🏳️‍🌈✝️ Taking Back My Power

By Paloma Cole

From HIVE

 

May 31, 2017

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Paloma Cole (Credit: Selfie by Paloma Cole)

I first heard about PrEP when I was still married, both of us are HIV negative and we were monogamous at the time, so I wasn't really interested.

My marriage ended, and after some time on my own, I was ready to put myself out there and get back into the swing of things. I am a very sensual woman, and I love sex which was honestly one of the reasons my ex and I were not truly compatible, he always had a lower libido then me and had a lot of issues and shame around his sexuality. So it's good for both of us to move on.

At first, I treated my encounters with men with the same trust or casualness that I did in a monogamous relationship, I don't think I understood how big the transition from being in a seven-year monogamous relationship to having multiple partners would be.

My good friend and social justice ninja is very vocal in her career as part of empowering women to make good choices for themselves and taking care of their bodies and their health. I learned first from her about PrEP, and over the years my circumstances changed to where it could be a smart choice for my health and self care. If I want to be a strong, independent woman then I have to be smart about my health and my body as it affects my life, my partners and even my children.

The awareness people have around HIV, and what we now know, has changed so much and the idea that taking a pill can actually protect you from contracting the virus is hard to believe.

I grew up very privileged in San Francisco, I went to all private schools and most of the people I knew when I was in school were wealthy and had everything they needed. I have since seen a lot of suffering, sickness and addiction across the board. I have seen people get sick quickly and die. The truth is, that no matter who you are and where you come from, anyone can get sick and struggle, sometimes never to recover. I have known IV drug users who never were able to get sober and a few of them did contract HIV and were not able to manage their health to where they could get better. It is a sad thing to look upon and to look back on.

I have never had any kind of STD, I've had mostly monogamous relationships and especially after getting married and having children, I didn't think I would be considering something like a pill to protect against HIV. When I consider what I first learned about HIV as a teenager, this would seem impossible.

The thought I had was, why isn't a condom enough? I'm being responsible and being careful, why should I need a "back up?"

When I sat with it, I realized with surprise, there is some shame around it. To begin with, I have to take medication on a daily basis for other reasons (depression), and I really did not want to add another pill to the mix. I also had this idea that, well, I would never fool around with someone who might have HIV. Another thought I had was more of a judgement of myself, that somehow taking this step and taking a pill every day to prevent contracting HIV makes me promiscuous somehow. 
For me, it's not something I would share with people but it would mean acknowledging that I'm having sex with multiple people at this time in my life and I'm going to keep doing it.

My mother is very critical, and we have an unusual history of abuse in my immediate family, I will not go into detail but it's there. She is South American, and my dad is English. Both came to this country before I was born. There is some repression on both sides, on the English side more of the stuffy, not sharing feelings or acknowledging the body, and on the Latina side, quite a serving of Catholic guilt and misogyny.

I have been through some sexual violence as well. I was slipped a rufi when I was 21 by my boyfriend at the time and his friend, and I was raped when i was 27. I still have a feeling of shame and that maybe there is something I could have done to stop it or prevent it.

Any kind of trauma, though this kind of situation is very common, is hard to work through.

Ultimately, for me, PrEP is about taking back my power. To take back my power and take ownership over my body. With this awareness I want to make positive choices for myself and walk through whatever fear I have.

I am very heartened to hear other women and men share similar stories. I am grateful for the people in my life who have supported me, held space for me, and inspired me through their own journeys, with their own stories.

Paloma Cole lives in Miami with her two kids.

 Read more articles from theBody, here.

🏳️‍🌈✝️ This Week in HIV Research: Predicting Long-Term Undetectable Viral Loads; and Spontaneous Controllers of HIV

By Warren Tong and Barbara Jungwirth

From TheBodyPRO.com

 

May 30, 2017

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This week, a study finds that people with HIV who achieve an undetectable viral load with their first regimen may never experience viral rebound. Another study finds that spontaneous controllers of HIV are more likely to be African Americans or women. And a modeling study suggests that the U.S. can still achieve the United Nation's 90-90-90 goals by 2020. To beat HIV, you have to follow the science!
 

Initial Viral Suppression Predicts Long-Term Undetectable Viral Load

People living with HIV who achieve viral suppression on their first antiretroviral treatment regimen may well never experience viral rebound, an analysis of data from the UK CHIC study published in The Lancet HIV showed.

 
Viral suppression was defined as a viral load of < 50 cells/mL, and rebound as at least one measurement of > 200 cells/mL. The overall rate of first viral rebound was 7.8 per 100 person years, but almost 30% of these were temporary viral "blips." Researchers calculated the likelihood of durable detectable viral load for various scenarios, arriving, for example, at a 1% chance for men who have sex with men and are at least 45 years old.

Longer duration of undetectable viral load, older age, more recent treatment start, and antiretroviral initiation at lower viral loads were all associated with a reduced risk of viral rebound. Conversely, sub-Saharan African origin slightly increased that risk. Study authors hypothesized that this may be related to socioeconomic conditions in that group.

Related: This Week in HIV Research: Can 2-Drug Treatment Regimens Become the New Gold Standard?
 

Majority of Spontaneous Controllers of HIV Are Women or African Americans

African Americans and women are more likely to control their HIV without antiretroviral treatment than are other demographic groups, a review of medical records published in AIDS found.

