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Positively Aware
HIV Treatment and Health
July / August 2009
Evany
Turk
A Success Story
The Journal of
Test Positive
Aware Network
Women and HIV
No More
One-on-One with
Dawn Averitt Bridge
The Feminization
of an Epidemic
Protect Yourselves, Ladies

Please read Important Safety Information below,
and talk to your healthcare professional to learn
more about PREZISTA.
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 the likelihood of your overall treatment
response. Your healthcare professional will work
with you to fi nd the right combination of other
HIV medicines
• The long-term effects of PREZISTA therapy are
unknown at this time. It is important that you remain
under the care of your healthcare professional
PREZISTA does not cure HIV infection or AIDS, and
does not prevent passing HIV to others.
IMPORTANT SAFETY INFORMATION
• PREZISTA, together with Norvir ® (ritonavir), has
rarely been observed to cause liver problems that
may be life-threatening. It was not always clear
if PREZISTA caused these liver problems because
some patients had other illnesses or were taking
other medicines. Your healthcare professional
should do blood tests prior to initiating
combination treatment including 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
Talk to your healthcare professional about the
signs and symptoms of liver problems. These
may include yellowing of your skin or whites of
your eyes, dark (tea-colored) urine, pale-colored
stools (bowel movements), nausea, vomiting,
loss of appetite, or pain, aching or sensitivity on
your right side below your ribs
• Skin rashes have been reported in patients taking
PREZISTA. Rarely, PREZISTA has been reported to
cause a severe or life-threatening rash. Contact
your healthcare professional if you develop a rash
• Taking PREZISTA with certain medicines could
cause serious and/or life-threatening side
effects or may result in loss of its effectiveness.
Do not take PREZISTA if you are taking the
following medicines: dihydroergotamine (D.H.E.45 ® ,
Migranal ® ), ergonovine, ergotamine (Wigraine ® ,
Ergostat ® , Cafergot ® , Ergomar ® ), methylergonovine,
cisapride (Propulsid ® ), pimozide (Orap ® ), oral
midazolam, triazolam (Halcion ® ), rifampin (Rifadin ® ,
Rifater ® , Rifamate ® ), indinavir (Crixivan ® ), lopinavir/
ritonavir (Kaletra ® ), saquinavir (Invirase ® ), lovastatin
(Mevacor ® ), pravastatin (Pravachol ® ), simvastatin
(Zocor ® ), or products containing St. John’s wort
• Before taking PREZISTA, tell your healthcare
professional if you are taking sildenafi l (Viagra ® ),
vardenafi l (Levitra ® ), tadalafi l (Cialis ® ), atorvastatin
(Lipitor ® ), atorvastatin/amlodipine (Caduet ® ), or
rosuvastatin (Crestor ® ). This is not a complete

Belief PREZISTA
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
• Tell your healthcare professional if you are taking
estrogen-based contraceptives (birth control).
PREZISTA might reduce the effectiveness of estrogenbased
contraceptives. You must take additional
precautions for birth control, such as condoms
• Before taking PREZISTA, tell your healthcare
professional if you have any medical conditions,
including allergy to sulfa medicines, diabetes, liver
problems (including hepatitis B or C), 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 if you are taking PREZISTA. You
should not breastfeed if you have HIV because of the
chance of passing HIV to your baby
• 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
• As with other protease inhibitors, taking PREZISTA
may strengthen the body’s immune response,
enabling it to begin to fi ght infections that have been
hidden. Patients may experience signs and symptoms
of infl ammation that can include swelling, tenderness,
or redness
• The most common side effects related to taking
PREZISTA include diarrhea, nausea, headache, and
abdominal pain. Uncommon but severe side effects
such as infl ammation of the pancreas and increased
blood fat levels have also been rarely reported.
This is not a complete list of all possible side effects.
If you experience these or other symptoms, talk to
your healthcare professional. Do not stop taking
{
in myself
in my doctor
in my care
now offers ONCE-DAILY
dosing for adults taking HIV meds for
the fi rst time.
PREZISTA must be taken with and at
the same time as ritonavir (Norvir ® )
and with food.
PREZISTA must be taken in combination
with other HIV meds.
Talk to your doctor to see if PREZISTA is
right for you.
Please visit www.PREZISTA.com
PREZISTA or any other medicines without fi rst talking to
your healthcare professional
• Please refer to the ritonavir (Norvir ® ) Product
Information (PI and PPI) for additional information on
precautionary measures
For adults taking HIV meds for the fi rst time:
PREZISTA 800 mg (two 400-mg tablets) must be
taken at the same time with 100 mg Norvir ®
once daily every day. y PREZISTA must be taken
with food.
You are encouraged to report negative side
effects of prescription drugs to the FDA. Visit
www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Important Patient Information on
the next page for more information, or visit
www.PREZISTA.com.
If you or someone you know needs help paying for
medicine, call 1-888-4PPA-NOW (1-888-477-2669) or
go to www.pparx.org.
Distributed by: Tibotec Therapeutics/Division of Ortho Biotech Products, L.P.
Bridgewater, New Jersey 08807-0914
©2009 Tibotec Therapeutics 01/09 28PRZ0249A1 PREZIS2183R

FDA-Approved Patient Labeling
PREZISTA ® (darunavir) Tablets
Patient Information about
PREZISTA (pre-ZIS-ta)
for HIV (Human Immunodeficiency Virus) Infection
Generic name: darunavir (da-ROO-nuh-veer)
ALERT: Find out about medicines that should NOT be taken with PREZISTA. Please
also read the section “Who should not take PREZISTA?”.
Please read this information before you start taking PREZISTA. Also, read the
leaflet each time you renew your prescription, just in case anything has changed.
Remember, this leaflet does not take the place of careful discussions with your
doctor. You and your doctor should discuss your treatment with PREZISTA prior to
the first time you take your medicine and at regular checkups. You should remain
under a doctor’s care when using PREZISTA and should not change or stop
treatment without first talking with a doctor.
WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD
KNOW ABOUT PREZISTA?
PREZISTA, together with NORVIR ® (ritonavir), has rarely been observed to cause
liver problems which may be life-threatening. It was not always clear if PREZISTA
caused these liver problems because some patients had other illnesses or were
taking other medicines. Your healthcare professional should do blood tests prior to
initiating combination treatment including 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. Please also
read the section “What are the possible side effects of PREZISTA?”.
Rarely, PREZISTA has been reported to cause a severe or life-threatening rash.
Contact your healthcare provider if you develop a rash. Your healthcare provider
will advise you whether your symptoms can be managed on therapy or whether
PREZISTA should be stopped.
WHAT IS PREZISTA?
PREZISTA is an oral tablet used for the treatment of HIV (Human Immunodeficiency
Virus) infection in adults. HIV is the virus that causes AIDS (Acquired Immune
Deficiency Syndrome). PREZISTA is a type of anti-HIV medicine called a protease
(PRO-tee-ase) inhibitor.
HOW DOES PREZISTA WORK?
PREZISTA blocks HIV protease, an enzyme which is needed for HIV to multiply.
When used with other anti-HIV medicines, PREZISTA can help to reduce the
amount of HIV in your blood (called “viral load”) and increase your CD4 (T) cell
count. HIV infection destroys CD4 (T) cells, which are important to the immune
system. The immune system helps fight infection. Reducing the amount of HIV and
increasing the CD4 (T) cell count may improve your immune system and, thus,
reduce the risk of death or infections that can happen when your immune system
is weak (opportunistic infections).
PREZISTA is always taken with and at the same time as ritonavir (NORVIR ® ), in
combination with other anti-HIV medicines. PREZISTA should also be taken with food.
DOES PREZISTA CURE HIV OR AIDS?
PREZISTA does not cure HIV infection or AIDS. At present, there is no cure for HIV
infection. People taking PREZISTA may still develop infections or other conditions
associated with HIV infection. Because of this, it is very important for you to remain
under the care of a doctor. Although PREZISTA is not a cure for HIV or AIDS, PREZISTA
can help reduce your risks of getting illnesses associated with HIV infection (AIDS
and opportunistic infection) and eventually dying from these conditions.
DOES PREZISTA REDUCE THE RISK OF PASSING HIV
TO OTHERS?
PREZISTA does not reduce the risk of passing HIV to others through sexual contact,
sharing needles, or being exposed to your blood. For your health and the health of
others, it is important to always practice safer sex by using a latex or polyurethane
condom or other barrier method 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 doctor if you have any questions on how to prevent passing HIV to other
people.
WHAT SHOULD I TELL MY DOCTOR BEFORE I TAKE PREZISTA?
Tell your doctor about all of your medical conditions, including if you:
• are allergic to sulfa medicines.
• have diabetes. In general, anti-HIV medicines, such as PREZISTA, might increase
sugar levels in the blood.
• have liver problems, including hepatitis B and/or C.
• have hemophilia. Anti-HIV medicines, such as PREZISTA, might increase the risk
of bleeding.
• are pregnant or planning to become pregnant. The effects of PREZISTA on
pregnant women or their unborn babies are not known. You and your doctor will
need to decide if taking PREZISTA is right for you. If you take PREZISTA while you
are pregnant, talk to your doctor about how you can be included in the
Antiretroviral Pregnancy Registry.
• are breastfeeding. Do not breastfeed if you are taking PREZISTA. You should not
breastfeed if you have HIV because of the chance of passing HIV to your baby.
Talk with your doctor about the best way to feed your baby.
IMPORTANT PATIENT INFORMATION
WHO SHOULD NOT TAKE PREZISTA?**
Together with your doctor, you need to decide whether taking PREZISTA is right
for you.
Do not take PREZISTA if you:
• are allergic to darunavir or any of the other ingredients in PREZISTA
• are allergic to ritonavir (NORVIR ® )
• take any of the following types of medicines because you could experience
serious side effects:
Type of Drug Examples of Generic Names (Brand Names)
Ergot Derivatives dihydroergotamine (D.H.E. 45 ® , Migranal ® )
(to treat migraine and ergonovine
headaches) ergotamine (Cafergot ® , Ergomar ® )
methylergonovine
Gastrointestinal Motility Agent cisapride
(to treat some digestive conditions)
Neuroleptic pimozide (Orap ® )
(to treat psychiatric conditions)
Sedative/hypnotics oral midazolam
(to treat trouble with triazolam (Halcion ® )
sleeping and/or anxiety)
Herbal Product St. John’s wort (Hypericum perforatum)
HMG-CoA Reductase nhibitors lovastatin (Mevacor ® , Altoprev ® , Advicor ® )
(also known as statins) simvastatin (Zocor ® , Simcor ® , Vytorin ® )
(to lower cholesterol levels)
Antimycobacterial rifampin (Rifadin ® , Rifater ® , Rifamate ® ,
(to treat tuberculosis or Rimactane ® )
Mycobacterium avium complex)
CAN PREZISTA BE TAKEN WITH OTHER MEDICATIONS?**
Tell your doctor about all the medicines you take including prescription and
nonprescription medicines, vitamins, and herbal supplements. PREZISTA and many
other medicines can interact. Sometimes serious side effects will happen if PREZISTA
is taken with certain other medicines (see “Who should not take PREZISTA?”).
Tell your doctor 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 a condom.
Tell your doctor if you take other anti-HIV medicines. PREZISTA can be combined with
some other anti-HIV medicines while other combinations are not recommended.
Tell your doctor if you are taking any of the following medicines:
Type of Drug Examples of Generic Names (Brand Names)
Antiarrhythmics bepridil
(to treat abnormal lidocaine (Lidoderm ® )
heart rhythms) quinidine
amiodarone (Cordarone ® )
digoxin (Lanoxin ® )
flecainide (Tambocor ® )
propafenone (Rythmol ® )
Anticoagulants warfarin (Coumadin ® )
(to treat and prevent blood clots)
Anticonvulsants carbamazepine (Tegretol ® , Carbatrol ® )
(to treat epilepsy and phenobarbital
prevent seizures) phenytoin (Dilantin ® , Phenytek ® )
Antidepressants trazodone (Desyrel ® )
(to treat depression) desipramine (Norpramin ® )
Anti-infectives clarithromycin (Biaxin ® )
(to treat bacterial infections)
Antifungals ketoconazole (Nizoral ® )
(to treat fungal infections) itraconazole (Sporanox ® )
voriconazole (Vfend ® )
Antimycobacterials rifabutin (Mycobutin ® )
(to treat tuberculosis or
Mycobacterium avium complex)
ß-Blockers metoprolol (Lopressor ® , Toprol-XL ® )
(to treat high blood pressure, timolol (Betimol ® , Combigan ® , Istalol ® ,
heart attack, or heart failure or Cosopt ® , Timoptic ® )
to lower pressure in the eye)
Benzodiazepines midazolam administered by injection
(to treat anxiety and/or
trouble with sleeping)
Calcium Channel Blockers felodipine (Plendil ® )
(to treat heart disease) nifedipine (Adalat ® )
nicardipine (Cardene ® )
Corticosteroids dexamethasone
(to treat inflammation or asthma) fluticasone propionate (Advair Diskus ® ,
Cutivate ® , Flonase ® , Flovent Diskus ® )
HMG-CoA Reductase atorvastatin (Lipitor ® )
Inhibitors pravastatin (Pravachol ® )
(also known as statins) rosuvastatin (Crestor ® )
(to lower cholesterol levels)
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Type of Drug Examples of Generic Names (Brand Names)
(cont.)
Immunosuppressants cyclosporine (Sandimmune ® , Neoral ® )
(to prevent organ transplant tacrolimus (Prograf ® )
rejection) sirolimus (Rapamune ® )
Narcotic Analgesics methadone
(to treat narcotic withdrawal
and dependence)
Neuroleptics risperidone (Risperdal ® , Risperdal ® Consta ® ,
(to treat schizophrenia or Risperdal ® M-TAB ® )
bipolar disorder) thioridazine
PDE-5 Inhibitors sildenafil (Viagra ® )
(to treat erectile dysfunction) vardenafil (Levitra ® )
tadalafil (Cialis ® )
Selective Serotonin Reuptake paroxetine (Paxil ® )
Inhibitors (SSRIs) sertraline (Zoloft ® )
(to treat depression, anxiety,
or panic disorder)
Tell your doctor if you are taking any medicines that you obtained without a
prescription.
This is not a complete list of medicines that you should tell your doctor that you are
taking. Know and keep track of all the medicines you take and have a list of them with
you. Show this list to all of your doctors and pharmacists any time you get a new
medicine. Both your doctor and your pharmacist can tell you if you can take these
other medicines with PREZISTA. Do not start any new medicines while you are taking
PREZISTA without first talking with your doctor or pharmacist. You can ask your
doctor or pharmacist for a list of medicines that can interact with PREZISTA.
HOW SHOULD I TAKE PREZISTA?
Take PREZISTA tablets every day exactly as prescribed by your doctor. You must
take ritonavir (NORVIR ® ) at the same time as PREZISTA.
• For adults who have never taken anti-HIV medicines, the usual dose is 800 mg
(two 400 mg tablets) of PREZISTA, together with 100 mg (one 100 mg capsule) of
ritonavir (NORVIR ® ), once daily every day.
• For adults who have taken anti-HIV medicines in the past, the usual dose is
600 mg (one 600 mg tablet or two 300 mg tablets) of PREZISTA, together with
100 mg (one 100 mg capsule) of ritonavir (NORVIR ® ), twice daily every day. Do
not take PREZISTA once daily if you have taken anti-HIV medicines in the past.
PREZISTA and ritonavir (NORVIR ® ) should be taken together at the same time every
day. If you have questions about when to take PREZISTA and ritonavir (NORVIR ® ),
your doctor can help you decide which schedule works for you.
Take PREZISTA and ritonavir (NORVIR ® ) with food. Swallow the whole tablets with a
drink such as water or milk. Do not chew the tablets.
Continue taking PREZISTA and ritonavir (NORVIR ® ) unless your doctor tells you to
stop. Take the exact amount of PREZISTA and ritonavir (NORVIR ® ) that your doctor
tells you to take, right from the very start. To help make sure you will benefit from
PREZISTA and ritonavir (NORVIR ® ), you must not skip doses or interrupt therapy. If
you don’t take PREZISTA and ritonavir (NORVIR ® ) as prescribed, the beneficial
effects of PREZISTA and ritonavir (NORVIR ® ) may be reduced or even lost.
Patients taking PREZISTA once daily
If you miss a dose of PREZISTA or ritonavir (NORVIR ® ) by more than 12 hours, wait
and then take the next dose of PREZISTA and ritonavir (NORVIR ® ) at the regularly
scheduled time. If you miss a dose of PREZISTA or ritonavir (NORVIR ® ) by less than
12 hours, take your missed dose of PREZISTA and ritonavir (NORVIR ® ) immediately.
Then take your next dose of PREZISTA and ritonavir (NORVIR ® ) at the regularly
scheduled time.
Patients taking PREZISTA twice daily
If you miss a dose of PREZISTA or ritonavir (NORVIR ® ) by more than 6 hours, wait
and then take the next dose of PREZISTA and ritonavir (NORVIR ® ) at the regularly
scheduled time. If you miss a dose of PREZISTA or ritonavir (NORVIR ® ) by less than
6 hours, take your missed dose of PREZISTA and ritonavir (NORVIR ® ) immediately.
Then take your next dose of PREZISTA and ritonavir (NORVIR ® ) at the regularly
scheduled time.
You should always take PREZISTA and ritonavir (NORVIR ® ) together with food.
If a dose of PREZISTA or ritonavir (NORVIR ® ) is skipped, do not double the next
dose. Do not take more or less than your prescribed dose of PREZISTA or ritonavir
(NORVIR ® ) at any one time.
WHAT ARE THE POSSIBLE SIDE EFFECTS OF PREZISTA?
Like all prescription drugs, PREZISTA can cause side effects. The following is not a
complete list of side effects reported with PREZISTA when taken either alone or with
other anti-HIV medicines. Do not rely on this leaflet alone for information about side
effects. Your doctor can discuss with you a more complete list of side effects.
PREZISTA, together with NORVIR ® (ritonavir), has rarely been observed to cause liver
problems which may be life-threatening. It was not always clear if PREZISTA caused
these liver problems because some patients had other illnesses or were taking other
medicines. Your healthcare professional should do blood tests prior to initiating
combination treatment including 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.
IMPORTANT PATIENT INFORMATION
Talk to your healthcare professional about the signs and symptoms of liver problems.
These may include yellowing of your skin or whites of your eyes, dark (tea colored)
urine, pale colored stools (bowel movements), nausea, vomiting, loss of appetite, or
pain, aching or sensitivity on your right side below your ribs.
Rash has been reported in 10.3% of subjects receiving PREZISTA. In some patients,
PREZISTA has been reported to cause a severe or life-threatening rash. Contact
your healthcare provider if you develop a rash. Your healthcare provider will advise
you whether your symptoms can be managed on therapy or whether PREZISTA
should be stopped.
Other relevant severe side effects reported at an uncommon or rare frequency
were inflammation of the liver or pancreas, increased blood fat levels, diabetes,
and changes in body fat.
Some side effects are typical for anti-HIV medicines in the same family as PREZISTA.
These are:
• high blood sugar (hyperglycemia) and diabetes. This can happen in patients
taking PREZISTA or other protease inhibitor medicines. Some patients have
diabetes before starting treatment with PREZISTA which gets worse. Some
patients get diabetes during treatment with PREZISTA. Some patients will
need changes in their diabetes medicine. Some patients may need new
diabetes medicine.
• increased bleeding in patients with hemophilia.
• changes in body fat. These changes can happen in patients taking anti-HIV
medicines, including PREZISTA. The changes may include an increased amount
of fat in the upper back and neck, 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 long-term health effects of these conditions are not known.
• immune reconstitution syndrome. In some patients with advanced HIV infection
(AIDS) and a history of opportunistic infection, signs and symptoms of
inflammation from previous infections may occur soon after anti-HIV treatment,
including PREZISTA, is started. It is believed that these symptoms are due to an
improvement in the body’s immune response, enabling the body to fight infections
that may have been present with no obvious symptoms.
The most common side effects include diarrhea, nausea, headache, and abdominal
pain.
Tell your doctor promptly about these or any other unusual symptoms. If the condition
persists or worsens, seek medical attention.
WHAT DO PREZISTA TABLETS LOOK LIKE?
PREZISTA 300 mg tablets are orange, oval-shaped, film-coated tablets mentioning
“300” on one side and “TMC114” on the other side.
PREZISTA 400 mg tablets are light orange, oval-shaped, film-coated tablets
mentioning “400” on one side and “TMC” on the other side.
PREZISTA 600 mg tablets are orange, oval-shaped, film-coated tablets mentioning
“600” on one side and “TMC” on the other side.
HOW SHOULD I STORE PREZISTA TABLETS?
Store PREZISTA tablets at room temperature (77°F (25°C)). Short-term exposure to
higher or lower temperatures [from 59°F (15°C) to 86°F (30°C)] is acceptable. Ask your
doctor or pharmacist if you have any questions about storing your tablets.
This medication is prescribed for your particular condition. Do not use it for any
other condition or give it to anybody else. Keep PREZISTA and all of your medicines
out of the reach of children. If you suspect that more than the prescribed dose of
this medicine has been taken, contact your local poison control center or
emergency room immediately.
This is a brief summary of information about PREZISTA. If you have any questions or
concerns about either PREZISTA or HIV, talk to your doctor.
For additional information, you may also call Tibotec Therapeutics at 1-877-REACH-TT
or 1-877-732-2488.
**The brands listed are the registered trademarks of their respective owners and are
not trademarks of Tibotec Pharmaceuticals, Ltd.
Manufactured for Tibotec, Inc. by: JOLLC, Gurabo, Puerto Rico
Distributed by:
Tibotec Therapeutics
Division of Ortho Biotech Products, L.P., Raritan NJ 08869
Patent Numbers: 5,843,946; 6,248,775; 6,335,460 and other US patents pending
NORVIR ® is a registered trademark of its respective owner.
PREZISTA ® is a registered trademark of Tibotec Pharmaceuticals, Ltd.
© Tibotec, Inc. 2006 Revised: December 2008 10101707 P

TPAN empowers people
living with HIV through
peer-led programming,
support services, information
dissemination, and advocacy.
We also provide services to
the broader community to
increase HIV knowledge and
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Editor
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Contributing Writers
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Opinions expressed in Positively Aware are not necessarily those of staff
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Positively Aware

Departments
9 Editor’s Note
Table of Contents
Designing for Women—Not
Just a Fashion Statement
Anymore
14 Readers Forum
16 Ask the HIV Specialist
This issue’s specialists:
Amy Sitapati, M.D., AAHIVS and
Joseph Caperna, M.D., MPH,
AAHIVS
17 From TPAN
Embracing “the Change”
TPAN’s new Executive Director
welcomes a new chapter
by Bruce Weiss
18 News Briefs
by Enid Vázquez
52 What’s Goin’ On?
Prepping for a PrEP
trial
Critical observations
before the study even
begins
by Keith R. Green
54 PA Online
July / August 2009 Volume 20 Number 4
On the Cover:
Evany Turk, see page 45.
Photography by ©Russell McGonagle
Distribution of Positively Aware is supported
in part through an unrestricted grant from
GlaxoSmithKline
PA • July / August 2009 • tpan.com • positivelyaware.com
24
34
Articles
24 One-on-One with Dawn Averitt Bridge
Wife, mother, and advocate for HIV-positive women
Interview by Jeff Berry
28 The Naked Truth:
Young, Beautiful and HIV Positive
The courageous tale of Marvelyn Brown
A book review by Keith R. Green
34 The Feminization of an
Epidemic
28Monica
Gandhi, M.D., MPH
Women and HIV in the United States
by Saraswati Iobst, M.D. and
40 Tiger Medicine
A Native American woman’s story
by Sue Saltmarsh
42 Protect Yourselves, Ladies
Young or old, black women continue to be at higher risk
by Enid Vázquez
40
A model, photographer, or author’s HIV status should not be assumed based on
their appearance in Positively Aware.
You can view these (and other stories from previous issues) online at
www.tpan.com and www.positivelyaware.com
Positively Aware
7

Table of Contents
July / August 2009 Volume 20 Number 4
Articles continued
45 45 Evany Turk
43 Joyce Turner Keller
A minister with AIDS lays reality on the line
Interview by Enid Vázquez
A success story
Interview by Sue Saltmarsh
48 Reaching Out to Our Sisters
Chicago women’s conference off ers knowledge and support
by Enid Vázquez
48
43
49 Doctors Urge the Government to Keep Up
with Medical Progress
HIV policy and funding left in the dust of treatment
success
by Enid Vázquez
49
8 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

