🏳️‍🌈✝️ Boy Silenced: Surviving Sexual Abuse

Photo courtesy of Google Images.

By C.L. Frederick -

  Internationally known LGBTQ columnist,

 actor, male model, and HIV awareness activist. 

04/05/2017 

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Child sexual abuse is widespread and one of the most difficult subjects to openly talk about. It is almost unbelievable to realize that social sexual stigmas often trump a child’s ability to speak out and seek help. There is an ugly truth that is rarely discussed, and it speaks volumes to the criminal neglect that social homophobia places on male youth. Sexually abused boys are forced into silence because society refuses to view homosexuality as anything other than abnormal. Too ashamed and too frightened by the “gay” label, sexually abused boys many times over are forced to keep their abuse to themselves. I was one of those boys.

I was nine years old when it happened. Sparing the graphic and unnecessary details, I never told a soul. I grew up in a household and community that were religiously tied to condemning anything that wasn’t straight, Caucasian and gender role specific. Gay was this mysterious and threatening “behavior” that was made out to be evil. I realized “gay” involved men who were affectionate toward each other like a man and woman in “normal” society. I had limited comprehension of what sex was and was completely vulnerable and defenseless against the sexual abuse, as any child would be.

The encounter left me silently shaken; it was an incredibly overwhelming experience that no child should ever have to go through. Adding to the residual scars from the abuse was the confusion I was left to deal with on my own—as a child. Fearing that I somehow was to blame, that I would be treated the way “gays” were by those closest to me, wrapping my head around the beginning realization that I was gay and the deep-seated shame that I felt were just some of the obstacles I encountered that prevented me from telling anyone. I have since come to understand that a sexually abused boy who would seek help and support from adults who harbor homophobic social ideology would be victimized yet again—a tremendous burden to bear, especially for someone so young.

In the United States, 1 in 53 boys under the age of 18 experience sexual abuse or assault at the hands of an adult. This statistic seems too low in comparison to 1 in 8 girls being sexually abused. It might be underreported due to social sexual stigmas. Reliable estimates of how many boys experience childhood sexual abuse are difficult to come by. Many survivors keep their experiences secret, so police data doesn’t provide good enough estimates. Male youth tend to suffer in silence because of fear, and, when their “manhood” or social identity is questioned, they simply do not report. Current studies place more realistic statistics at one out of every six boys and one out of every four girls will experience sexual abuse before the age 16. These statistics should have rippled across the nation long ago, but society continues to fail our youth. It is neither acceptable nor just for a child to be the victim of sexual abuse—no matter their gender.

Youth who keep their sexual abuse to themselves and are unable to access the support needed to emotionally heal are at greater risk for depression, drug abuse and suicide later in life. 

Unfortunately, both boys and girls face added stigma if they chose to report their abuse. It proves to be a cycle of victimization that could be ended if only the adults in the lives of youth traded stigmas and gender sexual norms for empathy and openness. We shouldn’t have such shame surrounding the sexual abuse of boys, and, as long as society continues to brush it under the rug for the sake of placing straight masculinity on a pillar, this crime will continue.

I have found myself in adulthood reeling from relationships with the men I have had in my life due to my childhood sexual abuse. Recently, I rekindled a past romance. We were in bed, and I flinched at one of his arm gestures. I realized at that moment I was always on edge with partners, fearing physical harm in those vulnerable sexual moments. Even the most tender and safe sexual encounters I have had as an adult can be reminders of what I had been through. I never wanted to tell my partners of my victimization. After I had flinched, my partner jokingly commented that I must have been abused and continued to fake hit me. That moment took my breath away. A simplistic but telling demonstration to the emotional toll childhood sexual abuse has in adulthood.

Today, I am picking up the pieces and working toward healing. Growing up, I needed to trust the adults in my life to have cared enough about me to not place social stigmas above my health and safety. I deserved to speak out without fear and to have been surrounded by compassion. 
Victimizing a victim is never warranted. Therapy has been a godsend; while it’s the most challenging thing I have ever taken part in, it has been my saving grace. Finally being able to open up and talk through this past experience is helping me heal, move on and embrace my future. Kids who have been victimized need to grow up without fearing social stigmas. It is imperative that every child have that most basic of needs met.

Read more articles from C.L. Fredrick, here.

  

🏳️‍🌈✝️ Five Things Media Makers Can Do NOW to Stand Up to HIV Stigma

Positive Women's Network USA

https://pwn-usa.org

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Mainstream reporting on issues concerning HIV is often sensationalized and stigmatizing, sometimes doing more harm than good. In fact, warned Josh Barro last year on MSNBC: “Negative attitudes about HIV are literally killing people.” Within the HIV community, this is widely known and well documented: Stigma fuels the HIV epidemic by creating barriers to HIV testing and care access, and by placing people with HIV at risk for discrimination and violence.

But the responsibility for addressing and ending HIV stigma cannot rest on people living with HIV alone. Makers of mainstream media have a responsibility to stop using language that labels and “others” people with HIV and communities at risk for HIV. According to a Kaiser Family Foundation survey, 62 percent of people in the US get their HIV information mainly from media. By becoming informed about the realities of living with HIV and incorporating these facts and stories into their reporting, media makers can also be some of our greatest allies in improving lives and upholding rights for people with HIV.

So, in the spirit of allyship – and helping media makers satisfy their professional responsibility to seek and report truth, Positive Women’s Network-USA (PWN-USA), a national membership body of women living with HIV, offers this primer for media makers to start today – right now! – to become allies in eliminating HIV stigma, one article and one report at a time.

To read each section of the statement as a separate article, click on the numbered section heading titles. 

Download a printable PDF version of this statement

Special thanks and deep gratitude to all the insightful PWN-USA members who acted as Co-Authors and Contributors to this statement: Valerie Wojciechowicz · Venita Ray · Naimah Oneal · Susan Mull · Asha Molock · Vickie Lynn · Tommy Luckett · Vanessa Johnson · Olga Irwin · Tami Haught · Barb Cardell

 

1. Watch Your Language!

2. Put the “Living” in “People Living with HIV”

3. Talk to Women Living with HIV

4. There Are Facts and Fictions About HIV. Choose Facts.

5. Write About HIV Disclosure as the Complicated Issue it Is

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1. Watch your language!
   

