THE NEWSLETTER OF the HAWAI ’ I ISLAND HIV/AIDS FOUNDATION
CHOICES May 2008
Virtual Prevention: Fighting HIV Online by David Evans
Describing the state of HIV prevention at a large, international AIDS conference recently, Ronald Stall,
PhD, of the University of Pittsburgh School of Public Health, said, “Is HIV prevention working among gay
men in the United States? I think to put it in the most polite terms, the best thing we can say is not as well
as anyone would like."
A set of key statistics published by the Centers for Disease Control and Prevention (CDC) on their web-
site in March of 2008 states it more plainly: The number of HIV-positive gay and bisexual men has in-
creased steadily between 2001 and 2005.
The problem has been well documented in various metropolitan areas. According to the New York City
Department of Health and Mental Hygiene, between 2001 and 2006, HIV diagnoses increased by 32 per-
cent among gay and bisexual men aged 30 or younger in the city. And in a five-city CDC study conducted
between June 2004 and April 2005, 40 percent of 462 gay and bisexual men tested for HIV were confirmed
to be positive for the virus—62 percent of them didn’t even know they were infected, and a whopping 8 per-
cent were likely infected within six months prior to testing.
So, what is causing the spike in new HIV diagnoses? Experts point to several possibilities from “cultural
amnesia around the epidemic” to the age-old misperception of invincibility among youth to increased drug
and alcohol use to a lack of sufficient fear of a disease that has been rendered “manageable” —and surviv-
able—with treatment. Others point out that in some cities younger gay men aren’t getting tested as often.
And since researchers think that the majority of transmissions in the U.S. happen during the first weeks and
months after infection, when people still think that they’re HIV negative, less frequent testing means people
remain unaware of their status and pass on HIV to others. All of these factors undoubtedly leave young
people more susceptible to contracting HIV.
But there’s another factor—the Internet. While its impact on relationships,
47% of gay and bisexual men dating and sex is still new and largely uncharted, most will agree that it has
participating in a recent online
drastically altered the way people, particularly those
POZ/AIDSmeds survey say they
looking for sex, connect. The Internet makes meet-
meet the majority of their dating
and sex partners online.* ing people more efficient. A single person can meet Inside this issue:
hundreds of people within a matter of minutes in
cyberspace—to do the same thing in the real world takes a lot more time. Meeting
We are HIHAF 2
online allows people to skip the stages of getting acquainted, cutting straight to a Health literacy 3
sexual encounter without the preamble that could provide the time and/or informa-
tion that would perhaps lead to a more considered decision. It may not be coinci- Letter re: Pantry 4
dental that as the number of Internet-based dating and sex websites has in- Medical News 5
creased, so has the numbers of new HIV infections. Speak Up, 1st Person 6
Simon Rosser, PhD, a researcher from the University of Minnesota, who spoke Cover story cont. 7
after Stall at the 15th Conference on Retroviruses and Opportunistic Infections
(CROI) this past February in Boston, believes that the rise of the Internet as a Medical cont. 8
Cover story cont. 9
place to easily and efficiently find sex partners is intimately connected with the
increased numbers of gay men who are becoming HIV positive. He likened the Cover story cont. 10
Internet’s impact on sex (rendering it more casual) to the drastic change that oc-
curred in attitudes about air travel. While airplanes were once thought to be the
realm of exotic thrill seekers, they are now commonly used by everyone from Notices
grandmas to babies. “If the Internet has a similar effect on sex, we have to
ask is casual sex about to get a lot more common continued on page 7 Calendar
CHOICES Hawai’i Island HIV/AIDS Foundation
is a publication of the
Hawaii Island HIV/AIDS Foundation
75-240 Nani-Kailua Dr. Suite 5
Kailua-Kona, HI. 96740
E-mail: email@example.com The Hawaii Island HIV/AIDS Foundation is a non-profit
organization dedicated to assisting those affected by HIV/
16-204 Melekahiwa Pl. AIDS to maximize their quality of life, and to ending the
Kea’au, HI. 96749 spread of HIV. We also utilize the lessons learned in the
Phone: 982.8800 HIV epidemic to care and advocate for others in the fight
FAX: 982.8802 against related diseases.
Georgie Kennedy/Executive Director Vision
To build a healthier, stronger, and more sustainable com-
Staff Hilo munity that supports all its members with a focus on HIV
Cindy Medeiros/Benefits Specialist issues.
Shannon Watanabe RN/Treatment Advocate
Diana Glynn/Housing Coordinator Core Values
Daron Scarborough/Prevention Coordinator Responsiveness: To people with HIV/AIDS and
John Puig/Prevention Specialist their families and to the prevention education needs of
Cyd Hoffeld/Prevention Specialist
Krysta Norman/Administrative Assistant
Accountability: To our consumers, funding sources,
and the community at large.
Integrity: To provide services to the entire community in
Wing Takakuwa/Treatment Advocate
Teri Hollowell/Case Management Coordinator
a humane, loving, non-judgmental manner.
Gene Smith/Client-Prevention Services Diversity: To embrace the philosophy of inclusiveness”.
Prevention Specialist Collaboration: To establish and maintain partnerships
Wiinic Pierce/Prevention Specialist within the community that maximizes resources and de-
Wes Smith/Office Manager creases duplication of services.
