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While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

All About HIV: Stages, Symptoms and Treatment

More than 40 years have passed since AIDS, the disease caused by HIV, was first identified in the United States. While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

HIV (human immunodeficiency virus) is a virus that attacks your immune system, making you more vulnerable to other illnesses. It is transmitted through contact with the blood, semen, or vaginal fluids of someone who has HIV.

If untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome), which is also considered the last stage of HIV. When HIV progresses into AIDS, your immune system has been significantly weakened by the virus.

Currently, there is no cure for HIV, but taking HIV medicine called antiretroviral therapy (ART) as prescribed stops the progression of the disease. As a result, most people living with HIV in the U.S. do not develop AIDS. There are also HIV prevention medications, PrEP and PEP, which are effective at preventing the transmission of HIV through sex or intravenous drug use.

As the HIV epidemic emerged in the U.S. in the 1980s and 90s, gay and bisexual men were disproportionately affected — in part because the virus transmits more easily through anal sex than vaginal sex — and subsequently stigmatized as carriers of the virus. However, the medical community soon discovered that anyone can contract HIV regardless of gender identity or sexual orientation, as the virus can be transmitted through anal sex, vaginal sex, or the sharing intravenous drug equipment such as needles or syringes.

In recent years, there has been significant progress toward reducing the annual HIV infection rate, and new cases of HIV among gay and bisexual men ages 13-24 dropped by 33% between 2015-2019. Still, gay and bisexual men accounted for 69% of all new HIV diagnoses in the U.S. in 2019. And in recent years, Black and Latinx individuals have been disproportionately affected by HIV. Racial and ethnic discrimination and disparities in healthcare access — which can discourage people from seeking HIV prevention services and testing — factor into HIV’s outsized impact on these communities.

There are three primary stages of HIV: acute HIV infection, chronic HIV infection, and stage 3 HIV, or AIDS.

Acute HIV infection, the first stage of HIV, may develop within two to four weeks of contracting the virus. During this stage of HIV, the virus multiplies rapidly and there is a high amount of HIV in your bloodstream (also known as your viral load). While the virus replicates and spreads, it destroys your CD4 cells, a type of white blood cell that plays a role in your immune system.

Some people with acute HIV infection quickly experience flu-like symptoms including fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. The only way to know your HIV status is by getting tested. If you have any of these symptoms and believe you may have been exposed to HIV, seek prompt medical care and take an HIV test. Find a free and confidential HIV testing site near you..

Experiencing these symptoms does not necessarily mean that you have HIV, as they overlap with symptoms of the flu and other illnesses. And some individuals with HIV develop these symptoms later, while others never develop them at all, which is why it’s critical to get tested for HIV on a regular basis — ideally every three months. You can still transmit the virus to others even if you do not have noticeable symptoms of HIV.

During the chronic HIV infection stage, the virus replicates less rapidly than it did in the acute stage, but it continues to damage your CD4 cells and weaken your immune system.

Many people experience no symptoms or mild symptoms during this latent period, which is also sometimes referred to as asymptomatic HIV infection or clinical latency. However, just like during the acute HIV infection stage, you can still transmit the virus to others even if you are not experiencing symptoms.

Without effective treatment, your viral load will increase and your CD4 cell count will decrease as this stage of HIV progresses. You are more likely to experience symptoms of HIV when your viral load is high and your CD4 cell count is low. Taking HIV medication as prescribed can help you maintain a low or even undetectable viral load and prevent your HIV from progressing into AIDS.

AIDS is the third and most advanced stage of HIV. In this stage, your immune system is severely weakened, your viral load continues to increase, and your CD4 cell count continues to decrease. 

HIV progresses into AIDS when you have a CD4 cell count of less than 200 cells per cubic milliliter or when you develop an opportunistic infection (OI), an illness that occurs more frequently in individuals with HIV because of their weakened immune systems.

Opportunistic infections experienced by individuals with HIV include kaposi’s sarcoma, a type of cancer that develops in your blood and lymph vessels; pneumocystis pneumonia (PCP), and mycobacterium avium complex (MAC), tuberculosis-related bacteria. However, OIs continue to occur less frequently as HIV treatment becomes more effective.

There are many effective HIV treatment options that can keep you healthy and help you maintain a low viral load. The primary treatment for HIV is called antiretroviral therapy (ART), a combination of medications that lower the amount of HIV in your bloodstream.

If you take your HIV medication every day as prescribed, you can maintain an undetectable viral load. This will preserve the strength of your own immune system and prevent you from transmitting the virus to others.

Starting ART as soon as possible after you receive an HIV diagnosis is critical to lowering your risk of developing AIDS and preventing you from transmitting the virus to others. If you have tested positive for HIV, reach out to your healthcare provider right away to begin treatment.

