LGBT Community & Harm Reduction: Nicotine Addiction

First I want to thank one of our champions, Damon L. Jacobs of New York for raising awareness of the damage tobacco/nicotine is doing to our community. Visit his Facebook page https://www.facebook.com/groups/smokingvapingheating: Rethinking nicotine in the LGBT Community. Damon is putting out some great information on this topic. Many of you know him for his awesome work with PrEP!

Being a former smoker myself I know that nicotine addiction is probably one of the hardest drug addictions to beat. I quit about 9 years ago now, and before that, I had quit for 5 years then stupidly picked them up again while at a club. I found it the hardest to resist when I was out partying with friends at the bar, alcohol, and cigarettes were a match made in heaven for me. When I quit for good 9 years ago I wasn’t aware of vaping being popular. The first E-cigarettes became popular in about 2007 in the US if memory serves, approximately a year or so after I quit.

Tobacco has affected me at the most personal and tragic level, my younger brother Ken died of lung cancer at 46 on April 1, 2012, he had started smoking very young and was a 2 pack per day smoker. I left my job and graduate studies to help my mother care for him. He passed 5 months after initial diagnosis leaving behind my 10-year-old nephew.  My mother, Judy passed away Sunday, June 22, 2014, of the most aggressive small cell lung cancer. She had never smoked until she was in her late 30’s and was a moderate smoker. We caught her cancer earlier than my brother’s and she went through aggressive chemo, but in spite of everything being done that could be done; cancer eventually spread to her brain, then her liver. I was with her, holding her hand when she passed. It was the hardest thing I have ever had to do. The anniversary of her death is coming and she is especially on my mind now and during the holidays, I suppose losing your mother or father is one of the hardest losses to face. It has forever changed me and I miss them every day.  The reason I share these events is not to scare people, but to remind people. Our choices do have consequences not just for ourselves but for those we love. I used to think the dangers of smoking would never affect me and they may not directly time will tell but smoking was the cause of great heartache and loss in my life.

The first time I quit I was the typical ex-smoker nightmare that all your friends warn about, I was a nag to everyone around me, thankfully this go-round I’m not such a bitch about smoking. I do encourage people who are trying to quit and I know vaping has helped many of my close friends kick the habit. I kicked it by buying a pack, smoking one, then cutting them up! It was an expensive way to do it but it worked for me and I encourage my friends and family by supporting them in whatever way works best for them whether it is vaping, nicotine patches, lozenges, or the gum. Sometimes it takes several tries as it did with me but keep after it, it’s worth it, and you’re worth it. With the evidence all coming together it looks as though vaping is the safest way to kick the habit. Just for the record, the temptation to smoke when out clubbing with friends has completely passed.

Defending U=U

Published in 1960, To Kill a Mockingbird chronicles lawyer Atticus Finch’s defense of a wrongfully-convicted Black man in Depression Era Alabama. Adored for his courage and integrity, Atticus has since become one of the most iconic literary heroes of the 20th century. This has been one of my favorite books and films since childhood. It taught me a lot and helped me form many of my values and how I looked at the world. What does Atticus Finch have to do with U=U? Valid question, give me a chance to explain.

My ex and I were together almost eight years and for the first 14 months, he harbored a secret. He was living with HIV. We had unprotected sex on several occasions, with increasing frequency the longer we were together. What amazes most people I have shared this with is that I never point blank asked him his status. It was my thought that if he had anything of importance to share he would.  One night before going to bed he sat me down and told me had something to tell me. I could see the fear in his eyes. After breaking the news he told me had been afraid to tell me. I was angry, hurt, and afraid. This was in 2001 and I had an almost irrational fear of HIV since 1981. I was in shock and the panic set in. I stormed out of our house and didn’t return for two days.

I stayed with my mom who endured my panic attacks and anger without knowing what I was panicked and angry about.  The second night we were watching TV and she was flipping channels until she stopped on TCM and they were showing To Kill a Mockingbird. The scene between Scout and Atticus came up on the screen when Atticus told her “you never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it.”

