A SMART+STRONGOCTOBER/NOVEMBERPUBLICATION2022POZ.COM$3.99 HEALTH, LIFE & HIV
Elias Diaz
anddiscriminationOvercomingHIV Latinos in the South
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` Those in the “Most Important Information About BIKTARVY” section.
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` rifampin
ABOUT BIKTARVY
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` dofetilide
`
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` The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).
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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.
Please see Important Facts about BIKTARVY, including important warnings, on the previous page and visit BIKTARVY.com. 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. Because HIV doesn’t change who you are. ONE SMALL PILL, ONCE A DAY Pill shown not actual size (15 mm x 8 mm) | Featured patient compensated by Gilead. #1 PRESCRIBED HIV TREATMENT * *Source: IQVIA NPA Weekly, 04/19/2019 through 05/28/2021. Scan to see D’Eva’s story. D’EVA LIVING WITH HIV SINCE 2009 REAL BIKTARVY PATIENT Because HIV doesn’t who you are. WITH HIV KEEP LOVING.
In “Zero Stigma,” four groups announce the launch of a new initiative, and in “Positive Lounge,” POZ blogger Mark S. King explores this aspect of AIDS conferences.
Advocates, researchers, politicians, thought leaders and folks just like you all have ideas worth sharing. Go to poz.com/ opinions to read topicsaboutsuch as living with HIV, improving care and treatment, increasing prevention efforts and fighting for social justice.
14 SPOTLIGHT
EXCLUSIVELY ON POZ.COM
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3 FROM THE EDITOR Down South
(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. 263 POSTMASTER: Send address changes to POZ/Smart + Strong, 157
22 LATINOS ARE FIGHTING HIV IN THE SOUTH
28 PROTECTING SEXUAL AND REPRODUCTIVE RIGHTS
People living with HIV have much at stake after the overturning of Roev.Wade. BY ALICIA GREEN
BY CHARLES SANCHEZ
POZ BLOGS
#UNDETECTABLE
The science is clear: People who have InHIVdon’tviralundetectableanloadtransmitsexually.additionto
Doxycycline reduces risk of sexually transmitted infections loneliness and depression hurt adherence another man cured after a stem cell transplant
CONTENTS
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.
LGBTQ people showed up for Pride Month in full force this year.
D
POZ DIGITAL
17 BASICS Heart health
poz.com/digital to view the current issue and read past issues online.
20 RESEARCH NOTES
PrEP disparities are worsening • could drones help provide HIV care?
32 HEROES
Black bean and sauteéd veggie tacos
The “I Am a Work of ART” campaign • ending AIDS in children by 2030 • a positive heart transplant • POZ Stories: Chiina
6 POZ PLANET
• Everyday: milestones in the HIV epidemic
advocates. Join the conversation in the comments section. Visit the blogs to find hope and inspiration from others.
16 NUTRITION & FITNESS
• expanding access to long-acting injectables HIV and monkeypox
•
keeping people healthy, effective HIV treatment also means HIV prevention. Go to poz.com/undetectable for more.
Scan the QR code (left) with camerasmartphoneyourorgoto
4 POZ Q & A
POZ Columbus
11 VOICES
Latinos are facing challenges and barriers such as language, immigration status and discrimination.
18 CARE & TREATMENT
• how often should I exercise?
Elias Diaz lives with HIV in Eagle Pass, Texas.
Longtime HIV advocate Francisco Ruiz is pursuing a doctorate in public health.
POZ OPINIONS
Our roster of bloggers spans the diversity of the HIV community. Go to poz.com/blogs to read varying points of view from HIV-negativewellthelivingpeoplewithvirusasasfrom
• hepatitis C treatment is lagging
AIDS as fact and fiction: In Rasheed Newson’s novel, a Black gay activist comes of age in 1980s New York City.
this past summer. The long days and nights of back-to-back heat waves tested us all. I run hot, so to speak, so even average heat can tax me. I always enjoy the cooler air of spring and autumn.
EDITORIAL ASSISTANT
OR EDITOR-IN-CHIEF@POZ.COM SMART + STRONG
Among all the reminiscences and historical accounts, Rasheed Newson’s debut novel stands out—it is a work of historical fiction. Many of the people and events are real, but others are fabricated. Set in 1980s New York City, the novel tells a very different story about ACT UP, Larry Kramer and more. Go to page 4 for our Q&A with the author.
Finally, on the topic of HIV history: The first successful heart transplant between a positive donor and a positive recipient took place earlier this year. Go to page 7 for more.
SHANE BURKE
As part of our Latino theme, this issue of POZ also includes another edition of POZ en Español (pull it out from the center) and a poster on sexual health (tear it off from the back). Both are in Spanish.
ART PRODUCTION MANAGER
JOE MEJÍA
SUBSCRIPTIONS WEBSITE@POZ.COM
Want to read more from Oriol? Follow him on Twitter @oriolgutierrez blogs.poz.com/oriol.
LAURA SCHMIDT
CONTRIBUTING ARTISTS
MEGAN STRUB
SCIENCE WRITER
LIZ HIGHLEYMAN
FROM THE EDITOR
LEGACY ADVISER
EDITOR-IN-CHIEF editor-in-chief@poz.com
and check out
I
CONTRIBUTING WRITERS
T WAS UNDOUBTEDLY HOT
JOAN LOBIS BROWN, LIZ DEFRAIN, ARI MICHELSON, JONATHAN TIMMES, BILL WADMAN
DEPUTY EDITOR
FOUNDER SEAN STRUB
SUBSCRIPTION@POZ.COMUNITEDHTTP://ORDER.POZ.COMSTATES:212-242-2163 FEEDBACK EMAIL
MICHAEL HALLIDAY
AND COO IAN
In this special issue dedicated to Latinos, we highlight others who are making their mark. HIV advocate Francisco Ruiz is one of them. In 2010, he was named to our inaugural POZ 100 list, which described him as a “real up-and-comer.” Now, he’s pursuing a doctorate in public health. Go to page 32 to learn more about his journey.
MANAGING EDITOR
TRENT STRAUBE
ORIOL R. GUTIERREZ JR.
COPY CHIEF
SHAWN DECKER, OLIVIA G. FORD, ALICIA GREEN, MARK S. KING, TIM MURPHY, CHARLES SANCHEZ
One of the most far-reaching decisions by the Supreme Court in recent memory is the overturning of Roev.Wade. Protecting sexual and reproductive rights is a concern for everyone. People living with HIV have much at stake as well. Go to page 28 to find out what you can do (hint: vote!).
ORIOL R. GUTIERREZ JR.
A. CORNELIUS BAKER, GUILLERMO CHACÓN, SABINA HIRSHFIELD, PHD, KATHIE HIERS, TIM HORN, PAUL KAWATA, NAINA KHANNA, DANIEL TIETZ, MITCHELL WARREN PRESS REQUESTS NEWS@POZ.COM
JENNIFER MORTON
DORIOT KIM
ADVISORY BOARD
EDITORIAL INTERN JILLEEN BARRETT
PRESIDENT E. ANDERSON
Through the years, POZ has spotlighted countless books, both fiction and nonfiction. As the decades of the AIDS era stretch on, so do the books. And they should—there’s still so much to remember and document.
I did, however, gain an appreciation of the South and its people. A major difference between those two summers and now is how the Latino population has grown. As these new arrivals provide the region with benefits, they continue to face challenges and barriers.
I still equate the idea of heat with the South. I was born in New York City, but I spent two summers in the South for Marine Corps boot camp and schooling. I appreciated those experiences, but I never wanted to go through that kind of heat again.
Our cover subject, Elias Diaz, knows these issues well. He is a Mexican-American man living with HIV in the border town of Eagle Pass, Texas. A native of the town, Diaz cofounded Eagle Pass SAFE (Sexual Advocacy for Everyone), an LGBTQ nonprofit organization serving the rural communities of South Texas.
EDITORIAL
EDITOR-IN-CHIEF
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DIRECTOR ORIOL R. GUTIERREZ JR. CHIEF TECHNOLOGY OFFICER CHRISTIAN EVANS VICE PRESIDENT, INTEGRATED SALES DIANE ANDERSON INTEGRATED ADVERTISING MANAGER JONATHAN GASKELL INTEGRATED ADVERTISING COORDINATOR SARAH PURSELL SALES OFFICE 212-938-2051; SALES@POZ.COM CDM PUBLISHING, LLC CEO JEREMY GRAYZEL CONTROLLER JOEL KAPLAN poz.com OCTOBER/NOVEMBER 2022 POZ 3 BROWNLOBISJOAN(GUTIERREZ)ISTOCK;(ILLUSTRATION) POZ.COM/FACEBOOKPOZ.COM/TWITTER POZ.COM/INSTAGRAM
Down South
Diaz and many others are working to address hurdles for Latinos living with HIV in the South, which include language, immigration status and discrimination. The Latino Commission on AIDS even has a dedicated program called Latinos in the South. Go to page 22 to read more.
SCIENCE EDITOR
You grew up in Indianapolis (like the novel’s protagonist, Trey). You went to college at Georgetown University in Washington, DC, and you now live in Pasadena, California. What drew you to writing a story set in New York?
An uncle, who is gay and only 14 years older than me, lived in New York City. Ever since I was 16, I would fly out there once or twice a year to see Broadway
BY TRENT STRAUBE POZ Q & A CONGRESS;OFLIBRARYYOUTUBE/(COTTON)CONGRESS;OFWIKIMEDIA/LIBRARY(RUSTIN) STALEYPETEROFCOURTESY(DEMONSTRATION)HILL;ETHAN(KRAMER)
I was not terribly brave [about coming out early], but I was also not fooling anyone. I never had a serious girlfriend and was on the down low dating other boys my age. When I did come out after college, I don’t remember anybody gasping.
Did that really happen? Hardly. But the novel is a work of historical fiction. Many of the people and events are real, but others are fabricated. It’s the clever tale of 18-year-old Trey, a Black gay man from the Midwest who comes of age in the heady world of HIV activism in New York City.
HE WAY RASHEED NEWSON TELLS IT IN HIS DEBUT NOVEL, My Government Means to Kill Me, set in 1980s New York City, the AIDS activist group ACT UP didn’t spring into existence after a rousing call to action by writer Larry Kramer during a speech at the LGBT Community Center. Nope. That narrative, commonly recounted today, amounts to a myth, a “lie [that] has a romantic sweep to it, if one finds beauty in the magic of accidents and perfect timing.” Instead, Kramer enlisted the help of civil rights leader Dorothy Cotton, who worked with Martin Luther King Jr., and the two secretly trained an AIDS army, going so far as to hire goons to rough up wannabe activists to see who could take the impending abuse.
