Friday, March 30, 2012

Game changers in HIV/AIDS this past year and the year to come...

What a year it has been with regard to scientific research, new treatment, new guidelines, and the hiring of D.R Colfax to run the Office of AIDS Policy (ONAP), and ever growing AIDS Drug Assistance Program challenges.  These have all been game changing events in the face of HIV/AIDS. 

August 5th, 2011 – nearly 10,000 individuals on ADAP wait-lists
At the height of the economic downturn the ADAP waitlist had grown to nearly 10,000 people across the United States.  At this point states began to scramble to find ways to save ADAPs.  Federal  and State contributions at this point were down significantly from prior years, and cash strapped states dis-enrolled individuals from the program, a re-certification process started, and states began making changes to financial and medical criteria, making it harder for People living with HIV/AIDS to enroll (PLWHA) into ADAPs.  Over the past year the number has now decreased to about 4,000 PLWHA.  The reason for this lowered number is because as states began changing financial and medical criteria, this virtually shut people out from enrolling into ADAPs when they would have been able to previously.

HPTN052 – Treatment as Prevention
One of the biggest highlights of the past year in May 2011 was the revelation of a study known as HPTN052 conducted by Professor Myron Cohen of the University of North Carolina at Chapel Hill. The study revealed that those on Anti-Retroviral therapy are 96% less likely to transmit the virus to their partner. This stresses the importance starting Anti-Retroviral early to suppress viral load, and lessen the likelihood of transmitting the virus. Thus, Treatment as Prevention was coined.

Complera – Once a day

Then, in August 2011 the FDA approves Complera.  A once daily pill which consists of Gilead’s Truvada (emtricitabine/tenofovir) and Tibotec Pharmaceuticals’ Edurant (rilpivirine), which was approved by the FDA in May.  The only other once daily pill on the market is Atripla that has been out since 2007.

CROI 2012 – Many research developments

Jumping ahead to March 2012 at the Conference of Retroviruses and Opportunistic Infections (CROI) promising research was announced. Currently 31 drugs are approved to treat HIV, and a list of these drugs can be found at www.positivelyaware.com/chart , but in the coming year this chart will be expanded.  One drug, dolutegravir (still experimental) is a second-generation integrase inhibitor that is active against HIV strains resistant to first generation inhibitors. This drug combined with other drugs in a once a day pill is currently being explored.

The other promising drug is GILEAD’s ‘QUAD’ tablet containing the experimental integrase inhibitor elvitegravir and boosting agent cobicistat along with tenofovir and emtricitabine and tenofovir. This quad tablet has been submitted for FD A approval – and seems to address the limitations of sustiva’s psychological side effects, such as found in Atripla.

Also from CROI 2011; Latent HIV was discussed. This is HIV that is not actively replicating and it lies dormant in reservoirs (In the gut, the brain…etc.) throughout the body.  This has been the biggest challenge, how to eliminate latent HIV from these reservoirs?  Anti-retrovirals work on blocking replication of HIV, but do not work on latent HIV.

Eradicating latent HIV is a TOP priority for scientists attempting to cure HIV and currently several drugs are currently being tested for their ability to reduce or eliminate this hidden reserve of the virus. One of the most discussed avenues behind curing AIDS is intensifying ARV treatment and combining new potent and less toxic drugs that can reach HIV infected latent cells, activate them and with those same drugs inhibit their ability to replicate – then it may be possible to eradicate HIV from the body.  Also, results of a small study using Zolina, a drug used to treat lymphoma may successfully reduce the size of the latent HIV reservoirs in HIV positive adults taking antiretrovirals. This study indicates latency can be targeted and will continue to be a significant step towards eradication of HIV.

Also at CROI 2012 Researchers in many of their discussions noted that rates of Metabolic problems, notably cardiovascular disease and diabetes, are elevated in people living with HIV.

CROI 2012: Co-Infection; new hope

With regard to co-infection of HIV and Hepatitis C Merck’s new drug boceprevir had a cure rate of 60 percent in people who completed 48 weeks of treatment and who had a sustained virologic response 12 weeks post treatment.  With Vertex’s drug called Telaprevir, 74 percent of co-infected study individuals were cured, after finishing treatment.  These two drugs in the past year have given hope to many, when interferon and ribavirin alone gave people with chronic HCV infection only about a 15-20 percent cure rate.

