Living
Gay, bi men remain key to HIV epidemic
After 30 years of AIDS, many breakthroughs but infection rates on the rise
On June 5, 1981, the U.S. Centers for Disease Control and Prevention published an article in its authoritative journal Morbidity and Mortality Weekly report that experts now consider the first signal that an unprecedented worldwide epidemic had begun.
“In the period of October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carini pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died,” the MMWR article stated.
“Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients,” said the article. “The occurrence of pneumocytosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual.”
It would take another few years before scientists named the condition detected in the men discussed in that MMWR article as Acquired Immune Deficiency Syndrome or AIDS. The name AIDS followed an earlier term used by some researchers and the media – Gay Related Immune Disorder or GRID.
In reflecting on the tumultuous developments surrounding AIDS over the past 30 years, leaders of AIDS advocacy organizations and LGBT activists in the U.S. who lived through the early years of the epidemic say that, to some extent, the MMWR article of June 1981 still has considerable resonance for gay men.
They acknowledge that so much has changed for the better over the past 30 years, including breakthroughs in biomedical research resulting in highly effective drugs that transformed AIDS from a death sentence into a manageable, chronic illness like diabetes.
But AIDS activists also point out that HIV and AIDS continue to disproportionately impact gay men or men who have sex with men (MSM) in the United States and other countries.
And although the perception of AIDS as a “gay disease” has largely receded from the minds of most Americans, AIDS activists say they find themselves in the ironic position of having to remind Congress and state and local governments that more resources and funding are needed for HIV prevention programs targeting gay and bisexual men.
“MSM is the only group for whom, according to the CDC, new infections are still increasing,” said Ronald Johnson, vice president for policy and advocacy for AIDS United, a national group formerly known as AIDS Action.
“So there continues to be a concern that there is not enough targeted prevention resources to MSM, particularly MSM of color and young MSM of all races and ethnicities,” Johnson said.
According to the CDC, while MSM account for about 2 percent of the U.S. population, more than half of all new HIV infections in the U.S. each year (53 percent) occur among MSM. CDC data also show that MSM make up nearly half of all people living with HIV in the U.S. – 48 percent.
CDC figures show that white MSM “account for the largest number of annual new HIV infections of any group in the U.S., followed closely by black MSM,” according to a CDC fact sheet released last month.
“There are more new HIV infections among young black MSM (aged 13-29) than among any other age and racial group of MSM,” the fact sheet says.
The Obama administration, with input from AIDS advocacy organizations, released a National HIV/AIDS Strategy document in July 2010 that, among other things, calls for an aggressive effort to develop better HIV prevention programs targeting MSM.
Johnson and Carl Schmid, deputy executive director of the AIDS Institute, a national advocacy group, praised the administration for developing the strategy document, which they say covers most of the bases needed for addressing HIV prevention programs for MSM.
But the two said the proposals in the strategy document have yet to be fully implemented. They note that delays in its implementation are due, in part, to the U.S. economic situation that has prevented needed increases in federal AIDS funds and severe cutbacks in state and local funding for AIDS-related programs.
Phill Wilson, president and CEO of the Black AIDS Institute, said in a commentary last week in the Washington Informer, a black community newspaper, that he fears the horrors of the AIDS epidemic of the 1980s, when friends and family members watched loved ones die due to a lack of effective medical treatment, could return to some degree in the next few years.
According to Wilson, if the federal government fails to boost funding for the federal-state AIDS Drug Assistance Program (ADAP), low income people who rely on the program to provide them the medications they need keep the AIDS virus in check could become casualties just as their predecessors became casualties years earlier. But this time, he said, an inability to gain access to medicine due to funding shortfalls would be responsible for their fate at a time when effective medicine is readily available.
He called such an outcome “immoral.”
The ADAP program was created under the Ryan White AIDS Care Act to provide life-sustaining drugs for low-income people with HIV and AIDS who are under insured or don’t have any health insurance to help pay for the drugs.
ADAP funding cuts by states and a large increase in the number of people applying for ADAP assistance has resulted in nearly 8,000 people being placed on state waiting lists for the AIDS drugs they need to remain healthy.
The health insurance reform law that President Obama proposed and Congress passed two years ago was expected to relieve the ADAP funding pressure on states when it takes effect in 2014. However, some states that oppose the law have filed lawsuits seeking to prevent its provision requiring all citizens to buy some form of health insurance from going into effect, making its outcome uncertain.
