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The intergenerational impact of aging with HIV

Dec. 1 is World AIDS Day

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World AIDS Day 2023 at the White House (Washington Blade Photo by Michael Key)

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.

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Kansas passes bathroom bounty hunter bill

A move reminiscent of slave catcher laws

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Kansas State Capitol (Photo by jzehnder/Bigstock)

Republican representatives in the Kansas Legislature recently passed a bill that bans people from using restrooms in government buildings that do not align with their sex assigned at birth. The bills SB 224 and HB2426 initially focused on rewriting legislation surrounding driver’s licenses but after amendments, the bill would not only stop trans people from updating their gender on these driver’s licenses but force people to surrender their existing licenses. These bills also carry the most severe anti-trans bathrooms ban of any state. 

According to Erin Reed for Erin In The Morning (EITM), “the measures would now even empower private citizens to act as bounty hunters — entering private business to search for transgender people in bathrooms and sue them for alleged violations.” 

The bills would allow anyone to report any people who utilize any bathrooms that do not align with their gender assigned at birth. Anyone who believes that someone has entered a restroom not in alignment with their gender assigned at birth can complain and pursue $1,000 in damages. The first time that someone complains about a person using the “wrong” bathroom, that person can face a written warning for their first violation. The second violation would require them to pay a $1,000 fine, and with each additional violation, they could receive a misdemeanor resulting in another fine or up to six months in jail. 

The Kansas Attorney General’s office is then responsible for determining whether the person has to pay the fine. Allowing people to police bathroom spaces is reminiscent of Florida’s bathroom law that allows transgender people to face criminal penalties, but even more dangerous, the bills extend this enforcement from “government-owned buildings” to private spaces. 

Government entities that manage bathrooms and locker rooms at public schools and universities, highway rest areas, and public parks are now required to assign a gender designation to multi-occupancy private facilities or face a $25,000 fine for the first violation and a $125,000 fine for any additional violations.

There is a section, Reed notes, that creates a “private right of action,” making it the first law to penalize trans people directly for using the restroom and would extend bathroom bans into private spaces. “Without the option of single-person or family alternatives, this essentially forces trans people out of public life by denying us the right to even relieve ourselves or wash up,” Isaac Johnson of Trans Lawrence Coalition told EITM. 

“Denying access to basic public amenities doesn’t just inconvenience people; it relegates them to second class citizenship,” Allison Chapman of Lawyers for Good Government told EITM. 

The legislation flew through the Kansas Congress (and by using procedural maneuvers, Republican lawmakers ensured that there was no public input on the bill). The bill is now heading to the Kansas Gov. Laura Kelly’s desk for signature. Thankfully, Kelly, a Democrat who has consistently vetoed anti-trans legislation, vetoed it, but even so, it could be passed if Kansas Republicans get the support of two-thirds of lawmakers in both chambers. 

The quick passage of these bills, and using the “gut-and-go” measure to ensure people had no opportunity to provide feedback after the bathroom elements were added, has drawn swift criticism.

The bills themselves have deeply unsettling historical parallels to slave catcher laws that allowed “bounty hunters” to track down and return escaped enslaved individuals to their enslavers for a cash reward. Federal laws, like the Fugitive Slave Acts of 1793 and 1850, enabled “bounty hunters” to operate even in free Northern states. These “bounty hunters,” also known as “slave catchers” or “kidnapping clubs” frequently kidnapped free Black people and sold them back into slavery, in what has been called the “Reverse Underground Railroad.” 

Both of these acts provided little to no protection to free Black Americans; in fact, these acts aided and abetted this violence by incentivizing the kidnapping and sale of people of color into slavery. Even if free people had official “freedom papers,” many kidnappers destroyed these documents, and even free people of color typically could not testify in court. Free and previously enslaved Black children who had escaped to the North were especially vulnerable to “slave catchers” because they often did not know how to assert their rights.

In fact, ICE’s kidnapping of five-year-old Liam Conejo Ramos echoes this long history of child snatching in the U.S., from bounty hunters capturing and selling Black children into slavery. 

