Danger,” “I Have AIDS. Please Hug Me” and “Care Enough to Love Safely.” In addition, a number of health experts, artists and advocates— including Avram Finkelstein of the Silence=Death Collective, Esther McGowan of the nonprofit Visual AIDS, artist Sur Rodney (Sur) and Anthony Fauci, MD—share their cultural and historical insights about specific posters. “It is my hope,” Albrecht tells POZ, “that these posters from the past provide models for action today.”

1 “GET CARRIED AWAY WITH CONDOMS” 1990, San Francisco San Francisco AIDS Foundation 2 “SILENCE = MORT” 1986, Paris ACT UP Paris

3 “AIDS IS A

WOMEN’S ISSUE” 1990–93, NYC New York City Department of Health and Mental Hygiene

4 “LOVE 7

CAREFULLY” 1988, Arizona White Mountain Apache Tribe of the Fort Apache Reservation, Arizona Health Education Department

5 [THE DEATH OF DAVID KIRBY] 1992, NYC United Colors of Benetton 6 “I HAVE AIDS. PLEASE HUG ME” 1987, Tiburon, Calif. The Center for Attitudinal Healing 7 UNTITLED, 2004 Montreal COCQ-SIDA 10

8 “AIDSGATE” 1987, NYC Silence=Death Collective

9 “AIDS—WHAT TO KNOW” (no date) Nairobi, Kenya National AIDS and STDs Control Programme 10 “I PARTY,

I BAREBACK, I’M POSITIVE, I’M RESPONSIBLE” (no date) Toronto AIDS Action Now!

11 “HEY MAN!

NO SHARING!!” (no date), NYC Brooklyn AIDS Task Force

poz.com APRIL/MAY 2022 POZ 7

POZ PLANET BY TRENT STRAUBE

An Artist, Prepared When Kwan Bennett was diagnosed with HIV in 1993, she embraced AIDS activism, speaking out for women and children. She also began preparing her daughter, Kia LaBeija, who was born with HIV in 1990, for the inevitable loss of her mom. When Bennett died, in 2004, she left behind a series of notebooks, memories and lessons, including a love of documenting her own life. Bennett’s influence is evident in Kia’s first solo museum show, prepare my heart, on display at Fotografiska New Clockwise from top York through May 8. “My mother is left: SHE KNOWS very much present in the show,” Kia, AND SHE LOVES ME an interdisciplinary artist, tells POZ, EVEN MORE (2021), “but it’s also about the experiences I Eleven (2015) and had on my own, the people I met, the Mother’s Day (1997) love I found, the love I have not found.” Those experiences include growing up as a queer person of color with HIV, struggling to take meds and keep secrets, facing loss, dealing with intimate partner violence, finding her voice as an artist and HIV activist and discovering beauty and community in New York City’s ballroom

scene—she was the overall mother of the iconic House of LaBeija, hence her name, though she is no longer involved and generally goes by her first name. Kia began photographing her life nearly 20 years ago. Her documentary style leans into fantasy and glam—as seen in the 2015 image Eleven, which presents Kia in her actual prom dress having her blood drawn by the same doctor she saw for nearly 25 years. The museum show also includes poetry, videos and ephemera, such as HIV pamphlets from the 1990s. “It’s the life of a person,” she says of the exhibit. (Visit POZ.com to read our full Q&A with Kia.) A recent standout work is SHE KNOWS AND SHE LOVES ME EVEN MORE from 2021, which shows text projected onto the bodies of Kia and her partner, Taina Larot, who have been together since 2014. The phrase references Larot’s acceptance of Kia’s HIV status and serves as a counterpoint to life’s darkness and loss. “I wanted to make that image to present optimism,” Kia says. “My mother taught me to express the fact that women with HIV can find love and be loved and are deserving of love.”

DYNAMIC DUETS Read more about Kia LaBeija and other HIV art figures. The nonprofit Visual AIDS prints a series of breezy, informative art books titled Duets in which established artists and activists discuss either their own work or the work of an influential artist with HIV. A 2018 volume includes an intergenerational conversation between Kia LaBeija and Julie Tolentino, both dancers and artists whose work is informed by race, gender and HIV. (Tolentino also appears in our profile of artist Ivy Kwan Arce on page 22.) The latest Duets celebrates the life and influence of William Olander (1950–1989), an art historian, curator and cofounder of Visual AIDS. In 1985, he invited ACT UP members to make an installation in the window of the New Museum; the piece became the first museum project to address the epidemic. As Visual AIDS executive director Esther McGowan says of Olander: “An innovator, he significantly changed critical practice in the art world and reformulated the art historical canon we study today.”

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William Olander is the latest Duets subject.

(KIA IMAGES) COURTESY OF FOTOGRAFISKA NEW YORK/KIA LABEIJA; (OLANDER) COURTESY OF VISUAL AIDS/DAVID DEITCHER; ((DUETS) COURTESY OF VISUAL AIDS

Kia LaBeija, born with HIV, documents her life in a solo show.

The Other Viral Pandemic Updates on efforts to end viral hepatitis

(LAD) FACEBOOK/TULSA CARES; (LIVER, TRANS FLAG AND FLOWERS) ISTOCK; (LEWIS) BILL WADMAN; (BURKE CARD) WIKIPEDIA

You’ve probably read about the national Ending the spurred by the opioid crisis and injection drug use. HIV Epidemic plan, launched in 2019 with the goal (Some 100,000 Americans died of drug overdoses of reducing new HIV rates by 90% by 2030. Well, between April 2020 and 2021, a new record.) last year the federal government released a Faced with these dire stats, the federal governsimilar strategy for battling viral hepatitis. That ment now supports evidence-based harm nationwide effort aims to prevent new hepatitis reduction methods, such as syringe exchanges. cases, improve health outcomes and reduce In December, New York City opened the first health inequities. officially authorized safe injection sites in the Viral hepatitis attacks the liver, which acts nation. Lawmakers in New Jersey and Maine have as the body’s filter. In fact, hepatitis means eased restrictions regarding syringes, and local “inflammation of the liver.” Over time, it can be advocates and health care providers have stepped deadly. The most common hepatitis viruses up awareness, testing and treatment efforts. The Madhuri Lad, DO, leads hep C nonprofit Tulsa CARES opened an HIV and hepatiare spread via contaminated food and water services at Tulsa CARES. (hepatitis A) and shared needles and sex tis C clinic (Oklahoma ranks third in the nation for (hepatitis B and C). Transmission via blood hepatitis C deaths and has a high rate of rural HIV transfusion is now very rare. Folks living with HIV are at higher cases). And earlier this year, advocates and researchers risk for coinfection with viral hepatitis. Effective vaccines are launched Hep ElimiNATION, a partnership to track and grade available for hep A and B. What’s more, hep C is curable in efforts to end hepatitis in each state plus DC and Puerto Rico. most cases (but not HIV and hep B). Also of note: May is Hepatitis Awareness Month, including Nearly 1.2 million people in the United States are living with National Hispanic Hepatitis Awareness Day on May 15 and HIV, compared with the 2.3 million people with chronic hepatitis National Hepatitis Testing Day on May 19. To learn more about C and the 862,000 with hep B. These numbers will likely climb, viral hepatitis, visit POZ’s sister publication HepMag.com.

