AIDS at 30: Quilt coming to Dallas

The largest display of the Names Project AIDS Memorial Quilt in 15 years will be at the Dallas Convention Center on Sept. 30-Oct. 1.

The Collin County-based AIDS organization C.U.R.E. that promotes education and prevention is behind the effort to bring more than 1,000 panels of the quilt to Dallas.

Event Director Tyler Sweatman said, “Fundraising is always a big challenge.”

The last time the entire quilt was displayed was in 1996 when the 47,000 panels were laid out on the Mall in Washington, D.C.

C.U.R.E. brought 225 panels of the Quilt to Dallas that were displayed in Lee Park as part of the Lone Star Ride in 2005. Each year on World AIDS Day the group hangs panels in a downtown Plano location and in several corporate headquarters in Collin County.

Sweatman said the speaker for the first night of the quilt presentation is Brryan Jackson, who is 19. His father, a hospital worker who didn’t want to pay child support, injected him with the HIV virus when he was 11 months old. He became deaf at the age of seven.

The goal of the quilt display, Sweatman said, was to “raise awareness and educate because here we are … 30 years later.”

— David Taffet

—  John Wright

AIDS at 30: Vaccine now in local trial shows promise

Dr. Mamta Jain

Advancements in treatments, ongoing prevention efforts give researcher hope for a world without AIDS

JAMES BRIGHT | Contributing Writer
editor@dallasvoice.com

HIV and AIDS: These two abbreviations require little explanation.

They have been on the minds of any sexually active person for the last 30 years regardless of gender, age or sexual orientation. Those six letters have produced fear in the uneducated, the disease they represent running rampant in impoverished communities and most of sub-continental Africa.

Thirty years ago, if a doctor diagnosed a patient with AIDS, it was essentially a death sentence — a quick death sentence. No one knew that they were dealing with and no one really knew how it spread.

The virus has been responsible for more than 25 million deaths since 1981, with 1.8 million dying in 2009 alone. It has decimated communities and is the scourge of entire continents.

In Dallas County a third of the people with HIV will have a diagnosis of AIDS in a year.

There is no known cure for HIV/AIDS, but doctors around the world are working tirelessly to eradicate the virus.

Jorge Diaz

Dr. Mamta Jain, director of HIV Research at UT Southwestern and acting medical director for HIV Services at Parkland Hospital, is one such doctor. She is currently involved in a trial vaccine that researchers hope could destroy HIV/AIDS in the U.S.

The HVTN 505 study that Jain is a part of is not actually up for FDA approval. But the knowledge gained from the tests could lead to a comprehensive vaccination, researchers say.

The important information is in the viral loads taken from candidates trying the vaccine. A reduced viral load in someone who is HIV-positive could delay the symptoms of the disease, giving the person a longer life and better quality of life.

The results of the trial will be a study on the rate of viral load changes between those who had the vaccine and those who didn’t.

The virus itself works by reducing the amount of cdT-cells in the body, which are responsible for fighting infection. If a person has HIV and his cdT-cell count drops below 200 they are considered, at that point, to have AIDS. All participants are HIV-negative.

Jain said trials of the 505 vaccine involving monkeys are being done at the National Institutes of Health and that results look very promising so far.

But it’s just the beginning.

“Models are models. Until you look at it with human beings you don’t know the full potential,” Jain said. “Every little step gives us a better understanding of what type of vaccine will work. That’s why we need volunteers.

“Until we try this vaccine and see the impact of it we won’t know how it works. It’s that knowledge that drives HIV study.”

Jorge Diaz is one of the trial’s current participants. He said his only incentive to try the vaccine was to help the community. Diaz just recently finished his last injection and said the whole ordeal was not really all that taxing.

“The only thing really rigorous about the trial is the amount of blood drawn,” he said. “The first time, they took 18 vials.”

Diaz said he suffered no side effects, and he thinks 505 could lead to an all-encompassing vaccine.

But while this vaccine may help to stop AIDS in America, it probably won’t do much for the African-born strain of the virus.

“There are different clades of HIV,” Jain said. (A clade is defined as a group consisting of an organism and all its descendants.)

“There are different things circling the African sub-continent,” Jain continued. “They are doing trials in Africa, so they can gain a better understanding of what vaccine would need to be there.”

Although not there yet, Jain said the 505 vaccine is definitely positive step forward toward complete understanding of HIV and its transmission.

Other advancements

Vaccinations are not the only area, Jain said, in which advancements have been made in the fight against the HIV/AIDS epidemic.

“In the last 30 years we have seen a tremendous amount of energy and support go into developing life-saving drugs,” she said.

At Parkland, Jain said, she has had patients that had a cdT-cell count below 200 who, with the right medicine, have improved their count to above 500 in a couple of months.

The work of researchers and doctors since the virus was discovered has transformed HIV from being uniformly deadly into a chronic, but manageable disease, Jain said.

Now if someone is diagnosed with HIV/AIDS at 20, they could live an additional 50 years using the right anti-retroviral.

This is a far cry from 30 years ago when people were dying six to eight months after being diagnosed.

Jain noted that while the earliest medicines used to combat AIDS were highly toxic, “We have better medicines now. If someone gets infected, we have incredible drugs to help them live a healthy life.”

There are pills now that can only need to be taken once a day and have very few side effects, especially compared to the old drugs. The new medication makes it easier to live with the virus since people don’t have to take pills every eight hours.

Despite these improvements, Jain said she has seen people who will stop taking their drugs for various reasons.

“Sometimes they lost their insurance and don’t have resources [to buy the medications],” she said. “Sometimes they feel OK and just don’t want to take them.”