When did you first learn about HIV?
Rustin NewACTKramerAIDSDorothyandCotton,activistLarryandanUPprotestinYorkCity
In Rasheed Newson’s debut novel, a Black gay activist comes of age in 1980s New York City.
In high school, in 1994, a teacher brought in a man who was HIV positive to speak to us. I was 15. It was a revelation. He has to have been the first person I ever knew who openly had HIV. I remember him being led into the room because at that point his vision was such that he could only see us as a shape or silhouette. Incredibly powerful.
opera]Brooklynfiguredofit.work.butthatshowsandhangout.We’dtellmyparents[myuncle]wastakingthedayoff,hewasalawyersowasn’tmissing[Iexploredonmyown]andlovedJusttoshowyouwhereIwasinmylife,allthethingsyoucoulddo,Ionceouthowtotakethesubwaytowheretheyfilmed[thesoap
Clockwise from far left: the cover of the book, a work of historical fiction civil rights activists Bayard
that weaves in real-life
4 POZ OCTOBER/NOVEMBER 2022 poz.com
Another World so I could stand outside and see, like, Linda Dano walk in.
AIDS AS FACT AND FICTION
T
Did you come out at a young age?
To learn what’s fact versus fiction in his book, we spoke with Newson, 43, as the married father of two was prepping for the new season of Bel-Air. He’s the showrunner and executive producer for the TV series (a dramatic reimagining of the ’90s sitcom The Fresh Prince of Bel-Air). He has also worked on the series Narcos, Shooter and The Chi. Our conversation has been edited for clarity and brevity.
Rasheed Newson
I volunteered at Grandma’s House [a home for foster care children living with HIV]. I’d help them with homework and be a playmate. Teachers and students were afraid of them, so our job was: I’m gonna love you like mad, and somebody’s going to think you’re the best thing ever.
Many novelists play with facts to get at underlying truths or to streamline a story. You include footnotes that explain historical people and events, but do you worry that readers might not know what’s fabricated?
And I’m hoping that [my fictionalized version] brings in younger people, that people who lived through [1980s AIDS activism] can get a sense of nostalgia and that this rings authentic, even if it’s not factually true.
Oh, this is historical fiction. As long as I gave you some indication of where you could follow up on the facts, I thought it was fair game. And in a few footnotes, I’m telling you I’m making this up. I’m trying to be openhanded about when something is real and when it’s not. But all the other [nonfiction] material is still out there for the taking. And at the end of the book, I give a reading list, like Sarah Schulman’s Let the Record Show: A Political History of ACT UP New York
gaylifeholdscivilLet’sclarifysomedetails.TreybefriendsrightsiconBayardRustin,whocourtatMt.MorrisBaths,areal-bathhousethatcateredtoBlackmen.Whatdowehavethere?
She’s a composite of all the lesbian sisters who stepped up during the crisis and who disappear from our stories of, like, five white guys holding hands on the beach facing AIDS. I’m not saying that didn’t happen, but there are other stories. Ultimately, this is the story of an enduring friendship between a femme gay Black man and this unapologetic butch lesbian, and I was happy with that.
Do you consider yourself an activist? I was much closer to it when I was in my 20s and could go to protests. Now I consider myself an activist in how I’m raising my children. I certainly use my dollars and donations for liberal causes. And I consider writing this book an act of activism. ■
Did Dorothy Cotton and Larry Kramer work together to train AIDS activists? Not that I know of. But she was for gay rights and marriage equality. And she had done trainings—that really was her talent. The idea of those lunch counter trainings back in the day [to prepare for the 1960 nonviolent sit-ins to protest segregated lunch counters], they knew they’d have hot coffee poured on them and people would get in their faces and scream, so without trying to do real harm [the trainings aimed] to simulate the chaos and instill how to stay calm and self-possessed.
Were you involved in AIDS activism?
Did ACT UP members subject themselves to these physical trainings at Kramer’s apartment?
Larry Kramer was alive when I started this book [he died May 2020], and a friend asked if I wanted to talk with him. I said, “I absolutely do not want to talk with Larry Kramer. I’m frightened of Larry Kramer.” But if I did, then it would get in my head in the wrong way, and I’d be stuck with whatever he tells me.
I know there were people at Larry Kramer’s apartment at the beginning of ACT UP organizing, but what happened there? That’s my invention. I did a lot of research, and almost everything was possible with ACT UP because each branch did its own thing. What I encourage other people to do—whether it’s to learn about Kramer or Rustin or Dorothy Cotton—is go online because there are hours and hours of video and audio of them talking about their lives.
Another main character is Angie, who runs an AIDS hospice that mostly caters to dying Black gay men. Is she based on a real person?
The facts cater to Rustin’s demographic. I know Rustin was [arrested and convicted] in Pasadena, California, in 1953, for sexual activity with two men in a parked car. What I took from that was: Oh, right, you know a lot of things about Rustin, but he is a man, a gay man, with sexual desires at a time when
poz.com OCTOBER/NOVEMBER 2022 POZ 5
In my nonprofit life, I worked for the Coalition for Juvenile Justice. In college, we’d protest against the death penalty. [That activism was] very much like the AIDS activism that I wanted to convey in the book: Yes, the subject is heavy, but protesting wasn’t somber. We’d joke around, and somebody cute would be there, and you’d get their number. You’d get to be friends with these people. That’s the vibe I want to remind everyone of.
“I’m hoping this rings authentic, even if it’s not factually true.”
MARRSNEWSON/CHRISTOPHERRASHEEDOFCOURTESY
those desires were criminalized. So I thought, Let’s continue the idea that he was still sexually active.
By the time you get to the ’80s, you’ve got people who’ve been in the civil rights movement, the women’s rights movement, the anti–Vietnam War movement. You have older people who are like, “I know who to call to get the Times interested in this story” or “This is how systems work and how change is brought about.” And then you have young people who are willing to throw their bodies into the movement and bring passion but are impatient. I think there has to be that push-pull. I’m all right with the clash and the messiness.
Your novel melds AIDS activism with civil rights history. What’s the link?
“I Am a Work of ART” campaign materials— including posters and flyers, rack cards, business cards, social media and video— are free and available for download at HIV.gov.
Featuring videos, posters, social media posts and more, the campaign’s goal is to “encourage people with HIV who are not in care to seek care, remain in care and achieve viral suppression,” explains HIV.gov.
What is it like to be a living, breathing work of art? Nine people who have HIV share that experience in the federal campaign “I Am a Work of ART.”
“The U.S. Department of Health and Human Services [HHS] launched the campaign in June 2022, as part of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative. The Centers for Disease Control and Prevention (CDC) estimates the overall viral suppression rate in the United States is 53%. Therefore, a key strategy to prevent new HIV transmissions is increasing the proportion of people with HIV who are virally suppressed.“Boththe National HIV/AIDS Strategy and the EHE initiative aim to reduce new HIV infections in the United States by 90% by
In a video on HIV.gov, Harold Phillips, MRP, director of the White House Office of National AIDS Policy, discusses “I Am a Work of ART.”
Samples of campaign materials are above, but visit the website for more, including posters, flyers and business cards you can download and print.
The “I Am a Work of ART” page at HIV.gov describes the campaign’s history and need:
HIV.GOV;ART”)OFWORKAAM(“I ISTOCKHEART)ANDHANDS(FRAMES, UPDATES ON HIV & AIDS POZ PLANET 6 POZ OCTOBER/NOVEMBER 2022 poz.com
“It’s a campaign that features nine people living with HIV,” Phillips says, “who tell their stories of their journey through life before HIV, then with HIV as well as getting into HIV medical care and taking their HIV medications and what it all means to them and what they’ve been able to accomplish by being in consistent medical care and taking their medications. It’s really exciting hearing from people with lived
experience influencing the campaign.”
Viral suppression—meaning that HIV is undetectable—is achieved by taking HIV meds known as antiretroviral therapy, or ART. Folks diagnosed with HIV who take meds and maintain an undetectable viral load not only experience slower disease progression and live healthier and longer lives, but they also don’t transmit HIV to their partners via sex, a fact referred to as Undetectable Equals Untransmittable, or U=U.
“Using2030.aco-creation approach, HHS engaged traditional and nontraditional HIV stakeholders and people with HIV in eight EHE priority jurisdictions across the U.S. to develop ‘I Am a Work of ART.’”
The campaign features a diverse group of people with HIV who share personal stories about getting into care and using ART to achieve viral suppression. —Trent Straube
People Living With HIV Become Art
The “I Am a Work of ART” campaign promotes viral suppression.
poz.com OCTOBER/NOVEMBER 2022 POZ 7
most after them, involved a deceased HIV-positive donor.
—Trent Straube
“In addition, challenges with the quality of care persist, with poor uptake of testing, gaps in ART initiation, low retention rates and poor adherence to HIV treatment. The COVID-19 pandemic has thrown us further off track—between 2019 and 2021, ART coverage among pregnant and breastfeeding women declined in some countries.” —Trent Straube
Only half of
HIV are currently on
To address this issue, several international AIDS organizations have joined a new effort to provide HIV care and treatment for children. Specifically, they launched the Global Alliance for Ending AIDS in Children by Stakeholders2030.inthe alliance include the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization, UNICEF, the U.S. President’s Emergency Plan for AIDS Relief and other partners, according to a UNAIDS press release.
What’s more, the first phase of the alliance focuses on 12 countries that have joined the effort: Angola, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.
1. Closing the treatment gap for pregnant and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment;
Here’s a heartbreaking disparity in the AIDS response: Globally, only half (52%) of children living with HIV are on lifesaving meds, compared with 76% of adults. This means that nearly 1.2 million children and adolescents ages 0 to 19 have untreated HIV.
4. Addressing rights, gender equality and the social and structural barriers that hinder access to services.
The report explains the reasons a new and updated alliance is needed:
“At the global level, however, we are far from ending new HIV infections in children. There are HIV high-burden countries and settings where progress in preventing vertical transmission has flatlined.