 

At that moment I realized how hard it matticus finchust have been for him to tell me. We reconciled and were together for another 7 years after this incident.  He went with me repeatedly to have myself tested, I was negative. I absolutely believe that it was because he was undetectable and he could not transmit the virus (U=U). I realize that some reading this won’t believe it, but he was undetectable and I admit that I can’t offer any proof to my belief in my particular case. But I can say he is alive and well and last I heard living in the Houston area. I have no doubt that if you stay adherent to the meds prescribed and reach an undetectable viral load you are unable to transmit the virus, this is not an opinion, this is a scientific fact. Scream it from the rooftops U=U! And when you take a break from promoting U=U read Harper Lee’s book To Kill a mockingbird or watch the film.

 

Verdict-Guilty:Trial By Community

First dates are always exciting, I enjoy getting to know a new person and have always found it a thrill. I recently asked a guy out to dinner, a really intelligent, accomplished guy, good looking and great smile! I live in a small city where in the LGBTQ community almost everybody knows everybody else or someone else who does.

On the way to dinner the conversation starts as most do, a little timid, a little nervous, small talk. Feeling each other out verbally. Maybe five minutes into the conversation he told me he was HIV positive, how long he has been positive, his viral load and that he knew who had transmitted it to him (not by name), and where he lived at the time. During this part of the conversation all I am thinking is “this is none of my business”. I’m not even sure how we got on this topic.I didn’t ask him and never would. Certainly not how he acquired the virus; definitely none of my business, not on a first date, not if we were married for the last twenty years is it my business!

He felt guilty on a subconscious level at least and as though he had to defend himself against something that neither he, nor I, or anyone else should have to defend themselves, a virus that he had been exposed to, that ANYONE could be exposed to given the right circumstances. What is far worse is the stigma attached to HIV. What’s worse than the stigma is the fact that it’s often attached by our own. This same guilty verdict is attached to those of us in the LGBTQ community that avail ourselves of the latest bio-medical protection of PrEP. This is very real to me, I’m a very vocal PrEP warrior in our community and have been taking Truvada for ten months now. Don’t think I haven’t heard the remarks made about me just within earshot, “that’s one of the Truvada whores” and it hurt at first but I have gotten past it.

I’m not innocent, I’m not guilty either!  I am proud of who I am and what I chose to do with my partner is nobody’s business but mine period. I am looking forward to another date with this sexy, intelligent, accomplished guy with the great smile.

I’ve Written A Letter To Daddy

Since “National Coming Out Day” I decided that writing out my thoughts and feelings might help me to heal the pain I still suffer by my father’s rejection so many years ago.  I wrote a letter to a boy I liked at school when I was in the 7th grade. I had a secret crush on him. It was really more like a diary entry for my eyes only; but boys didn’t have diaries then, they were for girls. Remember dad? After writing the letter I hid it under my mattress; but that wasn’t safe enough, someone might find it. So I hid it where I thought no one would find it. Remember the door dad? The bedroom door you kicked a hole in when you were mad at mom? Remember, she later made you take it down, and you hung it on the tool shed?  I stuffed that letter up inside that door thinking that I could always re-read it whenever I needed to and no one would ever find out my secret. Throwing that letter away would have been like throwing my love away, throwing a part of me away.

You were a giant to me then, a scary giant that blocked out the sun. Remember you grabbed me with one hand and started jerking me back and forth by my arm, while waiving my letter in the other. Remember dad? Remember the yelling? I felt like everyone was watching and reading my letter while you waved it around in the yard. Like the letter you crushed me, like you crushed our relationship. Remember dad? You dragged me to the barrel you burned leaves in and made me throw it in yelling: “It is too perverted and disgusting to put in the trash.” Remember dad? I tried to please you, to be the son you wanted. You dreamed of the athlete; I first failed at baseball, then football. I didn’t want to burn in hell like the leaves, like the love letter to a boyhood crush. Remember dad?

Many years have passed dad; you know I’m gay, we know what that means now. You said you still loved me, remember dad?  Remember, years later when you said: “I love you, but I’m old fashioned and don’t accept your lifestyle.” I’m a man now, you are my father. You brought me into this world and I thank you. Remember this: “I love you, but I’m proud of the man I have become, I’m proud to be a gay man and don’t accept your conditional love”. So when I can’t make it for the holidays, remember why dad.