AIDS is a psychological disease as much as it is physical, Jain said, adding that she has seen patients she’s had for years who are doing well but then will just hit a time where they stop taking pills due to pill fatigue.

That’s why Dallas service providers need to focus more attention on counseling, she suggested.

Jain said the LGBT community is largely responsible for much of the progress in the battle against AIDS.

“A lot of credit has to go to the gay community, which was there in the early days,” she said. “They played a very important activist role by trying to generate focus, energy and funding. With out that work we would not be where we are today.”

Jain cited viral Hepatitis-C as an example of what HIV/AIDS could have been without the activism of the LGBT community. Viral Hep-C affects more people, she said, but does not have the resources behind it that AIDS research does.

Looking ahead

Despite such improvements in treatments and advances in the search for a vaccine, the battle against AIDS is far from over, according to Jain.

“We can make tremendous improvements in people’s lives, but 20 percent of HIV-positive people in the U.S. don’t know they have it,” she said.

Because people could be infected with HIV and yet remain asymptomatic for years, the virus can do silent damage as it remains untreated — and they could pass it on without realizing it.

That’s why, according to Jain, the Centers for Disease Control has recommended universal testing.
Diaz agreed that testing is paramount.

“People should get tested every six months if they’re sexually active, and even if they aren’t they should be tested once a year,” he urged.

Jain said testing has been invaluable in virtually eliminating mother-to-child transmission of the virus in America. Every pregnant woman in the U.S. is tested for HIV and if she is positive, she can be put on powerful anti-retroviral therapy that can keep her from passing the virus to her unborn child.

Other areas of prevention

Aside from the vaccine, Jain said, work in other areas of prevention has yielded positive results.

“We know that behavioral risk counseling works and we also learned that circumcision can help resist the risk of HIV infection,” she said.

These methods are not 100 percent effective, though, and education about the virus is key to winning the battle. Transmission is not as prevalent in the LGBT community as it once was, according to Jain.

“The gay community has a great connection, and I feel like if I diagnose someone in the gay community they know where to get help,” she said.

Diaz agrees. He said he’s seen ads in publications like the Dallas Voice alerting people to where they can get tested and where they can get help. Some clubs even have free testing on Saturday nights.

The greatest rise of new HIV/AIDS positive patients has been African-Americans, Jain said.

This runs congruent with what Diaz said he is seen as well. He said men who don’t consider themselves to be gay but still have sex with other men can contract the virus and then pass it along to wives and girlfriends.

“Since they don’t see themselves as gay, they are not getting tested,” Diaz said, adding that it is vital to get information about testing and prevention to these groups. He suggested a hot line for those who don’t label themselves as gay, so they can get the proper information.

There have been some communication efforts with these groups though. Jain said she has seen a slow and steady decrease in new cases. This could be a good sign according Jain.

“It’s not a failure,” she said. “If we are testing more people and catching it earlier we can change the trajectory of their lives.”

Although not there yet, the dramatic changes in prevention and treatment of the virus have lead Jain to believe that there will one day be a world without HIV and AIDS.

—  John Wright

AIDS at 30: Boosting dendritic cells may be key to new therapy

Dr. Louis Sloan

In revolutionary new HIV research, Dr. Louis Sloan tests a vaccination that appears to get patients off medication

DAVID TAFFET | Staff Writer
taffet@dallasvoice.com

A revolutionary new vaccine allowed all 19 participants in a trial to stop taking any HIV medications during the investigation that lasted more than a year, according to a local physician participating in the trial.

A few who participated in the trial are back on medication. The majority are not, said Dr. Louis Sloan of North Texas Infectious Disease Consultants, located on the Baylor campus. Sloan is investigating the new HIV vaccine therapy that is individually designed for each person.

In the new therapy, dendritic cells are harvested from a patient through a blood draw. Those cells are then stimulated, boosted with Interferon and peptides in a lab at Baylor Hospital, and then injected back into the patient.

The theory of the vaccine, Sloan said, was to use these immune system cells to boost the CD8 cells, which would keep the HIV under control.

Sloan said Phase 1 of the trial, which primarily tested the safety of the vaccine, recently ended. Effectiveness was a secondary consideration.

The vaccine proved safe: The only side effect was some soreness at the injection site, Sloan said.

But the vaccine appears to have been effective as well — at least temporarily.

The 19 people who participated in the study were all HIV-positive and on medication, and each had undetectable viral loads when the study started.

The cells were reintroduced to the body with four injections over six months. The study lasted a year.

Bryan King, director of clinical research

During the period of the study, most of the patients were able to stop all HIV medications. Although the patients’ viral loads were no longer undetectable, those levels did remain low.

By the end of the study, their CD8 counts rose dramatically while their CD4 cell counts remained above 350 in most cases.

The protocol called for all of the participants to return to their medications at the end of the trial. A few did, Sloan said, but most have decided not to begin taking medication again.

“We’ve had to beg people to go back on medication,” he said.

Sloan’s director of clinical research, Bryan King, said that they are monitoring those patients closely, making sure they do not fall below a CD4 cell count of 350. That’s the lowest level he likes to see before beginning a patient on medication, he said.
Phase 2 will involve 70 to 100 patients.

Before that phase begins, researchers here and in France are evaluating whether the vaccine was more effective against certain strains of HIV or if certain portions of the vaccine combated the virus better than others.

Re-injecting a patient’s own dendritic cells to battle disease is not new. At Baylor, doctors have been treating melanoma successfully for almost a decade with this same method, putting that cancer into full remission.

Sloan doesn’t know if he will have the same success against HIV.

“I’m not sure we’ll ever have a cure with dendritic cells,” he said.

But, he said, he expects the treatment to lead to HIV becoming a long-term, non-progressive disease.