The wait times for heart transplants are long—often more than half a year, reports Bronx Times—and the donor heart can’t be placed in cold storage for more than four to six Thehours.heart transplant recipient in Montefiore had been on a wait list “for quite a bit of time,” her cardiologist, Omar Saeed, MD, an assistant professor of medicine at Einstein College, tells Bronx Times. So to increase her chances of finding a donor, Saeed and the medical team brought up the possibility of receiving a transplant from another person with HIV.
According to UNAIDS, the alliance has identified four main pillars for collective action:
Doctors at a New York City hospital performed the world’s first successful heart transplant between an HIVpositive donor and an HIVpositive recipient, according to a press statement from Montefiore Health System in the Bronx, where the surgery took place last spring.
3. Making tests, optimized treatment and comprehensive care for infants, children and adolescents exposed to and living with HIV accessible; and
“There has been remarkable progress in some countries in providing antiretroviral therapy (ART) to pregnant women living with HIV. By the end of 2021, 12 countries in sub-Saharan Africa reached the target of 95% ART coverage in pregnant women; and Botswana was the first high prevalence African country to be validated as being on the path to eliminating vertical transmission of HIV.
Ending AIDS in Children by 2030 kids with treatment.
Thesetofromplantsnation’sBaltimoreHopkinsuntiltransplantillegal.HIV-positivetransplantsObamasignedpassedOrganatransplantonceneworganmilestonerelease.ofmedicineMontefioretransplantUlrichwithlivesthatcontrollivingmedical“Thanksrecovering.tosignificantadvances,peoplewithHIVareabletothediseasesowelltheycannowsavetheofotherpeoplelivingthiscondition,”saidP.Jorde,MD,aheartspecialistatandprofessorofatEinsteinCollegeMedicine,inthepress“Thissurgeryisainthehistoryofdonationandoffershopetopeoplewhohadnowheretoturn.”ThegroundbreakingtookplacenearlydecadeaftertheHIVPolicyEquityActwasbyCongressandbyPresidentBarackin2013.Beforethat,betweentwopeoplewereThefirstHIV-to-HIVdidn’ttakeplace2016,whenJohnsMedicalCenterinperformedthefirstorgantrans-(akidneyandliver)anHIV-positivedonorHIV-positiverecipients.twotransplants,like
In 2019, Nina Martinez, a 36-year-old Atlanta woman who had contracted HIV from a blood transfusion as a newborn, became the first living HIV-positive kidney donor.
The recipient, a woman in her 60s who had advanced heart failure, also received a simultaneous kidney transplant. The lifesaving operation took four hours. The recipient stayed in the hospital for five weeks while
“She was really completely fine with [that] and accepted the risks and benefits and signed consent,” Saeed says, adding: “This is a major accomplishment for us. But for me, I am in awe of her bravery, and I’m just amazed by her strength.”
Montefiore is one of 25 medical centers in the United States able to offer surgeries like this
“Thisone.was a complicated case and a true multidisciplinary effort by cardiology, surgery, intransplantsHowever,accordingbenefit100,000betweenaddscareinfectiousnephrology,disease,criticalandimmunology,”Saeed.IntheUnitedStates,60,000andpeoplecouldfromanewheart,toMontefiore.onlyaround3,800wereperformed2021.
2. Preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women;
The recipient was a woman in her 60s.
A HeartPositiveTransplant
15 Chiina November 11
The only time you lose is when you don’t try.
WAYLAND
confidence in speaking out. It made comfortableme to do so as well.
“THAT’S WHAT FRIENDS ARE FOR, ” by Dionne & Friends (Elton John, Gladys Knight and Stevie Wonder), is released as a single to benefit amfAR, The Foundation for AIDS Research. (1985)
Positively Living
STRATEGIES FOR SURVIVAL: A GAY MEN’S HEALTH MANUAL
27
California becomes the first state in the country to allow the use of MEDICAL MARIJUANA FOR THE TREATMENT OF HIV and other diseases. (1996)
What is your greatest achievement? Overcoming negative thoughts of the virus and picking myself back up and getting back into care.
1
What person in the HIV/AIDS community do you most admire? My boss, Cedric Sturdevant. I was inspired by his
What keeps you up at night? Lately, nothing. I have been at peace knowing I spend my days doing what God has purposed me to do.
sador for the Centers for Disease Control and Prevention’s “Let’s Stop HIV Together” campaign and a community health worker/project coordinator at Community Health Pier, an HIV-driven community-based organization located in Greenville, Mississippi.
What is your motto? “Positively living is the only way to live.”
returns home to tell his parents he has AIDS.
What is your greatest regret? Feeling as if my life was no longer worth living because I was HIV positive and making the decision to get out of care, which almost cost me my life.
Ventriloquist(2009)
THE EQUALITY TO END AIDS: HIV/AIDS RALLY AND VIGIL takes place at the Ellipse in front of the White House in Washington, DC. The event precedes the National Equality March for LGBT civil rights on Sunday, October 11.
October
Read other POZ Stories or share your own at poz.com/stories.
What is the best advice you ever received? The only time you lose is when you don’t try.
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What drives you to do what you do? My dad passed away from AIDS-related complications when I was 13 years old. And my diagnosis at age 18 makes the fire burn much higher.
NBC broadcasts the first major film about AIDS, AN EARLY FROST, starring Aidan Quinn as a closeted young lawyer who returns home to tell his parents he has AIDS. (1985)
FOR THE AGE OF AIDS by Martin Delaney and Peter Goldblum, PhD, MPH, with Joseph Brewer is released. (1987)
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FLOWERS, who created the character Madame, dies of AIDS-related causes at age 58. (1988) NATIONAL LATINX AIDS AWARENESS DAY
If you could be any animal, what would you be? And why? A lion, because it’s strong, resilient and fierce, like me!
My name is Devanta Tyler; however, my preferred name is Chiina. I was diagnosed with HIV at the sensitive age of 18, the start of my adulthood. I was in denial and created delusions in my head that I was negative.
EVERYDAY
A giant helium balloon honoring artist KEITH HARING makes its first appearance at the Macy’s Thanksgiving Day Parade. (2008)
These dates represent milestones in the HIV epidemic. Visit poz.com/aidsiseveryday to learn more about the history of HIV/AIDS. BY JENNIFER MORTON
UPDATES ON HIV & AIDS POZ PLANET TYLER;DEVANTAOFCOURTESY(TYLER) FANDOM.COM(HARING)WIKIMEDIA;(FLOWERS) 8 POZ OCTOBER/NOVEMBER 2022 poz.com
I ended up in the hospital with HIV-related pneumonia and kidney failure. I was placed on a ventilator for months and barely weighed 90 pounds. Yet I stand here today strong—no more dialysis—and my HIV is undetectable. I decided to live a life that could help someone like me. I am now an ambas-
dies of AIDS-related causes at age 58.
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About Prudence Mabele and the Consortium
BLOGS AND OPINIONS FROM POZ.COM VOICES ISTOCK poz.com OCTOBER/NOVEMBER 2022 POZ 11
The four organizations that make up the consortium are NAZ (a minority-led HIV U.K.-based agency dedicated to improving people’s sexual health), the International Association of Providers of AIDS Care (IAPAC, a global network of clinicians and allied health professionals working to end the HIV pandemic), the Global HIV Collaborative and the Fast-Track Cities Institute.
If we are to have any hope of ending HIV and crossing the finishing line together, we must join forces, voice by voice, to end HIV stigma.”
NAZ has over 30 years of grassroots experience delivering HIV care and support and evidenced-based sexual health programs to Black, brown and other minority
N COMMEMORATION OF THE birthday of the late South African AIDS activist Prudence Mabele (1971–2017), a consortium of community, medical and urban health organizations has designated July 21 as #ZeroHIVStigmaDay, a new international awareness day meant to call attention to the persistent levels of stigma experienced by people living with and affected by HIV.
Prudence Mabele was the first Black South African woman to publicly share her HIV status. She was diagnosed with HIV in 1990 and went public with her status in 1992. She founded South Africa’s Positive Women’s Network in 1996. She died in 2017.
In an opinion piece titled New International Awareness Day Aims to End HIV Stigma,” four organizations announced the launch of this initiative. Below is an edited excerpt.
realizing the human right to dignity, health and well-being for everyone everywhere.”
BendpalitiescreatedoutcomesthepartnershiptiseliminateHIValscliniciansIAPACRepresentingcommunities.30,000members,isthelargestassociationofandalliedhealthprofession-workingtoendtheepidemicsofandtuberculosis(TB)aswellashepatitisBvirusandhepati-Cvirusby2030.TheGlobalHIVCollaborativeisathatstrivestoimprovecurrentglobaltrajectoryofHIVforBlackcommunities.TheFast-TrackCitiesInstitutewastosupportcitiesandmunici-worldwideintheireffortstotheepidemicsofHIV,TB,hepatitisandhepatitisC.
ZERO STIGMA
I
“In this fifth decade of the global HIV pandemic, stigma continues to undermine progress and, in combination with fear and shame, is still driving late diagnosis of HIV in a way that is unacceptable and entirely preventable,” says Parminder Sekhon, CEO of NAZ.
“Building on the legacy of Prudence Mabele, a fearless and irrepressible activist, we pledge to work toward a collective day of action in her name. We have 365 days to work together to shape a seminal day of global action.
A recent IAPAC survey across 50 cities and municipalities worldwide found that HIV stigma remains a serious concern for 91% of respondents. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), people living with HIV who perceive high levels of HIV stigma are 2.4 times more likely to delay enrollment in care until they are very ill, which leads to premature death and negates the prevention benefit of successful HIV“HIVtreatment.stigmais jeopardizing our ability to end AIDS as a public health threat by 2030. By eliminating HIV stigma, we can dismantle the barriers people living with and affected by HIV confront when accessing testing, prevention and treatment services. But we must also root out inequities and inequalities exacerbated by the ‘otherness’ ascribed to communities affected by HIV,” says José M. Zuniga, PhD, MPH, president and CEO of IAPAC and the Fast-Track Cities Institute. “Zero HIV Stigma Day, and its full year of affiliated actions, represents a concerted global effort to harness our collective power toward the aim of
■
“#ZeroHIVStigmaDay:
“I come here with a group of young people living with HIV,” Whitbread says, “and they’re overwhelmed. I bring them here to the lounge, and they relax or they cry. And I tell them, ‘These are your people, in this space. If you need to shut off the conference, you can do it Whitbreadhere.’”emphasizes that AIDS
POSITIVE LOUNGE
KINGS.MARK
BLOGS AND OPINIONS FROM POZ.COM VOICES
2022 isn’t immune to stigma. People living with HIV can still be treated here like second class, or patients in need of fixing, or simply viewed differently.
