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The state of HIV in Washington: 29 years later

From fear and despair to promising new treatments and hope

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On April 4, 1983, AIDS entered the public arena of the District of Columbia.

On a Monday evening 29 years ago, Whitman-Walker held the first public forum on AIDS in D.C. At that time, Cabbage Patch dolls were a hit, people were watching M*A*S*H, and AIDS was destroying the gay male community. A panel of public health experts and advocates spoke to a full house at Lisner Auditorium of The George Washington University. The audience of predominantly gay men was driven to the forum after watching friends, lovers and colleagues die quickly and horribly from AIDS. And they were in a state of fear bordering on panic.

The forum that night probably did little to calm that fear. Think about what was happening in 1983. AIDS had only been recently named. The HIV virus had not been discovered yet. There was no test to see if someone was infected and there was no treatment. In fact, people were unsure if you could catch AIDS from a simple kiss. In short, there was almost no good news that night; only fear and despair for the future.

Today, on the eve of the 2012 International AIDS Conference, there is far more good news in the world of HIV/AIDS.

Since that forum in 1983, HIV testing has become standard operating procedure for many Americans, particularly those in groups at high risk for HIV, like gay or bisexual men. Successful treatments are keeping people with HIV healthy and alive for many years. And people are more knowledgeable about condom use and other safer sex practices.

Over the last few years, even more developments have brought new hope and optimism in the fight against HIV/AIDS, including the idea of using HIV medications to prevent HIV transmission, also known as ā€œTreatment as Prevention.ā€

One of the best ways to reduce new HIV transmissions is by diagnosing people with HIV, getting them into care and on medications. These HIV medications can suppress the amount of virus in the person’s blood to very low levels, which make it much less likely for that person to transmit the virus. In fact, studies have shown successful treatment to reduce the risk of transmission by up to 96 percent. This same strategy is used to prevent the mother’s HIV from transmitting to the baby.

Another way HIV medications are used to reduce transmission is through HIV ā€œpost-exposure prophylaxisā€ or ā€œPEP.ā€ If a person has a needle stick at work or an unsafe sexual encounter they can take HIV medications for a month to prevent infection. This method is at least 80 percent effective if used within 72 hours of the potential exposure.

Recently, studies have shown HIV medications can be taken by individuals at high risk for HIV before they are exposed to the virus to protect them from infection. ā€œPre-exposure prophylaxisā€ or ā€œPREPā€ is still undergoing clinical trials but seems to be very effective for certain populations at high risk for HIV, such as men who have sex with men and serodiscordant couples (where one partner has HIV and the other is HIV-negative).

All of these new ā€œTreatment as Preventionā€ tools add to weapons in the fight against new HIV transmissions, but none are a magic bullet. Currently, in the District of Columbia, 70 percent of people diagnosed with HIV do not have a suppressed viral load. Why is this number so high? A large number of people in D.C. have HIV and do not know it. Others have been diagnosed with HIV but have not seen a doctor yet (often due to denial, stigma, etc.). And lastly, a good percentage of HIV-positive people on medication do not have a suppressed HIV viral load due to poor adherence to their medication regimen (often due to depression, addiction issues or competing priorities). We are lucky at Whitman-Walker to have comprehensive health care on site, including care teams, mental health practitioners, a pharmacy, and nurses that focus on patients’ barriers to care. Through this team model, 85 percent of our HIV patients on medications have a suppressed viral load.

Now that the health care community has more options in our fight against HIV, we have to figure out a comprehensive way to prevent new HIV transmissions from occurring. But the good news is that we are more knowledgeable about HIV transmission and there are more prevention options with known effectiveness.

So come join us in a Return to Lisner Auditorium on Tuesday, July 24, at 7 p.m. You will hear from leaders in the field that reducing the number of new HIV infections in Washington, D.C. is possible. You will learn about ā€œTreatment as Prevention.ā€ And we will all reflect on how far we have come in the past 29 years.

Dr. Ray Martins is chief medical officer of Whitman-Walker Health.

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Opinions

Medicaid cuts will lead to an uptick in STIs

Move threatens progress to end HIV epidemic

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We have come a long way from the days when HIV was an almost certain death sentence. But our work is far from over. The COVID-19 pandemic led to an uptick in rates of sexually transmitted infections (STIs), including HIV, and low-income communities, LGBTQ+ communities, and communities of color continue to be impacted at alarming and disproportionately high rates.

These communities are also more likely to be served by Medicaid. Medicaid is the largest source of insurance coverage for people living with HIV in the United States, covering an estimated 40 percent of nonelderly adults with HIV, and Medicaid accounted for 45 percent of all federal HIV spending in 2022. During September, Sexual Health Awareness Month, it is worth examining the crucial ways Medicaid works to keep people healthy — and what threatens our progress today.

