Michael
@neolithicrumba2
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HIV+ since 1993. U=U #plwh HIV research and service provider for over 30 years. #HIV tester, #PrEP provider, and support group facilitator.
California, USA
Joined May 2022
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I feel it’s worthwhile to make a 🧵 on why HIV is so common in gay men. My take comes from a background in research and writing grant proposals, work as a statistician and having spent much of my career working with gay and bi men at testing sites, support groups, and PrEP
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@jolzju
@theskinsensei
You need skin contact with the sore. No opening is necessary. Respiratory transmission would require very close and sustained contact, like from making out. This is not COVID. If it was airborne, it wouldn't almost exclusively be in gay men. Straight people breathe too.
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Today is our sixth wedding anniversary. HIV is never a barrier to your dreams
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#PLWH
for 29 years (that means I may have HIV in me that's older than you)! I post longish threads on the latest research, and take deep dives that explain labs, meds, culture, and politics. Ask questions, follow, and share. To beat HIV, you have to follow the science!
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The goal of ARVs is to stop replication so your immune system has the space to recover. Your CD4s will eventually recover. It's not a race or a contest. It's not dick size. I love you no matter what your number is. ❤️
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A Day with HIV is this Saturday, Sept. 23. I took this photo during a group hug at the end of my newly diagnosed group for a past Day with HIV, and it was featured in Positively Aware's magazine. Your photo could be next!
You’re invited to take part in A Day with HIV, Positively
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Looking at the ARV pipeline. The future is injectables. Cabotegravir (cabotegravir and rilpivirine) is now approved for dosing every two months. One shot in each hip every 8 weeks instead of a daily pill. There are better choices coming, now in clinical trials.
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@theskinsensei
I'm sure there are already dozens of cases in the Philippines. They just haven't been diagnosed yet. Currently respiratory cases are a hypothetical risk. We've seen a tiny number of household transmission, but to say how it spread is still conjecture.
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HIV positive in 1988, HIV negative in 2022.
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I run two HIV support groups. One for HIV+ gay men over 50, and one for the newly diagnosed. For the newbies, my goal is for long and healthy lives, so they can live to participate in the other group. Imagine yourself with wrinkles, grey hair, and laughing with friends.👴🏽🧓🏽👴🏻👵🏻👴🏻
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Poz magazine publishes an annual ARV chart of medications available in developed countries.
You’ll notice that Teldy or TLD is not on here. That’s thanks to capitalism and the illusion of the zero sum game.
The D and TL are made by different companies, and profit comes first
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Seven years ago, we went to City Hall, and got married ❤️
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Here I am, at UCLA Santa Monica Medical Center after my angioplasty procedure.
One of the side effects of the first effective ARVs was elevated cholesterol that didn't return to normal, even after you switched to different meds.
Now 25 years later, I'm experiencing the early
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To understand our viral load test results, it’s important to understand the test itself and how the virus lives inside our bodies. ARVs stop HIV replication in active cells. That’s it. We also have viral reservoirs where dormant HIV can emerge. That’s the reason for our daily 💊
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I don't usually tweet about my own HIV treatment and health, but since I just returned from my 2X a year visit with my infectious disease doc, I thought it might be informative. If you read this thread, take into consideration that I live in California, I'm 60, and work in HIV
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TLD as a monthly injection instead of a daily pill.
Would you prefer it?
Long-acting injectable version of the most popular HIV drug combination is possible
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As HIV scientists gather this summer to present their latest research, I’ll be following and sharing peer-reviewed presentations and announcements. This includes the latest report on new HIV drugs in the pipeline and efforts to explore both sterilizing and functional cures
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@theskinsensei
I think you weren't turned down for being gay, you were turned down for being a sexually active gay man. Those who are abstinent for the months can still donate
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@dieworkwear
Let it be known that my wardrobe does not reflect what I actually wear.
Some of it there as a cautionary tale, a reminder of my wayward past
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Sharing an update on the "New York Patient" and her road to an HIV cure.
