POZ April/May 2024

30 Years of POZ

Three decades of HIV coverage

30 Years of POZ

Three decades of HIV coverage

as soon

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16 REFLECTING ON 30 YEARS OF POZ A look back at three decades of HIV coverage BY JENNIFER MORTON

26 30 LEADERS LOOK TO THE FUTURE OF HIV

As POZ marks 30 years of service, we reflect on what’s next. BY

MATHEW RODRIGUEZ

3 FROM THE EDITOR

The Best Is Yet to Come

4 POZ Q & A

Formerly incarcerated, Kerry Thomas takes on a new role at the Sero Project to fight HIV criminalization.

6 POZ PLANET

Man dies after alleged denial of HIV medications in jail • R.I.P. “Feisty Fighter” Frankie Franklin-Foxx, an early advocate for women • fighting HIV among homeless people • less than 1% of emergency room visits include HIV testing • POZ Stories: Lashanda Salinas helped reform Tennessee’s HIV criminalization laws

• Everyday: Milestones in the HIV epidemic

11 VOICES

NMAC executive director Paul Kawata

acknowledges that efforts to reduce HIV funding were beat back in 2023, but he cautions against complacency in 2024.

12 CARE & TREATMENT

Early treatment boosts immune recovery

• HIV risk factors among trans women • changing causes of death for people with HIV • exercise reduces belly and liver fat

14 RESEARCH NOTES

Lenacapavir PrEP • dolutegravir resistance

• cure for babies? • too many meds

15 BASICS

Human papillomavirus

32 HEROES

Peter Oates began working as an AIDS nurse 30 years ago, the same year that he tested HIV positive.

Peter Oates (left) with his husband, Gary Paul Wright

EDITOR-IN-CHIEF

ORIOL R. GUTIERREZ JR.

MANAGING EDITOR

JENNIFER MORTON

DEPUTY EDITOR

TRENT STRAUBE

SCIENCE EDITOR

LIZ HIGHLEYMAN

COPY CHIEF JOE MEJÍA

EDITORIAL ASSISTANT

LAURA SCHMIDT

ART DIRECTOR

DORIOT KIM

ART PRODUCTION MANAGER

MICHAEL HALLIDAY

CONTRIBUTING WRITERS

SHAWN DECKER, OLIVIA G FORD, ALICIA GREEN MARK S. KING, TIM MURPHY, MATHEW RODRIGUEZ, CHARLES SANCHEZ

CONTRIBUTING ARTISTS

JOAN LOBIS BROWN, LIZ DEFRAIN, ARI MICHELSON, JONATHAN TIMMES, BILL WADMAN

FOUNDER

SEAN STRUB

LEGACY ADVISER

MEGAN STRUB

ADVISORY BOARD

A. CORNELIUS BAKER, GUILLERMO

CHACÓN SABINA HIRSHFIELD PhD, KATHI

The Best Is Yet to Come

IT HAS BEEN 30 YEARS

since Michael died. He was only 30 years old. He passed just before the first issue of POZ was published. He was among the countless people lost to the virus before effective treatment.

I long ago made my peace with the fact that I contracted HIV from Michael. I spent years blaming him, but the stigma and discrimination related to the virus that were— and still are—widespread wiped away my anger. By walking in his shoes, I soon understood why he hadn’t disclosed his status to me. As they say, it takes two to tango.

My feelings about Michael are indeed complicated. Despite that, and perhaps because of it, I need to make it clear that I loved him and still do. There hasn’t been a day in these past three decades that I haven’t communed with him. I take great comfort in keeping him close.

As POZ commemorates 30 years of service, we take a look at where we’ve been and where the HIV community is going. To that end, our cover showcases a collage of 30 years of HIV coverage from the pages of POZ. For our main feature story, we chose 30 moments that represent how the magazine and epidemic have evolved over three decades. Go to page 16 to read more.

In looking ahead, for our second feature story, we asked 30 leaders from today’s HIV community to share their thoughts about the future of the epidemic.

In alphabetical order, they are: Guy Anthony, Jeff Berry, Keiva Lei Cadena, Shelby Chestnut, Tori Cooper, Porchia Dees, Daniel Driffin, Grissel Granados, Tami Haught, Kris Hayashi, Tim Horn, Jeremiah Johnson, Kamaria Laffrey, Arianna Lint, Donja Love, Brandon Macsata, Marnina Miller, Tamara Oyola-Santiago, Jirair Ratevosian, Venita Ray, Bruce Richman, Jason Rosenberg, Francisco Ruiz, Tyler Spencer, Andrew

Spieldenner, Charles Stephens, Marvell Terry II, Kerry Thomas, Dafina Ward and Mitchell Warren. Go to page 26 to see what’s next.

A topic that encompasses the past, present and future of the virus is HIV criminalization. Transmitting HIV, or even subjecting someone to the perceived risk of exposure, has been equated with committing a crime. Effective treatment has all but eliminated the risk, but laws that unfairly punish people with HIV remain largely intact across the country.

A movement to address HIV decriminalization has arisen. Kerry Thomas, formerly incarcerated for 15 years as a result of these laws, despite not transmitting the virus, has a new role to effect change. Go to page 4 for more.

While Michael is marking 30 years of being lost to the virus, AIDS nurse Peter Oates is commemorating three decades of living with HIV. This is the first time he has disclosed his status publicly. In the January/February 2024 issue, we profiled his husband, Gary Paul Wright, who is HIV negative. Go to page 32 to learn how Peter is still making a difference.

ORIOL R.GUTIERREZ JR. EDITOR-IN-CHIEF editor-in-chief@poz.com

Want to read more from Oriol? Follow him on Twitter @oriolgutierrez and check out blogs.poz.com/oriol.

FREE AND GRATEFUL

Formerly incarcerated, Kerry Thomas takes on a new role at the Sero Project to fight HIV criminalization.

WHEN KERRY THOMAS BEGAN SERVING A 30-YEAR sentence in Idaho for nondisclosure of his HIV-positive status in 2008, becoming a prominent voice for people living with the virus was the furthest thing from his mind. But that changed when a few years into his sentence, he was notified that someone wanted to meet with him to discuss the injustice of his prosecution.

Thomas wasn’t interested at first. He was just trying to serve his time and not make waves. As he was walking to the visitors’ room for the meeting, he told the officer accompanying him, “I’m just doing this to be polite. Give me about 15 minutes, and get me out of here.”

The person waiting for Thomas was Sean Strub, founder of POZ and the Sero Project. Strub and Thomas ended up speaking for eight hours. By the time they were done, Thomas knew he had to become involved with the Sero Project. “I didn’t want the next person, in Idaho or otherwise, to go through what I went through,” Thomas says. “Anything I could do to help with that—I was on board.”

What followed was years of Thomas granting media interviews from prison and appearing at conferences via video chat. In September 2023, he was released after 15 years of incarceration, due, at least in part, to his involvement with the Sero Project and its fierce advocacy on his behalf.

Thomas spoke with POZ contributing writer Mark S. King about his new role as the community HIV decriminalization strategist at the Sero Project.

I’ve been watching you in interviews for years. The difference is that I have always heard you speaking from the confinesof the Idaho State Penitentiary.

Now you work with the Sero Project, which works to modernize or reform HIV criminalization laws, and you are Exhibit A. Can you tell us what happened 15 years ago?

In 2008, I was charged and convicted of “failure to disclose” my HIV status to my [sexual] partner. I decided to take a plea, and the judge sentenced me to 30 years.

You had sex with a woman with whom you used a condom, and you were undetectable at the time—so you had two modes of prevention and there was no HIV transmission.

Like with many nondisclosure statutes [across the country], they don’t require transmission, and it’s more like you have to prove that you did disclose. It’s a brutal process.

Clockwise from left: Kerry Thomas after being released from prison; Thomas in an HIV criminalization awareness campaign by the Sero Project; Thomas on the cover of Turn It Up!, a magazine for incarcerated people

You decided to cop a plea. Tell me why you made that choice.

My son was just turning 14 at the time. These kinds of charges encounter a lot of media attention. It was heavy. It was numbing. I felt fearful and alone.

I also had two parents who were elderly. The media attention had absolutely nothing to do with the virus or the medical facts.

Considering these laws are often a stand-in for homophobia and racism, you became the big, bad Black boogeyman. So rather than face a jury, you decided to go the route of pleading. It wasn’t necessarily to get out of the drama publicly. I would argue that people who are HIV positive just want to tell the truth.

It wasn’t as if people in my work environment didn’t know about my status, but it comes down to the people who need to know. It’s not a requirement that people who are positive have to put their business out there 24/7.

I have often said that my personal medical information is none of anyone’s business. Especially if I pose no threat to you.

Yes.

One might expect that you counted on some humanity from the judge, at least a sentence that did not amount to 30 years. That must have been a shock to you.

When you’re sentenced, they tell you why they are sentencing you to this time. What [the judge] said was, “I can’t trust you to be in society.” That really hit me. That’s a bold statement.

The profound ignorance of people who have our lives dangling on a string is quite often astounding.

And yet by the time that you were speaking from prison regularly at the HIV Is Not a Crime conferences, you had come to a place of acceptance and service to other people. That’s truly remarkable.

I appreciate that. I don’t disregard my accuser. [HIV criminalization] puts a strain on everyone, including the per-

son who’s making the accusation. There’s no opportunity to have that give and take, to give honest medical information to the person. That’s left out. They’re left to believe all the negative things—that I’m a pariah, that anyone who is HIV positive is reckless, the phobias and the racism.

And what I learned is that the victim in this case just wanted an explanation. She wanted to know why someone she trusted in an intimate way would put her “at risk.”

And her ignorance is understandable. She was afraid. Fear is a powerful thing. But once the cops are involved, there’s no going back It’s too late. Something I will always be grateful for is that I had to file what is known in Idaho as a commutation. It goes to the parole commission, and the parole

Kerry Thomas

trans people in prison or 18-year-olds who go there and aren’t sure how to survive. I was able to develop, because of the Department of Correction, relationships with a lot of people that way. It’s who I know now that brings value to my life and has brought freedom back into my life.

