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Research Posts

Know Your PrEP Options

by Daniel Vaillancourt

PrEP: So Many Options

As seen in GED Magazine

The HIV prevention world has changed dramatically in the more than 10 years since the U.S. Food and Drug Administration (FDA) approved Gilead Sciences’ Truvada as pre-exposure prophylaxis (PrEP) in July 2012.

Following the discovery that Truvada can pose renal and bone density problems in some individuals (which, thankfully, go away after the medication is discontinued), the FDA approved Gilead’s more kidney-and-bone-friendly Descovy as PrEP in October 2019. While Truvada is currently available as a generic equivalent, Descovy is still under patent.

More than a year ago — on December 20, 2021 — the FDA approved GSK’s Apretude, the first and only long-acting injectable form of PrEP, which requires a new dose every two months.

According to the Centers for Disease Control (CDC), when taken as prescribed, PrEP reduces the risk of HIV infection from sexual activity by more than 99%, and by at least 74% for those who use intravenous drugs. You should be on PrEP for HIV protection if you are 18 years or older, are sexually active (or soon planning to be), and are HIV negative.

“The great news with injectable PrEP is that it is a wonderful alternative for people who have issues with adherence and may forget to take their daily pill,” says DAP Health Clinical Supervisor of Sexual Wellness, Nurse Practitioner Trent Broadus. “It’s also very helpful for unhoused people who may have nowhere to store their meds, or who may be concerned that they’ll be stolen. Even more exciting, longer-lasting forms of injectable PrEP are currently being studied. Data are promising on one injection that would last a full six months.”

Before starting PrEP — whether orally or by injection — you’ll need to get tested for HIV, STIs, kidney function, and Hepatitis B and C.

Some people experience gas, nausea, or headache when beginning PrEP. These side effects typically go away within the first week. Note that it takes at least one week on PrEP before you’re protected for anal sex, and three weeks for vaginal sex.

Most insurance plans cover oral PrEP for HIV. Injectable PrEP is covered by Medi-Cal, but some Medicare and private insurance plans may require you to go through your primary care provider.

All forms of PrEP require regular follow-up HIV, STI, and kidney function testing. Every three months for oral PrEP; every two months for injectable PrEP.

You should talk to your doctor before stopping any medication. And if you stop taking PrEP, talk to a health care provider about using other HIV prevention strategies.

If you’re interested in PrEP, contact a DAP Health PrEP navigator at 760.656.8400. You can also talk to any nurse or nurse practitioner during your visit if you want to discuss which PrEP may be right for you.

If you don’t have health care insurance, or if you need financial assistance, a PrEP navigator can also explain your options, help you get access, and answer questions about finding a doctor or working with your pharmacy.

And remember: All PrEP visits and lab work done at DAP Health’s sexual wellness clinics in Palm Springs and Indio are always free of charge to all patients.

Anthony Velasco Elected Director-At-Larg …

by Steven Henke

Velasco Elected Director-at-Large for Association of Nurses in AIDS Care 

Anthony Velasco was reluctant to accept when the Association of Nurses in AIDS Care (ANAC) approached him about joining its board of directors. Even though he is a founder and current president of the Palm Springs chapter, he wondered if he had impostor syndrome. His colleagues knew better, as they elected Anthony Director-At-Large with the Association of Nurses in AIDS Care (ANAC).   

ANAC is made up of more than 40 chapters located around the world with over 2,200 members from 60 countries. Members include social workers, pharmacists, physician assistants, lawyers, and doctors from around the world committed to HIV/AIDS nursing.  

“ANAC is such a great venue to really connect with other people and see what they’re doing and compare what we’re doing,” Anthony says. “It’s so awesome to hear about the research being done on the national level and to see how it could potentially be applied at DAP Health.” 

Anthony, who chairs DAP Health’s Transgender Health Program, says the synergy helps both organizations.  

“I’ve told ANAC about the work we do at DAP Health and the great interdisciplinary culture we have here, including social work, community health, medical, and mental health,” he says.  

DAP Health provides holistic, compassionate, and comprehensive care.  

Anthony believes that DAP Health’s approach to care should be the model everywhere. This includes culturally competent care for transgender patients he serves, and more opportunities for nurses of color.  

While Filipinos make up about 20 percent of the nursing population in California, Anthony wants them to reach into leadership, research, and academia. (U.S. Census Bureau) 

He remembers noticing that there were never Filipino professors teaching his nursing classes as he completed his undergraduate and graduate school degrees in California. 

“Representation is one of the motivations I have,” Anthony says. “If a young Filipino nurse entering the field sees someone who looks like them in a leadership position, they will know that they can be in that position someday.”   

He provides compassionate care to people living with and without HIV. Caring about people who need special care does not stop there for Anthony.  

He provides comprehensive gender-affirming care and works to create more access to safe and gender-affirming spaces for all. At DAP Health and elsewhere, he has improved the health care experiences of many transgender patients in the Inland Empire.   

He belongs to the World Professional Association for Transgender Health (WPATH).  

Anthony is passionate about global health equity and has served on medical missions in Haiti and Honduras. Annually he gives his time and talent in the Philippines with Global Health Force, a non-profit organization providing access to free health care in underserved communities around the world.   

A Nurse Practitioner and credentialed HIV Specialist at DAP Health, Anthony has been working in HIV care since 2010. He is pursuing his doctorate in nursing at the University of Colorado. 

