The Effects Of HIV On The Body

Nov18 by D Gregory Smith

Once the human immunodeficiency virus (HIV) enters your body, it launches a direct attack on your immune system. It gradually weakens your natural defenses against disease and infection and can affect every part of your body. Find out how here.

The human immunodeficiency virus (HIV) seeks and destroys CD4+ cells, a type of T lymphocyte (T cell). T cells are critical to the immune system. They’re responsible for warding off diseases and most infections, including viral infections.
HIV targets the type of cells that would normally fight off an invader like HIV. As the virus replicates, it damages or destroys the infected CD4+ cell and produces more virus to infect more CD4+ cells. Without treatment, this cycle continues in most infected people until the immune system is badly compromised, leaving them open to many serious infections and illnesses. Many of the illnesses that people compromised immune systems get are rare in people with functioning immune systems.
How quickly the virus progresses varies from person to person. Factors like your age, overall health, and how quickly you’re diagnosed and treated can make a difference.
Acquired immunodeficiency syndrome (AIDS) is the final stage of HIV. At this stage, the immune system is severely weakened, and the risk of contracting opportunistic infections is much greater. Not everyone with HIV will go on to develop AIDS.
Importantly, many of the effects described here are related to the failure of the immune system in progressing HIV and AIDS. Many of these effects are preventable with early antiretroviral treatment, which can preserve the immune system. However, for anyone without access to effective antiretroviral treatment, these effects remain possible.
Immune System
Your immune system prevents your body from acquiring the diseases and infections that come your way. White blood cells defend you against viruses, bacteria, and other organisms that can make you sick.
When HIV enters the body, it goes straight for the CD4+ T cells that are a lynchpin for the operation of the entire immune system. As the virus infects and kills more of these T cells, your immune system grows weaker, and you become more susceptible to illness.
Early on, symptoms may be mild enough to be dismissed. Within a few months of becoming infected, most people experience a flu-like sickness that lasts a few weeks. Symptoms may include:
fever
chills
night sweats
diarrhea
headache
muscle aches
joint pain
sore throat
rash
swollen lymph glands
mouth or genital ulcers
The first stage of HIV is called the acute infection stage. The virus reproduces rapidly at this stage. You may not have much in the way of serious symptoms, but there are usually large quantities of virus in your blood. Many people are unaware of their HIV status at this point, but the risk of transmission during the acute infection stage is very high. Acute infection may cause flu-like symptoms, including decreased appetite, headache, night sweats, and others.
The next stage is called the clinical latent infection state. On average, it lasts 8 to 10 years. In some cases, it lasts much longer than that. You may or may not have symptoms during this stage.
As the virus advances, CD4 count decreases more drastically. This can lead to symptoms like:
fatigue
shortness of breath
cough
fever
swollen lymph nodes
weight loss
diarrhea
If HIV infection advances to AIDS, the body becomes prone to opportunistic infections. People with advanced HIV/AIDS are at increased risk of a number of infections, including a herpes virus called cytomegalovirus. It can cause problems with your eyes, lungs, and digestive tract.
Kaposi’s sarcoma, another possible infection, is a cancer of the blood vessel walls. It’s rare among the general population, but common in people who are HIV-positive. Symptoms include red or dark purple lesions on the mouth and skin. It can also cause problems in the lungs, digestive tract, and other internal organs.

HIV/AIDS also puts you at higher risk of developing lymphomas. An early sign of lymphoma is swollen lymph nodes.

Respiratory and Cardiovascular Systems
HIV increases the risk of colds, influenza, and pneumonias. According to the American Lung Association, HIV/AIDS can lead to opportunistic lung diseases. Without preventive treatment, people with advanced HIV are susceptible to tuberculosis, pneumonia, and a disease called pneumocystis carinii pneumonia (PCP). PCP causes trouble breathing, cough, and fever.