EVERYDAY April

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

NATIONAL YOUTH HIV & AIDS AWARENESS DAY

The first issue of AIDS TREATMENT NEWS, an influential biweekly newsletter by LGBT activist John S. James dedicated to educating people about HIV and AIDS, is released. (1986)

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NATIONAL TRANSGENDER HIV TESTING DAY

Long-term survivor JULIE LEWIS (mother of musician Ryan Lewis) launches The 30/30 Project, an initiative to improve health care access by funding the construction of 30 medical facilities worldwide. (2014)

May

Photographer Therese Frare captures the renowned image of HIV activist DAVID KIRBY on his deathbed surrounded by his family. The photo was published in LIFE magazine that year, and a colorized version (see page 7) was subsequently used by Benetton in a controversial ad campaign. (1990)

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HIV VACCINE AWARENESS DAY

NATIONAL ASIAN & PACIFIC ISLANDER HIV/AIDS AWARENESS DAY

GLENN BURKE,, an outfielder for the Los Angeles Dodgers and Oakland Athletics baseball teams, dies of AIDS-related causes. He was the first Major League Baseball player to come out as gay during his professional career. (1995)

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VOICES BLOGS AND OPINIONS FROM POZ.COM

STIGMA SUCKS

WAS ALL SET TO CHILL OUT AND play some video games, and then a gossip site ran a story suggesting that Kanye West is telling people that Pete Davidson has AIDS. I know, that’s a lot to take in. Just focus on someone using AIDS as an attempt at slander. I’ll preface this by saying that I don’t know what Kanye West tells his friends. What I do know? People from all walks of life use medical conditions to cast others in a negative light. The stigma that already exists is what allows the weaponization of a medical condition, and whether the suggestion is true or not matters little when the subject’s image has been damaged either way. In some way, we’ve all been the victim of some form of this, or we have contributed to that stigma by simply laughing awkwardly at something instead of challenging a bias. For those who don’t follow pop culture, musician Kanye West is married to entrepreneur Kim Kardashian, who is now dating funnyman Pete Davidson. Davidson is a slender fellow with a gaunt face. I only describe his features to explain why West might say such a thing. Not that he did. It’s what someone would point out if they were saying that Davidson looks sick. Where stigma

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is concerned, HIV and AIDS are still the kings. Anywho. Stigma sucks. Rumors suck. Humans? We are just the worst. The best we can do is try to be better. As a long-term survivor with HIV, seeing a story like this come back around is just like seeing some terrible fashion come back around. That’s what the “dude has AIDS” story feels like for me. I can still remember how I felt starting seventh grade, being HIV positive in a small town, with a lot of whispering going on about my status. There’d been a kerfufﬂe in the sixth grade when I tested positive, and I was kicked out of school with about two weeks left in the school year. My mom waged a private battle with school ofﬁcials to get me back in, and when she was successful, the last thing I wanted to do was tip my hand that I had HIV. Seems it had caused enough trouble as is. Kanye West is two years younger than me. He went through puberty under the shadow of HIV/AIDS, just like the rest of Generation X. West was probably a freshman in high school when Magic Johnson announced that he’d tested positive for HIV. If he is telling people that Davidson has AIDS,

he’s using the old-school playbook from some of the darkest, early days of the pandemic. In an interesting sidenote, I’ve been going through some old VHS tapes, digitizing them for future deletion. I came across a speech I made in December 1999. I was 24 years old. I’d just started on HIV meds after letting my viral load get way out of control. Still, after only a few months of treatment, my viral load was going down, and my own gaunt face was starting to get some more ﬂesh. At the time, I hadn’t done too much public speaking. My weak voice also reminded me of where I was in regaining my health. A couple of long minutes into my wayward speech, I was talking about my decision to open up about my status at age 20. I said I wanted to ﬁght stigma. “And, kind of like one of my heroes, Muhammad Ali, I wanted to tell people: ‘Who knew AIDS could be so pretty?’” I chuckled at half-my-age me’s wit. But I also recognized that, perhaps, I may have been leaning into the stigma of what the public’s perception of people with HIV/AIDS was too. Because, as Ali would prove when he was older and wiser, beauty is what’s on the inside and the kindness of spirit that connects us. ■

BOTH IMAGES: SHUTTERSTOCK

In a blog post titled “Kanye West Telling Friends Pete Davidson Has AIDS?” POZ contributing writer and long-term survivor Shawn Decker discusses the lingering stigma of HIV. Below is an edited excerpt.

IT HAPPENED! In a blog post titled “Testing Positive Again,” POZ blogger Andrew Spieldenner, PhD, shares how testing positive for COVID-19 brought up similar feelings from his experience living with HIV. Below is an edited excerpt.

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ES, IT HAPPENED. AFTER A complete vaccination cycle and a third (booster) shot of the COVID-19 vaccine, I got it (a mild case thanks to the aforementioned vaccine shots). Thanks to remote-work options, I have been splitting my time between Guadalajara and Montreal. In both places, mask mandates are mostly followed—at least where I live. In Canada, vaccine requirements are checked for indoor entertainment venues. In Mexico, a lot of recreation occurs outside or in open-window settings. I feel fairly safe in my bubble. But then I came back to the United States to switch out my Canada winter clothes for the Mexico suitcase. I met up with some friends. On the Monday following that, one friend (who gets tested weekly at his university) told me he tested positive. I called my brother and asked him for a home COVID test. He grabbed one and rushed it to me. It was positive. My brother is a health care professional. He indicated that I should isolate for 10 days from the ﬁrst symptom. He had heard a cough, but I had fatigue and a cold for a few days longer. It looked like my COVID-19 was mitigated through my vaccine shots, and my

experience would be mild. I was supposed to leave for Mexico in a few days. Was it safe to travel? How many people would be exposed? Some of my friends in Mexico have not been vaccinated yet, and there was a birthday party that weekend. These were the thoughts that raced through my head as I called the airline, found another ticket and booked a local hotel so that my family would not be further exposed. I packed up my luggage and went to the hotel for the rest of my isolation. I voice-messaged a friend I’d had dinner with the night before. He asked me to stop apologizing, saying it wasn’t my fault. I had not even realized I was apologizing so much. I felt like crap— “infectious” in a way that was familiar and unhealthy for my mind and spirit. Getting COVID-19 showed me a few important points: We do not live in a society that allows for time off for sickness. We expect to go to work with a cold, a ﬂu or any number of pains and aches. I am from a family of refugees who never believed in taking a day off, and this belief has carried into my life. Why do I have such a difﬁcult time staying at home or working from home if I feel ill?

We need COVID-19 home tests. With a trip ahead, I didn’t want to spend time in a testing facility waiting for my results. So without the home test option, I would have gotten on a ﬂight and seen my friends, exposing people. Home tests should be available for free to everyone who needs them. Isolation has costs. In my case, it was the hotel and food delivery, the change in travel plans and the shift in time spent with family and friends. Isolation brings on mental anguish too. Stigma and blame are dangerous. As we learned in HIV, stigma and blame are dangerous and become barriers to effectively battle a pandemic. In the case of COVID-19, I still hear people ask, “How did you get it?” and “Do you know who you got it from?” None of that matters. What matters is how we protect one another and ourselves. People have tried to make me feel “dirty” for my HIV for decades. Screw them: I refuse to engage that logic. Vaccines work. Thanks to the vaccines, I had a mild experience. Now we just need to end the global vaccine disparities. ■

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SPOTLIGHT BY JOE MEJÍA

LOVE & DEVOTION Whether it takes the form of self-love, the love of others or the love of community, love drives many of the efforts to combat HIV and stigma. Love helps us persevere through dark, challenging moments and enables us to visualize and achieve brighter tomorrows. And it’s love that inspires us to assist others on similar journeys. The month of February afforded numerous AIDS service organizations and other nonprofits a chance to show and spread that love. Groups sent valentines to let others know they’re not alone, held celebrations on National Black HIV/AIDS Awareness Day to honor those we’ve lost to the virus and hosted events to raise awareness of the many ways individuals can prevent HIV or, if already HIV positive, lead long healthy lives.