“This is supposed to be a reprieve from the information overload of the conference,” Arseneault explains, even if it isn’t what he initially envisioned. His activist educator hat was hard to remove. He had originally wanted a more dynamic space that educated people with HIV about issues and injustices they care about. He was convinced to do otherwise.
But that was then. Strolling through the AIDS 2022 Positive Lounge, I was having a tough time putting a finger on why the effort left me with mixed feelings. Was I in any way deficient or, more to the point, worthy of such treatment?
Will a leather sofa and a quiet space help with that? It couldn’t hurt. ■
Enter Jessica Whitbread, whom Arseneault waves over to our conversation. Whitbread, among many other significant accomplishments as a woman living with HIV, worked on the Positive Lounge for the last conference.
health. The corporate-luxe feel of the main lounge area isn’t what Arseneault had in mind, but the project has been a learning process for him.
T
“Imagine you are from the Global South,” Arseneault says about his change of heart, “and you come here to the lounge and I, as a white Canadian, have thoughtfully curated a poster exhibition about sub-Saharan Africa— it could go wrong really easily.”
Everything, from the elegant catering service to the modernist leather furniture (“It’s giving me a Brian Eno Music for Airports vibe,” Arseneault quips), comes courtesy of the conference host, the International AIDS Society (IAS), and Gilead Sciences, which foots the bill.
12 POZ OCTOBER/NOVEMBER 2022 poz.com
HE SERVER IS DRESSED IN A black bolero jacket, the kind of thing waiters in a fine restaurant might wear, and he is carrying a tray of juices to restock the food table. Clearly, he is conscientious about his work, because the table is a pristine assortment of baked goods, coffee service and other refreshments. The server returns to a catering area behind a black curtain for more supplies.
The lounge was created by a team that included Jordan Arseneault, a Montreal man living with HIV who is the cofounder of the SéroSyndicat, a collective focused on HIV justice and
In a post titled “Who Needs a Positive Lounge at AIDS 2022, Anyway?” POZ blogger Mark S. King explores this feature of the 2022 International AIDS Conference in Montreal. Below is an edited excerpt.
In the earliest years of the AIDS crisis, organizations in large epicenter cities did everything they could to make life, and looming death, as comfortable as possible. The list
This is the Positive Lounge at the International AIDS Conference (AIDS 2022), made available for attendees who are living with HIV. Walking into the lounge is an implicit disclosure of one’s HIV status.
included massages and complimentary dinners and chiropractic sessions and a whole lot of metaphysical healing, because why the hell not? I could have subsisted during those years—and maybe I did—on nothing but free pharma dinners and rides to support groups.
There is a white leather seating area in the center of the main lounge, beyond which are quiet spaces, mats for occasional yoga sessions and a curtained area with massage tables at the ready. Because the lounge is located on the highest level of the Palais des congrès de Montréal, there is a rooftop deck just outside featuring stunning views of the city. The entire operation is staffed by cheerful volunteers who speak in low, comforting voices.
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PRIDE MONTH
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Whether it was to raise awareness, raise hell or raise funds, LGBTQ people showed up for Pride Month in full force this year—in the streets, on sidewalks and onstage—proving that where there is community, there is power.
14 POZ OCTOBER/NOVEMBER 2022 poz.com BY JOE MEJÍA SPOTLIGHT CENTER/TESTINGGMHC(2)WORKS/INSTAGRAM;HOUSING(1) PLACE/INSTAGRAM;CHRISTIE’S(3)INSTAGRAM; DISTRICT/TWITTERHEALTHCOUNTYGALVESTON(4)
1. At New York City’s Queer Liberation March on June 26, Housing Works protested the Supreme Court’s overruling of Roe v. Wade, which triggered laws banning abortion in 13 states. 2. In observance of National HIV Testing Day (NHTD), June 27, the GMHC testing team did what it does best offsite at a Walgreens store. The pharmacy chain partnered with Greater Than AIDS to offer free testing nationwide. 3. San Diego’s Christie’s Place, which serves women, children and families affected by HIV, set up shop outside the Malcom X Library to let folks know that HIV testing equals self-care.
June, aka Pride Month, most notably marks an occasion to honor the pioneers who kicked off the 1969 Stonewall riots that ushered in an era of LGBTQ liberation. But Pride Month also serves as an opportunity for queer people to raise their voices regarding numerous intersecting issues, including health care, HIV and, this year, thanks to the Supreme Court’s June 24 overturning of Roe v. Wade, the right of pregnant people to have an abortion.
4. The Galveston County Health District promoted the healthy concept of HIV testing with its mobile health site and welcoming smiles.
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poz.com OCTOBER/NOVEMBER 2022 POZ 15
5. The opening number of Broadway Bares XXX, featured (left to right) performers Jason Tam, Timothy Hughes and Bonnie Milligan. After a three-year hiatus due to COVID-19, the 30th iteration of the modern-day burlesque revue featuring Broadway’s brightest stars took place live and in person on June 26 at New York City’s Hammerstein Ballroom. The benefit, whose theme this year was “Community, Unity and Nudity,” raised a record $1.89 million for Broadway Cares/Equity Fights AIDS (BC/EFA). Founded in 1988, BC/EFA has raised over $300 million over the years for HIV and AIDS organization’s and is the biggest financial supporter of the social services programs of The Actors Fund. 6. Maulik Pancholy, best known for his role on TV’s 30 Rock, made his Broadway debut alongside Bares veteran and recent Oscar winner (for West Side Story) Ariana DeBose at the BC/EFA benefit. 7. Broadway Bares creator and producer Jerry Mitchell is on hand to very happily accept a $200,000 donation to BC/EFA from the MAC Viva Glam Fund, a longtime supporter of HIV and AIDS causes.
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.OFCOURTESY(5,6) XXXBARESBROADWAY TICHLER;/JONATHAN BOFCOURTESY(7) XXXBARESROADWAY ZIMMERMAN/EVAN
6
SERVINGS: 2 / INGREDIENTS: 11
Federal guidelines recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous activity per week as well as strength training activities at least two days per week.
It is better to spread this activity over multiple ofexample,days—forahalfhourmoderateexercise five days a week—rather than doing it all at once.
1 tablespoon olive oil
BLACK BEAN & SAUTÉED VEGGIE TACOS
can add more activity to your day by taking the stairs instead of the elevator or parking farther away from your destination and walking part of the way.
These tacos have a fabulous shock of color.
½ tablespoon salt
½ onion, diced
3 limes, juiced
CHEF TIPS
Calories: 437; fat: 11 g; saturated fat: 3 g; polyunsaturated fat: 2 g; monounsaturated fat: 6 g; carbohydrates: 68 g; sugar: 10 g; fiber: 21 g; protein: 20 g; sodium: 1,233 mg
NUTRITION FACTS (per serving)
1 zucchini, diced
©2022 Fred Hutchinson Cancer Research Center, a 501(c)(3) nonprofit organization. Used by permission.
1 (14 oz.) can of black beans, drained and rinsed
HOW EXERCISE?SHOULDOFTENI
1 teaspoon salt
WHEN IN DOUBT, MAKE TACOS. It’s a mantra that home cooks everywhere have successfully applied to turn pretty good meals and leftovers into something a little more special. These tacos have a shock of color thanks to a fabulous assortment of veggies, but they’re also the total package in terms of immune-boosting phytonutrients, fiber and plant-based protein. And to go off book for a moment, we also think these would be delicious for breakfast topped with a beautifully fried egg!
1 tablespoon lime juice
INGREDIENTS
¼ cup plain Greek yogurt
3. Wrap the tortillas in a clean, slightly damp kitchen towel, and heat in the microwave for 20 seconds.
4 cups green cabbage, thinly sliced
2. Mix the yogurt, lime juice and salt in a small bowl until incorporated. Taste and adjust the seasoning if needed.
4 corn tortillas
If exercising is difficult due to physical limitations, even a small amount of activity is better than none.
GARCIALIFE/GINOYOURFORCOOKOFCOURTESY(TACOS)ISTOCK;BOARDS)(WHITE 16 POZ OCTOBER/NOVEMBER 2022 poz.com ADVICE ON DIET AND EXERCISE NUTRITION & FITNESS
1 bell pepper (yellow, orange or red), diced
4. Divide the tortillas, and evenly distribute the yogurt mixture. Spoon the cooked vegetables onto warmed tortillas, and garnish with the Mexican cabbage salad and hot sauce—if you’re using it.
1 cup Mexican cabbage salad hot sauce of your choice (optional)
FOR THE MEXICAN CABBAGE SALAD
DIRECTIONS
1. Warm the olive oil in a medium saucepan over medium-high heat. Add the diced zucchini, bell pepper and onion to the pan with a pinch of salt and pepper. Sauté until the onion becomes translucent and the zucchini and bell pepper start to brown around the edges. Turn off the heat, stir in the black beans and set aside.
The cooked vegetable mixture can be stored in an airtight container or freezer bag and frozen for up to several months. Simply thaw and reheat when you want to whip up a plate of these tacos.
The inggoal,overallaccord-totheCenters for Disease Control and Prevention, is to move more and sit less throughout the day. People who do any amount of moderate to vigorous physical activity gain health benefits.You
This is an excerpt from the “HIV and Exercise” Basics page on POZ.com.
1 carrot, shaved with a vegetable peeler
HIV AND HEART HEALTH
People with HIV are at greater risk for a variety of cardiovascular problems.
CVD is one of the most complex areas of HIV medicine, and countless studies have looked at associations between HIV and cardiovascular outcomes. HIV and its treatment have been linked to conditions including coronary and peripheral
H
The reasons for higher rates of heart problems among people living with HIV are not fully understood. HIV itself can cause chronic inflammation even in people on effective antiretroviral therapy. Specific antiretroviral medications have been either directly linked to heart problems or shown to contribute to metabolic problems—such as high blood sugar, elevated blood lipids and weight gain—that increase CVD risk. However, research clearly shows that promptly starting and staying on antiretroviral therapy leads to better outcomes than delaying
artery disease, arrhythmia, heart failure, heart attack and stroke, but findings are not consistent across studies. One recent analysis found that people with HIV had a 60% greater risk for heart attack than HIV-negative people, and the difference appeared to widen over time. Early data from the REPRIEVE trial, a large study evaluating whether a statin medication can prevent heart disease in people with HIV, found that HIV-positive people develop more cardiovascular problems at a younger age than their HIV-negative peers.
