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For Black History Month, we’re recognizing pivotal Black leaders in healthcare who’ve paved the way forward for our country and the Black community.

Services that reduce travel and encourage social distancing are now more essential than ever, not only for vulnerable populations but all of us as members of our communities. Alto’s free same-day doorstep delivery ensures you have safe and reliable access to medications in this time of uncertainty. 

Hear first-hand from members of the Alto technology teams.

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In May 2020, a major clinical trial found that injections of long-acting cabotegravir, an antiviral medication, were highly successful at preventing HIV when taken as a form of pre-exposure prophylaxis (PrEP). We take a closer look at the study to find out what’s likely giving cabotegravir the edge and what this means for the future of PrEP.

What We Know about Injectable PrEP for HIV Prevention

A Hopeful Start for a Promising New Form of PrEP

The past year has been an exciting time in the world of HIV prevention. In May 2020, a major clinical trial found that injections of long-acting cabotegravir, an antiviral medication, were highly successful at preventing HIV when taken as a form of pre-exposure prophylaxis (PrEP). The injectable, which is given every eight weeks, resulted in 69% fewer new cases of HIV than Truvada, a daily pill. 

Learn more about PrEP in “All About PrEP for HIV Prevention.” 

When taken as prescribed, Truvada is highly effective, reducing the risk of getting HIV from sex by about 99%. So how could injectable PrEP have such a strikingly superior protective effect? Let’s take a closer look at the study to find out what’s likely giving cabotegravir the edge and what this means for the future of PrEP.

The clinical trial looking into the effectiveness of long-acting cabotegravir for HIV prevention consisted of two parallel studies: HPTN 083 and HPTN 084. HPTN 083 looked at men who have sex with men (MSM) and transgender women, while HPTN 084 focused on cisgender women.

Each study randomly assigned participants to one of two arms: half were given a placebo injection and daily Truvada, while the other half received long-acting cabotegravir injections and a daily placebo pill. The Data and Safety Monitoring Boards overseeing the studies recommended that this randomized, blinded portion of both studies be stopped early, once data revealed cabotegravir to be highly effective in preventing HIV acquisition.

The results of these studies do not necessarily mean that long-acting injectable cabotegravir is more effective than daily Truvada. With perfect use, it’s likely that both forms of PrEP are similarly effective. 

What the results do suggest is that if a group of MSM and trans women are prescribed cabotegravir injections every eight weeks, they will end up with an estimated 69% lower HIV acquisition rate than a similar group that is prescribed daily Truvada. For cisgender women, that number is 89%. 

What makes cabotegravir more effective across a group of people is likely adherence (i.e. taking the medication as prescribed). Studies have shown that inconsistent use of oral PrEP can sharply reduce its effectiveness, and some people find it difficult to remember to take a pill every single day. Cabotegravir only needs to be administered every eight weeks, offering the potential to improve adherence, and thus, the preventative effect of PrEP.

Just like Truvada, injectable PrEP was considered safe and well-tolerated by the participants in the study. The most common side effects were injection site reactions such as pain, redness, and swelling. Only two percent of the 4,600 participants who received cabotegravir injections dropped out of the study due to this type of reaction compared to zero percent in the placebo group.

After the trials ended, the participants were informed about the results, and those who had been receiving daily Truvada were offered the choice to begin receiving injectable PrEP until the original end date of the study. They also had the option to continue taking Truvada. 

It may be some time before injectable PrEP becomes available to people outside the study, however. The results must first be rigorously reviewed and submitted for regulatory approval, and other safety measures and implementation issues will need to be addressed. 

While the news about injectable PrEP is undoubtedly a reason for excitement, oral PrEP continues to offer highly effective prevention for anyone at risk of HIV infection. 

The rate of HIV acquisition in the study was low overall, providing further proof of Truvada’s well-studied effectiveness. Still, the addition of a long-acting injectable form of PrEP offers an opportunity to improve adherence among those who have trouble with a daily regimen or simply find an injection every eight weeks preferable. 

As Myron S. Cohen, MD, the co-principal investigator of the HPTN trial and a professor at the University of North Carolina at Chapel Hill, said in a press release, “Each year, an estimated 1.7 million people are newly diagnosed with HIV. To lower that number, we believe more prevention options are needed in addition to currently available oral tablets for daily use. If approved, a new injectable agent, such as long-acting cabotegravir administered every two months, could play an important role in reducing HIV transmission and helping to end the HIV epidemic.”

If you have trouble remembering to take your daily PrEP pill, try our helpful Reminders feature within the Alto app to alert you when it’s time for your next dose. You can even manage multiple medication schedules throughout the day and track your progress. 

And to make sure you never run out of PrEP, you can opt into Auto Refills when scheduling your next delivery to get your future refills delivered automatically. We’ll always remind you when your next fill is on its way so you can make updates to your delivery details.

Download the Alto mobile app from the App Store or Google Play to get started. 

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

This October, a generic version of Truvada became available in the United States for the first time. In this article we'll explain what these means for PrEP users and how Alto can help.

An HIV Prevention Milestone: Truvada Goes Generic

The world of HIV prevention medications is still relatively new. In 2004, Truvada roared onto the scene and drastically changed the future of HIV. While the medication was initially used to treat HIV, in 2012 the FDA approved its use as a form of pre-exposure prophylaxis (PrEP), a daily prescription medication that prevents HIV infection.

