BECAUSE YOURE MORE

THAN YOUR STATUS

J UST DIAG NOS E D?

WE HAVE
TH E AN SWE R S

WHY TR E ATM E NT
I S TH E B E ST
PR E VE NTION

CARMEN
CARRERA
O N H I V, LOS I N G A DA D TO A I DS ,
A N D B E I N G A TR A N S S U P E R M O D E L

MAY/JUNE 2016
www.hivplusmag.com
WHAT IS GENVOYA?
GENVOYA is a 1-pill, once-a-day prescription medicine used to
treat HIV-1 in people 12 years and older. It can either be used
in people who are starting HIV-1 treatment and have never
taken HIV-1 medicines before, or people who are replacing
their current HIV-1 medicines and whose healthcare provider
determines they meet certain requirements. These include
having an undetectable viral load (less than 50 copies/mL) for 6
months or more on their current HIV-1 treatment. GENVOYA
combines 4 medicines into 1 pill taken once a day with food.
GENVOYA is a complete HIV-1 treatment and should not be
used with other HIV-1 medicines.
GENVOYA does not cure HIV-1 or AIDS. To control HIV-1
infection and decrease HIV-related illnesses, you must keep
taking GENVOYA. Ask your healthcare provider if you have
questions about how to reduce the risk of passing HIV-1 to
others. Always practice safer sex and use condoms to lower the
chance of sexual contact with body fluids. Never reuse or share
needles or other items that have body fluids on them.
IMPORTANT SAFETY INFORMATION
What is the most important information I should know
about GENVOYA?
GENVOYA may cause serious side effects:
Build-up of an acid in your blood (lactic acidosis), which
is a serious medical emergency. Symptoms of lactic acidosis
include feeling very weak or tired, unusual muscle pain,
trouble breathing, stomach pain with nausea or vomiting,
feeling cold (especially in your arms and legs), feeling dizzy or
lightheaded, and/or a fast or irregular heartbeat.
Serious liver problems. The liver may become large and
fatty. Symptoms of liver problems include your skin or the
white part of your eyes turning yellow (jaundice), dark tea-
colored urine, light-colored bowel movements (stools),
loss of appetite for several days or longer, nausea, and/or
stomach pain.
You may be more likely to get lactic acidosis or serious
liver problems if you are female, very overweight, or have
been taking GENVOYA for a long time. In some cases, lactic
acidosis and serious liver problems have led to death. Call
your healthcare provider right away if you have any symptoms
of these conditions.
Worsening of hepatitis B (HBV) infection. GENVOYA is not
approved to treat HBV. If you have both HIV-1 and HBV and
stop taking GENVOYA, your HBV may suddenly get worse.
Do not stop taking GENVOYA without first talking to your
healthcare provider, as they will need to monitor your health.
Who should not take GENVOYA?
Do not take GENVOYA if you take:
Certain prescription medicines for other conditions. It is
important to ask your healthcare provider or pharmacist about
Ask your healthcare provider if GENVOYA is right for you,
and visit GENVOYA.com to learn more.
medicines that should not be taken with GENVOYA. Do not
start a new medicine without telling your healthcare provider.
The herbal supplement St. Johns wort.
Any other medicines to treat HIV-1 infection.
What are the other possible side effects of GENVOYA?
Serious side effects of GENVOYA may also include:
Changes in body fat, which can happen in people taking HIV-1
medicines.
Changes in your immune system. Your immune system may
get stronger and begin to fight infections. Tell your healthcare
provider if you have any new symptoms after you start taking
GENVOYA.
Kidney problems, including kidney failure. Your healthcare
provider should do blood and urine tests to check your kidneys.
If you develop new or worse kidney problems, they may tell you
to stop taking GENVOYA.
Bone problems, such as bone pain, softening, or thinning,
which may lead to fractures. Your healthcare provider may do
tests to check your bones.
The most common side effect of GENVOYA is nausea. Tell your
healthcare provider if you have any side effects that bother you or
dont go away.
What should I tell my healthcare provider before taking
GENVOYA?
All your health problems. Be sure to tell your healthcare
provider if you have or have had any kidney, bone, or liver
problems, including hepatitis virus infection.
All the medicines you take, including prescription and over-
the-counter medicines, vitamins, and herbal supplements.
Other medicines may affect how GENVOYA works. Keep a list
of all your medicines and show it to your healthcare provider
and pharmacist. Ask your healthcare provider if it is safe to take
GENVOYA with all of your other medicines.
If you take antacids. Take antacids at least 2 hours before or
after you take GENVOYA.
If you are pregnant or plan to become pregnant. It is not
known if GENVOYA can harm your unborn baby. Tell your
healthcare provider if you become pregnant while taking
GENVOYA.
If you are breastfeeding (nursing) or plan to breastfeed. Do
not breastfeed. HIV-1 can be passed to the baby in breast milk.
You are encouraged to report negative side effects
of prescription drugs to the FDA. Visit
www.fda.gov/medwatch, or call
1-800-FDA-1088.
Please see Important Facts about GENVOYA
including important warnings on the
following page.
 GENVOYA does not
cure HIV-1 or AIDS.

SHOW YOUR
POWER
Take care of what matters mostyou. GENVOYA is a 1-pill, once-a-day
complete HIV-1 treatment for people who are either new to treatment
or people whose healthcare provider determines they can replace their
current HIV-1 medicines with GENVOYA.
 IMPORTANT FACTS
This is only a brief summary of important information about GENVOYA and
does not replace talking to your healthcare provider about your condition
and your treatment.
(jen-VOY-uh)

MOST IMPORTANT INFORMATION ABOUT GENVOYA POSSIBLE SIDE EFFECTS OF GENVOYA

Genvoya may cause serious side effects, including:
Build-up of lactic acid in your blood (lactic acidosis), which
is a serious medical emergency that can lead to death. Call your
healthcare provider right away if you have any of these symptoms:
feeling very weak or tired, unusual muscle pain, trouble breathing,
stomach pain with nausea or vomiting, feeling cold (especially in
your arms and legs), feeling dizzy or lightheaded, and/or a fast or
irregular heartbeat.
Severe liver problems, which in some cases can lead to death.
Call your healthcare provider right away if you have any of these
symptoms: your skin or the white part of your eyes turns yellow
(jaundice), dark tea-colored urine, light-colored bowel movements
(stools), loss of appetite for several days or longer, nausea, and/or
stomach pain.
Worsening of Hepatitis B (HBV) infection. GENVOYA is not
approved to treat HBV. If you have both HIV-1 and HBV, your HBV may
suddenly get worse if you stop taking GENVOYA. Do not stop taking
GENVOYA without first talking to your healthcare provider, as they
will need to check your health regularly for several months.
You may be more likely to get lactic acidosis or severe liver problems
if you are female, very overweight, or have been taking GENVOYA for a
long time.
ABOUT GENVOYA
GENVOYA is a prescription medicine used to treat HIV-1 in people
12 years of age and older who have never taken HIV-1 medicines
before. GENVOYA can also be used to replace current HIV-1
medicines for some people who have an undetectable viral load
(less than 50 copies/mL of virus in their blood), and have been on
the same HIV-1 medicines for at least 6 months and have never
failed HIV-1 treatment, and whose healthcare provider determines
that they meet certain other requirements.
GENVOYA does not cure HIV-1 or AIDS. Ask your healthcare
provider about how to prevent passing HIV-1 to others.
Do NOT take GENVOYA if you:
Take a medicine that contains: alfuzosin (Uroxatral), carbamazepine
(Carbatrol, Epitol, Equetro, Tegretol, Tegretol-XR, Teril),
cisapride (Propulsid, Propulsid Quicksolv), dihydroergotamine
(D.H.E. 45, Migranal), ergotamine (Cafergot, Migergot,
Ergostat, Medihaler Ergotamine, Wigraine, Wigrettes), lovastatin
(Advicor, Altoprev, Mevacor), methylergonovine (Ergotrate,
Methergine), midazolam (when taken by mouth), phenobarbital
(Luminal), phenytoin (Dilantin, Phenytek), pimozide (Orap),
rifampin (Rifadin, Rifamate, Rifater, Rimactane), sildenafil when
used for lung problems (Revatio), simvastatin (Simcor, Vytorin,
Zocor), or triazolam (Halcion).
Take the herbal supplement St. Johns wort.
Take any other HIV-1 medicines at the same time.
GENVOYA can cause serious side effects, including:
Those in the Most Important Information About GENVOYA section.
Changes in body fat.
Changes in your immune system.
New or worse kidney problems, including kidney failure.
Bone problems.
The most common side effect of GENVOYA is nausea.
These are not all the possible side effects of GENVOYA. Tell your
healthcare provider right away if you have any new symptoms while
taking GENVOYA.
Your healthcare provider will need to do tests to monitor your
health before and during treatment with GENVOYA.
BEFORE TAKING GENVOYA
Tell your healthcare provider if you:
Have or had any kidney, bone, or liver problems, including hepatitis
infection.
Have any other medical condition.
Are pregnant or plan to become pregnant.
Are breastfeeding (nursing) or plan to breastfeed. Do not
breastfeed if you have HIV-1 because of the risk of passing HIV-1
to your baby.
Tell your healthcare provider about all the medicines you take:
Keep a list that includes all prescription and over-the-counter
medicines, vitamins, and herbal supplements, and show it to your
healthcare provider and pharmacist.
Ask your healthcare provider or pharmacist about medicines that
should not be taken with GENVOYA.
HOW TO TAKE GENVOYA
GENVOYA is a complete one pill, once a day HIV-1 medicine.
Take GENVOYA with food.
GET MORE INFORMATION
This is only a brief summary of important information about
GENVOYA. Talk to your healthcare provider or pharmacist to
learn more.
Go to GENVOYA.com or call 1-800-GILEAD-5
If you need help paying for your medicine, visit GENVOYA.com
for program information.

GENVOYA, the GENVOYA Logo, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related
companies. All other marks are the property of their respective owners.

Version date: November 2015 2016 Gilead Sciences, Inc. All rights reserved. GENC0020 03/16
BECAUSE YOURE MORE
THAN YOUR STATUS

WHY
TACKLING
HIV AMONG
TRANS
WOMEN
MEANS
LISTENING
TO THEM
FIRST

I DONT WANT TO BE
SOMEONE WHO IS JUST
ABOUT GLAMOUR AND FAME,
AND NOT DEAL WITH
THE REAL ISSUES. I FEEL
A RESPONSIBILITY.
CARMEN CARRERA

MAY/JUNE 2016
www.hivplusmag.com
 EDITORS
LETTER
Ive known since middle school
that I was going to be a journalist
when I grew up. In fact, I was BECAUSE YOURE MORE
THAN YOUR STATUS

already writing a column for

our local newspaper (we only
had 2,000 readers, but that was
half the population of our whole J UST DIAG NOS E D?
WE HAVE
TH E AN SWE R S

town). I was high on the prestige, WHY TR E ATM E NT

I S TH E B E ST
PR E VE NTION

but when I closed my eyes at night

I dreamt of being a supermodel: CARMEN
having the whole world know my CARRERA O N H IV, LOS I N G A DA D TO A I DS ,
A N D B E I N G A TR A N S S U P E R M O D E L

name, walking the Paris runway MAY/JUNE 2016

www.hivplusmag.com

wearing haute couture from

designers whose clothes werent
even sold within 300 miles of my
tiny Idaho hometown. Alas, I was
BECAUSE YOURE MORE
THAN YOUR STATUS

WHY

a short, mixed-race, fat chick with TACKLING

HIV AMONG
TRANS
WOMEN

a giant nose, who had to settle for

MEANS
LISTENING
TO THEM
FIRST

living vicariously and plastering

my walls with photos of Cindy
Crawford, Gia, and Iman.
Im telling you this to explain I DONT WANT TO BE
SOMEONE WHO IS JUST
ABOUT GLAMOUR AND FAME,
AND NOT DEAL WITH

that I sturggled not to totally nerd out about fashion while talking with Carmen THE REAL ISSUES. I FEEL
A RESPONSIBILITY.
CARMEN CARRERA

Carrera, one of the most beautiful souls to ever walk a runway. Carmen may not be
poz, but she has quite literally become the face of HIV in an ad campaign gracing MAY/JUNE 2016
www.hivplusmag.com

New York City buses and subways.

But shes not just another model pegged for a public awareness campaign, shes an WHICH IS YOUR
eager participant in an action that honors the father she lost to AIDS complications. FAVORITE COVER?
Carmen remains committed to that campaign despite being advised against it; against Tell us and win
a free book!
aligning herself with this cause, lest others assume shes poz herself. After all, shes
been told, no one wants a Sports Illustrated swimsuit model associated with HIV. When you have a
supermodel on your
Unwilling to give upeither her support for people living with HIV or her career
cover, youve got to
dreamsCarmen tells me she doesnt want to be all smoke and mirrors, someone know the options will be
too glamorous to tackle the real issues facing men and women with HIVespecially endless. After a rousing
women who are transgender like her. debate, we chose the
This issue also features our special three-month investigation into what its like tough leather jacket-
clad glam shot you
to have HIV behind bars. That might seem a heavy subject for springtime, espe-
saw on the front of the
cially since it deals with the intersections of race, poverty, violence, and HIV. But magazine. But, this one,
with the Sero Project battling HIV criminalization laws and other groups work- offering a sweeter, softer
ing on getting former prisoners connected to care outside, its a hopeful one too. side of Carmen Carrera
Our annual Just Diagnosed segment reflects optimism as well. Learning youre (love the braid!)was a
close second favorite.
HIV-positive is no longer the devestating news it once was. Sure, it means new chal-
Which is your favorite
lenges, but were here to guide you through some of the hardest parts, begninning cover? Vote now
with disclosurecoming out to friends and family, talking to your kids, broach- at Facebook.com/
ing with your sexual partner the changes s/he might want to make. We also offer HIVPlusMag and a
advice on picking the right medications, and even explain how many doctors and random winner will win
your choice of books
exes (or hookups) youll want to call and why.
either Lust, Men, and
Take your meds, take care of yourself, and dont let anyone throw shade your way. Meth: A Gay Mans Guide
Happy Spring! to Sex and Recovery or A
Womans Guide to Living
With HIV Infection.*
BRADFORD ROGNE

DIANE ANDERSON-MINSHALL
EDITOR IN CHIEF *See what our editors thought about the
EDITOR@HIVPLUSMAG.COM books at HIVPlusMag.com

4 | MAY / JUNE 2016

 editor in chief DIANE ANDERSON-MINSHALL
SVP, group publisher JOE VALENTINO

art director RAINE BASCOS

senior editor JACOB ANDERSON-MINSHALL
managing editor TYLER CURRY
copy editor ELAINE MENDUS
contributing editor KATIE PEOPLES, MARK S. KING
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director, digital media SCOTT RAGAN
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VP, integrated marketing AMANDA JOHNSON
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jr. designer, integrated marketing PETER OLSON
coordinator, integrated ad sales/marketing, CASEY NOBLE
senior director, media strategy STEWART NACHT
sr. director, audience development & consumer marketing ROBERT HEBERT
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HIVPlusMag HIVPlusMag

HIVPLUSMAG.COM |5
 ON THE COVER
18 Supermodel Alert!
Transgender model Carmen
Carrera tackles HIV stigma.

JUST DIAGNOSED
32 The 6 Biggest Questions
What we get asked at Plus.
34 How to Disclose Your Status
What and how to tell family
and friends.
39 Here's Why Treatment is
the Best HIV Prevention
It can save your life and prevents
transmission.
40 How Do I Tell My Kids?
Professionals offer advice.

OUR SPECIAL
INVESTIGATIONS
42 We Dont Need Another Hero
Working with street educated
trans women changes a girl.

24 Locked Up & Lost

Is society throwing away
the key on prisoners with HIV?
COURTESY OF VH1

6 | MAY / JUNE 2016

 New Odefsey
is now available

Actual Size
(15.4 mm x 7.3 mm)

One small pill contains

rilpivirine, emtricitabine, and
tenofovir alafenamide (TAF).

Ask your
healthcare provider
if ODEFSEY is right
for you.

