Wednesday, August 31, 2016

The Half-Moon Secret

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A poet reflects on HIV, addiction and the death of her nephew.

August 31, 2016 By Joyce Angela Jellison 
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My nephew kept secrets beautifully.

Hidden beneath his tongue, in the incongruent wave of his dark hair, along the edges of crescent shaped nails. He curled the mystery of who he was tightly in his palms and in the half-moon curve of his smile. He shared himself only with others who, like him, were masters of secrecy and struggled with addiction.

Even as I write this, I can’t share his name.

My nephew, 38, had two constant, trusted confidants — heroin needles and coke lines — both tell no tales. There is a code amongst those struggling with addiction, “Keep your life to yourself and I will keep mine to myself.” More than anything, his death starkly stated this code. He died alone in a hotel room — quietly in his sleep. All of his beautifully kept secrets, tended to like rare trees in an arboretum — those went with him.

Except his HIV status. That secret escaped his control in death.

I learned of his HIV diagnosis from his sister as his funeral was being planned. Navigating Boston traffic, I was lamenting not having spoken to him in years and wondered if he knew he was loved. She assured me he knew he was loved, but it was hard for him to place it in the context of his daily life. He struggled with self-love. She, in her grief, consoled me by stating he knew I was struggling with depression and understood my long periods of silence. In a soft, steady voice she confided that her brother, my nephew, had been diagnosed four years before his death as being HIV positive.

My breath gathered in my belly and nested there, leaving a dry hollow in my throat. My niece, on the other line in another city, remained silent before continuing to speak. She was allowing me the impact of learning this and waiting for the inevitable question everyone seems to ask of those with the virus, “How did he become infected?”

I have always reviled that question, and yet there it was on the tip of my tongue and tumbling over my teeth into her ear. It is a question that simultaneously provides shelter and reveals human frailty, an unbearable vulnerability/truth. We have all been unsafe. We want to pluck ourselves from danger, and in asking how one got the virus we find a bastard, blasphemous safety.

She confided his drug use had become suddenly worse — he relapsed with a vengeance and, in a rare moment of openness, he shared that he felt he would never marry, never be loved and believed family, if we knew, would not want him around our children, our food. He believed he would never have children. He believed the world and all of its joys had been closed to him. In his sharing, he revealed that his lifelong battle with drugs had led him to seek shelter in drugs and secrecy.

My nephew’s body had slowly given under the pressures of drug use. His kidneys were below functioning at 40 percent, he suffered with diabetes and had his first heart attack before he was 32. His pain was constant as the result of diabetic neuropathy. Diabetic neuropathies are nerve-damaging disorders associated with diabetes. These neuropathies result in relentless pain that can push a person into hopelessness and despair. The hope he had for recovery was dimmed by ignorance of his health.

He heard HIV and then he figuratively went deaf and mute. His ears closed to possibility and his lips did not communicate what he needed. My nephew had the challenge of communicating his fears, his needs within the framework of this new and foreign diagnosis. He had a difficult time conceptualizing what it meant to LIVE with the virus — for him, dying of AIDS was easy to conceptualize, too damn easy. Living with the virus, having hope — rising with the sun, daring to not be defined by three letters, HIV — for my nephew, it was almost impossible.

There remain the unrealized possibilities, the proposed solutions blossoming after the fact. If he could have communicated his status, then I could have done this or that. If he could have opened up, then he would have been connected with this group or another. Still, behind the failed possibilities remains the reality that HIV carries for too many — a stigma, a shame, a quieting. A silence that dares not protect and grows fat on the fractures it births.

My niece tells me he sought support groups, but as a straight black man it was hard to find support outside of the gay community. He could not find himself in the HIV community. There was no group he could connect to, at least so he thought. It was explained to him the possibilities of love and marriage had not been extinguished by his HIV diagnosis and he was not alone, there were others like him around the world, millions in fact. But this man, who had spent a lifetime pushing against poverty, racism and socioeconomic barriers, designed specifically for him not to succeed, could not find the light in the darkness.

