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.
MOST IMPORTANT INFORMATION ABOUT BIKTARVY
BIKTARVY may cause serious side e ects, including:
` Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without fi rst talking to your healthcare provider, as they will need to check your health regularly for several months, and may give you HBV medicine.
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 that contains:
` dofetilide
` rifampin
` any other medicines to treat HIV-1
BEFORE TAKING BIKTARVY
Tell your healthcare provider if you:
` Have or have had any kidney or liver problems, including hepatitis infection.
` Have any other health problems.
` Are pregnant or plan to become pregnant. Tell your healthcare provider if you become pregnant while taking BIKTARVY.
` Are breastfeeding (nursing) or plan to breastfeed. Talk to your healthcare provider about the risks of breastfeeding during treatment with BIKTARVY. Tell your healthcare provider about all the medicines you take:
` 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.
` BIKTARVY and other medicines may a ect each other. Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.
POSSIBLE SIDE EFFECTS OF BIKTARVY
BIKTARVY may cause serious side e ects, including:
` Those in the “Most Important Information About BIKTARVY” section.
` Changes in your immune system. Your immune system may get stronger and begin to fight infections that may have been hidden in your body. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY.
` Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY.
` Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
` 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.
` The most common side e ects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).
These are not all the possible side e ects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY. You are encouraged to report negative side e ects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.
Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.
HOW TO TAKE BIKTARVY
Take BIKTARVY 1 time each day with or without food.
GET MORE INFORMATION
` This is only a brief summary of important information about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more.
` Go to BIKTARVY.com or call 1-800-GILEAD-5.
` If you need help paying for your medicine, visit BIKTARVY.com for program information.
People featured take BIKTARVY and are compensated by Gilead.
Ask your healthcare provider if BIKTARVY is right for you.
*Source: , 04/19/2019 through 05/19/2023. IQVIA NPA Weekly #1 PRESCRIBED HIV TREATMENT*
MORE TO LOVE
BIKTARVY® is approved for more people than ever before.
BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.
*This information is an estimate derived from the use of information under license from the following IQVIA information service: IQVIA NPA Weekly, for the period week ending 04/19/2019 through week ending 05/19/2023. IQVIA expressly reserves all rights, including rights of copying, distribution, and republication.
Scan to learn more about BIKTARVY.
Please see Important Facts about BIKTARVY, including important warnings, on the previous page and at BIKTARVY.com.
#ADVOCACY
Fighting against HIV and AIDS has always been a struggle. Much work remains to end the epidemic. POZ encourages you to get involved in advocacy. Go to poz.com/ advocacy to find the latest news and learn how you can make a difference in the fight.
D #CRIMINALIZATION
Advocates around the world are working to change laws that criminalize HIV, which harm people living with the virus. For more information and to learn how to get involved in reform efforts to make such laws reflect current science, go to poz.com/criminalization
D #UNDETECTABLE
The science is clear: People who have an undetectable viral load don’t transmit HIV sexually. In addition to keeping people healthy, effective HIV treatment also means HIV prevention. Go to poz.com/undetectable for more.
D
POZ DIGITAL
Scan the QR code (le ) with your smartphone camera or go to poz.com/digital to view the current and past issues online.
22 LAUGHTER IS THE BEST MEDICINE Daniel Garza uses humor to educate about sexual health. BY TIM MURPHY
28 TELLING A MODERN HIV STORY Timothy Guion Smith discusses HIV advocacy and art. BY CHARLES
3 FROM THE EDITOR A Moment Like This
4 POZ Q&A
Longtime HIV activist Eric Sawyer, known for his days at ACT UP and Health GAP, shares his history as a housing advocate.
6 POZ PLANET
U.S. businesses seek to accelerate ending HIV • vandals deface Los Angeles AIDS monument • HIV and STI testing in Atlanta and Memphis • report on prescription drug middlemen • independent pharmacies are struggling to stay open • hospitals say they won’t turn away immigrants • Everyday: milestones in the epidemic
Tami Haught and Kamaria Laffrey offer words of wisdom regarding advocacy today, and José Zuniga urges action in support of the transgender community.
14 SPOTLIGHT
A roundup of current health care advocacy
16 NUTRITION & FITNESS
Chilled pea soup • physical activity benefits
18 BASICS
Cancer screening for people with HIV
19 RESEARCH NOTES
Twice-yearly PrEP this summer? • treating resistant HIV • bnAb combination delays HIV rebound after stopping antiretrovirals • statins for artery health in people with HIV
20 CARE & TREATMENT
Trump’s moves imperil people with HIV worldwide • hazards of inadequate CD4 recovery • new pediatric HIV guidelines
• doxyPEP reduces STIs in California
32 HEROES
Youth health advocate Joshua Jaffe
Timothy Guion Smith in Next of Kin
SANCHEZ
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
GUILLERMO CHACÓN, SABINA
HIRSHFIELD, PHD, KATHIE HIERS, TIM HORN, PAUL KAWATA, NAINA
KHANNA, JESSE MILAN JR., DANIEL TIETZ, MITCHELL WARREN
PRESS REQUESTS NEWS@POZ.COM
SUBSCRIPTIONS HTTP://ORDER.POZ.COM
UNITED STATES: 212-242-2163
SUBSCRIPTION@POZ.COM
FEEDBACK
EMAIL WEBSITE@POZ.COM OR EDITOR-IN-CHIEF@POZ.COM
SMART + STRONG
PRESIDENT AND COO
IAN E. ANDERSON
EDITORIAL DIRECTOR
ORIOL R. GUTIERREZ JR.
CHIEF TECHNOLOGY OFFICER
CHRISTIAN EVANS
VICE PRESIDENT, INTEGRATED SALES
DIANE ANDERSON
INTEGRATED ADVERTISING MANAGER
JONATHAN GASKELL
INTEGRATED ADVERTISING COORDINATOR
SARAH PURSELL
SALES OFFICE
212-938-2051; SALES@POZ.COM
CDM PUBLISHING, LLC
CEO
JEREMY GRAYZEL
CONTROLLER
JOEL KAPLAN
A Moment Like This I
TESTED HIV NEGATIVE IN 1991. As a sexually active 21-year-old gay man living in New York City, I had every reason to feel relieved at that test result. The universe had given me a brief reprieve. I tested positive in 1992.
That year gave me the opportunity to reflect on my past behavior and prepare for a better future. I believe I did the best I could during that year. Regardless, despite my sincere efforts to avoid the virus, I got HIV.
Accepting the fact that I am not always in control when it comes to how my life turns out was a difficult lesson. But what it taught me was important: I am in control of how I respond to life’s curveballs. Ever since, I’ve been guided by that realization.
Fast-forward to 2025, when the Serenity Prayer has been my North Star: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can and wisdom to know the difference.” In or out of a religious context, I believe these simple words always have much to offer us, but more so these days.
That’s as true for the world of politics as it is for our personal lives. We cannot fight our best for what matters most to us if we are not well—physically, mentally and spiritually. I often fall short of keeping myself healthy, but I aspire every day to that goal. Total health is a journey, not a destination.
Our cover subject, Daniel Garza, is living proof of that idea. Now 54, he tested HIV positive in 2000. As a public speaker, he has much to share: “I get up and talk about growing up Latino and gay, about addiction, about my life with HIV, about having anal cancer and living with an ostomy bag and about the connection between all of them.”
Go to page 22 to read more about how Daniel uses humor to educate about sexual health and living a positive life.
In this special issue about sexual health, we also meet two other advocates: filmmaker and actor Timothy Guion Smith and youth health activist Joshua Jaffe.
Timothy, a Filipino American living with HIV, directed and acted in the short film Next of Kin,which features an HIV storyline. Sexual health and family ties are prominent themes of the film. Go to page 28 to read about his thoughts on HIV advocacy and art. Joshua, a 20-year-old student at the University of Oregon in Eugene, is the president of the Harm Reduction Club at University of Oregon, a student group affiliated with Oregon’s HIV Alliance. Go to page 32 to read how he hopes to make condoms cool again. If you are currently involved in HIV advocacy, then you may be in need of a pep talk. Go to page 12 to read words of wisdom by Tami Haught and Kamaria Laffrey, co–executive directors of Sero Project.
Raising awareness, promoting education and supporting policies and actions that improve prevention, treatment and care for folks living with and affected by HIV is a lot. Take our survey at the back of this issue to tell us your thoughts about HIV advocacy today.
ORIOL R. GUTIERREZ JR. EDITOR-IN-CHIEF editor-in-chief@poz.com Want to read more from Oriol? Follow him on X @oriolgutierrez and check out blogs.poz.com/oriol.
RAISING THE ROOF
Longtime HIV activist Eric Sawyer helped create housing for people with AIDS.
ERIC SAWYER, 71, A NEW YORKER LIVING WITH HIV, IS WELL known in the HIV and AIDS community for having been a principal player in ACT UP and then cofounding Health GAP, which helped get the first wave of effective HIV meds to low-income countries in the late 1990s and early 2000s.
But he is perhaps less known for having cofounded, in 1990, the ACT UP spin-off Housing Works to create secure, stable, medically appropriate shelter for people with AIDS who were homeless. Housing Works has since grown into a multipronged, multimillion-dollar New York City services agency.
Sawyer was interviewed by POZ contributing writer Tim Murphy for the Caftan Chronicles Substack series of interviews with notable older gay men. In this condensed and edited version of the Q&A, Sawyer discusses AIDS housing history.
You were raised an upstate New York farm boy. After graduate school in Colorado, you arrived in New York City in 1980.
I got an apartment on 22nd Street between 9th and 10th Avenues in Chelsea. It was run-down and becoming a gay offshoot of the West Village, the main gay neighborhood.
