National Latino AIDS Awareness Day

October 15th was National Latino AIDS Awareness Day (NLAAD). A day that hopes to bring HIV awareness to the Latino community: a community that is three times more affected by HIV than their White counterparts. NLAAD is a national community mobilization effort that aims at uniting the Hispanic/Latino (H/L) communities to increase HIV awareness, prevention, education, and (perhaps, most importantly) testing. In recognition of NLAAD and this week's Latino Commission on AIDS publication, The State of HIV/AIDS Among Hispanics/Latinos in the US and Puerto Rico, let us take a look at how the H/L has been and continues to be disproportionately affected by HIV. 

The State of HIV/AIDS among Hispanics/Latinos in the US and Puerto Rico (1)

With an estimated US population of 55 million, the H/L community currently is the largest and fasted growing minority group in our country. Thus, it is important to our national health to focus on the health concerns and disparities that face the increasing H/L community. In 2013, the H/L community made up only 17% of the US population while accounting for 23% of the new 50,000 HIV infections for that year.

The Black community continues to be the hardest hit ethnic/racial community nationally and internationally; however, with the staggering population growth within the H/L community, this community is quickly approaching similar critical mass. At this point, the rate of new HIV infections among H/L males is three times greater than white males. If the current trend in HIV infections within the H/L community continues, 1 out of 36 males and 1 out of 106 females will be diagnosed with HIV at some point within their lifetime.

Within the H/L community, Men who have sex with Men (MSM) continue to have the highest rates of new HIV infections by 72%, whereas, heterosexual males and females account for 21% of new HIV infections. At the end of 2012, close to 203,000 H/L individuals were living with HIV in the US. Since the beginning of the AIDS epidemic, there have been more than 250,000 AIDS diagnoses and over 125,000 deaths due to AIDS-related deaths.

In terms of H/L individuals living with HIV and the care continuum, the Latino AIDS Commission reports that approximately 80% have been linked to care. This 80% does not mean that all stay in care, receive HIV treatment/medications, or obtain and maintain an undetectable diagnosis (viral suppression). Out of the 80 linked to care, only 54% have been retained in care, 44% are receiving treatment, and only 37% are virally suppressed (undetectable). 

The cumulative statistics above (from rates of infection to viral suppression) reflect the persistent need for such HIV/AIDS Awareness Days. As our youth (ages 13-25) and ethnic/racial communities continue to be the most devastated groups affected by HIV, critical and accurate HIV information and education must be disseminated and HIV testing must be normalized and made universally accepted in hopes of reducing the stigma surrounding testing. Care and compassion for those of us living with HIV needs to exist and extend beyond HIV/AIDS Awareness days and events until every day is an HIV Awareness day.

Guillermo Chacon, President of the Latino Commission on AIDS and founder of the Hispanic Heath Network, stated, "We hope to contribute to a better understanding of the complex challenges we face as community members, and the urgent need to develop comprehensive and culturally-responsive strategies to address HIV, access to quality healthcare, and other health conditions disproportionately impacting our community."

ABOUT THE LATINO COMMISSION ON AIDS

The Latino Commission on AIDS is a nonprofit membership organization founded in 1990 dedicated to meet the health challenges and addressing the impact of HIV/AIDS. The Commission is the leading organization coordinating National Hispanic Hepatitis Awareness Day (May 15), National Latino AIDS Awareness Day (October 15), Latinos and the Deep South, and other prevention, research, capacity building, and advocacy programs across the United States and its territories. The Latino Commission is the founder of the Hispanic Health Network, dedicated to eliminate health disparities in our communities.

Join the Las Vegas HIV/AIDS Awareness Consortium Group and our supporters this Saturday, October 17th, from 10:00 am until 3:00 pm for our local NLAAD event. The event is free and will be held at The Center. Community resource and health fair, offering FREE HIV testing and flu shots, among other health-related screenings.

To read the full report by the Latino AIDS Commission: http://www.latinoaids.org. 

