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The struggle to maintain access to lifesaving HIV meds

Trump proposing dangerous changes to Medicare Part D

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(Scanning electromicrograph by NIAID via Flickr)

When I was diagnosed with HIV in 1985, there were no medications to treat it. Not one. I never imagined that the medical community would achieve the advancements in HIV treatment and prevention we see today. In fact, President Trump actually proposed a plan in his State of the Union address to end the HIV epidemic in America by 2030. This lofty goal would be thwarted, however, by proposed changes to Medicare Part D that jeopardize the advancements weā€™ve made in the fight against HIV.

I have lived with HIV for almost 35 years. Iā€™ve dealt with more doctors, stubborn insurers, and drug formulations than I care to count. But I do it to stay alive. What other choice do I have?

By 1995, 10 years after I contracted the virus, AIDS claimed as many as 50,000 lives per year. Today, fewer than 7,000 people die from HIV related causes. And recent data shows that although there are nearly 19,000 people living in Baltimore with HIV and 15,000 in D.C., less than a quarter of all new D.C. HIV diagnoses develop into an AIDS diagnosis within three months. This means that approximately 80% of these individuals newly diagnosed with HIV are taking steps to control and reduce their viral loads.

Becoming an ā€œempoweredā€ patient with consistent and unimpeded access to my medications through Medicare Part D has kept me alive. Had I not been relentless in my pursuit of the latest research, drug trials, and newly approved treatment regimens ā€” while also educating my own providers ā€” I likely would have been counted among the nearly half million Americans who perished from AIDS between 1981 and 2000.

For many years after my diagnosis, insurance companies rejected my prescriptions or tried to force me to rely upon medications that had been proven ineffective. When I became disabled due to HIV, my newfound access to Medicare Part D changed all of that. 

Medicare Part D and its protections against insurer interference finally brought some certainty to my treatment plan. With reliable access to effective medication, I was suddenly free to divert my time and energy away from day to day survival and focus it towards my friends, my family, and a better quality of life.

Unfortunately, the Trump administration is proposing a change to Medicare Part D in a way that would remove many of these certainties. The change ā€” in the name of reducing drug pricing ā€” removes the protected class status for HIV medication and would expose hundreds of thousands of people living with HIV to ā€œstep therapyā€ and ā€œprior authorization.ā€ 

Step therapy allows insurers to require Part D enrollees living with HIV to prove that less effective medications donā€™t work before agreeing to cover more effective, but more expensive treatments, as determined by our doctor. Prior authorization forces doctors to pre-clear prescriptions for certain HIV medication with insurers before the insurer agrees to cover the costs, a time consuming and complicated process that delays treatment.

As someone who has failed multiple drug categories over the years, I know these changes are dangerous because they would force me to fail on one medication before trying another. I need highly customized, effective therapies to keep my viral load in check. When a viral load is rendered undetectable, I cannot transmit HIV to someone else. Successful treatment, then, also prevents new HIV infections.

Interfering with access to effective treatment formularies for Medicare Part D enrollees under the guise of pricing reductions will cause more harm than good. In fact, a recent study published in the American Journal of Managed Care estimates that there would be 16,200 more cumulative deaths by 2025 if more restricted treatment options are allowed to take effect.

The priorities for people living with HIV are stark. First you pay your insurance premiums, then you pay your prescription costs, and then you pay for food and housing. That is how important our medications are to our survival. For us, failure is not an option. We must fight this new proposal that would end guaranteed access to the treatments we need to stay alive.

Mark S. King is an award-winning author, and HIV/AIDS advocate who has been involved in HIV causes since testing positive in 1985. His blog, My Fabulous Disease, was awarded the NLGJAā€™s ā€œExcellence in Bloggingā€ honor in 2014 and 2016. 

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Sexting with younger guy has me asking: How queer am I?

Reflections on LGBTQ life in 2024

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Jake Stewart is a recovering Hill staffer based in D.C. In addition to writing, he barbacks at the Little Gay Pub."

Once upon a time, not all that long ago, a man sexted another man. 

There were words. There were pictures. There were filthy questions and even filthier responses. You know, the way a good sexting convo ought to be, for those who dabble. 

One man was 33. The other, 24. And while it comes as no shock that I was the 33-year-old, it may be more surprising to learn it was the 24-year-old who grabbed the reins. 

What kinks you into? he asked. 

Shit ā€“ I didnā€™t know. I barely even bottomed before the pandemic, and now I had to know my kinks? 

Iā€™m open, I replied, evasively. You? 

His response left me coughing: ā€œLove musk sweat ws public group rough bb verbal bate edge roleplay and very open-minded.ā€ 

Now Iā€™m no prude (in fact, many would call me a downright whore) but this young man articulating his kinks and fetishes in such detail blew my mind. When did he learn what he liked? At 24, all I wanted was to top a guy and leave with as little communication or attachment as possible. At 33, I wasnā€™t sure what a few of the items he listed even meant.  

