Breaking Down the Language of HIV & PrEP

New HIV infections in the US continue to be on the rise, and like many other things, our QPOC communities continue to be disproportionately affected. With gay, bi, and queer men of color, and trans women of color being the most impacted by new infections.

Recently, there have been an increasing amount of conversations about Pre-Exposure Prophylaxis (PrEP), currently the daily pill regimen of the medication Truvada that can reduce a person’s risk of contracting HIV. Those conversations will, more often than not, focus on why PrEP is effective and only rarely discuss HOW it is effective, and often those conversations are full of language that is hard to follow. In response to this, we have created a quick, hopefully easily understandable, breakdown of the language that is often used when talking about HIV (which can be found below), as well as how Truvada, when used for PrEP, protects our cells from HIV replication.

So let’s break down how Truvada works in our bodies, this part may be filled with that language that is hard to follow that we were talking about. If you would like to know how Truvada works in the body, but aren’t interested in knowing the science behind it, feel free to skip to the next paragraph. Truvada works the same way in our bodies to prevent HIV as PrEP as it does when used to treat HIV. The major difference being that, when used to treat HIV, it is paired with other medications, as Truvada, by itself, is not a treatment for HIV. Both medications in Truvada, Emtricitabine and Tenofovir Disoproxil are nucleoside/nucleotide reverse transcriptase inhibitors (NRTI). When the reverse transcriptase enzyme, released by the HIV virus into our cells, is converting viral RNA into viral DNA it is using building blocks from inside the helper T-cell. NRTIs work by being very similar to, and taking the place of, those building blocks, except that NRTIs do not allow other building blocks to be connected to them. What this means is that, after they have been added into the viral DNA chain, the process cannot continue. This, in turn, forces the reverse transcriptase enzyme to stop converting viral RNA into viral DNA, keeping the new viral DNA from being created. HIV, as a result, is kept from replicating within your cells.

Another way to think about this is by thinking about the RNA and DNA compounds as building blocks like those in the picture above. When reverse transcriptase, released by HIV into our cells, is turning HIV RNA into HIV DNA, it is using the building blocks found in our cells. Each building block has ridges on its top that allows the next block to attach. The medications in Truvada work by being just like those building blocks, except that they do not have the ridges on top for the next block to attach. That means that reverse transcriptase can not continue to add additional building blocks to the chain causing it to stop production.

By taking the medication every day, a person ensures that their cells have enough of those NRTIs building blocks around to stop new HIV from replicating. It can take up to 7 days for NRTIs to build up in your system to offer the best protection during anal and vaginal sex, though some studies are showing that a higher dose of the medication over a longer period of time may be needed for vaginal sex to be as effective.

After learning about PrEP many people ask “How much does it cost?”

The answer to that is… It depends. Depending on where you live the full price of Truvada, without insurance or assistance, can be over $1,300, though very few people pay that. Some insurance companies cover the cost, and Gilead Sciences, Inc has an Insurance Assistance program which can help you navigate working with your insurance company and provider, as well as a Co-Pay Assistance Program that can help offset the cost. There are also organizations in Austin that can assist you in the process. The Center for Health Empowerment  and the Kind Clinic both have their own providers and staff available to assist people who wish to access PrEP for low to no cost, as well as a number of other health services.

The next question many people have is “Is PrEP right for me?”

The answer to that is again, it depends. PrEP isn’t right for everyone. Like every medication some people experience side effects and some people experience these side effects more than others. Common side effects are some nausea and stomach discomfort, diarrhea, tiredness, headache, dizziness, depression, problems sleeping, abnormal dreams, and rash. For many people these side effects are temporary, but you should tell your healthcare provider if you have any side effects that causes you discomfort or do not go away. For some people there have been a reduction in kidney function and a loss of bone density, both of these are reversible should be noticed by your provider at your regular check up. and Your provider should also schedule regular check ups with you to discuss how the medication is working for you, as well at to run tests to check your kidney function and bone density and to make sure you have not contracted HIV while taking Truvada.