Pia Wadkins/Accounting Assistant Leadership: To set the highest standards for responsi-
Cameron Bailey-Bram/Fund Development bility to our mission, vision and values, and be recognized
Barry Hanson/Administrative Assistant as a positive, inspirational role model in our community.
Advocacy: A collective public voice to speak on behalf
of those affected by HIV/AIDS.
BOARD OF DIRECTORS
'You can say any foolish thing to
The articles contained in this publication are meant to inform and entertain
a dog, and the dog will give you a
only. They do not constitute an endorsement. The publication of any name or
image does not necessarily imply anything about that persons condition,
health or sexual orientation. The opinions expressed are those of individual
look that says, 'My God, you're
authors and do not necessarily represent official positions of HIHAF or any
other organization mentioned herein. right!
I never would've thought of
Contributions of articles and other materials for publication are encouraged
HEALTH LITERACY: A TOOL
FOR PEOPLE LIVING
WITH HIV/AIDS BY AVA LENA WALDMAN,
M.H.S. Director of Community Education and Outreach
Have you ever:
• Felt unsure of how much of which medicine to take
how many times per day for how long?
• Been unclear on why you were receiving treatment or
undergoing a specific procedure? • Have higher viral loads,
• Found patient education materials or forms to be full • Were less likely to be taking antiretro-
of medical terminology, hard to follow, or difficult to viral medications,
• Reported a greater number of hospi-
If you answered “yes” to any of these questions, you talizations, and
are not alone. About half of all American adults, approximately • Reported poorer health. 
90 million people, have difficulty understanding Moreover, poor health literacy creates
and acting upon health information . barriers to fully understanding one’s
WHAT IS HEALTH LITERACY? health, illness, and available treatments.
Health literacy is the degree to which individuals can Misperceptions about HIV treatment
obtain, process, and understand the basic health information raise the risk of transmitting treatment-
and services they need in order to make appropriate resistant strains of the virus.
health decisions. Similar to the traditional understanding These results have alarming implica-
of literacy, health literacy incorporates a range of abilities: tions for patient education and treat-
• To read, comprehend, and analyze information; ment programs for people who have
• To decode instructions, symbols, charts, and diagrams; poor health-literacy skills and are living
• To weigh risks and benefits; and with HIV/AIDS . In other words, to im-
• To make decisions and deal with medical challenges.  prove upon current HIV health education
Health literacy is not only about education, but rather efforts, there is a demonstrated need to
comes from a convergence of education, cultural and improve health literacy levels and skills
social factors, and health services . While reading, writing, among people living with HIV/AIDS [1,4].
and math skills make up the core of health literacy, AIDS Research Alliance has adopted
many other skills and abilities are also important, including health as the key component of our com-
speaking, listening, having adequate background information, munity education program.
and being able to advocate for oneself in the health Educational materials and learning
care system . Not surprisingly, these are the very skills opportunities are available in English
that lead to longer life, improved quality of life, reduction and Spanish for communities threatened
of both chronic and health disparities, as well as cost savings. with HIV/AIDS throughout Los Angeles
Areas commonly associated with health literacy County. The overall aim of the commu-
include: nity education program is to develop
• Patient-physician communication; health literacy skills for improved health
• Drug labeling; decision making and access to HIV/AIDS
• Medical instructions and medical compliance; and clinical trials.
• Informed consent.  THERE ARE WAYS TO IMPROVE
WHAT IMPACT DOES LOW HEALTH YOUR HEALTH LITERACY
LITERACY HAVE ON HIV/AIDS? • Make a list of questions to bring with
Health literacy has been proven to be an important you to your medical appointment. This
factor in the health and treatment of people living with will help you remember everything you
HIV/AIDS. Research has demonstrated that, compared to want to discuss.
those with higher health literacy, HIV-infected people with Continued on page 12
Lower health literacy:
• Have lower CD4 cell counts,
To the clients who use the food pantry,
I’d like to address a few of the things that were brought up in the client satisfaction survey.
The Hawaii Island HIV/AIDS Foundation gets food items from several sources for our food pantries.
The main source we use is the Hawaii Island Food Basket (formerly the Hawaii Island FoodBank).
We do have to purchase the food we get from there; contrary to popular misconception it is not free.
However it is at a reduced price and the food is all priced per pound. One price for all items whether heavy canned
goods or weightless potato chips. These are donated to the Food Basket from local stores and outlets, usually when
they are outdated.
The Food Basket screens these items and tries to keep extremely outdated items from their shelves. Produce and
dairy items are disposed of at the proper time. I try to tell people to always check any items they get from our pantry
for spoilage or insect damage. Most people tend to keep their own store purchases much longer than the Food Bas-
As this is the cheapest source for the bulk of our food we use it as much as possible.
There is a definite difference between the westside and the eastside Food Baskets. There are higher end food
sources on the Westside and they tend to donate more. The eastside tends to have a higher demand on the Food
Basket and they run out of supplies sooner. We try to send things from the west side to the eastside when they are
available at the westside Food Basket
Our second source is purchasing from local stores ourselves. However this is usually not as cost effective so we
are limited to what we can get and quantities. We focus on purchasing protein items, ready meals and vegetables.
