40 Years of HIV/AIDS and the Gay/Bisexual Community

This year marks 40 years since HIV/AIDS was first reported in the United States. On June 5, 1981, the U.S. Centers for Disease Control (CDC) published an article in its Morbidity and Mortality Weekly Report (MMWR): Pneumocystis Pneumonia—Los Angeles. This article described “cases of a rare lung infection, Pneumocystis carinii pneumonia (PCP), in five young, previously healthy gay men in Los Angeles…This edition of the MMWR marks the first official reporting of what will later become known as the AIDS (Acquired Immunodeficiency Syndrome) epidemic.”

We are all too familiar with what followed. By 1992, the CDC reported that more than 250,000 people had been diagnosed with AIDS, nearly 90% of whom were men, and almost 230,000 had passed away from AIDS. As we honor National Gay Men’s HIV/AIDS Awareness Day #GMHAAD on September 27, we take this time to reflect upon the past 40 years of HIV/AIDS history in the United States and honor those many lives lost and those who fought for access to life-saving treatments and medications, while celebrating the message of U=U and what that means for ending the HIV epidemic. While HIV/AIDS does not only affect gay men, on #GMHAAD, we take this opportunity to honor the struggle and fear that mobilized and traumatized the gay community and their allies in the United States during the past 40 years.

Two documentary films we at Achieving Together find both informative and captivating about the early days of the HIV/AIDS crisis are 5B about the group of nurses and caregivers who opened the first AIDS ward in the world at San Francisco General Hospital and How to Survive a Plague about the activism of ACT UP in the 1980s and 90s.

We give thanks to those brave men and women who cared for AIDS patients over the years and to the activists who put their bodies on the line to fight for better care, treatment, and prevention. Enormous strides in treatments were made over the past 40 years, and we can now celebrate that an HIV diagnosis no longer means a life cut short. Thanks to these life-saving medications, people living with HIV who are on treatment can achieve an “undetectable” status, meaning they can live with the confidence that they cannot sexually transmit HIV to their partners. In other words, undetectable = untransmissible or U=U. You can watch U=U activists share the hope this message brings to people living with HIV, particularly gay men who may have witnessed their friends and loved ones perish from the disease at any point in the previous 40 years on a recent segment from the TODAY show.

You can read more about the U=U movement in our previous post here.

In Texas, almost 60% of people living with HIV are gay/bi-sexual men and they made up almost 2/3 of new diagnoses in 2019. 

One striking thing that we see in the visualization above is disparity that exists between White gay and bisexual men and their Black and Latinx counterparts. We see above that Black and Latinx gay/bi-sexual men represent 40% of people living with HIV in Texas and more than 50% of new diagnoses in 2019. We know that stigma and lack of equal access to prevention and treatment remain significant barriers for Black and Latinx gay/bisexual Texans. Therefore, we’d like to highlight just a few organizations in Texas who are trying to change that narrative and address the gaps that exist in providing HIV treatment and services to LGBTQ communities of color across our state (click on the links to learn more):

·      The Normal Anomaly

·      The Mahogany Project (Houston)

·      The Mahogany Project (Austin)

·      Whatsinthemirror?

·      Embrace

·      Valley AIDS Council

·      Borderland Rainbow Center

·      House of Rebirth

·      Dallas Southern Pride

·      allgo

·      Trans Fronterizxs

U=U Turns Five

Fact: A person living with HIV who is on treatment and has an undetectable viral load cannot transmit HIV through sex.

In other words, Undetectable = Untransmittable, or U=U

U=U recently celebrated its fifth birthday. July 21, 2021, marked five years since the launch of the Undetectable Equals Untransmissable Movement by the Prevention Access Campaign. Back in 2016, a group of advocates, activists, and scientists convened to announce that people living with HIV with undetectable viral loads (< 200 copies/mL) cannot sexually transmit HIV. Through their work, they came up with the phrase “Undetectable = Untransmittable” or U=U. If you are a person living with HIV, you can feel confident that if you’re on treatment and your viral loads are undetectable, there is zero chance that you will pass the virus along to your sexual partner(s). 