“It’s a reasonable alternative to being on medication,” Sloan said.

Sloan expects Phase 2 of the trial to be ready in 2012 but until then, he said, researchers will evaluate and tweak the vaccine.

Results of the study have not been published yet, but Sloan expects to publish them later this year.

_______

DEFINITIONS

Dendritic cells are cells in the immune system that process antigen material and present it on the surface to other immune system cells. They act as messengers between the innate and adaptive immunity. Dendritic cells are present in tissues in contact with the external environment, such as the skin and the inner lining of the nose, lungs, stomach and intestines. They can also be found in an immature state in the blood. Once activated, they migrate to the lymph nodes where they interact with T cells and B cells to initiate and shape the adaptive immune response.

Antigens are any substance that causes your immune system to produce antibodies against it. An antigen may be a foreign substance from the environment such as chemicals, bacteria, viruses or pollen. An antigen may also be formed within the body, as with bacterial toxins or tissue cells.

Pathogens are agents of disease, and the term most often refers to an infectious organism such as a bacteria, a virus or a fungus. Non-infectious agents of disease, such as a chemical, are also sometimes referred to as pathogens.

The innate immune system provides an immediate, but non-specific response when a pathogen invades the body. If pathogens successfully evade the innate response, the adaptive immune system is activated by the innate response and the immune system adapts its response during an infection to improve its recognition of the pathogen. This improved response is then retained after the pathogen has been eliminated, in the form of an immunological memory, and allows the adaptive immune system to mount faster and stronger attacks each time this pathogen is encountered.

Peptides are a type of amino acid that provide communication throughout the immune system and coordinate and control immune system actions. Peptides are referred to as cytokines in the immune system and through their communication ability they create a chain reaction of activity from cell to cell through “cytokine circuits” to generate and then control the immune response.

T cells are a type of white blood cell that are at the core of adaptive immunity. The T cells are like soldiers who search out and destroy the targeted invaders. There are two primary types of T cells: CD4 cells and CD8 cells.

CD4 cells are “helper” cells that initiate the body’s response to infections. CD4 cells are the host cells that aid HIV in replication. HIV attaches to the CD4 cells, allowing the virus to enter and infect the CD4 cells, damaging them in the process. The fewer functioning CD4 cells there are, the weaker the immune system and therefore the more vulnerable a person is to infections and illnesses.

CD8 cells are also called killer cells. They are instrumental in fighting cancer and viruses. CD8 cells also produce antiviral substances, or antibodies, that help fight off the foreign invader.

B cells are a type of white blood cell — specifically, a type of lymphocyte — many of which mature into what are called plasma cells which produce antibodies — proteins — necessary to fight off infections. Other B cells mature into memory B cells. All of the plasma cells descended from a single B cell produce the same antibody which is directed against the antigen that stimulated it to mature. The same principle holds with memory B cells. Thus, all of the plasma cells and memory cells “remember” the stimulus that led to their formation.

—  John Wright

AIDS at 30: Truvada study shows an increase in protection for HIV-negative men

Pre-exposure prophylaxis may be a way to help control the HIV epidemic, but many say the drug will promote unsafe sex, is too expensive and may have side effects

DAVID TAFFET | Staff Writer
taffet@dallasvoice.com

In November 2010, researchers released a study that found that HIV-negative men who took the anti-retroviral drug Truvada consistently and dramatically lowered their chances of contracting HIV.

But soon after, the AIDS Healthcare Foundation in Los Angeles published an ad in several newspapers — including Dallas Voice — disputing the results.

Among other concerns mentioned, they are afraid that men will stop using condoms if the drug is approved as pre-exposure prophylaxis, or PrEP.

A letter supporting the research was circulated and signed by 170 AIDS organizations. None of those was from Dallas, but several from Houston are on the list of supporters.

Dr. Robert Grant is the lead investigator of the Truvada study. The research was done independently of the drug manufacturer Gilead.

Although the company contributed the medication used in the study at no charge, Gilead had no other input.

Both those taking a placebo and those taking Truvada increased their condom use during the study. But the group that used Truvada consistently showed 72 to 95 percent more protection than those who only practiced safe sex.

Those who skipped a daily dosage were as unprotected as those who were on placebo.

In response to critics, Grant said that with counseling, condom usage should actually increase.

The AIDS Healthcare Foundation charged that condom usage would decrease with PrEP. They believe that many men would take the daily pill thinking that they would be protected from contracting HIV.

There is also concern that for those who use Truvada as a preventive medicine and then contract HIV, fewer treatment options would be available to control HIV. Representatives of the foundation questioned whether those who contract HIV after using Truvada as a prophylaxis might develop resistance to the drug.

Dr. Nick Bellos of Dallas, who has treated people with HIV since early in the epidemic, said he is pleased to see the PrEP study results.

“I think it’s promising. It does look like it could be beneficial,” Bellos said.

Although he said his long-term preference is for a vaccine, Bellos considers the PrEP treatment to be a step in the right direction.

Still, he said, he would like to see more research that shows the benefits of PrEP.

Dr. Louis Sloan of North Texas Infectious Disease Consultants at Baylor is less optimistic. He said he is concerned about the side effects associated with using Truvada, noting that even if only 3 percent of patients experienced kidney failure, that number was high when simple condom use is effective.

AIDS Arms Executive Director Raeline Nobles said that her agency will be doing some PrEP trials.

Nobles said that while she is also concerned about decreased condom usage, she thinks some situational PrEP usage might be extremely helpful in controlling the spread of the virus.

Grant suggested that some people who use Truvada as a prophylaxis will use it situationally. He said someone coming out of a long-term relationship might begin PrEP until they become more comfortable with safer-sex practices.