HIV raises the risk of pulmonary arterial hypertension (PAH). PAH s a type of high blood pressure in the arteries that supply the lungs. It puts added strain on the heart.
If you have HIV and have become immunocompromised (have a low T cell count), you’re susceptible to tuberculosis (TB), a leading cause of death in people who have AIDS. TB is an airborne bacterium that affects the lungs. Symptoms include chest pain and a bad cough that may contain blood or phlegm. Symptoms can linger for months.
Digestive System
A common HIV-related infection is called candidiasis. Symptoms include inflammation of and a white film on the tongue. It can also cause inflammation of the esophagus, which can make it difficult to eat. Another viral infection that affects the mouth is oral hairy leukoplakia, which causes white lesions on the tongue.
Salmonella infection is spread through contaminated food or water and causes diarrhea, abdominal pain, and vomiting. Anyone can get it, but if you have HIV, you’re at higher risk of serious complications from this infection.
Consuming contaminated food or water can also result in a parasitic intestinal infection called cryptosporidiosis. It affects the bile ducts and intestines. It can be particularly severe and cause chronic diarrhea in people who have AIDS. Cryptosporidiosis infection can occur in people with effective immune systems, but it can become a chronic problem in people with CD4 levels under 200.
HIV-associated nephropathy (HIVAN) is when the filters in your kidneys become inflamed, making it harder to remove waste products from your bloodstream.
Problems with your digestive tract can decrease your appetite and make it difficult to eat properly. Weight loss is a common side effect of HIV.

Central Nervous System
There are significant neurological complications of AIDS. Even though HIV doesn’t generally directly infect nerve cells, it does infect the cells that support and surround nerves in the brain and throughout the body.
All of the mechanisms of HIV-associated neurologic damage aren’t completely understood, but it’s likely that infection of these support cells contribute to nerve injury. Advanced HIV infection can damage nerves (neuropathy). Small holes in the conducting sheaths of peripheral nerve fibers (vacuolar myelopathy) can cause pain, weakness, and difficulty walking.
HIV/AIDS can cause HIV-associated dementia or AIDS dementia complex, two conditions that seriously affect cognitive function.
Toxoplasma encephalitis is another possible complication of advanced HIV. People with AIDS are at increased risk of inflammation of the brain and spinal cord due to this parasite found commonly in cat feces. Symptoms include confusion, headaches, and seizures.
Some common complications of AIDS include memory impairment, anxiety, and depression. In very advanced cases, hallucinations and frank psychosis can occur. Some people experience headaches, balance issues, and vision problems.

Skin
One of the more obvious signs of HIV/AIDS can be seen on the skin. A weakened immune response leaves you more vulnerable to viruses like herpes. Herpes can cause you to develop sores around your mouth or genitals.
People with HIV are at increased risk of shingles, which is caused by herpes zoster, the virus that gives you chickenpox. Symptoms of shingles include a painful rash, often with blisters.
A viral skin infection called molluscum contagiosum involves an outbreak of bumps on the skin. Another condition is called prurigo nodularis. It causes crusted lumps on the skin, as well as severe itching.

– See more at: http://www.healthline.com/health/hiv-aids/effects-on-body#sthash.IOtHxYfO.dpuf

Yes. I am. Positively Speaking.

Dec11 by Timber

By Timber

I have struggled with writing this blog for some time. I didn’t know when the right time was going to be to do it. There have been many factors influencing my decision. My partner, family, friends, work, theatre, etc. It’s been a bumpy ride and very challenging spiritually, emotionally, socially and physically. As I sit here in the middle of a snow storm next to my roaring fire in the comfort of my own home, I am mostly content. It feels safe here. The dogs are relaxing, the birds are quiet and I have the house to myself. I can almost feel like I am strong and nothing is changed. Nothing is different. Everything is going to be okay. But, four innocuous words, put together, could change that in an instant. You see, I have a secret. But I don’t like secrets. They cause way too much stress. No, it’s not that I’m gay. That’s no secret to anyone. I mean, HELLO!!! Do you know me? The secret is even larger than that. It is earth-shattering, in some aspects. It is a heavy burden to bear. And I’m finally at the point where I don’t know if I can, or should, keep it in the closet any longer. This is my secret. And, it is very scary for me to share it with you. I don’t know what it will do to my social standing or my friendships. There are select people in my life that already know. My partner, first and foremost, my family and some of my very close friends. And they have all been overwhelmingly supportive. I am hoping that there are more people like that out there. I’m sure that others already know because of the way that gossip spreads through the “grapevine,” but I want to be sure that people are hearing it from the horse’s mouth.

