POZ July/August 2025

HEALTH, LIFE & HIV

Breaking the Silence

Long-term survivor and advocate Mary Fisher continues to speak out against injustice

IMPORTANT FACTS FOR BIKTARVY®

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*

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 nd the latest news and learn how you can make a di erence in the ght.

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 e orts to make such laws re ect 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, e ective 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.

20 SPEAKING OUT FOR JUSTICE An excerpt from Mary Fisher’s new book, Uneasy Silence. INTRO BY JENNIFER MORTON

26 WHAT’S IN THE PIPELINE FOR HIV? Research on longer-acting therapies for HIV treatment. BY LIZ HIGHLEYMAN

28 VILLAGE APOTHECARY CONTINUES TO GO ABOVE AND BEYOND The New York City pharmacy has served people living with HIV since 1983. BY TIM MURPHY

14 NUTRITION & FITNESS

Peach sweet tea granita • health risks

16 BASICS

NMAC aims for a greater focus on the needs of adults living with HIV at its 2025 United States Conference on HIV/AIDS.

6 POZ PLANET

Symbolic die-ins to protest HIV cuts • Howard Brown Health and AIDS Foundation Chicago mark major milestones • remembering Michael Siever, PhD • POZ Stories: Erica Lavina • Everyday: reflecting back on the epidemic

10 VOICES

POZ contributing writer Shawn Decker thanks his longtime HIV physician, who recently retired.

12 SPOTLIGHT

AIDS Walk New York and more

Clinical trials

17 RESEARCH NOTES

New PEP options • update on doravirine and islatravir combo • bispecific T-cell engager • measuring cardiovascular risk

18 CARE & TREATMENT

Funding cuts could increase HIV cases • can HIV treatment lower cancer risk? • gender-affirming care linked to better HIV outcomes • expanding access to long-acting injectables

Sue Daugherty believes food is medicine.

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

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Love Is the Drug I

NEVER GOT ANY OF MY HIV medications at New York City’s Village Apothecary, an independent pharmacy in Manhattan’s Greenwich Village. But I remember always feeling welcome whenever I did stop in for this or that.

As a gay New Yorker, as well as someone who during the late 1980s into the ’90s went to college in Greenwich Village and lived in the East Village, I knew very well just how special Village Apothecary was to those of us living with HIV. Since 1983, the pharmacy has been at the forefront of caring for those with the virus. From the start, the staff has loved the clients, and the feeling is mutual. That connection was uncommon back then, and it’s even more so today. Pharmacy chain stores and mail-order pharmacies have made the personal touch a rarity. For folks with HIV, especially in the early days of AIDS, their lives often literally depended on the caring staff at independent pharmacies like Village Apothecary.

The challenges may be different now, but people aging with HIV undoubtedly still benefit from the personal touch. Please go to page 28 to find out why many longterm survivors say they’ll never go to any pharmacy other than Village Apothecary.

In this special issue of POZ focusing on HIV treatment, we spotlight the role that such care plays in the well-being of folks with the virus. We also take a look at what’s in the pipeline for HIV treatment. Researchers are working on longer-acting therapies to treat the virus. Go to page 26 for more.

Long-term survivors receive care from many health professionals, but perhaps the most direct connection is with their primary care providers. POZ contributing writer Shawn Decker has had a supportive relationship with his physician since 1999. Recently, he had to say so long to his doctor, who retired from practice earlier this year. Go to page 10 to read Shawn’s moving tribute.

Food is another component of proper care. Eating well can often make the

difference between just surviving and really thriving. Sue Daugherty knows that to be true. She’s CEO of the Philadelphia-based MANNA, a nonprofit that feeds chronically ill people. The group has grown from serving only people with HIV to feeding those in need across the region. Go to page 32 for more.

Mary Fisher, our cover subject, is most definitely someone who knows about the importance of substantive care in making HIV treatment effective for a lifetime. She tested positive for the virus in 1991. The following year, she took to the stage at the Republican National Convention to ask her fellow Republicans and Americans to “set aside prejudice and politics to make room for compassion and sound policy” regarding HIV and AIDS.

Mary was the fourth person to grace the cover of POZ in 1994. She has been an activist ever since. In a new memoir, Uneasy Silence, the mother and artist speaks truth to power and shares wisdom from her decades of HIV advocacy. Go to page 20 to read an excerpt.

Lastly, please go to the back of this issue for our 2025 HIV drug chart. The quick-reference chart lists current treatment options.

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

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

CENTERING AGING WITH HIV

NMAC argues for a greater focus on the needs of older people living with HIV.

NMAC’s 2025 United States Conference on HIV/AIDS (USCHA) will highlight aging with HIV. The annual event will take place in Washington, DC, from September 4 through 7.

The theme, “Aging and HIV,” aims to honor people growing older with HIV, examine their challenges and learn from their lived experiences. The program will focus on the different groups living with HIV, including the pre–protease inhibitor generation, post–protease inhibitor survivors and “dandelions” (those born with HIV). When protease inhibitors as a class became available in the mid-‘90s, they revolutionized treatment. HIV was no longer a death sentence. For those with access to medication, HIV became a manageable, albeit chronic, condition.

USCHA attendees will be able to explore any of 10 tracks aligned with the theme: advancing research and treatment for older adults; aging with HIV political determinants of health; behavioral health and aging with HIV; biomedical HIV prevention; community building; comorbidities and multiple chronic conditions of those aging with HIV; dandelions, aka lifetime survivors; the science of sexuality and pleasure; systems change and workforce development; and women aging with HIV.

Below, NMAC staffers explain why it’s time to center people aging with HIV.

Moisés Agosto Director, Treatment Division

Why is it important to spotlight this community at this moment in time? Because people 50 and older represent 50% of those living with HIV in the United States, and studies project that by 2030, in the next five years, we will represent 70%.

The silver tsunami is approaching. Are we ready to respond to the needs of older adults living with HIV? In our lived experience, we face early aging and multiple

comorbidities on top of HIV. The challenge facing older adults with HIV is monitoring and managing the increasing layers of health and daily living complications, for which we lack a comprehensive community response, funding and health systems.

These challenges translate into life adjustments that impact our resilience and how we thrive. I know this in my bones as a person living with HIV for 38 years. I know the meaning of AIDS in my body. I faced a death sentence and came back to health. I am fortunate to become a 60-year-old man and continue to have the opportunity to lead NMAC’s program on aging, HIV 50+ Strong & Healthy.

Personal and community resilience continue to be my most important medicine. Community is everything to me, and USCHA 2025 will be the space for me to connect with, learn from the wisdom of and honor the elders of our movement. USCHA 2025 is the oppor-

tunity to shape the future after ending the epidemic and how to get there.

Audrianna Marzette Associate Manager, Treatment Division

Growing up in Selma, Alabama, I saw firsthand how silence shaped the experience of HIV. My uncle lived with HIV in an era and environment where stigma was overwhelming and community support was almost nonexistent. He carried the burden of his diagnosis alone, never knowing that spaces like USCHA existed—spaces where he could have found affirmation, support and a sense of purpose. I often wonder how different his life would have been if he had had access to the kind of community-driven spaces we are working to strengthen today.

As a new team member at NMAC working with the HIV 50+ Strong & Healthy Program, I see echoes of that history repeating in far too many lives. But I also see an opportunity—to redefine aging with HIV. The theme of USCHA 2025 gives me hope. It centers long-term survivors, fosters meaningful peer support networks and tackles stigma through storytelling, policy advocacy and community building.

This work fuels my passion because I believe aging with HIV should not mean aging in isolation. Everyone deserves dignity, respect and access to quality care. USCHA plays a critical role in reducing isolation, improving awareness and ensuring that people living with HIV are not merely surviving but also thriving together.

At NMAC, I directly engage with the National HIV Aging & Advocacy Network (NHAAN), a collective of individuals committed to ensuring that people aging with HIV can do so with dignity—physically, emotionally, socially, financially and spiritually. As part of NMAC’s 50+ Strong & Healthy Program, NHAAN works to advance policies, programs and services tailored to the unique needs of older adults living with HIV and AIDS.

What sets NHAAN apart is its unwavering focus on centering the voices of those it serves. Membership is open to individuals aging with HIV who

want to drive change at the federal level and within their local communities. Through monthly support groups and dedicated spaces for women of color, LGBTQIA+ individuals and heterosexual men living with HIV, NHAAN fosters inclusive environments where people can share, connect and heal.

For me, being part of NHAAN is not just about advocacy—it’s about shaping a future where no one is forgotten. It’s about ensuring that longterm survivors of HIV have access to trauma-informed care, financial security and the respect they deserve.

More than just a network, NHAAN is a community, a movement and a family.

early activism of ACT UP in New York to my current leadership roles—including my work as an executive member of NHAAN and cochair of its Training of Trainers Committee—I have spent my life amplifying the voices of those aging with HIV.

That’s why NMAC’s work matters so much. Through initiatives like NHAAN, we are not just addressing aging with HIV as a medical condition—we are tackling the social, economic and structural challenges that come with it. NHAAN strengthens policies, expands access to traumainformed care and builds peer networks that ensure older adults living with HIV

“Are we ready to respond?”

I am honored to be part of this work and to contribute to a future where aging with HIV is met with strength, support and unwavering dignity.

Joey Pons

Executive Member, NHAAN

For me, attending USCHA 2025 is not just a professional commitment—it’s deeply personal. I have been living with HIV since 1987. In the early days of the epidemic, survival felt uncertain, and long-term possibilities seemed distant. Yet here I am, decades later, embracing the complexity of aging with HIV. The theme of this year’s conference recognizes that people like me—who were never expected to live this long—are now shaping what it means to age with resilience, dignity and purpose.

This journey has been about more than survival. It has been about advocacy, about ensuring that those aging with HIV are not overlooked and about building systems that meet the unique needs of long-term survivors. From the

feel seen, heard and valued.

At USCHA, we are shifting the narrative. Aging with HIV is about more than medications and doctor visits—it is about fighting stigma; confronting racism, ageism, homophobia and transphobia; and advocating for financial security and equitable health care. What makes this conference truly powerful is its commitment to the meaningful involvement of people living with HIV. We are not just attendees; we are stakeholders in shaping the future.

Being here, surrounded by others who share this commitment, fills me with a renewed sense of purpose. I am proud to be part of this movement, to stand alongside leaders, peers and advocates who are reshaping what it means to thrive as we age. Together, we will ensure that long-term survivors of HIV are not just acknowledged but actively supported in every aspect of life. Q

Go to nmac.org to learn more about NMAC and attending USCHA 2025.

BODIES AND COFFINS TO PROTEST HIV CUTS

The symbolic die-ins and caskets represent the deaths to come.

Pallbearers in black carried one coffin after another—206 in total—and stacked them in the form of a morbid mountain in front of the Washington, DC, office of the Department of State, where Secretary of State Marco Rubio is headquartered. The April 17 action was the latest by AIDS advocates protesting the gutting of funding for global and national HIV services and health programs.

Each casket represented 100,000 lives at risk, according to Health GAP, which organized the protest along with Housing Works and others. The coffins symbolize about 20 million adults and children, mostly in Africa, who have been receiving lifesaving HIV treatment thanks to the President’s Emergency Plan for AIDS Relief (PEPFAR), the global HIV program launched in 2003 by President George W. Bush that had received support from every administration until the current Trump White House.

Peter Staley (above); scenes from the protest

Vital health care programs and research within the United States are also on the chopping block. In addition to the massive cuts and restructuring implemented in recent months, the proposed fiscal budget for 2026 slashes an additional $17.6 billion from funding for the National Institutes of Health and $3.59 billion from the Centers for Disease Control and Prevention, according to The Choice Agenda, a global HIV prevention forum. The budget eliminates the Global Health Center and the National Institute on Minority Health and Health Disparities, among other programs.