This legislation also reeks of Texas Senate Bill 8 (SB 8), enacted in September 2021, that allowed private citizens to sue anyone who aids or performs an abortion after the detection of a fetal heartbeat, around six weeks of pregnancy. At the time, this was the most severe anti-abortion legislation on the books. It has remained there for five years, leading to a number of Rule 202 petitions that aim to collect more information that would provide a person who has violated SB 8. 

Just this past month, the Texas Supreme Court heard oral arguments for Sadie Weldon v. The Lilith Fund, a case where a private Texas citizen sought to depose Neesha Davé, deputy director of the Lilith Fund, a nonprofit that supports people seeking abortions. The case will not rule on SB 8’s constitutionality but would open a path to challenge the law. 

Bathrooms have long been a battleground to police people’s bodies, and this new Kansas soon-to-be law is no different. Think of segregation in the Jim Crow South between the 1890s and the mid-1960s when some White people acted as vigilantes ensuring that Black people remained out of “white-only” restrooms and other “white-only” spaces.

Just as Rep. Susan Hemphries, a Wichita-based Republican who brought the bill to the House floor said that the legislation is about the privacy for and safety of women, bathroom segregation was often justified by painting Black male sexuality as a threat to white women.

This even extended to the perceived threat of Black women in white women’s restrooms, with one group of white women in Detroit going on strike to protest the order prohibiting discrimination of people working in government and defense industries. These white women argued that they would contract syphilis from sharing toilet seats with Black women.

These new bills and all other anti-trans bathroom legislation, as many have argued, are the continuation of these racist bathroom restrictions.

There is deep historical precedence not only for policing public (and private) bathroom access but also enabling private citizens to act as bounty hunters. This form of bounty hunting threatens not just trans women but all women who anyone does not “assume” is cisgender who may be subject to legal complaints. As Orien Rummler reported for the 19th and them, anti-trans legislation and rulings threaten the rights of all women, especially cis women of color. And as science has long proved, gender is not binary–so it raises the question of how intersex people will be policed in these restrooms. 

And by commodifying the bounty, it emboldens anti-trans violence, and misogynistic violence writ large, in the most intimate of public and private spaces. 


Emma Cieslik is a museum worker and public historian.

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Criteria for supporting a candidate in D.C.

We deserve statehood and mayoral control of our National Guard

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Washington, D.C. (Washington Blade file photo by Michael Key)

Choosing a candidate to support for office in D.C. is a little different than choosing one in other places. As everyone knows, D.C. isn’t a state; though apparently not everyone understands what that means. 

D.C. was granted home rule in 1974, but the legislation gave us only partial control of our government. Congress retained the right to review all legislation and budgets for 30 days. During that time, it can reject legislation fully or just make changes. Recently, Congress has used that power to turn down legislation when the Council revised our criminal code and screwed with legislation regarding how we tax our own residents. Congress has messed with our budgets as well. We saw what happened when the felon in the White House took control of the MPD for 30 days, allowed under the home rule legislation, and how he has full control over the D.C. National Guard and the implications that has had. 

We have no representation in Congress, just a delegate. That person has been given a vote in committees when Democrats controlled the House, but even then, no vote in the full House. That all has severe implications for our elected officials. They must be aware of these things when they speak out, and when they propose and pass legislation. I personally saw that close up when we fought for marriage equality in the District. Those of us leading the charge worked with the Council on legislation to first recognize gay marriages from other states. Only after that legislation went through the review period without being stopped did the Council move to pass marriage equality in the District. Then we held our breath for the 30-day review period. There have been other instances where Congress stopped crucial legislation and put amendments onto our bills, like stopping us from spending certain money on needle exchange during the height of the AIDS crisis and stopping us from spending federal money on abortions.  

So, when deciding who to support I want to be sure a candidate understands the implications if they attack Congress and the president, especially when Republicans are in charge. The fact is we have been screwed even by some Democrats. In today’s world, until we get rid of the felon, and Democrats take back both houses of Congress, all of our elected officials, but particularly our mayor, will be walking a tightrope. Beating your chest and attacking what they are doing is not the way to go. Again, we are not in the same position as cities like Portland, Minneapolis, or LA. We saw that again when the courts said the National Guard had to leave those cities, the president couldn’t send them in, but D.C. was exempt from that decision because he can send them here. The president, not the mayor, controls the National Guard in D.C. 