One thing we have in common beyond HIV is that we were in a situation where we felt that all was lost, and we figured out a way to turn it outward toward others—which to me is the little secret to life. You take what’s going on with you and you use it to help somebody else.

Isn’t that the truth? The joy I get in the world is not mine anyway. It is not something that I own or possess.

It’s a gift. You get more by giving it away. You don’t hold on to it. And my

“I knew that Iwanted tobe involved.”

commission is the one that decides if they are going to modify my sentence. As part of that, my accuser wrote a letter [to the parole commission] saying, “I understand, and I’ll leave the decision up to you.”

You decided to be of service during yourtimeinprison.

I didn’t know what being an activist meant, but I knew that I wanted to be involved. The Idaho Department of Correction was equally a partner with me and Sero. They allowed me to speak at conferences.

The value for me was that it gave me the space to figure this thing out, to decide that I do want to be an advocate.

I realized I do want to speak up for

fear that I had during my initial HIV diagnosis was that I better hold on to whatever I thought that my self-worth was at the time.

As it turns out, all the corny things they say are true, in terms of giving and receiving. And either of us would have reason to be resentful or a little jaded at this point, taken what we have been through.

Holding on to resentment, that’s just chain-smoking hate. And I just can’t do that anymore. You’ve got to just let that stuff go. ■

Mark S. King is the author of My Fabulous Disease: Chronicles of a Gay Survivor and a GLAAD Award–winning writer

Man Dies After Alleged Denial of HIV Meds

Lawsuit claims he didn’t receive treatment for two months.

A California inmate with HIV died after allegedly being denied antiretroviral medication prescribed by his doctors and then contracting a preventable viral infection. The man’s family filed a wrongful death lawsuit against the county and its health care contractor, claiming they failed to provide the man’s lifesaving treatment.

In February 2022, Nicholas Overfield, 38, was arrested for failing to appear in court. During his arrest, he informed officers of his HIV-positive status and need for antiretroviral medication to maintain his health. Overfield’s mother, Lesley Overfield, a plaintiff in the lawsuit, reportedly gave her son’s prescribed antiretrovirals to officers, who took the meds with them, CBS News reports.

Just two months later, Lesley visited her son in jail and found that his health

had declined to the extent that he was too weak to walk and had to use a wheelchair. The next day, Overfield was rushed to the hospital; he was transferred to hospice care soon thereafter.

“Medical records show that he was denied his

prescribed HIV medication for the entire two months he was detained,” the lawsuit alleges.

Overfield died on June 21, 2022. According to the lawsuit, his death certificate stated that the immediate cause of death was varicella

R.I.P. “FEISTY FIGHTER” FRANKIE FRANKLIN-FOXX

In 1988, she was a founding member of the Chicago Women’s AIDS Project.

Frankie Franklin-Foxx, who learned she had HIV in the 1980s and became an early advocate for other women with the virus in Chicago, died of a heart attack on December 13, 2023 . She was 68, according to an obituary on Inclusive FuneralCare.com posted by her family, which added: “She will be remembered as a very strong and outgoing character— a feisty fighter!”

In 1988, Franklin-Foxx became one of the first members of the first support group for HIV-positive women in Chicago. She was a client and peer counselor and served on the board of directors. She was also active with the Women’s Interagency HIV Study, the nation’s largest observational study of women

living with or at risk of contracting HIV. (Funded by the NIH and launched in 1993, the multisite study is ongoing.)

A long-term survivor, Franklin-Foxx was interviewed by Oprah Winfrey and Dan Rather. And a panel on the AIDS Memorial Quilt is dedicated to her.

“She was one of the longest-lived members of that early group of women who came together and said, ‘We have to take care of each other, speak out, support each other,’” Catherine Christeller, founder and executive director of the Chicago Women’s AIDS Project, told the Chicago Sun Times.

Christeller recalled that the group rented space in a cobalt-blue Victorianstyle home in Edgewater. “We started

zoster virus encephalitis. Varicella zoster virus generally shows up as chickenpox or a painful rash known as shingles, but it can infect and damage the central nervous system and cause encephalitis, an inflammation of the brain. Overfield allegedly contracted the virus two months prior to his death— meaning while he was incarcerated—according to court documents.

The lawsuit filed on January 16 in U.S. District Court names as defendants the County of El Dorado and Wellpath Community Care, the jail’s health care contractor.

“Wellpath has a well-documented history of providing shockingly inadequate medical ‘care’ in jails and prisons across the country,” the lawsuit states. —Laura Schmidt

with one room and expanded to take over most of the building,” Christeller said. “It was old and drafty, but there was room for the women to meet and for their children to play, and there was a big kitchen for hot lunch, and we did Thanksgiving and Christmas and Mother’s Day.”

Frankie FranklinFoxx

Effective HIV treatment didn’t become available until the mid-’90s. Stigma, fear and misinformation prevailed during the early years of the epidemic, and few were willing to be the face of the disease. Franklin-Foxx was an exception, outspoken and willing to attend rallies and advocate for public policy and funds. —Trent Straube

FIGHTING HIV AMONG HOMELESS PEOPLE

A Boston program suppressed viral load and lowered new HIV cases.

As Boston’s largest homeless service provider since 1985, Boston Health Care for the Homeless Program (BHCHP) has transformed HIV care by delivering lifesaving treatment directly to homeless individuals living with or at risk for HIV. BHCP’s most recent study, “HIV Program Response to Boston HIV Cluster: Data Trends 2019–2023,” details the astounding progress the organization has made in recent years, the Boston Globe reports.

Led by Jennifer Brody, MD, MPH, director of HIV services at BHCHP, the study findings show the effectiveness of community outreach in reducing HIV transmission and increasing viral suppression. The program forgoes traditional doctor’s appointments and clinic visits and prioritizes nurses who work directly in communities handing out antiretroviral medications to those with HIV.

Dedicated nurses provide care in various unconventional settings, such as street corners, under bridges, down back alleys, community meal programs, overnight drop-in centers, emergency departments and more.

The program launched at the height of the COVID-19 pandemic, when HIV diagnoses among homeless people who use drugs in Boston spiked from about two a month to more than two dozen cases, according to the Boston Globe.

BHCHP nurses do more than provide HIV treatment to people on the streets. They also draw blood to determine individuals’ HIV status and act from there. Outreach teams then follow up to ensure participants continue taking their medication.

The study tracked the number of newly diagnosed people linked to care at BHCHP since 2019. Findings showed that diagnoses peaked in 2021 with about 60 new cases and have been declining steadily since. By the end of 2023, there were fewer than 10 new HIV diagnoses per month.

What’s more, as of August 2023, the viral suppression rate for people living with HIV who were receiving outreach-based adherence support was 90%. —LS

Less Than 1% of ER Visits Include HIV Testing Emergency rooms can offer access to HIV services.

Less than 1% of visits to the emergency room in 2019 and 2020 included an HIV test, according to findings published in the February 2024 issue of AIDS. This is despite the federal recommendation that people in health care settings should be tested for HIV unless they decline (referred to as opt-out screening).

What’s more, compared with other U.S. regions, the South saw the lowest rates of HIV testing in ER settings: 0.6% in 2019 and 0.5% in 2020. Compared with metropolitan areas, rates in the more rural South were even lower (0.1% or less each year).

This is notable because for several years, the South has been the epicenter of our nation’s HIV epidemic, particularly for people of color. In 2021, the South comprised 38% of the U.S. population but 52% of new HIV diagnoses, according to data from the Centers for Disease Control and Prevention (CDC).

Several factors contribute to higher HIV rates in the South, including poverty, unemployment, stigma, lack of access to care in rural areas and a lag in testing, treatment and education. In addition, many Southern states have not expanded Medicaid, the health insurance program for low-income and disabled Americans that is the largest source of health coverage for people living with HIV in the United States.

In addition, the CDC estimates that around 14% of the 1.2 million people living with HIV nationwide do not know they carry the virus, and nearly 40% of new HIV cases are transmitted by people who don’t know their status.

Thus, failing to test people for HIV when they are at the ER is a missed opportunity to diagnose and connect folks to care, since it is well established that emergency departments can offer vital access to HIV services. —TS

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MOST IMPORTANT INFORMATION ABOUT BIKTARVY

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ABOUT BIKTARVY

BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults and children who weigh at least 55 pounds. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements.

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS.

Do NOT take BIKTARVY if you also take a medicine [OH[JVU[HPUZ!

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BEFORE TAKING BIKTARVY

Tell your healthcare provider all your medical JVUKP[PVUZPUJS\KPUNPM`V\!

` Have or have had any kidney or liver problems, including hepatitis infection.

` Are pregnant or plan to become pregnant.

` Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

Tell your healthcare provider about all the medicines `V\[HRL!

` Keep a list that includes all prescription and over-thecounter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

` Ask your healthcare provider or pharmacist about medicines that interact with BIKTARVY.

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This is only a brief summary of important information about BIKTARVY® and does not replace talking to your healthcare provider about your condition and your treatment.

POSSIBLE SIDE EFFECTS OF BIKTARVY

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` Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

` ;OLTVZ[JVTTVUZPKLLffLJ[ZVM)02;(9=@ in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).

;OLZLHYLUV[HSS[OLWVZZPISLZPKLLffLJ[ZVM)02;(9=@ Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY. Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.

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CHANGING LAWS AND CHANGING LIVES

Advocate Lashanda Salinas helped reform Tennessee’s HIV criminalization laws.

B

y Lashanda Salinas

I’m an advocate living in the state of Tennessee. I have been living with HIV for 25 years. Last year, I wrote an article sharing how after ending a six-month relationship, I was charged with criminal exposure to HIV and sent to jail. I was offered a plea deal, which I didn’t want to take because I knew I was innocent. But taking the plea meant I could go home and be with my family. So I accepted it. But I wasn’t told that I would have to register as a sex offender for the rest of my life.

Three years ago, I decided to speak out about my story of being unjustly criminalized because of my HIV status. I decided to use my voice for the people who are afraid to stand up and speak out. I told my case manager at Nashville Cares I did not want anyone to go through what I had been through.