According to the Centers for Disease Control and Prevention (CDC), African Americans are the racial/ethnic group most affected by HIV in the United States. African Americans have the most severe burden of HIV of all racial/ethnic groups in the United States. Compared with other races and ethnicities, African Americans account for a higher proportion of new HIV diagnoses, those living with HIV, and those ever diagnosed with AIDS. At the end of 2012, an estimated 496,500 African Americans were living with HIV, representing 41 percent of all Americans living with the virus. Of African Americans living with HIV, around 14 percent do not know they have HIV.

The CDC lists socioeconomic factors as contributing to the numbers that are stark and seem to be devoid of hope. My nephew was black and poor — but he was more than a number. Behind the numbers, there is hope. But for one already struggling with addictions, poverty and mental illness, hope and HIV are not words that push off from one another.

He lived quietly, posting on Facebook occasionally, but only childhood photos. My nephew was an urban Peter Pan, the man who never left boyhood. There was a modicum of safety in his childhood. He was a healthy boy, running through the fire hydrant on hot days and peddling furiously on his bicycle on potholed Philadelphia streets. I remember chasing after him, sweaty in the summer, sneakers unlaced, feet pounding the pockmarked sidewalks. We were young, defiant and we ran until we panted like thirsty puppies, quenching our thirst from the garden hose on my grandmother’s front yard. We were invincible and our lives were wide-open books with pages furiously turned by the summer breezes. Then we were immortal and we kept track of time by the yellow flicker of streetlights.

Hope was the universe in our veins — cresting our temples and laying alms at our feet. That was before we grew to be silent and ashamed.

At his funeral, I lay my head on his chest and ran my fingers through those dark, thick curls — unraveling secrets and catching them in my palms. I kissed him and asked him to return. I needed to kiss this sleeping boy/man and hug him. In death, I held him as I never held him and later my family laughed, he would have mocked my sentimentality as being over the top, they nervously joked, as we picked over an after funeral dinner of tasteless candied yams and dry baked chicken.
But I knew then what perhaps they would never know. I know his secret and in my kiss I wanted to banish it, take its life.

But have I?

I carry the secret now. It is not mine to share. It was never for me to know. But secrets can only live for so long in one mouth. My niece’s tongue and gums grew weary of the weight. So now I write, already weary in the three months since his death, with his secret and shame. I can’t even share the name of the beautiful man that lived quietly with mysteries tangled in his dark curls and in the curve of his smile.

Joyce Angela Jellison is an author, a poet and a spoken word artist. She is also a former journalist and holds a Juris Doctor degree. To read an article she wrote for POZ in 2000, click here.

Read more articles from POZ, here.
  

HIV-Positive Organ Donors Are Now Able to Save Lives


By Matt Terrell
August 29, 2016 
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  Alexandra Harry was diagnosed with HIV in 1989, a time when the disease was a death sentence. Today, with the advent of advanced antiretroviral drugs, HIV (at least for those with access to proper treatment) is more akin to a chronic care condition, like diabetes. As such, Harry has had an undetectable viral load (meaning the amount of HIV virus in her blood falls below what lab tests can detect) since 1999.

But in 2005, she began to experience extreme fatigue, which was diagnosed as end stage renal disease, or kidney failure. Doctors were unable to say whether her renal failure was related to the disease itself or its treatment—either could be the cause. Her only treatment options were an organ transplant or dialysis.

At the time, Manhattan's Mount Sinai Hospital was part of a National Institutes of Health study of organ transplants on HIV-positive patients (using HIV-negative organ donors). Harry joined the study that same year and was admitted to its kidney transplant waiting list.

This May, after 11 years of waiting and dialysis, Harry finally received a kidney. But hers was a kidney from an HIV-positive donor. She received only the second such transplant of HIV-positive tissue into an HIV-positive donor in the United States—the first was at Johns Hopkins University School of Medicine this March—and is the first to publicly share her story.
 
 As of July 29, there are more than 119,000 candidates for organ transplantation on waiting lists, according to the United Network for Organ Sharing. With the arrival of an HIV-positive organ donor pool, HIV-positive patients awaiting organs will be given a new lease on life, and others on the transplant waiting list will receive organs sooner.

