Opinions
The aging face of HIV
Within a few years, half with the disease will be 50 or older
By DANIEL TIETZ
As we convene from around the world to discuss the future of HIV prevention and treatment here in Washington, we must recognize that AIDS is not confined to young people. Thanks to improved anti-retroviral drugs, HIV is increasingly a chronic, manageable disease for those with access to care and treatment. The CDC has estimated that within the next few years more than half of all Americans with HIV will be age 50 or older. In New York City alone, as of 2010, more than 43 percent of people with HIV are in that age group. The face of HIV is greying, which brings with it its own set of challenges. Here are just a few of the stories of the older adults with which my organization, ACRIA, works.
Douglas says: “I’m dealing with HIV, depression, kidney cancer, high blood pressure, lipodystrophy, and now my doctor tells me my cholesterol is going up.” He acknowledges that he hasn’t always dealt well with his conditions, sometimes refusing to take all his drugs (numbering in the double digits) when he gets tired of doing so. He has yet to tell his doctor about this, and is unable to work due to the side effects of his medications.
David, an African-American man, remained HIV negative at age 50. But, as he says, “I could count on both hands the number of people I wanted to invite to a birthday bash,” most of his past friends and partners having succumbed to AIDS before they turned 30. He spent his 50th birthday alone at home with his godson. Having been burned out by the loss of most of his gay peers, he has become a “reclusive, mature gay man.” He lives a life of “self-imposed isolation,” suffering from poor eating habits, strange sleeping hours, and incontinence. He chooses not to date because he deems explaining these issues not worth the hassle.
These are just a couple of examples — and each one illustrates a real problem. Douglas, like many older adults with HIV, has not only HIV but also a variety of other medical conditions, some of which may be more challenging now than dealing with HIV. David is HIV-negative, but he faces the same problem of isolation that many of those aging with HIV face. Many older persons, moreover, wrongly assume that AIDS is a young person’s disease, and that their age can somehow protect them.
All of these problems have solutions, but only if health and services providers and policymakers alike work together to solve them. Primary care providers whose patients include older adults with HIV must be trained to ensure that they are prepared to help patients confront their multiple chronic illnesses, and that they adhere to a treatment regimen that will keep them in the best possible health, as difficult as it may be. That includes addressing depression and other mental health issues, which our research has found to be the most consistent predictor of non-adherence to HIV treatment.
It also includes helping patients to discuss risky behaviors in a nonjudgmental space; if patients feel they will be subjected to harsh criticism, rather than advice, for the slightest bit of disclosure, they are less likely to discuss such behavior openly, rendering it all the more difficult to reduce. ACRIA has created an ad campaign based on this non-moralistic approach with the slogan “Have Sex? Age is Not a Condom.” And as David’s story shows, these older adults are more likely to become depressed when they’re isolated and lack social support networks. Without intervention, they’re unlikely to remain in good health. These adults need opportunities to socialize with their peers — and we need to endeavor to ensure they have them.
These are not the only challenges that older adults with HIV face. But these issues, and others, are why this week, at the International AIDS Conference in Washington, D.C., ACRIA, SAGE and GMHC, together with several international partners, will host a satellite conference on HIV and aging, sponsored by the MAC AIDS Fund. At this conference, we will describe and address HIV and aging as a truly global issue. Scientists, health and services providers, activists, policy makers, and older adults with HIV will speak, as will a panel of older adults with HIV. Together, we are working to create a world in which AIDS is universally recognized as a disease that people over 50 get — and in which we unite to ensure that they get the care and services they need.
Daniel Tietz is executive director of AIDS Community Research Initiative of America. Reach him via acria.org.
Opinions
Gloria Steinem’s life of substance and consequence
Iconic activist never stopped working to make life better for women
Gloria Steinem was an icon, a feminist, a woman of substance and consequence. A rare person who made a difference her entire life; sometimes quietly, sometimes by making noise. She was an incredibly beautiful woman, inside and out.
I heard of Gloria Steinem and admired her for all she was doing. But that was from a distance. I read about her, and saw her on TV. It was 1963 when Steinem wrote and published her undercover Playboy Bunny exposé, “A Bunny’s Tale,” about her going undercover at New York’s Playboy Club. Her account revealed the physical toll, exploitative conditions, and pervasive sexism faced by the women employed there, challenging the magazine’s image of empowerment.
It was 1972 when I first met her in person. That first meeting happened while I was campaigning for Bella Abzug (D-N.Y.) at a street rally. I said “Hello, Ms. Steinem,” and she said “It’s OK to call me Gloria.” I was honored to do so.