In Denver, I had co-bought and renovated a two-family home and sold my interest in it. But it had given me the renovation bug, so I kept looking for a building in NYC to buy. I’d become friends by then with Larry Kramer, and in 1981, he and I and my boss at American Standard [a manufacturing company], where I was working by then, were trying to buy two brownstones for a total of $225,000 on 100th Street
between West End and Broadway. But the deal fell apart. I’d heard that people were starting to renovate brownstones in Harlem, so I biked there.
I’d seen a house there listed for $26,000—a four-story brownstone with several squatters in it. So with money I borrowed from a friend of my father and the manager at the restaurant I worked at, I bought it. Then I moved in with my new boyfriend. There was no heat or hot water or gas—only electricity and cold water. There were water leaks everywhere and rooms filled with garbage as high as the refrigerator.
What was the neighborhood like?
My brownstone was one of only three on the block that was occupied. We were the only white people for 15 blocks. We’d get off the subway and people would yell and sometimes throw bottles at us. So I adopted a 95-pound
Clockwise from left: East 125th Street in Harlem, 1980; New York City newspaper headline spotlighting Eric Sawyer meeting his new Harlem neighbors, 1982; Eric Sawyer with his former boyfriend Frank Jump (top); brownstone kitchen before renovation
German shepherd to walk around the neighborhood with.
What was the renovation like?
I renovated it with my own hands. I hired people for the electricity and the plumbing, but I did all the demolition, framing, Sheetrocking, insulation and flooring myself. It took me until about 1988 to finish the whole thing. We had a working kitchen sink on the ground floor, a bathtub on the third floor and a toilet on the top floor, and we’d have to go between them.
How much did all of this cost and how did you pay for it?
I think the whole thing cost about $150,000, which I paid for either through tax refunds or money I’d saved or credit cards. That’s why it took me so long. Even after I started working at American Standard, I kept working at the restaurant three nights a week and double shifts on the weekends.
Then I was sold the building next door by a guy who would go and find buildings in foreclosure, buy the deed for pocket change, pay the back taxes on it to the city and then flip it. Then in 1985, I bought a building on West 123rd Street for $25,000 and never renovated it but sold it a year later for $85,000. And then I bought another adjacent building on Manhattan Avenue from a sealed bid Housing Preservation and Development auction. And then I bought a building on West 119th Street with a friend for $100,000 and sold it a couple years later for $125,000. By that point, my boyfriend had died of AIDS, and we’d started ACT UP, so—
Yes, amid all this, AIDS comes into the picture.
I knew about AIDS pretty much from 1981, when Larry Kramer started writing about it in The New York Native, but by 1982, I was symptomatic, and by 1984, my boyfriend, Scott, had Kaposi sarcoma, an AIDS-linked cancer. I was only lightly symptomatic. One of the first things I got was recurring shingles. Also swollen lymph nodes. It wasn’t really until 1983 or 1984 that I understood these as AIDS symptoms.
Fast-forward to 1987, the founding of ACT UP.
I called Larry Kramer, whom I hadn’t talked with much the year my boyfriend was dying of AIDS. I told Larry that Scott had died and that a lot of guys with AIDS were becoming homeless when they lost their jobs and got evicted. And also that a lot of homeless people were coming down with AIDS via injection drugs. I told him that I wanted to use my housing development skills to create housing for people with AIDS and could he introduce me to some of the right people.
And Larry said certainly and that he was speaking at the LGBT Community
organization, founded in 1982 by Kramer and others] to develop AIDS housing, and nobody there was willing. So we incorporated our own 501(c)(3) [nonprofit] and started Housing Works in 1990.
How did that go?
A lot of our early work was facilitated by Joe Allen and his wife, Rhonda Shearer, who allowed us to use her loft space as Housing Works’ first offices. Cofounder Charles King was the first employee, then Ginny Shubert and [Charles’s boyfriend] Keith Cylar [who died in 2004].
Our first program was procuring and providing scattered-site housing. We did a lot of bar and club benefits to pay
Eric Sawyer
“I renovated it with my own hands.”
Center the following week to call for the creation of an AIDS civil disobedience organization [which would become ACT UP].
I went to the speech with my boyfriend at the time, Frank Jump, and we both volunteered to help plan the first demonstration, and then we were both elected to ACT UP’s first coordinating committee.
A bit after that, this guy in ACT UP, Rich Jackman, an architect, came to me and said, “Let’s start an ACT UP Housing Committee.” So we did that and started doing lots of demos. One big demo we did was dumping a ton of garbage we’d collected—furniture, toilets, ovens—in front of the HPD building to block traffic. We demanded that the city create a $25 million capital fund to build AIDS housing. That got so much publicity that the city ended up announcing the fund, and a few weeks later the state matched it.
At that point, we’d been trying to get GMHC [the first U.S. AIDS services
for our expenses. And eventually, when the Ryan White CARE Act [to provide AIDS funding] was passed in 1990, we applied to it for a whole bunch of grants. We provided up to maybe 80 scattered-site units as well as social services to help care for the people living there. The actor Rosario Dawson’s mother was the head of maintenance.
And we kept growing with other contracts and eventually started developing the first building of our own, Cylar House, which opened on East 9th Street in 1997.
I stayed involved with all this until about 1996, when I started working exclusively on access in the developing world to the new, highly effective HIV drugs that had come online in the late ’90s and beyond.
What do you want to prioritize with the rest of your life?
Trying to document the work I was involved in during my life. I’ve never written a book about it, so I think I will soon. Q
U.S. Businesses Seek to Accelerate Ending HIV
Nearly 70 companies are addressing the virus.
In 2024, the Match Group dating apps BLK, Chispa and Archer—which are aimed at the Black, Latino and gay/ bisexual male communities, respectively—partnered with the Together TakeMeHome initiative to get free HIV self-testing kits into households most affected by the HIV epidemic (including Black and Latino households in high HIV incidence areas, such as the Deep South). The apps sent push notifications offering delivery of free at-home tests, resulting in more than 875 orders from BLK, more than 900 from Chispa and an unconfirmed number from Archer.
Match Group’s undertaking was driven by its involvement in U.S. Business
Action to End HIV (USBAEH), a public health/private sector partnership started in 2022 within Health Action Alliance, a broader such partnership. The Presidential Advisory Council on HIV/AIDS urged the Department of Health and Human Services to increase private sector involvement in the federal Ending the HIV Epidemic initiative, launched by the first Trump administration (and which HIV advocates hope will continue). In response, the HIV drugmaker ViiV gave USBAEH seed money.
USBAEH has since grown to include 68 official members (including ViiV, HIV drugmaker Gilead Sciences, CVS,
Walgreens, Uber, Walmart and Chevron) and roughly 500 companies with a lower threshold involvement, such as sharing USBAEH educational materials about HIV treatment and prevention with their employees.
However, as people living with HIV and their allies and service providers face potentially devastating cuts to HIV programs by new Trump administration advisers and a solidly GOP-led Congress, it’s an open question whether USBAEH—with its collective corporate power and influence—can stave off such losses. —Tim Murphy
VANDALS DEFACE AIDS MONUMENT
The Wall Las Memorias in Los Angeles has over 1,600 names.
Vandals defaced The Wall Las Memorias (TWLM) AIDS Monument in Los Angeles’s Lincoln Park in January, just weeks after its 20th anniversary.
“It is a sacred place to so many people who’ve lost their friends, lovers, partners, sons, daughters to AIDS,” TWLM executive director Richard Zaldivar tells POZ. “It felt like the space was violated.”
TWLM is committed to repairing the damage, Zaldivar stresses, while continuing to provide HIV services amid the chaos and destruction wrought by the Los Angeles wildfires and the changes in HIV and AIDS funding called for by the Trump administration.
Damage to The Wall Las Memorias
TWLM, the nonprofit responsible for the monument, is a community health and wellness organization dedicated to supporting Latinos, LGBTQ people and other underserved populations throughout Los Angeles.
In 2004, after much community input, the organization unveiled The Wall Las Memorias AIDS Monument, which consists of a park and eight wall panels. Six panels depict life with AIDS among Latinos, while two others are etched with the names of community members lost to AIDS. Today, it features over 1,600 names.
On January 13, a visitor noticed that one of the monument wall panels had been destroyed. A police report was filed.
The act of vandalism shocked and concerned the community, according to Zaldivar, who reassures that the monument will be restored.
TWLM has worked for more than 30 years to reduce stigma surrounding HIV and AIDS and provide a safe space for members of the community to support one another and share resources.
“I’m very grateful that we’ve had so many years of acceptance and respect from community,” Zaldivar says.
“The monument means so much to me personally for a number of reasons,” he adds. “It is the representation of hard work for so many years.”
The organization offers various specialized services, including HIV testing and prevention, preexposure prophylaxis (PrEP) access, substance use prevention and mental health services. TWLM programs and services are free to all. —Laura Schmidt
HIV and STI Testing for Youth in Memphis
New cases in Shelby County are higher than in the rest of the nation.
Spurred by an alarming jump in new HIV cases among teens in Memphis and the surrounding Shelby County, local health and school officials have agreed to expand young adults’ access to HIV testing and related services.
Specifically, the Shelby County Health Department will provide HIV and sexually transmitted infection (STI) testing, counseling, treatment, education, clinical training and proactive programs and services to students and their families in Memphis–Shelby County Schools.
These health services will be available to middle and high school students with parental consent. The aim is to lower the rates of HIV, syphilis and other STIs.
HIV diagnoses among youth ages 15 to 19 in the county increased by about 50% from 2022 to 2023, according to preliminary data from the Tennessee Health Department. What’s more, new HIV cases among young people ages 15 to 24 are five times higher than among the same age group in the rest of the nation.
“The impact of HIV and STIs on Shelby County’s young people is significant, and the burden of potential long-term health consequences is compounded by stigma and a lack of access to health care resources, specifically affordable and accessible sexual health services,” says Michelle Taylor, MD, DrPH, the director of health services for the county. “This valuable partnership with Memphis–Shelby County Schools will help us provide our young people with the information, screenings and preventive care they need to protect themselves.”