In recent weeks, we have seen a troubling trend develop. Five million Americans have been removed from Medicaid rolls, and many millions more are on the verge of losing coverage as a result of the Medicaid enrollment cuts. This represents the single greatest threat to our progress toward ending the HIV epidemic in years.   

During the pandemic, Medicaid enrollment grew by an estimated 20 million people, contributing to the uninsured rate dropping to the lowest level on record in early 2022. But, after a three-year period during which states provided continuous enrollment in exchange for enhanced federal funding, some states resumed dis-enrolling people from Medicaid on April 1. A recent KFF survey found that 17 million people could lose Medicaid coverage as a result of this process, referred to as the Medicaid ā€œunwinding.ā€

Many states are not doing enough to ensure that Medicaid-eligible residents don’t lose their coverage. While some have been removed from the rolls because they are newly ineligible, procedural issues account for 74 percent of people losing coverage. An unacceptably high number of FloridaTexas, and Virginia residents who are still eligible for Medicaid are losing coverage because of procedural reasons, such as failing to confirm proof of income or household size.

Our goal should be to ensure that no one who qualifies for Medicaid loses their coverage. The U.S. Centers for Medicare and Medicaid Services (CMS) gave states the option to use a 12-month grace period, along with other flexibilities, to prepare for the unwinding and make sure residents had what they needed to recertify. So why are some states so eager to remove their residents from Medicaid rolls?

New York, on the other hand, has made equity a cornerstone of recertification work and provides a template for what states can do to help their residents remain covered. The state maximizes the flexibilities offered by CMS and works directly with providers, health plans, and recipients to minimize procedural disenrollments and ensure that people retain health care coverage, either through Medicaid, the state’s health exchange, or private insurance. New York is among the nation’s top-performing states in terms of call center wait times, call drop rates, and average time it takes to make an eligibility determination, according to the Center on Budget and Policy Priorities. New York’s call center is also able to produce materials in 26 languages. In June 2023 alone, New York State certified renewals for more than 400,000 residents.

At Amida Care in New York, we know firsthand that gaps in care for people living with or placed at elevated risk of contracting HIV can be especially devastating. When people lose access to PrEP medication to prevent HIV, they are left vulnerable to contracting HIV, and when people living with HIV lose access to antiretroviral therapy, they risk becoming seriously ill and transmitting HIV to others. We support and guide our members through the recertification process with dedicated outreach efforts that include phone calls, mailings, text messages, and home visits to limit loss of coverage and interruptions in life-saving treatments. 

We cannot begin to address health inequity or end the HIV epidemic without strengthening Medicaid. The recent moves by some states to strip their residents of Medicaid coverage will undermine the progress we’ve made.

Doug Wirth is president and CEO of Amida Care, a Medicaid Special Needs Health Plan for people affected by HIV.

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Opinions

Jann Wenner’s racist, sexist take on musicians isn’t surprising

New book ā€˜The Masters’ excludes Black, women pioneers

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Jann Wenner (Screen capture via CBS Mornings YouTube)

I enjoyed sharing my birthday with Bruce Springsteen, until I read the bigoted remarks made by his friend Jann Wenner in a recent New York Times interview.

Then I wasn’t so glad to have the same b-day as Bruce.

Springsteen didn’t make the comments. I’m a fan of his music. But, as I write this, Springsteen, as well as some of Wenner’s other friends, hasn’t spoken out against Wenner’s hurtful comments.

As the saying goes: Some gifts keep on giving. Wenner, who was removed from the Rock and Roll Hall of Fame Foundation board after making sexist and racist remarks in a Sept. 15 interview with the Times, keeps on giving. But what’s he’s giving isn’t a gift. Not to Black people, women, music lovers, or queer folk.

Wenner’s one of us. He’s gay. 

I’m fine with his sexuality, but you’d hope that Wenner, for decades a gatekeeper of music and culture, would be a source of queer pride. But, that’s not the case with Wenner, a co-founder of the Rock the Roll Hall of Fame.

The fallout from Wenner’s Times interview is a needed wake-up call for queers.

Too often, we give ourselves a pass. We believe that because we live with homophobia, bi-erasure and transphobia, we know the score. That we’re not sexist, racist, ageist, ableist – we’re free of prejudice. Paragons of virtue.

Wenner, with his demeaning comments, is, I hope, getting us (especially, we who are Boomers) to look in the mirror. To check ourselves (as we examine our dogs for ticks) for our own prejudices, and for our virtue-signaling.