A couple who has recently begun a relationship may use PrEP until they feel enough time has passed for them to both be tested as negative. Or the negative member of a sero-discordant couple may use the preventive medication to maintain his negative status.

A heterosexual couple trying to get pregnant when one of the partners is positive is another short-term situational use of the medication.

Among other things, the AIDS Healthcare Foundation charges that the Truvada study shows that the drug is less effective than condom use. They wrote that the study did not replicate real world experience, pointing out that participants were counseled monthly, which doesn’t translate into the way most people would take the drug.

Another concern is cost. The current price of Truvada is $45 per pill, which is more than $16,000 annually. Insurance doesn’t cover the cost of a flu shot, an annual preventive vaccine that costs less than a single Truvada, and there are questions over whether insurance companies would cover the cost of a daily preventive medication.

They also question whether uninfected men are likely to take preventive pills daily for the rest of their lives. A quick, unscientific poll of 10 single gay men, some in the Dallas Voice office, showed that only three in 10 would.

As questions remain, however, PrEP studies continue, including one at Dallas’ AIDS Arms, that could answer some of them.

—  John Wright

AIDS at 30: Where to get tested

Dallas County

• Dallas County Health and Human Services Department:
The clinic is located on the third floor of the DCHHS building, 2377 N. Stemmons Freeway in Dallas, in Room 336. The fee is $15 or $20, depending on the type of test requested. Results can be obtained within an hour with the Rapid Test ($20) or in 3-to-5 days with the ELISA ($15).
Results must be picked up in person. Picture identification required.
To get tested for HIV and syphilis,
call 214-819-1980.
Appointments are required for individuals who chose to take the Rapid Test.
For more information, go online to
DallasCounty.org/Department/HHS/
HIVIntervention.html

• Dallas tSTD services:
LabCorp, 3801 Gaston Ave., Suite 104; Dallas; testing available Monday through Friday, 8 a.m. to 5:30 p.m. Complete HIV and antibody testing is $249. For information go online to TSTD.org.

• AIDS Interfaith Network:
Testing services offered free to qualified clients at the AIN offices, 501 N. Stemmons Freeway, Ste. 200 in Dallas. Call 214-943-4444 or go online to AIDSInterfaithNetwork.org.

•AIDS Arms:
Free testing offered Monday through Friday, 8 a.m. to noon, and 1 p.m. to 4:30 p.m. at the Peabody Health Center, 1906 Peabody St. in Dallas. Call 214-421-7848 or go online to AIDSArms.org for more information.

• Resource Center Dallas:
Free, confidential screenings offered at the Nelson-Tebedo Clinic, 4012 Cedar Springs Road in Dallas, including testing for syphilis, rapid HIV antibody and HIV-RNA tests. Rapid HIV results are available within 30 minutes; additional results available in seven business days. Standard HIV Test fee is $50 and results are available in less than seven days. Fee for anonymous Rapid HIV antibody screening is $90. Testing offered Monday, Tuesday, Wednesday and Friday, 10 a.m. to noon and 2 p.m. to 5 p.m., and Thursday noon to 3 p.m. Appointments are required and can be scheduled by calling 214-528-2336. There is also a Thursday walk-in clinic from 4 p.m. to 6 p.m.

Tarrant County

• Tarrant County Public Health:
Free rapid HIV testing available Monday through Friday, 8 a.m. to 11 a.m. and 1 p.m. to 4 p.m., and Tuesday from 8 a.m. to 5 p.m. Appointments are not required. Call 817-321-4803 or go online to TarrantCounty.com/ehealth/cwp for more information.

• AIDS Outreach:
Offers blood-draw testing for HIV and syphilis free of charge, with blood spot (finger poke blood test) available only if blood cannot be drawn. Results available within seven days. Testing offered at the AOC office, 400 N. Beach St. in Fort Worth: on Monday, 1 p.m. to 4 p.m., no appointment necessary; Tuesday and Wednesday, 9 a.m. to noon and 1 p.m. to 4 p.m., no appointment necessary; Thursday, 1 p.m. to 4 p.m. by appointment only; Friday, 9 a.m. to 1 p.m., no appointment necessary; and on the first Saturday of each month, by appointment only. Call 817-335-1994 for an appointment or for more information, or go online to AOC.org for more information.

—  John Wright

AIDS at 30: Funding shifting toward prevention as officials struggle to reach those on opposite ends of the age range

Zachary Thompson

While medical, support services will continue for those already infected, efforts to prevent new infections will get more attention, DHHS says

DRACONIS VON TRAPP | Intern
intern@dallasvoice.com

As new HIV infections continue to be recorded, officials are shifting the focus to a new, comprehensive prevention model, according to Dallas County Health and Human Services Director Zachary Thompson.

Thompson said that while funding will still go to support and medical services for those already infected with HIV, the focus on preventing new infections will be stronger than before.

Thompson said that Dallas leads Texas in the number of HIV and AIDS cases. The numbers are on the rise for youths ages 13 to 24, individuals aged 45 and older, African-Americans, and MSMs (men who have sex with men). New prevention programs are aimed at these audiences, which in the past have proven difficult to reach.

“Younger people think they’re invincible,” Thompson said, “while the individuals above 45 seem to think that their partners are safer.”

But neither assumption is true, Thompson said, encouraging those who think they transcend HIV to get tested and know their status, know their partner’s status, and protect themselves.

As for the numbers among people of color, Thompson said he expects to see an increase in HIV infections among African-American men and women.

“Reaching the people of color has been a challenge over the years,” said Thompson, revealing that for many years communities of color have seen HIV and AIDS as a “white person disease.”