The good news is that you can take steps to reduce your risk for heart disease. Perhaps the most important is smoking cessation. Studies of HIV-negative people have shown that CVD risk starts to drop soon after quitting and reaches the level of nonsmokers in 10 to 15 years. Quitting is easier said than done, but experts have developed effective interventions for people with HIV.
What’streatment.more,people with HIV have higher rates of traditional CVD risk factors, such as smoking, diabetes and high blood pressure (hypertension). Male sex, Black race and family history also play a role. But studies have shown that scoring systems designed to predict
Eating a well-balanced diet, maintaining a healthy weight and exercising can also reduce CVD risk. A healthy diet includes plenty of vegetables, fruits and whole grains and is low in processed foods, added sugar and sodium (which can raise blood pressure). Try to move more and sit less. Experts recommend 150 minutes of moderate-intensity physical activity per week. Getting enough sleep and reducing stress also contribute to good heart health.
ISTOCK poz.com OCTOBER/NOVEMBER 2022 POZ 17 BY LIZ HIGHLEYMAN BASICS
cardiovascular risk in the general population can underestimate the risk for people living with HIV.
Regular checkups, including monitoring blood pressure, blood sugar and cholesterol and triglyceride levels, can detect heart problems at an early stage, when they’re easier to treat. In some cases, medications—such as drugs to control blood pressure and statins to lower cholesterol—may be beneficial. Ask your doctor for advice about lifestyle changes and treatments that can help keep your heart healthy. ■
EART DISEASE IS THE LEADING cause of death for men and women in the United States. As people with HIV live longer thanks to effective treatment, they are more likely to develop age-related conditions, including cardiovascular disease (CVD). The large—and sometimes conflicting— body of research on CVD in HIV-positive people can be confusing, but you can take steps, like exercising and quitting smoking, to minimize your risk.
Cardiovascular disease is a general term for conditions that affect the heart and blood vessels. The most common is atherosclerosis (sometimes called “hardening of arteries”), which occurs when deposits of cholesterol and other material build up on blood vessel walls and impede the flow of blood. Coronary artery disease, or blockage of the arteries that supply the heart muscle, can lead to chest pain (angina) and heart attack (myocardial infarction). Bits of plaque or blood clots can block blood vessels in the brain, causing a stroke. Other heart problems include congestive heart failure (when the heart can’t pump enough blood), irregular heartbeat (arrhythmia) and heart valve disease.
BY SHANE BURKE CARE & TREATMENT BAKKER;NDREAMSTIME.COM/VIALS)(MONKEYPOX ONLY)PURPOSESILLUSTRATIVEFORUSED(MODELSISTOCKOTHERS:ALL
Another group led by Maxime Inghels, PhD, MPH, of the University of Lincoln’s International Institute for Rural Health, used drones to deliver blood samples for HIV testing of newborn babies in Conakry, the capital of Guinea, where extreme traffic can lead to delivery delays and ruined blood samples. Faster testing leads to more infants with HIV getting treatment in a timely fashion, thereby saving lives. The researchers estimated that drone delivery could add 24 years to life expectancy compared with motorcycle delivery.
PrEP DISPARITIES ARE WORSENING
Could drones play a role in getting HIV care to people in hard-to-reach areas? Some experts think so. At the 24th International AIDS Conference, two teams presented research testing drone technology in Africa. This approach might also help provide care for rural and Indigenous communities in the United States.
Trial drone deliveries of medications for conditions other than HIV have taken place across the United States and Canada. These include efforts by pharmacy start-ups, such as Zipline and Wing, a sister company of Google. If successful, drones could potentially help Native Americans and Alaska Natives living with HIV access care and improve their health outcomes.
HIVHelpDronesCouldProvideCare?
Using commercial pharmacy data, Patrick Sullivan, DVM, PhD, of Emory University’s Rollins School of Public Health, and colleagues identified nearly 125,000 people who were prescribed PrEP between 2012 and 2021. The researchers estimated equity using a metric called the PrEP-to-need ratio, calculated by dividing the number of PrEP users by the number of new HIV diagnoses in a population group. This ratio is a more meaningful way to look at PrEP uptake relative to need than absolute numbers, according to Sullivan.
While PrEP uptake rose steeply among white Americans relative to their number of new HIV diagnoses, prescriptions for Black and Latino people aren’t meeting the need. White people made up 65% of PrEP users in 2021 but accounted for just 26% of new HIV diagnoses in 2020. In contrast, Black people made up 14% of PrEP users despite having 42% of new diagnoses, while Latino people made up 17% of PrEP users and 27% of new diagnoses.
Only 8% of PrEP users were women, who account for 18% of new HIV diagnoses. People in the South are also less likely to use PrEP— a cause for alarm, as the region has become the epicenter of the American HIV epidemic. In each region, a higher proportion of white people used PrEP relative to need. Disparities in PrEP use have widened in all regions since its approval in 2012, but states that introduced PrEP assistance programs and expanded their Medicaid programs have seen more equitable rollouts.
“Prevention programs should be guided by PrEP equity metrics that take into account both use and need, not by PrEP equality metrics looking to get certain levels of coverage in all groups,” Sullivan says.
18 POZ OCTOBER/NOVEMBER 2022 poz.com
In Uganda, researchers found that it was feasible to use drones to deliver antiretroviral treatment to people with HIV in the remote Kalangala District, a collection of dozens of islands scattered across Lake Victoria. The area has the highest HIV prevalence in the country, at 27%, but half of HIV-positive people miss out on care, in part because of the difficulty of delivery and nomadic fisherRosalindlifestyles.Parkes-Ratanshi, MD, PhD, of the Academy for Health Innovation in Kampala, and colleagues developed five drone routes to deliver medication to 17 community groups, serving a total of 99 people. The drones are a lot faster, taking nine minutes for a delivery versus 35 minutes by boat.
Pre-exposure prophylaxis (PrEP) is not benefiting all Americans equally, and the disparities are growing over time, according to new data presented at the 24th International AIDS Conference (available via interactive maps at AIDSVu.org).
poz.com OCTOBER/NOVEMBER 2022 POZ 19 BY LIZ HIGHLEYMAN CARE & TREATMENT
A large proportion of people with monkeypox are living with HIV, according to recent reports. While anyone can get monkeypox through close physical contact, cases remain overwhelmingly concentrated among men who have sex with men.
AdherenceMayInjectablesLong-ActingHelpWith
A majority (24 people) had viral suppression on their current oral medications; all of them maintained an undetectable viral load after switching to the injections. But the big news is that outcomes were also good for the 15 people who started with a detectable viral load and substantial immune suppression: 12 (80%) achieved and maintained viral suppression, some of them for the first time.
People with HIV who contract monkeypox should continue their antiretroviral therapy, and those newly diagnosed with HIV and monkeypox at the same time should start as soon as possible. HIV-positive people and those on PrEP can take the antiviral medication TPOXX (tecovirimat) to treat monkeypox along with their antiretrovirals, according to recent CDC guidance.
Katerina Christopoulos, MD, MPH, and colleagues evaluated outcomes among 39 people who started Cabenuva at San Francisco’s Ward 86 HIV clinic. This safety-net clinic serves low-income people with HIV, many of whom struggle with substance use, mental illness and homelessness. It offers a range of support, including case managers and streetbased nursing services.
The two-dose Jynneos monkeypox vaccine is safe for people with HIV, but the older ACAM2000 smallpox vaccine should not be used by people with a weakened immune system. In an effort to stretch the limited Jynneos supply, some jurisdictions are using a one-dose strategy or intradermal administration, which splits a single vial into five doses. While the vaccine provides good protection for people with HIV, experts advise that HIV-positive people— especially those with a lower CD4 count—should be prioritized to receive the optimal number of doses using the most effective administration method.
Use of Cabenuva for people without viral suppression goes beyond the approved indication, and it might not be an option for those who don’t have access to such intensive support. But for some, it could offer a lifeline.
“Up to this point, our options for people who won’t take oral antiretroviral therapy have been highly limited,” says Paul Sax, MD, of Brigham and Women’s Hospital in Boston. “The alternative to trying this might be an HIV-related death. And no one in 2022 should die of AIDS without our doing everything we possibly can to get them on
The good news is that people with well-controlled HIV do not appear to have worse monkeypox outcomes. But this may not be true for those with untreated HIV and a low CD4 count. Prior reports from Nigeria showed that people with HIV had more severe illness and higher mortality.
Long-acting Cabenuva (injectable cabotegravir and rilpivirine), which is administered by a health care provider once monthly or every other month, is currently approved for people whose HIV is already under control, but it may also be an option for those who have been unable to achieve viral suppression because of adherence challenges.
HIV AND MONKEYPOX
The World Health Organization and the Centers for Disease Control and Prevention (CDC) both found that 41% of people with monkeypox are HIV positive. The rate is a bit lower in the United Kingdom, at 26%, but in the state of Georgia, 67% of cases are among people living with HIV. Among HIV-negative men with monkeypox, a majority are taking pre-exposure prophylaxis (PrEP).
“Although data are limited for monkeypox in patients with HIV, prompt diagnosis, treatment and prevention might reduce the risk for adverse outcomes and limit monkeypox spread,” the guidance states.
TREATMENT
Hep C Treatment
Taking the antibiotic doxycycline after sex can lower the risk of sexually transmitted infections (STIs), according to a recent study. Pre-ex posure prophylaxis (PrEP) dramatically cuts HIV acquisition, but forgoing condoms leaves people prone to other STIs. The DoxyPEP trial recruited more than 500 men and transgender women who have sex with men in San Francisco and Seattle. They were randomly assigned to get either a single dose of oral doxycycline as postexposure prophylaxis (PEP) within 72 hours after condomless sex or standard care (regular testing and treatment after diagnosis). The study was halted a year early after an interim analysis showed that doxycycline PEP significantly reduced STI incidence. Among participants living with HIV, doxycycline reduced the likelihood of being diagnosed with gonorrhea, chlamydia or syphilis by 62%. Among HIV-negative people on PrEP, the risk reduction was 66%. Adherence was high (87%), and doxycycline PEP was safe and well tolerated. Further analysis is underway to see whether this approach promotes drug resistance.