If you have tested negative for HIV, there are important HIV prevention medications that can help you continue to protect your health: PrEP and PEP.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. Pharmacists in a growing number of states can now prescribe PrEP, including pharmacists at Alto’s California and Colorado locations.

PEP, or post-exposure prophylaxis, is a medication taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. It can be prescribed by a healthcare provider at emergency rooms, sexual health clinics, community-based health centers, and, in some states, pharmacies. PEP is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, speak with your doctor about potentially taking PrEP for long-term protection.

We’re here to help you navigate HIV treatment and prevention therapies

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with antiretroviral therapy, PrEP, or PEP. We will coordinate with your doctor and your insurance provider to ensure that you’re receiving the best option for your needs at the best price. Pharmacists at our California locations are also able to prescribe PrEP and PEP, and pharmacists at our Colorado location are able to prescribe PrEP.

To learn more, reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

World AIDS Day, observed on December 1st every year, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

Take Action for World AIDS Day 2021

World AIDS Day, observed on December 1st every year since 1988, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

AIDS (acquired immunodeficiency syndrome) was heavily stigmatized from the beginning of the epidemic in the 1980s. Four years passed between the first cases of AIDS in the U.S. in 1981 and the Reagan administration’s first public mention of the disease. There were many misconceptions about how HIV (human immunodeficiency virus) — the virus that causes AIDS — can be transmitted and who is at risk of contracting it.

The stigma and lack of information about transmission and prevention led to many preventable cases of HIV/AIDS in the U.S. At the peak of the epidemic in 1995, complications from the disease were the leading cause of death for adults ages 25-44, and to date, more than 700,000 people in the U.S. have died from an HIV-related illness.

The HIV and AIDS landscape looks dramatically different today than it did back when World AIDS Day was first established. With greater awareness of HIV and AIDS, and more government funding of research, new HIV infections in the U.S. decreased by 73% between 1984 and 2019. Still, the fight to end AIDS isn’t over, with more than 1.2 million people living with HIV in the U.S.

In honor of World AIDS Day 2021, take a look at what has already been accomplished in the fight against AIDS and learn about what is needed next.

There were 34,800 new HIV infections in 2019

13% of those living with HIV don’t know it

57% of those living with HIV are virally suppressed (meaning they are not at risk of transmitting the virus to others)

Milestones in the history of HIV and AIDS

AIDS first emerged in the U.S. in 1981, but researchers did not learn that HIV caused AIDS until three years later in 1984. The history of HIV medication dates back to 1986, when clinical trials for azidothymidineor (AZT), the first antiretroviral HIV/AIDS medication, began. AZT was approved to treat HIV a year later.

Highly active antiretroviral therapy, often referred to as antiretroviral therapy (ART), became the frontline treatment for HIV in 1997. ART is a combination of medications that lower your viral load, which is the amount of HIV in your bloodstream. When taken every day as prescribed, these medications can help individuals with HIV maintain an undetectable viral load, virtually eliminating their risk of transmitting the virus to others.

The U.S. Food and Drug Administration (FDA) first approved a PrEP medication in 2012. PrEP, or pre-exposure prophylaxis, can lower the risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%.

With these breakthroughs in HIV treatment and prevention therapies, the U.S. government recently announced a goal to reduce the number of new HIV infections by 75% by 2025 and at least 90% by 2030, preventing an estimated 250,000 additional cases of HIV.

Next steps in the fight against HIV and AIDS

Despite the progress that has been made in the fight against HIV and AIDS, prevention, care, and treatment remain inaccessible for many individuals at risk of contracting HIV — both in the U.S. and around the world. The theme for World AIDS Day 2021 is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice, in recognition of how health inequities contribute to the epidemic.

In the U.S., racial discrimination and deeper inequities in healthcare have contributed to HIV’s disproportionate impact upon people of color. Black and Latinx individuals — particularly gay and bisexual men — are among the groups disproportionately affected by HIV. A variety of factors contribute to these disparities, including income inequality, unequal access to healthcare, and lower use of HIV prevention and treatment services. According to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

Fortunately, HIV prevention medication continues to become more accessible, with generic medication options and expanded health insurance coverage of PrEP. And legislation in a handful of states, including California and Colorado, allows pharmacists to prescribe PrEP. (Pharmacists at Alto’s California and Colorado locations are now able to prescribe PrEP — see our free, same-day prescription delivery areas here). There are also a number of organizations working hard to make HIV services more accessible to communities of color, like NMAC and Black AIDS Institute.

Getting an HIV test is one of the most important things you can do for World AIDS Day. Not only will learning your HIV status give you the information you need to take control of your health, it will also help combat the stigma surrounding HIV and AIDS. Each person who makes use of testing and prevention services — and each person who speaks openly about HIV and AIDS, without perpetuating fear or stigma — brings us closer to a future without AIDS.