Nearly all AIDS advocacy groups support the law, saying it would strengthen medical care for large numbers of people with HIV/AIDS.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, an arm of the U.S. National Institutes of Health, has been the leading federal government official monitoring the AIDS epidemic and directing AIDS-related research since the disease burst on the scene in 1981.
In a speech commemorating the 30th anniversary of AIDS at NIH headquarters in Rockville, Md., on Tuesday, Fauci said he’s optimistic that an AIDS vaccine can be developed in the near future.
“We have scientific evidence that a safe and effective HIV vaccine is possible,” he said in a statement released on May 18.
“In 2009, a clinical trial in Thailand involving 16,000 people demonstrated for the first time that a vaccine could safely prevent HIV infection in a modest proportion of study participants,” he said. “Many of the best minds in HIV vaccine science are examining blood samples and data from the Thai trial to learn how the vaccine candidate prevented HIV infections and to consider how it could be modified to be more effective.”
Fauci said NIAID is also optimistic about development within the next few years of effective vaginal and rectal microbicides that can be used to prevent the transmission of HIV during sexual contact.
Fauci and other researchers have also pointed to studies showing the effectiveness to a certain degree of prescribing HIV drugs for use by non-infected people believed to be at high risk for HIV infection, such as men who have sex with men.
Known as pre-exposure prophylaxis, or PrEP, the use of this prevention measure is said to have the drawback of being less effective if people fail to take the drug as required. Some also have expressed concern that people using this prevention method are subject to potential side effects of the drugs and may be discouraged from using condoms, which experts say is one of the most effective methods of HIV prevention.
Events and developments in the early years of AIDS
• 1981: The CDC reports in its June 1981 edition of MMWR and subsequent editions that year that an estimated 170 gay men had succumbed to Pneumocystis carini pneumonia and Kaposi’s sarcoma, a rare skin cancer, over the preceding two years. The CDC studies of these cases cited a serious malfunctioning of the body’s immune system in those who contracted the conditions.
• 1982: Gay Related Immune Disorder, or GRID, became the first name to describe what is now known as AIDS. Cases reached epidemic proportions in the U.S., moving beyond clusters of gay men in New York, San Francisco and Los Angeles and into groups with no obvious risk factors.
• 1983: Gay leaders, independent medical researchers and health and social services agency officials testify before a congressional committee that the federal response to AIDS was highly inadequate. They issue a plea for the federal government and the Reagan administration to increase federal funding and federal initiatives to fight AIDS.
• 1985: In late July, actor Rock Hudson stunned the nation when he issued a statement saying he had AIDS and was receiving treatment in Paris that he said he couldn’t get in the U.S. He died three months later at age 59. His announcement and death drew massive mainstream media attention to AIDS. His death prompted his close friend, actress Elizabeth Taylor, to help found the American Foundation for AIDS Research to raise funds for AIDS causes.
• 1988: The NAMES Project AIDS Memorial Quilt makes its second trip to Washington in the spring, where it’s displayed on the Ellipse near the White House. Later that year, about 1,100 AIDS activists staged a protest at the headquarters of the U.S. Food and Drug Administration in suburban Maryland outside D.C., denouncing the FDA for taking too long to approve new drugs for people with AIDS. Police arrested at least 176 of the protesters after they blocked access to the FDA building’s main entrance.
One of the biggest headaches of the new home process is the actual moving part. By the time someone is buying a home, most people are beyond the “I just need a pickup truck, a pizza and a case of beer for my friends.”
If that is still someone’s preferred way to move, that’s great. However, many people find they need a much more robust plan. It can also trigger a lot of feelings about items one owns, what to do with them, do they have too much, should I keep this memento that I never use? Etc.
Moving is a chance for a person to “clean house” literally, figuratively, spiritually and energetically. A person can figure out which items they want to keep, and which need to go. As someone who recently moved across the country, I can speak to this experience. It’s also time for what people call “the fresh start effect.” This phenomenon, according to psychologists, can happen in little moments (like the start of a new work week) and bigger moments (such as moving from one home to the next).
The fresh start effect offers these benefits often mentioned by psychologists:
- Mental Accounting: Dates act as chapter breaks, letting you put past failures into a previous period.
- Psychological Distance: You separate your flawed past self from your aspirational future self (“That was the old me”).