Doxy PEP
Another Cure?
CURE
PREVENTION
Adherence Risks
Hepatitis C can easily be cured with direct-acting antiviral therapy, but most people are not getting the treatment they need, according to a new report from the Centers for Disease Control and Prevention. More than 2 million adults in the United States have hepatitis C virus (HCV), and many people living with HIV also have HCV. Left untreated, hepatitis C can lead to cirrhosis, liver cancer and the need for a liver transplant. Researchers analyzed administrative claims data for 47,687 adults diagnosed with hepatitis C between January 2019 and October 2020 who had some type of continuous insurance coverage. Just 35% of people with private insurance started hepatitis C treatment within 12 months after diagnosis, while only 28% of those covered by Medicare and 23% of those covered by Medicaid did so. The likelihood of receiving treatment was lower in states with restrictions, such as only treating people with severe liver fibrosis or requiring abstinence from drugs and alcohol. This study did not include people without any insurance coverage, a group that likely has even less access to treatment.
Loneliness and depression can lead to lower adherence to antiretroviral treatment, according to recent research. One study, which included nearly 2,000 people living with HIV in Canada, found that those who reported frequent loneliness were more likely to miss medication doses. Almost half said they felt moderately to extremely lonely over the course of follow-up, which included the first year of the COVID-19 pandemic. Women, younger people, those with lower incomes and single, widowed or divorced people were more likely to experience loneliness. The second study evaluated treatment adherence among 557 HIV positive men who have sex with men in Taiwan, 14% of whom experienced depression. Men with depression reported worse overall quality of life and were more than twice as likely to say they didn’t always take their antiretrovirals consistently. But among those taking antidepressants, there was no significant difference in adherence. Ongoing research is looking at strategies to improve social connections and combat depression.
A 66-year-old Southern California man appears to be the fifth person cured of HIV after undergoing a stem cell transplant to treat cancer. Like Timothy Ray Brown (the Berlin Patient), the man, dubbed the City of Hope Patient, received stem cells from a donor with a rare genetic mutation, called CCR5-delta32, that blocks HIV from entering T cells. Compared with the other people previously cured using this approach, this man is older, has been living with HIV longer (since 1988) and received less harsh chemotherapy. After the transplant in 2019, he stayed on antiretroviral therapy for two years with an undetectable viral load before trying a carefully monitored treatment interruption. At the time of the report at the International AIDS Conference in July, he had been free of HIV for more than 17 months after stopping antiretrovirals. Experts caution that the risky transplant procedure is not an option for most people with HIV, but this case could provide clues to help researchers develop more widely applicable strategies for long-term HIV remission.
CONCERNS
BY LIZ HIGHLEYMAN RESEARCH NOTES ONLY)PURPOSESILLUSTRATIVEFORUSED(MODELSISTOCKIMAGES:ALL 20 POZ OCTOBER/NOVEMBER 2022 poz.com
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BY CHARLES SANCHEZ
22 POZ OCTOBER/NOVEMBER 2022 poz.com
CAREYKAT LATINOS ARE FACING CHALLENGES AND BARRIERS SUCH AS LANGUAGE, IMMIGRATION STATUS AND DISCRIMINATION.
“LET ME JUST TELL YOU ABOUT MY FIRST CLIENT,” says Jean Hernandez, “because she exemplifies all the barriers.” Hernandez, originally from Puerto Rico, is the dynamic and bubbly program coordinator for the Alabama Latino AIDS Coalition at AIDS Alabama in Birmingham, where she’s been working since 2011. She’s discussing obstacles that Latinos in the South face when it comes to HIV.
Elias Diaz lives with HIV in Eagle Pass, Texas.
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Hernandez told the nurse that she was going to translate, and the nurse sternly asked the client how long she had been in the United States. Hernandez took a breath, translated the question to her client and told the answer to the nurse: Her client had been living here for six years. The nurse snidely remarked, “She’s been living here for six years and still hasn’t learned to speak English?” “In another space and time,” Hernandez says, “I would’ve lost it and kicked her! But,” she laughs, “I had to maintain my cool for the client.” Barrier: discrimination.
Now, in 2022, Hernandez’s client is in need of a kidney transplant. Since her client is undocumented, she cannot be on the transplant list. Hernandez met a doctor who talked about how people living with HIV can be organ donors to other people living with HIV. “I got so excited! But because of where we are, we have to be careful; we have to be silent,” Hernandez explains. The doctor informed Hernandez that her client would have to find her own donor once they started doing the paperwork. Because the client is undocumented and uninsured, she will not be able to get the surgery.
HIV, particularly in the Southern United States. As defined by the U.S. Census Bureau, the South includes Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia.
Hernandez took over as translator for her client at medical appointments. (In fact, 11 years later, with 60 clients—almost 200 when you include the families, as the coalition does— the majority of Hernandez and her team’s time is spent translating for Hernandez’sclients.)clientalso had financial worries since her late partner had been the primary breadwinner. Because her neighbor knew the client’s HIV status, she now could no longer work as a babysitter. Barrier: financial stability.
Even though the client receives Ryan White Program benefits and gets help from the AIDS Drug Assistance Program, she doesn’t have the health insurance to cover the procedure, hospital stay and recovery. Not only that, but the donor, too, must have insurance to cover their side of the tests and procedures. “We’ve been dealing with that, and my client is getting sicker. A transplant is sometimes more than half a million dollars.” Barriers: immigration status and health insurance.
HERNANDEZ’S STORY ABOUT HER FIRST CLIENT illustrates just some of the barriers that Latinos face regarding
PasscofounderisofEagleSAFE,anLGBTQnonprofit.
Hernandez’s client also had diabetes, and by 2014, her kidney function was deteriorating. “She began to feel very ill, so I went with her to the emergency room,” she says. “I was doing all the translation, and then we finally get to the nurse.”
Elias Diaz
Latinos make up about 16% of the U.S. population. The Centers for Disease Control and Prevention (CDC) estimates that of the 34,800 new HIV cases in the United States in 2019, 29% were among Latinos. Of these, male-to-male sexual contact accounted for most new cases; indeed, 85% of new
“First,” she says, “my client’s partner was lost to AIDS, and she didn’t know her status. This was 2011, almost 2012. She went to the clinic for testing, and they told her to bring somebody with her to talk Spanish.” Hernandez’s client was an immigrant working as a babysitter in her community and took her neighbor to translate.
It was the neighbor who was first told about the client’s HIV-positive status. “She told me, ‘If I’d known they were going to tell me something like that, I never would have brought my neighbor!’” Two barriers: language and confidentiality.
CAREYKAT
Roughly 55% of all the new HIV cases in the nation were in the South, and almost a quarter of those were Latinos. (Due
poz.com OCTOBER/NOVEMBER 2022 POZ 25
Elias Diaz knows all about the challenges facing Latinos with HIV. Diaz is a Mexican-American man living with HIV in the border town of Eagle Pass, Texas. “It’s literally in the middle of nowhere,” he says. A native of Eagle Pass, Diaz is
“THE FACT THAT WE CAN’T TALK ABOUT SEX AFFECTS EVERYTHING.”
to the impact of COVID-19 on HIV testing, services and case surveillance, more recent data are not currently available.)
male cases were among cisgender men who have sex with men. For cisgender women, 87% of new HIV cases were from heterosexual contact. (Transgender and nonbinary people were not specifically included in the statistics.)
“I am a trans Latina,” Lint says. “I am from the South. I am living with HIV. The stigma is so big, so strong in this
HernandezJeanfightsHIVatAIDSAlabama.
26 POZ OCTOBER/NOVEMBER 2022 poz.com HERNANDEZJEANOFCOURTESY
“One of the biggest cultural considerations with regard to HIV is that the Hispanic culture is so family-focused, for better or for worse,” Diaz says. “We can’t move forward without our family. We see that in the way we internalize homophobia. We see that in the way we deal with each other as gay men.” He says that one reason many Latino men who have sex with men are resistant to taking pre-exposure prophylaxis (PrEP) is the possibility of family rejection. “Many believe the family would not be OK with that, just like they’re not OK with contraception.”“TheHispanic culture is very centered on machismo, very centered on the manly man,” he says. “Many believe that being a man is a God-given gift, so why would you slap your family in the face by being openly gay?” Moreover, Diaz says conservative religion is important in many Latino households and can stifle a person’s authenticity. “Many Hispanics are Roman Catholic. I grew up in a Pentecostal home. Many people use [religion] as a crutch, an excuse to be able to disapprove of others.”
Adding to the religious aspects is the taboo of sex. “The fact that we can’t talk about sex affects everything from teen pregnancy rates to new HIV infections. This lack of conversation leads to tangible results and health outcomes,” Diaz says. “Our silence can be deadly.” Barriers: family, religion, communication.
the cofounder of Eagle Pass SAFE (Sexual Advocacy for Everyone), an LGBTQ nonprofit serving the rural communities of South Texas. He’s also a compliance officer and mental health clinician for Maverick County Hospital District and a member of the Eagle Pass City Council.
ARIANNA LINT, A PASSIONATE TRANSGENDER educator and advocate originally from Peru, now lives in Miami, where she runs Arianna’s Center. The center serves trans Latinas and anyone in the trans community who is especially vulnerable. For Lint, the biggest challenge for trans people when it comes to HIV is stigma.
area, in South Florida. Thank God, things have gotten a little better. We have trans people being more open about their HIV status and PrEP and everything.”
Another challenge that she sees is the lack of representation. “People know we exist,” Lint says, “but we’re not at the table. We’re not in the conversations.” She talked about this with U.S. Assistant Secretary of Health Rachel Levine, MD, the highest-ranking trans person in the
er, commented on how Latinos who are marginalized because of language, immigration status, financial insecurity or a combination of factors are especially vulnerable and can become overwhelmed when dealing with the health care“Assystem.Latinos in this nation, we already realize that there’s a racial struggle. When you go down South, it’s even more intensified,” Claudio says. “Those who are Latino and have an intersection with identity, whether it’s gay, bisexual, lesbian or trans, have to keep in mind that we are in the South. And so not only are you having to deal with the lack of Spanish speakers, the lack of Hispanic and Latino representation, but then also in the few spaces that we do have, it’s not always affirming and welcoming forLatinosindividuals.”inthe South conducts research into what both Latinos and LGBTQ people need. “We’re trying to hear what’s happening,” Carcaño says. “How are you impacted? What are your experiences navigating care? How about PrEP? Are you receiving HIV care and testing across the board?” Last year, LCOA completed a mental health substance use assessment for Latinos in the South.
