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
Capitalism, patriarchy, and neocolonialism are repackaging the scramble for Africa

The old scramble for Africa was about land, minerals, and control. The new scramble is cloaked in buzz phrases such as “promoting and protecting African family values,” “natural family,” and “defending the sanctity of the African family,” but it is driven by the same trio: capitalism, patriarchy, and neocolonialism.
Across the African continent, violence against marginalized people, such as women, girls, and LGBTIQ+ people, is not just some unfortunate result of ignorance and intolerance. It is not a cultural misunderstanding. It is deliberate. It is precise. It is profitable. It is pro-hate legislation. It is ideologies. It is business and is being packaged, exported and sold under the glossy buzz phrases used by the same big global forces that have long treated Africa as an experimental lab, an extraction of resources and a playground with African lives. If we zoom out far enough to what looks like moral panic is actually a business model where patriarchy meets capitalism galvanized with extreme religious ideologies, leaving that familiar colonial aftertaste.
Can ‘Ubuntu’ counter hate?
The anti-rights and anti-gender movement is sweeping rapidly across Africa on a mission to cement hate within African communities, thus making our nations and governments their experimental lab, as mentioned earlier. But we all know that hate is inherently un-African. It does not originate from Africa. It was exported onto our African soil through colonialism, patriarchy, and capitalism.
When I say that hate is un-African, this is not to claim that our communities — pre and post colonialism — were utopias. It really is to push back against the idea that supporting and protecting marginalized groups is foreign, and that rejecting them is somehow essential to preserving African culture. Protecting and empowering groups such as women and LGBTIQ+ destabilises the pillars of patriarchy and threatens capitalism, as there would be no market to sell refurbished colonialism.
Africa is not immune to hate, but it is the result of intolerance and inequality that is being imported. Africa has long been a place of respecting diversity, and professor Sylvia Tamale describes it best in “Exploring the Contours of African Sexualities: Religion, Law and Power,” by alluding that “plurality is simultaneously the boon and the bane of Africa. The cultural diversity and richness found between and within the continent’s religious and cultural communities lend to its versatility and beauty.” Tamale reminds us that African diversity enriches and offers multiple intersectional ways of being, navigating the world, and living in community grounded in compassion and humanity — “Ubuntu!”
In their article “Understanding Ubuntu and Its Contribution to Social Work Education in Africa and Other Regions of the World”, Mugumbate et al. explore the African philosophy of “Ubuntu” and its relevance to social work education. In taking lessons from their article, “Ubuntu” emphazises interconnectedness, compassion, and communal responsibility. The authors argue that integrating “Ubuntu” can be a weapon used to counter imported hate theories and practices. In our current climate, where anti-rights and anti-gender sentiments are gaining traction across Africa, the principles of “Ubuntu” are more pertinent than ever. It serves as a reminder of the importance of community and shared humanity, advocating for inclusive practices that uphold human rights and dignity for all individuals regardless of their social status, gender identity or sexual orientation.
In all honesty, there is money in hate and exclusion. This is evident in the anti-rights and anti-gender U.S. and European religious conservative organisations’ funding of anti-rights legislation, to supporting conferences where “protecting African values” is code for keeping white supremacy, protecting patriarchy and keeping colonial control. “We see a kind of investment that pays off in political influence and dominance. But who is really in control? African leaders or global north anti-rights and anti-gender groups?”
Anti-rights and anti-gender conservative groups, such as Family Watch International, La Manif Pour Tous and Alliance Defending Freedom have been linked to supporting laws that criminalize LGBTIQ+ identities, strengthening platforms that silence women and girls and manipulate African politicians, Presidents and first ladies who are eager for power, votes and validation. It is colonialism in high definition, backed by capitalism and masked as African traditional values. It is no different from Europe’s scramble for Africa in the 19th century, but this time, they are after our minds, bodies, rights and democracy.