When taken as prescribed, Truvada is 99% effective at preventing sexually transmitted HIV infection. It has been shown to potentially cause decreased kidney function and a small amount of bone loss in some individuals. Though studies indicate these side effects are slight, they present a barrier for people with pre-existing renal and bone density issues. Descovy, an updated form of PrEP, was introduced last year with research showing kidney and bone safety improvements over Truvada. 

Truvada and Descovy are both patented and manufactured by Gilead Sciences. Both are considered highly effective, safe, and well-tolerated by most PrEP users. While Descovy is less likely to cause unfavorable changes in kidney and bone blood tests, Truvada has been shown to have a more favorable impact on blood fat levels and lead to less weight gain. The FDA has not yet approved Descovy for cisgender women or transgender men—more studies are still needed. Those who are uncertain which medication is right for them should discuss the options with their healthcare provider. 

For more on PrEP, read “All about PrEP for HIV Prevention.”

This October, a generic version of Truvada became available in the United States for the first time. Why the delay? When a brand-name medication enters the market, it is protected by patents and granted a period of exclusivity. Now that Truvada’s exclusivity period has ended, manufacturers with generic alternatives may seek approval from the FDA. 

Teva Pharmaceuticals was the first manufacturer to receive FDA approval for a generic version of Truvada. More generic versions will likely follow in 2021, increasing competition and driving down the price. 

Curious about how medication versions work? Read “What’s the Difference between Generic and Brand-name Medications?”

By lowering the cost of PrEP, the emergence of generic Truvada will ultimately put less strain on the U.S. healthcare system and help make PrEP more widely accessible to those at risk of HIV infection. Those who switch to generic Truvada will likely see their out-of-pocket costs decrease; however, there may be consequences for people who prefer Descovy—the newer formulation of PrEP.

In the wake of generic Truvada’s arrival, some insurance companies have decided to stop covering Descovy due to higher costs. While the two forms of PrEP may well be interchangeable for many patients, Descovy is not identical to Truvada. A small subset of people may have less desirable outcomes if compelled to switch versions by their insurers. People who need or prefer Descovy, especially because of preexisting renal or bone density issues, will likely need to obtain prior authorization approval and could face higher out-of-pocket costs. 

At Alto, we specialize in handling prior authorizations and performing thorough cost savings investigations. If we notice a change in your out-of-pocket cost, we’ll let you know, and we can work to identify ways to save you money. Here’s a closer look at how your pharmacy, healthcare provider, and insurance company work together to manage your prescriptions. 

How Insurance Companies Manage Medication Costs

Unsurprisingly, insurance companies tend to favor the cheapest version of a medication with similar efficacy. One way insurers encourage less expensive alternatives is through prior authorizations—a restriction that requires doctors to request that the insurance company cover certain medications. Not every prescription is subject to a prior authorization, but it’s commonly used when a doctor prescribes a brand-name drug with a generic available. The doctor must prove to the insurer why the specific version they prescribed is medically necessary. 

In most cases, prior authorizations are intended to ensure the safest and most cost-effective medication is used. However, they often require extensive paperwork and multiple phone calls from doctors’ offices, which can become a drain on time and resources for busy offices and clinics or cause delays in getting your prescription. 

For more on how the process works, read, “What is a Prior Authorization?”

Finding out that you need a prior authorization can feel daunting, but the right pharmacy partner will navigate the complexities for you. At Alto, we proactively file prior authorizations when they’re needed, taking the weight off the shoulders of both you and your doctor. We have a dedicated support team that works closely with your doctor’s office to obtain approval from your insurance company, and we’ll keep you updated throughout the whole process. 

After securing approval, we’ll conduct a thorough price investigation to identify sources of financial assistance and ensure you're getting the lowest possible price. We do all of this at no cost to you—we believe everyone should have access to the medications they need at an affordable price.

If you’re concerned about continued coverage for your preferred form of PrEP, we’re here to offer support. Our HIV specialists and care team are available from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends through secure messaging in our mobile app, or by texting or calling 1-800-874-5881. 

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.

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today. In this blog post we'll share an overview of the options as well as how Alto can help you in the path to parenting.

A Guide to LGBTQ+ Family Building

Assisted reproductive technology (ART) has expanded the paths to parenthood for all types of family structures. Whether exploring fertility as a single person, within a couple, or as a family unit, parenthood is now possible for more people than ever before.

A 2018 study found that 48% of LGBTQ+ millennials (aged 18-35) were actively planning to grow their families, compared to 55% of non-LGBTQ+ millennials. Researchers noted that this gap had narrowed significantly compared to older generations—the result of advances in technology and the movement for equality. 

Still, LGBTQ+ families confront unique challenges in an industry that often fails to center their needs. However, as more and more LGBTQ+ people seek to become parents through ART, the face of fertility is shifting. 

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today, including using a donor or surrogate for one or more components of biological conception (eggs, sperm, and uterus).

That being said, many options come with formidable costs so determining how to pay for treatment is an important part of planning. Family Equality Council shares this list of family-building grants that can help make ART more affordable. Your clinic may also offer financial assistance programs and payment plans. If prescription fertility medications are part of your treatment, we’ll comb through the available discount and rebate programs to ensure you get the lowest possible price. 