Photo © Russell McGonagle
Designing for Women—Not Just a
Fashion Statement Anymore
Certain words and phrases come to mind when we think
about women and HIV. Invisible. Stigma. Shame. Femalecontrolled
prevention methods. Feminization of an epidemic.
Half of the world’s infected population.
Th e problem is, we don’t always think about women and HIV
as much as we probably should.
According to the U. S. Centers for Disease Control and Prevention’s
(CDC) most recent data, HIV infection was “the leading cause
of death for black women (including African American women)
aged 25–34 years…[and] the 5th leading cause of death among all
women aged 35–44 years. Th e only diseases causing more deaths of
women were cancer and heart disease.”
Interestingly, according to the CDC “high-risk heterosexual
contact was the source of 80% of…newly diagnosed infections.” But
sadly enough, a recent study showed that women were “slightly less
likely than men to receive prescriptions for the most eff ective treatments
for HIV infection.”
Th is issue of Positively Aware poses a simple question to
our readers: Why is this happening—and what can we do about
it? Unfortunately, simple questions don’t always bring forth easy
solutions.
One of the solutions, however, and one which you’ll read about
more in this issue, is simple—at least in theory. Studies designed
with women in mind, and in which women and people of color are
adequately represented. Th is should be easier to do now that the
vast majority of studies concerning HIV medications are not using
experimental drugs, but, rather, are comparing standard-of-care
treatments. It can be done by not only recruiting these populations,
but also by retaining them, or keeping them, in the study. It’s also
important to select the appropriate study sites for any particular
study, and to then off er the sites the support they need in order to
be successful.
I was recently invited to attend an investigators’ meeting for the
GRACE study. GRACE, which stands for Gender, Race, and Clinical
Experience, was the fi rst study of its kind, enrolling approximately
70% women, the majority of whom were women of color. Th e study
was conducted by Tibotec Th erapeutics, using their newly approved
HIV protease inhibitor, Prezista (darunavir), and newly approved
HIV NNRTI, Intelence (etravirine) and was designed to observe
diff erences in viral load and CD4 response according to gender
and race. Th e results of the study will be published and presented
at upcoming conferences and in scientifi c journals in the coming
months, but some of the real successes of GRACE were not only in
the data, but in the stories and people behind the study itself.
Halfway through the day’s meeting, the folks at Tibotec decided
to mix it up between invited community representatives and
clinical site investigators, and those of us from the community were
able to hear fi rsthand some of the amazing stories behind GRACE.
Editor’s Note
We heard the story of one study participant who called a site
investigator over the Christmas holidays and told her she had run
out of her meds, and was confused about which medications to take,
and what they were for. Th e investigator cancelled an appointment
she had, went and got her the replacement meds, and brought them
to the study participant at the housing project where she lived, and
then sat down with her to explain the regimen.
Tragically, another woman’s house burned down, and her meds
were destroyed in the fi re. Th e investigator went to go fi nd her, and
called Tibotec to get her replacement meds.
One individual in the study travelled 40 miles to every visit.
Her mother read her the informed consent form for the study,
because she wasn’t able to read it herself. But she was able to do all
this, and had the motivation to succeed, because she received support
from her family and didn’t feel stigmatized.
We heard that, “Some of this is just the way women’s lives are.
We are the caretakers, the wives, the mothers.”
Ultimately, it speaks to the need for studies to be more inclusive
than exclusive. “Don’t not consider a patient because of their
past,” said one investigator.
Th e common thread woven through many of these patient success
stories were that patients felt valued, and that they mattered.
One investigator said that they just wouldn’t let the patients fail.
Another key to the study’s successes seemed to lie in the fact
that study sites were chosen where the community practitioners
were, and the study also provided the background regimen of drugs
to participants, free of charge. And it raises the question, “What is
the role of the clinical trial beyond getting data?”
Approximately 10% of these sites had never conducted or participated
in a study before. And granted, this was their only study,
whereas many sites typically have a dozen or more studies going on
at any given time, spreading their resources thin.
Th e important thing to remember is that the success of a study
can be measured not only by the data that comes out of it, but also
by the thought and planning that goes into it, the care that is provided
during the course of the study, and the ongoing connection
with patients that is made through direct contact and support. And
sometimes success is achieved just by going that extra mile, which
can make a world of diff erence to someone taking part in a study.
Take care of yourself, and each other.
Jeff Berry, Editor
publications@tpan.com
Positively Aware
PA • July / August 2009 • tpan.com • positivelyaware.com 9

IMPORTANT INFORMATION ABOUT REYATAZ® (atazanavir sulfate)
INDICATION: REYATAZ is a prescription medicine used in combination with other
medicines to treat people who are infected with the human immunodeficiency
virus (HIV). REYATAZ has been studied in 48-week trials in both patients who have
taken or have never taken anti-HIV medicines.
REYATAZ does not cure HIV or help prevent passing HIV to others.
IMPORTANT SAFETY INFORMATION:
Do not take REYATAZ if you are allergic to REYATAZ or to any of its
ingredients.
Do not take REYATAZ if you are taking the following medicines:
rifampin, Camptosar ® (irinotecan), Versed ® (midazolam) when taken
by mouth, Halcion ® (triazolam), ergot medicines, Propulsid ® (cisapride),
St. John’ s wort (Hypericum perforatum), Mevacor ® (lovastatin),
Zocor ® (simvastatin), Orap ® (pimozide), Crixivan ® (indinavir),
or Viramune ® (nevirapine).
Speak with your healthcare provider before taking the following
medicines if you are taking REYATAZ: hormonal contraceptives such
as birth control pills or contraceptive patch, Viagra ® (sildenafil),
Levitra ® (vardenafil), Cialis ® (tadalafil), Vfend ® (voriconazole),
AcipHex ® (rabeprazole), Nexium ® (esomeprazole), Prevacid ® (lansoprazole),
Prilosec ® (omeprazole), Protonix ® (pantoprazole), Axid ® (nizatidine),
Pepcid AC ® (famotidine), Tagamet ® (cimetidine), or Zantac ® (ranitidine),
Advair ® (fluticasone propionate and salmeterol inhalation powder),
Flonase ® or Flovent ® (fluticasone propionate), or Sustiva ® (efavirenz).
The above lists of medicines are not complete. Discuss all prescription
and non-prescription medicines, vitamin and herbal supplements, or
other health preparations you are taking or plan to take with your
healthcare provider.
Tell your healthcare provider right away if you have any side effects, symptoms,
or conditions, including the following:
• Mild rash (redness and itching) without other symptoms sometimes occurs
in patients taking REYATAZ, most often in the first few weeks after the medicine is
started, and usually goes away within two weeks with no change in treatment.
• Severe rash has occurred in a small number of patients taking REYATAZ.This type
of rash is associated with other symptoms which could be serious and potentially
cause death. If you develop a rash with any of the following symptoms,
stop using REYATAZ and call your healthcare provider right away:
– Shortness of breath
– General ill-feeling or
“flu-like” symptoms
– Fever
– Muscle or joint aches
– Conjunctivitis (red or inflamed
eyes, like “pink-eye”)
– Blisters
– Mouth sores
– Swelling of your face
• Yellowing of the skin and/or eyes may occur due to increases in bilirubin
levels in the blood (bilirubin is made by the liver).
• A change in the way your heart beats may occur and could be a
symptom of a heart problem.
• Diabetes and high blood sugar may occur in patients taking protease
inhibitor medicines like REYATAZ.
• If you have liver disease, including hepatitis B or C, your liver disease
may get worse when you take anti-HIV medicines like REYATAZ.
• Kidney stones have been reported in patients taking REYATAZ. Signs or
symptoms of kidney stones include pain in your side, blood in your urine,
and pain when you urinate.
• End stage kidney disease managed with hemodialysis.
• Some patients with hemophilia have increased bleeding problems with
protease inhibitor medicines like REYATAZ.
• Changes in body fat have been seen in some patients taking anti-HIV
medicines. The cause and long-term effects are not known at this time.
Other side effects of REYATAZ taken with other anti-HIV medicines include:
nausea, headache, stomach pain, vomiting, diarrhea, depression, fever, dizziness,
trouble sleeping, numbness, and tingling or burning of hands or feet.
You should take REYATAZ once daily with food (a meal or snack). You should take
REYATAZ and your other anti-HIV medicines exactly as instructed by your
healthcare provider.
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.
On REYATAZ,
Thursday
5:30
Choir
practice
Wednesday
Mary’s
birthday
party
Buy new
shoes
for Latisha
Fight HIV your way.
Please see Important Patient Information
about REYATAZ on adjacent pages.

how you spen d your time is up to you.
Once-daily REYATAZ can fit into your schedule and help fight your HIV.
REYATAZ, a protease inhibitor (PI), in HIV combination therapy:
◆ Can help lower your viral load and raise your T-cell (CD4+ cell) count
◆ Has a low chance of diarrhea (shown in clinical trials) *
◆ Is taken once a day with a snack or meal
* REYATAZ in combination therapy had a 1%-3% rate of moderate-to-severe diarrhea.
REYATAZ is one of several treatment options your doctor may consider.
Ask your healthcare team about REYATAZ. www.REYATAZ.com
Individual results may vary.
REYATAZ does not cure HIV, a serious disease, and has not been shown to reduce the risk of passing HIV to others.
REYATAZ is a registered trademark of Bristol-Myers Squibb Company.
SUSTIVA is a registered trademark of Bristol-Myers Squibb Pharma
Company. All other trademarks are the property of their respective
owners and not of Bristol-Myers Squibb.
© 2009 Bristol-Myers Squibb Company, Princeton, NJ 08543 U.S.A.
687US09AB10103 04/09

687US09AB10103_8x10.5: 5/27/09 9:20 AM Page 3
FDA-Approved Patient Labeling
Patient Information
REYATAZ ® (RAY-ah-taz)
(generic name = atazanavir sulfate)
Capsules
ALERT: Find out about medicines that should NOT be taken with REYATAZ. Read
the section “What important information should I know about taking REYATAZ with
other medicines?”
Read the Patient Information that comes with REYATAZ before you start using it and
each time you get a refill. There may be new information. This leaflet provides a
summary about REYATAZ and does not include everything there is to know about your
medicine. This information does not take the place of talking with your healthcare
provider about your medical condition or treatment.
What is REYATAZ?
REYATAZ is a prescription medicine used with other anti-HIV medicines to treat people
who are infected with the human immunodeficiency virus (HIV). HIV is the virus that
causes acquired immune deficiency syndrome (AIDS). REYATAZ is a type of anti-HIV
medicine called a protease inhibitor. HIV infection destroys CD4+ (T) cells, which are
important to the immune system. The immune system helps fight infection. After a
large number of (T) cells are destroyed, AIDS develops. REYATAZ helps to block HIV
protease, an enzyme that is needed for the HIV virus to multiply. REYATAZ may lower
the amount of HIV in your blood, help your body keep its supply of CD4+ (T) cells, and
reduce the risk of death and illness associated with HIV.
Does REYATAZ cure HIV or AIDS?
REYATAZ does not cure HIV infection or AIDS. At present there is no cure for
HIV infection. People taking REYATAZ may still get opportunistic infections or other
conditions that happen with HIV infection. Opportunistic infections are infections
that develop because the immune system is weak. Some of these conditions are
pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC)
infections. It is very important that you see your healthcare provider regularly
while taking REYATAZ.
REYATAZ does not lower your chance of passing HIV to other people through
sexual contact, sharing needles, or being exposed to your blood. For your health
and the health of others, it is important to always practice safer sex by using a latex
or polyurethane condom or other barrier to lower the chance of sexual contact with
semen, vaginal secretions, or blood. Never use or share dirty needles.
Who should not take REYATAZ?
Do not take REYATAZ if you:
• are taking certain medicines. (See “What important information should I know
about taking REYATAZ with other medicines?”) Serious life-threatening side
effects or death may happen. Before you take REYATAZ, tell your healthcare
provider about all medicines you are taking or planning to take. These
include other prescription and nonprescription medicines, vitamins, and herbal
supplements.
• are allergic to REYATAZ or to any of its ingredients. The active ingredient is
atazanavir sulfate. See the end of this leaflet for a complete list of ingredients
in REYATAZ. Tell your healthcare provider if you think you have had an allergic
reaction to any of these ingredients.
What should I tell my healthcare provider before I take REYATAZ?
Tell your healthcare provider:
• If you are pregnant or planning to become pregnant. It is not known if
REYATAZ can harm your unborn baby. Pregnant women have experienced
serious side effects when taking REYATAZ with other HIV medicines called
nucleoside analogues. You and your healthcare provider will need to decide if
REYATAZ is right for you. If you use REYATAZ while you are pregnant, talk to
your healthcare provider about the Antiretroviral Pregnancy Registry.
• If you are breast-feeding. You should not breast-feed if you are HIV-positive
because of the chance of passing HIV to your baby. Also, it is not known if
REYATAZ can pass into your breast milk and if it can harm your baby. If you are
a woman who has or will have a baby, talk with your healthcare provider about
the best way to feed your baby.
• If you have liver problems or are infected with the hepatitis B or C virus.
See “What are the possible side effects of REYATAZ?”
• If you have end stage kidney disease managed with hemodialysis.
• If you have diabetes. See “What are the possible side effects of REYATAZ?”
• If you have hemophilia. See “What are the possible side effects of
REYATAZ?”
• About all the medicines you take including prescription and nonprescription
medicines, vitamins, and herbal supplements. Keep a list of your medicines
with you to show your healthcare provider. For more information, see “What
important information should I know about taking REYATAZ with other
medicines?” and “Who should not take REYATAZ?” Some medicines can cause
serious side effects if taken with REYATAZ.
REYATAZ ® (atazanavir sulfate)
How should I take REYATAZ?
• Take REYATAZ once every day exactly as instructed by your healthcare
provider. Your healthcare provider will prescribe the amount of REYATAZ that
is right for you.
• For adults who have never taken anti-HIV medicines before, the dose
is 300 mg once daily with 100 mg of NORVIR ® (ritonavir) once daily
taken with food. For adults who are unable to tolerate ritonavir, 400 mg
(two 200-mg capsules) once daily (without NORVIR ® ) taken with food
is recommended.
• For adults who have taken anti-HIV medicines in the past, the usual dose is
300 mg plus 100 mg of NORVIR ® (ritonavir) once daily taken with food.
• Your dose will depend on your liver function and on the other anti-HIV medicines
that you are taking. REYATAZ is always used with other anti-HIV medicines. If
you are taking REYATAZ with SUSTIVA ® (efavirenz) or with VIREAD ® (tenofovir
disoproxil fumarate), you should also be taking NORVIR ® (ritonavir).
• Always take REYATAZ with food (a meal or snack) to help it work better.
Swallow the capsules whole. Do not open the capsules. Take REYATAZ at the
same time each day.
• If you are taking antacids or didanosine (VIDEX ® or VIDEX ® EC), take
REYATAZ 2 hours before or 1 hour after these medicines.
• If you are taking medicines for indigestion, heartburn, or ulcers such
as AXID ® (nizatidine), PEPCID AC ® (famotidine), TAGAMET ® (cimetidine),
ZANTAC ® (ranitidine), AcipHex ® (rabeprazole), NEXIUM ® (esomeprazole),
PREVACID ® (lansoprazole), PRILOSEC ® (omeprazole), or PROTONIX ®
(pantoprazole), talk to your healthcare provider.
• Do not change your dose or stop taking REYATAZ without first talking with
your healthcare provider. It is important to stay under a healthcare provider’s
care while taking REYATAZ.
• When your supply of REYATAZ starts to run low, get more from your
healthcare provider or pharmacy. It is important not to run out of REYATAZ. The
amount of HIV in your blood may increase if the medicine is stopped for even a
short time.
• If you miss a dose of REYATAZ, take it as soon as possible and then take
your next scheduled dose at its regular time. If, however, it is within 6 hours
of your next dose, do not take the missed dose. Wait and take the next dose at
the regular time. Do not double the next dose. It is important that you do not
miss any doses of REYATAZ or your other anti-HIV medicines.
• If you take more than the prescribed dose of REYATAZ, call your healthcare
provider or poison control center right away.
Can children take REYATAZ?
Dosing recommendations are available for children 6 years of age and older for
REYATAZ Capsules. Dosing recommendations are not available for children from
3 months to less than 6 years of age. REYATAZ should not be used in babies under
the age of 3 months.
What are the possible side effects of REYATAZ?
The following list of side effects is not complete. Report any new or continuing
symptoms to your healthcare provider. If you have questions about side effects, ask
your healthcare provider. Your healthcare provider may be able to help you manage
these side effects.
The following side effects have been reported with REYATAZ:
• mild rash (redness and itching) without other symptoms sometimes occurs in
patients taking REYATAZ, most often in the first few weeks after the medicine
is started. Rashes usually go away within 2 weeks with no change in treatment.
Tell your healthcare provider if rash occurs.
• severe rash: In a small number of patients, a rash can develop that is associated
with other symptoms which could be serious and potentially cause death.
If you develop a rash with any of the following symptoms stop using
REYATAZ and call your healthcare provider right away:
• shortness of breath
• general ill feeling or “flu-like” symptoms
• fever
• muscle or joint aches
• conjunctivitis (red or inflamed eyes, like “pink eye”)
• blisters
• mouth sores
• swelling of your face
• yellowing of the skin or eyes. These effects may be due to increases in
bilirubin levels in the blood (bilirubin is made by the liver). Call your healthcare
provider if your skin or the white part of your eyes turn yellow. Although these
effects may not be damaging to your liver, skin, or eyes, it is important to tell
your healthcare provider promptly if they occur.

REYATAZ ® (atazanavir sulfate) REYATAZ ® (atazanavir sulfate)
• a change in the way your heart beats (heart rhythm change). Call your
healthcare provider right away if you get dizzy or lightheaded. These could be
symptoms of a heart problem.
• diabetes and high blood sugar (hyperglycemia) sometimes happen in
patients taking protease inhibitor medicines like REYATAZ. Some patients had
diabetes before taking protease inhibitors while others did not. Some patients
may need changes in their diabetes medicine.
• if you have liver disease including hepatitis B or C, your liver disease may get
worse when you take anti-HIV medicines like REYATAZ.
• kidney stones have been reported in patients taking REYATAZ. If you develop
signs or symptoms of kidney stones (pain in your side, blood in your urine, pain
when you urinate) tell your healthcare provider promptly.
• some patients with hemophilia have increased bleeding problems with
protease inhibitors like REYATAZ.
• changes in body fat. These changes may include an increased amount of fat in
the upper back and neck (“buffalo hump”), breast, and around the trunk. Loss
of fat from the legs, arms, and face may also happen. The cause and long-term
health effects of these conditions are not known at this time.
Other common side effects of REYATAZ taken with other anti-HIV medicines include
nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness;
trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain.
Gallbladder disorders (which may include gallstones and gallbladder inflammation)
have been reported in patients taking REYATAZ.
What important information should I know about taking REYATAZ with other
medicines?
Do not take REYATAZ if you take the following medicines (not all brands may
be listed; tell your healthcare provider about all the medicines you take).
REYATAZ may cause serious, life-threatening side effects or death when used
with these medicines.
• Ergot medicines: dihydroergotamine, ergonovine, ergotamine, and
methylergonovine such as CAFERGOT ® , MIGRANAL ® , D.H.E. 45 ® , ergotrate
maleate, METHERGINE ® , and others (used for migraine headaches).
• ORAP ® (pimozide, used for Tourette’s disorder).
• PROPULSID ® (cisapride, used for certain stomach problems).
• Triazolam, also known as HALCION ® (used for insomnia).
• Midazolam, also known as VERSED ® (used for sedation), when taken by mouth.
Do not take the following medicines with REYATAZ because of possible serious
side effects:
• CAMPTOSAR ® (irinotecan, used for cancer).
• CRIXIVAN ® (indinavir, used for HIV infection). Both REYATAZ and CRIXIVAN
sometimes cause increased levels of bilirubin in the blood.
• Cholesterol-lowering medicines MEVACOR ® (lovastatin) or ZOCOR ®
(simvastatin).
Do not take the following medicines with REYATAZ because they may lower the
amount of REYATAZ in your blood. This may lead to an increased HIV viral load.
Resistance to REYATAZ or cross-resistance to other HIV medicines may develop:
• Rifampin (also known as RIMACTANE ® , RIFADIN ® , RIFATER ® , or RIFAMATE ® ,
used for tuberculosis).
• St. John’s wort (Hypericum perforatum), an herbal product sold as a dietary
supplement, or products containing St. John’s wort.
• VIRAMUNE ® (nevirapine, used for HIV infection).
Do not take the following medicine if you are taking REYATAZ and NORVIR ®
together:
• VFEND ® (voriconazole).
The following medicines may require your healthcare provider to monitor your
therapy more closely:
• CIALIS ® (tadalafil), LEVITRA ® (vardenafil), or VIAGRA ® (sildenafil). REYATAZ
may increase the chances of serious side effects that can happen with CIALIS,
LEVITRA, or VIAGRA. Do not use CIALIS, LEVITRA, or VIAGRA while you are taking
REYATAZ unless your healthcare provider tells you it is okay.
• LIPITOR ® (atorvastatin) or CRESTOR ® (rosuvastatin). There is an increased
chance of serious side effects if you take REYATAZ with this cholesterollowering
medicine.
• Medicines for abnormal heart rhythm: CORDARONE ® (amiodarone), lidocaine,
quinidine (also known as CARDIOQUIN ® , QUINIDEX ® , and others).
• VASCOR ® (bepridil, used for chest pain).
• COUMADIN ® (warfarin).
• Tricyclic antidepressants such as ELAVIL ® (amitriptyline), NORPRAMIN ®
(desipramine), SINEQUAN ® (doxepin), SURMONTIL ® (trimipramine), TOFRANIL ®
(imipramine), or VIVACTIL ® (protriptyline).
• Medicines to prevent organ transplant rejection: SANDIMMUNE ® or NEORAL ®
(cyclosporin), RAPAMUNE ® (sirolimus), or PROGRAF ® (tacrolimus).
• The antidepressant trazodone (DESYREL ® and others).
• Fluticasone propionate (ADVAIR ® , FLONASE ® , FLOVENT ® ), given by nose or
inhaled to treat allergic symptoms or asthma. Your doctor may choose not to
keep you on fluticasone, especially if you are also taking NORVIR ® .
The following medicines may require a change in the dose or dose schedule of
either REYATAZ or the other medicine:
• INVIRASE ® (saquinavir).
• NORVIR ® (ritonavir).
• SUSTIVA ® (efavirenz).
• Antacids or buffered medicines.
• VIDEX ® (didanosine).
• VIREAD ® (tenofovir disoproxil fumarate).
• MYCOBUTIN ® (rifabutin).
• Calcium channel blockers such as CARDIZEM ® or TIAZAC ® (diltiazem),
COVERA-HS ® or ISOPTIN SR ® (verapamil) and others.
• BIAXIN ® (clarithromycin).
• Medicines for indigestion, heartburn, or ulcers such as AXID ® (nizatidine),
PEPCID AC ® (famotidine), TAGAMET ® (cimetidine), or ZANTAC ® (ranitidine).
Talk to your healthcare provider about choosing an effective method of
contraception. REYATAZ may affect the safety and effectiveness of hormonal
contraceptives such as birth control pills or the contraceptive patch. Hormonal
contraceptives do not prevent the spread of HIV to others.
Remember:
1. Know all the medicines you take.
2. Tell your healthcare provider about all the medicines you take.
3. Do not start a new medicine without talking to your healthcare provider.
How should I store REYATAZ?
• Store REYATAZ Capsules at room temperature, 59° to 86° F (15° to 30° C).
Do not store this medicine in a damp place such as a bathroom medicine
cabinet or near the kitchen sink.
• Keep your medicine in a tightly closed container.
• Keep all medicines out of the reach of children and pets at all times. Do not
keep medicine that is out of date or that you no longer need. Dispose of unused
medicines through community take-back disposal programs when available or
place REYATAZ in an unrecognizable, closed container in the household trash.
General information about REYATAZ
This medicine was prescribed for your particular condition. Do not use REYATAZ for
another condition. Do not give REYATAZ to other people, even if they have the same
symptoms you have. It may harm them. Keep REYATAZ and all medicines out of
the reach of children and pets.
This summary does not include everything there is to know about REYATAZ. Medicines
are sometimes prescribed for conditions that are not mentioned in patient information
leaflets. Remember no written summary can replace careful discussion with your
healthcare provider. If you would like more information, talk with your healthcare
provider or you can call 1-800-321-1335.
What are the ingredients in REYATAZ?
Active Ingredient: atazanavir sulfate
Inactive Ingredients: Crospovidone, lactose monohydrate (milk sugar), magnesium
stearate, gelatin, FD&C Blue #2, and titanium dioxide.
VIDEX ® and REYATAZ ® are registered trademarks of Bristol-Myers Squibb Company.
COUMADIN ® and SUSTIVA ® are registered trademarks of Bristol-Myers Squibb
Pharma Company. DESYREL ® is a registered trademark of Mead Johnson and
Company. Other brands listed are the trademarks of their respective owners and are
not trademarks of Bristol-Myers Squibb Company.
US Patent Nos: 5,849,911 and 6,087,383
Princeton, NJ 08543 USA
1246226A3 F1-B0001B-04-09 Rev April 2009