To learn more visit

ODEFSEY.com

Please see Brief Summary of Patient Information with

important warnings on the adjacent pages.
Brief Summary of Patient Information
about ODEFSEY
ODEFSEY (oh-DEF-see)
(emtricitabine, rilpivirine and tenofovir alafenamide) tablets
Important: Ask your healthcare provider or pharmacist about
medicines that should not be taken with ODEFSEY.
There may be new information about ODEFSEY. This information is only
a summary and does not take the place of talking with your healthcare
provider about your medical condition or treatment.
What is the most important information
I should know about ODEFSEY?
ODEFSEY can cause serious side effects, including:
Build-up of lactic acid in your blood (lactic acidosis). Lactic
acidosis may happen in some people who take ODEFSEY or similar
medicines. Lactic acidosis is a serious medical emergency that can
lead to death. Lactic acidosis can be hard to identify early, because
the symptoms could seem like symptoms of other health problems.
Call your healthcare provider right away if you get any of the
following symptoms which could be signs of lactic acidosis:
feel very weak or tired
have unusual (not normal) muscle pain
have trouble breathing
have stomach pain with nausea or vomiting
feel cold, especially in your arms and legs
feel dizzy or lightheaded
have a fast or irregular heartbeat
Severe liver problems. Severe liver problems may happen in people
who take ODEFSEY. In some cases, these liver problems can lead to
death. Your liver may become large and you may develop fat in your liver.
Call your healthcare provider right away if you get any of the
following symptoms of liver problems:
your skin or the white part of your eyes turns yellow (jaundice)
dark tea-colored urine
light-colored bowel movements (stools)
loss of appetite
nausea
pain, aching, or tenderness on the right side of your stomach area
You may be more likely to get lactic acidosis or severe liver
problems if you are female, very overweight (obese), or have
been taking ODEFSEY or a similar medicine for a long time.
Worsening of Hepatitis B virus (HBV) infection. ODEFSEY is not
approved to treat HBV. If you have HBV and take ODEFSEY, your HBV
may get worse (flare-up) if you stop taking ODEFSEY. A flare-up is
when your HBV infection suddenly returns in a worse way than before.
Do not run out of ODEFSEY. Refill your prescription or talk to your
healthcare provider before your ODEFSEY is all gone.
Do not stop taking ODEFSEY without first talking to your
healthcare provider.
If you stop taking ODEFSEY, your healthcare provider will need to
check your health often and do blood tests regularly for several
months to check your HBV infection. Tell your healthcare provider
about any new or unusual symptoms you may have after you stop
taking ODEFSEY.
What is ODEFSEY?
ODEFSEY is a prescription medicine that is used to treat HIV-1
in people 12 years of age and older:
who have not received HIV-1 medicines in the past and have an
amount of HIV-1 in their blood (viral load) that is no more than
100,000 copies/mL, or
to replace their current HIV-1 medicines in people who have been on
the same HIV-1 medicines for at least 6 months, have a viral load that
is less than 50 copies/mL, and have never failed past HIV-1 treatment.
It is not known if ODEFSEY is safe and effective in children under 12 years
of age or who weigh less than 77 lb (35 kg).
When used to treat HIV-1 infection, ODEFSEY may help:
Reduce the amount of HIV-1 in your blood. This is called viral load.
Increase the number of CD4+ (T) cells in your blood that help fight
off other infections.
Reducing the amount of HIV-1 and increasing the CD4+ (T) cells in your
blood may help improve your immune system. This may reduce your risk
of death or getting infections that can happen when your immune system
is weak (opportunistic infections).
ODEFSEY does not cure HIV-1 infection or AIDS. You must keep
taking HIV-1 medicines to control HIV-1 infection and decrease
HIV-related illnesses.
Ask your healthcare provider about how to prevent passing
HIV-1 to others. Do not share or re-use needles, injection equipment,
or personal items that can have blood or body fluids on them. Do not
have sex without protection. Always practice safer sex by using a latex or
polyurethane condom to lower the chance of sexual contact with semen,
vaginal secretions, or blood.
Who should not take ODEFSEY?
Do not take ODEFSEY if you also take a medicine that contains:
carbamazepine (Carbatrol, Epitol, Equetro , Tegretol,
Tegretol-XR, Teril)
dexamethasone (Ozurdex, Maxidex, Decadron, BaycadronTM)
dexlansoprazole (Dexilant)
esomeprazole (Nexium, Vimovo )
lansoprazole (Prevacid)
omeprazole (Prilosec , Zegerid)
oxcarbazepine (Trileptal)
pantoprazole sodium (Protonix)
phenobarbital (Luminal)
phenytoin (Dilantin, Dilantin-125 , Phenytek)
rabeprazole (Aciphex)
rifampin (Rifadin, Rifamate, Rifater, Rimactane)
rifapentine (Priftin)
the herb St. Johns wort or a product that contains St. Johns wort
What should I tell my healthcare provider
before taking ODEFSEY?
Before taking ODEFSEY, tell your healthcare provider if you:
have liver problems including hepatitis B or C virus infection
have kidney and bone problems
have had depression or suicidal thoughts
have any other medical conditions
are pregnant or plan to become pregnant. It is not known if ODEFSEY
can harm your unborn baby. Tell your healthcare provider if you
become pregnant while taking ODEFSEY.
 Pregnancy registry: there is a pregnancy registry for women who
take HIV-1 medicines during pregnancy. The purpose of this registry is
to collect information about the health of you and your baby. Talk with
your healthcare provider about how you can take part in this registry.
are breastfeeding or plan to breastfeed. Do not breastfeed if you
take ODEFSEY.
You should not breastfeed if you have HIV-1 because of the risk
of passing HIV-1 to your baby.
At least one of the medicines in ODEFSEY can pass to your baby
in your breast milk. It is not known if the other medicines in
ODEFSEY can pass into your breast milk.
Talk with your healthcare provider about the best way to feed
your baby.
Tell your healthcare provider about all the medicines you take,
including prescription and over-the-counter medicines, vitamins, and
herbal supplements.
Some medicines may interact with ODEFSEY. Keep a list of your
medicines and show it to your healthcare provider and pharmacist
when you get a new medicine.
You can ask your healthcare provider or pharmacist for a list of
medicines that interact with ODEFSEY.
Do not start a new medicine without telling your healthcare provider.
Your healthcare provider can tell you if it is safe to take ODEFSEY
with other medicines.
How should I take ODEFSEY?
Take ODEFSEY exactly as your healthcare provider tells you to take
it. ODEFSEY is taken by itself (not with other HIV-1 medicines) to
treat HIV-1 infection.
Take ODEFSEY 1 time each day with a meal.
Do not change your dose or stop taking ODEFSEY without first
talking with your healthcare provider. Stay under a healthcare
providers care when taking ODEFSEY.
Do not miss a dose of ODEFSEY.
If you take too much ODEFSEY, call your healthcare provider or go
to the nearest hospital emergency room right away.
When your ODEFSEY supply starts to run low, get more from your
healthcare provider or pharmacy. This is very important because
the amount of virus in your blood may increase if the medicine is
stopped for even a short time. The virus may develop resistance
to ODEFSEY and become harder to treat.
What are the possible side effects of ODEFSEY?
ODEFSEY may cause serious side effects, including:
See What is the most important information I should know
about ODEFSEY?
Severe skin rash and allergic reactions. Skin rash is a common
side effect of ODEFSEY. Rash can be serious. Call your healthcare
provider right away if you get a rash. In some cases, rash and
allergic reaction may need to be treated in a hospital. If you get a
rash with any of the following symptoms, stop taking ODEFSEY
and call your healthcare provider right away:
fever
skin blisters
mouth sores
redness or swelling of the eyes (conjunctivitis)
swelling of the face, lips, mouth or throat
trouble breathing or swallowing
pain on the right side of the stomach (abdominal) area
dark tea-colored urine
Depression or mood changes. Tell your healthcare provider right
away if you have any of the following symptoms:
feel sad or hopeless
feel anxious or restless
have thoughts of hurting yourself (suicide) or have tried to hurt yourself
Change in liver enzymes. People with a history of hepatitis B or C
virus infection or who have certain liver enzyme changes may have
an increased risk of developing new or worsening liver problems
during treatment with ODEFSEY. Liver problems can also happen
during treatment with ODEFSEY in people without a history of liver
disease. Your healthcare provider may need to do tests to check your
liver enzymes before and during treatment with ODEFSEY.
Changes in body fat can happen in people who take HIV-1
medicine. These changes may include increased amount of fat in
the upper back and neck (buffalo hump), breast, and around the
middle of your body (trunk). Loss of fat from the legs, arms and face
may also happen. The exact cause and long-term health effects of
these conditions are not known.
Changes in your immune system (Immune Reconstitution
Syndrome) can happen when you start taking HIV-1 medicines.
Your immune system may get stronger and begin to fight infections
that have been hidden in your body for a long time. Tell your
healthcare provider right away if you start having any new symptoms
after starting your HIV-1 medicine.
New or worse kidney problems, including kidney failure. Your
healthcare provider should do blood and urine tests to check your
kidneys before you start and while you are taking ODEFSEY. Your
healthcare provider may tell you to stop taking ODEFSEY if you
develop new or worse kidney problems.
Bone problems can happen in some people who take ODEFSEY.
Bone problems may include bone pain, softening or thinning (which
may lead to fractures). Your healthcare provider may need to do tests
to check your bones.
The most common side effects of rilpivirine, one of the medicines in
ODEFSEY, are depression, trouble sleeping (insomnia), and headache.
The most common side effect of emtricitabine and tenofovir
alafenamide, two of the medicines in ODEFSEY, is nausea.
Tell your healthcare provider if you have any side effect that
bothers you or that does not go away.
These are not all the possible side effects of ODEFSEY. For more
information, ask your healthcare provider or pharmacist.
Call your doctor for medical advice about side effects. You may
report side effects to FDA at 1-800-FDA-1088.
This Brief Summary summarizes the most important information about
ODEFSEY. If you would like more information, talk with your healthcare
provider. You can ask your healthcare provider or pharmacist for
information about ODEFSEY that is written for health professionals.
For more information, call 1-800-445-3235 or go to
www.ODEFSEY.com.
Keep ODEFSEY and all medicines out of reach of children.
Issued: March 2016
ODEFSEY, the ODEFSEY logo, EMTRIVA, GILEAD, the GILEAD Logo, and GSI
are trademarks of Gilead Sciences, Inc., or its related companies. All other
trademarks referenced herein are the property of their respective owners.
2016 Gilead Sciences, Inc. All rights reserved. GILC0216 03/16
 MAY | JUNE 2016
COVER: Carmen Carrera photographed by Alex Evans;
BACK COVER: Shutterstock; INSERT COVER: Carmen
Carrera photographed by Melina Varela

BUZZWORTHY
11 Spin Class Proposal
A serodiscordant love
story is a viral sensation.

12 Goodbye, Gluten!
Is the latest dietary fad
right for you?

12 Positive Transplants
New rules pave way for
organ recipients.

13 Coffee RX
7 Ways to get a caffine fix.

14 The Cocktail Cure

Drink to your health.

14 Safer Than You Think

People in treatment
are less infectious than
they think.

15 Antidepressant Helps
Repair Brain
A new treatment could fight
neurological issues in PLWH.

15 Got Food?
Get your nutrients with a meal-
replacement smoothie.

TREATMENT CHRONICLES THE BEST OF THE REST

50 Salute This 48 I Love Your Microbiome
The VA boosts funding to cover New research suggests we
more vets living with hep C. actually fall in love with each
others stomach bugs.
51 First PrEP to Poz Case
Rare drug resistant HIV 54 Might Be Time to
strain was immune to PrEP. Switch Meds
Sleep weird hours? Take
52 Do You Need a pills without food? An
experts guide to which
Meningitis Vaccine? meds are right for your
Some people are particularly lifestyle.
vulnerable to the deadly disease.
SPECIAL INSERT
53 Put a Ring on It Poz Hollywood
This insertable vaginal ring could The HIV-positive actors,
prevent HIV in women. creators, and subjects
of 3 new projects:
53 Sex & Meth Unsure/Positive, Guys
The dangers of mixing the two. Reading Poems, and
SHUTTERSTOCK

D-Man.

10 | MAY / JUNE 2016

BUZZWORTHY
MIXED-STATUS COUPLE
BECOMES SOCIAL MEDIA SENSATION
Unless you have been living under a social media rock,
chances are you have seen the spin class flash mob propos-
al that took the Internet by storm. In less than 24 hours,
the marriage proposal of Adam Keller and Jared Marinelli,
now known as #TeamJadam, racked up over 3 million
views. Their engagement, however, was not the only
source of inspiration to come out of the spin class couple,
because Keller and Marinelli are also a public example of a
mixed HIV-status relationship.
On Valentine's Day, JoyRide spin instructor Keller
surprised his boyfriend and fellow JoyRide instructor,
Marinelli, when Marinellis class burst out into a top-secret,
choreographed wedding proposal. With Keller on a bike
front and center, everyone appeared to be cycling as usual.
But, when Marinelli began the warm-up, the music sudden-
ly changed and the cyclists stepped off their bikes and start-
ed to move in formation. Soon enough, Marinellis family
and friends began to fill the room and he started connect-
ing the dots. With not a dry eye in the room, Keller final-
ly broke from the crowd and approached Marinelli. Keller
was equal parts emotional and out-of-breath, but he man-
aged to eventually find the words and ask the big question.
Marinelli, while laughing and crying, emphatically said yes.
#TeamJadam became a certified overnight sensation.
Just days later, the two decided to do something useful
Keller (center)
and Marinelli
(right) with
family and
friends.
with the spotlight by revealing to Plus that they are in
serodiscordant couple. The pair had asked their friend
to write about how they became a couple, including the
point when Marinelli was crushing on Keller but afraid to
reveal his HIV-positive status.
The story goes like this. Keller came into JoyRide look-
ing for a job and Marinelli was instantly smitten. Marinelli
gushed over the new instructor to his friend, HIV-positive
artist Jonathan Joseph Ganjian, but also sharing his res-
ervations about revealing his own status. Ganjian assured
Marinelli that if Keller was the right guy, he would not be
deterred by something like HIV.
Keller was not only receptive to dating a person with
HIV; he also began actively seeking out information and
advice; which ultimately led him to begin taking PrEP. In
fact, it was Kellers idea to become a more vocal support-
er of his HIV-positive fianc and to speak out against the
HIV stigma that he has noticed in the LGBT community.
PrEP lifted a huge weight off our shoulders as far as
making sure were doing everything we can to protect our-
selvesI want to share that too, Keller said. I think were
just two guys in love who wont let something like sta-
tus stand in the way. #TeamJadam is now planning their
spring or fall 2017 wedding in Connecticut.
T Y L E R C U R RY
H I V PLU SM AG . C OM | 11
BUZZWORTHY
DO I NEED TO GO
GLUTEN-FREE?
For people who need it, the gluten-
free movement is far more than the
latest fad. When people with gluten
intolerance or celiac disease, remove
gluten (a protein found in wheat, rye
and barley) from their diet it has a range
of benefits from decreasing stomach
pain, bloating, and gas to reducing more
serious symptoms like joint pain, skin
rashes, and anemia. For those who dont,
its just money down the drain.

How do I know if I'm gluten sensitive?

A new blood test called Array 3, from
Cyrex Labratories identifies gluten
reactivity more accurately than earlier
tests. It's the the most comprehensive
analysis available for determining
gluten sensitivity, according to Dr.
Chad Larson, an advisor on the clinical
consulting team forCyrex (JoinCyrex.
com), because it accurately identifies
gluten reactivity and measures
antibody production against 8wheat
proteins and peptides, three essential
enzymes (transglutaminase-2,
transglutaminase-3 and
transglutaminase-6), and the gliadin
transglutaminase complex.
Thats a lot of science-y words. So who should take it?
Larson tells us that the test isnt for everyone. Array 3 is
only recommended for people who have non-responsive
gastrointestinal symptoms present with multiple-symptom
complaintsincluding joint pain, fatigue, muscle pain, brain
fog, hormone imbalances, and chronic inflammationor
suffer from depression or neurodegenerative symptoms
like peripheral neuropathy, Alzheimers disease, or multiple
sclerosis, says Dr. Larson.
And if you have those symptoms?
Ask your doctor about the Array 3 blood test. Results are
reported in about two weeks. Patients can then work with
their physician to develop an appropriate treatment plan that
may or may not include the elimination of gluten from their
diet, Dr. Larson adds. DA M

The First HIV-Positive Organ Transplant

For the first time, HIV-positive individuals may now receive organs from
HIV-positive donors in the United States, opening up a new pipeline of
treatment, according to advocates.
Johns Hopkins University School of Medicine recently received
approval from the United Network for Organ Sharing to perform two
transplants between HIV-positive patients: one kidney and one liver.Its
the first and only medical center approved for such an operation. The
number of HIV-positive donors is estimated between 500 and 600,
according to The New York Times. Those donors could savenearly
1,000 people a year.
The new policy will give HIV-positive patients with end-stage organ
diseases a new chance at life, says Dr. Dorry Segev, associate professor
of surgery at Johns Hopkins, and an advocate for the HIV Organ Policy
Equity Act.
For many years, HIV-positive patients werent consideredgood
candidates for organ donations, as they were not expected to live long.
Though they were not forbidden from receiving donor organs from HIV-
new possibilities opened up. In 2013, President Obama
signed theHIV Organ Policy Equity Act, which legalized
transplants between poz patients.The new law seems to
be a win-win, as HIV-positive patients will have more
potential donors while HIV-negative patients might move
up the organ donor lists.
Organ transplantation is actually even more important for patients
with HIV, since they die on the waiting list even faster than their HIV-
negative counterparts, said Segev. We are very thankful to Congress,
Obama, and the entire transplant community for letting us use organs
from HIV-positive patients to save lives, instead of throwing them away, as
we had to do for so many years.
Segev warnedThe New York Timesreporter Daniel Victor that it
will be slow at first to begin positive-to-positive organ transplants, as
these transplants were illegal for decades, and most medical centers
arent yet equipped to perform them. In addition, organs will only be
taken from deceased donors for now until it is established that it safe
SHUTTERSTOCK

negative patients, transplantsor even the study of transplantsbetween for living HIV-positive persons to donate. KAT I E P E O P L E S
two HIV-positive people had been illegal since 1988. But with the onset
of better medications and longer, healthier, lifespans for people with HIV,

12 | M AY / J U N E 2 0 1 6
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DIANE ANDERSON-MINSHALL

THE ONLY
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I went Keurig three MOCHA MOSES
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Try the Abraham Mocha Java, On a tight budget? Caf Valets Starter Combo includes the
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H I V PLU SM AG . C OM | 13
BUZZWORTHY
THE COCKTAIL
CURE
Want a drink that doesnt set your
health back? If youre in New York
City, SushiSambas new culinary
cocktails menu might be the an-
swer. Developed by Richard Woods,
winner of U.K.s Most Imaginative
Bartender Award, SushiSamba's
new drinks let you socialize, drink
your food, and have a healthy (even
a post-workout) cocktail you wont
feel guilty about tomorrow. Our
I Think
I Can?
faves: the vibrant green Avocado Batida (creamy,
colorful twist on a classic Brazilian favorite with A recent study of people
on antiretrovirals showed
fresh avocado pure swizzled through crushed ice
the disconnect between
with cachaa, almond syrup, and cacao and served
a persons viral load and
with an accompanying cone of maiz cancha, an their view of their likeli-
Andean snack like corn nuts), the Coco Ceviche hood of transmitting HIV.
(Bombay Dry gin swizzled through crushed ice with
52%
yuzu, passion fruit, and a dark chocolate liqueur
with a shot of ceviche with a tamarind ponzu), or
the Tom Yam (a fresh, fiery, cooling Asian combina-
tion of coriander, ginger, lime leaf, and chili spiked
with vodka and served with nigiri sushi). But if thought they were highly
youre booze-free or in recovery (congrats!), just ask or somewhat infectious
for a Lychee Cooler without the Grey Goose and St. after 3 years of treatment.
Germainstill yummy. DA M
90%
were wrongthey were
actually undetectable,
meaning their risk of
transmission was actually
close to zero.
10%
still had detectable viral
loads and were infectious.
But, at the
beginning of the
3-year study
16%
thought they had
low (or no) risk of
transmitting HIV.
100%of those people
were wrong.
Source: Landovitz/UCLA, CROI 2016

