here - CD8 T cells - The Body

positivelyaware.com 

september+october 2012 

CURE NEWS FROM 

AIDS 2012 

FACINg Up 

tO lIpOAtROphy 

POSITIVE 

WOmEn 

MAkINg DECISIONS, CREAtINg 

pOlICy, AND IMpROvINg lIvES

ABOUT PREZISTA ® 

PREZISTA ® (darunavir) is a prescription medicine. It is one treatment option 

in the class of HIV (human immunodefi ciency virus) medicines known as 

protease inhibitors. 

PREZISTA ® is always taken with and at the same time as ritonavir (Norvir ® ), 

in combination with other HIV medicines for the treatment of HIV infection 

in adults. PREZISTA ® should also be taken with food. 

• The use of other medicines active against HIV in combination with 

PREZISTA ® /ritonavir (Norvir ® ) may increase your ability to fi ght HIV. 

Your healthcare professional will work with you to fi nd the right 

combination of HIV medicines 

• It is important that you remain under the care of your healthcare 

professional during treatment with PREZISTA ® 

PREZISTA ® does not cure HIV infection or AIDS and you may 

continue to experience illnesses associated with HIV-1 infection, 

including opportunistic infections. You should remain under the 

care of a doctor when using PREZISTA. ® 

Please read Important Safety Information below, and talk to your 

healthcare professional to learn if PREZISTA ® is right for you. 

IMPORTANT SAFETY INFORMATION 

What is the most important information I should know 

about PREZISTA ® ? 

• PREZISTA ® can interact with other medicines and cause 

serious side effects. See “Who should not take PREZISTA ® ?” 

• PREZISTA ® may cause liver problems. Some people taking 

PREZISTA, ® together with Norvir ® (ritonavir), have developed liver 

problems which may be life-threatening. Your healthcare professional 

should do blood tests before and during your combination treatment 

with PREZISTA. ® If you have chronic hepatitis B or C infection, your 

healthcare professional should check your blood tests more often 

because you have an increased chance of developing liver problems 

• Tell your healthcare professional if you have any of these signs and 

symptoms of liver problems: dark (tea-colored) urine, yellowing 

of your skin or whites of your eyes, pale-colored stools (bowel 

movements), nausea, vomiting, pain or tenderness on your right 

side below your ribs, or loss of appetite 

• PREZISTA ® may cause a severe or life-threatening skin 

reaction or rash. Sometimes these skin reactions and skin rashes 

can become severe and require treatment in a hospital. You should 

call your healthcare professional immediately if you develop a rash. 

However, stop taking PREZISTA ® and ritonavir combination treatment 

and call your healthcare professional immediately if you develop any 

skin changes with these symptoms: fever, tiredness, muscle or joint 

pain, blisters or skin lesions, mouth sores or ulcers, red or infl amed 

eyes, like “pink eye.” Rash occurred more often in patients taking 

PREZISTA ® and raltegravir together than with either drug separately, 

but was generally mild 

Who should not take PREZISTA ® ? 

• Do not take PREZISTA ® if you are taking the following 

medicines: alfuzosin (Uroxatral ® ), dihydroergotamine (D.H.E.45, ® 

Embolex, ® Migranal ® ), ergonovine, ergotamine (Cafergot, ® Ergomar ® ), 

methylergonovine, cisapride (Propulsid ® ), pimozide (Orap ® ), oral 

midazolam, triazolam (Halcion ® ), the herbal supplement St. John’s wort 

(Hypericum perforatum), lovastatin (Mevacor, ® Altoprev, ® Advicor ® ), 

simvastatin (Zocor, ® Simcor, ® Vytorin ® ), rifampin (Rifadin, ® Rifater, ® 

Rifamate, ® Rimactane ® ), sildenafi l (Revatio ® ) when used to treat 

pulmonary arterial hypertension, indinavir (Crixivan ® ), lopinavir/ 

ritonavir (Kaletra ® ), saquinavir (Invirase ® ), boceprevir (Victrelis ), 

or telaprevir (Incivek ) 

• Before taking PREZISTA, ® tell your healthcare professional if you are 

taking sildenafi l (Viagra, ® Revatio ® ), vardenafi l (Levitra, ® Staxyn ® ), 

tadalafi l (Cialis, ® Adcirca ® ), atorvastatin (Lipitor ® ), rosuvastatin 

(Crestor ® ), pravastatin (Pravachol ® ), or colchicine (Colcrys, ® 

Col-Probenecid ® ). Tell your healthcare professional if you are taking 

estrogen-based contraceptives (birth control). PREZISTA ® might reduce 

the effectiveness of estrogen-based contraceptives. You must take 

additional precautions for birth control, such as condoms 

This is not a complete list of medicines. Be sure to tell your 

healthcare professional about all the medicines you are taking or 

plan to take, including prescription and nonprescription medicines, 

vitamins, and herbal supplements. 

What should I tell my doctor before I take PREZISTA ® ? 

• Before taking PREZISTA, ® tell your healthcare professional if you have 

any medical conditions, including liver problems (including hepatitis B 

or C), allergy to sulfa medicines, diabetes, or hemophilia 

• Tell your healthcare professional if you are pregnant or planning 

to become pregnant, or are breastfeeding 

— The effects of PREZISTA ® on pregnant women or their unborn 

babies are not known. You and your healthcare professional will 

need to decide if taking PREZISTA ® is right for you 

— Do not breastfeed. It is not known if PREZISTA ® can be passed 

to your baby in your breast milk and whether it could harm your 

baby. Also, mothers with HIV should not breastfeed because HIV 

can be passed to your baby in the breast milk 

What are the possible side effects of PREZISTA ® ? 

• High blood sugar, diabetes or worsening of diabetes, and increased 

bleeding in people with hemophilia have been reported in patients 

taking protease inhibitor medicines, including PREZISTA ® 

• Changes in body fat have been seen in some patients taking HIV 

medicines, including PREZISTA. ® The cause and long-term health 

effects of these conditions are not known at this time 

• Changes in your immune system can happen when you start taking 

HIV medicines. Your immune system may get stronger and begin 

to fi ght infections that have been hidden 

• The most common side effects related to taking PREZISTA ® include 

diarrhea, nausea, rash, headache, stomach pain, and vomiting. This is 

not a complete list of all possible side effects. If you experience these 

or other side effects, talk to your healthcare professional. Do not stop 

taking PREZISTA ® or any other medicines without fi rst talking to your 

healthcare professional 

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 refer to the ritonavir (Norvir ® ) Product Information (PI and PPI) 

for additional information on precautionary measures. 

Please read accompanying Patient Information for PREZISTA ® 

and discuss any questions you have with your doctor. 

28PRZDTC0288R8

IS THE PREZISTA ® 

EXPERIENCE 

RIGHT FOR YOU? 

There is no other person in the world who is exactly like you. And 

no HIV treatments are exactly alike, either. That’s why you should 

ask your healthcare professional about PREZISTA ® (darunavir). 

Once-Daily PREZISTA ® taken with ritonavir and in combination 

with other HIV medications can help lower your viral load 

and keep your HIV under control over the long term. 

In a clinical study* of almost 4 years (192 weeks), 7 out of 10 

adults who had never taken HIV medications before 

maintained undetectable † viral loads with PREZISTA ® 

plus ritonavir and Truvada. ® 

Find out if the PREZISTA ® EXPERIENCE is right for you. 

Ask your healthcare professional and learn more 

at DiscoverPREZISTA.com 

Please read the Important Safety Information and 

Patient Information on adjacent pages. 

Snap a quick pic of our logo to show your 

doctor and get the conversation started. 

*A randomized open label Phase 3 trial comparing PREZISTA ® /ritonavir 800/100 mg 

once daily (n=343) vs. Kaletra ® /ritonavir 800/200 mg/day (n=346). 

†Undetectable was defi ned as a viral load of less than 50 copies per mL. 

Registered trademarks are the property of their respective owners. 

Janssen Therapeutics, 

Division of Janssen Products, LP 

© Janssen Therapeutics, Division of Janssen Products, LP 

2012 06/12 28PRZ12036G

PREZISTA (pre-ZIS-ta) 

(darunavir) 

Oral Suspension 

PREZISTA (pre-ZIS-ta) 

(darunavir) 

Tablets 

Read this Patient Information before you start taking PREZISTA and 

each time you get a refill. There may be new information. This 

information does not take the place of talking to your healthcare 

provider about your medical condition or your treatment. 

Also read the Patient Information leaflet for NORVIR ® (ritonavir). 

What is the most important information I should 

know about PREZISTA? 

• PREZISTA can interact with other medicines and cause serious 

side effects. It is important to know the medicines that should not be 

taken with PREZISTA. See the section “Who should not take 

PREZISTA?” 

• PREZISTA may cause liver problems. Some people taking PREZISTA 

in combination with NORVIR ® (ritonavir) have developed liver 

problems which may be life-threatening. Your healthcare provider 

should do blood tests before and during your combination treatment 

with PREZISTA. If you have chronic hepatitis B or C infection, your 

healthcare provider should check your blood tests more often 

because you have an increased chance of developing liver problems. 

• Tell your healthcare provider if you have any of the below signs and 

symptoms of liver problems. 

• Dark (tea colored) urine 

• yellowing of your skin or whites of your eyes 

• pale colored stools (bowel movements) 

• nausea 

• vomiting 

• pain or tenderness on your right side below your ribs 

• loss of appetite 

PREZISTA may cause severe or life-threatening skin reactions or rash. 

Sometimes these skin reactions and skin rashes can become severe 

and require treatment in a hospital. You should call your healthcare 

provider immediately if you develop a rash. However, stop taking 

PREZISTA and ritonavir combination treatment and call your healthcare 

provider immediately if you develop any skin changes with symptoms 

below: 

• fever 

• tiredness 

• muscle or joint pain 

• blisters or skin lesions 

• mouth sores or ulcers 

• red or inflamed eyes, like “pink eye” (conjunctivitis) 

Rash occurred more often in patients taking PREZISTA and raltegravir 

together than with either drug separately, but was generally mild. 

See “What are the possible side effects of PREZISTA?” for more 

information about side effects. 

What is PREZISTA? 

PREZISTA is a prescription anti-HIV medicine used with ritonavir and 

other anti-HIV medicines to treat adults with human immunodeficiency 

virus (HIV-1) infection. PREZISTA is a type of anti-HIV medicine called a 

protease inhibitor. HIV is the virus that causes AIDS (Acquired Immune 

Deficiency Syndrome). 

When used with other HIV medicines, PREZISTA may help to reduce 

the amount of HIV in your blood (called “viral load”). PREZISTA may 

also help to increase the number of white blood cells called CD4 (T) cell 

which help fight off other infections. Reducing the amount of HIV and 

increasing the CD4 (T) cell count may improve your immune system. 

This may reduce your risk of death or infections that can happen when 

your immune system is weak (opportunistic infections). 

PREZISTA does not cure HIV infection or AIDS and you may continue to 

experience illnesses associated with HIV-1 infection, including 

opportunistic infections. You should remain under the care of a doctor 

when using PREZISTA. 

Avoid doing things that can spread HIV-1 infection. 

• Do not share needles or other injection equipment. 

• Do not share personal items that can have blood or body fluids on 

them, like toothbrushes and razor blades. 

IMPORTANT PATIENT INFORMATION 

• Do not have any kind of sex without protection. Always practice 

safe sex by using a latex or polyurethane condom to lower the 

chance of sexual contact with semen, vaginal secretions, or blood. 

Ask your healthcare provider if you have any questions on how to 

prevent passing HIV to other people. 

Who should not take PREZISTA? 

Do not take PREZISTA with any of the following medicines: 

• alfuzosin (Uroxatral ® ) 

• dihydroergotamine (D.H.E. 45 ® , Embolex ® , Migranal ® ), ergonovine, 

ergotamine (Cafergot ® , Ergomar ® ) methylergonovine 

• cisapride 

• pimozide (Orap ® ) 

• oral midazolam, triazolam (Halcion ® ) 

• the herbal supplement St. John’s Wort (Hypericum perforatum) 

• the cholesterol lowering medicines lovastatin (Mevacor ® , Altoprev ® , 

Advicor ® ) or simvastatin (Zocor ® , Simcor ® , Vytorin ® ) 

• rifampin (Rifadin ® , Rifater ® , Rifamate ® , Rimactane ® ) 

• sildenafil (Revatio ® ) only when used for the treatment of pulmonary 

arterial hypertension. 

Serious problems can happen if you take any of these medicines with 

PREZISTA. 

What should I tell my doctor before I take PREZISTA? 

PREZISTA may not be right for you. Before taking PREZISTA, tell your 

healthcare provider if you: 

• have liver problems, including hepatitis B or hepatitis C 

• are allergic to sulfa medicines 

• have high blood sugar (diabetes) 

• have hemophilia 

• are pregnant or planning to become pregnant. It is not known if 

PREZISTA will harm your unborn baby. 

Pregnancy Registry: You and your healthcare provider will need to 

decide if taking PREZISTA is right for you. If you take PREZISTA 

while you are pregnant, talk to your healthcare provider about how 

you can be included in the Antiretroviral Pregnancy Registry. The 

purpose of the registry is follow the health of you and your baby. 

• are breastfeeding or plan to breastfeed. Do not breastfeed. We do 

not know if PREZISTA can be passed to your baby in your breast 

milk and whether it could harm your baby. Also, mothers with HIV-1 

should not breastfeed because HIV-1 can be passed to the baby in 

the breast milk. 

Tell your healthcare provider about all the medicines you take including 

prescription and nonprescription medicines, vitamins, and herbal 

supplements. Using PREZISTA and certain other medicines may affect 

each other causing serious side effects. PREZISTA may affect the way 

other medicines work and other medicines may affect how PREZISTA 

works. 

Especially tell your healthcare provider if you take: 

• medicine to treat HIV 

• estrogen-based contraceptives (birth control). PREZISTA might 

reduce the effectiveness of estrogen-based contraceptives. You 

must take additional precautions for birth control such as a condom. 

• medicine for your heart such as bepridil, lidocaine (Xylocaine 

Viscous ® ), quinidine (Nuedexta ® ), amiodarone (Pacerone ® , 

Cardarone ® ), digoxin (Lanoxin ® ), flecainide (Tambocor ® ), 

propafenone (Rythmol ® ) 

• warfarin (Coumadin ® , Jantoven ® ) 

• medicine for seizures such as carbamazepine (Carbatrol ® , Equetro ® , 

Tegretol ® , Epitol ® ), phenobarbital, phenytoin (Dilantin ® , Phenytek ® ) 

• medicine for depression such as trazadone and desipramine 

(Norpramin ® ) 

• clarithromycin (Prevpac ® , Biaxin ® ) 

• medicine for fungal infections such as ketoconazole (Nizoral ® ), 

itraconazole (Sporanox ® , Onmel ® ), voriconazole (VFend ® ) 

• colchicine (Colcrys ® , Col-Probenecid ® ) 

• rifabutin (Mycobutin ® ) 

• medicine used to treat blood pressure, a heart attack, heart failure, 

or to lower pressure in the eye such as metoprolol (Lopressor ® , 

Toprol-XL ® ), timolol (Cosopt ® , Betimol ® , Timoptic ® , Isatolol ® , 

Combigan ® ) 

• midazolam administered by injection 

• medicine for heart disease such as felodipine (Plendil ® ), nifedipine 

(Procardia ® , Adalat CC ® , Afeditab CR ® ), nicardipine (Cardene ® )

• steroids such as dexamethasone, fluticasone (Advair Diskus ® , 

Veramyst ® , Flovent ® , Flonase ® ) 

• bosentan (Tracleer ® ) 

• medicine to treat chronic hepatitis C such as boceprevir 

(Victrelis TM ), telaprevir (Incivek TM ) 

• medicine for cholesterol such as pravastatin (Pravachol ® ), 

atorvastatin (Lipitor ® ), rosuvastatin (Crestor ® ) 

• medicine to prevent organ transplant failure such as cyclosporine 

(Gengraf ® , Sandimmune ® , Neoral ® ), tacrolimus (Prograf ® ), sirolimus 

(Rapamune ® ) 

• salmeterol (Advair ® , Serevent ® ) 

• medicine for narcotic withdrawal such as methadone (Methadose ® , 

Dolophine Hydrochloride), buprenorphine (Butrans ® , Buprenex ® , 

Subutex ® ), buprenorphine/naloxone (Suboxone ® ) 

• medicine to treat schizophrenia such as risperidone (Risperdal ® ), 

thioridazine 

• medicine to treat erectile dysfunction or pulmonary hypertension 

such as sildenafil (Viagra ® , Revatio ® ), vardenafil (Levitra ® , Staxyn ® ), 

tadalafil (Cialis ® , Adcirca ® ) 

• medicine to treat anxiety, depression or panic disorder such as 

sertraline (Zoloft ® ), paroxetine (Paxil ® ) 

This is not a complete list of medicines that you should tell your 

healthcare provider that you are taking. Ask your healthcare provider 

or pharmacist if you are not sure if your medicine is one that is listed 

above. Know the medicines you take. Keep a list of them to show your 

doctor or pharmacist when you get a new medicine. Do not start any 

new medicines while you are taking PREZISTA without first talking with 

your healthcare provider. 

How should I take PREZISTA? 

• Take PREZISTA every day exactly as prescribed by your healthcare 

provider. 

• You must take ritonavir (NORVIR ® ) at the same time as PREZISTA. 

• Do not change your dose of PREZISTA or stop treatment without 

talking to your healthcare provider first. 

• Take PREZISTA and ritonavir (NORVIR ® ) with food. 

• Swallow PREZISTA tablets whole with a drink. If you have difficulty 

swallowing PREZISTA tablets, PREZISTA oral suspension is also 

available. Your health care provider will help determine whether 

PREZISTA tablets or oral suspension is right for you. 

• PREZISTA oral suspension should be given with the supplied oral 

dosing syringe. Shake the suspension well before each usage. 

• If you take too much PREZISTA, call your healthcare provider or go 

to the nearest hospital emergency room right away. 

What should I do if I miss a dose? 

People who take PREZISTA one time a day: 

• If you miss a dose of PREZISTA by less than 12 hours, take your 

missed dose of PREZISTA right away. Then take your next dose of 

PREZISTA at your regularly scheduled time. 

• If you miss a dose of PREZISTA by more than 12 hours, wait and then 

take the next dose of PREZISTA at your regularly scheduled time. 

People who take PREZISTA two times a day 

• If you miss a dose of PREZISTA by less than 6 hours, take your 

missed dose of PREZISTA right away. Then take your next dose of 

PREZISTA at your regularly scheduled time. 

• If you miss a dose of PREZISTA by more than 6 hours, wait and then 

take the next dose of PREZISTA at your regularly scheduled time. 

If a dose of PREZISTA is skipped, do not double the next dose. Do not 

take more or less than your prescribed dose of PREZISTA at any one 

time. 

What are the possible side effects of PREZISTA? 

PREZISTA can cause side effects including: 

• See “What is the most important information I should know about 

PREZISTA?” 

• Diabetes and high blood sugar (hyperglycemia). Some people who 

take protease inhibitors including PREZISTA can get high blood 

sugar, develop diabetes, or your diabetes can get worse. Tell your 

healthcare provider if you notice an increase in thirst or urinate 

often while taking PREZISTA. 