The stigma attached to HIV is a significant barrier to living well with HIV.  By working together, we can raise awareness and help improve the lives of those living with HIV by being mindful of our language.  Language can be a tool to empower, or to further stigmatize.  Media messages can support HIV prevention, care, and treatment by using empowering, appropriate terminology:

a. Refer to those living with HIV as “people living with HIV.” Always put the person before the disease.  We are people first – we are not our disease.

b. Use “diagnosed with” or “acquired” HIV, instead of “infected with” HIV or “HIV-infected.”

c. Avoid words designed to shame or judge people – for example:

• “promiscuous” to describe a person who has had multiple sex partners is a judgmental term and is often applied differently to heterosexual men, gay men, and women.
• “prostitute” to identify a sex worker – the former is a legal term that does not apply in every context; the latter is preferred.
• “clean” or “dirty” when referring to HIV status. Clean and dirty should only be used when referring to laundry and dishes, not people.

d. AIDS is a diagnosis and not a disease – understand the differences between HIV and AIDS. People cannot transmit AIDS. AIDS is not a virus. Read a detailed definition of “AIDS” (from The Well Project)

e. Refrain from using the term “full-blown AIDS.” This terms is still used by many media outlets – but there is no such thing as full-blown AIDS. The term is “antiquated, redundant, stigmatizing and confusing” – as one longtime HIV provider recently put it. Replace with “an AIDS diagnosis” or simply “AIDS.”

f. Apply the information above and below to headlines, the gateway to stories – and avoid sensationalist headers such as “AIDS-Positive Alabama Pastor Who Slept with Congregants Banned from Church,” from the Associated Press last October.

 

For more information: View the full slide set for PWN-USA’s webinar “Eliminating Stigma from the Language of HIV Communications”  – or view a recording of the full webinar including slides and voices of presenters

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2.   #WeAreAllPeople: Put the “Living” in “People Living with HIV”
   

From the beginning of the epidemic, HIV in the US has been perceived by some people as a moral issue and not a human one.  People with HIV need the media to recognize, report, and share our stories as the mothers, fathers, sisters, brothers, aunts, uncles, neighbors, and grandparents that we are.

More often than not, those of us who are people living with HIV are framed in media as monsters, infected, dirty, predatory, and more. Those who are reported as having acquired HIV – or having been intimate with a person with HIV – are labeled as victims or as having been preyed upon. In truth, people living with HIV are just that: people. HIV is the human immunodeficiency virus that attacks the CD4 cells within a PERSON. And many of our partners choose to be with us because they love us and it is not “risky” to be intimate with us.

HIV is no longer the “death sentence” it was once thought to be. It is a chronic illness that can be managed with proper care and medication. Today, people living with HIV are doing just that and beyond; they are thriving. The life expectancy of a person living with HIV who takes medication is about the same in the US as those who are negative.

When reporting on a story, it is crucial that media makers actually talk to a person living with HIV in order to get an accurate reflection of life beyond the diagnosis of HIV. It is a common occurrence that most people did not educate themselves about HIV until they received a diagnosis. They are not at fault. Many people who acquired HIV state they never believed it could happen to them – in part because messages received through media imply that people living with HIV are somehow different from those who are not, when HIV status is the only difference. Therefore:

a. Coverage of people living with HIV should highlight accomplishments and achievements that are not focused on the virus.

b. Stories of people living with HIV should include our strength, survival, and courage.

c. The media could promote the importance of ending stigma, to create environments safe for knowing one’s status, HIV testing, and open communication with partners.

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3. HIV is not just a man’s issue; it never has been. Talk to women living with HIV.
   

We, women living with HIV, articulate truth that must not be distilled. While living with HIV, we work, raise families, cook, help aging parents, bear children, march, protest injustices, lead the way at conferences, fall in love, and empower each other.

Women account for at least a quarter of people living with HIV in the US, and more than half of all people with HIV worldwide. This makes us the overwhelming experts. We stand bold, as in front-page news. We are not the stuff of margins.

African-American women were 64% of all women diagnosed with HIV at last count, in 2010. A third of transgender women in the US are living with HIV; the majority of transgender women diagnosed with HIV are women of color. If you are not engaged in conversations about HIV with women of color, you are really missing the point.  You may be missing the whole truth, the undisputed truth, the unadulterated story of HIV in the US.

Resources for finding women’s stories:

• Positive Women’s Network – USA (PWN-USA) – Features a wide variety of advocacy resources for women with HIV, including opinion pieces and statements highlighting the perspectives and expertise of women advocates living with HIV.

• International Community of Women Living with HIV (ICW) – The only global network by and for women with HIV; features stories of women living with HIV around the world.

• The Well Project – Features cutting-edge information, personal reflections, and research by and for women with HIV.

• TheBody.com’s Women’s Resource Center – Features first-person stories and videos by women living with HIV, as well as basic information about women and HIV.

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4. There are facts and there are fictions about HIV. Choose facts.
   

It is ridiculous that, more than 30 years and loads of research and lived experience into the HIV epidemic, we continue to encounter and fight the same myths and misinformation about HIV, in newspapers and on TV as well as in our daily lives.