For more information regarding NLAAD: http://www.nlaad.org/

Bryan Heitz

Risk Reduction Specialist

(1) http://www.latinoaids.org

HIV Medication: From AZT to the 'One Pill A Day' in 3 Decades

The first six years of AIDS (1981-1987) saw more than 40,000 deaths and 50,000 new infections without any FDA approved drug therapy. In 1987, Azidothymidine (aka AZT or Retovir) became an answer to the staggering numbers of deaths from AIDS and new HIV infections over the last several years. AZT had a previously pharmaceutical use as an early anti-Cancer fighting agent known decades earlier as Compound S. AZT was hurried through the FDA hoops and hurdles in an unprecedented 25 months and “marked the introduction of the first effective weapon against the virus [HIV] and AIDS itself, what eventually would become a key element of the multi-drug cocktail of HAART itself.” (1)

AZT is not without its controversy that cannot be overlooked. In short, thousands of people were suffering and dying from AIDS in such short periods that a drug therapy had to be offered. AZT offered no cure and little to more than a year or so prolonged life to those suffering; consequently, its cost was astronomical at $10,000 dollars for a year’s therapy. AZT’s efficacy is a double-edged sword. The drug helps to prevent the HIV virus from invading, genetically altering T cells; however, the drug at high doses inhibits healthy cell division creating a myriad of health concerns. Drug resistance to AZT is common and is not tolerated well by most.  AZT as a singular drug therapy is rarely prescribed since the introduction of HAART (highly active antiretroviral therapy).  (1)

HAART

In 1996, fifteen years into the AIDS crisis, HAART revolutionized the HIV era by presenting multiple drug regimens meant to enhance the healing effects of AZT (often listed in drug cocktails as Retovir). HAART has expanded to include six classes of drugs that stops the genetic replication of the HIV viron, lowering the viral load to an undetectable level, as well as, decreases the ability for the virus to continue to alter itself into more strains than already identified. 

Since the introduction of HAART, the classes of drug therapies continue to become more robust than ever with more than 30 approved drugs in 6 different classes. With such a large selection of therapies to test and try, it helps to deal with those who build up drug resistance. Along with a wide selection of drug therapies the more recent additions have decreased side-effects and less strict dosing provisions. The most exciting is the ‘One Pill a Day’ options (All in One Combination Tablets), which is a HAART cocktail in one pill and taken once a day. This is a blessing to those of us whom have never had to take anything other than one pill a day and those who have had to take common cocktails of 5 to 10 pills throughout the day on a strict schedule. 

Currently Approved Drugs for HIV

HIV is a retrovirus: a virus that needs a host to invade and, through genetic mutation, replicate itself.  HIV drug therapies are called antiretrovirals because they attack the HIV retrovirus and they are highly effective (active). HAART drugs have a corresponding stage of HIV replication in which the drugs in that class target. The six classes of HAART are (as of March 2015):

• 4 All in One Combination Tablets (Multiclass Combination Products)
• 11 Protease Inhibitors (PIs)
• 11 Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
• 5 Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
• 2 Early Inhibitors including Fusion Inhibitors
• 2 Integrase Inhibitors

The connection between the phase of HIV replication and corresponding HAART drug needs an understanding of the 8 stages of the HIV replication process, which will be discussed in another blog. This should, if anything else shows the progression from a poisonous cancer fighting drug that often did more damage than good, to multiple all in one tablet options, and, hopefully, the cure will be in our future. To find a comparative chart of FDA approved drugs: CLICK HERE.

Bryan Heitz
Risk Reduction Specialist

 

(1)   http://motherboard.vice.com/read/happy-birthday-to-azt-the-first-effective-hiv-treatment

(2)  http://www.aidsmeds.com/articles/DrugChart_10632.shtml

Serodiscordant Relationships: What You Need To Know

Viral Suppression, Risk, and Serodiscordant Relationships: Should Serodiscordant couples practice safer sex practices? What's the real-life risk of HIV transmission? 

Remember seroconversion from your HIV 101: the physiological conversion from being HIV negative to becoming HIV positive. HIV statuses are reported in terms of positive and negative. Thus, Serodiscordant couples, also referred to as Magnetic Relationships, are those couples where one partner is HIV – and the other partner is HIV +.