You see, the reason I am giving away my secret is because I am an activist (if you hadn’t already noticed. . .tee hee). I want to educate people and I want to make people aware that this still happens. Let me give you just a little bit of background and we will kind of take it from there. I sit here and think of vipers like Dave Agema, the Michigan National Committeeman. “Folks, they (gay people) want free medical because they’re dying (when they’re) between 30 and 44 years old,” the paper quotes Agema saying last week. Funny. . .I’m almost 40 and I’m not dead. And, Dear Mr. Agema, I pay for my own health insurance. I pay all of my co-pays and even the costs that my insurance doesn’t cover. One of the things that the Affordable Care Act has done for me is to ensure that I don’t have to shell out 5 figures per year (yes, that much) because an insurance company might not want to cover my “pre-existing condition.” Perhaps Davey-boy thinks that I got what I deserved because I’m gay. Perhaps, he secretly rejoices with each new diagnosis of HIV because that means there will be one less queer in the world. Think again, Dave. I did not become HIV positive because I was promiscuous or because I was an IV drug user. As a matter of fact, I found out completely by mistake. That story will be told later. But, what I CAN tell you is that I got this disease because I loved and trusted someone. I was in a long term relationship. However, that person did not have the same respect for me and completely and totally betrayed my trust. The person lied to me about his status and there was ample opportunity to tell the truth. It would not have changed the way I felt about him, but it might have changed some of my behavior. That is the thing that I have struggled with the most out of all of this. I loved someone. I became HIV positive. The sense of betrayal is overwhelming at times. A friend of mine said it to me the best: The measure of a man and his heart is not the love he gives simply to feel validated and “loved” in return. Your heart is unconditional. . . But a human being that loves, that really understands being a living breathing man, doesn’t take advantage of that – he protects it and cares for it and nurtures is like the precious thing it is. He stole that and abused it and bent that into something twisted just to steal what he could, out of fear, of other’s love and affection. He put you all in harm’s way to protect himself, and he used love as his weapon to do it. It is the most awful sin a person who claims to be human can commit. (Thank you, Amber Meyer) I found out the results on February 13th, 2012. How’s that for an early Valentine’s Day present? When I talked with my partner (who is negative, thankfully), I asked him how this was going to affect our relationship. He said, “I don’t understand what you mean. This is “For Better or For Worse, In Sickness and In Health.” Isn’t that what we decided? I love you for who you are, not what you have or don’t have.” I cried. But don’t you dare EVER tell anyone that! I will deny it with my last breath! I have an image to maintain, here. . . But, for the record, I am healthy. I have been seeing a doctor since I found out. I am on one pill a day that keeps my viral load undetectable and my T cells have been steadily climbing since I started. I am back to a normal level. I am sick less often and my energy has started to come back. And now, I am ready to fight. I am ready to educate. I am ready for whatever the world has to throw at me. I am here. I am LIVING!! And I am not going to die anytime soon. My doctor told me to expect to live to a ripe old age (80+), that is, if I quit smoking. My thoughts are along the same lines, but that is unless I push an old woman out from in front of a bus and I bite the dust saving her life. Although, it would be my luck that she would sue my estate because she broke a hip. . . If you feel that this blog would help someone, please share it. If it moved you, please share it. And remember, as I have said before, we all know someone who is HIV positive. And now, you know me. And this is what living with HIV looks like:

MT World AIDS Day Award Acceptance Speech

Dec3 by D Gregory Smith

Once upon a time, there was a boy who grew up in a small town- in a time when things were said to be simple- but they were not.

For him.

He was unlike the other kids in ways that weren’t always noticeable to the people around him. He felt things a bit more keenly. He noticed things that other kids didn’t. He wasn’t great at sports, he wasn’t big and strong.

But he was smart.

And sometimes that meant he got picked on even more than other kids.

So he used that.

It made him tough. His parents were good, loving people. His church provided comfort. His books helped him escape.

Maybe it was God, maybe it was chance- it doesn’t really matter what made him different. He just was.

The fact remained that this boy- indistinguishable from a million other little boys- just wanted to be loved, even though he was different.

And when he grew up, he still wanted to be loved – sometimes desperately. Sometimes he trusted people who weren’t trustworthy- simply because the promise of love is often enough to make us overlook danger and potential tragedy.

The promise of love.

That’s what brings us here today.

That’s why I got infected. That’s how I got infected.

The promise of love. Not what you think about when you think of AIDS.

But I want you to think about it.

When I moved back to Montana almost seven years ago, I made a promise: that no gay kid would ever be so starved for love and support- would not be so handicapped by shame- that they couldn’t stay here and have a happy, successful, healthy and safe life if they wanted to. I would do everything in my power to make it happen.