• Changes in body fat. These changes can happen in people who take 

anti retroviral therapy. The changes may include an increased 

amount of fat in the upper back and neck (“buffalo hump”), breast, 

and around the back, chest, and stomach area. Loss of fat from the 

legs, arms, and face may also happen. The exact cause and longterm 

health effects of these conditions are not known. 

IMPORTANT PATIENT INFORMATION 

• Changes in your immune system (Immune Reconstitution Syndrome) 

can happen when you start taking HIV medicines. Your immune 

system may get stronger and begin to fight infections that have been 

hidden in your body for a long time. Call your healthcare provider 

right away if you start having new symptoms after starting your HIV 

medicine. 

• Increased bleeding for hemophiliacs. Some people with hemophilia 

have increased bleeding with protease inhibitors including 

PREZISTA. 

The most common side effects of PREZISTA include: 

• diarrhea • headache 

• nausea • abdominal pain 

• rash • vomiting 

Tell your healthcare provider if you have any side effect that bothers 

you or that does not go away. 

These are not all of the possible side effects of PREZISTA. For more 

information, ask your health care provider. 

Call your doctor for medical advice about side effects. You may report 

side effects to the FDA at 1-800-FDA-1088. 

How should I store PREZISTA? 

• Store PREZISTA oral suspension and tablets at room temperature 

[77°F (25°C)]. 

• Do not refrigerate or freeze PREZISTA oral suspension. 

• Keep PREZISTA away from high heat. 

• PREZISTA oral suspension should be stored in the original container. 

Keep PREZISTA and all medicines out of the reach of children. 

General information about PREZISTA 

Medicines are sometimes prescribed for purposes other than those 

listed in a Patient Information leaflet. Do not use PREZISTA for a 

condition for which it was not prescribed. Do not give PREZISTA to 

other people even if they have the same condition you have. It may 

harm them. 

This leaflet summarizes the most important information about 

PREZISTA. If you would like more information, talk to your healthcare 

provider. You can ask your healthcare provider or pharmacist for 

information about PREZISTA that is written for health professionals. 

For more information, call 1-800-526-7736. 

What are the ingredients in PREZISTA? 

Active ingredient: darunavir 

Inactive ingredients: 

PREZISTA Oral Suspension: hydroxypropyl cellulose, microcrystalline 

cellulose, sodium carboxymethylcellulose, methylparaben sodium, citric 

acid monohydrate, sucralose, masking flavor, strawberry cream flavor, 

hydrochloric acid (for pH adjustment), purified water. 

PREZISTA 75 mg and 150 mg Tablets: colloidal silicon dioxide, 

crospovidone, magnesium stearate, microcrystalline cellulose. The film 

coating contains: OPADRY ® White (polyethylene glycol 3350, polyvinyl 

alcohol-partially hydrolyzed, talc, titanium dioxide). 

PREZISTA 400 mg and 600 mg Tablets: colloidal silicon dioxide, 

crospovidone, magnesium stearate, microcrystalline cellulose. The film 

coating contains: OPADRY ® Orange (FD&C Yellow No. 6, polyethylene 

glycol 3350, polyvinyl alcohol-partially hydrolyzed, talc, titanium dioxide). 

This Patient Information has been approved by the U.S Food and Drug 

Administration. 

Manufactured by: 

PREZISTA Oral Suspension 

Janssen Pharmaceutica, N.V. 

Beerse, Belgium 

PREZISTA Tablets 

Janssen Ortho LLC, Gurabo, PR 00778 

Manufactured for: 

Janssen Therapeutics, Division of Janssen Products, LP, Titusville NJ 

08560 

NORVIR ® is a registered trademark of its respective owner. 

PREZISTA ® is a registered trademark of Janssen Pharmaceuticals 

© Janssen Pharmaceuticals, Inc. 2006 

Revised: June 2012 986588P

5537 N. broadway st. 

chicago, il 60640 

phone: (773) 989–9400 

fax: (773) 989–9494 

email: inbox@tpan.com 

www.positivelyaware.com 

editor-iN-chief Jeff Berry 

associate editor Enid vázquez 

copy editors Sue Saltmarsh, 

Jason lancaster 

web master Joshua thorne 

creative director Rick guasco 

coNtributiNg writers 

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Sal Iacopelli, laura Jones, 

Jim pickett, Matt Sharp 

photographers 

Chris knight, Joshua thorne 

medical advisors 

Daniel S. Berger, MD 

gary Bucher, MD 

Michael Cristofano, pA 

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Swarup Mehta, pharmD 

advertisiNg iNquiries 

lorraine hayes 

l.hayes@tpan.com 

distributioN maNager 

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A website—and app—that encourages truth in Internet dating 

www.positivelyaware.com/2012/12_06/mister.shtml 

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www.positivelyaware.com/2012/12_06/aids2012.shtml 

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© 2012. positively aware (ISSN: 1523-2883) is published bi-monthly by Test Positive Aware Network 

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4 SEPTEMBER+OCTOBER 2012 POSiTivElyAwARE.COM

SEP+OCT 2012 

VoLUmE 24 nUmBER 6 

departmeNts 

6 iN boX 

6 readers’ poll 

7 editor’s Note 

What is a woman? 

13 briefly 

FDA approves Truvada for HIV prevention. Rapid 

home HIV test approved. Initial study results find 

dolutegravir/Epzicom is superior to Atripla. 

34 coNfereNce update 

News from the XIX International AIDS Conference in 

Washington, D.C. 

44 ask the hiv specialist 

Safe sex is for seniors, too. 

45 wholistic picture 

Battle of the sexes? 

cover features 

22 Securing care for HIV-positive women 

Challenges and solutions for women living with HIV. 

26 Black women, society, and HIV 

An expert talks about the context of infection. 

28 ‘Everyone needs a support system’ 

How one therapist helps HIV-positive women learn 

to take care of themselves. 

30 Nine months to birth day 

HIV and pregnancy—keeping yourself and your 

baby healthy. 

feature 

41 The mirror has two faces 

A personal account of using facial filler for lipoatrophy. 

oN the cover aNd this page: 

TamaRa wILSon, HIV-PoSITIVE SIncE 1999, 

PHoTogRaPHED BY cHRIS knIgHT 

POSiTivElyAwARE.COM SEPTEMBER+OCTOBER 2012 5

In BOx joIn THE conVERSaTIon: iNboX@tpaN.com anD @posaware 

HIV testing in prison? 

First let me say this is 

strictly my opinion in 

answer to your reader’s 

poll question concerning 

HIV testing in prison. 

I believe it should be 

required upon entering 

and leaving prison. 

Prior to my incarceration, 

I worked at Prevention 

Point Philadelphia (a needle 

exchange program), the Gay 

& Lesbian AIDS Education 

Initiative, and I spoke at various events 

about HIV/AIDS in the prison system. I’ve 

been positive for 18 years and for the last 

11 years I’ve been trying to get as many 

people tested as possible. 

At present, I have three and a half years 

left on my sentence. During my incarceration, 

I have been a Peer Educator teaching 

a class called Positive Voices behind the 

Walls (a little plug never hurts!) and an 

advocate for testing. I’m open about my 

HIV status, so HIV can have a “face” that 

defies the expectations of some of the 

men in here. 

After taking my class for 16 weeks, I 

have seen men’s attitudes change completely 

because they see me living healthy, 

happy, with a loving family, and looking 

forward to a long life. 

So, yes, testing should be mandatory, 

along with education and good information 

about prevention. 

—larry 

wHITE DEER, PEnnSYLVanIa 

you’re not the only one 

Finally, I’ve found relief! On May 21st, I 

read my first ever issue of PoSITIVELY 

awaRE—the March+April Drug Guide. 

I had no idea that anyone 

has the same problems as 

me. The issue touched me 

deeply. 

Simply knowing you’re 

there, that I can reach out 

to someone for information 

seems to make everything a 

little bit better. I’m not sure 

how to receive future issues, 

but put me on your mailing 

list if at all possible! 

—Dwayne e. 

FLoRIDa 

good wishes 

Comment on July+August Editor’s Note: 

Thank you for the uplifting article, “Wish 

HIV Away.” Though easier said than done, I 

know that I’ll be able to pick my head up in 

the morning and continue on with a positive 

outlook on the day. I’m not at the stage 

yet where people can know, only because 

I’m just two months into this disease, but I 

know I will get there (fingers crossed). 

—steven 

VIa THEBoDY.com 

hidden no more 

I have to let you guys know how much 

I appreciated the article, “The Hidden 

People,” in your January+February 2012 

issue. I would love to have the Muslim 

brothers come to Memphis to speak in the 

very near future. My southern hat goes off 

to the writer Sue Saltmarsh for the article. 

And love to Karim Rush, Shadeed Jenkins, 

and Iman Boyd. 

Great job, PoSITIVELY awaRE! You 

guys rock! 

—Anthony Hardaway 

VIa THE InTERnET 

dO ThE WRITE ThInG. PoSITIVELY awaRE treats all communications (letters, e-mail, 

etc.) as letters to the editor unless otherwise instructed. We reserve the right to edit for 

length, style, or clarity. Unless you tell us not to, we will use your name and city. 

POSITIVELY AWARE 

5537 n. BRoaDwaY ST. 

cHIcago, IL 60640 

inbox@tpan.com 

WE REAd YOu. 

SHaRE YoUR commEnTS 

aBoUT oUR aRTIcLES aT 

positivelyaware.com 

REAdERS’ POLL 

In THE jULY+aUgUST ISSUE, wE aSkED 

Before you tested hIv-positive, 

did you think you were at risk? 

yes, but i 

practiced 

safer sex. 

24% 

i didn’t 

think 

about it. 

16% 

your commeNts: 

“I barebacked all the way after my first 

encounter—I have no one to blame but 

myself and my lack of self-esteem.” 

“After I found out, I wanted to kill myself— 

my partner never told me he had HIV.” 

“Before I tested positive, I always 

practiced safe sex. But I also remember 

feeling like no matter how much of a 

good boy I was, HIV was going to get me.” 

“I practiced safer sex until depression 

and drugs got in my way.” 

“I never thought about it. I suspect I 

was infected in 1986. At that time, there 

wasn’t much information available 

about infection and I had no idea what 

behavior was risky and what wasn’t.” 

“I thought those who caught HIV led 

reckless lives, taking drugs and having 

many anonymous partners and 

unprotected sex. I was naïve to believe 

I would be OK if I limited myself to one 

casual partner every few months.” 

this issue’s poll questioN: 

Who is more stigmatized 

because of hIv? 

cast your vote at 

POSITIVELYAWARE.COm 

6 SEPTEMBER+OCTOBER 2012 POSiTivElyAwARE.COM 

No. 

8% 

yes, but i 

didn’t care. 

19% 

yes, but i 

thought i was 

at low risk. 

33%

PHOTO: CHRiS KnigHT 

EdITOR’S nOTE 

jEFF BERRY 

@PaEDIToR 

What is a woman? 

I’VE hAd mAnY TEAChERS In LIfE, InCLudInG WOmEn 

who have taught me particularly important lessons about 

courage, strength, resilience, caring, and compassion. 

Cindy, the oldest of my three sisters, realized at an 

early age that it was her job to help look after the other 

four kids in the Berry clan. My sister Barb became a 

veterinarian, the first doctor in our family. The one who 

was closest to me in age, Wendy, became my best friend 

growing up. My mother Norma went back to work when 

I started preschool in the early 1960’s, and continued 

working as a schoolteacher and elementary school principal 

until she retired. And my grandmother, Ruby, lived 

to be 101, and would often recount to us colorful stories 

from her life, such as the one about traveling all day in 

a covered wagon to see the Wright Brothers perform 

breathtaking feats in their amazing flying machines. 

All these women and others demonstrated to me 

wonderful qualities that I respected and admired, and 

sought to emulate and incorporate into my own sense 

of values and ideals. There are countless examples in 

our culture of strong, courageous women and their 

many accomplishments and contributions to the world. 

So why is it that so many women who are in positions 

of power and leadership appear threatening to so many 

who live in our male-dominated society? 

A recurring theme at this year’s International AIDS 

Conference was the role of women in ending the 

epidemic. In her address at the conference opening 

plenary, Secretary of State Hillary Clinton talked about 

the essential role of communities, especially people living 

with HIV, in turning the tide on the epidemic. “And it 

will come as no surprise to you,” Clinton told the packed 

audience, “that I would like to highlight the particular 

role that women play.” 

Clinton pointed out that in Sub-Saharan Africa 

women account for 60% of people living with HIV. 

“Women want to protect themselves, and they want 

adequate health care, and we need to answer their call,” 

said Clinton. “Every woman should be able to decide 

when and whether to have children. This is true if she is 

HIV-positive or not. Women need and deserve a voice in 

the decisions that affect their lives.” 

In a lively morning plenary session by a panel made 

up of mostly women, HIV-positive 

educator and activist Linda Scruggs 

said it best by stating she wasn’t 

going to ask for anything, because 

women have been asking to be 

counted in for the last two decades. “Today I stand here 

to give you some directions. We’ve decided to stop asking, 

and maybe you just need the recipe.” 

Scruggs called for meaningful involvement of women 

at every level, from the government to local communities 

and organizations, and also made it clear that women are 

not just asking for male-run organizations that “tolerate” a 

women’s program. “We need the support and resources… 

to give us the power to heal our sisters, to change our 

men. We are the mothers of the earth.” 

In her talk, Scruggs also shared part of what she says 

got her to the stage that day. She learned she was HIVpositive 

while visiting a perinatal clinic and was 13-weeks 

pregnant, and had to decide whether to terminate the 

pregnancy and live five years, or have the baby and possibly 

live three. She says she’s glad that day the doctor 

was wrong, and her son, Isaiah, was born free of HIV, 

and he just recently turned 21. 

“I could’ve made the decision to have an abortion. 

An abortion would not have been the first one I had had, 

but I had an experience with God. I had an experience 

that…made me really look and reflect about women. 

After all, what is a woman who thinks she’s ugly? What 

is a woman who feels she has no self-value? What is a 

woman who allows not one, but two men to rape her in 

silence? What is a woman who allows an uncle to molest 

her and others and still be silent?... What is a woman 

who feels that she’s been broken and voiceless? What is 

a woman who’s afraid of understanding herself? What 

is a woman who spent a lifetime trying to be someone 

other than herself? 

“I’ll tell you, that cold November day, that woman 

was me, but it was through the support of this community 

that I was able to find a voice and a place, that 

I could be just who I say I am. I am a woman.” 

Take care of yourself, and each other. 

there are 

countless 

examples in 

our culture of 

strong, courageous 

women 

and their 

many accomplishments 

and contributions 

to the 

world. so why 

is it that so 

many women 

who are in 

positions 

of power 

and leadership 

appear 

threatening 

to so many 

who live in 

our maledominated 

society? 


Please turn past this page; it has intentionally been left blank.➤ 

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PHOTO: JOSHuA THORnE 

BRIEFLY 

EnID VázqUEz 

FDA approves Truvada for PrEP 

The Food and Drug Administration (FDA) 

in July approved truvada as the first 

medication to help prevent Hiv infection. 

As expected, the approval came 

with restrictions. 

Truvada, a combination of tenofovir 

(Viread) and emtricitabine (Emtriva), is 

one of the most prescribed medications 

for HIV in this country. For HIV prevention, 

the use of Truvada is called “PrEP,” 

for “pre-exposure prophylaxis.” 

“[We] commend the FDA’s approval of 

[Truvada] for the use of [PrEP] to prevent 

HIV transmission. This approach can 

prevent many new infections and could 

dramatically impact HIV transmission 

worldwide,” said Kenneth H. Mayer, MD, 

Medical Research Director and Co-chair 

of The Fenway Institute at Fenway Health. 

“My colleagues and I are delighted to have 

helped to demonstrate the utility of this 

promising approach for HIV prevention.” 

David Ernesto Munar, President/CEO 

of the AIDS Foundation of Chicago, said, 

“Our challenge now is to implement PrEP 

as strategically as possible, and to ensure 

the people who need it most, those who 

are most at risk for HIV, have access.” 

“This is an enormous turning point, a 

real game changer, in the fight against 

HIV,” said Jim Pickett, AFC’s Director 

of Prevention Advocacy and Gay Men’s 

Health. “The toolbox we have now has 

Truvada as PrEP. We can look forward to 

more sex acts being protected, especially 

among individuals who have already 

chosen, for whatever reason, to not use 

condoms consistently.” 

According to a press release from the 

FDA, “Truvada is to be used for [PrEP] in 

combination with safer sex practices to 

prevent sexually-acquired HIV infection in 

adults at high risk.” 

The FDA said Truvada for PrEP should 

be used as part of a comprehensive 

HIV prevention plan that includes risk 

reduction counseling, consistent and 

correct condom use, regular HIV testing, 

and screening for and treatment of other 

sexually-transmitted infections, stating 

that “Truvada is not a substitute for safer 

sex practices.” 

Truvada now carries a Boxed Warning 

on its drug label alerting health care 

professionals and uninfected individuals 

that Truvada for PrEP must only be used 

by people confirmed to be HIV-negative 

before being prescribed the drug and 

tested at least every three months during 

use to reduce the risk of developing 

drug resistance. Both the antiviral and the 

PrEP dose is one pill taken once daily. 

Truvada maker Gilead Sciences worked 

with the FDA to create a Risk Evaluation 

and Mitigation Strategy (REMS) for 

Truvada PrEP. The REMS focuses on a prescriber 

training and education program 

in counseling and managing individuals 

who are taking or considering Truvada for 

PrEP. The REMS looks at the elements of 

a comprehensive HIV prevention strategy, 

the importance of adhering to the recommended 

daily dosing regimen, and the 

serious risks of taking Truvada for PrEP if 

already infected with HIV or of becoming 

infected while taking it. 

According to the press release, 

“Truvada’s safety and efficacy for PrEP 

were demonstrated in two large, randomized, 

double-blind, placebo-controlled 

clinical trials. The iPrEx trial evaluated 

Truvada in 2,499 HIV-negative men 

or transgender women who have sex 

with men and with evidence of high 

risk behavior for HIV infection... Results 

showed Truvada was effective in reducing 

the risk of HIV infection by 42% compared 

with placebo in this population. 

Efficacy was strongly correlated with 

drug adherence in this trial.” 

It was also shown in iPrEX that there 

was a 92% reduction of risk for HIV in 

participants who 

took Truvada in the 

prescribed oncedaily 

dose. 

“The Partners 

PrEP trial was conducted 

in 4,758 heterosexual couples, 

where one partner was HIV-infected and 

the other was not (serodiscordant couples),” 

the press release continued. “The 

trial evaluated the efficacy and safety of 

[both] Truvada and [Viread] tenofovir 

versus placebo in preventing HIV infection 

in the uninfected male or female partner. 

Results showed Truvada reduced the risk 

of becoming infected by 75% compared 

with placebo. 

“No new side effects were identified 

in the clinical trials evaluating Truvada 

for the PrEP indication. The most common 

side effects reported with Truvada 

include diarrhea, nausea, abdominal 

pain, headache, and weight loss. Serious 

adverse events in general, as well as 

those specifically related to kidney or 

bone toxicity, were uncommon.” 

As a condition of approval, Gilead 

Sciences is required to collect and 

analyze samples from individuals who 

become infected with HIV while taking 

Truvada to see if they’ve developed drug 

resistance. The company is also required 

to collect data on women who become 

pregnant while taking Truvada for PrEP 

and to conduct other research. 