Gloria was there to support her friend. Bella had been through a grueling primary against Bill Ryan, after being redistricted out of her seat. She lost, but then Bill died of cancer before the election, and Bella was named the Democratic candidate in the general election for New York’s 20th congressional district. When Bella won that race, I went to work for her full time. It gave me the chance to meet Gloria again a number of times after that, once even with Bella at her apartment. While she was one of the many famous people I met while working for Bella, she was different. She wasn’t Hollywood. She began her career as a reporter, and worked hard for all she believed in. She was a true activist. That was what she saw herself as. She could say she came by the activism gene from her paternal grandmother, Pauline Perlmutter Steinem who Wikipedia reported, “chaired the educational committee of the National Woman Suffrage Association and was a delegate to the 1908 International Council of Women. Also, the first woman to be elected to the Toledo Board of Education and a leader in the movement for vocational education. She helped rescue many members of her family from the Holocaust.”
So yes, in many ways, activism was in Gloria’s genes. She was the one who told me it was OK to call myself a ‘feminist’. That it isn’t only women who can call themselves that, but also men who believed and fought for full social, economic, and political equality of the sexes. She helped me to understand I was brought up by a feminist. My mom, though she never called herself that, was one by dint of how she lived her life, and fought for others.
Gloria never stopped working to make life better for women, and to make sure other women joined her in her activism. In 1969, she co-founded Ms. Magazine. Then in 1971, with Bella Abzug, Betty Friedan and Shirley Chisholm, she founded the National Women’s Political Caucus, which provided training and support for women seeking elected and appointed office. Then in the same year she co-founded the Women’s Action Alliance, which until 1997 supported a network of feminist activists and worked to advance feminist causes and legislation.
Gloria would hold other women to task if they didn’t speak out, even at difficult times, but always with love. In 1986, Bella’s husband Martin died at the young age of 69. We were at the funeral home the night before the funeral, and Bella was sitting with some of us, and saying she didn’t know what she would do without Martin. It had been a true love affair. She was saying things like she didn’t even know where the checkbook was, what their rent was, etc., because Martin handled all that. Well Gloria overheard this and came over and said to Bella, “Don’t you dare say that in public, women look up to you as a feminist, as independent, you can’t say that.” And we all laughed, even Bella, as did Gloria, but she was serious.
Then in the 1990s Gloria helped to establish what she called ‘Take Our Daughters to Work Day.’ She did this to try to have young girls learn about future career opportunities. But her work wasn’t done and in 2005, along with Jane Fonda and Robin Morgan, she co-founded the Women’s Media Center. It is an organization that “works to make women visible and powerful in the media.”
The last time I saw Gloria was at the opening night of “Gloria: A Life,” at Theatre J in D.C. She was 88, as beautiful, and sharp as ever, having just come back from a speaking engagement in some far-off country.
Gloria, the world will miss you, RIP.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
Commentary
Anti-science, anti-LGBTQ movements go hand in hand
HHS under RFK Jr. has blocked gender-affirming care for youth
A newborn baby died after contracting measles in Pennsylvania last month, and, as if it wasn’t enough grief for his parents, anti-vax activists are trying to track down and harass his family. Apparently, Gov. Josh Shapiro tangled with Robert F. Kennedy Jr. over his “inaccurate and misleading claims.”
On Aug. 26, RFK Jr., the secretary of the U.S. Department of Health and Human Services, declared that the deaths could be fabricated. We live in peculiar times, when it is government officials, not freaks on the internet, who are spreading conspiracy theories. The new spread of measles in the United States since Donald Trump came to power is one of the most shameful parts of the story of modern American politics, and the tragedy of parents who lost their baby because more and more people refused to vaccinate may seem absolutely unrelated to LGBTQ rights, but actually, there is a pretty solid connection.
Because RFK Jr., the same man who was fighting vaccination, promoted the false idea that vaccines caused autism, and even curated the anti-vaccine organization Children’s Health Defense before going into politics, is also a known opponent of transgender rights. Under his “leadership,” gender-affirming care for trans minors was banned, and there were also created new healthcare guidelines recognizing only two genders.
All around the globe, there is a weird correlation between anti-LGBTQ — particularly anti-trans — ideas and anti-science movements. And it should be clearer to the general public. People who are speaking against LGBTQ rights are not just threatening minorities. They are a danger to everyone.
The Trump-Vance administration is an iconic example of such tendencies.
