Old barriers, new horizons

Each New Year offers us hope, the chance to start anew, and the opportunity to make resolutions that we may or may not keep. 2019 marks the 30th year since I tested positive for HIV. Many amazing breakthroughs in HIV treatment and prevention have occurred over the last three decades, and what’s interesting is that even more are on the horizon. Warren Tong’s article "Emerging Options" will give you a small taste of what’s to come, including long-acting injectable agents. POSITIVELY AWARE will continue to keep you updated in future issues about the innovative ways in which researchers are looking at how to, as the old activist saying goes, get drugs into bodies, including once weekly or monthly oral treatment, and new classes of drugs.

Of course all of this is great in a perfect world where every person has access to adequate health care that they can afford, is stably housed, and can get to a provider who is culturally competent and specializes in trauma-informed care. Barriers including stigma, discrimination, intimate partner violence, transphobia, gender differences, income inequality, and any number of other obstacles to care continue to thwart our best efforts. Biomedical breakthroughs in treatment and prevention are only one piece of the puzzle—we also require advances in how we deliver services and provide care. In this issue, Michelle Simek takes a look at three organizations and how they designed innovative programs to reach those most in need.

Each of these horizons is an opportunity for a new day, and new beginnings in the fight against HIV. None of them are the only answer, and there is no magic bullet or one size fits all.

As I write this, I learned of another friend living with HIV gone too soon. Lately the losses seem to have been occurring more frequently. Maybe part of that is what happens as you get older, but for those of us who lost multiple friends, family members, and co-workers decades ago at the height of the epidemic, it feels like we are on the precipice of a new tsunami of unanticipated grief. Add this to our already unresolved grief and survivors’ guilt, PTSD, loneliness and the isolation that can come as a result, and the outcome could prove devastating. It can all be so overwhelming and seem too much at times. We need to prepare ourselves as an entire generation of long-term survivors enters this new phase of their lives, and develop tools and resources to support them on their journeys. Newer generations of survivors will have their own unique journeys; David Durán talks about his story of survivorship.

Giving the gift of life as a living organ donor is possible for people living with HIV, but many aren’t aware of it. Activist Nina Martinez shows us how you can become a donor by describing and sharing with us her own story. Nina tells us how she came to her decision, and then set about actually doing something about it.

Each of these horizons is an opportunity for a new day, and new beginnings in the fight against HIV. None of them are the only answer, and there is no magic bullet or one size fits all. What seemed unthinkable only a few years ago, such as a pill to prevent HIV, is now a reality. The fact that you can’t pass on the virus sexually to someone if you are HIV positive and on suppressive antiretroviral therapy is one of the biggest breakthroughs of all. We are limited only by our own imaginations, and our ability, or inability, to think outside the box.

I hate to admit it but recently I missed a dose of my meds. Not just my HIV meds. Everything! My meds for high blood pressure, triglycerides, vitamins—all of them. And I’m probably the most adherent person you’ll ever meet (well clearly not the most, since I missed one). But we are not perfect human beings, and stuff happens. Wouldn’t it be nice if I could take a shot every other month, or every three months? Every six? And how great if I could just stop at the pharmacy on the way home from work to get my shot! Or even better, to be able to self-administer at home. I used to think not, since there are other medications I have to take. But missing those other meds every now and again, at least in my case, is not as serious as missing my HIV meds and developing resistance to them. If getting a shot was really convenient, it might be nice to not have that daily reminder of HIV. Maybe.

All of these things could be in our not-so-distant-future, and the future is indeed looking bright. But alongside developing these new and innovative treatments and interventions, we need to double down our efforts and focus on getting them into the populations who need them the most, including marginalized and underserved populations and communities of color. That is truly the new horizon I long for.

Take care of yourself, and each other.