These are not random acts, they are coordinated crackdowns on humanity. From Uganda’s Anti-Homosexuality Act to Ghana’s Human Sexual Rights and Family Values Bill to Namibia’s amended Marriage Act, we are seeing regressive legislation that is cut from the same hate cloth. Across Southern Africa, from Tanzania, Namibia, Malawi to Zambia, LGBTIQ+ people are being harassed, arrested, or killed. While human rights instruments, such as the Maputo Protocol, which protects women’s rights and bodily autonomy, have come under massive scrutiny by Family Watch International, possibly leaving the rights of women and girls at the mercy of these groups. What is even more saddening is that one can see African leaders mimicking hate sentiments that are being pushed by the global north’s anti-rights and anti-gender groups. “Do our leaders know that these hate groups are controlling them?” Some African leaders have adopted rhetoric that portrays women’s autonomy and LGBTIQ+ people as a threat to national identity and traditional values. But these sentiments are not rooted in African customs but are instead borrowed and repackaged from the anti-rights and anti-gender books.
The 2025 anti-rights and anti-gender Africa tour
If you thought the colonial era was over, think again. Between May and October 2025, Africa is hosting a series of anti-rights and anti-gender convenings that are supported by US and European conservatives.
From May 9-11, the Ugandan parliament hosted the third Inter-Parliamentary Conference, which was supported by conservatives pushing the controversial African Charter on Family Values. The conference was attended by 29 African MPs, including the deputy speaker of the National Assembly of Zimbabwe. The second Pan-African Conference on Family Values, which was held in Kenya from May 12-17, convened African political leaders, policymakers, and religious leaders. The Africa Christian Professionals Forum organized the conference under the theme “Promoting and Protecting Family Values in Africa.” Attendees included representatives from the Supreme Court of Kenya.
In June 2025, Sierra Leone will host the seventh edition of the Strengthening Families Conference, an event endorsed by the first lady of Sierra Leone. Notable attendees include leaders from Cote d’Ivoire, Congo, Ghana, Gambia, Kenya, Mali, Nigeria, and Senegal. The African Advocates Conference in Rwanda, funded by the U.S.-based Alliance Defending Freedom International, will take place from Aug. 12-17. Think of them as lawyers for oppression. The conference will host delegates from 43 African countries, including government officials, judges, academics, lawyers, and students. Advocates Africa has members from Angola, Botswana, Eswatini, Lesotho, Malawi, Namibia, South Africa, Zambia, and Zimbabwe. Finally, from Oct. 19-23, 2025, Ghana will host the Africa Bar Association Conference, a platform that pushes anti-feminist, anti-rights, and anti-gender narratives, under the guise of debating foreign interference.
These are not African-led spaces, they are U.S.- and European-led laboratories for exporting hate and mayhem. A global machine fueled by capitalism, patriarchy, and neocolonialism.
This article is part of the Southern Africa Litigation’s campaign around addressing hate speech, misinformation, and disinformation. #StopTheHate #TruthMatters
Bradley Fortuin is a consultant at the Southern Africa Litigation Center and a social justice activist.
Opinions
I interviewed Biden in late 2024 and he was attentive, engaged
CNN narrative about former president’s mental state is unfair, exaggerated

In the weeks since Jake Tapper and Alex Thompson’s “Original Sin” came out, there has been so much speculation about Joe Biden’s cognitive health that feels so pointlessly retrospective to me, or conveniently certain — even though I wouldn’t say I disagree fundamentally with what seems to have emerged as the consensus view.
Writing in POLITICO, James Kirchick took the Beltway reporters to task for what he argued was their (our) failure to investigate and cover the “truth” about the president’s mental acuity, as if the truth were a simple binary (is he okay?) and as if the answer was as evident at the time as it now appears with the benefit of hindsight.
“Lack of access is no excuse,” he wrote. I happen to disagree: Not only is that an excuse but it’s also a perfectly serviceable explanation.
We can report only what we know, and we can know only what we can observe with our own eyes and ears. If you happened to catch a White House press briefing in 2023 or 2024, there’s a pretty good chance you heard difficult questions about Biden’s health. When we don’t have much time with the president, we rely on the testimony of those in his inner circle who did.
