Opinions
The intergenerational impact of aging with HIV
Dec. 1 is World AIDS Day

BY TERRI L. WILDER | Today, Dec. 1, 2024, the global HIV community marks the 37th annual World AIDS Day (WAD). Here in the U.S., the face of HIV looks quite different than it did on the first WAD in 1988. It is estimated that more than 50 percent of people living with HIV (PLHIV) in the U.S. are aged 50 and older — an age that must have seemed impossible to the countless young people diagnosed during the height of the epidemic. Some were diagnosed later in life, whereas others have lived with HIV for many years — in some cases, since birth.
While their stories differ, PLHIV all face a common challenge: facing the impact of aging with HIV. The theme of WAD 2024 is “Collective action: Sustain and accelerate HIV progress.” A key to this progress is uplifting and understanding the real stories and lived realities of those growing older with HIV and using their experiences to guide proactive policy.
The spread of misinformation
In 1981, the first cases of what would later be identified as HIV (human immunodeficiency virus, the cause of AIDS) were reported. Three years later, Nathan Townsend was diagnosed with HIV at age 30.
When he got the call with the news, he was shocked. Early reports of HIV often suggested that only specific communities — most notably white gay men — were vulnerable to HIV. However, widespread misinformation contributed to the Black community later accounting for nearly half of all AIDS-related deaths, according to a 1999 CDC report.
Then, Nathan received more grim news: He was told by his doctors he only had two years to live. Believing he was going to die, Nathan purchased a casket and paid for his future funeral — one that thankfully didn’t come.
Today, Nathan is one of the growing number of older people who live with HIV, with researchers estimating that 70 percent of those living with the virus will be 50 and older by 2030.
The stigma of HIV diagnosis
As awareness of HIV grew in the late 1980s, many Americans expressed stigmatizing attitudes. A 1985 Gallup poll found that 28 percent of Americans reported that they or someone they knew had avoided places where gay men might be present because of HIV; by 1986, the percentage had grown to 44 percent.
This was the beginning of the endless stigma faced by those living with HIV — something Porchia Dees and Grissel Granados experienced.
Porchia was diagnosed at two months old through perinatal transmission and is part of the first generation of children born with HIV. Doctors indicated that Porchia wouldn’t live to see her fifth birthday. Fortunately, Porchia would prove them wrong.
Porchia still remembers the stigma she felt when she learned of her diagnosis in sixth grade from a social worker at the Children’s Hospital in Los Angeles. She recalled being pulled aside and asked if she was sexually active before being explicitly warned against having any sexual activity. The next time she heard about HIV was in a sex education class, which furthered the stigmatizing message that she would never live a “normal” life.
Today, Porchia is an advocate, changing people’s perspectives on what it means to live with HIV, but it does not come without challenges. At 38-years-old, Porchia is more focused on her health after witnessing long-term HIV survivors battle kidney failure, renal failure, bone density issues, cognitive issues, breast cancer, and shortened lifespans.
Grissel, another lifetime HIV survivor who acquired HIV through perinatal transmission, considers herself lucky that her mother explained the diagnosis to her at a young age. Despite her family’s support and honesty about HIV, a now 38-year-old Grissel still had to grow up with fear and uncertainty while now facing the fear of early mortality.
Social isolation
When Rev. Claude Bowen was 33 years old, he received a phone call that would change his life: His HIV test came back positive.
Believing he only had two years to live, he hid himself away, self-medicating and isolating himself from his support systems. These coping mechanisms served as an escape from his reality. But eventually, he realized that this was his reality and wanted to fight. He started getting involved in HIV education and advocacy work after his best friend disappeared in the late 80s. He would soon get a phone call, learning his friend had died of complications related to HIV.
For the LGBTQ+ community, losing friends and chosen family during this time became all too common. From 1984-1986, over 42,500 people in the U.S. died from HIV-related causes, which doesn’t account for individuals who died from complications related to HIV whose families or loved ones asked that the cause of death not be disclosed. For older PLHIV, this devastating loss of community has contributed to social isolation and loneliness.