The collaboration between the health department and education leaders comes on the heels of an HIV summit held in the county in 2024. Conversations at the summit raised awareness of the issue.
Taylor says the school system “services 106,000 students, and a lot of those students are adolescents—people we know we need to educate with comprehensive sex education and teaching them how to best protect their health in every way.” —Trent Straube
Free HIV and STI Testing in Atlanta
The event supported National Black HIV/ AIDS Awareness Day.
Health equity for Black Americans and other minorities may be under attack from the new Trump administration, but local and state service providers continue to offer free testing for HIV and sexually transmitted infections (STIs).
AvitaCare Atlanta and partner MedCura Health offered free, confidential STI and HIV testing February 3 to 7 at several of their locations as part of their event Stomp the Noise: Be Fearless. Get Tested.
“In 2025, there’s still large amounts of stigma,” Jewel Sawyer, DMSc, MSHS, an infectious disease physician assistant at Avita Care Atlanta, told Atlanta News First. “We’re not talking about proper education, how to access preventive screening and testing. So we really want to get the word out to come in and get tested, know your status and empower yourself in your health.”
Sawyer adds that confusion surrounds many aspects of HIV. People often wonder, she says, “Now that I’ve been diagnosed, what happens? What’s my long-term outlook? My health outcomes? And how can I be educated to have a patient-provider relationship to take care of my health?”
Georgia has some of the highest HIV rates in the country.
In fact, the state ranks fourth in total number of HIV cases, following Florida, California and Texas, according to the Centers for Disease Control and Prevention (CDC). Atlanta also sees high HIV rates; an estimated 43,257 residents were living with HIV in 2022 and nearly 70% of them were Black, according to AIDSvu.org, an interactive site that maps and visualizes HIV data for communities across the nation.
The free testing coincided with National Black HIV/AIDS Awareness Day, marked each February 7.
According to the CDC, about 1.2 million people are living with HIV in the United States. The CDC estimates that around 14% of people with HIV do not know they have the virus, and nearly 40% of new HIV cases are transmitted by people who don’t know their status. —TS
The Federal Trade Commission (FTC) published a second interim staff report in January on the prescription drug middleman industry, which focuses on pharmacy benefit managers’ (PBMs) influence over specialty generic drugs, including significant price markups by PBMs for cancer, HIV and a variety of other critical drugs.
The FTC staff’s latest report found that the Big 3 PBMs— Caremark Rx, LLC (CVS), Express Scripts, Inc. (ESI), and OptumRx, Inc. (OptumRx)—marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent.
Such significant markups allowed the Big 3 PBMs and their affiliated specialty pharmacies to generate more than $7.3 billion in revenue from dispensing drugs in excess of the drugs’ estimated acquisition costs from 2017 to 2022. The Big 3 PBMs netted such significant revenues all while patient, employer and other health care plan sponsor payments for drugs steadily increased annually, according to the staff report.
“The FTC staff’s second interim report finds that the three major pharmacy benefit managers hiked costs for a wide range of lifesaving drugs, including medications to treat heart
disease and cancer,” says FTC Chair Lina M. Khan. “The FTC should keep using its tools to investigate practices that may inflate drug costs, squeeze independent pharmacies and deprive Americans of affordable, accessible health care—and should act swiftly to stop any illegal conduct.”
“FTC staff have found that the Big 3 PBMs are charging enormous markups on dozens of lifesaving drugs,” says Hannah Garden-Monheit, director of the FTC’s Office of Policy Planning. “We also found that this problem is growing at an alarming rate, which means there is an urgent need for policymakers to address it.”
The latest report builds on a report issued by FTC staff in July 2024, which found that pharmacies affiliated with the Big 3 PBMs received 68% of the dispensing revenue generated by specialty drugs in 2023, up from 54% in 2016. —FTC
Independent Pharmacies Are Struggling
They are a lifeline in rural and underserved communities.
Independent drugstores are closing at an alarming rate—about one a day in 2023—squeezed by the huge companies that reimburse pharmacies for costly medications.
But with each closure, a community loses more than another place where they can buy medicine. Experts say independent drugstores are more likely to know their patrons, offer health and medication counseling and, crucially, serve communities in need.
A 2023 study funded by the National Institutes of Health found that the estimated 15.1 million Americans who rely on independently owned pharmacies are more likely to have lower incomes, live in rural areas and be at least 65 years old. Their health is more complicated, and they’re more likely to need one-on-one counseling to juggle multiple medications.
As a result, those communities— already vulnerable to lack of care—are hardest hit when independent pharmacies shutter. Lower drug reimbursements compared with those offered to
chain pharmacies, such as CVS and Walgreens, are a big factor.
“They’re going to close. If they’re relying on insurance, it’s not sustainable,” says Dima Mazen Qato, a University of Southern California clinical pharmacy and spatial sciences professor who studies pharmacy access.
In recent studies, Qato and her team found independent pharmacies were more likely to close compared with
chain pharmacies—and they were more likely to shutter in Black and Latino communities already facing disproportionate barriers to care.
“We have no negotiation power,” says Ben Ross, president and board chair of the Georgia Pharmacy Association, which represents pharmacists across the state.
“We definitely have a reimbursement issue, where pharmacies are struggling not because of volume, not because they don’t have the patients, but because of the reimbursements that were being paid by the PBMs,” he adds.
Pharmacy benefit managers, or PBMs, are companies serving as pharmaceutical middlemen. They manage insurance companies’ prescription drug benefits, processing between 80% and 90% of prescriptions dispensed nationwide. They decide how much to reimburse a pharmacy for each prescription. Big chains, such as CVS and Walgreens, routinely get better reimbursements than independent drugstores. —Stateline
Hospitals Say They Won’t Turn Away Immigrants
A policy not to make arrests at or near hospitals has been rescinded.
California is advising health care providers not to write down patients’ immigration status on bills and medical records and telling them they don’t have to assist federal agents in arrests. Some Massachusetts hospitals and clinics are posting privacy rights in emergency and waiting rooms in Spanish and other languages.
Meanwhile, Florida and Texas are requiring health care facilities to ask the immigration status of patients and tally the cost to taxpayers of providing care to immigrants in the United States without authorization.
President Trump returned to the White House declaring a national emergency at the U.S.-Mexico border, suspending refugee admissions and challenging birthright citizenship, or the policy of giving U.S. citizenship to anyone born in the United States. As he carries out the “largest deportation operation” in the nation’s history, states have offered starkly different guidelines to hospitals, community clinics and other health facilities for immigrant patients.
Trump has also rescinded a long-standing policy not to arrest people without legal status at or
near sensitive locations, including schools, churches and hospitals. A proposal to formalize such protections died in Congress in 2023.
But no matter the guidelines that states issue, hospitals around the country say patients won’t be turned away for care because of their immigration status. “None of this changes the care patients receive,” says Carrie Williams, a spokesperson for the Texas Hospital Association, which represents hospitals and health care systems in the state. “We don’t want people to avoid care and worsen because they are concerned about immigration questions.”
An estimated 11 million immigrants live in the United States without authorization, with the largest numbers in California, Texas, Florida, New York, New Jersey and Illinois, according to the Pew Research Center.
Half of immigrant adults likely without authorization are uninsured, compared with fewer than 1 in 10 citizens, according to the 2023 KFF–Los Angeles Times Survey of Immigrants, the largest nongovernmental survey of immigrants in the United States to date. —KFF Health News
DON’T FALL FOR HEALTH FRAUDS
Scammers are targeting potential job applicants.
National HIV care provider Vivent Health has issued a warning regarding scammers falsely claiming to be recruiters for the company.
The nonprofit offers health care and social services, such as HIV prevention, testing, education, mental health support, nutrition counseling and housing support. According to Vivent, scammers are contacting potential “candidates” with job offer letters and requesting personal data, such as banking information. Vivent Health urges individuals not to fall for job scams, explaining, “Vivent Health will never make an offer to a candidate without first going through an interviewing process, which includes live interviews with our HR and hiring teams at Vivent Health.”
The general public should be alert to potential frauds and schemes. Online scammers use several methods to coerce money or information from people, often pretending to be from an organization you know, pressuring you to act immediately to fix an urgent problem or even threatening to arrest you. Scammers may also insist you pay them using specific methods, including gift cards, bank wires or mobile payment apps, according to the Federal Trade Commission (FTC).
To avoid a scam, block all unwanted calls, text messages and emails immediately. Do not share personal or financial information in response to a request you did not expect. Do not feel pressured to act right away, no matter how urgent scammers may make the matter seem. Finally, before making any decisions, ask someone you trust for advice. Talking things over with a friend, neighbor or family member could help you identify a scam. Unfortunately, health fraud scams can be committed by medical providers, patients and other people who intentionally deceive the health care system to receive illegal benefits or payments.
If you were scammed or are aware of a scam, go to ReportFraud.ftc.gov to inform the FTC. —Laura Schmidt
Texas Lawmaker Proposes to His Partner at Capitol
State Representative Venton Jones lives with HIV.
Texas Representative Venton Jones (D–Dallas) shocked friends and colleagues in January when he got down on one knee and proposed to his longtime partner, Gregory Scott Jr., on the House floor in the State Capitol. The proposal took place moments after Jones was sworn in on the first day of the legislative session.
In 2022, Jones, who lives with HIV, became one of the first Black gay men elected to the Texas Legislature. In January, he marked the start of his second term as representative for House District 100, which includes parts of Dallas and Dallas County.
Following his proposal, Jones addressed the room and said he plans to use his power as House Democratic Caucus whip and vice chair of the LGBTQ Caucus “to protect all Texans.”
In a 2022 interview with POZ, Jones
EVERYDAY
April
said: “As a person who lives at the intersection of being Black, gay and a person living with HIV, I learned to be fearless not only in fighting for my own life but also in fighting for the lives of the people around me, my village.”