Researchers reviewed the records of more than 45,000 people living with HIV in the greater Los Angeles and Miami areas. They analyzed close to 30,000 of these for people whose viral load was below 50 RNA copies/mL for at least one year without treatment. Only 53 people fit that description. Almost half of these viral controllers were women and over 60% were African American. This corresponded to 0.58% of all women and 0.33% of all African Americans in the cohort, compared to 0.18% among all 30,000.

The frequency of viral "blips" predicted whether these spontaneous controllers' HIV durably returned to detectable levels. Results suggest that controlling HIV without antiretrovirals is "an extreme along a continuum of HIV-1 infection" and not qualitatively different from having undetectable virus while on treatment, study authors concluded.

U.N. 90-90-90 Goals Achievable in the U.S.

The U.S. can achieve the United Nation's 90-90-90 goals by 2020, a mathematical modeling study published in American Journal of Preventive Medicine showed.

These goals stipulate that 90% of people living with HIV know their serostatus, 90% of those living with HIV are on treatment, and the virus of 90% of those on treatment is below detectable levels. For 2030, these targets are 95-95-95. In the U.S., this translates into a maximum of 21,000 annual seroconversions by 2020 and no more than 12,000 per year by 2025.

Study authors noted that the first two of the 2020 goals have already been met in New York City, and the third goal has been achieved among white people in that city. However, to reach these targets nationally, "pernicious health disparities" among regions, races/ethnicities, and sexual orientations must be eliminated, they added. Authors called for real-time epidemiologic tracking and expanded implementation research to help guide the allocation of resources for HIV prevention and treatment.

Extracellular Vesicles Help Spread HIV in Body

A protein that facilitates the spread of HIV in a person is also carried by extracellular vesicles (EVs) that are released by HIV-infected cells, a study published in Scientific Reports found.

The protein, gp120, was previously thought to be carried by virions. Researchers devised a new method for separating EVs from other material by using magnetic forces. They then tested HIV preparations with and without EVs on human tissue in vitro and found a 50% reduction in infection when EVs were not present. Further experiments showed that EVs carrying gp120, in particular, facilitated the spread of HIV among cells.

"If we remove extracellular vesicles from HIV laboratory preparations, we also reduce HIV infection of human tissues in culture," study author Leonid Margolis, Ph.D., of the National Institutes of Health explained in a related press release. New anti-viral strategies could target these EVs to intercept the transfer of viral material to new cells, study authors concluded.
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Read more articles from theBodyPro, here.

 

🏳️‍🌈✝️ Inovio’s HIV Vaccine Prompts Excellent Response in Early Trial

 Nearly all those vaccinated had CD4 immune-cell responses, and the majority had CD8 immune-cell responses.

May 31, 2017


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An early trial of Inovio Pharmaceuticals’ experimental HIV vaccine showed considerable success in prompting immune-cell and antibody responses to the virus. Nearly all those who received the four-dose vaccine, which was paired with an immune activator, developed a CD4 immune-cell response, and a majority developed a CD8 immune-cell response to HIV; almost all produced HIV-specific antibodies.

The randomized, placebo-controlled multicenter Phase I HVTN 098 trial included 94 HIV-negative participants, 85 of whom were randomized to receive the vaccine, known as PENNVAX-GP, and nine of whom were randomized to receive a placebo. The trial is supported by the HIV Vaccine 

Trials Network (HVTN) and the National Institute of Allergy and Infectious Diseases (NIAID).

Findings were presented at the 2017 HVTN Spring Full Group Meeting in Washington, DC.

PENNVAX-GP includes four HIV antigens, or viral proteins, that apply to multiple strains of the virus seen worldwide. The vaccine has been constructed to prompt both antibody and immune-cell responses, with the goal of using it to prevent and even treat HIV. Given in four doses, the vaccine is combined with a DNA-encoded immune activator known as IL-12.

Participants received the vaccine either through injections into the skin (intradermal) or the muscle (intramuscular). The intramuscular dose was one fifth that of the intradermal.

Ninety-three percent (71 of 76) of the participants for whom there was evaluable data developed a CD4 or CD8 immune-cell response to at least one of the four vaccine antigens, including those known as env A, env C, gag and pol. Ninety-four percent (62 of 66) of evaluated participants produced antibodies specific to HIV’s outer casing, or envelope. None of the nine participants who received the placebo developed an immune-cell or antibody response to the vaccine.

Ninety-six percent (27 of 28) of those evaluated who received the vaccine intradermally developed an immune-cell response and 96 percent (27 of 28) developed an HIV-envelop-specific antibody response. One hundred percent (27 of 27) of those evaluated who received the vaccine intramuscularly demonstrated an immune-cell response, and 90 percent (19 of 21) developed an antibody response.

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

 

Read more articles from POZ, here.

 

🏳️‍🌈✝️ Growing Up on PrEP: Evan J. Peterson's PrEP Diaries and the Call to Confront Outdated Fears of HIV

By JD Davids

  From TheBody.com

 

May 30, 2017

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Evan J. Peterson (Credit: Selfie by Evan J.
Peterson)

Evan J. Peterson's The PrEP Diaries is a charasmatic exploration of the life of one middle-class white gay man in the United States. In a series of achronological funny-to-painful stories, vignettes, interviews and musings, Peterson shares how pre-exposure prophylaxis (PrEP) changed not only his current-day sex practices but also his own understanding of his personal sexual trajectory after a 1980s childhood. Peterson told TheBody.com that he added the subtitle A Safer Sex Memoir to the book because it's about how he negotiated safety with sex his whole life -- experiences ranging from awkward dating as a youth, sexual assault, embracing relationships with people with HIV, and, most pervasively, anxiety about HIV infection that often vastly exceeded his actual risk as a condom-using top.