Living and aging with HIV
With access to care, HIV is no longer a death sentence, thanks to scientific advancements in medications and treatments. Whether in your 70s like Nathan or 38 like Portia, many health challenges now faced by people living with HIV are more related to aging than to HIV-related illnesses.
Aging with HIV comes with a greater risk of health problems from inflammation from the virus and the long-term use of HIV medications. Many people aging with HIV also face the “dual stigma” of ageism and HIV-related stigma, leading to high rates of anxiety, depression, and substance use disorders. Furthermore, many have lost friends and family to the HIV epidemic, leading to loneliness and increased risks of cognitive decline and other medical conditions in older adults, as found in a 2023 study from Frontiers in Aging Neuroscience.
Acknowledging the challenges that people aging with HIV face helps ensure they get the necessary support to live a fulfilling and thriving life.
Taking action
The Older Americans Act (OAA) funds aging services and supports for older people across the country to age-in-place. In 2024, the federal Administration for Community Living (ACL) issued new regulations ensuring that LGBTQ+ older people and older people living with HIV could have more equitable access to the programs funded under the OAA. Yet, there is still more work that could be done to ensure equitable access for those living with HIV. Congress is currently in the process of reauthorizing the law.
While we face a challenging time in modern politics, we must urge our legislators to do whatever they can to ensure that the OAA and similar laws support PLHIV. And all of us must work with our state and area agencies on aging to robustly implement the latest OAA regulations, to ensure that all older people, including LGBTQ+ older people and those living with HIV, get the services and supports they need to remain independent.
States can also do more to protect people living with HIV by passing state-level LGBTQ+ and HIV Long-term Care Bills of Rights, as advocated for by activists and organizations, including SAGE, the world’s oldest and largest advocacy organization dedicated to improving the lives of LGBTQ+ elders. These laws ensure that LGBTQ+ older people and those aging with HIV receive equitable treatment in long-term care facilities. For instance, one long-term survivor, 82, who asked to remain anonymous for this piece, credits his doctor for his excellent treatment and care, saying, “It is tremendous to have someone in your corner that you can talk to openly and ask questions” without fear of judgment.
Finally, we must advance policies that address the needs of all those living with HIV and AIDS, no matter their ages.
The time is now
The impact of living with HIV is different for every generation. From lifetime survivors like Porchia and Grissel to those aging with HIV like Claude and Nathan, access to community support, services, and HIV-specific healthcare is essential for quality of life across generations.
This WAD, HIV advocates, aging organizations, and stakeholders must stand with local legislators to ensure care, protection, and support for all PLHIV.
Terri L. Wilder (She/Her), MSW, is the HIV/Aging policy advocate at SAGE, the world’s oldest and largest advocacy organization dedicated to improving the lives of LGBTQ+ elders. In her role, she implements SAGE’s federal and state HIV/aging policy priorities.
Terri has worked in HIV care since 1989, providing social services, directing education programs for clients and medical providers, and advocating for policy change. She is an experienced public speaker who has presented at conferences worldwide on various HIV topics. Terri is also an award-winning writer who has published on multiple HIV-related topics through The Body’s website, among others. Terri served on the New York Governor’s Task Force to End AIDS (EtE) and the New York Governor’s Hepatitis C Elimination Taskforce, where she contributed to the development of state plans to end the HIV epidemic and eliminate Hepatitis C.
She is a member of the New York State Department of Health AIDS Advisory Council EtE Subcommittee, and the Minnesota Council for HIV/AIDS Care and Prevention (MCHACP). Terri has been recognized for her work through the POZ 100: Celebrating Women edition of POZ magazine (2017), as well as awards from the NYS DOH AIDS Institute, AIDS Survival Project, and Bridging Access to Care, Inc.
Opinions
Supreme Court decision on opt outs for LGBTQ books in classrooms will likely accelerate censorship
Mahmoud v. Taylor ruling sets dangerous precedent

With its ruling Friday requiring public schools to allow parents to opt their children out of lessons with content they object to — in this case, picture books featuring LGBTQ+ characters or themes — the Supreme Court has opened up a new frontier for accelerating book-banning and censorship.