And so advocates have taken to the streets. On April 25, over 100 protesters converged on the steps of the Department of Health and Human Services building and collapsed on the ground as if dead to represent the LGBTQ deaths that will result from the extreme cuts to health department programs, grants and research.

The Trump administration has aggressively targeted programs that support diversity, equity and inclusion, decimating services particularly helpful to minority and at-risk populations, including Latino and Black Americans, women, underinsured people and LGBTQ people.

Such die-ins and mock funerals hearken back to protests in the early decades of the AIDS epidemic—the 1980s and ’90s. Those colorful, creative tactics by groups such as ACT UP not only effectively garnered attention but also brought about changes to policies and research protocols that eventually led to the development and rollout of lifesaving HIV treatment. They also furthered, one could argue, the advancement of health equity and human rights, including same-sex marriage equality and access to health care.

The LGBTQ advocacy group Human Rights Campaign (HRC) spearheaded the health department die-in. “Every person here represents countless other stories. Countless lives. Countless possibilities,” said HRC’s senior public policy advocate Matthew Rose. “And as the federal government cuts funding—from research to housing, from mental health to Medicaid—we’re not just watching systems disappear. We’re watching lives disappear.”

The coffin protest was conceived by Peter Staley, an AIDS activist from the days of ACT UP who in 1991 helped slip a giant condom over the house of conservative antigay Senator Jesse Helms, one of the most iconic AIDS protests of the time.

“The coffins we are carrying today represent the 20 million people whose lives have been put at risk by Elon Musk, the richest man in the

world,” Staley said in the Health GAP release. “Does President Trump even realize his legacy will be the worst chapter in the AIDS crisis—a relaunching of the pandemic that adds millions of infections and avoidable deaths, just as we were in reach of ending it?”

“Marco Rubio presides over the collapse of one of the most successful global health programs in history,” added Charles King, CEO of Housing Works. “If the U.S. allows PEPFAR to crumble, history will not be kind. It will remember that we had the power to stop an epidemic from reigniting— and chose not to. We must fully restore PEPFAR and renew our commitment to global health and human dignity.”

—Trent Straube

CHICAGO HIV GROUPS MARK MILESTONES

Howard Brown Health and AIDS Foundation Chicago hosted galas to celebrate.

The Chicago-based HIV service organizations Howard Brown Health and AIDS Foundation Chicago (AFC) both marked major milestones in April with festive fundraiser galas.

To celebrate 50 years of lifesaving work, Howard Brown, one of the nation’s largest LGBTQ health organizations, hosted an anniversary gala on April 26 at Chicago’s Theater on the Lake. The nonprofit has been rooted in LGBTQ liberation since 1974, when four medical students expressed a desire to help Chicago’s gay community.

Today, Howard Brown provides primary medical care, behavioral health care, HIV and sexually transmitted infection prevention services and more to over 40,000 Chicago adults.

The gala’s theme, “Let’s Grow Old Together,” highlighted the numerous ways Howard Brown helps improve the quality of life of many LGBTQ people in Chicago.

On April 5, AIDS Foundation Chicago celebrated 40 years of HIV community support with its gala fundraiser, AFC40, at The Geraghty hotel in Chicago.

Since its inception, the foundation has fought for equity and justice for people living with and at risk for HIV and other chronic conditions. The organization provides HIV services, housing, case management, food, emergency financial assistance and more to over 8,000 people each year.

AFC’s gala honored the organization’s history while renewing its commitment to the Getting to Zero Illinois initiative, which aims to end the state’s HIV epidemic by 2030.

Chicago native Craig Johnson received the Lori Kaufman Volunteer Award at the gala. A nationally recognized leader in LGBTQ health care, HIV care and health equity, Johnson, who has been living with HIV for two decades, has held numerous leadership roles at the foundation and other organizations.

“It’s an amazing honor, first of all, to even be considered. It’s just incredibly moving, personal and humbling,” Johnson said in an AFC news release. “To know so many people living with HIV and to have lost so many others who never made it out of their 20s, who never made it out of their 30s, who were in the prime of their life. For me, their lives, their spirit, their legacy helps to motivate me.”

The gala, which raised $770,000, featured live music, performances and an auction featuring such prizes as a boat cruise through Burgundy, France, custom art and a two-night stay at Claridge House, a boutique hotel in Chicago’s Gold Coast neighborhood. —Laura Schmidt

R.I.P. Michael Siever, PhD

The HIV activist, harm reduction advocate and psychologist was 74.

Michael Siever, PhD, a passionate HIV and AIDS activist, harm reduction advocate and psychologist, died April 10 at an assisted living facility in Seattle. He was 74.

Siever, who was gay, dedicated his life to serving the LGBTQ community in San Francisco through mental health, substance use and HIV health services.

As director of behavioral health at the San Francisco AIDS Foundation (SFAF), he cofounded the Stonewall Project more than 25 years ago. The harm reduction program helps gay and bisexual men with substance use issues.

Siever had been living with bone marrow cancer for several years, according to the Bay Area Reporter. His adopted son, Ethan Treber, said he helped care for Siever throughout the last few years. Last month, Siever decided that he was “done with transfusions.”

“We at San Francisco AIDS Foundation are saddened to hear of the passing of Dr. Siever,” Tyler TerMeer, PhD, the CEO of SFAF, told the Bay Area Reporter. “Michael was an incredible champion for the queer community—dedicating his life and career to building programs and services for gay, bi and trans men who have sex with men and others at risk for HIV.

“His deep expertise, and care, in crafting these services lives on today through two programs at SFAF he cofounded more than 20 years ago: the Stonewall Project, which provides substance use treatment and counseling, and Magnet, our sexual health clinic at Strut. Michael’s legacy lives on, and we are so grateful for his contributions to our community,” TerMeer continued.

“Michael was a visionary,” said Steve Gibson, cofounder of Magnet. “The way he saw gay men relative to methamphetamine and enabling gay men’s health beyond the paradigm of HIV positive or HIV negative— Michael and I had a vision to change that.”

In 2014, Siever retired from SFAF, but his work did not end. In fact, that same year, Siever was co-investigator for a study that highlighted the positive impact of the Stonewall Project on HIV and AIDS prevention.

The study showed that Stonewall Project participants decreased their use of stimulants, such as methamphetamine, and reduced their sexual risk behavior. —LS

Michael Siever

Above: Revelers at AFC’s gala

My Mom Is a Warrior and My Hero

Erica Lavina is fortunate to have her mom by her side

Both of my parents were diagnosed with HIV in 1993. My dad, Bill Lindemann (1953–1993), passed away five months after their diagnoses, leaving my 36-year-old mom, Pam, to navigate her own diagnosis while raising two teenage girls.

My dad insisted he didn’t know how he contracted the virus, but after his death, my mom discovered he had been having relationships with men. It breaks my heart that he felt he had to hide this part of himself from those who loved him, but I realize how different things were back then, especially for our suburban middle-class family. My dad took his diagnosis to his grave, with few people, including my sister and me, knowing the truth.

Lavina and her mother, Pam

Today, I want to celebrate my mom, a warrior and my hero. She’s never complained about the unfair hand life dealt her. When she was diagnosed, the prognosis was grim. For over 30 years, she’s lived with the stigma of AIDS, often calling herself “damaged goods.”

There have been countless illnesses, hospital stays, doctor visits, blood draws, trials and medications, and I know that sometimes it must have felt easier to give up. Yet she hasn’t,

EVERYDAY

July

and I am grateful for her strength.

A few years ago, she earned both bachelor’s and master’s degrees. When her private disability coverage ended at 65, she faced the harsh truth that she hadn’t saved for retirement, having never expected to live this long. Unfortunately, the sad reality is that she went back to work to cover living expenses and the cost of lifesaving medications, never once complaining.

While I miss my dad deeply, I am grateful for the gift of modern medicine that has kept my mom with us for all these years. I never thought she would be there to see my high school graduation, yet she was there to witness my oldest child graduate last May. So many milestones—graduations, engagements, weddings and the birth of grandchildren—she’s been able to experience, and we are lucky to share those moments with her.

In a world where so many have been lost, I consider myself one of the fortunate ones to still have my mom by my side.

This story was originally posted on @theaidsmemorial on Instagram. Read other POZ Stories or share your own at poz.com/stories.

These dates represent milestones in the HIV epidemic. Visit poz.com/aidsiseveryday to learn more about the history of HIV and AIDS. BY JENNIFER MORTON

Activist and POZ columnist STEPHEN GENDIN dies of AIDS-related complications at age 34 in New York City. (2000)

August

21-25

ZERO HIV STIGMA DAY

The AIDS MEMORIAL QUILT is displayed in its entirety for the first time since 1996 during the 19th International AIDS Conference in Washington, DC. (2012)

19 21 27 31

The 10th annual KIEHL’S LIFERIDE ends in Los Angeles, having raised $100K to support cure research at amfAR, The Foundation for AIDS Research. (2019) 20 23 25

SOUTHERN HIV/AIDS AWARENESS DAY

The Food and Drug Administration approves the drug SEROSTIM (somatropin) to treat wasting symptoms in people with AIDS. (1996)

The San Francisco Board of Supervisors declares August 25 as BROWNIE MARY DAY to recognize the volunteer work of medical cannabis activist Mary Jane Rathbun, who was known for baking and distributing marijuana brownies to people with AIDS at San Francisco General Hospital. (1992)

NATIONAL FAITH HIV/AIDS AWARENESS DAY

Mary Jane Rathbun

2025 USCHA September 4-7

Marriott Marquis Washington DC

nmac.org/uscha #2025USCHA

Honoring People Aging With HIV, Examining Their Challenges, and Learning From

Living Experiences

1: Advancing Research and Treatment for Older Adults

2: Aging with HIV- Political Determinants of Health

3: Behavioral Health and Aging with HIV

4: Biomedical HIV Prevention

5: Community Building

6: Comorbidities, and Multiple Chronic Conditions of Those Aging with HIV

7: Dandelions and Lifetime Survivors

8: The Science of Sexuality and Pleasure

9: Systems Change and Workforce Development

10: Women Aging with HIV

THANK YOU DR. GREG

In an article titled “When Shawn and Gwenn Met Dr. Greg,” POZ contributing writer Shawn Decker thanked his longtime HIV physician, who recently retired. Below is an edited excerpt.

IFIRST SAW GREGORY TOWNSEND, MD, in the early summer of 1999, the year I started HIV medications. Dr. Greg was the perfect fit for a guy in his early 20s who was more afraid of the potential side effects of HIV drugs than the virus itself. My now wife, Gwenn, attended that appointment, where I was finally taking HIV seriously. With just 38 T cells, I had no choice.

My one caveat to starting meds was holding off for a couple of weeks, as Gwenn and I had a beach trip planned to celebrate my 24th birthday. Dr. Greg agreed to the terms. A er some fun in the sun, I was ready to hold up my end of the bargain, but a er six weeks of strict adherence, I did the unthinkable and missed a dose.

In a panic, I emailed Dr. Greg. He congratulated me, saying most firsttimers don’t get that far, which made me proud. Still, adjusting to the HIV regimen while navigating the brutal side effects was exhausting.

The good news was, the treatment worked like a charm. Gwenn really helped too. She joined me for all of

those early appointments as the antidote to my decade-long habit of glazing over in the doctor’s o ce. When Dr. Greg asked how I was doing, I’d say, “I’m fine,” prompting a so nudge from my love to spill the beans about having to pull over on the highway to vomit a er band practice.

We were a good team. And no, my short-lived band, The So-So’s, weren’t that bad.

Looking back on how grueling those days were makes me so grateful that, over the years, most of my time with Dr. Greg has been spent sharing laughs. A er my T-cell count became robust and my viral load consistently undetectable, Gwenn stopped attending appointments because, well, she had other things to do.