To clarify which of the many paths-to-parenthood might be right for you, it can help to seek out an organization such as Family Equality Council that can provide specialized advice for LGBTQ+ families. It’s also essential to choose a clinic and doctor who can understand your needs and put you at ease. 

For LGBTQ+ couples exploring using a donor, it’s also essential to research the laws in your state regarding legal parentage procedures after your baby is born. For a starting point, you can learn about the laws in your area through Movement Advancement Project’s interactive ART law map; however, you should also speak with an experienced LGBTQ+ family lawyer in your state. 

Every budding family follows a unique path. It may include natural conception, adoption, foster care, or ART. For those considering the latter, here are some of the places your ART journey might take you. 

For those whose bodies cannot produce sperm or are experiencing infertility, a donor can be used. There are two ways to obtain donor sperm: from someone you know or from a sperm bank.

If you use a known donor—often a friend, family member, or other acquaintance—it’s crucial that you fully discuss the relational complexities involved and consult with a lawyer who specializes in working with LGBTQ+ families in your state. When choosing an unknown donor through a sperm bank, the donation’s legalities are less complex because the donor has already surrendered their parental rights. 

If you or your partner plan to carry the pregnancy, donor insemination is the process of placing the donated sperm inside the vagina or uterus to facilitate fertilization. There are two methods of insemination that may be used: 

Intrauterine insemination (IUI) is a simple medical procedure performed by a medical doctor where the sperm is placed directly into the uterus by using a very small tube passed up through the cervix.

With intravaginal insemination (IVI), the sperm is placed directly into the vagina. You can often perform IVI at home; however, many people choose to have a medical professional complete the insemination to increase the chances of success. 

Parents-to-be who were not born with ovaries or are experiencing infertility can use an egg donor. Like with sperm donors, an egg donor can be a known donor or be found through an agency. Again, when using a known donor, be sure to thoroughly discuss the arrangement’s details and consult with a lawyer who specializes in working with LGBTQ+ families in your state.

With both known and unknown egg donors, the egg must be fertilized in a lab and placed in a uterus through a medical procedure known as in vitro fertilization (IVF). 

Intended parents who cannot or will not be carrying the pregnancy for any reason can use a gestational carrier. The gestational carrier will have the embryos (eggs fertilized by sperm) transferred into their uterus, then carry and deliver the baby.

Choosing a gestational carrier is a critical decision that can take time. After all, your relationship will last the better part of a year. An agency can help you meet and screen candidates until you find the right match. 

IVF  is one of the most common fertility treatments. It involves combining an egg and sperm in a laboratory dish then transferring the resulting embryo into a uterus. IVF can be performed with donor sperm, donor eggs, or donor embryos. 

Reciprocal IVF, also known as co-maternity, is a specific instance of IVF where one partner provides the egg and the other carries the pregnancy. In this way, one partner is genetically related to the child while the other becomes biologically bonded through pregnancy. 

Egg or sperm freezing, also known as cryopreservation, is available to preserve future fertility for those looking to delay pregnancy or undergo gender affirmation treatment. Because gender affirmation treatment may affect fertility, it’s important to discuss the possibility of freezing your sperm or eggs with your doctor before undergoing treatment if you may want children who share your DNA in the future. For those currently undergoing Hormone Replacement Therapy (HRT), there may still be options available to preserve your fertility. Talk with your doctor about which choices may be right for you. 

There are many routes available to expand your family. Ultimately, every journey has the same destination in mind: the beautifully chaotic, utterly unique, yet completely universal journey of parenthood.

As you assemble a team you trust to guide your path forward, we’ll be here to support you if prescription medications become part of your plan. Our team of specialists has experience working with the LGBTQ+ community and receives training on how the nuances of the fertility experience may vary for each individual. We’d be happy to manage your medication needs so you can focus on your family during this life-changing time. Visit us at alto.com/fertility or reach out via phone, text, or the app to learn more. 

The Disproportionate Impact of HIV in America

It has been a year full of seismic shifts. A series of core-shaking events ranging from a global pandemic to an upwelling of the Black Lives Matter movement has exposed deeply entrenched inequities in our society. 

We need only look at the statistics emerging from the COVID-19 pandemic to see these inequities at work. According to the CDC, Americans who are Black, Hispanic/Latinx, American Indian, and Alaskan Native are nearly three times more likely to become infected with COVID-19 than white Americans and approximately five times more likely to be hospitalized due to infection. 

Rather than being an anomaly, studies have revealed a health gap between white Americans and Americans of color so wide that it has been named a public health crisis. This divide is perhaps most evident in the disproportionate impact of the HIV epidemic.

The Story of HIV, Told Through the Numbers

Advances in HIV treatment and prevention over the past several decades are reason to feel hopeful. The number of people infected with HIV each year has plummeted by more than two-thirds since the height of the epidemic in the 1980s, and we’ve dramatically transformed the outlook for those living with HIV. However, our efforts to combat the HIV epidemic have stalled in the face of a serious issue—HIV prevention and treatment are not accessible to everyone who needs them. 