Trump himself is a known critic of modern scientific studies — for example, believing in the same anti-vax conspiracies that Kennedy promoted, and showing obvious skepticism that global warming exists, despite all the evidence that has been shown by climatologists. And he is also a man who used trans people as boogeymen. Under his command, trans people were kicked out of the military. And even worse, recently he made an extremely chilling statement about the 2026 midterm elections, urging voters to “pretend I’m on the ballot” and vote for Republicans, and while discussing what he says is at stake, he said that if Republicans win, “transgenderism” will “end.” This is an offensive statement at best and genocidal at worst.
And, of course, I think everyone remembers the Department of Government Efficiency (DOGE), which was led by infamous billionaire Elon Musk, who announced to the world that he would destroy the “woke mind virus” that killed his child just because his trans daughter, Vivian Wilson, well, is happy to be a trans person.
DOGE is known not just for cancelling academic research around LGBTQ studies and gender studies. No, this agency abruptly canceled and froze thousands of federal science, research, and health grants, attacking such vital health programs as cancer research, vaccination research, and diabetes research, among others. As you can see, they are not just attacking people who are “affected” by the “mind” virus — they are dangerous to everyone, even if most of the public standing of Musk was around his anti-trans politics and he tried to present himself as a pro-science, pro-progress man by supporting the space industry.
An even more vivid example is the so-called Dark Enlightenment movement.
This extremely reactionary political movement was born in the late 2000s, and originally grew from very democratical classical liberal ideas. Until it became anti-democratic itself. And also often It was created by American software engineer Curtis Yarvin (writing under the pseudonym Mencius Moldbug) and expanded by British philosopher Nick Land. The movement is popular among some Silicon Valley businessmen, and got support from PayPal founder Peter Thiel, and one of their main ideas is that modernity is bad. They are basically obscurantists, who see modern universities as part of “the Cathedral” — a system that, in their opinion, promotes equality and modern science that society doesn’t need. Of course, the movement’s followers are mostly anti-LGBTQ rights, and, as you can see, anti-queerness once again go hand in hand with obscurantism. Unfortunately, the movement got the support of extremely prominent politicians, including U.S. Vice President JD Vance.
In his speech from 2021, Vance proved to be an obscurantist when he claimed that universities are the enemy. He is also a known homophobe and transphobe.
So, why are anti-vaxxers, people who oppose modern scientific studies, and people who hate universities more likely to be queerphobic? Why do the same people who are defending their transphobia by showing that they support common sense actually often show zero such sense when it comes to protecting themselves and their children from measles or decreasing the chances of getting cancer?
We don’t have any statistics or studies that show that all obscurantists are queerphobic, but around the globe, the same dynamic is visible.
In Russian anti-LGBTQ censorship, books about animal biology and zoology have been censored because the censors saw “LGBT propaganda” in them. The famous pro-Putin philosopher Alexander Dugin, who is extremely anti-queer, also speaks up against modernity itself.
In Taliban’s Afghanistan, modern science and LGBTQ rights are attacked at the same time.
Even in the UK, Reform UK is known as the most anti-trans and anti-queer party, and they are facing widespread criticism from scientists and medical experts for promoting climate change denial and anti-vaccine ideas. It doesn’t mean that LGBTQ supporters never believe in conspiracy theories or that progressive politicians always support science.
No, it just means that explicit anti-science and anti-LGBTQ statements often go hand in hand.
I think there are two reasons for this correlation.
First, LGBTQ people are real. You cannot deny that sex is not binary, gender and sex are different, and transition improves the quality of life of actual trans people. Or that same-sex relationships are natural, because even animals have same-sex sexual contacts. To deny it, you need an ideology or a conspiracy theory.
The second reason is that anti-scientific populism and anti-LGBTQ conspiracy theories are popular among the same category of people. It’s a “bundle” of ideas — a trend that conservative voters often adopt together. Studies also show that people who are likely to believe in one conspiracy theory are more likely to believe in another.
But the question is more broad. We don’t speak enough about the harm anti-scientific conspiracy theories and obscurantist politicians around the globe create for mankind in general. Not all people would suffer from a prohibition of hormone therapy, or attacks on same-sex marriage. But anti-global warming ideas, anti-vax advocates, and restrictions on modern research, especially medical research, are potentially dangerous to any human being.
And one of the best things LGBTQ activists could do is just show society that they are being used — that the same people who are stealing LGBTQ rights are also destroying medicine and the environment, and it’s a threat to their own traditional families and future of all kids no less than to queer people.
Opinions
Trans people need a politics of ordinary life
Seeking the freedom to stop explaining ourselves
For much of the modern transgender rights movement, our political vocabulary has understandably been a vocabulary of emergency. We talk about healthcare bans, bathroom restrictions, discrimination, violence, court decisions, and executive orders. We organize because something is being taken away, prohibited or threatened.