U=U aligns with Achieving Together’s goals of reducing HIV exposure and transmission, increasing viral suppression, and cultivating a stigma-free climate.

For many people, U=U represents relief and freedom. 

“When I learned about U=U…that was the best day in my life in over 50 years. I lived with so much internal stigma. I didn’t want to hurt anyone. When I learned about U=U, that put the fun back in my life. It allowed me to dream.” –Helen E. Turner

In the words of the Prevention Access Campaign:

U=U offers freedom and hope. For many people living with HIV and their partners, U=U opens up social, sexual, and reproductive choices they never thought would be possible. It is an unprecedented opportunity to transform the lives of people with HIV and the field: 

  • Well-being of people with HIV: Transforms the social, sexual, and reproductive lives of people with HIV by freeing them from the shame and fear of sexual transmission to their partners.
  • HIV stigma: Dismantles the HIV stigma that has been destroying lives and impeding progress in the field since the beginning of the epidemic.
  • Treatment goals: Reduces the anxiety associated with testing, and encourages people living with HIV to start and stay on treatment to stay healthy and prevent transmission.
  • Universal access: Offers a public health argument to increase access and remove barriers to treatment, care, and diagnostics to save lives and prevent new transmissions.

However, the majority of millions of people living with HIV do not know U=U, and many do not have access to the diagnostics, treatment, and care they need to achieve and maintain an undetectable viral load. There are still confusing messages, outdated websites, and uninformed policymakers and healthcare workers who are not comfortable sharing this information, don’t yet know about it, or don’t yet realize the significance of it. 

Research shows that people living with HIV report better health outcomes when their providers inform them about U=U. The more people know that U=U, the better. There are excellent resources available to help spread the word, including a customizable social media toolkit available at https://positiveseries.org

The folks at Prevention Access Campaign have also compiled a list of frequently asked questions: https://www.preventionaccess.org/faq

What does U=U mean to you?

Rethink Positive: It’s Time to Rethink HIV

By Tarrant County Public Health Disease Surveillance, Outreach and Prevention Division

“Stigma” has become a recent buzzword:

  • TV News anchors are talking about stigma
  • People are posting about stigma on social media
  • People are DMing about it, and it’s even made it to water-cooler chatter

Tarrant County Public Health (TCPH) wants to ensure that ending HIV stigma is more than just a buzz in our community’s ear. We need to keep people healthy by ending the HIV stigma. TCPH has had an individual-level HIV prevention program for years, including HIV testing, PrEP services, and caring for those who are HIV positive. Now we aim to overpower the HIV epidemic at the structural level – wherever people living with HIV encounter the system: in healthcare, education, community organizations, and corrections. 

TCPH created Rethink Positive with a grant funded by the CDC and the State of Texas. We are reaching out to healthcare providers, educators, school nurses, staff of community organizations, and correctional institutions. We don’t need to tell people living with HIV that a stigma exists; we need to change the negativity within the establishment.

We’ve adapted an evidence-based anti-HIV stigma program created by Health Policy Project that has successfully reduced stigma in nine other countries. More information on the Health Policy Project’s efforts can be found on their website

We’ve adapted the program to be relevant to our Tarrant County communities and have created interesting, engaging, and practical exercises. Our workshops include the basics on HIV and how it’s transmitted, education on institutionalized racism and its impact on the HIV epidemic, definitions and examples of HIV stigma and discrimination, and optional modules on Universal Precautions and creating a Best Practices Action Plan.

Our customized workshops are appropriate for our participants’ work environment, with examples of recognizing and challenging the stigma that are realistic. The workshops are offered online and in person. Our online workshops are one hour long, while our in-person workshops range from 1½ hours to several days in length.

The workshops started in February of 2021, and we have received valuable feedback that participants are enjoying the material and are learning about HIV stigma, its causes, and how to challenge stigma in their work environments. We’ve created an in-person exercise called a “Stigma Walk,” in which individual experiences of stigma are exemplified in a powerful way. Participants especially like the Stigma Walk exercise. They have indicated that they have learned about the importance of combatting HIV stigma and changing their workplace to be a more welcoming environment.