“Today’s decision is the culmination 

of almost 20 years of research involving 

investigators, academic and medical 

institutions, funding agencies, and nearly 

20,000 trial participants around the 

world, and Gilead is proud to have been 

a partner in this effort,” said Norbert 

Bischofberger, PhD, Executive Vice 

President, Research and Development 

and Chief Scientific Officer, Gilead 

Sciences. >> 


BRIEFLY 

EnID VázqUEz 

Moises Agosto 

>> the following is from a statement 

from Moises Agosto, Director of 

treatment education, Adherence, and 

Mobilization for the National Minority 

AiDs Council (NMAC): 

“While PrEP shows substantial promise as 

a supplement to current HIV prevention 

efforts, it is by no means a panacea and 

is only effective when used in conjunction 

with traditional prevention and risk reduction 

strategies, such as condom usage. 

“Anti-retroviral medications, like 

Truvada, are extremely powerful drugs 

with the potential for serious side 

effects. As such, PrEP should only be 

used by individuals who are highly vulnerable 

to HIV infection, including those 

in sero-discordant couples, sex workers, 

and gay men. Its efficacy is also directly 

related to an individual’s adherence to 

a regimen, and should only be used by 

those who can commit to taking it regularly. 

Finally, use of PrEP by individuals 

who may already be HIV-positive could 

increase the risk of drug resistance. 

“In recent years, there have been a 

number of promising developments in 

biomedical interventions—from treatment 

as prevention and pre-exposure 

prophylaxis to microbicides and vaccine 

research. These advances have resulted 

in the greatest expansion of HIV prevention 

tools than at any other time in the 

history of this epidemic. Coupled with the 

reforms included in the Patient Protection 

and Affordable Care Act, as well as the 

National HIV/AIDS Strategy, we are in a 

position for the first time in over three 

decades to finally end this epidemic. 

Today’s decision is another important 

step in realizing that goal.” 

Dolutegravir/Epzicom 

superior to Atripla? 

Shionogi-ViiV Healthcare LLC announced 

that initial results from its Phase 3 study 

SINGLE (ING114467) show superiority of 

its investigational HIV medication dolutegravir 

plus Epzicom over Atripla, one of 

the most widely prescribed antiviral medications 

in the country. At 48 weeks, 88% 

of study participants on the dolutegravir 

regimen achieved undetectable viral 

load (less than 50 copies/mL) vs. 81% of 

those on Atripla, a statistically significant 

difference. The company said the difference 

was primarily driven by a higher 

rate of discontinuation due to adverse 

events in the Atripla arm. All individuals 

in the study were taking antiviral therapy 

for the first time, a group that does the 

best in HIV treatment. There were 414 

individuals put on dolutegravir and 419 

put on Atripla. Overall, 2% of those on the 

dolutegravir-based regimen discontinued 

due to adverse events vs. 10% of those 

receiving the Atripla regimen. The most 

common adverse events while on Atripla 

were neurological (reported by 41% of 

Atripla recipients vs. 15% of participants 

receiving the dolutegravir), while the 

most common drug-related adverse 

events with dolutegravir were in the gastrointestinal 

system (reported by 22% of 

people on dolutegravir vs. 22% of those 

given Atripla). 

Dolutegravir is an investigational 

integrase inhibitor (INSTI), the same class 

as Isentress, the only INSTI currently on 

the market. 

Rapid home 

HIV test approved 

In June, the Food and Drug 

Administration (FDA) approved the 

oraQuick in-Home Hiv test, an Hiv 

self-test kit that does not require sending 

a sample to a laboratory for analysis. The 

kit, which tests a swab from your mouth, 

is approved for sale in stores and online 

to anyone age 17 and older. (Although 

HIV is not found in saliva, evidence of 

exposure to the virus—called HIV antibodies—is 

found in the mouth and indicates 

infection.) A positive result at home 

must then be followed up with a confirmatory 

blood test from a laboratory. 

The FDA said the test can be falsely 

negative for reasons that include the 

occurrence of HIV infection within three 

months before testing. People who 

engage in behaviors that put them at 

increased risk of getting HIV—including 

having unprotected sex with new partners, 

or injecting illegal drugs—should be 

re-tested on a regular basis. They should 

not interpret a negative test to indicate 

that engaging in high risk behavior is 

safe. 


FRom THE wEEkLY E-nEwS 

Website offers 

access to HIV meds 

for uninsured 

HarborPath, a new non-profit organization, 

has been established to create a 

program that offers a single place where 

uninsured Hiv-positive people who 

otherwise qualify for manufacturersponsored 

patient assistance programs 

(PAPs) can apply for and receive their 

medications. The “one stop shop” portal 

will provide a streamlined, online process 

to qualify individuals and deliver the 

donated medications through a mailorder 

pharmacy. HarborPath will pilot the 

program in states with high need, including 

Alabama, Texas, and Virginia. 

To create the portal, HarborPath 

worked closely with the National Alliance 

of State and Territorial AIDS Directors 

(NASTAD) and the Clinton Health Access 

Initiative (CHAI), which provided the seed 

funding for the organization. On World 

AIDS Day 2011, President Bill Clinton noted 

the need to fight HIV/AIDS in the U.S. 

“I am proud that my foundation is 

partnering with NASTAD and other 

pharmaceutical manufacturers to make 

sure Americans living with HIV have 

access to the life-saving medications 

they need,” said President Clinton. “This 

E-NEWS | 

is an important step forward in our fight 

against the disease.” 

ViiV Healthcare is the first pharmaceutical 

company to support the program 

with HIV/AIDS medications and funding. 

The goal of HarborPath is to get all 

HIV/AIDS medications into the program 

and serve uninsured individuals with: 

n An easy-to-use website with a single 

portal to determine eligibility for the 

program and to fill prescriptions for 

participating companies’ HIV/AIDS 

medications. 

n Automatic notifications for both the 

individual and the case manager of 

qualification for the program. 

n A pharmacy that ships a 3-month supply 

of all participating medications in 

one package within two business days 

of final approval and confirms delivery 

of the medications. 

n Renewal reminders to individuals and 

case managers to improve medication 

adherence. 

n A fully automated portal that case 

managers can access at any time 

for up-to-the-minute status of an 

individual’s application or shipment. If 

needed, live support is also available 

through a toll-free call center. 

Murray Penner, Deputy Executive 

Director at NASTAD, said, “Under the current 

PAP process, an individual or their 

case manager has to apply 

separately to each company’s 

program for these 

medications, which can be 

complex and time-consuming. 

Missing doses or failing 

to fill prescriptions because 

of complications sometimes 

associated with these processes 

may result in serious 

health consequences, or 

even death, in addition to 

increased transmission of 

the virus. HarborPath is 

designed to address this 

urgent need in the U.S.” 

Sign up for the weekly email newSletter of 

poSitively aware. go to positivelyaware.com 

Studies find 

once-daily ‘Quad’ 

is safe and effective 

The findings of two large international 

randomized studies published in The 

Lancet medical journal indicate that the 

new once-daily pill combining three 

antiretrovirals and a booster molecule is 

a safe and effective alternative to two 

widely used drug regimens for newly 

diagnosed Hiv-positive adults who have 

had no previous treatment. The study 

results also indicate that the new “Quad” 

pill is faster acting, doesn’t have the neuropsychiatric 

side effects associated with 

other combinations, and could improve 

compliance with treatment. 

“Patient adherence to medication is 

vital, especially for patients with HIV, 

where missed doses can quickly lead to 

the virus becoming resistant to medication. 

Older HIV treatment regimens 

involve taking several pills multiple times 

a day,” explains Paul Sax from Brigham 

and Women’s Hospital, Harvard Medical 

School, lead author of the first study. 

“Our results provide an additional highly 

potent, well-tolerated treatment option, 

and highlight the simplicity of treatment 

resulting from combining several antiretrovirals 

in a single pill. Studies have 

shown that single pill treatments improve 

both adherence and patient satisfaction, 

and help prevent prescription errors, 

thereby reducing the likelihood of treatment 

failure and drug resistance.” 

The first study randomly assigned 

700 patients from centers across North 

America to start treatment with two 

different single tablet regimens—either 

the Quad, combining the new integrase 

inhibitor elvitegravir (EVG) boosted with 

cobicistat (a new pharmacoenhancer; 

COBI) plus emtricitabine/tenofovir 

(Emtriva/Viread), or Atripla (efavirenz/ 

emtricitabine/tenofovir), the current gold 

standard regimen approved by the FDA 

in 2006. 

After 48 weeks of treatment, 88% >> 


BRIEFLY 

EnID VázqUEz 

of patients given the Quad had suppressed 

viral loads (less than 50 copies/ 

mL), compared with 84% in the Atripla 

group. 

Adverse events that led to patients 

discontinuing treatment were infrequent 

and similar in both groups. Mild nausea 

was more common with the Quad, but 

patients were less likely to have dizziness, 

abnormal dreams, insomnia, and rash 

compared with the Atripla regimen. 

The second trial included 708 

treatment-naïve adults from 146 medical 

centers across Australia, Europe, North 

America, and Thailand. Patients were 

randomly assigned to receive a once-daily 

Quad or a popular and recommended 

twice-daily combination of Norvirboosted 

Reyataz (atazanavir/ritonavir) 

plus Truvada (emtricitabine/tenofovir). 

The primary endpoint, to achieve viral 

levels below 50 copies/mL by week 48, 

was reached by 90% of people in the 

Quad group compared with 87% in the 

atazanavir/ritonavir/emtricitabine/tenofovir 

group. 

The safety of the two regimens was 

also similar. 

PA’s editor debuts 

blog on HuffPo 

PoSITIVELY awaRE editor Jeff Berry has 

joined other AIDS activists and journalists 

such as The Body’s Kellee Turrell, the AIDS 

Foundation of Chicago’s David Ernesto 

Munar, and others in becoming a blogger 

published by the Huffington Post. 

In advance of the upcoming AIDS 2012 

World AIDS Conference, Berry wrote 

“Reflections from an Epidemic: Carrying 

the Torch to AIDS 2012.” In it, he talks 

about the significance of this being the 

Simplify your life. 

first conference to be held in the U.S. 

since President Obama lifted the travel 

ban on HIV-positive people, his anticipation 

of such events as displays of the 

AIDS Memorial Quilt, a planned march 

and demonstration, the performance 

of the Tony Award-winning play The 

Normal Heart, as well as the many global 

leaders in AIDS policy, advocacy, and 

treatment advances that presented at the 

conference. 

Did he get infected? 

In the July+August issue of PoSITIVELY 

awaRE, a young man in Chicago, Chris, 

was anxiously awaiting the results of his 

HIV tests following a potential exposure 

through sex (“PrEPing,” July+August). 

Two months later, he remains 

HIV-negative. 

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PHOTO: MATTHEw gARSTECK 

TPan, publisher of PoSITIVELY awaRE, is commemorating 

25 years of service to chicago’s HIV community. 

JoiN Jamar rogers, of Nbc’s “the voice,” for a special performaNce. 

OCTOBER 4, 2012 

5:30–8:30 Pm | cHIcago cULTURaL cEnTER 

TIckETS aVaILaBLE aT www.tpan.com 

EVEnT SPOnSORS 

$100,000 anD aBoVE 

alphawood Foundation 

Bristol-myers Squibb 


abbott Virology 

EmD Serono 

Lloyd a. Fry Foundation 

ViiV Healthcare 

walgreens 

AnnIVERSARY PARTnERS 


janssen Therapeutics 


aIDS Foundation of chicago 

Blue cross and Blue Shield 

of Illinois 

cheetah gyms 

gilead Sciences, Inc. 

macy’s 

millercoors 

Steamworks

INDICATION 

COMPLERA ® (emtricitabine 200 mg/rilpivirine 25 mg/tenofovir disoproxil fumarate 

300 mg) is a prescription HIV medicine that contains 3 medicines, EMTRIVA ® 

(emtricitabine), EDURANT (rilpivirine), and VIREAD ® (tenofovir disoproxil fumarate) 

combined in one pill. COMPLERA is used as a complete single-tablet regimen to treat 

HIV-1 infection in adults (age 18 and older) who have never taken HIV medicines before. 

COMPLERA does not cure HIV and has not been shown to prevent passing HIV 

to others. It is important to always practice safer sex, use latex or polyurethane 

condoms to lower the chance of sexual contact with any body fl uids, and to never 

re-use or share needles. Do not stop taking COMPLERA unless directed by your 

healthcare provider. See your healthcare provider regularly. 

IMPORTANT SAFETY INFORMATION 

Contact your healthcare provider right away if you get the following side effects 

or conditions while taking COMPLERA: 

• Nausea, vomiting, unusual muscle pain, and/or weakness. These may be 

signs of a buildup of acid in the blood (lactic acidosis), which is a serious 

medical condition 

• Light-colored stools, dark-colored urine, and/or if your skin or the whites of your 

eyes turn yellow. These may be signs of serious liver problems (hepatotoxicity), 

with liver enlargement (hepatomegaly), and fat in the liver (steatosis) 

• If you have HIV-1 and hepatitis B virus (HBV), your liver disease may suddenly 

get worse if you stop taking COMPLERA. Do not stop taking COMPLERA without 

fi rst talking to your healthcare provider. Your healthcare provider will monitor 

your condition 

COMPLERA may affect the way other medicines work, and other medicines may 

affect how COMPLERA works, and may cause serious side effects. 

COMPLERA (emtricitabine/rilpivirine/tenofovir disoproxil 

fumarate) is a prescription medicine used as a complete 

single-tablet regimen to treat HIV-1 in adults who have 

never taken HIV medicines before. COMPLERA does not 

cure HIV or AIDS or help prevent passing HIV to others. 

one 

The for me 

Patient model. Pill shown is not actual size. 

Do not take COMPLERA if you are taking the following medicines: 

• other HIV medicines (COMPLERA provides a complete treatment for HIV infection.) 

• the anti-seizure medicines carbamazepine (Carbatrol ® , Equetro ® , Tegretol ® , 

Tegretol-XR ® , Teril ® , Epitol ® ), oxcarbazepine (Trileptal ® ), phenobarbital (Luminal ® ), 

phenytoin (Dilantin ® , Dilantin-125 ® , Phenytek ® ) 

• the anti-tuberculosis medicines rifabutin (Mycobutin), rifampin (Rifater ® , 

Rifamate ® , Rimactane ® , Rifadin ® ) and rifapentine (Priftin ® ) 

• a proton pump inhibitor medicine for certain stomach or intestinal problems, 

including esomeprazole (Nexium ® , Vimovo ® ), lansoprazole (Prevacid ® ), 

omeprazole (Prilosec ® ), pantoprazole sodium (Protonix ® ), rabeprazole (Aciphex ® ) 

• more than 1 dose of the steroid medicine dexamethasone or dexamethasone 

sodium phosphate 

• St. John’s wort (Hypericum perforatum) 

• other medicines that contain tenofovir (VIREAD ® , TRUVADA ® , ATRIPLA ® ) 

• other medicines that contain emtricitabine or lamivudine (EMTRIVA ® , Combivir ® , 

Epivir ® or Epivir-HBV ® , Epzicom ® , Trizivir ® ) 

• rilpivirine (Edurant ) 

• adefovir (HEPSERA ® ) 

In addition, also tell your healthcare provider if you take: 

• an antacid medicine that contains aluminum, magnesium hydroxide, or calcium 

carbonate. Take antacids at least 2 hours before or at least 4 hours after you 

take COMPLERA 

• a histamine-2 blocker medicine, including famotidine (Pepcid ® ), cimetidine 

(Tagamet ® ), nizatidine (Axid ® ), or ranitidine hydrochloride (Zantac ® ). Take these 

medicines at least 12 hours before or at least 4 hours after you take COMPLERA 

• the antibiotic medicines clarithromycin (Biaxin ® ), erythromycin (E-Mycin ® , Eryc ® , 

Ery-Tab ® , PCE ® , Pediazole ® , Ilosone ® ), and troleandomycin (TAO ® ) 

• an antifungal medicine by mouth, including fl uconazole (Difl ucan ® ), itraconazole 

(Sporanox ® ), ketoconazole (Nizoral ® ), posaconazole (Noxafi l ® ), voriconazole (Vfend ® ) 

• methadone (Dolophine ® ) 

This list of medicines is not complete. Discuss with your healthcare provider all 

prescription and nonprescription medicines, vitamins, or herbal supplements you 

are taking or plan to take.

Save up to 

$200 

per month 

Before taking COMPLERA, tell your healthcare provider if you: 

• have liver problems, including hepatitis B or C virus infection 

• have kidney problems 

• have ever had a mental health problem 

• have bone problems 

• are pregnant or plan to become pregnant. It is not known if COMPLERA can harm 

your unborn child 

• are breastfeeding; women with HIV should not breast-feed because they can pass 

HIV through their milk to the baby 

Contact your healthcare provider right away if you experience any of the 

following serious or common side effects: 

Serious side effects associated with COMPLERA: 

• New or worse kidney problems can happen in some people who take COMPLERA. 

If you have had kidney problems in the past or take other medicines that can cause 

kidney problems, your healthcare provider may need to do blood tests to check your 

kidneys during your treatment with COMPLERA 

• Depression or mood changes can happen in some people who take COMPLERA. 

Tell your healthcare provider right away if you have any of the following symptoms: 

feeling sad or hopeless, feeling anxious or restless, or if you have thoughts of 

hurting yourself (suicide) or have tried to hurt yourself 

• Bone problems can happen in some people who take COMPLERA. Bone problems 

include bone pain, softening or thinning (which may lead to fractures). Your 

healthcare provider may need to do additional tests to check your bones 

• Changes in body fat can happen in people taking HIV medicine. These changes 

may include increased amount of fat in the upper back and neck (“buffalo hump”), 

breast, and around the main part of your body (trunk). Loss of fat from the legs, 

arms and face may also happen. The cause and long-term health effect of these 

conditions are not known 

• Changes in your immune system (Immune Reconstitution Syndrome) can happen 

when you start taking HIV medicines. Your immune system may get stronger and 

begin to fi ght infections that have been hidden in your body for a long time. Tell 

your healthcare provider if you start having new symptoms after starting your 

HIV medicine 

You may be able to save on the co-pay for 

your COMPLERA prescription with a Gilead 

HIV Co-pay Assistance Card. 

Call 1-877-505-6986 for more information 

or visit www.COMPLERA.com.* 

COMPLERA. A complete HIV treatment in only 1 pill a day. 

Ask your healthcare provider if it’s the one for you. 

Common side effects associated with COMPLERA: 

• trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, 

nausea, rash, tiredness, and depression 

Other side effects associated with COMPLERA: 

• vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), 

and pain 

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 COMPLERA. For more 

information, ask your healthcare provider or pharmacist. Call your healthcare provider 

for medical advice about side effects. 

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. 

Take COMPLERA exactly as your healthcare provider tells you to take it 

• Always take COMPLERA with a meal. Taking COMPLERA with a meal is important to 

help get the right amount of medicine in your body. A protein drink does not replace 

a meal 

• Stay under the care of your healthcare provider during treatment with 

COMPLERA and see your healthcare provider regularly 

Please see Patient Information for COMPLERA on the following pages. 

* The co-pay program covers up to $200 per month for 1 year from card activation or until the 

card expires, up to $2400 in a calendar year. The program is subject to change or cancellation 

at any time. 