March 2012, the Institute of Medicine (IOM) Report
“Monitoring HIV Care in the United States” Indicators and Data Systems
The Office of National AIDS Policy (ONAP) asked the IOM to convene an expert committee to identify core indicators related to continuous HIV clinical care and access to supportive services, and to monitor the effect of both the National HIV/AIDS Strategy (NHAS) and ACA on improving HIV care. The committee outlined a number of obstacles that prevent people living with HIV to optimal health. These obstacles included; late diagnosis, delayed access to care, delayed prescriptions and intermittent use of life-saving antiretroviral therapy (ART), untreated substance use disorders, and unmet basic needs.

The expert committee concluded that the vision provided by the National HIV/AIDS strategy and the changes to the US Health Care system embodied in the ACA both have the potential to help curb the HIV epidemic and blunt it’s impact. The changed eligibility requirements for public and private health insurance resulting from ACA are expected to expand access to prescription medications and clinical care for HIV and other conditions that affect people living with HIV/AIDS (PLWHA), including mental health and substance use disorders.

The expert committee also concluded that an increased focus on why people diagnosed with HIV fail to enter or remain in care, as well as removing obstacles to care, such as by providing supportive services, will improve individual health and reduce transmission of HIV to others. As the committee outlined in its report it is critical to continue to monitoring improvements in HIV care resulting from the NHAS and ACA.

March 29th, 2012: The National Institutes of Health updated its guidelines

It’s biggest update is a recommendation that ALL HIV treatment Naive patients should be on Anti-Retroviral therapy.  Though, they triaged their recommendations as follows:

The Panel’s recommendations are listed below.
• ART is recommended for all HIV-infected individuals. The strength of this recommendation
a varies on the basis of pretreatment CD4 cell count:
    o CD4 count <350 cells/mm3 (AI)
    o CD4 count 350 to 500 cells/mm3 (AII)
    o CD4 count >500 cells/mm3 (BIII)
• Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following conditions:
    o Pregnancy (AI) (see perinatal guidelines for more detailed discussion)
    o History of an AIDS-defining illness (AI)
    o HIV-associated nephropathy (HIVAN) (AII)

    o HIV/hepatitis B virus (HBV) coinfection (AII)
• Effective ART also has been shown to prevent transmission of HIV from an infected individual to a sexual partner. Therefore, ART should be offered to patients who are at risk of transmitting HIV to sexual partners (AI [heterosexuals] or AIII [other transmission risk groups]).
• Patients starting ART should be willing and able to commit to treatment and should understand the benefits and risks of therapy and the importance of adherence (AIII). Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.  


Key Considerations When Managing Patients Co-infected with HIV and Hepatitis C Virus:

• All HIV-infected patients should be screened for hepatitis C virus (HCV) infection, preferably before starting antiretroviral therapy (ART).  • ART may slow the progression of liver disease by preserving or restoring immune function and reducing HIV-related immune activation and inflammation. For most HIV/HCV-coinfected patients, including those with cirrhosis, the benefits of ART outweigh concerns regarding drug-induced liver injury (DILI). Therefore, ART should be considered for HIV/HCV-coinfected patients, regardless of CD4 count (BII).  • Initial ART combination regimens for most HIV/HCV-coinfected patients are the same as those for individuals without HCV infection. However, when treatment for both HIV and HCV is indicated, consideration of potential drug-drug interactions and overlapping toxicities should guide ART regimen selection or modification (see discussion in the text).  • Combined treatment of HIV and HCV can be complicated by large pill burden, drug interactions, and overlapping toxicities. Although ART should be initiated for most HIV/HCV-coinfected patients regardless of CD4 cell count, in ART-naive patients with CD4 counts >500 cells/mm3 some clinicians may choose to defer ART until completion of HCV treatment.  • In patients with lower CD4 counts (e.g., <200 cells/mm3), it may be preferable to initiate ART and delay HCV therapy until CD4 counts increase as a result of ART.

Rating of Recommendations:  A = Strong; B = Moderate; C = Optional
 Rating of Evidence:  I = data from randomized controlled trials; II = data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = expert opinion


Highlights to come within the next year:

The RAPID 20 minute Orasure HIV Home Test Kit
Up for FDA Approval on May 15th, 2012, this at home test kit has been in the planning stages for years. There is already a Home Access test kit on the market in drug stores and supermarkets across the country to test for HIV and Hepatitis C; this new test from Orasure would be the standard 20 minute test you need to go to clinics for now. This test is already available in Europe could be approved within the next year here in the US. Also, it’s no surprise a rapid 20 minute at home Hepatitis C test is in development too.  