So briefly, here's a timeline of the NY Patient. She was diagnosed with HIV soon after infection and started ARVs immediately. Starting so soon after infection may have reduced her viral reservoir to a
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Here's some recent news about Cabenuva, the injectable ARV that's been available in developed countries for a few years now. Clinical trials for generic versions are ongoing, so expect to see Cabotegravir/Rilpivirine (CR) availability in the coming year.
A 🧵.
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Remembering
@jjhumantorch
today, August 3, on the 2nd anniversary of his passing. He did so much to bring together our blood siblings, creating the community we benefit from today ❤️
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True story.
Before they closed, my husband and I used to go to 1350, a nearby gay bathhouse.
I took a shower then walked by my husband, sitting and talking on the orange bench. The guy whispered to my husband (while pointing at me), "Don't have sex with him. He has HIV."
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Medications, supplements, and ARVs are either filtered out by our kidneys or liver. Because of our daily 💊, it's important to be aware of other things that can impact these organs. Let's look at our kidney:
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Another area for HIV cure research are broadly neutralizing antibodies (bNAB). These target areas of HIV that don't mutate, unlike vaccines. BNABs allow macrophages and natural killer cells to identify and eliminate HIV infected cells
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When we become HIV+, we still have other things going on in our lives.
We still have to go to work or school, juggle our finances, work towards our goals. We still get horny and hungry and lonely.
Now in addition, we have to manage our medications and go in for lab work.
It’s
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For those switching from LTE to TLD: one side effect of the Dolutegravir is gradual weight gain. Also, you no longer have to fast at night. That means more calories before bedtime (which turn to fat). You have two choices: diet and exercise, or pray that the fat goes to your 🍑.
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For me, sickness means the inability to do your normal daily activities. For me, ARVs allow for a normal, productive life.
I take ARVs daily to prevent illness.
In the same way, I brush my teeth twice a day not because I have cavities, but to prevent them ❤️
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At our weekly staff meeting, I told my boss that I’ll be retiring at the end of the year (I’ll be 62 and can claim early retirement).
This is a big deal for someone who at 32 had a viral load over 1 million and was expect to live for only 2 more years
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Science has achieved what seems close to the impossible. They have created a single pill that stops HIV in its tracks and turned a fatal disease into one that's easily controlled. You can't say the same for diabetes, respiratory diseases, or hundreds of other chronic conditions
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My tweets here are for my blood siblings ❤️. Besides living with HIV, I've been working in research and clinical services.
I'm thinking about setting up a Twitter Circle for other HIV professionals who follow:
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On August 3, 2021
@JJhumantorch
died. I never met him, but I can credit him for connecting me to my blood siblings around the world. Because of all the secrecy around or sexualities and diagnosis, I wonder if his family even knows the positive impact he had around the globe. ♥️
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@pozposibility
26 years. I started when effective ARVs first became available, in 1996. 24 pills taken twice a day with really bad side effects. I'm lucky to have survived to our single pill era. ♥️
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@theskinsensei
Unfortunately, tests used to screen the blood supply have a window period where there could be a false negative. As screening technology improves, becoming both more sensitive, rules will change. Remember that donations are pooled, so 1 unit has the potential to infect hundreds
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After six decades on earth (and living with HIV for half of that), the most practical thing I’ve learned is the power of the present moment. The past is the invisible pit that pulls us under. The future is unknowable. It doesn’t yet exist (and it never will).
All that exists is
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Blood sibs: I'm turning 61 years old today. Your goal should be to be like me one day: old, wrinkly, grey hair and living with HIV for decades. You'll have other chronic conditions, but they will be well-managed and you'll be happy, healthy, and thriving
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@dieworkwear
My heart broke a little when I read that
@dieworkwear
didn't have an esoteric name for the metal bits on suspenders 💔
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My HIV+ test results came in the mail. I came home from work and opened my mail.
My roommate was in the room, watching a football game.
He was the best person to tell. He was HIV+, working, dating, and doing all the regular things people in their 20’s do.