Readers Forum
Ask the HIV Specialist
Correction
Last issue’s HIV Specialist’s credentials
were mistakenly listed. Th e correct listing is
Sharon Valenti, MSN, ACNP-BC, AAHIVS,
AACRN, HIV/AIDS Nurse Practitioner, and
her affi liation is with St. John Hospital and
Medical Center in Detroit, Michigan. We
apologize for the error!
Thanks to “Dr. Z”
Hi! My name is Patricia and I’ve been
HIV-positive since May of 1996. Forgive me
if this letter is a little crude, as I’m real nervous.
I’ve never really reached out in this
manner before.
I was infected through IV drug use. As
bad as this is, I made a conscious decision
and I guess I must have thought I could
“beat the odds.” Well, I didn’t. In all honesty,
I’d been living in total disregard for my life,
afraid if I slowed down long enough, that I
would have to face my demons and I wasn’t
going to do that, I was just too scared.
One can only run for so long and it
was my time to stop. I ended up in prison,
with a whole new attitude and outlook on
life. I was so glad when I got arrested. I
know how that sounds, but it meant I could
fi nally stop using and killing myself. And
when I was arrested, I was sent to Cook
County [Jail, Chicago], where I met the
smartest and greatest doctor in the world,
Positively Aware will treat all
communications (letters, faxes, e-mail,
etc.) as letters to the editor unless
otherwise instructed. We reserve the
right to edit for length, style, or clarity.
Please advise if we can use your name
and city.
Write to: Positively Aware,
5537 North Broadway
Chicago, IL 60640
Fax: (773) 989–9494
E-mail: readersforum@tpan.com
14
Dr. [Chad] Zawitz! I truly thank God every
day for him.
I had been shooting heroin for years
and I had a habit of sucking on the cotton
that I used to draw up the heroin—
long story short, I had been dealing with
abscesses all over my body for three years
straight. I’d seen doctor aft er doctor, had
six surgeries and have scars, including one
from my shoulder to my elbow because
the muscle deteriorated so badly from the
abscesses. Th ere wasn’t a doctor who could
fi gure out why until I met “Dr. Z”—he was
genius enough to ask if I sucked on the cottons
and he saved my life.
Now, here I am with a CD4 count of
114 and a viral load that’s undetectable. I’m
on Truvada and Kaletra and the only side
eff ect I’ve had is diarrhea. I realize that I am
a walking miracle. I’m still in prison, but
I’m in the drug program here and I remain
open and teachable. I’m in therapy for all
my other issues and I’m working hard so
I’ll never have to come back here or pick up
another drug.
I’ve been doing so well, in fact, that I’ve
been asked to be an HIV peer educator and
I’m starting a support group. I’m totally saddened
by the way women here are so afraid
to come to a support group that’s 100% confi
dential. I’m in a prison with 500 women,
most of whom have one or more risky
behaviors and, so far, only two of us want to
be open and honest about it. I understand—
I’ve turned down the chance to speak at a
couple of health seminars because it would
mean “coming out of the closet,” and if the
women here aren’t willing to be honest with
themselves because of what might happen,
what will they do to me?
So I need some help as to how to handle
“coming out” and I also want to be informed
and armed with the best and latest information
possible. Also, I’m to be released in
about three months and I’m scared to death.
Aft er all the hard work I’ve done, I’d hate to
lose it because I didn’t have a proper plan
in place. I would be happy and grateful for
advice from anyone. Please help. Th ank you
so much.
Patricia Douglass R37503
PO Box 3035 B-wing
Decatur, IL 62524-3035
Positively Aware
Enid Vázquez resp onds: Chad Zawitz
was in New Orleans during Hurricane
Katrina in the Fall of 2005 and is one of the
doct ors who rushed to the aid of survivors.
At the time, he was slated to provide the doctor’s
comments to our 2006 HIV Drug Guide,
and he kept his deadline a few weeks later
desp ite the time taken for the emergency
care. His presentations here at Test Positive
Aware Network are always on the mark and
well-received. We meet a lot of the best and
brightest HIV sp ecialist s and we agree, Dr. Z.
is one of them. We passed your letter on to
him, and he was moved by your words. Good
luck to you.
Long-Term Survivor
I want to let you know how much
I appreciated your article “Th e Graying
Epidemic” [Editor’s Note, May/June issue].
Just when I start feeling like the only one
concerned about what my future holds, and
how much longer I have to live, I fi nd an
article that gives me some hope.
I have been HIV-positive for 21 years.
I am 42. Without exaggeration, my closest
friends from college who were gay are dead.
I didn’t plan on living past 35. I worked so
hard to be as successful as possible so that
when I did die, my family wouldn’t be burdened
with the cost of my medical issues or
my death.
I reached 35 and was not ready for
the future. Aft er a 13-year relationship
ended and I started with a new company, I
couldn’t imagine what was next. I was now
alone, except for my most faithful dog, and
I was scared. What if I get sick, what if I get
hurt? I felt like I was living in an old—I am
talking 60ish—body.
I got hurt last year and aft er two other
surgeries, I had to have my left hip replaced,
aft er a long fi ght with the insurance company.
Aft er almost a year to date, AVN
[avascular necrosis] has taken control of
my right hip. I should get it replaced within
a month.
I can’t help but wonder if this is only
the beginning of the end. I am now on disability
and have to fi ght with the long-term
disability company almost quarterly to
prove that I am not able to work. I try to
be positive about my situation, but I have
never felt so worthless. Th at’s something I
am working on.
PA • July / August 2009 • tpan.com • positivelyaware.com

I am volunteering with YouthPride in
Atlanta. I enjoy working with young people.
I perform HIV testing and risk management,
along with fundraising. I fi nd that
rewarding.
I could go on, but I think you understand
where I am coming from. Who knew
there would be a group of “long-term” survivors
at all? I tell myself that I am one of
the lucky ones.
Th anks again for your article!
Manuel Robles
Via the Internet
Missing Chicago
Mr. Jeff Berry,
When I read your articles you help me
stay connected to Chicago and, of course,
the latest of news to keep my health in order.
You help me to think of all of our wild times
at the Bistro and up and down Halsted St.
Th ose were the good old days. We didn’t
have a care in the world. I have been living
in Florida for the last fi ve years, working in
St. Pete but living in Naples. I only go home
on my days off . It’s always on my mind to
move back home, but until I do, thanks for
making me feel like a part of Chicago.
Marty
Naples, Florida
Comments to Nelson Vergel
Dear Nelson,
I just read your interview by Positively
Aware on Th e Body’s website and I have to
say that you are an inspiration to me as a
person living with AIDS.
I was diagnosed at the age of 30 with
zero T-cells and subsequently became very
ill, fi nally losing my hearing, my eyesight,
and my ability to walk from CMV myolitis.
I was considered terminal and set to be
sent off to hospice, but my parents took me
home and nursed me back to health. I have
regained my hearing and learned how to
walk again, but I am still completely blind. I
am now healthier in many ways than I ever
was before, going to the gym every day, eating
right, being pro-active about my health,
and always looking for alternative solutions
to my residual problems.
I saw you speak to long-term survivors
about six years ago in Ft. Lauderdale. I was
there with my guide dog and a blind friend
and his dog too. I was so proud and honored
to meet you then and you were a great
role model for me and my recovery. I am
still inspired by you and wanted to let you
know that I understand what you feel every
day. Yes, it is hard, but please be comforted
in knowing that you have changed lives
and brought so much to so many. I hope
that will sustain your mind and your body
as well.
I now speak to many diff erent groups
about blindness and guide dogs and I am
advocating for blind rights and accessibility
in my community of Miami Beach, Florida.
In many ways, this illness has been a gift ,
enabling me to educate and help many others.
I hope you feel the same way. Th ank you
for being you.
R. David New
Miami Beach, Florida
Hi, Nelson,
Imagine my surprise when I opened
my mail at Shanti and saw your picture on
the cover of Positively Aware!
I absolutely loved the article You’re
Getting Older and Better.
I love the title of your new book and
am so looking forward to reading it when it
hits the shelves.
You look fabulous! Th ank you for your
message, which profoundly aff ects so many
people.
Sarah Kasman
Executive Director
Shanti
Dear Mr. Vergel,
I recently read your profi le in the latest
issue of Positively Aware and was impressed
by the way you were able to frame the issue
of aging with HIV. Our current work at
ACRIA largely focuses on the psychosocial
challenges of HIV and aging. If you haven’t
seen it, please go to our website (www.acria.
org) and you will fi nd a copy of the report
“Research on Older Adults with HIV,” which
is currently in press in an expanded form
and should be available later this year. We
also have a couple of booklets that address
this issue from our HIV Health Literacy
Program that are available at no cost.
In addition to stigma, the two major
issues we see facing adults aging with HIV
are mental health (very high rates of depression)
and the importance of social supports
to meet the challenges of this condition now
and in the future. In our New York City
research, we are fi nding very high rates of
health comorbidities, at approximately
three times the rates found among older
adults in general. We are currently working
on interventions to address depression and
social isolation.
I noticed in the article that you are
planning a conference to address this issue
in the Houston area next year. If we could
be of any assistance, please let us know.
Mark Brennan, Ph.D.
Senior Research Scientist
Center on HIV and Aging
AIDS Community Research Initiative of
America (ACRIA)
New York, New York e
PA • July / August 2009 • tpan.com • positivelyaware.com 15
Positively Aware

Ask the
I am a 64-year-old male, diagnosed with HIV in 2006, and began
taking Truvada and Kaletra (4 once daily). My viral load fell from
362,000 to undetectable by early 2007 and remained undetectable
until my last blood test in January this year. My doctor said it may be
a blip, or the virus may have become resistant to the medication. I am
scheduled for another blood test in early June, but the wait is making
me very anxious. The last viral load reading was 108. My blood work
for all other areas tested has been excellent, including cholesterol,
PSA, liver and so on. My blood pressure is generally 115/72 or lower.
I never miss my medication. If the virus has become resistant to the
current medication, what are my options for other medication?
Signed,
Resistance or Blips?
Dear ROB,
We agree with your doctor. One does not know at this point
[when the letter was received in February 2009] if this small increase
in viral load was a “blip” or if the virus has become resistant.
Is your provider an AAHIVM-credentialed HIV
Specialist?
If you are living with HIV, you have a lot of choices to
make when seeking care and treatment. One of your most
important choices is your health care practitioner—so why
not choose someone who is knowledgeable about HIV and
experienced in its treatment?
The American Academy of HIV Medicine (AAHIVM)’s
HIV Specialist credentialing program is the first and
only clinical credentialing program offered domestically
and internationally to physicians (MDs and DOs), nurse
practioners, and physician assistants specializing in HIV
care. HIV care providers become designated HIV Specialists
after meeting experience and education requirements, and
successfully completing a rigorous exam on HIV-specialized
care. Look for the letters “AAHIVS” after their name.
Locate an HIV Specialist
Your search for an HIV Specialist is easy with AAHIVM’s
online Find-A-Provider directory at www.aahivm.org. Just
click on the “Find-A-Provider” window on the homepage, key
in your location and click on the search button for a list of
HIV Specialists near you.
Due to space limitations, not all submitted questions can be
answered in this column, but every effort is made to ensure
you receive the information you have requested. For more
information about AAHIVM, call 202-659-0699 or visit
www.aahivm.org.
Positively Aware
Submit your questions for Ask the HIV Specialist to AAHIVM@tpan.com
This issue’s specialists:
Amy Sitapati , M . D ., AAHIVS
and Joseph Caperna , M . D ., MPH , AAHIVS
If your virus has developed drug resistance, that is a topic for
another column. We would need to see the results of a resistance test
and the interpretation of resistance test results remains complicated.
It is also important to know whether there is any new medical
history, such as recent surgery, illness, or vaccination (these can
increase viral load more than a blip, or greater than 200 copies/ml).
A physician should assess you for new medications or herbs which
might interact with the antivirals. Finally, we assume you are taking
all doses of your medications. Intermittent “adherence” or not taking
100% of the doses, can lead to blips.
“Blips” are a common concern in the field of HIV. There are
several ways to look at an increased viral load. Depending on which
type of machine was used to measure the HIV viral load, the amount
of virus used to classify undetectable will vary. A “blip” is a viral load
increased to 200 (some authors use 400) copies/ml, slightly increased,
but not completely undetectable.
Historically, blips were discussed in 2000 or before, and at first
were thought to predict future virologic failure, or that sometime in
the future the viral load would increase dramatically. Using actual
numbers, one example is a patient with less than 50 for years who
has a new viral load of 188. It is uncertain whether or not this would
mean the viral load might increase significantly (such as up to 3 logs
or 188,000) in the near future. At the Durban International AIDS
Conference in 2000, Dr. Diane Havlir presented a study of patients
on indinavir [Crixivan] with prior long-term control of less than 50.
Blips in this group did not predict future virologic failure. In contrast,
Wensing et al, at the same conference, presented data on patients on
different regimens. The Wensing study showed blips were associated
with future greater increases in viral load.
Again, a single blip does not mean virologic failure. In fact, the
DHHS “Guidelines for the Use of Antiretroviral Agents in HIV-
1-Infected Adults and Adolescents” (Nov. 2008) define virologic
failure as “a confirmed HIV RNA level of greater than 400 copies/
ml after 24 weeks, greater than 50 copies/ml after 48 weeks, or a
repeated detectable HIV RNA level after prior suppression of viremia
[viral load].”
The definition of “blip” may change as newer assays (tests) are
developed that detect down to incredible levels, such as less than 1
copy/ml, and the new ability to see if patients with less than 50 have
less than 1 or somewhere between 1–50, and what that might mean.
We previously did not have this ability, and we are in transition with
these more sensitive assays. Finally, as we look to the future, and the
empowerment of patients, we hear of technology being developed
that will allow patients to monitor their viral loads from home. Visit
TheBody.com for excellent information on blips. e
Amy Sitapati, M.D., AAHIVS
Associate Director, Owen Clinic
University of California, San Diego
Joseph Caperna, M.D., MPH, AAHIVS
Clinical Physician, Owen Clinic
University of California, San Diego
16 PA • July / August 2009 • tpan.com • positivelyaware.com

Photo © Russell McGonagle
Embracing “the Change”
TPAN’s new Executive Director welcomes a new chapter
by Bruce Weiss
I
just made a complete change in my life. I packed up all my
belongings, grabbed my dog, said goodbye to my friends, and
left the city I had lived in for 15 years—Washington, D.C. I gave
up far warmer weather and people I loved to make this move. But
I took a wonderful opportunity to live in a great city like Chicago
and to become part of an incredible organization called Test Positive
Aware Network (TPAN).
Well, not a complete change. I still work in the non-profi t sector,
and continue my career in non-profi t management. Th is is the
second Executive Director position I have held in my career. And
TPAN is experiencing the same diffi cult economic times as almost
every non-profi t in the current economy.
I realize that you, the TPAN reader, might live anywhere in
the country or the world, so I want to take a moment to tell you
about TPAN. TPAN is an HIV care and prevention organization in
Chicago with a staff of more than 30 very hard-working people and
a volunteer base that really makes this organization possible. We
pride ourselves on being “peer-led,” meaning that there are HIVpositive
individuals throughout the organization, and that the voices
of HIV-positive individuals aren’t just heard, but they continue
to set the course of TPAN. We work hard to maintain, and even
enhance, this culture and philosophy as we continue to grow.
My focus for TPAN over the next year is nothing sexy or dramatic.
While we hope to continue increasing the distribution of
Positively Aware, our main focus in the next year will be internal.
We will build our fi nancial stability in a challenging economic
time, as well as improve the organization’s internal processes. As
I said, nothing sexy, but absolutely vital to any non-profi t in 2009.
Th is will involve change for TPAN—change you aren’t to likely see
where you are, but change that will take place for staff and will
hopefully improve the care and support we provide to clients. It is
the kind of change that takes place underneath, where you might
not notice it, until someone else mentions that they’ve noticed some
changes and then it dawns on you that you have too.
I recently had another life change that was more personal. And
it makes it very clear to me why Positively Aware is so important for
many HIV-positive people across the country. Soon aft er I moved to
Chicago in April, I had a fi rst visit with my new doctor. He recommended
a battery of tests, as doctors usually do, but he mentioned
a few I didn’t recall ever having had before. Two weeks later, I went
to see him and everything was great news, with a little surprise.
He mentioned that I was in something called “andropause,” which
means I had low testosterone. He told me the symptoms of andropause
and it dawned on me, as he spoke, that I had all these symptoms.
I had known that there was a pretty sudden change about four
or fi ve years ago, when I started gaining weight, felt a lot less energy,
a bit less “spark” in my life. Th at diminished spark meant both a
decreased joy in my life, and a decreased desire for sex. All of this
PA • July / August 2009 • tpan.com • positivelyaware.com
From TPAN
came rushing into my mind in about a minute as I began to discuss
this with my doctor. It was an epiphany, to say the least.
Th ere I was working in public health for years, running a
health care clinic for part of that time, going to a doctor regularly,
and I had never considered this as a possibility. It was right in front
of me, but until a new doctor gave me the results and explained
what the symptoms would look like, it had never crossed my mind.
So I began using a testosterone gel about three weeks ago and the
change has been pretty dramatic.
Many people are not as fortunate as I am to have a doctor who
is so thorough. Maybe if he had been my doctor a few years ago, I
would have known this sooner, because I am guessing my decreasing
testosterone didn’t happen suddenly or recently. Maybe not.
But there are so many people living across this country who may
have symptoms that have come on slowly over time, or even suddenly,
but it never occurred to them to ask their doctor. Maybe their
doctor doesn’t have as much awareness of important tests or they
don’t screen their patients as thoroughly and don’t ask the right
questions.
“It was right in front of me,
but until a new doctor gave
me the results and explained
what the symptoms would
look like, it had never
crossed my mind.”
Positively Aware has a responsibility to provide information
that might be that “aha” moment for you. Positively Aware can be,
and is, the place to learn about health issues, to let you know about
health information you might not have considered. Whether it is
through an issue on aging and HIV, or this issue focused on women
and HIV, Positively Aware is the source that makes you think about
your own health, that helps you understand what your doctor
should be asking, what you should be telling your doctor, what
tests you might want to ask for. Positively Aware is your resource. If
you’ve had your own “aha” moment, please let us know, if you think
it’s something that should be discussed in this magazine. You can
reach us at publications@tpan.com. You, our reader, are the reason
we exist, you are our “peers,” and we need your ideas to inspire
us. e
Positively Aware
17

News Briefs
by Enid Vázquez
GSK and Pfizer announce joint company
In April, GlaxoSmithKline (GSK) and Pfi zer announced that
they will combine their HIV operations into one new company,
which will account for nearly 20% of current HIV drug sales. Th is
deal, the fi rst of its kind, is likely the result of lack of growth in the
HIV drug arms of the two companies. Th e ever-evolving nature of
the epidemic creates fi erce competition for pharmaceutical companies
to develop newer compounds that are more tolerable and easier
to take, as well as to counter issues associated with resistance.
Relatively low returns on spending for research and development
of these drugs, however, are forcing more and more pharmaceutical
companies to explore ways to minimize their risks. Collaborative
eff orts between HIV drug-makers are becoming increasingly
common, as in the case of Bristol-Myers Squibb and Gilead
Sciences working together to produce the multi-drug combo pill
Atripla, currently leading the sale of HIV drugs.
Though this type of shared business
practice can oft en be rationalized
with respect to bottom lines for pharma
companies, advocates are concerned that
drug companies may be moving away
from HIV. “I hope we can get to a new
generation of better and more tolerable
drugs before progress in this fi eld halts,”
said Bob Huff , editorial director and ARV
project director of the New York–based
Treatment Action Group.
GSK chief executive offi cer Andrew
Witty contends that one of the goals will
be to develop new fi xed dose combination
therapies, using existing and novel medicines.
Witty cited benefi ts to both companies.
GSK will now have access to the
new medicines that Pfi zer has in clinical
development while Pfi zer will gain GSK’s
strong HIV marketing and distribution
expertise.—Keith R. Green
New AIDS awareness campaign
From the U.S. Food and Drug Administration (FDA): “A new
AIDS awareness campaign is being launched by FDA’s sister agency,
the U.S. Centers for Disease Control and Prevention (CDC). HIV
is still a signifi cant public health problem in the United States.
Although HIV infection is preventable, every 9½ minutes, someone
in the U.S. is infected with the virus.
“Th e new Act Against AIDS campaign is designed to contribute
to the goal of reducing HIV incidence in the United States. You can
get the facts about the epidemic, learn how to prevent transmission
18
Positively Aware
of the virus, delay the onset of AIDS with proper treatment for HIV
infection, and fi nd out ways to stem the tide of HIV infection in
the United States by spreading the word about AIDS at a new CDC
website Act Against AIDS, www.cdc.gov/nineandahalfminutes.”
Th e following is from the website.
As individuals:
• We should know whether or not we are infected with HIV;
• If we are infected, we should seek medical care and protect
others from becoming infected;
• We should protect ourselves and others from HIV;
• We should educate ourselves and others about HIV.
As communities:
• We should mobilize to overcome the challenges and barriers
to HIV prevention;
• We should fi ght ignorance and complacency related to HIV;
• We should increase the awareness about the severity of the
epidemic and the continued impact that HIV is having on
our communities;
• We should make sure that HIV prevention services, HIV testing,
medical care and treatment are
available to all who need them;
• We should work to prevent stigma
and discrimination, and to increase
support for people living with HIV.
Free Gardasil for positive
women
Nurse Joan Swiatek of Rush University
Medical Center in Chicago reminds
everyone that a free series of Gardasil
vaccine shots are still available for
HIV-positive women through a clinical
study. Th e vaccine protects against HPV
(human papilloma virus), a common
sexually transmitted infection that is
particularly troublesome for women living
with HIV. For more information on
the ACTG study (AIDS Clinical Trials
Group), e-mail Joan_A_Swiatek@rush.edu.
Latest views of the epidemic
In April, the Kaiser Family Foundation (KFF) released the
results of a survey the organization took of perceptions and testing
around HIV in the U.S. Th e following is from a KFF press release.
“Less than a year aft er the Centers for Disease Control and Prevention
(CDC) recalculated the size of the HIV/AIDS epidemic and
announced that there were 40% more new HIV infections each year
than previously believed, a new survey by the Kaiser Family Foundation
fi nds that Americans’ sense of urgency about HIV/AIDS as
a national health problem has fallen dramatically and their concern
PA • July / August 2009 • tpan.com • positivelyaware.com
Photo © Russell McGonagle

about HIV as a personal risk has also declined, even among some
groups at higher risk.
Key findings of the survey include:
• Th e share of Americans naming HIV/AIDS as the most urgent
health problem facing the nation dropped precipitously
from 44% in 1995 to 17% in 2006 and to 6% now.
• CDC estimates that HIV rates are
seven times higher among African
Americans and three times higher
among Latinos compared to whites.
While these groups are more likely
than whites to see HIV/AIDS as
an urgent problem, fewer say it is a
“more urgent” problem for their community
now than in 2006 (declining
from 23% to 17% of all adults, 49% to
40% of African Americans, and 46%
to 35% of Latinos).
• Th e share of those ages 18-29 who say
they are personally very concerned
about becoming infected with HIV
declined from 30% in 1997 to 17%
today; personal concern among
young African Americans declined
from 54% to 40% over the same time
period.
• More than half (53%) of non-elderly
adults say they have been tested for HIV, including 19%
who say they were tested in the past year. Testing is most
common among adults under the age of 30, with three in
ten young adults and nearly half (47%) of young African
Americans reporting having been tested in the past year.
However, reported testing rates for all these groups have not
changed much in the past decade.
“Many indicators of urgency and concern are moving in the
wrong direction, including for higher risk groups,” said Kaiser
President and CEO Drew Altman. “Th e survey underscores the
need for a new focus on domestic HIV,” he added.
Th e press released continued, “A signifi cant share of the public
also harbors misconceptions about prevention and treatment
of HIV/AIDS. Nearly one in fi ve (18%) do not know there is no
cure for AIDS and about one-quarter (27%) believe or are unsure
whether former professional basketball player Magic Johnson has
been cured of AIDS. Additionally, a quarter (24%) believe or are
unsure whether there is a vaccine available to prevent HIV infection.
Many of these misconceptions are more common in the African
American community, including that Magic Johnson has been
cured (37% of African Americans think he has been cured or are
unsure), that there is a vaccine available to prevent infection (36%),
PA • July / August 2009 • tpan.com • positivelyaware.com
and that there are drugs available that can cure HIV and AIDS
(30%).” Visit www.kff .org.
Pediatric warning on Testim and Androgel
Th e FDA has added a boxed warning on the drug labels for Testim
and Androgel aft er receiving reports of adverse eff ects in children
who were inadvertently exposed to these testosterone products
through contact with another person being treated with them.
According to an FDA announcement,
“Th e gels are approved for use in men who
either no longer produce testosterone or
produce it in very low amounts, and are
oft en used by men living with HIV who
have below normal testosterone levels.”
Visit www.fda.gov/medwatch for more
information.
Women’s conference in
Chicago
Pharmaceutical Boehringer-
Ingelheim (BI), maker of the HIV drugs
Viramune (nevirapine) and Aptivus (tipranavir),
is holding a free one-day women’s
meeting on HIV here in Chicago.
“Women Living Positively: It’s My Life,
National Women’s Summit” is scheduled
for Friday, July 17, from 9 a.m. to 2
p.m. at New Zion Banquets, 1950 W. 13th
Street (in the Illinois Medical District).
Breakfast and lunch will be provided.
Visit www.banquet.newzionmbc.com.
Women interested in attending the summit should call toll-free at
1–877–933–4310, extension 99512, as soon as possible to reserve a
seat. BI videotaped one of its previous women’s summits, held in
Florida. Judging from those speakers, the summit is an outstanding
event. Visit www.vodium.com/goto/womenlivingpositive.asp.
Due to issues of confi dentiality, question-and-answer sessions and
breakout groups were not taped.
Not taking it
During International Women’s Month, in March, the Women’s
Institute at GMHC (Gay Men’s Health Crisis) in New York City and
Iris House re-launched its HIV prevention and testing campaign
for women. According to a press release, the “We’re Not Taking It
Lying Down campaign… continues to boldly celebrate and reclaim
the sexuality, sexual health and strength of women of color. …Institutionalized
racism, poverty, and violence create environments of
risk.” It continued, “Both the Women’s Institute at GMHC and Iris
House promote safer and satisfying sex that’s consensual and in
one’s control. We subscribe to the idea that women don’t have to
‘take it lying down.’ Testing regularly for HIV is but one way to take
control.” Th e Women’s Institute provides community health education
and advocacy for women and families. Iris House provides
services to women, families, and communities aff ected by HIV,
promoting prevention, education, and awareness. e
Positively Aware
19

692US09AB02404_MeAd8x10.5:- 6/4/09 2:55 PM Page 1
ONCE-DAILY SUSTIVA IN HIV COMBINATION THERAPY:
• Can help keep viral loads undetectable* for a long time †
• Helps improve your body’s immune system by raising your T -cell count
*Undetectable is defined as a viral load of less than 400 copies/mL or less than 50 copies/mL (depending on the test used).
†
Up to 168 weeks.
SUSTIVA does not cure HIV and has not been shown to prevent passing HIV to others.
IMPORTANT INFORMATION ABOUT SUSTIVA ® (efavirenz)
INDICATION: SUSTIVA ® (efavirenz) is a prescription medicine used
in combination with other medicines to treat people who are
infected with the human immunodeficiency virus type 1 (HIV-1).
SUSTIVA does not cure HIV and has not been shown to
prevent passing HIV to others.
See your healthcare provider regularly.
IMPORTANT SAFETY INFORMATION:
Do not take SUSTIVA if you are taking the following medicines
because serious and life-threatening side effects may occur
when taken together: Vascor ® (bepridil), Propulsid ® (cisapride),
Versed ® (midazolam), Orap ® (pimozide), Halcion ® (triazolam), or ergot
medicines (for example, Wigraine ® and Cafergot ® ).
In addition, SUSTIVA and Vfend ® (voriconazole) must not be
taken together at standard doses. Some doses of voriconazole
can be taken at the same time as a lower dose of SUSTIVA, but you
must check with your healthcare provider first.
AS PART OF
HIV COMBINATION THERAPY:
SUSTIVA
&
SUSTIVA should not be taken with ATRIPLA ® (efavirenz 600 mg/
emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg)
because it contains efavirenz, the active ingredient of SUSTIVA.
Neither Fortovase ® (saquinavir) nor Invirase ® (saquinavir mesylate) should
be used as the only protease inhibitor in combination with SUSTIVA.
Taking SUSTIVA with St. John’s wort (Hypericum perforatum) is not
recommended, as it may cause decreased levels of SUSTIVA,
increased viral load, and possible resistance to SUSTIVA or crossresistance
to other anti-HIV drugs.
This list of medicines is not complete. Discuss with your
healthcare provider all prescription and non-prescription
medicines, vitamins, and herbal supplements you are taking
or plan to take.
Tell your healthcare provider right away if you have any side
effects or conditions, including the following:
• Severe depression, strange thoughts, or angry behavior
have been reported by a small number of patients taking
SUSTIVA. Some patients have had thoughts of suicide and a few
have actually committed suicide. These problems may occur
more often in patients who have had mental illness.