Once I am comfortable a candidate understands all that, my criteria for supporting them of course includes many other things. I am a liberal, born in New York City. I taught public school in Harlem and was a member of the teacher’s union. Then went to work for progressive Congresswoman Bella S. Abzug (D-N.Y.). After that, I served as Coordinator of Local Government for the City of New York, during the time of the financial control board there. Then came to D.C. in 1978 to work for the Carter administration. I have been an activist all my life in the areas of civil rights, women’s rights, disability rights, and finally LGBTQ rights. I am a community and Democratic activist. All this impacts my decisions regarding candidates. I want to hear consistency from them. I don’t have a problem with people changing their mind on issues based on principle but do have a problem when it seems like they do so based on which way the wind is blowing. Like those who screamed ‘Defund the Police’ until the community they thought wanted to hear that in D.C. actually told them they wanted more police, not less. They simply wanted them better trained, held more accountable, and more community oriented. 

I want a candidate to support statehood for D.C., but while fighting for that, they should speak out for budget and legislative autonomy. They must support mayoral control of the DC National Guard, and a full 4,000 member, well trained, MPD.  They must understand how MPD works with federal law enforcement like the FBI, park police, capitol police, and the secret service. They need to reject working with ICE. They need to support more affordable housing, but not city owned housing, which has proven to be a failed experiment. They need to pledge to work to end homelessness providing decent, and available, shelters around the city for both individuals, and families in need. I want a strong education Mayor who supports teachers, and works to expand accountability for charter schools, holding them to the same standards as the public schools. We must have strong programs for both college bound students, and those who want another path, including internships and apprenticeships. Strong support for UDC, healthcare both affordable and available for all, and rental and food assistance when needed. There needs to be a strong focus on reducing the cost of childcare.  A focus on the ARTS, libraries, and recreation centers, across all wards of the city.  A focus on the environment, and affordable and accessible transportation. Of course, for me it’s a given they must support, and speak out, for the full panoply of rights for the LGBTQ community.

Looking at that list clearly means the city needs to raise the money to pay for all of it. Any candidate running for office who says they don’t support a strong, and vibrant, business sector, is either naïve, or just dumb, and will not have my support.  A vibrant business community provides jobs, and in the long run the taxes that pay for the things we all want government to provide. 

Once again D.C. is in a different place. We don’t collect taxes from those who work here but live in Maryland or Virginia. So, we have to be smart about the businesses we encourage to locate here and encourage them to hire D.C. residents, who then will pay taxes here. D.C. has developed a strong sports economy. That will be enhanced by the new RFK site, and includes the teams at the Capital Center, Audi Field, and Nats Stadium. Together they bring millions of people into D.C., who spend their money here. When groups like the Working Families Party, who suggest they are anti-business, endorse a candidate, I am wary of that candidate. We can’t be anti-business in D.C. I look at some candidates trying to replicate Mamdani’s victory in New York City by promising the moon. What they don’t seem to realize, or pretend not to, but voters must understand, is we in D.C., our Council and mayor, can’t promise what a New York City mayor does, hoping the governor and Albany, will help him out. In D.C. we don’t have an Albany to help us out. There is no governor coming to the rescue, it’s just us, and what we can negotiate with our Albany, which unfortunately consists of the president and Congress. Some may remember in 1995 we had the Control Board foisted on us. It was lucky at the time the president was a Democrat, Bill Clinton, and he named the board and chair, first Andrew Brimmer, and then the incredible Alice Rivlin. Can you imagine if Congress did that today who Trump would name to control our city?  

So, we can’t only dump on them, and attack them, at least the mayor can’t, as she/he/they have to often ask them for help, and stave off their gratuitous attacks. As a columnist, and private citizen, I can attack the felon and his Republican sycophants in Congress all I want, I do and will continue to do so. But those we elect need to understand some constraint. The need to understand sometimes they are walking that tightrope when dealing with the White House and Congress. 

I urge everyone to look closely at all the candidates, and then when you decide who you want, make sure you VOTE!


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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The global cost of Trump’s foreign aid ideology

Expanded global gag rule polices people’s identity

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The White House (Official White House Photo by Adam Schultz)

U.S. Vice President JD Vance on Jan. 23 announced the new Promoting Human Flourishing in Foreign Assistance Policy. This policy, which has nothing to do with flourishing, is part of the Trump administration’s effort to weaponize U.S. foreign assistance to enforce ideological conformity, to police people’s identity, and to suppress dissent — both at home and abroad. 