4 1., 2., 3. Love was on display at MoMA PS 1 in Long Island City, New York, where the nonprofit arts organization Visual AIDS exhibited more than 500 valentines as part of Love Positive Women. After being shown at the contemporary art museum in early February, the symbols of love and support, crafted by artists, activists and HIV-positive women using handmade paper, were mailed to women around the world who are living with the virus. 4. On February 14, God’s Love We Deliver, a nonprofit in New York City that cooks and delivers nutritious, medically tailored meals for people too sick to cook or shop for themselves, including many clients living with HIV, delivered valentines handmade by volunteers alongside its meals.

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(1, 2, 3) COURTESY OF VISUAL AIDS/JESS SALDAÑA; (4) GOD’S LOVE WE DELIVER/FACEBOOK

5. Magic Johnson, diagnosed with HIV in 1991, participated in a roundtable discussion in recognition of National Black HIV/AIDS Awareness Day (NBHAAD) observed on February 7. The event was presented by the Clear Health Alliance and Simply Healthcare in Jacksonville, Florida. 6. As part of an NBHAAD commemoration ceremony, the In The Meantime Men’s Group and the Black AIDS Monument Planning Committee laid a wreath at the site of the Black AIDS Monument in Los Angeles. 7. In celebration of NBHAAD, the Bros in Convo Initiative, which promotes health equity among Black same-genderloving men, spent a weekend training folks in Orlando to become HIV testers and counselors. 8. The Nebraska AIDS Project celebrated Black History Month with a Black health and wellness event at Omaha’s Lotus House of Yoga. 9. On NBHAAD, New York City’s Iris House took to the streets in a van to offer free testing for HIV and other sexually transmitted infections.

(5) DANIEL J. DOWNER/INSTAGRAM; (6) JEFFREY KING/FACEBOOK; (7) BROSINCONVO/INSTAGRAM; (8) NEAIDSPROJECT/INSTAGRAM; (9) IRISHOUSEINC/INSTAGRAM

Send your event photos to POZ at website@poz.com or tag us on Facebook, Instagram or Twitter. For a list of community events, visit poz.com/calendar.

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CARE AND TREATMENT BY HEATHER BOERNER

Taking the First Step

WHAT PUTS BLACK PEOPLE AT RISK FOR HIV? Despite making up just 13% of the population, Black people account for more than 40% of new HIV diagnoses in the United States. But what makes some Black folks more vulnerable to HIV than others? Social vulnerability may play a role, according to new data published in Morbidity and Mortality Weekly Report. “Social vulnerability” is government jargon for the factors that make it hard for a community to bounce back from a natural disaster or public health threat—for example, low income, limited transportation and overcrowded or inadequate housing. Researchers with the Centers for Disease Control and Prevention (CDC) looked at where the 13,807 Black folks diagnosed with HIV in 2018 lived. Using the CDC’s Social Vulnerability Index, they found that 75% of the Black people who acquired HIV lived in communities with the highest or second highest social vulnerability. Only 8% came from the least vulnerable communities. Overall, Black people who lived in communities with the highest social vulnerability were 1.5 times more likely to acquire HIV than those in the least socially vulnerable neighborhoods. What’s more, same-gender-loving Black men who use drugs were 11.6 times more likely to acquire HIV if they lived in highly vulnerable communities. For cisgender women, the pattern was similar: Overall, Black women were 1.8 times more likely to acquire HIV if they lived in the highestvulnerability areas. “HIV disparities are not inevitable and can be addressed,” says the head of the CDC’s HIV Prevention Program, Demetre Daskalakis, MD. “Our nation must finally tear down the wall of factors—systemic racism, homophobia, transphobia, HIVrelated stigma and other ingrained barriers—that still obstructs these tools against HIV and COVID-19 from equitably reaching the people who could benefit from them.”

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By now, your New Year’s resolutions are likely a hazy memory. But if you resolved to move more, here’s some motivation. On average, people aging with HIV took 1,630 fewer steps a day than their HIV-negative peers, according to a study published in Research in Nursing & Health. The analysis, by Christine Horvat Davey, PhD, RN, and colleagues, found that among 105 HIV-positive and 86 HIVnegative people, those living with HIV took 5,450 steps a day—substantially fewer than the 7,080 steps taken by HIVnegative folks and about half of the 10,000 steps conventional wisdom advises for optimal health and longevity. The Department of Health and Human Services recommends that Americans get 150 minutes of aerobic exercise, such as brisk walking, each week. Both people living with HIV and HIV-negative folks consumed about the same amount of sugar-sweetened beverages, carbs and alcohol, and both groups scored about the same for healthy eating overall. However, people with HIV consumed more fiber. But take heart: Despite walking less, people with HIV did not experience more pain, anxiety, depression or trouble sleeping. And for everyone, the healthier their diet and the more toned their muscles, the better they were able to physically function.

59% of Trans Women With HIV Are Undetectable How well is the medical system serving transgender women living with HIV? Well, there’s certainly room for improvement, according to a recent systematic review and meta-analysis. Jeffrey Becasen, MPH, of the Centers for Disease Control and Prevention (CDC), and colleagues analyzed 50 studies that included more than 11,000 transgender people with HIV—mostly trans women— in 24 U.S. cities and one territory dating back to 1997. There were not enough data on HIV outcomes among transgender men and nonbinary people to conduct a separate analysis for these groups. Focusing on the trans women, 79% had ever received HIV care, 71% were currently receiving care and 76% of those were retained in care. However, only 65% were linked to care in a timely manner within three months of their diagnosis. Looking at treatment, 70% had ever been prescribed antiretroviral therapy, 72% were currently on treatment and 60% had good adherence. Among all trans women in the studies, 59% had an undetectable viral load, but this rose to 73% for those who were receiving care or treatment. CDC data from 2018 show a better picture: 88% of trans women were linked to HIV care within three months of diagnosis, and 72% had an undetectable viral load. But that’s still far from enough. “Integrating transgender-specific health needs (e.g., hormone therapy) into HIV care,” the study authors wrote, “might be needed to improve the percentages of transgender persons across the HIV care continuum.”

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

BONES TAKE A HIT FROM MENOPAUSE AND HIV It’s not just aging in general or HIV and its treatments that deplete bone mineral density (BMD) in women living with HIV, it’s also menopause, according to an analysis published in Clinical Infectious Diseases. Anjali Sharma, MD, of Albert Einstein College of Medicine, and colleagues tested the bone density of 158 women living with HIV and 86 HIV-negative women in the Women’s Interagency HIV Study, looking at associations with HIV status, stage of menopause and medication use. About half of the HIV-positive women were using tenofovir disoproxil fumarate, and half were using a protease inhibitor, both of which can affect the bones. Despite the fact that women with HIV were 12 times more likely to be taking calcium supplements and less likely to smoke, they were more likely to have low bone density. After controlling for other risk factors, like smoking, alcohol use, diabetes and hepatitis C, HIV-positive women had lower BMD at the lumbar spine, hip and forearm bone. Bone loss was more common among HIV-positive women who were at the end of perimenopause or entering menopause. Osteopenia—the precursor to osteoporosis— was also more common among HIV-positive women than their HIV-negative peers. However, the differences generally did not reach the threshold for statistical significance. While deficits in BMD by menopausal status “appear to be greater” for women with HIV compared with HIV-negative women, the study authors said more research with a larger group of people is needed to determine whether these differences truly exist.

