Living With HIV
Trekking With AIDS -- a Special Report
Taking on the Challenge of Hiking the Entire Appalachian Trail -- on Top of the Challenge of Remaining Compliant With a Five-Drug Antiretroviral Regimen
Dawn Averitt has been bucking the odds for more than a decade now -- ever since she learned that she had been infected with HIV by a man who took callous advantage of her when she was just 19 years old. She was told at the time that she would be lucky to live two years. Dawn defied those odds, and she defied the advice of her family physician, who counseled her to tell no one that she is HIV-positive. Instead, Dawn told the whole world -- in both words and deeds. She founded the very first AIDS service organization for seropositive women, and she became a passionate, compassionate, clear-headed, warm-hearted spokesperson for all people living with HIV.
This year Dawn is celebrating the thirtieth year of her life -- and her eleventh year of living with HIV -- by hiking the Appalachian Trail, all 2,160 miles of it, from Maine to Georgia. For Dawn, this trek fulfills a lifelong dream, one that has its origins in the day-long hikes that she, her brothers, and her parents took on the stretch of the Trail that passed near her childhood home. But Dawn's determination to follow her dream down the green spine of the Eastern Seaboard is something else as well -- it is vibrant, vital, valiant, visible proof that people with HIV need not set aside their aims and ambitions. After a decade of counseling other seropositive individuals to realize their dreams, Dawn is living out one of hers.
In this, too, the odds are against Dawn. Only 3,000 people try to hike the whole of the Appalachian Trail each year... and only 10% of these intrepid souls actually achieve their goal. Few of them have to be as scrupulous as Dawn must be about purifying all of the water they drink, and not one of them has to manage, despite the rigors of life on the Trail, to adhere to a highly complex five-drug antiretroviral regimen, as Dawn does, day in and day out.
But Dawn has been defying the odds for a long time now -- and so, when she says "I will do this," we know she will. As Dawn reports here, it hasn't been easy. First there was the record-setting heat wave, then the clouds of voracious black flies, then the misstep that resulted in a badly turned ankle... 3,000 feet up a mountain in northern Maine. But Dawn is apparently made of equal parts grit and gumption: she's back on the Trail after an unanticipated detour through the emergency room of a local hospital, and she and her party are averaging 12 to 15 miles a day -- which should get them home to Georgia just in time to celebrate the new millennium.
HIV Newsline will publish excerpts from Dawn's Trail diary in our October and December issues. Readers who want to keep closer track of Dawn's progress can do so by logging onto her web site, www.trekkingwithaids.com, which is updated on a regular basis with both new pictures and text. Dawn's trek is supported, in part, by a grant from Shamanbotanicals.com, which has developed a line of proprietary dietary supplements from medicinal plants that grow in the world's rainforests. These products are integral components of Shaman's Living with AIDS Initiative, a comprehensive approach to minimizing the pernicious side effects of multidrug antiretroviral therapy. In a sense, Shaman is the logical partner in Dawn's great adventure, since both share a belief in the healing power of nature. For further information on the products that Shaman is developing, see the company's web site: shamanbotanicals.com.
After a decade of urging other people who are living with HIV to go for their dreams, I am taking time out to fulfill one of mine. In a sense I am taking my own counsel, which is that no one with HIV should allow the virus to thwart their ambitions, to fog their future, to derail their dreams. This is the message that all healthcare providers should instill in all seropositive individuals, because it is as effective an antidote to hopelessness and despair as the most powerful antiretroviral regimen.
My companions and I knew that we were posing ourselves a particular challenge by electing to begin our great outdoor adventure at Mount Katahdin... but we had no idea how much of a challenge those first days would be. Maybe that's just as well, because if anyone had told me, before I shouldered my backpack and picked up my trekking poles on Day One, that on Day Eleven I would find myself sitting on a rocky outcrop, some 3,000 feet up Chairback Gap Mountain, nursing a badly turned ankle and wondering how I was ever going to get off that mountain, let alone all the way to Georgia....
I would still be sitting on that rock, but for my brother Scott, my friend Brad Bridge, and our cellular phone. My teammates helped me hobble the five miles back down Chairback Gap the way we had come, and they arranged for transportation to the nearest emergency room -- where I was told, by an overworked intern, that all I had was soft-tissue damage... and that I would be back on the Trail in two or three days.