Three key facts to remember:

a. HIV can only be transmitted through four body fluids getting into the body in very specific ways. The fluids that are capable of containing high concentrations of the virus – blood, semen, vaginal and rectal secretions, and breast milk – must come in direct contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to be possible. HIV transmission is not possible, under any circumstances, through a hug, a handshake, a toilet seat, sharing a cup, or eating food cooked by a person with HIV. Period. The fact that these myths persist in the general population is damaging to the wellbeing of people with HIV, and shows how great the need is for reporting on HIV that is not only accurate, but that actively counters misinformation.

b. People living with HIV can have HIV-negative babies. Now more than ever, women and men living with HIV are exercising their reproductive rights, and adding to their biological families. A baby born to a woman living with HIV has less than a 1% chance of acquiring HIV during pregnancy or birth if the baby’s mother has access to proper care and treatment. And if one partner in a couple is not living with HIV, the best prevention tool yet is for the partner who’s living with HIV to be on successful treatment. Then risk of transmission to the partner drops to virtually zero, even when having sex without condoms. Read more about that excellent and no-longer-new news here and here.

c. Laws that criminalize HIV-positive status do not protect or help women. As of this writing, 32 states and two US territories have HIV-specific laws that attach criminal penalties to the behavior and actions of people living with HIV. These laws are often framed in the media as protecting women “victims” from dishonest partners, but the laws help no one.  These laws codify stigma, and actually deter people from getting tested or being in care (a person who doesn’t know their HIV status cannot be prosecuted for HIV nondisclosure or exposure), thereby hindering public health solutions. In most HIV-related prosecutions, no transmission of HIV even occurred! Further, women have been sent to prison under these laws, and/or had their children taken away for no reason – often by partners who knew the woman’s HIV status but used the laws as a tool of abuse, coercion, or harassment when the woman attempted to end the relationship. Making it a crime not to disclose HIV-positive status should never be framed as the answer to addressing HIV in communities or to keeping people HIV negative.

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5. A person’s choice to tell someone their HIV status is complicated. Write about HIV disclosure as the complicated issue it is.
   

Telling another person, especially a potential partner, that you’re living with HIV is extremely complex, and not disclosing is never simply about “selfishness” or intent to harm – emotionally or otherwise.

Important points to keep in mind when reporting on HIV nondisclosure:

a. Simply saying “I’m HIV positive” is not always a safe option. The very real threat of intimate-partner violence may keep a woman from telling a partner she is living with HIV. The cases of Cicely Bolden and Elisha Henson, murdered in Texas due to their HIV status, are two devastating examples of this reality. Because of stigma and discrimination, disclosure may also place a person at risk for losing their employment, childcare provision, and more. Further, in the presence of laws that penalize people with HIV for knowing their HIV status, disclosing won’t protect a woman in a he-said-she-said argument in court, where the person who knows their HIV-positive status usually loses. Women are often the first person in the relationship to be aware of their HIV-positive status.

b. Preventing the transmission of HIV is each partner’s responsibility, not solely the partner who’s living with HIV. But unequal power dynamics in relationships, among other factors, can block the ability of either partner – whether living with HIV or not – to take action to prevent HIV. In many relationships, negotiating use of condoms or other prevention options may be difficult or even possible. One answer to empowering individuals in their relationships and fostering healthy, safe communication is to address the root causes of inequities that impact our lives and relationships, and drive the HIV epidemic – and to ensure comprehensive, medically accurate sex education. The solutions is not to blame people for having HIV, or cast their sexual partners as “victims.” Where there is a victim, there must be a perpetrator, and having HIV is not a crime.

c. HIV stigma does not operate alone; for many women of all gender identities living with HIV in the US, other stigmas – based on race, class, gender expression, sexuality, ability, or other factors – were likely already a part of life before acquiring HIV, and exacerbate HIV stigma after diagnosis. Any trait that sets a person apart from a societal norm can be challenging to talk about, or to disclose. HIV status is no different.

d. It is the right of all cisgender and transgender women, including women living with HIV, to be sexual beings. A key aspect of internalized stigma for many women with HIV is being cut off from their right to safe, pleasurable, intimate relations. When journalists convey messages that shame the sexuality of people with HIV in their reporting – as if to even be having sex as a person with HIV is somehow wrong – or imply that finding love, having sex, or being in relationships is impossible for people living with HIV, they validate that assumption. A healthy dose of nonjudgmental sex-positive messaging in mainstream media could save and improve lives.
e. Everyone who is living with HIV has a story of how they acquired HIV. It is a part of a person’s history, and does not have to involve a “victim” and a person “at fault.”

How a journalist reports on a story can determine the way the story is received – and the tone of comments people leave. A more humanizing, less oppositional approach to reporting on disclosure could foster more civil, less reactionary online discussion around challenging, and potentially unifying, topics like HIV.

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BONUS: When reporting on HIV, consult community resources like the ones referenced above, and in the list below!

AIDSmap.com – Independent, clear and accurate information about HIV

AIDSMeds.com – Quality information about HIV treatment and care

AIDS United – A wide variety of HIV resources

AIDS.gov – Federal resources as well as basic information about HIV

HIVPlus Magazine – Online home of the community news magazine (HIVPlus has also developed a brief, helpful guide for journalists covering HIV)

Kaiser Family Foundation – Provides trusted information on national health issues, including HIV

POZ Magazine – Online version of the longtime print publication

Sero Project – A network of people living with HIV and allies fighting for freedom from stigma and injustice, and opposing HIV criminalization

TheBody.com – The most comprehensive HIV news, information, and support resource on the Web
 

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 Read more articles from Positive Women's Network, here.

🏳️‍🌈✝️ Not One, but Two Types of Immune Cells Likely Make Up HIV’s Reservoir

Researchers have found that in addition to CD4s, macrophage cells can harbor HIV even in the face of antiretroviral treatment.

April 28, 2017


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In yet another finding that complicates HIV cure science, researchers have established that in addition to CD4s, macrophage immune cells can harbor virus in the face of antiretroviral (ARV) treatment and prompt a viral rebound if treatment is interrupted. The findings of their research, which was conducted in humanized mice, means that not one but two types of immune cells likely make up the viral reservoir, the existence of which prevents standard ARV treatment from curing the virus.

Publishing their findings in Nature Medicine, researchers built on laboratory research finding that macrophage immune cells could support HIV replication in the absence of CD4 cells. They conducted experiments on mice that were genetically engineered to have human immune systems that lack CD4s.

They found that ARV treatment strongly suppressed HIV replication in macrophage cells of the infected mice. After stopping treatment in the animals, the virus rebounded in a third of them.