ANTIDEPRESSANT MAY IMPROVE COGNITIVE
DAMAGE IN HIV-POSITIVE PEOPLE
You can live a long and healthy life
with HIV, but many still can experience
complications like cognitive damage
and chronic inflammation.
Studies have shown that HIV-
associated brain disorders can have
a serious health impact, accelerating
the aging process and increasing
death rates. Meanwhile, increased
inflammation is linked to cancer, heart
disease, kidney failure, dementia, and
autoimmune diseases.
Fortunately, researchers from
John Hopkins University School of
Medicine recently discovered that an
existing antidepressant may be able to
ameliorate these health concerns and
improve the quality of life for those
aging with HIV.
In a small, controlled study, the
antidepressant drug paroxetine (Paxil)
boosted mental functions related to
cognitive damage and suppressed
inflammation for patients with HIV.
The drug improved reaction time
and decision-making and moderately
SHUTTERSTOCK
suppressed inflammation in patients
known to have HIV-associated
neurocognitive disorders (HAND).
Got
Food?
In order to stay healthy
we try to remember
to take our meds and
use apps and activity
trackers to keep us fit,
but when were too busy
to eat, what happens?
We either skip the meal
altogether or end up
holding a greasy bag of
fast food on our way to
tick off another to-do
Over a period of 20 years and after list item. Heres a better
10 clinical trials, this is the first time we option: 100%FOOD, a
nutritionally complete
have been able to clearly demonstrate
meal replacement
benefitof cognitive performance smoothie that provides
for patients with HIV-associated all the nutrients
neurocognitive disorders, said lead including golden
author Ned Sacktor, a neurology flaxseed, hemp, sesame
professor at Johns Hopkins University, seeds, and rice flour,
noting the groundbreaking nature of as well as vitamins and
the findings. Omega oilsthat your
Even when virally suppressed, body needs to stay
people living with HIV can still healthy. Its vegan and
contains no genetically-
experience inflammation, which in
modified ingredients,
the brain causes damage to nerve and comes in two
cells. People who suffer from HAND flavors, the lightly malted
can often experience difficulty with chocolate flavor, Choco,
learning, decision-making, motor and Raw, which is a
function, and memory. vanilla similar to many
Paroxetine seems capable of protein powders. Even
stopping mental decline and reversing better: it comes with an
earlier damage. In a 2014 study, those app that allows you to
who took paroxetine saw significant simply drag and drop
suggested fruits and
improvement in decision-making and
vegetables (even energy
reaction time. Since Paroxetine is
boosters) into the on-
currently approved for mental health screen simulated blender
disorders, nothing should delay FDA- and note the changes in
approval, which could dramatically nutrient levels. Once
reduce the time before the treatment youve hit 100%, you are
is available to consumers.TC good to go. DA M
H I V PLU SM AG . C OM | 15
 D A I LY D O S E
BY TIMMOTHY J . H O LT
WITHOUT A DATE
AT 67, IM CLOSER TO DEATH FROM OLD
AGE THAN FROM AIDS COMPLICATIONS.
M Y N A M E A N D birthdate are engraved
on a grey, granite headstone in Woodlawn
Cemetery. At Dads death, Mom thought it best
if all our names were carved on the headstone.
It was cheaper. I have a constant reminder of
my immortality, as if I needed it.
Ive been at the threshold of death since
age 40 when I left a California testing cen-
ter holding a piece of a paper that said HIV-
positive. My life, and my friends instantly be-
came like batteries, forever viewed as positive
or negative. That day I felt fine. There was
no diarrhea, no night sweats, no neuropa-
thy, and no pill box. At that moment, I would
have been content to be Lots wife, a pillar of
salt caught in the moment, never to change,
looking like a graceful palm tree outside the
testing center. The only future I saw was dis-
ability, suffering, and death. So why not end
it now? That day, was a safe haven away from
a perceived empty future.
16 | MAY / JUNE 2016
Then, as time wore on, I became
the aftermath of a plague, archeo-
logical dustunwanted and sifted
out, a broken vessel.
I saw my parents names en-
graved on that headstone. Other
headstones and other names were
added, ending with Aunt Mary, the
last of my parents generation. Im
now the elder, and I never prepared
for this rank.
Though I often surrendered my-
self to the inevitability of death,
nights dark comfort, for 30 years, my
mortality escaped daily with the stars
into the brightness of day. Trouble
is, when youre not dead youd like
to talk to someone about being a
survivor. I want to tell someone my
thoughts, my concerns, my preoccu-
pation with death, but anyone who
might care stopped listening long
ago. Theyre weary of the same, old
survivor story. Conversations and
tears are reserved for those who died.
Those who listen do so out of kind-
ness, willing themselves to hear only
words, their meaning floating up and
away unnoticed, like smoke from the
morning fire.
Occasionally an unfamiliar person at the local coffee shop will engage
me in polite conversation. They inquire about the nature of my day, and
I want to tell them my day always starts with the thought of death. They
find this bizarre. Why not think of life if youre up and walking?
When she was young enough to still ride in the childs seat of the gro-
cery cart, my boisterous, redheaded daughter would often say, Daddy, I
said hello to that woman and she wont talk to me.
I responded, Honey, people dont always want to talk. She couldnt
comprehend why, and I couldnt understand why she kept asking. Now
I am the one wanting to know why people dont want to talk. Of course,
Im not as cute or as innocent as a 3-year-old redhead.
But Id still like to talk to someone about surviving AIDS.
I dont want casual conversations about lives lost. The number of
panels on the AIDS Quilt is well known to me. Ive seen them displayed
in the engine room of the Queen Mary in Long Beach and on the mall
in Washington D.C., and I have a patchwork quilt of my own, pictures
of my friends who died and visions of those I never knew. Problem is,
I ached to be a panel on that quilt, not look at others. And I wonder if
anyones memory can be reduced to a square of fabric.
So at 67, where does this leave me? I still have an uncertain future,
but I am much closer to death from old age than AIDS complications.
Looking at a chasm in my sexual history, friends who have died. Anxious
about long-term effects of HIV and the drugs used to treat it. Still hear-
ing voices of damnation: Gay is evil, AIDS is Gods punishment.
Most of all though, glad I did not become that pillar of salt. I would
have missed a lot of life. I would have missed telling my story.
SHUTTERSTOCK
Doctor Holt, a retired physician, 30-year survivor, and award-winning author of
Square Affair (TimmHolt.com), lives with his partner in Chicago.
BY DI ANE AND E RSO N -M IN S H ALL
CALL ME
CARMEN
SHES A MOM, A WIFE, AND A GIRL WHO LOST HER FATHER TO AIDS
COMPLICATIONS. NOW CARMEN CARRERA, AMERICAS FIRST TRANSGENDER
SUPERMODEL, IS USING HER CELEBRITY TO FIGHT HIV AND ITS STIGMA.
M I L L I O N S O F P E O P L E H AV E
seen actress and model Carmen Carrera
become the woman she is todayquite
literally. On RuPauls Drag Race, MTV
viewers watched Carrerathen identify-
ing publicly as a gay manpull off some
of the fiercest femme drag ever seen on
TV. Except it wasnt drag, not for Carrera.
That was the real her, the woman Carre-
ra had dreamed of being since she was a
precocious toddler trying on maxi pads
because shed seen her mom using them.
The transgender model now says she
was living between genders while film-
ing Drag Race; feeling like she was in boy
drag during the day and her real self at
night. Carrera didnt know how to tell her
husband Adrian Torres the truth, so she
didnt say anything. She just began taking
hormones and eventually her body said
everything for her: when she grew breasts,
Torres figured it out.
Fans of VH1s Couples Therapy know
all about thatand the transition, their
infidelities, the immense pressure Carre-
ra feels being one of the most high-profile
transgender models intheworld (signed
by Elite). The couple appeared on the
sixth season of the reality show, the first
trans-inclusive couple to spill their guts
to Dr. Jenn Mann and the viewing public.
By showing the ordinary challenges trans
(Carrera) and pansexual (Torres) individ-
uals face, it became groundbreaking, cul-
minating in Carrera becoming the first
transgender person to wed on cable TV.
18 | MAY / JUNE 2016
It definitely made us stronger and closer as far as seeing
each others points of viewto have an understanding of
each other [with] fewer expectations, says Carrera. But go-
ing through the process on television and letting everyone in
was a little scary at first.
Carrera, an HIV and LGBT activist in her own right, says
she and her quiet, press-shy husband decided being on the
show was a great opportunity for trans visibility. I wasnt
going to do it right away, because who wants to put their per-
sonal business out there? I did it anyway, because it was going
to be valuable to my community, and to the acceptance of us.
I wanted to drive home that me and Adrian are just a boy and
a girl trying to figure it out.
Her initial qualms were eased after she watched previous
episodes. Couples Therapy is not the kind of show thats sen-
sationalized drama. But, she admits, the experience was very
intense, and she worried about the judgment of other people,
the people that are watching and the people that Im opening
up toand how Im going to be perceived. But there was a part
of me that was comforted by the idea that I was doing some-
thing for my communityand it was good therapy.
Overall Carrera feels she was pretty successful, in reach-
ing her goals and says, Im happy that I did it.
The model, who has been featured in W, Elle, Glamour and
a big Orbitz campaign, stands out on screen and in magazines
as well as she does in person, coming across as relatable and
approaching others as though the majority of people arent
transphobic, they just need to be given real information in,
well, a relatable way.
If Im trying to educate them, its not going to work, she
says. I knew that I had to make it a casual conversation. I had
my boundaries, but tried not to be overly Laverne Cox about
the situation, because it wouldnt sink in.
BRENDAN FORBES
In addition to Couples Therapy, Carrera had a role last year
in the filmRicki and the Flash and she was photographed by
the legendary David LaChapelle (whose runway show she M
PHOTO CREDIT

HIVPLUSMAG.COM | 19
 SHUTTERSTOCK (PG 32)

Carrera and Torres,

who starred on
Couples Therapy,
have been together
nearly a decade.

20 | MAY / JUNE 2016

 walked), Mark Seliger, and Steven Meisel to name a
few. NARS, a luxury makeup brand, recently named
a lipstick afterCarreraas part of its new Audacious
Lipstick Collection. But closer to her heart is a proj-
ect many advised her against: representing New
York Citys new HIV prevention campaign in a saf-
er sex ad called Play Sure. Her face now graces the
sides of buses and greets subway riders as they travel
through the veins of our nations busiest city.
HIV has been a personal cause for Carrera ever
since she learned her father, a former injection drug
user, died of complications from AIDS.
My mom told me that he had died from an ep-
ileptic seizure, she recalls. He did suffer from ep-
ilepsy, and that was actually the second cause of
death. My mom dealt with a lot of the judgment [my
father experienced]. He was sick for about a year. I
was 2 when he passed away. She had to take him to
the clinic, because his family wasnt around. He was
living on his own. She was trying to take care of me,
have a career, and take care of himand keep him
off of the streets and out of doing drugs.
Her mother felt all the stigma attached to an AIDS
diagnosis and was freaked out at the time, because it
was so new. They didnt know how to treat it. My mom
carried a lot of that with her after he passed away.
Fearing what Carrera might say to others, or that
she would think that my dad was a bad person, her
mother never shared his HIV status. But the model-
to-be was tenacious. I started investigating when I
was 16. Thats when I found out.
Later, she also met her fathers family. I got to
meet them while I was transitioning, so, it was a lot
to take in. It was really weird, but they were very
accepting. I still have a relationship with them to
this day. I have two aunts and I have a bunch of cous-
insthey treat me with a lot of love.
Her fathers memory may have helped fuel her
HIV activism, but Carrera says, as a trans woman of
color, shes also painfully aware of how dispropor-
tionately HIV impacts her community. Trans wom-
en of color have the highest HIV rates in the country
and little is being done to change that.
So many of my friends from the club scene
would like get [HIV] and not take care of them-
selves, and it was so sad to see these things happen
right before my eyesand there was nothing I could
do because they wouldnt want to listen. They didnt
want to care about themselves anymore, as though
[they thought] their life was over.
She says now that marriage equality is the law of
the land, the LGBT community should turn its atten-
tion back to HIV and AIDS. If we take control of it,
we can really end AIDS sooner, she argues. If we
take the treatment serious; if we take our [medica-
tion]; if we talk about it so its not so taboo. Its not
COURTESY VH1
something to fear. Thats part of the reason why I
decided to work with New York City Department
of Health and to target the nightlife scene, because
I DONT WANT TO BE SOMEONE
WHO IS SMOKE AND MIRRORS,
AND JUST ABOUT GLAMOUR
AND FAME, AND NOT DEAL WITH
THE REAL ISSUES, BECAUSE IM
GOING TO FEEL SOME KIND OF
RESPONSIBILITY ABOUT IT.
I experienced it first hand. ... [there is] a dont ask,
dont tell around HIV status. Nobody talks about
it. It took me to educate myself, and I learned it first
hand to be able to speak back to my community.
There are other topics she thinks we need to talk
more about too, like sex work and the high percent-
age of trans women of color who are forced into sur-
vival sex when other economic avenues are closed.
Or about trans women who seek love at all costs,
even if it means not requesting to use a condom or
questioning their partners status.
The majority, maybe all, of my friends who influ-
enced me to make some decisions as far as my tran-
sition goesmy support group, really, they were all
sex workers, says Carrera. Thats what they did. Im
not surprised to hear that these numbers are so high,
because I definitely can understand that completely.
You just want that love. You want to feel that inti-
macya part of you that wants to feel like you are
completely desirable.
What she doesnt understand is why she gets a
lot of flak from the trans community for doing HIV
stuff. A lot of trans womenhave reached out to
me and said, Oh, people are going to think that you
have HIV, or People are going to think that being
intimate with trans women means you have a high-
er risk of getting HIV. You have a mainstream plat-
form like VH1, you have a lot of heterosexual people
that are learning from you, and the first thing you
want to talk about is HIV stuff ? Its not a good look.
In an effort to counter the myth that all trans
women are sex workers, Carrera fears activists have
left behind the women who are. The way I look at it
is, facts are facts, Carrera insists. And in order for
us to be above it, to actually be in control, is to talk
about it and to not be afraid of it. Because, these are
the facts. It is what it is. I dont want to be someone
who is smoke and mirrors, and just about glamour
and fame, and not deal with the real issues, because
Im going to feel some kind of responsibility about
it. AIDS doesnt just affect gay people or trans peo-
pleit affects the human race. Period.
Of course she still recognizes the weighty impact
HIV has on transgender women, in particular,
and she sees a unique way to engage trans people
HIVPLUSMAG.COM | 21

around that: recognizing healthcare as part of transitioning and embracing their
true selves. We have to keep ourselves healthy. We need to be able to live a full,
fulfilling life after the transition and how are we going to do that if were not
taking care of ourselves? if you keep avoiding it, youre just cutting your life
shorter. Whats the point, if youre going to live your life unhealthy, in going
through this transition? To just not take care of yourself after that is foolish.
She sees unhealthy people as being examples for the younger generation to not
make these decisions, and to not choose to avoid dealing with things. Some people
will last longer than others, and its something thats sad to say, but its honest, and its
something that maybe people do need to hear.
Carrera believes HIV-positive trans people have worked too hard to become
their true selves to just throw it away by not getting treatment. But Carrera also sees
how you can get lost in your transition sometimes. Ive seen it with my friends,
girls who are solely focused on looking 100 percent biological and [not trans]. Ev-
erything else goes out the window, and they triple up on their estrogen, or they tri-
ple up on their testosterone blockers, or whatever they need to do to look the way
they need to look so that they can go out and have interactions with people that
dont know theyre transjust to feel better, just to fit in. But its delusional. Its not
22 | MAY / JUNE 2016
Carmen Carrera models a dress featuring characters by the artist Keith Haring
during an event on World AIDS Day at the Apollo Theater in New York. The
state of New York will dedicate $200 million more to its $2.5 billion effort to
end the AIDS epidemic by 2020. Its already reporting significant milestones:
for the first time since the epidemic began, no new cases of mother-to-child
transmission were reported in the past year.
really dealing with the truth, and not really creating
stability for yourself as a trans person.
As a model, taking care of her own body is among
Carreras top priorities. It needs to be, especially if
she hopes to reach her goal of appearing in Sports
Illustrated or becoming a Victorias Secret model.
Her fans certainly want that; around 50,000 signed a
petition urging Victorias Secret to hire her. Carrera
makes that goal seem plausible. You get the feeling
shes on the cusp of even bigger acclaim.
Her HIV campaign is certainly putting her on the
map. Every single day, Carrera says, I get a tweet
or two: Oh, youre on the bus! or Sit on the bus with
Carmen! There was a huge billboard somewhere in
Chelsea, somebody sent me a picture of it. I think its
great. Im so happy that they used me for it. People
want to take photos, want to tweet it out, and want
to like it, share it, and stuff like that, just because its
me, which gets the message out even more. When I
see that, I feel proud of myself.
Does she wonder how her fatherthe man she nev-
er knew and who never had a chance to live a healthy
life with HIVwould feel about what shes done?
Oh, my dad would be so proud of me, she gush-
es. My mom tells me every day that my dad is smiling
down from heaven. I had one experience: I went to an
HIV/AIDS rally in Brooklyn and an older gentleman
just happened to be standing right next to meand
you can tell that he had to muster up whatever energy
he had just to get out of bed and go and be there. I got
the feeling that if my dad had been alive, I would have
probably been going with him to these rallies. I just
kind of felt like, I wouldve been there with him and
for a second I kind of felt that he was there with me.
That made me feel like hes definitely watching me, hes
really proud of me, and if he wouldve stuck around, we
wouldve been going through it together.
Today Carrera has her own family: Adrian Tor-
res and her two stepdaughters she helps raise, shar-
ing custody with his ex, Stephanie. [Were] about the
whole family unit. To be able to come home and func-
tion as a stepmom and as a wife, is amazing. It defi-
nitely gives me strength. We have an 11-year-old and
a 7-year-old who are going through their changes and
SETH WENIG/ASSOCIATED PRESS
coming into awareness of who they are, and I feel so
great to have a hand in that. Im a very active [par-
ent], because their mom goes to school and works
full-time, so I have the kids a lot of the time. I have a
different style of parenting that is different from Adri-
ans and different from Stephanies, and I love it. Their
support also helps me immensely.
 Carrera along with
genderqueer and
trans luminaries (from
left) Jacob Tobia,
Geena Rocero, Isis
King, Laverne Cox,
and Mila Jam at the
premier of the MTV/
Logo documentary
Laverne Cox Presents:
The T Word in 2014.
I HAD MY BOUNDARIES, BUT I
TRIED NOT TO BE OVERLY LAVERNE
COX ABOUT THE SITUATION,
BECAUSE IT WOULDNT SINK IN.
The girls, Stephanie, and a plethora of friends,
family, and fans watched her walk down the aisle
last year on Couples Therapy. After nearly a decade
together, this wasnt her and Torress first wedding,
but it was the first since Carrera came out to the
world as a woman. On that day, she was just a girl,
marrying a boy, in the dress of her dreams.
I felt like I was a born again virgin walking down
the aisle. Thats how I felt. Even though we had done
it right before, there was something about this expe-
rience that was way more special to me, and real, and
valuable. Before when we got married, the love was
SCOTT ROTH/INVISION/ASSOCIATED PRESS
real, but everything else was kind of in disarray. Now,
it just feels so much more real, and I value that expe-
rience so much.
The wedding episode aired last December, a cap
to a phenomenal year in which Carrera seemed to
be everywhere. But she says, she couldnt have got-
ten there without her husbands support.
He gives me the validation that a lot of trans
women look for in a relationship, she says. And I
feel humble because hes known me for so long. Hes my rock. I think that having
someone by my side that has been there for the journey, and has been able to stick
around to want to see me succeed gives me that validation and gives me that sense
of love. I think that is so priceless to have. With him I can just be myself. He doesnt
love me just because Im an actress, just because I model, just because I do this.
He loves me because he knows me as a person that wants to make things better.
Shes living the dreambalancing love, family, careerbut unwilling to rest
on her laurels.
I would love to be a triple threat, she admits. But its way too soon. Im still
pretty young, and I still have a long way to go. If J. Lo is a triple threat at 47 years
old, well, I have about 17 years to go! But Ill get there.
Some day down the line she wants to do a showgirlesque Cirque du Solei type of
acrobatic show, with Dita Von Teese influences. Thats long term, she says, because
there is something about the stage and live shows that, for me, is still my first love.
For now, pursuing those dreams means a lot of hours at the gym so she can
blow it out the water with modeling in an industry with high standards. I am
trying my best to match them, she says. Its kind of like running a marathon. Im
so in beast mode, training right now. [Audiences] have seen me as a drag per-
former, theyve seen me as a showgirlnow its the model that needs to emerge.
Im just focused on training and leaning out my body, bringing the supermodel
to realization, and then blowing people away. So theyre like, Wow, she looks
amazingshe is a supermodel!
Not satisfied with being a celebrity because of her visibility as a trans wom-
an, Carrera dreams of becoming so qualified that people are excited to have me
work with them. Im very hopeful right now. Because I feel like everything is
there, and now I just need to put in my effort, and take all of my creative juices,
and all of my experience that Ive picked up going throughmy transition and
show them something thats really new, and innovative, and amazing. So, yeah,
Im working on it. Its all a work in progress.
HIVPLUSMAG.COM | 23
LOCKED
UP
IS SOCIETY
THROWING
AWAY THE
KEY ON
PRISONERS
WITH
HIV?
B Y JAC OB A N DE R S ON - M I N SHA L L