"Allowing the transplantation of HIV-positive organs will generate 500 to 2,000 new donors annually and will be the largest increase to the donor pool ever." —Dr. Sander Florman 


South Africa has been performing HIV-positive to HIV-positive transplants since 2008, where 19.1 percent of the adult general population carries HIV, one of the highest rates in the world. While the UK's National Health Service Blood and Transplant agency revealed this May that the country has performed four HIV-positive to HIV-positive transplants over the past five years, the procedure remains in its infancy.

Transplants involving tissue from HIV-positive persons have been illegal in the US since 1988, when amendments to the Organ Transplant Act made such procedures illegal. The policy made sense at the time, given mortality rates for HIV/AIDS in the 1980s and the intense climate of fear surrounding the disease when the law was enacted (its original language evinced a lack of understanding that HIV was the cause of AIDS.) But today, given advances in medical science surrounding HIV and organ rejection, organs and tissues transplanted from well-screened HIV-positive donors are likely to see similar rates of success as those involving other sorts of high-risk patients.

In 2013, with bipartisan support, President Obama signed the HIV Organ Policy Equity (HOPE) Act into law, which allowed the transplantation of HIV-infected organs into HIV-positive patients. Three years later, during which the National Institutes of Health developed safeguards and criteria for such transplants, HIV-positive patients in need of organs now have another option to turn to in the face of dire demand. Such patients still have the option of waiting for HIV-negative organs, as well, and HIV-positive organs will not be used in HIV-negative patients.
Dr. Sander Florman, the director of the Transplant Institute at Mount Sinai, believes transplanting HIV-positive organs into HIV-positive recipients will help everyone awaiting an organ.

"We don't have enough organs, and many people will die on the waiting list before they ever receive a transplant," Dr. Florman told VICE. "Allowing the transplantation of HIV-positive organs will generate 500 to 2,000 new donors annually and will be the largest increase to the donor pool ever. Whenever someone with HIV receives a transplant and is removed from the list, everyone else will have a better chance."

According to Dr. Florman, safeguards in place for HIV-positive to HIV-positive transplants greatly reduce the risk of virus-related complications. He says that patients and donors are selected who have undetectable viral loads; furthermore, donors are screened for resistance to common HIV medicine. For Harry, this meant that her donor had to match her treatment regimen to ensure a viral match. By making sure that donors don't have a more virulent strain of HIV, the theoretical risk of "superinfection" can be reduced.

August is Harry's third month post-transplant, a critical time for patients. The body can potentially reject the new organ, meaning that it views it as a foreign invader, and the immune system tries to eliminate it. Studies of HIV-positive patients who have received HIV-negative organs have shown that, for unknown reasons, they experience transplant rejection at two to three times the rate of HIV-negative patients. Managing an HIV infection and the antiretroviral drugs used to suppress it alongside post-transplant care and immunosuppressants used to help bodies accept new organs presents a dual challenge for clinical teams. Much research and work remains to increase the safety and viability of HIV-positive to HIV-positive transplants; in one study, five out of 27 HIV-positive South African recipients of HIV-positive organs experienced acute rejection episodes, a 19 percent rate. Thankfully, a biopsy revealed that Harry's new HIV-positive kidney is faring just fine in her body.

Despite the HOPE Act, 15 states still have laws making transplanting HIV-infected organs a felony. While eight centers around the country have signed up to transplant HIV-infected tissue, other transplant centers are caught in a legal conundrum where NIH research goals, federal law, and state law aren't aligned.

This leaves individual hospital programs to pioneer initiatives that influence government policy. In May 2016, an HIV-positive patient at UCSF Medical Center had a small window of time to receive a partial liver transplant from his HIV-positive partner. At the time, transplanting HIV-positive tissue was still a felony in California, and Dr. Peter Stock at UCSF asked California governor Jerry Brown for emergency legislation to overturn the law, so he could help the patient without criminalizing his team.

"Patients with HIV on the transplant list move to death much quicker," says Stock. "We need to encourage HIV-positive to HIV-positive transplants. If a young person with HIV dies of trauma, those organs are good. We should use them."