The research team will now investigate what regulates the persistence of the virus in macrophage cells, where these persistently infected cells hide out in the body during ARV treatment and how macrophages respond to treatments that seek to eradicate the virus from the body.

To read a press release about the study, click here.

To read the study abstract, click here.

Read more articles from POZ, here.

  

🏳️‍🌈✝️ Increased coronary artery disease found in men with HIV

Researchers use CT scans to detect signs of subclinical coronary artery disease. (Photo/Multicenter AIDS Cohort Study)

USC leads research into link between high inflammation and narrowing of the arteries

By Mary Dacuma

http://keck.usc.edu

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A cardiac imaging study showed a correlation between higher inflammatory biomarkers and an increased prevalence of coronary artery disease (CAD) in men infected with human immunodeficiency virus.

CAD is a narrowing of the arteries, likely due to the presence of calcified and non-calcified plaque. The findings were published in the Journal of the American Heart Association.

Researchers examined nearly 925 men, 575 of whom were infected with HIV, from the Multicenter AIDS Cohort Study. The researchers used computed tomography (CT) angiography to detect signs of subclinical CAD, such as narrowed arteries and the amount, density and calcification of plaque.

Participants were also measured for the presence of seven inflammatory biomarkers. This study, which was funded by the National Institutes of Health, is the largest coronary CT scan imaging study on men infected with HIV to date.

“We found that men infected with HIV had higher levels of inflammatory biomarkers than men who were not infected,” said Hossein Bahrami, assistant professor of cardiovascular medicine at the Keck School of Medicine of USC, who led the study along with six other institutions. “There was a strong, independent association between the presence of these inflammatory biomarkers and subclinical CAD detected by CT scan. Although this study does not definitely prove the causal relationship between these markers and heart disease, it is suggestive of a possible role that persistent inflammation [even in HIV-infected patients that are under appropriate treatments] may play in increasing the risk of heart disease in these patients.” 

At greater risk

HIV-infected individuals are at an estimated twofold higher risk of CAD compared to those who are not infected with HIV. The development of antiretroviral therapy has significantly prolonged the life spans of those living with HIV infection. However, they are more prone to chronic illness, such as cardiovascular disease and CAD, and they present at a younger age. These factors combined have made research into treating chronic illness in men with HIV all the more important.

The CT imaging was crucial to this study, as researchers were able to detect subclinical CAD in a younger population rather than waiting until participants exhibited clinical symptoms. Moreover, researchers were using a broader set of inflammatory markers than in past studies, which provides more information about inflammatory pathways involved and potential causes for inflammation.

“Inflammation has only recently been studied as a possible reason for chronic heart disease,” Bahrami said. “Confirming the relationship between HIV-related inflammation and the marked increase of CAD among men infected with HIV allows us to move forward in our attempts to better manage the health of these patients according to their specific medical needs.”

In ongoing research efforts at the Keck School of Medicine, Bahrami and others are also using cardiac magnetic resonance imaging to study the changes in heart muscle, as well as details of coronary artery function in men affected by HIV. This advanced form of imaging evaluates several features of the heart that could not be evaluated with cardiovascular CT scans. This ongoing project is significant, as HIV-infected patients appear to have even higher risk of abnormalities in the heart muscles compared to their increased risk of coronary artery disease.

Bahrami’s research hopes to illuminate what causes HIV-related inflammation, as well as identify specific pathways involved and the best means of treatment or management of heart diseases in HIV patients.

 

Article from Keck School of Medicine of USC 

🏳️‍🌈✝️ Stopping a silent killer

Know the facts about heart disease and HIV

BY KATHLEEN FITCH, MSN, FNP

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“I had no idea that since I have HIV, I may be twice as likely to have a heart event compared to the general population,” said Frank Carroll, a 63-year-old man who has been living with HIV for over two decades.

 Unfortunately, that is the case for the majority of people who are living with HIV. Up to this point, there has been very little research conducted regarding heart disease and HIV, but here is what we do know:

People with HIV often have what is known as “inflamed non-calcified plaque” buildup in the heart.  

This plaque is considered “high risk” plaque because it is a leading risk factor for heart disease. This is important to know because “inflamed non-calcified plaque” is extremely vulnerable to rupture and that can lead to a sudden heart event, such as a heart attack. Traditional risk factors, including high blood pressure and high cholesterol, are well-known contributors to heart disease for those with HIV and the general population. However, an additional and significant HIV-related risk factor for developing heart disease is constant activation of the immune system; this happens even with antiretroviral therapy and when the virus is undetectable.

Heart disease rates among people living with HIV are elevated compared to the general population. If you add to that the fact that heart disease is often a silent killer with atypical symptoms, it is easy to understand why more research needs to be conducted on this subject.

It is important that health care providers gain a better understanding of the intersection of HIV and heart disease to inform how they educate, treat, and monitor patients. It is equally important that heart disease prevention tools are developed and tested, specifically among people living with HIV, to determine the most effective ways to treat and prevent heart disease events in these patients.

 “We know that people with HIV are living longer and aging. The HIV community has worked very hard for these successes; they have participated in research studies for the past 30 years to help develop antiretroviral therapy that works to suppress HIV. It is our goal now to find ways to keep people with HIV healthy as they age and help them achieve a full and healthy lifespan,” said Dr. Steven K. Grinspoon, Director of Massachusetts General Hospital Program in Nutritional Metabolism and Professor of Medicine at Harvard Medical School.

Gaining a better understanding of how HIV may contribute to heart disease and determining effective prevention strategies will enable health care providers and patients to act before significant damage and co-morbidities develop. The time to take action is now, before this silent killer strikes. 

 

Be proactive about heart health

“I never really thought I would live to be an old man, so it was not until a few years ago that I made the decision to take control of my overall health. I quit smoking and am now more conscious of my diet and exercise activities than in the past. Research has come a long way in helping people with HIV, but there are many things we can do as patients to help ourselves as well,” said Mr. Carroll.

Members of the HIV community should make it a priority to talk with their health care provider about additional ways to remain heart healthy. There are always helpful resources available at local HIV clinics such as smoking cessation programs, exercise groups, nutrition services, and research studies.