Thirdly we get private donations from people who just want to give us food. This is great but we can’t depend on it
as a regular source for the pantry but more as a windfall. We do have staff and clients who donate produce from their
own gardens and this is always appreciated.
I have tried to get volunteers, clients or non-clients, to help with the upkeep of the westside pantry but it has been
fairly futile so it has been pretty much up to me to keep it clean. There is only one volunteer on the eastside who does
Since our client levels keep growing and funding keeps being snipped away we have had to become stricter about
what and how much people can take from the pantries. I have hated doing this as I always wanted the pantry to be
more of an honor system market where clients may pick and choose as they would in a regular store.
One of the sources we have traditionally used for food purchase was our twice a year rummage sales on the west
side. This money was used for both sides and has really helped. Again though, volunteers to run these events seem
to have faded away and we haven’t had one for some time.
If you can help, donate or just get involved, please call me at 331.8177 on the westside or Krysta at 982.8800 on
the eastside. Any help will be appreciated.
Thank you, Gene Smith
Energy bill putting a dent in your wallet? Here are ten tips to help conserve
energy and lower your electric bill.
Use compact fluorescent lights.
Use fans instead of air conditioners.
Take shorter showers.
Fix leaky faucets
Wash clothes in cold water
Use a power strip to turn off computers, battery chargers, etc.
Air dry dishes instead of using dishwasher heated drying cycle.
Limit opening the refrigerator and the oven while cooking.
Install motion/occupancy detectors indoors and out instead of leaving lights on.
Use Energy Star Appliances.
For more information, learn more about CFL rebates, for money saving coupons, call (808) 94-POWER or visit http://
www.heco.com. To learn more about Energy Star products, long on to http://www.energystar.gov.
Thought you might like to include this link in the next newsletter: www.dtv2009.gov
It gives all the information about the conversion to universal digital television in February of next year, and allows each household
to print up to two coupons worth $40.00 each for converter boxes. Thanks, Diana
Spring Awakening: HIV, Allergies and Sinusitis M
by David Evans
In much of the United States, spring is well underway. Though nature’s green glory is a wel-
come change, springtime can also bring misery to those of us susceptible to allergies. Those
beautiful budding trees and blossoming flowers harbor a menace—pollen—that can condemn
many of us to weeks of sneezing, runny noses, red eyes and, if we’re not vigilant, sinus infec-
Untreated allergies are one of the leading causes of sinus infections, or sinusitis. Though si-
nusitis is rarely a life-and-death matter—thanks to potent antiretrovirals that keep immune sys-
tems healthy and harmful bacteria from spreading—it does diminish the quality of life for large
numbers of people.
Experts disagree about whether allergies and sinusitis are more common, have a worse
course or need to be treated differently in people living with HIV. They all agree, however, that no
one—HIV positive or negative—should suffer needlessly. Douglas Ward, MD, a longtime HIV
treater from the Dupont Circle Physicians Group in Washington, DC, says, “[Sinusitis] is the No. 2
diagnosis [in my practice].”
For those with minor or brief seasonal allergies, a little information and over-the-counter (OTC)
self-care will probably be sufficient. For those with more severe problems—such as fever, sinus
pain or a bad cough—or those with respiratory diseases like asthma or chronic bronchitis, a
health care provider’s care and guidance could mean the difference between enduring a short
stretch of symptoms and never-ending days of head-splitting sinus pain, difficulty breathing and
major discomfort. Ward says, “If you’re coughing up green phlegm, you’ve got an infection. Don’t
think, ‘Oh, it’s just allergies.’ Get it looked at and treated.”
Our nasal sinuses are pockets of air-filled mucus membranes that are connected to the nose by small
passages called ostia. Though scientists argue about their primary purpose, these hollow cavities protect
our eyes and the roots of our teeth from rapid temperature fluctuations and help cushion our brains if suf-
fering a blow to the face.
But the ostia are easily clogged by mucus in our noses and the swelling of the mucus membranes
caused by allergies or cold and flu viruses. According to Rona Vail, MD, an HIV specialist at Callen-Lorde
Community Health Center in New York City, when the ostia become clogged, “The mucus just sits there
without the ability to drain and then the bacteria, or fungus or [viruses trapped in the sinuses] multiply and
end up causing a problem.”
Vail says that there’s some controversy among primary care physicians about whether sinusitis is over-
treated, particularly with antibiotics, and so they’ve developed criteria to
properly diagnose it. She says, “The kind of symptoms that [doctors
look for] are facial pain and pressure, nasal blockage…and also nasal
discharge that is greenish-yellowish, loss of smell sometimes, and fe-
ver…. Other things that people [experience] are headaches, bad
breath, pain in the teeth, sometimes pain in the ears.”
Before the era of combination antiretroviral (ARV) treatment began in
1996, sinusitis was a serious problem. Chronic sinusitis, lasting 12
weeks or more, or recurrent sinusitis, was all too common. Though
ARV therapy preserves many people’s immune systems, protecting
them from the most severe and lingering forms of sinusitis, expert opin-
ion is mixed about whether sinusitis remains worse or more common
among people living with HIV.