Also in the next year battles will rage over PrEP (Pre-Exposure Prophylaxis), and an introduction of another Quad pill or two could be further game changers in the face of HIV/AIDS, and pharmecuetical companies will also be heavily invested in Hepatitis C therapies that pre-clude interferon based treatment. Discussions surrounding a ‘common portal’ for easier access and linkage to care for people living with HIV/AIDS will also be a hot topic.

DR Colfax

Within the past couple weeks the White House has chosen D.R Colfax to head up the Office of National AIDS Policy (ONAP).  This replacement of Jeff Crowley, who resigned in November 2011, is being hailed as a wise choice by many in the community. Undoubtedly D.R Colfax will alone be a game changer in the face of HIV/AIDS.

Grant Colfax, MD, Director of the HIV Prevention Section in the San Francisco Department of Public Health will coordinate the continuing efforts of the government to reduce the number of HIV infections across the United States. “Dr. Colfax has been instrumental in the decline of new HIV infections in San Francisco in recent years,” said San Francisco AIDS Foundation CEO Neil Giuliano. “His unique blend of experience serving on the front lines of the epidemic, implementing the national strategy at the local level, working as a direct service provider within the Ryan White CARE system, and conducting cutting-edge research makes him the right person at the right time to lead the Obama administration’s efforts to end HIV/AIDS in the United States.”

“Dr. Colfax will play a critical role over the next several years to ensure the implementation of the Affordable Care Act and HIV service integration to address the health care needs of people living with HIV,” said Ernest Hopkins, director of legislative affairs at San Francisco AIDS Foundation. “Having worked closely with him on complex issues and having seen his consensus-building skills among diverse populations, including communities of color, I am confident that the AIDS community will have a strong advocate within the administration. I know Dr. Colfax will work to ensure that the coming changes to our health care system are made thoughtfully, carefully, and with a strong focus on improving the health status of the most vulnerable people.” -–San Francisco AIDS Foundation.

Conclusion

The pace doesn’t seem to be slowing down with regard to advancements in science, research, new developments, and new guidelines for HIV AND Hepatitis C.  It can only be surmised that in the next year, and years to come, better treatments will become available, more people will enter care, and the forever quest for the cure will become closer and closer to a reality. D.R Colfax will undoubtedly be a strong advocate inside the white house for people living with HIV/AIDS (PLWHA), with firsthand knowledge of events happening on the ground, and capabilities and the knowledge to implement ideas and sway opinions inside congress. I look forward to the continuing work of the National AIDS Strategy, and look forward to the work of D.R Colfax and the Office of National AIDS Policy.  Welcome to Washington, D.C, D.R Colfax!

Until theres a cure,

Kevin Maloney
RiseUpToHIV
Facebook: http://www.facebook.com/riseuptohiv
Twitter: http://www.twitter.com/riseuptohiv
e-mail: kevin@riseuptohiv.org
"Voices of unity strengthening community"

Tuesday, March 27, 2012

In his own words; Willow Darkwater's Bath Salt Addiction: The Salt Tester


Chapter One


The room smelled of cigarettes, plastics and some other man-made material he couldn’t quite pinpoint.  He continued to open the door to the motel room but could see nothing.  He fumbled for a switch on the wall.  He had stayed in this motel twice before but could not remember the layout of the rooms.  He sighed with relief as he flipped a switch on the wall.

His spirit was weak and loosely attached to his gaunt frame. But the dopamine triggered in his body by the synthetic drugs made it a mute point; he was more than comfortable with his body, he masturbated a lengthy four hours a day, an hour was spent drawing at least ten shots into hypodermic syringes, depending on his supply, sometimes only a couple, sometimes fifteen if he had company or a zealous day of bath salt injections. This was a good day. And he was amply supplied for a couple of days: salts, syringes, and enough money to eat once a day and keep himself hydrated.

He truly was bored.  Deep inside, no matter the amount of dopamine, he was bored, discontented, guilt ridden and desperate for the touch of another human, preferably male.  He was more than willing to take whatever embrace, touch (hell, an accidental brush in a narrow grocery aisle); he was in no position to turn down any contact he could get. His gut cramped and made some alchemically unbalanced sound that let him know his lifestyle was not healthy.  It was cry for help from physical body to somewhere in the ethereal where his spirit spent most of it’s time in limbo debating separation from or staying with the string bean of a physical body that was its slim temple.