A “whole-body” approach to living longer with HIV is critical. HIV patients and their health care providers alike should understand that there are many pieces to the puzzle when it comes to keeping those living with HIV heart healthy.

 “I have treated many patients who were overweight, who smoked, and rarely exercised. In these instances, I always made it a point to explain the risk factors associated with heart disease and the concerns regarding inflamed non-calcified plaque unique to the HIV population. In future visits, many of these patients made lifestyle changes that, in the long run, led to increasingly positive health outcomes,” said Dr. Grinspoon.

Although smoking cessation, eating a healthy diet, and exercising are excellent ways to stay healthy, clearly, there are more tools needed to prevent heart disease among people living with HIV.

Could statins be the ideal heart disease prevention tool?

“Recent studies show that statins may reduce immune activation and shrink dangerous plaques in the blood vessels in the heart. Statins may therefore be a potentially useful treatment to prevent heart disease in the HIV population,” said Dr. Grinspoon.

Statin medications are a validated strategy with the potential to prevent heart disease, and target traditional and nontraditional risks in people living with HIV. In small studies examining the effects of statins among HIV-positive study participants, statins significantly decreased low-density lipoprotein (LDL) cholesterol, a known risk factor for heart disease. Statins also reduced blood markers of immune activation, inflammation, and inflamed non-calcified plaque in the coronary arteries of these study participants.

However, at this time, it remains unknown if statins will prevent heart disease events in people living with HIV. Although statins have proven safe and are widely prescribed, it is not fully understood how they will be tolerated in the HIV population. For example, some studies suggest older statins may cause an increase in blood sugar. However, newer statins, broken down by the body differently than those in the past, have not been shown to cause an increase in blood sugar. In fact, a 2013 study explored the effects of a newer statin called pitavastatin in over 200 HIV-positive study participants and results proved there was no effect of pitavastatin related to increased blood sugar levels. This study was reassuring to researchers because it indicated that newer statins are well tolerated among people living with HIV.

 Given the crucial need to find a heart disease prevention tool for the HIV community, investigators from the AIDS Clinical Trials Group (ACTG) Network and Massachusetts General Hospital sought funding from the National Institutes of Health (NIH) to conduct the largest heart disease prevention research study to date among people living with HIV.

About the REPRIEVE Trial

“I chose to participate in the REPRIEVE Trial because I want to do everything I can to prevent developing heart disease. It is also a way for me to give back to the researchers, the HIV community, and those amazing HIV study participants who came before me. Basically, it is a win-win situation for me,” said Mr. Carroll.

The REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) Trial launched in April 2015 and will test whether pitavastain prevents heart disease events in people living with HIV. REPRIEVE study participants will be randomized to take one pill, once a day of pitavastatin or a placebo, for an average of 4-5 years. REPRIEVE will enroll 6,500 HIV-positive study participants who are considered to have low to moderate traditional known risk factors for developing heart disease, but are likely at an increased risk due to HIV. Trial sites are located throughout the United States, Canada, Thailand, South America, and Africa.

A unique aspect of REPRIEVE is that there are several sub-studies incorporated into the clinical trial design. In one of the sub-studies, study participants will have a picture of their heart vessels taken by a CT scanner; the picture will be taken before the study medication is started and two years after to see if there are changes in inflamed non-calcified plaque with pitavastatin. Other sub-studies will explore if, by decreasing inflammation, pitavastatin improves kidney function and measures of quality of life.

Women also have a special place in REPRIEVE. To encourage women’s participation in REPRIEVE, there is a campaign just for women called Follow YOUR Heart. Follow YOUR Heart has an interactive website with helpful resources on HIV, heart disease, and women’s health and was developed to focus on including and educating women living with HIV about the clinical research process.

Until we know the results of REPRIEVE, people with HIV should follow the important steps outlined to prevent heart disease, such as not smoking, exercising regularly, and eating nutritiously. People living with HIV need to talk to their health care provider about heart health and consider joining the REPRIEVE trial. Joining REPRIEVE is a way for patients to learn more about their own bodies, while helping to determine a successful prevention strategy for the greater HIV community. 

Learn more about REPRIEVE; go to reprievetrial.org.

Kathleen Fitch, MSN, FNP, is the Project Manager for the Clinical Coordinating Center of the REPRIEVE Trial located at Massachusetts General Hospital. Kathleen has conducted several research studies that have increased the understanding of metabolic complications of HIV including lipodystrophy syndrome, diabetes, and cardiovascular disease. She has also explored different treatment strategies for these abnormalities, including lifestyle modification. In addition, she is a volunteer community educator at several HIV/AIDS service organizations throughout New England.

Read more articles from Positively Aware, here.

 

🏳️‍🌈✝️ Widespread Defective HIV in Immune Cells Undermines Efforts to Kill Viable HIV

This finding identifies yet another hurdle to finding effective therapies to clear the viral reservoir and ultimately cure HIV.

April 25, 2017


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Defective copies of HIV that are integrated into long-living immune cells distract the immune system, complicating the effort to track down and kill viable copies of the virus. This finding identifies yet another hurdle to finding effective therapies to clear the viral reservoir and ultimately cure HIV.

When HIV infects an immune cell, the virus integrates its genetic materials into the cell’s own DNA, yielding what is known as an HIV provirus. However, the majority of proviruses cannot produce new, intact copies of HIV because of flaws in the reproduction process. Consequently, until recently, researchers believed that proviruses amounted to a biological dead end and that cells latently infected (meaning they are not replicating and are therefore invisible to standard HIV treatment) with defective provirus could not prompt a repopulation of the virus in the body.

Publishing their findings in Cell Host & Microbe, scientists studied memory CD4 cells drawn from HIV-positive individuals as well as reconstructed defective proviruses drawn from people with HIV. Latently infected memory CD4 cells, which can live a very long time, are a major component of the viral reservoir, the presence of which frustrates attempts to cure the virus.