My first assignment was Day on the Hill in Nashville with the Tennessee AIDS Advocacy Network (TAAN), which works

with Nashville Cares. I was a nervous wreck because I had to speak to state senators and representatives and tell them my story and let them know how the laws do not match science. I spoke to one senator who did not know that criminal exposure to HIV was against the law. I shared my story and told him how stigmatizing that law is. I started working with more organizations and trying to repeal or amend these laws.

Well, my work paid off, because on May 17, 2023, Tennessee Governor Bill Lee signed a law that removes criminal HIV exposure from the list of offenses that require sex offender registration. (Criminal exposure is still classified as a class C felony, which carries a jail sentence of three to 15 years—the same as vehicular homicide.) The law was to go into effect on July 1.

On July 2 or 3, my best friend and fellow advocate was blowing up my phone. She was calling, texting, emailing

and reaching out on Facebook. I called her back, and she told me to go online and check the registry. I did and could not find myself listed. I kept refreshing the page because I thought it was a hoax. But as of July 1, I no longer had to register as a sex offender.

The sun began to shine. There was light at the end of the tunnel I was in. But there is a lot more work to do.

When people started hearing about me getting off the registry, the Lord opened so many doors for me. My fellow advocates decided to have a celebration day for me on November 1. It was a beautiful night, and I was surrounded by love and support from advocates from the Center for HIV Law and Policy, the Elizabeth Taylor AIDS Foundation’s HIV Is Not a Crime Council of Justice Leaders, the Sero Project, Positive Women’s Network–USA, Nashville Cares and TAAN. Without these organizations, I would not be where I am today.

To anyone afraid to speak up, know that I am your voice. I will put on the armor of God and fight the stigma for you. My motto is: “Changing Laws and Changing Lives.

Read other POZ Stories or share your own at poz.com/stories.

Lennox,Keys and John

GMHC holds its first AIDS Walk in New York City The event raises $710,000 and features Mayor Edward Koch and entertainer Peter Allen as special guests. (1986)

NATIONAL ASIAN & PACIFIC ISLANDER HIV/AIDS AWARENESS DAY

Fashion designer PERRYELLIS dies of viral encephalitis at age 46 His spokesperson refuses to say whether his death was related to AIDS. (1986)

STAY STRONG

In a blog post titled “2024 Vision,” NMAC executive director Paul Kawata acknowledges that efforts to reduce HIV funding were beat back in 2023 but caution

AFTER 35 YEARS IN THE HIV movement, I know 2024 will test our resistance like never before. We should be very concerned about potential federal budget cuts, investigations into HIV prevention and education materials, the 5th Circuit Court decision on Braidwood v. Becerra and our ability to end the HIV epidemic in America with much less funding than we had been allocated.

HOW DID WE GET HERE?

HIV funding is under a coordinated attack just because it goes against some people’s values. Those on the radical right will continue to weaponize our lives with inflammatory narratives that get their base to vote. Just as they want to control women’s bodies by outlawing abortion, they want to limit HIV support because it goes against their religious beliefs.

We know too well what that looks like. It means more from the same old playbook but much greater force: sweeping anti-LGBTQ, anti-women, anti–people of color legislation with continued attacks on health care access, PrEP [pre-exposure prophylaxis], abortion and affirmative action.

Our movement thankfully beat back some of these efforts in 2023, but

that’s no cause for complacency. Despite the strong policy efforts of multiple national organizations, there has never been a moment like the one in front of us.

WHAT CAN WE DO AS A COMMUNITY?

Get Out the Vote: Progressive movements must work to get the community to vote. While NMAC, as a 501(c)3 nonprofit, cannot take sides in any elections, we can, like other nonprofits, work to register voters and drive clients to the polls. While it might be hard to believe, it looks like it will be a rematch between Biden and Trump.

This election will also decide the future of many profoundly American issues that we deeply care about. It’s not only HIV but also gun control, climate change, abortion, immigration, student loans, affirmative action, Black Lives Matter, the wars in Ukraine and the Middle East, gender-affirming care, equality; the list goes on. It is a fight for the soul of America.

Build the Movement: Some might question NMAC’s focus on the election, but we know too well how policy affects our personhood. We also believe this is an all-hands-on-deck moment. While individually, NMAC is too small, we can

continue to make a deep impact by mobilizing and uniting as part of a national movement.

Strengthen Partnerships: In this crucial year, it is also imperative to continue our collaborations with progressive federal partners to End the HIV Epidemic in the United States and with our invaluable community coalitions. We have come this far only because we have persevered together and followed the science. I can truly never overstate the value of our people’s power.

2024 will be especially tough on the communities carrying the greatest burden of HIV, even after we’ve come so far. We’re working up and down the ballot, fighting to ensure America’s continued commitment to equality and justice. So now, we will not concede ground without a fight. But as we’ve witnessed, neither will the radical right, which is why I am so concerned.

They will call us horrible names like never before. While we know the truth, the trauma of their lies could impact our mental health and that of the people we serve. Hopefully, I’m wrong. But what I am right about is that it’s time for our community to get ready to vote!

Stay strong. ■

s against complacency in 2024. Below is an edited excerpt.

EARLY HIV TREATMENT BOOSTS IMMUNE RECOVERY

People who start antiretroviral therapy soon after acquiring HIV are more likely to experience full immune recovery, according to a recent study. Prior research has shown that starting antiretrovirals during acute HIV infection (the first month) can limit the size of the viral reservoir; starting treatment during primary HIV infection (the first six months), before extensive immune damage occurs, is also beneficial.

The HEATHER study included 204 people in the United Kingdom with documented primary HIV infection who started antiretroviral treatment within three months after diagnosis. Even at this early stage, most already showed evidence of immune dysfunction.

Almost everyone achieved a viral load below 200 after starting treatment. However, after nearly three years of follow-up, just 47% reached a CD4 T-cell count above 900 (normal for HIV-negative people is 500 to 1,500), and 64% achieved a normal CD4/CD8 ratio (greater than 1.0). Having a lower CD4 count, CD8 count or CD4/CD8 ratio at treatment initiation was associated with a longer time to CD4 cell recovery. For every day treatment was delayed, there was a lower likelihood of achieving a normal CD4 count and CD4/CD8 ratio.

While there was once uncertainty about when to start antiretrovirals, it is now well established that sooner is better. “Our findings further the rationale for same-day or earlier antiretroviral therapy, even during primary HIV infection, to support more rapid immune recovery,” John Patrick Thornhill, MD, PhD, of Imperial College London, and colleagues wrote.

Exercise Reduces Belly and Liver Fat

Getting enough physical activity can help older people with HIV shrink their waistline and reduce fat accumulation in the liver, according to two recent studies. Weight gain is a growing concern for HIV-positive people. The accumulation of visceral fat within the abdomen—indicated by a large waistline—is particularly detrimental to health.

The first research team assessed the association between physical activity and abdominal fat in 416 people (average age 58) with well-controlled HIV. The participants used an accelerometer to record their physical activity for about a week. After controlling for other factors, waist circumference was about 1 centimeter smaller for every additional 1,000 steps per day. Conversely, a greater amount of daily sedentary, or inactive, time was associated with a larger waistline.

In the second study, researchers looked at the link between physical activity and liver fat accumulation, or steatosis, among 466 people (median age 52) in the Swiss HIV Cohort Study. Transient elastography screening showed that half had at least moderate liver steatosis, and a third had severe steatosis; even among lean individuals, nearly a third had steatosis. After controlling for other factors, people who did not get the recommended amount of physical activity were more than twice as likely to have steatosis. What’s more, the likelihood of steatosis rose with each additional hour of daily sitting time.

“Future work should investigate how to tailor the amount, type and intensity of physical activity needed to reduce adiposity in people with HIV taking contemporary HIV medication,” Allison Webel, RN, PhD, of the University of Washington School of Nursing, and colleagues wrote.

HIV Risk Factors Among Transgender Women

Several factors, including discrimination, homelessness and violence, help explain why transgender women—especially women of color— have a higher risk for HIV, according to a collection of seven reports from the Centers for Disease Control and Prevention.

The findings come from the National HIV Behavioral Surveillance Among Transgender Women project, which surveyed more than 1,600 participants in seven U.S. cities during 2019–2020. Around two thirds were living in poverty, 42% had experienced homelessness during the past year and a third had exchanged sex for money or drugs. Most (70%) said they had experienced transrelated discrimination, and over half reported gender-based violence, abuse or harassment. More than a quarter reported recent psychological distress, and 18% said they had considered suicide during the past year. Those who reported social disadvantages, substance use or psychological distress were more likely to say they had condomless sex.

Among those surveyed, 42% had been diagnosed with HIV, but this varied by race/ethnicity: 62% of Black trans women, 35% of Latina women and 17% of white women were HIV positive. Most trans women diagnosed with HIV (90%) were currently on antiretroviral treatment. Over 90% of HIV-negative respondents knew about pre-exposure prophylaxis (PrEP), and nearly 60% had discussed it with a health care provider, but only 32% had recently used it.

—Laura Schmidt

CHANGING CAUSES OF DEATH AMONG PEOPLE WITH HIV

All-cause mortality has dropped among people with HIV in high-income countries over the past three decades, and the causes of death have been shifting, but not all groups have benefited equally.

One recent analysis looked at mortality trends among more than 189,000 adults in North America and Europe who started antiretroviral treatment between 1996 and 2020; a total of 16,832 people (9%) died during the study period. Over the entire period, the most common causes of death were AIDS (25%), non-AIDS/non-liver cancers (14%) and cardiovascular disease (8%). The all-cause mortality rate fell by half, from 16.8 deaths per 1,000 person-years during 1996–1999 to 7.9 per 1,000 during 2016–2020. Among people who inject drugs, however, the overall mortality rate decreased only slightly for men and increased for women. The proportion of deaths due to AIDS declined dramatically between the two periods, from 49% to 16%. Deaths due to cardiovascular disease, non-AIDS/non-liver cancers and liver disease also fell. The only increases in mortality were due to central nervous system causes, respiratory illnesses and substance use.