As we enter the fourth generation of HIV, we are surviving the disease and living longer lives than those in previous generations. Along with this amazing gift of survival, HIV positive men and women are faced with a myriad of new issues including mixed-status dating and relationships, creating a number of Serodiscordant couples. Serodiscordant couples are presented with a unique set of circumstances to circumvent in order to have an open relationship and a healthy, safe sex life. 

In a 2013 article, John Sovec discusses how Serodiscordant couples are faced with more anxiety and fear than many relationships due to the fear of unintentional HIV transmission: often both the positive partner fears transmitting HIV and the negative partner fears becoming infected. Other challenges include worries regarding HIV care if the positive partner becomes sick, finding psychosocial support for both partners (more services available for the negative partner in a Serodiscordant relationship are needed), and issues of disclosure (who do you tell that your partner is positive?) to name a few. Creating an open dialogue is crucial for any healthy long-lasting relationship; however, it may be more crucial for Serodiscordant couples due to the health risks involved in keeping secrets and lack of communication. "These worries can create a barrier to true intimacy and leave each partner feeling unfulfilled. This is a time when each partner must risk talking about his or her needs, what forms of sexual contact feel safest, likes and dislikes, and how the couple can find ways to keep their sex life active and intriguing."

Are safer sex practices necessary in a Serodiscordant relationship if the HIV positive partner is in treatment, seen regularly by a doctor, and is undetectable? 

 Serodiscordant couples persist with a silent goal in mind: to keep the HIV negative partner negative and to keep the HIV positive partner healthy and undetectable. The goal of becoming undetectable, or viral suppression, is two-fold. One, viral suppression is key in HIV positive people to maintain a healthy CD-4 count, an undetectable HIV viral load, and long-term survival. Second, viral suppression is integral to HIV Prevention due to the fact that having an undetectable viral load carries a low to no risk of HIV transmission depending upon the research. 

Research conducted and reported upon over the last several years regarding Serodiscordant couples and HIV transmission, when the HIV positive partner is undetectable, cumulatively suggest that the real life transmission of HIV between mixed-status partners is extremely low to none. Most recently, the PARTNER study (a study on HIV transmission among Serodiscordant couples where viral suppression is reached in the HIV positive partner) reported on their findings after the first 2-year mark (the full report will be expected in 2017 after the final phase of the study is complete). The findings are remarkable and may offer astounding news about preventing HIV transmission with or without condom use. The unique thing about this study in regard to many earlier studies is that both heterosexual and homosexual couples and sex are included in this study: data from over one thousand mixed-status couples and thirty thousand sexual encounters were collected. Two years into the study, not one instance of HIV has been transmitted regardless of condom use, regardless of whether the couples engaged in anal or vaginal sex. The study also reports that the maximum chance of HIV transmission during viral suppression is 1% for anal sex (insertive or receptive) and 4% for anal sex with ejaculation (with a receptive negative partner). "When asked what the study tells us about the chance of someone with an undetectable viral load transmitting HIV, presenter Alison Rodger said: Our best estimate is it's zero." 

Does this mean that those of us in Serodiscordant relationships can toss out the condoms? Not necessarily; however, this is extremely optimistic and viral suppression may be one of our greatest weapons in the arsenal to contain HIV and move closer to the goal of an AIDS-free generation. It is imperative to remember that open and honest communication regarding condoms, unprotected sex, and risk associated with various sexual acts, etc. is necessary for Serodiscordant couples to make their own decisions based on facts and personal decisions. Ultimately, it is up to the individuals within the couple and centers on the HIV positive partner's adherence history and viral load.

Personally, my partner and I have been together for nearly 8 years. We began dating less than a year following my HIV diagnosis. To this day my partner is HIV negative. I become livid when it is assumed that he is HIV positive simply because I am and we are in a relationship. I do not become upset out of shame or fear, but because of the ignorance in that assumption: it is impossible for two mixed-status individuals to have a healthy, 'normal' long-term sexual relationship without both ending up HIV positive. Yet, this assumption is partly to blame for why we see young gay men seek out HIV infection; why some HIV – allow themselves to seroconvert (become HIV +); and why PrEP is being peddled to Serodiscordant couples. 