The legal case, Mahmoud v. Taylor, was brought by a group of elementary school parents in Montgomery County, Md., who objected to nine books with LGBTQ+ characters and themes. The books included stories about a girl whose uncle marries his partner, a child bullied because of his pink shoes, and a puppy that gets lost at a Pride parade. The parents, citing religious objections, sued the school district, arguing that they must be given the right to opt their children out of classroom lessons including such books. Though the district had originally offered this option, it reversed course when the policy proved unworkable.
In its opinion the court overruled the decisions of the lower courts and sided with the parents, ruling that books depicting a same-sex wedding as a happy occasion or treating a gay or transgender child as any other child were “designed to present … certain contrary values and beliefs as things to be rejected.” The court held that exposing children to lessons including these books was coercive, and undermined the parents’ religious beliefs in violation of the free exercise clause of the First Amendment.
This decision is the latest case in recent years to use religious freedom arguments to justify decisions that infringe on other fundamental rights. The court has used the Free Exercise Clause of the First Amendment to permit companies to deny their employees insurance coverage for birth control, allow state-contracted Catholic adoption agencies to refuse to work with same-sex couples, and permit other businesses to discriminate against customers on the basis of their sexual orientation.
Here, the court used the Free Exercise Clause to erode bedrock principles of the Free Speech Clause at a moment when free expression is in peril. Since 2021, PEN America has documented 16,000 instances of book bans nationwide. In addition, its tracking shows 62 state laws restricting teaching and learning on subjects from race and racism to LGBTQ+ rights and gender — censorship not seen since the Red Scare of the 1950s.
Forcing school districts to provide “opt outs” will likely accelerate book challenges and provide book banners with another tool to chill speech. School districts looking to avoid logistical burdens and controversy will simply remove these books, enacting de facto book bans that deny children the right to read. The court’s ruling, carefully couched in the language of religious freedom, did not even consider countervailing and fundamental free speech rights. And it will make even more vulnerable one of the main targets of those who have campaigned for book bans: LGBTQ+ stories.
When understood in this wider context, it is clear that this case is about more than religious liberty — it is also about ideological orthodoxy. Many of the opt-out requests in Montgomery County were not religious in nature. When the reversal of the opt-out policy was first announced, many parents voiced concerns that any references to sexual orientation and gender identity were age-inappropriate.
The decision could allow parents to suppress all kinds of ideas they might find objectionable. In her dissent, Justice Sotomayor cites examples of objections parents could have to books depicting patriotism, interfaith marriage, immodest dress, or women’s rights generally, including the achievements of women working outside the home. If parents can demand a right to opt their children out of any topic to which they hold religious objections, what is to stop them from challenging books featuring gender equality, single mothers, or even a cheeseburger, which someone could theoretically oppose for not being kosher? This case throws the door open to such possibilities.
But the decision will have an immediate and negative impact on the millions of LGBTQ+ students and teachers, and students being raised in families with same-sex parents. This decision stigmatizes LGBTQ+ stories, children, and families, undermines free expression and the right to read, and impairs the mission of our schools to prepare children to live in a diverse and pluralistic society.
Literature is a powerful tool for building empathy and understanding for everyone, and for ensuring that the rising generation is adequately prepared to thrive in a pluralistic society. When children don’t see themselves in books they are left to feel ostracized. When other children see only people like them they lose out on the opportunity to understand the world we live in and the people around them.
Advocates should not give up but instead take a page from the authors who have written books they wished they could have read when they were young — by uplifting their stories. Despite this devastating decision, we cannot allow their voices to be silenced. Rather, we should commit to upholding the right to read diverse literature.
Elly Brinkley is a staff attorney with PEN America.
Opinions
Pragmatic presidents invest in America
We need targeted, accountable investment in workforce stability

America may soon elect a president who identifies as LGBTQ. This possibility is no longer far-fetched, nor should it be alarming. What matters far more than who the president is, is whom the president serves.
In America, we care who the president loves because we want to know whether they love the people they represent. Not just the powerful or the visible, but those struggling to contribute more fully. The farmer in Iowa. The single mother in Ohio. The veteran in Houston who sleeps in his truck.