Existentialism, transcendentalism, philosophy,
spirituality and religion, even Love, not just love, but Love with a capital “L”—everything seemed so obsolete, overdone, overestimated.  He was not sure which he was more tired of:  living or dying.  He didn’t care to ponder the question either because one inevitably inferred the other. Life supposed death. Death supposed having lived.  The only thing that seemed to be of any interest to him was sensuality, sexuality, and increasingly, fetishes and kink.  He was getting wilder in his bath salt addiction than he wanted to acknowledge and some of the thoughts than ran through his head made him do more than blush, he felt the need to put on a hairshirt and reach out to something, someone for absolution.  In his mind he flogged himself and even that turned him on.

The bath salts weren’t for baths by any means.  The price alone said there was something more than “invigorating” about a half of a gram of some times sandy pink to fine white floury powder that said “retail methamphetamines” but everyone referred to them simply as “salt”.  There were four main active ingredients in the powders and they were inhalable through snorts, puffs of smoke, or infusions, and the preferred mode: injection.  The ingredients were methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, and pyrovalerone.   

The only thing he had found that countered the varying combination of drugs to the point of sleep was melatonin. Surprisingly, melatonin worked against the retail meth and it brought sleep at a fair dose of 20 mgs or so.  He didn’t like his physical dependence and felt himself slipping into some psychological abyss; a psychosis, he was sure. Eventually, it happened to everyone on retail meth and he had some anxiety about it but still, the drug cried, and his body craved it’s own demise.  He hoped his spirit survived.

The weather worked against his slim body.  It was winter, barely the end of January.  Going out into the windy, sharp weather made his veins shrivel and dry up making purchase harder as the scar tissue mounted, the hydration fluctuated, and his blood pressure rose and fell. There was no part of this addiction that hid itself, no facet he didn’t consider and with the playing field leveled, he looked his devil in the eye and kissed him sexually like an incubus and knew they would never marry.  The love child was scar tissues.  He scrubbed with a loofah and put a thin layer of triple antibiotic ointment over his after shower moisturizers, the loofah stimulated circulation and the warm soapy water got him clean (kept scabs from forming thickly and other things like nutrients, proteins, (dope!) all in steady supply to his well kempt body.

His head ached as his blood pressure soared and a faint itch in his chest said his heart felt it. It was always in the back of his mind when giving himself an injection:  Will this be the one that finally does me in? It never slowed the plunger through the syringe. There was an excitement to not knowing and it made the rush of the chemicals a bit more intoxicating. As if that were possible. It didn’t matter, nothing did. Steady, he undid the tourniquet and lay back on the bed. He made his shots thick and small so he could get all the medicine and fewer headaches from water. The headaches from high blood pressure seemed to cancel out any efforts in that area. His vision became choppy and his leg twitched, only once, and he felt the erection growing in his Levi’s. God, what a rush. The designers knew what they were doing when they engineered this one. And for that, he was grateful. Where was the moon? He needed to howl.



At the café down the street from his seedy motel, he sipped coffee with milk and a ton of sugar.  He had to get calories from somewhere and it might as well not be counterproductive-- more stimulants.  His high broke with a sudden mood swing and he felt anxious. He took a small prescription bottle from his bag and poured several tablets in his hand.  Xanax was an excellent buffer on the comedown, but only in excess.  The reason why doctors didn’t think benzodiazepines were helpful in dealing with bath salt overdoses was that they were too conservative with their measurements. One doctor had even used general anesthesia, he had read in the paper.  General aneasthisia? But no Valium buzz—it was extreme. 

The chemicals, especially mephedrone, were highly scrutinized globally and they should have been.  They were a hot mess and the problem was growing. As states banned the bath salts, the manufacturers changed things up. From bath salt to plant food to ladybug attractant, they were one step ahead. He wondered where the obscure little laboratories were and if he could visit.  If they would make a batch in front of very eyes and he could "scarface" the table in front of him as they placed the finished product before him.

He was developing a nervous tick from the salt and he was self-conscious as he fought some compulsion to run from the table flipping it over and spraying other patrons with ashtrays and artificial sweetener packets. He laughed out loud at himself and his thoughts, observed a woman eye him with skepticism and looked through his bag for no other reason than to avoid the woman’s eyes.

 Why were there still ashtrays? All of the states had banned smoking at least ten years ago and yet the ashtray stood proud like the flag of some defeatist veteran. He shook the thought from his head and realized he was about to cry. Absolutely not. He never cried and he wasn’t starting. Dopamine would fix that and he went to the café bathroom carrying his trusty bag.