Similarly, an analysis of deaths in the Swiss HIV Cohort Study found that HIV/AIDS-related mortality decreased steeply, falling from 19% of all deaths during 2005–2007 to just 4% during 2020–2022. The share of liver-related deaths also decreased dramatically, from 15% to 2%. Most liver-related

deaths were due to hepatitis C, and the decline was attributable in part to the advent of antiviral treatment. In contrast, nonAIDS/non-liver cancer deaths doubled, rising from 15% of all deaths during 2005–2007 to 31% during 2020–2022, with lung cancer being the most common cause. Cardiovascular deaths remained relatively stable at just over 11%.

“Comprehensive health care strategies focusing on nonAIDS-related comorbidities, cancer management and sustaining liver and cardiovascular health are needed to bridge the ongoing health disparities between people with HIV and the general population,” the study authors concluded.

PREVENTION

Lenacapavir PrEP

Gilead Sciences is conducting five clinical trials to test lenacapavir for pre-exposure prophylaxis (PrEP). In 2022, the Food and Drug Administration approved lenacapavir (Sunlenca) for treatment-experienced people with resistant virus. It is also being tested for first-line therapy and HIV prevention. Participants in the PURPOSE trials will receive twice-yearly lenacapavir injections or daily PrEP pills. The studies will compare the rate of HIV acquisition among people who use either form of PrEP against the background rate. PURPOSE 1 enrolled adolescent girls and young women in Africa, while PURPOSE 2 enrolled cisgender and transgender men, transgender women and nonbinary people in the United States and six other countries who have sex with men. PURPOSE 3 and PURPOSE 4 are recruiting U.S. cisgender women and people who inject drugs. Finally, PURPOSE 5 will be conducted in France and the United Kingdom. If found to be effective, lenacapavir could become the longestacting PrEP option, administered just once every six months.

Dolutegravir Resistance TREATMENT

People who use dolutegravir are unlikely to develop drug resistance, but the odds are greater if it is used alone or with companion drugs that are not fully active. Dolutegravir—sold alone as Tivicay and a component of the Dovato, Juluca and Triumeq single-tablet regimens—is a potent integrase inhibitor with a high barrier to resistance. It is a recommended first-line option in U.S. treatment guidelines and one of the most widely used HIV medications worldwide. The RESIST study looked at 599 mostly treatmentexperienced people in eight countries who had a detectable viral load despite taking a dolutegravir-based regimen. Genotypic resistance testing showed that 14% had a detectable integrase resistance mutation, and 3% had more than one. The risk of resistance was greatest for people who used dolutegravir alone and was also higher for those who used dolutegravir plus lamivudine without a third drug. Resistance was more likely among people who had NRTI resistance mutations, which could mean dolutegravir was essentially acting as monotherapy.

CURE

Cure for Babies?

Infants who start antiretroviral therapy (ART) very early may be able to maintain viral suppression after stopping treatment. In 2013, researchers reported on the Mississippi Baby, an infant born with HIV who started antiretrovirals 30 hours after birth. Her treatment was stopped at 18 months, but she maintained viral suppression for more than two years off ART. Now, the same team has reported findings from a study of 54 babies born with HIV, suggesting that starting antiretrovirals within the first days of life may lead to sustained viral control. The researchers estimated that infants born to mothers who were not on ART had a 33% chance of maintaining viral suppression after stopping antiretrovirals, while those born to mothers on treatment had a 57% chance. Among the children with an undetectable plasma HIV RNA viral load at age 2, a majority also had no detectable HIV DNA, indicating a very small or nonexistent viral reservoir. However, the children have not yet stopped treatment to see whether they achieved a functional cure.

Too Many Meds CONCERNS

Many older people living with HIV take multiple medications, some of which they may not need. Researchers in Spain found that around a third of older HIV-positive individuals may be taking medications that are inappropriate for their current condition or are using them longer than recommended. Prolonged use of medications for depression and anxiety, including benzodiazepines and anticholinergic drugs, was a particular concern.

Side effects of anticholinergics may include decreased mental alertness and poor coordination. On the other hand, clinicians were not prescribing certain drugs, such as statins, for some people who could benefit.

A second study found that people taking multiple medications had a slower gait speed—a sign of frailty— and were more likely to experience recurrent falls. In addition to their antiretrovirals, 36% of study participants ages 60 and older were usin fi ve or more prescription drugs. Thes fi ndings suggest that regular reviews can help ensure that older people are not taking meds that are unnecessary or inappropriate.

HUMAN PAPILLOMAVIRUS

Some types of HPV can cause cervical, anal and other types of cancer.

HUMAN PAPILLOMAVIRUS

(HPV) is the most common viral sexually transmitted infection in the United States. While most of the more than 100 types of HPV don’t cause symptoms, some can lead to serious problems, including several types of cancer. Fortunately, an effective vaccine can prevent HPV infection and its complications.

HPV lives in epithelial cells on the surface of skin and mucous membranes, most often affecting the cervix, genitals, anus or mouth and throat. It is easily transmitted via sexual contact, and a majority of sexually active people have had one or more types of HPV at some point. In many cases, the immune system can successfull fi ght the virus and clear the infection.

Some types of HPV trigger abnormal cell growth. HPV types 6 and 11, for example, cause genital or anal warts. High-risk, or oncogenic, HPV types— especially types 16 and 18—can cause abnormal cell changes that may progress to cervical, anal, oral, penile or vulvar cancer. At different stages, abnormal cells may be called dysplasia, low-grade or high-grade squamous intraepithelial lesions or cervical or anal intraepithelial neoplasia.

While HPV is common in the general population, people living with HIV are more likely to acquire HPV, more likely to

carry multiple HPV types, less likely to naturally clear the virus and more prone to develop dysplasia or cancer. Invasive cervical cancer is included in the definition of AIDS, but anal cancer is not.

PREVENTION AND TREATMENT

Condoms can reduce HPV transmission, but they provide only limited protection. The best protection is the HPV vaccine. The current Gardasil 9 vaccine protects against nine types of HPV (6, 11, 16, 18, 31, 33, 45, 52 and 58). The vaccine is recommended for both girls and boys ages 9 to 12, with catch-up vaccination through age 26. But some older people can still benefit, and the Food and Drug Administration has approved Gardasil 9 for those up to age 45.

Dysplasia is usually diagnosed with a Pap smear. This involves removing a sample of cells and examining them under a microscope for abnormalities. An HPV DNA test may also be done to detect cancer-causing types. Regular Pap smears and HPV tests are recommended for women, trans men and other people with a cervix. Anal Pap smears and HPV tests are still not routinely done, but the ANCHOR study showed that screening and early treatment can reduce the risk of anal cancer in people living with HIV.

There is currently no specific antiviral therapy for HPV infection, so treatment

focuses on managing dysplasia and preventing progression to cancer. In some cases, dysplasia resolves on its own, but this is less likely for people with HIV. If a Pap test shows dysplasia, the next step is colposcopy or anoscopy, in which a doctor examines the cervix or anus using a lighted magnifying instrument.

A variety of treatments are available to remove or destroy abnormal cell growth, including medicated gels or creams, freezing lesions (cryotherapy), burning off lesions using electricity (electrocautery), infrared light or lasers, and minor surgery. The effectiveness and side effects of these treatments can vary widely. Some methods cause more discomfort, some require multiple administrations and some require more recovery time.

Once dysplasia or neoplasia has progressed to cancer, more aggressive treatment may be needed. This can include surgery, radiation, chemotherapy, targeted therapy medications or immunotherapy. Ask your doctor whether you might be eligible for clinical trials of new treatments.

People with sexually transmitted infections often experience shame or stigma, which can discourage seeking care. But regular HPV screening and prompt treatment of dysplasia can prevent progression to cancer that is harder to treat. ■

REFLECTING ON 30 YEARS OF POZ

HIV COVERAGE

THREE DECADES OF

FOR THE PAST

three decades, POZ has chronicled the HIV epidemic in the United States and around the world. The magazine has explored the highs and lows in the ongoing battle against HIV and tackled issues often ignored by other media outlets. When the April/May 1994 issue launched, the protease revolution was still on the horizon, and millions of people across the globe were dying of AIDS-related illnesses.

POZ became a lifeline for many of our readers, providing access to critical information about the prevention, care and treatment of HIV.

Throughout its publication, POZ has also shared personal stories of survival as well as loss. POZ has given people hope, not only showing those living with HIV that they aren’t alone but also empowering them with the knowledge and courage to live with dignity.

As we look back at the history of the HIV epidemic, it often seems that the more things change, the more they stay the same. We’re still battling stigma, homophobia, racism, sexism, homelessness, addiction and poverty. But today, thanks to lifesaving medications, we have the tools to prevent HIV, and most people with the virus can have a healthy life. While the end of the epidemic might not be imminent, as we look back at some of POZ’s coverage over the past 30 years we can see perseverance, progress and a promising future.

BY JENNIFER MORTON

PEDRO LEAVES US BREATHLESS AUGUST/SEPTEMBER 1994

When Pedro Zamora graced the cover of our third issue, he had already won the hearts of millions as one of the first openly gay men living with AIDS to appear on TV. As a member of the cast of the third season of MTV’s The Real World, set in San Francisco, the charismatic Miami-based AIDS

educator put a face to a disease that many people still feared. “I thought it would be a great way to educate people,” he told POZ. “I thought being on the series would be a great way to show how a young person actually deals with HIV and AIDS.” Zamora drew international attention to the epidemic. He died on November 11, 1994, hours after the airing of the final episode of the reality series and a few months after the issue was published.

DO YOU BELIEVE IN MAGIC?

JUNE/JULY 1996

In 1991, professional basketball player Earvin “Magic” Johnson Jr. abruptly retired after announcing at a press conference that he had HIV. Johnson’s declaration stunned the world. He vowed to battle the deadly disease and become a national HIV spokesman. Although Johnson shone a spotlight on the epidemic, many AIDS activists—including Larry Kramer—felt he wasn’t doing enough. POZ caught up with Johnson for our June/July 1996 issue. He had recently returned to play for the Lakers before retiring for the third and final time. “My focus is to educate and bring awareness to the AIDS issue and to raise money to support HIV/AIDS organizations,” he told POZ. “Larry Kramer has been very effective as an activist and has done many wonderful things for people with HIV and AIDS. But I decide what my role will be, not anyone else.” Johnson and his wife, Cookie, have continued to raise awareness about HIV; last September, both were honored by the Elizabeth Taylor AIDS Foundation for their efforts.