"I had to commit to honesty in my book," Peterson told TheBody.com. "And the thing is, I know that the PrEP conversation is revolving around things like condomless orgies. That's not what turns me on.

"I don't think I'm a statistical outlier," he added. "I think there's a lot of us -- especially with our sexualities shaped by the AIDS crisis -- who don't fit the stereotypical profile of 'dude who likes it up the butt.' And I just wanted to be really honest about what I actually do."

In this highly readable but often painfully honest memoir, Peterson re-examines his life from a new standpoint: Now on PrEP and at effectively zero risk of HIV, he examines the crushing concerns about HIV acquisition he's had his whole life.

Peterson also explores the complexities of HIV denialism (including conversations with a beloved family member who passionately believes that HIV doesn't cause AIDS), the intersection of sexuality and spirituality, and online cruising (in addition to its PrEP theme, the book could also serve as an engaging primer for those seeking to understand the new world of hookup apps).

When Peterson began having nightmares of becoming HIV positive, several months after starting PrEP, he sees the powerful "cultural paranoia" that still remains in his psyche. The book pivots from this personal experience to a powerful call to unroot societal stigma against HIV in a full-chapter "interlude," in which Peterson delves into these nightmares and their pervasive cultural roots.

He calls on today's gay communities to take their next collective step forward to confront and expel outdated ideas of what it means to prevent or live with HIV -- just as earlier generations (including today's long-term survivors and allies) confronted the challenges at the emergence of HIV as an epidemic. You can read a full chapter in this excerpt of The PrEP Diaries.

Evan J. Peterson (Credit: Selfie by Evan J.
Peterson)

Chapter 7: Interlude (Waking Up)

The nightmares came and went for a few months. I don't know how many dreams; I had at least three, perhaps many more that my sleeping brain absorbed and didn't convert to waking memory.

As I recall, they didn't begin until two or three months into my PrEP regimen. Once they did, they distressed the hell out of me. The ones that made it out of my hippocampus were disparate, but they all followed the same basic pattern:

I'm with others. Sometimes they're friends, sometimes a doctor or a nurse. I receive the news I'd dreaded for years before getting on PrEP: Your test came back positive. You have HIV.

In these dreams, I've been on Truvada long enough to have that 99% effectiveness rate. I panic.

But I was safe -- I don't even have much anal sex -- I'm always the top -- I always use a condom -- How is this possible?

In dreams, all is possible. Things don't behave the way I expect them to. In dreams, I see written words, but I can't read them, and it's like being suddenly struck with dyslexia or some aphasia. I can't read what the doctor wrote down, or what's on my computer screen in my test results, but I know it means I'm HIV positive.

Sometimes I think, Ah! I bet I'm dreaming. Wake up, Evan. But dreams are tricky. Sometimes I get caught in a dream loop, a series of scenes in which I realize I'm dreaming and I wake up, even get out of bed, but I'm still in the dream. It's like the curse that Neil Gaiman's Sandman, Morpheus, inflicts upon those who've crossed him. They're doomed to eternal waking, only able to wake up inside yet another nightmare.

In dreams, there's an oversimplification of symbols, or else a confusion of them. The certainty of my recurring PrEP nightmares is that, despite my best efforts, despite religious swallowing of daily Truvada and using condoms and cutting down on other risk factors, I still end up HIV positive. The panic leads to a desperate inventory of the past few months, trying to figure out what went wrong.

Did I forget to take it one day, or several days in a row? Who did I have sex with recently? Did I somehow have unprotected sex and not even remember it? Was I drugged and raped? Did I step on a dirty syringe? Did I check a payphone coin return and get pricked by a trap needle?

After I wake up into this external world and not just another dream, the feeling of panic and desperation lingers for a few minutes, coupled with that sense of being responsible for my own blunder. Don't most people feel this after a particularly emotional dream?

As my friend Anthony, a psychotherapist, says about the content of dreams, "Your Superego isn't there to lecture your Unconscious." My Superego is one version of myself, a story of who I'm supposed to be. My Unconscious, however, can't give half a shit about that story.

I don't know how much waking life feeds into our dreams, or for that matter how much our dreams steer our conscious choices and reactions. What I do know is that dreams are both irrational and ultra-rational. Sometimes dreams make no sense at all, but sometimes they simplify everything down to yes/no, live/die, escape/suffer.

When I have a nightmare in which I've contracted HIV despite taking multiple scientifically-proven precautions, I'm not thinking about how shitty it is for me to consider HIV one of the worst things that could possibly happen to me. I'm not thinking about my poz friends who are healthy, happy, and living long lives. In nightmares, I don't stop to think that my health is protected by insurance, and that I should be grateful for my middle class advantages.

In real life, HIV and its treatments are remarkably less destructive than they were 30 years ago. 
In real life, people with access to proper health care are rarely collapsing into gaunt, lesion-riddled victims right in front of us. In real life, people aren't burying half their friends and praying that the plague won't get them, and American children aren't contracting HIV from blood transfusions.

My unconscious doesn't live in "real" life. My unconscious is a horny, judgmental, nervous teenager with a churning imagination. Thank goodness she doesn't have a credit card. This is why I don't take Ambien.

The payoff of the nightmares is in what I can learn and how I can grow more resilient. The PrEP-failure terrors teach me that I am indeed still affected by the common fears that people blast onto the internet. That cultural paranoia remains with me, albeit overpowered by the optimistic, rational, and informed sections of my mind. While I can articulate the scientific facts, the successful studies, and all the people I've met who haven't contracted HIV since getting on PrEP -- even after dropping other forms of precaution -- I know that deep in my childlike unconscious mind, I'm still banging my head to Marilyn Manson songs and fearing that sex will kill me.