ME
Individual results may vary.
. .. We’re in this together.
• Dizziness, trouble sleeping or concentrating, drowsiness,
unusual dreams, and/or hallucinations are common, and tend
to go away after taking SUSTIVA for a few weeks. Symptoms
were severe in a few patients, and some patients discontinued
therapy. These symptoms may become more severe with the use
of alcohol and/or mood-altering (street) drugs. If you are dizzy,
have trouble concentrating, and/or are drowsy, avoid activities
that may be dangerous, such as driving or operating machinery.
• If you have ever had mental illness or are using drugs
or alcohol.
• Pregnancy: Women should not become pregnant while
taking SUSTIVA and for 12 weeks after stopping SUSTIVA.
Serious birth defects have been seen in children of women treated
with SUSTIVA during pregnancy. Therefore, women must use a
reliable form of barrier contraception, such as a condom or
diaphragm, even if they also use other methods of birth control.
• Breast-feeding: Women with HIV should not breast-feed
because they can pass HIV through their milk to the baby. Also,
SUSTIVA may pass through breast milk and cause serious harm
to the baby.
• Rash is a common side effect that usually goes away without any
change in your medicines, but may be serious in a small number
of patients. Rash may be a serious problem in some children.
• If you have liver disease, your healthcare provider may want to
do tests to check your liver.
• Seizures have occurred in patients taking SUSTIVA, usually in
those with a history of seizures. If you have ever had seizures or
take medicines for seizures, your healthcare provider may want
to switch you to another medicine or monitor you.
SUSTIVA and the SUNRISE logo are registered trademarks of Bristol-Myers Squibb P harma Company.
ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other trademarks are owned by third parties.
© 2009 Bristol-Myers Squibb Company, Princeton, NJ 08543 U.S.A. 692US09AB02404 05/09
Changes in body fat have been seen in some patients taking anti-HIV
medicines. The cause and long-term health effects are not known.
Other common side effects of SUSTIVA taken with other anti-HIV
medicines include: tiredness, upset stomach, vomiting, and
diarrhea. Some patients taking SUSTIVA have experienced increased
levels of lipids (cholesterol and triglycerides) in the blood.
You should take SUSTIVA on an empty stomach, preferably at
bedtime, which may make some side effects less bothersome.
SUSTIVA is one of several treatment options your doctor may
consider.
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.
Ask your doctor if SUSTIVA is right for you.
Visit www.sustiva.com
Please see Patient Information about SUSTIVA on the next page.

692US09AB02404_MeAd8x10.5:- 6/4/09 2:55 PM Page 3
FDA-Approved Patient Labeling
Patient Information
SUSTIVA ®
[efavirenz ]
capsules and tablets
ALERT: Find out about medicines that should NOT be taken with SUSTIVA.
Please also read the section “MEDICINES YOU SHOULD NOT TAKE WITH
SUSTIVA.”
know about your medicine. This information is not meant to take the place of
talking with your doctor.
What is SUSTIVA (efavirenz)?
SUSTIVA is a medicine used in combination with other medicines to help treat
under the care of your doctor.
What are the possible side effects of SUSTIVA?
Serious psychiatric problems.
Common side effects.
with SUSTIVA. These side effects may be reduced if you take SUSTIVA at
right away if any of these side effects continue or if they bother you. It is possible
call your doctor right away. Rash may be a serious problem in some
children. Tell your child’s doctor right away if you notice rash or any other side
effects while your child is taking SUSTIVA.
Changes in body fat.
taking SUSTIVA.
SUSTIVA ® (efavirenz)
Contact your doctor before stopping SUSTIVA because of side effects or for any
other reason.
This is not a complete list of side effects possible with SUSTIVA. Ask your doctor
or pharmacist for a more complete list of side effects of SUSTIVA and all the
medicines you will take.
How should I take SUSTIVA?
General Information
which may increase the frequency of side effects.
bothersome.
doctor or pharmacist.
to stop.
contact your local Poison Control Center or emergency room right away.
Capsules
children may be lower (see Can children take SUSTIVA?
Tablets
by mouth.
Can children take SUSTIVA?
be a serious problem in some children. Tell your child’s doctor right away if you
notice rash or any other side effects while your child is taking SUSTIVA. The
dose of SUSTIVA for children may be lower than the dose for adults. Capsules
determine the right dose based on your child’s weight.
Who should not take SUSTIVA?
Do not take SUSTIVA if you are allergic
What should I avoid while taking SUSTIVA?
Women should not become pregnant while taking SUSTIVA and for
12 weeks after stopping it.
offspring of animals and women treated with SUSTIVA during pregnancy.
It is not known whether SUSTIVA caused these defects. Tell your doctor
right away if you are pregnant. Also talk with your doctor if you want to
become pregnant.
birth control. SUSTIVA may remain in your blood for a time after therapy

SUSTIVA ® (efavirenz)
Do not breast-feed if you are taking SUSTIVA.
SUSTIVA may pass through breast milk and cause serious harm to the
These medicines include prescription and nonprescription medicines and
(Hypericum perforatum).
Before using SUSTIVA, tell your doctor if you
have problems with your liver or have hepatitis.
have ever had mental illness or are using drugs or alcohol.
have ever had seizures or are taking medicine for seizures [for
What important information should I know about taking other medicines
with SUSTIVA?
SUSTIVA may change the effect of other medicines, including ones for HIV,
and cause serious side effects.
it is very important to:
doctor a complete picture of the medicines you use. Then he or she can decide
the best approach for your situation.
(Hypericum perforatum)
recommended. Talk with your doctor if you are taking or are planning to take
MEDICINES YOU SHOULD NOT TAKE WITH SUSTIVA
taking SUSTIVA:
The following medicine should not be taken with SUSTIVA since it contains
SUSTIVA ® (efavirenz)
The following medicines may need to be replaced with another medicine
when taken with SUSTIVA:
The following medicines may require a change in the dose of either
SUSTIVA or the other medicine:
These are not all the medicines that may cause problems if you take
SUSTIVA. Be sure to tell your doctor about all medicines that you take.
General advice about SUSTIVA:
Medicines are sometimes prescribed for conditions that are not mentioned
in patient information leaflets. Do not use SUSTIVA for a condition for
which it was not prescribed. Do not give SUSTIVA to other people, even if
they have the same symptoms you have. It may harm them.
www.sustiva.com
___________________________________________________________

Dawn Averitt Bridge, who turned 40 last December, was diagnosed with HIV in 1988
when she was just 19 years old. Her doct or had never diagnosed another woman and had no
idea what to expect , other than that an HIV diagnosis at the time meant a life expect ancy of
about six months. Dawn’s fi rst goal was to make it to her 20th birthday. She is now happily
married with two daughters, Madelyn Grace, 7, and Sophie, 5, both of whom are happy,
healthy and HIV-negative.
Dawn sat down with PA recently to talk about her family, her dreams, and her life’s
work—educating and empowering other women with HIV, and letting them know that
they are not alone.
JEFF BERRY: Have you talked to
your daughters about your status and having
to take meds? Is it something you’ve discussed
with them yet?
DAWN AVERITT BRIDGE: I’ve
never hidden it from them, but I also haven’t
focused on it being extraordinarily unique—
it’s their “normal.” About two years ago,
Good Housekeeping did an article on my
choice as an HIV-positive woman to have
children, and I focused on my whole family
in a way that I hadn’t let play out in the
mainstream media very much. It was really
24
One-on-One wit h
Dawn Averit t Bridge
Wife, mother, and advocate for HIV-posit ive women
Positively Aware
Interview by Jeff Berry
a hard choice for me to make, because we’d
just moved to this small, rural community
in Virginia, and Maddy was all of four-anda-half,
and I realized that, although I had
made the choice to be a very public person
long before they were ever around, having
the kids really turned that on its ear. I had
to do some serious soul-searching, figuring
out what was important to me, and what
was fair to them. I was [already] out [about
my status], so perhaps the best thing I could
do was reinforce for my children that there
was nothing to be ashamed of. So, kind of
take it head on, and deal with people’s fears,
and unfortunately, at times, their anger, or
dislike or bigotry, or whatever we want to
call it.
So I had to tell Maddy and Sophie—
Sophie was only two-and-a-half, so this
was a very short conversation with her—but
I had to tell Maddy a little bit more about
HIV. Maddy is this little redheaded, pixiefaced
artist, an old soul, if you will. And
she’s sitting in the back seat of the car, and
I say, “Hey, Maddy, so you know how you
see Mommy taking medicine?” And she
said, “Nope.” [Laughs.] And I thought, oh,
c’mon, your two-and-a-half year-old sister
reminds me if I haven’t taken them. But
of course, she wasn’t going to give me any
room, so I thought, okay, I’m going to have
to come at this from another angle.
[Aft er they spoke, Dawn said it was
a huge relief to have fi nally had “the talk”
with Maddy, but she realized that it was just
the beginning of an ongoing conversation
that she would be having with her for the
rest of Maddy’s life.]
JB: So how did WISE and The Well Project
come about?
DAB: WISE was a completely separate
entity from The Well Project [TWP]. Basically,
when I was diagnosed my doctor said,
“Don’t read anything, it’s too confusing, and
don’t tell anyone, because it will ruin your
family’s life.” And I took that advice for a
number of years. I finished college, and
went to D.C. and worked for a U.S. Senator,
and it was there where I discovered what
grassroots advocacy and activism truly was,
and decided that I’d rather be on that side
[laughs].
PA • July / August 2009 • tpan.com • positivelyaware.com
Photos provided by Dawn Averitt Bridge

It was actually during the whole gays
in the military debacle that I was on the
receiving end of ACT UP and Queer Nation,
and all of these other advocacy groups. Of
course, nobody knew that I was HIV-positive.
I was also progressing fairly rapidly
with the disease, and not tolerating treatment
very well, and decided that I wanted
to be back in Atlanta, closer to my family,
and wanted to shift from government to
working in community-based organizations.
A friend of mine told me there was a
position open at the Atlanta chapter of the
National Association of People With AIDS
[NAPWA], which became the AIDS Survival
Project, and it would be really awesome
to have a positive woman as the treatment
resource specialist. Which was a complete
joke—I knew about fi ve things about HIV. I
knew I had it and I knew more T-cells were
better than less T-cells. So I spent a weekend
cramming and memorizing the whole
Project Inform [PI] opportunistic infection
chart, and I marched in there with my
pumps and pantyhose, to this beleaguered
set of queens who were sitting there looking
at me like I’d just been sentenced to community
service. And they said, “Why are
you here?” And I had to say, “Well, I have
HIV too,” and they were shocked. I quickly
blurted out every infection; viral, parasitic,
bacterial, and fungal, which of course was
relatively useless information, but it meant
that I was trainable. Remarkably, they hired
me as Treatment Resource Specialist, and
they didn’t even change the title. Th at was
the early nineties, and the learning curve
was extraordinarily steep. I found myself in
a lot of places I probably had no business
being, because I was a complete anomaly.
I was a middle-class white girl from the
South who was interested in the science.
I found myself on everything from FDA
advisory panels to NIH task forces and all
kinds of things.
Within about 12 months, I realized
there was nothing out there for women,
certainly nothing on treatment. I wrote my
fi rst grant overnight, and it got funded. In
1995, I launched WISE [Women’s Information
Service and Exchange] and, to the best
of my knowledge, we were one of the fi rst
group to focus on treatment information
and advocacy specifi cally for women.
I merged WISE with Project Inform
[in San Francisco] in 1997 and then, all of
a sudden I was about to turn 30 and I’d
lived with HIV for 10 years. So I decided
to act out a childhood dream and hike the
“I marched in
there wit h my
pumps and
panty hose,
to this
beleaguered set
of quee ns who
were sit ting
there looking
at me like
I’d just bee n
sentenced to
communit y
service.”
Appalachian Trail, from Maine all the way
down to Georgia, which was a 2,200 mile
journey, with my fi ve-drug combination in
tow. On that journey I spent a lot of time
thinking about what had worked and what
hadn’t worked, in terms of reaching out to
and mobilizing women and developing new
treatment advocates. And what came out
of it was a series of regional focus groups
that ultimately gave me what I needed to
develop a web portal that would service the
whole spectrum of people involved in HIV
disease management, so that people had
tools for communicating about the challenging
issues involved in living with HIV
from a whole person perspective. What
came out of that was Th e Well Project web
portal, launched in 2003, and at the same
time, we launched the Women and HIV
Th ink Tank, which has now become the
Women’s Research Initiative [WRI] on HIV/
AIDS, a year-round initiative that has done
some really amazing stuff , working with the
FDA, and the companies, and research in
general, and that’s all kind of fallen under
the rubric of TWP.
JB: I understand you just got back from
a meeting of WRI—anything come out of
that meeting that was exciting, that you’d
want to share with our readers?
DAB: Yeah, actually this year the WRI
went back to where we started at our first
meeting, looking at gaps and controversies
in research, but in a much more refined way.
Like how much do we really know about
how women are infected with HIV? And
how women can protect themselves, asking
some very basic questions about what’s
going on in a female body’s immune system.
It was a fascinating meeting, and the group
has a statement [with] a series of priorities
around answering those questions. The goal
of the WRI is more, better, faster research
for women. And a lot of great things have
come out of WRI. The validation that the
GRACE study could be done and would
work came out of the work of the WRI, as
did the Women Living Positively Survey
and some of the other things that you may
be aware of.
JB: So what are some of the issues that are
important to women with HIV that you feel
need more research or study?
DAB: I think that there are a lot of issues
that are really critically important. We
are perpetually trying to understand better
what happens, in relationship to pregnancy
and fertility, in those women who
choose to become biological mothers. It’s
not just about whether the baby is going be
infected with HIV, which we now know is
way less likely to happen [especially when
treated]. But we’re still struggling with how
best to treat women during pregnancy and
beyond, especially for women in the developing
world. I think the microbicide issue
is extraordinarily important, because it’s
incredibly exciting, for both HIV-negative
and positive women, and I think that there’s
a lot of work still to be done on bringing the
reproductive health community together
to champion the microbicide research with
those of us who’ve been working on women
and HIV-related issues.
I think I have a lot of basic science
questions that are about the infl ammation
process and what’s happening inside our
bodies. I think that Bob Silicano’s talk at
CROI [Conference on Retroviruses and
Opportunistist Infections] this year was
fascinating and the possibility that we don’t
know everything we think we know is very
real. We need to understand how to dose
women appropriately; we need to under-
PA • July / August 2009 • tpan.com • positivelyaware.com 25
Positively Aware

stand how women process these drugs so
that we know how to manage the toxicities
and side eff ects over the long term. Th ere
are a number of things for me that kind of
stand out as big questions.
JB: Why do you think that women have
traditionally been underrepresented in
clinical trials? What can be done to include
more women in trials and why is that so
important?
DAB: Women have been underrepresented
in clinical trials for a very long time, and
not just in HIV, for a whole host of reasons.
The biggest reason has been, of course, their
ability to bear children, and the risk that if
they become pregnant on an experimental
therapy that they are going to cause significant
damage to a fetus or even lose the baby.
The FDA really came from the response to
what happened when women were treated
with thalidomide during pregnancy and
we ended up with 10,000 or more thalidomide
babies. The government said we’ve
got to have a better grip on these things.
Fortunately, there’s been significant progress
made over the years, and increasingly,
women are actively recruited to participate
in clinical trials. There’s still a number of
challenges—the sites where clinical trials
are done are typically sites where many
women are not being cared for, I’m speaking
about HIV specifically now. The studies
are not always designed with women’s
issues or special circumstances in mind—
how the studies are run, what questions
are asked, or how the sites are prepared to
manage the unique needs of women who
are primary caretakers, and that type of
thing. For years we’ve listed transportation
and child care as the primary barriers for
Dawn’s two daughters, Maddy (l) and Sophie (r) in April, 2009.
women to clinical research, and I would
say that, although child care and transportation
are critical issues that should be
addressed, they are not the primary drivers
in preventing women from participating in
clinical research.
It’s important because we need to
understand how these drugs work in
women, and how this disease impacts
women, specifi cally. I think it’s great news
when we can actually power a study well
enough to be able to say, look, we’ve had
enough women in the study to actually tell
you that there’s not a diff erence between
men and women in terms of this aspect of
this treatment. But there are a number of
cases where, over time, as we’ve had more
women on treatment, we’ve had unique
issues, needs and circumstances that have
arisen because we’ve fi nally had the drug in
enough women. Th e obvious case is the differential
prescribing structure for nevirapine
[Viramune] for women versus men, and
some of the side eff ects and toxicities that
occur. Basically, we need women in clinical
trials so that we can answer those questions
and so we can know that when my doctor
prescribes a drug for me, we know how it’s
going to behave in my body.
JB: So what are some of the challenges
in designing trials for women, including
the recruitment and retention? Could you
talk in particular about the GRACE and
SPRING studies?
DAB: There are some significant challenges
in designing trials for women, and I
think GRACE has shown us that retention
is also a challenge. How do we make it possible
for women to participate over the long
term in a study, and what are the things that
threaten their ability to participate successfully?
There are some great lessons that
came out of the GRACE study, and for me,
that makes it a huge success.
From a protocol level, in the design of
a clinical trial, you have to think about the
questions you truly need answered. It’s really
hard trying to fi gure out what information
needs to be collected, anticipating what
information you wish you had three years
down the road. But we also have to consider
what people are willing to do. How many
visits do you really need? Do you have sites
that have evening hours and fl exible schedules?
Are treatments provided free of cost
or do people have to pay for things, going
through insurance to get them, just as they
would if they had to go to their doctor’s
offi ce? So what is their incentive to participate
in the trial, other than to increase your
hassle factor, despite the fact that you’re
trying to be altruistic. Th en, of course, site
selection is a very, very big issue. Th ere are
a lot of wonderful people out there who
care passionately about women’s issues, but
whose sites just frankly are not positioned
to enroll women eff ectively, just because
women won’t go there, or feel like they
don’t understand or trust the research that
is happening. Th ere are a lot of myths in the
community about clinical research overall,
so the site selection is an essential piece to
how we roll out clinical trials eff ectively.
And then from there, what are you
doing to provide support so the site understands
how to meet the unique needs of the
26 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

people, not just patients, who come through
their door? A whole lot of what worked in
GRACE was just about the sense of being
a part of something bigger than yourself,
being really valued, appreciated, and
respected in an environment where, frankly,
a lot of people are dealing with shame and
stigma. Nothing that we’ve done in GRACE
was rocket science, it was just a lot of basic,
commonsense shift ing around and thinking
about things a little bit diff erently, that
yielded a great result, which was successfully
enrolling so many women and specifi -
cally women of color.
In fairness, you can’t really compare
the challenges with SPRING to GRACE,
because they’re radically diff erent studies,
diff erent patient populations. SPRING was
more specifi cally for more advanced populations,
it was run in eight countries, it was
a very diff erent deal than GRACE, but I
think there are a few things that could have
been diff erent for SPRING. One was that
we didn’t eff ectively communicate what the
study was for, and why we were doing it, to
the patient community or to people out in
the mainstream. Th at makes it really hard,
when you go to www.clinicaltrials.gov to
sort out between the dozens and dozens of
other studies that are out there. You need
some way to identify a study so it surfaces,
for the patient, the investigator, and the staff
at the research site. Because they’re probably
doing dozens of studies, and they need
a study that’s kind of, “top of mind,” if you
will. Th e branding around GRACE really
seemed to work—it was easy to remember,
it was colorful, and pretty. SPRING didn’t
have any of that going for it. I think, frankly,
that SPRING, on a conceptual level, was a
fascinating study about using therapeutic
drug monitoring [TDM] to do some individualization
of care, a real step forward.
JB: So what can women do to become
more involved, as advocates for their own
health care or for others?
DAB: Well, lots of things. One of the
things that keeps women from jumping
into advocacy is that the term “advocacy” is
a little daunting. I have to remind people
that even though advocacy seems like something
that only the fringe element might do,
if you’ve ever been at the grocery store and
the pickles were on sale for $1.25 and they
charged you $2.50 for them, and you said,
“Hey, wait a minute, that’s the wrong price,”
you’ve been an advocate—we use advocacy
PA • July / August 2009 • tpan.com • positivelyaware.com
in all aspects of our lives. The first thing
that women need to know is that advocacy
begins with speaking up for yourself, and
for people that you care about. You’re an
advocate when you ask somebody to explain
something you didn’t understand. You’re an
advocate when you ask somebody to work
around a conflict so you can make something
work. You’re advocating for yourself
and for your own healthcare when you get
that clarity and peace of mind. When you
stand up for yourself and you figure out that
you do have a voice, and it’s an important
voice, there are all kinds of opportunities to
get engaged. WORLD [Women Organized
to Respond to Life Threatening Diseases],
based out in Oakland, has been willing
to parent the development of a new group
called The Positive Women’s Network, and
PWN is a coalition of HIV-positive women.
I am a part of PWN, and many other women
and organizations around the country are a
part of PWN. It’s an exciting opportunity
for positive women to find a place where
they can, in a collective sisterhood with
other positive women, find their voice, and
figure out how they’re going to help themselves,
their friends, or somebody on the
local level, or for those who’re ready, to take
the next step and do stuff on a regional or
even national level. I find that incredibly
exciting, because when I started in this,
there wasn’t anything like that. There was
a lot of desperation and a huge amount of
need, and that certainly motivated many of
us to find our ways into offices and rooms
where we may not have been invited, to put
in our two cents, to ask questions and get
answers. It has paved the way for some real
opportunities to have advocates at the table,
leading the discussions, something that I
think, in terms of other disease categories,
people are trying to emulate. And it’s pretty
exciting to be part of that.
JB: What would be the first and foremost
thing you would want to tell a woman who
has just been diagnosed with HIV?
DAB: You know, for the thousand times
I’ve been asked that question, I wish I had
that answer that I loved, and could spit out
beautifully. The thing that automatically
comes out of my mouth, and it comes out
of many of the mouths of women I know is,
“You’re not alone.” There is an enormous sis-
“Basically, we nee d women in
clinical trials so we can know that
when my doct or prescribes a drug
for me, we know how it ’s going to
behave in my body.”
terhood of women living with HIV, though,
unfortunately, we are still largely invisible,
especially to the mainstream. But there are
all kinds of advances in our understanding
of HIV, and people are living well, they’re
living healthy, and they’re living out their
dreams, whether that’s crazy, silly dreams
like hiking Appalachian trails, or realistic
“real people” dreams like having a family.
And as devastating a blow as an HIV diagnosis
can be, it is also your key, I believe, to
staying well and taking care of yourself in a
way that you may never have thought about
doing before.
JB: Anything else you’d like to tell us?
DAB: No, except that I just feel incredibly
grateful and privileged to do the work
that I do. There are not many people in the
world who feel they’re doing what they’re
supposed to be doing, and I’m really thankful
to have that. e
Visit www.thewellproject .org.
Positively Aware
27