Seeing Dr. Greg became more about sharing the absurdities of daily life, inspiring cackles that loudly echoed through the hallways of the Ryan White clinic. That hard-earned normalcy, however, took a turn a few months ago when he delivered the toughest news I’d received in the clinic since

1999. Dr. Greg was retiring.

The day before our last appointment, I was a mess, crying and then talking it out with Gwenn before more waterworks. I was truly acknowledging that this long, transformative chapter in my life was coming to an end. “I’m coming with you to that,” Gwenn said as she held me close. I couldn’t have imagined it happening any other way, and Greg was so delighted to see her.

“Gwenn!” he exclaimed, rushing in for a group hug before an audience of one med student and one resident who probably had four weeks of “Why a Doctor Should NEVER Touch a Patient” classes, which I imagine being heavy on old General Hospital, Scrubs and Grey’s Anatomy episodes.

I presented Dr. Greg with a little plastic MTV Video Music Awards moon man, as a nod to his appearance on the second edition of MTV’s Staying Alive, a 2000 World AIDS Day special showcasing our plight as doctor, patient and partner of patient. “No pressure, but we represented the HIV/AIDS epidemic in North America,” I said, putting a

little shine on our team’s early work.

My tear ducts were further moistened rewatching that program. At the time, I’d just gone off that first round of HIV medications, despite improving T-cell counts and a diminishing viral load. I was feeling beyond wiped out a er 10 months of nausea and diarrhea, and, while thankful for the improved health, I’d been thoroughly defeated by the side effects.

Reliving that time in my life, I recalled how apprehensive I was wondering how Dr. Greg would react to my desire to stop meds. So I did what I always did and led with a joke sent to his inbox: “I want a new drug, one that won’t make me sick.” Dr. Greg’s reply opened with some simple questions of his own: “One that won’t keep you up all night? One that won’t make you sleep all day?”

He didn’t just flex his Huey Lewis and the News bona fides. Dr. Greg said I didn’t have to feel so terrible, that we’d find a combo that worked without the quality-of-life tax. He did what a doctor should do: set his patient at ease by creating an environment where someone with previously tight lips felt comfortable disclosing what was really happening. And we did find a better option.

As a result, Gwenn and I were able to travel far and wide to educate about HIV and the advances in treatment that had saved my life. That would have been impossible if Dr. Greg had pressured me to stay on a drug that necessitated close proximity to home, namely the half bath closest to the entrance.

A couple of years into that second drug regimen, I started to notice mental fog. I was curious about “drug holidays,” a phrase born out of people with HIV leaving their pills at home when going on a long weekend trip. I figured Dr. Greg would bristle at my idea of two weeks on and two weeks off, and he did.

So we compromised: I’d try one week on and one week off. I had no problem sticking to the trickier regimen, and we were both surprised by the results of

“I HADN’T REALLY DARED TO THINK ABOUT A FUTURE MORE THAN A FEW YEARS AHEAD.”

my first labs: There were no alarming changes in T-cell count or viral load; for the next decade, this would be my regimen of choice.

When Dr. Greg invited me to participate in a presentation he was giving at the University of Virginia, I was happy to help. He thought the audience of first-year med students would benefit from hearing the perspective of a lifelong patient born with hemophilia and diagnosed with HIV at a young age. More important, they got to see a doctor and patient laughing together in what could only be described as a true bond of trust and respect, even a friendship.

When a student asked what my prognosis was, Dr. Greg jumped in, explaining that if I treat the challenges of aging the same way I treat HIV, I would have a normal lifespan ahead of me. He added that it’s entirely conceivable that I could outlive him. That surprised me.

I hadn’t really dared to think about a future more than a few years ahead.

When I got home, I recited the entire scenario for Gwenn; the reality of us growing older together was cathartic. Part of surviving is accepting bittersweet victories.

As our final appointment was coming to an end, I joked that—medically speaking—Dr. Greg is the easiest person to replace on my health care team. “I know!” he said with a big, satisfied smile. “All of my patients are doing so well!” I loved hearing that. For them. For him.

Before we le , I handed Dr. Greg a card. It contained a few sentences worthy of Hallmark before I cracked. In a state of desperation, I scribbled that we should still see each other every six months or so, suggesting we go to the movies “until one of us croaks.” Thanks for everything, Dr. Greg. I rest easy knowing that I’ll always hear that brilliant, infectious laugh.

Whether it’s in my heart or while sharing a tub of popcorn at the next Dumb and Dumber sequel, it’ll be my treat. Q

Dr. Greg (center) with Gwenn and Shawn

ADVOCATES IN ACTION

HIV advocates have been working double time these days. They’ve been plenty busy making noise to protest the Trump administration’s proposed and enacted cuts to budgets affecting the health of people living with the virus (see POZ Planet, page 6). At the same time, they continue to keep busy doing the quieter work of educating and uplifting communities and raising funds for and awareness of HIV.

In New York City, three events varying in scale and focus showcased the dedication and optimism that have been hallmarks of the HIV community since the 1980s.

On May 5, Iris House held its annual Women as the Face of AIDS Summit. Iris House offers support, prevention and education services for women, families and underserved populations affected by HIV and AIDS. Held at Bethel Gospel Assembly, the summit marked its 20th anniversary this year. On May 8, the Elizabeth Taylor AIDS Foundation (ETAF) hosted its New York fundraising dinner at Rockefeller Center’s Rainbow Room honoring longtime advocates Gary Dell’Abate and Rosie Perez. And on May 19, the nation’s biggest HIV fundraiser, AIDS Walk New York, marked 40 years, drawing 10,000 participants to Central Park.

1. Iris House executive director Ingrid Floyd launched the summit in 2005 with media producer Tonya Lewis Lee. This year’s theme was “Legacy, Liberation, Leadership: The Evolution of Women in the Movement” and featured discussions of HIV treatment, PrEP for prevention, and stigma. 2. Floyd posed with (left to right) two of the summit’s honorees, Uché Blackstock, MD, and Eishelle M. Hargrave-Tillery, DSW, who were recognized for their dedication to health equity, and long-term survivor and advocate Maria Davis , who spoke as part of the plenary panel. 3. At the AIDS Walk, Broadway star Javier Muñoz , who is living with HIV, sang “Love Don’t Need a Reason,”

which was sung at the first AIDS Walk New York. 4. Longtime advocate and actor Wilson Cruz , kicked things off with his opening remarks at the walk. 5. The House of MiyakeMugler vogued for the walkers, who raised nearly $2 million to benefit GMHC. 6. NYC Council member Erik Bottcher (center) took a selfie with NY Assemblyman Tony Simone and Francine Goldstein, the walk’s top individual fundraiser, who raised almost $60,000. 7. Flanked by NYC Public Advocate Jumaane Williams (left) and NYC Comptroller Brad Lander (right), Jonathan Mallow celebrated his first AIDS Walk as GMHC’s CEO. 8. TV journalist Don Lemon hosted ETAF’s New York dinner. 9. HIV activist and actress Rosie Perez, a longtime supporter of ETAF’s Lifebeat, which mobiizes the music and entertainment industry to fight HIV, and producer Gary Dell’Abate , a Lifebeat advisory board member, were honored for their longtime advocacy.

PEACH SWEET TEA GRANITA

A little lemon juice enhances the peachy taste.

THIS REFRESHING TAKE ON A SUMMER CLASSIC blends delicious ripe peaches with black tea and sugar, plus a little lemon juice. It’s a time-tested chef’s trick: Lemon juice boosts fruit flavor the way salt enhances savory flavors. You’ll hardly taste the lemon, but you will really taste the peach.

SERVINGS: 4 / INGREDIENTS: 6 / PREP: 15 MINUTES

INGREDIENTS

1 black tea bag (English breakfast or Darjeeling, see Chef Tips) ¾ cup hot water

DIRECTIONS

1 small ripe peach, pitted, peeled and diced

1 tablespoon lemon juice ¼ cup cold water 1 to 2 tablespoons sugar, to taste

1. Steep the tea bag in hot water for 3 minutes, then discard the tea bag.

2. Using a food processor or blender, puree the diced peaches with the hot tea until smooth. Stir in the lemon juice and sugar until the sugar is dissolved, then mix in the cold water. Taste for sweetness. Pour into a 9-by-9-inch baking pan. Cover and place in the freezer.

3. After 1 hour, using a fork, scrape the frozen top layer and break any chunks into pieces. Return to the freezer. Continue to scrape every 15 to 20 minutes until the granita has a fluffy, snowy consistency, about 2 hours. Eat immediately or keep for three days in the freezer, scraping every so often.

CHEF TIPS

If you typically drink loose-leaf tea, just make a pot of your favorite black tea and measure out ¾ cup through a strainer.

NUTRITION FACTS (per serving)

Calories: 32; fat: 0 g; saturated fat: 0 g; polyunsaturated fat: 0 g; monounsaturated fat: 0 g; carbohydrates: 8 g; sugar: 8 g; fiber: 1 g; protein: 0 g; sodium: 3 mg

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Heart disease and stroke are leading causes of death in the United States. Getting at least 150 minutes a week of moderate physical activity can lower your risk for these diseases. You can reduce your risk further with even more exercise.

Regular physical activity can also lower blood pressure and improve your cholesterol levels. What’s more, it can reduce your risk of developing type 2 diabetes and metabolic syndrome. Metabolic syndrome is some combination of too much fat around the waist, high blood pressure, low high-density lipoprotein (HDL) cholesterol, high triglycerides or high blood sugar. With a regular schedule of moderate-intensity physical activity, people see a benefit from even less than 150 minutes a week of such activity. Additional amounts could lower your risk even more.

Physical activity may help reduce the risk of serious outcomes from infectious diseases, including COVID-19, the flu and pneumonia. For example:

• People who do little or no physical activity are more likely to get very sick from COVID-19 compared with those who are physically active. In a Centers for Disease Control and Prevention (CDC) review, physical activity was associated with a decrease in COVID-19 hospitalizations and deaths; inactivity increases that risk.

• People who are more active may be less likely to die of the flu or pneumonia. In one study, adults who met the aerobic and muscle-strengthening physical activity guidelines were about half as likely to die of the flu and pneumonia than adults who met neither guideline. Being physically active lowers your risk of developing several common cancers. Plus, if you are a cancer survivor, getting regular exercise improves your physical fitness as well as your quality of life.

Adapted from: Physical Activity Basics, CDC.gov

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CLINICAL TRIALS

Studies are the key to advances in HIV prevention, treatment and cure research.

EVERYTHING WE KNOW ABOUT HIV prevention, treatment and the potential for a cure comes from research involving people at risk for or living with the virus. Joining a clinical trial can be a good way to access new therapies and contribute to science, but it’s important to weigh the pros and cons.

Clinical trials are a key part of the multistep process for testing new prevention, treatment or cure approaches.

• Preclinical: Most experimental therapies rst undergo testing in a laboratory, followed by animal studies. But promising activity in a lab or in animals does not mean a drug will work in people.

• Phase I: Early safety trials usually include 10 to 100 participants, o en starting with healthy volunteers. They look for common side e ects and collect information about pharmacokinetics, or how a drug is processed in the body.

• Phase II: Mid-level trials typically include a few hundred participants. They assess whether a new therapy appears safe in a larger group and gather preliminary information about e cacy.

• Phase III: The largest and longest trials, typically involving hundreds or thousands of participants, test how well a therapy works compared with other options. Less common side e ects may show up only a er a drug is used by many people over a longer period.

• Phase IV: A er a drug has been approved, post-marketing studies are done to see how well the therapy works in the real world.

Randomized controlled trials are the gold standard for testing new therapies. A controlled trial means participants are assigned to get the experimental drug or a comparison intervention—for example, the current standard of care or a placebo. Randomization means participants could end up in any study arm, ensuring that the groups are otherwise similar.

Trials for new prevention methods follow a similar pathway, but the safety bar is higher because they will be used by healthy people. Other types of trials assess behavioral interventions, such as exercise or smoking cessation.

HIV cure trials are more complex and can involve greater risk. To determine whether a cure strategy leads to longterm remission, participants may need

to temporarily stop their antiretrovirals, which could lead to disease progression and HIV transmission.