Aging Positively — Reunion Project 202 …

by Dustin Gruber
HIV and Aging Conference Header Image

Contact: Steven Henke                                 
Director of Brand Marketing 
(612) 310-3047 
shenke@daphealth.org 

FOR IMMEDIATE RELEASE  

August 5 2021  

Local Organizations Collaborate on HIV & Aging Conference  

Aging Positively — Reunion Project Set September 18, 2021  

Aging Positively — Reunion Project, the annual Coachella Valley conference aimed at providing practical information and inspiration for those aging with HIV, will bring together community leaders to improve the lives of older adults living with HIV for a virtual conference on Sept. 18, 2021. The conference will feature an HIV research panel of top experts discussing HIV and aging issues in our community.   

September 18 is National HIV/AIDS and Aging Awareness Day — a day to call attention to the growing number of people living long and full lives with HIV and to aging-related challenges of HIV prevention, testing, treatment, and care.    

The virtual conference is free to attendees and open to the public. Presented by Eisenhower Health, this year's event is the result of a unique collaboration among local service providers and organizations focused on improving the shared experience of older adults living with HIV.  

People with HIV are living longer lives, thanks to advancements in scientific research and medical treatments; today, about half of HIV positive individuals in the U.S. are age 50 and above. Aging persons living with HIV have experienced tremendous loss, stigma, and discrimination throughout their lifetime and within the healthcare system.  In comparison to similar HIV-negative populations, individuals aging with HIV may experience an early onset of aging complications such as neurocognitive decline, impaired physical function, frailty, and falls.    

Karl Schmid, the entertainment reporter for ABC7 LA will speak on HIV and the media. The ABC reporter, who came out as HIV Positive in 2018, uses his multimedia platform, +Life, to educate and combat HIV stigma.  

At ABC7, Karl has been a regular contributor since 2013, joining the team as a correspondent and producer on the then-weekly and syndicated "On The Red Carpet." 

A passionate activist in the fight against HIV stigma, Schmid launched +Life (www.pluslifemedia.com) in 2019 online to help foster a new conversation around what it means for people living with HIV and to tackle the stigma still associated with the virus. +Life is also part of Localish TV on the newly launched Localish TV network. 

"HIV is not killing people but stigma is, and this is what needs to change," Schmid said in a statement. "We need to talk more about HIV and its advancements, about what U=U means, and we should not be stigmatized by society. 

"We need to have more information on mainstream media about how you contract HIV, prevention and treatments available so that people stop stigmatizing those that are positive and realize that anyone can have HIV and live a completely normal and healthy life."  

Since coming out as HIV-positive, Schmid has used his platform to educate and fight bias.  

Keynote speaker Andy Bell of Erasure fame will share his personal story. Bell is a founding member of Erasure.  Formed in 1985, when former Depeche Mode and Yazoo member Clarke advertised for a new singer. The duo quickly became enormously successful in the U.K., U.S., and several other countries with hits like “Chains of Love,” “A Little Respect,” and “Oh L’amour.” Now, three decades into their career, they are considered one of the most adored and influential synthpop bands selling more than 25 million records. In 2019, Erasure released their 18th studio album, The Neon. 

Bell has become an icon within the LGBTQ+ community for his honesty, compassion and support. Among his support of various LGBTQ+ causes, Bell has served as an ambassador for New York’s Hetrick-Martin Institute, and he is currently a patron of the Cambridge, England-based charity Diverse and of Above The Stag, London’s only LGBTQ+ theater. 

Topics and speakers:  

  •  Keynote speaker: Andy Bell from Erasure 
  • “Honoring Our Experience” with Gregg Cassin 
  • “KeeLee Meditation” with Dr. Daniel Lee, from the University of California, San Diego's Owen Clinic 
  • “HIV & The Media”: Karl Schmid is the entertainment reporter for ABC7 LA. He recently revealed his HIV status and has been an advocate for U=U as well as breaking down HIV stigma. 
  • HIV research update panel: 
    • Borrego Health: Valerio Iovino, i-Care 
    • DAP Health: Dr. Tulika Singh 
    • Eisenhower Health: Dr. Ken Lichtenstein 
    • Palmtree: Dr. Carlos Martinez 
    • HIV+ Aging Research Project-Palm Springs (HARP-PS): Jeff Taylor  
    • Caregiving with Perry Wiggins from The Center, end-of-life doula Alex Snell, and Richard Bass from PALS (Planning Ahead for LGBTQ Seniors)
    •  “Let’s Kick ASS”: Brian DeVries speaks about sustaining and making new friendships late in life 

What: The Aging Positively — Reunion Project 6th annual HIV conference is a collaboration between the HIV+ Aging Research Project—Palm Springs and other nonprofit community partners. It will be a virtual conference consisting of a mix of facilitated discussions, panels, and presentations led by key researchers, advocates, and long-term survivors of HIV/AIDS.  

When:  The 6th Annual Aging Positively — Reunion Project virtual conference will be held 9 a.m. to 2 p.m. on Sept. 18, 2021. 

Where:  Attendees can attend the conference from the digital device of their choice.  In-person elements may be announced later.  

How: Registration is free and open on Eventbrite: https://www.eventbrite.com/e/hiv-aging-virtual-conference-tickets-162082616469  

Collaborating Organizations:  

ANAC   

The Association of Nurses in AIDS Care (ANAC) is the leading health care organization responding to HIV/AIDS. Since its founding in 1987, ANAC has been meeting the needs of nurses and other healthcare professionals in HIV/AIDS care, research, prevention, and policy.  

 ANAC aims to promote the health and welfare of people affected by HIV/AIDS by:  

  • Creating an effective, engaged network of nurses in AIDS care. 
  • Studying, researching and exchanging information, experiences and ideas leading to improved care and prevention. 
  • Providing leadership to the nursing community in matters related to HIV/AIDS infection and its co-morbidities. 
  • Advocating for effective public policies and quality care for people living with HIV. 
  • Promoting social awareness concerning issues related to HIV/AIDS. 