I have scars from those childhood experiences but to anyone who reads this: “Always remember, it does get better.” Help is available, you are loved, and you are worth it. Always remember that.

PTSD & Depression in the LGBTQ Community

Until recently I would never have thought I could suffer from PTSD (Post Traumatic Stress Disorder) I had thought that this was a disorder only suffered by members of our military. From the outside looking in most people would agree that I have had an easy life in almost every regard. And I have done my best to perpetuate that image to friends, family, and coworkers. Looks can be deceiving. First I must apologize for the long silence with my blog and I hope all 5 of you will forgive my silence. I have been dealing with depression since 2012. I thought all my issues stemmed from losing my younger brother and mother to the same disease within 18 months of each other. I am certain these deaths of immediate family members drove me into treatment for depression. But I have been fighting depression and PTSD for much longer, years longer.

I am in treatment now with anti-depressants and CBT (cognitive behavior therapy) and I am deeply grateful to my employer and co-workers who support me in my journey to healing. It’s been a roller-coaster of a journey with many ups and downs. One experience in particular stands out for me, at the age of 17 I came out and began working at a gay club. At 17 I was painfully naive. One afternoon two older men that I only knew from the club took me to their apartment across the street. I didn’t pick up on anything out of the ordinary and didn’t realize I was invited over for sex. I was raped by both men. The experience led to a distrust of men and has bubbled to the surface frequently over the past 30 plus years. I always felt guilty, that it was all my fault, “I must have sent the wrong signals” or “shouldn’t have trusted two practical strangers”.  I never shared this experience with a soul. It was made worse by the fact that the two guys kept coming to the club I worked in,  I felt shame and embarrassment every time I saw them. I left that job within six weeks of the incident and never went back.

Through therapy I now realize that experience had a profound effect upon my life, my sexual life, and in my relationships since that time. Many times the guys I dated would tell me that I was “closed off emotionally” and I suffered from sexual hang-ups too. I always had to be the one in control of the situation, to be the one who “topped” eventhough I have always desired to experience that closeness and trust that comes from “bottoming” but could never still my fears and make myself vulnerable. Then AIDS rocked our world and the sexual landscape for gay men changed. AIDS related diseases took my friends, often seemingly a whole neighborhood in Oaklawn would disappear overnight.

This fanned the flames of my insecurities and fear surrounding my sexuality in general, and sex in particular. This was aggravated by my religious upbringing and my families disapproval. But we’ve come along way, HIV is no longer a death sentence thanks to the advancement of anti-virals those who are now diagnosed with HIV can expect to live normal life spans and if adherent to  viral suppression don’t need to worry they will pass the virus to their partners. Pep and PrEP have been added to the arsenal in addition to condoms that give negative men and women the tools to protect themselves against HIV. So get tested and KNOW YOUR STATUS! I have made it this far and will continue to heal; my biggest regret is that I didn’t start this process many years earlier.

My purpose in sharing this now is to help others, especially LGBTQ youth to know that tomorrow will come, there is help available, and it does get better. Never allow anyone to put you down, being LGBT isn’t a choice it’s how you were beautifully made.  Reach out to your local ASO, talk to a friend you trust, seek professional help if you need to, call the Trevor Project, a national, toll free, confidential suicide hotline for gay and questioning youth. The Trevor Project can be reached at 866.488.7386, 24/7 if you are feeling suicidal or just need to talk. On the web visit itgetsbetter.org for links to services in your area. If you are dealing with gender questions the Transgender Suicide Lifeline is 877.565.8860 or online at translifeline.org

 

 

 

 

PrEP Follow-up

I have now been through my first health check after taking Truvada for PrEP. I have completed 3 months on PrEP and all my blood work came back within the normal range. No STI’s and I’m still HIV negative, no adverse effects on my kidney or liver function.My PCP  was pleased with my test results and I will continue on the PrEP regime and get HIV and blood work done again in 3 months!