“And that gives me hope,” Hernandez says, “because we’re heading in the right direction. We’re saying, ‘We’re here.’” ■
TO ADDRESS THESE ISSUES, BARRIERS AND more, in 2007, the Latino Commission on AIDS (LCOA) launched the strategic program initiative Latinos in the Deep South. The program began with seven states: North Carolina (where the program is based), South Carolina, Alabama, Georgia, Tennessee, Louisiana and Mississippi. In 2019, the program changed its name to Latinos in the South and added Texas and Florida to the ranks.
Lint also pointed out that many programs aren’t tailored fortheSouth.“Programs from the West, like from Los Angeles or San Francisco, they’re good. But working in California is so different from working in the South.” She mentions that in states like California or New York, the government has programs and funding set up to support trans service organizations and trans people. “The politics, the demographics, all these things are so different in the South,” she says. “In Florida, they want transgender people to disappear.”
Joaquin Carcaño, director of LCOA’s Southern health policy, gave an overview of the work that Latinos in the South is doing. “We do capacity building, working with organizations, health departments and other health providers to engage our community,” he says. A component of that is providing language justice work and training the providers and community members themselves. “Language justice is everything from Spanish to English,” he says, “but also gender-affirming language, first-person language, really just supportive, nurturing language across the board.”
federal government, on the doctor’s recent visit to South Florida. “We talked about immigration status barriers, access to health care, language barriers.” She went on: “If we don’t talk about this to the people who have the power, who are at the tables, we will always be behind.”
“We also do leadership institutes around advocacy,” Carcaño continues. “We did a leadership institute around language justice, specifically working with both people who are working in HIV but also interpreters who are looking to jump into HIV and other sexual health work.” The program is also deepening the advocacy and policy work that is part of its mission, specifically HIV decriminalization, immigracommunitiesheenvironment,they’reexpansion.billstion,issuesrelatedtotheLGBTQcommunity,theanti-LGBTQbeingproposedthroughouttheSouthandMedicaid“ThesearespecificthingshappeningintheSouthwherehittingthecommunitiesharderbecauseofthepoliticalthelackofcommunityorcommunitysupport,”says.“We’rereallythinkingholisticallyabouthowourareimpacted.”JessieClaudio,theprogram’scommunity-buildingmanag-
Diaz says there have been major changes to the landscape of the small rural town of Eagle Pass. “Last year, we flew the Pride flag over city hall for the first time. I’m hoping that the Eagle Pass that I grew up in doesn’t exist anymore,” he says. The nonprofit organization he runs, Eagle Pass SAFE, is literally a safe place for people in the LGBTQ and HIV communities to find family. “They’ve started a Del Rio chapter, and they’re about to start one in Temple, Texas,” he says. “Rural towns all across Texas are noticing the work that we’re doing and the validity in the work and wanting to create their own SAFE
“THAT GIVES ME HOPE, BECAUSE WE’RE HEADING IN THE DIRECTION.”RIGHT
THE HURDLES AND barriers Latinos living in the South face are many, but advocates across the Southern states are meeting these challenges headon. Not only that, but they do it with compassion.
poz.com OCTOBER/NOVEMBER 2022 POZ 27
Hernandezchapters.”talks about another client of hers who volunteered and interned as part of her team at the Alabama Latino AIDS Coalition: “I just found out about this from him. Years ago, I had put the Latino AIDS Coalition page up [on Facebook], and he saw it, and that’s why he decided to move from Mexico to Alabama.” He had seen that there was an HIV program for Latinos in Alabama and knew he’d have family there. And when he got his citizenship, the first thing he did was go see Hernandez. He asked her, “Help me fill out the application to vote.”
BY ALICIA GREEN PEOPLE LIVING WITH HIV HAVE MUCH AT STAKE AFTER OVERTURNINGTHEOF ROE V. WADE.
As news of the court’s decision spread across the country, advocates like Jones wondered what this ruling would mean for marginalized communities.
“We tend to forget about people who are living with HIV, as if pleasurable sex that can sometimes lead to an unintended pregnancy doesn’t exist for [this community],” Jones says. “And then we totally forget about the fact that everybody who has a womb does not identify as a woman.”
THE MORNING OF JUNE 24 STARTED OFF LIKE ANY OTHER FOR MARSHA Jones. That is, until the devastating news broke that the Supreme Court had overturned Roe v. Wade. After almost 50 years, the 1973 landmark case that established women’s constitutional right to an abortion had been reversed by the decision in Dobbsv.Jackson Women’sHealthOrganization. States each now had the power to establish their own laws to protect, restrict or ban abortion.
“I was really upset,” says Jones, the executive director of The Afiya Center (TAC), a reproductive justice organization dedicated to Black women and girls in Dallas. “My feelings about this are centered around the most vulnerable folk who are going to be harmed the most and what happens next.”
“We’re going to force people back into not talking about the conditions they’re living with and to live in isolation,” TAC’s Jones says. “We know when people live in isolation, it increases health disparities and negative health outcomes.”
According to Khanna, surveillance registries that track pregnancies are another cause for concern.
BALLOT.IS“ABORTIONONYOURHAVE TO SEND A NOVEMBERSIGNALCLEARINWITHOURVOTES.”
an HIV organization focused on women and girls at risk for and living with the virus. She worries about the clinics that will get shut down because they offer abortion services and how that will affect people with HIV.
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Khanna advises people to be careful about what they share via social media and even to think twice about using apps that track menstrual cycles.
“We’re going to create a whole new level of stigma,” Jones says. “[For people with HIV], the only difference is the stigma’s going to be different.”
“When services start being cut at the top, you are going to feel it the hardest at the bottom,” Jones explains. “And if you are losing services, for whatever reason, in the metro areas, you are going to feel it the worst in the rural areas.”
Jones adds, “In Texas, they criminalize HIV as assault with a deadly weapon.” She explains that this can put a pregnant person with HIV at risk, especially if they’re seeking an abortion and their complete medical records become accessible.
executiveprovideof“Therelikethatmoney,Parenthood“Whencommunities.yourPlannedstartslosingthey’regoingtotakemoneyfromservicesHIV,”Jonesexplains.willbeacertainlevelservicethatthey’renotabletoanymore.”KristaMartelagrees.SheisthedirectorofTheWellProject,
“There’s going to be an assumption that sex happened because a person is pregnant,” she says. “So that person can be criminalized right there on the spot for HIV exposure. I haven’t seen it happen yet, but this is something that could very well happen.”
“We need to be really mindful of what the vulnerabilities of those kinds of surveillance systems could be,” she says. “Providers could be subpoenaed in any situation to provide information about whether a patient or client has been pregnant in the past in a state that criminalizes abortion.”
ADVOCATES BELIEVE THAT THE OVERRULING of Roev.Wadewill also exacerbate HIV stigma.
THE FALL OF ROE V. WADE WILL ALSO MEAN a loss of access to certain health care for people at risk for and those living with HIV. For instance, although Planned Parenthood may be best known for providing abortion access across the United States, the organization also offers HIV prevention, treatment and support services. And it’s only one of a few groups that address multiple health needs within their
WE
IMMIGRANTS, LGBTQ PEOPLE, YOUNG PEOPLE, low-income people and Black women are some of the addi-
30 POZ OCTOBER/NOVEMBER 2022 poz.com
“It may curb HIV testing and giving [people] better access to pre-exposure prophylaxis [PrEP] and regular preventative wellness checkups,” Martel says. “It’s very possible that there are going to be even higher rates of HIV transmission.”
Naina Khanna, co-executive director of Positive Women’s Network–USA, which supports women living with HIV, blames the lack of such protections for people with the virus havekidsorhavecanmoreforseekingacaninalizationtionthosethetion.andtheirwhichportionatelywithsheKhannafertilitycounseledwithjudgmentalproviderstheirdifficultiesHIVonstigma,discriminationandproviderbias.“Peoplewithwhocangetpregnantmayalreadyhavetalkingtotheirprovidersaboutsexlives,”sheexplains.“Theirandcliniciansmightbeaboutsexuality.”DatashowthatpeoplelivingHIVarenotadequatelyaboutpregnancy,orcontraception,says.Inaddition,notesthatpeoplelivingHIVhavedispro-lowincomes,furtherimpedesaccesstobirthcontrolemergencycontracep-SuchbarriersincreaseriskforpregnancyamonglivingwithHIV.“Nothavingtherighttoabor-alsoincreasestheriskofcrim-forpeoplewithHIVwhogetpregnant,”Khannasays.WhilepersonwithHIVcouldbecriminalizedfororhavinganabortion,theycouldalsobepunishedhavingababy,sheexplains.“WehavelawsthatcriminalizepeoplelivingwithHIVinthantwodozenstates,”Khannasays.“Andthoselawsextendtobreastfeedingandchest-feedingaswell.TherebeensituationsofpeoplelivingwithHIVwhobreastfeedchest-feedwhohavebeenthreatenedwithhavingtheirtakenawayfromthemandothertypesofthings.”AccordingtotheCenterforHIVLawandPolicy,30statesHIV-specificlawsorgeneralfelonylaws.
The impact could be more devastating for residents of rural communities, where services are sometimes lacking or nonexistent. In many cases, those living in rural areas drive hours to see providers, have prescriptions filled and receive other services, including abortions.
Supreme Court Justice Clarence Thomas has called for the reconsideration of gay rights following the overruling of Roe. His comments have further energized anti-LGBTQ individuals and groups to continue their attacks on this community through enacting discriminatory policies. According to the Human Rights Campaign, more than 300 anti-LGBTQ bills have been introduced this year, more than 130 of which target trans people.
HIV rates are also higher among Black women than women of other racial groups. These rates are especially high in the South, where abortion laws are stricter. That’s why advocates are working to ensure that all these women have the support theyTAC’sneed.Jones says the group will continue to assist Black women living with HIV, those seeking abortions and those who are forced to carry pregnancies.
Luckett adds that the LGBTQ community and people living with HIV have endured decades of medical discrimination and a lack of autonomy. She says the overturning of Roe v. Wade will have far-reaching implications for people who need access to medication and treatment that conservative courts no longer support them receiving.