The Naked Truth:
Young, Beautiful
and HIV Positive
The courageous tale of
Marvelyn Brown
A book review by Keith R. Green
If Magic Johnson going public about his HIV status served notice
to African Americans that they were not exempt from the sting
of HIV, Marvelyn Brown’s story is a clear indication that the
younger generation did not get that memo.
Marvelyn was a daddy’s girl from Nashville, Tennessee. Th ough
she was oblivious to the ongoing drama between her parents, and
far too young to comprehend the details related to it, her troubles
in life can be traced to their separation.
Her mother ruled their household with an iron fi st, which,
from Marvelyn’s perspective, forced her father to leave when she
was only fi ve years old. From then on, he’d only show up occasionally
for birthdays or on holidays, leaving Marvelyn feeling rejected
and yearning for the type of consistent and (arguably) healthy male
aff ection that her father provided.
What she didn’t know was that he suff ered from addiction to
crack cocaine. Her mother had asked him to leave only aft er she’d
had enough of covering for him and pulling the weight of their
family on her own.
With only half the story, Marvelyn blamed her mother’s strictness
for her father’s departure, and, over time, developed a degree
of resentment towards her that would tarnish their relationship for
years to come.
As she grew older, the harder her mother pushed, the more
Marvelyn rebelled. School was never really her thing, but athletics
kept her involved, barely. She excelled in both basketball and
track, but allowed her insecurities to get the best of her, limiting
28 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware
Cover design by Mary Schuck • Cover photograph © Steve Azzara

her potential to succeed. She never really believed that she could be
good enough to make her mother proud.
From the long list of do’s and don’ts that her mother repeatedly
held over her, the thing that stood out the most for Marvelyn was to
not get pregnant. Neither HIV nor any other sexually transmissible
infection, for that matter, was ever mentioned.
Th ough she had learned a little about HIV in her high school
health class, Marvelyn attributes the lack of understanding that she
had about her own risks to the images in her textbook of sickly gay,
white men and terribly thin people from Africa. For her, those were
the faces of AIDS. And, because she was not having nearly as much
sex as she had read Magic Johnson was having in his heyday, nor
was anybody she knew, she was never able to recognize her connection
to the virus even through his example.
For the most part, though, she played it safe. Th ere were times,
however, when her desire to fi ll the void that had been left by her
father’s departure got the best of her. She tried, unsuccessfully, to
get pregnant a couple of times, believing that carrying a man’s child
would guarantee his love for her. Th e deprivation of a father’s love
can lead to warped thinking within a child. Marvelyn’s search for
love and acceptance from a man, however, eventually led her to
place her trust in the wrong one.
Her Prince Charming (as she aff ectionately dubbed him) came
complete with all the trappings of perfection, and a little something
extra to top it off . He was older, good looking, gainfully employed,
had his own place and car, and treated Marvelyn like the princess
that she knew deep down inside she was. Aft er several failed
attempts at love, Marvelyn was convinced that this was the one.
A couple of months into their relationship though, Marvelyn’s
dream was shattered as quickly as it had come to life. In relatively
great shape from her years as a high school athlete, Marvelyn was
perplexed by her sudden onset of chronic fatigue and drastic weight
PA • July / August 2009 • tpan.com • positivelyaware.com
loss. She assumed at fi rst that it was simply a passing bug, until her
symptoms became so severe that she literally passed out one morning
while getting ready for work.
She was not alone in her confusion with regards to her symptoms.
Test aft er negative test, doctors at a local hospital were also
baffl ed by what was going on with Marvelyn. One curious doctor
decided to conduct an HIV test, the results of which would change
Marvelyn’s life forever.
Th is doctor was able to determine that Marvelyn’s infection
was a recent one, but was amazed at the rate at which the virus
had advanced (her symptoms were not those typically associated
with HIV seroconversion). Completely unaware of the stigma associated
with HIV, Marvelyn began sharing her diagnosis with any
and everyone, in hopes of gaining a better understanding about the
virus that was ailing her. Why didn’t she know that she was at risk
for HIV, she wondered? And if she didn’t know, how many other
young, black women were also in the dark?
Th us began Marvelyn’s miraculous journey from a dying
young victim of the virus that causes AIDS to a world-renowned
advocate whose story has been featured everywhere from BET to
MTV to Th e Oprah Winfrey Show, and throughout the African
diaspora. Her story is chronicled in her deeply moving and inspiring
autobiography entitled Th e Naked Truth: Young, Beautiful and
(HIV) Positive. Th is book is a must-read for us all, but especially
for young African American women who, like Marvelyn, may be
totally unaware of their own vulnerability to HIV. e
The Naked Truth: Young, Beautiful, and (HIV) Positive (2008),
by Marvelyn Brown with Courtney E. Martin is published by Amistad,
an Imprint of HarperCollins Publishers; www.amist adbooks.
com. Visit www.marvelynbrown.com.
Positively Aware
29

697US09AB01702_DTC_LaunchAd_8x10.5_v3 2:- 4/6/09 3:49 PM Page 1
Important Information
INDICATION
ATRIPLA ® (efavirenz 600 mg/emtricitabine 200 mg/
tenofovir disoproxil fumarate [DF] 300 mg) is a
prescription medication used alone as a complete
regime n or with other medicines to treat HIV-1
infection in adults.
ATRIPLA does not cure HIV-1 and has not been
shown to prevent passing HIV-1 to others.
See your healthcare provider regularly.
IMPORTANT SAFETY INFORMATION
Contact your healthcare provider right away if
you experience any of the following side effects
or conditions associated with ATRIPLA:
• 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.
• If you have HIV-1 and hepatitis B virus (HBV),
your liver disease may suddenly get worse if
you stop taking ATRIPLA. Do not stop taking
ATRIPLA unless directed by your healthcare
provider.
Do not take ATRIPLA if you are taking the
following medicines because serious and
life-threatening side effects may occur when
taken together:
Vascor ® (bepridil), Propulsid ® (cisapride),
Versed ® (midazolam), Orap ® (pimozide),
Halcion ® (triazolam), or ergot medications (for
example, Wigraine ® and Cafergot ® ).
In addition, ATRIPLA should not be taken
with: Combivir ® (lamivudine/zidovudine),
EMTRIVA ® (emtricitabine),
Epivir ® or Epivir-HBV ® (lamivudine),
Epzicom ® (abacavir sulfate/lamivudine),
SUSTIVA ® (efavirenz),
Trizivir ® (abacavir sulfate/lamivudine/zidovudine),
TRUVADA ® (emtricitabine/tenofovir DF),
or VIREAD ® (tenofovir DF), because they contain
the same or similar active ingredients as ATRIPLA.
Vfend ® (voriconazole) or REYATAZ ® (atazanavir
sulfate), with or without Norvir ® (ritonavir), should
not be taken with ATRIPLA since they may lose their
effect and may also increase the chance of having
side effects from ATRIPLA. Fortovase ® or
Invirase ® (saquinavir) should not be used as the
only protease inhibitor in combination with ATRIPLA.
Taking ATRIPLA with St. John’s wort or products
containing St. John’s wort is not recommended as it
may cause decreased levels of ATRIPLA, increased
viral load, and possible resistance to ATRIPLA or
cross-resistance to other anti-HIV drugs.
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.
Contact your healthcare provider right away if you
experience any of the following side effects or
conditions:
Please see Patient Information on the following pages.
• Severe depression, strange thoughts, or angry
behavior have been reported by a small number
of patients. Some patients have had thoughts of
suicide and a few have actually committed suicide.
These problems may occur more often in patients
who have had mental illness.
• Dizziness, trouble sleeping or concentrating,
drowsiness, unusual dreams, and/or
hallucinations are common, and tend to go away
after taking ATRIPLA (efavirenz 600 mg/
emtricitabine 200 mg/tenofovir DF 300 mg) for
a few weeks. Symptoms were severe in a few
patients and some patients discontinued therapy.
These symptoms may become more severe with
the use of alcohol and/or mood-altering (street)
drugs. If you are dizzy, have trouble concentrating,
and/or are drowsy, avoid activities that may be
dangerous, such as driving or operating machinery.
• Kidney or liver problems. If you have had kidney
or liver problems, including hepatitis infection or
take other medicines that may cause kidney or
liver problems, your healthcare provider should do
regular blood tests.
• Pregnancy: Women should not become
pregnant while taking ATRIPLA and for
12 weeks after stopping ATRIPLA. Serious birth
defects have been seen in children of women
treated during pregnancy with one of the
medicines in ATRIPLA. Therefore, women must use
a reliable form of barrier contraception, such as a
condom or diaphragm, even if they also use other
methods of birth control.
• Breast-Feeding: Women with HIV-1 should not
breast-feed because they can pass HIV-1 through
their milk to the baby. Also, ATRIPLA may pass
through breast milk and cause serious harm to the
baby.
• Rash is a common side effect that usually goes
away without treatment, but may be serious in a
small number of patients.
• Seizures have occurred in patients taking a
component of ATRIPLA, usually in those with
a history of seizures. If you have ever had seizures,
or take medicine for seizures, your healthcare
provider may want to switch you to another
medicine or monitor you.
• Bone changes. If you have had bone problems in
the past, your healthcare provider may want to
check your bones.
• If you have ever had mental illness or use illegal
drugs or alcohol.
Changes in body fat have been seen in some people
taking anti-HIV-1 medicines. The cause and
long-term health effects are not known.
Other common side effects of ATRIPLA include
tiredness, headache, upset stomach, vomiting, gas,
and diarrhea. Skin discoloration (small spots or
freckles) may also happen.
You should take ATRIPLA once daily on an empty
stomach. Taking ATRIPLA at bedtime may make
some side effects less bothersome.
ATRIPLA is one of several treatment options
your doctor may consider.
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.
Patient model.
Individual results may vary.
© 2009 Bristol-Myers Squibb &
Gilead Sciences, LLC. All rights reserved.
ATRIPLA is a trademark of Bristol-Myers
Squibb & Gilead Sciences, LLC. EMTRIVA,
VIREAD, and TRUVADA are trademarks of Gilead
Sciences, Inc. SUSTIVA is a registered
trademark of Bristol-Myers Squibb Pharma
Company. REYATAZ is a registered trademark
of Bristol-Myers Squibb Company. All other
trademarks are owned by third parties.
697US09AB01702/TR1495 03/09

Please see Important Safety Information, including information
on lactic acidosis, serious liver problems, and flare-ups of
hepatitis B virus (HBV) on adjacent page.
*Synovate Healthcare Data; US HIV Monitor, Q3 2008.
“ATRIPLA has all my HIV meds
in one pill daily, and helps
me take charge of my HIV.”
ATRIPLA is the #1 prescribed HIV regimen. *
• Only ATRIPLA combines 3 HIV medications in 1 pill daily.
• Proven to lower viral load to undetectable † and help raise T-cell
(CD4+) count to help control HIV through 3 years of a clinical study.
Talk to your doctor to see if ATRIPLA is right for you.
Your doctor may prescribe ATRIPLA alone or with other HIV medications.
† Defined as a viral load of less than 400 copies/mL.
Steven
on ATRIPLA for 2 years
To learn more, visit
www.ATRIPLA.com

697US09AB01702_DTC_LaunchAd_8x10.5_v3 2: 4/6/09 3:49 PM Page 3
FDA-Approved Patient Labeling
Patient Information
ATRIPLA ® (uh TRIP luh) Tablets
ALERT: Find out about medicines that should NOT be taken with ATRIPLA.
Please also read the section “MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA.”
Generic name: efavirenz, emtricitabine and tenofovir disoproxil fumarate (eh FAH vih renz,
em tri SIT uh bean and te NOE’ fo veer dye soe PROX il FYOU mar ate)
Read the Patient Information that comes with ATRIPLA (efavirenz/emtricitabine/tenofovir
disoproxil fumarate) before you start taking it and each time you get a refill since there may
be new information. This information does not take the place of talking to your healthcare
provider about your medical condition or treatment. You should stay under a healthcare
provider’s care when taking ATRIPLA. Do not change or stop your medicine without first
talking with your healthcare provider. Talk to your healthcare provider or pharmacist if you
have any questions about ATRIPLA.
What is the most important information I should know about ATRIPLA?
• Some people who have taken medicine like ATRIPLA (which contains nucleoside
analogs) have developed a serious condition called lactic acidosis (build up of an acid
in the blood). Lactic acidosis can be a medical emergency and may need to be treated in
the hospital. Call your healthcare provider right away if you get the following signs
or symptoms of lactic acidosis:
• You feel very weak or tired.
• You have unusual (not normal) muscle pain.
• You have trouble breathing.
• You have stomach pain with nausea and vomiting.
• You feel cold, especially in your arms and legs.
• You feel dizzy or lightheaded.
• You have a fast or irregular heartbeat.
• Some people who have taken medicines like ATRIPLA have developed serious liver
problems called hepatotoxicity, with liver enlargement (hepatomegaly) and fat in the
liver (steatosis). Call your healthcare provider right away if you get the following
signs or symptoms of liver problems:
• Your skin or the white part of your eyes turns yellow (jaundice).
• Your urine turns dark.
• Your bowel movements (stools) turn light in color.
• You don’t feel like eating food for several days or longer.
• You feel sick to your stomach (nausea).
• You have lower stomach area (abdominal) pain.
• You may be more likely to get lactic acidosis or liver problems if you are female, very
overweight (obese), or have been taking nucleoside analog-containing medicines, like
ATRIPLA, for a long time.
• If you also have hepatitis B virus (HBV) infection and you stop taking ATRIPLA, you
may get a “flare-up” of your hepatitis. A “flare-up” is when the disease suddenly
returns in a worse way than before. Patients with HBV who stop taking ATRIPLA need
close medical follow-up for several months, including medical exams and blood tests to
check for hepatitis that could be getting worse. ATRIPLA is not approved for the treatment
of HBV, so you must discuss your HBV therapy with your healthcare provider.
What is ATRIPLA?
ATRIPLA contains 3 medicines, SUSTIVA ® (efavirenz), EMTRIVA ® (emtricitabine) and VIREAD ®
(tenofovir disoproxil fumarate also called tenofovir DF) combined in one pill. EMTRIVA and
VIREAD are HIV-1 (human immunodeficiency virus) nucleoside analog reverse transcriptase
inhibitors (NRTIs) and SUSTIVA is an HIV-1 non-nucleoside analog reverse transcriptase
inhibitor (NNRTI). VIREAD and EMTRIVA are the components of TRUVADA ® . ATRIPLA can be
used alone as a complete regimen, or in combination with other anti-
HIV-1 medicines to treat people with HIV-1 infection. ATRIPLA is for adults age 18 and over.
ATRIPLA has not been studied in children under age 18 or adults over age 65.
HIV infection destroys CD4 + T cells, which are important to the immune system. The immune
system helps fight infection. After a large number of T cells are destroyed, acquired immune
deficiency syndrome (AIDS) develops.
ATRIPLA helps block HIV-1 reverse transcriptase, a viral chemical in your body (enzyme) that
is needed for HIV-1 to multiply. ATRIPLA lowers the amount of HIV-1 in the blood (viral load).
ATRIPLA may also help to increase the number of T cells (CD4 + cells), allowing your immune
system to improve. Lowering the amount of HIV-1 in the blood lowers the chance of death or
infections that happen when your immune system is weak (opportunistic infections).
Does ATRIPLA cure HIV-1 or AIDS?
ATRIPLA does not cure HIV-1 infection or AIDS. The long-term effects of ATRIPLA are not
known at this time. People taking ATRIPLA may still get opportunistic infections or other
conditions that happen with HIV-1 infection. Opportunistic infections are infections that
develop because the immune system is weak. Some of these conditions are pneumonia,
herpes virus infections, and Mycobacterium avium complex (MAC) infection. It is very
important that you see your healthcare provider regularly while taking ATRIPLA.
Does ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate) reduce the risk
of passing HIV-1 to others?
ATRIPLA has not been shown to lower your chance of passing HIV-1 to other people
through sexual contact, sharing needles, or being exposed to your blood.
• Do not share needles or other injection equipment.
• Do not share personal items that can have blood or body fluids on them, like
toothbrushes or razor blades.
• Do not have any kind of sex without protection. Always practice safer sex by using a
latex or polyurethane condom or other barrier to reduce the chance of sexual contact with
semen, vaginal secretions, or blood.
Who should not take ATRIPLA?
Together with your healthcare provider, you need to decide whether ATRIPLA is right for you.
Do not take ATRIPLA if you are allergic to ATRIPLA or any of its ingredients. The active
ingredients of ATRIPLA are efavirenz, emtricitabine, and tenofovir DF. See the end of this
leaflet for a complete list of ingredients.
What should I tell my healthcare provider before taking ATRIPLA?
Tell your healthcare provider if you:
• Are pregnant or planning to become pregnant (see “What should I avoid while taking
ATRIPLA?”).
• Are breast-feeding (see “What should I avoid while taking ATRIPLA?”).
• Have kidney problems or are undergoing kidney dialysis treatment.
• Have bone problems.
• Have liver problems, including hepatitis B virus infection. Your healthcare provider
may want to do tests to check your liver while you take ATRIPLA.
• Have ever had mental illness or are using drugs or alcohol.
• Have ever had seizures or are taking medicine for seizures.
What important information should I know about taking other medicines with
ATRIPLA?
ATRIPLA may change the effect of other medicines, including the ones for HIV-1, and
may cause serious side effects. Your healthcare provider may change your other medicines
or change their doses. Other medicines, including herbal products, may affect ATRIPLA. For
this reason, it is very important to let all your healthcare providers and pharmacists know
what medications, herbal supplements, or vitamins you are taking.
MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA
• The following medicines may cause serious and life-threatening side effects when taken
with ATRIPLA. You should not take any of these medicines while taking ATRIPLA: Vascor
(bepridil), Propulsid (cisapride), Versed (midazolam), Orap (pimozide), Halcion (triazolam),
ergot medications (for example, Wigraine and Cafergot).
• ATRIPLA also should not be used with Combivir (lamivudine/zidovudine), EMTRIVA, Epivir,
Epivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), Trizivir (abacavir
sulfate/lamivudine/zidovudine), SUSTIVA, TRUVADA, or VIREAD.
• Vfend (voriconazole) should not be taken with ATRIPLA since it may lose its effect or may
increase the chance of having side effects from ATRIPLA.
• Do not take St. John’s wort (Hypericum perforatum), or products containing
St. John’s wort with ATRIPLA. St. John’s wort is an herbal product sold as a dietary
supplement. Talk with your healthcare provider if you are taking or are planning to take
St. John’s wort. Taking St. John’s wort may decrease ATRIPLA levels and lead to increased
viral load and possible resistance to ATRIPLA or cross-resistance to other anti-HIV-1 drugs.
It is also important to tell your healthcare provider if you are taking any of the following:
• Fortovase, Invirase (saquinavir), Biaxin (clarithromycin); or Sporanox (itraconazole); these
medicines may need to be replaced with another medicine when taken with
ATRIPLA.
• Calcium channel blockers such as Cardizem or Tiazac (diltiazem), Covera HS or Isoptin
(verapamil) and others; Crixivan (indinavir); Methadone; Mycobutin (rifabutin); Rifampin;
cholesterol-lowering medicines such as Lipitor (atorvastatin), Pravachol (pravastatin
sodium), and Zocor (simvastatin); or Zoloft (sertraline); these medicines may need to
have their dose changed when taken with ATRIPLA.
• Videx, Videx EC (didanosine); tenofovir DF (a component of ATRIPLA) may increase
the amount of didanosine in your blood, which could result in more side effects.
You may need to be monitored more carefully if you are taking ATRIPLA
(efavirenz/emtricitabine/tenofovir disoproxil fumarate) and didanosine together. Also, the
dose of didanosine may need to be changed.
• Reyataz (atazanavir sulfate) or Kaletra (lopinavir/ritonavir); these medicines may increase
the amount of tenofovir DF (a component of ATRIPLA) in your blood, which could result in
more side effects. Reyataz is not recommended with ATRIPLA. You may need to be
monitored more carefully if you are taking ATRIPLA and Kaletra together. Also, the dose
of Kaletra may need to be changed.
• Medicine for seizures [for example, Dilantin (phenytoin), Tegretol (carbamazepine), or
phenobarbital]; your healthcare provider may want to switch you to another medicine or
check drug levels in your blood from time to time.