Today, the focus for activists like Dr. Stock is on increased outreach and education within the HIV-positive community about the HOPE Act. For years, many HIV-positive people have thought they were excluded from being an organ donor. With the passage of the HOPE act and pioneering hospitals like Mount Sinai and Johns Hopkins, they finally have the ability to help save the life of their fellow infected—but only if they know such programs exist.

Follow Matt Terrell on Twitter.

Read more articles on VICE, here.
 

Greg Louganis' Stunning Naked Shot for ESPN

Greg Louganis poses nude for ESPN The Magazine's annual Body Issue
Richard Phibbs for ESPN The Magazine

56-Year-Old Diver Opens Up About Living with HIV: 'I'm a Lot Stronger Than I Ever Believed I Was'

 
06/23/2016

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Four-time Olympic gold medalist diver Greg Louganis was diagnosed with HIV at age 28, just six months before competing in the 1988 Olympics.

"At the time I was diagnosed, we thought of HIV as a death sentence," Louganis tells ESPN The Magazine for its upcoming annual Body Issue, in which the retired athlete poses nude. "I was like, 'Well, I'm going to pack my bags and go home and lock myself in my house and wait to die.' "


Louganis kept the diagnosis a secret – "Had they known about my HIV status at the '88 Olympics in Seoul, I would have never been allowed into the country," he says – suffering in silence but staying positive by continuing to train for the games. 


 "The diving was much more of a positive thing to focus on. I did suffer from depression – if we had a day off I couldn't get out of bed," he recalls. "I would just pull the covers over my head. But as long as I had something on the calendar, I showed up ... I've long suffered from chronic depression, so even when I was younger I didn't think I'd see 30." 

Now, nearly three decades later, Louganis – who at 56 is the oldest athlete to be featured in this year's Body Issue – says he feels fitter than most of his peers. The former diver is preparing to head to Rio as an official athlete mentor for the USA Diving Team. But first he sat down with ESPN's Morty Ain to talk about living with HIV, staying in shape at 56 – and that infamous head injury in Seoul.

Louganis made fans around the world wince when he smashed his head into the diving board while attempting a reverse two and a half somersault during the 1988 Olympics. "I heard this big hollow thud and I go crashing into the water and I was thinking, 'What was that?' " Louganis says. "Then I realized, 'Oh my God, that was my head.' "

"My first feeling was embarrassment. I was embarrassed. I was thinking, 'How do I get out of this pool without anyone seeing me?' It's the Olympic Games and I'm supposed to be a pretty good diver and good divers don't do that," he says with a laugh.  


 Just 35 minutes later, Louganis climbed back up the ladder to perform a dive that would qualify him for the finals. Less than 24 hours later, he won the gold medal in the event, cementing himself as one of the greatest Olympians in history.

Louganis' diving career might have been at its peak, but privately he was struggling.


WATCH: Former Olympian Greg Louganis Shares What It Means to Him That Rio Set the Record for Most LGBT Athletes This Year



 "I felt so isolated because of the secrets at that time," recalls Louganis, who is gay. "I was out to friends and family, and everybody in the diving world knew about my sexual identity, but very few people knew about my HIV status. I felt like I was living on an island."

Louganis says he also experienced some discrimination from his teammates, who, he later found out, secretly held meetings about who would room with him when they traveled internationally.

"I ended up rooming with maybe a coach, or maybe they would get me my own room," he says. "There was usually one person on the team that was secure enough in their sexuality that it didn't matter, but no one really wanted to room with 'the f-g.' "

"Things are different now," adds Louganis, who publicly came out during the Gay Games of 1994. "I think we've come to a place of acknowledging bullying and recognizing the importance of standing up for your fellow teammate. I think there is less of that. There is much more sensitivity and people are much more open. Just look at how many athletes have come out now."

Louganis says that living with HIV has helped motivate him "mentally and physically."

"I look at working out and doing something physically active every day as being as important as taking my meds," he says.

"When I look around at my contemporaries, I'd say I'm probably in better shape than most of them," Louganis adds. "It's all about making healthy choices."