THEY SHOOT BAREBACKERS, DON’T THEY?

FEBRUARY 1999

In November 1997, HIV-positive gay activist Tony Valenzuela gave an honest and impromptu speech about his sex life at the Creating Change Conference in San Diego. His frank acknowledgement that he enjoyed condomless sex (known as barebacking) caused an uproar and inflamed community leaders. POZ caught up with Valenzuela for our February 1999 cover, for which he cheekily agreed to pose bareback on a horse. “I wanted to get rid of shame by being vocal about the things so many positive men do silently,” he told POZ. “I certainly wasn’t out to encourage anyone not to use condoms.” By speaking his truth, Valenzuela created a space for other gay men to do so as well.

SIDE FX

SEPTEMBER 2000

In 2000, there were 14 antiretroviral drugs approved by the Food and Drug Administration for the treatment of HIV. Unfortunately, most of those drugs caused troubling side

THE LATEST ON EARLY INTERVENTION

OCTOBER 1998

When effective combination therapy to treat HIV became available in 1996, it was justifiably hailed as a miracle. However, two years later, at the International AIDS Conference in Geneva, it was revealed that even individuals responding well to therapy have residual replicating virus, raising concerns about the potential development of drugresistant HIV. Our October 1998 issue explored the evolving challenges in HIV treatment and the uncertainty surrounding the optimal treatment approach. As researchers continued to seek answers on when to start treatment, how long it should be continued and when to switch drugs, individuals living with HIV had to make difficult decisions about how to best manage their virus— considering factors like overall health, viral load and CD4 count—in an effort to save future drug options.

effects, including abdominal pain, aggressive behavior, anemia, bone loss, buffalo humps, diabetes, diarrhea, fatigue, gas, insomnia, kidney stones, muscle loss, nausea, neuropathy, pancreatitis, paranoid reactions, severe depression, taste perversion, vomit-

ing and much more. POZ’s September 2000 issue featured “A User’s Guide to Everything You Never Wanted to Know About Med Meanies,” which aimed to help people living with HIV cope with the awful side effects by providing a variety of useful tips.

MISSING IN ACTION

OCTOBER 2000

LIFE VS. METH JULY/AUGUST 2002

Our October 2000 issue paid tribute to AIDS activist Stephen Gendin, who died suddenly after starting treatment for AIDS-related lymphoma. Four versions ofthecovercapturedGendin in various stages: empowered and marching with ACT UP New York in 1990; sexy as he posed in Hawaiian sand in 1996; sick and carrying his beloved dog, Zoom, in 1998; and deceased in 2000. Gendin’s death was a huge loss for the HIV community, for which he’d spent 15 years as a fierce advocate. He’d been a member of ACT UP, a founder of the Community Prescription Service and a contributing editor at POZ, where his writing was sometimes controversial but always painfully honest.

PERFECT 10

MAY 2004

Crystal. Tina. Ice. Sparkle. By the early 2000s, an alarming number of gay men were being drawn to an alluring drug known by many names: crystal methamphetamine. Cheap, long-lasting and readily available, the drug boosts self-esteem and produces intense sexual experiences. Its popularity and association with condomless sex and other risky behaviors also contributed to a rise in new HIV cases. Our July/August 2002 cover story was written by a man in recovery for crystal meth addiction, who shared his personal struggles with the drug, detailing a descent from recreational use to injecting the drug regularly. Despite the destructive consequences of meth use, including isolation, paranoia and a decline in physical and mental health, the party drug continues to thrive in the gay community—and destroy the lives of many who use it.

PREPING FOR SEX

JULY/AUGUST 2003

POZ first mentioned pre-exposure prophylaxis— or PrEP—as an HIV prevention method in the July/August 2003 issue. The idea of prescribing antiretrovirals to people who were HIV negative to prevent the virus was a bitter pill for some in the community, who felt money would be better spent on treating people living with HIV.

On a cold morning in March 2004 at the New York City restaurant Florent, POZ gathered a group of people living with HIV who had agreed to literally bare all for the cover image of our 10th anniversary issue. For the occasion, POZ enlisted the artist Spencer Tunick, known for his large installations of naked bodies. Within minutes of stripping down, a sense of solidarity pervaded the restaurant. One participant noted, “We became one, without fear, our souls without judgments.” The moving experience was memorialized in the documentary Positively Naked, which was released in 2006 and is available to stream on Max.

Approved in July 2012, PrEP, which reduces the risk of acquiring HIV via sex by about 99% but does not protect against other sexually transmitted infections, ignited a new debate about barebacking. Some saw PrEP as a welcome opportunity to ditch condoms and embrace a sexual freedom lost to AIDS. Others worried about drug resistance. Two years after PrEP’s release, POZ took an in-depth look at the drug’s rollout and future in our October/November 2014 issue.

SENIOR CLASS NOVEMBER 2004

POZ celebrated both the 80th (in the November 2004 issue) and 90th (October/November 2014) birthdays of Nello Carlini, who was a proud member of San Francisco’s gay community. Carlini was 71 years old when he tested positive for HIV while abroad. He returned home to San Francisco, where he overcame Pneumocystis pneumonia, not to mention anal cancer. Carlini acted at Theatre Rhinoceros, the city’s LGBT theater company, and was a president of the San Francisco Gay Men’s Chorus. Among the guests at his 80th birthday party were friends, family and a singing gorilla birthday-gram. His birthday wish at his 90th birthday party? “I wish I were able to kick my heels a little bit, because if I could,” he said, “I’d still be traveling.” Carlini died in 2018 of complications of lung cancer.

JUST MARRIED

JANUARY 2005

POZ began following Shawn Decker when he started blogging about HIV in 1996 at age 22. Decker, who contracted HIV from blood products used to treat hemophilia, was diagnosed with the virus at age 11. In total, he has appeared on eight POZ covers, including a few with his wife and fellow HIV educator, Gwenn Barringer. (The couple met while waiting in line to meet Ryan White’s mother, Jeanne White-Ginder.) POZ was thrilled to have scored an invite to the serodiscordant couple’s wedding on October 23, 2004, in Charlottesville, Virginia; we shared their wedding photos in our January 2005 issue. “We use our relationship to break down some of the myths about HIV transmission and condom use,” Decker told POZ in 2013, “and we put our personal life out there in hopes of educating people.” The dynamic duo will celebrate their 20th wedding anniversary this fall, proving that the couple that advocates together stays together.

MORE THAN JUST A NUMBER

DECEMBER 2007

In 2005, POZ started including surveys in the magazine to ask readers about various topics related to HIV. In the December 2007 issue, we tallied your answers to create a snapshot of what it was like to live with HIV in America. “The numbers tell an amazing story about your lives, your guilty pleasures, your romances, your health care, your treatment choices, your beliefs, your fears, your hopes,” read the introduction. More than 100 surveys later, POZ continues to take the pulse of the HIV community on topics such as treatment, side effects, aging, stigma, discrimination and more.

SOUTHERN DISCOMFORT

JULY 2005

“America’s Hidden HIV Epidemic” declared a June 2017 New York Times Magazine article spotlighting the alarmingly high HIV rates among Black gay and bisexual men—particularly in the U.S. South. Earlier that year, POZ covered the same topic in our January/February 2017 cover story. But it wasn’t the first time we sounded the alarm about the raging HIV crisis in the South. Our July 2005 cover story shared how factors such as extreme poverty, government funding shortfalls and HIVrelated stigma and discrimination complicated the prevention and treatment of HIV and gave rise to disproportionately high rates of the virus in the area. In our January/February 2011 issue, POZ highlighted the work of HIV advocates in the South who were working to overcome the barriers to care. The HIV epidemic in the South has never been hidden—most of the country just hasn’t been paying attention to it.

ANONYMOUS NO MORE

APRIL 2006

It’s not always easy to tell someone you are living with HIV, so imagine announcing it to the world by appearing on the cover of a magazine. That’s exactly what Regan Hofmann did when she took hold of the reins of POZ as its first female editor-in-chief. For four years, Hofmann, who had lived with HIV in secret for nearly a decade, had written the Anonymous column in the magazine. “I am no longer afraid to say I have HIV,” she proclaimed on the cover of the April 2006 issue. “I believe our stories can change the world.” Indeed, they have.

SERVICE INTERRUPTION

JULY/AUGUST 2008

When 25-year-old Jeremiah Johnson was forced to leave the Peace Corps after testing positive for HIV in Ukraine, he didn’t fancy himself an HIV activist. But he became just that when he enlisted the help of the American Civil Liberties Union to sue the Peace Corps for his dismissal. Thanks to his efforts, the organization officially revised its policy, agreeing to no longer terminate volunteers because they have HIV. Unfortunately, the new policy was not strictly enforced, as evidenced by our July/August 2018 cover story, which shared the stories of other volunteers dismissed from the Peace Corps after testing positive for HIV abroad. It’s a stark reminder that the need for advocacy never ends.

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POZ/AIDSMEDS DRUG CHART

DECEMBER 2008

In the early days of HIV combination therapy, treatment involved taking a handful of pills at various times of the day. Some medications needed to be taken with food and some without, and keeping track of the various side effects and interactions was a feat unto itself. Thankfully, over time, antiretroviral options became easier to tolerate, and the pill burden lessened for many. In December 2008, POZ (along with our sister brand AIDSmeds) created a quick-reference HIV drug chart detailing available medication options, including dosing and dietary restrictions. Six years later, the POZ HIV Drug Chart became an annual feature in our July/ August issue.

CRIMINAL INJUSTICE

JUNE 2012

WONDER WOMEN

MARCH 2010

In the early 1990s, ACT UP created the slogan “Say It: Women Get AIDS” because so few people knew that women could get HIV. In 2010, HIV was the leading cause of disease and death among women ages 15 to 44 worldwide. Historically, women have been uniquely vulnerable to HIV due to various social, biological, psychological, political and economic factors. Our March 2010 issue featured first-person accounts of seven resilient women living with HIV in the United States not only facing their own challenges with the virus but also actively supporting other women contending with similar struggles. Sisterhood is indeed powerful.