So I came out as gay- and HIV positive- just to show that there is no shame in having a disease. It’s a virus, it’s not a judgment.

A microscopic being that happens to live in my body. And I want to keep it from living in any one else’s.

And so do you, I hope.

This disease has been around for over three decades. And yet the state of Montana has never allocated state funds for its prevention. Not a penny.

Which begs the question- why?

Is it because of the shame at how the disease is transmitted?

Is it because we might have to talk about sex, needles, addiction and shame and fear?

Isn’t thirty two years long enough to avoid having this hard conversation?

In the Montana that little boy grew up in- that I grew up in- we prided ourselves on helping out where it was needed. We filled sandbags, we stopped when it looked like people were in trouble on the road, we ran to the fire house when the siren rang.

But not for HIV. Not for AIDS. Well, let me correct that.

A few very brave people did stand up. They braved ridicule and stigma to hold candlelight vigils and to hold the hands of people whose parents were too afraid to touch them. I know. I was there. I held some of those hands. And so did Laurie Kops and probably a few others in this room.

I’m not trying to toot my own horn here, but it’s important that we get back to something very basic here in the state of Montana.

Caring for our people.

ALL people.

It’s time to recognize that all people deserve the promise of love in their lives. Deserve the dignity and respect that I believe God gives everyone simply by being born. Deserves the respect of having information and materials at their disposal provided by the state that is charged with enabling public health and well-being. It’s what I want out of my taxes- I hope it’s what you want from yours.

There are a few legislators here you can tackle on the way out….

My life is good. I have family that love me, a partner who is always there for me and more friends than any man ever deserves.

But it could be better.

Somewhere in the state of Montana there is a kid who doesn’t believe that he’s worthy of love.

And he’s part of our responsibility. Because he does deserve love. And he deserves help to be healthy about it.

Shame is keeping us from health.

Kinda crazy, isn’t it?

It’s time to have those hard conversations.

It’s time to stop shame in its tracks.

It’s time to return the promise of love to all Montanans.

Thank you for listening- and for this awesome award.

2013 World AIDS Day honorees Stephanie Cole, Chris Gehring, Chantz Thilmony, Greg Smith Lisa Fairman with Gov Bullock and DPHHS Director Opper

Me and a really cool Governor

Capitol rotunda ceremony honors AIDS Day award recipients (billingsgazette.com)
5 honored at Montana Capitol for AIDS work (missoulian.com)
5 honored at Montana Capitol for AIDS work (ravallirepublic.com)
5 Montanans to be honored on World AIDS Day (missoulian.com)

3rd Annual Red Ribbon Ball

Nov15 by D Gregory Smith

Yep- it’s that time again! Every entry gets 1 free raffle and drink ticket!

Raffle items include a 2 night stay and ski package from Big Sky Resort; VIP tickets to Spruce Moose, Avalaunch and Interchange; an opal pendant from the Gem Gallery; a $50 gift card to Se7en Sushi; two beautiful works of art by Jonathan Raney- and the opportunity to see and buy tickets for the quilt made by the Gallatin Quilt Guild.

Live Jazz, food and fun for the whole family!

Montana HIV Men’s Retreat Scheduled For September

Aug21 by D Gregory Smith

HIV Cures Come At A Price

Jul3 by D Gregory Smith

Also published on Bilerico.com

Today, amfAR grantee Dr. Timothy Henrich announced two HIV-positive patients who have undetectable levels of HIV after undergoing stem-cell transplants at the 7th annual International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia.

Money (Photo credit: 401(K) 2013)

We’ve had some excellent news about the curing of HIV-infected people in the past year. But it comes at a price.

It’s important to note that the individuals involved received intensive care and went through extreme discomfort in order to eradicate the virus from their bodies. It’s not something that we’ll be able to replicate for the general population anytime soon.

And I think we need to remember that people are still dying of HIV-related causes every day- thousands of people. And new infections aren’t really slowing down- even in the First World where there is convenient access to safe sex supplies. There’s still a disconnect. There’s still ignorance and apathy out there.

It’s still good news however.

From amFAR:

The patients had been on long-term antiretroviral therapy for HIV when they developed lymphoma. To treat the cancer, the patients underwent reduced intensity chemotherapy followed by stem-cell transplants. Since the transplants, Dr. Henrich has been unable to find any evidence of HIV infection.