The moral test of any president is whether they recognize that a nation cannot call itself strong when millions of its people are locked out of participating in the economy. This is not sentiment. It is strategy.
We are heading toward a century of global competition where population, productivity, and workforce strength will decide which nations lead. The United States cannot afford to ignore the foundational truth that economic health begins with human stability. Without a well-fed, well-housed, well-prepared workforce, the American economy simply cannot compete.
Today, millions of Americans remain outside the labor force. According to the Bureau of Labor Statistics, roughly six million working-age Americans are not working or actively looking for work. Another 36.5 million live below the poverty line. Many of them lack the basic conditions required to contribute to our modern economy: shelter, nutrition, healthcare, or safety.
The result is predictable. A smaller workforce. Greater dependencies. Stagnant productivity. In 2024, the Congressional Budget Office projected a long-term decline in labor force participation unless structural barriers are addressed. This is not only an economic issue. It is a national security issue.
China and India are investing heavily in their own labor capacity. Meanwhile, we risk squandering ours. This is the backdrop against which the next president, whoever they are, must lead.
The role of government is not to provide individual comfort or cradle-to-grave care; that responsibility rightly belongs to families, communities, and civil society. Its role is to maintain the conditions necessary for every willing individual to contribute productively and invest with confidence. This means access to a safe home. It means access to basic nutrition. It means access to the building blocks of a productive life. Securing for our work forces what the Apostle Paul called diatrophas and skepasmata; or food and a place to sleep. These are not luxuries or favors. They are investments that yield growth in national capacity.
Too often these issues are framed in moral or ideological terms rather than pragmatic business interests. This rhetoric can mask poor planning, inefficiencies, and broken promises that leave communities worse off. Meanwhile these concerns go beyond common sense. They make business sense.
Consider housing. The National Low Income Housing Coalition reports a shortage of more than seven million affordable rental homes for extremely low-income households. This gap affects workforce mobility, job retention, and family stability. In cities with severe housing stress, employers cannot fill jobs because workers cannot live nearby.
Or take hunger. The USDA estimates that more than 47 million Americans live in food-insecure households. Children who are malnourished underperform in school. Adults who skip meals cannot stay focused on work. These are not abstract concerns. They are immediate threats to productivity and growth.
A president who understands this will not be swayed by ideology. They will ask: What strengthens our democracy? What builds a workforce that can out-innovate, out-produce, and out-lead our rivals?
The answer is not more bureaucracy. It is a targeted, accountable investment in workforce stability. Presidents should promote responsible public-private partnerships and remove barriers to full engagement. Communities need to strengthen local support and work with businesses on food, housing, and job training. Businesses recognize the returns on investments in workforce development and inclusive workplaces. Individuals should engage locally, build skills, and participate in practical solutions for community prosperity.
There is precedent. Conservative leaders have long understood that a stable society is a prerequisite for economic freedom. Abraham Lincoln supported land grants and public education. Dwight Eisenhower built the interstate system to connect markets and communities. Ronald Reagan expanded the Earned Income Tax Credit.
The next president should recognize these approaches. It is time to revive a governing vision that puts dignity at the heart of national strategy. That includes all Americans, from skilled professionals to warehouse workers, nurse’s aides, and long-haul truck drivers. Everyone has a responsibility to do their part to keep the economy moving.
This is where leadership matters. Not in posing as a cultural warrior, but in protecting our investments in the people who keep the nation running. A president who cares about this country will not ask what’s needed to make things easier. They will ask what’s needed to help us thrive together. They will help us choose the right way, the hard way, and maybe even the long way because building a competitive economy and a secure nation requires investing in the realities that make that happen.
If the next president can rise to that standard, then identity will matter far less than results. And maybe that is the clearest sign of progress yet.
Will Fries is a Maryland communications strategist with experience in multiple major presidential campaigns.
Opinions
We can’t afford Medicaid cuts in fight against HIV
A dangerous message about whose lives are deemed worth protecting

Right now, members of Congress are considering a budget proposal that would rip away life-saving health care coverage, particularly Medicaid from millions of people in the United States. This isn’t just unjust—it’s dangerous.