That's what we're really talking about here: the lingering, widespread fears that HIV is the same thing as AIDS, that HIV is inevitably deadly, and that unprotected sex will kill us. Even failed attempts at protected sex will kill us. A condom breaks, a bitten lip or canker sore creates an open wound in the mouth, and your clock begins to tick.

The gay community has to grow up at this point. I can't speak for straight people here. They have their own way of working out HIV, which varies further along racial and economic lines. But I can speak for gay dudes, at least for the middle class with health care access: We have to grow up when it comes to PrEP and HIV.

Our emerging culture found the opportunity to grow up when the virus first became understood, and we did grow up some. We were forced to look out for one another, to advocate for one another, to have uncomfortable conversations that would help and protect one another. We sacrificed some immediate gratification and comfort for the greater good, individually and as a community.

Maybe we stopped there. Maybe we backslid, made mistakes, got frustrated. Maybe we stopped using condoms, started again, figured out whether we wanted monogamy, polyamory, abstinence, open relationships, or orgies. The older generation of queers did a great job of keeping the community strong through the trauma. Gay culture across the world grew up a lot. Now, we need to keep growing.

America, as a nation, had to grow up after September 11. Our tumultuous cultural adolescence of the 20th century resulted in a wariness of authority and conformity. September 11, however, meant another national growing-up was needed. Like a recently legal adult going off to college and getting blindsided by a sexual assault, the collective psyche of our culture needed to deal with this trauma and figure out what kind of culture to be in the aftermath. Clearly, we're still working on this: war, racism, and doomsday cults are as old as human tribes, but we've found new ways to keep them fresh and glamorous since 9/11.

The international gay community, on the other hand, already went through our personalized September 11, but it lasted 20 years. This applies to the rest of the queer community as well: even though lesbians weren't contracting HIV at anywhere near the rate of men who have sex with men, lesbians still buried their friends and dealt with the homophobic fallout of AIDS. Trans and bisexual folks can fall into all the previous categories and more; don't fail to recognize them or the fact that trans people often get the worst of whatever's directed at the gay community, whether they're gay or not. Even through all of this, our shared community has survived and flourished.

In the past few years, more and more queer people in the world have received the human rights of marriage, health care, and safer schools. Queer and trans people are showing up more and more often in the media, but less and less often as villains, clowns, and victims.

Now, we have Truvada. Instead of a tragedy that necessitates maturity, the gay community is now facing an opportunity to keep growing up after a scientific breakthrough. Straight people went through this with the birth control pill. We're going through it with PrEP.

I don't want to live in an adolescent world of fears about what will happen if I have sex. I want to live in the reality of information, education, and confident decisions. I want to live here, now, where I have every advantage to prevent HIV while still having healthy, intimate relationships. We're finally there.

Read more articles from theBody, here. 

🏳️‍🌈✝️ My Close-Knit Latino Family Helped Me Beat Drug Resistance

Dealing with HIV treatment got a lot easier with his mom by his side.

By Diane Anderson-Minshall

 

May 31 2017 

 

 

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Growing up in Orange County, California, the child of Latino immigrants, Jorge Diaz learned early that “I came from a different social class and … [to some] being Latino meant being inferior.”

His parents never took government assistance, even as they struggled financially. “My parents built everything they now have from nothing. It created this sense that we must do it on our own.”

The insistence on self-reliance was so engrained, he didn’t seek help even when he learned he had HIV. But as a 21-year-old college student and go-go dancer with no insurance, he was terrified. 

Now a mental health and substance abuse program manager with Bienestar, a social service health organization for Latinos in Southern California, Diaz shares his story to educate others and combat stigma and shame.

In 2001, Diaz says, “I viewed HIV as a death sentence. I felt a sense of loss — loss of health, loss of identity. The shame I brought upon myself, the fear of being rejected by my peers … or being viewed as a disappointment to my parents and family — was all going through my head.”

He was afraid of a paper trail, too. “What I heard from that [first doctor’s visit] was, ‘If you want to be invisible with your HIV, clinical trials are the way to go.’ Looking back, I simply feared being outed.”

He took the advice and enrolled in a clinical trial. “It was the worst experience of my life. It was my first regimen; in a sense, my first step into the world of HIV. Managing the side effects became overwhelming; Sustiva was not an easy medication for me. It truly gave me horrible side effects. The vivid dreams caused me to have insomnia and the insomnia impacted so many aspects of my daily functioning.” 

Yet every night he’d go to the club to dance, and escape into an alter ego who was the center of attention. “[Dancers] are idolized and sexualized by many,” Diaz admits. “It was like living a double life. On one hand, I was desirable and sexy. However, when the lights went off, the crowd went home and the club closed, I was simply another HIV-positive guy.”

Looking back, he admits, “I wanted to be liked by those who didn’t even know me. I wanted to be loved by all the wrong men. I felt ashamed of myself, yet I wanted to be desired.”

Five months into his clinical trial, his treatment failed, which later impacted his treatment options. 
He wasn’t able switch to Atripla, the once-a-day regimen, when it came out because Sustiva was one of the drugs included in the regimen. “I soon realized how many new drugs are, at times, a combination of a new drug with an old one,” he says.