These are not all the medicines that may cause problems if you take
ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate). Be sure to tell your
healthcare provider about all medicines that you take.
Keep a complete list of all the prescription and nonprescription medicines as well as any
herbal remedies that you are taking, how much you take, and how often you take them.
Make a new list when medicines or herbal remedies are added or stopped, or if the dose
changes. Give copies of this list to all of your healthcare providers and pharmacists every
time you visit your healthcare provider or fill a prescription. This will give your healthcare
provider a complete picture of the medicines you use. Then he or she can decide the best
approach for your situation.
How should I take ATRIPLA?
• Take the exact amount of ATRIPLA your healthcare provider prescribes. Never change
the dose on your own. Do not stop this medicine unless your healthcare provider tells
you to stop.
• You should take ATRIPLA on an empty stomach.
• Swallow ATRIPLA with water.
• Taking ATRIPLA at bedtime may make some side effects less bothersome.
• Do not miss a dose of ATRIPLA. If you forget to take ATRIPLA, take the missed dose right
away, unless it is almost time for your next dose. Do not double the next dose. Carry on
with your regular dosing schedule. If you need help in planning the best times to take your
medicine, ask your healthcare provider or pharmacist.
• If you believe you took more than the prescribed amount of ATRIPLA, contact your local
poison control center or emergency room right away.
• Tell your healthcare provider if you start any new medicine or change how you take old
ones. Your doses may need adjustment.
• When your ATRIPLA supply starts to run low, get more from your healthcare provider or
pharmacy. This is very important because the amount of virus in your blood may increase
if the medicine is stopped for even a short time. The virus may develop resistance to
ATRIPLA and become harder to treat.
• Your healthcare provider may want to do blood tests to check for certainside effects while
you take ATRIPLA.
What should I avoid while taking ATRIPLA?
• Women should not become pregnant while taking ATRIPLA and for 12 weeks after
stopping it. Serious birth defects have been seen in the babies of animals and women
treated with efavirenz (a component of ATRIPLA) during pregnancy. It is not known whether
efavirenz caused these defects. Tell your healthcare provider right away if youare
pregnant. Also talk with your healthcare provider if you want to become pregnant.
• Women should not rely only on hormone-based birth control, such as pills, injections, or
implants, because ATRIPLA may make these contraceptives ineffective. Women must use
a reliable form of barrier contraception, such as a condom or diaphragm, even if they also
use other methods of birth control. Efavirenz, a component of ATRIPLA, may remain in your
blood for a time after therapy is stopped. Therefore, you should continue to use
contraceptive measures for 12 weeks after you stop taking ATRIPLA.
• Do not breast-feed if you are taking ATRIPLA. The Centers for Disease Control and
Prevention recommend that mothers with HIV not breast-feed because they can pass the
HIV through theirmilk to the baby. Also, ATRIPLA may pass through breast milk and cause
serious harm to the baby. Talk with your healthcare provider if you are breast-feeding. You
should stop breast-feeding or may need to use a different medicine.
• Taking ATRIPLA with alcohol or other medicines causing similar side effects as ATRIPLA,
such as drowsiness, may increase those side effects.
• Do not take any other medicines, including prescription and nonprescription medicines
and herbal products, without checking with your healthcare provider.
• Avoid doing things that can spread HIV-1 infection since ATRIPLA does not stop you
from passing the HIV-1 infection to others.
What are the possible side effects of ATRIPLA?
ATRIPLA may cause the following serious side effects:
• Lactic acidosis (buildup of an acid in the blood). Lactic acidosis can be a medical
emergency and may need to be treated in the hospital. Call your healthcare provider
right away if you get signs of lactic acidosis. (See “What is the most important
information I should know about ATRIPLA?”)
• Serious liver problems (hepatotoxicity), with liver enlargement (hepatomegaly) and fat
in the liver (steatosis). Call your healthcare provider right away if you get any signs of liver
problems. (See “What is the most important information I should know about ATRIPLA?”)
• “Flare-ups” of hepatitisBvirus (HBV) infection, inwhich the disease suddenly returns
in a worse way than before, can occur if you have HBV and you stop taking ATRIPLA. Your
healthcare provider will monitor your condition for several months after stopping ATRIPLA
if you have both HIV-1 and HBV infection and may recommend treatment for your HBV.
• Serious psychiatric problems. A small number of patients may experience severe
depression, strange thoughts, or angry behavior while taking ATRIPLA. Some patients have
thoughts of suicide and a few have actually committed suicide. These problems may occur
more often inpatients who have had mental illness. Contact your healthcare provider right
away if you think you are having these psychiatric symptoms, so your healthcare provider
can decide if you should continue to take ATRIPLA.
• Kidney problems. If you have had kidney problems in the past or take other medicines
that can cause kidney problems, your healthcare provider should do regular blood tests to
check your kidneys.
• Changes in bone mineral density (thinning bones). It is not known whether long-term
use of ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate) will cause damage
to your bones. If you have had bone problems in the past, your healthcare provider may
need to do tests to check your bone mineral density or may prescribe medicines to help
your bone mineral density.
Common side effects:
Patients may have dizziness, headache, trouble sleeping, drowsiness, trouble concentrating,
and/or unusual dreams during treatment with ATRIPLA. These side effects may be reduced if
you take ATRIPLA at bedtime on an empty stomach. They also tend to go away after you have
taken the medicine for a few weeks. If you have these common side effects, such as
dizziness, it does not mean that you will also have serious psychiatric problems, such as
severe depression, strange thoughts, or angry behavior. Tell your healthcare provider right
away if any of these side effects continue or if they bother you. It is possible that these
symptoms may be more severe if ATRIPLA isusedwith alcohol or mood altering (street) drugs.
If you are dizzy, have trouble concentrating, or are drowsy, avoid activities that may be
dangerous, such as driving or operating machinery.
Rash may be common. Rashes usually go away without any change in treatment. In a small
number of patients, rash may be serious. If you develop a rash, call your healthcare provider
right away.
Other common side effects include tiredness, upset stomach, vomiting, gas, and diarrhea.
Other possible side effects with ATRIPLA include:
• Changes in body fat. Changes in body fat develop in some patients taking anti-HIV-1
medicine. These changes may include an increased amount of fat in the upper back and
neck (“buffalo hump”), in the breasts, and around the trunk. Loss of fat from the legs,
arms, and face may also happen. The cause and long-term health effects of these fat
changes are not known.
• Skin discoloration (small spots or freckles) may also happen with ATRIPLA.
Tell your healthcare provider or pharmacist if you notice any side effects while taking ATRIPLA.
Contact your healthcare provider before stopping ATRIPLA because of side effects or for any
other reason.
This is not a complete list of side effects possible with ATRIPLA. Ask your healthcare
provider or pharmacist for a more complete list of side effects of ATRIPLA and all the
medicines you will take.
How do I store ATRIPLA?
• Keep ATRIPLA and all other medicines out of reach of children.
• Store ATRIPLA at room temperature 77 °F (25 °C).
• Keep ATRIPLA in its original container and keep the container tightly closed.
• Do not keep medicine that is out of date or that you no longer need. If you throw any
medicines away make sure that children will not find them.
General information about ATRIPLA:
Medicines are sometimes prescribed for conditions that are not mentioned in patient
information leaflets. Do not use ATRIPLA for a condition for which it was not prescribed. Do
not give ATRIPLA to other people, even if they have the same symptoms you have. It may
harm them.
This leaflet summarizes the most important information about ATRIPLA. If you would like more
information, talk with your healthcare provider. You can ask your healthcare provider or
pharmacist for information about ATRIPLA that is written for health professionals.
Do not use ATRIPLA if the seal over bottle opening is broken or missing.
What are the ingredients of ATRIPLA?
Active Ingredients: efavirenz, emtricitabine, and tenofovir disoproxil fumarate
Inactive Ingredients: croscarmellose sodium, hydroxypropyl cellulose, microcrystalline
cellulose, magnesium stearate, sodium lauryl sulfate. The film coating contains black iron
oxide, polyethylene glycol, polyvinyl alcohol, red iron oxide, talc, and titanium dioxide.
September 2008
ATRIPLA is a trademark of Bristol-Myers Squibb&Gilead Sciences, LLC. EMTRIVA, TRUVADA,
and VIREAD are trademarks of Gilead Sciences, Inc. SUSTIVA is a trademark of Bristol-Myers
Squibb Pharma Company. Reyataz and Videx are trademarks of Bristol-Myers Squibb
Company. Pravachol is a trademark of ER Squibb & Sons, LLC. Other brands listed are the
trademarks of their respective owners.
SF-B0001B-10-08 21-937-GS-005 ST0064 Sept 2008

The
Feminization
of an Epidemic
Women represent the fastest growing demographic of HIV
infections worldwide. In order to work on reversing this
trend, we must have a thorough understanding of the
unique issues that aff ect women living with HIV infection. To date,
the medical community has focused a large amount of its research
eff orts on HIV/AIDS in men. 1, 2 However, both clinical experience
and the observational data that we do have suggest that, despite the
many similarities between HIV-positive men and women, there are
some sex/gender-related diff erences with important HIV prevention
and treatment implications. Th ese diff erences range from the
interaction of HIV and the female immune system, to the social
vulnerability that places women at higher risk for HIV and its complications.
In order to design eff ective prevention and treatment
strategies for HIV-positive women, we will need to understand and
address any gender diff erences in the susceptibility to, and progression
of, HIV infection. Th is article will review what we do know
about women and HIV in terms of prevention and treatment, as
well as highlighting areas that still require more research.
The statistics
Th e statistics serve as a potent reminder that specifi c HIV prevention
strategies for girls and women are greatly needed. Women
represent 46% of all people in the world infected with HIV. However,
the rate of new infections among women is climbing, with
50% of all new infections worldwide occurring in women (www.
unaids.org). Th e United States has not escaped this global trend.
Th e proportion of all AIDS cases in women has more than tripled
in the past 15 years, from 7% in 1985 to 29% today. 3
Women who are racial or ethnic minorities in this country are
disproportionately at risk for HIV/AIDS. Th e Centers for Disease
Control and Prevention (CDC) reports that, among HIV-positive
women in the United States, over 80% are either African American
or Hispanic. AIDS remains the leading cause of death in black
women ages 25-34 in the U.S., while it represents the 10th leading
cause of death in white women of the same age group.
Th e threat of death from HIV/AIDS remains high in older
African American women as well: AIDS is the 3rd and 4th leading
causes of death in black women ages 35-44 and 45-54 years old,
respectively. 4 Clearly, the rising rates of HIV infection in women
Women and HIV in the United States
by Saraswati Iobst, M.D. and Monica Gandhi, M.D., MPH
and the disproportionate impact on women of color in this country
require special attention.
Women may be unaware of their risks for HIV
infection
In order to prevent new HIV infection in women, we must fi rst
understand how women are being infected with HIV. According to
many studies, approximately 40% of HIV-positive women report
that they contracted HIV through sex with men. Th is number has
not changed dramatically over the past two decades.
What has changed, however, is an increasing number of
women who do not know how they got HIV. In one large study
of over 2,000 HIV-positive women, 48% of participants could not
identify how they had contracted HIV. 5 Other studies have shown
similar percentages of women not knowing how they contracted
HIV, which likely indicates that women may not necessarily know
the risk status of their male partners. 6
A commonly-described phenomenon in the African American
community, which may place black women at additional risk, is
“down-low” behavior, where non-gay-identifi ed men have secretive
sex with other men and then unprotected intercourse with female
partners. 7 However, some analyses have shown that there is no real
evidence that “down-low” behavior is fueling the epidemic among
black women and that HIV prevention eff orts in the African American
community should not be focused on a single risk behavior. 8
Because the majority of women in the United States acquire
HIV through sex with men, oft en without any knowledge that they
are at risk, prevention eff orts in women must focus on increasing
awareness of risk and routine diagnosis. Early diagnosis is critical
to the prevention of HIV and AIDS.
We know that identifying HIV in an individual decreases the
risk of him or her infecting somebody else because of behavior
modifi cation. 9 HIV treatment also decreases a person’s infectivity
if he or she achieves undetectable viral loads. People who are diagnosed
earlier also have a lower risk of progression to AIDS.
Unfortunately, an estimated 24–27% of people living with
HIV in the United States are unaware of their status. Furthermore,
according to a National Health Interview Survey conducted in 2007,
only 36% of adults reported ever being tested for HIV. 10
34 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

In hopes of strengthening HIV prevention eff orts and maximizing
the effi cacy of treatment for HIV-positive individuals, the
CDC published new recommendations in September 2006 that all
adults aged 13-64 should be tested at least once for HIV in a medical
setting and that people at higher risk should be tested annually.
11 Th e guidelines recommend opt-out screening, where a patient
would be informed that he or she will be tested for HIV infection
and given the opportunity to decline, instead of the previously
instituted opt-in screening, where written consent was required for
testing. Th e guidelines relaxed requirements on written consent
and pre-testing counseling, which can be
both time and labor intensive, in the hopes
that this would decrease barriers for HIV
screening for both patients and providers.
These recommendations have not
been fully implemented throughout the
United States, since each state has needed to address the guidelines
separately. California turned the CDC recommendations into law
Table 1: Female-controlled methods of HIV prevention
Method Current status
Female condom Effective in reducing HIV
transmission, but limitations
include its expense, the fact
that the female condom is not
covert and the potential noise
that the latex can make during
intercourse.
Microbicides Multiple trial failure; PRO2000
(0.5%) in preliminary studies
shows up to 30% reduced risk of
transmission
Diaphragms No evidence of efficacy in
reducing infection rates to
women
Oral tenofovir-based
prophylaxis
In trials
Partner treatment Reduces risk of transmission to
serodiscordant partners
PA • July / August 2009 • tpan.com • positivelyaware.com
in 2007 with the passage of AB 682, which waives the need for written
consent for HIV testing in this state. Widespread implementation
of these recommendations would be especially benefi cial to
women in this country, given the lack of perceived risk factors for
HIV in this population. [Also see “Doctors Urge the Government
to Keep up With Medical Progress” on page 49.]
HIV prevention strategies in women
Women are biologically and sociologically more vulnerable to
HIV infection than men. Women are at greater risk of HIV infec-
Prevention efforts
need to focus on
providing women with
female-controlled
prevention modalities.
tion through heterosexual sex than are men simply by virtue of an
unequal exchange of genital secretions. Th e risk of transmission of
HIV from a man to a woman is approximately 1 in 1,000 for each
sexual contact, whereas the risk of transmission from a woman to
a man is much less (approximately one in 2,000). 12
Women may also be at increased risk of infection during certain
phases of their menstrual cycles (7-10 days following ovulation)
because of hormonal interactions with the immune system, 13
though further studies are needed on this topic.
Women living in both resource-rich and resource-poor settings
are vulnerable to HIV infection through sex for a variety of
reasons, oft en arising from positions of dependence and an inability
to insist upon the use of male condoms.
Because women are more vulnerable to HIV through heterosexual
sex, prevention eff orts need to focus on providing women
with female-controlled prevention modalities. Currently, the male
condom is the most eff ective form of HIV prevention for people
engaging in sex, followed by male circumcision in terms of specifi
c protection for the male partner. Obviously, women have much
less control over the use of a male condom during a heterosexual
encounter than men. Women-focused methods for HIV prevention
are listed in Table 1. Although the female condom does have
some effi cacy in reducing HIV transmission, it is not completely
covert, as the outer ring or frame is visible outside the vagina. Further
reducing its acceptability is the potential noise that the latex
can make during intercourse. Additional hindrances to the use of
the female condom include the fact that it is not readily available
Positively Aware
35

in many countries, can be diffi cult to insert and remove, can be
more expensive than male condoms and historically, can be used
only once.
Microbicides and diaphragms have received a lot of attention
as they are relatively inexpensive and are completely female-centered
modalities of prevention.
Diaphragms were studied with lubricant gel in a large randomized
open-label controlled trial of 4,948 HIV-negative Zambian and
South African women and showed no effi cacy in protecting women
against HIV transmission. 14
Microbicides are biological or chemical substances that reduce
transmission of HIV or other sexually transmitted diseases when
applied to the vagina or rectum. Ideally a microbicide would be
eff ective, safe with frequent use, widely available, easy to store and
use, surreptitious, and acceptable to a variety of cultures. Most
studies to date on diff erent microbicide products, starting with the
failure of nonoxynol-9 to protect women against HIV infection
(and the possibility of increased transmission rates), have shown
disappointing results in terms of interrupting transmission.
A recent study has provided some hope for the fi eld of microbicides
and for the possibility of a female-controlled HIV prevention
method at last. Th e interim safety and eff ectiveness results of
a microbicide called PRO2000 (0.5%) were released at the 2009
Conference of Retroviruses and Opportunistic Infections (CROI)
in Montreal, Canada a few months ago. PRO2000 (0.5%) is a highly
negatively-charged molecule (a polyanionic polymer) that is
designed to interfere with HIV entry into target calls. Th e HPTN035
We are starting to
see a new trend of
better outcomes
in women compared
to men.
trial was also designed to study another microbicide product
(Buff erGel) whose primary action is to lower vaginal pH levels. Th e
trial enrolled 3,909 women from Malawi, South Africa, the United
States, Zambia, and Zimbabwe, into four arms: the PRO2000 (0.5%)
gel arm, the Buff erGel arm, a placebo gel arm, and a no gel arm. Th e
trial followed participants for a mean of 20.4 months.
Both microbicide products showed favorable safety profi les in
the trial. While Buff erGel did not show a protective eff ect against
HIV, the trial indicated that PRO2000 was at least 30% more eff ective
than any other arm in the study in preventing new HIV infections.
Th is preliminary trial was not designed to generate defi ni-
tive data on PRO2000, although the data is highly suggestive of the
potential effi cacy of this product. Th ese fi ndings were viewed with
a great deal of enthusiasm in the microbicide and HIV prevention
fi elds and other studies are underway. Studies that are looking at
the effi cacy of a once-a-day pill (tenofovir or tenofovir/emtricitabine)
for HIV-negative people to protect themselves against HIV
infection (the pre-exposure prophylaxis or PrEP trials) are also
underway. [Also see What’s Goin’ On on page 52.]
Treatment issues for HIV-positive women
HIV viral loads and CD4 counts in women versus men
Th ere are clearly many unique issues that aff ect HIV prevention
strategies for women, and the same is true for HIV treatment.
Once a person is diagnosed with HIV, clinicians depend on viral
loads and CD4 counts to determine when a patient should start
treatment and to determine if their medications are working.
It is generally assumed that a higher viral load means more
viral activity in the body, and a higher CD4 count means a stronger
immune system against HIV.
We aim for undetectable viral loads and higher CD4 counts in
the context of antiretroviral therapy. However, these assumptions
and treatment guidelines were based mainly on studies on men. We
are now learning that the immune system in women and HIV may
interact diff erently than they do in men. Th ese fi ndings have led to
some changes in treatment guidelines, as summarized below.
Multiple studies have shown that
women have lower levels of HIV (as measured
by HIV RNA levels) in their blood
than men do, even at the same CD4
counts. 15 Th is means that at a certain CD4
count (usually at higher CD4 counts), men
will tend to have a higher viral load than
women. Th is diff erence can be as much as
two to six-fold for HIV viral levels.
However, both men and women will
progress to AIDS at the same rate. Another
way to interpret this is that women are at
increased risk of progression to AIDS when
compared to men with the same viral loads,
especially early on in infection. It is unclear
why this phenomenon occurs, but these
fi ndings have led to important treatment
guideline changes.
Prior guidelines recommended incorporating
the HIV viral load to guide decisions
regarding when to start treatment and
when to modify therapy. However, that recommendation would
mean that women would oft en get started on treatment much
later than their male counterparts even though they had the same
amount of immune suppression.
Guidelines have now changed to refl ect that women oft en have
viral loads that are much lower than men and the decision regarding
when to start treatment is now made based on CD4 counts
instead of viral loads.
Women also tend to have higher CD4 cell counts than men, at
least early on in infection. Th is does not necessarily mean that they
have stronger immune systems, because we have found that women
36 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

can develop AIDS at higher CD4 counts
than men. Some authors have argued that,
because women have higher CD4 counts
when they develop AIDS, perhaps they
should be started on highly active antiretroviral
therapy (HAART) at higher CD4
counts than men. More research is needed
to determine how to use viral loads and
CD4 counts in women to determine when
to start antiretroviral (ARV) treatment.
Efficacy of HAART in women versus men
Despite the above diff erences in CD4 counts and viral loads
between men and women, recent studies have shown that HAART
is just as eff ective in women as it is in men. Early in the HIV epidemic,
women with HIV seemed to progress faster to AIDS and
death than men, 16 most likely because of decreased HIV testing,
access to antiretrovirals (ARVs) and HIV care, lower rates of medication
adherence in HIV-positive women, and higher rates of IV
drug use among women with HIV.
Disease progression to AIDS and death between men and
women seemed to level out in the mid-1990s to early 2000s as more
and more women were diagnosed with HIV and started on ARV
treatment. 17 In the current era, we are starting to see a new trend of
better outcomes in women compared to men. 18
Th e reasons for this trend are multifactorial and all are not well
understood, although increased access to HIV testing and ARVs
have defi nitely contributed. Women also tend to have higher levels
of ARV medications in their blood than men, which may lead to
improved responses to treatment. Th e consequence of higher drug
levels than men, however, can also be a higher number of adverse
eff ects.
Antiretroviral drug levels in women versus men
Cross-sectional and small pharmacokinetic studies have
shown that women tend to have higher levels of antiretrovirals in
their blood than men. 19 Th is may partially explain the recent trend
of improved outcomes among women as more and more women
have access to medications.
In addition, in the current era, it is possible that drug-experienced
patients on antiretrovirals may have better outcomes when
they have higher drug levels in their blood. Th ere are many variables
that contribute to how people’s bodies process medications,
many of which are aff ected by
gender and hormones.
For example, women generally
weigh less and will therefore
oft en have higher plasma levels
of ARVs at a given dose. Estrogen
aff ects protein production in the
body, which will aff ect drug levels
because proteins oft en attach
to drugs in the blood and carry
them around. Men seem to clear
antiretroviral medications more
rapidly than women due to differences
in kidney and liver function.
In general, there are a multitude
of reasons why women may
PA • July / August 2009 • tpan.com • positivelyaware.com
have higher levels of HIV medications in their bloodstream and
this fact may explain better treatment responses and higher rates
of side eff ects.
Rates of side effects on antiretrovirals are higher
in women than men
Higher levels of ARVs may also have detrimental eff ects for
women. We have found that women experience more frequent and
severe side eff ects from antiretrovirals compared to men. 20
Th is remains an important issue to understand and address
because side eff ects aff ect women’s quality of life, overall health,
and place them at risk for stopping medications that they cannot
tolerate, which could have devastating
eff ects on their HIV treatment.
Th ere are many diff erent side
effects of antiretrovirals, but the
most commonly reported side eff ects
that seem to be worse in women are
rashes, liver toxicity, and fat distribution
changes.
Women of child-bearing age
represent an important category to
consider because certain antiretrovirals
can have negative eff ects on
the fetus if a woman should become
pregnant.
Rash
People commonly develop rashes
as a side eff ect of antiretrovirals; most are mild, but some can
lead to serious complications, including hospitalization and even
death.
Studies have shown that non-nucleoside reverse transcriptase
inhibitor (NNRTI)-induced rashes are more common and tend to
be more severe among women. 21
A study of nevirapine (Viramune) showed that 15.8% of women
compared to 8.4% of men developed rashes. Women were approximately
seven times more likely than men to develop a severe rash,
and 3.5 times more likely to discontinue nevirapine because of their
rash. 22
Another study confi rmed this fi nding and also reported a
trend of increased risk of rash among patients with higher CD4
counts. 23
Studies of pregnant women have shown varied results, but
most studies suggest that they have either the same or a reduced
risk of NNRTI-induced rash than non-pregnant women.
Another study of a new NNRTI, etravirine (Intelence), also
showed that women had an increased risk of rash compared to men,
34% versus 18%. 24
Liver damage
Women are also at increased risk of liver damage related to
nevirapine compared to men. In fact, according to reports from
post-marketing surveillance of this drug, women with CD4 counts
higher than 250 cells/mm 3 had a 12-fold increased risk of developing
clinically signifi cant liver damage compared to women with
CD4 counts less than 250. Th is is in stark contrast to men who had
a fi ve-fold increased risk of liver damage with higher CD4 counts
(at greater than 400 cells/mm 3 ) compared to men with lower CD4
Positively Aware
37

counts. 25 In a study from South Africa of HIV patients on nevirapine,
20% of women compared to 12.8% of men had serious liver
damage. Interestingly, 50% of the liver damage in the female group
occurred in very thin women with body masses indices less than
18.5. 26
Fat redistribution
Antiretroviral medications are well-known for their fat redistribution
side eff ects, though this has been improving with more
recent agents. However, women are uniquely aff ected by these side
eff ects compared to men. Th is is likely due to a few reasons. First,
women have more total body fat than men. And second, HIV-positive
women tend to have more central obesity. However, women
and men tend to have equal rates of fat loss from their extremities.
Patients have described this fat pattern in women as resembling
“beach balls on sticks.” [See “Lipodystrophy and Women,” May/
June 2004 issue.] Further studies need to be done to understand the
specifi c fat redistribution eff ects of ARVs in women, especially to
determine if these changes could have detrimental eff ects on their
overall health.
Bone thinning
Osteoporosis is defi ned as decreased bone mineral density and
abnormal architecture of bone that increases the risk of serious
fractures, which are in turn associated with a higher risk of death
over 5 to 10 years.
We already know that women in general are at increased risk
of developing osteoporosis aft er menopause, but studies have also
shown that HIV infection alone increases a person’s risk of losing
bone mineral density. Th is places both men and women infected
with HIV at increased risk of osteoporosis. 27
HIV-positive women are at even higher risk, in fact approximately
three times higher, for bone thinning than HIV-positive
men. Other risk factors for HIV-positive individuals and bone loss
include older age, lower body mass indices, higher viral loads, and
lower CD4 counts. 28
Th ere is some data to suggest that certain antiretrovirals may
lead to bone mineral density loss. For example, two studies found
that HIV-positive individuals on protease inhibitor (PI)-containing
ARV regimens had higher rates of osteopenia and osteoporosis than
HIV-positive individuals not on PI-containing regimens.
Tenofovir (Viread) has been associated with bone thinning
over time in randomized studies, possibly related to phosphate
wasting on this drug. A large study that randomized patients to
continuous therapy versus intermittent therapy (the SMART study)
showed that patients in the continuous antiretroviral arm had
higher rates of bone loss than those on intermittent ARVs.
Most studies, however, show that HIV itself is a risk factor,
whether or not antiretrovirals are implicated, and that higher viral
loads, lower CD4 cell counts, and longer durations of HIV infection
are associated with higher rates of bone mineral density loss, arguing
that treatment of HIV infection is important in the prevention
of osteoporosis. Many other studies have looked at standard osteoporosis
treatments with bisphosphonates and calcium/vitamin D
supplementation in HIV-positive patients on ARVs and have found
these to be safe and eff ective treatments for osteoporosis. Most
authors argue that vitamin D defi ciency should be ruled out in any
HIV-positive patient with signifi cant osteoporosis to determine the
need for extra supplementation.
Th e bottom line here is that women with HIV need to be
screened for osteoporosis regularly, and that both the treatment of
their HIV and regular treatment for osteoporosis are warranted.
HIV treatment considerations in pregnancy
Women who could become pregnant require special consideration
when deciding on the appropriate antiretroviral regimen
because of the various eff ects of certain ARVs on pregnant women
and the fetus.
Efavirenz (Sustiva), which is a component of Atripla, is especially
worrisome because this drug is known to cause serious neurologic
consequences in the fetus and should be avoided in pregnancy.
Women should be on birth control if they are sexually active
while on efavirenz.
Other ARVs that should be used with caution in pregnant
women include didanosine [Videx] and stavudine [Zerit] together,
which can lead to serious metabolic and liver conditions in
women.
Women with CD4 counts above 250 cells/mm 3 have been
shown to be at higher risk of life-threatening liver toxicity and rash
when starting nevirapine, as reviewed above, so this agent should
also be used with caution in pregnant women.
Important psychosocial considerations for HIVpositive
women
We have reviewed many of the biological and pharmacologic
issues that are important in the treatment of HIV-positive women.
However, many social and cultural issues, with special relevance
to women, aff ect HIV treatment considerations just as they aff ect
HIV prevention.
Only 60% of HIV-positive females who qualify for HAART in
the U.S. are on this life-saving therapy, compared to 75% of HIVpositive
men who qualify for therapy. Th e reasons for this gender
disparity need to be further elucidated, but some of the reasons lie
in community beliefs regarding HIV/AIDS.
An interesting survey in 2005 interviewed 500 African Americans
in the U.S. about their beliefs about HIV (65% were women).
Of those surveyed, 53% believed that a cure for AIDS exists, but
was being withheld from the poor; 44% felt that people taking new
medications were “guinea pigs”; and 27% thought that AIDS was
created in a government lab. 29
Clearly, conspiracy beliefs and suspicions regarding the medical
establishment in the African American community will aff ect
HIV-positive women more than men, given the disproportionate
percentage of minorities.
Another reason that women are less likely to engage in HIV
treatment or care lies in higher rates of physical and sexual abuse
38 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

