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 ÿnd the latest news and learn how you can make a di°erence in the ÿght.
D #POZ STORIES
When people living with and a°ected by HIV share their stories, it can break down the shame, silence and stigma surrounding the virus. These stories can inspire, educate and empower others. To read POZ Stories or to share your own, visit poz.com/stories
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.
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20 STILL FIGHTING TO SERVE Some people living with HIV are currently allowed in the military, while others struggle to enlist. BY TIM
MURPHY
26 WRITES & WRONGS The graphic novel Bitter Pill weaves together stories of gay journalist Randy Shilts, AIDS history, Patient Zero and Superman. BY TRENT STRAUBE
3 FROM THE EDITOR
Bittersweet Symphony
4 POZ Q&A
Demetre Daskalakis, MD, MPH, is the new chief medical officer at the Callen-Lorde Community Health Center in New York City.
6 POZ PLANET
New bike rides to raise HIV funds • the importance of pharmacists • rural communities face unique challenges accessing HIV care • POZ Stories: Christopher Reilly
• Everyday: moments in the epidemic
12 VOICES
Black communities still pay the highest price from HIV • a reminder that when things feel heavy, seeking help is OK
Protecting the LGBTQ community
16 BASICS
17 RESEARCH NOTES
Accessing PrEP through telehealth • resistance to lenacapavir may come at a cost to viral fitness • exceptional elite control of HIV • persistent aftereffects of mpox
18 CARE & TREATMENT
The high cost of frailty and falls • are you protected against measles?• HIV research is helping to solve long COVID • immune checkpoint inhibitors for people with HIV
32 HEROES
Raul Ramirez Perez strives to combat HIV in Nashville and beyond by advocating for education, prevention and treatment.
33 SURVEY
Accessing HIV care and treatment
Raul Ramirez Perez is on the steering committee of the U.S. People Living With HIV Caucus.
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Bittersweet Symphony
IWAS JUST A FEW YEARS into my time as a member of the Marine Corps Reserve when I experienced the high of potentially serving as an out gay man. During his campaign, President Bill Clinton promised to make it happen. I was soon disappointed.
After he took office in 1993, Don’t Ask, Don’t Tell (DADT) became the official policy of the U.S. Armed Services. In 1992, I had tested HIV positive. The double whammy forced my hand into separating from the military. That low moment in my life made my honorable discharge feel like a small silver lining. Bittersweet indeed.
across the country these days when it comes to civil rights in general, but especially so as it concerns LGBTQ people and folks living with HIV.
The overturning of DADT in 2011 was a victory, of course. Lesbian, gay and bisexual people could serve openly. However, transgender people were still banned. The Biden administration welcomed trans folks into service, but the Trump administration has reinstated their exclusion.
The ability of people living with HIV to serve has also changed over time. Since I found out I had HIV while in the military, I was given the chance to stay, but I would have been reassigned into a noncombat role. I didn’t disagree with that logic at the time, but it wasn’t what I wanted, so I took the alternative option, which was separation.
For decades, the situation for folks with HIV in the military remained much the same, even with the advent of effective treatment. In 2022, however, a federal court ruled that service members who were undetectable could not be barred from commissioning as officers or being deployed.
So it’s no surprise that Isaiah Wilkins, our cover subject, was encouraged at his chances to enlist. In 2024, a federal court ruled in his favor, which would have allowed all people living with HIV who were qualified for military service to enlist. A roadblock appeared earlier this year when an appeals court ruled against him. Go to page 20 to learn more.
Two steps forward and one step back seems to be an increasingly true reality
Young people are finding themselves ever more affected by these current events, which include matters related to HIV. At 24, Isaiah is an encouraging example among his peers of putting words into action. We’re pleased to be able to highlight his advocacy in support of National Youth HIV & AIDS Awareness Day, which is marked each year on April 10.
Another advocate promoting visibility for young people living with HIV is Raul Ramirez Perez. He was 25 when he tested positive for the virus. Raul didn’t have the best experience after learning his status, so he has dedicated himself to making sure that others have better sexual health outcomes. Go to page 32 to read more about his work.
Please also go to page 26 for a sneak peek at a new graphic novel that’s not just for young people titled Bitter Pill: Randy Shilts and the Dawn of the HIV/AIDS Epidemic Author Clément Xavier shares why he delves into this aspect of AIDS history.
ORIOL R. GUTIERREZ JR. EDITOR-IN-CHIEF editor-in-chief@poz.com
DEMETRE DASKALAKIS GETS BACK TO HIS ROOTS
The community health leader puts his principles and his identity front and center.
ALEADING NATIONAL EXPERT ON HIV AND LGBTQ HEALTH,
Demetre Daskalakis, MD, MPH, has a new position as chief medical officer at Callen-Lorde Community Health Center in New York City. He is also serving on NYC Mayor Zohran Mamdani’s transition committee on health. Most recently Daskalakis was director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), a position from which he resigned in protest last August after CDC director Susan Monarez, PhD, was ousted for clashing with Health Secretary Robert F. Kennedy Jr. over vaccine policy. “As I move on to the next phase of my career, I will continue to advocate for the values that have always driven my work—science, data and evidence-based solutions to public health challenges,” he wrote in his blistering resignation letter.
Daskalakis started his career in HIV as a frontline physician. In 2006, he founded the Men’s Sexual Health Project, which offered HIV and sexually transmitted infection testing at sex clubs and bathhouses. He was named deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene in 2013, and he became the director of the Division of HIV/AIDS Prevention at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in 2020. Two years later, he was tapped to colead the White House response to the mpox outbreak.
Widely acclaimed for his intimate knowledge of and connection to the communities he serves, Daskalakis is not shy about putting his identity as a gay man front and center. He recently spoke with POZ about his new job and the ongoing national turmoil affecting public health.
Congratulations on your new position! Tell us a bit about what Callen-Lorde does and what the new job entails.
Callen-Lorde, at its core, is a community health center. They have three clinics, in Chelsea, Brooklyn and the Bronx. It’s very specifically focused on the LGBTQ+ community as well as the community of people living with and at risk for HIV. With a history dating back to the Stonewall uprising, it’s the nation’s preeminent LGBTQ health provider, and its approach is emulated in other places.
First, I’m seeing patients again. I did see patients while I was at the CDC in Atlanta, but, because my job was so crazy, I wasn’t able to do longitudinal care. At Callen-Lorde, my job is to supervise the entire medical team and work with CEO Patrick McGovern and others on key policy issues. It’s not just about HIV but about a bigger vision of LGBTQ health.
Left: Demetre Daskalakis and David Malebranche in their 2016 #AskTheHIVDoc YouTube series from Greater Than AIDS.
Right: Callen-Lorde CEO Patrick McGovern announces Daskalakis’s appointment as chief medical officer in December 2025.
What are some of the advantages and drawbacks of returning to local work versus working at the national level?
I left the national work because I think that you can’t get anything done there. The way the current administration is treating its health agencies, there’s very little you can do to effect change. That’s where my grassroots gene kicked in and made me look at the opportunity at Callen-Lorde as a chance to go back to the front lines and be a better advocate for policy instead of toeing a line. I drew the line at toeing a line that I thought was unethical and immoral. A lot of the value I’ve added is understanding what happens at the front. I’m looking at this as a great opportunity to flex that muscle. I’m excited to be an advocate again and speak up in a different way than you can when you’re in government.
What does losing culturally competent health leadership at the national level mean, especially for the South?
We’ve learned that things that happen closer to the ground are more impactful and less easily destroyed. The disparity in the South is going to get worse before it gets better, but if they pull the plug on Ryan White, even cities like New York and San Francisco and Los Angeles are going to be in trouble. A lot of people with consequential voices are leaving national government, but the front line is going to hold it down and keep things going for when the time comes to reimagine what this all looks like. I think it’s going to feel a bit like the late ‘80s and early ‘90s, because we’re going to need some pretty loud activism.
While working on mpox and vaccine policy at the national level, you were criticized for your unapologetic presentation. Did that hamper your work?
There’s the avatar of what folks say about me, and then there’s the reality of what my everyday looks like. If I were worried about right-wing attacks, I’d be in the corner of my apartment crying, but I don’t care. Still, sometimes you need to know when you’re not the voice. In the HIV and LGBTQ space, I’m a trusted messenger. When I went to the White House to do mpox, my job was to
actually use my identity to do good public health. But that voice may not always be me. When I was doing measles work with the Hasidic community in New York City, the Orthodox Jewish Women’s Medical Association and the Orthodox nurses became the voices— they just needed the support of public health to get the information and funding to do the work. Like Kenny Rogers says, “You got to know when to hold ‘em, know when to fold ‘em.”