Search for a free and confidential HIV testing site near you.

View the CDC’s HIV stigma language guide to learn the power of the words you use when discussing HIV and AIDS.

Get support navigating HIV treatment and prevention medication

At Alto, we’re committed to doing our part to make HIV treatment and prevention services as accessible as possible. Our extensive library of HIV-focused content covers the information you need to make informed decisions about your health. And if you take PrEP or ART, our team will coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option for your health needs at the lowest price.

To learn more, reach out via text or phone at 1-800-874-5881, or in-app messaging.

How to Take Action for World AIDS Day 2021

October 11 marks National Coming Out Day, an opportunity to celebrate all those who have come out as LGBTQ+ and recognize the courage they’ve demonstrated by choosing to be their authentic selves.

Celebrating National Coming Out Day at Alto

October 11 marks National Coming Out Day, an opportunity to celebrate all those who have come out as LGBTQ+ and recognize the courage they’ve demonstrated by choosing to be their authentic selves. In honor of this annual celebration, we sat down with two Alto team members — Ben Romero (he/they), Business Operations Manager for Health Plans and Travis White (he/him), Senior Software Engineer — who generously shared their experiences of coming out as bisexual/queer. Here are their stories, in their own words.

Ben: Like a lot of folks, I avoided coming out for most of my life. I grew up knowing that I wasn’t exactly straight and later recognized that I’m bisexual. I remember my entire experience around my sexuality being wrapped in shame. I would reluctantly conform to heteronormativity just to avoid the fear of being outed or questioned. It wasn't until college that I first felt like I could open myself up to the experience and validation that I deserved. By the time I graduated from college, I had a refreshed sense of my place in the world, but I was still hiding my sexuality from my family.

Five years after college, I was finally ready to be open with my family about being bisexual, and it was the first time I felt as if I had to “come out.” At the time I was engaged to my non-binary/queer partner. My family knew my partner as a woman, but my partner was also beginning to validate their nonbinary gender experience. All I could think about was how much of a disservice it would be to our identities as a queer couple if we started our marriage having to assume more invalidating heteronormative assumptions. I first told my closest family members — my younger brother and parents — who supported me unconditionally and showed me so much love. Not every family member was as accepting of my sexuality, which was really disappointing, but I had more than enough support from my chosen family to finally overcome the fear that I had held on to for so long. 

Travis: I realized I wasn’t completely straight at some point in high school. Growing up Catholic, I was always taught that men are attracted to women and that being gay was a sin. So when I found myself attracted to both girls and guys during high school, I wondered what was wrong with me. I brushed it off and ignored that aspect of my sexuality for a long time, which I would later come to regret since it definitely fed into ongoing anxiety and depression in college.

I first came out to my closest friends during my junior year of college. By that point, I had fully accepted that I wasn’t straight, but I had never acted on my bisexuality. I had only dated girls, so my friends saw me as completely straight. I couldn’t quite figure out how to tell them, and it ended up happening organically while hanging out on a Friday night. We were playing a game around the table that required everyone to share something no one else knew about them. Something came over me and I decided to throw caution to the wind with a, “by the way… I’m bi.”  

I came out to my parents several years later when I was working my first engineering job out of college, living in Silicon Valley and loving life. I knew that if they chose not to accept me, it was going to be their loss. After a night out (and an amazing prime rib dinner) when they were in town, I told them that there was something I wanted to tell them about myself - that I am bisexual. My dad’s first response was, “What does that mean?” I informed them that it means I am attracted to both men and women, though more recently, I’ve come to think of myself as being attracted to interesting people regardless of the gender they identify as. My parents were very supportive, but truthfully I had reached a point where I could be accepting of the worst-case scenario. 

Ben: I was most grateful for the sense of relief I experienced. Despite facing criticism and homophobia from some of my siblings after coming out, I couldn’t shake the sense of pride I felt from allowing myself to be unapologetically queer and visible. I’m finally allowing this part of me to flourish and grow. It’s liberating to be radically honest with yourself and others, regardless of what anyone else may think. I’ve now come to identify with the term queer in addition to bisexual. Part of the growth I’ve experienced involves unlearning so much of what I’ve been socialized to believe about the gender binary, and I’m just now starting to understand where I exist outside of it.  

Travis: When I came out to my friends during college, we stayed up talking until very late into the night. I left feeling a huge weight lifted off of my shoulders — and so full of love and support from some of the people I was closest to.

And later when I came out to my parents, they accepted me with open loving arms, for which I’m grateful, but I was also prepared to move forward with my life even if they did not accept me as my true authentic self.

What resources, support groups, or communities did you rely on when coming out? 