And at this point I become agnostic on the question of whether there was a coverup by those closest to him or an effort to obfuscate the truth. Because even now the reality looks murky to me, and I was fortunate enough to spend more time with Biden than many of my colleagues near the end of his tenure in the White House.
As many of our readers will know, in September 2024 I had the great privilege of interviewing the president one on one across the Resolute Desk in the Oval Office.
Biden was as attentive and engaged as anyone I’ve spoken with. When I reflect on the experience, I remember how blue his eyes looked and how electrifying it felt to have his gaze and focus fixed on me.
Part of that is charm and charisma, but I also think he took very seriously the opportunity to talk about his legacy of helping to advance the equality of queer people in America. He wanted to be there. He spoke clearly and from the heart.
The president came with a binder of talking points prepared by the press secretary and the communications director, but he barely glanced at the notes and needed assistance from his top aides only very briefly — on two moments when he stumbled over the name of the Heritage Foundation’s Project 2025 (specifically the “2025” part) and Karine Jean-Pierre spoke up to help him.
On the one hand, Project 2025 was a critical part of the messaging strategy of his and then his vice president’s 2024 campaign, and our conversation came at the tail end of the election cycle last year. On the other hand, considering the totality of my experience talking with Biden, looking back it doesn’t seem like those lapses were that big of a deal.
I guess what I am ultimately trying to say is this: I think we should extend some grace to the former president and those closest to him, and we should also have some humility because a lot of these questions about Biden’s cognitive health are unclear, unsettled, and even to some extent unknowable.
And another thing. I am grateful for the opportunity to interview him, for his years of public service, and for his unwavering defense of my community and commitment to making our lives better, safer, richer, healthier, happier. I pray for his recovery such that these words might come to describe not only his legacy in public life, but also his years beyond it.
Christopher Kane is the Blade’s White House correspondent. Reach him at [email protected].
Opinions
LGBTQ health equity must not be abandoned
Beneath the glitter of Pride there is a simmering fear

Pride month feels different this year. There is a simmering fear beneath all the glitter. Of course, Pride has always been a festivity interwoven with a certain amount of unease. Our rainbow parades were forged from protest marches, demonstrations that erupted from a community under the searing fire of violence and humiliation. Accordingly, our rhinestone costumes and glimmering disco balls have always held an element of precarity, though that edge may have felt less present recently. Nevertheless, Pride is a holiday in active conversation with our communities’ place in society. At once, it is a moment of radical celebration while also an act of resolute defiance.
However, Pride month feels different this year because that conversation has shifted. The discourse around our communities carries a renewed threat of violence: systemic, political, and physical. In just six months since the inauguration, the Trump administration has worked swiftly to strip protections from LGBTQ+ communities, erase our histories, and demonize us in the public imagination. The vitriol that Trump and his lackeys have spewed against the trans community specifically is completely baseless and profoundly dangerous. Although our communities have long weathered such abuse, the return of such bigoted ideology at the highest levels of power is alarming, to say the least.
One of the key ways Trump has attacked LGBTQ+ communities is by targeting our access to healthcare. While healthcare is essential for anyone, for LGBTQ+ people, it can mean life or death. Our medical needs are unique and complex, often compounded by intersecting identities of race, ethnicity, gender, and sexual orientation. Denying us affirming, equitable care is not just negligent, it’s dangerous. By enacting barriers to gender affirming care, slashing tens of millions of dollars in grants for LGBTQ+ medical research, and stripping away essential protections, the current federal administration is carrying out a calculated assault with catastrophic consequences.
As a queer, nonbinary person and practicing psychiatrist, I have an intimate, visceral understanding of these issues. Even before Trump ever set foot in the Oval Office, the medical disparities affecting my LGBTQ+ friends, colleagues, and patients were obvious to me. As a young medical student in Indiana, I quickly became aware of the substantial gaps in access to healthcare for LGBTQ+ communities. At a base level, there is already significant distrust between LGBTQ+ patients and their providers, stemming from a long history of mistreatment and, in many cases, outright gaslighting, abuse, and trauma. This distrust can prevent patients from seeking care, and even when they do, providers often lack the training to deliver the affirming care they need.