The controversy around Wenner began when he sat for the interview with David Marchese of the Times on Sept. 15 to promote his new book ā€œThe Masters,ā€ released by Little Brown and Company on Sept. 26.

ā€œThe Mastersā€ is a compilation of seven interviews that Wenner conducted with acclaimed musicians who are (or were before their death) his friends: Bob Dylan, John Lennon, Mick Jagger, Pete Townshend, Jerry Garcia, Bono, and Springsteen. All of the interviewees are white, male and Boomers.

ā€œThat there are no women or Black musicians in this collection is obvious,ā€ Wenner writes, according to Kirkus Reviews, in ā€œThe Masters.ā€ ā€œThis is reflective of the prejudices and practices of the times.ā€

It’s hard to describe how bigoted and absurd this is. As many have noted, rock ā€˜n’ roll was invented by Black people.

You have to wonder what Wenner was thinking. Had he never heard of Jimi Hendrix or Janis Joplin? Stevie Wonder? Joni Mitchell? Madonna?

Though too much racism and sexism exist today, the culture has gotten somewhat better. Attitudes have evolved. We’ve become more aware of our biases. 

Unfortunately, this isn’t so for Wenner. Marchese asked Wenner why every musician he talked with in ā€œThe Mastersā€ is white and male. ā€œInsofar as the women,ā€ Wenner responded, ā€œjust none of them were as articulate enough on this intellectual level.ā€

When pressed by Marchese, who wondered how he could say Joni Mitchell wasn’t ā€œarticulate enough,ā€ Wenner said, ā€œJoni was not a philosopher of rock ā€˜n’ roll.ā€

ā€œI mean, they just didn’t articulate at that level,ā€ Wenner said of Black musicians.

Reading the interview, I wondered if he’d read Rolling Stone, the magazine he edited for decades. Had he missed the covers with Melissa Etheridge, Joplin, and Tina Turner (to name a few of the women and Black artists featured on the magazine’s cover)?

Sadly, Wenner’s condescending, racist and sexist take on Black and women musicians isn’t surprising. Often, people with power (rich white men) believe they’re smarter, more talented, and more entitled to be cultural gatekeepers than those from marginalized groups. They’re convinced they’re more talented and ā€œarticulateā€ than those who don’t have power. 

Forget ā€œThe Masters.ā€ Check out Etheridge’s new memoir ā€œTalking to My Angels.ā€ That’s a good read.

Kathi Wolfe, a writer and a poet, is a regular contributor to the Blade.

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Commentary

O’Shae Sibley’s murder is an attack on LGBTQ people and their expression, as both rise

More than 350 anti-LGBTQ attacks reported between June 2022 and July 2023

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O’Shae Sibley (Headshot from O'Shae Sibley's Facebook page)

BY HENRY HICKS IVĀ | What do the banning of a children’s picture book about two male penguins, white supremacist stand-offs outside of weekend brunches and a killingĀ during impromptu dancing at a gas station have in common? Plenty. Each impinges on the escalating trend of attacks on LGBTQ+ people and their right to free expression.Ā 

On the evening of July 29, O’Shae Sibley pulled into a Brooklyn gas station parking lot with his friends to fill up their gas tank. As they waited for the tank to fill, the group spilled from the car and used the moment to move joyfully in the hot summer night, cranking the car radio’s volume and dancing together. Sibley, a gay man, was also a skilled professional dancer and choreographer. He displayed his talents this night, voguing to the sounds of BeyoncĆ©, an artist that Sibley and his friends were fans of. By coincidence, the artist was performing just a few miles away that night, with professional voguers joining her on stage.

Vogueing, a dance style born out of the traditionally queer ballroom scene, is known for its electrifying dips, drops and duckwalks. The style has been prominently featured in the Golden Globe-winning television showĀ “Pose” — and, more recently, on stage in Beyoncé’s all-consumingĀ Renaissance World Tour. The energy of the ballroom scene has spirited communities across the country, as Beyoncé’s tour has touched down city-by-city, and Sibley and his friends were not exempt to this reach. He was, in fact, eager to participate in his artistry as someone known for his role as a dancer, choreographer, and active member of New York’s ballroom community.Ā 

As he and his friends vogued to BeyoncĆ© in the parking lot, moves that Sibley was adept in as an artist himself, they grabbed the attention of hostile onlookers. As captured on surveillance footage, Sibley was first berated with homophobic slurs — Sibley’s vogue performance seeming to signal his sexuality to his attacker. Shortly following the verbal assault, things turned violent. Sibley was stabbed and murdered in a tragic hate crime, fueled by homophobia and triggered by Sibley’s open expression as a dancer and artist. 