Perhaps I shouldnā€™t be surprised when young men ā€” and the younger generation across the LGBTQ spectrum in general ā€” have already figured out their sexual interests. I arrived in D.C. from Idaho in 2008 as a fresh-faced 18-year-old; I came out three years later in 2011. Attitudes toward queerness have shifted substantially since then, and these days it is undeniably easier for younger people to explore their sexual and gender identities (which, by the way, is fantastic). 

But this conversation left me wondering: What do I like? I havenā€™t sought out that many new sexual experiences, and while fetishes, kinks, and sexual desires can seem trivial, theyā€™re inextricably intertwined with gender and relationships. If I canā€™t articulate what I like in the sack (or in public, if I dare), then how do I know what Iā€™m seeking from a long-term partner, or if thatā€™s even what I want? 

As soon as I came out, I thought my job was done. All I needed after that was to snatch up a cutie and settle down. Instead, my identity centered on building my career in politics, where sexual openness isnā€™t as appreciated. I, like many D.C. queers around me, moved here bright-eyed, bushy-tailed, and ready to change the world for good. 

Then came a tough lesson: Just because I wanted to improve the world didnā€™t mean people wanted me to. I was inexplicably fired from not one job but two, and suddenly the do-gooder in me grew jaded. The career I dedicated years to was suddenly ripped from my hands, and I became so disillusioned I didnā€™t even want it back. Oh, and the cherry on top: My boyfriend dumped me two days later. 

Once everything unraveled, I wondered: Was the me of the past the me I truly wanted? Or was I reflecting back what I thought everyone wanted me to be? 

Well, a few major meltdowns and an extended slut phase later, my life couldnā€™t be more different. I now work at a new gay bar in town to support myself, and Iā€™ve given myself space to pursue the arts. This former straight-laced, type-A, tightly wound gay abandoned the safe track and he couldnā€™t be more terrified. He also couldnā€™t be more excited. 

But losing my old career also left an existential-sized hole in my identity. So, as I sexted this 24-year-old with newfound awareness of my limitations, I decided this must change. 

How? As I said, I work at a gay bar in one of the queerest cities in America. Now more than ever Iā€™m surrounded by those who are LGBTQ and every shade in between. Why not learn from those around me, whether younger, older, or around the same age, but whose experiences are no less queer? Why not carve out time to have in-depth discussions and discover what the possibilities are? 

If being queer means to go against the established norms of gender and sexuality, then thereā€™s still plenty of territory for me to explore. No longer can ā€˜bottomā€™ or ā€˜topā€™ be my only options. 

So, the purpose of this column ā€“ aptly titled Queer Quest ā€“ is to capture my exploration of queer identity. Itā€™s not to teach you as much as it is to teach myself, and you can either learn alongside me or simply be entertained. At the very least, Iā€™ll have a series of portraits on what itā€™s like to be queer in the mid 2020s. At most, Iā€™ll have a better understanding of who I am as a queer person. 

Then maybe, just maybe, Iā€™ll become a better sexter. 

Jake Stewart is a D.C.-based writer.

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What will you do to make Pride safe this year?

Anxiety reigns among American Jews after Oct. 7

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(Washington Blade photo by Michael Key)

Each year, hundreds of thousands of Jews and supporters of Israel attend Pride marches. With a few exceptions, these spaces have always been safe and welcoming for the broader Pride community. 

But this year is different. 

For American Jews, anxiety reigns as we head into this Pride season. The appalling rise of antisemitism since Oct. 7 forces us to ask difficult questions. As many Jews increasingly feel alienated and excluded from progressive spaces, weā€™re left to wonder: If I wear a Jewish symbol, march with a Jewish group, or wave a rainbow flag adorned with the Star of David, will I be safe at Pride?

Even before Oct. 7, LGBTQ Jews had plenty of reason to feel trepidation about their safety at Pride. From blanket bans on Stars of David at past Pride gatherings to antisemitism on display at the recent Sydney Pride, too often Jews feel forced to choose between their LGBTQ and Jewish identities and hide their connection to Israel.

Since Oct. 7, terms like “apartheid,” “genocide” and “Zionism equals racism” are increasingly thrown around casually, often without a nuanced understanding of their impact or the realities they oversimplify. This rhetoric not only alienates but also endangers Jewish queer people. It makes us feel emotionally unsafe. It increases the chances that we will be physically unsafe as well. 

We must not allow the Israel-Palestine conflict to be imported into Pride.

I will always remember the euphoria of the first Pride rally I attended. I was barely 18 years old, in a crowd of people of all ages, races, genders and gender orientations ā€” and they were like me. Queer. It felt safe. It was the first time I experienced that feeling of safety, and it will always stay with me. 

Like Pride events everywhere, it was a vibrant, colorful space for LGBTQ people to celebrate our true authentic selves, without fear or reservation.