Ben: The isolation of being in the closet can sometimes lead to stories or expectations of yourself that aren’t necessarily helpful, or true. For me, as a bisexual, some of those expectations sounded like “I’m not queer enough,” “I don’t fit into the queer community,” or “people won’t believe I’m bi/queer.” I looked to my queer friends and even to LGBTQ+ advocates on social media and was relieved to find that they had many of the same fears about coming out as I did. I found that learning from other people’s experiences could help validate my own feelings, even if we had a different orientation or gender. As a queer Latinx, I also sought validation from people who shared similar intersections around my identity, which helped me navigate the concerns I had about coming out to my family.

Travis: My friends were very supportive so I was really able to lean on them. It was also helpful to just search online for other people’s coming out stories. Before I could tell my family, I knew I had to reach a point where I would be secure in my identity regardless of the outcome of that conversation. Part of the reason it’s so important to share coming out stories is because hearing other people’s experiences helps inspire you to do the same.

What advice would you give to others considering coming out? 

Ben: Above all, put your safety first. Try your best to not take on the burden of guilt for not being your authentic self — that is not a reflection of you, but a reflection of how our environment can fail to provide the validation we deserve. Take your time and build your comfort with folks who will validate your experience. There’s a whole community of people who will back you up and care for you if someone you come out to is hurtful or invalidating. 

Travis: Do it if, and when, you’re ready. You can never control how others will react, so just accept that other people’s responses have nothing to do with you. It took me years to reach that point with my family. It can be incredibly tough, and you can never know in advance how anyone will respond, but if they cannot accept you for your true authentic self, there are plenty others out there who will.

Do you have any suggestions for allies? 

Ben: I would stress the importance of familiarizing yourself with queer history and how our struggle for acceptence has evolved over the years. The LGBTQ+ community and allies have so much to be proud of today, like the repeal of “Don’t ask, don’t tell” (a former U.S. policy that directed military applicants to not disclose their sexual orientation), the legalization of gay marriage, and more queer representation on our screens — just to name a few.

At the same time, while all of those are certainly celebratory milestones, I ask that allies also recognize that our pride comes from so much more than a handful of legislative victories over the last decade. Our pride comes from the queer folks who came before us and fought for our visibility by rallying voices to speak out against injustice. Allies can research events such as the Compton’s Cafeteria riot, the Stonewall uprising, or the works of the Combahee River Collective. Understanding this historical context is important for also understanding the intersectional nature of the LGBTQ+ struggle for acceptance and restorative justice. Even though we have much to celebrate, our struggle continues as we fight for those who are still excluded or marginalized. 

Travis: Listen. The number one thing you can do is to listen and accept what someone in the LGBTQ+ community is telling you as their truth. It may change in the future — and that’s okay! Sexuality and gender are not a binary, and both can be incredibly fluid.

For parents: how you discuss sexual orientations and gender identities at home can leave a lasting impact on your children. I remember asking my mother about her thoughts on gay marriage, and she shared a more traditional view of marriage as a union between a man and a woman. That stuck with me for a long time and is a key reason I waited so long to tell them who I truly am. Read your toddler a book about a gay couple that gets married, teach your teens about prominent members of the LGBTQ+ community (and why they’re important), and if your LGBTQ+ child asks you to drive them to gay prom, treat the scenario as completely normal — because it is.

Why is it important for you to work at a company that values diversity in all forms? 

Ben: For me it’s a requirement that a company I work for prioritizes diversity and inclusion. I appreciate that Alto provides visibility into the progress that we’ve made towards building a diverse team that reflects the diversity of the patients we build solutions for. We also hold space to identify the work that still needs to be done. It’s really validating to have your background recognized at company celebrations and events or in spaces like employee resource groups (ERGs)*. It’s also important that we do all we can in our everyday actions to foster a collaborative and inclusive environment — one where people feel comfortable enough to be their authentic selves and not like they have to mask their gender, race, neurodivergence, or any other part of their identity. 

Travis: The U.S. — and the world — is made up of so many different people. There’s diversity of thought and beliefs, educational experiences, socioeconomic status, gender, race, A homogenous company that doesn’t mirror that diversity  will never be able to serve the entire population, and will miss out on a lot of opportunities. Alto’s mission is to fulfill medicine's true purpose — to improve quality of life — for everyone who needs it. The key word to me is everyone, and to truly fulfill the promise of that mission, we need a company as diverse as our customers. I personally find it rewarding to work at a company that values diversity and has strong representation of many identities, because that’s how the best ideas come to fruition and ultimately how the most positive impact is achieved.

At Alto, we believe in a world where every perspective matters. Diversity fosters creativity and creates innovation, and we welcome candidates of all backgrounds, skill sets, and experiences. To learn more, read Why We Prioritize Diversity at Alto. 