There was no no
Living with HIV: Disclosure
To whom did you first disclose your HIV status?
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Viral load test results; undetectable, not detected, detected <40.
What do they mean?
Is there a difference?
What about U=U?
A 🧵
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@dieworkwear
I was gifted a flannel lined Carhartt denim barn coat from a client/volunteer when I was working on a study with injection drug users. He got it in LA County Jail (it was stamped LA CO over the breast pocket). It gave me street cred among the junkies when doing needle exchange
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Let’s talk about HIV disclosure and dating. For 12 years, I’ve run a newly diagnosed support group and had hundreds of conversations on the topic.
There are no wrong or right answers and we each have to follow a path that’s comfortable for us.
First, let me share some options
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This is unacceptable.
We have the tools to eliminate HIV transmission: HIV testing, biomedical prevetion (PrEP), and ARVs that make transmission impossible.
These tools are being implemented worldwide, and the number of new infections is going down.
Except for the Philippines
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Here's an interesting and small study, with 24 participants. It compared 2 popular ARVs in North America and Europe, Biktarvy and Dovato. These were all newly diagnosed blood brothers who were followed for six months. Viral levels were measured in blood, semen, and rectal fluid
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For HIV sexual transmission to occur, 4 things are necessary:
1: 2 people need to have anal or vaginal sex
2: No condom was used for all or part of the sex
3: 1 person is + and one is -
4: The PLWH is not on ARVs and undetectable
If 1 of the 4 is missing, transmission won’t occur
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Connect to your blood siblings!
#normalizinghivchallenge
Name: Michael Buitron
Age: 61
Children: None
Married: for six years to an HIV-negative partner. ♥️wins!
HIV status: Positive since 1993
ARVs: Dolutegravir and Lamivudine aka Dovato
ARVs stop HIV
Visibility ends stigma
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@theskinsensei
We've had 279 cases in LA County. In my clinic, 5 all sores were on the penis, perineum, and around the anus and mouth. One had pustules inside the rectum. Better advice would be to dial back on the multiple partners thing until you get vaccinated.
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I see my HIV doc for 15 minutes, 2X a year. That includes an exam, going over labs, and any questions or issues I have.
I realized that I spend more time reading posts, tweeting & DMs with my blood siblings here than I do with my MD. You are a bigger part of my healthcare team
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GS-8588 is an exciting and novel approach to kill HIV-infected cells, unlike ARVs, which just stops HIV replican while ignoring inactive but infected cells. Looking forward to future results
@GileadSciences
have a bispecific antibody-like protein, GS-8588, currently in phase 1 human studies for
#HIVcure
at
#AIDS2024
How it works: Directs effector T cells to target HIV infected CD4 cells with HIV and expressing Env.
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More proof that dolutegravir is an excellent ARV.
In this study, a small group of virally suppressed Swiss patients—who also started ARVs soon after infection—were randomised to continue on their 3 ARVs or be switched to dolutegravir monotherapy.
After two years, 64/64 on
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@Inad_Rie
@benicetoRed
Statements like this leave me completely flummoxed. I expect better. I expect them to be up to date, and we’re ingrained to respect and not contradict our doctors. After all, they are gatekeepers of our life saving 💊
I prefer to speak to them in private, after, with evidence
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A pivotal moment in our battle against HIV-related stigma came in 2008 with the release of scientific consensus called the Swiss Statement: If the HIV positive partner in a serodiscordant couple was virally suppressed, they wouldn’t transmit HIV to their negative partner.
There
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A big barrier to an HIV cure are resting T-cells infected with HIV. They don't cause harm, because the cells are dormant, therefore the HIV can't replicate. When some cells activate, so does their HIV, which is why we have to continue to take our 💊
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I spent 5 years in the STD clinic in Long Beach working on HIV prevention research, and another ten years at St Mary Medical Center working in an HIV clinic. I'm also a sexually active gay man and PLWH. This 🧵 includes personal observations and experiences with STDs
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We measure the HIV in our body with a viral load test, but we know that HIV is transmitted sexually, where no blood is involved.