"HIV taught me that I'm a lot stronger than I ever believed I was," he adds. "Also, not to take anything for granted. I didn't think I would see 30, and here I am at 56."

ESPN The Magazine's eighth annual Body Issue will be available online July 6 and on newsstands July 8.

 

Richard Phibbs for ESPN

 

More photos from Louganis' shoot


The above story from People

Read more about Greg Louganis at ESPN 

Understanding the Immune System






Submitted on Jun 14, 2016
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Table of Contents



The immune system is made up of cells and organs that protect your body from outside invaders such as bacteria, viruses, fungi, and parasites (types of germs) that can cause infection and disease. The immune system also gets rid of abnormal pre-cancerous cells and cancerous cells that are growing out of control. When it works correctly, it fights off infection and keeps you healthy. However, when it does not work correctly, germs and other abnormal cells in the body can more easily cause disease.



http://www.thewellproject.org/sites/default/files/Understanding-immune-system.pdf




Click above to view or download this fact sheet as a PDF slide presentation



Key Organs of the Immune System


The first line of defense against germs is your skin, the single largest organ of the body. It provides a physical barrier that keeps bacteria and viruses from entering the body. Viruses such as HIV cannot get through normal, healthy, unbroken skin. HIV can, however, get into the body through unbroken mucous membranes, which are the moist membranes of the vagina (birth canal), rectum, and urethra ('pee hole').  


Germs that get inside the body are taken care of by the internal parts of the immune system. The white blood cells that defend the body from invaders and get rid of possibly dangerous abnormal cells begin their lives in the bone marrow. Once they leave the bone marrow, they travel to the lymph organs, which serve as a home base for mature white blood cells. There, the white blood cells await instruction to go out and fight infection.

Lymph organs are spread throughout the body and include the lymph nodes, thymus, spleen, appendix, tonsils and adenoids, and clumps of tissue in the small intestine known as Peyer's patches. Lymph nodes are located in the neck, armpits, abdomen, and groin. Each lymph node contains cells ready to fight invaders. 

The lymphatic vessels connect the lymph nodes and carry lymph, which is a clear fluid that "bathes" the body's tissues and helps to clean out invaders or germs.


The spleen is an important organ for a healthy immune system. It is about the size of a fist, and it is located at the upper left of the abdomen. One of its key roles is to filter blood and to identify and get rid of worn-out white blood cells.



Key Cells of the Immune System



Some key cells of the immune system are:

  • Neutrophils
  • Dendritic cells and macrophages
  • Helper and Killer T cells
  • Natural killer cells
  • B cells

Neutrophils

Neutrophils are one of the "first-responders" in the body's response to infection. Normally, you have more neutrophils than any other type of white blood cell. They circulate in the bloodstream and are your main defense against bacteria. They eat bacteria and produce toxic chemicals that destroy them. These are the cells that give pus its whitish/yellowish color.


Dendritic Cells and Macrophages


Dendritic cells are found mostly in the skin and mucous membranes that protect the openings of the body (e.g., nose, mouth, and throat). These cells capture and carry invaders to the lymph nodes or spleen. Macrophages (their name comes from Latin and means "big eaters") protect different organs, including the intestines, lungs, liver, and brain. Like dendritic cells, macrophages capture and carry invaders to the lymph organs.


These two types of white blood cells are known as scavengers. They engulf (eat) foreign invaders, break them apart, and display pieces of the germs—known as antigens (from antibody-generating) —on their surfaces. The body can then make antibodies to that specific germ, which helps the body get rid of that invader faster and remember it in the future. These cells also produce chemical messengers (known as cytokines) that instruct other immune cells to go into action.


T Cells


Once antigens are processed and displayed on the surface of macrophages, they can be recognized by helper T cells (also known as CD4 cells). When CD4 cells "see" the antigens displayed, they get busy and put the word out to other immune system cells. In other words, these cells coordinate and direct the activity of other types of immune cells—such as killer T cells, B cells, and macrophages—calling them into action to fight the intruder. CD4 cells produce many different cytokines in order to communicate effectively with other immune system cells.