Borrego Health   

Borrego Health provides high-quality, comprehensive, compassionate primary health care to the people in our communities, regardless of their ability to pay. They serve these communities and adjoining regions with respect, dignity, and cultural sensitivity as a medical home and safety net for essential health care and social services. Borrego Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and a Federal Tort Claims Act Deemed (FTCA) facility.  

DAP Health   

At DAP Health, no one wonders if they belong — they just feel it. People can rely on culturally competent and stigma-free care at DAP Health.    

DAP Health offers medical and mental healthcare tailored to patients and clients by clinicians who listen to them. DAP Health has been meeting the diverse needs or its community since 1984, and it offers culturally competent care with no stigma about a person’s race, being LGBTQ+, or living with HIV. By actively listening, we can offer people care and services that meet their unique needs.     

  • Sexual wellness — DAP Health’s Orange Clinic offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and hepatitis C testing.
  •  Thriving with HIV and ending the epidemic — DAP Health helps patients living with HIV thrive by staying healthy, undetectable and untransmittable to others. They become part of DAP Health's family beginning with testing, linkage into care, and then being enrolled in medical and mental healthcare, dentistry, social services, and prescription access. 
  • Mental health services — DAP Health offers individual and group therapy and has a substance abuse program that emphasizes recovery and relapse prevention. Mental health is health — no stigma, no shame. It just takes seeing a person truly where he/she/they are in their personal journey. 
  • Ongoing primary care — Join more than 9,700 patients who enjoy culturally competent care from clinicians and care teams who become like family. DAP Health's team works with patients to coordinate their care and ensure they have everything they need to stay healthy.  

Eisenhower Health  

Eisenhower HIV Clinic: Recognizing the complex health care needs of the LGBTQ patient population, Eisenhower Medical Center offers a comprehensive range of clinical, research and education resources — starting with a team of dedicated primary care doctors who have exceptional experience and expertise.  

Eisenhower HIV Clinic Primary Care Services: Providing state-of-the-art care for HIV patients requires knowledge of the latest treatments and best practices in the detection and treatment of HIV. Eisenhower's HIV Primary Care program is focused on the overall health of each patient, including:  

  • Appropriate utilization of advances in HIV care to sustain the best possible quality of life, including appropriate STD and cancer screening as well as healthy aging  
  • Best practices to prevent the spread of HIV  
  •  Compassionate access to new medicines for highly drug-resistant patients  
  • Our team includes HIV primary care doctors Board Certified in Internal Medicine or Family Medicine, with an additional certification as an HIV specialist with the American Academy of HIV Medicine (AAHIVM).  
  • Eisenhower Health is proud to collaborate with many nonprofit organizations here in the Coachella Valley providing HIV and related healthcare services, through partnership connectivity of services, referrals, and education.  

HARP-PS   

The HIV+ Aging Research Project-Palm Springs is a grassroots community non-profit that conducts research and provides education to improve the quality of life for long-term HIV survivors in the Coachella Valley. They collaborate with academic partners throughout Southern California and nationally to conduct socio-behavioral research on issues like resiliency and COVID-19 affecting HIV survivors. They hold monthly provider events to provide education on HIV Treatment issues, and they held monthly COVID Rounds during the peak of the COVID-19 pandemic. They also provide the monthly Positive Life HIV education series with topics and speakers tailored to the unique needs of their HIV survivor community. They created the annual Reunion Project daylong regional seminar to bring together the HIV and aging community in Southern California. Last year they combined forces with DAP Health and other community partners on the Aging Positively-Reunion Project event, which is held each year on or around HIV and Aging Awareness Day on September 18.    

Jewish Family Service of the Desert 

Since its inception as part of the Jewish Federation of Palm Springs and Desert Area in 1982, JFS has grown—not just in size, but in its ability to serve the people of the Coachella Valley. Beginning as a small group of volunteers who checked in on seniors and disabled people who lived alone, JFS Desert has evolved into an organization of professionals and volunteers that provide a broad range of support and services to thousands of Coachella Valley residents each year.  

JFS Desert’s experienced case managers can assist in exploring potential resources. They will assess clients’ eligibility for services and programs and can help facilitate the application process to obtain benefits and support. JFS case managers are a resource for the Coachella Valley, providing emergency financial assistance to prevent homelessness. JFS also works with local and county organizations to advocate for the rights of seniors in the valley. The JFS case management team takes a holistic service approach, collaborating with internal departments to ensure clients’ needs are addressed. We are dedicated to making sure that mental health issues and affordable housing stay front and center for our valley citizens.   

Let’s Kick ASS Palm Springs 

Let’s Kick ASS Palm Springs is an inclusive social group seeking to reduce the stresses of AIDS Survivor Syndrome. They welcome members regardless of HIV status, race, gender, age, or sexuality, believing that the individual is the best judge of the impact of HIV on their life. LKAPS organizes social functions providing opportunities to develop friendships and community.  

They support education and advocacy to raise awareness of AIDS Survivor Syndrome, long-term survivors, and the challenges they face.  

People feel better when engaged in social activity. LKAPS helps long-term survivors overcome isolation by creating social opportunities. From their popular monthly potlucks, twice-monthly coffee socials, bowling team, and movie nights, to now-established annual events such as June 5's Long-term Survivors Day reception and the Thanksgiving Day feast, LKAPS benefits its members through engagement with their local community of HIV survivors.  