According to the CDC, Black Americans are the most affected racial or ethnic group with a lifetime HIV risk of one in twenty for men and one in forty-eight for women (compared to an overall risk of one in ninety-nine for all Americans). Gay and bisexual Black men have been hit hardest of all: it’s estimated that if current infection rates continue, one in two will contract HIV in their lifetime. Gay and bisexual Hispanic/Latino men face a similarly distressing statistic, with an estimated one in four at risk of HIV infection. 

These numbers paint a bleak picture, yet Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, offers hope. “As alarming as these lifetime risk estimates are,” he says, “they are not a foregone conclusion. They are a call to action.”

There is a complex set of socioeconomic factors—such as income, housing, and occupation—that impact a person’s risk of contracting HIV and affect the quality of care they receive. In the United States, HIV infections are mainly concentrated in urban areas and among those of a lower socioeconomic status. 

Like COVID-19 and HIV, poverty rates in the United States reveal clear racial and ethnic disparities. The data shows that one in four Black Americans and Native Americans live in poverty and one in five Hispanics/Latinos. For white Americans, the number is one in ten. 

There are significant barriers to accessing quality healthcare for those living in poverty, including financial insecurity and fear of discrimination. Many services that help to decrease HIV transmission rates—such as prevention education, substance abuse counseling, STI treatment, and antiretroviral therapy (ART)—remain mostly out of reach for these communities. In this way, the people who are most vulnerable to HIV infection continue to face an ever-growing risk. 

An HIV diagnosis today is vastly different than it once was. With antiretroviral therapy (ART), a person living with HIV can suppress the virus and stop the progression of HIV disease. Not only will maintaining viral suppression help them stay healthy, but it also means they will have effectively no risk of transmitting HIV to others. 

For those at risk of infection, pre-exposure prophylaxis (PrEP), an HIV prevention method available by prescription, can virtually eliminate that risk. However, unless we ensure HIV prevention, testing, and treatment are widely available and affordable, we will continue to see tens of thousands of new infections year after year. 

Want to learn more about PrEP? We explain the basics in “All About PrEP for HIV Prevention.”

These are significant issues to tackle, but we can each do our part by talking with our doctors if we’ve never had an HIV test or if we think we may be at risk of infection. We can support organizations like NMAC and Black AIDS Institute that work to make HIV services more accessible to communities of color. And we can encourage our elected officials to help fight HIV through government funding and programs. 

Lastly, we should avoid perpetuating the fear and stigma that’s often associated with HIV. When we talk about HIV openly and neutrally, we help create a culture where everyone feels safe to seek testing and care. 

Looking for a supportive partner to help manage your HIV medications? We’re here for you. You can reach out and talk with an HIV specialist between 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; call or text 1-800-874-5881, or download the mobile app for secure messaging.

We are building a pharmacy where every patient matters and is included. To do that, we need to foster a culture and company that is committed to challenging existing racism, injustice and prejudice, in order to create a culture and service that is inclusive. 

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

At Alto, we are redefining the pharmacy experience which has been part of a very old, broken way that has fueled systemic racism. We are building a pharmacy where every patient matters and is included. To do that, we need to foster a culture and company that is committed to challenging existing racism, injustice and prejudice, in order to create a culture and service that is inclusive.  Our team consists of committed and passionate individuals who champion to effect positive change on issues related to race, injustice and prejudice.

This passion for equality is what we strived for when we first set out to build a team with a broad representation of diversity. Our goal was to create a community that reflects an inclusive culture regardless of age, education, gender, race, ethnicity, religion, sexual orientation, socio-economic status, or other dimensions of diversity. Yet even with the best of intentions we recognize that there is more work to be done to dismantle the systems and structures that fuel racism and inequity.

2020 has been a year like none other for so many.  HR professionals around the globe have stepped center stage to support our organizations, teams and communities in ways many of us could not imagine.  I wanted to write this post to share my personal journey on this topic while supporting others in capturing this moment.  I am a white gay cis man.  Many of my identities provide much privilege.  I am committed to educating myself. I am building an environment where our teams can push past their fears to learn and grow.

Read more about Why We Prioritize Diversity at Alto.  

In 2019 we initiated our focused DEI (Diversity Equity Inclusion) work with the goal of ensuring employees felt safe, and included, and ensuring that candidates and employees have equal access to opportunity for advancement in the organization. We learned a few things during the early days of this work including balancing listening while creating the right structure to move to action.  Fast forward to early 2020, in the midst of the global COVID-19 pandemic and the murder of Ahmaud Arbery, Breonna Taylor, Tony McDade, George Floyd, and Jacob Blake, we like many other organizations did not want another moment for action to pass by.

Read more about Alto’s Mission and Values. 

The week after George Floyd’s murder we hosted a series of listening sessions for Altoids.  We began them with a simple statement:  “We are holding this space for you.  Tell us how you are feeling.  Share your experiences.” The results were powerful moments of revelation, pain and heartbreak.  Black, Asian, Native and Latinx Altoids shared experiences of racism, sexism, and prejudice in their lives.  As a leadership team, we started to wake up to the enormity and urgency of the work we had ahead of us.