This lack of equitable and affirming healthcare led me to found OutCare Health. OutCare started with a carefully curated list of medical professionals with the knowledge, training, and experience to provide LGBTQ+ people with the care they desperately need and deserve. That list has since blossomed to more than 6,000 providers and has become a vital resource for LGBTQ+ communities, their families, and allies. Over the last decade, our grassroots efforts have grown into a national force, and our programming has expanded to include health equity training, care navigation, and public education. That early momentum gave me hope that we were making headway in the fight to ensure that LGBTQ+ communities have access to the care they deserve.
However, with the return of Trump to the White House, it feels like everything has changed. We endured his first administration, bolstered by what felt like a nationwide resistance to his presidency, but this time, something is different. Instead of resistance, the air feels thick with despair, lulling the country into a doleful acceptance of our fate. Moreover, there is a pervasive sense of fear. Some providers have asked to have their names removed from our OutList of affirming providers, not out of a desire to stop helping our community, but out of a legitimate fear of retribution, professional retaliation, and even their own safety. This is a request I completely understand. There is nothing wrong with protecting yourself, your livelihood, and your family, but the need to do so speaks volumes about the political climate in which we find ourselves.
What has been truly demoralizing has been the behavior of the healthcare field at large. The willingness to grovel to the unscientific, harmful, and ignorant policies of the Trump administration is not just disappointing, it’s disgraceful. Even more disturbing is the speed and enthusiasm with which some health systems and organizations have preemptively distanced themselves from LGBTQ+ equity work, as if racing to prove their compliance with regressive ideology. Many of our past partners have vanished, most without a last goodbye. To those outside our communities, this quiet retreat from providing life-saving care to those of us who are being vilified may seem unfortunate yet pragmatic. But let me be clear: if you abandon your values in moments of inconvenience, you never really held them in the first place.
Nevertheless, I do not believe we can resign ourselves to walking despondently into the future being laid out for us. Although we are seeing an attempt to systematically dismantle many of the structures that we have put in place to help ensure health equity for LGBTQ+ communities, it is worth remembering that it was we who built those structures. Fifty or even 25 years ago, we had so much less than we do now, even after these attacks. Today, we have life-saving medications and therapies that we used to only dream of. We have networks and coalitions with deep knowledge and formidable strength. They may force us to take a step backward, but they cannot and will not make us turn around.
Most importantly, we have each other, and we have the wisdom of those who came before to guide us. From the Stonewall Riots to seizing control of the FDA, the LGBTQ+ community has shown a staunch resilience and strength of spirit that has always been one of our greatest assets. Although we are a broad and diverse banner and may not always agree, we must remember that our sense of community and our ability to organize are what have gotten us where we are today. We must stand shoulder to shoulder, hand in hand. The echoes of our footsteps drumming the streets can cause even the most unyielding enemy to cower. These are lessons we cannot afford to forget. Our survival depends on it.
So yes, Pride month does feel different this year. There is indeed a simmering fear beneath the glitter, but deeper than that fear, more enduring and infinitely stronger, there is grit—grit forged in fire and defiance. We are vibrant, colorful, and unapologetically queer, but do not mistake our joy for weakness. We’re loud, we’re resilient, and we’re holding the damn line.
In this spirit, let me make one thing abundantly clear: OutCare Health is not going anywhere. When I founded this organization 10 years ago, I knew it wouldn’t be easy, but I didn’t do it because it would be easy. I did it because it was necessary. Because it was right. Because it was my life. Your life. Our lives. We will not back down, and we will not be erased. We will continue to uplift our communities and fight for truth, equity, and democracy—no matter what the bigots throw at us.
To my OutCare family and all LGBTQ+ families, know that we are here for you, and we will not stop. To our allies, now is the time to show up—loudly, proudly, and relentlessly. To those who fear our freedom, despise our joy, and resent our very existence: our glitter may catch your eye, but don’t underestimate the strength burning beneath it. We will not break. We will not be silent. We’re not going anywhere.
Happy Pride!
Dustin Nowaskie, MD is founder and chief medical officer of OutCare Health.
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