- Optimism Boost: New beginnings clear mental clutter and increase your sense of agency and control
Does this mean that “the new you” will be the perfect version you envisioned? Probably not. We are humans. But it might mean you get a chance to “leave some of the old you behind” within the walls you used to live in, and now have a chance to have a new layout, a new décor, a new color pattern, new wallpaper, donate old furniture and books or magazines, throw out clothes you no longer use or fit in, and enjoy the opportunity to literally use the, “Does this spark joy?” method that was made so popular by Marie Kondo in her Netflix series.
So, for all its hassle and headache, moving is a chance to shake off the “old you” and try on the new you, to incorporate the items you would like to keep and use more of, and shed the items, habits, and ways of thinking that you feel no longer serve you.
I can speak to the experiences that several of my clients had when they moved from a previous residence to a newer one. It usually coincided with a change in relationship status, a change in employment, a change in family size, but sometimes it just seemed to correlate to a new attitude and perspective that the client was really hoping for.
I have literally had clients come to me after the fact, in tears, that they were so happy they made the decision to move out of a situation that no longer served them, and move into one that felt like a much better fit.
Change can be annoying and overwhelming at times, but usually most people come out the other side, not wanting to return to the way they were before.
Joseph Hudson is a referral agent with RLAH. Reach him at 703-587-0597 or [email protected].
Despite a U.S. political climate that has made electric vehicles about as welcome as a vegan at a Texas barbecue, automakers haven’t gotten the memo. The 2027 BMW iX3 and Rivian R2—in showrooms soon—prove the point. But think of them as distant cousins: one arrives impeccably dressed; the other probably has a kayak strapped to the roof.
BMW iX3
$62,000
Range: Up to 434 miles
0 to 60 mph: 4.7 seconds
Cargo space: 30.4 cu. ft.
PROS: Huge driving range. Distinctive styling. Cutting-edge interior.
CONS: Quirky digital controls. Only one U.S. trim level. Pricey options.
WHAT’S NEW: This is BMW’s first production model on its state-of-the-art Neue Klasse platform, radically changing the technology, cabin and electric drivetrain.
The iX3 arrives on our shores in one trim level, the iX3 50 xDrive. Load it up with options and you can sail well past $80,000.
Depending on configuration, this luxe EV delivers an astonishing range before recharging. And a dual-motor, all-wheel-drive system produces 463 horsepower, which allows you to tootle around as fast as a Porsche 718 sportster.
The new “Panoramic iDrive” spreads information across the base of the windshield, supplemented by a central display and steering-wheel controls. An available 3D head-up display adds even more info. It’s futuristic, busy and unmistakably BMW—like someone decided the dashboard needed its own coming-out party.
Then there’s the “Heart of Joy” computer, which coordinates the motors, braking and steering for sharper responses and smoother control. The name may sound like something from a self-help retreat, but the innovation makes the iX3 seriously entertaining to drive.
You also can charge the iX3 from 10 percent to 80 percent in just 21 minutes. Nice.
This isn’t merely an electric X3 with the gasoline bits removed. It’s a tech reset for BMW. Compared with the R2, the iX3 is more polished, more luxurious…but, alas, considerably pricier.
RIVIAN R2
$45,000
Range: Up to 345 miles
0 to 60 mph: 5.9 seconds
Cargo space: 28.7 cu. ft.
PROS: Affordable luxury. Rugged looks. Clever storage.
CONS: No smartphone integration. No glass-roof shade. Touchy touchscreen.
WHAT’S NEW: Everything—the R2 is Rivian’s all-new, smaller electric SUV, and it brings the brand’s adventure-first attitude to a price point far below the larger R1S.
If the BMW iX3 is wearing a beautifully tailored jacket, the Rivian R2 has its sleeves rolled up.
With edgy styling, this is no anonymous crossover wearing an EV costume. Chunky details. Upright proportions. Distinctive lighting all give off an outdoorsy vibe without turning the R2 into a rolling REI catalog.
There are four configurations, with pricing from $45,000 to $58,000. That’s a big difference from the BMW—and potentially the R2’s biggest weapon.
The stats aren’t shabby, either. Driving range is from 275 to 345 miles. The dual-motor, all-wheel-drive setup produces between 350 horsepower and a frankly bonkers 656 horsepower. And the high-performance model lets you zip from 0-to-60 mph in just 3.6 seconds.
Drag-racing credentials? Absolutely!
Inside, there is lots of clever packaging, with flexible seating and generous storage. This EV is designed to carry actual stuff, not merely impress your neighbors.