Killer T cells directly attack and destroy cells infected by viruses as well as abnormal cells that may become cancerous. Suppressor T cells call off the immune system attack once the invader is conquered. This is to make sure the killer T cells stop killing once their job is done. Both killer T cells and suppressor T cells are also known as CD8 cells.


Natural Killer Cells


Natural killer, or NK cells also destroy infected or abnormal cells. NK cells are an important part of the early response to viral infections because they kill cells infected by virus while the body is recruiting killer T cells into action.


B Cells and Antibodies


B cells are another type of immune cell that is activated by CD4 cells. When a B cell recognizes an antigen, it goes into action and produces antibodies (also called immunoglobulins). An antibody is a protein that attaches to an antigen like a key fits a lock. Each antibody matches a specific antigen. When an antibody has matched up with an antigen, it has marked the intruders for destruction by scavenger immune cells. Antibodies also activate a complex chemical reaction that destroys bacteria by punching holes in their outside surface (the bacterial membrane), which kills them.


When you are exposed to a germ for the first time, it usually takes a while (several weeks to a few months) for your body to produce antibodies to fight it. But if you were exposed to a germ in the past, you will usually still have some B cells (called memory cells) in your body that recognize or 'remember' the repeat invader. This allows the immune system to go into action right away. This is why people get some diseases, such as chickenpox or measles, only once. They may get chickenpox or measles germs in their bodies more than once, but their bodies remember the germs and react so quickly that they do not get sick.


This is also how vaccines work— they introduce your body to an inactive form of a particular germ and trigger your immune system to produce antibodies to that germ. The inactive form prevents you from getting sick while still allowing your body to make important memory B cells. This is why the expression "vaccinated against" some disease (e.g., smallpox) is used.



HIV and the Immune System



HIV attacks immune system cells called CD4 T cells. With a healthy immune system, the body responds normally to this new infection by producing antibodies to HIV. However, the antibodies your body creates in response to HIV do not protect you against HIV like antibodies for other infections. Instead, HIV turns the CD4 T cells that would kill it into factories for making more copies of itself. This is why, in the case of HIV, being antibody positive does not mean you are protected, but rather that HIV is weakening your immune system and using it to make copies of itself.


As HIV reproduces, it damages or kills CD4 cells. Over time, the virus decreases both the number and type of CD4 cells. Without CD4 cells organizing the rest of the immune system, important immune cells do not know which invaders need to be removed from the body. When the immune response is not properly activated and organized, people are at risk for opportunistic infections (OIs) and cancers that usually do not harm people with healthy immune systems.


HIV can also infect macrophages and other immune cells. Your immune system recognizes and produces antibodies to HIV, but antibodies alone are not enough to eliminate the virus. This is partly because HIV changes or mutates faster than the immune system can respond to it.


HIV persists in the body by forming a "reservoir." The HIV reservoir refers to a collection of inactive, ‘resting,’ or latent HIV-infected cells. Researchers have reported evidence suggesting that HIV-infected cells can persist and expand by genetically cloning or copying themselves. In other words, elimination of HIV in the body (complete cure) will require not only that HIV be eliminated from the bloodstream, but also that we find a way to prevent these latent cells from multiplying or empty the reservoirs altogether.


There are several known reservoirs, including immune cells in the gut, lymphoid tissue, blood, the brain, the genital tract, and bone marrow. It is unclear when reservoirs are established, but recent research suggests that it could be as early as 24 hours after initial infection.


Other problems may result from limiting the activity of the bone marrow, which can occur as a side effect of certain HIV drugs like Retrovir (zidovudine). Since the bone marrow is where immune cells are produced, if its activity is reduced you may have lower numbers of immune cells available, which again may cause you to be more vulnerable to infections.


The good news is that early treatment with a combination of HIV drugs can minimize the size of the reservoir. In addition, newer HIV drugs have fewer side effects and are more effective at stopping the virus from multiplying (making copies of itself) and infecting more CD4 cells. Since CD4 cells are key to a healthy immune response, this can give your immune system a fighting chance to replenish its supply of CD4 cells and to defend itself (you!) against opportunistic infections.

Read more articles from The Well Project, here.