PALS  

PALS (Planning Ahead for LGBTQ Seniors) is a volunteer-led community initiative based in Palm Springs that helps LGBTQ+ adults and friends plan ahead before a health or other life-altering situation arises.   

Having a plan in place mitigates stress and anxiety, ensures that LGBTQ+ adults are in control of their future care and legacy, and relieves the burden on family and friends.  

The Center   

At The Center, they like to say they create vibrant community by helping LGBTQ+ people along their way, wherever they might be in life’s journey. Even better, The Center likes to live it, breathe it, and do it. If someone is looking to meet new friends, get resources, or enrich their life and their place in community, they have come to the right place.  

Based in the Coachella Valley, The Center serves people of all ages, totaling more than 70,000 visits annually. How do they attract so many people? They do it with meaningful, relevant and mission-focused programming that addresses three strategic initiatives:  

  •   Ending isolation and loneliness  
  •   Connecting people to resources and community  
  •   Enriching individual and collective experiences 

About DAP Health 

DAP Health is an advocacy-based health center in Palm Springs, Calif., serving more than 10,000 patients, offering medical and mental healthcare, STI testing and treatment, dentistry, pharmacy, and lab services. A variety of wraparound services enable patients to experience optimal health, including social services, support groups, alternative therapies, and other wellness services. Excellent HIV care is provided by the largest team of specialized clinicians in the area.      

DAP Health opened one of California’s first COVID clinics and hotlines to offer screening, testing, and treatment. DAP Health also is working to address the social determinants of health that are causing negative health outcomes during this pandemic, like food and housing insecurity, joblessness, isolation, and access to ongoing healthcare.  

DAP Health’s sexual health clinic offers STI testing and treatment, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and HIV and hepatitis C (HCV) testing. DAP Health has earned Charity Navigator’s highest rating for the twelfth consecutive year — landing DAP in the top 6% of nonprofits rated. The distinction recognizes that DAP Health exceeds industry standards in terms of financial health, accountability, and transparency.      

Visit www.daphealth.org to learn more.     

 

Dr. Tulika Singh co-authors major HIV cl …

by Dustin Gruber

Dr. Tulika Singh co-authors major HIV clinical research study

By Robert Hopwood

Published: June 18, 2021

DAP Health is gaining recognition from the clinical research trials underway at the health center.

The results from a clinical research trial that DAP Health conducted were published online in early June by the medical journal AIDS. Additionally, the results will be published in the printed journal.

Dr. Tulika Singh, associate chief medical officer and director of research at DAP Health, co-authored the published manuscript that reports the study's findings.

The ViiV Healthcare STAT Study researched if the antiretroviral drug Dovato could be used in a rapid start setting, said Greg Jackson, the clinical research manager at DAP Health. Study participants began the medication within 14 days of their HIV diagnosis.

ViiV Healthcare is a London-based pharmaceutical company. Its U.S. headquarters is located in North Carolina’s Research Triangle Park.

"We've now become a preferred site for ViiV Healthcare's research because of our successes," Jackson said.

The FDA will look at the data from the STAT study and decide if doctors can prescribe Dovato to people within days of an HIV diagnosis.

DAP Health recruited 14 adults for the STAT study, Jackson said. That was the third-highest number of participants recruited among the organizations conducting the study. In total, the study had 131 participants.

"It has been an exciting honor to be part of the STAT study and being able to contribute to the science and the success of the rapid start treatment regimen for Dovato," Singh said.

The STAT study, which concluded in 2020, will be presented at the 11th IAS Conference on HIV Science in July. It was one of several studies underway at DAP Health.

Currently, there are three active clinical research trials at the health center. DAP Health is studying whether patients can switch their current antiretroviral therapy drug for another, if a long-lasting injectable treatment for HIV can supplant a daily pill, and if screening and treatment of precancerous cells can prevent anal cancer.

The most recent study launched by DAP Health was the Biktarvy SWITCH Study, which began in May 2021. Singh and Jackson co-authored the study.

Participants in the study, which is open to HIV-positive patients aged 65 or older, will be switched from their current antiretroviral therapy to Biktarvy, which combines three HIV medicines into one pill.

"With the advent of successful treatment regimens, more than 25% of people with HIV will be over the age of 65 by the year 2030," Singh said. "We are studying HIV regimens, such as Biktarvy, to determine the benefits to quality of life in patients 65 and older."

Gilead Sciences Inc., a Bay Area biopharmaceutical company, is collaborating with DAP Health in the SWITCH study.

DAP Health wants to enroll 50 patients in the study. So far, the health center has enrolled two people in the clinical research trial.

"It is a lot of work to find these patients," Jackson said.

DAP Health also is in the course of the GSK/ViiV SOLAR Study and the ANCHOR Study.

The SOLAR study, a global clinical research trial, also is being done in collaboration with ViiV Healthcare. Recruitment for the study ended in June 2021.

Patients in the SOLAR study will switch their HIV medication for a long-acting injection, according to ViiV Healthcare. The goal is to develop an HIV treatment that offers patients more convenience; a treatment that is easier to adhere to; and an increased quality of life.

"The treatment of HIV has evolved tremendously over the past three decades to a point where patients can now get long-acting treatments rather than take a pill once a day," Singh said. "We are evaluating exciting regimens at DAP for safety and efficacy in where patients can get an injection once every two months to control their HIV."

The ANCHOR study, which is still accepting patients, is probing the best way to prevent anal cancer among people living with HIV. The National Cancer Institute of the National Institutes of Health is funding the collaborative study.

More clinical research studies are in the planning process, but unfortunately, Jackson could not go into details.