Venton Jones pops the question.
Throughout his career, Jones has advocated for health equity and social justice for marginalized communities in the South. Today, he works with numerous organizations in support of this mission, including as chairman of the Dallas County HIV Task Force and vice chair of the Ryan White Planning Council of the Dallas area.
Jones is also the CEO of the Southern Black Policy and Advocacy Network, a nonprofit that works to train and mobilize a new generation of public health leaders.
“My policy work was so much deeper than just HIV. It was about ending racism and discrimination, improving economic outcomes and social justice and building bridges for communities to have their seat at the tables of power and influence,” he told POZ. —Laura Schmidt
These dates represent milestones in the HIV epidemic. Visit poz.com/aidsiseveryday to learn more about the history of HIV and AIDS. BY
RONALD JOHNSON of the Minority Task Force on AIDS is named as the first citywide coordinator of AIDS policy in New York City. (1992)
THE AIDS COALITION TO UNLEASH POWER (ACT UP) joins the OCCUPY WALL STREET movement to protest changes to HIV housing policies in New York City and to demand a financial speculation tax to end AIDS. The protest honored the 25th anniversary of ACT UP. (2012)
2 9 10 10 18 18 27
GOD’S LOVE WE DELIVER celebrates the delivery of its 15 millionth meal. Founded as an AIDS service organization in 1985, the organization serves those who are too sick to shop or cook for themselves. (2014)
May 19
JOAN RIVERS is named the winner of season 8 of The Celebrity Apprentice. She donates her $250,000 cash prize to God’s Love We Deliver. (2009) HIV VACCINE AWARENESS DAY NATIONAL ASIAN & PACIFIC ISLANDER HIV/AIDS AWARENESS DAY
JENNIFER MORTON
NOW WHAT?
In an opinion piece titled “So Now What? A Clarity Offering From Sero Leadership,” Tami Haught and Kamaria Laffrey, co–executive directors of Sero Project, offer words of wisdom for advocacy today. Below is an edited excerpt.
OUR FEELINGS ARE VALID.
Sit with them; name them. We have a wide range of emotions that are then managed by our choices, intentionality and impact. Our feelings can be what we use as fuel to get through the next four years in protecting our community and sustaining our organizations, pushing back with strategy and substance—without evoking further harm to ourselves or one another. How? We are still grappling with concrete steps as we hear from our most trusted subject matter experts—you.
For one, we are feeling the fear and anxiety and want to encourage you that this is not a time to be reactive to the onslaught of every single tactic that comes out of the White House. We know that they are coming for all of us, but we must believe that they won’t succeed, and we won’t be quiet about it. It is their goal to keep us trapped in our feelings, being solely reactive and not having the capacity, resources or clarity on how to strategize and fight back. This is a time to leverage the anger and be responsive to what the community needs in light of
what we’re being threatened with.
This is a time to acknowledge the feeling of defeat but not give in to it. Channel it by taking a moment to assess the bandwidth of your coalitions, networks, organizations, advisory boards, etc. Focus on what you can influence, collaborate with those doing things that you aren’t able to identify capacity for and be flexible with those who are offering time and energy as a resource. We all have a lane; we all have a role to play—we can only swallow this bitter pill of our crumbling democracy one sip at a time.
We have to stop playing it safe. We have never been safe. Some of us have been more privileged in our movement than others to identify progress as proximity to safety, but we are a society that repeats history no matter the harm, and we have to stop being complicit in that. For people living with HIV, we can look back and find so many similarities in our struggle made more di cult by the lack of support from elected o cials. It hasn’t stopped. Our job is not to solely focus on what the government can do for us. It isn’t going to save us. We have to save ourselves.
We must be willing to make sacrifices and peel back the layers of our ego to examine what has kept us rooted in this work. We should ask ourselves what more we can do differently, with a clear intention toward the future we envision and for the people we care about—people who may not share our geographical, racial or gender identity. Accountability to one another is essential.
Our specific work at Sero Project is through our mission to remain committed to people living with HIV who have experienced criminalization, the threat of criminalization, discrimination or violence because of their HIV status and to the networks, coalitions and stake holders that make moves and throw down in their various states to change laws.
We are in this with you. Every staff person at Sero is a part of a network or coalition in their home state. Every staff member at Sero is a person living with HIV. We are charged by our history, our ancestors and our integrity to stay rooted in our dedication to end the criminalization of people living with HIV. The people have always been and will always be our why. Because we are the people. Q
RIPPLE EFFECT
In a blog post titled “The Consequences of Trans Erasure: A Global Ripple Effect,” José Zuniga, PhD, MPH, president and CEO of the International Association of Providers of HIV Care, urges action. Below is an edited excerpt.
THE EXECUTIVE ORDERS
issued by President Trump, along with ensuing actions taken by federal agencies, have set a dangerous precedent that threatens the fundamental rights and dignity of transgender people in the United States and beyond. These actions, including limitations on legal gender recognition, are not simply administrative decisions. They are an outright attack on the existence and humanity of transgender individuals.
At the core of these policies is an insidious attempt to erase trans people from legal and social recognition. By rolling back protections and rights for trans individuals, the government signals that their lives and identities are expendable. This is not just a matter of bureaucratic oversight; it is an intentional and harmful strategy that has real-world consequences. When governments make categories of people invisible in policy, the effects ripple outward, making them more vulnerable.
For trans individuals, the stakes are life-altering. Research has consistently shown that trans people face disproportionately high rates of poverty, unemployment, homelessness and barriers to accessing health care. The implementation of policies that deny them legal recognition only exacerbates these disparities. Without proper identification documents that reflect their gender
identity, many transgender people are le vulnerable to discrimination in employment, housing and education.
Equally alarming is the rollback of access to gender-a rming medical care. In several states, emboldened by these federal actions, lawmakers have moved aggressively to restrict access to treatments that are essential for the well-being of transgender individuals. These attacks on health care not only deepen stigma but also lead to increased mental health struggles, including higher rates of anxiety, depression and suicidality among trans youth.
The implications of these policies extend far beyond U.S. borders. The United States has long played a role in shaping global human rights norms, and when it takes steps backward, it gives cover to other nations to do the same. Already, anti-trans rhetoric and policies are on the rise worldwide. Countries that had limited legal protections for trans individuals may now pass even more repressive laws.
For instance, in some parts of Eastern Europe and Latin America, there has been a growing movement to ban gender-a rming medical care and legal gender recognition, o en citing similar justifications to those being made in the United States. The proliferation of these policies threatens to undo years of progress and puts trans lives at even greater risk, particularly in countries
where violence against LGBTQ individuals is already alarmingly high.
The impact is not just governmental. Anti-trans rhetoric from political leaders fuels societal stigma, encouraging discrimination and violence at an individual level. Hate crimes against trans people have been on the rise in the United States and many parts of the world, and anti-trans policies and legislation that delegitimize the existence of trans people only makes it easier for such gender identity–motivated violence against an already vulnerable community to go unchecked.
The fundamental truth remains: Trans people exist. No executive order, policy change or political ideology can erase their humanity. They are part of our families, workplaces, communities and societies. While laws may attempt to make them invisible, their lived experiences and contributions remain undeniable. Making people invisible in policy does not erase their humanity. Full stop. We cannot allow this tide of discrimination and erasure to continue. We must stand in solidarity with trans individuals, a rming their right to exist, to thrive and to be seen. Injustice thrives in silence, but resistance is fueled by visibility and solidarity. Now is the time to speak up, to act and to a rm the simple but powerful truth: Trans people are here, and no government decree can change that reality. Q
FIGHTING BACK
What do HIV and LGBTQ advocates do when health care comes under attack? Fight back!
Since Inauguration Day, President Trump has been issuing executive orders threatening the long-term health of both vulnerable Americans and citizens of developing countries. In response to funding freezes for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and mass firings at the United States Agency for International AID (USAID) plus threats to professionals who provide gender-affirming health care, the long-resilient HIV and LGBTQ communities have been taking to the streets to show their numbers and voice their anger.
In February, activists rallied at the State Department to protest the dismantling of USAID and billions of dollars in cuts to PEPFAR while similar actions were held around the world. And in New York City and Chicago, trans people and their allies challenged the federal pause on the provision of gender-affirming health care, particularly to trans youth under 19, as well as the administration’s rollback of President Biden’s guidance on Title IX protections that allowed trans students to access school sports teams and sex-segregated facilities that align with their gender identity.
1.,2., 3., 4., 5. On February 8, hundreds attended the Rise Up for Trans Youth rally in New York, organized by Trans formative Schools (an after-school program for trans youth), the Gender Liberation Movement and ACT UP New York. The event aimed to build community among and demonstrate solidarity with trans youth, their families, caregivers, educators and health care providers who continue their work in the face of legal threats. Notable attendees included actor and onetime POZ cover subject Javier Muñoz (2), who is living with HIV, and ACLU LGBT & HIV project codirector Chase Strangio (5), who is the first trans person to make oral arguments before the Supreme Court.
6. Ugandan human rights activist Fabz UG, founder of PRISM Uganda and CEO of Haven of Pride Africa, protests cuts to PEPFAR and USAID as a direct attack on human rights and LGBTQ+ rights imperiling the lives of LGBTQ+ and displaced people around the world. 7. On February 6, ACT UP NY, Treatment Action Group and Housing Works held a rally outside the State Department’s Harry S. Truman Building in Washington, DC, stating, “We reiterate the call for the U.S. government to immediately reinstate PEPFAR and all HIV programs that have been frozen, in illegal contravention of federal statutes ordering the delivery of foreign aid—we demand that our tax dollars be used for the reasons that they were taken! Fight AIDS, not diversity!”
CHILLED SPRING PEA SOUP
Easy to make and totally delicious.
THIS COLD MINTY SPRING PEA SOUP is a breeze to make and super yummy. Plus it looks absolutely beautiful. If fresh peas are out of season, you can substitute frozen, just make sure there’s no sugar added to them.