Thompson made a reference to Magic Johnson and how his infection brought the attention to communities of color.

“We’ve got to move past the stigmas and focus on prevention efforts,” Thompson said.

The new comprehensive prevention model, Thompson explained, tries to target these high-risk groups. He said the county has been working towards setting up more testing facilities in areas that have higher numbers of HIV infections, such as the 75243 zip code.

New funding is also going towards setting up community-based organizations for prevention.

Thompson said that prevention must start at a community level and start “bottom-up, not top-down.”

In order to reach men and women aged 45 and over, Thompson has said that the county is looking into having HIV and AIDS education available in the community libraries, civic groups and churches. For the youths in the 13-to-24 age range, they’re looking into social networking technology such as Facebook and Twitter to get the word out, as well as starting more school-based programs.

But Thompson also said that people have gotten too caught up in the numbers and infection rates and haven’t paid enough attention to the individual communities that don’t have the resources to help prevent the spread of HIV and AIDS. He agreed that AIDS has fallen out of popularity as a “cause,” and that some are getting complacent about taking care and protecting themselves.

But AIDS isn’t going away and we are not in a safe zone yet, Thompson said. The key is prevention, paying more attention to the community and getting tested.

“Testing, testing, testing,” Thompson emphasized. Know where you stand and keep yourself protected.

—  John Wright

AIDS at 30: Being HIV-positive and living a positive life

Shannon Sims

Shannon Sims knows all about the circumstances that cause many trans women to contract HIV, because she’s lived through it

RENEE BAKER | Contributing Writer
editor@dallasvoice.com

Life as a prostitute, a drug dealer, a homeless woman, a transgender woman, an HIV-positive woman, a Texas prisoner and guard, a showgirl and a college student brings her a mix of experiences few could match.

But at 31 years of age, despite her difficult road so far, Sims has hope. She says she has never given up on God and that her bad karma is behind her now.

“I am going to have a childhood someday,” she says, “and have a birthday party.”

Sims grew up in the South Dallas area as one of four children who all had different fathers. Sims never had a chance to know her own father.

Making it harder was the fact that her mother, Dorothy Walker, was never able to accept the feminine side of her transgender daughter.

“I was on my own since 13, when my mom gave me the boot,” Sims says.

She says her mother reached a breaking point when Sims evolved past playing with Barbie dolls and began expressing herself in a more feminine and vocal manner. That was the beginning of Sims’ life as a transient.

“I used to sleep on the streets for weeks at a time,” she says, “mostly in the South Dallas and Fair Park area.”

Sims lived under bridges and was “in and out” of trash cans, finding food to eat wherever she could.

She says many have no idea what it was like living and sleeping with “roaches and insects crawling all over me.” She says her circumstances left her little choice but to turn to prostitution to survive, a choice that she wishes she had never been forced to make. She said she “came to Oak Lawn to prostitute [herself] for years and years.”

Even today, though it is largely past her, Sims says she has had to “turn a trick or two” to make ends meet, since other jobs can be very hard to come by. To those who might judge her for her decision, Sims says they need to understand that when you are an obviously transgender woman, “you can’t just walk into a place and hand them a resume.”

Indeed, the National Center for Transgender Equality reported in 2011 that 16 percent of a national transgender population feels “compelled to work in the underground economy for income (such as doing sex work or selling drugs).”

When Sims was 17 years old, she got a lucky break. By night, she had been living in a ticket booth at Fair Park in Dallas, sneaking through the air conditioning ducts to get in. To lull herself to sleep, she would read through the telephone book.

“By the grace of God, I came across the number for the Job Corps,” she says.

The next day, Sims called the Job Corp number, and she kept calling until she was given a chance to join the North Texas Job Corps program. That gave her a new start in life, allowing her to get her GED, a driver’s license, clean clothes, career planning and job placement as a security guard.

But at 18, Sims just hadn’t reached a level of maturity to handle the responsibility of her new life. Then she started selling drugs,and it all came crashing down around her.

“I got pulled over for about a kilo — 960 grams of crack cocaine,” she says. “That was my first time in trouble with the police.”

That first time cost her five years of prison time — three years from 2000 to 2003, and another two years from 2005 to 2007. The official charges were drug possession, drug manufacturing and drug distribution.

It was not quite four years ago, Sims says, that she came out of prison “with a new attitude.” She said she had to make a change and “either continue to do the stuff I was doing, or begin to experience the positive side of life.”

While her new positive attitude was a good thing, though, her newly HIV-positive status left her with another obstacle to overcome.

Sims explains that she engaged in some risky behaviors while she was in prison, and she believes that is how she contracted HIV.

“In prison, I was the queen of the block and the most feminine thing there,” she says.

Sims’ life on the streets gave her the smarts to keep her safe in prison, but she was unable to protect herself from the AIDS virus. While she was between stays in prison, Sims received support, as well as her diagnosis as HIV-positive, from the Renaissance III AIDS service organization in South Dallas, which closed its doors in 2005.

As an HIV-positive transgender woman, Sims is not alone. The HIV infection rate among transgender individuals is approximately four times the national average. According to the 2011 NCTE national survey, the HIV infection rate is 0.6 percent for the general population and 2.6 percent for the national transgender sample of 6,450 individuals.

The HIV infection rate increases to 15.3 percent for transgender individuals that engage in sex work. People of color in the transgender sample reported higher rates of infection: 24.9 percent for African-Americans, 10.9 percent for Latinos/Latinas, 7 percent for American Indians, and 3.7 percent for Asian-Americans.

Sims is not surprised that the infection rates are higher for the transgender population. She says it’s a result of the things many trans women have to do to survive.

She says she knows too many transgender women that are in the same situation she’s in, “just trying to survive and make it.”