“You are not alone,” she says. “There are people out there who will fight for you. Sometimes, it does feel overwhelming, but I’m confident that we are going to be able to fight this and get to a better place than we were before.” ■
But Luckett believes community will continue to be the bridge that connects people who are denied lifesaving treatment to services and resources. “We’ve always taken care of each other,” she says. “That still holds true today as the fight continues.”
For LGBTQ people, Roe’s reversal threatens basic rights that this community worked long to achieve. Experts are concerned because the right to intimate same-sex relationships (Lawrence v. Texas), for example, as well as the right to same-sex marriages (Obergefellv.Hodges) were protected on the basis of the right to privacy, which was the foundation for the right to an abortion established by the decision in Roev.Wade.
tional communities likely to be heavily impacted by the reversal of Roe v. Wade. These groups also tend to have higher HIV
“We all have a stake in this fight,” says Tiommi Luckett, an organizer at the Transgender Law Center, a national trans-led organization. “Bodily autonomy and agency are under attack. As certain politicians continue to push an agenda, it will continue to leave all of us at risk.”
Khanna says it’s a fight for humanity and dignity. She is calling on folks to protect abortion access by voting in November.“Abortion is on your ballot whether you know that or not,” Khanna explains. “There are candidates on your ballot that stand either to protect abortion or not to protect it. And I can guarantee you that those candidates who will not protect abortion access also will not protect trans rights and LGBTQ communities. We have to send a clear signal in November with our votes.”
“We’re prepared to serve them no matter how things look as we fight to get people’s rights back and to have access to the full spectrum of reproductive health care,” Jones says. “We will meet you right wherever you are.”
Martel also encourages people to vote to dismantle the systems that want to limit bodily autonomy. She wants people to pressure elected officials to fight against the Supreme Court’s attacks on human rights. But, most important, Martel doesn’t want people to lose hope.
Many immigrants fear being apprehended by Immigration and Customs Enforcement and then deported, a risk they also face if they seek or have an abortion in states where it is illegal.“It’svery risky and dangerous,” Khanna says. “It could be dangerous for your whole family and your livelihood. But it’s also even dangerous to access contraception. It can also place you in harm’s way for deportation.”
“Black women experience a lot of discrimination within the health care system,” Khanna says. “That can include dismissive treatment, stereotypes and not paying attention to conditions that disproportionately impact [them]. All of this contributes to medical mistrust, which is also a reason that Black women may not access contraception.”
abortion nationwide could lead to a 21% increase in pregnancy-related deaths overall. For Black women, there would be a 33% increase in death.
poz.com OCTOBER/NOVEMBER 2022 POZ 31
Jones wants people to be aware that although abortion may be illegal in some states, it is still legal in others. “So call the numbers and get the information and resources you need to make the decision that’s best for you,” she says.
DESPITE THE CURRENT STATE OF ABORTION rights across the United States, advocates have not given up the fight. They’ve organized and marched. They are making sure the voices of those most affected are heard on the state and federal level. But the fight is not theirs alone—everyone has a stake in this battle.
ADVOCATESARGUETHAT ROE’SOVERTURNING will disproportionately affect Black women. According to the Centers for Disease Control and Prevention, Black women are nearly four times more likely to have an abortion than white women. Forcing this population to carry unwanted pregnancies could have deadly consequences.
It is imperative that people know that there are organizations and health care providers out there that care deeply about this, she explains. They can provide support for those who need it. In cases where they may not be able to help, they will work to find someone who can.
Accordingrates.toKhanna, the Trump administration severely compromised the overall health of immigrants. Clinics have reported that fewer immigrants are accessing services in states with large immigrant populations.
That’s because Black women are also more than three times as likely to die of pregnancy-related complications than their white counterparts. One study found that banning
HEROES
Ruiz has served in roles at organizations such as the Peace Corps, the National Alliance of State and Territorial AIDS Directors and the Centers for Disease Control and Prevention (CDC). As a Latino, Ruiz says having representation for different groups of people is important in this kind of work so those who are affected by related issues may have a hand in solving them.
■
“When I was diagnosed a few years ago, I put it on Facebook,” Ruiz says. “Basically, it was me sharing my story, what I had to battle with. I had to put myself out there, [and] that vulnerability— it was scary.”
Ruiz has also led the CDC’s Vaccine Equity Coordination Unit, where he helped build trust in the COVID-19 vaccine.
Longtime HIV advocate Francisco Ruiz is pursuing a doctorate in public health.
RICHARDSONKEN
Public Servant
“There are different ways to address [HIV],” Ruiz says. “It’s not a sprint; it’s a marathon, especially [when] living with HIV. There is help there, and there are opportunities, and there’ll be times where it seems it’s overwhelming, but there will be some traction again, giving some grace and time to heal.”
“After sharing my story, I received a lot of feedback and comments, private and public messages from people who also have been living with HIV but had never shared their story because of fear of stigma and shame,” he says.
“Despite working in the field for over two decades, I have never sat in a public health classroom,” Ruiz wrote in a Facebook post. “I entered this field from a social justice lens. Now, I look forward to fueling my advocacy and lived experiences with some additional intellectual stimulus.”
His openness inspired others to talk about their own journeys with HIV.
BY JILLEEN BARRETT
In 2010, Francisco Ruiz was named to the inaugural POZ 100 honoring AIDS advocates, describing him as a “real up-and-comer.” Now, Ruiz is pursuing a doctorate at Harvard University’s T.H. Chan School of Public Health.
“I have had the privilege to be in spaces where a lot of our community members are not,” Ruiz says. “It’s important to have a representative government, ensuring that the folks at the table making decisions on programs and policies and funding understand the nuances of our community so that we are informed not only by our training but also our lived experiences.”
As a person living with HIV, Ruiz believes it is important for him to be transparent about his status. Disclosure is necessary, Ruiz says, to keep the subject of HIV in the public’s mind.
In 2016, as part of the CDC’s Zika outbreak response, he led an interdisciplinary team in Puerto Rico that worked with health care workers to educate women of reproductive age on Zika prevention.Ruizsays he advises people living with HIV, or those who think they’re at risk, to prioritize their health over stigma.
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La salud sexual incluye aspectos físicos, emocionales, mentales y sociales de tu sexualidad. Puedes mejorar tu salud sexual de muchas maneras, empezando por cuidar tu salud y bienestar general. Aquí te ofrecemos varios consejos.
Las drogas y el alcohol disminuyen tus inhibiciones, pero también reducen tu libido y pueden causar disfunción eréctil en los hombres.
Hacer ejercicio con regularidad aumenta el flujo sanguíneo y la circulación, lo que puede mejorar el rendimiento sexual y la satisfacción. El ejercicio físico también puede hacerte sentir más sexy al mejorar tu seguridad y autoestima.
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HABLA SOBRE I=I (EN INGLÉS U=U) Los medicamentos
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Una dieta saludable es esencial. Para un rendimiento óptimo dentro y fuera del dormitorio, consume una dieta balanceada que contenga una variedad de alimentos, incluyendo frutas, verduras, granos enteros, carnes magras, aves, pescado, frijoles, huevos, frutos secos y productos lác teos descremados.
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Fumar hace daño a la salud de muchas maneras. Hay estudios que sugieren que fumar está relacionado con la disfunción eréctil así como con el bajo recuento de esperma.
Los bienestarmejoranantiretroviralesmedicamentosnosólolasaludyeldelaspersonas con VIH, también previenen la transmisión del virus. Hay estudios que demuestran que las personas que mantienen una carga viral indetectable no transmiten el virus a través del sexo, un dato que se conoce como Indetectable es igual a Intransmisible, I=I (en inglés Undetectable Equals Untransmittable, o U=U).
Haz que el sexo sea más disfrutable para ti y tu pareja prestando atención a los deseos de cada uno.
CONTROLA EL ESTRÉS
Hazte con regularidad y habla con tu médico/a sobre cualquier tema relacionado con tu salud sexual. Si bien puede ser difícil hablar sobre estos temas, muchos tratamientos pueden ayudar.
Los lubricantes no sólo aumentan tu placer sexual, sino que también pueden prevenir rasgaduras en la piel, lo que puede causar infecciones. Prueba diferentes tipos de lubricantes para las distintas necesidades.
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Tener una actitud positiva frente al sexo y una perspec tiva positiva sobre la vida puede traducirse en una experiencia más positiva en el dormitorio.
Fumar hace daño a la salud de muchas maneras. Hay estudios que sugieren que fumar está relacionado con la disfunción eréctil así como con el bajo recuento de esperma.
Si eres VIH negativo, el sexo con condón no es la única opción para permanecer así. Ciertos medicamentos contra el VIH son muy eficaces, como profilaxis previa a la exposición (PrEP) y profilaxis posterior a la exposición (PEP). Además del VIH, hay otras infecciones de transmisión sexual (ITS) a tener en cuenta, así como infecciones que se propagan a través del contacto personal cercano, como la viruela símica (viruela del mono). Aprender a prevenir estas infecciones, hacerse pruebas de ITS y tomar PrEP o PEP puede mantenerte a ti y a tus parejas sexuales saludables.
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El estrés es un aguafiestas en el dormitorio y a menudo puede causar disfunción sexual. El ejercicio físico y la meditación son excelentes métodos para controlar el estrés.
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If you’re living with HIV, a major goal is to get your viral load to undetectable. This means that there is so little virus in the blood that a test can’t measure it. How can you get to and stay undetectable? By taking HIV treatment every day. Current research shows that getting to and staying undetectable prevents the spread of HIV to others through sex.
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Have an open conversation. There’s no cure for HIV, but when you work together it helps your healthcare provider find the treatment that’s right for you.
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TREATMENT HELPS PREVENT
“ HIV: It’s Called Treatment as Prevention“ about Treatment as Prevention (TasP) and staying on treatment can help protect you people you care about. YouTube.com/ HelpStopTheVirus THEWITHVIRUSYOU. share information, and help stop the virus. HelpStopTheVirus.com YouTube.com/HelpStopTheVirus START HELP PROTECT YOUR HEALTH. HIV TREATMENT. There is no cure for HIV, but find out how treatment helps make it possible to live a healthier life. SEE INSIDEare trademarks of Gilead Sciences, Inc. All other marks are owners. © 2020 Gilead Sciences, Inc. All rights reserved.