What are your thoughts about the recent changes at the CDC?
There’s been an active effort to dismantle public health. At the CDC, they’ve
cation training centers, the entire CDC division of HIV prevention are potentially on the chopping block. We’re seeing historic cuts that mean that a lot of people living with HIV are not going to be able to use Medicaid services. We have all this technology and new interventions to end the HIV epidemic, but it’s really just been thrown in the garbage. Local health departments are in suspended animation. The administration is erasing whole swaths of at-risk populations, including transgender folks. Everybody has been working so hard to connect them to HIV services, and they’re being given signals that their health doesn’t really matter. It also
Demetre
Daskalakis, MD, MPH
created this Swiss cheese with gaps that have left us less prepared than we were during the COVID-19 pandemic. This administration has put everyone on notice that if you don’t agree with their policies, you’re at risk for losing your funding. They made a very clear statement by saying that CDC no longer supports harm reduction or “gender ideology” or DEI [diversity, equity and inclusion]. So much of public health— which is to make sure that everyone has the best shot at achieving their optimal health—is going to be harder to do. It’s like taking a giant leap backward.
How will the changes at the CDC and other federal health agencies affect efforts to end the HIV epidemic?
The president’s budget is, first and foremost, a moral document, and it communicates the priorities of the administration. We’re at a place where HIV intervention services, the dental program, AIDS edu-
“I’m excited to speak up in a different way than you can when you’re in government.”
means a talent and brain drain because people are leaving public health leadership. All of us doing work in the HIV and LGBTQ space are on the short list because someone is going to think it’s more important to get rid of wokeness than to end HIV.
At this stage in your career, what makes you hopeful for the future?
Back to Callen-Lorde, Michael Callen was one of the coauthors of the Denver Principles, which was all about “nothing about us without us.” Coming back to New York, I’m excited that the new administration seems very interested in leading with the key social factors that are so important in public health. I’m coming with a lot of experience, and I hope that I get to be a resource. Some pretty aggressive action is going to be needed to make sure that we don’t fail our community of people living with and at risk for HIV. Q
NEW BIKE RIDES TO RAISE HIV FUNDS
The events are legacies of AIDS/LifeCycle.
After nearly 30 years of HIV fundraising, California’s iconic AIDS/LifeCycle bike ride came to the end of its road last summer with its final seven-day trek from San Francisco to Los Angeles in June. But two new paths for fundraising bike rides have emerged in 2026: Cycle to Zero supports the San Francisco AIDS Foundation (SFAF), and Center Ride Out supports three LGBTQ centers and their HIV services across Southern California, including Los Angeles, San Diego and Palm Springs/Coachella.
In total, AIDS/LifeCycle raised over $349 million for HIV services provided by the Los Angeles LGBT Center and SFAF. Last year’s event raised $17.8 million. The hope is that the legacy events will not only help replenish that financial support but also build community and bolster related services.
The new rides are shorter, each lasting three days instead of seven, and they offer more flexibility for participants. On the second day of both events, riders can choose bike routes of various lengths or to rest and recuperate while building community.
Center Ride Out will take cyclists from Los Angeles to San Diego from April 24 to 26. Cycle to Zero will start in San Francisco and head to Guerneville through Sonoma and back along the San Francisco coast from May 29 to May 31.
“Center Ride Out honors a rich legacy while charting a bold path forward…and recommits us to fight for health equity, compassion and visibility for all LGBTQ+ people,” said Joe Hollendoner, CEO of the Los Angeles LGBT Center, in a press release from the center.
The organization noted that fundraising events like Center Ride Out have become more essential to sustaining services at the center, especially in light of diminishing government support of LGBTQ programs.
In addition to supporting HIV services and prevention, the ride will support the center’s work in four main areas: health care, housing and social services, culture and education, and advocacy. What’s more, 10% of net proceeds will benefit the San Diego LGBT Community Center and The LGBTQ Community Center of the Desert.
Cycle to Zero and Center Ride Out both support HIV services.
of achieving health justice for all and reaching zero stigma, zero overdose deaths and zero inequity,” according to a press statement from SFAF.
“Center Ride Out is more than a ride— it’s a movement,” said Melissa Lewis, the ride’s director. “We’re uniting cyclists, volunteers and supporters across Southern California to celebrate who we are and why we ride: for community, for pride and for the future of LGBTQ+ equity. Whether a first-time rider or a seasoned cyclist, there’s a place for you on this ride. Every participant helps move our mission forward.”
Meanwhile the name Cycle to Zero was chosen with input from the community because it reflects “SFAF’s larger goals
“More than 40 years into the epidemic, we know that HIV prevention and care can’t operate in a vacuum,” said SFAF CEO Tyler TerMeer, PhD, in the release. “HIV is driven by the contexts in which we live—fostered by racism, homophobia, transphobia and inequity— and linked to overlapping issues related to substance use, mental health concerns and more.
That’s why our approach and mission must encompass these overlapping issues while keeping us laser focused on reaching an end to HIV.”
To that end, funds raised by Cycle to Zero will benefit not just HIV services but also sexual health, substance health, overdose prevention and other community programs at SFAF. —Eva Lorenz
The Importance of Pharmacists
They play a key role in HIV services.
Pharmacists have long been trusted health care providers for the communities they serve, but today, their role is more vital than ever. From providing everyday health guidance to supporting HIV prevention and treatment, pharmacists are helping expand the reach of critical services and are building healthier, more connected communities.
For many people, especially those in rural areas or neighborhoods with limited health care options, pharmacists are often the most accessible health care professionals. Whether it’s answering health questions, offering immunizations or comanaging chronic conditions, pharmacists are embedded in the daily lives of the people they serve.
In the context of HIV, pharmacists play a crucial role by:
• Expanding access to HIV testing and prevention tools;
• Serving as trusted bridges to doctors, clinics and public health programs;
• Creating strategies for medication adherence;
• Helping people understand HIV treatment plans, lab reports and procedures. These efforts go beyond dispensing medicine. It’s about meeting people where they are, empowering them to take control of their health and improving health outcomes nationwide. By fostering ongoing relationships and providing compassionate care, pharmacists are essential to HIV prevention and treatment.
Across the country, innovative pharmacybased programs are driving real impact. In some areas, pharmacists can now prescribe pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) directly. Others are participating in public health partnerships to offer HIV testing right in the pharmacy setting. Clinical pharmacists are embedded in primary care medical homes, working alongside the care team by providing direct care to patients living with HIV.
These efforts are expanding the availability of care in ways that are practical, scalable and centered on community needs. When pharmacists are empowered to provide these services, everyone benefits. Pharmacists are essential to HIV care and prevention. They are medication experts and trusted professionals who help people stay in care. —HIV.gov
SUPPORT FOR RURAL COMMUNITIES
They face unique challenges in accessing HIV care.
If you live in a rural area, getting HIV care can feel like an uphill battle. This might mean driving long distances, not having many doctors or clinics to choose from or struggling to get to appointments. You might also worry about what others will think or say.
All of this can make it hard to get tested or to access the HIV prevention or treatment services that you need. But remember, you’re not alone.
Here are tips for accessing HIV services in rural areas:
Get tested: You can search for testing options near you using the HIV.gov HIV Services Locator. You can also request a free HIV selftest from Together TakeMeHome, a program supported by the Centers for Disease Control and Prevention that mails self-tests to help make HIV testing more accessible across the United States.
Explore telehealth options: Ask whether your provider or an HIV clinic in your region or state offers virtual appointments for HIV care or PrEP (pre-exposure prophylaxis).
Find a provider who meets your needs: The HIV.gov HIV Services Locator can also help you connect with care providers and support services—even in surrounding counties or nearby cities. You can
also check with your local health department.
Stay engaged in care: Consider setting reminders for appointments or enrolling in programs that offer care coordination or navigation services so you have someone you can reach out to with questions between appointments.
There are also related federal programs:
• The Indian Health Service offers HIV care and prevention for Indigenous communities, including those in rural regions, making sure care fits cultural needs.
• The Ryan White HIV/AIDS Program helps people living with HIV, including those in rural areas, access medical care, medications and essential support services by working with clinics, providers and community programs.
• The Health Center Program supports local health centers all over the country. Many of these centers are located in rural areas. Health centers offer HIV testing, and many also provide prevention and treatment services.