So the question is, "What's going on in our semen?"
"Does the amount of virus in semen also drop when we start ARVs?"
A 🧵
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Every day, every skill, every setback, every pill. Eventually, we get there ❤️
And we don't do it alone 🙏🏽 to my followers, to those who ask questions, and to those who lead by example, you're my rock stars!
62 and counting
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June 5 is HIV Long-Term Survivors Awareness Day. We have siblings diagnosed with HIV before effective ARVs, and even before the HIV anti-body test was invented. They are still with us today.
If you’ve been diagnosed more recently, consider yourself a long-term survivor in
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Singapore no longer requires mandatory HIV disclosure if a person has been virally suppressed for >6 months.
Law makers think this will be an incentive for all PLWH to start on ARVs.
But it is also an incentive for persons who engage in unprotected sex to not get tested
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Our CD4 numbers change from morning to night and will fluctuate depending on the amount of sleep we had the night before our blood draw (among other factors). A better number to track is our CD4%, which is more consistent.
After a few years, our CD4s will level off at our
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Thanks to ARVs, we're living longer. In my community, PLWH who are over 50 are more than 60%
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#NormalizingHIVChallenge
is about destigmatizing HIV. It’s about treating PLWH as normal humans, not as vectors of disease.
The only reason HIV-negative gay men see this as sexual is because it triggers their realization that they are vulnerable to HIV infection from
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February 28 is
HIV is Not a Crime Awareness Day.
It’s important to realize that HIV impacts society’s most vulnerable populations: gay and bisexual men, sex workers, injection drug users, and women, including trans women. Folks whose lives are criminalized and suffer injustice
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About ten years ago, I got a grant so our hospital’s ER could offer opt-out HIV testing. That means everyone who got a blood draw in our ER got an HIV test, unless they “opted out”. We went from 1-2 tests a month to 1,000
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@StarBright2022
If you're undetectable you can't transmit HIV. Period.
Your sex partner can't get HIV
With or without PrEP
With or without condoms
We've been told by society that we're dirty and those thoughts get internalized. It can take time for our mindset to change
❤️
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Just returned from my twice-a-year visit with my ID doc. I thought I’d share what my attitides and thoughts are like after more than 29 years of HIV care. Currently I’m seeing my 9th infectous disease specialist. We used to be colleagues at Harbor-UCLA Medical Center
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I’ve recently made several threads on STDs, and I’d like to finish up with a very important one: HPV, or genital warts. Like I’ve said before, bacterial STDs can be treated and cured with antiobiotics, but viruses are for life. Fortunately, with HPV, we have a vaccine, Gardasil 9
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40 years ago--before any HIV treatment, before HIV had been identified, or a test had been developed, the only way to know if someone was infected happened when they developed AIDS. In these dark times, a group of AIDS activists came together to develop the Denver Principles
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A doctor explaining U=U: In the studies, there were 130,000 acts of condomless sex between a positive and negative person and the negative partner was not on PrEP. For 1 person, you would need to bareback with undetectable guys 6 times a day for 60 years! Anything for research!😆
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@hankgreen
Political parties are not part of the government in the same way voters, lobbyists, wealthy donors to political campaigns, and the media are not part of the government
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I'm planning to post a series on HIV cure topics: what the hurdles are, the different paths to cure research, and what we've seen so far. There were two big cure stories at the International AIDS Conference that concluded last week. Don't just hope, follow the science!
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ARVs don’t kill HIV. They stop replication.
When a CD4 is infected with HIV, the protein coat of the CD4 and the HIV envelope merge, so the insides of the HIV can be deposited in our cell. But infection changes the outside of the infected cell, so it can now be identified by a
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37 years ago, AZT, the very first ARV, was approved to treat HIV.
AZT was approved in record time, with a clinical trial that lasted only 19 weeks. The trial was stopped early because so many people were dying in the placebo group. Today, new ARVs are compared to existing
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You've tested HIV+ and your CD4 is 💩
You start 💊 and your CD4 moves back to a normal range (400-1500, depending on the lab).