For more information on how to make your workplace safe and equitable for LGBTQ+ team members, read 11 Simple Ways You (Yes, You!) Can Make Your Workplace More LGBTQ Inclusive. 

If you or someone you know is considering coming out, we encourage you to review these resources:

Parents, Families, and Friends of Lesbians and Gays (PFLAG) Recommended Reading: Coming Out

*ERGs are meant to empower community groups within an organization by directly linking decision makers and implementing policies that support the group’s specific needs. The groups often center around a shared identity or experience and focus on building community, providing support, and contributing to its members’ personal and professional well-being. By creating an open forum for employees to come together, discuss challenges and opportunities, and foster a sense of belonging, ERGs help both individuals and organizations thrive.

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. We explain more including male infertility causes, symptoms, and treatment options.

Male Infertility: Causes, Symptoms, and Treatment

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. About one-third of infertility cases include factors related to male reproductive function.

If you’ve experienced infertility, you’re not alone: about 9% of men and about 11% of women in the U.S. have experienced fertility challenges. And while these challenges may feel overwhelming, they do not necessarily mean that you won’t be able to start a family one day — there are a variety of fertility treatment options for both men and women to support your family building journey.

Below, we explain more about male infertility, including causes, symptoms, and treatment options that can help you build or add to your family.

Male infertility most often stems from issues with sperm production. In some cases, it may be a problem with the quality of your sperm, like how fast or how well your sperm move. In other instances, it’s a matter of sperm quantity: you may not be able to produce any sperm, or you may have a low sperm count (the threshold is typically a sperm count under 15 million sperm per milliliter of semen.)

Sperm production problems may also occur as the result of other health conditions, including hormone, pituitary gland, or immune system problems or genetic conditions like cystic fibrosis, a progressive disease that makes it difficult to breathe, and hemochromatosis, a condition in which you have an excess of iron in your system.

Lifestyle and environmental factors can also play a role: heavy smoking (20 or more cigarettes per day), consistent heavy drinking or binge drinking (for men, five or more drinks in a two-hour timeframe), drug use, and exposure to toxins like endocrine disruptors contained in plastics and pesticides have been linked to male infertility.

Beyond issues with sperm production, anything that blocks a reproductive organ can interfere with the flow of semen, including inflammation from a sexually transmitted infection, scar tissue from surgery, or swollen veins in any of your reproductive organs. Additional factors in male infertility include erectile dysfunction, premature ejaculation, liver or kidney disease, and treatment for seizure disorders.

You may have a greater chance of experiencing fertility issues if you have had any of the following:

Inflammation of your prostate or genital infections

Certain prescription medications may also increase your risk of infertility, including:

5-alpha-reductase inhibitors, a medication class used to treat prostate enlargement and hair loss, which includes finasteride (Propecia®) and dutasteride (Avodart®)

Alpha blockers like silodosin (Rapaflo®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), terazosin (Hytrin®), doxazosin (Cardura®), which are used to treat prostate enlargement

Some selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety, including sertraline (Zoloft®) and paroxetine (Paxil®)

Spironolactone, which may be used to treat high blood pressure or acne

Cimetidine, which is used to treat acid reflux and Gastroesophageal reflux disease (GERD) 

If you and your partner are unable to conceive after trying for at least a year, one or both of you may be experiencing infertility. If you have experienced any of the following symptoms, you may wish to consult with your doctor about a potential diagnosis of male infertility:

Problems with ejaculation, including delayed ejaculation

If you have previously had surgery in your genital area, you should also consult with a doctor about potential infertility issues.

To evaluate you for an infertility diagnosis, your doctor will first ask questions about your medical history, including your sexual history and any other factors that may affect your reproductive health and fertility. They may also do a physical exam to check your genitals for any abnormalities.

The next step is typically a semen test, sometimes called a sperm count. Your doctor will ask you for a sample of semen. During their evaluation, they will look at how many sperm you produce and whether the sperm are normal in shape and movement — healthy sperm have an oval head and long tail.

Your doctor may recommend additional tests, including blood tests to evaluate your hormone levels and to rule out other health conditions and genital ultrasounds to identify potential reproductive health issues.

Thanks to the medical community’s advances in fertility treatment and technology, infertility issues do not mean that you won’t be able to build a family. There are a range of treatment options that can help increase your chances of conception. Your doctor will make recommendations for the best course of treatment based on the underlying cause of your fertility issues.

In some cases, hormone imbalances or problems with how your body uses hormones may impact your sperm production. If that’s the case, your doctor may recommend hormone treatments or medications such as gonadotropin therapy or antibiotics to increase the number of sperm in your semen.