• The CDC supports health departments and communitybased organizations that provide HIV testing and prevention services, including in rural and high-need communities. —HIV.gov
Memories of a Long-Term Survivor
Christopher Reilly found healing from childhood sexual abuse through sharing his experience.
Over 30 years have passed since I was diagnosed with AIDS. In 1991, I was shocked to learn via an article in Newsday that my former dentist, whom I had dated in the 1980s, had passed away from AIDS-related Pneumocystis pneumonia and his patients were getting tested for HIV. I went to get tested as soon as possible, and the test came back positive. For me, the news was catastrophic. I was only 26 years old. The beginning of the AIDS epidemic was a really scary time in history. There was confusion, panic and much misinformation regarding transmission and treatment of HIV. Many people were living in fear and worried about when they would become sick. I had to keep my diagnosis a secret. It was sheer agony not to be able to tell anyone about my condition. AIDS was known as the “silent battle,” and it truly was. When I was younger, I was bullied for being gay. From early childhood into adolescence, I was abused—sexually, physically and mentally—by a family friend. As a young adult, I struggled
EVERYDAY
April
with hate, bigotry and stigma.
I came out as gay when I was in my early teens. I disclosed my sexuality to my family, minister and some trusted friends. I also shared the truth about my sexual abuse and rape. I had suppressed the trauma and abuse for so long.
Having the courage to tell my story was a double-edged sword. For my family, it was extremely painful to watch friends and other family members walk away from us. It was like I had done something unspeakably wrong. Yet it was something I could not control or even fully understand. My immediate family stood by me and loved me no matter what.
Survival is universal—that’s what we’re all here for. We need not experience our feelings in isolation. We can reach out to others for support. We no longer need to pretend to be something we’re not solely because other people may feel threatened.
Self-acceptance leads to change and growth. We do not have to prove ourselves to anyone. Always be yourself.
If you could change one thing about living with HIV, what would it be?
Christopher Reilly
I would change the stigma related to HIV and AIDS. The LGBTQ+ community is so marginalized, and there is so much hate.
What is your greatest regret?
Not having enough time to do all the things I need to do in this life.
What adjectives best describe you? Resilient, fastidious and persistent.
What drives you to do what you do?
A desire to help others—especially those who have HIV/AIDS, those in the gay community and survivors of sexual abuse and emotional abuse.
If you could be any animal, what would you be? And why?
A cat, specifically a puma. They are worshiped and mysterious creatures.
Read other POZ Stories or share your own at poz.com/stories.
dates represent milestones in the HIV epidemic. Visit poz.com/aidsiseveryday to learn more about the history of HIV and AIDS. BY JENNIFER MORTON
NATIONAL YOUTH HIV & AIDS AWARENESS DAY
10 18 18 19
NATIONAL TRANSGENDER HIV TESTING DAY
IN THE GLOAMING, a film directed by Christopher Reeve about a prodigal son’s return to his family’s home to die of an AIDSrelated illness, premieres on HBO. The film stars Robert Sean Leonard, Glenn Close, David Strathairn and Whoopi Goldberg. (1997)
HIV VACCINE AWARENESS DAY
NATIONAL ASIAN & PACIFIC ISLANDER HIV/AIDS AWARENESS DAY
The Centers for Disease Control and Prevention launches the HIV awareness campaign “START TALKING. STOP HIV,” which features messages that engage, inspire and spark conversations between sexual partners and provides practical tools and tips for talking about HIV prevention. (2014)
STILL PAYING
Below is an excerpt of an opinion piece titled “Four Decades In, Black Communities Are Still Paying the Highest Price From HIV” by Amida Care, the NEW Pride Agenda and the National Black Leadership Commission on Health.
FORTY YEARS AGO, THE CENTERS for Disease Control and Prevention (CDC) rst sounded the alarm that Black and Latino communities were disproportionately impacted by HIV. That warning still echoes. Despite much progress, Black Americans continue to pay the highest price. For Black women, youth, gay and bisexual men and transgender, gender-nonconforming and nonbinary (TGNCNB) communities, these impacts have become even more pronounced. What began as a public health crisis has become a long-running measure of our national resolve. The question before us is no longer whether we know how to prevent HIV or treat it e ectively. The question is whether we are willing to confront the inequities that have allowed this epidemic to persist. Condoms remain one of the most e ective, accessible and proven tools for preventing HIV and other sexually transmitted infections. Yet today, we also possess medical tools that empower people to protect themselves. Pre-exposure prophylaxis (PrEP) can prevent HIV with remarkable e ectiveness. Post-exposure prophylaxis (PEP) can stop infection a er potential exposure. Modern treatment allows people to achieve viral suppression, live long and healthy lives and eliminate the risk of trans-
mission. Plus, long-acting injectable options for prevention and antiretroviral treatment have bene ted those who may struggle with adherence to daily oral medications. Ending the epidemic is scienti cally possible. Yet the bene ts of these advances remain unevenly distributed.
Black people account for approximately 12% of the U.S. population but represent nearly 40% of new HIV diagnoses and people living with HIV, according to the most recent CDC data. Of particular concern is the disproportionate impact of HIV among Black women, youth, trans women and gay and bisexual men as well as the higher rate of concurrent HIV and AIDS diagnoses and a faster progression from HIV to AIDS in Black men with HIV. Overall, Black individuals represent the highest proportion of deaths from HIV and AIDS (43%) compared with any other group.
In addition, Black Americans are signi cantly less likely to have access to or use PrEP, be linked to care when diagnosed with HIV and achieve viral suppression compared with their white counterparts. These gaps are driven not by lack of need or awareness but by systemic barriers and stigma. Among TGNCNB individuals—especially transgender women of color—HIV prevalence remains alarmingly high, and they face signi cant barriers
leading to lower access and uptake of PrEP compared to other groups.
Access to PrEP and treatment is shaped by insurance coverage, provider bias, medical mistrust rooted in historical injustice, transportation challenges and gaps in culturally responsive care. For many Black individuals, especially those in under-resourced neighborhoods or rural areas, preventive care and treatment remain di cult to access, prohibitively expensive or inadequately promoted by health care systems. The result is a prevention and treatment landscape that too o en fails the people most at risk.
Intentional investment works. When Black-led and Black-serving organizations are resourced to deliver culturally responsive, community-driven care, people get tested earlier, start treatment sooner and remain engaged in care. When prevention tools like PrEP are made a ordable, accessible and stigma-free, uptake increases and new cases decline. Investing in high-quality, culturally sensitive HIV treatment and prevention services provided by community health care providers is vital to meet people where they’re at and break down barriers to care.
Cuts to safety-net programs would be devastating. The time for re ection has passed. The time for deliberate, sustained action is now. Q
FINDING LIGHT
In a blog post titled “Finding Light When Things Feel Heavy: A Gentle Reflection on Depression and Hope,” long-term survivor and former New York State Senator Tom Duane shares why seeking help matters. Below is an excerpt.
I’M A PRETTY UPBEAT GUY. EVEN as we as a nation face the continual onslaught of horrible news coming from the current presidential regime, I can usually ÿnd a way to be optimistic and hopeful. I’m not a Pollyanna, but I mostly ÿnd the bright side of a situation. I truly believe we will be able to restore our democratic republic and even make it better and stronger than it was before.
But here’s a confession, and one I’m loath to admit. Around the holidays— and by the way, it had nothing to do with the holidays—I hit a wall. Depression got the better of me, and I was in a very dark place that lasted for days and days.
I’ve always been open about my mental health struggles, addictions, experiences in recovery, etcetera. There is no shame whatsoever in needing help. It’s always been my belief that by telling my truth, perhaps someone else will relate and not feel so alone in their strife. We all experience mental health setbacks, and sometimes, just like with bodily health, professional care is needed to get back on track. Over my lifetime, I have been in several types of therapy, analysis and self-help
groups, so I know the value of these kinds of remedies.
I realize now that I should have called my doctor and gotten some kind of treatment or medication—something to help me get out of this severe melancholy. Hindsight is 20/20. Truthfully, I didn’t talk to anyone about how I was feeling until I was through it.
Sometimes, when I’m in the middle of a deep depression, I can’t see what I need. In those times, the rational part of my brain that would steer me to see my doctor is not functioning correctly, and I think I can handle it by myself, without the need to talk to anyone. My rational brain knows that isolating myself isn’t good for me, but when my rational brain is ailing, my judgement is cloudy.
In advance of my next bout of hopelessness (because there will be another one, probably sooner than I’d like), I’ve instructed friends and colleagues to let me know if they notice a negative change in me or a depression. I ask them to call me out and tell me to see a professional. I don’t deserve to feel that badly for that long.