S
pend a little time talking with Bryan C.
Jones and youll have a hard time thinking
of him as average. But, like far too many
black men, the 55-year-old from Ohio has
spent time locked up.
When Jones was released from an Ohio State
penitentiary in 2008 he recalls that a social work-
er attempted to link him with care, providing him
with directions to HIV service providers and giving
him a bottle of antiretroviral medication to bridge
the gap.
The college-educated, world travelerwhod
been HIV-positive, and in care, for decadesprob-
ably seemed like a perfect candidate for the reentry
program. But, like thousands of other HIV-positive
former inmates, Jones never showed up at the ad-
dresses hed been given.
Im not going there, he decided.
Worse, he discarded the pills hed been given.
They handed me two weeks worth of medica-
tion, he remembers. And most people probably
PHOTO CREDIT

did just like meI left them at the bus station. I was
like, Well Ive got two weeks worth, but what the
hell am I to do after that? M

24 | MAY / JUNE 2016

HIVPLUSMAG.COM | 25
 His behavior may seem shocking, but
it reflects a startling reality: 90 percent of
HIV-positive prisoners experience interrup-
tions in their treatment upon their release from prison.
Treatment interruptions can have long-term, negative
impacts on the health of those living with HIV. The lon-
ger the interruption, the more time the virus remains
unfettered, the more damage it can inflict and the great-
er reservoirs it can establish. More than 60 percent of
former inmates report experiencing treatment inter-
ruptions lasting two months or more.
Jones, who was also featured in Plus magazines spe-
cial investigation on depression, is an activist, peer ed-
ucator, and performer with the unique ability to bring
people to tearsfrom laughing so hardeven when
talking about seriously depressing shit.
He grew up in poverty in the heart of the ghet-
to, where he was a victim of child sexual abuse. After
growing up and coming out gay, Jones moved to Atlan-
NEARLY ONE IN FOUR AMERICANS
LIVING WITH HIV WILL BE
INCARCERATED AT SOME POINT THIS YEAR
ta where he was later diagnosed with AIDS. That was
in 1984, and Jones was told he had six months to live.
Outliving that predictionfor whatever reason, Im
still trying to figure it outJones has had the un-envi-
able luck of watching others fade away. Everyone else
just died, he reflects now. Most of my friends60, 70
people in the span of a few years.
Nearly 20 years after his HIV diagnosis, Jones was
back in Ohio and still struggling when, he admits, my
depression led me to prison. Jones may have depression
to blame, but far too often what leads those with HIV to
prison seems to be the color of their skin.
The mass incarceration of African-Americans has
become commonplace in the United States, both a result
of and contributor to enormous racial and economic
disparities in employment, education, healthcare, pov-
erty, and even mortality. For guys like Jones, this stacked
deck begins early and casts a long shadow.
Inadequate prenatal care, childhood exposure to
lead and other toxins in the home, poverty, and other
early childhood trauma all predispose underserved chil-
dren to poor performance in school, argues Georges
Benjamin, the executive director of the American Pub-
lic Health Association. Minor behavior patternses-
pecially among kids of colorcan result in school sus-
pensions as early as preschool. This practice starts the
school-to-prison pipeline.
More than 2 million people in the United States are
incarcerated in federal, state, and local correctional fa-
cilities on any given day. Despite representing only 13.5
percent of the U.S. population, blacks accounted for al-
26 | MAY / JUNE 2016
most 40 percent of the total prison and jail population
in 2011. African-Americans are incarcerated at five
times the rate of whites. The probability that a young
black man will go to prison is tripled if he doesnt fin-
ish high school.
The decades-long war on drugswhich Benjamin
calls a war on peopleand mandatory sentencing
laws, have filled prisons to capacity. They also dispro-
portionately criminalize people of color, Benjamin ex-
plains, by enforcing laws that penalize African-Ameri-
cans more harshly. For example, he says the punishment
for possession of crack cocaine was 100 times stricter
than for powder cocaine, the latter of which was favored
by whites.
Black gay and bisexual men are also disproportion-
ality impacted by mass incarceration, according to a
2014 Louisiana Public Health Institute report. The
studys author, Russel Brewer, director of the Insti-
tutes HIV/STI program, tells Plus, I think what was
surprising was that there was such a high prevalence
of incarceration history among the black, gay [and]
bisexual men in this study. About 60 percent of the
menI think it was over 15,000 men enrolled in the
studyhad a history of incarceration.
Pulling disproportionately from disadvantaged com-
munities with higher risks for HIV, correctional facili-
ties have long reported much higher rates of HIV than
external communities. In 2010, the rate of diagnosed
HIV infection among inmates in state and federal pris-
ons was more than five times greater than the rate
among the general public.
But in the last two decades, institutions have also
benefitted from outside HIV prevention efforts and
wider access to antiretroviral medications. The number
of AIDS-related deaths in prisons overall plummeted
77 percent between 2001-2010. In the same period, the
estimated number of inmates with HIV also declined,
although by a much smaller amount, just 16 percent.
Still, people living with HIV appear to be at an in-
creased risk of being incarcerated, and studies show 20
to 26 percentthats nearly one in fourof all Amer-
icans living with HIV are incarcerated at some point
each year.
Though HIV rates among black women are down
overall, African-American women remain particular-
ly vulnerable to being HIV-positive and imprisoned. In
SHUTTERSTOCK (PG 24)
fact, prisons are the only setting in the U.S. where HIV
prevalence is higher among women than men, with ap-
proximately 2.6 percent of female and 1.8 percent of
male state prison inmates known to be HIV-positive.
Further, African-Americans make up two-thirds of all
newly reported HIV cases among women and 34 per-
cent of female inmates.
Despite widespread concern that mass incarcera-
tion of African-American men has fueled the HIV epi-
demic in the black community, most experts, including
those at the Centers for Disease Control and Prevention
(CDC), insist that the majority of those locked up with
HIV were positive prior to their incarceration.
Its also a misconception that gay and bisexual men
spread HIV in prison through sexual contact; several
studies have shown that men who had anal sex with
other men were far less likely to report this activity
while they were locked up than prior to and after their
incarceration.
The research is really saying that folks are already
living with HIV before they enter prison, or jail, Brew-
er confirms. And they just dont necessarily know
their status.
One of the biggest barriers to that knowledge is the
fact that there are no universal protocols on testing in-
mates for HIV. While some facilities mandate HIV test-
ing for all incoming inmates, most rely on various vol-
untary options. Some facilities offer testing during an
inmates intake while others only test inmates upon re-
lease. Very few prisons test both incoming and exiting B RYA N C . JO N E S
prisoners for HIV.
Brewer, whose home state of Louisiana has the high-
est incarceration rate in the U.S., says his agency is try-
ing to expand HIV testing in the states correctional fa-
cilities, so that upon entry, folks know their status so
that they can get the care that they need while theyre
there. Unfortunately, most people incarcerated in the
United States actually serve their time in jail cells rather
than prisons. Jails are short-term facilities typically run
by the county, while state and federal prisons are where
time is served after sentencing. Some jail systems are
enormous and dwarf many prisons. For example, Los
Angeles has the largest jail system in the country, with
approximately 18,000 inmates at any given time.
The transient nature of the jail population makes HIV
testing even more difficult. In fact, nine out of 10 jail in-
mates are released in under 72 hours, generally not long
enough for a lab to process the test and notify the indi-
vidual before they are releasedlet alone for providers
to link the HIV-positive to care.
A 2010 study of New York City jails found that 28
percent of inmates with HIV hadnt been diagnosed
at the time of their admission. Furthermore, research-
ers concluded, Despite a four-fold increase in jail test-
ing, most undiagnosed infections still are not identified
through routine, voluntary jail testing, largely because
of the low acceptance of HIV testing.
There is also no denying that HIV can spread be-
hind bars. Despite legal prohibitions, inmates contin-
ue to have sex and inject drugs. Prison tats had long
been thought to spread HIV between inmates but sev-
eral studies ruled tattooing out as an HIV vector. One
CDC examination of seroconverters in Georgia state M

HIVPLUSMAG.COM | 27
 prisons created genetic fingerprints for the
prisons various HIV strains, and then fol-
lowed them back to determine how each in-
mate was exposed. Those who initially insisted their
only risk-factor was tattooing, later admitted to having
sex with other prisoners prior to testing positive.
Efforts at preventing the spread of HIV inside prisons
face more hurdles than those outside and the services
provided arent consistent throughout the correctional
system. Some, but hardly all, institutions offer educa-
tional materials, instructor-led trainings, peer-to-peer
programs, and prevention case management. Although
other countries have successfully integrated harm re-
duction options for inmates who use injection drugs,
no American facility has yet to authorize a needle ex-
change program.
The World Health Organization and CDC both rec-
ommend the distribution of condoms in prisons, but in
2014, California became only the second stateafter
Vermontto do so.
That condoms work is not a mystery, Los Ange-
les jail epidemiologist Garrett Cox told Al Jazeera af-
ter the law passed in California. Unfortunately, even in-
mates who are aware of their HIV status and/or want
to practice safer sex rarely have access to condoms. In-
stead they employ creative solutions like using plastic
wrap, latex gloves, or plastic grocery bags secured with
rubber bands.
Other inmates may not understand risks associat-
ed with sex or drug use. Or they just may not care. The
Georgia prison study found that of those who serocon-
verted in prison, 44 percent had been previously incar-
cerated, 86 percent had committed a violent offense,
and 34 percent were serving life sentences. While some
of these men may not have understood their risks, oth-
ers may have felt they had nothing to lose or that the risk
PRISONS ARE THE ONLY PLACE
IN THE U.S. WHERE HIV PREVALENCE
IS HIGHER AMONG WOMEN THAN MEN
of HIV was worth the high or sexual contact.
Jones, the one-time Ohio prisoner, recalls that for
those facing long prison sentences, people just did
what they did. Even knowing someone had HIV
wouldnt necessarily stop someone else from having
sex (or sharing a needle) with them. (Interestingly, that
Georgia study did confirm thatas in the general pop-
ulationthose who find out they are HIV-positive
while in prison do alter their risk taking behavior after-
wards and thereby decrease their likelihood of transmit-
ting HIV to others.)
As prison populations swell, correctional facilities in-
creasingly find themselves serving as primary health care
providers. Considering that those serving time often hail
28 | MAY / JUNE 2016
from disadvantaged communities with limited resourc-
es, the healthcare correctional institutions provide may be
the first such care an inmate has ever received.
Unfortunately the economic downturn and result-
ing healthcare cuts have dramatically impacted the jail,
making it the provider of first resort for any number of
health problems, HIV included, the Cook County, Il-
linois, sheriff s office said in a statement to Chicagos
Windy City Times. We are working to better identify
those with medical and behavioral healthcare needs, in-
cluding HIV, and developing better transitions to care
in the community with the hope that people will con-
tinue to access that care rather than cycling through the
jail for care.
Medical care of prisoners may be constitutionally re-
quired but there are no guarantees about the quality and
inclusivity of that care. Many prison systems outsource
their medical care to other providers and not all of them
are equal. In fact, several have been sued for allegedly
denying HIV care.
While researching her report, HIV Treatment in U.S.
Jails and Prisons, Mary Sylla, founder and director of
Policy & Advocacy for the Center for Health Justice, dis-
covered that only 43 percent of surveyed correctional
care providers reported that an HIV specialist was of-
ten available to see patients at their facility. More dis-
turbingly, 38 percent reported that an HIV specialist
was never available.
Kerry Thomas isnt surprised.
Although the medical contract reads like a medical
plan comparable, if not better than, a private plan in the
community, says Thomas, in application it is difficult
to get the services we need at times.
Thomas, a straight black man, is serving a 30-year
sentence in an Idaho prison for not disclosing his sta-
tus to a woman he had sex witheven though he used
condoms, had an undetectable viral load, and did not
transmit HIV.
As a person living with HIV, Thomas is a part of his
prisons Chronic Care Clinic, where he says he sees a
provider three to four times a yearjust not the same
provider.
It has been my experience that the person Ive seen
is unfamiliar with my case, he admits. On one occa-
sion the provider thought I was there for hep C follow
up. Although the contract says that counseling and ed-
ucation is offered, it is not at this facility.
Although he is able to see his doctor from the out-
side community once a year, Thomas says getting his
antiretroviral prescriptions filled isnt a breeze. I have
CO N T I N U E D A F T E R I N S E RT
 BOYS &
POETRY
An HIV-positive actor helps make an
incomparible neo-noir feature film.
BY DIANE ANDERSON-MINSHALL
When it premiered at the the 21st Palm Beach
International Film Festival, the ingenious film,
Guys Reading Poems, broke all the rules by
integrating visual poetry with traditional nar-
rative, in black-and-white (shot on the new Red
Epic monochrome camera). The film follows a
resourceful child who uses poetry to survive
when his disturbed avant garde painter mom
locks him in a puppet box and builds an art
JASON FRACARO (GUYS IN TIES); MICHAEL MARIUS PESSAH (DANIEL); SEAN PAUL FRANGET (HUNTER)
installation around his imprisonment.
While there are celebs among the cast (The
Last Kingdoms Alexander Dreymon; Young &
Hungrys Rex Lee), director/producer/writer
Hunter Lee Hughes also defied Hollywood
expectations by casting Daniel Berilla, an
HIV-positive actor. I believe in Daniel, says
Hughes. Hes has a lot to offer as an actor and
human being.
Here the guys chat about poetry, film, and HIV.
DANIEL BERILLA,
ACTOR & ASSOCIATE
PRODUCER
Youve appeared in a few
films and had a memorable
spot on Its Always Sunny
in Philadelphia, but this
project was different.
What drew me to Guys
Reading Poems first was my friendship with
the director. Hunter's been gracious enough to
include me in his projects and he showed me
the script for this film and youre right, it was
very different, very unique. And it just sounded like Id be able to explore
a new side of myself in a movie that is super creative.
Whats Hunter like as filmmaker?
As a filmmaker, Hunter is very intuitive. He listens to peoples opinions
and takes them seriously. As an actor, that makes it easier to have confi-
dence in what Im doing.
Will audiences get this film or is it too avant garde?
This film does speak to a niche audience, to be honest, but its also going
to create a whole new genre of film. I hope its the start of something new
and innovative.
Has making this movie changed you in any way?
As associate producer, Ive been able to experience a whole new side of
this business and without this experience I might not have [known]
what I was capable of. And as an actor, I learned I look pretty damn fetch
in black-and-white.
Youre one of the few actors who is out about being HIV-positive.
Yeah, I am, and proud to be. Back in 2009 when I was diagnosed, I, like
anyone else in the world, was frightened, scared of what my friends and
family would think. I felt lost. I knew I had a choice to make when it came
to what I moved out here to do: act and be gay. So I looked deep down
inside myself and thought for days on end. Should I tell anyone? The
answer was yes and, to my astonishment, I received a resounding accep-
tance from friends and the people I like to call my family in L.A. Ive never
looked back or regretted the decision to tell the truth because I knew there
are many people my agethat need to know that you can still chase your
dreams and live a healthy life, all while being HIV-positive.
Has that impacted your career in any way?
Yes, it honestly has, but not to the point to where its ruined my career. Ive
always looked young, and I always wanted to do Disney and Nickelodeon
shows, especially when I first moved here. But I was diagnosed less than
a year after my move and I told myself, to stop pursuing those shows"
because I honestly believed Middle America wouldnt want their sons or
daughters to Google me and find out that their favorite character was
positive. The good thing that came out of my situation was my involve-
ment in gay charities, becoming a speaker for the LGBT Center in L.A.,
being in a national commercial that still airs today about being positive,
being in multiple gay-themed moviesand still living my life to the fullest.
I realized that trying to make a difference in the world was just as import-
ant as being on Disney.
Do you think well see a day when being HIV-positive is
treated as commonly as say asthma?
We can already see a change happening. Society has already
begun to accept, support, and try to change how HIV is per-
ceived.The fact that HIV is a sexually transmitted disease,
means it will always have [some] opposition.
more about my grandmother, since she had underlined key
phrases, starred certain titles, even made notes in the mar-
gins. The poems became like psychological puzzle pieces that
helped me figure out a fuller picture of who my grandmother
was. It was just a matter of time before I found a way to try
to use poetry as cinematic puzzle pieces in a film.