PATIENT NO MORE

JUNE 2011

In June 2011, POZ featured Timothy Ray Brown aka “the Berlin Patient” on the cover. Diagnosed with HIV in 1995, Brown was living in Berlin when in 2006 he was diagnosed with leukemia. To treat the blood cancer, he underwent two bone marrow transplants using stem cells from a donor with a rare genetic mutation that blocks HIV from entering cells. In 2008, following chemotherapy and radiation, Brown’s cancer was in remission, and his newly rebuilt immune system had eradicated his HIV. His story gave hope to millions of people living with the virus and spurred the scientific community to renew its search for a cure. Sadly, Brown died in 2020 after battling a recurrence of leukemia.

Over the years, POZ has tackled the issue of HIV criminalization in various ways, but in the June 2012 issue, we featured three new faces in the HIV decriminalization movement: Robert Suttle, Nick Rhoades and Monique Moree. Each of them had recently faced criminal charges related to their HIV status and had shared their stories in HIV Is Not a Crime, a short documentary by POZ founder Sean Strub. Strub had recently launched the Sero Project, part of a growing national movement to reform out-of-date laws that prosecute people based on their HIV-positive status. Soon, more and more advocates began to mobilize around HIV criminalization, and in May 2014, Iowa became the first state to repeal its HIV-specific criminal statute.

NOT LOST IN TRANSLATION

APRIL/MAY 2013

Boston-based Devarah “Dee” Borrego was the featured POZ Hero in our April/May 2013 issue. The transgender advocate, who was diagnosed with HIV in 2005, a few weeks after her 21st birthday, shared her story in the hopes of empowering others and was photographed confidently smiling in a white button-down shirt and dark brown pencil skirt. According to a 2022 article in The Guardian, Dee’s photo caught the eye of an inmate at a men’s maximum-security prison in Missouri who had a subscription to POZ. Jessica James Hicklin had known she was a woman since age 8 but had never heard the word transgender until she flipped through the pages of POZ and saw Borrego’s photo. She thought, There I am. That’s me. Hicklin became the first transgender inmate in Missouri to successfully sue for the right to access hormones. She was released on parole in 2022.

THE SOUND OF STIGMA

JUNE 2013

When AIDS advocate, author and blogger Mark S. King asked whether he could use yellow paint as a prop for his upcoming POZ cover shoot, what choice did we have but to say yes? The resulting images appeared in our June 2013 issue along with King’s moving essay on why HIV-related stigma persists among gay men. “The more HIV treatments improved,” King wrote, “the wider the viral divide became. Our mutual resentments and jealousies worsened.” King’s powerful photos and essay struck a chord with many of our readers. “The Sound of Stigma” remains one of the most commented-on articles on POZ.com.

AGAINST ALL ODDS

APRIL/MAY 2014

THE POZ 100: CELEBRATING UNSUNG HEROES DECEMBER 2013

We created the POZ 100 list in 2010, but the 2013 POZ 100 marked the first time the list was made up entirely of advocates living with the virus. It was also the first time the honorees were nominated directly by the community. Instead of highlighting familiar, high-profile advocates, POZ celebrated unsung heroes in the community who were making a difference in the fight to end the epidemic. From volunteers and policy advocates to educators and case managers, the list represented a diverse spectrum of people living with HIV who inspired us with their commitment to the cause.

Most of us take risks every day without even thinking about it—let alone trying to wrap our heads around the odds associated with those risks. But when it comes to HIV risk, people can be preoccupied with percentages. And the numbers don’t always reflect the many factors that can raise or lower one’s risk. In the April/May 2014 issue, POZ drilled deep into the data and explained the differences between cumulative risk, absolute risk and relative risk. The underlying ideas and messages in the article remain relevant today, but, with so many more HIV prevention tools, the odds may be more in your favor. “Numbers can be a good tool for helping people understand risk,” said James Wilton, of the Canadian AIDS Treatment Information Exchange, “they just need to be packaged with a lot of information.”

BLACK LIVES MATTER

JANUARY/FEBRUARY 2016

The Black Lives Matter movement dates back to 2013 when the social media hashtag #BlackLivesMatter first appeared following the acquittal of George Zimmerman for the killing of Trayvon Martin. It gained momentum after the killings of Michael Brown, Eric Garner and Rekia Boyd, among others. In our January/February 2016 cover story, POZ delved into the impact of trauma in the Black community, drawing parallels between the systemic violence Black people face and the trauma people living with HIV experience. POZ explored the shared lessons and strengths of the Black Lives Matter movement and the HIV activism community, advocating for an intersectional approach to help overcome the systemic challenges both communities face.

QUEST FOR HEALING

MARCH 2018

Our March 2018 cover story examined the challenges American Indians and Alaska Natives (AIs/ANs) face in dealing with HIV, highlighting the cultural, economic and logistical obstacles they encounter when it comes to testing and accessing HIV care and treatment. According to the Centers for Disease Control and Prevention (CDC), annual HIV diagnoses in the United States declined by 19% percent among the general U.S. population from 2005 to 2014 but rose by 19% among AIs/ANs. Lack of health insurance, high rates of poverty, high rates of exposure to violence and crime, and historical and intergenerational trauma are some of the factors that contribute to health disparities among Native Americans. This is all complicated by the fact that each tribe has its own policies and norms informing their approach to HIV.

UNDERSTANDING UNDETECTABLE = UNTRANSMITTABLE MARCH 2019

In 2008, a consensus statement by Swiss HIV experts asserted that individuals with HIV who maintain an undetectable viral load through treatment cannot transmit the virus during sex. Early proof came in 2011, when study results from the randomized trial HPTN 052 found that treatment reduced HIV transmission in serodifferent couples by at least 96%. Further proof came via the results of the 2018 PARTNER2 study. Yet this incredible news was not reaching most people living with HIV. Our March 2019 issue highlighted the efforts of the U=U (Undetectable Equals Untransmittable) campaign, which aimed to simplify and amplify the message. Launched in 2016 by the Prevention Access Campaign, U=U overcame skepticism and gained widespread support, significantly transforming the perception of HIV transmission risk, to the delight of people living with HIV everywhere.

LATINOS IN THE SOUTH

OCTOBER/NOVEMBER 2022

COVID-19 AND HIV JULY/AUGUST 2020

When the COVID-19 pandemic emerged in early 2020, memories of the early days of AIDS flooded back for many in the HIV community. Our July/August 2020 cover story explored the new uncertainties facing those living with HIV, such as the risk of contracting COVID, potential impacts on accessing HIV care and the effects of social isolation and financial instability. While those with compromised immune systems are generally more susceptible to infections, early reports suggested that individuals on antiretroviral treatment with an undetectable viral load and a near-normal CD4 count did not appear to be at higher risk for severe COVID. As the world grappled with a new virus, the HIV community worked to find a balance between maintaining COVID precautions and continuing its HIV treatment and prevention efforts, while also addressing the structural inequities and disparities highlighted by both pandemics.

LIVE TO TELL MARCH 2024

In our October/November 2022 issue, POZ focused on the challenges that Latinos in the Southern United States face regarding HIV, spotlighting barriers such as language, confidentiality, financial stability, discrimination, immigration status, health insurance, family and religion. It also showcased the efforts of the Latino Commission on AIDS program“Latinos in the South,” which addresses these issues through capacity building, language justice work, leadership institutes and advocacy on topics such as HIV decriminalization and Medicaid expansion. Despite the numerous hurdles, advocates in the Southern states are working compassionately to meet the challenges and create affirming and welcoming spaces for Latinos to access HIV care and treatment.

DOXYPEP 101

JANUARY/FEBRUARY 2024

Although PrEP is highly effective at preventing HIV, ditching condoms can often lead to other STIs. In our January/February 2024 issue, POZ provided the 411 on doxyPEP, a morning-after antibiotic pill that lowers the risk of chlamydia, gonorrhea and syphilis. In October, the CDC issued its first national doxyPEP guidelines, recommending a new way to have safer sex. As they did when PrEP emerged, skeptics worried about drug resistance and an increase in condomless sex, even though effective, evidence-based prevention options can help slow the spread of STIs and HIV. DoxyPEP is simply another tool in the healthy sex toolbox.

Visit poz.com/magazines to read the full archive of POZ magazine.

Considering her long history of AIDS activism, it wasn’t hard to justify our love for Madonna by putting her on the cover of our March 2024 issue. The pop star was in the midst of her Celebration tour, which includes a moving tribute to individuals who died of AIDS-related causes. In 1987, the Material Girl performed the first AIDS benefit concert at Madison Square Garden in New York City, raising $400,000 for amfAR, the American Foundation for AIDS Research. Her 1989 album, Like A Prayer, included an insert with facts about AIDS; her 1992 album, Erotica, included songs dedicated to those lost to the disease. In 2006, Madonna cofounded Raising Malawi, a nonprofit that helps raise awareness about the critical needs of the country’s children who have lost one or both parents to AIDS. We cherish the fact that Madonna has opened her heart throughout her career to uplift the HIV community. ■

AIDS 2024, the 25th International AIDS Conference, will take place in Munich, Germany, and virtually from 22 to 26 July 2024.

AS POZ MARKS 30 YEARS OF SERVICE, WE REFLECT ON WHAT’S NEXT.

ANNIVERSARIES PRESENT AN OPPORTUNITY TO pause and reflect—not only on the progress that lies along a journey but also on the challenges ahead. In the HIV community, we know that these moments are great for sharing knowledge and refueling. That means POZ’s 30th anniversary is a perfect time to share wisdom gained in the fight against HIV. To that end, we spoke to 30 leaders in the HIV community and asked them each a question about an aspect of the ongoing AIDS epidemic that they know best. Their answers represent decades of experience, sweat,

love, grassroots organizing and setting the table and sitting down at it. The people we surveyed span many disciplines within the HIV field: Some specialize in harm reduction, others in criminalization, some in prevention and others in treatment. Combined, they are just a small portion of the large number of people working to create a better world for those living with HIV as well as the communities that shoulder the heaviest burdens of the epidemic, including LGBTQ people, people of color, women and more.

