Living
Gay, bi men remain key to HIV epidemic
After 30 years of AIDS, many breakthroughs but infection rates on the rise
On June 5, 1981, the U.S. Centers for Disease Control and Prevention published an article in its authoritative journal Morbidity and Mortality Weekly report that experts now consider the first signal that an unprecedented worldwide epidemic had begun.
“In the period of October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carini pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died,” the MMWR article stated.
“Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients,” said the article. “The occurrence of pneumocytosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual.”
It would take another few years before scientists named the condition detected in the men discussed in that MMWR article as Acquired Immune Deficiency Syndrome or AIDS. The name AIDS followed an earlier term used by some researchers and the media – Gay Related Immune Disorder or GRID.
In reflecting on the tumultuous developments surrounding AIDS over the past 30 years, leaders of AIDS advocacy organizations and LGBT activists in the U.S. who lived through the early years of the epidemic say that, to some extent, the MMWR article of June 1981 still has considerable resonance for gay men.
They acknowledge that so much has changed for the better over the past 30 years, including breakthroughs in biomedical research resulting in highly effective drugs that transformed AIDS from a death sentence into a manageable, chronic illness like diabetes.
But AIDS activists also point out that HIV and AIDS continue to disproportionately impact gay men or men who have sex with men (MSM) in the United States and other countries.
And although the perception of AIDS as a “gay disease” has largely receded from the minds of most Americans, AIDS activists say they find themselves in the ironic position of having to remind Congress and state and local governments that more resources and funding are needed for HIV prevention programs targeting gay and bisexual men.
“MSM is the only group for whom, according to the CDC, new infections are still increasing,” said Ronald Johnson, vice president for policy and advocacy for AIDS United, a national group formerly known as AIDS Action.
“So there continues to be a concern that there is not enough targeted prevention resources to MSM, particularly MSM of color and young MSM of all races and ethnicities,” Johnson said.
According to the CDC, while MSM account for about 2 percent of the U.S. population, more than half of all new HIV infections in the U.S. each year (53 percent) occur among MSM. CDC data also show that MSM make up nearly half of all people living with HIV in the U.S. – 48 percent.
CDC figures show that white MSM “account for the largest number of annual new HIV infections of any group in the U.S., followed closely by black MSM,” according to a CDC fact sheet released last month.
“There are more new HIV infections among young black MSM (aged 13-29) than among any other age and racial group of MSM,” the fact sheet says.
The Obama administration, with input from AIDS advocacy organizations, released a National HIV/AIDS Strategy document in July 2010 that, among other things, calls for an aggressive effort to develop better HIV prevention programs targeting MSM.
Johnson and Carl Schmid, deputy executive director of the AIDS Institute, a national advocacy group, praised the administration for developing the strategy document, which they say covers most of the bases needed for addressing HIV prevention programs for MSM.
But the two said the proposals in the strategy document have yet to be fully implemented. They note that delays in its implementation are due, in part, to the U.S. economic situation that has prevented needed increases in federal AIDS funds and severe cutbacks in state and local funding for AIDS-related programs.
Phill Wilson, president and CEO of the Black AIDS Institute, said in a commentary last week in the Washington Informer, a black community newspaper, that he fears the horrors of the AIDS epidemic of the 1980s, when friends and family members watched loved ones die due to a lack of effective medical treatment, could return to some degree in the next few years.
According to Wilson, if the federal government fails to boost funding for the federal-state AIDS Drug Assistance Program (ADAP), low income people who rely on the program to provide them the medications they need keep the AIDS virus in check could become casualties just as their predecessors became casualties years earlier. But this time, he said, an inability to gain access to medicine due to funding shortfalls would be responsible for their fate at a time when effective medicine is readily available.
He called such an outcome “immoral.”
The ADAP program was created under the Ryan White AIDS Care Act to provide life-sustaining drugs for low-income people with HIV and AIDS who are under insured or don’t have any health insurance to help pay for the drugs.
ADAP funding cuts by states and a large increase in the number of people applying for ADAP assistance has resulted in nearly 8,000 people being placed on state waiting lists for the AIDS drugs they need to remain healthy.