I am relieved that the tests didn’t show any adverse effects on my kidney or liver function. My adherence has been good overall, I have missed a couple of doses over the first 90 days. Since switching to a bedtime dosage I have taken my little blue pill daily. I am glad that I decided to commit to taking PrEP because it has eliminated my anxiety concerning sex and intimacy. I have vivid memories of the early days of the epidemic, losing many of my friends to AIDS.

In fact it’s difficult to remember what it was like before HIV. I came out at 17 way back in 1978! So I had a few years free from the worry of HIV and AIDS then my friends and loved ones began to disappear. The rest of us were to left wait our turn to get sick and to die but this never happened to me. I remained HIV negative for reasons I will never know or understand.

It’s hard to explain to the generation born in the eighties and nineties. They didn’t witness almost an entire generation of their peers disappear in what seemed like a blink of an eye, promising young lives, many gone before their thirtieth birthday. I do have “survivors guilt” and miss my friends and loved ones lost to AIDS. I remember them often and especially everyday when I take that little blue pill.

NMAC Announces the National HIV PrEP Summit

 

NMAC Announces the National HIV PrEP Summit
December 3-4, 2016, San Francisco, CA
TARA BARNES-DARBY| APRIL 19, 2016NMAC is pleased to announce a new conference that will focus on the importance of Pre-Exposure Prophylaxis (PrEP) and biomedical HIV prevention interventions to curb the spread of HIV. 

National HIV PrEP Summit (NHPS)
December 3 – 4, 2016
Hilton Union Square
San Francisco, CA

The first National HIV PrEP Summit (NHPS) will bring together leaders to focus on the implementation and infrastructure needed to turn the promise of the science of PrEP into an effective community-level HIV prevention option for communities of color.  This will be accomplished through skills-building sessions and feedback vehicles to make policy recommendations for the new administration.  NMAC is partnering with a number of organizations that have been instrumental in the implementation of successful PrEP campaigns in their communities.  The NHPS logo is a collage featuring the impactful work of some of the summit partners. Keeping NMAC’s mission to lead with race at the forefront of our programs, the NHPS goals are to:

  • Increase access to quality PrEP services for people of color.
  • Collaboratively build the infrastructure needed to support biomedical HIV prevention.
  • Bring together diverse leaders and constituents.

Summit Format

The summit’s sessions will include 24 workshops and 4 plenary sessions focusing on both capacity building and policy development.  Proposed conference tracks include: Research, Program Implementation, Priority Populations, Public Policy, Healthcare Providers, Education Campaigns and Training Programs.  A needs assessment and constituent survey will inform program development.  There will be no exhibit hall this year; however, partners’ PrEP campaigns will be displayed throughout the conference space.
Registration
Registration is now open!  Unlike USCA, registration for NHPS is limited to 400 participants.  Don’t wait; register now.

Scholarships
Scholarship opportunities are available to support PrEP navigators, community based organizations and health departments that are working to establish PrEP programs.  Apply for a scholarship.

Sponsorship

NMAC thanks Gilead Sciences for their major support of the meeting.  However, additional support is needed. For information on sponsorship opportunities visit the NHPS website or contact NMAC’s Development Division.

NHPS SPONSOR

NHPS PARTNERS

Community Based Organizations
AIDS Foundation of Chicago, Asian & Pacific Islander Wellness Center, Bienestar, Gay Men’s Health Crisis, Hyacinth AIDS Foundation, Mass AIDS Coalition, San Francisco AIDS Foundation and SisterLove

Corporate
Avita Pharmacy Solutions and Walgreens

Social Media
Grindr
PrEPFacts

Federal Agencies
Centers for Disease Control and Prevention, Health Resources and Services Administration/HAB, National Institutes of Health, Office of HIV/AIDS and Infectious Disease Policy/HHS and Office on Women’s Health

Foundation
Kaiser Family Foundation

Health Centers
Callen Lorde Community Health Center and Fenway Institute

Health Departments
Broward County Health Department, Fulton County Health Department, Los Angeles County Department of Public Health and New York City Health Department

National Organizations
AIDS United, AVAC, Black AIDS Institute, Black Women’s Health Imperative, Center of Excellence for Transgender Health, HIV Medicine Association, Latino Commission on AIDS, National Black Women’s HIV/AIDS Network, National Coalition of STD Directors, Project Inform, Sexuality Information and Education Council of the United States and Treatment Action Group

Academic Institutions
UCSF School of Medicine, University of Mississippi and University of Puerto Rico

For additional information on NMAC’s conferences, please contact the Conferences division at conferences@nmac.org.