What about A-list performers coming out as poz?
It just happenedlook at Charlie Sheen! Charlie is one of the
most relevant people working in entertainment today, and he
took the risk to put his career, his family, his life on the line
because I believe deep down that he was trying to make a dif-
ference as well. He was accepted by most, but not everyone.
Theres an online list of cutest men of 2015 and youre sand-
wiched between Josh Hutcherson and Tyson Beckford. How
does that feel?
Im sandwiched between them? Thats not my preferable
position, butIm actually honored and very surprised that
Im on a list with people of that stature. So thank you, America!
HUNTER LEE HUGHES, DIRECTOR,
PRODUCER & WRITER
What led you to create Guys
Reading Poems?
After my grandmother passed away,
my mother, brother, and I had to walk
through her house and decide what we
might like to keep. I decided to take her
poetry collection. I came to learn a lot
Are audiences ready for this type of storytelling?
At my local ice cream place here in L.A., theyre now selling
a flavor called Strawberry Honey Balsamic with Black Pepper.
So yeah, I think we can handle a poetry neo-noir feature film.
Maybe not everybody, but enough people are buying Strawberry
Honey Balsamic with Black Pepper to keep it on the menu. So I
dont see why Guys Reading Poems cant find its audience, too.
What led you to cast Daniel?
Hes a charmer, but even more of a fighter than a charmer
and I like that about him. He and Patricia [Velasquez], and
Rex do have a lot in common because all three of them were
friends of mine before we shot. I love working with actors I
already know. So much of our work is about whether or not
the actors trust me enough to take risks and touch an uncom-
fortable or tender part of themselves.
Hes one of the very few actors who is out about living
with HIV. Does that anything to the project?
One beautiful part of being an actor is that even challenging
moments in your life can be used for creative fuel if youre
CO N T I N U E D O N PAG E 4 6

For the new hit web series following characters through

Unsure/Positive, creator and
star Christian Kiley (left) drew
inspiration from his personal
seroconversion. After pre-
miering online, the series
which follows Kieran from
the moment of his HIV-pos-
itive diagnosishit Bostons
International Film Festival and
Wicked Queer, the citys LGBT
film fest.
The project began as just a
few pages of dialogue Kiley
wrote for his graduate film
program at Emerson College.
His fellow classmates didnt
know that Kiley was pulling
from his own experiences as
an HIV-positive man learning
to deal with a new diagnosis.
Soon, Kiley began working on
the script outside of class and
his assignment quickly turned
into a passion project.
I remember very specifically
multiple episodesletting them
act and react against a con-
stantly changing backdrop.
During that conversation,
Kiley says, things crystallized.
I was going to write a serial-
ized narrative about a character
like myself.
He admits that HIV-positive
people have been pigeonholed
or simply not represented in the
mainstream media since the epi-
demic began, something he
wants to change. For Unsure/
Positive, Kiley took inspiration
from other serialized shows that
resonated with him (Nurse Jackie,
Louie, and Breaking Bad to name
a few), shows that helped him
realize what was missing.
Protagonists whose imper-
fections were their defining
aspects, he says.
"I think this trend is actually a
vector for creators who are mak-

Unsure/Positive a conversation, over drinks,

The Series Creator Talks About Silence,
Meth Use, and the Power of Post-Its.
BY TYLER CURRY
with my close friend Jacqui,
he recalls. We were talking
about the value of serialized
storytelling in media, specif-
ically on TV, and the idea of
ing shows that are more true to
their central characters. Shows
like that can tell stories that
run the gamut in terms of emo-
CO N T I N U E D O N PAG E 4 6
 STARTING HIV TREATMENT
STARTINGHIVHIVTREATMENT
STARTING TREATMENT
HELPS PROTECT
HELPSPROTECT
HELPS YOUR
PROTECTYOUR HEALTH.
YOURHEALTH.
HEALTH.
There is no cure for HIV, but treatment can stop the
There
virus
There isno
nocure
inisyour cure
body for
and
for HIV,
the
HIV, but
but treatment
damage can
HIVcan
treatment stop
causes.
stop thethe
virusininyour
virus yourbody
body and
and the
the damage
damage HIVHIV causes.
causes.
Treatment also helps make it
Treatmentalso
Treatment also helps make it
possible to live a helps
healthymake
life.it
possibletotolive
possible livea ahealthy
healthy life.
life.
 STAYING ON TREATMENT HELPS LOWER
STAYING ON TREATMENT HELPS LOWER
THE AMOUNT OF VIRUS IN YOUR BLOOD.
THE AMOUNT OF VIRUS IN YOUR BLOOD.
The amount can get so low, it cannot be measured by a test. This is
Thecalled
amountbeing
canundetectable and it means
get so low, it cannot you areby
be measured taking care
a test. ofisyour
This
calledhealth. It also lowersand
being undetectable the itchance
meansof passing
you HIV care
are taking on toofothers.
your
health. It also lowers the chance of passing HIV on to others.

TALKING ABOUT HIV TREATMENT

TALKING ABOUT HIV TREATMENT
An open conversation with your healthcare provider can help
Anput you
open on the pathwith
conversation to a your
long healthcare life. When
and healthyprovider canyou
helpwork
together,
put you on the pathit to
helps your
a long healthcare
and provider
healthy life. When find the
you work
treatment
together, it helps that is right
your healthcare for you.
provider find the
treatment that is right for you.

HelpStopTheVirus.com
HelpStopTheVirus.com H I V P LU S M AG . CO M
STARTING HIV TREATMENT
IS A HEALTHY STEP.
Here are two resources that can help.

Watch videos, share information, and

see how we can all help stop the virus.
www.HelpStopTheVirus.com

Get the answers you need,

privately, on your phone.
www.HIVanswers.com/app

2015 Gilead Sciences, Inc. All rights reserved. UNBC1771 03/15

BY TYLER CURRY
THE MAKING OF AN
AIDS-INSPIRED
DANCE MASTERPIECE
More than two decades later, a new film
revisits the backstory with a millennial touch.
In 1989, the award-winning choreogra-
pher, artistic director, and dancer Bill T. started as a lighthearted ballet about the movement of water
Jones (pictured above) gifted the world
with his explosive tour-de-force, D-Man
in the Waters, an emotional dance per-
formance and tribute to dancer Demian
Acquavella and others who died from
AIDS-related complications during the
height of the epidemic. More than 25
years later, the documentary D-Man gives
audiences a chance to revisit the heart-
breaking time that led Jonesnow 64 and
living with HIVto create his bittersweet
celebration of life.
The film's co-director/producer,
Rosalynde LeBlanc, performed with the
Bill T. Jones/Arnie Zane Dance Company
and teaches dance at Loyola Marymount
University. She's looking to fans to help bring
the heartfelt documentary to life.
The only obstacle to making this film is
financial, LeBlanc says. Everyone who has
seen the footage has rallied around it. It is
a high caliber production. It is being made
thoughtfully and well. People want to see this
film get made. People need this film to get
made.
Although LeBlancs team has only reached
the halfway mark in their goal to raise more
than $500,000 for the production, filming has
already begun. The documentary starts in a
dance studio in 2015, where LeBlanc is teach-
ing D-Man in the Waters to nine of her most
skilled students from LMU. As the dancers are
put through their paces, we understand their
inquiries into the history of the dance. We see
their difficulties, and later how their under-
standing deepens.
D-Man, LeBlanc says, is not about AIDS.
It was the glorious alchemy that resulted
when a dance company committed to to
putting one foot in front of the other while
an epidemic raged in and around them. The
virus hasnt been eradicatedthe face of
AIDS has changed, and the location of the
epidemic hasshifted, but it is still here.
LeBlanc wanted to explore the tragic back-
story that led Jones to create the dance. In
doing so she uncovers the stories of risk, sac-
rifice, love, loss, and resurrection that were
embedded in the choreography over two
decades ago. In the film, Jones and seven of
his former dancers recall reeling from the 1988
loss of co-director, Arnie Zane, to AIDS com-
plications. Only weeks into rehearsals for their
new dance called Waters, a beloved member
of the company, Demian D-Man Acquavella,
was also diagnosed with AIDS.
Over the next six months, Jones created his
seminal dance even as Acquavellas health deteriorated. What
transformed into a penetrating look at love and survival during a
plague. Renamed, "D-Man in the Waters" in honor of Acquavela,
the dance brought the audience inside the heartbreaking strug-
gle of love and ultimate loss that the AIDS epidemic represents.
Jones, still an active choreographer, director, and dancer has
earned numerous accolades, including Kennedy Center Honors, a
MacArthur Genius Grant," Tony Awards, and the National Medal
MARK ELIAS/ASSOCIATED PRESS
of Arts. The National Young Arts Foundation honored him for
having a significant influence on the development of young
American artists, and that influence is reflected in the ages of
those supporting the making of D-Man (D-ManDocumentary.
com). Perhaps thats a reminder that those with the most to learn
about the impact of the epidemic are those too young to have
lived through it.
 K E R RY T H O M A S

CO N T I N U E D F R O M PAG E 2 8
to stay on top of the pharmacy to make sure there isnt a delay, one that could serious-
ly impact his health.
With so many inmates either learning for the first time they have HIV, or finally
having access to health care in prison, its not surprising that studies show 75 percent
of HIV-positive inmates receive their first antiretroviral treatment while incarcerated.
Living with HIV while locked up adds a layer of complication to what can already
be a stressful and life-altering chronic illness.
In terms of confidentiality, Jones says, in prison, its not something that exists.
First, he says, inmates cue up in the pill line to get their medication and everyone
else can see what youre getting. You cant take a handful of pills without other people
looking, so everyone knows.
In the Ohio facility where Jones served his time, inmates with HIV saw a specialist
via telemedicine, rather than in person. You would talk to a doctor on a TV, he recalls.
They would call you out during count time. Im up there with five other people and
were all in this room to talk to this particular doctor. So it doesnt take a lot for other
people to realize we all must be positive.
In prison culture, where any sign of weaknessor isolationcan open an inmate
up to violence and victimization, having other people know your HIV status isnt some-
thing to be taken lightly. You might be harmed, Jones admits. You could be harassed
in a lot of ways. You could be ostracized.
Lara Strick of the Washington-based Northwest AIDS Education and Training Cen-
ter, encouraged prison administrators and health care providers attending the 2014 Or-
egon Corrections Conference to seriously consider side effects when choosing which
HIV meds to give inmates.
For example, Strick noted that jaundice could broadcast ones ill health to other pris-
SERO PROJECT

oners, drowsiness could impact both alertness and a prisoners ability to respond to a
threat, and one of the biggest side effects of ART, diarrhea, is a big deal in prison be-
cause inmates dont have free access to a bathroom. M

HIVPLUSMAG.COM | 29
 For Jones, his time in prisonand his
healthwere further complicated when he
was diagnosed with terminal cancer. The cre-
ator of the one-man show about his experience, And
I Die Slowly, jokes about it now. Having stage four
cancer, with one leg chained to a bed while being de-
pressed? Its not something you want to experience.
His cancer added to the many reasons Jones says hav-
ing a good relationship with the nurses [makes] all the
difference in the world. A good provider can help you
get the right meds, deal with side effects, access facili-
ties, and feel like a human being instead of an offender.
We are called, offenders, Thomas says. Im not a big
fan of that term. I was charged with an offense, men here
ONLY 5% OF HIV-POSITIVE INMATES
FILLED A PRESCRIPTION FOR TREATMENT
WITHIN 10 DAYS AFTER THEIR RELEASE
may have even offended, but to me the term offender
implies that a certain behavior is ongoing. I believe that a
behavior or crime is what a person did, not who they are.
The people who see inmates only as offenders rare-
ly see the value in providing HIV prevention (especial-
ly condoms or needle exchanges) and sometimes even
HIV treatment (especially when it comes with a hefty
price tag). But prison administrators and public health
advocates are starting to see common ground.
Condom distribution has not only reduced transmis-
sion inside the L.A. jail system, but has also had a ripple
effect on public health in outside communities.
More than 95 percent of prison inmates will be released
at some point during their lifetime, adds Nina Harawa,
who previously worked in Los Angeles County Depart-
ment of Public Healths HIV Epidemiology Program. Now
a professor at Charles Drew University and the University
of California Los Angeles (UCLA), Harawa has launched
a number of innovative and successful programs for Afri-
can-Americans living with or at risk of HIV.
The concern over prison inmates going out into the
larger community is what really fuels HIV prevention
and treatment efforts inside. Talk about releasing people
with undiagnosed or untreated HIV back into a com-
munity and suddenly even the most pro-law enforce-
ment public officials may discover the political will
and fundingto preempt a public health nightmare.
Add to that the potential that those prisoners may be
taking drug-resistant strains back to their home com-
munities and suddenly controlling HIV in prisons
sounds like a taxpayer bargain. The Georgia HIV study
proved exactly that, that many of the HIV strains in the
prison system were drug-resistant and could further
compromise efforts to treat the chronic condition, in-
side and outside prison walls.
30 | MAY / JUNE 2016
All released inmatesnot just those with HIVex-
perience social and economic barriers to their efforts to
reestablish connections with friends and family, secure
housing and employment, and deal with untreated sub-
stance use issues and mental health disorders.
Having served time can bar a person from receiv-
ing public assistance and forever alter ones legal rights.
Upon release, bans on welfare, public housing, edu-
cational aid, employment, and voting make it virtually
impossible for ex-offenders to have a real chance at life,
notes Brewer in one of his studies. Thus, almost guar-
anteeing recidivism.
Having HIV chips away at even those slim chances
of success, particularly because health outcomes for poz
people generally plummet post-incarceration. While
the majority of HIV-positive inmates respond well to
antiretroviral medication during their prison sentence,
most discontinued their treatment following release
from prison.
In fact, national studies show only 5 percent of inmates
receiving antiretroviral medications in prison filled a pre-
scription for the drugs within 10 days after their release
and only 18 percent filled one within 30 days. As few as 20
percent were successfully linked to any type of HIV-relat-
ed care within a month after their release.
A 2010 review of Texass attempts to connect recent-
ly released HIV-positive inmates to care found that 90
percent of the time there were treatment interruptions;
in more than 70 percent of the cases, that interruption
lasted at least a month. Over 60 percent of the former in-
mates experienced treatment interruptions lasting two
months or more.
University of Texas researchers followed HIV-pos-
itive repeat offenders, inmates who were reincarcer-
ated after being provided discharge planning services
like a 10-day supply of antiretroviral medications and
assistance applying for AIDS Drug Assistance Program
(ADAP) funding for a 30-day supply of meds. One
striking finding was that between the time of release
from prison and reincarceration, inmates experienced
dramatic decreases in their CD4 lymphocyte counts and
simultaneous increases in their viral loads.
Bottom line: the health of inmates with HIV deteri-
orated after they were released from prison. These find-
ings arent that surprising, given the known negative
health outcomes associated with interrupted or discon-
tinued antiretroviral therapy. These interruptions have
also been associated with the development and trans-
mission of drug-resistant HIV strains.
 Formerly incarcerated people with HIV who had un-
detectable viral loads at the time of their release were
more likely to fill their prescriptions within the first ten
days, though, as were those who received assistance
completing a Texas ADAP application.
It really is difficult to find employment, find hous-
ing, or other services that you might need, Brewer says,
repeating what hes heard from former inmates and try-
ing to explain why people are getting lost after they get
out of prison. So, forget care. Youve got to worry about
other stuff; your immediate needs. You cant be focus-
ing on going to the doctor yet. Youve got to take care of
your other business.
When it comes to transitioning HIV care after re-
lease, Thomas says hes heard that there are issues in
Idaho in this area. But his personal experiencehes
been in and out several times while living in the same
Idaho city where he was incarceratedhas been con-
sistency in care. In fact, he says, his HIV provider is with
the same clinic that serves the prison system. Therefore
I have had the same doctors since 1988 and before my
release in 2003 a case manager came out to the prison
to determine which services I needed.
When Jones was released he was given those two
weeks of medication he left at the bus station, an action
that stuns Harawa. As someone who helped establish
similar programs in Los Angeles, Harawa is shocked
by Joness admission that he discarded expensive an-
tiretroviral drugs in a public venue.
But, she stammers, He was on medication in the
jail! Why did he not know what to do with it? She also
worries about the person who stumbled upon the med-
ication after that. What are they doing?
Despite Joness experience, Harawa still believes in
providing people getting out of prison with a starter
supply of antiretroviral meds. In the state of California,
she says, HIV-positive inmates are supposed to get 30
days of release meds, and generally people were getting
that, and that helped. It might take that long for some-
body to reestablish their care, but they were generally
able to do so, especially if they already had a care pro-
vider before they went to prison.
Jones says the Department of Corrections in Ohio
sends somebody from the health department to visit
poz prisoners maybe 30 days before your release date.
But they need to start that process a lot earlier, Jones
explains. So Ive been trying to propose to our Depart-
ment of Corrections a peer program. To have a positive
person thats been incarceratedso positive inmates
can [listen] to another positive person saying, Ive been
in and this is what I did. If necessary give me a call when
you get out, I can go with you to a doctors appointment.
A lot of people dont even want to go into a hospital, be-
cause thats where infectious diseases breed.
Thats where a peer can intervene, Jones says. He now
runs a pre-release support group for HIV-positive in-
mates closing in on their exit dates.
Its important to me to make sure that people who
are coming out of prison are linked to care, he explains,
proud that the program has gotten a positive response.
I was surprised that people would attend these, that
they were bold enough to attend. Its amazing to me that
[it] went so well.
DeAnn Gruber, STD/HIV Program Director at Lou-
isianas Department of Health and Hospitals, agrees that
pre-release interactions need to start earlier. Louisiana
launches its program 180 days before the clients release
date in order to complete the requisite paperwork and
applications for post-release HIV medical care, case
management, and ADAP enrollment. Finding that the
traditional system offered a limited focus and little op-
portunity for dialogue, Grubers department launched
a video conferencing program (funded by Special Proj-
ects of National Significance) to encourage more back-
and-forth communications and hopefully increase the
likelihood that HIV-positive prisoners will link to care
within 90 days of their release.
Los Angeles has started a peer navigator program,
doing much of the same things that Jones hopes to see
in Ohio. There is transitional case management that
goes on in our jails, Harawa acknowledges. But you
know, it often, like beautiful plans, fell apart quickly af-
ter people [left jail].
So William Cunningham, a professor at UCLA,
launched LINK LA, a first-of-its-kind program and
clinical study that employs people who share back-
grounds with those coming out of jail to meet them at
the gate upon release, help them access HIV services,
and reintegrate into the community.
The jail system represents an important aspect of the
epidemic that hasnt been addressed sufficiently, Cun-
ningham explained when the program began. Recidi-
vism rates for HIV-positive men are extremely high
its like a revolving door between the community and
the jail.
If Link LA, a randomized controlled trial funded by
the National Institutes of Health, succeeds in slowing
that revolving door, it could end up serving as a model
for other correctional facilitiesand the communities
those released inmates return to.
Post-release programs are making an impact.
Those who are getting social services, support, case
management, and other services, seem to do better,
Harawa concludes. And that has a positive effect.
But, she admits, they still arent reaching everyone.
The people who really seemed to struggle in our
study, Harawa says, were those who found out [they
were HIV-positive] when they got to prison, or maybe
theyd only first gotten care in prison. When they got
out, they were justpretty lost. And, unless they found
a really good social service provider, or a friend sup-
port network who could help them along the way, they
seemed to stay pretty lost.
This article was produced as part of a 2015 Equal
Voice Fellowship awarded Jacob Anderson-Minshall
by a partnership of New American Media and the
Marguerite Casey Foundation.
HIVPLUSMAG.COM | 31
 JUST
DIAGNOSED