Yes, there are quirks. Rivian skips Apple CarPlay and Android Auto, while everyday controls—some of which are less than intuitive—live on the touchscreen. And the panoramic glass roof lacks a conventional shade. Huh?
For some owners, those will be minor annoyances. For others, they’ll become daily reminders that Rivian marches to its own beat.
Perhaps that’s not a bad thing, though. The R2 feels less buttoned-up, more mischievous. It’s the automotive equivalent of Billy Porter ignoring the dress code and somehow looking better than everyone who followed it.
Advice
We’re getting married but our parents object
Will their disapproval and shortcomings derail our hopes for a happy life?
Dear Michael,
My girlfriend and I are getting married! We’re really excited, but we’ve got some big concerns as well.
All of our parents have had multiple marriages. I think 10 between the four of them. So we don’t have much in the way of role models for a successful marriage.
Also, we don’t have any parental support. Except for one of my ex-stepmothers whom I’m close to, none of our parents are happy that their daughter is getting married to another woman. That’s an understatement. Religious objections, moral objections, being angry that we’re “embarrassing them,” these are some of the things we’ve been told.
We do have some supportive siblings and step-siblings, which is great, although they’re getting pushback from parents about attending our wedding.
Given all this, what suggestions do you have for how we can make a go of our marriage? The divorce rate is over 50 percent for everyone. With all this baggage, we’re worried that we have even less of a chance. Thank you.
Michael replies:
First, congratulations!
Regarding your lack of family support: I’m sorry that you both have to deal with so much criticism, disdain, and judgment. Please don’t let your parents’ negativity influence your own views of yourselves and your relationship. Focus instead on the love and caring you will get from friends, community and the family who are present on your big day (I hope your siblings are brave enough to make it!). Being the recipients of that support is one of the sweetest parts of getting married.
Don’t worry about the high divorce rate. While some couples really shouldn’t stay married, lots of people get divorced because they don’t know what is required to have a good marriage, or don’t put in the effort to do so. That does not have to be your fate.
Similarly, your parents’ terrible track record doesn’t mean you have to repeat their marital histories. The skills to have a strong marriage are learnable.
To that end, here are the best tips I can offer the two of you:
- If you want a loving marriage, be a loving partner. Don’t snipe, sulk, or do the silent treatment when you’re mad. Unconditional love is largely a myth. Even our dogs won’t love us if we are mean to them.
- Don’t spend much time or effort focusing on what your spouse is doing wrong or how she is letting you down. Doing so leads to resentment and feeling like you’re a powerless victim. Instead, ask yourself what your own contribution is to the problem, and what you can do to make things better. You don’t have much power over your partner, but you have a lot of power over yourself.
You can certainly ask your spouse for what you’d like from her, but don’t expect to always get it. And don’t base your own wellbeing or good behavior on what your partner does or doesn’t do.
- Because any two people are always different in some important ways, there is no way that you both can always want the same things, or think the same way, or have the same priorities. Accept this! There has to be room for each of you to be an individual, not only part of a couple.
- Be generous as often as you can be, and have a boundary when it’s important for you to have one.
- When your spouse states that she has a boundary, respect it. Do not push her to back off from something that is important to her.
- Don’t keep score, including how much more you do or how often you don’t get your way. Instead, work together to have a collaborative marriage where you work together to make decisions and get things done.
- Strive not to weigh the relationship down with neediness. Once we’re grownups, it’s mainly our own job to soothe ourselves. You don’t want to burn out your partner’s empathy.
Of course you can ask for a hug, love, reassurance, support, advice, and a shoulder to cry on when you’re down. Just aim be the first person you turn to when you’re upset, and do your best to keep your own mood steady.
- Do not wait for your significant other to go first. Not on planning a date, not on apologizing, not on loading the dishwasher or cleaning the bathroom. If you wait for her to make the first move, you will have a resentful relationship where nothing good ever happens.
Keeping these principles part of your operating system, even — and especially — at those moments when your spouse isn’t doing her best, will go a long way toward helping you build and maintain a loving and happy marriage.
Michael Radkowsky, Psy.D. is a licensed psychologist who works with couples and individuals in D.C., Maryland, Virginia, New York, and all PSYPACT states. He can be found online at michaelradkowsky.com. All identifying information has been changed for reasons of confidentiality. Have a question? Send it to [email protected].
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