Another way that I am protecting my
mental health is by limiting how much awful news and media I consume. I only let myself get worked up about two things: two horrible news items or events a day. And for every two awful things, I have to also find something to bring me joy. When there’s so much that is dreadful happening, I have to ÿnd something that brings light. It can be as simple as getting a haircut or watching an episode of The Great British Bake O˜
Just as I didn’t deserve to feel that badly for that long, you don’t either. If you’re feeling low and it’s more than just seasonal blues, tell someone. Reach out to your medical provider to ask for help. Or even just talk to a friend. A°er all, there’s truth in the old proverb “A problem shared is a problem halved.”
We have to take extra good care of ourselves and one another if we are going to succeed against the current regime. We need 100% of you to ÿght against the terrible things that are happening in our country and world. And we need your light and energy to help build the stronger, more beautiful United States I know is in our future. Q
DIRECT ACTION
On February 9, 2026, citing a policy directive that President Trump had issued a couple of weeks earlier, National Park Service (NPS) officials removed the Pride flag from New York City’s Stonewall National Monument, which marks the birthplace of the modern LGBTQ rights movement. The directive had instructed the NPS that only the U.S. flag, certain agency flags and a few exceptions could be flown on federal park flagpoles. But on February 13, city officials and activists, including members of ACT UP and Gays Against Guns, hoisted a new Pride flag.
And on Tuesday, February 17, in Washington, DC, 25 demonstrators were arrested after blockading the headquarters of the Department of Health and Human Services (HHS). The date marked the end of the public comment period for proposed HHS rules that would effectively ban gender-affirming care for most trans youth. These rules would forbid hospitals that participate in Medicaid and Medicare programs (virtually all hospitals) from providing puberty blockers, hormone therapy or surgical procedures to trans youth. The blockade was spearheaded by the Gender Liberation Movement with the participation of members of ACT UP New York and ACT UP Pittsburgh.
These bold examples of direct action are a response to the Trump administration’s targeted attacks against minority populations. The protests serve to underscore the importance of vigilance in safeguarding the dignity, rights and health of all Americans. As long as those in power act against the people, the people will keep acting up.
1. Protesters blocked the entrance to the Hubert H. Humphrey Building, which houses Health and Human Services, an agency run by Health Secretary Robert F. Kennedy Jr. Proposed HHS rules would also prohibit Children’s Health Insurance Program funds from covering trans care nationwide. Other signs read “Hands Off Our ’Mones,” meaning hormones, and “HHS, RFK: Trans Youth Are No Debate.” 2. Gender Liberation Movement cofounder and strategic director Raquel Willis was among the 25 people arrested. 3. The blue and pink of the trans flag symbolize the traditional colors for baby girls and baby boys, while white represents people who identify as intersex, gender-neutral, gender-nonconforming or transitioning. 4. Protesters included trans youth and their parents. Another proposed rule would amend Section 504 regulations to allow disability discrimination against trans people.
5. New York City–based entertainer and advocate Tym Moss (right) posed with Representative Dan Goldman (D-N.Y) at the Stonewall monument. 6. Activists took matters into their own hands in reraising the Pride flag. 7. Senate Minority Leader Chuck Schumer (D-N.Y.) declared, “The Trump administration’s removal of the Pride rainbow flag from the Stonewall National Monument is a deeply outrageous action that must be reversed. It’s an effing disgrace.” 8. Teenager Tirha was said to be the first to jump the park’s fence to restore the flag. The entrance to the Stonewall Inn is across the street from the monument beneath the scaffolding seen in the background.
Send your event photos to POZ at website@poz. com or tag us on Facebook, Instagram or X. For a list of community events, visit poz.com/calendar.
YOUTH AND HIV
Adolescents and young adults living with HIV may face additional challenges.
NEARLY ONE IN FIVE PEOPLE newly diagnosed with HIV in the United States and about 2% of those living with the virus are adolescents and young adults. Pre-exposure prophylaxis (PrEP) and antiretroviral treatment are e˜ective for young people, but this age group may face challenges such as stigma and limited access to health care.
Youth ages 13 to 24 accounted for 18% of the more than 39,000 people newly diagnosed with HIV in 2023, according to the Centers for Disease Control and Prevention (CDC). The good news is that the HIV incidence rate for this group has declined by 12% since 2019. Adolescents and young adults living with HIV belong to two distinct groups: those who were born with the virus or acquired it very early in life (lifetime survivors) and those who acquired HIV in their teens or early adulthood.
About 80% of newly diagnosed youth with HIV are young gay or bisexual men. Among young women, heterosexual contact is the most common risk factor. But HIV risk varies substantially by race/ethnicity and geography. Nearly half (47%) of newly diagnosed young people were Black, 35% were Latino and 13% were white; more than half lived in the South.
PrEP is a highly e˜ective tool for preventing HIV, along with using condoms and not sharing drug injection equipment. Two once-daily PrEP pills—Truvada (tenofovir disoproxil fumarate/ emtricitabine) and Descovy (tenofovir alafenamide/emtricitabine)—and two long-acting injectables—Apretude (cabotegravir) and Yeztugo (lenacapavir)— are approved for adolescents and adults weighing at least 77 pounds. While PrEP use among young people has increased in recent years, many still face barriers to access.
With good care and prompt treatment, adolescents and young adults with HIV can live long, healthy lives, but youth are less likely than those in older age groups to have been tested and know their status. Testing is important because people who know they are positive can start treatment, which both halts disease progression and prevents HIV transmission because those with an undetectable viral load do not
transmit the virus via sex.
Treatment guidelines recommend that all adolescents and young adults should start antiretroviral therapy as soon as possible a°er diagnosis. According to the CDC, 82% of youth diagnosed with HIV in 2023 were linked to care within one month, and 71% achieved viral suppression within six months. Treatment is usually e˜ective for young people, and guidelines are mostly the same for adolescents and adults of all ages. However, lifetime survivors who have been on antiretrovirals for decades may require more complex management, and they may need extra support as they transition from pediatric to adult care.
In general, young people have a more robust immune system and may experience faster CD4 T-cell recovery a°er starting treatment than older people with HIV. On the other hand,
adolescents and young adults may face treatment barriers, including stigma, lack of health insurance and unavailability of youth-friendly services. Young people who feel well and don’t have other health concerns may put o˜ regular medical care, and studies suggest they may have more trouble maintaining consistent adherence. Compared with their HIV-negative peers, people living with HIV are at greater risk for coexisting health conditions, such as cardiovascular disease, liver disease and bone loss, and they tend to develop them at younger ages. While these comorbidities are uncommon among adolescents and young adults, it’s never too early to establish good health habits, such as eating a healthy diet, getting enough exercise, not smoking, limiting drug use and heavy drinking, and seeing your health care provider regularly. Q
BY LIZ HIGHLEYMAN
PREVENTION
Nearly one in ÿve people using pre-exposure prophylaxis (PrEP) get it through the nation’s largest telehealth PrEP provider. Researchers analyzed records from more than half a million people— predominantly young men— who contacted MISTR about PrEP between 2018 and 2025. Over half did not proceed a˛er their initial intake survey or did not follow up with the required clinician video visit or lab tests. Of the 162,422 people who received a prescription, three quarters had not previously used PrEP, and more than a third were uninsured. The study conÿrmed the well-known disparity in PrEP use: 51% were white, 25% were Latino and 12% were Black. Telehealth PrEP use increased over time, from 204 people in 2019 to 110,068 in 2024. Looking at the bigger picture, the proportion of all national PrEP users who accessed it via MISTR’s telePrEP program rose from less than 1% in 2019 to 19% in 2024. These ÿndings suggest that telePrEP is “a critical part of HIV prevention infrastructure” in the United States, the study authors concluded.
TREATMENT
Viral Fitness
HIV can develop mutations that confer resistance to lenacapavir, but doing so comes at a cost to viral ÿtness. The long-acting HIV capsid inhibitor is approved as a component of treatment for people with multidrugresistant HIV (Sunlenca) and as a single agent for pre-exposure prophylaxis (Yeztugo). Gilead scientists characterized resistanceassociated capsid mutations in 40 HIV samples collected from people treated with lenacapavir in two clinical trials as well as 44 sitedirected mutants (genetically altered virus). In laboratory tests, HIV with capsid mutations had various degrees of reduced susceptibility to lenacapavir. The mutations that conferred the most resistance also substantially impaired the virus’s ability to replicate e°ciently. The development of resistance to lenacapavir remains rare in clinical practice, but these ÿndings underscore the importance of combining it with other active drugs for HIV treatment, using sensitive tests to rule out acute infection before starting PrEP and maintaining good adherence.