Anyone who wants more information about any of DAP Health's research should contact Greg Jackson at (760) 992-0445 or gjackson@daphealth.org. 

Vaccinations: Winning Faith, Trust and C …

by Dustin Gruber

Vaccinations: Winning Faith, Trust and Credibility  

A look at the history of global pandemics 

By Shubha Kerkar MD, FIDSA, FACP, AAHIVS 

The possibility of control and eradication of the current global pandemic of coronavirus (SARS-CoV2) is now a distinct reality because of two promising vaccines that have shown safe and effective performance in preventing 95 percent of infections in preliminary data of phase 3 trials. 

How will these vaccines work? 

Vaccination prepares the human immune system to combat specific infections. In addition to the very basics, such as barriers to exposure with facial covering/masking, physical distancing and handwashing, vaccination is a powerful tool in the armamentarium of defenses against COVID-19.  

Both the Pfizer and the Moderna vaccines are based on a novel platform using “messenger” RNA to create vaccines (mRNA). They do not use the live virus or even any particle of a virus. They do not affect or interact with our DNA in any way. mRNA never enters the nucleus of the cell, which is where our DNA (genetic material) is kept.  

The cell breaks down and gets rid of the mRNA soon after it is finished using the instructions.  

COVID-19 mRNA vaccines give our cells instructions to make a harmless piece of “spike protein,” which is found on the surface of the virus that causes COVID-19. COVID-19 mRNA vaccines are given in the upper arm muscle. Once the instructions (mRNA) are inside the muscle cells, the cells use them to make the protein piece. In a placebo-controlled clinical trial where 30,000 to 40,000 volunteers in vaccinated vs. unvaccinated groups, there was a total of 100 infections, five in the vaccinated group and 95 in the placebo group. All volunteers who received the vaccine experienced no serious side effects, thus proving safety and efficacy.  

What does history tell us? 

In the real world, however, vaccines are only as good as the ability to be accepted by everyone. Winning faith and trust in vaccines depends on the credibility of the doctors, scientists and experts, and their ability to educate and help calm fears.  Once accepted, then the details of how to administer to the entire world population are practical challenges.   

 History tells us that vaccine strategies have successfully eradicated some of the deadliest infections on Earth, including smallpox, polio and measles, in times of scarce resources. The concept of vaccination was first noticed by the famous Dr. Edward Jenner in 1796 when he gave “lymph fluid” obtained from a milkmaid who had cowpox to James Phipps and established that he developed protection from smallpox.   

 In 2020, we celebrated the 40th anniversary of the eradication of smallpox, a deadly disease causing global pandemic for thousands of years. Worldwide vaccination was carried out in an era of no computers, no internet, no easy overseas transportation – all on foot – and simply targeting the world’s population one person at a time.  Of course, now, the challenges are different. 

What are we seeing today? 

Today, as I look around, not everyone is willing to accept vaccination as a silver lining in the dark cloud of this global pandemic. Perhaps there is no clarity, only doubt and mistrust, due to misinformation filtering through the current geopolitical scene, civil conflicts and social media, thus creating confusing layers. 

I remind all to look back in history: When Dr. Jonas Salk discovered the polio vaccine, 70 million mothers stood in line to get their children vaccinated – even before the benefits were confirmed.  Infantile paralysis was a devastating condition seen every year prior to that. Thanks to the polio vaccine – and the trust in that vaccine – today, it is part of childhood vaccination, providing 100 percent effectiveness in preventing polio.  

It is not just us here in the valley, our state or county. We must focus and be part of collaborative international cooperation and the contribution of global intelligence and unite in celebrating this great discovery. We must educate ourselves, gather all the courage and will to educate and counsel each other, and slowly win faith and trust in the possibility of prevailing in this battle against the COVID-19 pandemic. 

Dr. Kerkar is director of infectious diseases at Desert AIDS Project and an infectious disease consultant at Desert Regional Medical Center and Eisenhower Health. For more information on vaccinations visit www.cdc.gov/vaccines. 

Image of DAP care provider

Shubha Kerkar, MD, MS

Physician, FACP, AAHIVS, FIDSA

Shubha has been performing infectious disease consultation since 1991 and has the distinction of having been a part of DAP since 1993 when she joined us as a part-time infectious disease consultant. Her practice is primarily focused on inpatient or hospitalized patients at both Desert Regional Medical Center and Eisenhower Health where she cares for individuals with serious infectious diseases. Once these patients recover and leave the hospital they continue on their path to a healthier life by transitioning to Shubha's office-based skilled management program at DAP. Click here to learn more about Dr. Kerkar.

More HIV Care with Updated HIVMA Guideli …

by Dustin Gruber

Media Contact:
Jack Bunting
jbutning@desertaidsproject.org
(760) 323-2118

More HIV Care with Updated HIVMA Guidelines

Dr. Tulika Singh noticing more equity in HIV care

(Palm Springs, CA) November 12, 2020 – Significant additions to nationally accepted HIV care guidelines will help more patients receive excellent care, and will help stop new infections, according to Dr. Tulika Singh, DAP director of research.

The HIV Medicine Association of the Infectious Diseases Society of America updated its care guidelines for people with HIV (PWH). DAP’s Dr. Singh was one of only eight co-authors who worked on this important resource that will have a national impact on PWH. This is the first update since 2013.

“It is a one-stop shop for primary care guidance for all HIV clinicians!” says Dr. Singh. “Patients benefit when they get the best care.”