The investigators concluded that the presence of the defective proviruses promotes the survival of the overall HIV infection by serving as a decoy. The immune system, recognizing the viral proteins that serve as signs of infection in the cells infected with defective proviruses, wastes resources attacking those cells.

In its effort to seek out and destroy proviruses, the immune system is confronted with a needle-in-a-haystack effort because people with HIV have about 1,000 times more defective proviruses than viable ones, and the immune system apparently cannot detect the difference between them.

This decoy effect also complicates the effort to measure the viral reservoir because most current tests also cannot distinguish between defective and viable provirus.

To read a press release about the study, click here.

To read the study abstract, click here.

Read more articles from POZ, here.

  

🏳️‍🌈✝️HIV Levels Before Treatment Can Predict This Immune System Indicator

Researchers may have answered a bedeviling chicken-or-egg question about the persistence of HIV during antiretroviral treatment.

April 24, 2017


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Researchers may have finally answered a bedeviling chicken-or-egg question about the relationship between the persistence of HIV in the body during antiretroviral (ARV) treatment and the virus-related immune system activation and inflammation that also continues while people are on ARVs. This finding likely adds further weight to the urgency of diagnosing and treating HIV as soon as possible following infection.

HIV hides its genetic material in cells or locations in the body that remain out of reach of ARVs. This result of this overall effect is known as the viral reservoir, the existence of which prevents standard HIV treatment from curing the virus.

Publishing their findings in PLOS Pathogens, researchers from the AIDS Clinical Trials Group (ACTG) studied 101 people with HIV who had plasma and blood-cell samples taken before they started ARVs, one and four years after beginning HIV treatment, and once more between years six and 15 of treatment. All the participants achieved a viral load considered undetectable by standard laboratory measures and maintained this level of viral suppression for an average of seven years, with some doing so for more than a decade.

The participants experienced the steepest decline in measures of HIV’s genetic material (detected with highly sensitive tests) during their first four years on ARVs; afterward, they still experienced a decline, albeit at a slower pace.

Looking at the samples taken before the participants started ARVs, the researchers identified a correlation between levels of HIV and indicators of immune system activation and inflammation. 

However, this association ceased after the individuals started treatment for the virus. More specifically, the low levels of HIV found in the samples taken while people were on ARVs did not seem to influence the levels of immune system activation and inflammation during that time.

The investigators ultimately concluded that the levels of both immune system activation and HIV in the pretreatment samples predicted the levels of persistence of the virus and immune activation seen in the samples taken when the participants were on ARVs.

“Our findings suggest that damage to the immune system that occurs before people are started on [HIV] treatment leads to continued immune activation, even though the medicines are keeping the virus in check,” the study’s lead author, Rajesh Gandhi, MD, of the Massachusetts General Hospital Division of Infectious Diseases, said in a press release. “This suggests that diagnosing HIV and starting antiretroviral therapy as soon as possible may prevent the elevated immune activation that can lead to health problems, such as heart disease. The results also suggest that new strategies focused on reducing immune activation may need to be added to novel interventions designed to reduce and eventually eliminate HIV.”

To read the study, click here.

To read a press release about the study, click here.

Read more articles from POZ, here.

🏳️‍🌈✝️ You Might Have Less HIV In Your Body Than Your Doctors Think

While defective forms of HIV were thought to be harmless, studies show they're tricking our immune systems into thinking we have more HIV in our bodies than is the case.

By David Artavia

 

April 24 2017

 

 

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New evidence coming out of John Hopkins and George Washington Universities suggest that defective forms of HIV are creating proteins that are interacting with our immune system, making it think we have more HIV in our bodies than we actually do.

The proteins that are released by defective HIV are monitored by specific T-cells called cytotoxic T-Cells. And while scientists previously thought defective HIV was harmless, research now suggests otherwise.

According to the study published in Cell Host and Microbe, while defective HIV proviruses cannot create functional (and by that we mean infectious) HIV once they’re defective, they create a specific subset called “hyper mutated” HIV proviruses, which then births new types of proteins.
From there, the cytotoxic T-cells mistakenly recognize these proteins as HIV, even though they’re — they’re simply a result of defective HIV proviruses. Our immune system then starts to think it’s becoming infected by more HIV cells than are actually present.

As a result of the confusion, it also makes things more complicated when doctors try to measure our viral loads, exhaust immune systems, or shield functional HIV from attack by natural means or drugs. It may also complicate the development of a cure for HIV, reports Medical News Today.
But lead lead study investigator and instructor of medicine at the John Hopkins University School of Medicine, Dr. Ya Chi Ho, still has hope.

"The virus has a lot of ways, even in its defective forms, to distract our immune systems, and understanding how they do this is essential in finding a cure," Ho said to MNT. "The fact that defective proviruses can contribute to viral RNA and protein production is concerning, because it means that the measurements of HIV load in infected patients may not be as accurate as we thought. Part of the count is coming from defective viruses.”

After doing additional studies, it was found that cells containing “hyper mutated” HIV can be recognized by an HIV-positive patient’s cytotoxic T-cells.

This makes Ho confident that new research might lead to a cure. That is, if researchers know where to look.

"If we identify and find a way to use the right protein, perhaps one of those expressed by the ‘hypermutated’ HIV we found in this study, we could create a potent vaccine which could boost the immune system enough to eliminate HIV altogether," said Ho. "The cytotoxic T lymphocytes' ability to identify and target the real threat appears to be greatly impaired, because they may attack proteins from defective proviruses instead of the real thing.” 

Read more articles from PLUS, here.

 

🏳️‍🌈✝️The Unmet Sexual Health Rights of LGBT Youth

This National Youth HIV & AIDS Awareness Day, Advocates for Youth spent the day educating and spreading awareness. There's still a long road ahead.

By Pepis Rodriguez

 

April 20 2017

 

 

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At the last Creating Change, a session on the sexual health care rights of young people gave me hope. Amidst all the strategizing and anxiety of the weekend — on the eve of a new administration taking office—young queer activists were sharing their remarkable experiences of advocacy in their own communities.