Since the late 1970s, there has been a strong push to advance the rights and well-being of LGBTQ+ elders, including the growing number of people aging with HIV. This community faces unique and often complex quality of life issues that require consistent, comprehensive care. Medicaid provides essential coverage for these services, including access to HIV medications, primary and specialist care, long-term care, and behavioral health support. Proposed cuts to Medicaid would destabilize this vital lifeline, threatening the health and dignity of one of the most medically vulnerable and historically marginalized communities in our country.
Congress is deciding just how deeply Medicaid could be cut. What’s at stake amounts to one of the most significant threats to public health in recent memory—one that would have a devastating impact on people aging with HIV.
The facts are clear: Medicaid is the single largest source of health care coverage for people living with HIV in the United States, covering roughly 4 in 10 people living with the disease. Many of those individuals are older people who rely on Medicaid not just for access to HIV treatments, but for managing other conditions that often accompany aging with HIV—such as cardiovascular disease, cognitive issues, and diabetes.
We have made remarkable progress in responding to HIV. Today, with effective treatment, people living with HIV can lead long, healthy lives. When HIV is suppressed to undetectable levels, it cannot be transmitted sexually. But this progress depends on consistent access to care. Without Medicaid, many people risk losing access to the medications that keep them healthy and alive—and that help prevent the transmission of HIV.
Moreover, Medicaid expansion has been directly associated with increased access to PrEP, a medication that is up to 99% effective at preventing HIV acquisition. Scaling back Medicaid would not only affect people already living and aging with HIV, but it would also limit preventive care that is essential to reducing new cases of HIV. In a world that too often dismisses older people as non-sexual and overlooks their need for HIV prevention services, the last thing we need is to further restrict access to sexual health services.
Older people with HIV often experience higher levels of isolation, stigma, and economic insecurity. They are more likely to be housing insecure and to have little to no family support. Medicaid helps older people maintain independence and age with dignity. Cutting Medicaid isn’t just a policy decision—it would create real hardship and suffering in the community.
Across the country, advocates and service providers see this reality every day. Countless LGBTQ+ elders and people aging with HIV rely on Medicaid for basic care and services. But that security can disappear quickly. That’s why taking action—right now—to help protect Medicaid is critical.
Here’s what you can do:
Call your members of Congress at 866-426-2631 and tell them “No cuts to Medicaid.”
Write your members of Congress and tell them that Medicaid must be protected for people aging with HIV. Our colleagues at AIDS United have created a simple and effective tool to help you reach your representatives directly.
Join the SAGE Action Squad. When you sign up, you’ll receive alerts and updates on urgent advocacy issues affecting LGBTQ+ elders and people aging with HIV. It’s a powerful way to stay informed and engaged—and to ensure your voice is part of this movement.
We understand that budget decisions are complex. But we also believe that protecting health care for the most vulnerable members in our community should never be negotiable. Cutting Medicaid doesn’t just reduce spending—it puts lives at risk. It creates new barriers for people aging with HIV to access care, manage their health, and live with dignity. It also limits critical prevention services for those vulnerable to acquiring HIV, undermining efforts to end the HIV epidemic.
If enough of us act, we can help stop these Medicaid cuts from happening. We can ensure that Medicaid continues to serve the people who need it most.
SAGE has been at the forefront of this fight for decades. We’ve helped secure victories in access, equity, and representation. But we can’t do it alone. We must come together to defend the programs that safeguard the health, dignity, and future of our community. Cutting Medicaid would not only roll back progress—it would deepen disparities, put lives at risk, and send a dangerous message about whose lives are deemed worth protecting. We must speak out and demand that our elected leaders prioritize care over cuts. Let’s protect Medicaid. Let’s protect people aging with, and vulnerable to, HIV. Let’s protect our community—and build a future where every older person with HIV can age with health, respect, and pride.
Terri L Wilder, MSW is the HIV/Aging Policy Advocate at SAGE where she implements the organization’s federal and state HIV/aging policy priorities.
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