The health insurance reform law that President Obama proposed and Congress passed two years ago was expected to relieve the ADAP funding pressure on states when it takes effect in 2014. However, some states that oppose the law have filed lawsuits seeking to prevent its provision requiring all citizens to buy some form of health insurance from going into effect, making its outcome uncertain.
Nearly all AIDS advocacy groups support the law, saying it would strengthen medical care for large numbers of people with HIV/AIDS.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, an arm of the U.S. National Institutes of Health, has been the leading federal government official monitoring the AIDS epidemic and directing AIDS-related research since the disease burst on the scene in 1981.
In a speech commemorating the 30th anniversary of AIDS at NIH headquarters in Rockville, Md., on Tuesday, Fauci said he’s optimistic that an AIDS vaccine can be developed in the near future.
“We have scientific evidence that a safe and effective HIV vaccine is possible,” he said in a statement released on May 18.
“In 2009, a clinical trial in Thailand involving 16,000 people demonstrated for the first time that a vaccine could safely prevent HIV infection in a modest proportion of study participants,” he said. “Many of the best minds in HIV vaccine science are examining blood samples and data from the Thai trial to learn how the vaccine candidate prevented HIV infections and to consider how it could be modified to be more effective.”
Fauci said NIAID is also optimistic about development within the next few years of effective vaginal and rectal microbicides that can be used to prevent the transmission of HIV during sexual contact.
Fauci and other researchers have also pointed to studies showing the effectiveness to a certain degree of prescribing HIV drugs for use by non-infected people believed to be at high risk for HIV infection, such as men who have sex with men.
Known as pre-exposure prophylaxis, or PrEP, the use of this prevention measure is said to have the drawback of being less effective if people fail to take the drug as required. Some also have expressed concern that people using this prevention method are subject to potential side effects of the drugs and may be discouraged from using condoms, which experts say is one of the most effective methods of HIV prevention.
Events and developments in the early years of AIDS
• 1981: The CDC reports in its June 1981 edition of MMWR and subsequent editions that year that an estimated 170 gay men had succumbed to Pneumocystis carini pneumonia and Kaposi’s sarcoma, a rare skin cancer, over the preceding two years. The CDC studies of these cases cited a serious malfunctioning of the body’s immune system in those who contracted the conditions.
• 1982: Gay Related Immune Disorder, or GRID, became the first name to describe what is now known as AIDS. Cases reached epidemic proportions in the U.S., moving beyond clusters of gay men in New York, San Francisco and Los Angeles and into groups with no obvious risk factors.
• 1983: Gay leaders, independent medical researchers and health and social services agency officials testify before a congressional committee that the federal response to AIDS was highly inadequate. They issue a plea for the federal government and the Reagan administration to increase federal funding and federal initiatives to fight AIDS.
• 1985: In late July, actor Rock Hudson stunned the nation when he issued a statement saying he had AIDS and was receiving treatment in Paris that he said he couldn’t get in the U.S. He died three months later at age 59. His announcement and death drew massive mainstream media attention to AIDS. His death prompted his close friend, actress Elizabeth Taylor, to help found the American Foundation for AIDS Research to raise funds for AIDS causes.
• 1988: The NAMES Project AIDS Memorial Quilt makes its second trip to Washington in the spring, where it’s displayed on the Ellipse near the White House. Later that year, about 1,100 AIDS activists staged a protest at the headquarters of the U.S. Food and Drug Administration in suburban Maryland outside D.C., denouncing the FDA for taking too long to approve new drugs for people with AIDS. Police arrested at least 176 of the protesters after they blocked access to the FDA building’s main entrance.
Michael,
I’m 34, and after being on the dating scene for about 12 years, I’m coming to the conclusion that I don’t want to be in a relationship.
I don’t love hanging out with the same person over and over again. I don’t feel all gooey when I’ve been with someone for a while. I run out of things to say, and also, it just gets boring.