CURE
Elite Control
A woman in Spain may have been functionally cured of HIV without antiretroviral treatment. Le˛ untreated, HIV almost always causes progressive disease, but scientists have described some cases of elite control, in which people maintain an undetectable viral load and remain healthy without antiretrovirals, and even a few cases of exceptional elite control, in which people seem to have naturally eliminated the virus. The 48-year-old Indian woman in Spain was ÿrst diagnosed with HIV in 2002. Despite not receiving antiretrovirals, she maintained an undetectable viral load and a stable CD4 cell count for 22 years, and she never developed clinical manifestations of HIV. Intact HIV DNA was not detected in resting T cells that make up the viral reservoir. She had well-preserved T-cell function, with low expression of markers of cell exhaustion, apoptosis and senescence, as well as active natural killer cells. She also had low levels of in˝ammatory biomarkers. “Functional cure is an uncommon but feasible outcome of HIV-1 infection,” the study authors concluded.
Persistent Mpox CONCERNS
People who have had mpox (also known as monkeypox) may experience persistent physical, psychological and social a˛ere˙ects. Mpox, caused by a virus related to smallpox, is primarily transmitted via skin-to-skin contact, including sex. The global mpox outbreak that started in May 2022 reached more than 32,000 cases in the United States, resulting in 58 deaths. The characteristic sign is a rash, sometimes accompanied by ˝u-like symptoms; people with advanced HIV are more likely to develop severe illness. In an analysis of more than 150 people in New York City and Houston who contracted mpox during that outbreak, nearly 60% reported lasting physical a˛ere˙ects, such as skin discoloration or scarring, 13% reported ongoing e˙ects on physical function, 45% reported increased depression and 49% said they had ongoing issues related to their social life up to 18 months later. Mpox continues to circulate at a low level in the United States, and health o°cials urge people at higher risk— including gay men—to get two doses of the Jynneos vaccine.
THE HIGH COST OF FRAILTY AND FALLS
The lifetime toll of frailty and falls among people with HIV is likely to be substantial as the population ages, according to a recent study. Regardless of HIV status, frailty is a common syndrome among older adults that comes with an increased risk for poor outcomes, including falls, cognitive impairment, hospitalization and death.
Karen Smith, PhD, of Harvard Medical School, and colleagues, used mathematical modeling to estimate the anticipated lifetime health losses and costs attributable to prefrailty, frailty and falls among people living with HIV in the United States, assuming a representative population of more than 500,000 HIV-positive people ages 40 and older with viral suppression.
At the individual level, the model projected that frailty would result in 2.6 life-years lost, 2.1 quality-adjusted life years (QALYs) lost—a measure that combines length and quality of life—and $16,900 in additional spending per person. Scaling up to the population level, this would amount to 1,352,000 life-years lost, 1,091,000 QALYs lost and $8.8 billion in lifetime costs. What’s more, falls could lead to more than 180,000 total life-years lost and over $3 billion in lifetime costs.
However, a simulation that included prevention interventions projected that decreasing the risk of prefrailty and frailty could dramatically reduce QALYs lost and save billions of dollars. “Interventions such as exercise programs could improve outcomes, and future work should aim to identify high-value interventions to prevent and treat frailty and falls among people with HIV,” the authors wrote.
Medical therapies may also play a role. The AIDS Clinical Trials Group recently announced a Phase II clinical trial, dubbed IPACE-HIV, to evaluate dasatinib (Sprycel) and quercetin—two senolytic drugs that target cells involved in biological aging—for improving physical function among HIV-positive people who are frail or at risk for frailty.
Are You Protected Against Measles?
Measles cases are rising in the United States as vaccine hesitancy increases, and people with HIV may not be adequately protected. According to the Centers for Disease Control and Prevention, 2,280 conÿrmed cases were reported in 45 states in 2025, with more than 900 additional cases through late February 2026. Experts fear that recent changes to vaccine policy could lead to the loss of population protection against measles.
Measles is caused by a highly contagious airborne virus. The illness typically begins with °u-like symptoms, followed by a characteristic rash. While most people recover, some develop life-threatening complications. People with HIV—particularly those with a low CD4 T-cell count—are at greater risk for severe illness and death. Federal guidelines recommend that all people with HIV should be assessed for measles immunity, meaning documented prior vaccination, a blood test showing adequate antibodies, past measles infection or being born before 1957, when most people were exposed and developed natural immunity. HIV-positive people ages 1 year and older
without presumptive immunity who are on antiretroviral treatment and have adequate immune function should receive two doses of the combination MMR vaccine, which also prevents mumps and rubella. The vaccine is safe for HIV-positive people with a CD4 count of at least 200, or a CD4 percentage of at least 15% in young children. But because it contains weakened live virus, the vaccine is potentially dangerous for those with compromised immunity.
In a recent study, Hayden Andrews, MD, of the University of Texas Southwestern Medical Center, and colleagues reviewed medical records from more than 13,600 HIV-positive people receiving care at a large clinic in Dallas. Only 11% had presumptive immunity. Among the 311 people who received serology blood tests, 18% lacked adequate antibodies.
“Increasing measles immunity in people with HIV is essential given increasing outbreaks,” the study authors wrote. “While prior high levels of community immunity could o˛er protection to this vulnerable population, this can no longer be taken for granted.”
HOW HIV RESEARCH IS HELPING SOLVE LONG COVID
HIV research has led to remarkable advances in prevention and treatment, but it has also yielded beneÿts for people with other conditions, including long COVID. In the early months of the COVID-19 pandemic, University of California San Francisco (UCSF) researchers were already seeing young, previously healthy people who reported fatigue, cognitive impairment and other symptoms that lingered long a°er the acute phase of the disease.
In March 2020, UCSF established the LIINC (Long-term Impact of Infection with Novel Coronavirus) program to look at outcomes over time. Cofounder Steven Deeks, MD, is a leading expert in long-term HIV and functional cure research. Recruiting more than 1,700 patients, the researchers conducted some of the ÿrst studies on the causes of long COVID. Drawing on lessons from HIV, the collaborative e˛ort includes clinicians, public health o˝cials and the a˛ected community.
LIINC launched the world’s ÿrst COVID biological specimen bank, and researchers have conducted imaging studies to look for changes that aren’t re˙ected in standard blood tests. They found that pieces of the SARS-CoV-2 virus can persist for years in gut, bone marrow, brain and other tissues. What’s more, they have seen di˛erences in cardiopulmonary and vascular function, immune response and in˙ammation between people with and without long COVID.
The program is also running clinical trials of potential treatments. “In the early era of HIV, we tried single-drug therapies, but nothing worked. Two drugs—that didn’t really work. Three drugs— boom,” Deeks says. “That’s the way it worked for HIV, and that may be the way it works for long COVID.”
LIINC’s work could ultimately also advance the understanding of other infection-associated chronic conditions, such as myalgic encephalomyelitis/ chronic fatigue syndrome and persistent Lyme disease. But ÿnding answers requires more federal funding and investments from the pharmaceutical industry and private donors.
“HIV taught us how chronic viral infections can a˛ect the body long a°er the initial illness and how important it is to involve patients in that research,” says LIINC director Michael Peluso, MD.“Applying those lessons to long COVID has helped us accelerate discovery and move closer to answers and treatments.”
Immune Checkpoint Inhibitors for People With HIV
New studies add to the evidence that immune checkpoint inhibitors are safe and e˛ective for people with HIV and cancer. These monoclonal antibodies interfere with receptors on immune cells that regulate immune response. For example, drugs that block PD-1 can restore lost T-cell activity, while those that block CTLA-4 promote T-cell multiplication.
In one recent analysis, Anna Coghill, PhD, MPH, of Mo˝tt Cancer Center, and colleagues compared the safety and e˝cacy of checkpoint inhibitors in 24 people with HIV and 24 HIV-negative patients. The overall response rate—indicating tumor shrinkage— was a bit lower for HIVpositive people relative to HIV-negative people (29% versus 38%), but the di˛erence was not statistically signiÿcant. Overall survival rates were similar (63% and 67%, respectively), and the frequency of adverse events was also comparable.