A good study design is essential for ensuring that trials provide reliable information. It is important that they enroll the full range of those who will use a new therapy, including women, transgender people and people from diverse racial and ethnic groups.

Your HIV care team, advocates and support groups can be good sources of information about available clinical trials. The National Institutes of Health’s ClinicalTrials.gov website lists open studies for all conditions.

When considering a trial, learn all you can about the therapy being tested and what other options are available. Find out the frequency of study visits and whether the trial reimburses expenses. Don’t be afraid to ask questions! Before agreeing to join, you must sign an

informed consent document, but this is not a contract—you have the right to withdraw at any time for any reason.

Bene ts of trial participation include early access to promising new therapies, care delivered by leading experts and altruism—knowing you are contributing to science and helping others. Drawbacks can include time-consuming study visits, the need to forgo other therapies and the risk of side e ects. And in a randomized trial, you might not get the experimental treatment.

Remember, trials of new antiretroviral drugs, HIV prevention methods and cure approaches can’t o er guarantees. Researchers don’t yet know how e ective experimental therapies will be, and they can’t rule out unforeseen adverse events. Despite this uncertainty, clinical trials can be a gateway to better prevention and treatment options for yourself and others. Q

BY LIZ

PREVENTION

New PEP Options

In May, the CDC issued updated guidance for nonoccupational HIV postexposure prophylaxis (PEP)— the rst revision since 2016— which now includes more modern antiretrovirals. PEP is a 28-day course of daily oral antiretroviral therapy started within 72 hours a er an exposure that poses substantial risk, such as condomless sex or sharing needles with an HIV-positive person who does not have an undetectable viral load. The new guidelines emphasize the importance of starting within 24 hours if possible. The updated guidance recommends two PEP options for adults, including pregnant women, adolescents and children ages 2 to 12 years: Biktarvy (bictegravir/tenofovir alafenamide/ emtricitabine) as a complete regimen or dolutegravir (Tivicay) plus either tenofovir disoproxil fumarate or tenofovir alafenamide plus either emtricitabine or lamivudine. Alternative regimens may be considered in special situations. Providers are encouraged to counsel PEP recipients about whether they could bene t from pre-exposure prophylaxis (PrEP) on an ongoing basis.

TREATMENT

Doravirine/Islatravir

A once-daily combination pill containing doravirine and islatravir maintained viral suppression for a year in a pair of Phase III trials. Doravirine (Pifeltro) is a nextgeneration non-nucleoside reverse transcriptase inhibitor, while islatravir is the rst nucleoside reverse transcriptase translocation inhibitor. Islatravir hit a snag in 2021 when participants in earlier trials showed declines in CD4 and total lymphocyte counts, but the doses used were too high. Two subsequent trials tested a single-tablet regimen containing doravirine plus a lower dose of islatravir. Participants with viral suppression on Biktarvy (bictegravir/tenofovir alafenamide/emtricitabine) or another oral regimen were randomized to switch to doravirine/islatravir or stay on the same combo. More than 90% of people in all treatment groups had an undetectable viral load at 48 weeks, showing that doravirine/islatravir was non-inferior. Treatment was well tolerated, and the researchers did not see the same blood cell declines that doomed higher doses of islatravir.

CURE

T-Cell Engager

Immunocore’s IMC-M113V, an experimental bispeci c T-cell engager, may help enable long-term HIV remission. IMC-M113V is an engineered antibody-like molecule that attaches to both CD8 killer T cells and HIV proteins expressed on infected CD4 cells, forming a “bridge” that enables the killer cells to attack the infected cells. In the Phase I/II STRIVE trial, 16 men with viral suppression on antiretroviral therapy received once-weekly infusions of IMC-M113V for 12 weeks and then paused their antiretrovirals in a 12-week analytical treatment interruption. A er stopping their meds, laboratory tests showed changes in cytokines and HIV RNA and DNA levels consistent with T-cell activation and reduction of the viral reservoir. Most participants experienced normal viral rebound, but three showed evidence of viral control. They experienced initial viral rebound, but their viral load then fell to a low level. Two remained o antiretrovirals for the full 12 weeks. IMCM113V was generally safe and well tolerated. The ongoing study is now evaluating higher doses and longer treatment interruptions.

Cardiovascular Risk CONCERNS

Body mass index (BMI)— a ratio of weight to height— may be a poor measure of cardiovascular disease (CVD) risk for people with HIV, underscoring the importance of more comprehensive screening. Weight gain is a known predictor of CVD, and excess visceral fat within the abdomen—indicated by a large waist circumference— is more harmful than subcutaneous fat under the skin. Researchers looked at associations between BMI, excess visceral abdominal fat (EVAF) according to CT scans and CVD risk in 170 people with viral suppression on antiretroviral therapy. As expected, people with obesity (BMI above 30) were most likely to have excess visceral fat. But EVAF was also seen in 47% of those classi ed as overweight (BMI 25 to 29.9) and even in 43% of those classi ed as normal weight (BMI of 20 to 24.9). People with more visceral abdominal fat had higher 10-year cardiovascular risk scores than those without EVAF regardless of BMI. CT scans are expensive and not readily available from primary care providers, but waist measurement is a feasible alternative.

FUNDING CUTS COULD INCREASE HIV CASES

New HIV diagnoses rose by about 1,000 cases nationwide in 2023, according to the latest surveillance report from the Centers for Disease Control and Prevention (CDC). But these data precede the Trump administration’s recent federal health cuts, and advocates fear that numbers will rise further in the future.

Given recent disruptions at the CDC, the fate of this year’s national HIV surveillance update was uncertain, but the agency released key findings in April. According to the new data, 39,201 people were diagnosed with HIV in 2023, up from 37,981 in 2022. Men accounted for 81% of new HIV diagnoses, while women made up 19%. Unlike past reports, however, there is no mention of transgender people. Overall, 38% of newly diagnosed people were Black, more than a third were Latino and over half lived in the South. Two thirds of new diagnoses were attributed to male-to-male sexual contact and 6% to injection drug use.

The CDC noted that publication of its companion report on estimated HIV incidence and prevalence has been delayed, and this year’s prevention and care monitoring report does not include information on pre-exposure prophylaxis (PrEP) coverage due to a reduction in the workforce. But this could be just the tip of the iceberg, advocates say, as budget proposals from the White House and Congress include deep cuts to HIV programs.

“From small towns to big cities, every state across the country may lose lifesaving HIV prevention, testing and research programs,” says HIV Medical Association chair Colleen Kelley, MD, MPH. “The result will be more HIV infections nationwide, taking a devastating toll on health and the health care system.”

Can HIV Treatment Lower Cancer Risk?

People with HIV who maintain or regain an adequate CD4 T-cell count on antiretroviral treatment are less likely to develop cancer, according to a recent study. Cancer is a growing concern as the HIV population ages. It is well known that people with advanced immune deficiency have an elevated risk for AIDS-defining malignancies, but even less severe impairment can reduce the immune system’s ability to fight cancer.

Win Min Han, MD, PhD, of the University of New South Wales, and colleagues assessed the impact of CD4 cell recovery on cancer incidence among more than 48,000 adults in Europe and Australia who had viral suppression on antiretrovirals for at least two years. A total of 1,933 participants (3.9%) were newly diagnosed with cancer over a median six years of follow-up. These included 258 AIDS-defining cancers and 1,675 non-AIDS malignancies. About a third were infection-related, such as anal cancer caused by human papillomavirus or liver cancer caused by hepatitis B or C. The most common types were lung cancer, anal cancer, prostate cancer, non-Hodgkin lymphoma and breast cancer. A higher recent CD4 count and larger CD4 cell gains a er starting antiretrovirals were associated with reduced cancer risk, regardless of how low the count had fallen before starting treatment. This effect was especially strong for infection-related cancers. These findings confirm that starting antiretroviral treatment early, before immune function declines, leads to better outcomes. “This highlights the critical importance of diagnosing HIV at the earliest opportunity, promptly initiating antiretroviral therapy to ensure optimal immune recovery and sustained cancer risk reduction and ensuring people with poor immune recovery despite effective antiretroviral therapy undergo appropriate cancer screening strategies,” the study authors wrote.

Transgender and nonbinary people who receive gender-a rming hormone therapy may be less likely to acquire HIV and more likely to achieve viral suppression if they do, according to a recent study. In recent years, researchers have made progress in understanding outcomes among trans people living with or at risk for HIV, but political shi s could put further advances in jeopardy.

Sari Reisner, ScD, of the University of Michigan School of Public Health, and colleagues looked at outcomes among gender-diverse people receiving primary care at Callen-Lorde Community Health Center in New York City and Fenway Health in Boston. More than a third were transgender women, about 30% were trans men and the proportion of nonbinary people more than doubled over time.

As the proportion of trans people receiving gender-a rming hormone therapy increased, HIV prevalence and the likelihood of having uncontrolled virus declined. In 2013, 86% of the 2,983 participants were prescribed hormone therapy, and 9% were HIV positive; of these, 22% did not have viral suppression. By 2019, there were 8,109 participants, and the proportion on hormone therapy had risen to 89%. A smaller proportion were HIV positive (7%); of these, 16% did not have viral suppression. The overall HIV prevalence in this study was lower than rates previously reported for trans people, but Black and Latina transgender women were much more likely to be HIV positive than the cohort as a whole.

The researchers calculated that receiving hormone therapy was associated with a 37% lower rate of HIV seropositivity and a 44% lower likelihood of having uncontrolled virus. “Gender-a rming care is important for optimizing HIV outcomes among trans people,” they concluded. “Combination interventions that pair gender-a rming hormone therapy with other services, such as PrEP for HIV prevention and HIV care, might hold promise.”

Gender-Affirming Care Linked to Better HIV Outcomes EXPANDING ACCESS TO LONG-ACTING INJECTABLES

Long-acting treatment with Cabenuva (injectable cabotegravir and rilpivirine) can be a feasible option for people who are unable to maintain an undetectable viral load on oral antiretrovirals due to adherence challenges, especially if they receive enhanced support.

All modern antiretroviral regimens are effective, so treatment success o en comes down to consistent use. Cabenuva is administered by a health care provider once monthly or every other month. The Food and Drug Administration approved Cabenuva in 2021 as a switch option for people who have already achieved viral suppression on an oral regimen, but this leaves out some people who could benefit.

Researchers at the Ward 86 HIV clinic at San Francisco General Hospital have been evaluating Cabenuva for people without sustained viral suppression on oral treatment; a majority are dealing with substance use, mental health issues and unstable housing or homelessness, and many have advanced immune deficiency.

In 2022, the team reported initial results showing that 12 of 15 people who switched to Cabenuva achieved viral suppression, some for the first time. This set the stage for SPLASH—the Special Program on

Long-Acting Antiretrovirals to Stop HIV—which offers case management, street-based nursing services and other support. At this year’s Conference on Retroviruses and Infections, they presented results for 129 people who started Cabenuva with a detectable viral load between January 2021 and September 2024. A year a er the switch, 98% maintained viral suppression.

“These long-acting treatments are likely to be transformative for people in this population,” says lead investigator Matthew Spinelli, MD. “We’ve had folks who struggled for years, and when we put them on injectables, it’s like magic. It’s exciting to see success in the population we’re most worried about.”

Speaking Out Justice for

Mary Fisher in her home with her pug, Daisy

ARI MICHELSON

FOR MORE THAN 30 YEARS, MARY FISHER HAS

been a beacon of courage and compassion. The long-term survivor—of HIV and breast cancer—kicked off her advocacy journey onstage at the 1992 Republican National Convention with her powerful speech, “A Whisper of AIDS.” Fisher, a former aide to President Gerald Ford, came from a prominent political family. She was diagnosed with HIV in 1991. Speaking as a mother with two young boys, she urged her fellow Republicans and Americans to “set aside prejudice and politics to make room for compassion and sound policy” regarding HIV and AIDS.