RESEARCH NOTES BY LIZ HIGHLEYMAN

mRNA HIV Vaccine

TREATMENT

Every 2 Months

CURE

How HIV Hides

Fatty Liver

The first participants in a new study of an experimental HIV vaccine regimen that uses the same messenger RNA (mRNA) technology as COVID-19 vaccines have received their first doses, the International AIDS Vaccine Initiative and Moderna announced in late January. HIV mutates rapidly, enabling the virus to evade the common, narrowly targeted antibodies produced by most people with HIV. But rare broadly neutralizing antibodies (bnAbs) can target hidden parts of the virus that don’t change much. The Phase I IAVI G002 trial is testing an approach known as germline targeting, which aims to train immature B cells in a stepwise fashion to produce bnAbs that target multiple strains of HIV. In a proofof-concept study, 97% of people who received an earlier version of the vaccine regimen developed specialized B cells capable of producing bnAbs. The latest study will use mRNA technology to speed up production of successive versions of primer and booster vaccines that deliver a cluster of engineered HIV proteins.

The long-acting injectable regimen Cabenuva (cabotegravir/rilpivirine) can now be administered by a healthcare provider every other month instead of once monthly. This means some people with HIV can take their antiretroviral treatment just six times a year. The Food and Drug Administration approved the less frequent dosing schedule on February 1; the monthly schedule was approved last year. Two large trials showed that monthly injections of cabotegravir and rilpivirine suppress HIV as well as daily pills. The follow-up ATLAS-2M study showed that injections given every eight weeks are as safe and effective as injections every four weeks: After three years, nearly 90% in both groups maintained viral suppression. However, sticking to the schedule is even more important with less frequent dosing. Pharmacological modeling showed that delaying the injections by up to one week should have little impact, but longer delays could be a problem. People who need to miss an injection visit can temporarily use cabotegravir and rilpivirine pills.

Over time, HIV may increasingly hide its genetic material, known as a provirus, in inactive parts of the human chromosome where it can’t produce new virus. HIV inserts its genetic blueprints into T cells and establishes a long-lasting reservoir that’s unreachable by antiretrovirals. Researchers previously reported that a small group of elite controllers, who maintain viral suppression without treatment, had their HIV DNA locked up in inactive parts of chromosomes dubbed “gene deserts.” New research suggests that some people on long-term treatment may also sequester proviruses in gene deserts, which could lead to a functional cure. Analyzing proviruses in immune cells from six people on antiretroviral therapy for at least nine years, scientists found that latent HIV appeared to increasingly concentrate in inactive regions of the genome, similar to what happens in elite controllers. Strategies that put the virus into a deeper sleep could potentially allow a “peaceful coexistence” between HIV and the host and enable drug-free control.

About one third of young people living with HIV may have non-alcoholic fatty liver disease (NAFLD). Over time, NAFLD can lead to inflammation, cirrhosis and liver cancer. It is often accompanied by obesity and metabolic syndrome. Management involves lifestyle changes, such as weight loss and exercise. Spanish researchers analyzed 38 children, adolescents and young adults with perinatal HIV, meaning they acquired the virus around the time of birth. They were all on antiretroviral therapy, and most had viral suppression. Eleven people with HIV (29%) were diagnosed with NAFLD using noninvasive imaging, compared with just three of 38 HIV-negative young people (8%). HIVrelated parameters, such as viral load and CD4 cell count, generally did not differ significantly between those with and without NAFLD, and the condition was only partially explained by overweight and metabolic syndrome. The researchers suggested that routine liver ultrasound imaging should be considered for young people with perinatally acquired HIV.

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CONCERNS

ALL IMAGES: ISTOCK

PREVENTION

BASICS

BY LIZ HIGHLEYMAN

WOMEN AND HIV Many women could benefit from pre-exposure prophylaxis to prevent HIV.

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OMEN IN THE UNITED States have lower HIV rates than gay and bisexual men, but a substantial number are at risk of acquiring the virus—and that risk varies widely by race/ethnicity and geography. Fortunately, women respond equally well to antiretroviral treatment, and many could benefit from pre-exposure prophylaxis (PrEP). Women, who make up about half of the U.S. population, accounted for about 1 in 5 new HIV diagnoses in 2019, or approximately 7,000 cases. Women make up nearly a quarter of people with HIV in the United States but about half of those living with the virus worldwide. Black women are disproportionately affected by HIV, accounting for nearly 60% of new cases among U.S. women. White women and Latina women each account for around 20%. The Centers for Disease Control and Prevention (CDC) projects that 1 in 309 Black women and 1 in 287 Latina women will acquire HIV in their lifetime, compared with 1 in 874 white women. This means Black women are nearly three times more likely than white women to be diagnosed with HIV. But Black women have seen a decline in HIV incidence in recent years, while white women have seen an increase. Women ages 25 to 34 are most likely to be diagnosed with HIV—a bit older

than the average age for men. While women in areas such as the Bronx and Washington, DC, are more likely to be living with HIV, new cases are increasingly shifting to Southern states. Nearly half of women diagnosed with HIV live in regions with high poverty. Most cisgender women living with HIV were exposed through heterosexual contact (85%), followed by injection drug use (15%). Transgender women are at greater risk for HIV than cisgender women, accounting for an estimated 2% of new HIV diagnoses. Many women living with HIV face additional challenges, including poverty, lack of health insurance, homelessness, incarceration and criminalization related to their HIV status.

CARE AND TREATMENT The CDC estimates that 90% of women living with HIV have been tested and are aware of their status. Testing is important because people who know their status can start antiretroviral treatment and suppress their viral load, which prevents HIV transmission. For every 100 women diagnosed with HIV in 2018, according to the CDC, 76 received some HIV care, 58 were retained in care and 63 achieved viral suppression. HIV does not progress faster among women, and they respond equally well

to antiretroviral therapy. Treatment guidelines are generally the same for men and women. Women at risk for HIV are much less likely than gay men to be taking PrEP: Only 7% of women who could benefit from PrEP were receiving it in 2018. PrEP options for cisgender women include the daily tenofovir disoproxil fumarate/ emtricitabine pill (Truvada or generic equivalents) and every-other-month Apretude (cabotegravir) injections. Along with using condoms and not sharing drug injection equipment, PrEP is a highly effective prevention tool. Women who wish to have children have some additional concerns. HIV can be passed from mother to baby during pregnancy or delivery, but effective antiretroviral treatment prevents vertical transmission. For HIV-positive women with an HIV-negative male partner, or vice versa, PrEP can enable safe conception without putting the negative partner at risk. Women are often responsible for caring for others, and they may not prioritize their own needs. But knowing your HIV status, using the best prevention tools if you’re negative and staying on effective treatment if you’re positive can help optimize your own health and put you in a better position to care for your loved ones. ■

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ASK POZ

WELLNESS TIPS FROM POZ.COM

CAN ASPIRIN PREVENT HEART ATTACKS AND STROKES? Some studies suggest aspirin therapy may also help lower the risk for colorectal cancer.

