Change and continuity

Forty years is a long time. That’s how long San Francisco General Hospital’s Ward 86, the first and longest continuously operating HIV medical clinic in the country, has been open. Four decades into the epidemic, Ward 86 is still a pioneer and leader in HIV care, research and education. How do you manage change while still maintaining a standard of excellence?

As Mathew Rodriguez’s cover story explains (READ here), one key to Ward 86’s success is that “as providers identify a need, they establish a program to address it.” In 2008, they established a clinic for women living with HIV. In 2013, they created a program to get people newly diagnosed onto antiretroviral treatment the same day. And when it became clear that a significant majority of people living with HIV in San Francisco were over age 50, they launched the Golden Compass program in 2017 to address some of the health complications associated with aging with HIV.

People often think that change and continuity are two opposing ideas. But if the purpose of change is to adapt and continuity is to ensure intentionality, then I believe that one can help inform the other. If life has a motto, it could be summed up in one word: adapt.

One of my favorite lines in the animated TV series Futurama is when Philip J. Fry says, “People hate change. It makes them angry and confused.” As Homer J. Simpson would say, “That’s so funny because it’s true!”

But it doesn’t have to be. Change challenges us to adapt. That often means going outside of our comfort zone, what we’re familiar with and instead trying new things when old ways of thinking no longer work. The worst reason for continuing to do something is, “because we’ve always done it this way.” If we are to win the fight against HIV, we’re going to have to fight it on its terms. The virus mutates; we have to adapt.

If we are to win the fight against HIV, we’re going to have to fight it on its terms. The virus mutates; we have to adapt

Ward 86 has not only been around for so long but has been a leader in part because of that concept. “Another essential ingredient to the clinic’s success is the unique relationship between patients and providers,” Mathew writes. “These advances in treatment are only possible because staff are attuned to the needs of the people who come through the clinic’s doors.”

That speaks to intentionality. Why do you do what you do? And if you’re in the HIV sphere—as a care provider, case manager, researcher, policymaker or advocate—why do you do what you do, if not for the most vulnerable and the most in need?

That’s in stark contrast to the experience of Bridgette Picou, who encountered stigma at the office of her care provider, of all places. Stigma is the one form of thinking that has refused to change in over 40 years. It can be hurtful when care providers (or their staff) have biased or outmoded attitudes toward the people they’re supposed to care for. As Bridgette says in her column, Being Bridgette, “Clinicians must be the light.”

“HIV is stigmatized, criminalized and misunderstood for both what it was and what it is now,” she writes. “What it has always been is a human condition. Clinicians must learn to connect to humans and not the virus. My favorite affirmation is ‘when you cannot find the light, be the light.’” Amen to that!

Elsewhere in this issue, our coverage of the International AIDS Society’s conference in Australia, known as AIDS 2023, looks at how research and innovation are addressing disparities in public health and in the face of uncertainty around the world.

Writing about how lifestyle changes could lower cardiovascular risk for women with HIV, innovative tech solutions to prevent HIV in vulnerable populations or how New York City’s queer community helped shape the local response to mpox, Larry Buhl’s AIDS 2023 reporting shows how innovative thinking can help lead in the fight against HIV (READ here).

Taking a cue from Bridgette, it’s up to all of us to be the light when the need arises. Be an agent of change.

You are not alone.

P.S. POSITIVELY AWARE has a breakthrough of its own this year. In addition to the wall-size and Pocket Edition HIV drug charts, we’ve introduced the HIV Drug Chart Pocket Edition in Spanish. We hope you share this news with everyone who needs it. Order your charts, in single or bulk orders; go to

PD: Por primera vez, la Tabla de Medicamentos para VIH de Positively Aware Edición de

Bolsillo está disponible en español. Esperamos que compartas esta noticia con todos los que lo necesiten. Visite la pagina web