The 6 Top
Questions
People
Ask Us
About
HIV
THE THINGS THE
NEWLY DIAGNOSED
ASK US ABOUT
BEING POZ MIGHT
SURPRISE YOU.
SHUTTERSTOCK

BY D I A N E A N D E RS O N - M I N S H A L L ,
E D I TO R I N C H I E F O F P L U S M AG A Z I N E

32 | MAY / JUNE 2016

IS IT POSSIBLE I GOT A FALSE POSITIVE?
When your initial test comes back positive you
should be offered a confirmatory test, a second test
to make sure youre HIV-positive. The likelihood
of two false positives is extremely rare. If you took
the at-home test, its a good idea to go to a doctor or
clinic for the second test. False negative test results
can happen too, so if you come up positive and your
partner comes up negative, be cautious. According
to AIDS.gov, It takes time for seroconversion to
occur. This is when your body begins to produce
the antibodies an HIV test is looking foranywhere
from two weeks to six months after infection. So if
you have an HIV test with a negative result within
three months of your last possible exposure to HIV,
the CDC recommends that you be retested three
months after that first screening test. A negative
result is only accurate if you havent had any risks
for HIV infection in the last six months.
HOW MANY FORMER SEX
PARTNERS DO I HAVE TO TELL?
This is kind of a murky area, with debate between
activists and public policy experts. You will be asked
to notify, or have the health department notify, any-
one you have had sex with or shared needles with
since your last negative HIV test or, if this was your
first one, your recent sex partners (say, in the last
year). Your partner(s) will need to be tested now
and, if their test is negative, again in three months.
According to the New York Department of Health,
how far back in time known partners should be
reported is determined on a case-by-case basis
depending on such factors as the approximate dates
when you believe you were exposed and how will-
ing (or able) you are to dig up those names and con-
tact info. The federal Ryan White HIV/AIDS Pro-
gram requires states to make a good-faith effort to
notify current spouses and anyone who has been
the HIV-positive persons spouse within the last
10 years. However, public health departments and
clinics aren't supposed to pressure you for this infor-
mation and they cannot withhold your test results
or penalize you in any way for not divulging.
WHAT WILL CHANGE NOW THAT I'M POZ?
With proper treatment, being HIV-positive is a
manageable, chronic condition like lupus, diabe-
tes, or asthma. You might need to exercise cau-
tion with some of your regular activities. Unless
you had other health conditions prior to diag-
nosis, youll likely see a physician more than you
did before because its vital that you monitor your
health closely. Regular visits with your HIV health
care provider will keep you up to date. Speak with
your doctor about changes that need to be made to your diet, exercise regimen,
and use of alcohol, prescription medicines, and recreational drugs. If drugs were
a factor in your transmission (theres a link between crystal meth use and HIV
transmission, for example), your doctor may recommend rehab. You may tire
more easily, be more prone to infections, or have medical side effects you didnt
have before. But hands down, the biggest change in your daily routine will be
taking medication. HIV medication requires strict adherence to the prescribed
daily dosage, and the drugs often have (mostly minor) side effects. Open com-
munication with your doctor will ensure that you are fully equipped to handle
the changes in your life.
CAN I TRANSMIT HIV THROUGH ORAL SEX?
Because you cant transmit HIV through saliva, you cannot pass HIV to your
partner if you perform oral sex on them. Period.
With blow jobs, it is technically possible, but extremely rare, to transmit HIV
to your partner if you ejaculate into their mouth. Years ago, a study by Eric Vit-
tinghoff, a professor at University of California San Franciscos Center School of
Medicines Department of Epidemiology and Biostatistics, looked at oral trans-
mission among men who had sex with men. He determined the rate of HIV trans-
mission via oral sex was about four one-hundredths of one percent (0.0004). In
fact, by the early 2000sdecades after the start of the AIDS epidemic, with more
than 36 million people infected by the virus world widefewer than 40 cases of
possible oral transmission had been reported in medical literature. HIV acqui-
sition by receptive oral sex without ejaculation is so unlikely, that we dont have
any firm evidence even to show that it actually occurs, said Dr. Laurence Peiperl,
former director of UCSF Center for HIV Information, at a roundtable on the
subject. So its a biological possibility but its exceedingly rare and heres why: As
an HIV-positive man, even if you ejaculate into someone elses mouth, they need
to have open wounds in the mucous membranes in their mouth in order for the
virus to penetrate them. Swallowing semen or pre-cum is not a risk because stom-
ach acid and other enzymes kill HIV.
And if you are a woman with HIV, having someone perform cunnilingus on
you is also extremely low risk, especially if youre not menstruating and your
partner doesn't have open sores in her or his mouth (even then the risk is low).
Although the risk of HIV transmission is exceedingly low, you can still get other
sexually transmitted diseases, including gonorrhea, via oral sex.
ARE THERE SYMPTOMS I SHOULD WATCH OUT FOR NOW?
There are certain signs and symptoms to look out for and a few health fac-
tors that should be constantly monitored. According to Rose Farnan, RN, and
Maithe Enriquez, RN, authors ofWhat Nurses Know About HIV/AIDS,you
should pay special attention to particular symptoms: diarrhea, weight loss or
loss of appetite, trouble or pain when swallowing, white patches or sores in or
around your mouth, long-lasting fever, new cough, shortness of breath, head-
aches, dizziness, blurred vision, or difficulty remembering things. It can be hard
to distinguish whether these symptoms are just passing or sign of a more serious
issue, but keeping track of your bodys patterns will greatly benefit your health.
Farnan and Enriquez suggest keeping written records of weight and other fac-
tors that can change over time.
DO I NEED TO STOP HAVING SEX?
No! In fact, we encourage you not to. Orgasms help you sleep, boost your immu-
noglobulin levels (which fight infections), and reduce stress and depression.
There are ways to protect yourself and your partner, including condom use,
PrEP (for an HIV-negative partner), serosorting, and Treatment as Prevention
(see page 39) .
HIVPLUSMAG.COM | 33
 JUST
DIAGNOSED

HOW TO
DISCLOSE
YOUR HIV
STATUS
TO YOUR
FAMILY AND
FRIENDS
Your First Step Is Making
Sure Youre Not Alone In This.
BY TY L E R C U R RY

W HEN YOU FIR ST LE AR N T H AT

you are HIV-positive, one of the immediate,
dreaded thoughts that can come to mind
is this: How will I ever tell my family and
friends that Im positive? What will they
think of me?
What usually follows is a barrage of
TALK TO OTHER HIV-POSITIVE PEOPLE Its always better
what-if scenarios of rejection and shame
to crawl before you walk, and walk before your run. If you can, it helps
that flood your headspace, all before you
to get advice from a person who has personal experience. Reach out
utter those three little letters out loud. The
to someone in your life who you know is HIV-positive. If nobody
trauma caused by these theoretical night-
comes to mind, talk with someone you know who has at least dated
mares is often enough to keep you sec-
someone with HIV. Seek out online support groups and look for a new
ond-guessing who to tell and who to keep
friend who can give you good advice. Gaining a real life perspective
quiet around for far longer than it should.
can easily assuage any stress or apprehension you may have.
The best way to stay healthy and manage
your virus well is to create a support sys- ARM YOURSELF WITH THE FACTS Just like when you
tem of people who you love and trust. In first found out, chances are the people you disclose your status
order to do that, you need to get over your to will have quite a few questions. Prepare yourself with some of
hang-ups and come out about your status the facts and figures about the state of HIV treatment to put their
to those who are important in your life. To mind at ease. Once you allay their concerns about your health, you
help you get there, here are a few ways to can graduate to deeper discussions. But make sure you get your
make the process easier. facts straight by only using reputable sources: search topics on

34 | MAY / JUNE 2016

 HIVPlusMag.com, the Center for Disease Control and Preventions
HIV site, and AIDSMap to start.
TAKE IT ONE PERSON AT A TIME Dont worry about how
everyone in your life will handle the news. Start with the person
you're closest with, someone who supports you no matter what.
After you've told the people in your inner circle, you can decide
how to approach the rest of the world. Every time you say "HIV"
out loud, it will get easier and easier.
BE PATIENT Its more than likely that your family and friends
wont know the most up-to-date information about HIV, and they
may have stigmatizing beliefs about HIV-positive people. They may
SHUTTERSTOCK
initially mistake your new HIV status as a terminal one, rather than
the manageable chronic condition it is. Give them time to learn and
process the information. Support them through this and they will
likely return the favor. Remember, people
who love you will probably be very con-
cerned and upset at first. Thats because
they are worried about you. Its a natural
reaction, just like the one you probably had
when you first learned of your status. Be
patient. In a month or two, you will be dis-
cussing your lab results and your T-cells in
the same way you talk about your job and
your love life.
BE BRAVE Discussing HIV with someone
who you care about is never easy. Then
again, nothing worthwhile ever is. Be brave
and believe that youre worthy of love and
supportbecause you are.
HIVPLUSMAG.COM | 35
 5 Reasons
Why TasP
Is the Best
HIV
Prevention
WHY THE MOST UNDERRATED
AND LEAST TALKED ABOUT
FORM OF SAFER SEX MIGHT
JUST BE THE BEST.

BY TY L E R C U R RY

ALTHOUGH THE USE of Truvada as

pre-exposure prophylaxis (PrEP) contin-
ues to make headlines, the use of treatment JUST
as prevention (dubbed TasP) is one of the DIAGNOSED
most underrated yet most effective ways to
prevent the spread of HIV.

WHAT IS TASP?
TasP is when someone who is HIV-
positive achieves an undetectable viral
load through the use of consistent antiret-
roviral medication. When a person with
HIV has a viral load that is suppressed to
undetectable levels, they reduce their risk
of transmitting the disease by96 percent.
To date, there has not been one confirmed
case of someone with a suppressed viral
load who has transmitted HIV.
Study after study, TasP has been
proven to work. When evaluated with the
added benefits associated with antiretro-
viral meds, its simply the best HIV pre-
vention methods out there. Here's why:
IT CAN HAVE A BIG IMPACT.
An estimated 1.2 million people in the U.S.
are living with HIV and 50,000 new infec-
tions occur annually. Currently, only 30
percent of people living with HIV are uti-
lizing TasP by being on and adhering to
their treatment to maintain a suppressed
viral load. TasP users represent a more tar-
geted, at-risk audience who have a greater
reason to use this prevention method.
IT SAVES LIVES.
Not only is TasP on of the most effective
ISTOCK
butunlike PrEP, PEP, or even condomsthe use of TasP to prevent HIV has the added
benefit of saving an HIV-positive persons life. Whereas an HIV-negative person doesn't have
to take PrEP, a person living with HIV must stay on treatment to remain healthy.
IT EMPOWERS HIV-POSITIVE PEOPLE.
Unfortunately, the majority of people with HIV aren't in treatment or taking advantage
of TasP, due to numerous reasons, including not knowing their status or having access to
care. There's also no denying the disempowerment people feel when they are first diag-
nosed. Promoting the effectiveness and benefits of TasP can show those living with HIV
that their treatment is empowering, not just a symbol of stigma.
IT REDUCES HIV STIGMA AND PROMOTES HEALTHY CONVERSATION.
Its difficult to talk about PrEP without getting bogged down into anecdotal discussions
about worst-case scenarios and slut-shaming rhetoric. That's because HIV stigma still
very much exists. When it comes to PrEP and TasP, one is not better or worse than the
other. But when it comes to advocating for PrEP, the inclusion of TasP removes the barrier
between HIV-positive and negative people and encourages conversation about shared
interests in preventing HIV. The use of TasP, and more importantly, the conversation
about TasP can greatly reduce the stigma of living with HIV and promote healthy dis-
cussion between sexual partners.
IT WORKS. IT REALLY WORKS.
TasP doesnt work only in conjunction with PrEP. It doesnt work only in conjunction
with condoms. It just works. Period. On its own. An HIV-positive person who is using
TasP as their HIV prevention method has virtually no risk of transmitting HIV. TasP is
the best way for anyone with HIV to protect themselves from transmitting HIV and still
have a healthy sex life. Like PrEP, TasP doesn't prevent other STIs . Couples can choose
and use whatever additional protective methods they deem necessary. But make no mis-

and under-utilized form of HIV prevention, take, TasP works. No disclaimers needed.

HIVPLUSMAG.COM | 39
 JUST
DIAGNOSED

Finding out youre positive is tough; figuring out

SHUTTERSTOCK

how to tell your children is even harder. A noted child

therapist talks to several experts about doing it right.

40 | MAY / JUNE 2016

DO I HAVE TO TELL THEM? You can assure them thatunlike years agothere are now med-
Probably. Ninety-eight percent of the icines that help people with HIV live long, healthy lives. Or, if your
time, unless its a highly unusual circum- diagnosis has a more serious prognosis because of comorbidities or
stance, telling your child is best, says AIDS complications, explain, I have some other health conditions
Christa Peterson, PsyD, and a certified child that means this is very serious. Peterson suggests acknowledging
life specialist at Seattle Childrens Hospital. if your prognosis is serious, by saying, This is very distressing, and
Often, the child already senses something were going to have some really hard days, but also make it clear
is wrong. And even very young children that not every day is going to be hard.
intuitively know when a parent is lying,
warns Bernard Douglas, a psychotherapist
WHAT SHOULDNT I SAY?
in private practice.
What can you leave out of this initial conversation? You dont need
Older children may figure out the parent
to share how you got HIV, says Steve Lapuk, a psychotherapist in
has HIV on their own, by going through the
private practice.
parents medicine cabinet, says Ken Howard,
Allow the child to have the choice [whether or not] to ask that
founder of Gay Therapy LA. This can spark
question, says Douglas. But be prepared if they do. This conversa-
feelings of betrayal.
tion is also not a time to bring up safer sex.Yes, you want to educate
The child wonders, What else havent
your child, but do it at another time.
they told me? Am I not part of this family?
Do they not feel I can handle it? They can
start to question their own abilities, says WHAT ABOUT PRIVACY?
Rebecca Hobbs-Lawrence, Pathways Pro- The smallest children, will say, My mommys sick but generally
gram and Grief Services Coordinator at The wont use the word HIV, says Hobbs-Lawrence. With a young-
Dougy Center. A child who feels betrayed er child, Douglas says parents need to ask themselves how being
that you didnt tell them, can lose confi- open about their diagnosis could impact their childs invitations to
dence in you, says Douglas. sleepovers, sporting events, and other activities with their peers.
Parents may think, Im going to stand up to the stigma, Douglas
says, but if their child will be excluded, that has to be considered.
AM I READY TO SHARE?
For older kids, you can ask your teenager, What do you want to
Dont rush home from learning about a
do with this information? Douglas says.Talk about possible conse-
HIV diagnosis and tell your child imme-
quences. Give them power by including them in that decision-mak-
diately. Sit down with your medical
ing process. Its one thing to deal with ignorance, he says, but its
team first and hear about your treatment
another thing entirely to have had absolutely no say about it.
options, advises Peterson. Put a plan in
Hobbs-Lawrence offers another option: You can tell your teen,
place. You want to be able to tell them
My preference is that the whole school wont know.You need some-
some concrete details, like, This is the
one to talk towho would you pick? A best friend, teachers, a ther-
name of my medication. Youll also want
apist? Well make sure they have accurate info. That ensures your
to think about your goals for sharing this
child is not keeper of the secret, which can be a huge burden. Be
with your children, says Douglas.
sure to add that if it does get around, its not anyones fault. Well
Make a list of your goals, and a list of
handle it.
your fearswhat your children could expe-
rience that you dont want, he says. You
want to be able to temper your expectations AFTER YOU COME OUT TO YOUR KIDS
for how your children should react. Your first conversation will be the beginning of a continuous conver-
sation with your family. Tell your child you want to hear their ques-
tions. Ask how they want to share information. Say, Do we want
HOW DO I DO THIS?
to share one-on-one?' says Hobbs-Lawrence. Maybe we want a
You want to use age-appropriate language,
rule that anyone can call a family meeting? Maybe a Q&A box?
which means using simple terms for young
Families that focus on problem solving do best, says Peter-
children, and more details for teens or
son. Children feel protected when they hear, Were a team, well
young adults. Hobbs-Lawrence says you
face this together. No one is going to be left alone in this, adds
can try something gentle but clear, like:
Hobbs-Lawrence.
This is hard for me to tell you. I havent
been feeling well. The doctors ran some
tests, and they found out what I have. Its
something called Human Immunodefi- Athena Brewer, MA, LMFT, is an expert in the treatment of angry and high-intensity children. She
ciency Virus. Some people call it HIV. has a private practice in Seattle, and welcomes your feedback at athena@athenabrewer.com.

HIVPLUSMAG.COM | 41
42 | MAY / JUNE 2016
 We Dont Need
Another Hero
Working with street educated trans women around
HIV and health issues taught me more about life,
survival, and feminism than my entire college degree.

by elaine r. mendus
I M OV E D T O N E W YO R K C I T Y after college graduation
to get out of rural America for good. BOOM! Health, a Bronx-
based provider that integrates HIV, housing, legal, and advocacy
services for disadvantaged communities, was the first place to give
me a desperately needed reprieve from unemployment alley and
the chance to wet my feet in social work as a peer mentor. As
my grant-funded position was set to end, Erik, a transgender
colleague, approached me with another opportunity. She had
developed a class to teach other trans women about health issues
and wanted me to become her co-facilitator. M
SHUTTERSTOCK

Editors Note: Erikas name has been changed to protect her privacy.