These answers have been edited for length and clarity. The leaders are presented in alphabetical order.

GUY ANTHONY President & CEO, Black, Gifted & Whole Foundation

How is education part of th fi ght for health justice for Black men?

Black queer men are more than their sexuality. They can be seen in their wholeness. If education is the great equalizer, then they must have access to the same resources, financially and emotionally, that their counterparts do. We awarded our last cohort, who are studying STEM [science, technology, engineering, mathematics] at their respective HBCUs [historically Black colleges and universities], $5,000 to offset costs. We have monthly, sometimes weekly, check-ins. We celebrate their small victories and hold them accountable when they fall short. We treat them like they matter because they do.

JEFF BERRY Executive Director, The Reunion Project

What do long-term survivors have to offer in the ongoin fi ght against AIDS?

1 2 3

It’s critically important that we preserve and share the unique and diverse experiences of long-term survivors. Research advocacy is one area where we can provide mentorship and training. Many of us have been providing input on clinical trial design and research for years. Others of us have volunteered for studies, given blood, even carried out and published some of the research ourselves. There needs to be a more formalized structure to help train new research advocates.

KEIVA LEI CADENA Co–Executive Director, Positive Women’s Network–USA (PWN-USA)

How can we continue to meet the needs of women and girls living with HIV?

Despite the high impact of HIV on Black women and trans women, we still aren’t consistently practicing effective ways to dismantle antiBlackness, misogynoir and anti-trans language and behaviors in our spaces. The threats against women’s reproductive rights and gender-affirming care threaten our HIV work, and these issues disproportionately affect Black women and women of color living with HIV.

SHELBY CHESTNUT Executive Director, Transgender Law Center

How are the current pushes against transgender people in the United States and th fi ght for health justice interrelated?

I think these are so closely connected, because, ultimately, lawmakers are seeking to limit people’s basic human rights and bodily autonomy. But we know firsthand that our communities are resilient and are working in broad coalitions to make sure they have access to health care. Conservative lawmakers are spending millions each year to target trans communities, and, even with limited resources, our communities are fighting back and stopping many of these unconstitutional laws from going into effect.

TORI COOPER

Director

of Community Engagement, Trans Justice Initiative, Human Rights Campaign

How do HIV prevention and care factor into th fi ght for trans rights?

I see the trans and LGBQ communities as living through three epidemics: the ongoing fight against HIV/AIDS, COVID and an increase in anti-trans and LGBQ legislation and rhetoric. Society’s loud conservative minority is attempting to legislate every aspect of our existence. These are folks who fought public health strategies based solely on personal beliefs. They fought against sex education and condom campaigns, and now, they are tying up the courts with frivolous and dangerous legislation to deny access to gender-affirming care.

4 5 6

PORCHIA DEES Advocacy Consultant

What about your work in the AIDS community gives you hope right now?

People born with HIV are now being included in discussions regarding HIV and aging and recognized as lifetime survivors. It gives me hope that we got onstage at USCHA 2023 and lettheHIVcommunityknowwhoweare. We demanded inclusion and for the community to no longer make us an afterthought. We demanded that we be reflectedinresearch,policy,programming and at decision-making tables. We demanded funding for dedicated initiatives designed and driven by our population.

DANIEL DRIFFIN, DrPH Cofounder, Thrive SS

How can the public healt fi eld better account for the experiences of Black queer men?

We need more Black queer men in meaningful positions inside institutions creating policy and implementing services. I can count the number of Black queer men at local and state health departments on less than one hand. When you extend the search to the federal government, it is the same story. I, along with others, have and will continue to create novel organizations and initiatives detached from public health due to not having a space at the proverbial table.

GRISSEL GRANADOS Senior Director of Youth Education, Planned Parenthood Los Angeles

What about your work in the AIDS community gives you hope right now?

7 8 9

Mobilizinglifetimesurvivorsissomething I have been passionate about for a long time, and I am excited to see that things are finally coming together for a national community. This is the right time because we are now adults who can speak for ourselves, leverage our skills and expertise, and create a movement led by us directly without outside influence.

TAMI HAUGHT

Co–Executive

Director, The SERO Project

How has the conversation around HIV decriminalization changed in the past 10 years?

More people are working and talking about HIV decriminalization.Forthefirsttime,apresident, President Biden, mentioned HIV criminalizationinhisWorldAIDS Day statement and boldly declared, “We have to follow science, and that means eliminating the laws that perpetuate discrimination, exacerbate disparities, discourage HIV testing and take us further away from our goal.”

KRIS HAYASHI

Director

of Advocacy and Action, National LGBTQ Task Force

How are the current pushes against transgender people in the United States and th fi ght for health justice interrelated?

They are frankly one and the same. The conservative right seeks to advance laws, policies and narratives that aim to prevent trans people from receiving health care and from having accurate identification and trans youth from playing sports and that ultimately aim to eliminate our very existence and deny our humanity.

TIM HORN Director, Medication Access, NASTAD

What is the greatest roadblock to accessing pre-exposure prophylaxis (PrEP) nationwide?

HIV prevention is more medicalized than ever, yet we’re contending with a highly fragmented health care system that continues to throw up all kinds of structural barriers: affordability issues, unnecessarily restrictive and overly complex insurance coverage policies, “churning” in and out of different types of insurance and government bureaucracy, to name a few. The levels of patience and determination people need to navigate such a system, which can also be discriminatory and stigmatizing, just aren’t realistic. We can do much, much better than this.

10 11 12

JEREMIAH JOHNSON Executive Director, PrEP4All

What is the greatest roadblock to accessing PrEP nationwide?

TherootcausesofPrEPdisparitiesaresystemicandstructural. There are numerous co-occurring obstacles that individuals, particularly if they are marginalized, have to face to get PrEP. Those most in need of PrEP are disproportionately uninsured or underinsured, more likely to struggle to find an informed prescriber, more likely to experience stigma and less likely to receive accessible messaging about PrEP. We’re calling for a National PrEP Program that removes many of the roadblocks and clears the pathway for equitable PrEP access.

13

KAMARIA LAFFREY Co–Executive Director, The SERO Project

What about your work in the AIDS community gives you hope right now?

16

BRANDON MACSATA Managing Partner, Purple Strategy Group

What gives me hope is the ongoing pressure that many community groups continue to put on our federal government to hold them accountable about their plan to end HIV. I am inspired by the advocates who amplify the need to prioritize quality of life as a measured consideration in HIV plans. While we may end HIV transmissions through a biomedical response, that doesn’t include a cure and the ongoing care that requires funding, strategy and support to sustain a quality of life.

14

ARIANNA LINT CEO, Arianna’s Center

What has it been like to organize trans women in Florida, which has become the model for transphobic policies nationwide?

We’ve had obstacles to overcome— for example, having to hire a medical doctor instead of a nurse practitioner on our limited budget. However, policies can’t stop us from getting together and making progress.

15

DONJA R. LOVE Playwright

How is theater a part of th fi ght for justice for people living with HIV?

Black and Brown people are the most affected by the virus. Redlining, poverty and lack of adequate health care and education are factors in high infection rates, but so is a lack of representation. Theatrical work often centers affluent cis white queer men: The Normal Heart, Angels in America. People who saw themselves reflected in the work felt heard, and those who didn’t got the message that our stories don’t matter. There is a direct correlation between whitewashing in AIDS representation and higher infection rates for Black and Brown people.

How is HIV funding changing as LGBTQ rights are under attack? Our political landscape is changing because what was once viewed as fringe with one political party has now become “acceptable.” That acceptance has normalized hate. That cancer is targeting not only HIV funding or LGBTQ rights but also reproductive rights, disability rights and parental rights, among others. The political landscape— fueled by misinformation and disinformation—can get even more toxic. Voter mobilization is probably the most important tool the HIV and LGBTQ communities have to combat this cancer.

17

MARNINA MILLER Co–Executive Director, PWN-USA

Who in the AIDS community has most inspired your work?

Naina Khanna, the founding director of PWN-USA, has been a pivotal figure. Naina’s steadfast commitment to cultivating and nurturing new leaders and her unwavering allegiance to the well-being of all self-identified women and genderdiverse people living with HIV/ AIDS have served as a guiding force in shaping my work. Her enduring legacy in this community will have a ripple effect that will be felt for decades to come. Her leadership is a constant reminder of the undeniable power of women living with HIV.

TAMARA OYOLA-SANTIAGO Cofounder, Bronx Móvil

What about your work in the AIDS community gives you hope right now?

People who use and inject drugs who are harm reductionists give me hope. They are warriors who challenge us to consider a society and a world where human behavior is respected in all of its forms. They are at the forefront of saving lives, whether it be via dispensing syringes or providing naloxone.

JIRAIR RATEVOSIAN Congressional Candidate, California’s 30th District

How can electoral politics help people living with HIV?

22

JASON ROSENBERG Member, ACT UP New York

19 20

Electoral politics can significantly impact people living with HIV through the creation and implementation of policies that truly tackle social determinants of health, fight stigma and discrimination through modernizing laws, and mobilize significant resources to continue the unfinished business of fighting HIV here at home and around the world. That’s exactly why I am running for Congress.

VENITA RAY Executive Director, Black

What about your work in the AIDS community gives you hope right now?

South Rising

Black women and the broader HIV community give me hope because they continue to show up no matter what. They are unshakeable and unstoppable. It seems that we are continuing to advocate for the same things, like human dignity and intersectional non-biomedical approaches. The solutions continue to be top-down instead of based on communitydesigned responses. The people closest to the problem are also closest to the solution.

21

BRUCE RICHMAN Executive Director, Prevention Access Campaign

What has it been like to see the message of Undetectable Equals Untransmittable (U=U) catch on?