Learn more at www.COMPLERA.com

FDA-Approved Patient Labeling 

Patient Information 

COMPLERA ® (kom-PLEH-rah) 

(emtricitabine, rilpivirine and tenofovir disoproxil fumarate) Tablets 

Important: Ask your doctor or pharmacist about medicines that should not be 

taken with COMPLERA. For more information, see the section “What should I tell my 

healthcare provider before taking COMPLERA?” 

Read this Patient Information before you start taking COMPLERA and each time you 

get a refill. There may be new information. This information does not take the place of 

talking to your healthcare provider about your medical condition or treatment. 

What is the most important information I should know about COMPLERA? 

COMPLERA can cause serious side effects, including: 

1. Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in 

some people who take COMPLERA or similar (nucleoside analogs) 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: 

• feeling very weak or tired 

• have unusual (not normal) muscle pain 

• have trouble breathing 

• have stomach pain with 

- nausea (feel sick to your stomach) 

- vomiting 

• feel cold, especially in your arms and legs 

• feel dizzy or lightheaded 

• have a fast or irregular heartbeat 

2. Severe liver problems. Severe liver problems can happen in people who take 

COMPLERA or similar medicines. In some cases these liver problems can lead to death. 

Your liver may become large (hepatomegaly) and you may develop fat in your liver 

(steatosis) when you take COMPLERA. 

Call your healthcare provider right away if you have 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 for several days or longer 

• nausea 

• stomach pain 

You may be more likely to get lactic acidosis or severe liver problems if you are 

female, very overweight (obese), or have been taking COMPLERA or a similar 

medicine containing nucleoside analogs for a long time. 

3. Worsening of Hepatitis B infection. If you also have hepatitis B virus (HBV) infection 

and you stop taking COMPLERA, your HBV infection may become worse (flare-up). A 

“flare-up” is when your HBV infection suddenly returns in a worse way than before. 

COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV 

therapy with your healthcare provider. 

• Do not let your COMPLERA run out. Refill your prescription or talk to your healthcare 

provider before your COMPLERA is all gone. 

• Do not stop taking COMPLERA without first talking to your healthcare provider. 

• If you stop taking COMPLERA, your healthcare provider will need to check your health 

often and do regular blood tests to check your HBV infection. Tell your healthcare 

provider about any new or unusual symptoms you may have after you stop taking 

COMPLERA. 

What is COMPLERA? 

COMPLERA is a prescription HIV (Human Immunodeficiency Virus) medicine that: 

• is used to treat HIV-1 in adults who have never taken HIV medicines before. HIV is the 

virus that causes AIDS (Acquired Immunodeficiency Syndrome). 

• contains 3 medicines, (rilpivirine, emtricitabine, tenofovir disoproxil fumarate) 

combined in one tablet. EMTRIVA and VIREAD are HIV-1 (human immunodeficiency 

virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and EDURANT is an 

HIV-1 non-nucleoside analog reverse transcriptase inhibitor (NNRTI). 

It is not known if COMPLERA is safe and effective in children under the age of 18 years. 

COMPLERA may help: 

• Reduce the amount of HIV in your blood. This is called your “viral load”. 

• Increase the number of white blood cells called CD4+ (T) cells that help fight off 

other infections. 

Reducing the amount of HIV and increasing the CD4+ (T) cell count may improve your 

immune system. This may reduce your risk of death or infections that can happen when 

your immune system is weak (opportunistic infections). 

COMPLERA does not cure HIV infections or AIDS. 

• Always practice safer sex. 

• Use latex or polyurethane condoms to lower the chance of sexual contact with any 

body fluids such as semen, vaginal secretions, or blood. 

• Never re-use or share needles. 

Ask your healthcare provider if you have any questions about how to prevent passing 

HIV to other people. 

Who should not take COMPLERA? 

• Do not take COMPLERA if your HIV infection has been previously treated with 

HIV medicines. 

• Do not take COMPLERA if you are taking certain other medicines. For more 

information about medicines that must not be taken with COMPLERA, see “What 

should I tell my healthcare provider before taking COMPLERA?” 

What should I tell my healthcare provider before taking COMPLERA? 

Before you take COMPLERA, tell your healthcare provider if you: 

• have liver problems, including hepatitis B or C virus infection 

• have kidney problems 

• have ever had a mental health problem 

• have bone problems 

• are pregnant or plan to become pregnant. It is not known if COMPLERA can harm 

your unborn child 

Pregnancy Registry. There is a pregnancy registry for women who take antiviral 

medicines during pregnancy. Its purpose is to collect information about the health 

of you and your baby. Talk to your healthcare provider about how you can take part 

in this registry. 

• are breast-feeding or plan to breast-feed. The Centers for Disease Control and 

Prevention recommends that mothers with HIV not breastfeed because they can pass 

the HIV through their milk to the baby. It is not known if COMPLERA can pass through 

your breast milk and harm your baby. Talk to your healthcare provider about the best 

way to feed your baby. 

Tell your healthcare provider about all the medicines you take, including prescription 

and nonprescription medicines, vitamins, and herbal supplements. 

COMPLERA may affect the way other medicines work, and other medicines may 

affect how COMPLERA works, and may cause serious side effects. If you take certain 

medicines with COMPLERA, the amount of COMPLERA in your body may be too low and 

it may not work to help control your HIV infection. The HIV virus in your body may become 

resistant to COMPLERA or other HIV medicines that are like it. 

Do not take COMPLERA if you also take these medicines: 

• COMPLERA provides a complete treatment for HIV infection. Do not take other HIV 

medicines with COMPLERA. 

• the anti-seizure medicines carbamazepine (CARBATROL ® , EQUETRO ® , TEGRETOL ® , 

TEGRETOL-XR ® , TERIL ® , EPITOL ® ), oxcarbazepine (TRILEPTAL ® ), phenobarbital 

(LUMINAL ® ), phenytoin (DILANTIN ® , DILANTIN-125 ® , PHENYTEK ® ) 

• the anti-tuberculosis medicines rifabutin (MYCOBUTIN ® ), rifampin (RIFATER ® , 

RIFAMATE ® , RIMACTANE ® , RIFADIN ® ) and rifapentine (PRIFTIN ® ) 

• a proton pump inhibitor medicine for certain stomach or intestinal problems, 

including esomeprazole (NEXIUM ® , VIMOVO ® ), lansoprazole (PREVACID ® ), omeprazole 

(PRILOSEC ® ), pantoprazole sodium (PROTONIX ® ), rabeprazole (ACIPHEX ® ) 

• more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium 

phosphate 

• St. John’s wort (Hypericum perforatum) 

If you are taking COMPLERA, you should not take: 

• other medicines that contain tenofovir (VIREAD ® , TRUVADA ® , ATRIPLA ® ) 

• other medicines that contain emtricitabine or lamivudine (EMTRIVA ® , COMBIVIR ® , 

EPIVIR ® or EPIVIR-HBV ® , EPZICOM ® , TRIZIVIR ® ) 

• rilpivirine (EDURANT ) 

• adefovir (HEPSERA ® )

Also tell your healthcare provider if you take: 

• an antacid medicine that contains aluminum, magnesium hydroxide, or calcium 

carbonate. Take antacids at least 2 hours before or at least 4 hours after you take 

COMPLERA. 

• a histamine-2 blocker medicine, including famotidine (PEPCID ® ), cimetidine 

(TAGAMET ® ), nizatidine (AXID ® ), or ranitidine hydrochloride (ZANTAC ® ). Take these 

medicines at least 12 hours before or at least 4 hours after you take COMPLERA. 

• the antibiotic medicines clarithromycin (BIAXIN ® ), erythromycin (E-MYCIN ® , ERYC ® , 

ERY-TAB ® , PCE ® , PEDIAZOLE ® , ILOSONE ® ), and troleandomycin (TAO ® ) 

• an antifungal medicine by mouth, including fluconazole (DIFLUCAN ® ), itraconazole 

(SPORANOX ® ), ketoconazole (NIZORAL ® ), posaconazole (NOXAFIL ® ), voriconazole 

(VFEND ® ) 

• methadone (DOLOPHINE ® ) 

Ask your healthcare provider or pharmacist if you are not sure if your medicine is 

one that is listed above. 

Know the medicines you take. Keep a list of your medicines and show it to your 

healthcare provider and pharmacist when you get a new medicine. Your healthcare 

provider and your pharmacist can tell you if you can take these medicines with 

COMPLERA. Do not start any new medicines while you are taking COMPLERA without 

first talking with your healthcare provider or pharmacist. You can ask your healthcare 

provider or pharmacist for a list of medicines that can interact with COMPLERA. 

How should I take COMPLERA? 

• Stay under the care of your healthcare provider during treatment with COMPLERA. 

• Take COMPLERA exactly as your healthcare provider tells you to take it. 

• Always take COMPLERA with a meal. Taking COMPLERA with a meal is important 

to help get the right amount of medicine in your body. A protein drink does not 

replace a meal. 

• Do not change your dose or stop taking COMPLERA without first talking with your 

healthcare provider. See your healthcare provider regularly while taking COMPLERA. 

• If you miss a dose of COMPLERA within 12 hours of the time you usually take it, take 

your dose of COMPLERA with a meal as soon as possible. Then, take your next dose 

of COMPLERA at the regularly scheduled time. If you miss a dose of COMPLERA by 

more than 12 hours of the time you usually take it, wait and then take the next dose 

of COMPLERA at the regularly scheduled time. 

• Do not take more than your prescribed dose to make up for a missed dose. 

• When your COMPLERA supply starts to run low, get more from your healthcare provider 

or pharmacy. It is very important not to run out of COMPLERA. The amount of virus in 

your blood may increase if the medicine is stopped for even a short time. 

• If you take too much COMPLERA, contact your local poison control center or go to the 

nearest hospital emergency room right away. 

What are the possible side effects of COMPLERA? 

COMPLERA may cause the following serious side effects, including: 

• See “What is the most important information I should know about COMPLERA?” 

• New or worse kidney problems can happen in some people who take COMPLERA. 

If you have had kidney problems in the past or take other medicines that can cause 

kidney problems, your healthcare provider may need to do blood tests to check your 

kidneys during your treatment with COMPLERA. 

• Depression or mood changes. Tell your healthcare provider right away if you have 

any of the following symptoms: 

- feeling sad or hopeless 

- feeling anxious or restless 

- have thoughts of hurting yourself (suicide) or have tried to hurt yourself 

• Bone problems can happen in some people who take COMPLERA. Bone problems 

include bone pain, softening or thinning (which may lead to fractures). Your 

healthcare provider may need to do additional tests to check your bones. 

• Changes in body fat can happen in people taking HIV medicine. These changes may 

include increased amount of fat in the upper back and neck (“buffalo hump”), breast, 

and around the main part of your body (trunk). Loss of fat from the legs, arms and 

face may also happen. The cause and long term health effect of these conditions are 

not known. 

• Changes in your immune system (Immune Reconstitution Syndrome) can happen 

when you start taking HIV 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 if you start having new symptoms after starting your 

HIV medicine. 

The most common side effects of COMPLERA include: 

• trouble sleeping (insomnia) 

• abnormal dreams 

• headache 

• dizziness 

• diarrhea 

• nausea 

• rash 

• tiredness 

• depression 

Additional common side effects include: 

• vomiting 

• stomach pain or discomfort 

• skin discoloration (small spots or freckles) 

• pain 

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 COMPLERA. 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 (1-800-332-1088). 

How do I store COMPLERA? 

• Store COMPLERA at room temperature 77 °F (25 °C). 

• Keep COMPLERA in its original container and keep the container tightly closed. 

• Do not use COMPLERA if the seal over the bottle opening is broken or missing. 

Keep COMPLERA and all other medicines out of reach of children. 

General information about COMPLERA: 

Medicines are sometimes prescribed for purposes other than those listed in a Patient 

Information leaflet. Do not use COMPLERA for a condition for which it was not prescribed. 

Do not give COMPLERA to other people, even if they have the same symptoms you have. 

It may harm them. 

This leaflet summarizes the most important information about COMPLERA. If you 

would like more information, talk with your healthcare provider. You can ask your 

healthcare provider or pharmacist for information about COMPLERA that is written 

for health professionals. For more information, call (1-800-445-3235) or go to 

www.COMPLERA.com. 

What are the ingredients of COMPLERA? 

Active ingredients: emtricitabine, rilpivirine hydrochloride, and tenofovir disoproxil 

fumarate 

Inactive ingredients: pregelatinized starch, lactose monohydrate, microcrystalline 

cellulose, croscarmellose sodium, magnesium stearate, povidone, polysorbate 20. The 

tablet film coating contains polyethylene glycol, hypromellose, lactose monohydrate, 

triacetin, titanium dioxide, iron oxide red, FD&C Blue #2 aluminum lake, FD&C Yellow 

#6 aluminum lake. 

This Patient Information has been approved by the U.S. Food and Drug Administration 

Manufactured and distributed by: 

Gilead Sciences, Inc. 

Foster City, CA 94404 

Issued: August 2011 

COMPLERA, the COMPLERA Logo, EMTRIVA, HEPSERA, TRUVADA, VIREAD, GILEAD, and 

the GILEAD Logo are trademarks of Gilead Sciences, Inc. or its related companies. 

ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other 

trademarks referenced herein are the property of their respective owners. 

© 2012 Gilead Sciences, Inc. All rights reserved. 

202123-GS-000 02AUG2011 CON12383 3/12

Securing care 

for Women 

living With hiv 

Challenges and solutions for Hiv-positive women 

by NaiNa khaNNa 

FIVE YEaRS ago, womEn HaD THE DUBIoUS 

distinction of surpassing men as the majority of people 

in the world living with HIV. And in some countries, 

including Cambodia, Mozambique, and Rwanda, women 

now comprise nearly two-thirds of people living with the virus. 

In the U.S., the HIV epidemic looks 

very different. Women comprise over a 

quarter of the estimated 1.2 million people 

living with HIV in the U.S.—not including 

transgender women, for whom no accurate 

data are available. In 1984, women 

represented only 8% of HIV infections in 

the U.S. Thus, even at a national level, the 

trend is troubling. Data from 2012 show 

that in the District of Columbia, rates of 

new HIV diagnosis among black women 

have doubled. In Maryland, 35% of all AIDS 

diagnoses are among women, and in the 

U.S. Virgin Islands, 36.4% of people with 

an AIDS diagnosis were women in 2009. 

And when you drill down further, particularly 

in the U.S. South, in some counties, 

HIV infection rates among females may 

be even higher. Let’s be clear: this is not a 

numbers game anyone wants to win. 

Of even more concern, in the United 

States, HIV acquisition among women 

is correlated with race, poverty, experience 

of trauma, mental illness, substance 

use, and vulnerability to assorted social 

stigmas—the same factors that reduce 

likelihood of positive health outcomes in 

people living with HIV. That is, these socioeconomic 

factors increase vulnerability to 

poor health outcomes, with or without an 

HIV diagnosis. U.S. women living with HIV 

are disproportionately likely to be women 

of color (over 80%), especially black and 

Latina, and living in poverty, compared 

to men living with HIV. According to the 

HIV Cost Services and Utilization Study 

(HCSUS), 64% of HIV-positive women in 

ongoing medical care had annual incomes 

under $10,000, compared with 41% of 

HIV-positive men in care. More than twice 

as many HIV-positive women (76%) as 

HIV-positive men (34%) are living with and 

caring for at least one child under the age 

of 18. Thus, care systems for HIV-positive 

women must account for caretaking 

responsibilities, including provisions for 

minor children. 

Alarmingly, data show that adherence 

to anti-retroviral therapy tends to 

decrease among women living with HIV 

as the number of children under 18 living 

in the home increases. This is no real surprise. 

As women, we tend to prioritize caring 

for others over ourselves. Sometimes 

it’s a matter of practicality—we only have 

so many dollars to go around and hours 

in the day and bus vouchers. Sometimes 

it’s a matter of stigma—we don’t want 

others to see us taking our meds or going 

to medical appointments. And frequently 

it’s a reflection of how we value ourselves, 

especially as poor women, women of 


PHoTo: © IaS/STEVE SHaPIRo-commERcIaLImagE.nET 

ORGAnIzInG PRInCIPAL: Megaphone in hand,

Naina Khanna, Director of Policy and Community Organizing, WORLD, rallies demonstrators at the International AIDS Conference in July. 

color, women living with HIV. We have 

internalized that our health, our wellness, 

our wellbeing is too often not a priority for 

our society and political leaders—so why 

should we make it a priority for us? 

Transgender women are especially 

likely to live in extreme poverty, to face 

exceptional barriers to safe housing, 

employment, and access to quality health 

care, and, if HIV-positive, are less likely 

than other populations to receive antiretroviral 

therapy and more likely to experience 

negative interactions with health care 

providers. Transgender women are also 

disproportionately likely to face violence in 

their communities. 

Although researchers within the U.S. 

and internationally have known for years 

that women who have experienced violence 

and trauma are at elevated risk of 

acquiring HIV (even in non-conflict settings), 

new data released in 2012 show 

that women with HIV in the U.S. are 

twice as likely to have been victims of 


Women’s bodies are not only about making babies. 

Fully upholding our human rights includes upholding our right 

to be sexual beings who experience joy and erotic pleasure. 

intimate partner violence and suffer posttraumatic 

stress disorder at a rate five 

times greater than HIV-negative women. 

Rates of violence faced by transgender 

women are likely to be even higher—data 

released in 2011 by the National Coalition 

of Anti-Violence Programs showed that 

transwomen comprised 44% of all LGBTQ 

murder victims. The same study found 

that over half of LGBTQ violence survivors 

did not even report attacks, with the highest 

rates of non-reporting being among 

transgender women of color. Not that 

surprising, given that transwomen also 

face disproportionate sexual, physical, and 

verbal harassment at the hands of police, 

according to Injustice at Every Turn—A 

Report of the National Transgender 

Discrimination Study. Research shows that 

women, including transwomen, who have 

experienced trauma are less likely to be 

adherent to medication and are more likely 

to face multiple barriers to care overall. 

Systemic violence against women also 

persists. Women living with HIV in the U.S. 

continue to report significant reproductive 

rights violations, despite medical progress 

and research and treatment advances that 

clearly demonstrate HIV-positive people 

can live a long and healthy life, avoid passing 

the virus to children with appropriate 

care and treatment, and even avoid passing 

the virus to their sexual partners, when 

viral load is suppressed and other factors 

that increase vulnerability (such as genital 

sores or ulcers) are not present. 

Importantly, for many women living 

with HIV, motherhood may be one of the 

only socially valued identities available to 

them. As described by Michelle Berger in 

Workable Sisterhood, many women living 

with HIV in the U.S. already exist at the 

intersection of race, class, and gender 

oppression, in addition to societal stigma 

about any behaviors they engage in, or life 

experiences they have had—even prior to 

HIV diagnosis. “When they became HIVpositive 

all the positions they occupied— 

drug user, sex worker, poor woman, were 

already concentrated, or saturated, with 

a set of representations and assumptions 

about those positions.” Thus, HIV becomes 

just another one of several stigmatizing 

social markers. Yet having a socially valued 

identity may impact HIV-positive women’s 

feelings about themselves and may inspire 

them to take better care of themselves. In 

one study, HIV-positive women reported 

that pregnancy and childrearing provided 

them a socially sanctified feeling of being 

important and valued. Motherhood 

became a highly valued identity that 

helped mitigate regret related to HIV 

acquisition and other life circumstances. 