Truvada can also interact with other medications. It is important that you tell your provider about any medication you are taking before starting a new medication. It is also most effective if you remember to take it every day and pair it with other sexual health strategies. People should talk with their healthcare provider to discuss the pros and cons of starting and taking a medication. Remember, PrEP is not 100% effective, but by combining it with other sexual health strategies, people can significantly reduce their chances of contracting HIV. If you are interested in talking to a provider about PrEP, and how to you may be able to access it for low to no cost, contact Center for Health Empowerment  or the Kind Clinic to schedule an appointment.

In order to better understand how HIV and medications like Truvada work we created this list with some definitions:

ARV (AntiRetroViral) – the name of a group of medications that interrupt the replication cycle of a retrovirus. Taking ARVs to treat a virus is called being on ART (AntiRetroviral Therapy)

Retrovirus – a virus that contains single stranded RNA (genetic material) inside of it, instead of double stranded DNA. RNA and DNA are used by our cells as a set of instructions about how to build more cells. Below is a picture that shows the difference in how RNA and DNA look

PrEP (Pre-Exposure Prophylaxis) – a medicine you take before exposure to a virus to reduce your chances of contracting that virus. In reference to HIV it is, currently, a daily pill regimen that, if taken correctly, may reduce the risk of HIV infection by up to 92%.

PEP (Post-Exposure Prophylaxis) – a medicine regimen that begins after exposure to a virus to reduce the chance that the virus will be able to cause new infection. In reference to HIV is it a month long daily pill regimen that must be started within 72 hours of exposure, and may reduce your risk of HIV infection by up to 72%

 

Truvada – an antiretroviral, made by the company Gilead Sciences, Inc. that is used in combination with other medications to treat HIV. Also, it is, currently, the only medication approved for PrEP.

TasP (Treatment as Prevention) – the use of antiretroviral medication to help people living with HIV to achieve an undetectable viral load, which will lower the chances of HIV transmission to their sexual partners.

Undetectable – through the use of antiretroviral medications a person living with HIV may reach an undetectable level of the virus in their system. Studies have shown that people living with HIV who reach an undetectable viral load have much better health outcomes than those who do not. Reaching an undetectable viral load may also reduce the chances of passing the virus to others by up to 95%. Achieving an undetectable viral load status does not mean that a person is cured of HIV, as there is currently no cure for HIV.

Viral Load – is the amount of virus within a person’s body. Can also be used in a larger context such as community viral load, which is in reference to the impact of HIV on specific communities.

Adherence – in reference to medication, it is the ability of a person to take medication as prescribed.

Helper T-Cell – also known as CD4 cells, CD4+, or T-cells, are white blood cells that search out infectious or cancerous agents in our bodies and send a signal to other white blood cells that a response is needed.

Enzyme – A protein that helps start or speed up a chemical or biological process.

Now that we are all on the same page with definitions, let’s learn a little bit about the HIV replication cycle, which we will need to understand if we want to know how medications work.

There are 7 steps in the HIV replication cycle

Step 1: Entry – HIV attaches to the outside of a helper T-cell and merges with the cell, releasing its two single stranded viral RNA and three enzymes (reverse transcriptase, integrase, and protease) into the host cell.

Step 2: Reverse transcriptase – the enzyme reverse transcriptase takes the single strand viral RNA and converts it to double stranded viral DNA.

Step 3: Integration– the enzyme integrase takes the viral DNA and connects it to the DNA of the helper T-cell.

Step 4: Transcription – The helper T-cell’s own processes are used to read the new viral DNA and begin the process of creating more viral RNA.

Step 5: Translation – The new viral RNA once again uses the helper T-cell’s own processes to create the rest of the components needed to create new virus particles.

Step 6: Assembly – The new viral components begin to assemble at the edge of the helper T-cell, using the cell’s proteins to create a bud that will become the new HIV virus. The enzyme protease separates each of the viral components into individual proteins.