Vail and Ward say that sinusitis is about equally common in their
The air-filled nasal sinuses can become in-
HIV-positive and HIV-negative patients. Antonio Urbina, MD, medical
fected when clogged with mucus from aller- director of HIV/AIDS education and training at St. Vincent Catholic
gies, leading to facial pain and pressure, na- Medical Center in New York City, on the other hand says that the inci-
sal blockage, greenish-yellow discharge and dence of sinusitis “is still higher [in people with HIV] than continued on page 8
Ever noticed how round our lives and behaviors are?
We travel amongst circles in society; we have circles of
friends; we go to circuit parties; get caught in a down-
wards spiral and run circles around others. Even the
saying "What goes around, comes around" is indicative
of circular behavior. Soul-mates circle around each-other for years before finally meeting, ensuring that
each person has become a well-rounded individual. And as we mourn the loss of a loved one, we are
comforted by the fact that life, once again, has come full circle.
One would think that with that many circles going on more people would start to sway back and forth
I was online earlier this week when I received an email from the last person I ever expected to hear
from. And while my first reaction was that of annoyance and anger, it did not take more than one second
before I actually had to smile because of the appropriateness in its timing.
I received an email from the person who infected me with HIV.
All he asked me was how I was doing. Nothing more and nothing less than that.
3 years after he told me that it was to be understood that he was HIV+, and had been so for 4 years. 3
years after realizing that along with that "understanding" he also had exposed me to syphilis and Hepatitis.
3 years after his "understanding" became responsible for changing not only every aspect in my life but
every aspect of me as a human being.
3 years later, he wants to know how I am doing.
His email could not have been timed better if I had asked for it myself. It came within hours of my attor-
ney starting settlement negotiations with my former employer. Barely one week after my birthday and at a
time where I am starting to prepare myself for the day when the last of the big events of these last three
years will be wrapped up.
I remember writing not all that long ago about this feeling of appropriateness that I have about loose
ends getting tied up and saying my goodbyes. Now that feeling has grown into a reality with a clear and
set end date. I have started to make decisions about my future and know that there are many more I still
have to make. I have started to set boundaries of what I will and will not accept in my life. I have finished
most of my goodbyes and tried to make right what I did wrong whenever I could.
I have circled the date on my calendar. Not as the End Date but as the Start Date.
Right now I cannot even remember what I had envisioned my life to be like while growing up. Somehow I
am pretty sure it was a far cry removed from what it ended up being today: an amazingly interesting, in-
tense and pretty damn good life. And a life that I never would have had if it hadn’t been for me becoming
To quote a friend of mine, I don’t think I will ever be doing cartwheels over having become HIV+; but I
will do a cartwheel every day as gratitude over the life it has given me. Luckily I don’t know how to do cart
wheels, so I will just go about my daily routine without breaking a sweat.
When I first tested HIV+ my attitude was that if nobody else seemed to give a shit about me, why should I
give a shit about myself?
Nobody else seems to care about my life, so why should I?
Why? Because nobody else HAS to care about my life except me.
It is my life to care for and my life to be responsible for. The same as it is mine to enjoy and mine to live.
Nobody else can do that for me, so I better start doing it myself (after all: if you want things done right: you
have to do them yourself!)
3 years ago somebody told me it was to be "understood" and I was scared, angry and confused.
3 years later I can tell that same person that now I understand:
I have come full circle.
No corners to cut,
Speak up !!!!!!!
Beginning and End entwine
Like a circle, bend
From front page
and even more casual?” he asked.
While it has yet to be proven that the Internet is a direct cause of increased HIV infections, the Web has un-
doubtedly created an arena that presents new challenges for those looking to do prevention outreach work.
And some worry that the surge in online traffic will soon leave many more traditional venues for hooking up—
like parks, baths and bars—empty. In an article in Xtra West, Terry Trussler, the research director of Vancou-
ver’s Community Based Research Centre, explained that the proportion of men who spend more than 50 per-
cent of their free time with the gay community—where traditional prevention efforts are focused and where
young men can learn about safer-sex norms—decreased from 62 to 42 percent, and said, “[For] many gay
men who are 20 now, their first sexual encounter will have happened through connections made through their
Rosser, speaking at the conference, concurred, pointing out that while the gay community has grown con-
siderably online, the traditional gay infrastructure is eroding, and since online hookups are so much more effi-
cient than bars or bathhouse hookups, gay men are having more sex with more people than before. More sex
means that occasional slipups or decisions to forgo condoms with a special guy are also more likely to occur.
Acknowledging the potential link between a rise in online connections and the spread of HIV, prevention
experts are beginning to examine what can and should be done to prevent HIV online—perhaps even in those
very settings that seem to contribute to behaviors that can lead to HIV. One challenge is that most of the
groups in the U.S. responsible for doing HIV prevention work, and the government agencies that fund them,
have a limited presence in cyberspace. Critics of current off-line prevention efforts point out that even if we
could deliver new web-based prevention tools tomorrow, they will have limited efficacy unless we find ways to
integrate them into the activities that gay and bisexual men already enjoy doing, such as participating in so-
cial-networking sites, shopping online and using the Internet to learn about non-health topics.