Along the way, he had lost his family and friends. He had made a choice, and the chemicals won. Everyone was kept safely away; he socialized by Internet and rarely met anyone in person. The meth retailers were his only real contact and in exchange he worked as a tester.  They would give him a sample of a new drug and he would tell them whether it would sell or to negate the offer from the vendor. There were perks to being a tester like a line of credit when money was tight or discounts, needle exchanges and of course, free dope. The credit line always seemed to pay itself and he had cell numbers for at least two people on every shift. He was well protected from the pitfalls of addiction; it was his best friend and worst enemy, the tester. How easy they made it. He marked grateful somewhere in his mind.

Once, he had run out of dope and slept for five days. The store had run out, the manufacturers sold out. Bone dry, sober as the proverbial judge, his mind had saved him and shut down.  Things to be grateful for were at every turn and he didn’t fail to notice.

He had been a high priest at one point in his life, before salt before everything got so hectic and he paid homage to the Matriarch at this point.  It was different, he noticed his spirit was removed, empty almost, or preoccupied and he didn’t like it.

He had been to South America on scholarship because of his sixth sense development. He had worked with the last first level Chavin culture shaman, maestro Mancoluto, and four fourth-level shaman from the same culture. They had said wonderful things about him, told him he was “sheer will-power”, that he could, “manifest anything,” and he had been more than flattered. He was sharp on every level and he had been dulled at the same time. He was reluctant to accept this change as anything but bad but the dopamine won. The addiction won over spirit and he knew this was a bad sign.  It was an omen of the worst kind.

He was never blind, in any situation he could see more than most, and of course he felt more than most, before the salt.  Before this addiction, drugs had been used in combination with spiritual tools to be catalysts for a profound number of things, witchcraft on a high level. From meditation to creative visualization, to ritual ingestion, to now, bath salt. What a confession!  What a shameful sight his laughable life had become.  To even say, “I am addicted to salt? Bath salt?” Who makes these admissions? He had had students, pupils, witches that studied under him and now he had no one. Where had he disappeared to and on what level did he even still exist, other than some ego driven maniac that got his beans on designer drugs.  Holy shit, indeed.  And working as a tester? Well, that just took the cake. His reputation was no better than mud he was sure.  Good grief, and from Seattle to Virginia, some dark smear across some page of The Book of Judgment and probably in some profane and indelible ink. He was most sure. For this, he was not grateful. He was fucking pissed.



Somewhere, there was three generations of women sitting by a fire, one telling a story of a man, one she had loved greatly, and he had loved her.  There had been many storms that winter. The man had left to find food and had never returned. This was some old love story, and it drifted on the smoke into the trees and disrupted by limbs, got separated by the up-reaching arms that tickled the night’s underbelly like the probing fingers of a precocious child, and abducted part of the myth like the calloused hands of a underhanded man that drove a white utility van.



During the next few weeks he settled back into his mother’s home.  He tried to keep his addiction a secret, keep his private life tucked discreetly into his bag, but the buzz won over tidiness and a syringe was left lying about, a spoon, something and he could not lie. What would be the point and who would have benefitted?

His mother had aged twenty years in the past two; his father had succumbed to cancer on the third and final round but had given a more than dignified fight; he had chosen chemotherapy and radiation when the time was right and he had chosen neither by the same intuition. He had crossed with grace and tranquility. He embodied an officer and a gentleman through the entire war with cancer, though fought mostly on the inside.

Most of the war was unobserved or more unobservable, it was no spectacle, and the family, though experiencing malignance in it’s nucleus for the first time, acted as well trained veterans.  The man’s wife of 52 years, the mother of the Tester, was a force to be reckoned with, a sublime example of the Matriarch and she, body stretched and pulled from four pregnancies and raising four children, plowing, seeding, growing, hoeing, and hauling tobacco. Not to mention the cooking, feeding, laundering, schooling and disciplining of the four children and the farm animals. It was a sustainable community run by one man, his wife and four children, and that’s how southwest Virginia had been for a couple hundred years and he figured nobody was in a real rush to fix a machine that didn’t necessarily seem broken.

Her body looked like any fertility goddess from any culture, and it was packed full, as her zodiac sign of Cancer would suggest, of love.  She was a constant source of love.