Step 7: Release – the new HIV particle is released from the host cell, where it will go on to infect a new helper T-cell and create more virus. Each infected helper T-cell can make millions of new virus particles before eventually being destroyed.

We hope you’ve found this information to be informative and will share it with your loved ones. Please follow us onFacebookTwitter, and Instagram to stay connected and informed!

What’s in your grocery bag? By Gbeda Tonya Lyles

Our bodies need food and water to continue to function.  Intuitively we know that all “food’ is not food. How do you shop for quality, nourishment, and longevity? More and more research shows that our food quality is diminishing from mass food production, insecticides, and hormone injections. In addition, good food is limited by pre-selected food availability, the quantity of local organic growers, and access to small farming industry products. Your ultimate health comes down to what you pack into that grocery bag and bring home. This could determine your health and quality of life.  How do you know what you are truly eating; how do you make better food choices; and what are the food myths or fallacies to health and nutrition? The secret to wellness is often in food, movement, and stress management.  The focus here is food. Unlearning and relearning what is healthy for your body can be a lifelong lesson, but worth investigating and changing.

 

Supplementing your nutrition with medicinal herbs is also of great value.  Medicinal herbs are often regarded as the ‘forgotten foods’. There are certain herbs that should be available in your kitchen that have medical benefits. Examples of these dried or fresh herbs are licorice root, cinnamon sticks, Astragalus root, burdock root, yellow dock, Echinacea, goldenseal and turmeric root.  Some therapeutic grade essential oils can be safely ingested and cooked with as well.

 

For people who ‘do not cook’, eating out is often a risk. The quality of food choice and the way it is prepared is in someone else’s hands. We hope those hands and kitchens are clean! We know that fast food isn’t the answer and that slow cooked meals are an asset to health and wellness.  Choosing to prepare more of your meals at home can be a life saver.

 

Ideal nutrition balances the body. Nutritious foods help to bring the body to its ideal alkaline balanced state, making it harder to nourish disease living in an acidic body. To balance the body, it is important to eat fresher living foods, move closer to a plant-based diet, and drink enough water to help release toxicity.  When looking into your food consumption, access the following.  What foods are alkaline or acid? Which foods give the body more yin or yang?  What type of food gives you life, based on your body’s constitution? Let’s consume the good stuff that raises your internal vibration. Start a revolution in your kitchen.

 

Gbeda Tonya Lyles is a licensed acupuncturist, herbalist, and sound therapist. Her nutritional experience with food therapy comes from treating clients with gastrointestinal disease, studying Asian food theory, learning holistic and folk medicine, recommending dietary changes, and researching professional health and wellness literature. She is the founder of Gbeda Acupuncture and Sound Medicine in East Austin and is pursuing a doctorate at AOMA Graduate School of Integrative Medicine. For an appointment gbedaacusound@gmail.com or  512-426-4595. Gbeda.com is coming soon!
We invite our QPOC community members to continue this conversation with us Tuesday, August 8th, 2017 from 6:00pm-8:00pm at allgo during our “What is in your grocery bag?” discussion group facilitated by Tonya Lyles of Gbeda Acupuncture and Sound Medicine.

 

Why preventative care matters to QPOC

The term ‘preventative care’ is often used when talking about health, but it’s never really talked about in depth. What is Preventative care? And why is it important to QPOC? Preventative care may be taking steps to care for yourself, or meeting with a healthcare provider, before you are sick or experiencing symptoms of sickness. By doing so, you may be able to reduce the chances of becoming very sick, and increase the chances that you and your provider will be able to notice any new changes to your health. Currently most insurance providers cover preventative care and yearly wellness check-ups at no cost to you.

Why is it important?