Significant additions in four areas address vital health issues facing PWH, and the teams caring for them. They include:

  • guidance for physicians treating transgender and non-binary patients with HIV,
  • leveraging Undetectable = Untransmittable (U=U) as part of patient education,
  • care for aging with HIV over 50, and
  • care standards for rapid start antiretroviral treatment.

DAP Health is an established authority in these areas, offering patients access to excellent and compassionate care, regardless of insurance. These updated HIV primary care guidelines used by thousands of clinicians in the U.S. will enable better care for patients, even if they never come to DAP.

“This will help clinicians all over who might need more experience and resources in these areas,” says Dr. Singh.

Transgender and Non-Binary Patients Added

This is the first time these guidelines approach HIV care for transgender and non-binary patients, a group disproportionately affected by HIV and who face extra barriers in healthcare.

“HIV care for transgender and non-binary patients is special, and it needs to be treated so,” says Dr. Singh, who was the second lead for this section of the report.

According to a study by UC Riverside, only 15% of transgender and non-binary individuals reported it was easy to find a provider with sufficient knowledge and experience on issues related to transgender people.

“Education and experience in this area are helpful to reduce bias, and that is important,” says, Dr. Singh. “We want to establish trust and enable transgender and non-binary patients to be fully engaged in their care.”

U=U and Rapid Start ART

Other important affirmations affecting health outcomes for PWH include treatment as prevention, starting antiretroviral therapy (ART) as soon after an HIV diagnosis as possible, and aging with HIV.

Even though effective HIV treatment reduces the level of HIV to "undetectable" levels and makes PWH incapable of transmitting HIV to their sexual partners, many clinicians are not sharing this information with PWH. These guidelines address U=U as well as the stigma it can prevent.

According to the update:

“Clinicians should emphasize that adherence to antiretrovirals not only improves the patient’s health but prevents HIV transmission to others. Undetectable = Untransmittable messaging is welcomed and encouraged by communities with HIV and should be part of routine messaging in the clinic as a means to mitigate stigma. The primary reason for treatment failure, particularly among patients who take initial regimens, is suboptimal adherence to care or treatment regimens.”

Dr. Singh says how quickly patients start ART also affects transmission rates and points to why doctors haven’t been as effective they’d like in stopping new cases.

“Despite having extensive experience in HIV treatment and care, caregivers struggle to reduce high HIV prevalence and rising HIV incidence rates, due to delays in starting ART,” Dr. Singh says. “This is due to previous protocols and practicing traditional HIV medicine.”

DAP recently won designation as a Rapid ART Implementation Site, standing with just 10 other healthcare organizations in the U.S. The Award for Special Projects Of National Significance was won in a competitive grant process and is bestowed by the Health Resources and Services Administration (HRSA). Read more here.

About Desert AIDS Project

DAP Health (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

For more information, visit www.desertaidsproject.org. 

About U=U & Prevention Access Campaign

Prevention Access Campaign is a health equity initiative to end the dual epidemics of HIV and HIV-related stigma by empowering people with and vulnerable to HIV with accurate and meaningful information about their social, sexual, and reproductive health. Find out more here.

Undetectable = Untransmittable (U=U) is a growing global community of HIV advocates, activists, researchers, and over 990 Community Partners from 102 countries uniting to clarify and disseminate the revolutionary but largely unknown fact that people living with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV.  

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Uncovering New Reasons for Hope

by Dustin Gruber

Uncovering New Reasons for Hope  

Weekend Wrap Message – Saturday, October 31, 2020, from David Brinkman, Desert AIDS Project CEO 

Gratitude for a successful Desert AIDS Walk 2020 

COVID could not stop Desert AIDS Walk 2020, as this community laced up last weekend and walked to end HIV, support our COVID Clinic, and increase healthcare equity for all. With some slight reimagining, this community came together for the tradition safely and with a lot of love. 

We are so thankful to everyone who walked this year, as well as our sponsors who supported us.  

Sandie Newton hosted an NBC Palm Springs special broadcast featuring reasons this event is more important than ever. And to keep with tradition, you can hear the Palm Springs Gay Men’s Chorus performing the opening song, a beautiful rendition of “Rise Again”. 

Preventing Flu During COVID 

With a third wave of COVID upon us while flu season is also starting, many risk becoming co-infected with both viruses if they have not received their influenza vaccination.  

“It’s an especially important year to get your flu vaccine,” says to Dr. David Morris, our chief medical officer. He and his team are concerned about our hospitals becoming overwhelmed with cases that could be prevented with a flu shot. Anyone who is interested in talking to someone about COVID and the flu should call our COVID Hotline at (760) 992-0407. You can learn more in this DAP Talks.  

DAP Study: One Shot Every Two Months for Viral Suppression 

For some PLWHA, taking medication in pill form every day is difficult, and it can cause poor adherence that harms their health and puts others at risk. DAP Health is committed to offering more options for antiretroviral treatment (ART), and we are one of the few health centers in the U.S. working on a study using only six ART injections per year for viral suppression, with ViiV Healthcare. You can read more here. 

ViiV SOLAR Study at DAP: Injectable ART …

by Dustin Gruber

ViiV SOLAR Study at DAP: Injectable ART every 2-Months

Diversity was key in choosing participants

DAP Health is one of the few health centers in the U.S. working on a study using only six injections per year for maintaining viral suppression in people with HIV (PWH). The SOLAR study with ViiV Healthcare began in November and will last one year. 

The FDA approved once-monthly Cabenuva injections to treat HIV in January 2021. 

At this time, the participant panel is complete, and no applications are being accepted. 

For some PWH, taking medication in pill form every day is difficult, and it can cause poor adherence that harms their health and puts others at risk. Traditional HIV meds can also lead to side effects with long term use. 