I thought back to this session last Monday, on National Youth HIV&AIDS Awareness Day (NYHAAD), a day to educate the public about the impact of HIV on young people and the important work young people are doing in response. I remembered feeling that, despite the uncertainty of a new administration, there was reason for optimism with these young activists so passionately engaged.

It’s the other part of NYHAAD — increasing public awareness about the impact of HIV and AIDS on young people — that also gives me pause. Awareness is not enough. What are we telling young people when we say we want to make the public aware of a problem directly affecting them, but then do nothing concrete about it? What message do we convey when we highlight transmission rates and the fact that, for many young people — mostly young Black gay men — things are actually getting worse, but then we not only provide no solutions or help, we actively obstruct their attempts to remedy the situation?

NYHAAD highlights the need for comprehensive, shame-free, medically- and culturally-competent sexual health care to address the HIV epidemic. Treatment alone is not enough, though. Waiting until a young person receives a diagnosis is too expensive in human terms alone; it increases risk of poor health outcomes, even early death, and eliminates their agency.

Prevention must play a key role as well. Young people need free, broad access to sexually transmitted infection (STI) and HIV screenings and treatment, safer sex tools like condoms and pre-exposure prophylaxis (PrEP). The key ingredient, however, is sexual health literacy—an essential part of informed use of these services and individual, sexual autonomy.

Sexual health literacy includes guidance on topics like STI and HIV transmission, prevention, and care; healthy relationships, consent, and recognition of abuse; the continuum of sexual orientation and gender identity and expression (SOGIE); and the harmful effects of SOGIE-based stigma and violence. Some young people receive “sex ed.” in schools, but it’s rarely comprehensive, many states have no requirement that information provided be medically accurate, and some states even require students receive negative information on non-heterosexual sexual activity.  For queer kids in detention, it’s even worse: much higher risks of STIs and other health issues, much lower possibility that any form of sexual health care and literacy services will be available.

Sexuality is a fundamental part of who we are, and sexual health care is a medical issue we all share. This is no less true for young people, regardless of whether or not we choose to give them the support and services they need. Young people have an inalienable right to comprehensive and affirming sexual health; it’s not just something that would be nice to have. Can you imagine helping young people manage their diabetes without explaining to them the significance of diet, nutrition, and a healthy lifestyle, how they can take charge of staying alive and healthy? We should treat sexual health no differently, and, health departments should be taking the lead on this public health issue – particularly in places where the state has custody of our young people and a corresponding obligation to provide for all aspects of their care. That is why The Center for HIV Law and Policy has launched a campaign to demand these services.

If we don’t demand comprehensive sexual health care for all young people, NYHAAD can be a cruel joke. Awareness signals the creation of responsibility. But we should not set young people up to fail.

Pepis works at the Center for HIV Law & Policy to uphold the sexual health rights of young people in state custody and to end HIV criminalization. He received his J.D. from the Georgetown University Law Center.

Read more articles from PLUS, here.
 

🏳️‍🌈✝️ Health Care Gains Made Under Obamacare Remain at Risk

Although Republicans were not able to repeal the Affordable Care Act, the future remains unclear with LBGT and people of color likely to lose out the most.

By Eric Brus

 

April 19 2017

 

 

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Now that Congress is no longer considering the American Health Care Act (AHCA), a bill filed by House Speaker Paul Ryan to replace the Affordable Care Act (ACA), the future of efforts to repeal and replace the ACA, also known as Obamacare, are unclear. What is clear, as a policy brief by The Fenway Institute on the AHCA explained, is that the AHCA would have harmed LGBT people, persons living with HIV, and Black and Latino Americans.

“This bill holds potentially devastating consequences for low-income LGBT people, people living with HIV, and Black and Latino people,” according to Sean Cahill, director of health policy research for The Fenway Institute. “The rates of uninsurance among LGBT people and people living with HIV have dropped dramatically since 2013, when the Affordable Care Act’s Medicaid expansion was implemented. While people of all races benefitted from the expansion of insurance access, on a per capita basis Black and Latino people benefitted disproportionately. Those gains could be completely erased if this bill becomes law.”

 

Although Obamacare remains in place for now, the President, Congress, and federal agencies can choose whether to take action to stabilize and strengthen the program or to undermine it either through direct action or inaction. In an article on March 27, Vox.com’s health policy reporter Sarah Kliff highlighted several decisions the Trump administration will make that affect the future of Obamacare and the U.S. health care system. These include:

Should it run a very active outreach campaign to encourage uninsured persons to buy coverage? If it doesn’t, fewer healthy people might enroll, which could drive up insurance premiums.

How should the administration handle counties where no companies want to sell coverage on the Obamacare insurance marketplace? Will it negotiate with insurers, as the Obama administration did, to convince them to provide coverage in such areas?

Will the federal government continue to pay cost-sharing subsidies that make health coverage affordable for low-income enrollees?

Some Congressional Democrats have indicated they are willing to work with the Republican majority and President Trump to safeguard Obamacare’s gains and fix its problems. Speaking on ABC’s This Week, U.S. Senate minority leader Chuck Schumer said, “We Democrats, provided our Republican colleagues drop [repeal and replace] and stop undermining the ACA, are willing to work with our Republican friends—as long as they say no more repeal.” Schumer also noted that, “We have ideas, they have ideas to try to improve Obamacare. We never said it was perfect. We always said we'd work with them to improve it—we just said repeal was off the table.”

Potential impact of Trump’s 2018 Budget

The Trump administration’s “America First” budget blueprint for fiscal year 2018 (FY18), released on March 16, would increase defense spending $54 billion, but would impose deep budget cuts to many federal agencies and programs, including the Department of Health and Human Services (HHS), the Environmental Protection Agency (EPA), and the State Department. Funding for HHS would be reduced approximately 18%, from $84.1 billion in FY17 to $69.0 billion in FY18. 
The budget blueprint says these changes would be achieved by eliminating “programs that are duplicative or have limited impact on public health and well-being. The Budget allows HHS to continue to support priority activities that reflect a new and sustainable approach to long-term fiscal stability across the Federal Government.”