In reflecting on these tragic murders and Altoid voices, we realized we needed to expand the building blocks of our 2020/2021 DEI strategy. We recognized that we didn’t want to rely on the members of our underrepresented communities to lead us on this journey.  We do not expect underrepresented professionals to teach us, especially cis white men, about the history and experiences that led us to this moment. 

We made the decision to find a partner to help.  What struck me about Pathfinder and Trier Bryant, is their ability to push our thinking on this critical work while meeting us where we are (each one of us). Trier is a strategic leader with distinctive Tech, Wall Street, and military experience spanning across 15 years. Pathfinder has an unwavering commitment to advise leaders on how to create a more equitable, inclusive, and thriving culture to produce prosperous companies. I appreciate many aspects of Trier’s support including that she too is a Chief People Officer, she wears these shoes.  Given that experience plus Pathfinder’s work with clients like Equinox, Compass, SoundCloud, Gusto, and eBay, we gain perspective and lessons learned.

Our first half-day session with Trier focused on educating the group about the language of diversity (e.g. Is it okay to say Black? What makes up the LGBTQIA+ community?).  Next we spent time learning about key historical events starting from 1619 that have shaped our current society with respect to race, oppression, and white supremacy in America.  We watched videos displaying more covert forms of white supremacy [see Ellen Tuzzelo’s Pyramid of White Supremacy]. 

These are actions I could recognize in myself (i.e. not challenging racist jokes when told by my family members, not always believing the stories of Black victims).  I felt sadness and shame. Sharing these feelings and our part in the current state of our nation is an important step. We took time to process and walked away with an epiphany.  

Over the past decades, America and specifically Corporate America lulled itself into thinking that we’ve been fighting bias.  Our aim up until this moment was to reduce or eliminate bias.  We were wrong.   Our fight, our work is to eliminate racism and white supremacy in America. This work is neither a marathon nor a sprint; we’re committed to doing this work all our lives.   

With that realization in mind we got more specific about what diversity meant to us and where we wanted to focus our teams at Alto. Diversity by nature is very broad and inclusive. We used individual characteristics, experiences, and abilities consistent with our values and mission that includes but is not limited to:

*Sexual Orientation and language abilities will begin to be captured with Workday, our new HR system.

As a part of the above education, we learned that while we all have various identities and intersections that represent our Altoids, intersectionality is a term that must be clearly understood to comprehend unique modes of discrimination and privilege that occur in the workplace.  

Identity - the fact of being who or what a person is; affinity (i.e. Hispanic/Latinx, Black, Male, Female, Nonbinary) 

Intersections - a point at which two or more identities  intersect (i.e. Hispanic/Latinx Gay Male, Black Heterosexual Female)

Intersectionality -  the cumulative way in which the effects of multiple forms of self-identifications intersect, overlap, or combine to create unique modes of discrimination and privilege; intersectionality identifies advantages and disadvantages that are felt by people due to a combination of factors

While Alto recognizes a broad and inclusive definition for diversity of various identities, there are strategic priorities for underrepresented groups at the company. After benchmarking current tech and health care demographics, we decided to focus our DEI work for Altoids including our leadership, managers and independent contractors on the following underrepresented groups at Alto: 

Women in STEM (Science Technology Engineering Math)

The following month we read So You Want to Talk about Race by Ijeoma Oluo. What an incredible read! This engaged us in thinking about and naming our privilege.  In the next half-day session with Trier, we discussed the book to name our privilege and explored how it influenced our personal and professional development.  

We learned several lessons from Ijeoma and Trier including that we’re going to make mistakes and say the wrong thing; that is part of the journey yet we still must do the work.  Also that microaggressions are as damaging as overt racism and we must do better at calling these detrimental behaviors out everyday. 

Lastly, non-white people fear retaliation most when the topic of racism and prejudice comes up; we must create a space for everyone’s voices and perspectives to not only be heard but respected.

As I reflected on our second half-day session together, I saw the journey for our leadership team through four stages.

Stage 1: Self-Awareness-doing the personal work regarding racism and privilege

Stage 2: Awakening-acknowledgement of role of racism, privilege, and gressions,; doing the work in our professional life

Stage 3: Empowering-identifying the work to be done with our team, team members and building more inclusion on our teams

Stage 4: Advocating-taking our roles as a senior leaders at Alto to change behaviors and lead change at the company and our communities 

For the last round of workshops we split up our senior leaders into smaller groups so that we could focus on the work needed to be done with each of their teams.  In these sessions, we learned more about identities.  How do we identify?  What do we learn and acknowledge about our team members identities?  We discussed specific examples of how intersectionality shows up in the workplace and the role it places in each other’s experiences.  This pivot allowed us to move into Stage 3.

As we embarked on taking this work to our team, we felt more prepared and comfortable because of the time spent educating, processing and doing our own work ahead of time. This allowed each of us to live one of our core values “start with empathy.” Being empathetic is hard when you haven’t done your own work.

As a result of all the foundational work we’d done as individuals, as a team and as a company, in July, our leadership team committed to a bolder, crisper DEI plan that includes four strategies with clear goals:

Hire - ensure we have diverse teams and insure all are valued

Include - increase inclusion and community 

Develop - educate our leadership team and all Altoids

Invest - support initiatives with money and time  

This new DEI plan rallied the team and catalyzed us to make some significant changes with clear alignment, commitment and clarity around the problem we’re trying to solve. For example, one immediate change we made was to focus our executive search process on underrepresented talent. I’m excited to share that only a few months later (most searches take 6 months), we were able to hire several outstanding candidates from underrepresented backgrounds. 