This shift in the way we meet and date online is leading several ingen-
ious pioneers to try to capitalize on the Internet’s potential to stretch the 49% say that the number of romantic
and sexual partners they meet online
boundaries of traditional HIV prevention thinking. It’s too early to tell
has increased or greatly increased,
whether they’ll succeed in changing behavior and reducing new infec- compared with the number of
tions, or even whether they’ll be able to convince their fellow prevention “connections” made five years ago at
workers to join them on the Web. But recent statistics point to a critical venues like bars and clubs.*
need to find a mechanism that will reach those who are looking for love—
and everything else—online. And such a mechanism should have enough sophistication, fun and sexiness to
compete with other things that men are also doing online, such as checking e-mail, downloading music and
updating their Facebook.com profile.
Stall’s conclusion that HIV prevention wasn’t working well for gay and bisexual men was based on his care-
ful scrutiny of all the available data he could find on HIV incidence, which estimates how many new infections
occur each year. He and his colleagues found that by the most conservative estimate, 2.39 percent of gay
and bisexual men in the U.S. were becoming infected annually between 1995 and 2005. Stall then calculated
what would happen to a group of men who were 20 years old in 1995 and had a 2.39 percent HIV incidence
rate. He found that by 2005, when the men had turned 30, nearly a quarter of them were likely to be infected
with HIV, and that by 2015, when the men would turn 40, over 40 percent would be HIV positive.
If we consider this hypothetical group of twentysomethings, HIV wasn’t the only thing that began to affect
them in 1995. By then the most technologically advanced were regularly using the Internet for e-mail and to
find information. By the end of the century, gay chat rooms were the rage, and more sophisticated websites
devoted to personal ads for sex and dating were beginning to show up all over the Web.
Epidemiologists began to see the influence of the Internet around 2000, when rising syphilis rates among HIV-
positive men were often traced back to online chat rooms and websites where people could meet and hook
up. Early evidence also suggested that HIV transmission was being facilitated online. Rosser says research-
ers like him began to ask, “Is there something magical about the Internet? Is it attracting men of higher risk?
What’s going on?”
83% agree or strongly agree that they Professor Jonathan Elford, of City University London, in England, says
are less likely to suffer from discrimina-
the Internet has “opened up opportunities for conducting research,
tion, harassment or abuse due to their
HIV status when meeting men through
which didn’t exist 10 years ago,” and that “What we do find, is that men
POZ Personals than more general dat- who are recruited through the Internet are more likely to report high lev-
ing/hookup websites for people of any els of risk.”
continued on page 9
persons who are HIV negative, but less now in the era of [ARV therapy].”
Whether or not sinusitis is more common in people with HIV, all support treating its underlying causes. To
guard against cold and influenza virus infections, experts recommend that people get their flu shot each year
and wash their hands thoroughly many times throughout the day. For allergies, Vail and Urbina recommend a
combination approach that may include steroid-based nasal inhalants and oral antihistamines and deconges-
tants. The steroids and the antihistamines calm down the immune system’s response to whatever you may be
allergic to. The decongestants simply block the production of mucus.
People with asthma or other obstructive respiratory problems, such as emphysema or chronic bronchitis,
should also monitor their allergy symptoms with the help of a health care provider, as seasonal allergies can
sometimes trigger serious flare-ups of these diseases.
Why call my MD when there’s OTC?
It’s hard to say whether people living with HIV are better than their HIV-
negative peers about turning to a health care provider when allergies or sinus
infections arise. Some may be concerned that their allergy symptoms are HIV
med side effects or signs of an AIDS-defining opportunistic infection, prompt-
ing a call to their doctors. Others, however, may feel silly calling their doctor
about sniffles, sneezes and wheezes while undergoing care for a potentially
life-threatening disease like HIV.
One reason to consult a health care professional about allergies is to pick
and choose OTC medications wisely.
Another reason to seek professional guidance is when allergies may have Nasal irrigation, with a properly
possibly crossed the line into sinusitis. Though Urbina says that many sources mixed warm saline solution, does-
n’t burn. In a Neti Pot (pictured), or
of sinus infections are viral, bacteria can also cause them, and prescription
rubber ear syringe, mix ½ tea-
antibiotics are often used to treat bacterial sinus infections. Catching infections spoon kosher salt with 8 ounces of
early often results in a faster recovery and less time feeling ill. Vail cautions, warm water (first timers may wish
however, that “antibiotics are great for the initial relief of the infection and the to reduce salt and water amounts
pain, but they’re not enough.” by half). Lean over the sink—or
Vail is an advocate of a do-it-yourself method that’s low cost—saline nasal stand in the shower—and rotate
your head to the side so that one
irrigation.She admits that “people often don’t wbecause it gets kind of messy. nostril is directly above the other,
You know, irrigating saline up your own nose,” but says, “It’s actually pretty with your forehead remaining level
easy to get used to and incredibly effective.” with the chin, or slightly higher.
Other OTC options include nasal sprays, although Vail warns against the Gently insert the Neti Pot spout
use of brands that contain oxymetazoline hydrochloride (found in Afrin, Zicam, into the upper nostril, forming a
comfortable seal. Keep your mouth
etc.). She uses the word addiction to describe some people’s attachment to open and raise the handle of the
these nasal sprays, explaining, “I know why people get hooked on Afrin, be- Neti Pot, so that the solution enters
cause they immediately feel better. But in the long run it causes rebound in- the upper nostril and drains out
flammation and swelling and the problem just gets worse and worse.” through the lower. Repeat with
Antihistamines, which include over-the-counter drugs like Benadryl another 4- to 8-ounce saline mix in
the other nostril.