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consult their doctor to evaluate their individual risks and benefits. The new draft says daily aspirin is not recommended for this group, as the potential benefits do not outweigh the risk of bleeding, which rises with age. The old guidelines said there wasn’t enough evidence to assess the balance of benefits and harms for people older than 70 or younger than 50. That’s still the case for those over 70, but the new draft says some people in their 40s may see a small benefit from daily aspirin. Randomized trials have shown that daily aspirin therapy for primary prevention may reduce the risk for heart attacks and strokes by as much as 10% to 20%. But the management of cardiovascular disease risk has improved in recent years thanks to lifestyle changes, better blood pressure control and the use of cholesterol-lowering statin medications. This means the benefits of aspirin have diminished relative to its risks. The new draft brings the USPSTF guidelines more in line with those of other

medical organizations. The American College of Cardiology and the American Heart Association recommend that aspirin therapy for primary prevention should be prescribed selectively for people ages 40 to 70 who have an elevated risk for cardiovascular disease and no increased risk of bleeding. Some studies suggest daily aspirin therapy may also help lower the risk for colorectal cancer, liver cancer and ovarian cancer. The USPSTF recommended daily low-dose aspirin for colorectal cancer prevention in its previous guidelines, but the new draft says more evidence is needed. The new guidelines do not apply to people of any age who are currently on daily aspirin. Such individuals should consult their doctor before they stop taking aspirin therapy. The benefits and harms of low-dose daily aspirin for prevention vary from person to person. Consult your doctor to discuss whether aspirin therapy is right for you. —Liz Highleyman

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

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SPIRIN IS BEST KNOWN AS a pain reliever, but it also has anti-inflammatory properties and acts as a blood thinner. While taking aspirin to relieve pain or reduce fever is safe for most adults, taking it daily can lead to gastrointestinal bleeding and bleeding in the brain. In October 2021, the U.S. Preventive Services Task Force (USPSTF) released draft guidelines that question the widespread use of daily aspirin for cardiovascular and colorectal cancer prevention. For years, doctors have recommended aspirin therapy for people who have already had a heart attack or stroke, known as secondary prevention. The protective benefits are well established, and that advice has not changed. But guidelines for people who have not yet had a heart attack or stroke, known as primary prevention, have shifted. In its 2016 guidelines, the USPSTF recommended daily low-dose aspirin (equivalent to a baby aspirin) for people in their 50s who have at least a 10% risk for cardiovascular events over 10 years. The new draft advises these individuals to consult their doctor to evaluate their risk-benefit balance. The previous guidelines advised at-risk people in their 60s who have not yet had a heart attack or stroke to

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ESA

Ivy Kwan Arce near her home in New York City

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CONNECTING WITH OTHERS HAS HELPED ACTIVIST AND ARTIST IVY KWAN ARCE NAVIGATE LIFE WITH HIV.

MEGAN SENIOR

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BY ALICIA GREEN

VY KWAN ARCE HAD BEEN living in New York City for less than a year when in 1992, a poster on the subway caught her attention. It read, “Women don’t get AIDS—they just die from it.” The bottom of the poster included a list of HIV risk factors for women. poz.com APRIL/MAY 2022 POZ 23

“I had dated somebody who was a drug user for a short time, so I decided to get tested,” says Kwan Arce, an HIV activist and artist. At age 25, Kwan Arce didn’t know much about the U.S. health care system. Born in the United States to Chinese parents, she spent her early life in Bolivia. English was her third language. But Kwan Arce eventually located a doctor, who gave her an HIV test. The positive result changed her life forever. The doctor didn’t know where to refer her, so he suggested she take another look at the poster she’d mentioned seeing. He thought it might list some resources. “It happened to be an ACT UP [AIDS Coalition to Unleash Power] poster, so that’s how I ended up at the ACT UP meetings,” she recalls. “There was nowhere else to go. Up until that point, I was constantly told [HIV] wouldn’t affect women.” KWAN ARCE’S STORY IS LIKE THAT OF MANY women diagnosed with HIV or AIDS at the beginning of the epidemic. Back then, even as cases among women rose across the United States, women were often overlooked and sometimes isolated. During the early 1980s, many people believed that only gay men could acquire HIV. The research and information provided by the Centers for Disease Control and Prevention (CDC) initially focused primarily on this population. Women living with HIV had limited resources and lacked proper support. At the same time, Asians, Pacific Islanders and Native Americans living with and affected by the virus were categorized as “other” in HIV and AIDS data. These groups also received little to no help from the government to fight the epidemic in their communities. Language barriers and other obstacles often also prevented them from getting assistance or finding support. At ACT UP meetings, Kwan Arce couldn’t find anyone else like her—an Asian-American woman living with HIV in one of the biggest cities in the country. “I saw no Asian women and hardly any women who were positive,” Kwan Arce says. “That kind of stigmatized me and made me feel very singular.” As a first-generation Chinese-American woman living with the virus, Kwan Arce faced her own set of unique challenges. Not only was English not her first language, but she was also unfamiliar with how to access services and navigate the health care system in the United States. When she was growing up in Bolivia, her parents never took her to the doctor. She also didn’t understand how insurance worked. “I was new to this,” she says. “I never had even asked for [copies of] my records because I didn’t have practice going to a doctor’s office. I never really had yearly checkups.” Kwan Arce continued attending ACT UP meetings to receive vital information. But she often felt isolated and overwhelmed. As a newcomer, she found it difficult to connect to

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Kwan Arce designed these illuminations, which were projected on the south wall of the United Nations Secretariat building in early January 2022. The action called on nuclear-armed nations to join the Treaty on the Prohibition of Nuclear Weapons.

other women living with HIV and was often mistaken for someone’s nurse. She was also discriminated against at the advertising agency where she worked as a graphic designer after she was forced to disclose that she was living with HIV. When

ALL IMAGES THIS PAGE: COURTESY OF IVY KWAN ARCE; OPPOSITE PAGE: (TOP) SETH SHELDEN; (BOTTOM) RAZID SEASON

Top: Graphics Kwan Arce designed for the PWA Health Group in the ’90s; bottom left: 2020 March for the Dead, honoring those lost to COVID-19; bottom right: promos she designed for an ACT UP health fair that she organized with support from TAG

her bosses found out about her HIV status, they limited the type of work she could do, and she was eventually fired. “I couldn’t do my job,” she recalls. “I went from someone who brought them a huge account to someone they feared. Suddenly, I felt like a danger to everybody.”

KWAN ARCE FELT ALL ALONE AND BROKEN. It wasn’t until she was introduced to the PWA (People With AIDS) Health Group that she finally felt seen. Founded in 1987, the group provided people living with HIV support and access to experimental treatments. It also created a safe space for women with HIV. It taught women about treatment options, how to read their lab results, how to take part in clinical trials and how to prevent opportunistic infections. “That alignment was really important,” Kwan Arce recalls.

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wide audience, she is proud that her contributions served her community. “It saved my life,” she says of the organization. “It was so essential. I don’t think I would have survived without it.”

“It basically gave me the tools to ask for my labs and to review them, and the group was generous to explain them when I just couldn’t digest the concepts.” PWA Health Group director Sally Cooper entrusted Kwan Arce with the creation and development of Ivy Kwan Arce graphics and artwork for the group’s many got tested for HIV after seeing events and materials covering different a poster in the subway. topics. Although her work didn’t reach a

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WHEN SHE LOOKS BACK ON the romantic relationships in her life, Kwan Arce believes she lucked out. She has had partners who were HIV negative and supported her through her journey. In 1993, she married her husband, who has stood by her side for almost 30 years. “My husband would sit and help me go through data and learn how to understand it,” Kwan Arce says. Although she had found love, Kwan Arce didn’t initially plan to be a mother. Memories of the harsh conditions her family endured back home in Bolivia and the fact that she was HIV positive made the prospect daunting. “[Doctors] would say, ‘Don’t even think about having a child. You’d be so irresponsible,’” she recalls. “From 1990

MEGAN SENIOR

“THE THING THAT BRINGS ME THE MOST JOY IS MY CONNECTION TO PEOPLE .”