Fisher continued speaking out against the injustices faced by those living with the virus and became a passionate advocate for the HIV community. Focusing on combating stigma and promoting compassionate, science-based public policy, her advocacy work has propelled her around the globe. Fisher is also an accomplished visual artist and writer who uses her creative talents to support humanitarian causes. Her latest book, Uneasy Silence, is a call to listen, to understand and to act. The collection of essays challenges readers to confront society’s uncomfortable truths and to find the courage to condemn injustice. Her words encourage us to break the silence that often surrounds the suffering of others.

Uneasy Silence is a testament to the power of one voice to effect change. Through personal recollections and reflections, the 77-year-old Fisher invites us to examine our silence and find our voice in the face of adversity. She reminds us that though silence may be comfortable, it is often in speaking out that we become our true selves. The following is a lightly edited excerpt from her book.

It was an accident. I never intended to be an activist. I was working on being a contented artist when I was found by a tiny virus that changed my life.

When I think of activists, I think of Ida B. Wells (anti-lynching), Malala Yousafzai (girls’ education), Opal Lee (“Grandmother of Juneteenth”), or Gloria Steinem (women’s rights). Interestingly, none of the activists that come to mind are elected leaders. They don’t have lofty titles or huge armies. What they have in common is a strong conviction that something in society needs to change, and change now.

My friend Larry Kramer released Reports from the Holocaust: The Making of an AIDS Activist in 1989. I didn’t put his book on my reading list. But by the time we met four years later, I knew he was leading a campaign for change in how America responded to the burgeoning AIDS epidemic. I was a quiet mother from Florida who spoke softly in public. He was my screaming colleague, my model of what an activist should be.

I thought of activists as the organizers of marches, authors of diatribes, and firebrand community spokespersons. Larry fit the mold. I clearly did not. But between our first meeting in 1993 and Larry’s passing in 2020, I came to see myself as engaged in my own campaign for change.

I had become an activist.

BEARING WITNESS

My campaign for change centers on the truth about AIDS and how America responded, and still responds, to this disease. As best I can, I try to tell the truth without exaggeration. I prefer not to take cheap shots at those with whom I disagree, in part because I want their support. If someone is clearly opposed to the truth, I’m willing to call them out. But overall, I won’t achieve much by irritating those I want to convert.

The United States has never had an official policy of extermination for those hosting the AIDS virus. But the epidemic flourished in the ’80s and early ’90s owing in part to the intentional inaction on the part of political leadership. Those with the

power of the purse strings chose to look the other way while hospices filled with dying young men. Then came Republican President George W. Bush. In his January 28, 2003, State of the Union Address he announced the launch of PEPFAR (the President’s Emergency Plan for AIDS Relief), marshaling private and public funding to slow, and eventually eradicate, HIV in Africa and elsewhere. In its first 20 years, more than $100 billion have been invested in PEPFAR’s goals, saving no less than 25 million lives. Note: That’s 25,000,000 men, women and children. It’s no wonder that when I visit Rwanda or Zambia or any AIDS-battered nation, George Bush is seen as heroic, and Bill Clinton is remembered for “talking a good game.”

Fisher at the 1992 Republican National Convention

malnutrition comes with war. Talk of a Holocaust is merely exaggeration by Jews and their sympathizers. Since the Holocaust didn’t happen, then we needn’t worry about the lies that resulted in the concentration camps: division of the races (Jewish and Aryan in Germany, Black and white in the U.S.), establishing that certain groups are not fully human (gypsies in Germany, Black slaves in the U.S.), and so forth. Denying history enables us to deny the impact of the patterns we see being repeated today.

Bearing witness to these truths has its own power. When Jewish survivors of Dachau bore witness, they told the truth about the cruelties and deaths that permeated the [concentration] camp. They established on the record the brutality of individuals, some of whom were subsequently prosecuted for their crimes. Without the witnesses who told their own stories, conviction of evildoers would have been improbable. It was the truth, recounted by witnesses, that offered the power of justice.

A new crop of Holocaust deniers has recently sprouted, popularized in right-wing media and aimed at dismissing the truth of 6 million victims of fascism. Fascism isn’t really that awful, they claim. Tortures weren’t really severe, and

Tour the National Memorial for Peace and Justice (informally known as the National Lynching Memorial) in Montgomery, Alabama. Read the narratives describing the conditions of slavery and sanctions of Jim Crow. Stare at the photographs of Black bodies that have been dragged through the streets of rural Mississippi or slashed, branded, and hanged on a nearby sycamore. Come face-to-face with the realities of thousands—thousands!—of lynchings used to instill fear and assure obedience. The memorial bears witness. Powerful, shameful, unforgettable witness.

The state of Florida recently instituted a new educational curriculum in which it is noted that “some slaves developed highly specialized trades from which they benefited.” Claiming that slaves were helped by slavery is absurd. It can only be imagined to be true if we yield to the fallacy of “balanced reporting,” in which each of two sides are seen to be of equal importance, accuracy, and usefulness, whether

or not they are equally true.

The media has fallen for the fallacy, and someone should quickly and consistently bear witness to the truth.

COST OF ISOLATION

The COVID-19 pandemic came without warning, a gloomy cloud of lonesomeness rolling into every American’s life.

I’d moved to California days before the pandemic’s alarms were being sounded. Twenty-five years earlier, I’d been an active citizen in the AIDS community, one among many, accepted and even valued. I was part of the informal team, the woman who was called to speak the truth to power. I had a role in the community, and I knew how to fulfill that role. I was a messenger, and I was grateful for it. Subsequently, other communities—an international quilting community, for example—welcomed me in.

But as the years rolled by, age and illness took a personal toll on my social interactions. I circled the world a few more times, meeting with government leaders and women with AIDS. But calls for me to speak to a live audience or worship community slowed. I’d paid my own way when giving speeches, contributing any honoraria to charity because I could. I was grateful for every opportunity and every audience because speaking had been my primary mode of bearing witness to the devastation of the American AIDS community, my way of keeping alive those we lost and preserving the truth about brutalities we endured. When invitations to speak slowed almost to a halt, I felt diminished and my sense of purpose wilted.

Then came the pandemic. It shut down social interactions of nearly every kind, from worship to parades, shopping to funerals. If requests for speeches had previously slowed, now they stopped. Recognizing that speeches were no longer a way to make a difference, I tried publishing essays on various online platforms, including Medium and Substack. My pieces were warmly received. But by the time 75 or 80 essays were circulating, I knew how keenly I missed face-toface connection with a live audience.

It was 2022. By almost any measure, I did not have a bad

life. I had survived COVID-19. I wasn’t impoverished. I had grandchildren to wear me out. But my life wasn’t satisfying. My interaction with the world was mostly as a spectator, seeing troubling events and noisy people through a television screen. I occupied the sofa. I felt old. Finished. Done.

MOVING INTO THE COMMUNITY

During the press of the COVID-19 pandemic, Project Angel Food’s director of philanthropy, Mark McBride, visited me with a request for support. I promised to keep helping.

Weeks later, an acquaintance called to ask if I’d join her at Project Angel Food for a chef’s dinner. We’d tour the place, she explained, then meet a volunteer or two, listen to a staff Fisher published Uneasy Silence in May 2025.

ARI MICHELSON

member explain the challenges, and go home. Frankly, I was still fearful of the COVID-19 virus, but I heard myself offer my caller a reluctant OK.

On a cool December evening in 2022, I was one of perhaps a dozen guests at Project Angel Food. As promised, we toured the kitchen—immaculate!— and the offices. We heard stories from staff and volunteers. If my mind wandered it was because I was remembering food brought to me in communities that had no food to spare. I recalled meals of nshima [a thick porridge made from maize flour] while sitting around charcoal fires in Zambia with women who had AIDS. I heard [Project Angel Food cofounder and my friend] David Kessler saying, “Our first act of love in this world is feeding someone, our child.” I remembered other evenings around meals in other places where the gay community and the AIDS community were one, embracing me.

“WHAT I NEED TO DO IS SPEAK CLEARLY USING MY STORY TO BEAR WITNESS TO THE TRUTH THAT I KNOW.”

When I refocused on what was actually being said in that room, I offered to volunteer my time in the kitchen or wherever I could be useful. Being a donor is fine; it’s also solitary. I wanted to become a member of the crew volunteering to serve. These were my people.

If they’d let me in—and they have!—this is my community.

JOY IN SERVICE

I live with an uneasy silence when I think of all the troubles that scar this world. Raped women dare not speak out; someone needs to speak for them. Why not me? Why not now? Abused children are gagged by their abusers. Political “leaders” in Texas and Arizona say they’re “in prayer” for survivors of mass shootings and migrants who were stuffed into a hellishly hot truck and died at the border. And the ghoulish list goes on. I can paralyze myself with the desire to represent every cause and cure every evil. It doesn’t work.

According to David Kessler, the first day we met, I said to him, “I’d like you to help me die.” It told the truth about how I was feeling.

I’ve changed. The depressive moods have lifted, in part because David helped me see that I wasn’t so much “depressed” as “grieving” and that I could live with the grief while finding avenues to joy.

What I need to do is speak clearly using my story to bear witness to the truth that I know. That’s all. Stop. Now I need to get off the sofa and into serving others if I want to retain some semblance of a grandma’s mental health. There’s plenty of science that proves helping others helps us. Even without the science, my experience says it’s true.

For me, my engagements with Project Angel Food were at least mood-shifting and perhaps life-changing. It’s a special joy to belong in a crowd of people happily meeting the needs of others. Peeling an onion isn’t saving the world, but it may add savor to a meal that would otherwise be bland. Such are

the hopes amid the kitchen volunteers, including me. There are tens of thousands of places where you could volunteer. Step up and join the community!

One of my important heroes is Mother Pollard, whose life of service was famous [she participated in the 1955–1956 Montgomery bus boycott]. “For untold decades she had cared for the sick and raised the orphans, Black and white alike,” wrote historian Taylor Branch. Like Mother Pollard, my feet are often weary, but my soul is rested. Martin Luther King Jr., two months before he was assassinated, said that he hoped to be remembered as one who “tried to give his life serving others.” One by one the people I admire have given testimony not only to the power of service but also to the satisfaction that serving others brings us.

I’ve long lived with gratitude for my sons, serving them as a mother does. Now I live with the staggering joy of grandchildren, a gift I never imagined I would live to enjoy. They call me to report their important preschool projects. They explain why they’re afraid, or why they’re ecstatic, using tears and giggles to express it all. They bring light to the darkest day, joy to the hardest moments. They’re noisy, busy, and bundles of love.

I feel no sorrow at the recognition that by the time my grandchildren read this book (if ever), I will likely have transitioned to another world. I hope those I love will miss me but not too severely. I trust that one of you will take up the role of bearing witness for justice. Another might say that I learned joy through service. I hope you’ll be willing to speak for those who are unheard in our society because “when you don’t have a voice you can’t stand up for yourself” [from Seven Sins, by Arti Manani].

My hope is that we will, all of us, grandchildren and grandmother included, stand up courageously because: “a man dies when he refuses to stand up for that which is right. A man dies when he refuses to stand up for justice. A man dies when he refuses to take a stand for that which is true.” [From a sermon by Martin Luther King Jr. the day after Civil Rights protesters were beaten on the Edmund Pettus Bridge.]

Take my hand; let me pull. I want to stand up. Q

Excerpt from Uneasy Silence by Mary Fisher. Copyright © 2025. Reprinted with permission from Mary Fisher. All rights reserved. Visit maryfisher.com to purchase a copy of the book or to learn more about her work.

TRESEARCHERS ARE WORKING ON LONGER-ACTING THERAPIES FOR HIV TREATMENT.