Participants in the SOLAR Study at DAP will receive intramuscular (IM) injections of CABENUVA every two months for HIV treatment.  This regimen is not publicly available, but it holds a lot of promise for DAP patients, according to Dr. Tulika Singh, DAP director of research. 

It was important to Dr. Singh that the SOLAR Study at DAP includes participants who are usually underrepresented in HIV research: cisgender women and transgender women. 

“With the help of this study, we are able to start closing a research gap,” said Dr. Singh, “and we can contribute to serving these patient groups better.” 

Specifically, this phase IIIb, randomized, multicenter, parallel-group, non-inferiority, open-label study will evaluate the efficacy, safety, and tolerability of switching to long-acting Cabotegravir plus long-acting Rilpivirine from a Bictegravir single tablet regimen in HIV-1 infected adults who are virologically suppressed. 

Once-Monthly CABENUVA is Available in Canada 

Health Canada approved a once-monthly version of CABENUVA for use there in March. CABENUVA is the first and only complete long-acting regimen for the treatment of HIV-1 infection in adults to replace traditional antiretroviral therapy. 

About DAP Health  

DAP Health (DAP) is an advocacy-based health center in Palm Springs, CA serving over 8,000 patients, offering medical and mental healthcare, STI testing and treatment, dentistry, pharmacy, and lab. A variety of wraparound services enable patients to experience optimal health, including social services, support groups, alternative therapies, and other wellness services. Excellent HIV care is provided by the largest team of specialized clinicians in the area.      

DAP opened one of California’s first COVID clinic and hotlines to offer screening, testing, and treatment. DAP is also working to address social determinants of health that are causing negative health outcomes during this pandemic, like food and housing insecurity, joblessness, isolation, and access to ongoing healthcare.  

DAP’s sexual health clinic offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP has earned Charity Navigator’s highest rating for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that DAP exceeds industry standards in terms of financial health, accountability, and transparency.      

Visit www.daphealth.org to learn more.      

About ViiV Healthcare 
ViiV Healthcare is a global specialist HIV company established in November 2009 by GlaxoSmithKline (LSE: GSK) and Pfizer (NYSE: PFE) dedicated to delivering advances in treatment and care for people living with HIV and for people who are at risk of becoming infected with HIV. Shionogi joined in October 2012. The company’s aim is to take a deeper and broader interest in HIV/AIDS than any company has done before and take a new approach to deliver effective and innovative medicines for HIV treatment and prevention, as well as support communities affected by HIV. For more information on the company, its management, portfolio, pipeline and commitment, please visit www.viivhealthcare.com. 

About GSK 
GSK is a science-led global healthcare company with a special purpose: to help people do more, feel better, live longer. For further information please visit www.gsk.com. 

DAP Patients Joining ANCHOR Study for An …

by Dustin Gruber

DAP Patients Joining ANCHOR Study for Anal Health

Research Contact:
Greg Jackson
(760) 992-0445
gjackson@desertaidsproject.org

 

Media Contact:
Jack Bunting
(760) 323-2118
jbunting@desertaidsproject.org

(Palm Springs, CA) October 21, 2020 -- There are only four places on the entire West Coast where people living with HIV / AIDS (PLWHA) can participate in The ANCHOR Study, and DAP Health Center is one of them. HPV-related anal cancer disproportionately harms PLWHA, especially cisgender gay men and transgender women. Unfortunately, prevention, treatment and support are difficult for them to find. Now, DAP patients can receive long term screenings and treatment, thanks to our designation as an ANCHOR Study site.

DAP medical and research clinicians worked hard to earn a place in this groundbreaking project. ANCHOR Study seeks to stop cases of preventable anal cancer in PLWHA by establishing testing and treatment protocols.

There are 40 participants enrolled at DAP so far, and “the team is welcoming more,” according to Dr. David Morris, chief medical officer. Participants are paid $100 per study visit to compensate for time, effort, and travel expenses.

For many DAP patients living with HIV, screening and treatment for a variety of cancers is part of their continuum of HIV care. If they take part in ANCHOR Study, they will monitor and support their anal health with top doctors and researchers, staying in contact for five-to-eight years. They will be contributing to groundbreaking scientific research that will help save lives in the future.

Living with HIV puts many of our patients at higher risk for anal cancer, even if they are on successful antiretroviral therapy (ART). ANCHOR Study aims to show treatment of pre-cancerous cells will lead to a reduction of 75% of incident HPV-related anal cancer.

Anyone interested in the ANCHOR Study is invited to contact Greg Jackson, DAP research coordinator, at (760) 992-0445 or gjackson@desertaidsproject.org. To read more about ANCHOR Study at DAP click here.

More about ANCHOR Study

"No one knew that cervical cancer was preventable before the use of Pap smears became widespread in the 1960s and cut the incidence of the disease by 80 percent."- Dr. Joel Palefsky, Principal Investigator

While deaths from AIDS are way down, anal cancer among people living with HIV is on the rise. We think that anal cancer can be prevented by routine screening and removal of precancerous cells. This strategy has reduced cervical cancer rates by 80%. But to get the insurance companies to cover routine anal cancer screening and preventative treatment, we need to prove that this strategy actually prevents cancer. The best way to show that is to recruit people with High Grade Squamous Intraepithelial Lesions (or HSIL for short) into a study and assign them randomly to a treatment arm or a monitoring arm. We then follow everyone for five years to compare the rates of cancer in both study arms. At the end of the study we’ll know whether screening and treatment of HSIL are effective strategies in preventing anal cancer. We’ll also learn a lot about HPV and other risk factors and why these sometimes cause cancer.