Now you should be watching your CD4/CD8 ratio (a normal ratio is usually >0.9)
A look at how age affects recovery 🧵
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The IAS HIV science conference is coming up next week, so in preparation for that, let's do a basic review of HIV cure research as it stands now. First I'd like to cover some common questions I get, like, why is it so difficult? Are "they" hiding the cure for profit? 🧵
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To understand why random hookups are more dangerous than condomless sex with an an HIV+ on ARVs, it's important to look at people who test positive. When we look at studies of people who test positive in the days before ARVs, PLWH would abstain, use condoms, or forego anal
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Just a reminder: The strength and abilities of our immune system is not represented by a CD4 result. It has various components, some that create barriers to infections, some that make our bodies inhospitable to pathogens, and others that target specific microbes
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This popped up on my feed, from five years ago. I was working with The Stigma Project with the goal of ending sigma in my community ♥️
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I’ve received a few DMs asking about
@JJhumantorch
His life was a gift to all of us PLWH that have discovered each other on X. He lives on though our connections ♥️
Some of those DMs asked about the reason he died. That’s something I’ll never know.
A 🧵:
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I've talked about U=U with my husband, and he's also on PrEP. Not to protect him from my HIV (my ARVs take care of that). His PrEP is to protect him from other guys at the bathhouse: those who became positive after their last negative test, so they don't know, and aren't on ARVs
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How do new ARVs become available in the Philippines, Thailand, Malaysia, Vietnam, Indonesia, and other developing countries? Pharmaceutical companies in the US, Europe, and Japan (the main HIV drug developers) have patents that give them the rights to make and sell their ARVs.
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For all you Catholics out there:
September 1 is Saint Fiacre feast day.
St. Fiacre is the patron saint of those with hemorrhoids, fistulas, and sexually transmitted infections.
To my blood brothers and sisters, happy St. Fiacre day!
❤️💊❤️
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Let's talk about DoxyPEP, the clinical trial, and new data on real-world effectiveness. A 🧵
DoxyPEP is taking a single dose (200mg or 2💊) after condomless sex to prevent the most common STDs: Chlamydia, Gonorrhea, and Syphilis
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A study of a statin (Pitvastatin) to lower cholesterol in HIV+ over 40 had to be stopped early because the benefits were so dramatic. Cardiac events were cut back by a third and death from heart attacks was reduced by 21%.
Now that we have the virus under control, we need to
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I've told hundreds of people that they tested positive for HIV. I remember a few, but I guarantee that none of those people have forgotten me or that moment.
What do you wish the person who gave you your positive results had said to you?
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In 1979 I came out to my parents. Months later, I left home and went to Europe. This is me in Amsterdam, 17 years old and stoned.
#TBT
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If you feel alone, visit
#NormalizingHIVChallenge
I look through your photos, and see an army of love.
I see my siblings embracing their health and protecting their partners.
I don't see a slogan, I see the embodiment of hope.
I see your potential.
♥️
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@bahalanabukas
It can be the "end of everything" if you want it to be. In the 29 years since I tested HIV+, I went back to school for my master's degree, advanced my career, presenting HIV research at national and international conferences and now married to an HIV-negative man.
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@FirstDoctor
@kar3yon
I really don’t like tweets like this. We know from public health research that fear-based campaigns don’t work. We see in countries where gross pictures of smoker’s lungs on cigarettes packs are used, smoking rates remain the same.
Removing saliva from sexual encounters will not
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@ArchiPositivity
Everybody dies. ARVs stop viral replication. That's it. It’s not an imortality pill.
For all people, positive or negative, the immune system declinces as we age. That’s why the majority of people who died of covid were over 70. In older people, their immune system wasn’t up to
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If there was one person who became the first face of AIDS for many Americans, it was Rock Hudson (1925-1985). The TV show Dynasty was a weekly event for a group of my gay friends where we’d order pizza and have a watch party. I remember an audible gasp in the room when Rock
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