BY LIZ HIGHLEYMAN

HE EVOLUTION OF HIV TREATMENT IS among the most remarkable success stories in medical history. From handfuls of pills taken multiple times a day to injections administered just twice a year, antiretroviral therapy has come a long way. Today’s HIV treatment regimens are highly effective and generally well tolerated. What’s more, most people can take a single once-daily pill—similar to taking a statin to manage high cholesterol.

But the quest for new longer-acting options continues. Some people have trouble maintaining good adherence to daily oral treatment because they forget to take their pills, don’t want to think about having HIV every day or are living in situations where their meds could be lost or stolen. And it’s not just about convenience. Given the Trump administration’s deep cuts to foreign aid funding, including PEPFAR (the President’s Emergency Plan for AIDS Relief), long-acting treatment could help stretch limited resources.

The current longest-acting complete HIV treatment, ViiV Healthcare’s Cabenuva (injectable cabotegravir and rilpivirine), is administered once monthly or every other month. Gilead Sciences’ capsid inhibitor, lenacapavir (Sunlenca), is given every six months, but it is only approved for heavily treatment-experienced people with highly resistant virus.

By the time this issue of POZ is published, lenacapavir is expected to be approved for twice-yearly pre-exposure prophylaxis (PrEP). But while a single antiretroviral is enough to prevent HIV, treatment requires a combination approach.

Today, there are no equally durable meds to build a complete biannual regimen, but many candidates are in the pipeline.

NOVEL ANTIRETROVIRALS

When it comes to oral treatment, taking pills once weekly or monthly instead of every day would be more convenient.

Gilead and Merck are evaluating lenacapavir pills plus islatravir, the first nucleoside reverse transcriptase translocation inhibitor, as a once-weekly oral regimen. Phase II results presented at IDWeek showed that 94% of people who switched from standard daily treatment to the weekly combo maintained an undetectable viral load. A fixed-dose combination pill is now being tested in Phase III trials.

Gilead is also testing a once-weekly integrase inhibitor (GS-1720) plus a pro-drug of lenacapavir (GS-4182) in Phase II studies as well as potential once-monthly oral integrase inhibitors and a monthly lenacapavir pro-drug (GS-3107) in Phase I. Pro-drugs—precursors that are converted to an active drug in the body—can improve oral bioavailability, allowing for lower doses and smaller pills.

Oral medications have inherent limitations to their durability, however, so treatment that works for months will likely continue to require shots. As potential twice-yearly partners for lenacapavir, Gilead is looking at two long-acting injectable integrase inhibitors (GS-1219 and GS-3242) and an islatravir pro-drug (GS-1614).

ViiV, too, is working on longer-acting candidates. At the Conference on Retroviruses and Opportunistic Infections (CROI) in March, researchers presented early data on oral versions of a third-generation integrase inhibitor (VH184)

and an experimental capsid inhibitor (VH499). Both drugs demonstrated potent antiviral activity and a high barrier to resistance. This laid the groundwork for Phase I trials of long-acting injectable formulations of VH184 and VH499, with the goal of a complete regimen that can be administered every six months or less.

“It’s clear long-acting injectable medicines deliver on unmet patient need and will play a critical role in achieving our ambition of ending HIV and AIDS,” says Kimberly Smith, MD, MPH, ViiV’s head of research and development.

BROADLY NEUTRALIZING ANTIBODIES

Looking beyond antiretrovirals, researchers are also exploring broadly neutralizing antibodies (bnAbs) for HIV prevention, treatment and functional cure.

People with HIV normally produce antibodies, but these mostly target parts of the virus that are hidden or highly variable. However, a small proportion of individuals make more potent antibodies that bind to conserved parts of the virus. Therapies derived from these natural bnAbs have been enhanced to improve their bioavailability.

Gilead is studying a pair of bnAbs, teropavimab (GS-5423) and zinlirvimab (GS-2872), as potential partners for injectable lenacapavir. Teropavimab is derived from a natural bnAb called 3BNC117 that targets the CD4 binding site, while zinlirvimab is derived from 10-1074, a bnAb that binds to the V3 loop on HIV’s surface.

At CROI, Onyema Ogbuagu, MBBCh, of Yale University, presented findings from a Phase II trial of lenacapavir, teropavimab and zinlirvimab—dubbed LTZ—for people with viral suppression on daily oral treatment. After testing to ensure sensitivity to both bnAbs, 53 people were randomly assigned to switch to LTZ, receiving subcutaneous injections of lenacapavir and IV infusions of teropavimab and zinlirvimab every six months, while 27 stayed on their daily regimen. At 26 weeks, 96% of participants in both groups maintained viral suppression. LTZ was safe and well tolerated with no severe drug-related adverse events.

“We believe that the high efficacy of viral suppression and the safety data support continuing our study and support the clinical development of what we think is an exciting six-monthly HIV regimen,” Ogbuagu said. “The beauty of it is that they can all just be administered together.”

In another bnAb study, Babafemi Taiwo, MD, of ViiV, and colleagues evaluated long-acting cabotegravir plus N6LS (also known as VH3810109), an antibody that targets the gp120 protein on HIV’s surface.

A previous analysis showed that a single IV infusion or subcutaneous injection of N6LS substantially reduced viral load, but the bnAb alone did not maintain viral suppression for long, so the Phase II EMBRACE trial combined it with cabotegravir. The study enrolled 125 people with viral suppression who were screened for sensitivity to N6LS. They were randomized to stay on their current regimen or switch to injectable cabotegravir every month plus N6LS infusions or injections every four months.

After six months, 96% of people randomized to N6LS infusions and 88% of those on N6LS injections maintained viral suppression. The bnAb was safe when administered by either route, but the infusions were better tolerated. The study is now evaluating cabotegravir every other month plus N6LS infusions every six months. In the future, N6LS might be paired with experimental ultra–long-acting formulations of cabotegravir or perhaps with VH184 or VH499.

Two other studies at CROI evaluated whether bnAbs can maintain viral suppression without antiretrovirals. In the RIO trial, which enrolled men in Europe, 75% of those who received infusions of the antibodies 3BNC117-LS and 10-1074-LS did not experience viral rebound five months after stopping standard antiretroviral therapy, and a third were still in remission at 18 months. In the FRESH study, which enrolled women in Africa, 30% of those who received two other bnAbs, VRC07-523-LS and CAP256V2-LS, plus the immune-modulating drug vesatolimod maintained viral suppression for a year, including four who remained off antiretrovirals for more than two years.

The ultimate goal in the HIV field is a cure, but research has proceeded slowly with many disappointments. What’s more, future advances in HIV basic science are threatened by reduced federal funding through the National Institutes of Health—the largest supporter of HIV and AIDS research worldwide. While researchers and advocates aren’t giving up on a cure, people living with HIV can look forward to better treatment options on the horizon. Viral eradication may not be possible, but twice-yearly therapy is approaching long-term remission, or a functional cure.

While advances in treatment are not as dramatic as a oneand-done cure, a look back at history shows how far we’ve come, according to Joseph Eron, MD, of the University of North Carolina at Chapel Hill, lead investigator of the LTZ trial.

“We’ve gone from asking patients to wake up every four hours to take zidovudine [AZT], to combination treatment with 15 to 20 pills a day, to now having the opportunity to give therapy every six months,” he says. Q

THE PHARMACY HAS SERVED PEOPLE LIVING WITH HIV SINCE 1983. MANY LONG-TERM SURVIVORS SAY

THEY’LL NEVER GO ELSEWHERE.

BY TIM MURPHY

AS A LONGTIME NURSE FOR

PAUL BELLMAN, MD, THE pioneering HIV doctor who retired a few years ago, Tyrone is professionally very well-acquainted with New York City’s Village Apothecary (VA), located in Greenwich Village. When Tyrone, who asked to withhold his last name, started working for Bellman in the early 1990s, before the advent of effective antiretroviral treatment for the virus, it was common for VA to have a staffer rush over a prescription to Bellman’s office so that the patient there—often weak or even confused by dementia—wouldn’t have to walk to VA to pick up the medication himself.

Having lived with HIV for more than 35 years himself, Tyrone also has a personal relationship with VA. He’s a longtime client who says the beloved downtown NYC institution, which opened in January 1983, is special because it continues to provide mom-and-pop personal service. And this is despite both the extreme gentrification of the neighborhood it has long called home and the ongoing corporatization of the pharmacy landscape that serves to squeeze out independent shops, replacing them with brick-and-mortar chain stores, like CVS and Walgreens, as well as mail-order pharmacies.

“Despite the battles against the chains and mail order, VA has said to its customers, ‘We’ll continue to stand with you and give you quality, friendly care,’’’ says Tyrone. “You don’t get that comfort and compassion with the big chains. It just makes sense to go to VA, where you go in and no one is judging you but instead is speaking to you with respect. There’s nothing more important than that.”

Recently, says Tyrone, when he called VA about some of his prescriptions, John Kaliabakos, a VA pharmacist since 1994, noted that Tyrone’s voice sounded scratchy. When Tyrone’s order from VA arrived at his house—yes, the pharmacy delivers all over town, including to hospitals and doctor’s

offices—he found complimentary cough drops among his meds. “It’s small things like that that make a big difference,” says Tyrone.

Talk to even just a handful of VA’s longtime clients— many of whom survived the worst days of AIDS with VA’s help—and you’ll hear countless such stories. The ones about how Kaliabakos and the other pharmacists would go over especially complex orders with customers in the pharmacy’s private back area to protect their privacy, even though many customers with AIDS said they never worried about others in the store learning their status because it was such a loving sanctuary for people with HIV. The ones about how VA’s longest-serving delivery guy, Eric Lora, who started as a teen and still works there, would often walk or wheel home customers who couldn’t make their way on their own. And, of course, the ones about how the store would take a hit out of its own pocket to make sure all its customers had access to AZT or whatever other med offered the greatest promise of keeping people alive at any given moment.

Longtime survivor and activist Richard Berkowitz, who cowrote the seminal tract How to Have Sex in an Epidemic in 1983, the same year VA opened, recalls breaking his ankle about a decade ago and subsequently getting himself to VA

in a wheelchair to buy a cane, only to realize he’d left his wallet at home. “They not only gave me the cane but had one of their guys wheel me home,” he says. “It’s like a family there. Try to get that at a CVS.”

NEW

YORK CITY MAY BE FAMOUS FOR ITS

GREEK

diners, but the story of VA is the story of a Greek pharmacy. It was started by Michael Konnon (an abbreviation of Kazantzakis), an openly gay Greek American entrepreneur who owned a pharmacy in Harlem and then in the 1970s got into the nightclub business before semiretiring and moving to the Village. Over time, he became bored and, just as a strange new disease started affecting his friends, found a storefront at 346 Bleecker, on the corner of West 10th Street, that had once been a butcher shop. He decided to convert it into a pharmacy.

In the final months of 1982, Konnon enlisted the help of his entire family, including his nephew, George Manos, to prepare the space. Manos was so inspired by the work that he ended up going to pharmacy school himself, becoming a VA pharmacist and buying the business from Konnon in 1995. In 2012, he sold the business to its current owner, pharmacist entrepreneur Vijay Desai, who has kept the store’s family-style atmosphere intact.

“We all went in and stocked the shelves for the opening—me, my mom, my dad,” recalls Manos.

Even though the syndrome that would come to be known as AIDS was being seen in a relatively small number of gay men and drug users in the early 1980s, it wasn’t until VA gained traction in the middle of the decade that the epidemic revealed its terrifying scope amid NYC’s gay neighborhoods, including the Village. “Friends of my uncle were coming into the store panicked, this dreaded look on their face, telling my uncle privately in the back that they had AIDS,” says Manos. “And often, as soon as six months later, they were dead.”

cluding antibiotics, antifungals, steroids and Chinese herbs. When it became known that the antibiotic Bactrim could prevent Pneumocystis pneumonia, one of the most common causes of death related to AIDS, VA pharmacists would compound the drug themselves to start customers on a low dose before increasing it to prevent the extreme allergic reaction to an instant full dose that many takers experienced. “We would dilute it into 20 different bottles for people to start microdosing it,” recalls Kaliabakos.