One study, published in AIDS Patient 

Care and STDs in May 2010, demonstrated 

that of 181 predominantly African 

American HIV-positive women in care in 

two urban HIV medical clinics, only 31% 

reported a personalized discussion with 

their HIV provider about their own fertility 

desires and intentions. Of those 31%, 64% 

had initiated the conversation themselves 

with their providers. The same study 

found that age was a strong predictor of 

provider-patient communication about 

pregnancy, with women under the age of 

30 being six times more likely to have had 

a general conversation about pregnancy 

with their providers. Another study of 118 

HIV-positive women conducted at the 

University of Rochester found that 54% 

of participants in that study had been 

sterilized. The study found high rates of 

“tubal regret” among participants, and 

pointed to a need to counsel women living 

with HIV about reversible methods of 

contraception. And research conducted by 

the U.S. Positive Women’s Network found 

that women living with HIV self-reported 

high rates of coerced abortion, tubal ligation, 

and sterilization. When HIV-positive 

women do have conversations with providers 

about their fertility plans, some health 

care providers perceive the pregnancyrelated 

needs of women living with HIV 

to be limited exclusively to the prevention 

of vertical transmission. In addition, data 

collected by the U.S. Positive Women’s 

Network suggest that HIV criminalization 

laws, currently on the books in 36 states 

and U.S. territories, may deter women 

from HIV testing, from accessing care, and 

may intimidate them with regard to disclosing 

sexual behavior to providers. 

Despite the fact that there are many 

other diseases and genetic disorders with 

higher risk of parent to child transmission, 

and that assisted reproduction is not only 

permitted but often encouraged in such 

cases, HIV status has been used as a special 

reason to deny HIV-positive women the 

right to conceive naturally or with assistance; 

the right to comprehensive family 

planning and counseling service; and the 

right to retain custody of their children. 

Given last year’s HPTN 052 data, which 

demonstrated a 96% reduction in HIV 

transmission among heterosexual serodiscordant 

partners when viral load was 

suppressed, people living with HIV and/ 

or their partners who want to conceive 

should be counseled about a range of 

options, including natural conception and 

now pre-exposure prophylaxis (PrEP) for 

the negative partner. Prevention justice 

demands that a range of HIV prevention 

options be available, including options that 

are controlled by women. But women’s 

bodies are not only about making babies. 

Fully upholding our human rights includes 

upholding our right to be sexual beings 

who experience joy and erotic pleasure. 

And for some of us, that means not using 

condoms, with our partner’s knowledge 

and consent. This will require a conscious 

effort of providers counseling patients 

who have experienced stigma, sometimes 

multiple concurrent stigmas, to provide 

accurate information about risk. 

Despite the significant epidemic among 

U.S. women—it is estimated that 300,000 

women are living with HIV in the U.S., and 

25% is no minor proportion—the National 

HIV/AIDS Strategy, released in July 2010, 

failed to articulate a single goal specifically 

for women. It does not detail how to 


HIV care is more than just medical care. It must be coupled with 

services designed to uphold sexual and reproductive rights and 

to address the impact of violence and trauma in women’s lives. 

reduce new HIV infections among women, 

to increase access to care, or a strategy to 

improve women’s health outcomes. The 

Strategy similarly failed to articulate the 

relationship between violence or trauma 

and HIV for women. And nowhere in the 

Strategy was the need to strengthen 

sexual health and reproductive choice for 

women living with HIV even mentioned. 

And just this year, although the 

President’s proposed domestic HIV budget 

for FY 2013 was relatively good, the Part D 

program was the only part of Ryan White 

for which a decrease was proposed. Part 

D is the only program within Ryan White 

specifically designed to meet the needs of 

women, youth, and families. This is indicative 

of an alarming trend away from women-centered 

care and supportive services 

when they are more critical than ever. 

Thus, not only are we faced with a 

well-documented social and political 

“war on women” from the far right, with 

all women’s rights and body sovereignty 

being utilized as a political football in the 

2012 election cycle—but women living with 

HIV are literally facing disproportionate 

wars: violence, and a battle for their lives, 

health, and dignity in their own communities, 

neighborhoods, and homes. 

And in the midst of all this, somewhere 

along the way we lost our will to address 

the gender nuances of the domestic HIV 

epidemic. 

2011’s HPTN 052 results demonstrated 

that achieving viral suppression in people 

living with HIV can effectively reduce 

onward transmission of HIV. Thus, ensuring 

high-quality care and access to voluntary 

treatment for people living with HIV should 

be one of our primary goals as an HIV community—to 

achieve the National HIV/AIDS 

Strategy’s prevention and care goals. 

In July, the International AIDS 

Conference (AIDS 2012) returned to the 

U.S. after a 22-year absence. The theme of 

AIDS 2012 was Turning the Tide Together— 

meaning that we have the science to end 

new HIV infections and to keep people 

living with HIV healthy. Now we have to 

muster the political will and resources to 

make this possibility a reality. Just last 

June, the Supreme Court of the United 

States upheld the Affordable Care Act 

(ACA)—a piece of legislation that holds 

great promise for all women, and especially 

for women living with HIV. But HIV 

care and treatment is more than just medication 

and more than just medical care, 

especially for women. It must be coupled 

with services designed to uphold sexual 

and reproductive rights and to address the 

impact of violence and trauma in women’s 

lives. Women living with HIV still face 

unique vulnerabilities in 2012 and turning 

the tide on the epidemic for women will 

require a gender-sensitive response. 

Because women’s access to health 

care and ability to adhere to medication 

is related in large part to other life factors, 

including our physical, psychological, and 

emotional safety, addressing logistical barriers 

to care and promoting safety for women 

is central to achieving the National HIV/AIDS 

Strategy’s goals and to achieving the promise 

of the Affordable Care Act for women. 

Through ACA implementation, we must 

also keep in place services that facilitate 

access to care for women living with HIV, 

including but not limited to psychosocial 

support, peer-based services, transportation, 

and childcare. 

Thankfully, President Obama’s March 

30 release of a memorandum establishing 

a federal interagency working group to 

address the intersection of HIV/AIDS, violence 

against women and girls, and gender-related 

health disparities presents a 

new opportunity to align the domestic HIV 

response with international standards and 

to rectify some of these serious oversights. 

The workgroup is charged with, among 

other things: 

n Integrating sexual and reproductive 

health services, gender-based violence 

services, and HIV/AIDS services, where 

research demonstrates that doing so 

will result in improved and sustained 

health outcomes. 

n Promoting research to better understand 

the intersection of the biological, 

behavioral, and social science bases 

for the relationship between increased 

HIV/AIDS risk, domestic violence, and 

gender-related health disparities. 

2012 marks a critical moment in the 

global HIV response. It’s time we truly 

commit to upholding women’s rights and 

the rights of all people living with and 

disproportionately impacted by HIV as an 

essential component to turning the tide of 

the epidemic. This must include: 

n Meaningful and visible leadership of 

women living with HIV in all aspects of 

decision-making. 

n Research on and funding for womencontrolled 

prevention options—tools 

which a woman can use without the 

consent or even the knowledge of her 

partner, and which uphold our full 

rights to sexual pleasure and sexual 

and reproductive health. 

n Bold action, including a plan and a 

timeline from the White House Office 

of National AIDS Policy to address 

the intersections of violence against 

women, HIV, sexual and reproductive 

rights, and women’s health. 

NaiNa khaNNa is the policy director at 

Women Organized to Respond to Lifethreatening 

Disease (WORLD) in Oakland, 

California and coordinates the U.S. Positive 

Women’s Network (PWN). She was 

appointed to President Obama’s Advisory 

Council on HIV/AIDS (PACHA) in 2010. 

She has presented and advised on women’s 

rights and achieving gender-sensitive, 

human rights-grounded policies informed 

by people living with HIV. Ms. Khanna was 

diagnosed with HIV in 2002. 


lack WOmEn, 

SOcIETy, 

and HIV 

An expert talks about 

the context of infection 

takeN from aN iNterview with 

adaora a. adimora, md, mph 

editor’s Note: Adaora A. Adimora, MD, MPH, received her medical degree from 

Yale University School of Medicine and Master’s in Public Health in epidemiology 

(the study of how disease spreads among people) from the University of North 

Carolina at Chapel Hill (UNC). Dr. Adimora’s work as both a physician and an epidemiologist 

has focused on infectious disease, particularly HIV and its disproportionate 

effect on minority populations. Her groundbreaking research includes the 

publishing of the first national data on concurrent sexual partnerships in women 

and analysis of the contextual (social, economic, and environmental) factors that 

promote concurrent sexual partnerships among African Americans in the United 

States. She has testified before a Congressional committee on the HIV epidemic 

and, for World AIDS Day in 2010, was invited to the White House to speak in a 

panel discussion. The following is taken from an interview with Dr. Adimora. 

—EnID VázqUEz 

In THE mID-1900S, THERE waS 

the rise of so-called “risk factor 

epidemiology.” People became 

much more focused on individual 

determinants, the individual behaviors and 

characteristics of people that put them 

at risk for disease. And these things are 

important. 

But it turns out there’s increasing 

evidence that in order to really make headway 

with the HIV epidemic in this country, 

and in the world, there’s going to need 

to be more attention paid to some of the 

social factors that drive people’s behavior 

and also set them up to acquire infection. 


It appears, for example, that the connections 

between black people in the U.S. 

differ to some extent compared to the 

connections among white people in the 

sense that there are more disassortative 

relationships, or relationships between 

people with different risk factors. There’s 

more of a tendency for African Americans 

to have relationships with people who 

have much greater risk for HIV than they 

themselves do. There’s also the issue of 

partnerships that overlap in time, or sexual 

concurrency. In addition, they tend to find 

partners within their communities, which 

are often segregated. Sexual concurrency 

TAmARA WILSOn, HIV-PoSITIVE SIncE 1999, VoLUnTEERS aT 

cHIcago womEn’S aIDS PRojEcT. SHE cREDITS HER moTHER 

wITH HELPIng HER To managE HER HIV, anD TPan FoR 

HELPIng To SaVE HER LIFE. PHoTogRaPH BY cHRIS knIgHT 

has been found to put people 

at greater risk for HIV than 

serial monogamy, even if 

people in both groups have 

had the same number of 

partners over the same 

period of time. 

THE THIng THaT 

is really, really 

important is the 

observation that 

it is the social context of 

life in the United States that 

really contributes to those 

partnership patterns. It’s 

pretty clear that black people 

as a whole tend to live under 

very different circumstances 

in the United States than 

white people do. And some 

of these characteristics that 

we have been studying, like 

incarceration for example, 

not only contribute to HIV, 

but they’re also emblematic 

of the oppression that 

minority populations are 

living under in the United 

States. A history of incarceration, 

for example, which is 

experienced by black men 

more than any other group, 

primarily as a result of the war on drugs, 

lowers the possibility of employment and 

increases the risk of poverty, while at the 

same time disrupting the stability of longterm 

partnerships. Incarceration and death 

due to violence and disease in black men 

lead more black women to enter into relationships 

with men who have greater risk 

factors for HIV than they do. 

This doesn’t mean that each and 

every minority, each and every African 

American, in the United States is poor and 

oppressed. But as a whole, it is these types 

of factors that contribute to the spread 

of HIV, STDs, and in fact different rates of 

other diseases, such as diabetes and heart 

disease. Black people are at greater risk 

of acquiring HIV infection independent of 

their own low-risk behavior compared to 

other groups. 

I 

woULD aLSo EmPHaSIzE THaT 

we do have personal responsibility for 

our behavior. However, I think some 

people tend to look at this work and 

say, “Oh, they’re just blaming the environment, 

blaming the majority population.” 

That’s really not exactly it. While we do 

have personal responsibility for our behavior, 

I think it’s very critically important to 

realize that black people have substantially 

increased risks than other populations, 

even with the same behavior. And this has 

been demonstrated. This is true for black 

gay men as well as for black heterosexual 

men and women. 

I would say to black women living with 

HIV, keep the faith. Teach your sons and 

daughters all the lessons you’ve learned. 

You have a wealth of experience, and certainly 

resiliency. 

We need to work in whatever ways we 

can to change the social and economic 

factors that are putting our people at risk, 

and putting our children at risk. 

It would help if everyone in the United 

States had health care. It’s astonishing to 

me that, apparently, health care is not a 

right. It remains an open question in the 

United States that people should have 

health coverage, even though it’s clearly 

most cost effective for the nation as a 

whole. This is a civil rights issue. That’s 

what I mean by working to change the 

economic factors that put people at risk. 

Health care availability, affordability for 

all, would make a huge difference in terms 

of transmission of HIV, and also in terms 

of the personal health of people who are 

living with HIV. 

go To positivelyaware.com To REaD 

PUBLISHED STUDIES anD aBSTRacTS. 


‘everyone needS a Support 

How one therapist helps 

Hiv-positive women learn 

to take care of themselves 

by eNid vázquez 

FOR MORE THAN 10 YEARS, 

psychotherapist Kesha 

Burch, LCPC, has 

counseled HIV-positive 

women at the Chicago Women’s 

AIDS Project (CWAP). Whether 

positive or negative, the women 

she counsels face similar 

problems, she says, with health 

being an added and important 

concern for those living with 

HIV or any other chronic illness. 

“The HIV-positive women I work with 

have the same types of issues, but it’s even 

more important that they address emotional 

and life concerns because their health 

depends on it,” says Burch. While women 

often focus on interpersonal problems and 

family stress, improved health is always an 

underlying goal of Burch’s work at CWAP. 

“Stress that comes from emotional and 

psychological problems can be a threat to 

a woman with HIV,” she says, pointing out 

that stress and depression are known to 

increase mortality for positive women. 

Nevertheless, she finds that many 

women worry about their lovers and families 

more than they do about themselves, 

even in the face of HIV. 

“Women in our society are rewarded 

for taking care of other people,” Burch 

said. “We often don’t think about taking 

care of ourselves independent of someone 

helping us with that or coaching us 

through it. We may not be socialized to be 

assertive. And of course, all of that really 

comes through in thinking about how to 


PHOTO: PROEllEMEnTS PHOTOgRAPHy

SyStem’ 

negotiate safe sex practices and so on and 

so forth. 

“You don’t want to get away from all 

the nurturing,” she notes, “but how do you 

take care of other people and take care of 

yourself as well? There has to be some balance. 

Hopefully, counseling helps women 

achieve greater balance. It’s about feeling 

empowered enough to be themselves and 

to pursue things that they’re worthy of 

having in their lives,” says Burch. 

Instead, she finds that many women 

settle for less than they deserve, which can 

begin a cycle of more unhappiness in their 

lives. Others have problems establishing 

healthy relationships and may have negative 

coping skills, experiencing difficulty 

with attachment (including having many 

sexual partners) and figuring out who is 

worthy of being with them. These women 

often feel that they have to accept bad 

behavior in order to be in a relationship or 

are confused about what they have to do 

to be in one. 

“There are also issues around disclosure 

and that relates back to self-esteem and 

self-worth. It’s important for them to communicate 

with partners for their own health 

and also so that they can be truly known 

and accepted and loved,” she said. “This is 

similar to the things that other people are 

dealing with, being true to themselves.” 

Once a woman has a healthier relationship 

with herself, her other relationships 

are healthier too. Burch cites support 

groups and support buddies as being 

important for positive women, along with 

caring friends, family members, and supportive 

partners. 

“We were created to be in relationships 

with each other. It’s not just about 

romantic relationships, but about learning 

how to be a good parent and how 

to have a healthy friendship…all kinds of 

relationships that are essential to human 

existence,” she says. “Everyone needs a 

support system, and the healthier your 

support system, the better off you are. 

It’s about the people in your life who 

are for you and support you. That helps 

anybody’s mental health and physiological 

health as well. It helps anybody to become 

more resilient and do better.” 

What’s different for people living with a 

chronic illness like HIV, she says, is that the 

same skills they use for creating healthy 

relationships also work in managing their 

health care. 

“Sometimes negative issues can seep 

into their attitudes towards their health, 

their health care, and their provider. 

When I talk to them about using skills in a 

relationship, I recognize that those assertiveness 

skills can help them ask for what 

they need from their medical provider so 

they don’t just think that they go to their 

doctor and are told what to do, but report 

things that are of concern to them and 

ask, can we check into this?” Burch said. 

“Sometimes I rehearse with them. ‘What 

would you like to say when you go to the 

doctor?’ I had a client who felt that her 

doctor wasn’t listening to her. There were 

some things that she thought needed to 

be addressed, but she was complaining 

about it to other people and not taking it 

back to the doctor to say ‘this really worries 

me’ or ‘I wish that at my last appointment 

we could have talked about this.’ 

“So I helped her narrow down her complaints 

and her concerns to three things 

per visit, because there’s some reality 

there too. The doctor cannot spend 90 

minutes on a visit. The alternative was for 

her to feel consistently frustrated with her 

experience with the doctor,” Burch said. 

“She didn’t realize she could ask for what 

she wants. For the first item on her list, she 

was able to get a referral to a specialist. 

That also then reduced her anxiety and 

worry about what was going on with her.” 

She notes that not being able to communicate 

with a provider or understand 

what was being asked of them could lead 

some people to not take their medication 

correctly. 

Burch pointed to other practical things 

people can do to support their self-worth 

and value. “It could be as simple as putting 

on make-up. It could be signing up to take 

a class or to stop talking to someone who 

is not doing right by them—any behavioral 

steps that reinforce the message that 

they’re of value.” 

Going for counseling, she believes, is 

one big step towards self-care. 

“When you show up to therapy, that’s 

just in and of itself an affirmation that 

you’re worthy of a better life and this is 

part of what you are going to do about it,” 

Burch says. “There’s always some kind of 

spark I see that pulls women in, something 

I can’t describe that gives them just a little 

bit of hope that things could be different. 

Especially for the women who are dealing 

with addiction, it’s that little piece of 

themselves that helps to pull them out, 

to show up on the doorstep of a detox or 

drug treatment program. There’s a ton 

of internal strength and resiliency there, 

and that’s something that I reflect back to 

them sometimes. ‘Look at all that you’ve 

been through to get to this point.’ 

“When you see that spark, that’s the 

essence of who that person really is,” says 

Burch. “The trick is to get them to see it, 

despite their circumstances.” 

She sometimes suggests that people 

make positive affirmations, keep a journal, 

and read certain books or authors. While 

she can help weed out negative beliefs 

people have about themselves that they 

may not even be aware of, these activities 

can keep people focused on messages 

that are the opposite of the negative 

beliefs and feelings. “It’s about changing 

that message,” she said. 

She sometimes has clients take time 

to just relax and sit silently. Many people 

are often too busy running around doing 

everything they have to do to give themselves 

time for reflection and hearing 

what’s inside them, she said. 

Perhaps the most important part of 

her work, she believes, is treating people 

with kindness and respect. “That’s really 

at the core of the Chicago Women’s AIDS 

Project,” she notes. “The mission statement 

is about empowering women, seeing 

the value in each and every woman.” 


nine monthS to Birt 

Hiv and pregnancy—keeping yourself and your baby healthy 

by JohN verNa, ms, pa-c 

WELL, aS YoU SUSPEcTED, YoUR PREgnancY 

test is positive. Congratulations! Pregnancy can 

be an exciting time, and a really wonderful experience. 