Two or three days indeed. A week later I could finally bear weight on my injured ankle, and I began adjusting to the sports brace that I will have to wear for the remainder of my time on the Trail. It was two more weeks before we were able to resume our journey -- by hiking back up Chairback Gap, for the third and final time.
What I have learned
I stopped drinking unfiltered, unpurified water at the time I received my AIDS diagnosis, in July of 1994. (At that time my CD4 cell count was 74; thanks to my current five-drug regimen of efavirenz, ddI, saquinavir, ritonavir, and hydroxyurea, it is now ten times that.) So I didn't anticipate that I would have any difficulty adjusting, as all through-hikers must, to purifying all of the water they drink, cook with, and brush their teeth with. I was a bit more apprehensive about how well I would be able to adhere to my daily dosing regimen.
Perfect adherence is an article of faith with me -- as you know if you read "Hit the Road, Jack -- and Jill," an article that I wrote for the June 1998 issue of AIDS Care about how I manage to stay on my medication schedule even while I am crisscrossing continents and oceans in my role as a treatment advocate for people living with HIV. But perfect adherence is much easier to achieve on airplanes and in hotel rooms than it is on footpaths and in tents.
At home, I can space out my evening doses, taking my two protease inhibitors as prescribed -- with a "substantial meal" that is high in fat content -- and then waiting to take my efavirenz dose at bedtime. As all of us who take efavirenz know, this potent new non-nucleoside reverse-transcriptase inhibitor can produce sleep disturbances and mild disorientation, especially if it is taken with a high-fat bedtime snack, so I generally take this medication on an empty stomach.
This restriction presents no problems at home -- where bedtime is sometime around midnight and my refrigerator and larder are well stocked with low-fat snacks, in case I feel peckish at that late hour. But for the next five months my home is a Kelty Ultra-Light Windfoil tent... and bedtime is shortly after sundown -- which is when squadrons of mosquitoes emerge from the woods, to feast on anyone foolish enough to be out after dark. On the Trail, bedtime comes right after dinnertime. As I have already discovered, after I have hiked all day long with a 55-pound pack on my back, my interest in food is practically nil... and I have to force myself to eat the rehydrated glop on my plate in order to optimize the absorption of my medications. Moreover, our meals are usually supplemented with high-fat, high-protein power bars -- which means that I often have to lie awake in the tent, waiting for time to pass, before I can take my efavirenz nightcap and crawl into my sleeping bag.
Interestingly enough, compliance with my dosing schedule has not been the problem that I thought it might be; I've made the necessary adjustments, and I'm working with my current regimen to make it more manageable. As importantly, the side effects of therapy have not been a problem -- at least not so far. Diarrhea, which is a fact of life for virtually everyone who takes a protease inhibitor as part of a multidrug antiretroviral regimen, was a particularly worrisome prospect. Combining strenuous, unremitting physical activity with a diet long on fat and short on complex carbohydrates, supplemented by powdered protein and dried fruit, seemed almost certain to induce turmoil in my gut. Happily, that hasn't proven to be the case.
Indeed, if I have a concern about how I'm going to hold up on the Trail, it has to do with making sure that I eat enough to maintain my weight. I've already lost my appetite for instant oatmeal, a staple of life on the Trail, and I've begun to fantasize about green salads, juicy hamburgers, and raw carrots. When my companions and I reach one of the resupply depots and mail-drops along our route, they head straight for the beer cooler... and I head for the salad bar.
The friends who are following my progress -- and who have heard about the record-setting heat-wave that enveloped us just south of Katahdin, and the clouds of black flies that we swatted our way through, and the bone-chilling rains that fell for three straight days as we hiked the legendary Hundred-Mile Wilderness in central Maine -- ask me if I regret my decision. If they could have been with me, the evening I reached the top of Bigelow Mountain, if they could have shared in the vast stillness of that place, lit only by the Milky Way, they would not need to ask the question... because they would know my answer.
For Part 2 of this report, click here.
For Part 3 of this report, click here.
Dawn Averitt is founder of Women's Information Service and Exchange.
Back to the August 1999 HIV Newsline contents page.
This article was provided by San Francisco General Hospital. It is a part of the publication HIV Newsline.