SERVINGS: 4 / INGREDIENTS: 7 / MINUTES PREP: 20
INGREDIENTS
1 tablespoon butter
4 scallions, white and pale green parts only, chopped
2 mint sprigs, washed
DIRECTIONS
2 pounds fresh peas, shelled or frozen peas
6 cups good-quality unsalted chicken stock
BENEFITS OF PHYSICAL ACTIVITY
Physical activity has many immediate and long-term benefits.
A single session of exercise can boost your mood (including reducing depression and anxiety) and help you function and sleep better.
Adults who sit less and perform any amount of moderate- to vigorousintensity physical activity on a regular basis will see health benefits in the long run. These include keeping your thinking and learning skills sharp as you age and reducing your risk for heart disease, diabetes, liver disease and some cancers.
Source: Physical Activity Basics, CDC.gov
½ cup of cream or buttermilk (optional)
2 mint sprigs, leaves stripped and chopped, for garnish
1. In a heavy-bottomed pot, melt the butter over medium-low heat. When it has melted and stopped foaming, add the chopped scallions. Sauté until they have softened.
2. Add the whole mint sprigs and sauté for a couple of minutes, then add the peas and salt to taste. Add the stock and cook until the peas are soft and bright green—this will go fast for frozen peas. Remove the mint sprigs and blend until the soup is completely smooth. Check for seasoning and add cream or buttermilk, if using.
3. Let the soup chill in the fridge for at least 2 hours. Serve cold with chopped mint.
CHEF TIPS
This soup can be made both with or without the liquid dairy element—it’s delicious either way.
Screening can detect several types of cancer at an early stage, when it’s easier to treat.
IN THE ERA OF HIGHLY EFFECTIVE
antiretroviral treatment, cancer is a leading cause of illness and death for people living with HIV. HIV-positive people are at greater risk for some cancers compared with the general population, and they may develop cancer at a younger age, but rates of most malignancies are similar.
Screening can detect several cancers at an earlier, more treatable stage. In general, screening recommendations are the same for HIV-positive and HIVnegative people, and the HIV Medicine Association (HIVMA) advises following guidelines from the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society.
Cervical and anal cancer: These malignancies are caused by human papillomavirus (HPV), a common sexually transmitted infection. People with HIV are at higher risk. Screening includes Pap tests (cytology) to collect a cell sample for examination under a microscope and HPV tests. Follow-up
involves colposcopy or anoscopy, which use a lighted magnifying instrument to view the cervix or anal canal.
For cervical cancer, national HIV guidelines recommend cytology screening for women ages 21 and older at the time of HIV diagnosis and then yearly; a er three normal tests, the interval can be every three years, with no upper age limit. Those ages 30 and older may also be tested for HPV. The first anal screening guidelines for people with HIV were issued last year a er a large study showed that screening and prompt treatment can prevent progression to anal cancer (see page 27).
Breast cancer: A mammogram (low-dose X-ray) is the primary method of breast cancer screening. The USPSTF recommends screening mammograms every two years for women ages 40 to 74 at average risk. Those at higher risk may benefit from more frequent screening.
Colorectal cancer: The USPSTF recommends colon and rectal cancer screening for adults ages 45 to 75 at
average risk. People at increased risk may need earlier screening. Options include a colonoscopy every 10 years, flexible sigmoidoscopy every five years or stool tests every year. A colonoscopy uses a flexible lighted tube to view the colon. Tests that look for blood or cancer DNA in a stool sample collected at home are not as accurate, but some people are more likely to get them done.
Liver cancer: Chronic hepatitis B or C, heavy alcohol use and fatty liver disease can lead to cirrhosis and liver cancer. Screening is not recommended for the general population. Experts recommend semiannual liver cancer screening using ultrasound scans and alfa-fetoprotein blood tests for people with cirrhosis. HIVMA advises surveillance for those with hepatitis B coinfection or a history of hepatitis C and advanced liver fibrosis.
Lung cancer: Screening with chest CT scans is not recommended for the general population. The USPSTF recommends annual scans for people ages 50 to 80 with a 20-pack-year smoking history who currently smoke or have quit within the past 15 years. The American Cancer Society advises screening for people in this age group regardless of how long ago they quit.
Prostate cancer: Screening with prostate-specific antigen (PSA) blood tests can detect aggressive prostate cancer early, but routine testing can also find slow-growing precancer or malignancies that never would have become life-threatening. According to the USPSTF, men ages 55 to 69 should make an individual decision about PSA testing with their health care provider, taking into account personal preferences and risk factors. The American Cancer Society recommends that men at average risk should discuss PSA screening starting at age 50 or as soon as age 40 for those at higher risk.
Skin cancer: Regular visual examination of the skin can detect abnormal growths that might be cancerous. When performing a self-exam, check all parts of the body, including the palms and soles, scalp and ears. Look for moles that are large, oddly shaped or have changed in size, shape or appearance. Regular skin exams are especially important for people with weakened immunity.
HIVMA advises clinicians treating people with HIV to regularly ask about cancer risk factors and encourage recommended screenings. Consult your doctor promptly if you experience symptoms that might suggest cancer. Q
BY LIZ
PREVENTION
Twice-Yearly PrEP
Twice-yearly lenacapavir pre-exposure prophylaxis (PrEP) could be available this summer pending Food and Drug Administration (FDA) approval. The target decision date is June 19, and preparations for the U.S. launch are “well underway,” according to Gilead Sciences. The PURPOSE 1 trial showed that lenacapavir PrEP was 100% effective for young cisgender women in Africa. Likewise, the PURPOSE 2 study showed that lenacapavir injections every six months reduced the risk of HIV acquisition by 96% for gay and bisexual men and gender-diverse people. In both trials, lenacapavir was safe and well tolerated. In December, Gilead said that it had completed New Drug Application (NDA) submissions for lenacapavir PrEP. It was granted an FDA breakthrough therapy designation and priority review status, intended to speed up regulatory review. Under the Prescription Drug User Fee Act, expedited therapies can be approved in as little as six months, but it is unclear how FDA reorganization and staff layoffs under the new presidential administration could affect the timeline.
Highly Resistant HIV TREATMENT
An experimental regimen containing lenacapavir and a monoclonal antibody was able to control HIV replication in a person with multidrug-resistant virus, according to researchers from the National Institute of Allergy and Infectious Diseases. Standard antiretroviral regimens are usually effective, but they don’t always work against highly resistant virus. This case study involved a 58-year-old man with Kaposi sarcoma (KS), an indicator of advanced immune suppression. He had used several regimens over three decades and developed resistance to all available antiretrovirals and most HIV antibodies. Over 70 weeks, he was treated with the HIV capsid inhibitor lenacapavir (Sunlenca), two other antiretrovirals (tenofovir and emtricitabine), the monoclonal antibody semzuvolimab (UB-421), antibiotics (trimethoprim/sulfamethoxazole and azithromycin) and chemotherapy and immunotherapy for KS. Within two weeks, his viral load rapidly declined, becoming undetectable a er a year of treatment. What’s more, his CD4 T-cell count rose, indicating immune system recovery.
CURE
Triple bnAb Cocktail
A combination of three broadly neutralizing antibodies (bnAbs) may maintain viral suppression for several months a er antiretroviral treatment interruption. People with HIV normally produce antibodies, but these usually don’t recognize evolving viral mutations. A small proportion naturally produce bnAbs that target conserved parts of the virus. To overcome resistance and neutralize more HIV strains, researchers tested a combination of three bnAbs, dubbed PGT121, PGDM1400 and VRC07-523LS. Twelve people with HIV received up to six monthly infusions of the bnAbs, stopping antiretrovirals two days a er the first dose. Two participants experienced early viral rebound, but 10 of the 12 (83%) maintained an undetectable viral load throughout the dosing period, and five (42%) had viral suppression for about a year, even a er blood bnAb levels fell. Early viral rebound was associated with baseline resistance to PGT121 and PGDM1400. These results suggest the triple bnAb cocktail could replace antiretrovirals for a prolonged period but only in people without preexisting resistance.
Artery Health CONCERNS
Taking a statin can help stabilize coronary artery plaque, reducing the risk of heart attack and stroke. The large REPRIEVE trial showed that middle-aged HIV-positive people with low to moderate cardiovascular risk scores who took daily pitavastatin (Livalo) reduced their risk for major cardiovascular events by 35%. Statins lower LDL cholesterol, which contributes to the buildup of plaque in arteries, or atherosclerosis. Unstable plaque can break off, causing clots that block blood vessels supplying the heart and brain. A REPRIEVE substudy found that the statin reduced the volume of noncalcified plaque in arteries. In a post hoc analysis, 558 participants underwent coronary CT angiography scans and protein and gene expression analysis at baseline and a er two years. Those randomized to pitavastatin had higher levels of the enzyme PCOLCE, which controls deposition of collagen, a component of plaque. Changes in PCOLCE were associated with reduced noncalcified plaque volume and altered composition, suggesting plaque stabilization. More stable plaque is less likely to rupture and block blood flow.
TRUMP’S MOVES THREATEN PEOPLE WITH HIV WORLDWIDE
Policy and funding changes during the first several weeks of Donald Trump’s administration are imperiling people living with HIV. On the day of his inauguration, Trump signed executive orders to withdraw the United States from the World Health Organization and halt funding for foreign aid, including PEPFAR, the President’s Emergency Plan for AIDS Relief, which provides HIV treatment for more than 20 million people worldwide. The Centers for Disease Control and Prevention, the National Institutes of Health (NIH), the Food and Drug Administration and other health agencies were told to suspend external communications, and their websites were scrubbed of content related to “gender ideology.” This was followed by employee layoffs across federal agencies.