Of course, now that you’re expecting, you 

probably have lots of questions, some of which relate to how your 

HIV-positive status will impact your pregnancy and your baby. 

The goal in every pregnancy is to keep 

both mom and baby healthy—and I’m 

happy to say that this is a goal that’s well 

within your reach. Just because you have 

HIV does not mean you can’t have a happy, 

healthy pregnancy, and a happy, healthy 

baby. Basically, the same things that keep 

you healthy will keep your baby healthy. 

Risks of transmitting the virus to your baby 

decrease as your own viral load decreases. 

In fact, if you are on HIV medication 

and take the medications as prescribed, 

there’s only a 1% chance of passing HIV 

to your baby. In my 11 years as an HIV 

specialist, and having seen over 150 pregnant 

patients with HIV, I have never had 

a patient pass HIV to her baby. However, 

if you’re not on HIV meds, or don’t take 

them like you’re supposed to, there’s 

a 25% chance (basically a one in four 

chance) that you will pass HIV to the baby. 

Even medication at the last minute, at the 

time of labor, cuts the risk and some states 

have laws about testing mothers during 

labor if an HIV test result is not on file for 

the pregnancy. 

So let’s talk about what you need to 

do to keep both you and your little one 

healthy. Many women wonder how HIV 

can be transmitted to the baby. HIV can 

be transmitted during pregnancy, during 

labor and delivery, or by breastfeeding. 

We’ll talk about what you can do during 

pregnancy, during labor, and after your 

baby is born to decrease the chances of 

transmitting the virus. 

hOW TO REduCE ThE RISk Of 

TRAnSmITTInG hIV TO YOuR 

BABY duRInG PREGnAnCY 

KEEPIng YoUR VIRaL LoaD 

low is important during pregnancy 

to reduce the risk of 

transmission. Regardless of 

what is recommended based solely on 

your CD4+ and VL levels, you may want to 

start taking HIV meds as soon as you learn 

you are pregnant. Yes, there are guidelines 

from the Department of Health and 

Human Services (DHHS) that recommend 

when to start treatment based on CD4+ 

and VL, but there are groups of people 

for which treatment is recommended no 

matter what. Pregnant women are one of 

those groups. We are trying to prevent 

your baby from becoming infected. 

Earlier initiation of therapy may 

be more effective in reducing in utero 

transmission. In fact, a 2010 study conducted 

in France found that “early and 

sustained control of HIV viral replication is 

associated with decreased residual risk of 

transmission and favors initiating HAART 

drugs as early in pregnancy as possible 

for all women.” In other words, starting 

HAART (highly active antiretroviral 

therapy) drugs early to control the viral 

load as much as possible decreased the 

chances that the virus would be transmitted 

to the baby. In fact, we know that having 

an undetectable viral load substantially 

lowers the risk of transmission of HIV to 

the fetus and lessens the need for consideration 

of cesarean delivery (C-section). 

That’s why I have always suggested that 

my patients start HAART immediately 

after learning about their pregnancy. 

So, if you are not currently taking HIV 

medications (whether you are treatmentnaïve 

or have taken them in the past), tell 

your HIV specialist about what medications 

you’ve taken in the past and provide 

all laboratory tests (genotypes, phenotypes, 

HLA B*5701) and be honest about 

any adherence issues that you’ve had in 

the past. Also talk about any tolerability 

issues and drug allergies you have had 

with any old regimen(s). 

As soon as you learn that you’re pregnant, 

you should contact your HIV specialist 

to discuss your options for medication 

and to review what you’re currently taking 

to make sure your medications are safe 

for the baby. If you are taking HIV medication, 

like HAART, your clinician will likely 

continue your treatment. However, if you 

are taking a regimen that contains efavirenz 

(Sustiva, which is also a component 

of Atripla), you’ll need to make a change. 

Efavirenz is a Pregnancy Category D medication, 

meaning it should not be taken 


h day 

while pregnant, especially during the 

first trimester of your pregnancy. 

It’s reassuring, however, to know 

that of 14 studies with 1,345 

pregnant women on efavirenz 

published in the journal AIDS 

two years ago, there was only 

one infant born with a birth 

defect, a rate no different 

from the general population 

of pregnant women. 

Many women wonder 

if HIV medications are 

going to harm their 

babies or themselves. 

Several HIV medications 

have been found 

to be safe for pregnant 

women and babies. As 

a matter of fact, there is 

an international registry 

(the Antiretroviral Pregnancy 

Registry) that monitors 

for potential 

birth defects 

in infants 

exposed to 

HIV medications 

in 

utero. The 

Department 

of Health and 

Human Services 

(DHHS) currently 

recommends Kaletra 

and Combivir taken twice 

a day. Ask your HIV specialist 

what is going to be best for 

you and keep in mind that 

results of any past or current 

POSiTivElyAwARE.COM SEPTEMBER+OCTOBER 2012 31 

PHOTO © JAni BRySOn

You should have discussions with both your obstetrician and HIV specialist 

to help determine what is best for you and your baby. If you don’t have a 

specialist, now might be a good time to seek one out. 

genotype test will also be considered. If 

you have a viral load of more than 1,000 

copies, your provider will order a genotype 

before starting you on medications. 

Any drug resistance found by the test may 

limit your treatment options. 

So there is a lot to consider here, and 

you should have discussions with both 

your obstetrician and HIV specialist to 

help determine what is best for you and 

your baby. Assuming that you have an 

HIV specialist, your specialist will refer 

you to an obstetrician who has experience 

with HIV-positive mothers. If you don’t 

have a specialist, now might be a good 

time to seek one out. You can visit the 

websites of the American Academy of HIV 

Medicine (www.aahivm.org) and the Gay 

and Lesbian Medical Association (http:// 

glma.org), or call the National AIDS Hotline 

(open 24 hours a day every day of the 

year) at 1-800-CDC-INFO (232-4636). 

ThE RIGhT dOCTOR 

And ThE RIGhT TESTS 

IT can BE VERY HELPFUL To 

have an obstetrician with experience 

treating HIV-positive women, in part 

because the decisions regarding 

whether to use certain “invasive” genetic 

tests can be difficult. Many pregnant 

women undergo a variety of screening 

tests. During the first trimester these tests 

include a fetal ultrasound and a blood 

test for mom. This screening process can 

help determine the risk of the fetus having 

certain birth defects (Down syndrome, trisomy 

18, or trisomy 13). Second trimester 

prenatal screening may include additional 

blood testing (of mom) called Multiple 

Markers. These include alpha-fetoprotein 

(AFP), hCG, estriol, and inhibin. These 

markers provide information about a 

woman’s risk of having a baby with genetic 

conditions or birth defects. This screening 

is usually performed between the 15th and 

20th weeks of pregnancy. 

If the results of these tests are 

abnormal, genetic counseling is recommended. 

Additional testing may be 

needed for an accurate diagnosis. These 

tests include chorionic villus sampling 

(CVS) and amniocentesis, both of which 

are considered “invasive.” During amniocentesis, 

a small amount of amniotic fluid 

is removed by inserting a long, thin needle 

through your belly and into the womb. 

In CVS, chorionic villi cells are removed 

from the placenta, either in the same way 

amniocentesis is performed or through the 

cervix using a catheter and gentle suction. 

Because these tests are invasive, they 

involve at least a theoretical increased 

risk of transmitting the virus to the baby. 

To date, there have been 159 reported 

invasive procedures on HIV-positive moms 

with no transmission of HIV to the baby. 

In all cases, women were on HAART with 

undetectable viral loads and though no 

transmissions of HIV have occurred, a 

small increase in risk can’t be ruled out. 

Therefore, any HIV-positive woman undergoing 

any invasive procedure should be 

on HAART and have an undetectable viral 

load at the time of the procedure. 

Some experts consider CVS too risky 

to offer to their HIV-positive patients and 

recommend limiting invasive procedures 

to amniocentesis only, but existing data 

on transmission risk associated with 

these procedures are limited. Invasive 

testing procedures should be discussed 

thoroughly with your OB and between 

you and your partner. Your OB (or genetic 

counselor) will discuss the pros and cons 

of invasive testing with you. But ultimately, 

whether to test (or not to test) is a personal 

decision. 

LOWERInG ThE RISk 

duRInG LABOR And dELIVERY 

AgaIn, THE goaL IS To 

limit the baby’s exposure to 

the virus. So it’s probably not 

surprising that your options 

for labor and delivery depend upon your 

viral load (another important reason to 

take your HIV meds as prescribed). The 

American College of Obstetricians and 

Gynecologists (ACOG) has recommended 

considering a scheduled C-section delivery 

for HIV-positive women since 1999. A 

scheduled C-section is recommended for 

women with a viral load that’s greater than 

1,000 copies/mL near the time of delivery 

(36 weeks’ gestation) and for any woman 

with an unknown viral load. It is also 

recommended for women who did not 

receive HIV medication during pregnancy. 

In these situations, ACOG recommends a 

scheduled C-section at 38 weeks’ gestation 

in order to decrease the likelihood of 

onset of labor or rupture of membranes 

before delivery. 

For women with a viral load that’s 

less than 1,000 copies/mL near time of 

delivery, a scheduled C-section is not 

routinely recommended. So, if your viral 

load is less than 1,000 copies/mL near the 

time of delivery, your choices for labor 

and delivery are essentially the same as 

a woman who doesn’t have the virus, and 

you can have a vaginal delivery. The risk 

of perinatal transmission of HIV in women 

with an undetectable viral load (at 36 

weeks gestation) is 1% or less, even with a 

vaginal delivery. No evidence is available 

to show that this risk can be lowered further 

by performing a scheduled C-section. 

Remember, a C-section is major surgery 

and has its own risk of complications, compared 

with vaginal delivery. 

Under new DHHS guidelines, only 

women with viral loads of more than 400 

copies/mL should be given IV zidovudine 

(AZT) continuously, even if your genotype 

shows resistance for this drug. The 

use of AZT is recommended because of 

its unique characteristics and its proven 

record in reducing transmission. 

To help prevent transmission, your 

baby will be given liquid AZT immediately 

after birth and this will be continued (by 

you at home) twice a day for six weeks. 


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EmaIL aDDRESS 

Women in the U.S. with HIV should not breastfeed their babies 

due to increased risk of transmitting the virus. Baby formula 

is a safe and healthy alternative. 

Unfortunately, women in the U.S. with 

HIV should not breastfeed their babies 

due to increased risk of transmitting the 

virus. Baby formula is a safe and healthy 

alternative to breast milk and there are 

many brands and options that are available 

to you. Also, while the risk is very 

low, HIV can also be transmitted to a baby 

through food that was pre-chewed by an 

HIV-positive mother (or caretaker). To be 

completely safe, babies should not be fed 

pre-chewed food. 

dOES ThE BABY hAVE hIV? 

THERE aRE Two TYPES oF 

tests that will be performed on 

your baby to find out if he or she 

has HIV. The first is the HIV antibody 

test. All babies born to a mom with 

HIV will test positive for the first several 

❑ Enclosed is my donation of 

❑ $25 ❑ $50 ❑ $100 ❑ $250 ❑ $500 ❑ $_______ 

months of their lives. This does not mean 

that they have HIV. Rather, it means that 

the baby has simply been exposed to his/ 

her mother’s HIV. The second test, PCR 

testing, looks for the virus and not just the 

antibodies to the virus. It is this test that 

can tell whether the baby has HIV or not. 

This test will be done during the first few 

days of his/her life. 

The PCR test will be repeated several 

times on your baby. To know for certain 

that your baby is not infected with HIV, the 

baby must not be breastfeeding and must 

have two negative PCR tests, the first at 

one month (or older) and the second at 

four months (or older). Many experts confirm 

the HIV-negative status of the baby 

with an HIV antibody test at age 12 to 18 

months. To be diagnosed with HIV, a baby 

must have two positive PCR tests. 

Bill to: 

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charge my: ❑ Visa ❑ MasterCard ❑ American Express 

total amouNt: $___________ 

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Aware Network (tPAN) is a not-for-profit organization dedicated to providing 

support and information to all people affected by HIV. 

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nAME 

AgEnCy (if APPliCABlE) 

AddRESS 

Again, just because you have HIV does 

not mean you can’t have a healthy pregnancy 

and baby. In fact, just this past year 

I had an HIV-positive patient who followed 

her regimen and had a healthy pregnancy, 

and an uncomplicated vaginal birth. She 

and her husband welcomed a healthy 

HIV-negative baby into the world. It can be 

done, and it is done by lots of women just 

like you every day. So, again, congratulations! 

JohN verNa has spent his entire professional 

career providing health care to individuals 

with HIV. For the past three years, 

he has worked at Access Community 

Health Network in Chicago. John knows 

just how special (and scary) pregnancy 

can be, as he and his wife recently welcomed 

their first child. 

CiTy STATE ZiP

COnfEREnCE uPdATE 

AIdS 2012 

washiNgtoN, d.c. 

CuRE CAuCuS: (above, from left) Sharon Lewin, MD, PhD; Rowena Johnston, vice president of research, amfAR; Steven Deeks, MD, 

University of California San Francisco; Françoise Barré-Sinoussi, new president of the International AIDS Society; Mark Harrington, 

Treatment Action Group; and UNAIDS executive director Michel Sidibé review developments in HIV cure research. 

After a 22-year absence, the International 

AIDS Conference returned to the U.S. following 

President Obama’s lifting of the federal immigration 

and travel ban against people from outside the 

U.S. with HIV/AIDS. An estimated 22,000 activists, 

advocates, clinicians, and others converged on 

Washington, D.C. in July. For conference webcasts 

and transcripts go to www.aids2012.org. 

IAS cure workshop highlights 

advances and challenges 

by Jeff berry 

At this year’s conference we 

heard about exciting advances 

in cure research, as well as 

the launch of the International 

AIDS Society’s (IAS) “Towards 

an HIV Cure” global scientific 

strategy. A two-day pre-conference 

workshop brought 

together researchers and 

community advocates to preview 

some of these advances 

and provide insight into work 

being done in the seven different 

areas of research that 

the agenda has identified as 

highest priority. 

The workshop, cochaired 

by Steven Deeks, 

MD, University of California, 

San Francisco, and IAS 

president and Nobel laureate 

Françoise Barré-Sinoussi, 

Pasteur Institute, Paris, was 

opened by Dr. Anthony S. 

Fauci, Director of the National 

Institute of Allergy and 

Infectious Diseases, NIH. In 

his opening remarks, Fauci 

stated that a cure that only 

benefits 0.01% of the population 

is not going to excite 

anyone—it has to be scalable. 

During the community 

literacy session Australian 

researcher Sharon Lewin, MD, 

PhD, gave an overview presentation 

addressing major 

barriers to a cure, including 

what actually defines a 

cure and potential targets 

and mechanisms, as well as 

underscoring the importance 

of assays for future research 

and the need for these tests 

to undergo rigorous standardization 

with labs before 

going into wider use. 

Activist and PoSITIVELY 

awaRE contributor Matt 

Sharp talked about his experiences 

as a cure research 

study participant, and the 

challenges that lie ahead, 

including ethical study 

design, Analytical Treatment 

Interruptions (ATI), and 

informed consent. 

Sharp noted that some 

cure research may be quite 

risky, with little chance for 

benefit. He asked what the 

“reasonable” risks are for HIVpositive 

individuals who will 

be participating in early and 

potentially dangerous cure 

studies, and how can we best 

protect them? Developing 

guidelines for determining 

when potentially risky 

treatment interruptions are 

appropriate is a critical next 

step, said Sharp, and community 

input and community 

advisory boards are essential 

in ensuring ethical, patientoriented 

studies. 

An elegant presentation 

given by Robert Siliciano, MD, 

PhD, Johns Hopkins University 

School of Medicine, was perhaps 

one of the clearest and 

most concise presentations 

I’ve ever seen on the basics 

of immunology, HIV infection, 


PHOTOS: ©iAS/STEvE SHAPiRO-COMMERCiAliMAgE.nET

and the multiple molecular 

mechanisms which maintain 

HIV latency. HIV is not completely 

eradicated from the 

body by standard antiretroviral 

therapy because some of it 

lies resting in memory CD4+Tcells, 

which can proliferate for 

an average of 73.4 years in 

the human body. However, if 

you stop taking therapy, the 

virus typically comes roaring 

back within a matter of weeks. 

One eradication approach 

would be to remain on standard 

ARV therapy to keep 

the virus suppressed, while at 

the same time purging these 

latent reservoirs and blocking 

them from infecting new 

cells, so that they would have 

nowhere to go and eventually 

die off, ridding the body of 

HIV. But it’s complicated—the 

number of latently infected 

cells may be much higher 

than previously thought, by as 

much as 50-fold, according to 

Siliciano. 

Sarah Palmer, PhD, Swedish 

Institute for Communicable 

Disease Control and Karolinska 

Institute, gave a presentation 

on measuring persistent HIV 

infection, including an excellent 

slide outlining some of the 

advantages and disadvantages 

of the four currently available 

assays which measure persistence. 

In concluding her talk, 

Palmer emphasized that “looking 

ahead, to determine the 

effectiveness of curative strategies, 

our field will need to 

develop a more standardized 

assay system which is sensitive, 

efficient, less costly, and 

adaptable in local settings.” 

Other presentations 

covered recent advances in 

the development of accurate 

animal models for 

use in future cure 

research, vaccine 

and immune-based 

therapies and the role 

of immune activation 

and inflammation in 

viral persistence. 

The conference 

ended with a slightly 

unorthodox, yet 

immensely informative 

and entertaining 

presentation by Fred 

Verdult of Amsterdam 

on the psychosocial 

benefits of a cure for 

HIV. Verdult, after 

finding out he had HIV 

in 1998, started Volle 

Maan, an organization 

that conducts studies 

and communication projects 

on health and disease to 

encourage people to live full 

and worthwhile lives. Volle 

conducted a survey of 458 

individuals in the Netherlands 

asking how important to them 

a cure for HIV is, why a cure is 

important, and which type of 

cure is preferred. 

The majority of the survey 

respondents indicated they 

were in good health, with 

only 14% stating that their 

health was poor. Seventy-two 

percent said that it was very 

important to them to be cured 

of HIV, while another 22% said 

it was somewhat important. 

Yet when asked about how a 

cure might look, participants 

had varying responses. 95% 

thought that a total cure 

without any risk of future 

transmission or infection very 

desirable, while only 41% considered 

it desirable to have a 

cure that had no risk of future 

transmission but carried a risk 

ShARP TuRn: PA contributor Matt 

Sharp talks about his experiences as a 

cure research study participant. 

of future infection. The survey 

also asked about disadvantages 

of living with HIV—the 

risk of experiencing health 

problems in the future was 

the number one answer, while 

psychosocial effects such as 

stigma and the risk of infecting 

someone else were also 

highly ranked. 

Deeks closed the twoday 

workshop by declaring 

Verdult’s presentation the 

“highlight of the meeting,” 

and remarking on the spirit 

of collaboration among the 

attendees. Barré-Sinoussi said 

that next steps include the 

efforts of the working groups, 

including a newly added 

social sciences research team 

and an ethics working group, 

as well as a call for more cure 

research funding and collaboration. 

The next IAS Towards 

an HIV Cure workshop is 

scheduled for immediately 

prior to the 2013 international 

conference in Kuala Lumpur, 

Malaysia. 