Before, we had just been “hoping” for diversity and thus looking in all the wrong places.  Once hiring diverse talent  at the executive level became a critical mandate, that forced us to really seek the right kind of strategy. I’m excited to share some more of the significant changes we’ve made, over a series of posts over the next few months.

We are far from perfect.  We have work to do to meet our goals.  These are our first steps.

In January, we will share our first DEI Report including workforce demographics, success stories, lessons learned from 2020, and aspirational goals for 2021 and beyond.

We condemn the violence and systemic racism that has harmed marginalized communities, specifically Black communities, for far too long. At the same time, we commit to look inward and educate ourselves to continue to create safe spaces for Altoids and to act on what we learn. 

This will be a lifelong journey and we will continue to share updates on our progress. Our actions must be sustained and focused on keeping the momentum of enabling change now and for future generations. 

Last, personally this work is the most fulfilling of my career. There are days I am exhausted.  There are days I need help.  Yet there are many days I overflow with pride in our team.  I am most hopeful about the work ahead and seeing the early fruits of this work while challenging us each day to do more.

In honor of National Diabetes Month, here are seven ways we can take action together to spread the word about diabetes prevention.

88 Million Reasons to Support National Diabetes Month

November is National Diabetes Month—a time to raise awareness about the diabetes epidemic that is quietly underway in our country. It’s a chance to come together and take action, not just for the one in ten Americans who have diabetes, but for the 88 million of us who are at high risk of developing it due to high blood sugar levels (a condition known as prediabetes). 

As you walk through your city or town today, consider that, statistically, one in three people you see has prediabetes and more than 80% don’t know they have it. These numbers may come as a shock, but there is hope that we can change them. By making certain lifestyle changes, those of us with prediabetes can significantly lower our risk of a type 2 diabetes diagnosis. 

Could you be one of the 88 million people in America with prediabetes? Don’t be afraid to learn about your risk—knowing where you stand will allow you to take control of your health. The CDC-led National Diabetes Prevention Program offers a free risk test and other helpful resources at doihaveprediabetes.org. If you determine that you’re at risk, talk to your doctor so you can assess your risk level and develop a prevention strategy together. 

Remember the “one in three” statistic and consider sharing this tool with your loved ones or even via your social media channels. Raising awareness is the best way to turn the tide on diabetes. 

The COVID-19 pandemic has placed a spotlight on the widespread inequities in our healthcare system, which contribute to higher risk levels and worse outcomes in underserved communities. Just like COVID-19, diabetes disproportionately affects minority and low-income Americans. According to the ADA, Americans of color are nearly twice as likely to have diabetes and related chronic diseases.

Equal access to health care is a human right—no matter your race, gender, income, sexual orientation, age, or education. We urge you to read the ADA’s Bill of Rights to know your rights and better understand the injustices that many communities are currently facing. Please also consider sharing this resource to help shine more light on a dire issue. 

If you feel inspired to make waves for change, contact your government representatives to advocate for affordable and accessible healthcare for everyone. The ADA has created this online resource to help you reach out to lawmakers in your area and ask them to support legislation designed to end health disparities during the COVID-19 pandemic—from expanding health insurance coverage to making insulin more affordable. You can also sign up as an ADA Advocate to stay informed about issues affecting people with diabetes and keep using your voice to create change. 

If you or someone you know has type 1 diabetes, you might also consider signing up to become an advocate for JDRF—a nonprofit funding research and advocating for policies to help people with type 1 diabetes (T1D). According to JDRF, “Advocates use the most powerful tools they have — their own personal stories — to communicate the financial, medical, and emotional costs of T1D to our nation's leaders.” 

From enlightening talks to a live cooking class, the American Diabetes Association (ADA) is hosting some amazing virtual events throughout the month. Ask questions, listen to inspiring stories, and learn tips that can help you live a healthier life. 

You’ll also find a slew of virtual events hosted by JDRF on their monthly calendar, including a holiday auction, various meet and greets, and a Q&A session with an endocrinologist. 

Healthy choices matter for all of us, regardless of our risk level. This is a great opportunity to work on a new habit throughout the month. Whether you decide to take a daily walk or experiment with healthy kitchen swaps like chickpea pasta or nut-based milk, pick an activity that you might actually enjoy and try your best to keep it going. 

The jury is still out on how long it takes to solidify a new habit, but one recent study found that it took an average of 66 days before participants felt that new habits like eating fruit at lunch or running for 15 minutes became automatic. Of course, the actual time will vary by person and the perceived effort of the new activity. But the study found that daily repetition during the first few weeks was the key to making the new habits stick. 

If you’re currently living with diabetes, use this month as an annual reminder to recommit to your treatment plan. Taking medications as prescribed and keeping up a healthy lifestyle, including proper nutrition and exercise, is an essential part of reducing the impact of diabetes on your long-term health and well-being. 

And if you’re among the 1.5 million people who were newly diagnosed with diabetes this year, we share some helpful tips for settling into your routine in “Managing Your New Diabetes Diagnosis.” 