(diphenhydramine), Claritin (loratadine) and most recently Zyrtec (cetirizine),
may be used regularly throughout a bout with allergies. About decongestants, which include pseudoephedrine
(Contac Non-Drowsy, Sudafed, etc.) and phenylephrine (Sudafed PE), Vail says, “[They] are fine for short-
term use, just for symptom relief.”
Prescription options, such as inhaled corticosteroids like Nasarel (flunisolide) and Nasonex (mometasone),
can be particularly effective if people start using them at the first sign of symptoms, as the drugs can take a
while to start working. People with HIV should beware, however, of potential interactions between many HIV
drugs and the corticosteroid fluticasone (found in Advair, Flovent or Flonase). Norvir (ritonavir), especially,
can substantially raise blood levels of fluticasone, leading to an increased risk of Cushing’s syndrome, an en-
docrine disorder that can result in obesity, water retention and puffiness, diabetes, high blood pressure, thin
skin, aches and pains, and mood swings.
ant to do it,
Immunotherapy: Hope for long-term allergy relief
Another allergy remedy that can work when allergies are persistent and don’t respond well to other treat-
ments is allergy desensitization immunotherapy, also known as allergy shots. Desensitization involves inject- 7
ing a person with small but increasing amounts of the substance they are allergic to, known as an allergen,
Ends on page 12
From page 7
bar or bathhouse, but that because hooking up online is so much more efficient, they are having more sex.
“In the old days, let’s say I might score five times a week; now I can score 50 times a week, and we don’t
think it’s just increased it a little bit, it’s increased it a lot,” he says.
While increased HIV risks and new diagnoses may cause some to automatically assume that HIV-
positive men are knowingly having sex with unconcerned and irresponsible HIV-negative men, experts say
this is a rare phenomenon. In fact, the vast majority of people with HIV, once they’ve been diagnosed,
cease having unprotected sex with partners who say they are HIV negative or don’t know their status.
Rather, new HIV cases appear to happen in clusters, among men who assume they are HIV negative, all of
them in the early-infection stage with very high viral loads. Since young gay men are having sex more often
with more people, but getting tested for HIV less often, taking higher risks or slipping up on safer-sex com-
mitments turns into a numbers game that more and more men are losing.
What’s more, “The Internet has now taken over as the No. 1 venue for meeting sexual partners for men
at high risk,” says Rosser. He’s reported data from the Minneapolis St. Paul area that showed 52 percent of
single gay and bisexual men surveyed met sex partners online, compared with 47 percent who met part-
ners at a bar or club, and just 11 percent who met partners at either a bathhouse or a sex club.
Rosser also feels that the Internet isn’t just affecting HIV transmission 76% say they would be some-
among gay and bisexual men; it may also be affecting the physical brick- what to very likely to visit a web-
and-mortar gay community. He has reported that with the exceptions of site devoted to HIV prevention
gay Meccas like San Francisco or New York, “gay neighborhoods and gay designed specifically for people
infrastructure, for instance gay bars, all appear to be in decline.” living with HIV (as opposed to
Elford doesn’t feel that the Internet is replacing physical venues in the those who aren’t infected).*
gay community as much as adding to them. He says, “Most of the men
who said they used the Internet also went to bars and clubs…. That’s what we found in London, and there’s
some evidence that the same is probably true in bigger U.S. cities.”
We Need New Tools and New Messages
Though experts may disagree about the effect that the Internet has had on real-world gay environments,
most agree that the majority of gay and bisexual men probably have spent at least some of their time cruis-
ing for sex partners online and that HIV prevention interventions should increasingly be focused there.
Researchers have been quick to move some aspects of their research online, such as surveys and be-
havioral surveillance, but few have moved beyond what currently constitutes the majority of online HIV pre-
vention efforts, which are mostly limited to written HIV prevention information, prevention workers who
cruise chat rooms or post ads on craigslist.com, profiles on Facebook and MySpace and e-mail notifica-
tions to the sex partners of people who’ve tested positive for a sexually transmitted infection (STI) like HIV
Joshua Tager, senior digital editor for Out and The Advocate magazines in New York City, says that he
worries that even if prevention experts do manage to build new online tools, they may fail to work if they
follow the model of existing off-line prevention efforts, which rarely adhere to the kinds of guidelines that
gay businesses do if they want to be successful—namely that their products need to be sexy and enjoy-
able. Rosser, himself one of those prevention experts, agrees, saying, “One of the problems [with existing
prevention programs] is that we made them more clinical and we had idiots like me develop more profes-
sional-type seminars and we sort of left the community out of it, and we actually left sex out of it.” In short,
the newer prevention tools are going to have to go far beyond a simple message of “use a condom every
time” if they are going to match up with the kind of subtle risk assessment strategies that gay and bisexual
men are already using. And they’re going to have to be entertaining and sexy to get their point across.