Now she was widowed and only a few months into the life of a single woman again.  Her husband had past in the month of October.  The Tester had flown in from Seattle to see his father before he had died and had made it within the timeframe of his physical death but not before the cancer-induced dementia had wiped the slate of his mind clear.  The tester looked deep into his father’s eyes and there he was:  A scared, tired man, without words, without communication but so many emotions.  His eyes screamed to be engaged, and those eyes got more than sympathy, they received solace, comfort, and hugs from everyone who bothered or was strong enough to look.  He was a husband who deserved it, a father who was never denied it, and spirit that could simply ask and receive it. He was asking, simply, and his proverbial cup ran over.  His life had been long and full, he had had many stories to tell that were now on the tongues of others or lost to his failing mind forever. He was sure, the right and important ones, were on the tongues and in the hearts of the next generation. They would rightfully be carried on the shoulders and in the hearts of the children and the grandchildren and their children for many generations to hear, enjoy, and gain knowledge and morals.  His path was landmark and it deserved to be passed on.  Was this just the sensationalizing of a parent all children do? Maybe, but it was his father, and romanticizing the man who taught him everything, could have been his twin brother, they looked and acted so much alike. They had fought like brothers in barroom brawls, had laughed, cried, and shared every emotional experience a father and son should, with the exception of a couple of adult thrown punches.  But what do mirrors do?  They reflect in the opposite, so a clash had always been inevitable.

It was the last ritual the Tester performed:  Helping his father’s spirit pass over.  It was the most rewarding and stinging; it was bittersweet heartache and relief.  He felt his father’s spirit brush past him as he closed the witch’s circle.  He knew his father was gone.  He knew he had helped him transition. The ferryman paid, the River was flowing, slow and steady, delivering his father to the other side.  Peace be with you, gentleman.  His father had crossed precisely when he had known he did.


  Chapter Two



            The town was small and some of the city drugs like heroin or powdered cocaine didn’t make it the towns nestled here in the Appalachian foothills.  It was a blessing and a curse, and the curse part had really just recently reared its haunting head.  There was a population waiting on a designer drug like “bath salt” to hit the market.  There was a black market to the point of a “need” just waiting for the city drugs to bleed in or the designer drugs to be made and so, the bath salts were received with open, welcoming arms.

          The retailers were not shunned but praised, and, in the beginning, the community was blind to the side effects that lay in wait with the salts and their deadly combinations.  The communities didn’t care as long their dopamine levels were raised and the street legal dope was more plentiful than cocaine in Columbia or Brazil.  Between the two states of Virginia and Tennessee, Virginia, with its supposed Democratic party, had shut down the bath salt market more than year before Tennessee had and the town of Bristol was a town divided by the two state lines. So on the Virginia side, there was a squelched public participation in the bath salt psychosis and on the Tennessee side there was a party of moonlighters that went well into the eighty or more hours of non-stop debauchery that usually satiated the most zealous salt partaker. Usually.

          Then there were the types like the Tester who had to have it on a daily basis, were usually able to sleep on it, eat on it and had gotten past most of the “amphetamine” like side effects and were more functional than most.  He did realize he was not functional and was far from it.  He was sure that the addiction had affected him in certain ways that would never allow him to be a fully functional member of society. His anxiety level was through the roof, and he was shaky most all of the time.  The nervous tick he was developing made him very self-conscious and he had a real problem with going out into public because of the combination of the two.  It was hard to try to address someone and have an arm twitching uncontrollably at your side, or to be hypo- or hyperventilating.  He was sure, one day soon he would be in a public situation and he would hold his breath to the point of passing out, or would hyperventilate to point the of hallucinating and make a total scene.  He was sure it was in the offing and soon.  The pangs of depression hit his chest in a manifestation of anxiety and he hated this feeling the worst. “If I can just make it through a couple more of these.” He said to himself, in an attempt to buy time.  He knew that the anxiety never stopped, would be with him forever like some conjoined twin and still he played the game with himself.  He had just administered a substantial shot, why was he feeling so anxiety ridden the rush killed every emotion but this time it seemed fleeting, lasting no longer than fifteen minutes and where?  Where was the comfort in that?

          He took out a second shot and registered blood in the syringe and sank the plunger.  The chemicals this time hit his brain with the break of glass that was the usual auditory hallucination that meant he had done it up right, then a second breaking glass, then a third, he had never heard these last two, a cat in an alley somewhere sounding bigger than it was, on purpose, he was sure.  It was his own mind against the over dose of chemicals he had just administered.  There was no faking it out, the nausea churned in his stomach not realizing any purging would be futile, it was already in the blood stream, never in the stomach, he was one step ahead of the body.  Except right now, he felt vaguely sleepy, and then sleepy out-right.  Two hours later he woke with the capped syringe in his hand.