In 1987, the Food and Drug Administration (FDA) approved AZT, the first anti-HIV drug. It was priced at the then-unbelievable sum of $10,000 a year per patient, putting it out of reach of many who needed it. This was three years before Congress would pass the Ryan White CARE Act, which covered HIV and related medications for people with no other coverage. (This was also years before the Affordable Care Act and expanded Medicaid.)

John Kaliabakos at Village Apothecary

Yet amid this atmosphere of fear, confusion and stigma, VA staff exuded warmth and compassion, says Berkowitz. “It was a safe place for people with AIDS, many of whom were dying. The staff was so sensitive and welcoming.” Even early on, he says, “they understood that you couldn’t get AIDS by touching someone or breathing the same air.”

In constant consultation with Bellman and other early local AIDS doctors, including the late Joseph Sonnabend, MD, VA would prescribe its customers with AIDS everything and anything under the sun that might prevent or fight the myriad infections and other complications caused by the illness, in-

Whereas other pharmacies would buy AZT at $1,000 a bottle and mark it up as high as $3,000 for customers, “Michael said, ‘I can’t make money that way—it’s not right,’” recalls Manos. He says Konnon priced it just about $100 above the wholesale price and would arrange payment plans for customers so they could access it.

Whereas other pharmacies might order only as much AZT as was asked for, “Michael said he always wanted 100 bottles in stock,” says Manos, so people who needed it could start right away. “We probably lost about $100,000 a year,” he recalls. In turn, he says, as VA’s reputation as a business that sometimes behaved like a nonprofit grew, wealthy locals and even celebrities, such as Bruce Springsteen, started popping in and buying over-the-counter luxuries, like fragrances and candles, in order to support the store. Even Mother Teresa, on a celebrated 1987 visit to New York, stopped by the store, Manos says, and blessed the staff.

When the Ryan White CARE Act was passed, it included the AIDS Drug Assistance Program (ADAP)—which is still the payer of last resort for countless people living with HIV and AIDS. According to Norman Saban, a pharmacist at VA from 1985 until his recent retirement, VA was one of the first pharmacies to sign up with the New York office of ADAP, consulting with ADAP workers day in and day out to get VA customers’ meds covered. Saban became such good friends with ADAP staffers over the years that he wound up attending some of their children’s weddings.

Then, in 1996, the FDA approved the protease inhibitor

Crixivan (indinavir)—the first drug that when taken with older meds like AZT often brought viral loads down to undetectable, making it the first step in the lifesaving HIV treatment revolution to occur over the following years.

“Many of our customers got a second wind,” says Manos, estimating that in the ensuing years, the proportion of VA customers lost to AIDS plunged from as high as 90% to 5%. VA was also among those entities that ultimately successfully pressured the drugmaker Merck to expand distribution of Crixivan to pharmacies other than Stadtlanders, to which it initially gave a dispensing monopoly.

EVEN AFTER EFFECTIVE TREATMENT ARRIVED,

customers too far gone from AIDS complications or who had developed too much resistance to the first HIV meds, died. But overall, as HIV treatment improved, VA customers began not only to survive but also to thrive with HIV. “It was amazing to see,” says Saban, “almost like a weight had been lifted, because suddenly there was a lot less death.”

In the first 25 years of the 21st century, VA has seen its share of changes. Not only did Desai become the owner in 2012—“It’s hard in retail pharmacy to find quality businesses that have a connection with the community,” he says of why he bought it—but in 2024, the store moved to 407 Bleecker Street.

“They were like my nanny,” he says, “taking care of me in a way that I know CVS would not.”

Longtime treatment activist Jules Levin says that as his meds require more and more prior authorizations, the VA staff is always there to call his doctor or his insurance provider and sort things out for him. “It’s a very welcoming environment there for people with HIV,” he says.

And one longtime client who prefers to be identified by his drag name, Ruby Rims, says that even though he now lives dozens of blocks uptown from VA, he still goes there for his meds “because it’s a fun atmosphere.” He remembers one Christmas when VA delivered him a surprise package filled with his favorite cologne and other items. “It’s a momand-pop store,” he says. “They care about you.”

“WHEN WE GET

FEEDBACK THAT

Of course, says Desai, like many independent pharmacies, VA must struggle against so-called pharmacy benefit managers (PBMs), corporate middlemen who require people on many insurance plans to fill their prescriptions at affiliated pharmacies—usually CVS or Walgreens—or via mail order. When PBMs do allow independent pharmacies to fill scripts, they often reimburse them at far lower rates than they do their affiliated corporate partners.

WE

HELPED SOMEONE, IT MAKES

One thing hasn’t changed: its fiercely loyal customer base. It seems almost every VA customer living with HIV has a story to tell about the store’s kindness and generosity. Joseph Guerrero, 50, who lives at the nearby longtime HIV residence Bailey House, says that the store has many times gifted him over-thecounter items, including mouthwash and an electric toothbrush. “They said to me, ‘No, just take it, you’re a good customer,’” he says.

EVERYTHING WORTHWHILE.”

Willie, age 60, who asked to withhold his last name, shares that he once took a friend with AIDS—an undocumented bartender—to the store, where the staff connected him to counseling as well as to ADAP to access his meds. “The people who work there have such humanity,” he says. “They’re not just there to make money.”

Mark de Solla Price, a former POZ staffer, remembers when his late husband, Vinnie, had such a complicated med schedule that Price told VA he couldn’t keep track of it. The store, he says, sorted Vinnie’s meds into timed packages with labels, including his over-the-counter vitamins. “It made such a difference,” says Price, adding that years later when he needed to take opioids for pain but worried he would take too much and become addicted, VA arranged for him to come in every morning for his day’s supply.

“Year after year, we have no choice but to take these losses,” Desai says, adding that VA is part of a coalition of indie pharmacies advocating for PBM reform in New York state. Says Kaliabakos, “We’d have twice as many customers if it weren’t for mail order and PBMs.”

But overall, remarkably, the store has hung in there for more than 40 years—thanks in part to loyal customers who include not only people living with HIV or AIDS but also the increasingly wealthy and famous residents of 21st century Greenwich Village, whose handsome 19th-century brownstones are now valued in the multimillions. “You’ll have an Oscar winner waiting in line behind a kooky old lady who’s yelling about something,” says Kaliabakos. With a typical pharmacist’s discretion, he declines to name the Oscar winner in question.

Another reason for the store’s longevity? Its staff loves to work there and tends not to leave for decades. “Most pharmacists are probably not as happy with the day-to-day as we are,” says Kaliabakos. “When we get feedback that we helped someone, it makes everything worthwhile.”

Manos and Saban back him up. “We know we’re doing good, contributing to the neighborhood, and I’ll take that feeling over being the richest person any day,” says Manos. “We know a lot of people are alive today because of what we did.”

Says Saban, “Even though I’m retired, I still talk on the phone or email with a few customers. We never turned anyone away. I feel like I did something good with my life.” Q

Helping People Live

Sue Daugherty, RD, LDN, has a lot of hungry mouths to feed. As CEO of the Philadelphia-based MANNA, a nonprofit that feeds chronically ill people, she leads an army of staff and volunteers who in 2024 prepared and delivered over 1,300,000 medically tailored meals in the city and surrounding counties.

Daugherty, who started working at MANNA in 1999 as a dietitian, has watched the group evolve from an organization feeding Philadelphians living with HIV into a behemoth that serves anyone in greater Philadelphia, southern New Jersey and beyond who is at nutritional risk because of chronic cardiovascular disease, cancer, diabetes, kidney disease, HIV or AIDS.

“In the mid-’90s, it was like, ‘They have AIDS, tell them to eat whatever they want,’” Daugherty recalls. “This was a time when people were dying [at a high rate]. In 1999, when I joined MANNA, effective treatment was on the market.” And those new medications meant new side effects.

“I was counseling one of my HIV-positive patients whose triglyceride level was off the charts,” Daugherty says. “Turns out, that’s an unfortunate side effect of early HIV meds. It was the first time I was exposed to this metabolic disorder. I remember watching the gooey mac and cheese coming out of our kitchen and thinking that something needs to change. That’s when we shi ed from helping people die to helping people live.”

Hence, MANNA pivoted from cooking comfort food for the dying to preparing medically tailored meals for terminally ill clients living longer lives. Daugherty’s rationale: If you’re not eating right, you won’t heal or thrive. And thanks to MANNA’s commitment to researching the benefits of nutritional science, “food is medicine” is more than a mantra.

The proof is in the health care savings. Says Daugherty: “A research study published at Tu s University a couple years ago showed that if everyone in the country who was prescribed a medically tailored meal had access to that meal, a er the cost of the intervention, the projected savings was $38 billion a year.”

Perhaps unsurprisingly, President Trump’s budget priorities affect MANNA and its clients, many of whom are on Medicaid.

According to Daugherty, MANNA receives close to $1 million a year in Ryan White funds specifically to serve its clients living with HIV, a cohort that makes up 8% of MANNA’s clientele. But Daugherty, who de ly navigated MANNA through the COVID-19 pandemic, won’t let Trump’s funding cuts keep her from serving.

“We’re hosting a roundtable discussion with our corporate foundations and higher-end donors to talk about [Trump’s budget cuts], and we’re doing more philanthropic outreach and looking at potential diversified funding streams,” she explains.

Daugherty’s advocacy also includes trips to Washington, DC, and to Pennsylvania’s capital, Harrisburg, to urge lawmakers to expand insurance coverage for MANNA’s services. Those efforts led to a pioneering agreement with an insurance company to cover the costs of MANNA meals for clients with diabetes, something Daugherty is keen to build upon. Q

CEO Sue Daugherty began working at MANNA in 1999.

If your test result is positive (reactive)

Today, it’s recommended that people living with HIV start treatment as soon as possible. Starting and staying on today’s treatment can help you get to and stay at an undetectable status and prevent transmission of HIV to others through sex. Here are some steps you can take for yourself and your sexual partner(s):

Talk to your healthcare provider

Ask what your test results mean for you and find out about HIV treatments that could best fit your personal routine.

Use condoms, practice safer sex, and start and stay on the treatment discussed with your healthcare provider. 1 3 2

Find out everything you can

The more you know about HIV, the better. You can discover resources by scanning the QR codes, or even find helpful information on your own.

Maintain your sexual health

Help l terms to know

TasP

Treatment as Prevention

If you’re living with HIV, current research shows that taking HIV treatment as prescribed and getting to and staying undetectable prevents transmitting HIV to others through sex. This is also known as U=U (undetectable=untransmittable).

PrEP

Pre-Exposure Prophylaxis

A major goal of HIV treatment is getting your viral load to undetectable. Undetectable means that there is so little virus in the blood that a lab test can’t measure it. If you have questions about your lab results and what it means to be undetectable, talk with your healthcare provider.

PrEP (pre-exposure prophylaxis) means routinely taking prescription medicine before you’re exposed to HIV to help reduce your chances of getting it. There are di erent PrEP options available, some of which are 99% e ective. Just remember, PrEP doesn’t protect against other STIs, so be sure to use condoms and other healthy sex practices.

ATRIPLA *

efavirenz + tenofovir disoproxil fumarate + emtricitabine

One tablet once a day. Each tablet contains 600 mg efavirenz + 300 mg tenofovir disoproxil fumarate + 200 mg emtricitabine. Take on an empty stomach. Dose should be taken at bedtime to minimize dizziness, drowsiness and impaired concentration.

BIKTARVY

bictegravir + tenofovir alafenamide + emtricitabine

One tablet once a day. Each tablet contains 50 mg bictegravir + 25 mg tenofovir alafenamide + 200 mg emtricitabine. Take with or without food.

CABENUVA

cabotegravir + rilpivirine

A long-acting injectable regimen administered as two intramuscular injections every four weeks or eight weeks.