About Desert AIDS Project

Desert AIDS Project (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering DAP Total Care – a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic, The DOCK, offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

Visit www.desertaidsproject.org to learn more.

 

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DAP Patients Will Get HIV Meds Quicker U …

by Dustin Gruber

DAP Patients Will Get HIV Meds Quicker Under New Rapid ART Program

Media Contact:
Jack Bunting
jbunting@desertaidsproject.org
(760) 323-2118

Palm Springs, CA (September 3, 2020) -- DAP has reached an important milestone in the fight to end HIV, winning designation as a Rapid ART Implementation Site, standing with just 10 other healthcare organizations in the U.S. The Award for Special Projects Of National Significance was won in a competitive grant process and is bestowed by the Health Resources and Services Administration (HRSA).

By joining this national demonstration project and collaboration with HRSA, DAP will share its 36 years of experience in the fight to end HIV, and it will boost resources for its HIV testing and treatment programs for people in the Coachella Valley.

For a three-year period, DAP will continue to build and share its best practices for making sure PLWHA receive antiretroviral therapy (ART) quickly after receiving an initial HIV diagnosis, or immediately after requesting it if they had stopped ART for any reason.

It’s a surprise to many, but people are still developing and even dying from AIDS in 2020, right here in the Coachella Valley. Our early intervention program had 160 referrals for attempts to find patients who had stopped filling their ART prescriptions, ceasing their HIV treatment without explanation. (Based on calendar year 2019)

Falling through the cracks means that some patients whose bodies had stabilized with life-saving HIV meds have stopped taking them, sometimes for five years or more. And for others, it means not starting therapy at all after receiving an HIV diagnosis.

Without accessing care, they are waiting until they are sick from HIV-related illnesses before attempting to resume ART and primary care.

Waiting to begin or resume ART always leaves a dangerous gap of time that could result in catastrophe, such as failing to ever adhere to medication therapy, or even death. Another consequence is the effect on others as sex partners are put at risk for HIV.

This collaboration with HRSA seeks to remedy the problem with a protocol that provides ART ASAP:

  • Same day as HIV diagnosis (some exceptions)
  • Quickly after request is made to resume therapy

The vast majority (about 80 percent) of new HIV infections in the U.S. in 2016 were transmitted from the nearly 40 percent of people with HIV who either did not know they had HIV, or who received a diagnosis but were not receiving HIV care. (CDC)

According to Dr. Tulika Singh, DAP Associate Chief Medical Officer, not all physicians are permitted to treat their patients without administrative obstructions that derail health outcomes.

“Despite having extensive experience in HIV treatment and care, caregivers struggle to reduce high HIV prevalence and rising HIV incidence rates, due to delays in starting ART,” she says. “This is due to previous protocols and practicing traditional HIV medicine,” like having to do unnecessary lab work or jumping through hoops with insurance.

“No more!” says Dr. Singh.

Greater access for ART through this project will be enabled by DAP’s referral and linkage networks, with extensive arrangements with regional medical centers, community clinics and individual providers, in addition to this grant.

“We are able to provide rapid start ART for newly diagnosed persons living with HIV as early as the same day of diagnosis,” she says. “This will help us get to UN 90-90-90 goal sooner than anticipated and help our patients age in a healthy way.”

The Courage To Resume ART
Given what we know about the health consequences of stopping ART, the public health argument is strong for offering the resources to resume therapy quickly and without delay.

When it comes to why people fall out of care, “Every situation is so different,” says C.J. Tobe, Director of Community Health at DAP.

Poverty affects most DAP clients, but it affects PLWHA uniquely. They might cope with denial, depression, and suicidal ideation. Stigma is often made worse by rejection from loved ones, and drug and alcohol abuse are more likely to increase.

But other factors may include housing insecurity, unemployment, lack of transportation, and fear of government due to immigration status. Being a recent transplant to the Palm Springs area from other parts of the U.S. also can also be a reason.

“People are also dying by not accessing all the things you need to make the medication keep working,” says Tobe.  “There’s a lot that goes into getting that treatment, starting with walking through those doors.”

In addition to ART, DAP helps patients thrive with HIV with access to social services they are eligible for, ensuring they receive needed food, housing, transportation, and home health care support if they need it.

U=U Helping End The Epidemic

The more people who are on treatment and undetectable, the fewer new transmissions there will be. According to Prevention Access founder Bruce Richman,

“We need access to treatment and removing barriers, not just for the wellbeing of people living with HIV,” he says. “But also, to prevent new transmissions.”

About Desert AIDS Project

Desert AIDS Project (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering DAP Total Care – a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic, The DOCK, offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

Visit www.desertaidsproject.org. 

About U=U & Prevention Access Campaign

Prevention Access Campaign is a health equity initiative to end the dual epidemics of HIV and HIV-related stigma by empowering people with and vulnerable to HIV with accurate and meaningful information about their social, sexual, and reproductive health. Find out more here.

Undetectable = Untransmittable (U=U) is a growing global community of HIV advocates, activists, researchers, and over 990 Community Partners from 102 countries uniting to clarify and disseminate the revolutionary but largely unknown fact that people living with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV.  

About UNAIDS 90-90-90

Removing barriers to ART is in support of UNAIDS 90-90-90, the global plan to end AIDS as a public health threat by 2030.

The goal is that globally,

90% of all people living with HIV will know their HIV status, and  

90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and

90% of all people receiving antiretroviral therapy will have viral suppression.

According to its 2020 update, “the response could be set back further, by 10 years or more, if the COVID-19 pandemic results in severe disruptions to HIV services.”

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