A program aimed at reducing HIV stigma is successful only if it changes the institutionalized stigma experienced by people living with HIV and those at risk. At present, participants complete HIV- and stigma-knowledge pre-and post-tests to measure the impact of the training. We also plan to have healthcare providers survey their patients on existing stigma in their facility before the workshop and 3- and 6-months post-workshop. We will be using evidence-based stigma-measuring tools that have been revised to specifically measure HIV-related stigma to confirm we are making a real difference in reducing systemic HIV-related stigma.

TCPH is excited to make a difference in our community by combatting institutionalized HIV stigma. We invite everyone to join the effort by instituting changes in their own organization and reaching out to other entities to inform them about the importance of ending the HIV epidemic.

To learn more about our Rethink Positive program or to schedule a workshop for your organization, we invite you to visit our webpage, rethinkpositive.tarrantcounty.com, contact us by via email at PHOutreach@tarrantconty.com or call or text us at 682-216-0657. 

Cultivating a stigma-free climate of appreciation and inclusion is one of the Achieving Together Plan’s focus areas. To learn more about addressing stigma, see the Stigma Resources Page on our website

Guide to Gender Identity Terms

Cultivating a stigma-free climate of appreciation and inclusion is one of the Achieving Together Plan’s focus areas. We recognize that language changes over time and we aspire to create shared language that promotes appreciation and inclusion of all people.

While language and usage may change, what’s important is recognizing and respecting people as individuals. People use a variety of terms to identify themselves, so you should always listen for and respect a person’s self-identified terminology.

NPR recently shared a guide to gender identity terms, with the goal of helping people communicate accurately and respectfully with one another.

“Proper use of gender identity terms, including pronouns, is a crucial way to signal courtesy and acceptance. Alex Schmider, associate director of transgender representation at GLAAD, compares using someone’s correct pronouns to pronouncing their name correctly – ‘a way of respecting them and referring to them in a way that’s consistent and true to who they are.’”

You can find NPR’s guide here. The guide, which was created with help from GLAAD, is not exhaustive and is Western and U.S.-centric.

Remember that we are all learning and evolving and we might make mistakes with regard to someone’s preferred pronouns and gender identity, but if that is the case, simply apologize, move on, and be more cognizant of it in future interactions. We know that creating a life-affirming environment that will promote health and wellness for all people is the only way we can truly create a stigma-free climate of appreciation and inclusion.

Want to further explore ideas of gender identity?

  • Human Rights Campaign also shared a glossary of gender identity terms here.

Law Harrington Senior Living Center: A Place for LGBTQ Seniors to Live with Dignity & Pride

There is strong evidence that housing impacts health. Housing stability, quality, safety, and affordability all affect health outcomes. Housing is “one of the best-researched social determinants of health, and selected housing interventions for low-income people have been found to improve health outcomes and decrease health care costs” (Health Affairs).

The Montrose Center’s Law Harrington Senior Living Center (LHSLC) represents one venture to improve housing options for seniors in Houston, Texas. The Center hosted its grand opening on June 24. As an LGBTQ-affirming center, the LHSLC offers specific programs and policies to support LGBTQ residents and protect them from discrimination. Since one of Achieving Together’s focus areas is cultivating a stigma-free climate of appreciation and inclusion, we interviewed staff from the new Senior Living Center to learn more about the program.

Photo by Alex Rosa for OutSmart magazine

How did the Senior Living Center get started?

For over 40 years, the Montrose Center has empowered our community of primarily lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals and their families to live healthier, more fulfilling lives by providing a number of critical programs to LGBTQ Houstonians.

Housing is one of the greatest financial challenges and, correspondingly, one of the greatest needs for older adults across the nation. One in eight LGBQ adults and one in four transgender adults in the U.S. say they have experienced housing discrimination on the basis of their sexual orientation or gender identity.