Other news on 

the cure front 

A group of patients in France 

who became infected with 

HIV and then started on 

antiretroviral therapy (ART) 

early in the post-infection 

period have shown no signs 

of a resurgence of their Hiv 

infection seven years after 

being taken off therapy. 

“These results suggest 

that…antiretroviral treatment 

should be started very early 

after infection,” said Charline 

Bacchus, lead researcher 

of the study at the French 

National Agency for Research 

on AIDS and Viral Hepatitis 

(ANRS). 

The patients in the ANRS 

EP47 VISCONTI cohort (known 

as the Visconti Cohort) have 

an extremely low reservoir of 

HIV in their cells similar to that 

of “HIV controller” patients. 

HIV controllers are those who 

are able to control their HIV 

infection without the use of 

ART for an extended period of 

time, and represent about one 

out of every 300 people who 

have HIV. 

In the study, 12 patients 

started therapy within 10 

weeks of infection, were on 

therapy for an average of 

three years, and were able to 

control HIV after an average 

of seven years off therapy. 

At a press conference Asier 

Saez-Cirión, one of the study 

investigators, said they 

were interested in finding 

out whether HIV controller 

status could be induced. He 

estimated that 5–15% of those 

treated early could eventually 

control HIV off therapy. But 

don’t stop those HIV meds 



AIdS 2012 


just yet—not only would we 

need to figure out how to 

identify who would have this 

type of response to early 

treatment, but also get those 

individuals onto treatment 

immediately following infection. 

The other question one 

might ask is, could some of 

those in the study already 

have been HIV controllers to 

begin with? While the genetic 

alleles commonly associated 

with HIV controllers was not 

found in these patients there 

may be other factors playing 

a role, which researchers now 

are trying to uncover. 

Another study looked 

at two men who had been 

infected with Hiv for many 

years, on suppressive antiretroviral 

therapy (ART), and 

who underwent treatment of 

lymphoma via an allogenic 

(meaning foreign, or from 

another donor) stem cell 

transplantation. Both patients 

received a milder form of 

chemotherapy, known as the 

conditioning regimen, prior 

to transplant, which allowed 

them to stay on their ART during 

and after the transplant. 

One patient was on Atripla, 

the other on Isentress/ 

Truvada. HIV was detectable 

in their cells immediately after 

the transplant, but the transplanted 

donor cells replaced 

the patients’ own lymphocytes 

over time. The amount 

of HIV DNA in their blood 

cells decreased and became 

undetectable, for up to two 

years now in one patient and 

three-and-a-half years in the 

other. CD4s declined in both 

patients initially, followed by 

a robust CD4 increase in one 

patient, and the stabilization 

and no further decline of 

CD4s in the other. 

Unlike Timothy Ray 

Brown, the “Berlin” patient, 

who received cells that were 

resistant to HIV because they 

lacked the CCR5 receptor, 

these patients received cells 

that were CCR5+. It is believed 

that the antiretroviral treatment 

protected the donor 

cells from becoming infected, 

leading one researcher to refer 

to it as “a form of PrEP [preexposure 

prophylaxis] at the 

cellular level.” Further tissue 

sampling and analytic treatment 

interruption will need to 

be conducted to assess the full 

extent of the reduction of HIV 

in the reservoir. 

At a press conference 

held the same day these two 

studies were presented, David 

Margolis, MD, University of 

North Carolina at Chapel 

Hill, was asked by a reporter 

about the media’s role in 

reporting on cure advances 

responsibly and accurately, 

while at the same time not 

giving too much hope or creating 

complacency. 

“That’s your job,” said 

Margolis. “We are very 

careful about what we say 

[as researchers], and we’ve 

defined cure several different 

ways. Different kinds of 

cure and eradication mean 

different things to different 

people, and have different 

levels of value. Perhaps we 

should come up with a word, 

like ‘complicated-eradicationchemo-immunotherapy,’ 

to 

slow people down. But you 

can’t argue with the goal and 

you can’t get there without 

working on it—and I can’t say 

how long it will take.” 

Drug updates 

by eNid vázquez 

Complera, the newest single 

tablet regimen (STR), comprised 

of rilpivirine (Edurant) 

plus emtricitabine/tenofovir 

(Truvada), continues to hold 

its own. Previously, it had 

been shown to be non-inferior 

to Atripla, another STR, made 

of efavirenz (Sustiva) plus 

emtricitabine/tenofovir. This 

time, however, it has been 

shown to maintain an undetectable 

viral load (of less 

than 50 copies/mL) in people 

who were switching from 

a Norvir-boosted protease 

inhibitor (PI) combination. 

These were 24-week 

results in nearly 500 individuals, 

of whom two-thirds were 

switched to Complera and the 

rest maintained on their PI 

regimen. Overall total cholesterol, 

LDL (“bad cholesterol”), 

and triglycerides decreased 

to a greater extent among 

those switched than on those 

maintained on their PI. The 

differences were statistically 

significant. 

“We all know that regimen 

simplification improves quality 

of life,” said Frank Palella, MD, 

of Northwestern University 

when he presented these 

results from the SPIRIT study. 

Also continuing to do 

well: the still investigational 

elvitegravir and dolutegravir, 

both integrase inhibitor medications 

(INSTIs). In 96-week 

results from Study 145, elvitegravir 

continued to be noninferior 

(as it was in earlier 

48-week results) to Isentress, 

the only INSTI currently on 

the market. Development of 

INSTI drug resistance was 

low (about 7%) and similar 

with both medications. The 

700 participants in this study 

were treatment-experienced, 

so they were less likely to 

achieve undetectable viral 

load. Overall, 47.6% of the 351 

participants on dolutegravir 

had undetectable viral loads, 

compared to 45% of those on 

Isentress. 

In 48-week results from 

the SPRING-2 study, dolutegravir 

was as effective as 

Isentress, with 88% vs. 85% of 

participants in the two groups 

achieving undetectable viral 

load. The participants were 

treatment-naïve (first time 

on HIV therapy), See more 

dolutegravir news in Briefly. 

GETTInG A BOOST 

The investigational drug cobicistat 

(COBI), which boosts 

drug levels (a “pharmacoenhancer”), 

was given with 

Reyataz plus Truvada and 

compared to Norvir-boosted 

Reyataz plus Truvada, a 

preferred regimen under 

U.S. treatment guidelines. In 

Phase 3 study results after 48 

weeks, cobicistat-boosted 

reyataz was non-inferior 

to Norvir-boosted reyataz, 

with high rates of virologic 

success (viral loads of less 

than 50 copies per mL) and 

similar safety and tolerability. 

Nearly 700 individuals participated 

in Study 114. 

“Cobicistat appears to be 

an effective drug for boosting 


PHOTO: © iAS/RyAn RAyBuRn-COMMERCiAliMAgE.nET 

protease inhibitor levels, 

with greater potential for coformulation,” 

said presenter 

Joel Gallant, MD, MPH of 

Johns Hopkins University 

School of Medicine. He noted 

the various co-formulations 

of cobicistat with protease 

inhibitors that are in development. 

Moreover, he pointed 

out that, “[Norvir]-boosted 

Reyataz is known to be a 

lipid-friendly regimen and 

cobicistat is no different.” 

“This is all good news,” 

said session co-facilitator 

Christine Katlama, MD, of 

Hospitalier Pitie-Salpetriere in 

Paris, “because all the drugs 

work and when they don’t 

work there is no resistance.” 

Risky business 

for sex workers 

Several sessions looked at 

abuses that put sex workers 

at risk for HIV—and we’re not 

talking sex. 

Instead, it’s police actions 

around the world—including 

here in the United States—to 

confiscate condoms and 

to use them as evidence 

of prostitution that puts 

sex workers at risk for HIV. 

Advocates 

said the situation is 

such that many sex 

workers are afraid 

to carry condoms 

because of the police 

harassment this can 

cause. In fact, even 

outreach workers 

have been followed 

by the police so that 

sex workers can be 

arrested when they 

take the condoms 

offered. As advocates 

pointed out, it is 

not illegal to carry 

condoms. Rather, 

confiscation serves as another 

avenue of illegal detention 

and intimidation. 

Moreover, criminalization 

of consensual sex work keeps 

workers under dangerous conditions. 

In the “Criminalizing 

Condoms and Sex Work” 

session, Acasia Shields, author 

of Criminalizing Condoms, a 

report from the Open Society 

Foundation, said, “Police 

routinely search sex workers 

to confiscate and destroy condoms. 

This affects their ability 

to practice safe sex and they 

know it.” 

Of the U.S. sex workers 

surveyed, 52% said they 

were afraid to carry condoms 

because of fear of police 

harassment. Shields said 

other abuses include 

threats of arrest to 

exhort sex, 

and beating 

or raping sex 

workers. 

Discussing 

the findings 

from the first 

national congress 

of sex workers in 

Bangladesh, Simon 

mY BOdY, mY BuSInESS: Discussing sex workers’ issues. 

Risen, MD, MPH, PhD, of Save 

the Children, said, “Violence 

against female sex workers 

spreads far beyond individual 

incidents and factually is gender-based 

violence.” Among 

other recommendations, Save 

the Children in Bangladesh 

says behavioral change campaigns 

should be aimed at 

changing community perceptions 

and creating acceptance 

of sex workers in mainstream 

society, and that maternal and 

child services should focus 

more on issues related to sex 

workers. 

Darby Hickey of the Los 

Angeles chapter of SWOP 

(Sex Workers Outreach 

Project), said, “We think 

sometimes that countries like 

the United States are a world 

apart from countries like 

Bangladesh, but unfortunately, 

we face the same issues. 

It is about law and about 

policy change, but also about 

how police operate outside 

the range of law. So we need 

to change policies, holding 

police accountable, and 

address the wider societal 

indifference and downright 

hostility.” She said efforts to 

“rescue and save” sex workers 

should be called “arrest 

and abuse.” 

In the session titled “The 

Oldest Profession: Is Sex 

Work Work?,” Naomi Akers 

said equating sex work with 

human trafficking is insulting 

and hurts both sex workers, 

who are targeted by raids, 

and victims of trafficking, 

who aren’t helped at all. 

“When you’re doing sex work, 

of course you see it as work. 

It buys you food and helps 

you take care of your family,” 

she said, calling trafficking 

“horrible.” 

Deanna Kerrigan of the 

Johns Hopkins Bloomberg 

School of Public Health in 

Baltimore detailed findings 

of higher HIV risk among sex 

workers around the world, and 

said support for sex workers’ 

groups, as well as human and 

health rights is critical for all 

sex workers, including men 

and transgender people. 

Labor rights, the focus of the 

session, would help to eliminate 

stigma and discrimination 

and increase HIV prevention 

efforts for this group of workers, 

she said. Richard Howard 



AIdS 2012 


of the International Labour 

Office (ILO) said, “Decent 

work [as outlined by ILO] 

should exist for all human 

beings, regardless of whether 

it’s legal or not, whether it 

takes place in a formal or 

informal environment.” 

Underscoring the human 

rights issues affecting sex 

workers were protests against 

the U.S. Consulate for denying 

them visas to attend the 

conference. 

In the final analysis, the 

sex workers movement advocates 

for decriminalization of 

sex work as the most important 

way of protecting their 

human rights. 

“The epidemic is not 

driven by the lack of a pill 

or a gadget, the epidemic is 

driven by repression,” said 

plenary speaker Cheryl Overs, 

Senior Research Fellow at 

the Michael Kirby Centre for 

Public Health and Human 

Rights at Monash University 

in Melbourne. 

She founded a sex workers’ 

rights organization in 

Australia in the ‘80s and the 

Global Network of Sex Work 

Projects in the ‘90s. She has 

worked in HIV policy and programming 

for male, female, 

and transgender sex workers 

in more than 20 developing 

countries. “And that brings 

me to law and policy,” she 

continued. “Sex workers 

from Sweden to Singapore 

to Swaziland all say that the 

greatest threat to their health 

and human rights is the law 

that makes it impossible to 

find safe places to work, and 

prevents them from having 

the same protections as other 

workers and other citizens.” 

At the center of research 

A look behind the National institutes of Health 

story aNd photographs by rick guasco 

With an annual budget 

approaching $31 billion, the 

National Institutes of Health 

(NIH) is the medical research 

agency of the federal government 

and the largest source of 

funding in the world for medical 

research. the NiH is also 

a driving force behind AiDs 

and Hiv vaccine research; 

10% of the agency’s budget 

—$3 billion—goes toward 

HIV/AIDS, funding research 

conducted at academic, commercial, 

and private labs, as 

well as at NIH headquarters in 

Bethesda, Maryland. 

Some 75 buildings are 

scattered throughout the 

312-acre NIH campus. During 

the International AIDS 

Conference, the agency 

hosted a press tour of two 

of those buildings, offering a 

closer look at the role the NIH 

plays in clinical research and 

treatment. 

ThE VACCInE CEnTER 

Opened in 2000, the Vaccine 

Research Center is a five-story 

facility where research is done 

to find vaccines not only for 

HIV, but for influenza, Ebola 

virus, and other diseases that 

pose global health risks. 

Gary J. Nabel, MD, PhD, 

director of the Vaccine 

Research Center, opened the 

tour, explaining how the facility 

serves as an “intellectual 

hub” by putting all the stages 

of vaccine research and 

development under one roof. 

Basic research is 

first conducted to find a 

promising vaccine candidate. 

A vaccine is of 

little use, however, if it 

can’t be efficiently and 

safely mass-produced, 

so it undergoes test 

production for good 

manufacturing practices 

and quality control. 

From there, a successful 

candidate then goes 

to clinical trials to 

determine how safe it is 

for patient use. Results 

from the trials are 

reviewed in a series of 

assessments. If the vaccine 

candidate doesn’t 

pass this process with 

flying colors, it goes 

back to basic research, 

and the cycle begins 

again. The three-phase 

cycle can take 10–18 years 

for a would-be 

vaccine to complete. 

Nabel said that the search 

for a vaccine has been 

elusive, because, “HIV is constantly 

mutating, changing its 

genetic make-up and protein 

structure.” 

“HIV is a sugar-coated 

virus,” Nabel explained. 

Sugars produced by the body 

are converted into proteins by 

the virus. “This makes it invisible 

to the body’s immune 

system, which does not perceive 

the virus as a threat.” 

However, Nabel offered 

some perspective on the 

VACCInE ChIEf: The NIH’s Vaccine 

Research Center is headed by 

Dr. Gary J. Nabel. 

search for an HIV vaccine. 

Although it took 17 years to 

develop a vaccine against 

hepatitis B, he pointed out 

that a polio vaccine took 

45 years. 

“A vaccine is at least 10 

years into our future,” Nabel 

said. “What we’ve learned is 

that HIV is a very crafty virus.” 

While one or two vaccine 

candidates look promising, it 

will be at least until mid-2013 

before an assessment can be 

made, and a little longer to 

evaluate more mature data, 

Nabel said. Even if a vaccine 


were discovered today, it 

would take at least four years 

of additional testing and evaluation 

before it could become 

publicly available. 

ThE CLInICAL 

RESEARCh CEnTER 

Next stop on the tour was 

the Mark O. Hatfield Clinical 

Research Center, a hospital 

where 1,500 clinical trials for 

a variety of illnesses (including 

HIV/AIDS) are conducted. 

Opened in 2005, the Hatfield 

Clinical Research Center is 

connected to the Warren 

Grant Magnuson Clinical 

Center, built in 1953, to form 

the largest hospital in the U.S. 

dedicated to clinical research. 

The Clinical Research 

Center has spawned numerous 

treatments, from the 

first pediatric chemotherapy 

to development of AZT, 

the first anti-HIV drug. The 

center houses an HIV clinic 

that treats 500 patients, only 

one or two of whom are ever 

in-patients. 

Dr. Henry Masur is the 

research center’s Director of 

Critical Care Medicine, but has 

focused the major part of his 

career on HIV and its associated 

complications. Although 

a research institution, Masur 

said the clinic recognizes the 

importance of keeping HIVpositive 

patients connected 

to care. That’s why while 

half the clinic’s nursing staff 

is in research, the other half 

of the nurses are also case 

managers. 

Hepatitis C is a major concern 

for people who are HIVpositive, 

Masur said. There 

are 3–5 million people who 

have hep C out of 314 million 

Americans. While the current 

standard of care for hepatitis 

C can sometimes be difficult 

to tolerate and only helps to 

clear the virus in about onethird 

to one-half of patients, 

recent advances have raised 

the cure rate to 75% and 

higher. Masur said advances 

in treatment look even more 

promising, comparing them to 

the advent of protease inhibitors 

and combination therapy 

for HIV that came in 1995. 

As people are now living 

longer with HIV, Masur said 

the research center is beginning 

to look at aging and 

other complications. “We’ll 

soon be examining neurocognitive 

issues,” he said. 

“Beyond anecdotally, does it 

happen, and if so, what can 

we do to reverse it?” 

“Knowledge is bi-directional,” 

Masur said. “What 

we learn in the lab will help 

patients. But there is a lot we 

can learn from patients and 

put to use.” 

CLInICAL CARE: Dr. Henry Masur (above) introduces Senora 

Mitchell, a medical clerk who has been with the Hatfield Clinical 

Research Center’s HIV clinic since 1987. “I love my work,” Mitchell 

said. “I get to make a difference every day.” 

mOdEST ACCOmmOdATIOnS: You might expect that an 

examination room in the most prominent medical research 

hospital in the country, if not the world, would look better than 

this. But Masur noted that taxpayers pay for NIH facilities, so the 

exam room looks the same as at any other doctor’s office. 


ScEnES 

FROm 

A WEEk 

THAT WAS 

words & images 

by rick guasco 

BEYonD THE HEaDLInEmaking 

sessions of 

the International AIDS 

Conference, there was much to 

see and do inside and away from 

Washington, D.C.’s convention 

center. “What would an AIDS 

conference be without a little 

protesting?” said an unflappable 

Secretary of State Hilary Clinton 

as a small group of demonstrators 

rose and chanted when she took 

the stage on opening day. 

During a panel discussion 

addressing the efficiency of 

overseas anti-AIDS efforts, Bill 

Gates spoke candidly: “The 

amount of money we have [now] 

is not enough to treat everyone. 

We’re in a period of incredible 

uncertainty about how much this 

funding will stay strong. Even the 

uncertainty creates instability in 

how the investment ahead will 

be made. The voices of the AIDS 

community are going to have to 

be louder than ever.” 

The week of the conference 

offered opportunities to honor 

the fallen and plea for the living. 

Visitors to the AIDS Memorial 

Quilt, displayed on the Mall, could 

not only see the panels, but also 

recite the names of those memorialized 

by the Quilt. 

In the streets, approximately 

1,000 marchers took their messages 

to the White House. 

Discordant voices—demonstrating 

for sex workers’ rights, against 

Wall Street, opposing HIV criminalization 

laws—were united by 

one refrain, “cure AIDS now.” 


the mirror haS 

tWo faceS 

A personal account of using facial filler for lipoatrophy 

by Jeff berry 

eVER SIncE IT FIRST BEgan aPPEaRIng wITH 

some regularity in people with HIV in the mid 1990’s, 

lipoatrophy has earned its well deserved reputation 

as the Scarlet Letter of HIV, also known as “the look.” 

Lipoatrophy is the loss of subcutaneous fat under the skin, most 

notably in the face, but also in the butt, arms, and legs, and is 

thought to be part of a larger syndrome called lipodystrophy, 

which is the redistribution of fat in the body and can include buffalo 

hump, enlarged breasts, and visceral fat in the abdomen. 