in women. A history of abuse has been shown to decrease the
likelihood that a woman will start and stay on an antiretroviral
regimen.
In addition, women who suff er from substance abuse issues,
such as cocaine addiction, are also at increased risk of not starting
treatment for their HIV when relevant.
And let’s not forget the overwhelming eff ect of stigma, which
disproportionately effects women both internationally and
domestically.
A national survey performed by the American Foundation for
AIDS Research (AMFAR) and released in 2008 revealed the following
disturbing results regarding stigma against HIV-positive
women: of almost 5,000 individuals polled, approximately 70%
would not want an HIV-positive female dentist; 60% would not
want an HIV-positive physician or childcare provider; and 50%
would not want an HIV-positive food server. Only 14% of Americans
polled felt that HIV-positive women should have children.
Th is is less than the percentage of Americans who felt that women
with schizophrenia or Down’s Syndrome should have children, at
17% and 19% respectively.
Strategies to improve HIV prevention and treatment in women
need to address physical and sexual abuse, stigma, community
beliefs, and substance abuse issues in order to be successful.
Ending with a success story
Th ere has been one major treatment success story in women
in the U.S. that needs to be commended, which is in the domain
of prevention of mother-to-child transmission (PMTCT). Th e
risk of HIV-positive mothers giving birth to HIV-positive babies
has decreased from approximately 25% in 1993 to less than 1%
today due to appropriate treatment. Th is decline is secondary to
increasing HIV testing rates during pre-natal visits, increasing
use of HAART in HIV-positive women during their pregnancies
to prevent transmission to the fetus, and an increase in elective
Cesarean-section births by HIV-positive women with viral loads
that are greater than 1,000 copies/ml.
Worldwide, the number and percentage of women accessing
PMTCT medications has also increased from approximately 10%
in 2004 to almost 35% in 2007, although rates of such access are
still woefully low.
Th e current guidelines in the U.S. for PMTCT are to start
HAART in the second trimester if the mother is not already on
therapy and to give intravenous zidovudine (AZT) to the mother
during delivery. At the time of delivery, the options for the delivery
mode are determined by the mother’s HIV viral load.
If the viral load is less than 1,000 copies/ml, vaginal delivery is
as safe as C-section in terms of transmission rate to the baby. Th e
baby receives six weeks of oral AZT aft er delivery. If no treatment
is started prior to labor, the mother and infant should receive treatment
at birth and the infant should receive post-exposure prophylaxis
[HIV medications used to prevent infection].
In summary, HIV infection rates are increasing disproportionately
among women, especially in minority groups. Prevention of
HIV in women needs to come from increased awareness of HIV
through routine screening and through providing women with
eff ective, safe, female-centered prevention methods. Of the little
that is known regarding HIV treatment and women, we know that
women will do as well, if not better, on ARVs compared to men.
Th is may be in part due to higher levels of drugs found in women,
PA • July / August 2009 • tpan.com • positivelyaware.com
which may also explain the higher levels of side eff ects of these
medications in HIV-positive women.
Despite the improvement in HIV treatment outcomes in
women, gender disparities, abuse, and stigma still remain signifi -
cant barriers to HIV prevention and treatment.
And fi nally, it is important to focus on PMTCT as a success
story in the U.S. because this story shows that, when signifi cant
research and program implementation eff orts are instituted, amazing
progress in HIV prevention and treatment is possible. Th is
should serve as an example for increasing research eff orts and special
programs aimed at improving HIV prevention and treatment
for women. e
Strategies to improve
HIV prevention and
treatment in women
need to address
physical and sexual
abuse, stigma,
community beliefs,
and substance abuse
issues in order to be
successful.
Monica Gandhi, M.D., MPH, is an Assist ant Professor of Medicine
in the Division of HIV/AIDS at the University of California, San
Francisco (UCSF). She sp ecializes in the clinical care of HIV-infect ed
women and direct s the HIV inpatient consult service at San Francisco
General Hosp ital. Her research career is focused on examining
treatment issues for HIV-infect ed women in the Women’s Interagency
HIV Study (WIHS), a large prosp ect ive multicenter cohort st udy
of HIV-infect ed women.
Saraswati Iobst , M.D., is a second-year resident in the University
of California Primary Care (UCPC) program at the University of
California, San Francisco (UCSF). She graduated from the University
of Pennsylvania, School of Medicine in 2007. Her career interest s
include HIV, primary care, and international health.
Referenced footnotes available online at www.positivelyaware.com.
Positively Aware
39

Aft er searching unsuccessfully for
an HIV-positive Native American
woman to interview here in Chicago,
the American Indian Community
House in New York suggested Lisa Tiger.
We spoke by phone; her honesty and willingness
to share her experiences and wisdom
were refreshing and inspirational.
No shame
A member of the Muscogee Nation and
of Creek, Seminole, Cherokee, and Irish
descent, Lisa Tiger has been one of the few
public Native American faces of AIDS since
1992 when she was fi rst diagnosed with HIV,
advancing to AIDS in 1999.
When asked how she became an advocate
in the fi rst place, she explained, “It
was something that just happened. Th ere’s
something about me—things just don’t
embarrass me. From the moment I found
out I was positive, I told everybody. My
mom thought I was crazy and my uncle told
me not to go around telling everybody. But,
even though at fi rst I was shocked to fi nd
out I was positive, I wasn’t embarrassed or
ashamed.”
Wilma Mankiller, fi rst female chief of
the Cherokee Nation, asked her to come
to the reservation and share her story. She
accepted the invitation because, she says,
“Th ere is such a need for education. And
people weren’t paying attention to the Red
Cross coming in with their classes. Th ey
needed to hear from one of their own.” She
also believes that prevention eff orts must be
made more authentically culturally-based
in order to get the message out to Native
American people.
Hardship
It was clear, hearing her story, that this
is a woman who has dealt with more tragedy
in her life than most of us can imagine.
Starting with the death of her father when
she was 2½, she has also lost her brother
and an adopted daughter, both murdered,
as well as an ex-fi ancé who “drank himself
to death.” In addition to her losses, she is
dealing with Parkinson’s disease as well as
AIDS.
As if all that wasn’t enough, she is currently
in the midst of a divorce and custody
battle over her fi ve-year-old daughter, who
she conceived by self-administered artifi cial
insemination. With a deep sense of perception
and a touch of sadness, she told me, “My
husband is a good guy,” remembering times
when his support helped her face some of
life’s diffi culties. As our phone conversation
continued while she drove towards Santa Fe
to fi nd her daughter, she stated hopefully
that they would work things out.
Forgiveness
Her ability to look past anger and sadness
is the result of several life lessons. She
told me that when she was 40, she gave herself
10 years to fi nally tell the truth about
all the things she’d done in her life that she
Tiger Medicine
A Native American woman’s story
by Sue Saltmarsh
regretted or was ashamed of. In giving me
some examples, I thought that if everyone
were willing to be as honest about their
human foibles as she was, we’d all be better
off ! She found that once she started with her
honesty campaign, it turned out to be not
as daunting as she’d thought and she was
able to get it all done way before the 10-year
deadline.
She also gave Oprah, and some of her
guests, credit for inspiring her to make a
conscious eff ort to “be a healthier person”
in many ways. She found that once she forgave
herself for the mistakes she’d made, she
found forgiveness of others easier. “Th ere’s
no hate, no anger. Anything’s forgivable.”
She has even found a way to replace the
anger she felt towards the killers of her
brother and daughter with compassion and
peace.
Dedication
Tiger credits tenacious dedication to
exercise as one of her survival secrets. “I’ve
done a mile every day for over two years
now,” she proudly states. “It doesn’t matter
if I walk, run, or do the stationary bike as
long as I do a mile of something.” She found
that even while at the hospital bedside of a
dying friend, her commitment got her to
the gym every day.
Th at dedication shows up in other ways
as well. In addition to the public presentations
she does, she admits that she “always
wants to be a good friend, the one people
40 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware
Photo © Gerald Woff ord

call when they need someone to talk to” and
her generosity of heart is evident in everything
from her 1996 adoption of four abandoned
and abused children from the Pine
Ridge Indian Reservation, to the opening of
her home to her ex-fi ancé’s cousin. She even
has a plan in case she wins the lottery—to
build a fi tness center on the Pine Ridge Reservation
in honor of her friend, Leo Black
Feather.
Native American factors
When asked about some of the factors
that are contributing to the increase in HIV
infections among Native Americans (see
sidebar), women in particular, Tiger cited
poverty, self-esteem issues, and alcoholism,
but added that those things, along with
domestic violence, accidental death, and
suicide are so common in Native American
communities that HIV is not at the top of
the list of diffi culties and dangers that tribal
people must deal with. In fact, in a way, she
feels that HIV has become, for her, a way out
of a painful life—it has given her purpose
and through the speaking she does, sharing
the story about her life and HIV/AIDS, she
has found emotional healing.
When asked about her philosophy of
life, Tiger noted that the Native American
sense of humor had oft en gotten her
through hard times. “Aft er all,” she laughed,
“you gotta go through the manure to get to
the magic.” e
PA • July / August 2009 • tpan.com • positivelyaware.com
There’s no hate, no anger.
Anything’s forgiveable.
Native Americans & HIV/AIDS
According to the most current data available from the U.S. Department of Health
and Human Services’ Offi ce of Minority Health and the Centers for Disease Control
and Prevention (CDC) 2005 HIV/AIDS Surveillance Report, revised in August 2008,
it has been determined that in the 33 states with long-term, confi dential, name-based
HIV reporting, the rate per 100,000 persons with HIV/AIDS diagnoses was 10.4 for
Native Americans, as compared to 71.3 for African Americans, 27.8 for Latinos, and
8.8 for whites. It should be noted that the number for Native Americans may be skewed
by racial misclassifi cation during data-gathering. For instance, according to the CDC,
“In Los Angeles, 56% of American Indians and Alaska Natives with AIDS were racially
misclassifi ed.” In addition to HIV infection rates being high, Native Americans also
have the lowest AIDS survival rate of any group – only one in four lives longer than
three years aft er an AIDS diagnosis. Th e Center for AIDS Prevention Studies at the
University of California San Francisco cites factors such as poverty (32% of NA live
below poverty level, as compared with 13% of the general population), high rates of
alcohol and substance abuse, STDs, and mental health problems as all playing a part in
the HIV infection rate.
According to the CDC, in 2007, 201 new cases of HIV infection were reported
among Native American men and 69 among women. Th is puts the rate of infection
among women at almost 26%, a rate three times higher than the rate for white women.
Violence, domestic and otherwise, may be an underlying cause. According to the U.S.
Department of Justice (1999), “the rate of violent crimes against Native American
women is highest among all ethnic categories.” A 2006 study published in the American
Journal of Public Health reported that 48% of NA women reported being raped, 62%
reported physical assault, and 40% reported multiple victimizations. Th e Department of
Health and Human Services reports that “Native American and Alaska Native women
experience the highest rate of intimate partner violence of any ethnic group.” With 68%
of HIV infections in these women being attributed to heterosexual contact, domestic
violence is obviously a signifi cant factor.
In order to promote prevention and testing programs in Native communities, the
CDC funds Capacity Building Assistance programs through such organizations as the
National Native American AIDS Prevention Center and the Inter Tribal Council of
Arizona. Mobilization eff orts like National Native American HIV/AIDS Awareness Day
(the second annual day occurred on March 20 of this year) help communities to plan
events like talking circles, pow-wows, testing opportunities, and the presentations of
speakers like Lisa Tiger that will hopefully continue to raise awareness and help develop
sound strategies for Native Americans to lessen the toll the disease takes on their communities.
Th anks to Felicia and Alice at the American Indian Health Service in Chicago for
providing insight and information and for the work they’re doing to reach out to those
at risk in the Native American community.—Sue Saltmarsh e
Visit their website at www.natHIVeamericanawareness.org
Positively Aware
41

When I started working here at Test Positive Aware Network
(TPAN) more than a decade ago, I heard of women
infected during the 1980s who thought they weren’t at
risk because “it’s a gay disease.”
Now, working on this issue, I’ve heard of recently infected
women who didn’t think they were at risk because they thought
that “it’s a gay disease.”
Of special concern today is the fact that black women make up
66% of all new infections among women in the U.S.
“I thought he loved me”
A former co-worker here at TPAN went to another organization
and was astounded at the number of newly diagnosed young
women he sees, including middle-class, black college students.
He said that when he asks them about condoms, they tell
him, “I thought he loved me” or “We’ve been seeing each other for
a while.” “One girl told me, ‘I’ve been with this guy since I was 16.
We’ve broken up once or twice, but he would never do
anything to hurt me.’ One of the women had a
partner who was recently in jail for drug possession.
Most of them saw the HIV ads on
Protect
Yourselves, rselves, Lad Ladies
the [Chicago public] trains, but didn’t
think the message applied to them.”
He explained their reasoning.
“They weren’t sleeping around.
Th ey weren’t prostituting. Some
of them already have a kid
with their partner. If they get
with a guy close to their age,
they expect him to be HIVnegative.
Their life was so
heterosexual and their man
was straight and not on the
down-low. Th ey didn’t think
they were at risk at all. ‘How did
it cross over to me?’
“It crossed over with unfaithful
men and not knowing what they’re
doing and who they’re doing it with,” he
said. “Th e black community still thinks it’s
only the promiscuous and the drug users who
get infected, but if you’re having sex, you’re at risk.”
What he fi nds especially disturbing is the emotional
manipulation he sees being used against the women. He has seen
women test positive during pregnancy, and when getting the news,
the male partner showed no emotion or seemed to be supportive
(“this doesn’t mean we have to break up”). My friend interpreted
this as an indication that the man wasn’t surprised to fi nd out
she was positive, because he already knew he was. “Th e fact that
the women are getting tested fi rst lets the guy off the hook,” he
explained. “He lets her think that she infected him or he doesn’t
get tested at all.”
Grandmas
He also sees newly infected senior citizens, both male and
female. Th ey didn’t worry about sexually transmitted diseases
because they weren’t worried about pregnancy. “Seniors defi nitely
didn’t believe they would be positive this late in life. Remember,
their generation didn’t test,” he said.
Th e seniors tell him that they may have had sex “once, two
years ago or twice, three years ago.” Although shocked, he says they
repeat a common saying among African American churchgoers,
“God didn’t put more on me than I can bear, so I will deal with it.”
At a nearby clinic specializing in HIV, another service provider
said so many seniors have been newly diagnosed, there was thought
given to opening a special program.
“Th e women are over 50, their children are grown, they’re starting
to date, and coming up positive,” she said. “Th ey are 60, 70, 72.
Th e numbers are really high, and they’re like, ‘I don’t believe it.’
Th ey say, ‘I’m a grandmother. What am I doing with an STD?’ I met
a lady today. She was 68 years old.”
Blame game
A long time ago, I heard a black gay man say that women are
equally to blame for their infection for not insisting on condoms.
Th is sounded so wrong to me. It made me realize that vulnerability
is one thing, culpability is another.
At the same time, I remember the words of
community advocates who point out that
there’s also something wrong when you
don’t protect yourself.
I struggled over my former
co-worker’s comments about
the young men who must have
known they were positive when
they got a woman pregnant and
the idea that men like them
shouldn’t be demonized.
In the middle of my
struggle, my co-associate editor,
Keith Green, walked in,
fresh from graduating with his
masters degree in social work
from the University of Wiscon-
Young ng or old old, black wo women
continue to be at higher risk
sin-Madison.
Keith has been a source of
enlightenment, love, and understanding
about HIV in the black community
in his many years of working here at TPAN.
He has become a powerful force at the national
level. I asked him about what he’s learned and how
he thinks I should proceed.
“Th at’s your story,” he told me. “Everybody is to blame. How
do you talk about these men? You balance it out. What they did is
absolutely wrong, but you encourage the women to step up.
“Mental health is needed on both sides,” Keith continued.
“Something’s got to be wrong with you to knowingly infect someone.
But something’s not quite right with you if you’re not protecting
yourself. Th at opens up a big can of worms. Why do black people
disproportionately need mental health? Maybe we don’t, but we just
lack access to mental health services, or we lack trust in those services
to help us and not harm us.
“Th ere’s a segment of the gay community that’s trying to prove
that women are not being infected by down-low men,” he said.
“Th ere’s no data to prove this one way or another, but my impression
is that many women are, especially black women. I keep getting
into conversations about stigma and mental health. You have
a recipe for disaster.” e
by Enid Vázquez
42 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

Joyce
Turner
Keller
Joyce Turner Keller is the founder and CEO of Asp irations, a non-profi t organization
in Louisiana. A minist er for 40 years, she founded Asp irations aft er learning of her HIV
infect ion. Aft er so many decades of helping to empower others, she was able to disclose her
infect ion to her family within hours of learning of it. She advocates for the elimination of
st igma for all people living with HIV and for awareness of the risk of infect ion. She is on
the board of the National Minority AIDS Council, based in Washington, D.C.
Enid Vázquez: Tell me about
yourself.
Joyce Turner Keller: I
am a 59-year-old HIV-positive woman living
with AIDS. I contracted the disease
through rape. I’m the mother of three and
the grandmother of many.
I work with people from all walks of
life. I don’t judge people based on race, religion,
creed, color, or any gender preferences.
I thought it was necessary that people know
PA • July / August 2009 • tpan.com • positivelyaware.com
you don’t have to be gay or white, you don’t
have to be using drugs, you don’t have to
be a commercial sex worker, to be infected
with HIV.
Th e other thing I wanted to bring to
the public is that it doesn’t matter how
you become infected. When I say, “I’m a
woman living with AIDS,” the eyebrows
go up, because they can’t look at me and
tell. Th ere are times when I get sympathy or
empathy or people tend to change their tone
once they fi nd out how I became infected.
A minister
with
AIDS lays
reality on
the line
Interview by
Enid Vázquez
People seem to be more accepting then and
that sometimes infuriates me, because I
don’t think there’s anybody in this world
who says, “You know, I think I’ll get infected
with HIV today.”
Whether it was consensual, whether it
was assault—whatever, the same side eff ects,
the same discrimination, the same ills, the
same woes, the same concerns are there
for me just as they are for the woman who
may have gotten high, the young man who
may have had sex with another man, or the
wife who didn’t know her husband was on
the down-low, or the man who didn’t know
his wife was on the down-low. It’s no different,
and I thought it was necessary that
I come out and talk about it so that we can
erase some of the stigma, dispel some of
the misconceptions of how this disease is
transmitted.
EV: How do you address the idea that
someone could have protected themselves?
JTK: Life happens to all of us. We know
that in the heat of passion, nobody is trying
to get infected with HIV or another STD,
or hepatitis, and definitely not trying to
get pregnant. What I do is talk about sex,
because that’s one of the “s” words we have
to deal with, even in church. I talk about
that because we equate sex to sin, and sin
to shame.
But I talk about sex because it’s a normal
bodily function. So I tell people we need
Positively Aware
43

to be protected before we go into the water.
Sex is good. Sex is real good. But there’s a
way to do anything. I try not to be judgmental,
because sometimes we fi nd ourselves in
places dealing with things we had no idea
that we were going to be dealing with. And
there are times when people just become
attracted to each other and we know that’s
normal.
Th at’s the message I try to get out. I
tell people we need to be more cautious
and more concerned and more open when
talking about sex with our young people. It
would be better if we told them how good it
is and that it’s normal, that it’s not a shameful
thing, and if we also tell young people
that abstinence is the only way not to get
infected with HIV, but if you choose not to
abstain, then these are your other choic-
es. We need to teach people how to make
healthier choices. Just don’t judge.
Th ey say they deserve it because they
did this, that, and the other. Sometimes I
have to remind some people in my family
who are older to take a step back and
remember that I know when they were
younger, some of the choices they made
were not the best.
Th at’s the way it is with a lot of people.
Ministers in the pulpit who frown on people
living with AIDS and they’re infected as
well. Ministers who have a tendency to talk
about homosexuals and are very negative,
and they themselves could defi nitely be gay
or have someone in their family who is.
We don’t have to participate in the
behavior of others, but I think we could be
a little bit more understanding. A whole lot
more understanding.
EV: I was just talking to someone who
works at a clinic (see page 42) and it seems
like women still don’t know they’re at risk.
Do you see this?
JTK: I do see it, even in my family. It’s
this trust factor. “He said that he got tested,”
or “he showed me a piece of paper.” Someone
shows you a piece of paper showing that
they tested negative today, but what if they
“We need to to
recognize
this disease
as a weapon
of mass
destruction
in our
community.”
went out last night and had unprotected sex?
Does that still mean that he’s not infected?
Or there’s just the complacency, the
idea that “it can’t happen to me.” People
actually believe that there’s a house on fi re,
but it’s not my house.
I tell them, “You may know what you’re
doing, but there are 24 hours in the day. I’m
not trying to get you to distrust your man,
but what I am trying to do is tell you to protect
yourself.” I use the phrase “passion and
protection go hand in hand.”
I see a lot of women who still believe
that the only way they can hold on to a man
is to do what he wants, the way he wants
it. And I think a lot of it goes back to selfesteem
and women not valuing themselves
enough.
Another issue is the fact that women
believe that there aren’t enough men to go
around. But there are plenty of men around.
Th ey just have to value themselves enough
and let a good man fi nd them rather than
picking up whatever they can have. It’s
like going to the store and just shopping
from the bargain basket when there may
be things on the shelf that you could aff ord.
You may get a better quality. You may be
paying a little more, but it’s worth it. [Just
a few days aft er this interview, a woman
with HIV told me she was afraid to let go
of her boyfriend because she didn’t think
she could fi nd someone else, but when she
released him, three other men showed up in
her life trying to take his place.—EV.]
I bared my soul to the world and
it’s fi ne, because I want young people to
understand that this is a disease of opportunity.
I want the middle-aged to know that
they’re just as much at risk as I am. And
I want older people to know—the elderly,
the grandmothers in their 70s—that just
because you’re having sex with a man who’s
70, 75, or 80 doesn’t mean that he’s safe.
We need to recognize this disease as
a weapon of mass destruction in our community.
It’s out there every day and not just
on days we raise awareness. If it means my
disclosing to the world who I am and what
I’m living with, fi ne. I want people to know
that this is no walk in the park. Despite
how good I look, I want young people to
understand … I want everyone to understand.
I say young people because many
young people feel invincible, and I’m pretty
sure I felt that same way when I was a
teenager, when I was a young adult, when
I was a young mother. I felt invincible, that
the world was my oyster and I could eat it
whenever I chose. I think many of us have
that perception of life and we don’t see the
dangers that await us.
At the same time I guess my biggest
message to the world is to let them know
that this is not a diagnosis of death, that
AIDS is something that you can live with.
I wanted people to understand that just
because you’re diagnosed positive does not
demean who you are—if anything, AIDS
has propelled me to another level. e
44 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