Stall and others point out that many HIV-positive men are already
using a strategy called serosorting, whereby they choose to have sex 35% agree or strongly agree that they
only with other HIV-positive men or at least only have unprotected predominantly have sex with other HIV
positive men in order to have unpro-
anal sex with these men, as a way to keep from passing HIV on to
tected anal sex without worrying about
HIV-negative men. This strategy isn’t perfect, as the flurry of syphilis HIV transmission. Thirty-eight percent
cases among HIV-positive men around the globe indicates, but it does disagreed or strongly disagreed, and
mean that HIV-positive men are not putting their HIV-negative part- 24% neither agreed nor disagreed.*
ners at risk. While serosorting may be great for HIV-positive men who
wish to bareback, its effectiveness for HIV-negative men who’d also like to try condom-free sex is ques-
tionable. Continued on next page
“If someone in their ad says that they’re HIV positive, and another person responds who says that
they’re HIV positive, chances are they really are HIV positive. But if two men say that they’re HIV negative,
that depends on when they’ve had their last test, and what they’ve done since their last test. It’s much less
reliable,” explains Elford.
Another risk-reduction strategy that some gay and bisexual men are trying out is called strategic posi-
tioning, whereby HIV-negative men have unprotected anal sex with partners who are HIV positive or whose
HIV status is unknown, but only as the insertive partner. As Michael Ross, PhD, from the University of
Texas School of Public Health in Houston, observes, however, “You know strategic is a word that George
Bush uses all the time in reference to the war in Iraq, but just because we say that something is strategic
doesn’t mean that it makes a lot of sense.”
Yet another factor causing gay and bisexual men to weigh the pros and cons of condoms, is a Swiss
proclamation made earlier this year that stated that for straight monogamous couples, where one is HIV-
negative and the other HIV-positive, HIV transmission was impossible provided that the HIV-positive part-
ner was taking antiretroviral drugs, had an undetectable viral load for at least six months, and didn’t have
any other STIs.
Brave New World
New online prevention tools, therefore, need to be both technologically innovative and offer sophisticated
and comprehensive sexual-risk-assessment strategies. But Tager feels they need to go even further. He
says, “If you think about most HIV prevention workshops, they’re always these stand-alone activities that
someone has to make time and effort to attend. Rarely, if ever, are they incorporated into the kinds of ac-
tivities that most gay men find enjoyable. I wish that people doing prevention would ask for the help of
[experts in the field of gay website development] in devising new prevention efforts. I think we’ve got a lot to
Fortunately, the handful of people conducting research about what will constitute the most effective
online prevention tools have taken Tager’s message to heart. A Dutch group led by Gerjo Kok, PhD, from
the department of experimental psychology at Maastricht University in the Netherlands, in what Ross calls
“pretty much the gold standard for interventions at this point in time,” has built a virtual gay cruise ship to
help men navigate and learn about sexual decision making. Men get to choose from one of four attractive
animated male pursers, guiding them through the cruise ship and helping them think through a number of
sexual decision-making scenarios arising from encounters with other animated ship passengers.
Most men who participated in the gay-cruise prevention website liked it. In
49% find the Internet to be
their evaluations, 86 percent said it was enjoyable, 53 percent said it helped
more effective than traditional
venues like bars and bath- them to know more about their sex life, and 61 percent said they became
houses for meeting dates and more conscious about dating and sex.
sex partners.* You’d think, given this kind of response, that there’d already be an online
gay-cruise prevention tool available worldwide. But the release of such a tool
has been held up because there’s a problem. Though Kok and others proved that you can engage and re-
tain large numbers of gay men to complete an online intervention, they also recognized that it is remarkably
difficult to find those same men three or six months later to follow up and see if their behavior changed as a
result of the intervention. Thus, as innovative as the gay-cruise prevention tool may be, the researchers
were unable to effectively track whether or not it caused the men who experienced it to ultimately take
fewer HIV risks.
Rosser is leading another team at the vanguard of online HIV prevention. It’s developed an online inter-
active health and sexuality environment called SexPulse that is being rigorously evaluated. SexPulse is in
its third of 12 months of follow-up; involving about 600 gay men, though early results are promising, the
project is not yet ready for primetime as, like with the online cruise ship, its longer-term effectiveness is still
“What we’re trying to do with SexPulse is to come up with engaging, fun ways that guys can learn about
their sexuality…. I mean there’s a real gay sensibility that is wonderful and relevant to the online experi-
ence [of SexPulse] that we don’t see in other [prevention] tools. For instance we have modules on how to
chat online, how to get the information you need in order to make an informed decision, and one about
body image,” explains Rosser. But as excited as Rosser and his multidisciplinary team are, they are also
proceeding cautiously. He says, “We’re trying to be realistic and modest and study it well, and so
maybe if version 1 won’t work, maybe version 5 will.” continued on page 11
From page 8
Rosser also points out that his group is just one of several others around the U.S. doing this kind of work.
He praises Anne Bowen, PhD, at the University of Wyoming, for her work on the Internet with rural men,
and Sheana Bull, PhD, at the University of Colorado, who is building STI interventions that are based on
the principles of social-networking sites like Facebook or Twitter, where the users generate their own con-
35% say they spend three or more
Rosser, who has been doing HIV prevention work for 25 years, de-
hours online each week seeking ro-
scribes the work he and his team are doing with a zest and enthusiasm mantic and sexual partners.*
reminiscent of a person fresh out of graduate school. He credits the in-
terdisciplinary nature of the work, saying, “You know the NIH came out
with a big report round about 2000, and they said that major scientific advances of the 21st century are
unlikely to occur by Simon Rosser sitting in his office thinking up a brilliant thought. Rather, they said that
the major scientific advances are likely to occur in multidisciplinary teams where people from very different
backgrounds are coming together and working together to solve a common problem.”