But that feeling of safety wasnā€™t shared by everyone in my small New England town. I soon noticed a few people scattered throughout the crowd wearing paper bags over their heads, with eye holes so they could see but not be seen. I later learned that those faceless people were teachers who, in those days before civil rights protections, needed to protect their identities and their careers. 

They did not feel safe. Will Jews and those who are connected to Israel feel safe this year?

The history of Pride is a testament to courage in the face of adversity. It wasn’t long ago when attending Pride events was a defiant act against societal norms, where participants like those teachers faced tangible threats of discrimination, ridicule and even violence. Even today in some places, our queer community still navigates a gauntlet of hatred as we try to celebrate who we are.

It’s crucial to recognize that within the Jewish community, there is a wide spectrum of views on the Israeli-Palestinian conflict, including many who are deeply committed to advocating for Palestinian rights. In fact, many of the 1,200 innocent Israelis murdered on Oct. 7 were Zionists who devoted their lives to reconciliation and peace with their Arab neighbors.

We are at a pivotal moment, one that demands action: What can we do to ensure Pride remains a safe space for everyone, including Jewish participants?

It’s imperative that Pride committees around the country proactively address these concerns. They must implement training programs focused on de-escalation and fostering an environment of understanding and respect.

As individuals who stand in solidarity with the values of Pride, each of us must consider our role in this effort. Will you march alongside those of us who feel vulnerable, offering your presence as a shield against intolerance? Will you engage in dialogues that challenge the importation of external conflicts into Pride, advocating instead for a celebration that unites rather than divides?

The true test of inclusivity at Pride lies not merely in welcoming a diverse crowd, but in ensuring that every participant feels safe and valued. If we remain indifferent to the vulnerabilities faced by Jewish queer people this Pride season, we will fall short of the very ideals of inclusivity and solidarity that Pride stands for.

Just as we expect schools to protect trans and nonbinary students like Nex Benedict, we have a responsibility in the LGBTQ community to ensure that people can carry an Israeli flag or a Palestinian flag, wear a yarmulke or a hijab and be safe.

As we look forward to this year’s Pride, let us commit to making it a space where safety is not a privilege afforded to some but a right enjoyed by all. Let’s engage with our local Pride committees, advocate for comprehensive safety measures and stand in solidarity with those who feel at risk.Ā 

Only then can we celebrate the true spirit of Pride, rooted in love, acceptance and the unwavering belief in equality for all.

Ethan Felson is the executive director of A Wider Bridge.

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How to protect your sobriety on St. Patrickā€™s Day

Celebrate with a supportive friend and carry a mocktail

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Sobriety can be challenging, whether you overcame alcohol or drug addiction or chose to abstain from alcohol for a healthier life. Holidays like St. Patrickā€™s Day can serve as a reminder of the past or could be looked at as another day. 

Many celebrate St. Patrickā€™s Day sober, as there are generally family-friendly gatherings, community events, or even sober celebrations. If you have concerns about your sobriety, there are practical tips you can use to protect it on St. Patrickā€™s Day. 

For instance, remind yourself why you are sober, and donā€™t do it alone. You can still have fun and celebrate but do it with other sober people. Everyone has their reasons for stopping drinking; remind yourself of those reasons and hold yourself accountable.  

Know your triggers; it doesnā€™t matter if you are a recovering addict or have removed alcohol from your life. Be cautious around possible triggers that pose a challenge. Most people in this situation choose to skip the bar and find something fun to do or go to a sober St. Patrickā€™s Day celebration. 

Keep a non-alcoholic drink or mocktail in your hand. People will not bother you to ask if you want a drink if you already have something to sip on, like a mocktail. This also leads to planning how to say no. You will encounter social pressure if you go to a bar on St. Patrickā€™s Day. Itā€™s unavoidable. Itā€™s wise to practice ways to refuse alcohol. 

Finally, if all else fails, take a walk outside if you feel overwhelmed. The most straightforward solutions are usually the best. Remove yourself from any situation you know will lead to relapse. This is also why itā€™s essential to be with a sober friend or loved one; there is accountability and someone to lean on.

The benefits of being sober are plentiful, along with the numerous health perks, such as better quality sleep, more mental alertness, and lessened anxiety or depression. Yet, there is one benefit that is not necessarily always spoken about. 

Being sober on St. Patrickā€™s Day or any day removes all chances of impaired driving. Unfortunately, days that promote heavy alcohol use may increase the chances of drunk or drugged driving. For example, in Washington State, impaired driving has been involved in roughly half of fatal crashes for decades. In 2022, 52% of traffic fatalities involved an impaired driver, according to the Traffic Safety Commission. 

Moreover, drivers ages 21 to 30 make up one-third of impaired drivers in fatal crashes, and another 20% are ages 31 to 40. If you are celebrating St. Patrickā€™s Day sober, take the necessary precautions and look out for one another. If you choose to consume alcohol, drink responsibly, know your limits, and do not drink and drive.

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