A one-month lead-in period with Vocabria (cabotegravir) + Edurant (rilpivirine) pills is optional. Take with food.

COMPLERA

rilpivirine + tenofovir disoproxil fumarate + emtricitabine

One tablet once a day. Each tablet contains 25 mg rilpivirine + 300 mg tenofovir disoproxil fumarate + 200 mg emtricitabine. Take with a meal.

DELSTRIGO

doravirine + tenofovir disoproxil fumarate + lamivudine

One tablet once a day. Each tablet contains 100 mg doravirine + 300 mg tenofovir disoproxil fumarate + 300 mg lamivudine. Take with or without food.

DOVATO

dolutegravir + lamivudine

One tablet once a day. Each tablet contains 50 mg dolutegravir + 300 mg lamivudine. Take with or without food.

GENVOYA

elvitegravir + cobicistat + tenofovir alafenamide + emtricitabine

One tablet once a day. Each tablet contains 150 mg elvitegravir + 150 mg cobicistat + 10 mg tenofovir alafenamide + 200 mg emtricitabine. Take with food.

This quick-reference chart compares antiretroviral (ARV) options for the treatment of HIV, including adult dosing and dietary restrictions. Visit poz.com/drugchart for more info.

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CIMDUO

tenofovir disoproxil fumarate + lamivudine

One tablet once a day. Each tablet contains 300 mg tenofovir disoproxil fumarate + 300 mg lamivudine. Take with or without food.

DESCOVY

tenofovir alafenamide + emtricitabine

One tablet once a day. Each tablet contains 25 mg tenofovir alafenamide + 200 mg emtricitabine. Take with or without food.

EMTRIVA *

emtricitabine (also known as FTC)

One 200 mg capsule once a day. Take with or without food.

EPIVIR *

lamivudine (also known as 3TC)

One 300 mg tablet once a day, or one 150 mg tablet twice a day. Take with or without food. Also approved for the treatment of hepatitis B virus but at a lower dose. People living with both viruses should use the HIV dose.

EPZICOM *

abacavir + lamivudine

One tablet once a day. Each tablet contains 600 mg abacavir + 300 mg lamivudine. Take with or without food. Should be used only by individuals who are HLA-B*5701 negative.

TEMIXYS

tenofovir disoproxil fumarate + lamivudine

One tablet once a day. Each tablet contains 300 mg tenofovir disoproxil fumarate + 300 mg lamivudine. Take with or without food.

TRUVADA *

tenofovir disoproxil fumarate + emtricitabine

One tablet once a day. Each tablet contains 300 mg tenofovir disoproxil fumarate + 200 mg emtricitabine. Take with or without food.

VIREAD *

tenofovir disoproxil fumarate

One 300 mg tablet once a day. Take with or without food.

ZIAGEN *

abacavir

One 300 mg tablet twice a day, or two 300 mg tablets once a day. Take with or without food. Should be used only by individuals who are HLA-B*5701 negative.

EVOTAZ

atazanavir + cobicistat

One tablet once a day. Each tablet contains 300 mg atazanavir + 150 mg cobicistat. Take with food.

KALETRA *

lopinavir + ritonavir

Two tablets twice a day, or four tablets once a day, depending on HIV drug resistance. Each tablet contains 200 mg lopinavir + 50 mg ritonavir. Take with or without food.

PREZCOBIX

darunavir + cobicistat

One tablet once a day. Each tablet contains 800 mg darunavir + 150 mg cobicistat. Take with food.

PREZISTA darunavir

One 800 mg tablet, or two 400 mg tablets plus one 100 mg Norvir tablet once a day, or one 600 mg tablet plus one 100 mg Norvir tablet twice a day, depending on drug resistance. Take with food.

REYATAZ * atazanavir

Two 200 mg capsules once a day, or one 300 mg capsule plus one 100 mg Norvir tablet once a day. Take with food.

ISENTRESS

raltegravir

Two 600 mg Isentress HD tablets (shown) once a day for those who are treatment naive or whose virus has been suppressed on an initial regimen of Isentress. One 400 mg Isentress tablet twice daily for people with HIV treatment experience. Take with or without food.

TIVICAY dolutegravir

One 50 mg tablet once a day for those rst starting ARV therapy or for those who have not used an integrase inhibitor in the past. One 50 mg tablet twice a day for people with treatment experience who have HIV that is resistant to other integrase inhibitors and when taken with certain ARVs. Take with or without food.

VOCABRIA cabotegravir

One 30 mg tablet taken once a day with once-daily Edurant for a month as an optional lead-in regimen before switching to Cabenuva injections or for short-term treatment. Take with food.

GENVOYA

elvitegravir + cobicistat + tenofovir alafenamide + emtricitabine

One tablet once a day. Each tablet contains 150 mg elvitegravir + 150 mg cobicistat + 10 mg tenofovir alafenamide + 200 mg emtricitabine. Take with food.

JULUCA

dolutegravir + rilpivirine

One tablet once a day. Each tablet contains 50 mg dolutegravir + 25 mg rilpivirine. Take with a meal.

ODEFSEY

rilpivirine + tenofovir alafenamide + emtricitabine

One tablet once a day. Each tablet contains 25 mg rilpivirine + 25 mg tenofovir alafenamide + 200 mg emtricitabine. Take with a meal.

STRIBILD

elvitegravir + cobicistat + tenofovir disoproxil fumarate + emtricitabine

One tablet once a day. Each tablet contains 150 mg elvitegravir + 150 mg cobicistat + 300 mg tenofovir disoproxil fumarate + 200 mg emtricitabine. Take with food.

SYMFI AND SYMFI LO efavirenz + tenofovir disoproxil fumarate + lamivudine

One tablet of either Sym or Sym Lo once a day. Each tablet of Sym contains 600 mg efavirenz + 300 mg tenofovir disoproxil fumarate + 300 mg lamivudine. Each tablet of Sym Lo (shown) contains 400 mg efavirenz + 300 mg tenofovir disoproxil fumarate + 300 mg lamivudine. Take on an empty stomach. Dose should be taken at bedtime to minimize dizziness, drowsiness and impaired concentration.

SYMTUZA

darunavir + cobicistat + tenofovir alafenamide + emtricitabine

One tablet once a day. Each tablet contains 800 mg darunavir + 150 mg cobicistat + 10 mg tenofovir alafenamide + 200 mg emtricitabine. Take with food.

TRIUMEQ

dolutegravir + abacavir + lamivudine

One tablet once a day. Each tablet contains 50 mg dolutegravir + 600 mg abacavir + 300 mg lamivudine. Take with or without food. Should be used only by individuals who are HLA-B*5701 negative.

Entry Inhibitors

VIREAD * tenofovir disoproxil fumarate

One 300 mg tablet once a day. Take with or without food.

ZIAGEN * abacavir

One 300 mg tablet twice a day, or two 300 mg tablets once a day. Take with or without food. Should be used only by individuals who are HLA-B*5701 negative.

EDURANT

rilpivirine

One 25 mg tablet once a day. Take with food.

INTELENCE

etravirine

One 200 mg tablet twice a day. Take with food.

PIFELTRO

doravirine

One 100 mg tablet once a day. Take with or without food.

SUSTIVA *

efavirenz

One 600 mg tablet (shown) once a day, or three 200 mg capsules once a day. Take on an empty stomach or with a low-fat snack. Dose should be taken at bedtime to minimize dizziness, drowsiness and impaired concentration.

RUKOBIA fostemsavir

Capsid Inhibitors

or for those who have not used an integrase inhibitor in the past. One 50 mg tablet twice a day for people with treatment experience who have HIV that is resistant to other integrase inhibitors and when taken with certain ARVs. Take with or without food.

VOCABRIA cabotegravir

One 30 mg tablet taken once a day with once-daily Edurant for a month as an optional lead-in regimen before switching to Cabenuva injections or for short-term treatment. Take with food.

NORVIR * ritonavir

Norvir is usually taken to boost the levels of other ARVs in the blood. Take with food.

TYBOST cobicistat

One 150 mg tablet once a day in combination with ARVs that require boosting. Used only to boost other drugs. Take with food.

SUNLENCA lenacapavir

Sunlenca tablets are taken as a loading dose, with injections once every six months therea er. Take with or without food.

These antiretroviral medications are rarely prescribed and no longer recommended:

APTIVUS tipranavir

COMBIVIR * zidovudine + lamivudine

CRIXIVAN indinavir

One 600 mg tablet twice a day for people with HIV treatment experience. Take with or without food.

SELZENTRY

maraviroc

One 150 mg, 300 mg (shown) or 600 mg tablet twice a day, depending on other meds used, for people with HIV treatment experience. Take with or without food.

TROGARZO ibalizumab

A long-acting injectable administered intravenously as a single loading dose of 2,000 mg followed by a maintenance dose of 800 mg every two weeks for people with HIV treatment experience.

FUZEON enfuvirtide

INVIRASE saquinavir

RETROVIR * zidovudine (AZT)

TRIZIVIR abacavir + zidovudine + lamivudine

VIRACEPT nelfinavir

VIRAMUNE nevirapine LEXIVA fosamprenavir

ZERIT stavudine (d4T)

If your test result is negative (non-reactive)

When it comes to HIV prevention, the Centers for Disease Control and Prevention (CDC) recommends that ALL sexually active adults and adolescents be informed about PrEP (pre-exposure prophylaxis). PrEP means routinely taking prescription medicine before you’re exposed to HIV to help reduce your chances of getting it. Here are some steps you can take for yourself and your sexual partner(s):

Talk to your healthcare provider

Have a conversation with your healthcare provider about all of your HIV prevention options, including PrEP.

Regularly test for HIV and other sexually transmitted infections (STIs), use condoms, and communicate honestly with your partner(s). If you have been prescribed PrEP, continue to take it exactly as prescribed. 1 3 2

Find out everything

you can

Scan the QR codes and explore resources on your own to get tips on how to be proactive about protecting your sexual health, including understanding your HIV prevention options, like PrEP medications.

Maintain your sexual health

If your test result (reactive)

Today, it’s recommended that people living with Starting and staying on today’s treatment can help status and prevent transmission of HIV to others take for yourself and your sexual partner(s):

Talk to your healthcare provider

Ask what your test results mean for you and find out about HIV treatments that could best fit your personal routine.

Find out everything you can

The more you know HIV, the better. discover resources scanning the QR even find helpful on your own.

Whatever your results may be...

Speak with a healthcare provider:

1.How can I help protect myself and others?

2.How often should I get tested and retested?

3.How can I talk to my partner(s) about my status and theirs?

Share

your status with partner(s)

It may not be easy, but having a conversation with your partner(s) about your HIV status can help:

•Normalize the conversation around status, sexual health, and testing

•Empower others to make informed decisions about their sexual health

• Encourage all people to have conversations and stay engaged with their healthcare providers

Help l terms

Treatment as Prevention

If you’re living with HIV, current research shows that taking HIV treatment as prescribed and getting to and staying undetectable prevents transmitting HIV to others through sex. This is also known as U=U (undetectable=untransmittable).

PrEP

Pre-Exposure Prophylaxis

PrEP (pre-exposure prophylaxis) means routinely taking medicine before you’re exposed to HIV to help reduce of getting it. There are di erent PrEP options available, are 99% e ective. Just remember, PrEP doesn’t protect STIs, so be sure to use condoms and other healthy sex

everything can know about better. You can resources by QR codes, or information own.

Maintain your sexual health

Use condoms, practice safer sex, and start and stay on the treatment discussed with your healthcare provider.

A major goal of HIV treatment is getting your viral load to undetectable. Undetectable means that there is so little virus in the blood that a lab test can’t measure it. If you have questions about your lab results and what it means to be undetectable, talk with your healthcare provider.

HIV start treatment as soon as possible. help you get to and stay at an undetectable through sex. Here are some steps you can taking prescription reduce your chances available, some of which protect against other sex practices.