Dr. Henrich was awarded a grant through the amfAR Research Consortium on HIV Eradication (ARCHE) after presenting preliminary findings on these patients at the International AIDS Conference last July. With support from amfAR, he conducted a clinical study in which his research team withdrew the patients’ antiretroviral therapy and performed several sophisticated assays looking for signs of viral rebound in blood and other tissues. One patient has been off treatment with no detectable virus for approximately 15 weeks, and the second patient for seven weeks, with similar results. However, it is too soon to draw any definitive long-term conclusions.

It is also unclear how long viral rebound might take in a patient whose viral reservoirs have been dramatically depleted, but not eradicated. According to amfAR/ARCHE grantee Dr.Robert Siciliano of Johns Hopkins University, it may take over a year. Previously a patient in a study by the National Institutes of Health had gone 50 days after treatment withdrawal without viral rebound. Dr. Henrich’s patients are at or beyond this threshold, and more definitive answers will emerge as these patients continue to be closely monitored.

“These findings clearly provide important new information that might well alter the current thinking about HIV and gene therapy,” said amfAR CEO Kevin Robert Frost. “While stem-cell transplantation is not a viable option for people with HIV on a broad scale because of its costs and complexity, these new cases could lead us to new approaches to treating, and ultimately even eradicating, HIV.”

The first person to be cured of HIV, Timothy Brown (“the Berlin patient”), also underwent a stem-cell transplant to treat his leukemia. These new cases differ significantly, however, in that the stem-cell donors lacked the genetic mutation (CCR5 delta32) that renders a person virtually resistant to HIV infection. Nor did Dr. Henrich’s patients undergo the intensive chemotherapy or total body irradiation that preceded Timothy Brown’s stem-cell transplant.

“Dr. Henrich is charting new territory in HIV eradication research,” said amfAR Vice President and Director of Research Dr. Rowena Johnston. “Whatever the outcome, we will have learned more about what it will take to cure HIV. We believe amfAR’s continued investments in HIV cure-based research are beginning to show real results and will ultimately lead us to a cure in our lifetime.”

I still can’t help but think we’ve not done our best in response to this epidemic- especially in the last decade. I wonder if, as a community, we settled for simply not dying as a substitute for true health.

If so, what does that say about our self-esteem, self-care and community spirit? Have we lost interest in each other beyond the obvious?

That’s a heavy price to pay.

No Trace of HIV After Stem-Cell Transplants, Researchers Say (news.health.com)
Two patients clear of HIV after stem-cell transplants (irishtimes.com)
Stem-cell therapy wipes out HIV in two patients (thestar.com)

Analysis: Most At-Risk For HIV Not Studied

Jun19 by D Gregory Smith

New Analysis of World’s Premier AIDS Conference Finds Poor Coverage of Populations Most-at-Risk for HIV

Hundreds of Organizations Worldwide Call on Conference Organizers to Increase Meaningful Coverage of Gay Men, Transgender People, People Who Inject Drugs, and Sex Workers

A new report produced by a coalition of global advocacy organizations shows that the International AIDS Conference (IAC) program continues to lack meaningful coverage of populations most-at-risk for HIV, including men who have sex with men (MSM), transgender people, people who inject drugs (PWID), and sex workers. Over 220 organizations from more than 70 countries around the world have called on the organizers of the IAC to take concrete measures to increase coverage of HIV-related issues concerning the health and human rights of these populations worldwide.

The report features a systematic quantitative audit and qualitative analysis of the topics and countries covered by abstracts on most-at-risk populations at the 2012 IAC, also known as AIDS 2012. These populations are also called “key populations,” because they are both key to the epidemic’s dynamics and key to the response. As an in-depth examination of research presented at the world’s premier AIDS conference, the report also offers a glimpse into the current state of research on these key populations globally.

The quantitative audit of the AIDS 2012 program showed that only 17% of all abstracts presented at the conference were exclusively focused on MSM, transgender people, PWID, or sex workers. Some key populations were better represented than others. The percent of all abstracts exclusively dedicated to each key population was 8% for MSM, less than 1% for transgender people, 5% for PWID, and 4% for sex workers.