Those fights are necessary. But they cannot constitute our entire vision of transgender life.
The Williams Institute at UCLA estimates that approximately 2.8 million Americans ages 13 and older identify as transgender, including roughly 2.1 million adults. Transgender people are only about 0.8 percent of the adult population. Yet transgender Americans occupy an extraordinary amount of the country’s political attention.
Behind those political arguments are millions of people doing profoundly ordinary things.
We commute to work. We complain about rent. We walk our dogs. We sit in traffic. We buy groceries. We fall in love with people who sometimes disappoint them. We worry about our parents getting older. We try to make enough money to retire. We drink coffee before work and wonder what to make for dinner.
This ordinariness should be part of the political project.
For years, LGBTQ advocacy has emphasized visibility. Visibility was necessary because silence allowed discrimination to flourish. Americans needed to understand that gay and transgender people existed in their families, workplaces and communities.
But visibility is a means, not an end.
The endpoint of civil rights is not permanent visibility. It is freedom.
And freedom includes the freedom to stop explaining yourself.
There should be nothing remarkable about a transgender accountant preparing someone’s taxes, a transgender teacher grading papers, a transgender novelist writing a book that has absolutely nothing to do with gender, or a transgender retiree arguing with the homeowners association about somebody’s fence.
That sounds almost comically mundane. That is precisely the point.
For many transgender Americans, mundane life remains harder to obtain than it should be. The 2022 U.S. Transgender Survey, which collected responses from more than 92,000 people, found that 34 percent of respondents were experiencing poverty and 18 percent were unemployed. Eleven percent of respondents who had ever worked reported losing a job because of their gender identity or expression. Nearly 30 percent had experienced homelessness during their lives.
Those numbers tell us something important about what transgender politics should accomplish.
A successful movement cannot measure progress exclusively by representation in television shows, corporate Pride campaigns or the number of transgender politicians elected to office. It must also ask whether transgender people can build stable, boring lives.
Can you find a job?
Can you rent an apartment?
Can you go to the doctor without becoming a political subject?
Can you walk into a restaurant with your spouse without calculating whether everyone is staring at you?
Can you spend an afternoon thinking about something other than being transgender?
Even healthcare illustrates the distance between formal inclusion and ordinary dignity. A 2024 KFF analysis found that 33 percent of LGBT adults who had recently used healthcare reported being treated unfairly or disrespectfully by a healthcare provider, compared with 15 percent of non-LGBT adults. Thirty-nine percent said a negative healthcare experience had made them less likely to seek care.
Equality therefore cannot simply mean keeping a clinic open. It must mean being able to enter that clinic, receive competent treatment and leave without feeling that your identity has swallowed the entire encounter.
There is a broader political lesson here.
Transgender Americans have sometimes been transformed into abstractions by both sides of the culture war. To some conservatives, we are evidence of social decline. To some progressives, we become symbols of resistance. Neither description leaves much room for the complicated, frequently uninteresting reality of being a person.
Most people do not wake up every morning thinking about their demographic categories. They think about deadlines, relationships, bills, ambitions, annoyances and whether there is enough milk in the refrigerator.
Transgender people deserve that luxury too.
A politics of ordinary life would therefore defend transgender healthcare and civil rights vigorously while articulating something beyond defense. Its objective would be integration: transgender Americans participating in civic life without every interaction becoming a referendum on gender.
That means protecting employment and housing. It means making competent healthcare routine rather than exceptional. It means creating communities where transgender children can imagine futures that extend beyond surviving adolescence. And it means allowing transgender adults to become bankers, mechanics, professors, parents, entrepreneurs and retirees without expecting them to become activists simply because they are transgender.
There will always be people who choose activism. We need them. There will always be people who speak publicly about their transitions. Their testimony matters.
But there should also be room for the transgender person who wants none of that.
Civil rights movements succeed not merely when marginalized people become visible, but when their presence stops requiring explanation.
The most radical future I can imagine for transgender Americans is therefore surprisingly conventional: a country in which being transgender can become one fact among hundreds about a person rather than the organizing principle of a life.
Perhaps the ultimate measure of transgender equality will not be how frequently America talks about transgender people. It will be the day when it no longer has to.
Isaac Amend is a transgender man and writer based in D.C. In 2017, Isaac starred in National Geographic’s “Gender Revolution” documentary. He sits on the board of the LGBT Democrats of Virginia. His author’s portfolio is available at isaacamend.com and you can find him on Instagram at: @isaacamend.
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