In a second study, Florence Brunet-Possenti, MD, PhD, of Hôpital Bichat-Claud Bernard in Paris, and colleagues looked at realworld outcomes among 54 HIV-positive people with aggressive skin cancers who received checkpoint inhibitors. Overall response rates were 43% for patients
with melanoma, 58% for those with cutaneous squamous cell carcinoma and 75% for those with Kaposi sarcoma.
“These ÿndings support managing well-controlled people with HIV similarly to the general population and highlight the importance of including this population across all settings of skin cancer trials,” the authors concluded.
Two recent medical literature reviews assessed outcomes among HIV-positive people with non-small-cell lung cancer treated with checkpoint inhibitors. In both reviews, response rates, survival and adverse events varied across studies but were generally comparable to those reported for HIV-negative patients. Importantly, checkpoint inhibitor use did not lead to HIV viral rebound.
In fact, checkpoint inhibitors may help promote control of HIV, and they are being studied as a potential functional cure strategy. PD-1 is heavily expressed on exhausted CD8 killer T cells that ÿght HIV and cancer as well as on CD4 helper T cells that harbor hidden HIV. Several studies suggest that drugs that block PD-1 may delay viral rebound a°er stopping antiretrovirals and might help shrink the viral reservoir.
SOME PEOPLE LIVING WITH HIV ARE CURRENTLY ALLOWED IN THE MILITARY, WHILE OTHERS STRUGGLE TO ENLIST.
BY TIM MURPHY | PHOTOGRAPHY BY ELEY
Isaiah Wilkins is seeking to enlist in the
U. S. Armed Forces.
ISAIAH WILKINS, 24, IS A STATE TROOPER IN TEMPLE, Georgia, almost an hour’s drive west of Atlanta. But what Wilkins really wants to do with his life is serve in the U.S. Armed Forces. “I’ve always wanted to be in the military,” he says. “My mom was an Army veteran. It’s about being part of something bigger than yourself and giving back.”
At age 17, Wilkins was already on his way to getting his wish. He enlisted in the National Guard, and by age 19, he had completed a program at Georgia Military College. Afterward, he was accepted into a one-year preparatory program at West Point, the prestigious military academy. But after a standard physical screening process for the program, he was surprised to learn he was HIV positive and, hence, according to military policy, not fit for service. This was the case even though it has long been established that people with HIV on effective treatment are generally as healthy and fit as their HIV-negative counterparts and cannot transmit the virus to others sexually. Wilkins was disenrolled from the program.
Devastated by his disenrollment, Wilkins did some research and connected with Lambda Legal, the group that has long fought in court for the rights of LGBTQ people and people living with HIV. It turned out that Lambda had in 2022 notched a victory in a case on behalf of HIV-positive service member Nick Harrison. In Harrison v. Austin, a federal court ruled that service members living with HIV (usually those who became HIV positive after enlisting) who were undetectable could not be barred from commissioning as officers or being deployed—both key factors in military career advancement—solely on the basis of their HIV status. (The longtime prior policy had banned them from doing so.) The Department of Defense (DoD) under President Biden did not appeal the ruling, thus paving the way for its implementation.
With one victory under its belt, Lambda in 2024 took Wilkins’s case challenging the ban on enlisting people with HIV to federal court and won. But this time, Biden’s DoD, apparently wanting to keep such policymaking within the military and out of the courts, appealed the decision. Consequently, a three-judge appeals panel heard Wilkins’s case last December.
In February of this year, the panel—made up of one
“IT’S ABOUT BEING PART OF SOMETHING BIGGER THAN YOURSELF AND GIVING BACK.”
George H.W. Bush appointee and two Trump appointees— ruled against Wilkins, saying that the courts should defer to Congress and the White House on military matters. “We are deeply disappointed that the Fourth Circuit has chosen to uphold discrimination over medical reality,” says Greg Nevins, Lambda’s senior counsel and director of its Employment Fairness Project, of the ruling.
As POZ went to press, how Wilkins’s legal team will respond to the ruling—whether to ask for a full-panel hearing or appeal to the Supreme Court—remains to be discussed, says Scott Schoettes, one of his lawyers, who has been arguing in court on behalf of service members with HIV for many years.
Schoettes says he had a bad feeling about the case during oral arguments, because “it felt like the judges had decided— based on their own misconceptions about living with HIV— that the previous decision of this same court was wrong.”
So that’s the current situation regarding people with HIV and the military under President Trump and Secretary of Defense Pete Hegseth. Service members who are already enlisted are finally able to be made officers and deployed— with some exceptions and usually only after a lot of legwork on their part, as the 2022 ruling has not yet been codified in military guidelines. But as Wilkins’s case plays out, people with HIV are still banned from enlisting; in fact, in midJanuary, the Pentagon announced that because it was expecting the appeals panel to rule against Wilkins, it was pausing the training of HIV-positive recruits.
“To me,” says Wilkins, “this indicates that it can be very difficult to get someone to change their opinion even when you present them with factual evidence.”
TO BE CLEAR, LIVING AS A SERVICE MEMBER OR
veteran with HIV is a lot better today than it was decades ago. Back in the 1980s and early ’90s, living with HIV often meant suffering through a long period of physical decline, illness and eventually death—the main reason, along with the threat of transmission of the virus during active combat, that people with HIV were originally barred from enlisting. This was also why service members discovered to have HIV after they’d enlisted could not become officers or deploy.
But the advent of effective treatment in the mid-’90s, plus confirmation in the 2010s that folks with HIV who are undetectable cannot spread the virus sexually, lent fire to legal arguments against these bans—with the first major victory being Harrison’s in 2022.
Many military veterans with HIV today were diagnosed after completing their military service, meaning that at this point the only intersection of their HIV and the military is health care. It should be noted that many of these veterans and their advocates say that militaryderived care for veterans— whether TRICARE for those who were eligible for retirement or the Veterans Administration (VA) for those who were not—is solid, serving more than 30,000 people with HIV, despite cuts and changes made to the VA by the Trump administration that critics say are harming or will harm veterans.
“Everything seems to be going well with health care,” says Cathy Marcello, senior vice president of advocacy and training for the Modern Military Association of America, which advocates on behalf of LGBTQ and HIV-positive service members and veterans. But she says other factors continue to make serving with HIV more difficult than it should be. Despite Harrison’s win, HIV will still be the factor that bars service members from some deployments (for example, if the host country bars people living with HIV). “This can impact promotions,” she says.
And the military still requires service members living with HIV to both inform their sex partners of their status and wear a condom— an antiquated rule that doesn’t factor in 21st-century science’s finding that people with HIV who are undetectable cannot transmit the virus sexually. Theoretically, says Marcello, “this could make a service member subject to
“IT CAN BE VERY DIFFICULT TO GET SOMEONE TO CHANGE THEIR OPINION.”
Below: Wilkins wears his Georgia Military College ring and a bracelet in memory of fellow state trooper Jimmy Cenescar.
prosecution for having consensual sex within their marriage.”
On top of that, under Trump and Hegseth’s leadership, the DoD has taken a rightward turn, with the military once again banning transgender members (as it did during Trump’s first term before Biden reversed it) and eliminating DEI (diversity, equity and inclusion) measures in the military as it has across the entire government and replacing them with rhetoric seeking to make the military more “masculine” and focused on a “warrior ethos.”
Such measures have likely chilled conversations by service members living with HIV about their experiences, says Marcello. (Indeed, calls for comment for this story via Marcello and others to several private groups of current and former service members with HIV yielded few replies, despite the option of talking anonymously.)
In fact, she says, “there’s a real fear right now that [despite the Harrison ruling] active-duty service members will be the next group to be pushed out of the military.”
One former service member who talked with POZ is Dontá Morrison, PhD, 54, who directs community outreach and engagement at an HIV-specializing UCLA care center. Morrison was diagnosed with HIV five years after leaving the Air Force in 1994, which he says he did because it was stressful serving while hiding his sexuality under the military’s defunct Don’t Ask, Don’t Tell (DADT)
rule for gay service members, which was repealed in 2011.
“I had to put on a different kind of face to survive in that heteronormative toxic environment,” he says, adding, “I was depressed when I left because I didn’t really want to leave.” Now, postDADT, Morrison says, “I have resentment and sadness because I have openly gay [service member] friends married to their partners who got to retire with benefits post-DADT, but I missed out on all that.”
Nonetheless, Morrison says he receives good HIV care from the VA, although he hears from many fellow veterans that wait times, especially for mental health, can be very long.