HIVPLUSMAG.COM | 43
 Not only was it a reprieve from
my pending joblessness, I was
honored to be wanted. I happily
accepted the offer and on the subway ride
home, I couldnt get over the fact that I had
garnered the respect of someone Id never
even worked with. I didnt know Erik well,
but I respected her for her brash, outspo-
ken attitude. I was thrilled that she was
taking me on to assist in this endeavor.
Later that night, I started imagining all
the good I could do in this new role. I could
really teach these women something. Hell,
maybe I could even save a life. My inner
Wonder Woman bursting to the surface,
I fell asleep with a smile. Only my room-
mates were happier than I was because
this new position meant the rent would be
on time.
I spent time studying a course outline
Erik provided. I read up on hepatitis c,
silicon pumping, needle sharing, and other
44 | MAY / JUNE 2016
topics that might have been familiar to
others but were quite new to me. I wanted
to make sure I understood them all before
the training began. I needed to impress
Erik and others at BOOM!, especially
those making permanent hiring decisions.
I wanted to hit a home run and use this as
a springboard to a full-time position.
Sure, I was thinking about future pay-
checks, but I also had people to save. I
planned to introduce a segment on inti-
mate partner and sexual violence. I knew
trans women were often victimized by
such violence, especially since some of our
students would be coming from sex work
backgrounds. As a liberated young trans
millennial with a college degree and tons
of earnestness, I just knew I would be able
to save women who hadnt had the educa-
SHUTTERSTOCK
tion and enlightenment I had.
My first day would show me just how
wrong I was.
 I came in early. I was decked out in black dress pants, a mint
green blouse, and black Doc Martins. A long, black trench coat
protected me on the way up from the subway. When I stepped into
the office-space-turned-lounge, Erik greeted me with a smile.
She wore leggings, a red tracksuit top, and bright red sneakers.
Her long and perfectly manicured nails clicked when she touched
pretty much anything. The other girls were also dressed more casu-
ally than I.
As we waited for everyone to arrive and sorted out lunch, the
girls chatted. Words flew back and forth, and I didnt really pay
attention, at least not until one sentence hit me like a freight train.
She looks cunt!
My mom would have backhanded me for saying the c-word at
home.
Now these women were throwing it around like it was just
another word. Yet it didnt seem like they were using it to
offend or cut each other down. This was a safe space, but
shade was everywhere. Girls had no problem with call-
ing each other a man or saying that somebody else
looked like a man in jest, or to be shady, suggesting
a trans woman didnt pass. But their use of the c-word
didnt sound like shade.
Cunt couldnt be a compliment, could it?
I had come to teach these women, but I was quickly getting an
education. It turned out that cuntlike fishwas a hell of a com-
pliment to these women. It implied that a girl was born female. It
was sort of like the more politically correct term passing, only
with a little more chutzpah.
I held my tongue and listened to how the girls talked that day.
It was a gateway to a whole new world. The women I was here to
educate exuded that infamous New Yorker attitude, and it was
delightful, even if it seemed strange and unfamiliar to me. They
seemed isolated from, and outside of the transgender commu-
nity that I was familiar with, the one that had blossomed on the
Internet and come of age in college gender studies classes.
Teaching these women actually turned into an education for
me. I learned just how asinine my savior approach had been.
These women may have lacked degreessome hadnt even
graduated from high schoolbut they had the street smarts to
make it through the tumultuous times before Laverne Cox was
a TV star, before Janet Mock was Redefining Realness, before
Jazz Jennings, Carmen Carrera, and legions of trans resources
existed on the Internet.
Some of these women were engaged in sex work, but instead of
the exploited and trafficked women I had imagined, they exuded
power. They had survival skills. They didnt need saving. You cant
save those who are already saving themselves. They were already
being their true selves. These girls had let nothing stop their tran-
sition in an era where it was still dangerous to even be gay, much
less trans, and yet they had survived.
There was something tangible about them. They seemed far
more real to me than the trans women I encountered complaining
on social media sites, or even the middle class activists who showed
up at protests and Pride parades. To put it another way, these girls
simply werent camera-friendly enough to
even appear in a public service announce-
ment and the only way they would be in
the media spotlight was as some kind of
cautionary taleand yet they had a lot to
teach me.
In the college educated, social justice
world, black and brown trans women have
become a little like unicorns, nearly myth-
ical beasts that everyone wants to study
and to help save.
Rather, I was quickly learning that
these women were totally real, and they
werent about to be taught (or saved) by
a light-skinned Puerto Rican girl who
thought she was better than them. They
wouldnt be caught in a classroom dis-
cussing abstract gender studies, nor did
they need to. They didnt need lectures on
why cunt was an offensive term. They
wouldnt have known what it meant if Id
called the c-word a trigger.
What I learned they didand do
need are opportunities from a society
too often closed to them. And they need
their voices heard. Black and Latina trans-
gender women have some of the highest
rates of HIV, of death from AIDS com-
plications, of death from violence. These
women receive a lot of love and rest in
power comments when they are dead, but
its time we started paying these women
attention while they are still alive. Black
and brown trans women are real people.
Not sacred idols, or people we should only
evoke once a year on Transgender Day of
Remembrance.
The wisdom and courage of those
women at BOOM! has continued to
inspire me more than any protest or radi-
cal activism Ive witnessed since. Lets stop
talking about how precious or import-
ant the lives of black and Latina trans
women are and start listening to them.
Let them speak and youll discover that
many already know what they needwe
just have to get out of their way. Bring
trans women of color to the front and let
them lead for a while. Maybe then we can
stop turning dead trans women of color
into rest in peace and in power protest
memes.
HIVPLUSMAG.COM | 45
UNSURE/POZ HOLLYWOOD
CONTINUED FROM INSERT
tions and reactions: from affection
to disgust, and back again. Thats
where Kieran comes from. In Irish,
the name Kieran means little dark
one, and that seemed perfect.
Reactions from viewers have run
a similar gamut, Kiley admits.
My father-in-lawwho I admire
greatlysawa few seconds from
the scene where my character,
Kieran, relapses with three other
guys in a sexually suggestive mon-
tage. He was so dismayed. I think
hes still on the fence about watch-
ing the show.
Thats not the only scene viewers
have reacted to. One of the most
hopeful and upbeat moments of
the show, Kiley says, has drawn
out a bit of controversy. Id talk
about that more, but Im only
allowed one spoiler.
Theres also a fairly intense epi-
sode in which Kieran uses meth.
I consider that high praise! he
says. We aimed to shoot the scene
so that the adrenaline rush that one
might experience before decid-
ing to relapse was something tan-
gible, palpable. Casting that scene
was one of the longest processes
in the production. We needed our
actors to fully commit to the spe-
cifics of what that world is like. It
paid off though, because everyone
involved understood [it] was cru-
cial in getting things right. So I have
to give props to my crew and cast
for maintaining a completely pro-
fessional set while we shot this dif-
ficult scene.
Kiley says the realism paid off,
perhaps too well. On a personal
level, I had to compartmentalize
the relapse scene very carefully.
My husband, who was my fianc at
the time, did not like that scene. We
had to discuss it a lot, and I would
remind him over and over that we
were just acting out a situation,
that this wasnt reality. His worry
was that the scene might act as a
trigger for me, which was a very
legitimate concern. But in the end,
I think acting out that whole scene,
explaining to my very talented cast
members what this situation was
really like from my own past expe-
rience, was in some way a turning
point for me and my struggle with
past meth use.
Kiley felt it was necessary to
include the scene, in part, because
Kierans story is derived from his
own personal history and because
its something that people dont
like to talk about. Sometimes when
a subject like crystal meth use
comes up, people instinctively try
to change the subject. I think the
problem of meth use in the gay
community is that its treated as a
taboo subject, which just creates
stigma around those who use it.
The only way to make progress on
that front is to actually engage in
fruitful discourse around the sub-
ject. There was a time when talking
about interracial marriage was sim-
ilarly taboo. Im all about moving
the discussion forward.
With season two on the horizon,
he says everyone is very excited to
do it and part of the reason for that
is, with the world of the show now
established, were looking forward
to delving into some of the charac-
ters lives in more detail. Allie, played
by Amy DePaola, and Paula, played
by Maureen Kieller, are characters
that we really want to explore not
to mention Ottavio, played by Ken
Breese, the weird roommate.
He says that Kierans story, which
has really just begun with season
one, is important for a few reasons.
Most importantly, there needs to
be an HIV-positive character, who is
relatable, accessible to a mainstream
audience, giving voice to the scores
of young people who are newly
infected and living with HIV now.
Kiley admits its a completely
different thing to receive an pos-
itive diagnosis today than it was
20 years ago, but the media hasnt
caught up. When I was first diag-
nosed, [if] there had been a series
about a character who was deal-
ing with post-diagnosis depression,
along with lifewhich goes on for us
poz folks these daysI might have
felt more empowered to reach out
to friends and loved ones and ask
for the help I needed. Unfortunately,
I had no model for that, so Kierans
three months of silence is actually
nothing compared to the nearly five
years of isolation I experienced after
my diagnosis.
Unsure/Positive is filling that gap,
and dozens of viewers have thanked
him for offering a perspective that
they hadnt ever considered, he
says. Some of them are HIV-pos-
itive long-term survivors; some of
them simply have never really felt
affected by the epidemic. Maybe,
now, they feel as though they know
someone who is HIV-positive.
Despite the high praise (or per-
haps because of it), viewers
shouldnt expect controversy to go
away next season.
A second season will also allow
us to contribute to the discourse
around life with HIV and all that
goes with it PreP comes to mind,
and so do other topics, like having
an undetectable viral load, the per-
spective of long-term survivors, and
the people who love them. Theres a
lot to work with, and if you walk into
my apartment, that fact manifests
itself physicallyas lots of Post-it
notes, lots and lots of color coded
Post-its. They really are a miracle.

POETRY/POZ HOLLYWOOD
CONTINUED FROM INSERT
as open, vulnerable, and talented as Daniel. His
living with HIV provides a whole range of new
experiences to bring to the table. And it deep-
ens his work, too.
Will we see a day when HIV is treated like
other medical issues?
I hope so. Here in Hollywood, especially with
male actors, theres an illusion of perfection
that the studios and actors themselves sometimes strive to create. Thats
why Im so proud of casting four openly gay actors in the film, between
Patricia, Rex, Daniel, and myself. Theres a psychological cost to pay for
denying your truth and, sadly, many artists do pay it.
What poem really sticks with you?
I was really so moved by Steven Reigns poem, Recipe Box, that I had to
put it in our film. It takes place just after the period when so many suc-
cumbed to AIDS and the author recounts all his friends who died. He
decides to sort the names of his friends into categories in the same way
that recipe boxes are organizedhors doeuvres, entrees, desserts. Theres
a reason I chose Recipe Box as the final poem of the film.

46 | MAY / JUNE 2016

YOU CAN LIVE A
HEALTHY LIFE WITH HIV.
TREATMENT HELPS
MAKE IT POSSIBLE.

Starting treatment means youre

protecting your health. Find out why its
so important at HelpStopTheVirus.com
2015 Gilead Sciences, Inc. All rights reserved. UNBC1857 03/15
BY WILLIAM B. MILLER, JR. M.D.
I LOVE YOUACTUALLY
I LOVE YOUR MICROBIOME
YOU MAY NEED REAL CHEMICAL ATTRACTION TO FIND A MATE.
W H AT D E T E R M I N E S C H E M I S T R Y
between two people? Who has not said, They
have good chemistry together? We hear it so
often that it seems trite. Typically, we direct
that remark towards a couple that looks mis-
matched to our judgment. We ask ourselves,
What do they see in each other? Our usual
answer is that their chemistry is just right.
This is often our only way of reconciling the
force of attraction between these two opposites.
However, what if the concept of chemical
attraction has a direct biological basis? New
research is revealing that it does and many of
the reasons why.
Its becoming increasingly apparent that
our microbiome has a tremendous influence
upon us. The microbiome represents all the
microorganisms that are in us and on us.
Astoundingly, these are so numerous that they
outnumber our own innate cells by a factor of
ten to one or more. The current estimate is that
we harbor 100 trillion cells that we would not
think of as our own.
Importantly, our relationship with our
microbial companions is essential to our well
being. Their influence is a crucial element
of metabolic pathways. They are critical
participants in glucose regulation, the
mediation of our immune systems, and they
even partially regulate our emotional responses
to stress.
Our relationships with these obligatory
microbial partners are intimate. We cannot sur-
vive without them and they cannot exist with-
out us. It should not be totally surprising then
that they can affect our social choices and even
our love life.
48 | MAY / JUNE 2016
How could germs influence our sexual choices? Those factors had
remained hidden from our appraisal until recently. We simply did not
have the technological means to assess them.
Now we do and current research has found that the amount of microbial
life in our mouths is startling and the transfer between kissing partners
is extensive. However, the particular surprise is that although frequent
intimate kissing between partners does correspond to the composition of
the microbes that are shared between each, there is more afoot. It seems
that there is a shared linkage in microbial composition in the mouths
of sexual partners that operates regardless of kissing frequency. The
implication is that there is a background connection with the microbial
realm that might influence our initial choices of sexual partners.
For example, the microbiota on the back of the tongue is more similar
between kissing partners than unrelated individuals, but that identity
does not clearly correlate to any kissing behavior or frequency. Nor does
it appear to be due to specifically shared environmental factors. Some-
thing extends beyond that.
COULD IT MEAN THAT WE ARE ATTRACTED TO ONE ANOTHER ON THE
BASIS OF FORCES THAT ARE UNAPPARENT TO OUR TYPICAL SENSES?
There is evidence to suggest that this the caseand that it is based on
our immunological status, which we depend on for our survival. So it
should not be shocking that our immunological status might affect our
choice of mates. Afterall, we exist on a planet also inhabited by aggres-
sive bacteria and other microorganisms.
How might any organism cope? Our evolutionary path, and that of all
other complex organisms includes mechanisms directed towards protect-
ing our offspring as much as possible. This biological imperative signifi-
cantly influences how we select mates. As part of this process, we each
have a group of genes crucial to immunological defenses. Experiments
have shown that we are unconsciously attracted to other partners whose
immunological background is complementary to our own.
In order to best protect our children against an intrusive and agitating
microbial realm, we tend to seek to mate with those that differ from our-
selves on an immunological basis. Although this may seem odd on first
consideration, it actually makes sense from an evolutionary perspective.
The combining of the immunological capacities of healthy mates that are
 different confers better protection to the next generation.
There are research studies that reinforce this finding.
Experiments have demonstrated that sexual partners are
attracted to certain body odors. Microbes play a part in creat-
ing those human aromas. However, in a crucial evolutionary
twist, that odor attraction is not for similarity but for oppo-
site types. In the aggregate as a species, we seem to search
for sexual partners that are not our match immunologically.
What might underlie this instinct?
The answer lies within both our own personal genes and our
particular microbial complement. On an evolutionary basis,
our species is best protected by the mixing of opposing genes
and microbes. Successful mating proceeds for many reasons,
but there is an important one that has been previously obscure.
That additional reason is our critical association with a vast
microbial partnership that is crucial to our immunological
balance. When contrasting individuals both mix genes and
share microbes, the next generation gets a boost.
Even more astoundingly, the influence of the microbial
SHUTTERSTOCK
sphere extends well beyond these factors. Research has
demonstrated that infection with certain parasites can
overtly guide sexual choice. Such an example is a parasite
called Toxoplasmosis. Cats serve as an intermediate host
but it also frequently infects humans. Although it rarely
causes illness in those with healthy immune systems, it can
lead to an infection of the brain among people living with
HIV. Surprisingly, the parasite has also been shown to affect
human behavior, physiology, and even physical appearance.
As strange as it may seem, in carefully controlled experiments,
human females perceive infected males as more dominant
and more masculine than uninfected males.
What should we make of all this? The next time you gaze
lovingly at your favorite other, tip your hat mentally to your
hidden microbial partners. In truth, your microbiome might
have made you do it.
Dr. William B. Miller has been a physician in academic
and private practice for over 30 years. He is the author of
The Microcosm Within: Evolution and Extinction in the
Hologenome (themicrocosmwithin.com). He currently
serves as a scientific advisor to OmniBiome Therapeutics,
a pioneering company in discovering and developing solu-
tions to problems in human fertility and health through
management of the human microbiome.
HIVPLUSMAG.COM | 49
TREATMENT

VETERANS CAN
NOW GET THE HEP C
TREATMENT THEY NEED
After outsourcing treatment last
year, the VA increases funding
to cover more veterans living
with hepatitis C.
Treatment for hepatitis C has dramatically
improved in recent years, with the
development of new curative therapies
like Gileads Sovaldi. But, with costs for
the three-month regimen running close
to $80,000, Veterans Affairs Hospitals
had limited treatment to those who were
severely ill.
That led to more than 180,000 veterans
being outsourced for their HCV therapy
last year. Now, thanks to an increase in
funding and a decrease in drug prices,
all veterans will be able to receive HCV
treatment through the VA regardless of the
stage of their liver disease.
Were honored to be able to expand
treatment for veterans who are afflicted
with hepatitis C, VA Under Secretary
for Health Dr. David Shulkin said in a
statement. To manage limited resources,
previously we established treatment
priority for the sickest patients.
Veterans Affairs spent $696 millionor
17 percent of their total annual pharmacy
budgeton HCV medication in 2015. This
year, it has dedicated nearly a billion,
which it hopes to increase to $1.5 billion
in 2017.
According to recent studies, one out
of 10 U.S. veterans are living with HCV,
a rate five times higher than the average
population. Veterans of the Vietnam War
are considered to be at particular risk due
to blood transfusions and blood contact
during warfare.
With the increase in the budget for HVC
SHUTTERSTOCK
PHOTO CREDIT

treatment, the VA is encouraging veterans

living with the disease to take advantage of
the life-saving treatment. TYLER CURRY