Funding for domestic health efforts, such as the Ryan White HIV/AIDS Program, is also threatened. Trump has expressed support for a congressional budget proposal that includes deep cuts to Medicaid, which covers some 40% of people with HIV. The NIH— the nation’s major funder of biomedical research—said it would slash grant support for universities and medical centers.
Some of these moves have been walked back or halted by lawsuits, but the situation remains dire as POZ goes to press. PEPFAR was granted a waiver for lifesaving medical care, but pre-exposure prophylaxis (PrEP) was limited to pregnant and breastfeeding women. Despite the waiver and a court order, providers in Africa have reported clinic closures, staff layoffs and suspension of HIV clinical trials. According to UNAIDS, a 90-day funding freeze could lead to 8.7 million new infections and a tenfold increase in AIDS-related deaths over time.
Interrupting antiretroviral therapy even briefly can lead to viral load rebound, raising the risk for HIV transmission and drug resistance. Going without treatment long-term leads to declining immune function and disease progression. “People are going to die because lifesaving tools have been taken away from them,” says UNAIDS director Winnie Byanyima.
Inadequate CD4 Recovery Linked to More Clinical Events
People who don’t experience full CD4 T-cell recovery a er starting antiretroviral treatment remain susceptible to both AIDS-defining clinical events and non-AIDS infections, according to a recent review. Antiretrovirals halt HIV replication, allowing CD4 cells to recover, but around 15% to 20% of people who start treatment with a very low count never reach a normal level of 500 or higher.
A meta-analysis of 15 relevant studies with a combined total of 188,945 participants showed an inverse correlation between CD4 cell levels and morbidity. People with a CD4 count below 200 a er starting treatment had a sevenfold higher risk for AIDS-defining events, while those with a count of 200 to 350 had a 63% elevated risk compared with people whose count reached 500 or higher. For non-AIDS infections, people with a CD4 count below 200 had nearly a threefold higher risk, while those in the 200 to 350 range had a 50% higher risk. But noninfectious non-AIDS clinical events did not differ significantly between people with good and poor CD4 cell recovery. Indeed, research shows that people with HIV—even those on effective treatment with a normal CD4 count—are more prone to non-AIDS comorbidities, such as heart disease and kidney disease. The lack of a link between CD4 count and noninfectious non-AIDS events “highlights the need for comprehensive care that addresses other risk factors beyond immunological recovery,” the study authors concluded.
UPDATED PERINATAL AND PEDIATRIC HIV GUIDELINES
In December, the Department of Health and Human Services updated its HIV treatment guidelines for pregnant women and children to reflect recent research. The revision recognizes that mothers on effective antiretroviral therapy with an undetectable viral load have a very low risk of transmitting HIV to their babies during pregnancy, delivery or breastfeeding.
Older guidelines advised mothers living with HIV not to breastfeed if safe formula and clean water are available, but HIV-positive women have advocated for more autonomy. The January 2023 update for the first time recommended “evidence-based, patient-centered counseling to support shared decision-making about infant feeding.”
The latest guidelines recommend that infants at high risk for HIV acquisition during gestation or delivery—meaning those born to a mother with a viral load of 50 copies or higher during the four weeks prior to delivery—should receive a threedrug antiretroviral regimen starting at birth and continuing for two to six weeks, while those at low risk should receive AZT alone for two weeks. Infants are considered at low risk for HIV acquisition during breastfeeding if the mother is on antiretroviral treatment with sustained viral suppression for at least three months before delivery. The panel members did not reach a consensus about whether such infants should receive extended antiretroviral prophylaxis.
The revision includes a discussion about what to do if viral load becomes detectable during breastfeeding. The authors recommend that breastfeeding should be stopped temporarily while viral load is rechecked, causes of viral rebound are assessed and the importance of adherence is reinforced. If viral load goes back to undetectable on repeated tests, a joint decision can be made about whether breastfeeding may safely resume.
DoxyPEP Reduces STIs in California
Taking a single dose of the antibiotic doxycycline a er sex—known as doxyPEP—has already helped reduce bacterial sexually transmitted infections (STIs) in California, according to three recent real-world studies.
In October 2022, San Francisco was the first city to recommend doxyPEP for gay and bisexual men and gender-diverse people. Researchers with the San Francisco Department of Public Health compared monthly STI cases before and a er the guidance. Overall, STIs declined significantly citywide a er doxyPEP implementation. Chlamydia cases fell by 50%, and early syphilis decreased by 51% relative to predicted levels, though there was a small increase in gonorrhea.
In a second study, researchers compared STI rates among people receiving HIV pre-exposure prophylaxis (PrEP) at Kaiser Permanente Northern California—an integrated health system that covers the San Francisco Bay Area and nearby counties—before and a er doxyPEP initiation. Recipients saw a 79% reduction in chlamydia and an 80% decrease in syphilis. The 12% decline in gonorrhea was less impressive but still statistically significant. A third study showed reductions in all three STIs in Los Angeles.
“Our patients have enthusiastically embraced this proactive approach to reduce their STI risk,” says Jonathan Volk, MD, MPH, of Kaiser Permanente San Francisco. “A er doxyPEP became available for our PrEP patients, we have seen a dramatic decline in positive STI tests and less need for treatment a er STI exposures.”
Daniel Garza lives in Laguna Beach, California.
BY TIM MURPHY
PHOTOGRAPHY BY ARI MICHELSON
WHEN ADVOCATE AND SPEAKER DANIEL
Garza shares his journey of living with HIV and other health challenges with crowds of high school and college students and young adults, he leaves little out.
“I get up and talk about growing up Latino and gay, about addiction, about my life with HIV, about having anal cancer and living with an ostomy bag and about the connection between all of them,” says Garza, 54, who tested positive for the virus in 2000. He estimates that in one recent year, he spoke to a total of 3,500 people.
“Because when you talk about sexual health, it’s not just where you put your penis. That’s the physical part,” continues Garza, who lives in Laguna Beach, California. “The mental part is, ‘What’s the purpose of what I’m about to do?’ And the spiritual part is, ‘How is this going to make me feel—not just now, but after?’ When I speak, I’m not there to lecture. I’m just saying, ‘This is my story—use me as a map to decide where you’re going and how you’re going to get there.’”
That’s Garza when he’s not being particularly funny, which he is a lot of the time. The fact that he talks in a rapid-fire rasp, like a gay Latino Joan Rivers, adds to the laughs.
Discussing his bad mood while undergoing chemotherapy, he compares himself to “Imelda Marcos after losing all her shoes.” Waxing rhapsodic about his love of tacos, he says, “Hand me a carne asada with onions and cilantro and a very hot red sauce and I am putty in your hands.” If you ask about his life goals, he replies, “I want to be kept and rich and lie in a cabana somewhere—isn’t that the goal of every gay man?”
It’s easy to see why Garza has used humor to smooth out his journey of sexual health—and, more broadly, of his mind, heart and soul—which has been bumpy, to say the least. Born in Monterrey, Mexico, to a Mexican mom and a Texan dad of Mexican descent, at age 3, he moved with them to Dallas, where he endured a childhood of extreme bullying, targeting his gay mannerisms, as well as sexual molestation.
Coming of age realizing he was gay caused a split in him. “The American side of me was saying, ‘Everyone on TV and in movies is having sex, this is fun and OK, I love boys and I can enjoy this.’ But my Mexican side was saying, ‘God’s watching you, you’re going to hell, you’re the only boy in the family and a total disappointment because you’re not going to carry the family name.’ I was doing everything I could so that nobody could figure me out. I felt like a glass of Coke that you drop a Mentos into—I was about to explode!”
Garza was outed to his family at age 17—a reveal his sisters initially didn’t take well to. His parents, on the other hand, were supportive. “My mom was very upset that I hadn’t trusted her enough to tell her, because for years, she’d been asking, ‘Is there anything you want to tell me?’ And while
my American side had always secretly thought, Yes. This is the after-school special moment I’ve been waiting for, my Mexican side had been like, You can’t say anything.”
FOR TWENTYSOMETHING GARZA, THE
’90S WERE a blur of sex—sometimes with a condom, sometimes without— and alcohol and drugs. “I knew about condoms and safer sex, but all that info would go out the window with a line of coke,” he says. Toward the end of the decade, he was losing weight and was beset by fatigue and coughing fits. “But I had an excuse for everything,” he says. “I was smoking crack, so of course I had a cough.” Deep down, though, he feared the reason was HIV. He had actually fled a clinic early in the decade before getting the results of the one test he took.
Garza’s fear was confirmed when he became so visibly ill that a friend took him to a clinic, whereupon he was hospitalized for three weeks and diagnosed not just with HIV but with AIDS, as his CD4 cell count was just above 100. His family even summoned a priest to give him last rites, but Garza sent him away.
Quickly, he got on HIV meds as well as drugs to prevent the opportunistic infections that often occur with a very low T-cell count, but he was still so fragile when he left the hospital that he had to return a few weeks later. After that, when he finally felt up to it, he started volunteering for Valley AIDS Council in the border town of McAllen, Texas, assembling condom packets and lobbying for the translation of the group’s materials into Spanish.
“We’d have potluck days, and my sister would come and finally got the information she needed about HIV prevention and treatment,” he says. He adds, only half-jokingly, that if someone wants to promote HIV acceptance within a Latino family, “find a matriarch—educate that one woman in the family and you’ve got it made.”
But his new career as a burgeoning activist didn’t keep him from drinking and doing drugs; his substance use got so bad that in 2007, he wound up in rehab. “I learned to be a man and to hold myself accountable for what I’d done.” The rehab offered not only 12-step literature and programming but also an array of material—from the Bible to books on
faith to poetry volumes—that set him on a spiritual path he’s still on. Today, he’s a Reiki master.
FOR
THE NEXT
SEVEN YEARS,
LIFE PROCEEDED nicely for Garza. He met someone in Houston and moved to California with him, then, after they broke up, he met his current partner in 2012 via OkCupid. But in 2014, he started having trouble pooping and constantly felt bloated. “It was like everything I ate hit me wrong,” he recalls.