Gonadotropin therapy may be used to treat both male and female infertility and is typically administered via injections. Common side effects of gonadotropin therapy for men may include pain, redness, and swelling at the injection site, stomach pain, nausea, and vomiting. In some cases, it may lead to the enlargement of male breast tissue.

Since lifestyle habits like heavy smoking or alcohol use can affect sperm production, you may be able to increase your sperm count with healthy choices like exercising regularly and abstaining from cigarettes, alcohol, and drugs.

There are several fertility treatment options that can increase your chances of conceiving a child, including in vitro fertilization (IVF) using a technique called intracytoplasmic sperm injection (ICSI) and different forms of artificial insemination like intrauterine insemination (IUI).

In intracytoplasmic sperm injection (ICSI) a single sperm can be injected directly into an egg. This procedure is often incorporated into an IVF cycle for many couples affected by male infertility. IVF is a process in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. Women trying to conceive may undergo IVF treatment if their partner is experiencing male infertility to increase their chances of conceiving. ICSI can be the fertilization method used in IVF.

In IUI, sperm that have been washed and concentrated are placed directly into your partner’s uterus around the time that they are ovulating, helping your sperm reach an egg more easily.

A fertility pharmacy partner you can rely on

At Alto, we understand that there are many paths to parenthood, and that each individual or couple’s needs are different. Our team of pharmacists is experienced in male infertility treatment options, and we’ll be here at every step of the way if fertility medications become part of your plan. 

Reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

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September 27 is National Gay Men’s HIV/AIDS Awareness Day, an important reminder that the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) disproportionately affect gay and bisexual men.

National Gay Men's HIV/AIDS Awareness Day

September 27 is National Gay Men’s HIV/AIDS Awareness Day, an important reminder that the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) disproportionately affect gay and bisexual men. In 2019, these individuals accounted for 69% of new HIV diagnoses in the U.S.

The high rates of HIV and AIDS among these individuals date back to the origins of the epidemic in the 1980s and 90s, in part because the virus transmits more easily through anal sex than vaginal sex. And this deep-rooted prevalence of HIV and AIDS in LGBTQ+ communities perpetuates a cycle: since HIV and AIDS are historically more common among gay and bisexual men, other gay and bisexual men face a higher risk of contracting it.

In recent years there has been significant progress toward reducing the annual infection rate. New cases of HIV among gay and bisexual men ages 13-24 dropped by 33% between 2015-2019. But there’s still much more progress to be made. Several factors contribute to HIV’s continued disproportionate impact upon gay and bisexual men, including ongoing stigma around HIV — which can deter people from seeking HIV prevention services and testing — race/ethncity discrimination, and disparities in healthcare access.

Even as HIV cases continue to decline and more effective treatment options allow individuals with the virus to have active, full lives, it’s important to stay vigilant about testing and prevention services. 

An estimated 1.2 million people in the U.S. are living with HIV, and about 13% of them aren’t aware of their HIV status. According to the CDC, nearly 40% of new HIV infections are transmitted by people who do not know that they have the virus.

Getting tested is the only way to know your HIV status. It’s free, it’s confidential, and it’s one of the most important things you can do to protect your health and the health of potential sexual partners.

If your test results are positive, there are effective treatment options that can keep you healthy. Antiretroviral therapy (ART) is a combination of medications that reduce the amount of HIV in your bloodstream (known as your viral load). When taken every day as prescribed, ART can help you reach an undetectable viral load. Maintaining an undetectable viral load can keep your immune system strong and prevent you from transmitting the virus to others.

It’s important to start ART as soon as possible, so reach out to your healthcare provider right away if you’ve tested positive for HIV. Delaying treatment can put you at a greater risk for developing AIDS or transmitting the virus to others.

If your test results are negative, you can continue to protect your health by using condoms and taking an HIV prevention medication called PrEP if you and your doctor decide it’s right for you.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. 

In recent years, PrEP has become even more accessible, with generic medication options and expanded health insurance coverage of PrEP. In addition, a handful of states, including California and Colorado, recently passed legislation that allows pharmacists to prescribe the HIV prevention medication. Pharmacists at Alto’s California locations are now able to prescribe PrEP (see our free, same-day prescription delivery areas here).

The following resources can connect you with a provider who may prescribe PrEP:

Using PEP for emergencies and accidental exposures

There’s another HIV prevention medication to be aware of: PEP, or post-exposure prophylaxis, which is taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. 

PEP can be prescribed by a healthcare provider at emergency rooms, sexual health clinics, community-based health centers, and, in some states, pharmacies. The sooner you begin taking PEP, the more effective it is at blocking the virus, so if you have been exposed to HIV after standard working hours, visit your nearest hospital’s emergency department as soon as possible.

PEP is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, consider asking your doctor about taking PrEP for long-term protection.