Find the Best Pharmacy for Your Diabetes Care

Managing your monthly medications should never be a struggle. Our pharmacists are on-call to field medication queries and walk you through doses or injections. We can deliver whatever you need—including insulin, glucose monitors, test strips, and more—directly to your door for free. For more on how we can help, read “The Best Pharmacy for Diabetes Care.” 

Want to learn more about Alto? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone/text at 1-800-874-5881, or the app. 

We offer the latest advice on how you can access the medications and services you need while protecting yourself from infection with COVID-19.

Navigating HIV Treatment and Prevention During COVID-19

Living with HIV during the COVID-19 pandemic

It’s been over six months since the first stay-at-home orders swept across the country, and we’re just beginning to replace widespread uncertainty about the coronavirus with real-world data. There’s still much we don’t know about how COVID-19 affects those living with HIV, but researchers are working quickly to glean insights from cases over the past months. 

Though our understanding is continually evolving and the data is limited, experts believe that people with HIV who are receiving treatment have the same risk for COVID-19 as the general population. We do know, however, that people with weakened immune systems are more likely to get severely sick from COVID-19, which underscores the already vital importance of preventing new HIV infections and ensuring access to treatment. 

If you are at risk of HIV infection or living with HIV, we encourage you to not put prevention or treatment on hold. It’s also crucial that you stick to the plan outlined by your doctor as closely as possible, especially by taking your medications correctly and on time. As your pharmacy, we’re here to help you overcome any challenges in maintaining your regimen that may arise. Let’s walk through the latest advice on how you can access the medications and services you need while protecting yourself from infection with COVID-19.

Is COVID-19 illness more severe in people living with HIV?

As we mentioned, when HIV is being treated, it does not seem to increase the risk of infection or severe illness. Those who are living with HIV and not on treatment or virally suppressed, however, may be at greater risk of COVID-19 complications. Additionally, older people living with HIV and those with other underlying health conditions may also be at greater risk of serious illness from COVID-19. It’s important to take precautions to protect yourself from COVID-19 infection by following CDC guidelines, such as wearing a mask, social distancing, and washing hands and high-touch surfaces often. 

We know that people living with HIV are more vulnerable to respiratory infections when their HIV is not well managed. That’s because their weakened immune systems may be unprepared to deal with an invading virus. For this reason, it’s incredibly important to continue your antiretroviral treatment (ART) as prescribed. If you are having difficulty continuing your treatment for any reason, talk with your healthcare provider right away.

What additional precautions should people living with HIV take?

The most important actions you can take for your health are to continue your HIV treatment and avoid potential exposure to the coronavirus. Follow the preventative guidelines outlined by the CDC to protect yourself and others from getting sick. Additionally, you should take the following precautions:

Keep your regular medical appointments and discuss ways you can reduce your risk of exposure to COVID-19 during your visits. Use telehealth services whenever possible; your doctor can advise you on the remote options available to you.

Keep at least a 30-day supply of your HIV medications on hand as well as any other medications or supplies you need to manage your health. If possible, ask for a three-month supply and choose a pharmacy that offers home delivery to avoid spending time in close contact with others while standing in lines. (Alto’s couriers will hand-deliver your medications to your doorstep, so you never have to worry about mail delays either!)

People living with HIV are at a higher risk of serious flu-related complications, make sure all your vaccinations are up-to-date, especially your flu shot.

The CDC recommends maintaining a healthy diet, aiming for 8 hours of sleep every night, and taking steps to reduce stress. 

If you start to feel sick, especially if you have a dry cough, fever, fatigue, and/or a loss of smell or taste, stay at home and contact your doctor immediately so you can determine your next steps. You will need to self-isolate to avoid spreading the coronavirus to others as you await instructions from your doctor. For this reason, we strongly recommend having a plan in place for if you get sick, including keeping 30 days’ worth of medications, food, and other supplies on hand.

How can I get tested for HIV during the COVID-19 pandemic?

It’s as important as ever to know your HIV status. If you’re at risk for HIV, talk to your healthcare provider about your options for getting tested. The CDC has stressed the importance of continued access to HIV testing and encourages people who are at risk for HIV infection to get tested in ways that support social distancing and stay-at-home orders (when they are in place), such as self-testing when possible. They have created this resource that lists self-testing services by state. You can also find in-person testing locations here. 

I’ve lost my insurance. How can I continue to get my HIV medication?

As we face this public health crisis, record numbers of people are also losing their jobs and employer-based coverage. If you’re currently uninsured or cannot afford your out-of-pocket costs, there are resources that can help. HIV.gov puts out this list of toll-free helplines that can help you find programs and services in your state to lower your treatment costs. They also list a variety of federal resources here. 

The AIDS Drug Assistance Program (ADAP), which is part of the Ryan White HIV/AIDS Program was created to help cover the cost of HIV-related prescription medications for people who have limited or no prescription drug coverage. Eligibility may vary by state, so find out more by using the ADAP Directory to identify your local program. 

How can I continue to access PrEP during the COVID-19 pandemic?

If you are at risk of HIV exposure, protecting yourself needs to remain a top priority. PrEP, or pre-exposure prophylaxis, is an HIV prevention method that's available by prescription. We explain more in our article, “All About PrEP for HIV Prevention.”