The qualitative analysis of abstracts on these populations was even more revealing, indicating that more abstracts on key populations focused on individual risk factors (40%) than any other topic, including structural factors [e.g. policy, stigma, violence] (26%); primary prevention (19%); testing, care, and treatment (15%); and surveillance (10%). Only 29% of abstracts on key populations focused on describing interventions, while 71% described vulnerabilities without offering any detailed solutions.

“This meager level of coverage on issues concerning our communities at the International AIDS Conference is unacceptable,” said Dr. George Ayala, Executive Director of the Global Forum on MSM & HIV (MSMGF) and co-author of the report. “Not only was there a comparatively low number of abstracts on key populations at the conference, but the content of these abstracts was largely divorced from the most urgent needs of key populations as identified by members of the populations themselves.”

The report cites the body of abstracts at AIDS 2012 focused on MSM as an example of the gap between the kind of research prioritized by key population stakeholders and the kind of research ultimately presented at the conference. Ahead of AIDS 2012, the MSMGF conducted a global survey of nearly 300 MSM advocates and service providers around the world to identify the topics they felt would be most important to address at the conference. The top three themes were “Prevention,” “Stigma and Discrimination,” and “Law and Criminalization.” Of all abstracts presented at AIDS 2012, the percentage dedicated to these themes in relation to MSM was 1.6%, 0.5%, and 0.3%, respectively.

“After thirty years of AIDS, we know key populations are at much greater risk than the general population in nearly every country around the world,” said Allan Clear, Executive Director of the Harm Reduction Coalition and co-author of the report. “Our communities deserve proper attention, and mounting evidence argues that addressing HIV among key populations is central to ending the global AIDS crisis. It is time for the IAC and the broader AIDS response to start addressing HIV among key populations in a more equitable, more appropriate, and ultimately more effective way.”

In addition to examining the number and focus topics of abstracts on key populations, the report also assessed geographic coverage. Of all abstracts on key populations, nearly 40% focused on North America and Western Europe. A country-level analysis revealed that nearly two-thirds of all key population abstracts were concentrated in 10 countries alone. Of the remaining 79 countries represented in these abstracts, 32 had only 1 abstract on 1 key population. Numerous regions and countries with concentrated epidemics among key populations were either underrepresented or entirely absent.

“The poor coverage of topics concerning key populations, especially from lower-income countries, may reflect inequitable global funding for research on key populations as much as it reflects the IAC’s processes that reinforce these inequities,” said JoAnne Keatley, Director of the Center of Excellence for Transgender Health at the University of California, San Francisco and co-author of the report. “The IAC’s organizers must update the conference’s processes to ensure the event is as valuable as possible for addressing the urgent HIV epidemics among key populations. As the premier platform for sharing the latest research on HIV and AIDS, it must lead the global AIDS research field to do the same.”

“The IAC represents a unique and powerful opportunity to impact the global AIDS epidemic,” said Anastacia Ryan, Global Policy Officer on HIV and Sex Work at the Global Network of Sex Work Projects (NSWP). “The conference offers unparalleled potential to shape the industry’s discourse, funding priorities, and locus of scientific inquiry, giving key affected populations the recognition they deserve as partners in fighting the epidemic. By updating its processes to increase meaningful engagement with and coverage of key populations, the IAC will not only support the development of more effective strategies to address the needs of key populations, it will bring the global AIDS response closer to developing the comprehensive solutions we need to end the epidemic.”

The report concluded with a set of 5 recommendations for measures that can be taken by conference organizers to increase meaningful coverage of key populations at future IACs. The recommendations include conducting community consultations, issuing targeted calls for abstracts, and advocating with large funders and research institutions for more appropriate funding and support for research on key populations. A total of 221 organizations from 73 countries endorsed the recommendations for action.

The full report, entitled “Coverage of Key Populations at the 2012 International AIDS Conference,” is available online at http://www.msmgf.org/files/msmgf//Advocacy/AIDS2012_KeyPopulations.pdf The report was jointly produced by the Global Forum on MSM & HIV (MSMGF), Global Action for Trans* Equality (GATE) , the Center of Excellence for Transgender Health (CoE), the Harm Reduction Coalition, the International Network of People Who Use Drugs (INPUD), Different Avenues, and the Global Network of Sex Work Projects (NSWP).

The full list of recommendations and endorsements can be found online at http://www.msmgf.org/files/msmgf//Advocacy/Action_Alerts/AIDS2014_CCC_Signatures.pdf.