The HIV prevention landscape is regularly evolving, and we have an extensive library of PrEP, PEP, and HIV-focused content to help you understand and access HIV prevention medications and services. Consult with a healthcare provider to make the best decisions for your needs.

Here are just a few of the resources we offer:

Getting PrEP for HIV prevention at an affordable cost

Expanded PrEP access at pharmacies: What to know

What updated CDC guidelines mean for PrEP access

What to Know About State-Funded PrEP-DAP Programs

Alto can help you navigate HIV treatment and prevention medication

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with antiretroviral therapy, PrEP, or PEP. We will coordinate with your doctor and your insurance provider to ensure that you’re receiving the best option for your needs at the bestprice. Pharmacists at our California locations are also able to prescribe PrEP and PEP.

PEP is a medication you can take within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. Read on to learn more about who is eligible for it and when to use it.

What to Know About Using PEP to Prevent HIV Infection

PEP, or post exposure prophylaxis, is a medication you can take within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. While some research indicates that this groundbreaking medication may be able to lower your risk of HIV infection by up to 80%, it is only effective when taken as prescribed and is not intended to be a method of ongoing, recurring HIV prevention (see our article on PrEP to learn more about long-term preventative options).

Read on to learn more about what PEP is (and what it isn’t), who is eligible for it, and when to use it.

PEP is a medication regimen that you begin taking as soon as possible after potential exposure to HIV and continue with for at least 28 days. It typically consists of three medications: Truvada® (emtricitabine/tenofovir) with either Tivicay® (dolutegravir) or Isentress® (raltegravir). Your healthcare provider will recommend the best medication regimen for your health needs during your consultation.

These medications are antiretrovirals, a type of medication that blocks various stages of a virus’ life cycle. In this case, PEP prevents HIV from spreading throughout your body. Taking PEP medications as prescribed throughout the entire 28-day duration is critical to its effectiveness.

It’s important to reach out to a healthcare provider or pharmacist to start PEP as soon as possible if you believe you were exposed to HIV. The virus spreads very quickly — typically within 24 to 36 hours of exposure — and it is recommended to begin taking PEP within 72 hours, or three days, of potential exposure. 

And the sooner you begin your PEP regimen within that 72-hour window, the more effective the medication is at blocking the virus. If your potential exposure to HIV falls outside of that 72-hour window, you should still seek medical attention as soon as possible for further evaluation.

PEP may cause some side effects such as nausea, vomiting, diarrhea, and fatigue, however these are mild in most cases. Be sure to inform your healthcare provider of any other medications you currently take, as these may interact with PEP.

If you experience a rash or fever while taking PEP, you should contact your doctor as soon as possible, as these may indicate the early stages of HIV.

PEP works most effectively for people who may have been exposed to HIV within the last three days. That primarily includes anyone who had unprotected sex with or who shared needles or other drug paraphernalia with someone who may have HIV. It is also recommended in instances of sexual assault or if you used a condom that broke while having sex with someone who may have HIV.

PEP baseline testing and ongoing monitoring

Recommended baseline screening for PEP includes a rapid HIV test, kidney and liver function tests, a pregnancy test for women of reproductive age who aren’t using birth control, and screening for sexually transmitted infections (STIs). However, if baseline screening isn’t available when you reach out to a healthcare provider or pharmacist to start PEP, they will likely advise you to take your first dose before you complete the tests, in the interest of starting PEP as soon as possible. Additional HIV testing is recommended at 30 days and 90 days after the potential exposure to confirm your HIV status.

In all states, any licensed doctor or nurse can prescribe PEP. And in a growing number of states, including California, Colorado, and Nevada, pharmacists are also allowed to prescribe PEP. (If you live in California, an Alto pharmacist can prescribe PEP for you after a phone consultation.)

Since the medication should be taken as soon as possible after exposure, PEP is commonly prescribed by emergency room doctors. It is also available at many sexual health clinics and community-based health centers, but if you have been exposed to HIV after standard working hours, you should visit your nearest hospital’s emergency department as soon as possible.

PEP isn’t an ongoing method of HIV prevention

PEP is only for emergencies and infrequent exposures, as it is not 100% effective in preventing HIV even when taken as prescribed. It should not be considered a substitute for proven methods of long-term HIV prevention, including condoms and/or taking PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. It is also important to continue using condoms during your 28-day course of PEP.

If you have had several potential exposures to HIV, speak with your doctor about potentially taking PrEP to prevent HIV infection in the long term.

Alto can help you navigate PEP or PrEP access

Alto pharmacists at our California locations are able to prescribe PEP. We will work with your insurance (if applicable) and any third party savings programs so that you can get PEP at the lowest possible price. 