Hopefully research will continue to support the findings of low to no risk of HIV infection with ART therapy & viral suppression and HIV concerns will no longer be a part of the equation for love and healthy relationships. 

For further reading: 

Should HIV Serodiscordant Couples Always Take Preventative Measures? Experts Debate

Undetectable Viral Load Essentially Eliminates HIV Transmission Risk in Straight Couples 


Bryan C. Heitz
Risk Reduction Specialist
Community Counseling Center  

HIV/AIDS Long Term Survivors

 

Today is National HIV/AIDS Long-Term Survivor Awareness Day (NHALTSAD). It is a day to celebrate those who have survived decades of surviving, not just living, with HIV/AIDS. It was on June 5, 1981, that the disease now known as AIDS first appeared in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

National HIV/AIDS Long-Term Survivors Awareness Day is held annually on June 5th on the anniversary of the first published report of what came to be known as AIDS.

 

“[NHALTSAD] is a day to celebrate our survival and begin envisioning the future we never imagined. The first decades of our adulthood were overwhelmingly consumed with illness, death and fear. Now it is up to us to ensure that the next decades are the best they can be. The least we can do is afford survivors the respect they have earned and acknowledge them as elders, teachers and leaders.” -- Tez Anderson is the lead organizer of NHALTSAD (2014)

Research was conducted by Dr. George Solomon and Dr. Lydia Temoshok on how the mind and emotions impact the immune system. The purpose of their study was to understand how "long-term survivors" of HIV are different from people who follow the expected course of HIV disease. Through their research they were able to identify eight characteristics among long-term survivors of HIV.

The eight characteristics are:

1. They are realistic and accept their diagnosis and do not take it as a death sentence.
2. They have a fighting spirit and refuse to be helpless/hopeless.
3. They have changed lifestyles.
4. They are assertive and have the ability to get out of stressful and unproductive situations.
5. They are tuned into their own psychological and physical needs -- and they take care of them.
6. They are able to talk openly about their illness.
7. They have a sense of personal responsibility for their health, and look at the treating health care provider as a collaborator.
8. They are altruistically involved with other persons with HIV.

Long term survivors are now experiencing unique and complicated litany of challenges including, but not limited to, effects of stigma/discrimination/prejudice, depression, isolation, long term side effects of HART, compounded health problems due to long term HIV/AIDS infection, loss of friends or family, etc. So, if you have a Long Term Survivor of H/A in your circle of friends or family, reach out and express support in their continued fight and survival! Or, just support by posting on your social media sites and let the world know your support Long Term Survivors and their struggle!

 

Bryan C. Heitz

Risk Reduction Specialist, CCCofSN

Newly Diagnosed with HIV? Read This.

Newly diagnosed with HIV? Finding out your positive status can be difficult but you are not alone. Once diagnosed, starting a new regimen of HIV meds is just another challenge. The following is a list of expected and common questions that come to mind prior to beginning treatment. Often one is attempting to make this decision while processing a new HIV diagnosis, compounding the difficulty of the decisions one is forced to make in order to survive with HIV.

The mental challenge of starting a new regimen of HIV meds:

• Are you hesitant to start treatment?
• What if it is the wrong medicine for me?
• Have you heard horror stories from friends or loved ones on HIV meds?
• What should you expect?

Challenges of Side Effects:

• What side effects should I look for from my meds?
• Will my HIV meds interact with other medication I am currently taking?
• How long will the side effects last?

Challenges of Cost and Access to Meds

• Will insurance pay for HIV meds?
• If I can’t afford my HIV meds, where can I find help with paying for my meds?
• Do pharmaceutical companies help pay for meds if I can’t pay for them?

For answers to these questions and a myriad of other questions, please refer to The Body’s web page, Resource Center on Starting HIV Treatment.

Bryan C. Heitz 

Risk Reduction Specialist, CCCofSN

Did You Know?

 

For more information about today's events, please visit the The Gay & Lesbian Community Center of Southern Las Vegas (The Center).