It can sometimes be extremely disfiguring, 

and almost always causes some level 

of emotional distress, even depression, 

and oftentimes self-imposed isolation in 

those who suffer from its stigmatizing 

effects. It can also affect adherence to HIV 

medications, and deter people from starting 

treatment in the first place. 

The cause of lipoatrophy has been 

linked to certain HIV medications, most 

notably d4T (Zerit, stavudine) and to a lesser 

extent AZT (Retrovir, zidovudine) and 

ddI (Videx, didanosine); other HIV meds, 

including some protease inhibitors; and it 

has also been linked to HIV itself. D4T is 

rarely prescribed in the U.S. anymore, but is 

still widely used in many developing countries 

due to its availability and low cost. 

While we don’t see as many new cases of 

lipoatrophy here in the U.S. with those who 

have since initiated therapy using newer 

and less-toxic antiretrovirals, it is still prevalent 

among those using d4T in developing 

countries, although d4T continues to fall 

out of favor with providers and is used less 

and less as more and newer drugs become 

available in those regions. 

For those who have been treated with 

some of these older, more toxic drugs 

(when that was all that was available), 

many have developed the sunken cheeks, 

veiny arms and legs, and loss of fat in the 

butt to the point where it is uncomfortable 

to sit for more than a short period of time. 

Once you discontinue taking a drug like 

d4T, you can sometimes stop the lipoatrophy 

from progressing any further, but it 

can take a long time to see any reversal of 

its effects, if ever, so some people will turn 

to using facial fillers to replace the fat in 

the face that has been lost. 

I have written several articles in the 

past, for both PoSITIVELY awaRE and 

TheBody.com, about my experiences 

dealing with the physical and emotional 

aspects of having lipoatrophy and its 

stigmatizing effects, as well as my experience 

using a facial filler, Sculptra (known 

then as New-Fill) back in 2001. The results 

I saw in 2001 were only moderate, and 

disappeared within about six months to 

a year, mainly due to the fact that I only 

received two treatments because that was 

all that I could afford. 

In THE FaLL oF LaST YEaR, I 

decided to revisit the idea of receiving 

another round of facial filler 

treatments, and I went to see Dr. Dan 

Berger of Northstar Medical Center in 

Chicago for a consultation. Dr. Berger, who 

also writes for PoSITIVELY awaRE, and 

has over 12 years of experience providing 

Sculptra, recommended that I undergo 

five or six “sessions” due to the level of 

facial lipoatrophy that I had. Facial lipoatrophy 

is graded on a scale of 1 to 5, with 1 

being mild, and 5 being severe—mine was 

severe, between grade 4 and 5. During 

each session, I was to receive injections of 

two vials, or one “kit” of Sculptra, one vial 

for each side of my face. 

Sculptra, or injectable poly-L-lactic 

acid, is one of only two FDA approved 

treatments in the U.S. for HIV-associated 

facial lipoatrophy, the other being 

Radiesse. Both of these injectables work 

by being absorbed into the body and 

stimulating the growth of the body’s own 

collagen, so they are not permanent fillers. 

There are other fillers available (see 

table, page 43) that are also used for 


FAcE On: Berry before his initial treatment, and three months after the sixth and last session. 

facial lipoatrophy, but they are permanent 

and can sometimes cause serious side 

effects and allergic reactions (as can both 

Sculptra and Radiesse). Only one is FDA 

approved (Silikon 1000) and none are 

approved for use in HIV. Anecdotally, I’ve 

heard of people who have used them and 

are pleased with their results, but personally 

I did not want to use something that 

was going to be permanent. 

I felt comfortable using Sculptra because 

I had used it before and I already knew what 

to expect, but also because I would be getting 

six treatments instead of two, so I was 

hoping to experience better results this time 

around. Plus, as Dr. Berger explained it, after 

getting six treatments, my face would never 

go back to the way it was before receiving 

Sculptra, and I would only require a “touchup” 

session once a year. 

The cost of Sculptra is expensive, running 

about $1,700 for one kit (two vials), 

or $850 per 367.5 mg vial, which also 

includes the cost for the session—doctor, 

time, and procedure. Most insurance 

companies still consider its use to be a 

cosmetic treatment and are therefore 

likely to refuse to cover the drug as well as 

the procedure. However, if you are initially 

denied, you should appeal and see if you 

can get them to recognize it as a medical 

necessity (which it really is). Recognizing 

the high cost and lack of coverage by most 

plans, and the great need of those who 

have this condition, the manufacturer created 

a patient assistance program (PAP) 

for people with HIV that assists in helping 

to pay for Sculptra. However, a new 

company (Valeant) recently took over the 

PAP, and it now only covers those with up 

to $61,940 in annual income, and provides 

just two kits plus one follow up kit after a 

two-year period. Under the PAP Sculptra is 

free for those with an annual income less 

than 200% of the Federal Povery Level 

($22,340 for an individual, slightly higher 

based on family size and in Alaska and 

Hawaii), and then on a sliding scale above 

this amount and up to $61,940. The staff 

at Northstar was very helpful in getting 

me set up with the PAP, and in November 

of 2011 I received my first treatment. 

IT IS VERY ImPoRTanT THaT THE 

physician who is performing the procedure 

be trained specifically in the 

use of Sculptra and how to properly 

inject it, which requires a certain threading, 

or tunneling, technique. According to the 

package label, “during the first injection 

session with Sculptra, only a limited correction 

should be made. The contour deficiency 

should be under-corrected, never 

fully corrected or overcorrected (overfilled) 

during any injection session. Re-evaluate 

the patient no sooner than two weeks after 

the injection session to determine if additional 

correction is needed.” 

Each session only takes around 40-45 

minutes, and it would begin with Dr. 

Berger marking my face with a white 

pencil to guide him while injecting the 

Sculptra. Starting with ice packs on my 

face to minimize the swelling, and then 

a local anesthetic to numb my face, he 

would begin injecting the filler into different 

areas of my face, using his hands 

to help “move” the filler into place once it 

was injected. Even with the local anesthetic, 

I experienced a good deal of discomfort 

when the needles went in and he tunneled, 

especially during the first couple of sessions 

when there was little fat in my face 

for him to work with. But the discomfort 

was only temporary, and when the session 

was over, I was left with some temporary 

swelling, a few marks, and on occasion, 

some slight bruising, but the swelling went 

down in a few hours and any marks or 

bruising were gone within a day or two. 

Following each session, and according 

to the package label, I was to “massage in 

a circular fashion the treated areas for five 

minutes, five times per day for five days,” 

in an effort to stimulate collagen growth 

and “even out” the facial filler under my 


“AfTER” PHOTO: CHRiS KnigHT

SOuRCE: fACiAlwASTing.ORg 

FAcE OFF: Commonly used options for HIV-related facial lipoatrophy 

PRoDUcT TYPE/SESSIonS aPPRoVED? coST 

Sculptra 

Poly-L-lactic acid 

Radiesse 

Calcium hydroxylapatite 

(CaHA) microspheres 

Silikon 1000 

Microdroplets 

Bioalcamid 

Polyalkylimide gel 

pMMA 

Polymethylmethacrylate 

skin. I went back for five more sessions, 

one every four weeks. 

Non-permanent; 

3–7 or more sessions 

needed. 

Non-permanent; 


needed. 

Permanent; 


needed. 

Permanent; 

1–2 sessions needed. 

Permanent; 

1–2 sessions needed. 

PaTIEnTS aRE aDVISED THaT 

after the initial treatment and 

within a week the effects will 

completely disappear, and the 

contour of the face returns to how it was 

before. With each subsequent session, 

however, you begin to see the cumulative 

benefit of each successive treatment, and 

the effects are more noticeable and last 

longer. By the third or fourth treatment, I 

was really looking more and more like my 

old self, and couldn’t wait for each following 

treatment, pain or no pain! 

Treatment advocate Nelson Vergel 

warns that not everyone experiences the 

same level of results. “Some people in my 

online discussion group, especially those 

with moderate to more advanced cases of 

facial lipoatrophy, have complained of poor 

response with Sculptra after spending a few 

thousand dollars for several sessions that 

did not end up restoring their faces.” Vergel, 

founder of FacialWasting.org and pozhealth 

at yahoogroups.com, says that some of 

them end up getting silicone microdroplets 

in the U.S. or flying to Mexico to get permanent 

options like PMMA (see table, above). 

FDA approved. Patient Assistance for product only 

(under $61,940 yearly income): 

www.needymeds.org/papforms/ 

sculpt1039.pdf. Labor cost average 

$400 per session. Full price: $1,100 

per session for product. 

FDA approved. Patient Assistance available: www. 

radiesse-fl.com/Physician-section/ 

Patient-access-program/ 

Full price: $1,200 per session. 

Off-label use; FDA approved for 

intraocular injections to treat 

CMV-related retinal detachment. 

Not FDA approved. Available in 

Canada, Mexico, and Europe. 

Not FDA approved. Available in 

Mexico and Brazil. American version 

Artefil is too expensive for 

the amount required. 

Of course, nothing is perfect, and there 

are side effects associated with Sculptra. 

The most common side effects reported 

in studies are bruising, swelling, discomfort, 

and rash, but these typically resolve 

within a few days to a few weeks. There is 

a “device-related adverse event” called an 

injection site subcutaneous papule, which 

is a small lump or bump under the skin, the 

onset of which can occur anywhere from 

a few weeks to a few years afterward. I 

experienced several of these lumps, one 

under my left eye, and two under my 

right temple (sometimes if you get these 

papules you can feel them under your 

skin, but they are barely noticeable—other 

times they can be more visible). There are 

also more serious adverse events that can 

potentially occur, so be sure to read the 

full package label. 

In THE EnD, FoR mE THE FEw 

small lumps, the cost of treatment, 

and the pain were all a small price to 

pay for what it has ultimately done for 

my self-esteem. I feel better about myself 

overall, because I look healthier. The effect 

for me was subtle, most people didn’t really 

notice or say anything, other than “you look 

rested” or “you look really great!” 

No Patient Assistance Program. 

$400–800 per session, depending on 

the physician. 

$4,500 average total. Two sessions. 

Infections reported after 3–4 years. 

$2,000 average cost for total reconstruction. 

Patient assistance in Tijuana: 

www.MedicalPMMA.com 

I realize that I am very lucky to have a 

decent-paying job that has afforded me the 

ability to benefit from this treatment, and 

that many others are not as fortunate. I also 

realize that even though the HIV treatments 

available today are much less likely to 

cause facial lipoatrophy (if at all), the fear 

of developing facial lipoatrophy still may 

deter some people from ever starting treatment, 

or may cause those who are on treatment 

to be less than fully adherent to their 

regimen. While Medicare finally agreed to 

cover the procedure a few years ago, the 

amount that they reimburse is well below 

what providers charge. That is why I plan to 

continue to advocate for insurance companies, 

Medicare, and Medicaid to cover this 

procedure at a reasonable amount, much 

in the same way that breast reconstruction 

is provided to women with breast cancer 

who have undergone a mastectomy. The 

benefit of these treatments is vital to the 

psychological well-being and quality of life 

for so many people living with HIV who are 

affected by this condition. 

go to www.sculptra.us for more 

information. For a list of providers trained 

in the use of Sculptra, visit www.sculptraaesthetic.com. 


SEARCh 

fOR An hIV 

SPECIALIST 

Finding an Hiv 

specialist 

is easy with 

AAHivM’s 

referral link: 

www.aahivm.org. 

enter your ZiP 

code on the 

home page, 

and click 

on the “Go” 

button for 

a list of Hiv 

specialists 

near you. 

ASk ThE hIV SPECIALIST 

HELEn c. koEnIg, mD, mPH 

Safe sex is 

for seniors, too 

Q: 

i am a 65-year-old womaN. 

I lost my husband six years ago and 

have finally decided to enter the dating 

world again. My friends have convinced 

me to go on a cruise especially for single seniors, 

but my daughter is giving me all kinds of warnings 

about sexually transmitted diseases and HIV. HIV didn’t 

even exist back when I first became sexually active. 

Seriously, how great is my risk of contracting such 

diseases? After all, we are all going to be senior citizens 

and I’m not going on this cruise intending to “hook up” 

(as they say). Is all this safe sex stuff really necessary? 

A: 

as you head for the suN, 

the all-you-can-eat buffets, and the 

cruise festivities, don’t forget to pack 

some condoms with your sun block. 

While the risk of bringing home HIV or another sexually 

transmitted infection (STI) is not high, it’s not zero 

either. You are joining a growing population of women 

who are sexually active in their 60s and 70s and, unfortunately 

seeing a higher rate of STIs than ever before. 

What really is your risk of acquiring an STI? This 

depends entirely on the partner or partners with whom 

you choose to be sexually active, what type of sex you 

choose to have (oral, vaginal, or anal) and whether 

you choose to use protection or not. You have no way 

of knowing the sexual history of the men you’ll meet 

or their risk of having an STI. Studies have shown that 

even doctors, after taking a complete sexual history in 

a medical setting, are still terrible at predicting whether 

someone has HIV. Your prospective partners may 

not know they have STIs, as many can be present for 

months or years without symptoms, including HIV. 

Women who have been in a monogamous relationship 

for the last 20 or 30 years, or for whom sex hasn’t 

been an issue, may find it difficult to think about buying 

and asking their partner to use condoms. But here are 

some good reasons to brave that aisle at the drug store 

before you hit the high seas, as well as empowering 

yourself enough to make sure they’re used: 


n 

3,500 women over age 45 were diagnosed with 

AIDS in 2009. People over the age of 50 now 

account for 15% of new HIV/AIDS diagnoses, and 

over 35% of all deaths from AIDS. 

n The highest percentage of trichomoniasis (a parasitic 

infection, considered the most common curable STI) 

is now actually in women over 50. Also on the menu 

are syphilis, gonorrhea, chlamydia, hepatitis B and C, 

herpes, and human papilloma virus. 

n Postmenopausal women are at a particularly high 

risk of acquiring HIV and other STIs because the 

vaginal wall is thinner as a result of lower estrogen 

levels and the immune system is not as strong as it 

used to be. 

You can’t control the risk of STIs in your partners, 

but you can control the risk of bringing one home 

yourself with correct condom use. Perhaps you think it’s 

“the man’s job” to come prepared with protection, but 

I encourage you to bring your own as backup! Chances 

are, the condom colors, flavors, and textures out there 

have changed a bit since you last looked. Lubricants 

now also come in wider varieties and are important 

if you experience vaginal dryness, both for your own 

comfort and to prevent condoms from tearing. So pack 

some protection and enjoy the festivities ahead! 

illuSTRATiOn © KARlKOTASinC

PHOTO: CHERyl MAnn 

WhOLISTIC PICTuRE 

SUE SaLTmaRSH 

Battle of the sexes? 

with all the evideNce that there is iNdeed 

a “war on women” being waged by “conservatives,” 

it’s hard not to feel a “feministic” response. I am not a 

feminist. But I am also not in favor of any woman being 

forced to have a child she cannot support financially, 

emotionally, physically, or spiritually, just as no man 

should be forced into fatherhood that he doesn’t want 

and can’t do well. 

But I digress. Some feminists have been heard to 

say that no man would be here without his mother’s 

body having created him. I have to wonder how they 

could have missed the fact that a man (the sperm had 

to come from one of them, after all) was also involved 

in that creation. But then, I thought, couldn’t such 

biological criteria be used to argue the case for the 

opposite side of every agenda? Women have testosterone 

too and yet the number of female-only causes 

far outweighs male-only ones. At this stage of human 

history, I doubt that there is any black or white person 

who doesn’t carry a gene inherited from an ancestor of 

the other color and yet we have racism from both sides. 

And, as I’ve said before, aren’t people who develop 

cancer after years of chain smoking just as deserving of 

the medical care and treatment they need to survive as 

people who acquire HIV after years of unprotected sex 

with multiple partners? 

When feminists angrily accuse me of misogyny, I 

stand by my belief that BOTH sexes are as valuable and 

as worthy of living as the other. And yet, if a man published 

a calendar called “How is a jar of Vaseline better 

than a woman?” I’ve no doubt he would be verbally castrated 

by the very women who publish “How is a cucumber 

better than a man?” And, by the way, the word for 

the female equivalent of misogyny, misandry, rarely sees 

the light of day, though both obviously exist in full force. 

I have frequently been amazed by the number of 

commercials on PBS and other progressive media 

sources that tout the urgent need to get more girls to 

become scientists, engineers, and mathematicians. 

What about the boys who are truly, innately passionate 

about math and science? And where are the commercials 

urging more boys to become nurses, teachers, and 

dancers? Fact is that each sex has natural tendencies 

and the problem is not in getting 

people to go against those natural 

leanings, but in the rest of us 

accepting whatever choices they 

make. As a former girl, I can tell you 

that there is nothing on Earth that 

could’ve induced me to become a 

scientist, engineer, or mathematician. 

Why should I have been forced 

into a field I had no interest in? Why 

should any boy be forced to take 

Home Ec over Shop, to play the flute instead of football, 

or vice versa against his own interest? 

Throughout history, there have been courageous 

activists of both sexes fighting for things that were 

good for everybody. Without Elizabeth Cady Stanton 

and Susan B. Anthony, the issue of women voting might 

never have come to the forefront, but it took 56 men in 

Congress to pass the amendment that gave women the 

right to vote. Rosa Parks and Martin Luther King were 

both crucial to the civil rights movement, but it was 

Lyndon Johnson, a white guy from Texas, who made it 

the law of the land. 

We need to stop putting each other in neat little 

boxes. People—every sex, every race, every religion, 

every size, every age, with every illness—have to decide 

for themselves what’s worth fighting for in this lifetime. 

Since 2009, we’ve had a lot of people, many who call 

themselves Christians and/or Republicans, deciding 

that the only thing worth fighting for is whatever goes 

against everyone who doesn’t look, believe, or act 

like them. But now we also have more, including some 

Christians/Republicans, waking up, shaking off complacency, 

and standing together in all their glorious varieties 

to fight for justice, equality, and the things that are 

best for the Whole. 

“Men should be advocates for all and not just their 

own gender!” feminists stridently shout. Shouldn’t 

women? Shouldn’t we all? Regardless of the composition 

of our chromosomes, we are all human. None of us 

would be here without the contributions of both male 

and female. So I propose we stop being “feminists” or 

“masculinists” (See? not even a word for it!) and do our 

best to become humanists. 

Breathe deep. Live Long. 

we need to 

stop putting 

each 

other in neat 

little boxes. 

regardless 

of the composition 

of 

our chromosomes, 

we are all 

human. 


On September 21, 

take your best shot 

against HIV. 

a day with hiv 

Whether we’re positive or negative, we are all affected by HIV. Take your best shot 

against HIV/AIDS—take part in A Day with HIV, the HIV awareness and anti-stigma 

campaign presented by PoSITIVELY awaRE. On Sept. 21, use your smartphone or digital 

camera and take a snapshot of a moment of your life. Upload your picture and story to 

ADaywithHIV.com or email them to photo@adaywithhiv.com. Select 

pictures will appear in a special section of the November+December 

issue of PoSITIVELY awaRE. Additional pictures will be featured on 

ADayWithHIV.com. 

GET In ThE PICTuRE. 

aDaywithHIV.com

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