KWAN ARCE THINKS ABOUT how much things have changed for women living with HIV in the past 40 years. She appreciates that women today don’t have to suffer the same trauma as those who were diagnosed in the early days of the epidemic. But she believes there remains a lot of work to do when it comes to teaching women about prevention, especially pre-exposure prophylaxis (PrEP), a pill or injection taken to prevent a person from getting HIV. According to the CDC, among those for whom PrEP is recommended, uptake is about three times as high among men (25%) compared with women (10%). This is concerning because cisgender women account for 19% of new HIV diagnoses every year. “The few PrEP [advertisements for women] I’ve seen I couldn’t tell if it’s a tampon or juice,” she says. “To tell people to take something when they don’t have the illness is a very complicated thing.” She believes that conversations about prevention need to include more long-term survivors who are women. Otherwise, she worries that women will continue to be left behind and young women today won’t be as knowledgeable about HIV and PrEP.

to 1997, that was the message for women.” Kwan Arce, who had been undetectable since the mid’90s, eventually became pregnant. In 2000, she gave birth to her first son. He was born without HIV, but that didn’t mean motherhood was easy. “I had to give him oral AZT for several weeks,” she recalls. “Child services had to be involved. They told me if I didn’t do it in front of them, they would take the child.” THE EXPERIENCE WAS MENTALLY DRAINING. If she made even just one mistake, she could lose her son to foster care. On top of that, she couldn’t breastfeed him. She endured the same situation when her second son was born in 2004. Today, Kwan Arce’s children are ages 17 and 22. “They’ve been really great,” she says. She recalls watching the HIV documentary How to Survive a Plague with her sons and the family of Catherine Gund, a fellow soccer mom and a veteran AIDS activist from ACT UP and DIVA TV. Although at first, Kwan Arce’s sons didn’t understand much about HIV, she used the film as a vehicle to educate them. When Kwan Arce began taking her oldest son to her speaking engagements, he slowly started to understand the impact of his mother’s activism. But because her other son was much younger at the time, she explains, he was more removed from it all. “I think now he feels overwhelmed by the power of the story because he can’t grasp it,” Kwan Arce says. “His approach is very different.” However, in their own ways, her sons have come to terms with their mother’s status and the work she does. IN NOVEMBER 2021, KWAN ARCE RECEIVED THE Research in Action Award from the Treatment Action Group (TAG) for her decades of activism. The award is presented annually to individuals who have made extraordinary contributions to the fight against HIV, hepatitis C and tuberculosis. “It felt amazing,” she says. “I slept with my award because I don’t get that many awards.” It wasn’t the first time Kwan Arce was recognized for her HIV work. Three years ago, Performance Space New York honored her as well. During her three decades of living with HIV, Kwan Arce has been a vital part of her community. From 1995 to 1999, she served as a voting member on the HIV Planning Council of New York. She helped allocate appropriate funding to AIDS service organizations across New York City. In addition, Kwan Arce played a part in the grassroots formation of important New York City–based HIV/AIDS organizations, such as God’s Love We Deliver and the Asian and Pacific Islander Coalition on HIV/AIDS (now APICHA Community Health Center). She also spent several years fighting on the front lines with Rise and Resist, a direct-action group formed in response to the 2016 presidential election.

Although she’s pulled back a bit, Kwan Arce continues to do her part in the HIV community. Last year, with support from TAG, she organized an ACT UP health fair that provided HIV testing, COVID-19 vaccinations and PrEP information at a Reclaim Pride event in New York City. She also actively advocates for PrEP access. Though she is proud of all the work she’s done for the community over the years, Kwan Arce says activism can be depleting and she has sometimes even neglected herself for the greater good. “What has helped is that my children will call me out on it,” she says. “It happened a lot [when former President Trump was in office]. I would get caught in a lot of conflicting situations, and they would beg me to step back.” IN JANUARY, KWAN ARCE WAS NAMED ONE OF 63 artists and collectives whose work will be displayed at the Whitney Museum of American Art in New York City as part of the 2022 edition of the longest-running survey of American art, the Whitney Biennial. “I’ve never been in a museum showing on this scale,” Kwan Arce says. “It’s really exciting.” Her artwork, made in collaboration with visual and performance artist Julie Tolentino, whom she first met at an event at the museum, will be a part of the 80th biennial, titled Quiet as It’s Kept. It will be on display from April 6 to September 5, with some exhibits and programs continuing until late October. “Julie and I connected,” she says. “It was very emotional. Every time I meet an activist that I didn’t know back then, I thank them for the work they’ve done because it led me to knowledge [about HIV].” The pair’s contribution to the biennial challenges what art and activism can do while honoring the histories and experiences of people who have made an impact on others but who may not be commonly known. The multi-experiential work consists of a poster, a light installation, a glass and mirror array, a web portal, an international talk following the 24th International AIDS Conference in Montreal and a durational performance at the museum in October. Kwan Arce’s older son, Atom, will be a part of a Whitney Museum teen program that will debut midway through the show. As an homage to treatment activist Mark Harrington, a family friend and long-term survivor who is the executive director of TAG, Atom has created a bespoke T-shirt project titled #bornbeforethecure. According to Tolentino and Kwan Arce, their multispoked artwork is “an effort to penetrate at multiple points to transmit and hold the many unseen lives and actions that resonate across generations, borders, identities.” It’s fitting that the duo’s artwork centers people, especially those who aren’t always seen. As Kwan Arce puts it, “The thing that brings me the most joy is my connection to people. It really begins and ends with being able to have a connection. It’s the way I was able to survive.” ■

poz.com APRIL/MAY 2022 POZ 27

HOW HIV CRIMINALIZATION LAWS TARGET WOMEN—AND HOW WOMEN ARE FIGHTING BACK BY HEATHER BOERNER

JUSTTICE ILLUSTRATION AND FENCE: ISTOCK

IFFANY MOORE HAD A PANIC ATTACK AT A TENNESSEE playground. That’s how her 2021 ended. All she’d wanted was to give her 8-year-old daughter the gentle childhood she’d never had. By age 10, Moore had for years been strapped down repeatedly in mental health wards and “pumped full of drugs” in different hospitals. That was in addition to the abuse she’d experienced at home. Half a decade later, she would be on the streets, surviving through work with sex trafﬁckers and pimps. At age 10, she says, she didn’t expect to see adulthood. Now, as a mother, she was determined her daughter would grow up enjoying her childhood experiences, including afternoons on swings and slides with her mommy. But until December 2021, when a change in Tennessee law that she fought for went into effect, Moore was legally forbidden from visiting a playground. That’s because at 21, she was convicted of aggravated prostitution—the aggravation being that she’d acquired HIV during a rape. And even though she did not transmit HIV to anyone, Moore spent 20 years on

Tennessee’s sex offender registry as a result of her status. Within weeks of her removal from the registry, Moore was at a playground surrounded by children, and every ﬁber in her body told her to ﬂee, that she was one call to the police away from being separated from her daughter. “They’ve instilled for 20 years that you’re a danger to children and your child. You can’t go here; you can’t go there. You can’t be here; you can’t be there,” she says. “I just know—I know I have a lot of pieces to pick up.”