50 | MAY / JUNE 2016

 FIRST MAN TO BECOME HIV-POSITIVE
WHILE ON PREP IS RARE EXCEPTION
After tens of thousands of PrEP successes, the first documented case of someone
becoming poz involves rare multiclass drug resistance.
Its been nearly two years since the Centers for Disease Control and
Prevention issued historic guidelines recommending that thousands
of Americansparticularly gay and bi men, transgender women,
injection drug users, and partners of HIV-positive individualsstart
taking Truvada as pre-exposure prophylaxis (or PrEP) to prevent
HIV infection.
PrEP has proven to be around 99 percent effective at preventing
HIV transmission among those who take it daily as prescribed. As
was reported at the Conference on Retroviruses and Opportunistic
Infections (CROI), PrEP is still 86 percent effective even among
those using it on demand (which is technically one dose two to 24
hours before sex, and then twice more the two days following sex).
Sure, Truvada as PrEP has had its critics, most notably Michael
Weinstein, the head of AIDS Healthcare Foundation, who has led
what some activists call a moral crusade against the drug. However,
far more scientists, doctors, public health experts, and activists have
AP/ JEFF CHIU
heralded the prevention method as a game changer. In fact, a new
CDC study shows PrEP has the potential to reduce new HIV infec-
tions by at least 70 percent if adopted across the country.
Still, naysayers recently got the tiniest bit
of ammunition for their culture war over
PrEP, with the first documented case of
HIV infection in a PrEP user. The 43-year-
old Canadian man appears to have been
using PrEP as prescribed. The report was
presented at CROI by Dr. David C. Knox, a
physician at Torontos Maple Leaf Medical
Clinic, who noted that clinical and phar-
macokinetic data backed up the patients
claims that he seroconverted despite having
adhered to his treatment.
The mans virus was found to have an
uncommon resistance to multiple drugs,
including emtricitabine and tenofovir, the
two main ingredients in Truvada.
Researchers from several other facilities,
including Torontos St. Michaels Hospital, the
British Columbia Centre for Excellence in M
HIVPLUSMAG.COM | 51
TREATMENT
HIV/AIDS, and the University of Colorado ran a battery
of tests. Completing standard and deep sequencing
of the virus revealed CCR5-tropic clade B HIV-1 with
mutations that were resistant to nucleoside reverse transcrip-
tase inhibitors (NRTIs), non-nucleoside reverse transcriptase
(NNRTI), and integrase inhibitors.
In other words, the strain is resistant to many of the medi-
cations most commonly used to treat HIV, including Isentress
(raltegravir), Vitekta (elvitegravir), Tivicay (dolutegravir),
Ziagen (abacavir), Viread (tenofovir), Epivir (lamivudine), and
Emtriva (emtricitabine). Fortunately, Pozs Benjamin Ryan
reports that despite all these resistance mutations, the man in
the case study is currently on successful HIV treatment, with a
fully suppressed viral load. He is taking Tivicay (dolutegravir),
Prezcobix (darunavir/cobicistat), and Edurant (rilpivirine).
Phylogenetic analysis of the mans HIV strain revealed a very
narrow range of sequence diversity, consistent with infection
from a single source, leading researchers to conclude that the
virus acquired the drug resistance prior to being transmitted to
the man.
How can researchers be certain the man was really adherent
to PrEP? They reviewed his pharmacy records, which showed
consistent prescription refills. Liquid chromatographymass
spectrometry was performed on the untimed plasma sam-
ple from day zero to determine the quantities of each medi-
cation in his system. Dried blood spot testing collected on day
16 showed consistent dose-taking in the preceding one to two
months, thus overlapping with the time period when he would
have seroconverted to HIV-positive.
In addition, standard population sequencing and deep
sequencing to 2 percent of the viral population was completed
on day 7, as was phenotypic testing for resistance to integrase
inhibitors, and phylogenetic analysis of the V3 loop of enve-
lope protein gp120 to characterize the founder virus.
Thats a lot of scientific jargon, but it boils down to labo-
ratory confirmation that the man was following PrEP guide-
lines, making him, the first reported case of breakthrough HIV
infection with evidence of long-term adherence to [Truvada as
PrEP], according to Knox.
After the litany of tests the newly-poz man has already
undergone, further analysis seems unwarranted. Moreover,
considering PrEP is 99 (not 100) percent effective, this case
may indeed reflect that one percent failure rate. While none
of the nearly 10,000 people in the famed iPrEx study of PrEP
among gay and bi men and trans women acquired HIVand
a mutation like this wasnt seen among the participants
scientists have always cautioned that the possibility existed.
While resistance to tenofovir is cited as a main concern
among people living with HIV who are resistant to treatment
worldwide, tenofovir-resistant strains of HIV only account for
about one percent of all cases. Resistance to Truvadas other
active ingredient, emtricitabine, is more common, but the
strain that managed to bypass the safety of PrEP for the man in
this study involved a mutation that was resistant to both medi-
cations, an exceedingly rare occurrence.
This case reiterates that there is no 100 percent guarantee
of preventionnot even with PrEP. But, most experts, includ-
ing those in this study, say that cases like this will likely remain
rare.DIANE ANDERSON-MINSHALL
52 | MAY / JUNE 2016
DO YOU NEED A
MENINGITIS VACCINE?
If you have HIV, yes, you do.
Meningitis is a highly-contagious, fast-moving disease that
leads to death in 20 percent of cases, says Anthony Hayes, Public
Affairs and Policy Vice President at Gay Mens Health Crisis.
Meningitis is a serious infection of the brain and spinal cord
that can lead to deatheven with treatment.
People living with HIV and AIDS, Hayes adds, are at greater
risk than the general population of acquiring the infection.
HIV-positive people arent just more susceptible to the
disease; they are also more likely to die if infected. In fact,
the New York City Department of Health and Mental Hygiene
reports that over half (55 percent) of bacterial meningitis
infections that occurred in the city from August 2010 to March
2013 were among people with HIV. A greater proportion of
deaths also occurred among those who were HIV-positive (32
percent) than those who were HIV-negative (20 percent).
That is one of the reasons GMHC has prioritized fighting the
disease. The organization led public education, outreach, and
vaccination efforts to help end a meningitis outbreak in 2012. Not
content in simply making the vaccine available at GMHCs clinic,
the organization went beyond their doors to stem the New York
outbreak. Dr. Demetre Daskalakis and Dr. Frank Spinnelli, two
doctors on GMHCs board, provided over 2,600 vaccinations in
bars and clubs in the city as well as on Fire Island.
Since then, GMC has lobbied tirelessly for legislation requiring
meningitis vaccinations for children. The HIV organization also
teamed-up with dozens of other groups, local politicians, and
even family members of those whove died of the diseaselike
Kevin Cummines, whose fiancee, Kyle Spidle, was one of the first
HIV-positive gay men to die in the 2012 outbreak.
Last year, GMHCs pressure helped push a meningitis vaccine
bill through the New York State Legislature. With the new law,
New York has become the 29th state to require meningitis
vaccinations for youth in public schools, as recommended by the
Centers for Disease Control and Prevention. Previously, New York
State only required colleges and universities to provide education
about meningitis and offer the vaccine to incoming students.
Meningitis is a silent killer, GMHC CEO Kelsey Louie said in
a written statement announcing the passage of the New York
law. But gratefully there is a vaccine that is safe, effective, and
SHUTTERSTOCK
life-saving.
We urge [everyone], including those living with HIV
and AIDS, to get vaccinated and protect themselves, Hayes
concludes now.DAM

PUT A RING ON IT
Study suggests that use of an insertable vaginal
ring can prevent HIV infection for some women.
New England Journal of Medicine
reports that a ring filled with the
antiretroviral drug dapivirine and
inserted within the vagina provided
extended protection against HIV
at least for older women. Now the
National Institute of Allergy and
Infectious Diseases has announced it
will fund follow-up research to deter-
mine why the ring wasnt as effective
for younger women.
Two large studiesthe Ring Study
and ASPIRE (A Study to Prevent
Infection with a Ring for Extended
Use)conducted in Africa among sex-
ually active, but not pregnant, women
18-45 years old found the ring was
only 27 percent effective. That success
rate rose to 37 percent when scientists
removed data from locations where
it was apparent early on that many
women were not returning for study
visits or using the ring consistently.
Results were remarkably different
when it came to women 25 and older,
for whom the ring lowered the rate
of HIV infection by 61 percent. Based
upon the amount of dapivirine in
the younger womens blood streams,
the scientists determined that
the disparity existed because the
younger women werent using the
ring consistently. If you could get a
61 percent efficacy in the older group,
that means there is something about
this that works, Dr. Anthony Fauci,
NIAID director said in a statement.
The real question is, in the real
world, why is it not working in the
younger group?
The research was conducted in Sub-
Saharan Africa, home to 80 percent of
the worlds women living with HIV.
HIV transmitted through rape is also a
major issue in the region, where a 2011
United Nations study found frequent
conflicts serve as harbingers of sexual
violence against women.
The ring isnt nearly as effective
as PrEP, but many women in Sub-
Saharan Africa have little chance of
accessing that preventative protocol.
The ring, which is still at least a year
from market, would offer women a
form of HIV prevention that is under
their control and doesnt rely on the
use of condoms by sexual partners;
which makes it a life saving device in
a region wracked by sexual violence.
E L A I N E R I TA M E N D U S
3 THINGS TO KNOW
ABOUT METH AND SEX
The expert-author of Lust, Men, and Meth:
A Gay Mans Guide to Recovery gives us
the lowdown on a drug up to 30 percent
of young gay and bi men have used.
Methamphetamine use in the gay community
has reached epidemic proportions, taking a
terrible toll on users. Most gay and bi men
know of the drugs power to intensify sexual
experience, but few realize its devastating
impact on sex and intimacy. Here are three
crucial things to know.
1. METH INCREASES SEXUAL DYSFUNCTION
Sure, meth reduces inhibitions, but it increases
a false sense of confidence, and sends sexual
compulsion into overdrive. Users spend
sleep-deprived days immersed in the pursuit
ofand then the painful recovery from
high-risk sexual encounters. But while meth
stokes the brains ravenous hunger for sex, it
ironically also causes erectile dysfunction, and
the constant barrage of sexual thoughts and
images eventually dulls ones ability to actually
achieve sexual arousal.
2. METH ESCALATES HIGH-RISK SEXUAL
BEHAVIOR Meth destroys the brains dopamine
receptors, the so-called pleasure centers. The
first exhilarating high is therefore not obtainable
again. Consequently, meth users turn to darker,
rougher, and generally unprotected sexual
behaviorplacing them at riskin an attempt to
recapture the initial intoxication.
3. METH CREATES SEXUAL AND INTIMACY
PROBLEMS Meth and sex quickly fuse in
the minds and bodies of users. They simply
cant have one without the other. This results
in persistent sexual dysfunction. Disconnecting
meth from sexuality is crucial for recovery,
and requires time, patience, and therapeutic
supportbut it is wholly possible.DAVID
FAWCETT, PHD
Nationally-recognized psychotherapist Dr. David
Fawcett provides a roadmap to recovery in Lust,
Men, and Meth. Learn more at David-Fawcett.com.
HIVPLUSMAG.COM | 53
BY TYLER CURRY
ARE YOU ON THE RIGHT MEDS?
WHEN IT COMES TO YOUR HIV TREATMENT, NOT ALL PILLS ARE CREATED EQUALLY.
N OW T H AT H I V has become a chronic disease that,
in best cases, can be relatively easy to manage, you might
think that there isnt much difference when it comes to se-
lecting your antiretroviral medication. However, its crucial
for a person living with HIV to consider a variety of fac-
tors in order to get the maximum outcome with the mini-
mal amount of unnecessary side-effects. Unfortunately, if
you dont know the right questions to ask, your doctor could
make the wrong decision for you.
To help figure out what meds will work best for you,
we asked nurse practitioner Eric Klappolz, an HIV spe-
cialist in Dallas, Texas, who treats a variety of people liv-
ing with HIV.
Most people might just buy into the one-pill once-a-day
and that is it, but there are plenty of factors that someone
should consider when choosing their HIV medication, says
Klappholz. Your job, your schedule, you lifestyle, these all
factor into determining which medication will work best.
Klappholz says that he regularly treats new patients who
elect to switch meds because they didnt know enough when
they first started taking treatment. New patients can often
be so fixated on their diagnosis that they do not think to
ask their doctor the right questions. Not only that, but pa-
tients can be reticent to share some of their behaviors that
could help their doctor make the right choice. Once a person
with HIV has successfully achieved viral suppression and the
emotional component of treatment has subsided, he or she
is in a place where they can better assess if there is a better
54 | MAY / JUNE 2016
medication to fit his or her needs.
Klappholz tells us which medications would correspond
best with several common lifestyle factors.
IF YOU HAVE AN UNUSUAL SCHEDULE
Maybe you travel to different time zones often or, you work
alternating or swing shifts. An unusual schedule can make
it difficult to comply with a strict dosage schedule. For some
medications, missing even a dose or two here and there can
be quite the problem. I would typically prescribe Prezcobix
and Truvada for this patient, just because the Prezcobix is the
most forgiving if you are likely to miss dosages. The chances
of building a resistance is low, and even if you do, it doesnt
eliminate a lot of other options later on, says Klappholz.
IF YOURE OTHERWISE HEALTHY
If you are not dealing with any coinfections, you dont smoke
or drink heavily, and you arent overweight, you may be con-
sidered what doctors call otherwise healthy. This just means
that you arent at any significant risk for cardiovascular dis-
ease, which makes you the perfect candidate for Triumeq.
Right now, I am putting my new patients on Triumeq when
I can, because there is no other interactions with other medi-
cations and it just seems to me to be the best thing out there.
SHUTTERSTOCK
IF YOU CAN BE CONSIDERED OVERWEIGHT
Although Triumeq is an excellent drug choice for some, it
does come with certain cardiovascular risks. Therefore,
 Klappholz doesnt recommend that patients
who are overweight take this drug. Instead,
he says a Tenofivir-based medication, such as
Stribild or Genvoya, is the best choice.
IF YOU ALSO HAVE HEPATITIS C
More than 20 percent of people living with HIV
are also living with hepatitis C. An HIV/HCV co-
morbidity more than triples a persons risk for
multiple liver issues, so it is important to select
the right medication to best treat both diseases
while minimizing any unnecessary risks. New
medications are making hep C easier to treat,
as well. If one of my patients also has HCV,
Complera is the safest bet during the duration
of the persons HCV treatment. Once he or she
is determined to be HCV-negative, a patient can
then re-evaluate their HIV medication about
three to six months afterwards.
IF YOURE A HEAVY DRINKER OR
RECREATIONAL DRUG USER
Much like people with unusual schedules, a per-
son who engages in heavy alcohol or recreation-
al drug use runs the risk of missing their daily
TYLER CURRY
dose by time specified or altogether. Likewise,
the same suggestion of Prescobix and Truvada
is recommended because, once again, it is the
most forgiving when it comes to drug resistance
for patients who might miss doses.
IF YOURE A LONG-TIME USER OF ATRIPLA
Atripla was once the go-to for people with HIV,
but the arrival of new medications such as
Stribild, Complera, Truimeq, and Genvoya has
knocked the popular drug down a notch. Now
that Atripla is no longer a first-line medication,
Klappholz recommends that his patients switch
to a newer medication that provides all of the Our new expert on-call
benefits with fewer side-effects. I will often hear, is nurse practitioner
But its working and I dont have any bad side-ef- Eric Klappholz, an HIV
fects, so why change? Klappolz says. But even specialist in Dallas,
patients who claim to no longer have side-effects Texas, who treats people
from Atripla usually come back in a month or two living with HIV.
saying that they are so happy with the switch.
IF YOU SMOKE
A person who smokes should avoid Triumeq in
order to avoid any additional increase in car-
diovascular risks. Unfortunately, many patients
will try and minimize their tobacco use when
speaking with their doctor. Even if you smoke
occasionally, let your doctor know. If you have
yet to completely give up smoking, Klappholz
says that Stribild or Genvoya are most likely the
best options for you.
HIVPLUSMAG.COM | 55
A GENETIC MUTATION THAT
BLOCKS HIV MAY HOLD THE KEY
TO FUTURE TREATMENT AND,
PERHAPS, A CURE
BY E L A I N E M E N D U S A N D T R U DY R I N G
E V E N T H E M O S T careful individuals
can find themselves with a positive HIV diag-
nosis, while others couldnt get the disease if
they tried. Researchers trying to find out why
discovered some people carry a genetic muta-
tion that makes them highly resistant to HIV
infection. This mutation, called Delta32, keeps
a protein called CCR5 from rising to the surface
of the immune systems T cells. When CCR5 is
on the surface of the cell, HIV is able to latch on
to it and infect the cell; when it is not, the cells
door is effectively closed to HIV.
Very few people have this genetic variation,
which some scientists think has been inherited
from ancestors who survived the massive bubonic
plague in Europe centuries ago. About 1 percent of
Caucasians have it, and it is even rarer in Native
Americans, Asians, and Africans. A 2005 report
indicated that 1 percent of people descended from
Northern Europe are virtually immune to AIDS.
Those lucky enough to be resistant must
inherit the HIV-shielding genes from both par-
ents, though having only one parent with the
mutation still leaves a child better prepared
to defend HIV than having none. At least one
genetic testing company, 23AndMe.com still
does the HIV immunity test (among their battery
of tests, not as a stand alone), though many com-
panies that once catered specifically to gay men
for the HIV immunity test have closed down.
In the case of Timothy Ray Brown, the
so-called Berlin Patient cleared of HIV after
receiving stem cell transplants to treat his leu-
kemia, there was great difficulty finding a donor
who not only had this mutation, but matched
other components of Browns immune system
closely enough that his body would not reject the
cells. Researchers are now focusing on the pos-
sibility of introducing the rare genetic mutation
into a patients body, infusing T-cells that have
been modified so as to have the CCR5 variation.
Under the sponsorship of the National
Institutes of Health, researchers at the
University of Pennsylvania Perelman School of
Medicine in Philadelphia, the Fred Hutchinson
56 | MAY / JUNE 2016
Cancer Research Center in Seattle, and other institutions and biomedi-
cal companies are conducting research on this process, first to assess its
safety, then its effectiveness. The latter will involve stopping study partic-
ipants anti-HIV medications to see if their immune systems continue to
suppress the virus.
Joining in such research will be the Timothy Ray Brown Foundation,
which Brown has formed in partnership with the World AIDS Institute.
The Timothy Ray Brown Foundation will be solely dedicated to finding a
cure for AIDS, Brown said at the U.N. AIDS conference in July.
Brown is now a vocal advocate for bringing a cure to others living with
HIV. However, a recent interview with Brown, and the doctor who cured
him, has served to underscore how much luck played a role in Browns
own cure.
His doctor, Gero Htter, pointed out that Brown was in the right place
at the right time. In fact, later efforts by doctors to successfully cure other
patients using Htters treatment method have all failed, with patients
dying from the stem cell transplant itself, or other complications before it
could be determined if HIV had been removed from their bodies.
That said, the groundwork laid down by Htter in curing Brown of his
HIV is now viewed as one blueprint for creating a cure to HIV. The con-
sortium of academic and private sector research institutions of defeatHIV
a Delaney Cell and Genome Engineering Initiativeare hoping to use
stem cells from HIV-positive individuals to mimic the genetics of humans
immune to HIV. Clinical trials are now opening up within the consortium
for patients who meet multiple eligibility factors.
It may be a while until we can find a cure to HIV, but, it seems that there
is real possibility following the path of the Berlin Patient. That possibility
is enough to excite researchers into seriously pursuing further results,
SHUTTERSTOCK
and their enthusiasm should excite those who live with HIV. There might,
indeed, be a light at the end of the tunnel. How soon they can find it,
though, is still very much up in the air.
 You want time Walgreens HIV-specialized pharmacies can
coordinate your prescription reflls so you can
pick them all up on the same day. Plus, we can

for important remind you about medication doses and reflls.

Its our way of helping you simplify your

things busy life.

To learn more, visit HIV.Walgreens.com.

2015 Walgreen Co. All rights reserved. 97483-620-1015

BECAUSE YOURE MORE
THAN YOUR STATUS

WHY TREATMENT IS
THE BEST PREVENTION
F I N D I N G TH E M E DS TH AT A R E R I G HT FO R YO U

MODE L CAR M E N CAR R E R A S PE AKS OUT

G R E AT N EWS FOR VETS WITH H E P C
CAN OR AL S E X TR AN S M IT H IV ?

MAY / JUNE 2016

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