If you are already taking PrEP, talk to your provider about the possibility of telehealth options for the time being and see if you can get a prescription for a 90-day supply of PrEP. To find an in-person or online provider, visit one of the following websites:
PleasePrEPme.org
Greaterthan.org

If you need help paying for PrEP, there are assistance programs available that can cover the costs. PleasePrEPme.org maintains a comprehensive list of available resources here. 

What are some ways to cope with stress and anxiety right now?

It’s normal to experience heightened emotions during times of stress. And, unfortunately, some of the actions we are taking to protect ourselves, such as social distancing, can negatively impact our emotional well-being. Here are some ways you can protect your mental health and cope with the stress and uncertainty of the COVID-19 pandemic.

Unplug when you need to. It’s important to stay informed, however, the constant cycle of news reports and social media updates can become all-consuming and overwhelming. Take breaks from your devices when necessary and try to focus on reliable news sources and avoid social media accounts and websites that may be spreading rumors or false information.

Find soothing activities and practice them daily. Maybe you turn to a calming classic like meditation when you need to recharge or perhaps nothing makes you happier than whipping up a batch of chocolate chip cookies from scratch. Whatever helps you unwind is good for your emotional well-being and overall health. 

Stay on top of your health and wellness. Stress can disrupt your usual healthy habits. Try to move your body frequently, incorporate healthy foods, and get a full night’s sleep. You may not succeed every day and that’s okay. Just do your best to keep up your healthy habits most of the time. 

Seek help if you need it. If feelings of fear, anger, sadness, worry, or numbness interfere with your responsibilities for several days in a row or if you find yourself turning to unhealthy coping strategies like drugs or alcohol, please reach out for help. The CDC offers this list of free and confidential resources.

We are committed to ensuring you receive your HIV medications safely and on time throughout the COVID-19 pandemic. Our pharmacy locations are fully stocked, our couriers are ready, and our pharmacists can assist with coordinating early refills and longer fills. We offer free, contactless delivery, plus ongoing access to support and advice.  

Reach out to our HIV speciality team at 1 (800) 874-5881 (call/text) or send us a message through our mobile app. We’re available from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends.

Dr. Lisa Sterman, M.D., MPH, is an expert in the field of HIV medicine who has been in private practice in San Francisco for over 20 years. She kindly agreed to sit down and talk with us about pre-exposure prophylaxis (PrEP), an HIV prevention method that's available by prescription.

HIV Health Spotlight: A conversation about PrEP with Dr. Lisa Sterman

This interview has been edited for length and clarity.

Dr. Lisa Sterman, M.D., MPH, is an expert in the field of HIV medicine who has been in private practice in San Francisco for over 20 years. After obtaining her Master’s in Public Health, she completed her training in medicine and HIV at UCSF. She’s been involved in clinical research for HIV medications and has worked in the community as an educator and advocate, including serving on the Board of Directors for the San Francisco AIDS Foundation, for many years. 

Dr. Sterman kindly agreed to sit down and talk with us about pre-exposure prophylaxis (PrEP), an HIV prevention method that's available by prescription. The most important thing she wanted us to know? This conversation is for everyone.

Can you tell us a little about how you got started in your field?

It’s been a long road. I started working with HIV in the ’80s. I was at college in Berkeley, and I do a lot of rock climbing. My friend and rock climbing partner was a nurse at SF General, at their famous HIV ward. I knew I wanted to go into medicine and she said, “You should come volunteer on our ward.” It was the ‘80s, so it sounded totally controversial and dangerous and I was like, “I’m in.” That’s my personality, so that's how I got started. Really, it was the doctors and nurses there that inspired me to go into HIV. They were just incredible. 

What’s something everyone should know about PrEP?

Everyone needs to know that there is a pill that prevents HIV. So many people haven’t even heard of the concept. Nearly everyone is eligible with a short screening set of labs, so talk to your provider and find out if you might want to consider PrEP.

A lot of people may think, “I’m not at risk” or, “that’s not my group of people.” The way I teach it is: if you’ve ever had sex, you’re at risk for HIV. If you’ve ever shared drug needles, you’re at risk for HIV. Everyone should know their status. 

Editor’s Note: To learn more about PrEP and how it works, see our article, “All About PrEP for HIV Prevention.”

If you’re using condoms every time you have sex, would you still recommend PrEP? 

Yes, condoms break or fall off, and then you can have exposure. They are not 100%. I would say we’ve come as far as we can with condoms, that piece of HIV prevention efforts is great, and this is the next step. Condoms may prevent or reduce the risk of other STIs, but they are not the only or appropriate way to protect yourself from HIV if you are at higher risk for HIV.

Some groups of people at risk for HIV can’t always ask their partner to use condoms. They may not have the power in the relationship or they may be under pressure because they’re exchanging sex for commodities like housing, money, food, shelter, or drugs. PrEP helps empower many people who are at risk and can be taken without a partner’s knowledge or consent. In this way, some groups of people have a better chance of protecting themselves against HIV.

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Navigating HIV Treatment and Prevention During COVID-19

HIV Health Spotlight: A conversation about PrEP with Dr. Lisa Sterman

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All about PrEP for HIV Prevention

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