SHE’S NOT ALONE. THOUGH THE PUBLIC FACE OF HIV CRIMINALIZATION laws has been primarily gay men—particularly gay Black men—recent data show that such legislation also targets Black women. In particular, research conducted by the Williams Institute at the University of California at Los Angeles has found that in California, for instance, Black women make up 3% of the population and 4% of people living with HIV but 22% of people prosecuted under that state’s old HIV criminalization law.

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In Georgia, Black women make up 17% of the population and 18% of those living with HIV but fully half of people prosecuted under that state’s HIV criminalization laws. In Kentucky, which has a law similar to Tennessee’s, 32 people have been arrested on HIV criminalization charges. All but one of those charges was associated with sex work. In that state, those arrested have mostly been white women. According to an article in a Tennessee newspaper, by 2009, 38 people besides Moore had been arrested under the aggravated prostitution charge. “The image we have around HIV criminalization laws maybe is of a gay cisgender man who doesn’t disclose his status to a sex partner,” says Nathan Cisneros, MS, the Williams Institute’s HIV criminalization analyst and the coauthor of the Kentucky study as well as a forthcoming report on Tennessee’s laws. “What we fi nd in states that have prostitution-specific HIV laws, though, is that sex work ends up taking on a substantial minority, sometimes a majority and sometimes the overwhelming majority of enforcement actions. And those primarily affect women,” he says. Because arrest records reflect someone’s assigned gender at birth and not their preferred gender, it’s unclear how many of those arrested are women of transgender experience living with HIV, but other data suggest that this group is overrepresented among sex workers nationwide. Yet women with HIV aren’t just the target of these laws— they are also fighting them, forming coalitions, writing legislation and, like Moore, testifying about the science and impact of the laws to effect change.

even semen donation by those who are HIV positive and want to become parents. In addition, nine states have so-called sentence enhancements that can take a preexisting charge unrelated to HIV and increase prison time and penalties for people living with the virus. Six states may require people living with HIV who are found guilty to register as sex offenders. The states that specifically increase the severity of penalties for people involved in sex work primarily impact women living with HIV. In Tennessee, where Moore lives and served time, a sex work charge alone is a misdemeanor, punishable by a fine. But add in the HIV charge and suddenly a woman is facing a felony, punishable by years in prison. That conviction also requires registration as a sex offender, with the heightened punishment of being classified as a violent offender. “It makes it difficult to get housing and stable employment, to receive certain benefits, to vote in elections,” Cisneros says. “And of course, if you have children, it creates all these other terrible complications. You can’t pick your child up from school. You can’t visit them at the playground. You can’t have your children’s friends over for a sleepover.”

“YOU CAN’T GO HERE; YOU CAN’T GO THERE. I KNOW I HAVE A LOT OF PIECES TO PICK UP.”

TODAY, 30 STATES HAVE STATUTES SPECIFICALLY PROSECUTING people living with HIV for real or imagined crimes related to HIV transmission or exposure, according to The Center for HIV Law and Policy. The list of potential crimes reads like an HIV stigma fever dream. In some instances, people with HIV can be arrested for allegedly not telling a partner they are living with the virus—even if they are taking HIV medications and are undetectable, which eliminates the risk of transmitting it to a partner. They can be prosecuted even if they did tell the partner they were living with HIV but their partner tells the police that they didn’t. In other instances, people living with HIV can be arrested for exposing others to bodily ﬂuids, including via spitting and biting, acts that don’t transmit HIV. Yet other laws prosecute syringe sharing among people living with HIV who inject drugs, and still more criminalize

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FROM THE BEGINNING, MOORE’S EXPERIENCE OF LIVING WITH HIV was intertwined with incarceration. When she was arrested for sex work in March 2002, the state of Tennessee also required her to get an HIV test. That’s when she found out she was living with the virus. But she wasn’t allowed a private moment to process it. Instead, when court staff read out the charges at her arraignment, “my status was read out loud in court,” she remembers. For her, she says, that was the “initial attack” in a yearslong journey through the court system. She wasn’t offered care or services. She simply left jail and went back to her former life. She evaded the public health workers who were circulating her name and photo among the trafﬁckers who could use it to hurt her. She was 20, not even legally able to drink. To cope, she’d been cutting herself for years. When that failed to stop the terror and ﬂashbacks, she turned to crack. “That was my Prozac,” she says. “My entire left wrist is cut up from my coping skills. [Using drugs] was the way to not cut myself. That was the only way I knew to keep myself safe.” Now that she knew her HIV status, future arrests carried with them the extra weight of the criminalization statute. By August 2002, she’d been arrested again and could either stand trial, which could result in a 15-year prison term, or she could plead guilty to the charges and accept a four-year

sentence with no possibility of parole and be added to the sex offender registry as a violent offender. No one had acquired HIV from her. She hadn’t even been engaged in sex work when the arrest happened. She’d just been loitering in a prostitution zone while living with HIV. That began what would eventually total eight and a half years behind bars, off and on—always being released between 11 p.m. and 2 a.m., always fi nding johns waiting for her and always fi nding that drug treatment centers couldn’t take her because of her HIV diagnosis or her status as a registered sex offender. Halfway houses were out of the question—the sex offender registry again. It was maddening, Moore says now. She wanted to get off the streets, but the criminal code kept her stuck. One thing did change during this time. She started on HIV meds in prison, at fi rst on drugs that made her sick every day. About three years into her fi rst term, she had an undetectable viral load, which means she couldn’t transmit the virus. But that didn’t stop the arrests from coming. “I was always arrested before the medication ran out,” she says, so her treatment wasn’t interrupted. In the Kentucky report from the Williams Institute, Cisneros and colleagues found that most of the arrests were made on the streets or in parking garages. At least 15% of arrests were “almost certainly for conduct that did not involve sex work. Indeed, arrests for allegations of sex work do not need to include actual sex acts.” In 2011, Moore left prison for the last time. She fi nally found a treatment center that would accept her despite her status on the sex offender registry. She quit drugs. She started working with an HIV service organization and for the fi rst time began addressing her posttraumatic stress disorder. Importantly, she fi nally connected with others living with HIV through the Sero Project, a group of people with the virus who are working to change criminalization laws. And, almost as quickly, she started working to modernize Tennessee’s HIV laws. By 2015, she was also a new mom. What’s more, for the fi rst time, she had her own apartment, a car and a job. “I started to realize,” Moore says, “that what was done to me wasn’t right.” AGAIN, MOORE WASN’T ALONE. WOMEN AND NONBINARY PEOPLE living with HIV have been working along with gay men to guide the decades-long effort to reform HIV criminalization laws. Whether it’s Tami Haught, who was key to getting Iowa to remove people living with HIV from the sex offender registry in 2014, or Barb Cardell, who advocated successfully in Colorado for the elimination of mandatory HIV testing for people arrested for sex work and the removal of felony charges from someone living with HIV convicted of sex work, or Naina Khanna and other members of Positive Women’s Network–USA, who worked to reduce sex work charges for women with HIV from felonies to misdemeanors, women living with HIV have been guiding the move-