          Sleep deprivation or slight overdose.  Slight? Either he did or he didn’t like conceiving a child.  It didn’t matter, apathy got him everywhere and he picked up another dose of salt in a syringe preordained to make or break him.  He had trouble finding purchase, then as the blood gave feedback he sank the plunger half way counted to five and administered the rest of the medicine.  His shoulder jerked, which made his anxiety level rise, and he found the Xanax bottle laying on the desk beside him and but four under his tongue. As the salt circulated and more hit receptors he felt rise in his groin and he knew everything, though blurry, was going to be just fine.  His shoulder jerked again.  Unusual.  Then a breaking of glass, and he knew if there was a second to lie down quickly.  The second never came and for that he was grateful. He was glad he had separated the injection into two, though mere seconds apart.

By Willow Darkwater
you can e mail Willow at: willowdarkwater@gmail.com

 _______________________________________________________________________
Currently 33 states ban bath salts. Other states and territories have yet to introduce legislation, or legislation is pending. You can see all this info on the site of the National Conference of State Legislatures, last updated on March 7th, 2012. Write your state legisltors and leaders in Washington, D.C. to demand a federal ban on Bath Salts! Visit http://www.votesmart.org to find who your legislatures are.

From Youtube:
20/20 from ABC News: Bath Salts: A Deadly, Legal High? 


Friday, March 16, 2012

Not Your Typical HIV/AIDS Support Group/Cruise Retreat


By Tom Donohue

Snorkeling, a Mad Hatter Party, and dinner among what becomes 200 and more of your newest friends is not what anyone would think as your typical HIV/AIDS support group. Neither is the location; hundreds of miles off the coast of the United States among on the beautiful blue ocean or on the exotic islands of Aruba, Curaco and Princess Cays.

In November, I had the pleasure of joining some I knew and many I didn’t to take part in the 2011 Cruise Retreat. This event welcomed hundreds of HIV positive men and woman, infected and affected to the coast of Florida where we began a journey that we will never forget.

Our first glimpse of each other was when we gathered at a local resort on Friday. Our leader Paul Stalbaum and hosts welcomed each other and got the conversation and introductions started. It was fun because it was also the first time that those who choose to save some money and have roommates met their roommate. It was a great icebreaker and with that our excitement grew to board our new home on the high seas.


Throughout the week we spent time getting to know each other at social and educational events all of which are optional to attend. I found that the more events I attended the more I began to feel this group become more of a family rather than friends I had just met. Our mutual connection, “the recipe” provided private times where just our group attended. It was a great way to connect with other HIV-positive people who just understood the challenges of being positive – it was refreshing especially for me, someone from a rural town to network with other positive guys.

Although there were moments when we bonded emotionally, I can’t stop

thinking about all the fun we had. The times when we got to let loose forget about us being HIV-positive and have a ton of fun. Paul sets up these private excursions for our group. An excursion is basically a tour on the island that we visit – that is generally action packed and lots of fun. This year one excursion was a catamaran to snorkel – we rode out into the blue seas where we were able to swim among all types of colorful fish and see the wreckage of this ship, it was awesome. Did I forget to mention drinks were on the house while on the catamaran? By the time we returned to land, we had forgotten about what we had had in common and the group were dancing, singing and just having a ‘boatload’ of a time.

The trip is different for everyone such as the experience it gave William Querica of Avon Parks Lake, Florida. He says “It gave me strength and now I am Vice-Chair of West-Central Florida's Ryan White Care Council helping thousands cope and live healthier lives. I see the cruise as being one huge support group with experiences and education needed to live a wonderful life.” We all have something in common, yet we all take something different away from this trip. Paul’s mission was to create a safe environment that allows people from all over the country to come together for a life affirming week of camaraderie, laugh out loud events and the chance to walk away with many new friends. He says “I am proud to say that over the years aside from literally hundreds of lasting friendships we have had dozens of people meet their next partner on our cruise.”

This year the cruise is heading out of Fort Lauderdale and over Halloween sailing to Princess Cays Bahamas, Grand Turk, St. Thomas, and St Maarten on Princess Cruise Lines. This will be my third trip with this bunch, in addition to being a host I’m also friends with many of those who join us, I can honestly say that these trips continue to be the highlight of my year and provide life lasting memories and friends you’ll connect with throughout the year.

For more information about the cruise retreat, visit http://www.hivcruise.com
TOM DONOHUE is the founding director of Who’s Positive, a national organization that humanizes HIV through firsthand accounts of people living with the virus. He also sits on the board of trustees of the National Association of People With AIDS. Reach Tom at tom@tomdonohue.org

Bon Voyage!

Tuesday, March 6, 2012

Tell Gilead Pharmacueticals to reduce the cost of their HIV meds now!! Organization and Individual sign on needed!