Yours in the struggle,Tara Barnes-Darby, CMP
Director of Conferences
NHPS IMPORTANT DEADLINES

Scholarship Application: September 1, 2016

Hotel Reservations:
November 2, 2016

Registration:
November 4, 2016

Prevention Tool PrEP

The next step in the fight to end the transmission of HIV has found its way to Shreveport.

In 2012, the FDA approved a combination of two HIV medicines for daily use to help prevent individuals from getting HIV from a sexual partner who’s positive. The concept of taking HIV medicines daily to lower the chance of getting infected from a partner living with HIV  — more commonly known as Pre-Exposure Prophylaxis — recently caught the attention of local advocates, and many have now dedicated resources and time to educate northwest Louisiana on its benefits.

Chip Eakins, advocacy coordinator for The Philadelphia Center in Shreveport, has presented the benefits of the drug to about 50 people locally.  He plans to target universities in the future.

Eakins recently embarked on a journey as educator and proponent of PrEP.

“I wanted to know firsthand how easy or difficult it would be to get on it,” said Eakins, who writes about the process, expense and side effects associated with PrEP on his Philadephia Center blog.

Eakins, who does not have HIV, began taking the drug in January.

“I may meet someone who is HIV positive that I want to be in a relationship with and this will make it less stressful for me and for them,” he said.

What is PrEP?

PrEP is a general treatment term for specific types of medication taken to prevent the transmission of HIV.

At present, the only medication approved by the FDA for PrEP is Truvada, a pill manufactured by Gilead. The drug combines two anti-HIV medications — Emtriva and Viread — in a single tablet form. In addition to its approval for use in prevention, Truvada is used in conjunction with other medications to directly treat HIV-positive patients.

A 2012 study that led to FDA approval of the medication for PrEP, found a great reduction in the transference and transmission of the virus between parties as compared to those who received a placebo. The study included heterosexual couples with one partner who was HIV positive.

Since its approval for PrEP, Truvada is a medication that has found its way into dating profiles and modern social consciousness — particularly in the gay, bisexual and transgender communities — more specifically between men who have sex with men.

In a known case of an individual believed to be adherent to PrEP contacting HIV, transmission was believed due to the fact the individual had sexual contact with someone with a strain of HIV highly resistant to treatment.

The Centers for Disease Control recommends patients taking Truvada do so daily for the maximum amount of protection. Men who have sex with men can expect maximum benefits to begin within seven days, but benefits for women can take longer to reach maximum potential.

“It’s the same thing as being adherent to HIV medications in a way,” said Eakins. “They tell people that are HIV-positive that you must adhere to your regimen and take your medicine every day or your virus is going to rebound. They won’t be undetectable anymore.”

People with HIV may refer to themselves as detectable or undetectable, but it’s clear that others may not understand what these terms mean.

“Undetectable means there is not enough virus in your blood stream to show up on a test,” said Eakins. “You’re still positive and less likely to transmit the virus, but you’re still positive.”

HIV-positive individuals who say they are undetectable are 98- to 99-percent less likely to transfer the virus, but viral loads in patients can fluctuate, particularly when they are less adherent to their medication regimen, according to Eakins,

“There’s only so many medications out there,” he said. “You’re playing Russian roulette when you start adhering and then not adhering.”

Access to PrEP

Agencies such as Acadiana CARES in Lafayette and The Philadelphia Center in Shreveport focus on educating the public on HIV prevention, helping the public access testing, and assisting in the procurement of medications for prevention and treatment. .

High risk individuals without HIV, particularly those with multiple sex partners, should educate themselves on PrEP, said Eakins.

PrEP is not a substitute for condom use.  However, when combined with other forms of risk reduction, it will decrease — or eliminate — rates of new infections of HIV, especially among those aged 14 to 24.  Increased rates of infection are showing in that particular age group, mostly among males who have sexual contact with other males.