Six months after that treatment failure, Diaz finally came out to his mother. “It was the hardest thing I ever had to do, but I couldn’t manage the secret anymore. We both cried. We both held each other … Then, my mother stopped crying. She looked me in the eyes, grabbed [my] hand, and said, ‘We are going to be OK, and we will fight together.’ And indeed, we have. My mother was instrumental in my fight against HIV.”

With her support, Diaz had success with his second regimen and eventually earned a master’s degree. “Graduate school allowed me to work on me and process unfinished business. It was an amazing opportunity that paved the way to begin to heal … and forgive. Forgiveness truly set me free.” 

He choose social work to help guys like him. “I wanted to provide the space for individuals to process how HIV has impacted [them] …and identify healthy coping skills and tools during this life changing experience. There is shame and stigma associated with mental health. I wanted to be part of that change, be part of the solution.”

Having overcome so much, Diaz now talks about his “amazing life,” full of nieces and nephews to whom he is godfather. Next he plans a series of books on the Latino LGBT community and maybe “running for office — and winning!”

Read more articles from PLUS, here.

 

🏳️‍🌈✝️ Philadelphia Mourns the Unexpected Loss of a Harm Reduction Advocate

“I think it makes people much more humble about how challenging addiction is and how challenging recovery is,” said Silvana Mazzella, of Prevention Point, a harm reduction group Yabor had been involved with.

 

POZ NEWSFEED

May 30, 2017

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Philadelphia’s harm reduction community is mourning the unexpected loss of Paul Yabor, an HIV, hepatitis C virus (HCV) and addiction-treatment advocate who had devoted his life to serving people in recovery. Yabor was 55 years old and died of an apparent overdose, Newsworks reports.

Born and raised in Philadelphia, Yabor’s personal struggle with addiction began in the 1980s, during which time he was diagnosed with AIDS and later, while serving time in prison, hepatitis C. In response to the diagnoses, Yabor became an activist with ACT UP and several harm reduction groups across the city. 

Yabor lobbied the U.S government for the rights of people living with HIV/AIDS and advocated for expanded access to hepatitis C treatment, needle exchange services for people who use drugs and overdose prevention. He also helped lead the campaign to create the Philadelphia Land Bank, a program that helps simplify the city’s acquisition and sale of vacant land for housing and other community projects.

Yabor’s friends, family and fellow advocates say his death in the midst of Philadelphia’s ongoing opioid epidemic comes as a complete shock and serves as a reminder of all the work that still needs to be done to help support people in recovery. 

According to the Philadelphia medical examiner’s office, Yabor died of an overdose while alone near a site popular among injection drug users where he had helped others many times.

“I think it makes people much more humble about how challenging addiction is and how challenging recovery is,” said Silvana Mazzella, of Prevention Point, a harm reduction group Yabor had been involved with. “It really tells me we need to break down stigma; we need to make it an open door when you are using, an open door when you relapse and really support people.” 

Read more articles from POZ, here.

 

🏳️‍🌈✝️ Why Can't I Stop Barebacking?

When it comes to sex, people often throw caution to the wind.

By Gary McClain

 

May 30 2017

 

 

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Don’t judge me. I’m HIV-negative and I love barebacking. It is so intense that it is almost a spiritual experience for me. I have to admit I feel kind of guilty afterwards. But then the next time I have an opportunity to go bare, I do it again. I’ve heard the safe-sex lectures, okay? 

 

So, no safe sex lectures allowed? That’s like asking me to respond with one hand tied behind my back. While I will do what I can to avoid the lecture, I am going to bring in a couple of different perspectives to answer your question. I'm going to assume that you don't know your sexual partners' HIV status of if they are HIV-positive that they are not undetectable (that is on treatment, with undetectable viral loads to the point where you cannot contract HIV from them). You wouldn't ask this question if you knew the sex you were having was safe.

I am going to start by asking you to imagine we are sitting across from each other in my office. I’ll be wearing my unfashionable cardigan sweater, the therapist uniform. I will start with a story.

When I was about 14, my Sunday school teacher took it upon herself to discuss the sins of the flesh with a class of teenage boys. Brave, right? Or maybe just naïve. What I remember the most was when she told us that “nothing feels better than skin on skin.” And while at that age I hadn’t actually experienced anything close to what she was referring to, I recognized the power of these words and have continued to over time. 

Of course, “skin on skin” has special meaning in the age of HIV, particularly around the role of condoms. I don’t think anyone would dispute that having sex without a condom feels pretty good. I certainly don’t judge you for not loving having to suit up for sex. 

However, as a therapist, I have a couple of questions I ask my clients when I am talking to them about barebacking. The first question is: How much do you love yourself? Admittedly, that is not such an easy question to answer. The question that follows is probably pretty obvious: Do you love yourself enough to take the best possible care of yourself?   

If we were talking together and I asked you these questions, how would you answer? 

My goal is not to back you into a corner. But I do want to encourage you to consider what it means to have risky sex. Sure, it feels really great at the time. Maybe even so mind-blowing it feels like a spiritual experience. And in the heat of the moment, it’s hard to deny yourself something that you enjoy so much.   

But it also sounds like you’re having some second thoughts about the choices you are making, otherwise you wouldn't have written to me. And I’m wondering if the enjoyment in the moment isn’t being overshadowed by the concerns about the potential risk to your health that are also coming up for you. Risks that include not only HIV, but other sexually-transmitted infections which are on the rise right now.

I encourage you to listen to that inner voice that is questioning the wisdom of bareback sex. Maybe that’s your voice of self-love talking to you. Don’t use it as a way to criticize yourself or scold yourself, or to make yourself feel guilty. That’s not helpful at all. 