I like my space. I don’t like having to share the bathroom or have someone next to me all night, especially when they want to go to sleep holding me. I know that sounds like heaven to a lot of people but it just feels intrusive to me.
It’s a pain to have to compromise what I want to do. When I want to go someplace on vacation, or try a restaurant, or get up early to go to the gym, or sleep in, I don’t want to have to run that by someone else and get their OK. Life’s short. I want to do what I want to do.
I feel like we are constantly bombarded with the message to date and find a mate, but I don’t really see the point. I don’t think I’m an introvert—I have a lot of friends—but I also like to spend time by myself and not be accountable to anyone.
When I think about marriage, it seems like a very old-fashioned concept, developed for straight people who want to have children. Historically you needed one person to work and another one to stay home and raise the kids. And you needed to stay together to give your kids two parents and a stable home. I get that.
But if I’m not having kids, what’s the point? I don’t need a husband to have sex. I can and do hook up all the time. It’s so easy to find someone online. And I get to have a lot more variety when I’m single than when I’m dating. Even though my relationships are always open, when I am dating someone, I always hook up a lot less, because I have to worry about the boyfriend’s feelings being hurt if I hook up “too much.”
I know I sound unromantic and maybe selfish but this is how I see it.
My friends are all about having a boyfriend. They think I’m being ridiculous. Can I get another opinion?
Michael replies:
You make great points. Relationships do require us to give up some of our independence. They can feel stifling at times. And when the excitement of a new partner fades, things will at times feel “boring” in all sorts of ways, including sex. You can choose to avoid all of this by remaining single.
But relationships also give us tremendous overlapping opportunities to grow, including:
Being pushed to develop a clear sense of self: When we must constantly decide what we are willing to do or not do as part of a couple; and when our partner inevitably and frequently has interests, values, and priorities that conflict with ours, then we are challenged, over and over, to decide what is most important to us and how we want to live our lives.
Frequent opportunities to build resilience: All those old issues from our past that get us upset or riled up? We have to work through them so that we can stay (pretty) calm rather than losing our minds when our buttons are pressed.
Improving our ability to have hard conversations – and without rancor: Unless we’re able to disagree, speak up, or confront when it’s important to do so, we are going to twist ourselves into a pretzel striving to accommodate the other person. And being able to engage in tough talks in a loving way is necessary if we want to have a loving relationship.
Becoming a more generous person: You wrote that you like to have things your way. But part of life, whether or not we are partnered, involves being thoughtful, considerate, and willing to put someone else first at times. Great relationships require us to do all of these things regularly—and many of us find that contributing to the happiness of someone we care about can increase our own happiness.
Besides these ongoing challenges, relationships give us the experience of someone knowing us deeply, and knowing someone deeply. There can be great comfort in going through life with someone with whom we have this intimate connection, along with ongoing shared experiences of trust, support, comfort, and love. Long-term companionship is also an adventure: Can we keep the relationship vibrant and fun as we both keep changing over time?
If you choose to remain single: Many people play their friendships on the easy setting, keeping things pleasant, on-the-surface, and non-confrontational; and cutting people off when things aren’t going well. Hanging in there to deal with the rough stuff can lead to deeper, longer friendships, and plenty of personal growth.
I do have a question for you: I am curious what sort of relationships you saw growing up, and what your own relationship experiences have been.
Intimate relationships aren’t for everyone, and you get to decide what is right for you. But if your negative view of relationships is influenced by having witnessed or experienced intrusive or just plain awful relationships, maybe you want to do some work (therapy, for example) to heal from this stuff, rather than letting your past limit your future. A healthy relationship means being part of a couple while also remaining a vibrant individual, not being stifled, bored, and losing your independence.
(Michael Radkowsky, Psy.D. is a licensed psychologist who works with couples and individuals in D.C., Maryland, Virginia, and New York. He can be found online at michaelradkowsky.com. All identifying information has been changed for reasons of confidentiality. Have a question? Send it to [email protected].)
Autos
Wagons ho! High-class, head-turning haulers
Automakers still offer a few good traditional station wagons
As a teenager, one of the first cars I drove — and fell in love with — was our family’s hulking full-size wagon. It stretched over 19 feet in length and weighed a whopping 5,300 pounds. That’s three feet longer and 1,000 heavier than, say, a Ford Explorer today.