WHEN THE MILITARY TOLD NICK
Harrison, currently a lawyer within the DC National Guard, that he could not be named an officer or deploy because of his 2013 HIV diagnosis, he knew he had to either fight back legally or move on from the military. “I’m a lawyer with an MBA, so I knew I could go out and make six figures,” he says. But, he says, what drove him to keep pursuing a legal challenge was “remembering that not every [service member living with HIV] has the options outside the military that I do.” He decided to fight not only for himself but also for his fellow military folks living with HIV. And he won his case.
Since doing so, he’s coached other service members living with HIV through the struggle to be commissioned and deployed, because despite the legal win, the military has yet to issue detailed guidance to commanders on how to proceed, leaving folks to advocate for themselves with their higher-ups. “I’ve told people that when their commanding officer says they have to wait for the guidance to tell them, ‘No, don’t wait—I want this now.’”
In a related but separate case, Kevin Deese, a former Navy midshipman, and an anonymous fellow plaintiff, reached a settlement with the DoD in 2024 that allowed them to be commissioned as officers despite their HIV-positive status. Currently in the Navy reserve in Buffalo, where he works for a bank, Deese, 34, looks forward to mobilizing at some
KEY DATES FOR HIV IN THE MILITARY
1985:
HIV screening in the military becomes mandatory. A positive result is cause for an absolute bar from enlisting. For several years, those who test positive while serving are also ejected.
2022:
A court rules that the military can’t block enlisted service members with HIV from being commissioned and deployed solely on the basis of their HIV-positive status (if their HIV is undetectable).
2024:
A court rules that people cannot be barred from enlisting in the military solely because they have HIV.
2025:
The Department of Defense appeals the 2024 ruling; arguments on both sides are made before a three-judge appeals panel.
2026:
The panel, saying that the courts should defer to Congress and the White House on military matters, rules that people living with HIV cannot enlist in the military. At press time, a response to the ruling is undecided.
point—even as he pursues a seat in the New York State Assembly.
Deese says he learned he was positive after a medical screening revealed he had a very low platelet count, prompting an HIV test. “I was told I’d graduate from the Naval Academy but not commission because the issue was black-and-white and I couldn’t get a waiver.” He was given a medical discharge in 2017.
But then came Harrison’s 2022 win, which applied to Deese and opened a path to his own legal challenge, which resulted in the settlement that allowed him to commission. “I wish I could’ve had my original goal of commissioning 10 years ago as a submarine officer,” he says, “but that wasn’t possible.”
Yet now, with the ban on commissioning and deployment for folks with HIV off the table, he says, “I’m finally going to be able to do the job I fought very hard to do.” Should he win his assembly seat and then be called up for service he says he’ll take a leave from the assembly to go and serve.
In the meantime, Deese plans to tell his story of successfully fighting back against the military on the campaign trail. “This is a scary time right now for many people in my district, and in the country, but courage is contagious,” he says—a fact he thinks his legal battle illustrates. “If I hadn’t done what I could when I had the chance to fight and then found out that someone else living with HIV came behind me [in the same situation], I wouldn’t have been able to live with myself.”
Will Isaiah Wilkins—currently the poster boy for all people living with HIV who want to enlist in the military—ultimately succeed, like Harrison and Deese? Only time will tell. He knows one thing for sure, though: what he’d say to the judges who presided at his recent hearing who questioned his ability to serve with HIV.
“If they had a family member living with HIV,” he says, “I’d ask them why they think that person shouldn’t be allowed to serve.” Because, he says, “HIV is a chronic, manageable illness that poses no real risk to anyone else.” Q
Randy Shilts in a detail from the cover of Bitter Pill
Writes & Wrongs
IN HIS GRAPHIC NOVEL BITTER PILL, CLÉMENT XAVIER WEAVES TOGETHER
STORIES OF GAY JOURNALIST
RANDY SHILTS, AIDS HISTORY, PATIENT ZERO AND SUPERMAN.
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In this excerpt from Bitter Pill, reporter Randy Shilts embarks on his first day at the San Francisco Chronicle, forced to work in a literal closet.
Based in France, comic artist Clément Xavier is another gifted storyteller able to craft entertaining tales out of an overabundance of complex, nuanced history. His newest graphic novel is Bitter Pill: Randy Shilts and the Dawn of the HIV/AIDS Epidemic, with illustrations by Héloïse Chochois. Xavier is a kindred soul of Shilts in that both are magpie storytellers, picking and choosing what best suits their narrative truths. For example, Xavier sprinkles digressive mini-stories titled “Tales From the Closet” throughout Bitter Pill to provide a larger cultural context, and Christopher Reeve’s Superman swoops in for surprising thematic effect.
“My job is to manipulate the reader—and honestly, I’ll do whatever it takes to tell a good story. That’s bad, I know, but it’s the truth (or maybe that’s just another lie—who knows?),” Xavier coyly states. “Anyway, what really speaks to me about Randy is that he’s constantly walking a tightrope. So am I, because I make graphic novels based on real events, and that means I have to follow a certain ethical code—otherwise, I’d be better off writing pure fiction.”
He continues, “Randy was a journalist, yes, but also one hell of a writer. His prose is phenomenal! So he straddled
this murky in-between space. People even criticized him for using literary techniques in his reporting, like giving characters inner thoughts. ‘How could you possibly know what Harvey Milk was thinking, Mr. Shilts?’ But I’m a scriptwriter, so my imposture is intentional. It’s part of the contract with the reader: I’m not hiding it. To me, a lot of people who present themselves as journalists are really just writers who haven’t realized it yet. They’re telling stories. They should toss out their press credentials.”
Originally published in French, Bitter Pill arrives stateside in October courtesy of Abrams ComicArts. Here’s a sneak peek at this exciting work along with our interview with Xavier, who shares his unique introduction to Shilts and HIV history through director Gus Van Sant and COVID-19.
How did you ÿrst learn about HIV?
I was born in 1981—the very same year that the first cases of what would later be known as AIDS would be officially announced in the U.S. In a certain way, I grew up with HIV as a continuous backdrop.
I didn’t experience the first years of the epidemic, but I grew up in its shadow. For my generation, HIV wasn’t a specific historical event: It was more of a diffuse threat, tied to sexuality. It showed up in prevention messaging, in public campaigns, in sex education. It was linked to danger, risk,
death—but in an almost abstract way.
I knew that the disease had claimed countless lives, that it had taken artists, actors, intellectuals, an entire generation. But I couldn’t quite grasp the scale of the void it had left behind. Nor could I imagine that there had once been a “before.”
For my parents, who had lived through May ’68 [a period in France marked by strikes and upheaval tied to the sexual revolution], sexuality had been synonymous with emancipation. For my generation, it was associated with caution and fear. Condoms weren’t a choice—they were nonnegotiable. HIV wasn’t a crisis that had passed; it was a constant presence, almost eternal.
As I grew older, I began to understand the historical and cultural magnitude of the epidemic more fully, especially through the public figures it had touched. But I didn’t truly immerse myself in the history of HIV until much later, during the COVID pandemic.
COVID marked a turning point for me. Living through a global health crisis allowed me to grasp what collective shock can feel like in the face of an unknown virus: the anxiety, the conflicting hypotheses, the search for modes of transmission, the fear of contact, the stigma, the rumors.
AIDS was constantly invoked as a historical precedent. That was when I felt the need to return to that history. As I began researching it, I discovered not only a public health
catastrophe but also a story of political neglect and stigma alongside one of struggle, activism, solidarity and, also, artistic creation.
Many POZ readers are long-term survivors of HIV. They’re familiar with Randy Shilts. How did you learn about him—in France, no less?
I discovered Randy Shilts indirectly, almost by accident, in a very particular context: the lockdown during COVID.
At the time, people were constantly talking about “patient zero.” I didn’t fully understand what the term meant. Out of curiosity, I did a quick online search, and very soon, I came across articles referring to other “patient zeros” in the history of epidemics, among them Gaëtan Dugas.
I remember the photograph that accompanied the article very clearly: a handsome young man, smiling, sitting on a swing. The article explained that he had been wrongly identified as patient zero for AIDS, and that the idea had spread widely after the publication of one of Shilts’s books.
I told myself that Randy must have been some kind of dreadful figure—a sensationalist journalist, willing to twist reality to manufacture a dramatic narrative.
I read a few articles about him out of curiosity. That’s when I was drawn in. First, by the man himself, then by the era.
The first thing that surprised me was learning that his
work had inspired Gus Van Sant’s film Milk 2008 movie about gay politician Harvey Milk, who was murdered in 1978; Sean Pean earned an Oscar for the title role]. That movie left a deep impression on me with its political and emotional power. Discovering that Shilts was the author of the biography on which the film was based started to erode my initial judgment.