But instead, I encourage you to focus on my first question. How much do you love yourself? And then think about what you can do to manifest your self-love. Create a vision of you acting on your self-love by taking the best possible care of yourself, physically and emotionally and spiritually. Get specific with yourself on what that would look like in your life.

With that vision in mind, it is both my belief and my experience that doing right by yourself becomes second nature. Sure, the choice is still there. But the answer is also clearer. 

Next, I am going to ask you to imagine that you are speaking with my alter ego, an individual wearing a tee shirt, with a trendy haircut and very cool glasses. My alter ego just happens to be an HIV educator (who also promises not to lecture you). 

I'm going to discuss PrEP with you, just in case you’re not educated on PrEP. At the risk of lecturing you, or of stealing the HIV educator’s thunder, let me just say that while PrEP (the HIV prevention treatment) won’t completely take away the risk of becoming HIV-positive, it lowers your risk by 99 percent. There've only been two verified cases where a person has become HIV-positive while using PrEP properly. Both cases involved rare mutated strains of HIV. (A third case, thus far, appears to be lack of adherence, which is a reminder that like condoms, if not used properly PrEP cannot ensure your safety.)

You can learn more about PrEP from these short videos here and here.

But before I go, please indulge me one last time. I just need to add that unsafe sex can be a form of self-destructive behavior. If you had trouble answering the question about loving yourself, or if you find yourself getting involved in unsafe sexual situations as a way of coping with feelings like fear or anger, or with loneliness, then it may be time to do some shrink shopping. What you are experiencing is treatable through working with a mental health professional. Don't go through this alone. 

Take good care of yourself, my friend.

Read more articles from Plus, here.
  

🏳️‍🌈✝️ FDA Approves New Once-Daily HIV Med Isentress HD

Until now, Isentress (raltegravir) had been available only as a twice-daily drug.

May 30, 2017


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The FDA has approved a new once-daily version of Merck’s antiretroviral (ARV) Isentress, known as Isentress HD.

Treatment with Isentress HD entails taking two 600 milligram tablets once a day, compared with taking 400 mg of Isentress twice daily. The new drug has been approved for use in combination with other ARVs to treat HIV in adults and pediatric individuals of at least 40 kilograms (88 pounds) who are new to treatment for the virus or who have an undetectable viral load thanks to treatment with twice-daily Isentress. Isentress HD can be taken with or without food.

The FDA approval was based on data from the ongoing multicenter double-blind, randomized, active comparator-controlled Phase III ONCEMRK trial, which showed comparable efficacy and tolerability between Isentress HD and Isentress. The participants, first-timers to HIV treatment with a viral load of at least 1,000, were randomized to receive Truvada (tenofovir disoproxil fumarate/emtricitabine) plus either Isentress HD or Isentress.

After 48 weeks of treatment, 89 percent (531 participants) of those who received Isentress HD had a fully suppressed viral load, compared with 88 percent (266 participants) of those who received Isentress.

Adverse health events occurring in at least 2 percent of participants receiving either version of Isentress, included abdominal pain, diarrhea, vomiting and decreased appetite.

Less than 1 percent of those who received Isentress HD developed mutations in their virus that led to any drug resistance.

The two versions of Isentress will be priced the same. Isentress HD should be available in pharmacies in about four weeks.

To read a press release about the FDA approval, click here.

Read more articles from POZ, here.

  

🏳️‍🌈✝️Interconnected, Intertwined, and Colliding: Co-Occurring Epidemics of HIV, Viral Hepatitis, and Opioids

Richard Wolitski

May 30, 2017 • By Richard Wolitski 

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I have to admit it. I’ve been feeling a little daunted about how much ground we have lost to the opioid epidemic as we struggle against viral hepatitis. We had been seeing progress against hepatitis C virus (HCV) and hepatitis B virus (HBV), but the invasive spread of the opioid epidemic has changed that. Last week, CDC released new data showing that new HCV infections nearly tripled in the past 5 years, largely as a result of opioid-related injection drug use.

But even on the darkest days, there are moments when you are re-energized and reconnect with your purpose for doing this work. I had one of those moments recently, when I was able to join many of our nation’s top policy makers and leading voices in the response to the opioid epidemic at the 2017 National Rx Drug Abuse & Heroin Summit, which was held in Atlanta in late April. 

These leaders included the heavy hitters like Dr. Nora Volkow, the Director of the National Institute on Drug Abuse; NIH Director Dr. Francis Collins; and HHS Secretary Dr. Tom Price. Although the challenges are sobering, it was motivating to hear from them and talk to them and so many other people who are on the front lines of the opioid epidemic in communities around the country.

I was there to participate in a panel discussion about the inescapable interconnections between the opioid epidemic, HIV, viral hepatitis, and other diseases that are spread by injection drug use. The panel focused not only on the many challenges, but also on the opportunities to better integrate our responses and, by doing so, to expand access to comprehensive, integrated prevention services for people who inject opioid drugs.

The need for these services is great—and growing. According to CDC, opioid-related addiction and deaths have been increasing for nearly two decades, and overdoses of prescription opioids and heroin killed more than 33,000 people in 2015—the most ever recorded. Injection drug use is a significant aspect of this problem.

We’ve known for a very long time that injecting drugs puts people at risk for blood-borne infections, because used needles and syringes are brutally effective at transmitting a host of known and yet-to-be-known infectious diseases. From my perspective as Director of the HHS Office of HIV/AIDS and Infectious Disease Policy, the current situation threatens to become a perfect storm, with the opioid, HIV, and viral hepatitis epidemics intersecting in dangerous ways.