Referencing the latest figure from the National Alliance of State and Territorial AIDS Directors (NASTAD), as of February 23rd, 2012, 4,251 individuals across 11 states are on the AIDS Drug Assistance Program (ADAP) waitlist. These are indviduals who are uninsured or underinsured who have received an HIV + diagnosis, and are unable to properly attain the drugs they need to remain alive, healthy, and productive

In support of the following letter sent to GILEAD from the Fair Pricing Coalition, and signed by individual members, the FPC outlines it's concerns, and requests specific actions be taken by Gilead. Any interested individual or organization is welcomed, and encouraged to sign on. Please share WIDELY across your networks.

It is essential that GILEAD understand the negative impact of theyre actions on people living with HIV/AIDS (PLWHAs). Since 2009, Gilead has raised prices three times each for Viread and Truvada for a total of 22.1% and 24.5% respectively; twice for Emtriva for a total of 15.3%,and agreed to four price increases on for Atripla, totaling 21%, and agreed to a 7.3% price increase for Complera. These increases are dramatically higher than the rate of inflation. They also come at a time when many people with HIV have lost their jobs, their employer-based insurance coverage and, in many instances, their ADAP coverage, all resulting in desperate patients attempting to access HIV drugs on the open market, a market plagued with constantly increasing drug prices.

As U. S. economic stagnation persists, PLWHAs continue to lose jobs, income, health care benefits and ADAP coverage. At the same time, third party payers are imposing higher premiums as a direct result of escalating drug prices. Some patients have abruptly stopped treatment because they can no longer afford their medications. Although PAPs exist to help people who cannot afford medication, barriers to access are significant. Many people are unaware of the existence of PAPs. Others cannot cope with the labyrinth of multiple forms and requirements. Even with Gilead’s PAP eligibility at 500% of the Federal Poverty Level, a PLWHA earning $56,000.00 annually is not PAP eligible and will have to pay $20,000.00 or more to purchase Atripla at retail prices. This figure represents at least two-thirds of their net income.

The pharmaceutical industry’s extravagant price increases reverberate throughout the healthcare industry. They come at a time when many ADAPs are covering private insurance payments for their clients and result in ADAPs paying significantly increased premiums as a result of exorbitant price increases. This policy also results in higher premiums for people with HIV who are insured at a time when more and more people have less and less income due to unemployment, underemployment, reduced wages and reduced hours. Moreover, higher healthcare costs mean higher co-pays and pharmacy deductibles for people with private insurance and high share-of-cost plans which also result in increased costs to patients as well as decreased benefits. More restrictive access within insurance plans affects the cost of drugs, but also ancillary services, such as mental health, prevention healthcare, rehabilitation and substance abuse services.

Escalating costs for private and employee healthcare plans occasioned by continuous drug pricing increases will undoubtedly have a deleterious effect on the states as they design their health care exchanges in preparation for the 2014 implementation of the Affordable Care Act (ACA). Many states are likely to set a minimum standard for drug coverage for their “essential health benefits” package that requires only limited coverage of antiretrovirals and other higher cost drug classes. Additionally, with non-preferred generic antiretrovirals entering the marketplace we are concerned that higher drug prices will increasingly result in key coverage decisions being driven by cost rather than the standard of care for HIV treatment.

Much of this crisis is occasioned by irresponsible pharmaceutical industry behavior. We firmly believe that Gilead’s price increases are particularly egregious because Gilead currently has the lion’s share of the antiretroviral market.

We believe that the best way to begin to address these issues is for industry to change its price increase practices and agree to the following:

- Gilead must agree to take no more than one CPI consistent price increase annually.
- Gilead must use its sales force to disseminate information regarding its PAP and co-pay programs.
- Gilead must contribute to foundations that provide co-pay program access to Medicare Part D clients.
- Gilead must cooperate with the FPC and other stakeholders in designing and implementing a seamless, industry-wide standardized PAP criteria and enrollment process.

Now is the time for Gilead to reconsider its price increase policy and rescind its latest unreasonable price increases. The FPC, it members and the undersigned sincerely hope that Gilead will agree to the above and we look forward to your immediate response.

If you are an organization that would like to sign onto this letter please send an e mail to kevin@tiicann.org with your organizations name, city, and state.

You may also sign on individually by going to a petition started on change.org, click below to be taken to the petition. Please share this letter, and petition WIDELY.

http://www.change.org/petitions/tell-gilead-pharmaceuticals-to-reduce-the-cost-of-hiv-medications-now

Until there's a cure,

RiseUpToHIV
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