As exciting and hopeful as these new interventions sound, they aren’t cheap, and as Sheana Bull points
out, we still don’t know for sure if they work. Nevertheless, she says, “My call is more to my own colleagues
to stay ahead of innovations or at least try to anticipate things that are coming out and being prepared to do
quick evaluations to get strategies out there to communities. Because they can take them and run with
them more quickly and do more adaptations than we can in the academic setting.”
Perhaps the most beneficial aspect of building online prevention tools is that once something is proven
effective, there’s no need to wait months and years and spend many thousands or millions of dollars ramp-
ing it up and rolling it out. Of SexPulse, Rosser says, “If version 5 works, then we can just hit the switch and
everybody in the world has access. So the days of having to show demonstrated and effective programs
and then scaling [them] up for everybody to repeat it—well we don’t need to repeat it, because it’s the
World Wide Web.”
It’s a cyber
From page 5 • Take time to think about a health-related decision.
so that the immune system develops a tolerance Rarely do you need to make any health-related
for that specific allergen. When it works well, some decision right at the moment that the choice is pre
people are able to do away with a daily regimen of sented.
pills and inhalers, and even when a person can’t • Attend an AIDS Research Alliance community edu-
stop allergy meds altogether, they often find they cation event to learn more about HIV/AIDS clinical
have to take them less often. trials.
When it comes to desensitization for people liv- For more information about our health literacy pro-
ing with HIV, official recommendations and actual gram,
practice are not necessarily in agreement. Accord- contact Ava Lena Waldman, MHS, Director of Com-
ing to Roger Emert, MD, a specialist in allergies munity
and immunology from the Weill Cornell Medical Education & Outreach at:
School of New York Presbyterian Hospital, “The firstname.lastname@example.org.
recommendations from the American Academy of REFERENCES
Allergy, Asthma and Immunology are that if some- 1. National Institutes of Health www.nih.gov/icd/od/
one is HIV positive they should not get allergy de- ocpl/resources/improvinghealthliteracy.htm
sensitization immunotherapy.” 2. Institute of Medicine. “Health Literacy: A Prescrip-
Recommendations like these were often issued tion to End Confusion”
when having HIV almost invariably meant having 3. Kalichman SC, Rompa D. “Functional health liter-
AIDS and a compromised immune system. Aside acy is associated with health status and health-
from the fact that desensitization probably wouldn’t related knowledge in people living with HIV-AIDS.” J
work as well in people with CD4 cells in the single Acquir Immune Defic Syndr. 2000 Dec 1;25(4):337-
digits, experts feared it could also do harm. Times 44.
have changed, however, and now plenty of people 4. Kalichman SC, Benotsch E, Suarez T, Catz S,
have good CD4 counts and undetectable virus. Miller J, Riompa D. “Health literacy and health-
Emert is willing to buck the official recommenda- related knowledge among persons living with HIV/
tions for these individuals. He says, “I have done AIDS.” Am J Prev Med. 2000 May;18(4):325-31.
[desensitization] with HIV-positive patients suc-
cessfully without any problems. If your HIV viral
load is undetectable, there’s no reason that I know
of that it would adversely affect the immune sys-
Still, people wishing to undergo allergy desensi- The Bisexual Son
These four gents go out to play golf one day. One is detained
tization should probably ensure that their primary
in the clubhouse and the remaining three are discussing their
HIV care provider work closely with the allergy spe-
children while walking to the first tee.
cialist to guard against any problems. "My son," says one, "has made quite a name for himself in
If treated early and appropriately, allergies can be the homebuilding industry. He began as a carpenter,but now
reduced to a mere nuisance. If left untreated or owns his own design and construction firm. He's so successful
mistreated, however, minor symptoms can literally that in his last year he was able to give a good friend a brand
turn into a major headache. And while everyone new home as a gift."
else is outside enjoying the sunny days of spring- The second man not to be outdone, told how his daughter
time, you may find yourself in bed with sinusitis, began her career as a car salesperson,but now owns a multi-line
too sick to smell the flowers. dealership. "She's so successful, in fact, in the last six months
she gave a friend two brand new cars as a gift."
From page 3
The third man's son has worked his way up through a stock
• Take notes at your medical appointment to help brokerage firm and in the last few weeks has given a good
friend a large stock portfolio as a gift.
you remember what has been discussed.
As the fourth man arrives, they tell him that they have been
• Ask your medical provider to explain anything you discussing their children and ask him about his son.
do not understand, including how, when, and how "To tell the truth,I'm not very pleased with how my son has
much of your medication you should take. turned out," he replies. "For fifteen years, he's been in and out
• If you need to make a health-related decision, of work and I've just recently discovered he's a bisexual. But,
• Discuss it with people whom you know and on the bright side, he must be good at what he does because
trust. his last three lovers have given him a brand new house,
two cars, and a big pile of stock certificates."
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