When I then dove into And the Band Played On, I encountered a writer of rare narrative ambition. His work stands on a knife’s edge between investigative journalism and literature. He constructs a sweeping, carefully structured, almost novelistic narrative to recount a very real catastrophe. To my mind, he belongs in the company of a Truman Capote or an Upton Sinclair—writers capable of turning reportage into powerful narrative art.
What ultimately struck me the most was the position he occupied as an openly gay journalist working at the heart of a crisis that was striking his own community, trying to sound the alarm at a moment of chaos, scientific uncertainty and political abandonment.
My swift initial reaction, which had been almost accusatory, gave way to a fascination with the complexity of the
man and his time. What I discovered was not a simplistic narrative but a constant tension between responsibility, commitment, narrative ambition and historical urgency.
And it is precisely that tension—human, moral and political—that continues to fascinate me today.
Your graphic novel is not presented as a biography of his whole life. How did you decide what to focus on?
There are already remarkable biographies out there devoted to Randy Shilts (unfortunately, never translated into French). I hope this graphic novel will encourage readers to turn to those more comprehensive studies. [See the sidebar on page 31 for books by and about Shilts.]
What guided me was a narrative intuition.
In working on Shilts, I came across interviews in which he explains that for a long time he was unable to write the biography of Harvey Milk. He couldn’t find the right angle. Then he realized that he shouldn’t simply tell the story of a man but use Milk as a vehicle to tell the story of an era—the political emergence of the gay community in San Francisco.
Very modestly, and on an infinitely smaller scale, that is what I have tried to do in my own book.
Clément Xavier
6
What interested me most was his paradoxical position. Shilts is both a journalist and a member of the community directly affected. He stands at the heart of a terrible drama, confronted with a public health catastrophe that, in its early stages, was largely ignored because it struck individuals who were considered by the broader culture to be marginal or even undesirable. Unlike COVID, which was immediately perceived as a universal threat, AIDS was first seen as someone else’s problem.
This period crystallizes several fundamental tensions: the responsibility of the media, the implicit hierarchy of which lives are deemed worthy of attention and the difficulty of documenting a tragedy while it is still unfolding.
Dramatically and politically, it is a moment of rare intensity.
It’s that tension—between personal commitment, journalistic ambition and historical urgency— that drew me in. By focusing on this slice of his life, I was able to explore those questions in depth, rather than dilute them within the broader frame of an exhaustive biography.
Finally, how did your understanding of Shilts and his work change?
What changed for me was my understanding of the context in which he was working. He wrote And the Band Played On while the epidemic was still unfolding, as scientific knowledge continued to evolve, amid very real tensions within the gay community and while public authorities were slow to act. He didn’t have the historical perspective we have today. He was writing with urgency, in anger and, at times, in isolation.
I also became aware of the delicate position he occupied—that of an investigative journalist and a gay man working on a disease that was devastating his own community. That dual position placed him in a constant conflict: between community loyalty, journalistic rigor and the desire to sound the alarm as widely as possible.
I stopped seeing him merely as a controversial figure and began to regard him as a tragic figure of his time.
His historical importance became clearer to me along the way. He helped inscribe the epidemic into the American national narrative, to bring it out of silence. One can criticize certain aspects of his methods or some of the consequences of his work—and it’s healthy to do so— but it’s impossible to deny he shaped the way this story was told.
In working on this project about him, I moved from a swift judgment to a more nuanced understanding and perhaps a more human one. Q
BOOKMARKS
The Mayor of Castro Street: The Life and Times of Harvey Milk (1982)
Shilts’s biography of the gay civil rights leader killed in 1978 simultaneously tells the story of San Francisco’s emerging gay community. It was later turned into a documentary and, in 2008, the Oscarwinning ÿlm Milk.
And the Band Played On: Politics, People, and the AIDS Epidemic (1987)
Based on Shilts’s investigative reporting, this tome chronicles the unfolding of AIDS in the early 1980s and establishes the boogeyman Patient Zero. Science has since altered our understanding of the epidemic’s origins, but this bestseller transformed the public’s perceptions about HIV. In 1993, HBO released a starpacked ÿlm based on the book.
Conduct Unbecoming: Gays & Lesbians in the U.S. Military (1993) Published when openly LGBTQ people were not allowed to serve, this book traces the history of queer people in the military, from Vietnam to the Persian Gulf War.
Patient Zero and the Making of the AIDS Epidemic (2017)
In this account of the life of Gaëtan Dugas, the Canadian °ight attendant maligned as Patient Zero, Richard A. McKay o˛ers a corrective to the myth that Dugas knowingly transmitted HIV nationwide— an idea generated by Shilts.
The Journalist of Castro Street: The Life of Randy Shilts (2019)
The late Andrew E. Stoner, PhD, published the ÿrst deep dive into the pioneering journalist.
When the Band Played On: The Life of Randy Shilts, America’s Trailblazing Gay Journalist (2025)
Researcher and educator Michael G. Lee’s biography o˛ers a more intimate look at Shilts by exploring his earlier life, relationships and legacy.
Bitter Pill: Randy Shilts and the Dawn of the HIV/AIDS Epidemic (2026)
Clément Xavier’s graphic novel is based on real events, with illustrations by Héloïse Chochois.
What to read by and about Randy Shilts
Promoting Visibility
The U.S. People Living With HIV Caucus is a national organization empowering those living with HIV. When its participants went looking for steering committee members, they speciÿcally sought candidates whose lived experience matched their mission to eradicate the virus. The HIV Caucus didn’t want a rubber stamp. The group wanted members who are equally committed to ÿghting the systemic injustices that put people at risk for HIV to begin with.
Raul Ramirez Perez of Nashville answered that call.
“There are far too few queer Latino men from the South who actually are advocating, putting themselves out there, visible for our HIV community,” Ramirez Perez tells POZ. “I have been a verbal advocate about HIV education, prevention and treatment. I deliberately have put myself in these spaces.”
His election to the HIV Caucus board is the latest milestone in Ramirez Perez’s remarkable activist journey.
A special education teacher by trade, Ramirez Perez also serves on the Nashville Regional HIV Planning Council, where he and fellow council members help distribute money and resources to organizations working to combat HIV in the Nashville region. Ramirez Perez is also active in Planned Parenthood’s Spanish-language Promotores program focusing on sexual and reproductive health for and by Latinos. Ramirez Perez previously served as community liaison for the Tennessee Department of Health, a position that was phased out due to government budget cuts. According to Ramirez Perez, funding cuts are a threat HIV activists in conservative states have long been familiar with, regardless of who occupies the White House.
“I still see a lot of the people from the Tennessee Department of Health in these councils and committees that I’m a part of,” he notes, highlighting his resilience and persistence.
“I was 25 years old and living in California when I got the news that I was HIV positive,” Ramirez Perez explains. “And because I didn’t have any friends or family in the Los Angeles area, my experience ÿnding out I was positive was not the best. There was no one to talk to, or to vent to, or to help me process what I was going through. So for a good chunk of the beginning of my HIV journey, I just hadn’t processed that I was HIV positive in a healthy way.”
That’s when Ramirez Perez moved back home to Tennessee, where he quickly became involved with the End HIV 901 Committee, a community-driven initiative aligned with St. Jude Children’s Research Hospital to curb HIV cases in the Memphis region.
“I really thought about this,” he says. “What do I want to get out of this? What do I want to accomplish? And I think the biggest thing is just providing that visibility and that presence that a lot of times isn’t seen in organizations like these. If I put myself out there and show my vulnerability and show myself transparently, then that will motivate other people to be like, Hey, I can do this too. Just being able to be that person that you can see yourself in. Especially as a queer person of color in the South, I want to push that because it just feels like it’s very isolating here.” Q
Raul Ramirez Perez is an HIV advocate in Nashville.
MICHAEL TEDESCO
ACCESS TO CARE
Timely access to quality care and treatment can help people with HIV live long, healthy lives, but getting that care isn’t always easy. Many factors can shape a person’s experience in seeking and staying on treatment. Take our survey and let POZ know what accessing HIV care has been like for you.
1 How long have you been living with HIV?
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T20–29 years TI’m not living with HIV.
T 10–19 years
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TVA facility
TOther (Please specify.): ___________________
T I am not currently in care.
3 How easy or difficult is it for you to access HIV care?
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(Check all that apply.)
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TOther (Please specify.): ___________________
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16 What is your annual income?
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