Sims’ lack of choices landed her in the Dallas jail for prostitution. After getting out of prison, Sims didn’t know what to do and went “out on my own to Cedar Springs. … An officer propositioned me, and they [ended up putting] a leg monitor on me.”

At one point, when Sims was just out of jail, “this dude on a bus” gave her a phone number for Project Reconnect, a program operating through the city of Dallas that helps prisoners gain re-entry into society.

“Without them, I don’t know where I would be,” she says of the program, adding that this program was what finally helped her turn her life around and helped her transition to a normal daily life. She also credits health and food pantry programs at the Resource Center of Dallas as “making a way, when there was no other way.”

Sims says she has seen at least 10 of her friends die of HIV and she wants to make sure she takes care of herself.

Sims works with Oak Lawn restaurants now, and is pursuing an associate’s degree in business at El Centro College. She hopes to pursue a bachelor’s degree in accounting next.

After completing her education, Sims says she would like to channel her energies into creating a resource group that specifically advocates for and supports transgender health and vocational education.

At night, Sims is also known as Laylonni Duvall on the drag circuit. And for now, Sims is thrilled to be able to afford her own place with “a flat-screen TV, a few pretty things and a sleigh bed.” And, she says, she loves being a non-operative transgender woman and doesn’t want to have gender reassignment surgery.

But then she looks up for a minute and says, “Well, maybe one day.”

—  John Wright

AIDS at 30: Marine goes from the closet to a positive life

A former Marine talks about how being closeted led to drug use, which led to HIV infection. But he doesn’t let the virus control his life

Editor’s note: Daniel is identified in this story by his first name only at his request.

DAKOTA SHAIN BYRD | Contributing Writer
editor@dallasvoice.com

Daniel’s lifelong dream was to join the U.S. Marines, and so at age 18, fresh out of high school, he enlisted.

Daniel was determined to be the best Marine he could be, and he trained hard. But when he started to struggle with his sexuality and the difficulty of staying closeted while in the service, all the training couldn’t help. So Daniel, desperate for some relief, some escape, turned to IV drugs. Soon he was addicted.

Eventually, Daniel conquered his addiction and two years ago, at the age of 38 and after 20 years of service and after rising to the rank of master sergeant, he prepared to retire from the military.

Two months shy of retirement, though, Daniel came down with a cold that he just couldn’t seem to shake. So he went to his doctor, who took blood for testing. The results weren’t good.

Daniel had HIV.

As dire as the news seemed, Daniel’s doctor offered some hope, telling him that an HIV infection is no longer the death sentence it once was. The doctor told him, “You can live 30 maybe 40 more years — maybe even longer with the strides they’re making in trying to find a cure for this,” and urged Daniel to find out everything he could about HIV/AIDS and the treatments that are available.

Daniel took that advice and today, at age 40, he is optimistic about his future and refuses to let HIV/AIDS control his life. Instead, he says, his life controls the disease, as he explains in this conversation with Dallas Voice.

Dallas Voice: What do you mean that your life controls your infection?

Daniel: Well, I don’t let the infection keep me from doing what I want to do in and with my life. I’m going to college; I have a loving boyfriend, and I have a career. The disease keeps me from doing some things, and I don’t go to certain places where I know I run a higher risk of getting a cold that could become worse. But really, it doesn’t control me. I do the things I want to do, and live pretty much how I want to live. Well, I want to live in a mansion, but that’s obviously not happening anytime soon!

DV: How do you maintain such a positive outlook?

Daniel: I’m glad you asked me that question, because it’s a really good one. Most people think that when you become infected with HIV it’s a quick death sentence. It was, 30-some-odd years ago, and yes, there are still strains of HIV that can kill a person within a year. But for the most part, HIV and AIDS itself won’t kill you. Your weakened immune system and catching a cold that turns into pneumonia or something like that are what usually kill people. Well that, and hatred and ignorance.

DV: What was it like learning that you were HIV-positive in the Marines?

Daniel: It wasn’t easy. I thought there might be a chance, because I’d remembered somebody I had used with was HIV-positive. But I didn’t remember sharing a needle with them. Turns out I did. Point is, it wasn’t easy.

I’m from the generation that thought being gay was the worst thing ever and that it was a choice whether or not to be gay. We didn’t know much about being gay and what’s worse is that HIV wasn’t taught to us so much. We were taught to use protection, but what about those of us who turned to drugs to ease the pain of our lives? What about those of us who were in the closet and didn’t want to seduce young men, but instead, just have a man our age to come home to and love?

My generation made it hard, and that mentality carried over into Marines.

I went through the five stages of depression, of course, and the men in my platoon were told. They all knew I had been an addict at one point, and that I’d gotten clean. I told them that was how I got infected and they believed me. I kept my orientation quiet and played like “one of the guys.” I had to or else I’d have gotten booted out under [the military’s anti-gay policy called] “don’t ask, don’t tell,” which is still technically in action. It’s being reviewed for a repeal but it still exists on a case-by-case sort of deal.

DV: What is a day-to-day example of your life due to your status?

Daniel: I’m not a cripple; as I said my status isn’t all-controlling. I live my life just like anybody else: I get up in the morning, get a shower, eat breakfast and go to school and then to work. And then come home, make and eat dinner, then, if my boyfriend and I feel up to it, have sex. I’m normal, just like anybody else. That’s what a ton of people’s lives are like.

Yeah, I have to take medicine for it. But I also live a pretty healthy and fit lifestyle. The medicine is expensive; everybody knows that. If you live a healthy lifestyle and take care of yourself, your life won’t be much different from before.

It might sound cheesy, but to quote Miley Cyrus, “Life’s what you make it.”