There are several patient assistance programs designed to reduce the cost of PEP for individuals without insurance, including Gilead’s Advancing Access Program and ViivConnect. If you’re eligible, we’ll automatically enroll you in these programs as soon as we receive your prescription.

We can also help you get started with PrEP if you and your doctor decide that it’s right for you. In addition to support with navigating insurance and patient assistance programs, you can expect:

Discrete, private packaging and free, same-day delivery

Med syncing support to eliminate extra deliveries each month and in-app reminders to stay on track

Pharmacists directly available through phone, text or within the Alto app seven days a week

Reach out any time to get started via text or phone at 1-800-874-5881, or in-app messaging.

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology.

Spotlight on Men Having Babies & Dr. Guy Ringler

There are many ways to start a family and raise a child. And as recent decades have brought forth milestones in marriage equality and the fight for LGBTQ+ rights, the options for LGBTQ+ family building have also expanded.

According to 2019 data from the Williams Institute, almost 29% of people who identify as members of the LGBTQ+ community are raising children, up from 16.2% between 2014 - 2016. That includes a growing number of gay men who’ve had children through surrogacy, a process in which a woman who is not related to the child — a gestational surrogate — carries a baby who is biologically related to one of the fathers and an egg donor.

Breaking down barriers to LGBTQ+ family building

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology. Throughout the twenty-five years that he’s been in practice, he’s seen how scientific advances and cultural changes have broken down barriers for gay men interested in parenthood.

“Over two decades ago, when I began my career, people barely understood the concept of surrogacy for gay men,” he says. “It wasn’t as easy to find women who wanted to become surrogates for gay couples. There was still fear about HIV, and there were questions about the impact of surrogacy on a child’s development.”

The landscape looks a lot different today. Thanks to cultural shifts and greater understanding of the science behind surrogacy — and to awareness-raising organizations like Men Having Babies — there are now more options than ever to become a parent regardless of your sexual orientation or gender identity.

“Greater acceptance of the LGBTQ+ community and marriage equality has opened people’s minds and allowed them to see that gay families can thrive, just like any family,” Dr. Ringler says. “Gay men are now able to plan for a future that we once didn’t know was possible.”

Getting to meet prospective fathers at Men Having Babies’ annual conferences is one of Dr. Ringler’s favorite things about working with the organization. He’s observed a greater number of gay men pursuing parenthood at an earlier age.

“I’m so inspired by the next generation of gay men, who are planning their families in their twenties. That simply wasn’t an option when I was their age.”

Men Having Babies and financial assistance for IVF and surrogacy

There are many steps on the road to parenthood for LGBTQ+ individuals and couples: fertility treatments, legal consultation, and financial planning are all required to start a family.

“Having a baby doesn’t just happen for gay men,” Dr. Ringler says. “It takes thoughtful planning and there are many decisions along the way.”

That’s why support from organizations like Men Having Babies is so critical. The organization started as a program at The Center (formerly the NYC LGBT Center) in 2005 and officially became a nonprofit in 2012. Today, Men Having Babies supports thousands of gay men and couples around the world in starting their families through surrogacy, with monthly workshops, annual conferences and financial resources. 

Determining how to pay for IVF and surrogacy is an important part of planning your family. As part of the process, Dr. Ringler suggests mapping out a vision for your family. Knowing how many children you want can help you prepare for the cost: “When you’re making the commitment to start a family as a gay man, think about how you will financially support the decision. It may feel overwhelming, but it’s similar to the process of buying a house. If it’s really important to you, you can find a way to make it work.”

There are many resources to help alleviate the cost, including Men Having Babies’ Gay Parenting Assistance Program (GPAP) . The program offers different forms of financial support, including:

Discounted and free services donated by more than one hundred leading IVF, surrogacy, egg donation, and legal service providers to prospective parents (Stage I support)

Discounted and donated ancillary services, including fertility medication, escrow services, and insurance resource services (Stage I support)

Cash grants for approved prospective parents based on income eligibility (Stage II support)

Learn more about the criteria for applying to Stage I or Stage II support from the GPAP.

You must be a member of Men Having Babies to receive financial assistance. You can become a member by making an annual donation of $150 or more. Learn more about the membership process.

Blog

All About HIV: Stages, Symptoms and Treatment

How to Take Action for World AIDS Day 2021

Celebrating National Coming Out Day at Alto

Male Infertility: Causes, Symptoms, and Treatment

National Gay Men's HIV/AIDS Awareness Day

What to Know About Using PEP to Prevent HIV Infection

Spotlight on Men Having Babies & Dr. Guy Ringler

What to Know About Transgender Hormone Therapy Side Effects

What to Know About State-Funded PrEP-DAP Programs

Prioritize Your Health with Preventative Care

What Updated CDC Guidelines Mean for PrEP Access

Expanded PrEP Access at Pharmacies: What to Know

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