Photo © Russell McGonagle
Interview with
Evany Turk
Sue Saltmarsh: What’s the most important
thing that women should know about HIV?
Evany Turk: That it’s not a death sentence, that you
can live pretty much a normal life with it.
SS: Did you start on meds right away?
ET: Yes, and that was a struggle. At that time, I was given like 16
pills to take twice a day, so it was real hard for me to do it, but after
some hard work and some therapy, I finally got it together.
SS: What would you say your everyday food, exercise, and sleep
formula is to stay healthy?
ET: I try to have breakfast every morning, because they say that’s
the most important meal. I try to go to bed every night at 9:00,
because I need my proper rest. I try to drink plenty of water, plenty
of green tea. I’ve eliminated sugars out of my diet completely and
that’s because I learned that viruses feed off of sugar. As far as exercise,
I walk as much as I can—I walk up stairs and to the store - and
I dance a lot. I love to dance and that’s good exercise. I don’t do any
drugs and I don’t smoke. I do drink socially, but I try to limit my
drinks to two per weekend. In order to stay sane with seven kids, I
have to have a social life! Oh, and stress! I try to eliminate as much
stress as possible.
Stigma
by Sue Saltmarsh
Evany Turk is an insp iration. Positive for eight years,
Evany works as the Program Coordinator for the Positive
Adherence Stable Housing Now program at Chicago
House and Social Service Agency, as well as being a mother
and fost er parent. On the day we met for this interview,
Evany was fi ghting a cold, but her good energy and positive
outlook on life, as well as her dedication to her work
and family, were st rongly evident.
SS: What’s been the most difficult thing about being positive?
ET: The stigma. And dating. And the dating part is because of the
stigma. When to tell, when not to tell, who to tell and how to tell—
that’s been the most difficult part. It’s easier now that I’ve told most
of the important people in my life. But it took me a while to do it. My
PA • July / August 2009 • tpan.com • positivelyaware.com
A success
story
family
found
out just by
looking up
my medication
on the Internet, but
I didn’t tell other people
until three or four years ago.
SS: Is there anything that you think can
be done to reduce the stigma?
ET: Yes. I think if we had bigger campaigns around HIV and the
risks and how it’s really affecting individuals—I definitely think if
there were more African American women, more women, period,
out saying in public that they’re positive, it would give it a face that
people could relate to.
I know that people think, “Oh, it’s not going to aff ect me, I’m
not close to that, I don’t know anybody who’s positive” and I’m fi nding
more that when I tell individuals I’m positive, they say, “Wow!
I never thought I’d know anybody who was HIV-positive.” It turns
their attitude towards the whole thing around, just because they’ve
never been close to anybody who’s positive before. It’s just not out
Positively Aware
45

there like, say, a cancer campaign. I think
it would really change things if individuals
could start seeing people who are in their
neighborhoods, in their social circles, who
are talking about being positive.
SS: Of the times that you’ve disclosed
your status, have you found people to be
sympathetic or judgmental?
ET: For the most part, individuals I’ve
disclosed to are sympathetic—they’re positive
reactions, I should say. I’ve only had
one bad reaction to it and it wasn’t horrible,
more like, “Uh, I’ve never really dealt with
that and I don’t want to deal with it.” And
I was like, “Okay, that’s fine. If you ever
want to talk about it, you can call me.” But
for the most part, I’ve been lucky to have
good people who want to learn more and
I haven’t been rejected because of it. I was
very surprised that they weren’t afraid and
they just wanted to learn more and once
they did, they were very accepting of it.
Learn, Learn, Learn
SS: What advice would you give to a woman who had just been
diagnosed?
ET: I would advise her to first learn about how healthy she is and
what she needs to do to stay that way. I would definitely advise her
to get a therapist immediately—even if she didn’t think she needed
one. When you’re battling HIV, in my opinion, you automatically
get a mental health diagnosis, because it’s such a life-changing
thing. So I would advise her to get a therapist, work on her health,
and just put her priorities in order as to what’s most important to
her and what’s going to make her happy, now and in the future.
When you’re positive, you have to stay as healthy as possible, which
includes eliminating lots of stress and things in your life that don’t
need to be there. I would advise her to learn as much as she could
about the virus and the medications she’s taking, if she’s taking any,
and go from there.
SS: I know you’re a graduate of TEAM (Treatment, Education,
Advocacy, Management, here at Test Positive Aware Network)—did
you find that helpful in your own learning process?
ET: Yes, it was very helpful. Actually, TEAM was the first class I
took about the virus and it taught me so much and opened up a lot
of avenues for me to research other stuff. It also showed me that I
didn’t know as much as I thought I did! I thought that just by talking
with my doctor, I knew everything there was to know, but once
I went through TEAM, I was like, “Wow! I didn’t know about any
of this stuff!” I wasn’t really communicating with other people who
were HIV-positive and I didn’t know about a lot of the other stuff
that comes along with being positive. So when I came to TEAM,
and started hearing about everyone else’s experiences, it helped me
see that my situation wasn’t so bad compared to what some people
“No matter what
a person looks
like, acts like, or
is doing, don’t
judge them,
because you
never know what
they’re going
through.”
went through. TEAM opened my eyes to a lot of new things, new
information. It humbled me in the sense that I now know there will
always be something new to learn about and it’s always changing.
So TEAM was great for me.
SS: How has being positive changed your life in a negative way?
ET: That I have to take medications. Before I found out I was
positive, I never took any kind of medication. I really never got
sick! Now I have this extra thing that I have to do automatically, so
that’s hard.
SS: And how has it changed your life in a positive way?
ET: It has made me very non-judgmental of pretty much everything.
I have my own personal philosophy—no matter what a
person looks like, acts like, or is doing, don’t judge them, because
you never know what they’re going through. That has helped me
become good at the work that I do—counseling people and helping
them to figure out what they’re going through.
It’s also helped me to see life in a diff erent way—no one’s guaranteed
to be here tomorrow, so you might as well be happy today. I
try my best not to stress out anymore and if I fi nd myself tensing
up, I release it, because I know stress is not good for anybody. Every
night when I go to bed, I refl ect back on my day to see what I’ve
learned, because I want to learn something new every day. If I made
a mistake, I want to learn from that mistake so I don’t make it again,
because I really don’t have time to make mistakes that are going to
stress me out. It’s helped me be happier and more productive and
that’s refl ected by my children, which is a good thing. Something
happens, we just roll with the punches. I try to teach them, “Don’t
worry about it, we’ll get through it.” We try to have as much fun
and laughter as we can, love each other as much as we can, because,
again, you can be here today and gone tomorrow. So it just opened
46 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

my eyes to the whole what-life-is-about thing and about what I
should be doing while I’m here on earth.
Parenting
SS: You mentioned children and I can’t imagine what it would be
like dealing with this illness and being a mother at the same time.
I think a lot of women who are HIV-positive have struggled with
that. Do you have any parenting secrets?
ET: Again, it’s about making life as normal as possible. My secret
is pretty much just trying to stay happy and deal with things as
they come along and not stress about them, because once something
happens, it’s just the process of how you deal with it, your
outlook on it, as to how it turns out. And the kids—we sit down and
talk about everything. As a matter of fact, I have two biological kids
and five foster kids and five of the seven are teenagers. My mother
says I’m crazy! It’s sort of fun, though—they keep me young, even
though they make me grow grey hairs! And they all know—every
time I get a foster kid, I make sure we sit down and have “the talk.”
I explain to them about being positive. I explain to them, “You’re
going to see me taking this medication every night, so I want you to
know what I’m doing, why I’m taking it.” And it serves as a preventive
for them—I have this, you could get it, please protect yourself.
SS: That’s what I was going to ask next—do you think they have
an awareness of applying your lesson to their own lives?
ET: A few of them do and a few of them are still bumpin’ along,
but we have open conversations. I tell them to be as honest as possible
with me and that way, we can deal with whatever comes up
and we can prevent a lot of things. I didn’t used to be that kind of
mother before—but now, I know that if someone had talked to me
when I was a teenager, if someone had sat down and let me be as
PA • July / August 2009 • tpan.com • positivelyaware.com
honest with them as I want my kids to be with me, I possibly would
not have become HIV-positive. I didn’t have a hard childhood, but
sex was never talked about, drugs were never talked about—those
things were just not dealt with. I couldn’t bring it up because they
wouldn’t want to talk about it. So applying that to my own parenting
skills has allowed me to make it easier for the kids to come
and talk to me—that way, if something is going on or they need
some advice, I can give it to them and prevent them from getting
on drugs or getting pregnant or getting somebody pregnant. My
centerpiece on my dining room table is a big bucket of condoms!
I know they all have sex, except the little ones, and I say, “I prefer
you not to do it, but if you’re going to do it, at least protect yourself.”
Because once the kids are out of the house, you can’t control
what they do, so I would rather keep them protected than not. I tell
them when I get sick, it’s because my immune system isn’t doing so
well and I say, “I love to go to parties, but I can’t party like I used
to because it’s stressful on my system. You don’t ever want to get
something that’s going to compromise your immune system.” They
ask me questions, they bring their friends over to talk to me—I
don’t know how well their parents like that, but I’m just trying to
keep the kids from getting something that they shouldn’t. And all
that, the honesty and parenting skills, I wouldn’t have any of that
if I hadn’t become HIV-positive, because I wouldn’t have known, I
wouldn’t have learned about emotions and things like that. So all
of those things have been beneficial for me.
Ideas for Improvement
SS: Is there anything about how this country is dealing with HIV/
AIDS that you’d like to see change or improve?
ET: I should first say that things could be worse—the services
that positive individuals receive are exceptional services and there
are a lot of services out there, at least in the city, that people can utilize.
But if there was something the nation could do better, I’d say
it would be to make it equal for all cities, all states. And of course,
give more money to it. There are a lot of programs out here that
work and if they had the money to expand, they would. I think the
president and his administration should look at some of these programs
and make them nationwide, because I think they would work
for prevention and for treatment and care. A lot of HIV treatments
and services are on the cutting edge of things that could work for
individuals with other chronic illnesses. If they could make some of
those programs universal, I think that would help a lot with health
care.
And, of course, if we could get rid of the stigma, make our messages
more popular and get people, positive and negative, to talk
about it more oft en on a regular basis, do more national education
on it for everybody, I think those things would help a lot, and help
it stop spreading.
It remains to be seen how President Obama and Congress will
change our health care syst em and the way HIV/AIDS is dealt with
in this country. In the meantime, having people like Evany Turk willingly
st anding in her truth; leading by example and act ively helping
others who are HIV-positive; and raising her children to know that
honest y is good and knowledge is power, may be one of the most eff ective
ways we have of battling this disease. e
Positively Aware
47

Reaching Out
to Our Sisters
Chicago women’s
conference offers
knowledge and support
by Enid Vázquez
As this issue geared up to go to press,
the Chicago Women’s AIDS Project
(CWAP) and one of the local
branches of the national Women’s Interagency
HIV Study (WIHS), located at the
CORE Center, held their second annual
conference for their clients and patients,
called Reaching Out to Our Sisters. It was
a chance for women to gather together in
support and to learn more about HIV.
The event included workshops on
depression, living your best life, recovery,
spirituality, aging, and supporting transgender
women. Th e workshop “Writing
Your Story” was conducted by the Chicagobased
activist/literary duo AquaMoon (visit
www.spokenexistence.com).
Gathered together in the auditorium,
the approximately 200 women in attendance
listened (and told their own stories)
as Dr. Mardge Cohen, principle investigator
of the Chicago WIHS, discussed the
powerful case for HIV medications, listed
the negative statistics for women (especially
black women), and addressed the need to
“reach out to our sisters.”
Dr. Cohen said that women made up
8% of U.S. AIDS cases in the late 1980s, but
today they make up 27%. 83% of women
become infected through heterosexual sex
and 16% through drug use; however, the
sexual activity is sometimes with drugusing
men, so drugs aren’t completely out of
the picture, she noted. Black women make
up 66% of all AIDS cases in women, but
only 14% of the U.S. population.
“So women are doing worse, and black
women are doing worse,” said Dr. Cohen.
“One of the ways we measure worse is mortality—people
die.”
According to June 2007 statistics from
the U.S. Centers for Disease Control and
Prevention (CDC), increases in persons
dying of HIV/AIDS were seen in three different
groups: women, black people, and
individuals over the age of 45.
Moreover, a black woman is 13 to 20
times more likely to die of HIV/AIDS than
a white woman. Black men are also more
likely to die compared to white men. And
older black women are 20 times more likely
to die.
Yet, there were places in the U.S. where
the death rate was the same between races.
“Why the diff erence?” asked Dr. Cohen.
“Lack of insurance. Lack of trust—not
treated equally.” She noted lack of treatment
access in general. Th is has been called
“poor HAART diff usion.” (HAART stands
for “highly active antiretroviral therapy,” or
HIV treatment.)
“Th e data’s in… by and large, if you take
HAART, you don’t progress to AIDS, you
don’t die [of AIDS-related causes],” said Dr.
Cohen. “It’s not negotiable. We want your
T-cells to go up and your viral load to go
down.”
Now that newer HIV drugs are easier
to take and therapy is more successful,
other causes of death are taking on a greater
importance in the U.S. epidemic.
“People are dying of non-AIDS related
things,” Dr. Cohen explained. “Th ere are
other issues that are very important, like
liver disease, heart disease, and cancers—
smoking, which we could do something
about. It’s very important to know your
hepatitis status. Get your Pap test. Stop
smoking.”
Smoking doesn’t just lead to lung cancer,
she said. “In spite of the emphysema,
despite the dysfunction of the arteries that
leads to heart disease, it also hurts your HIV.
Your viral load doesn’t respond as well.”
She pointed out the success story of
pregnancy in HIV. Th anks to HIV testing
and treatment during pregnancy, transmission
from mother to child has virtually
been eliminated in the United States. “We
have to tell our daughters, there’s trust and
there’s lack of trust, but we can take control
of our health.”
“HIV defi nes the fault lines that divide
our society,” she concluded. “We need to
make access totally decent and available
to everyone. Tell other women. Reach out
to your sisters—that’s the name and the
message of the conference. HIV meds are
important, so make the clinic work for you
and make them work for everyone.” e
48 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

PA • July / August 2009 • tpan.com • positivelyaware.com
Doctors Urge
the Government
to Keep Up with
Medical Progress
HIV policy and funding left in the dust
of treatment success
by Enid Vázquez
What an era. Tolerable and easy-to-take medications can
stop HIV in its tracks. Th is prevents AIDS. It prevents
new infections. It saves mega-bucks.
And so, say a group of medical providers, it’s time for this
country to catch up with the reality of medical progress. It’s time
for Medicaid and Medicare, as well as private insurers, to pay for
HIV testing and thereby catch infections early. It’s time for earlier
treatment, which is much less expensive than later treatment.
Th is could not only save money and protect health, but also avoid
spreading of the virus by those who don’t know they’re infected.
Instead, what doctors see to this day is large numbers of
patients come in suff ering from advanced infection when that could
have been easily prevented. At this stage treatment is not only more
expensive, but also less successful.
Without coverage for HIV testing, poor people, and anyone
else with fi nancial diffi culties, will not be able to aff ord the $60 or
more it costs to pay for the test, and doctors can’t order it knowing
that their clinic won’t be reimbursed.
“Can the Red Ribbon survive red tape?” the doctors asked.
And, they added, it’s time for the federal government to pay for
proven prevention strategies like needle exchange, and stop wasting
it on abstinence-only education, which has been proven to be
ineff ective.
Following are remarks made during a media teleconference by
representatives of the two groups that issued the policy statement,
the American College of Physicians (ACP) and the HIV Medicine
Association (HIVMA), which is part of the Infectious Diseases
Society of America (IDSA).
Michael S. Saag, M.D.
“Th e background of [our policy statement] is that there’s been
incredible progress in the care of HIV patients. It was a disease
that wasn’t known in 1980, fi rst described in 1981, had no therapies
available at all until 1987, and was virtually a universal death
sentence for almost everyone who was infected with HIV through
the 1980s.
“It emerged in the 1990s with a revolution in therapies, now up
to 32 individual medications that are available and on the market
for use and that, especially when used in combination, are able to
halt the virus in its tracks—stop its replication.
“What that translates into is an ability for people who are HIVpositive
today to live near-normal lifespans based on these inter-
Positively Aware
49

Early identifi cation is
only going to come about
through routine screening.
ventions, and that type of progress was really unimaginable when
most of us started working in this fi eld in the 1980s.
“So what’s happened is that this progress has moved forward
very rapidly, but a lot of the public policy that we’re using today to
manage this epidemic in the United States were policies that were
established in the late 1980s and early 1990s, and have not really
been re-visited in a serious way since that time.
“We know this virus is transmitted person-to-person, either
through sexual activity, through sharing of blood through needles,
or through pregnancy from mother to child. We basically
stopped transmission from mother to child simply by doing prenatal
screening of the mom to see if she’s HIV-positive while she’s
being followed by her obstetrician. If she’s found to be HIV-positive
through this universal opt-out testing, she gets treated, her virus
goes to undetectable levels, and when she delivers, under those circumstances,
there is no transmission of HIV from mother to child,
whereas untreated that transmission rate would be about 25%, or
one in four.
“Th e problem today, though, is that that same concept needs to
be applied to the entire population. Th e reason I say that is because…
we are pretty much fi nding most of our patients when they’ve been
infected for 10 to 12 years and they start getting sick due to the
impact of the virus, and then they show up in our emergency room
sick. We get them into care at that point, but the success of the
therapy is diminished when people show up late.
“And during that entire time while the virus was replicating
in them, if they are having contact with somebody and exposing
someone to the virus, it’s possible that that virus can be transmit-
ted. Whereas if that person is on therapy,
and their virus is reduced to undetectable
levels, the risk of transmission from person
to person is markedly reduced.
“Briefl y, some data that can support this
whole concept can be found at our clinic,
where we follow, annually, the median
of what’s called the CD4 count of people
when they show up to clinic. CD4 count
normally in an uninfected person is 500 to
1,500. When somebody has advanced HIV
it’s below 200.
“The median CD4 count of people
showing up at our clinic over the last
decade is around 200, so that means half of
our patients are showing up late.
“Th e one exception to that is a group of
patients who show up with a CD4 count of
around 400 or so, and those are pregnant
women. Why? Because of opt-out testing,
being found when they have less advanced
disease. Th ey get on treatment, they can live to a near-normal
lifespan, take care of their child, not have a child who’s infected,
everything’s better.
“So what we need to do is implement a policy of opt-out testing
that was recommended by the CDC two years ago, but to really
make that happen, not just talk about it but implement it, so that the
public health improves and the health of the individual improves.”
Michael S. Saag, M.D., is a professor of medicine at the University
of Alabama and chair of Infect ious Diseases at UAB. He is the
HIVMA chair elect .
Jeffrey Harris, M.D.
“Last December the ACP and the HIVMA issued a guidance
statement recommending that routine screening should begin. Th e
CDC issued a similar recommendation, in September 2006. But
federal funding and reimbursement lagged far behind.
“It’s our understanding that the Centers for Medicaid and Medicare
Services, the CMS, is now considering covering HIV testing,
but limiting it to high-risk patients. What we would recommend
to the CMS is that they expand this policy for routine screening
to cover all Medicare benefi ciaries, that they also encourage the
coverage and screening of the Medicaid population, and that they
provide adequate funding. Th e screening could take place in community
health centers, Federal Bureau of Prisons, and the Department
of Veteran Aff airs.
50 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

“We also believe that part of this evolving
health reform debate should address
the issue of expanding routine screening
for HIV. Th is proposal is driven by the reality
of funding. Th e cost of routine screening
plus the cost of treating those who are
detected earlier is simply less than the cost
of treating those who present at a more
advanced stage when they are immunecompromised.
“Currently, it was suggested that about
40% of those people who are turning out to
be HIV-positive arrive at a time when they
are already immune-compromised and
thus much more ill. Th ere are data to suggest
that when the CD4 cell count is greater
than 350 when diagnosed, the cost of treating
that individual is demonstrated to be
$13,885.
“In contrast, when a CD4 count is less
than 50, the cost of treating that patient at
that juncture is $36,533 annually.
“Th us early identifi cation is only going to come about through
routine screening. And this is only going to be possible if we can
persuade federal programs and private insurers to embark upon a
much broader screening program.”
Jeff rey Harris, M.D., is president of the ACP.
Kathleen E. Squires, M.D.
“Th e ACP and the HIVMA has taken the position that it’s really
time to support evidence-based prevention. We really do know what
transmits HIV. So we do have evidence-based prevention strategies
for the two major transmission factors, which are sexual activity
as well as the use of intravenous drugs and things like exchanging
needles and so forth.
“Over the past several years, a major emphasis on the part of the
federal government in terms of looking at prevention strategies is
to fund abstinence-only education instead of supporting comprehensive
sex education. Th is is despite the fact that there have been
now numerous studies that really document that abstinence-only
education is not eff ective.
“If you look at federal spending on this issue since 1996, the
federal government has spent more than 1.5 billion dollars on
abstinence-only education. In the year 2009, Congress continues
to spend about $99 million on abstinence-only education eff orts.
[In the latest budget from President Obama, this $99 million has
been cut from abstinence-only programs.]
PA • July / August 2009 • tpan.com • positivelyaware.com
The federal government
really doesn’t support
needle exchange programs
despite numerous studies
that demonstrate that
these programs are very
highly effective.
“In terms of looking at the issue of intravenous drug use, the
federal government really doesn’t support needle exchange programs
despite numerous studies that demonstrate that these programs
are very highly eff ective at reducing HIV and hepatitis C
transmission, and do not increase drug use in the people who are
participating in these exchange programs.
“Th e other thing that we need to think about at the global level
is that we are exporting ideological prevention strategies like the
use of abstinence-only eff orts to other countries where it’s really
important for us to employ all of the tools that have been proven to
be eff ective at reducing transmission of HIV.
“Now, this year and just last week [week of April 13th], the
White House and the CDC announced a very important campaign,
$45 million and a fi ve-year new communication campaign to
raise awareness about the domestic HIV epidemic and specifi cally
addressing the impact of HIV in African American people in this
country. Th is campaign is one component of a broader HIV prevention
strategy, but it’s really critical to increase funding across the
range of tools that have been shown to be eff ective.”
Kathleen E. Squires, M.D., is HIVMA vice-chair and direct or of
infect ious disease at Jeff erson Medical College and associate professor
of medicine at University Hosp ital in Philadelphia.
“HIV Policy: Th e Path Forward” was published in the April 17
Clinical Infect ious Diseases. Read the text and list of recommendations
at www.hivma.org. e
Positively Aware
51

What’s Goin’ On?
I
recently accepted a position as Project
Director for a research study designed to
assess the initial acceptability and feasibility
of a pre-exposure prophylaxis (PrEP)
trial among young men who have sex with
men (YMSM) in Chicago.
The concept of PrEP, in a nutshell,
involves administering medications used in
the treatment of HIV (particularly Viread
or Truvada at this point) to “high risk” HIVnegative
individuals, in hopes of preventing
transmission of the virus. Several PrEP trials
are currently underway across the globe,
many of which will likely demonstrate the
Prepping for a PrEP trial
Critical observations before the study even begins
by Keith R. Green
effi cacy of both Viread and Truvada as biomedical
interventions for the prevention of
HIV.
Th ough young men who have sex with
men, particularly those of color, continue to
contract HIV at alarming rates, these cur-
I asked him how
he addressed
homosexuality
during his church
prevention work.
His response made
my head spin.
52
Positively Aware
rent trials ironically have very few young
men enrolled in them. Th erefore, if in fact
these studies are able to prove the eff ectiveness
of PrEP, we will know very little about
its implementation within the population
that could benefi t most from this technology.
Th e PrEP study that I am involved with
seeks to provide some insight into this.
For this study, we will attempt to
recruit 99 YMSM between the ages of 18
and 22, and to follow them over the course
of two years.
Th ere are three separate arms in the
study. All participants will go through an
intensive evidence-based behavioral intervention
and then be randomized to one of
three groups. One group will receive oncedaily
Truvada, another group will receive
a placebo (or sugar pill), and yet another
group will receive nothing. Participants will
be regularly monitored for HIV seroconversion,
behavioral disinhibition (getting buck
wild sexually because they feel that they are
protected by PrEP), and any adverse eff ects
(among a host of other things).
Aware of my search to hire research
assistants who will largely be responsible
for recruiting and retaining participants, a
close friend recommended a friend of his for
one of the positions. Trusting the judgment
of my friend, I followed up on his recommendation
and called his friend to arrange
an interview.
I didn’t expect him to be knowledgeable
about PrEP. Th e average person wouldn’t
be. His sexual orientation and racial identity
were also of no concern to me. I simply
needed him to be able to connect to
the population that we have committed to
engage in order to recruit and retain them
in the study.
I asked him what kind of experience
he had with HIV prevention, and he mentioned
that he had done some work within
his church. Knowing that he was African
American, and curious about the position
that his church takes on homosexuality, I
asked him how he addressed this when it
came up during his prevention work there.
His response made my head spin.
He told me that he does not condone
homosexuality, but that he doesn’t knock
anybody for their choice. He said that
everybody has to answer to God for their
own sins, and that all he can do is help to
steer people in the right direction.
PA • July / August 2009 • tpan.com • positivelyaware.com
Photo © Russell McGonagle

As taken aback as I was by this response,
that wasn’t actually the part that did me
in. Unfortunately, I’ve come to expect this
type of mentality from people who make
an eff ort to do HIV prevention work in the
church (though I must point out that I have
been pleasantly surprised at times). What
got me was that while telling me about
this friend of his who might be a good fi t
for this position, my friend who’d recommended
him inadvertently told me that he
was somebody he “got down with every now
and then.” Of course, I didn’t mention that
during our conversation, but listening to
him dissociate himself from his own sexual
behaviors made me sick to my stomach.
Th ere was no way in hell I could trust
him with the potentially vulnerable members
of the population that our study intends
to enroll. To do so would be like throwing
the whole “do no harm” clause of ethical
research out the door. Th e young people
Get
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Aware!
J/A 2009
Mail to:
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who choose to participate in this study
deserve to have someone working with
them who will support and encourage them
to lead healthier lives—physically, mentally,
and spiritually. I immediately thanked him
for his interest, but assured him that he was
not the man for this job. I then called my
friend back and chewed him out for wasting
my time by not screening this guy before
giving me his number, but also to thank
him for helping me to put some things into
perspective.
Could this mentality be partially to
blame for why the existing PrEP studies
(and many other types of studies related
to HIV for that matter) lack participation
from young people, and young people of
color specifi cally? We continue to hear that
people are more likely to become engaged
in research and services if they feel that they
have some connection to the researcher or
service provider. But just because a provider
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PA • July / August 2009 • tpan.com • positivelyaware.com 53
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Comments
• Finding a mate
• I just was diagnosed in 2007
when I was expecting my fi rst
baby. I wonder if I’ll have the
chance to have more babies
now that I am in this condition.
• Reproductive issues
• Emotional support
54 PA • July / August 2009 • tpan.com • positivelyaware.com
Positively Aware

AIDS Run & Walk Chicago 2009
Saturday, October 3, 2009
Grant Park, Chicago
aidsrunwalk.org
Top Fundraiser can win two round-trip
tickets to Europe on American Airlines!
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& sign up to run or walk at aidsrunwalk.org
Photography by Mark Wiens

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