But this Leviathan felt safe and practical, especially when tootling around town with my crew or traveling solo cross-country. Of course, this hauler was also an eco-disaster.
Luckily, that’s not the case today. And even though the number of traditional station wagons keeps shrinking, automakers are still offering a few gems.
VOLVO V60 CROSS COUNTRY
$54,000
MPG: 23 city/31 highway
0 to 60 mph: 6.6 seconds
Cargo space: 51 cu. ft. (rear seats folded)
PROS: Elegant design. Composed handling. Top safety features.
CONS: So-so power. Modest rear legroom. Only two trim levels.
The 2026 Volvo V60 Cross Country doesn’t cry for attention — and that’s the point. This is the automotive equivalent of Kristen Stewart, a celebrity who’s confident in her own skin and sees no need to post about it.
Under the hood, there’s a four-cylinder turbo engine paired with a mild-hybrid system, producing 247 horsepower. You won’t outrun other drivers, but there is a sense of calm authority when accelerating. The standard all-wheel drive and 8.1 inches of ground clearance mean this wagon is ready for dirt roads, bad weather or a spontaneous weekend jaunt.
And inside? Scandinavian minimalism at its finest. Clean lines. Gorgeous materials. Google-based infotainment that mostly works — though occasionally the system could be a bit faster, at least for my taste. The ride is smooth, composed and quiet, even if acceleration feels more “measured sip” than “espresso shot.”
But here’s the twist: After more than a decade, this is the final Volvo wagon in the U.S. Its farewell tour ends in 2026. That alone gives it collector-car status.
MERCEDES-AMG E53 WAGON
$95,000
MPG: 21 city/25 highway
0 to 60 mph: 3.4 seconds
Cargo space: 64.6 cu. ft. (rear seats folded)
PROS: Supercar vibe. Hybrid versatility. Stunning interior.
CONS: Some fussy controls. Can feel heavy when cornering.
If the Volvo V60 Cross Country is subtle, the 2026 Mercedes-AMG E53 Wagon is a screamer. It’s like being at a Lil Nas X concert: flashy, high energy, and full of shock and awe.
This performance wagon — a plug-in hybrid, no less — pushes well over 500 horsepower (and in some configurations over 600 horsepower), launching from 0 to 60 mph as fast as a $300,000 Aston Martin supercar.
Yes, deep down, this is still a wagon. But you also can do a Costco run in something that could embarrass sports cars at a stoplight. That duality is delicious.
Inside, Mercedes leans all the way in. The high-tech Superscreen setup stretches across the dash. Ambient lighting glows like a curated art installation. The 4D surround-sound audio literally pulses through the seats. It’s immersive. Borderline excessive. And entirely the point.
Rear-axle steering helps mask the size of this car, but there’s no hiding the weight — it’s a big, powerful machine. Still, this hauler handles far better than physics suggests it should.
PORSCHE TAYCAN CROSS TURISMO
$121,000
Range: 265 miles
0 to 60 mph: 2.8 seconds
Cargo space: 41 cu. ft. (rear seats folded)
PROS: Lightning fast. Space-age design. EV smoothness.
CONS: Very pricey. Options add up quickly. Limited rear visibility.
The Porsche Taycan Cross Turismo completely rewrites the wagon formula. Fully electric. Shockingly fast. Designed like it belongs in the Louvre.
Performance is instant. Depending on trim level, you’re looking at 0-to-60 mph in less than 3 seconds. No exuberant engine noise — just that smooth, purring EV surge.
Handling? Pure Porsche. Low center of gravity thanks to the battery-pack placement. Precision that makes winding roads feel like choreography. And then — hello — there’s also a Gravel Mode for light off-road use.
Inside, the style is restrained but high-tech. Digital displays dominate, including a 10.3-inch passenger side touchscreen. Yet the layout feels intentional rather than overwhelming. Build quality is exceptional. Options, including leather-free materials and an active-leveling system for hard cornering, are endless — and expensive.