ment against HIV criminalization for years. And that doesn’t even include advocates living in states that have yet to reform their laws, like Indiana, Georgia and Ohio. So in 2015, when Moore testified before the Tennessee Statehouse to advocate for people placed on the sex offender registry to be able to have themselves removed if they had been sex trafficked, raped or abused, she was part of a bigger sisterhood. But it came at a price. She went back to her old coping mechanism. She relapsed. It was the fi rst time, she says, that she knew what it was like to lose everything because “before, I had nothing.” In the last seven years, though, Moore has held on to her recovery with both hands. “I grew up,” she says. “It was like, literally, wisdom overnight.” Now, she’s stepping into advocacy again. She is part of a complaint fi led by The Center for HIV Law and Policy asking the Department of Justice to investigate HIV criminal statutes in Tennessee and Ohio. And it looks like the tide is turning. In 2016, the Association of Nurses in AIDS Care released the fi rst clinical guidelines on addressing HIV criminalization, and the American Psychological Association officially came out against HIV criminalization laws. This was followed by a consensus statement issued in 2018 by the world’s premier HIV scientists and clinicians arguing that laws should be revised to reflect the actual science of HIV transmission. The following year, the American Medical Association came out against the laws. Now, the Centers for Disease Control and Prevention’s website has a page dedicated to how HIV criminalization laws are inconsistent with the national effort to reduce new HIV transmissions by 90% by 2030. For Moore, being removed from the sex offender registry at the end of 2021 was bittersweet. The aftereffects linger, she says, and she still thinks about how Tennessee’s law might be different had she been able to tolerate “the uncomfortable second” that comes with the overwhelming urge to hide in just one more inhalation on a crack pipe. As written, the law requires people seeking removal from the list to prove that they were abused, raped or otherwise sex trafficked in order to gain their freedom. Courts can require trials that force women to come up with proof of the abuse. Now, Moore says she’s on a new healing journey, with the registry behind her. She will continue to pick through the traumatic effects of surviving her childhood and living with the stigma of the registry. Still, when she sees her daughter playing in her own room, surrounded by all the things she didn’t have growing up, in an apartment Moore pays for with a job she selected, with a car she owns parked outside, she says a sense of peace and happiness comes over her. “I just want her to be a kid,” she says. “There’s so much time for her heart to be broken by the world we live in right now. I just want her to play with slime and dolls.” ■

poz.com APRIL/MAY 2022 POZ 31

HEROES BY ALICIA GREEN

32 POZ APRIL/MAY 2022 poz.com

Iya Dammons is the executive director of Baltimore Safe Haven.

JOANNA TILLMAN

Stay Strong As a sex worker, Iya Dammons always lived in survival mode. She experienced homelessness and violence. But Dammons wouldn’t let that be her narrative—she had an idea for moving forward. “I wanted to empower my community,” says Dammons, a Black transgender activist from Baltimore. “This couldn’t be all that life has to offer us.” Dammons, age 36, aspired to start an organization that would provide resources to LGBTQ people at risk for homelessness, substance use and sex work. She also specifically wanted to help Black transgender women. Her idea became a reality in 2018, when she established Baltimore Safe Haven. Dammons is the organization’s executive director. “It started as a mobile outreach unit driving around the areas that were known for sex work and giving out condoms,” Dammons says. “Then, it extended to transitional housing and low-barrier shelter services.” Today, the organization provides housing at five locations to clients ranging from young adults to seniors. Clients can also enjoy hot meals and pick up groceries and clothing at a local drop-in center. Plus, the organization provides mental health support as well as legal services. “We decided to create an infrastructure where our community can rely on us for sustainable and equitable housing,” Dammons explains. Baltimore Safe Haven partners with real estate agents and landlords to help secure living accommodations for clients. Once they’re housed, clients are offered GED prep courses and vocational training. “We are building [clients] up and giving them all the tools that they need,” Dammons says, “so they can enrich their community after coming through their own trials and tribulations.” In addition, Baltimore Safe Haven supports the health of its clients and community by offering HIV testing and other prevention services. The organization tests about 500 people annually. “[We] are totally up for the challenge to go to the most marginalized communities and provide them with HIV tests, [pre- and post-exposure prophylaxis] referrals and linkage to care,” Dammons says. She aims to expand the organization to provide more individuals with adequate housing and other vital services. “I’d love to see a Rainbow Row, where we own a whole block,” she says. She’d also like to see more government officials invest in Baltimore and its residents. Even without their support, Dammons will continue to fight for the lives of the city’s transgender residents, who, she explains, experience disproportionately high death rates. “We will march in the street,” she says. “We will knock on City Hall’s doors. We will not stop until we know that our lives matter.” Dammons invites the public to visit Baltimore Safe Haven, whose doors are always open. She also encourages people to work with their local LGBTQ agencies, which can identify and meet their needs. “Stay strong,” Dammons says. “I know this life can be taxing. However, there is a rainbow after the rain.” ■

SURVEY

Do you take your HIV medications with food?

❑ Yes ❑ No 9

Do you use reminders to take your HIV medications?

❑ Yes ❑ No 10

ON SCHEDULE Taking your HIV medications exactly as prescribed by your health care provider is essential to halt HIV replication and keep your viral load undetectable. Take our survey and let POZ know how you stay adherent and on schedule. 1

❑ Yes ❑ No 11

What year were you born? __ __ __ __

What is your gender?

❑ Male ❑ Female

Do you generally have any issues taking your HIV medications as scheduled?

❑ Take the meds as soon as I remember. ❑ Wait until my next scheduled dose to take the meds. ❑ Depends on how long it’s been since I missed the dose.

What are some reasons you’ve missed a dose? (Check all that apply.) I forgot.

ISTOCK

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

I fell asleep. I wasn’t feeling well.

What is your current level of education?

❑ Some high school ❑ Some college ❑ High school graduate ❑ Bachelor’s degree or higher

I didn’t have my HIV meds with me. I felt overwhelmed. I ran out of my HIV meds. I couldn’t afford my HIV meds.

What is your ZIP code? __ __ __ __ __

I didn’t want to take them in front of someone else. Other (Please specify.): ___________________

Are you resistant to any class of drugs?

❑ Yes ❑ No ❑ I don’t know. 7

What is your sexual orientation?

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

If you miss a dose, what do you do?

❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑

❑ Transgender ❑ Other

❑ Straight ❑ Bisexual ❑ Gay/lesbian ❑ Other

Do you talk to your health care provider if you have issues taking your HIV medications as scheduled?

❑ Yes ❑ No ❑ Sometimes

Where do you get your HIV medications?

❑ Local pharmacy ❑ Mail-order pharmacy ❑ Through my health care provider ❑ Through a prison or other correctional institution ❑ Other (Please specify.): ___________________

Do you worry about traveling with your HIV meds?

❑ Yes ❑ No

❑ Yes ❑ No ❑ Sometimes 3

Do you frequently run out of your HIV medications?

❑ Yes ❑ No

How often are you scheduled to take your HIV medications?

❑ Once a day ❑ Twice a day ❑ Every month ❑ Every two months ❑ Other (Please specify.): ___________________

Do you hide your HIV medications from others?

Is your viral load undetectable?

❑ Yes ❑ No ❑ I don’t know.

Scan this QR code with your smartphone to take this survey at poz.com/survey. Or email a photo of your completed survey to website@poz.com.

Care you can trust. t “I love being part of a company where I’m valued as an individual.. As a transgender woman, it’s so empowering to be accepted and respected for who I am—it makes me want to work even harder for our patients. Avita truly prioritizes patient care above everything else, and I feel proud to be a part of that.

“

Charlize Croner Care Coordinator at Avita Pharmacy

Visit us online at avitapharmacy.com to learn more and transfer to Avita. MK.02.01.01R0821

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