We recently witnessed that intersection in a 2015 outbreak of HIV and HCV in Scott County, Indiana, after people in that small, rural county began injecting opioids and sharing injection equipment. That led to an outbreak of HCV that went unrecognized at first, followed by an HIV outbreak that caught the nation’s attention. The small town where most of the cases occurred went from diagnosing a total of 5 new infections between 2004–2013 to having 181 cases in a single year. More than 90% of the people who were diagnosed with HIV during the outbreak were also coinfected with HCV.

The outbreak in Scott County turned a floodlight on the intertwined nature of opioid use, HIV, and HCV. It became clear that we need better systems to ensure we can quickly detect increases in new HCV cases—which can indicate where HIV transmission might follow. It’s possible that the opioid epidemic could already be having a similar impact in other communities. In fact, when CDC tried a new approach that combined different types of data from multiple sources, it found that at least 220 U.S. counties may be at risk for similar outbreaks of HCV and HIV if no preventive action is taken.

But it’s important not to overlook the positive lessons about the response in Scott County. When local community leaders took action and were joined by state officials like then-Governor Mike Pence, leaders from the Indiana Department of Health, and staff from HHS agencies, they were able to bring a rapid halt to the outbreak. They did so with a comprehensive plan to increase the availability of key resources, including: drug treatment, HIV and HCV testing, prevention education, antiretroviral medications to treat and prevent HIV, and syringe-service programs.

This type of coordinated and comprehensive response will be key to ending the opioid, HCV, and HIV epidemics. The National Viral Hepatitis Action Plan 2017-2020 offers a strategic framework that we can use to facilitate collaborations across diverse sectors. This type of integrated approach can help us better serve populations that face health threats that occur together, rather than in isolation from each other, and promote efficient use of taxpayer dollars. The Action Plan demonstrates how 23 federal partners are working together to fight viral hepatitis in partnership with states, counties, cities, and hundreds of organizations around the country. It is these partnerships, which share much in common with the ones created in Scott County, that will make it possible to stop the opioid, HCV, and HIV epidemics and the sickness, misery, and deaths they cause across the United States.

Richard Wolitski, Ph.D., is Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services; This post was reprinted from AIDS.gov, May 17, 2017.

Read more articles from POZ, here.

 

🏳️‍🌈✝️ Serious Lung Issues More Common in Those Living With HIV

Even when an undetectable viral load, two recent studies show that those living with HIV are at a higher risk for serious respiratory health issues, including lung cancer.

By Desiree Guerrero

 

May 30 2017

 

 

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Results from a recent study from the UK, which compared HIV positive and HIV negative participants, showed that those living with HIV tended to have much higher instances of serious respiratory health problems, even those on antiretroviral therapy (ART) with a fully suppressed viral load.

 

The study, conducted by researchers at the Royal Free Hospital in London, wanted to further understand the relationship between HIV infection and respiratory health in the new age of ART. There was a higher prevalence of respiratory health impairment and breathlessness among the people with HIV compared to HIV-negative participants.

“Breathlessness was common in HIV-positive participants, with 47% reporting this to be present and of at least moderate severity, compared with 25% of the HIV-negative participants,” stated the authors of the study.

Impaired respiratory health was associated with poorer lung function and depression. Combining the HIV-positive and HIV-negative groups, there were no significant associations between respiratory health and gender, ethnicity, smoking status and drug use.

Another recent study, conducted at various Kaiser Permanente facilities in California, showed evidence that a history of smoking, alcohol intake and a history of pneumonia increased the chances of developing lung cancer for those living with HIV.

In the Kaiser study, published in the International AIDS Society Journal, researchers followed nearly 300,000 people of mixed HIV status (some positive, some negative), and found that factors like smoking and drug or alcohol abuse also contributed to a higher lung cancer risk in people living with HIV, but a low or suppressed viral load did not seem to lower the risk.

These findings are significant because it shows that, regardless of viral load levels, people living with HIV are more susceptible to developing serious respiratory issues like lung cancer. This information helps researchers direct their focus, so that they can figure out why this is occurring, as well as to find better treatment and prevention options for these types of issues in relation to HIV.

Read more articles from PLUS, here.
  

🏳️‍🌈✝️ Proposed 2018 Trump Budget Devastates STI Prevention Funding

The Trump administration will vastly reduce STI and HIV prevention efforts.

By David C. Harvey

 

May 30 2017

 

 

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Last week, President Trump’s White House released his proposed budget for Fiscal Year 2018 (FY18) and squarely in its sights for cuts are the Centers for Disease Control and Prevention (CDC). Of particular concern is a proposed $22 million cut to the Division of Sexually Transmitted Disease Prevention (DSTDP) on top of the $5 million cut in the final FY17 budget. If Trump’s budget is enacted, CDC has warned that it would no longer be able to fund STI prevention programs in all states, territories, or directly funded cities, thereby decimating the nation’s ability to fight a raging STI epidemic.

 

CDC officials state that STI rates are rising at a time when the country’s systems for preventing those infections is eroding – STI prevention staff sizes have waned, and STI clinics are shutting down. This infrastructure will only continue to deteriorate with these severe cuts.

This tone-deaf proposal of extreme cuts come when STI funding is already at a 20 year low and STI rates have skyrocketed to a 20 year high. The reason STIs reached such historic heights? Look no further than the lack of investment in STI prevention infrastructure, which has perennially failed to meet the needs of this burgeoning epidemic. Now is certainly not the time to back away from prevention efforts.