At first, doctors thought the issues stemmed from what turned out to be a hernia, for which he had surgery. But weeks after the operation, he was still experiencing the same issues. His primary care doctor gave him a digital rectal exam to investigate.
Garza turned out to have anal cancer, which is more common among men who have sex with men, especially those living with HIV. Treatment for the malignancy can be both painful and difficult. But anal cancer is preventable with regular screenings, which can include digital exams, Pap smear screenings for anal precancer and tests for human papillomavirus, a virus that causes anal as well as cervical and oral cancers. If a Pap test result is positive, follow-up testing includes an anoscopy, in which a slim probe with a camera is inserted into the anus.
In 2022, the large ANCHOR study showed that screening and prompt treatment of anal precancer can prevent progression to invasive cancer. But a lack of awareness about higher risk for anal cancer and how to screen for it—even among HIV doctors—and, until recently, a lack of uniform screening guidelines (see sidebar) mean that some people living with HIV, especially gay and bi men, are diagnosed when the cancer has advanced. With Garza, for example, by the time he was diagnosed, “I’d been presenting and educating about HIV and sexual health for 14 years, and no health provider had ever brought up anal cancer prevention.”
Two rounds of chemotherapy plus 38 rounds of radiation followed. He was supposed to have 40 rounds, but “My body just couldn’t handle it anymore,” says Garza. The treatment cured the cancer. He lost his hair, but a more serious consequence was that the treatment damaged his anus and rectum to the point where he needed a permanent ostomy, which is when an opening is created, usually in the abdomen, to divert waste. An ostomy bag, which must be emptied or changed regularly, is attached to collect the waste.
WITH TYPICAL HUMOR TO LEAVEN HARDSHIP,
Garza named his ostomy bag Tommy. He says, “I don’t think I’ll ever completely get used to Tommy, but I love him because he helped save my life.” Cancer tested him but ultimately taught him resilience. Garza also says his current partner was there for him every step of the way and acknowledges that the toll an illness takes on caregivers is often insufficiently discussed.
Garza also says that as someone who for so long derived both affirmation and pleasure from sex, the changes to his body and self-image post-cancer have been difficult to
“MY OWN GOAL IN LIFE IS TO EXPERIENCE AS MUCH AS I CAN.”
face. “It’s been challenging to reconnect with my body,” he says. “And if you don’t see yourself as a sexual being, you can’t invite anyone to be a part of it, so intimacy has been difficult for me.”
Garza advocates for both HIV and cancer awareness.
When asked whether he thinks he’ll ever work through the emotional aftermath of the cancer, he says, “How can I say this without sounding bitchy? You just deal with it! You can tell me all you want about what’s going to happen [during or after a health episode], but I won’t really know until I’m in it. I’m about to hit 25 years living with HIV, and there are still things I don’t know about it.”
It’s that candor that makes Garza such a great advocate for and educator about sexual health. He has a new job as director of anal cancer, HIV and hepatitis C advocacy for Cheeky Charity, a nonprofit that aims to expand awareness, education, resources and advocacy to counter anal and colorectal cancer in the LGBTQ community by, among other things, promoting at-home, mail-in anal Pap smear swabbing.
“Part of my job will be traveling to Pride events, conferences and health fairs to speak to people about anal cancer, from prevention to treatment to posttreatment,” he says. “We want to work with not just patients but also caregivers. We can
offer tips and insights if you’re going through treatment and support groups if you’re posttreatment.”
It won’t be a surprise at all if Garza brings his tell-it-like-it-is humor to the job, as he has to all of his sexual health speaking gigs. “After everything I’ve been through, good and bad, my responsibility is to share whatever wisdom I learned from it,” he says.
“My own goal in life is to experience as much as I can, talking about health issues and traveling the world doing my life coaching. This may sound cheesy, but one of my fears is that I’ll be forgotten after I die, so I work very hard to leave my mark on the world. For so long, I felt like I was nothing. Now, I want to be involved—I want to be part of something.” Q
Learn more about Daniel Garza and his work at @iamdanielggarza on Instagram.
ANAL CANCER SCREENING FOR PEOPLE LIVING WITH HIV
Learn about the new guidelines.
The overall incidence of anal cancer among people living with HIV is low, but it’s significantly higher than it is among HIV-negative people, especially for men and transgender women who have sex with men. This is why folks with HIV should be screened regularly for anal precancer, which are treatable lesions that could become cancerous.
According to government guidelines issued in 2024:
• All adults with HIV should be assessed annually for anal symptoms and receive a digital anal-rectal exam.
• If symptomatic, gay and bi men and trans women under age 35, and others under 45, should undergo standard anoscopy.
• Symptomatic gay and bi men and trans women 35 and older, and others 45 and older, should undergo high-resolution anoscopy (HRA), if available, with laboratory cell analysis and human papillomavirus (HPV) testing.
• HRA should be done regardless of symptoms if testing shows cell abnormalities or high-risk HPV types.
Outside of large metropolitan areas like New York, Los Angeles and San Francisco, providers are o en still unaware of anal cancer screening guidelines, and HRA may not be available. If you bring this up with your provider and they don’t know about it or dismiss it, impress on them its importance. Even if they can’t do the screening, try to enlist them in helping you find the nearest provider who can.
What’s more, HPV vaccination can prevent precancerous anal lesions and anal cancer as well as cervical and oral cancers. The Gardasil 9 vaccine protects against nine HPV types that cause cancer or genital and anal warts. The vaccine is recommended at age 11 or 12, with catch-up vaccination through age 26. But some older people can still benefit, so ask your doctor. Email dggarza@cheekycharity.org or call (951) 708-0989 for a referral near you. You can also search the LGBTQ+ Healthcare Directory or contact the National LGBT Cancer Network.
—Tim Murphy and Liz Highleyman
FILMMAKER AND ACTOR TIMOTHY GUION SMITH DISCUSSES HIV ADVOCACY AND ART.
BY CHARLES SANCHEZ
TELLING A MODERN HIV STORY “O
NE OF THE THINGS THAT’S EXASPERating for me as someone who watches a lot of lm and TV is that in 2025, HIV is almost like a period piece,” says Los Angeles–based lmmaker and actor Timothy Guion Smith. The artist continues, “Producers and directors, TV networks—they never want to explore what it’s like to be positive in this day and age. It’s like they are only interested in exploring HIV within the context of the ’70s through the ’90s. Heaven forbid it’s a story taking place today—it’s like a B plot on a gay episodic.”
Stills from the short film Next of Kin
Frustrated with the portrayal of HIV in modern media, Smith, a Filipino American living with the virus, wrote, directed and acted in the short film Next of Kin. Featuring an HIV storyline, Smith’s film packs a whole lot of story and heart into 15 minutes. To date, it has been screened at Outfest Fusion in Los Angeles, the San Diego Asian Film Festival and San Francisco’s CAAMFEST 2024.
The film begins with a trio of adorable young gay men playfully flirting on a couch. (Alert: spoilers ahead!) As Tommy, played by Smith, and his friend with benefits, Andrew, are getting to know a new friend, Bryan, the scene evolves from steamy mutual kissing to a sweaty bedroom threesome. When the subject of condoms and safer sex comes up, Tommy mentions that he’s HIV positive and has an undetectable viral load, which means he’s on effective treatment and cannot transmit the virus sexually.
The disclosure sharply shifts the mood from sexy to shivery. Although he’s taking pre-exposure prophylaxis (PrEP), Bryan fears contracting HIV and peppers Tommy with questions, asking whether he takes his HIV medications regularly and how often he gets tested. Ultimately, Bryan rejects Tommy, who, uncomfortable and shook, goes home alone.
Then, in a series of flashbacks, viewers learn that Tommy has been living with HIV his whole life, having contracted it from his mother. In the movie’s last scene, he visits her, and she talks to him about how, although the stigma surrounding HIV has evolved since the early days of the AIDS crisis, it still manages with every rejection to be incredibly hurtful, “like a rock being pelted at us.”
She explains that it’s up to her and Tommy, as people living with HIV, to let go of the negativity and not let other people’s ignorance and fear weigh them down. In the film’s final moments, mother and son hold each other, bearing the burden of HIV stigma and together finding a way through with love.
THE FILM IS BEAUTIFUL,
heart-tugging and modern in its depiction of how HIV affects its disheartened hero. Next of Kin doesn’t offer a happy ending, a pretty bow to tie up its story. Rather, the film ends with the frayed edges of reality, uncertainty and hurt and the comfort of family. And although it’s about a Filipino American man and his Filipina
mother, it doesn’t delve into racial issues or stereotypes, rendering the tale all the more real and relatable.
Smith is a native New Yorker. “I lived on Staten Island until I was 10,” he says. His Irish American father’s family immigrated to the United States around the time of the American Civil War, while his mother emigrated from Manila to New York City in 1981. “The community calls it Fil-Am, but I guess technically, I’m Filipino Irish American.” The family was working-class, so they didn’t have a lot of money for theater and live entertainment. Smith discovered acting via the movies.
“We would movie-hop a lot!” Smith says. “That’s one of my first memories, just illegally movie-hopping. That’s my memory of falling in love with storytelling.”
Poster promoting the short film
Next of Kin
The acting bug also bit early. “The first thing I did as a performer,” Smith says, “was onstage with my brothers. It was an after-school kind of latchkey kid thing, where they just let the kids go onstage and do sketches.” Smith and his brothers performed a classic sketch by the radio, film and TV comedy duo Abbott and Costello where the two buffoons meet the Mummy. “It’s kind of the lore, if you will, of my family. The three boys up there onstage doing Abbott and Costello. What other 6- or 7-year-olds are doing that?”
Smith’s love for acting and storytelling grew as he did. When it was time to decide on a college, he chose New York University, where he focused on acting and musical theater performance. After graduation, he wound up in Los Angeles.