First off, it keeps you healthier. For some people going to a provider or doctor before you are sick may seem counterintuitive, but many sicknesses, diseases and medical conditions are easier and less expensive to treat if noticed and treated earlier. And often times as QPOC we, for many reasons, avoid going to a health care provider unless absolutely necessary, which can lead to us receiving diagnoses for health conditions later and begin treatment further in the progression of the disease.  Annual or regular preventative visits to your provider can help you and your provider track any changes that are happening, as well as giving you an opportunity to ask questions about health and wellness. We should not wait until we are in pain or discomfort to begin to take care of ourselves. This point intersects with all aspects of our health, but is especially noticeable when it comes to our mental health. Many people do not put the time or effort into caring for their mental health. Preventative care for mental and spiritual health is just as important as physical health.

It can save you money

It has actually been shown that preventative care can, for some people, lower the overall cost you end up spending on health and wellness. For some sickness, diseases, and medical conditions the more time that passes before treatment begins the more it can cost to effectively treat or care for those conditions. As well as the fact that most preventative care will hopefully be small costs at regular intervals instead of large unaccounted for treatment costs.

Things you can do to practice preventative care:

Annual wellness check-ups can help you and your health care provider stay on top of any changes that are happening with your body and health.  Annual Wellness check ups are often covered by most insurance companies, and some providers may offer a sliding scale or reduced rate for people without insurance who wish to have a wellness check up.

Preventative care doesn’t always have to mean going to your health care provider. Something as simple as tracking your blood pressure may help you be aware of when things are happening in your body. High and low blood pressure can be signs of many different things happening in your body and regularly checking can help you to understand what you are experiencing. You can buy blood pressure monitors from most pharmacies. It is a good idea, if you have insurance, to call your insurance company before you buy one, as some companies may reimburse some or all of the cost to purchase one. In fact it’s a good idea to call your insurance before buying any medical device as they may cover a lot more than most people expect.

Working out for at least 30 minutes a day may help prevent many different health conditions and has been shown to lower the risk of heart disease and stroke. Working out may also help improve sleep, relieve stress and help regulate sugar levels.

As I said above, it’s a good idea to know the things that your insurance covers, and some insurers cover more than some people know about. Many insurance companies make money by having many people pay for coverage, but few that access services. Meaning that they have money coming in, but not going out. In this way they are incentivized to not let you know about all the services that they cover, or offer to you at no cost to you. Currently, the Affordable Care Act (ACA) requires all marketplace policies, and a few others, to cover certain preventative health care services at no cost to you. Some policies which are not available on the marketplace still follow these guidelines. At the bottom of this blog we have included links that will let you know what services are covered at no cost to you by ACA and other insurance plans

Preventative Care can have a large impact on helping to make our QPOC communities strong and healthy. It might be a good idea, with all that is happening around the ACA to schedule an  appointment with your healthcare provider now.

For people without insurance, there are many free or low cost wellness services offered through local and state health departments and community organizations. The City of Austin Health Equity department has some free and low cost services that can be accessed by many people. We have included links to some of these services below.

Let’s work together as a community to ensure that our QPOC community members are able to live long, happy, healthy lives. How do you practice preventative care? What recommendations do you have for other QPOC around health and wellness? Let us know, and make sure to send this to someone who can benefit from knowing more about preventative health care.

Follow us on Facebook, Twitter, and Instagram to keep up to date with all the things we are doing.

 

Links to Preventative Care Services:

Click here to see all the Preventative Medical Services available at no cost to adults who have a ACA health care plan, click here for services specific to women’s health, and here for services specific to children’s health. Remember that these services are required under the ACA to be covered by your insurance company at no cost to you. Also remember that many plans that do not fall under the ACA must also offer these services at no cost. If you do not have insurance some providers may have a sliding scale program for people wanting to access preventative health care services.
Click here to see how to access low to no cost vaccinations through the City of Austin (CoA). The CoA also has a Mobile Van Program where you can receive blood pressure, blood sugar, and cholesterol checks, as well as pregnancy, and HIV/STI tests, click here to see more information. Click here for free services in Austin to help quit tobacco. The second Saturday of every month from 9:00am-2:00pm HEB pharmacies offer free blood sugar and blood pressure checks, click here to learn more.

 


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