DV: You said that you’re sexually active. Is your boyfriend HIV-positive, too?

Daniel: No, he’s not — thank God for that. He’s negative, and we take all the steps possible to keep him that way. … Just be protected and be cautious. A small amount of time and caution could save you from a lifetime of the disease.

DV: What do you have to say to the addicts out there who might be putting themselves at risk of becoming HIV-positive?

Daniel: First off, addiction is a disease. It’s a sad thing that the generation before mine, and my generation, didn’t realize this before. Today’s generation and the generations coming up are becoming more aware of this.

Secondly, addiction has no known cure, just like HIV doesn’t. It’s smarter to sober up — and sober is synonymous with being clean because any substance abuse at all is still addiction, whether it be alcohol or narcotics — and make meetings rather than to run the risk of infecting yourself with a second incurable disease.

If you are out there using, or in the rooms of NA or AA and are thinking about using, seek help. Don’t use, because you may just come down off that high and find yourself in a worse situation than you were before.

Thirdly, if you’re not at the point in your life yet to where you can get clean, be smart. Don’t share needles, syringes or anything like that. If you do a [“play and party,” where you get high and have sex], use a condom. I can’t stress that enough: If you’re going to use, protect yourself as best you can.

I still think you shouldn’t use at all, and I’m a prime example that there is life after addiction and that you can live your life without using drugs. Just get yourself some help. Find some recovery. That goes for the kids who go to raves and clubs to meet people, too.

DV: Why do you think so many people are afraid to talk about HIV?

Daniel: Do you mean besides the fact that we live down here in Texas, where there’s a hell of a lot of conservatives? Well most people are afraid to talk about it because they don’t understand it. As the age-old idiom states: “What we don’t understand, we fear.”

People need to be educated, especially the youth in schools. MTV has its “Teen Mom” TV series, and that’s almost glorifying pregnancy and unprotected sex among teens. We gays aren’t the only ones affected by HIV; the straight community is, too.

Teens and young adults need to be taught about abstinence, I can understand that. After that though, they need to be taught about safe sex, and sex between gay couples. The gay community is majorly harmed by this not being discussed in the health classes in high schools and middle schools.

Teens are teens; they’re going to have sex, going to experiment to some degree. It’s better that they be protected and have knowledge not just about abstinence, but that they also know about safe sex and sex between same-sex couples.

DV: How do deal with the knowledge that you’ve got to live with this disease the rest of your life? And what do you have to say to those out there who find out they are HIV-positive?

Daniel: Well, I kind of feel like I answered this one already through most of my other answers. But here’s how I live life: I make myself get up on the days when I feel like crap. Even when I’m having a horrible day, I think, “Hey, it could be a lot worse. I could be dying right now, or starving to death because my government decided I’m not an actual person, or even be a slave to human trafficking.”

Yeah, I’ve got HIV. Yes, there are times when it is hard, and where I can feel myself being hit. But you just have to force yourself to keep at it. The going will get tough, but you can do it.

I try not to think morbidly, but sometimes I do. And that’s okay, because it puts things in perspective for me.

You have to take life as it comes, one day at a time, and live it on the terms of that day. Sometimes you’ll be a on a pink cloud, happy and enjoying life, when everything is good like an upbeat pop song. At other times, you will have issues and have to live with them.

As for what I have to say for those who find out they are HIV-positive: Breathe, pray, seek out your friends and family, and find out all you can about your exact status and conditions. The more informed you are the better.

Life may feel like it stops when you get the diagnosis, but it doesn’t. You can still keep living life, still follow after and achieve your dreams, and you can inspire others to do the same. You are still the same person you were before you got the diagnosis, and you still have a life to live; so keep your head up and live it.

—  John Wright

The value of an ounce of prevention …

It’s true that after 30 years, treatments are available that can control HIV, but the question is, can we afford the treatments?

DAVID WEBB | The Rare Reporter

Three decades into the HIV/AIDS epidemic, more is known about the disease than ever before. But the future looks as uncertain as ever in terms of how it will be managed in coming decades.

Treatments for HIV infections have radically evolved since the early days when medications like AZT prolonged the lives of some HIV-infected individuals but failed to help others because side effects like nausea and pain caused the patients to quit taking the drugs.

Now, HIV-infected people often appear to be living longer and healthier lives, thanks to the development of the anti-retroviral drugs in the 1990s.

Although healthy appearances often belie the massive, complicated regimens of multiple, often-changing medications to sustain patients, there is no doubt HIV-infected people are enjoying a better quality of life.

Ongoing research by scientists around the world gives hope to the possibility there will someday be a vaccine to protect against HIV and possibly even eradicate it after infection.

Just recently, it was reported that a man suffering from both leukemia and HIV who received a bone marrow stem cell transplant in Germany in 2007 is now HIV-negative. His bone marrow transplant reportedly came from a donor who was immune to HIV, an immunity that some scientists believe exists in about 1 percent of the Caucasian population.

The downside of all this is the enormous cost of HIV treatments when they eventually become available to the public. The bone marrow transplant treatment is incredibly painful, dangerous and expensive, so its widespread use is unlikely.

Billions are already being spent on the delivery of anti-HIV drug cocktails, and those costs are expected to spiral in the next decade to astronomical amounts.

At the same time, all of the major countries in the world are struggling to remain solvent during the worst financial crisis of more than a half-century.

Regardless of what medical treatments become available, the majority of people may not be able to afford them. Millions of people in the U.S. are unemployed and uninsured for health problems they face.

The states and the federal government have long provided health care and other resources for HIV/AIDS patients, but crashing budgets are already placing limits on those programs.

And it’s only going to get worse as governments struggle to make ends meet.