According to the National Coalition for the Homeless, there are at least nine seniors waiting for one occupied unit of affordable elderly housing nation-wide. In some cases, a senior can spend three to five years on the wait list for access to affordable housing. As in the Montrose neighborhood, many long-time senior residents of the larger Third Ward area are seeing their rents and property taxes increase beyond their means.

Unfortunately, there are few options for those who seek to downsize and remain independent, save for very poorly maintained and unsecured apartment complexes. The Greater Third Ward is currently undergoing rapid demographic shifts due to redevelopment trends and increased interest in the area’s comparatively affordable real estate, creating gentrification.

The vast majority of LGBTQ-affirming neighborhoods, businesses, churches, and service organizations remain centrally located to Montrose and the surrounding areas. However, the lack of affordable housing in Montrose has pushed many LGBTQ low-income seniors, and longtime residents of Third Ward, to seek more affordable, yet less community-centric, areas. These areas may be away from their friends, family, and social support services.

In 2015, led by honorary campaign co-chairs, former Mayor Annise Parker and State Representative Garnet Coleman, the Montrose Center launched the “There’s No Place Like Home” campaign to help fund the Law Harrington Senior Living Center, with a commitment to providing an affordable senior-housing community that is also LGBTQ-affirming. The project was first made possible by a land grant for the 2.87 acre lot from the Midtown Redevelopment Authority, initiated by State Representative Garnet Coleman with the support of Midtown Redevelopment Authority staff.

What are the goals of the Law Harrington?

The goal of the Law Harrington is to provide seniors a place able to age with dignity and pride in a stable, safe, and affirming community, with access to specialized services and support. This project will also serve as the cornerstone of the Montrose Center’s comprehensive approach to support seniors, regardless of their gender identity or sexual orientation. We really see the Law Harrington becoming a hub for our LGBTQ seniors and hope it will become a vibrant community where seniors from all across the city, regardless of sexual orientation or gender identity, can come to enjoy critically needed services and programs.

It’s mentioned on the website that there are services for seniors living with HIV. What sort of HIV services will be available?

We have Legacy Community Health providing onsite primary care services for residents and the larger community. Seniors living with HIV will be able to take advantage of the clinic for check-up appointments and other medical needs. Staff from the Montrose Center will also be available onsite to provide case management, educational programs, advocacy, and service linkage, and can make referrals to other Center staff located at our main building for interpreter services, individual, couple/family, and or group counseling, or other needs.

What would you like for people to know or understand about the Senior Living Center?

The Law Harrington Senior Living Center is named after Charles Law and Gene Harrington. Charles Law was a significant force in the gay and lesbian communities in Houston. He was Co-Chair of the Executive Committee for Houston’s Town Meeting in 1978. He was also the founder of the Houston Committee, a black gay men’s professional organization, active in the late 1970s.

(Eugene) Gene Harrington, a tireless gay-rights activist, worked with the Houston AIDS Equity League, the Houston Gay and Lesbian Political Caucus, and the Texas Human Rights Foundation, receiving honors from all for outstanding volunteerism. 

The complex is the largest LGBTQ-affirming senior housing complex in the nation (137,838 SF) and features 112 one- and two-bedroom, independent living apartments for low-income seniors ages 62 and above. Rental is limited to single older adults and couples whose annual income is below a certain amount, the details of which are based on an annual calculation of income from the Houston area. The Law Harrington provides apartments at the following area median income (AMI) levels:

  • 24 units at 30% AMI
  • 45 units at 50% AMI
  • 43 units at 60% AMI

Additional features of the property include: a social services department managed by the Montrose Center, geriatric primary care clinic provided by Legacy Community Health, a group dining area, meeting and game rooms, a fitness center, dog park, and outdoor recreational spaces.

The most important thing to know about the complex is that it is LGBTQ-affirming, meaning that it is a safe, affirming place for LGBTQ seniors to live with dignity, pride, and without fear of hiding their sexual orientation or gender identity. While the complex is LGBTQ-affirming, it is open to all seniors who meet the age and income requirements.