Range varies by model. But as with any EV, your lifestyle (and charging access) matters.
Overall, this is a wagon that looks and behaves like one helluva class act.
Advice
My family voted for Trump and I cut off contact
Now my father is ill and I don’t know what to do
Dear Michael,
I stopped talking to my family last year because they all voted for Trump. It’s not like they didn’t know whom they were voting for — they’d already had four years of seeing him in action.
I decided that I couldn’t remain in contact with people whom I felt wanted to take away my rights as a gay man. That is what they essentially did by voting for Trump.
They had come to my wedding in 2012, they had welcomed my husband and me into their homes for the holidays for our entire relationship, so I couldn’t believe how little they actually cared about me and my community. I was profoundly hurt.
They’ve reached out but I have been too angry at their hypocrisy to engage in more than a perfunctory way. I miss them, sure, but as I’ve watched our community be attacked, I just get so angry that I don’t want to talk. I certainly don’t want to hear them justify bigotry and hatred.
Now one of my siblings has reached out to let me know that my father’s health is rapidly declining. I’m wondering if I should rethink my decision and reach out to him, maybe even visit, before he dies.
But then I think of ICE’s attack on our country and the removal of the Pride flag from Stonewall and I don’t want to talk to people who support what is happening to vulnerable, marginalized people and the LGBTQ community.
My father was a good father to me. Even when I first came out to him, he was loving and supportive. I can’t square his behavior personally toward me with his support of this regime. The hypocrisy makes me so angry. How could he purport to love me and then vote against my freedoms?
I would love some suggestions about how to square my two opposing viewpoints.
Michael replies:
Many years ago, a great mentor taught me that the one thing you can count on in a relationship is learning to tolerate disappointment: Both being a disappointment, and being disappointed in the other person. This is true for love relationships and it’s also true for other significant relationships. All of us are different in some major ways and so we are bound at times to disappoint our loved ones in major ways, and to be disappointed by them in major ways.
That is why I’m not a fan of purity tests. To expect that someone must think like you (much less vote like you) in order for you to have a relationship with them is unrealistic, impractical, and sometimes damaging.
Of course, a person may hold some beliefs that give you reason not to want to have any connection to them. But is that the case here?
From your description, your family has always been loving and supportive of you as a gay man. That is no small thing. They seem to care about you enough to have continued to reach out, even though you have stopped talking to them.
Perhaps they had some other reasons for voting as they did, other than to roll back LGBTQ rights and to attack immigrants.
Instead of wondering how they could be so hypocritical, how about talking with them and striving to understand their choices? I don’t know what they will say, and you may hear different answers from your various family members. But at least you will get some clarity, rather than presuming that they made their voting choices from a place of malice. Then you will be in a better position to decide if you want a relationship going forward.
Another point to consider: Very few things are set in stone. Even if your family made their voting choices based on holding positions that you neither like nor respect, they may be open to shifting their views over time. One way to perhaps influence their thinking is by engaging with them, sharing your thoughts, and asking them to consider the possible consequences of their actions. If you choose to re-engage with them, two points to consider:
First, don’t expect that you will change their minds. You can advocate for what you want, but you have to let go of the results.
Second, they are more likely to consider your points if you do not approach them from a judgmental, self-righteous stance.
Many years ago, when I was newly a vegetarian, I was eager to challenge and “educate” friends who weren’t following my dietary ideas. Guess what? It didn’t work. Then I got some great advice: A great way to influence others to consider eating fewer animals was to serve them delicious vegetarian food.
The same point is true here. We can’t beat people over the head to agree with us. But if we approach them with some kindness, rather than with the certainty that we hold the moral high ground, we may help them see a bigger picture.
And sometimes, we too may see a bigger picture.
Michael Radkowsky, Psy.D. is a licensed psychologist who works with couples and individuals in D.C., Maryland, Virginia, and New York. He can be found online at michaelradkowsky.com. All identifying information has been changed for reasons of confidentiality. Have a question? Send it to [email protected].
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