One of the policy’s three pillars advances a discriminatory framework that denies transgender people’s existence and seeks to censor organizations that affirm transgender people and their rights. 

The new policy expands the Mexico City Policy, also known as the global gag rule, which has restricted U.S. foreign aid to non-U.S. civil society organizations providing abortion care under every Republican  administration since 1984. What is new — and unprecedented — is the expansion of this rights-restricting logic to efforts addressing gender identity and, more broadly, nondiscrimination efforts. 

The new policy also applies to more categories of aid recipients, including multilateral organizations such as UN agencies. 

With the expanded global gag rule, the Trump administration seeks to make transgender people invisible globally, as it has within the U.S. Whether it is threatening steep tariffs for countries that resist Trump’s appetite for Greenland, or withholding  funds for organizations that refuse to toe the ideological line, the chilling message is clear: standing in the way of the administration’s political or ideological goals will come at a high cost.

Under this rule, organizations risk losing U.S. funding if their activities are seen to fall under the spurious concept of “gender ideology.” Organizations are not allowed to provide, refer for, or support access to gender-affirming care. Neither can they offer accurate information, counseling, or public-facing support for transgender people. The restrictions even apply to cultural activities such as “drag queen workshops, performances, or documentaries.” 

Organizations that receive any foreign aid from the U.S. will need to censor themselves, even if their own national or regional laws enable — or oblige — them to speak up for human rights.

This new policy comes after the Trump administration dismantled the U.S. Agency for International Development, which has for decades provided the bulk of U.S. international development and humanitarian assistance.

To be clear, LGBT people, regardless of where they are, do not depend on the United States to organize, advocate, and stand up for their rights. And foreign aid is not the answer to undoing global inequity. But the sharp reversal of U.S. foreign policy will have wide-ranging consequences. 

For years, protecting the rights of LGBT people had been a core tenet of the U.S. commitment to human rights. U.S. embassies often functioned as safe havens for human rights defenders in places where governments stoked homo- and transphobia for political gain. For LGBT people in the 65 countries that still criminalize same-sex intimacy, civil society-run clinics, supported with U.S. funds, became life-saving spaces — people could get HIV and other care there without fear of being turned away, ridiculed, or reported to the police.

Much of this is progress is now at risk. As a result of the U.S. funding cuts, organizations that directly provided health care and other services for LGBT people were forced to stop services abruptly, cutting off people’s access to chronic medication often without alternative care in place. 

The impact extends beyond individual harm. Public health programs by definition are more likely to fail when stigma and fear are institutionalized. Transgender people are among the groups most at risk for ill health precisely because of discrimination and violence.

By prohibiting organizations, from local civil society groups to multilateral organizations like UNAIDS, from affirming transgender identities or addressing these underlying conditions, the expanded global gag rule actively undermines the foundations of effective public health programs. 

Under the new and expanded gag rule, organizations face a terrible choice for accepting any U.S. funding. They can either self-censor and stop all work related to transgender people’s rights and needs. Or they forego U.S. funds and risk jeopardizing their organizational survival in an increasingly tough economic and funding climate. 

This matters because civil society is one of the few effective counterweights to the global rise of populist and authoritarian governance. Alongside a coordinated global backlash against women’s and LGBT people’s rights are efforts to concentrate power, erode accountability, and close civic space.

Civil society organizations are crucial in exposing and resisting the authoritarian creep and in supporting marginalized groups. Gagging organizations into silence, or hollowing them out through funding cuts, accelerates civic space closure, and strengthens authoritarian governance.

Where the U.S. retreats and bullies, other countries and communities need to step up to offset the funding shortfalls and reduce organizations’ dependency on ideologically restricted U.S. foreign aid. 

They need to support marginalized groups, increase funding for civil society groups, and commit funds to bolster multilateral mechanisms such as the Global Fund, which supports funding to combat HIV/AIDS, TB, and Malaria. They should clearly and consistently affirm everyone’s human rights, without exception.

Alex Muller is the director of Human Rights Watch’s LGBT Rights Program.

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