I spent my last birthday with the Cambodia Positive People Living with HIV Network and hundreds of people parading on bikes, tuk-tuks and motorcycles with U=U banners for the launch of U=U in front of the ancient Angkor Wat temple’s religious monuments. I was sobbing with joy to see such hope and courage in such a sacred place. The U=U movement’s explosive growth is a testament to the power and resilience of people living with HIV.

How is health justice linked to the many other types of activism, including trans rights and queer liberation activism? The fight against genocide and apartheid in Gaza is intrinsically connected to ending theepidemicandensuringhealthcare for all. Congress has proposed almost $1 billion in cuts to HIV/AIDS programs domestically and globally, all while our taxpayer dollars aid the destruction of health care infrastructures and contribute tothehumanitariancrisisinGaza.It’sour dutyasAIDSactiviststocallforanimmediateandlastingceasefireanddemandourgovernmentfundhealthcare,notwarfare.

23

FRANCISCO RUIZ PhD Candidate, Harvard School of Public Health

How can the public healt fi eld better account for the experiences of queer people of color?

Fully embracing and integrating the experiences of queer people of color starts with a representative workforce. As [diversity consultant] Vernˉa Myers insightfully put it, “Diversity is being invited to the party. Inclusion is being asked to dance.” But we need to go further: Equity is being able to set the playlist. Queer people of color must have a decisive role in creating strategies and policies. Their unique perspectives are central to the development of health initiatives, particularly in the response to HIV.

24

TYLER SPENCER, PhD Executive Director, Grassroots Health

How has your understanding of the epidemic changed in your 15 years in th fi eld?

We started our work before PrEP and before we knew that U=U. My understanding of HIV prevention has become much more nuanced. We are ignoring some of the most critical ingredients of an effective HIV response. We need to continue to think about how we drive demand for prevention and care services in the communities that need them the most. If we want science to have an impact on HIV, we have to include and support interventions that foster trust, comfort and “resource literacy.”

25

ANDREW SPIELDENNER, PhD Executive Director, MPact Global Action

How are the COVID-19 pandemic and the AIDS epidemic related?

KERRY THOMAS Community HIV Decriminalization Strategist, The SERO Project

How do storytelling and science work together in th fi ght for justice for people living with HIV?

COVID-19 further demonstrated the structural disparities for queer people and people of color. HIV prepared me for COVID because I knew how to manage the idea of risk and vulnerability after four decades of HIV in LGBTQ communities. As someone living with HIV, I had felt isolation before, and the lockdowns were more manageable because I knew this feeling. And as the waves of deaths hit the world, I was reminded of the lack of government action (and malfeasance) at the start of the HIV pandemic.

26

CHARLES STEPHENS Executive Director, Counter Narrative Project

What role does storytelling play in th fi ght for health justice?

Bad narratives lead to bad policies. And before bad narratives, there were first a bunch of bad stories that culminated in that bad narrative: newspaper articles, social media posts, sermons, rumors, films. We must fight bad policies—not only in the realm of politics but also in the realm of art, in the realm of storytelling and in the realm of narrative change. In our age of misinformation, especially about marginalized folks, storytellers and artists are indispensable to the preservation of democracy.

MARVELL L. TERRY II Project Manager and Community Engagement Leader, ALAI UP

Are long-acting injectables getting us closer to ending the AIDS epidemic in the United States?

Long-acting injectables do get us closer to ending the AIDS epidemic. However, there is still an issue of equity and access. We must correct the systemic problems to ensure those most impacted by HIV have access to long-acting injectables while also addressing the medical mistrust and distrust that exist among communities affected by the AIDS epidemic, specifically Black people. There are costs for clinics and consumers, insurance and rural accessibility.

In the realm where stories meet science, a compelling narrative unfolds— a narrative of resilience, activism and justice for those living with HIV. These stories serve as beacons of hope, illuminating the path toward understanding and compassion. In courtrooms and legislative halls, the echoes of these stories reverberate, shaping policies and laws that protect the rights and dignity of people with HIV. The fight for justice is not just a battle against a virus but a quest for equality, dignity and human rights.

DAFINA WARD

Executive Director, Southern AIDS Coalition

What do people misunderstand about th fi ght against AIDS in the U.S. South?

One of the greatest mischaracterizations is that Southerners are apathetic. People believe the injustices we experience are a result of some failure on the part of Southern communities. The systemic racism and hate codified in Southern states is the result of institutional intention. HIV is one result of these systems, as are voter suppression, misinformation and the weaponizing of religion. There is no one-size-fits-all solution to the South’s HIV epidemic: It is a policy fight, a cultural fight, a misinformation fight, a rural and metropolitan fight.

MITCHELL WARREN Executive Director, AVAC

What should the United States learn from th fi ght against AIDS globally?

The term “global health” has somehow become synonymous with the health of others, often those in resource-limited settings. We did not need COVID to remind us that infectious diseases do not respect borders. We need to embrace a definition of global health as truly global—north and south, east and west, rich and poor. The sooner we recognize that no one country has all the answers—and that disparities and inequalities exist everywhere—the sooner we will create the health systems that work for everyone, everywhere. ■

Englishman in New Jersey

When Peter Oates graduated from nursing school in 1975 in his native England, the AIDS crisis was on the distant horizon.

Oates’s first years as a nurse were largely spent caring for older adults, first in the Netherlands and then in England. His patients included Lord John Spencer, Princess Diana’s father.

“I started doing private-duty nursing until I could find a job that I really liked,” Oates says. “It was during that period that I got a call from the agency to say, ‘Go take care of this guy.’ I didn’t know who he was.” Lord Spencer had had a stroke, and Oates remained with him full time until his recovery.

An intense bond formed between the caretaker and the Spencer family. Oates even attended Prince Charles and Diana’s wedding in 1981 and kept in contact with Princess Diana until her death.

And after Lord Spencer’s convalescence, the Spencers treated Oates to a vacation. He chose to visit San Francisco in 1980 for about a month. He liked it so much that he soon decided to return.

“I went back to San Francisco in 1983, and I got my nursing license in California during that period,” Oates says. “I volunteered, and I saw the community being devastated by AIDS. During that time, I went for an interview at San Francisco General Hospital’s brand-new AIDS unit. Unfortunately, they weren’t hiring foreign nurses at the time.”

That’s a long and ironic story considering foreignborn nurses are now the backbone of America’s health care system.

Oates began working as an AIDS nurse in 1994, the same year he tested positive for HIV. By then, he had settled in New Jersey. Oates handled his HIV diagnosis in the most British way possible: with a stiff upper lip. Caring for others helped too.

“I have to honestly say, I just accepted it and thought, I’m going to take care of this,” Oates says. “I took my pills and didn’t think about it. The patients helped me work through that. It’s like you’ve got a job to do—get on with it.”

In 2022, Oates retired from full-time nursing as director of health care services at the FrancoisXavier Bagnoud Center at the Rutgers University School of Nursing. He continues to serve on the board of the Association of Nurses in AIDS Care, which recently honored him with a lifetime achievement award.

Upon his retirement, Oates was also lauded by Hyacinth, New Jersey’s largest and oldest AIDS service organization.

“New Jersey has been so lucky to have Peter Oates find his way to us,” says Kathy O’Brien, Hyacinth’s executive director. “He has been fiercely fighting to end the HIV epidemic since its earliest days. Peter is smart, funny and down-to-earth— all qualities that have endeared him to the HIV community in New Jersey. He is passionate about inequalities in health care. Peter has never sought the limelight—he’s the guy getting the work done each and every day.” ■

THE COST OF CARE

If you’re living with HIV in the United States, you can access health care coverage in many different ways. But navigating our nation’s health care system can be daunting. POZ wants to know about your experience with health care coverage and costs.

1 What type of health insurance do you currently have? (Check all that apply.)

❑ Employer-based insurance

❑ Individual-based insurance (including coverage through the Affordable Care Act)

❑ Medicaid ❑ Medicare

❑ Veterans Affairs

❑ Other (Please specify.):

❑ None

2 Do you use any of the following programs to help with your health care costs? (Check all that apply.)

❑ Patient assistance program (PAP)

❑ Cost-sharing assistance program (CAP)

❑ Ryan White HIV/AIDS Program (including ADAP)

❑ Other (Please specify.):

❑ None

3 On average, how much do you spend on your health insurance coverage each month?

❑ None ❑ $300–$499

❑ Less than $100 ❑ $500 or more

❑ $100–$299

4 On average, how much do you spend each month on out-of-pocket costs for your health care (for example, co-pays and deductibles)?

❑ None ❑ $300–$499

❑ Less than $100 ❑ $500 or more

❑ $100–$299

5 Do you worry about how to pay for your health care?

❑ Yes ❑ No

6 Have you ever skipped or delayed health care because of the cost?

❑ Yes ❑ No

7 Are you satisfied with your health care coverage?

❑ Yes ❑ No

8 How difficult is it for you to navigate the health care system?

❑ Very difficult

❑ Somewhat difficult

❑ Not very difficult

9 How far do you travel for your HIV medical care?

❑ Less than 5 miles ❑ 25–50 miles

❑ 5–10 miles ❑ More than 50 miles

❑ 10-25 miles

10 Do you have dental insurance?

❑ Yes ❑ No

11 What year were you born? __ __ __

12 What is your gender?

❑ Male ❑ Female

❑ Transgender ❑ Other

13 What is your sexual orientation?

❑ Straight ❑ Bisexual

❑ Gay/lesbian ❑ Other

14 What is your ethnicity? (Check all that apply.)

❑ American Indian or Alaska Native

❑ Arab or Middle Eastern

❑ Asian

❑ Black or African American

❑ Hispanic or Latino

❑ Native Hawaiian or other Pacific Islander

❑ White

❑ Other (Please specify.):

15 What is your current level of education?

❑ Some high school ❑ Some college

❑ High school graduate ❑ Bachelor’s degree or higher

16 What is your annual household income?

❑ Less than $15,000 ❑ $50,000–$74,999

❑ $15,000–$34,999 ❑ $75,000–$99,999

❑ $35,000–$49,999 ❑ $100,000 or more

17 What is your ZIP code? __ __ __ __ __

Scan this QR code with your smartphone to take this survey at poz.com/survey. Or email a photo of your completed survey to website@poz.com