Investing in Prevention Works

Evidence shows that adequate investment in preventive efforts work. According to recent CDC data, cases of HIV fell by more that 18 percent from 2008 to 2014. This progress was made due to tremendous advancements in treatment and prevention efforts such an ART and PrEP, AND sustained and increased funding to the CDC Division of HIV/AIDS Prevention (DHAP). This encouraging trend illustrates that with proper investment in prevention, progress can be made to combat these epidemics.

This kind of federal investment also works to address the curable STIs as well. In the late 1990s, CDC launched a syphilis elimination plan. This plan brought new money into the STI prevention field to enhance existing programs and develop new strategies to combat the disease. Evaluation of that program showed that this increased funding resulted in notably lower syphilis rates than expected in subsequent years.

The progress made in the STI and HIV Prevention fields is imperiled by Trump’s proposed slash of the DHAP budget by 16 percent and DSTDP by more than 17 percent.

STI Prevention is HIV Prevention

Traditionally in the United States, STI Prevention and HIV Prevention programs were independent entities working parallel to each other to control their diseases of focus. However, increasingly over the years, the consensus has shifted around these programs working in concert to play a vital role in comprehensive programs to prevent both STIs and HIV.  More and more, STI prevention is viewed as integral to HIV prevention and detection. It’s know that people who test positive for an STD, particularly syphilis and gonorrhea, are more likely to also test positive for HIV or to get HIV in the future.

Furthermore Disease Intervention Specialists (DIS) – the boots-on-the-ground STI prevention workers – are on the frontline of fighting the STI epidemic and are often key entry points for individuals to access STI and HIV testing. It is their job to track down those at high-risk in the community and make sure they get the care that they need. DIS also often facilitate screening for STIs and HIV that otherwise might not happen. Coordinated efforts between HIV and STI programs are integral for identifying and stopping the spread of infection, linking individuals to care, and for preventing these more serious and often avoidable health consequences.

An exciting new study released this month shows that use and adherence to CDC PrEP recommendations for STI screening can result in reductions in STI amongst men who have sex with men, a population who bear a huge burden of STI and HIV infection.

Prevention Means Health Care Savings

Slashing prevention budgets to “save” money is short-sighted and misguided. CDC has estimated that for every dollar spent on STD prevention, $1.88 in health care costs is saved.

STIs and HIV are often asymptomatic and don’t rear their heads until it’s too late. Undiscovered STIs and HIV can result in more serious health consequences resulting in need for intensive health care treatment, infertility, and even death. These extreme and avoidable negative health results cost the health care system billions of dollars annually. The most recent data shows that STIs cost the United States health care system upwards of $17 billion dollars and cost individuals even more in immediate and life-long health consequences. 

While this budget is only a proposal and many legislators have indicated that this bill is “dead-on-arrival,” it indicates a failure to understand, at the highest levels of power in this country, the real cost to the health care system and human lives that these preventable diseases pose.

The Future of STIs

At a time when STIs rates are high and climbing, a reduction in funding for STI prevention will only result in more congenital syphilis, more undiagnosed chlamydia and gonorrhea, more undiagnosed HIV, and ultimately more cost to the health care system.

STI funding cuts mean that efforts to fight against babies being born with Congenital Syphilis, increasing levels of drug-resistant Gonorrhea, and skyrocketing rates of Syphilis -- especially among gay men -- will be devastated.

Until adequate funding is put in place for STI prevention STI rates will continue to skyrocket and HIV prevention will suffer as a result.

David C. Harvey, MSW, ACC, is executive director of the National Coalition of STD Directors.
 

Read more articles from PLUS, here.

🏳️‍🌈✝️ HIV-Positive People With Blood Clots Require No Difference in Warfarin Dosing

People living with HIV are up to 10 times more likely to have venous thrombosis, an intense blood clot in the vein. 

By David Artavia

 

May 29 2017

 

 

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Despite the fact that HIV-positive people are up to 10 times more likely to have venous thrombosis, according to studies, no further research has addressed the effects they might have when combining antiretroviral medications with warfarin, a blood thinner used to treat thrombosis.

Though it’s been led to believe that HIV-positive need to increase their warfarin dosage, a study published in BMJ Open shows they require the same amount as any HIV-negative person.

In case you didn't know, VTW is described on Heart.org as a blood clot that starts in a vein. It’s the third leading vascular diagnoses after heart attack and stroke, affecting around 300,000 to 600,000 Americans each year.

Deep vein thrombosis usually happens in a deep vein in the leg, sometimes in the arm or other veins. Pulmonary embolism happens when a DVT clot breaks free from a vein wall, travels to the lungs, and blocks some or all of the blood supply. 

The study was led by Dr. B.S. Jackson of the University of Pretoria and Steve Biko Academic Hospital. It collected data from 234 people between 2013 and 2015 with acute DVT of the lower limb.

The group was mixed with those who were HIV-negative and HIV-positive, and all of them were taking warfarin to treat thrombosis, first using a slow regimen beginning with a loading dose of sodium/warfarin, then later into heavier doses. 

After reviewing calculations, it was determined there was no significant difference in results as it related to dosage between HIV-positive people and HIV-negative people, except in the case of certain HIV-positive women on ART, who needed slightly higher doses of warfarin.

The investors then concluded: “It is recommended that warfarin dosing and coagulation monitoring be the same in the routine management of HIV-infected patients as for HIV-uninfected patients.”
A larger study might be needed to find more differences in warfarin requirements for HIV-positive people.

Read more articles from PLUS, here.