In mourning, and in defiant protest in the days following, the New York City queer communityĀ Ā hosted a memorial at the site of his murder where they honored his memory through performance,Ā with a vibrant and resistant ball.Ā 

ā€œYou won’t break my soul. / You won’t break my soul, no, no. / I’m telling everybody,ā€ BeyoncĆ© sings defiantly in her single, ā€œBreak My Soul.ā€

The murder of O’Shae Sibley was devastating — and a signal of a disturbing trend. Increasing violence toward LGBTQ+ people, and attempts to quash their personal and artistic expression, are on the rise in the United States. Advocacy organizations such as GLAAD and the Anti-Defamation League have reported surges in harassment, vandalism and physical violence against LGBTQ+ people — with 356 instances being reported between June 2022 and April 2023. Transgender people, as well as drag performers, have been targeted at notably high rates. The Human Rights Campaign reported 34 murders of trans people ā€” mostly trans women of color — in 2022  (HRC emphasizes that the actual number is likely higher, as most attacks go unreported, or are reported inaccurately.) 

Drag shows across the country have faced threats and intimidation from armed protesters,Ā including the far-right extremist group, the Proud Boys. Gay bars have been targeted by armed assailants, such asĀ the tragic massacre thatoccurredĀ at Club Q in Colorado Springs, Colo., last November. Hospitals providing gender-affirming care to transgender youthĀ have been targeted with bomb threats. On Aug. 18, a California store ownerĀ was shot and killed for displaying a Pride flag. Harassment, threats of violence, and hate crimes against the LGBTQ+ communityĀ have steadily risen in recent years. It is clear that this bigotry has been emboldened and its first goal is to silence the free expression of LGBTQ+ people, through violence if necessary.Ā 

The exponential increase in physical violence against LGBTQ+ people over the last few years cannot be divorced from the recent legislative environment that has grown ever-more hostile to LGBTQ+ expression. Bills categorizing drag shows as obscenity, book bans targeting LGBTQ+ authors and stories about queer identities in schools and public libraries, as well as other legislative attacks are part of this trend against the LGBTQ+ community. The attacks, both physical and through laws and bans, risk enabling a culture that normalizes repression of queer voices and increases the risk of violence aimed, in part, at suppressing expression of LGBTQ+ people, even when individuals are simply voguing to BeyoncĆ© in public. 

Starting in 2021, we’ve seen a historic surge in book bans around the country, targeting LGBTQ+ voices and stories at a disproportionately high rate. PEN America has reported that among the top eleven books targeted by bans in the first half of the 2022-2023 school year, four focused on LGBTQ+ narratives. These challenges, paired with the historic number of bills targeting LGBTQ+ people in state legislatures across the United States — with at least 566 bills ensnaring the broader LGBTQ+ community, according to the Trans Legislation Tracker ā€” contribute to the normalization of repressing personal and artistic expression of queer people. As these policy attacks continue to advance, violence against the LGBTQ+ community has surged. 

And while O’Shae Sibley’s murder occurred in New York, a state that has passed no anti-LGBTQ+ bills in the most recent legislative session, his brutal killing shows just how pervasive the impact of anti-LGBTQ+ legislative attacks on free expression in other states are, shaping a culture that spills across borders and impacting LGBTQ+ people throughout the country. Even states perceived to be supportive to the LGBTQ+ community, such as New York, are not immune to the cultural reach of anti-LGBTQ+ repression and intimidation: the home and office of Erik Bottcher, a gay city councilmember in New York City, was vandalized last December after he voiced support for Drag Story Hour, and more recently, a rainbow Pride flag at a Manhattan restaurant was intentionally lit on fire.

Political threats to LGBTQ+ expression, whether it be through restricting and chilling on-stage performance or making it virtually impossible to even acknowledge the existence of LGBTQ+ people in Florida and other states’ schoolshave and will continue to put LGBTQ+ people at risk everywhere, chilling their ability to express themselves and potentially even sending them back into the closet, which, at its core, is a form of self-censorship. 

A culture of free expression, where people can speak, write — or dance — free from fear of violence, is essential to a thriving democracy. LGBTQ+ people deserve to equally enjoy this right — through creative performance, gender expression, or displays of joy. The ongoing trend of legislative attacks on drag, attempts to label LGBTQ+ stories as “obscene,” and the accompanying trend of violent assaults on LGBTQ+ people are attacks on free expression and must be condemned as such.

Henry Hicks IV is the coordinator for PEN America’s U.S. Free Expression program. PEN America is committed to defending against attacks on LGBTQ+ free expression. 

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