IN 2017, WHILE CHASING the Hollywood dream, Smith shared a facet of himself that he’d been keeping private— his HIV status—via video.
“I was hearing all sorts of really aggravating things at parties or social events. And it got to a point where I had to take my voice back, to let people know someone in their own social circle is living with HIV,” he says. “For me to just find some ground to stand on, I decided to come out about it.”
“I came out about my status to family, friends and coworkers over a video that I posted to all my social channels,” Smith says. In the poignant video, he shares that when he was 19, he survived a rape that
resulted in him contracting HIV.
“This incident happened,” Smith shares, “and then 90 days to the day after the incident, I went to get tested. I was never symptomatic. I never felt like I came down with the flu. I was at the student health center three months to the day and then found out I was positive. And that was so shell-shocking.”
Smith decided to use his disclosure video as a fundraising tool for HIV organizations in California. “We raised $6,000 spread three ways, for APLA [AIDS Project Los Angeles], Equality California and the last bit of it was for RAIN [Regional AIDS Interfaith Network].” He was surprised and delighted when the crowdfunding project extended past family and friends. “I was shocked that I basically told a bunch of my normie coworkers, posting it on LinkedIn and asking previous colleagues to donate, then there were all these VPs and stuff that I never sent it to, and they would drop like $100 or $250.”
“THEY NEVER WANT TO EXPLORE WHAT IT’S LIKE TO BE POSITIVE IN THIS DAY AND AGE.”
Former classmates also chipped in, but Smith was truly surprised by some of his relatives who donated. “My MAGA family at the time,” he says, “there were some family members that were—the way that my aunt said it when she heard [about my HIV status] was like, ‘You never think about cancer until it hits your family, and you don’t think about this until this hits your family.’ And she only had the most loving, positive things to say to me, that she loves me unconditionally, all that stuff.”
Between the success of his video and film, Smith seemed poised to make more HIV art. “It’s funny because, obviously, I’m a lot. This is a rant, but I feel like somewhere along the way, I felt like we had enough of an understanding of misinformation and when things are being politicized. But I feel like it’s gotten to a new low this last year or two, to the point it discourages me from wanting to be an advocate,” he says.
“I still do my advocacy and my part. I just did this commercial. It was actually a little controversial. It was against Proposition 34. [Aimed at the AIDS Healthcare Foundation, the proposition requires providers to spend revenue from a federal drug discount program on patient care, not politics.] I came out about my HIV status, and that had a lot of airtime during the election. So I still do my advocacy work, but with how ugly things have gotten, it just gets me so angry.”
On a personal level, Smith is continually surprised by the misinformation about HIV that pervades our society, especially queer men. “When people finally have the opportunity to talk to someone living with HIV, you’re the projection of all their misinformation and their hate and their frustration and the entitlement they feel to reject you. That’s why I put my HIV status on my Hinge profile and my Tinder profile because I don’t want to deal with those conversations.”
He adds, “The annoying thing about those conversations
is that those people want to use that opportunity to tell you why they have the right. And I don’t care. Don’t use me as your emotional dartboard.”
WHICH IS ANOTHER REASON SMITH DECIDED to make Next of Kin —to rebel against common misconceptions about HIV and about Filipinos. “I wanted to subvert expectations and explore HIV from the perspective of a Filipina mother and her gay son who was born positive,” he says.
“I think it’s interesting with Filipinos because at a time when all the cases of HIV are decreasing, the Philippines actually has an alarming rise in cases, like exponential compared to other Southeast Asians,” Smith says. “Compared to other Asian-American ethnicities, Filipino Americans are disproportionately affected when it comes to HIV. Filipinos are like nearly a third [of Asian Americans with HIV], and the next closest ethnicity was 10%. I think there’s something to be said about that and even just getting awareness for that and encouraging people to talk to each other as a means of dispelling medical misinformation.”
Smith has been working on expanding his short film. “I was working on making this into a series, but my friends who are staff writers on shows tell me that TV is currently dead. The only thing that has a minimal pulse is feature work, but like micro-budget feature-type stuff.” What he had been creating as a series, he’s now reimagining as a two-hour feature.
“HIV is not the main focus, but it’s part of it,” Smith says. “It’s through more so the lens of something like HIV. Like we know that mental illness is something that’s not being addressed within the API [Asian Pacific Islander] community. What does mental illness manifest itself as? Substance use, riskier sexual encounters or higher incidences of nonconsensual sex. And I think HIV broadly is included in that. This isn’t a film about a mother and her son who are HIV positive. It’s going to be three generations of the family. What happens in this family? There’s addiction, there’s mental illness. It’s more like how these things are all related.”
Smith hopes to complete the film by 2026, but he’s realistic about how the industry works. “Now, it’s about getting the money and getting the script out there,” he says. Q
Safer Advocacy
Joshua Jaffe wants to make condoms cool again. A 20-year-old premed student at the University of Oregon in Eugene, Jaffe is the president of the Harm Reduction Club at University of Oregon, a student group a liated with Oregon’s HIV Alliance. Together, these organizations aim to eradicate HIV while addressing the needs of those living with it.
“We have an event planned, and it’s all about safer sex,” Jaffe explains. “It is the University of Oregon Condom Fashion Show showcasing outfits made entirely out of raw, unprocessed condoms. They look amazing! And it’s all about safer sex. I think people should be a little concerned about diseases and infections. A lot of these are curable, but a lot of them aren’t, which is why I think we should keep our guard up.”
Increasing sexual health awareness is a timely mission for Jaffe’s more than 22,000 classmates and for the community of Eugene, which has a population of about 177,000. Jaffe notes that advancements in birth control have diminished the role of condoms in the average undergrad’s sex life.
“Our message is, ‘Hey, we know you may not get pregnant. Wear a condom anyway.’ Because I think a lot of people are unaware what condoms can protect them from because modern birth control has gotten really good,” Jaffe says. “Many women are on the pill or have IUDs [intrauterine devices]. As a result, many dudes just say they’re going to pull out. When it comes to condoms, lots of men aren’t quite there yet. The reality is sexually transmitted infections [STIs] are on the rise in universities because virtually no one uses a condom anymore because they’re not at risk of having a baby.”
Jaffe’s attention is not limited to the mostly heterosexual, relatively a uent student body. He’s especially mindful of those living on the margins and at increased risk for HIV. He’s particularly focused on Eugene residents who inject drugs, many of whom are homeless.
“The biggest accomplishment that we’ve completed is getting other needle exchanges up and running around Eugene,” he says. “We used to only be able to run a needle exchange from our main o ce location. We weren’t able to take it on the road and park vans across the city. We now have a mobile needle exchange, and I really enjoy that outreach. They come for the needle exchange, but we also offer a series of homeless services. We had a project where about 300 people enrolled last year, and by the end of it, 76 of them had permanent housing.”
And all the while, Jaffe remains committed to the sexual health of his clients and classmates, something he likens to a good investment in dollars and in lives.
“Health services on campus spends a lot of resources managing STIs,” he explains. “I spend a lot of time combating these diseases because if we can just lower those rates by a little bit, the entire university health system will improve.” Q
Joshua Jaffe seeks to increase sexual health awareness.
VOCAL POWER
HIV advocacy involves raising awareness, promoting education, reducing stigma and supporting policies and actions that improve prevention, treatment and care for individuals affected by HIV. Take our survey and let POZ know your thoughts on HIV advocacy.
1 Are you living with HIV?
TYes TNo TI don’t know.
2 How comfortable are you discussing HIV-related issues with others?
TVery comfortable TSomewhat comfortable
TNot comfortable
3 How often do you participate in events related to HIV advocacy or awareness?
TFrequently TOccasionally TRarely
4 How likely are you to volunteer or donate to HIVrelated causes or advocacy groups?
TVery likely TSomewhat likely TNot likely
5 Are you aware of organizations in your community that advocate for HIV awareness or support individuals living with HIV?
TYes TNo
6 Do you believe that HIV awareness and education programs are sufficient in your community?
TYes TNo TI don’t know.
7 How often do you encounter misinformation or misconceptions about HIV in your community?
TFrequently TOccasionally TRarely
8 How would you rate the effectiveness of HIV prevention efforts in the United States?
TVery effective TSomewhat effective
TNot effective
9 Do you think schools should include HIV education in their standard curriculum?
10 Do you support policies that protect individuals living with HIV from discrimination in health care, employment and other areas?
TYes TNo
11 How important do you think it is for our government to fund HIV prevention and treatment programs in the United States?
TVery important TSomewhat important
TNot important
12 How important do you think it is for our government to fund HIV prevention and treatment programs around the world?
TVery important TSomewhat important
TNot important
13 What year were you born?__ __ __ __
14 What is your gender?
TMale TFemale
TTransgender TOther
15 What is your sexual orientation?
TStraight TBisexual
TGay/lesbian TOther
16 What is your ethnicity? (Check all that apply.)
TAmerican Indian or Alaska Native
TArab or Middle Eastern
TAsian
TBlack or African American
THispanic or Latino
TNative Hawaiian or other Pacific Islander
TWhite
TOther (Please specify.): ___________________
17 What is your current level of education?
TSome high school TSome college
THigh school graduate TBachelor’s degree or higher
18 What is your annual household income?
TLess than $15,000 T$50,000–$74,999
T$15,000–$34,999 T$75,000–$99,999
T$35,000–$49,999 T$100,000 or more
19 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
TYes TNo
IAS 2025, the 13th IAS Conference on HIV Science, will take place in Kigali, Rwanda, and virtually, from 13 to 17 July 2025, with pre-conferences on 13 July.
The IAS Conference on HIV Science is the world’s most influential meeting on HIV research and its applications. This biennial conference presents the critical advances in basic, clinical and operational HIV research that move science into policy and practice. Through its open and inclusive programme, the meeting sets the gold standard of HIV science, featuring highly diverse and cutting-edge research.