Included in the HHS budget cuts are:

A $5.8 billion cut in funding for the National Institutes of Health (NIH) to $25.9 billion in FY18. This would be achieved largely through “a major reorganization of NIH’s Institutes and Centers to help focus resources on the highest priority research and training activities . . . and other consolidations and structural changes across NIH organizations and activities,” according to the blueprint.

The elimination of discretionary programs within HHS’s Office of Community Services, including the Low Income Home Energy Assistance Program (LIHEAP) and the Community Services Block Grant (CSBG) – reducing the HHS FY18 budget by $4.2 billion compared to the previous year. 

The blueprint contends that, compared to other income support programs serving similar populations, “LIHEAP is a lower-impact program and is unable to demonstrate strong performance outcomes. CSBG funds services that are duplicative of other Federal programs, such as emergency food assistance and employment services, and is also a limited-impact program.”

The elimination of health professions and nursing training programs totaling $403 million, “which lack evidence that they significantly improve the Nation’s health workforce,” the blueprint contends. The proposed budget would, however, continue funding activities that provide scholarships and loan repayments in exchange for service in areas of the U.S. where there is a shortage of health professionals.

Shortly after the budget blueprint was released, five HIV/AIDS and STD organizations issued a joint statement that was largely critical of the proposal. Noting that the blueprint “severely cuts funding to agencies responsible for protecting the public health and responding to infectious diseases, including HIV,” the statement called on the U.S. Congress to reject the budget and ensure that funding for non-defense discretionary programs is maintained. The five groups issuing the joint statement are: AIDS United, the National Alliance of State and Territorial AIDS Directors, the National Coalition of STD Directors, NMAC, and The AIDS Institute.

“We appreciate that the administration recognizes the importance of the Ryan White providers, other safety-net providers, and global health, including PEPFAR [President’s Emergency Plan for AIDS Relief],” commented Michael Ruppal, Executive Director of The AIDS Institute. “However the cuts to the National Institutes of Health, Department of Housing and Urban Development, and other parts of HHS, including public health infrastructure, will reverse our progress on ending the HIV epidemic. If enacted, the budget would be devastating to our nation’s public health infrastructure and would harm people living with and/or at risk for HIV and STDs. HIV and STD programs are critical to the public health of our nation and must not be cut.”

FEATURED HEALTH RESOURCES

Materials for National Youth HIV and AIDS Awareness Day (April 10)

The fifth annual National Youth HIV and AIDS Awareness Day (NYHAAD) is being observed this year on Monday, April 10. Many national, state, and private organizations are partners or supporters of NYHAAD. The day’s founding partners include: Advocates for Youth; AIDS Alliance for Children, Youth, and Families; AIDS United; National Alliance of State and Territorial AIDS Directors; National Coalition of STD Directors; NMAC; and Sexuality Information and Education Council of the United States.

According to Advocates for Youth, the establishment of NYHAAD is a step toward acknowledging and addressing the needs of young people in the HIV and AIDS response. Each year, young activists in high schools and at colleges and universities across the country use the day to organize and educate about HIV and AIDS. They promote HIV testing, fight stigma, and start the necessary conversations to deal honestly and effectively with the challenges of fighting HIV/AIDS among youth.

To support activities commemorating NYHAAD, we have compiled an annotated list of online resources focusing on HIV/AIDS among children, adolescents, and young adults.

Fact Sheets from Advocates for Youth

Young People and HIV in the United States
 
Young People Living with HIV Around the World
 
Understanding Disparities in the HIV Epidemic
 
Young Women of Color and the HIV Epidemic
 
Young Women of Color and Their Risk for HIV and Other STIs
 
Young African American Women and HIV
 
HIV and Young American Indian/Alaska Native Women
 
HIV/STD Prevention and Young Men Who Have Sex with Men. Also available in Spanish.
 
Young Men Who Have Sex with Men: At Risk for HIV and STDs. Also available in Spanish.

Materials for National Transgender HIV Testing Day (April 18)

The second annual National Transgender HIV Testing Day (NTHTD) will be observed on Tuesday, April 18. The event is being organized by the University of California-San Francisco’s Center of Excellence for Transgender Health (CoE). According to the CoE, “NTHTD is a day to recognize the importance of routine HIV testing, status awareness, and continued focus on HIV prevention and treatment efforts among transgender people. This initiative encourages community-based organizations, health jurisdictions, and HIV prevention programs to participate by hosting local trans HIV testing community events (HIV testing, visibility campaign, community forums) and/or develop trans-specific HIV testing campaign materials and resources, As part of the NTHTD initiative, the CoE has developed a Transgender HIV Testing Toolkit, which includes five modules “designed to reflect the most current HIV prevention research and best practices for serving trans and gender non-binary people.” The modules are: 1) Get the Facts about Trans People and HIV; 2) Testing and Enhanced Communication Approaches with Trans People; 3) Building Capacity to Increase HIV Testing Efforts for Trans People; 4) Community Engagement and National HIV Transgender HIV Testing Day; and 5) NTHTD and Toolkit Resources. The CoE has also produced a number of other resources for the testing day, including a condensed toolkit for health departments, testing placards in English and Spanish, and a series of flyers to promote testing.

To support activities commemorating NTHTD, we have compiled an annotated list of online resources focusing on HIV/AIDS among transgender people.

General Information

Center of Excellence for Transgender Health – Website that includes many resources on transgender health

Transgender Persons – CDC’s compilation of resources and fact sheets related to transgender health

Transgender Health – Resource page from Fenway Health

National LGBT Health Education Center – Program of The Fenway Institute

Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE) – Organization that provides services and advocacy for LGBT elders

LGBT Education and Training – Resource with a list of articles, training, and educational materials from the LGBT Resource Center at UCSF

All Children-All Families: Benchmarks of LGBTQ Cultural Competency – from the Human Rights Campaign

Eric Brus writes about HIV policy. His HIV/AIDS Disparities Report is produced by the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.
 

Read more articles from PLUS, here.