Insurance premiums are rising so quickly in tandem with the rising cost of health care that many companies are struggling to provide benefits for employees. A decade ago, it was common for companies to pay for 100 percent of employees’ health insurance policies, but now it is more common for employers to require 20 percent payments of premiums by employees.

In addition to government cuts, the amounts of money HIV service organizations have been able to raise from the charitable public is almost certainly going to decrease as well. People just don’t have as much income to share with less fortunate people.

For older Americans looking to retire and anticipating the end of their job-afforded health insurance, the availability of medical care through the federal Medicare program is going to be more problematic, as it will be for younger people contracting new HIV infections.

And even if an older American has abundant financial resources to access whatever medical care is available, the truth is that the drug cocktails that have prolonged the lives of younger people just don’t work as well for anyone over 50, according to scientific studies.

It’s hard to believe that the 30th anniversary of the HIV epidemic observed this month was accompanied by a United Nations report that 30 million people have died from the disease, and that 7,000 new infections occur globally every day.

What’s more, a Centers for Disease Control and Prevention study was released earlier in the month reporting that LGBT students are more likely than heterosexual classmates to engage in risky behavior like alcohol and drug use, which presumably could lead to unprotected sexual activity. It is believed that an estimated 40,000 new infections occur yearly in the U.S., often in people who are unaware of their HIV-positive status.

So three decades into the HIV epidemic, we find ourselves pretty much where we were in the beginning back in 1981 when we realized it was likely a blood-borne, sexually-transmitted disease in most cases. No matter how rich someone is or how old they are, an HIV infection is unaffordable in every way imaginable.

Prevention of an infection is still the best answer for everyone.

David Webb is a veteran journalist who has covered LGBT issues for the mainstream and alternative press for three decades. E-mail him at davidwaynewebb@yahoo.com.

—  John Wright

‘AIDS at 30’ forum set for Tuesday

Manisha Maskay, Ph.D, Dr. Brady Allen, M.D, and Dr. Christopher Evans M.D.

Panel discussion to explore the current status of HIV treatment and the future of treatment and prevention efforts in next decade

TAMMYE NASH | Senior Editor
nash@dallasvoice.com

Thirty years after the first cases of what would eventually come to be known as AIDS were discovered in gay men in Los Angeles, San Francisco and New York, the struggle to contain the world-wide epidemic continues.

But where do we stand today in that fight, 28 years after HIV was determined to be the cause of AIDS, and 24 years after the FDA approved AZT as the first real treatment to fight HIV?

On Tuesday, June 28, Dallas Voice — in partnership with Cathedral of Hope and a slate of business sponsors and community organization partners — presents “AIDS at 30: A Community Forum,” to explore the questions of where we are now in the fight, and where we are headed.

The forum will be held at Cathedral of Hope’s Interfaith Peace Chapel, 5910 Cedar Springs Road. Doors open at 6 p.m., and the forum runs from 6:30 p.m to 8 p.m.

The forum is free and open to the public.

“We decided to produce this forum, ‘AIDS at 30,’ from a ‘today and tomorrow’ perspective,” said Robert Moore, Dallas Voice publisher.

“We all know the story of AIDS over the last 30 years. What people are really hungry for now is a real-world look at where HIV prevention and treatment are headed over the next decade,” Moore added. “People want to know that there is hope for a cure, and that the issue of HIV and AIDS is not yesterday’s story, but that it is, indeed, tomorrow’s story.”

The forum will be divided into three sections, with AIDS Arms Associate Executive Director Manisha H. Maskay, Ph.D., leading off on the topic of “HIV Prevention Strategies and Challenges for the Next Decade.”

Maskey has more than 30 years of experience in the field of public health, medical nutrition therapy and health education and behavior change. In addition to her work at AIDS Arms as both associate executive director and director of community and client services, she has worked for the Columbus Health Department in Columbus, Ohio, and as an assistant professor of medicine and director of clinical nutrition and health education services at the University of Chicago.

Dr. Brady Allen, M.D., with Uptown Physicians Group will lead the discussion on the evening’s second topic, “HIV/AIDS Treatment Today.”

Dr. Allen, who graduated from Southwestern Medical School in Dallas and completed his internship and residency at New Haven Hospital in Connecticut, has been one of the preeminent doctors in treating HIV/AIDS since the early days of the epidemic in Dallas.

After a brief retirement in 2008, he returned to Dallas and to Uptown Physicians in January 2009 to continue his practice.

Dr. Chris Evans, M.D., M.P.H., with AIDS Arms’ Peabody Health Center in Oak Cliff, winds up the presentation with a discussion on “What is the Future of HIV Treatment? The Facts. The Hope. The Fiction.”

A Yale University graduate, Dr. Evans completed medical school at Drexel University in Philadephia before completing his residency in Internal Medicine and a fellowship in Infectious Diseases at Montefiore Hospital in The Bronx. He has been involved in clinical researcher on HIV/AIDS since 2001 and has participated as a sub-investigator in more than 15 studies on HIV/AIDS treatments.

The forum concludes with an opportunity for audience members to ask questions of the panelists.

Platinum sponsors for the forum are Uptown Physicians Group and the Vasquez Clinic. Rx Partners Pharmacy is a gold sponsor.

Community organizations partnering with Dallas Voice to present the forum are AIDS Arms, AIDS Outreach Center of Tarrant County, AIDS Interfaith Network, AIDS Services of Dallas and Resource Center Dallas.

Proceeds from sponsorships and donations go to Lone Star Ride Fighting AIDS, the annual bike ride that raises funds for AIDS Services of Dallas, AIDS Outreach Center and Resource Center Dallas.

—  John Wright