Rates also are increasing in the African American community and in populations where economics, discrimination, and easy access to medical care are major barriers to education, prevention, testing, and treatment, Eakins said.

The goal of PrEP treatment is to eliminate new cases of HIV, but information and education are the first steps toward achieving that goal, he said.

The next barrier is accessing the medication.

How patients access Truvada

Access to PrEP is one of the largest challenges at this time, according to Thomas Huseby, a case manager for people living with HIV at Acadiana CARES in Lafayette.

He said some medical providers are not yet aware of PrEP and some may be uncomfortable prescribing it. There also are many perceived complexities in prescribing anti-HIV medications.

Primary care providers can prescribe PrEP after determining an individual meets the criteria set by the screening process, he said.

“Primary care providers can and should prescribe PrEP when appropriate,” said Huseby.

Many people, including medical providers in the community, believe only infectious disease specialists can write prescriptions for the medication, but that is not the case, according to Huseby.

“Prescribing PrEP essentially guarantees each patient will have a minimum of four medical visits each year,” said Huseby of what he believes could be an otherwise missed opportunity for Louisiana physicians.

Huseby said many potential PrEP patients are younger and otherwise less likely to regularly visit a doctor. “PrEP is an unrealized revenue maker.”

The CDC has guidelines for medical providers on how to properly prescribe PrEP, and those guidelines include a set of criteria that can help a medical provider determine what patients should be considered for the medication.

There are multiple resources for medical providers to consult when they have questions regarding the treatment, Huseby said. He hopes more providers in the state of Louisiana will do so because of limited availability to the medication in many areas.

“Your primary care physician is the one person you should tell everything,” said Eakins who noted that there is much more to Truvada than simply taking the medication every day.

Patients on PrEP should be fully educated on the medication and should report to their physicians for regularly scheduled tests on kidney function, liver function, bone density and continued HIV testing.

“To be on PrEP, you have to be negative,” said Michael Freeman, the wellness coordinator for the Wellness Center at The Philadelphia Center.

Freeman assisted in starting a PrEP clinic in Monroe in 2014. It exists as a point of access and follow-up testing site for patients. Freeman is working to create a similar clinic in Shreveport. His first step is to find a physician with whom to collaborate. Freeman typically does all the footwork, paperwork, and follow-up testing involved with running such a clinic and needs a doctor to open the clinic.

Although Freeman said the process is off to a slow start, he hopes to find the right medical collaborators to help him very soon.

Costs associated with PrEP

Truvada retails for about $1,500 per month because it is a top-tier specialty drug. Its manufacturer Gilead offers programs for assistance with the cost through their website, said Huseby.

“It’s not inexpensive, but it’s accessible,” said Eakins, who noted that coverage from health insurance varies among plans. Gilead offers a co-pay assistance card that can defer some or all of the cost left after insurance has paid. The manufacturer also offers different programs for those without insurance.

“It’s a lot less expensive than lifetime treatment,” said Eakins, who hopes to continue seeing more programs and medications to eliminate new cases of HIV in the community.

Did you know there are different forms of HIV?

  • When HIV replicates by infecting a new cell, mutations can occur and there can be different types of HIV, even within a single person living with HIV. HIV-1 and HIV-2 are two totally different viruses. HIV-1 is the predominant virus worldwide, while HIV-2 is particularly concentrated in West Africa.
  • The strains of HIV-1 are classified into four groups. Group M is the major group because it is responsible for the majority of the global HIV epidemic. Groups N, O, and P are mainly found in areas outside the United States.
  • Groups are further divided into sub-types. HIV-1 has at least nine genetically distinct sub-types and geographical patters can start to emerge when looking at the various sub-types. 

​Steps to accessing and taking PrEP:

1. Get Educated!

2. Get Tested!!

3. Go to your primary care doctor and tell her/him everything — doctors are not mind readers and they are of maximum assistance when they know everything they can about you and your body.

4. Take the medication daily. Missed doses show reduction in the efficacy of the drug.

5. Continue to meet with your doctor for routine follow-up testing and care

Sources: Chip Eakins of the Philadelphia Center and avert.org.