Mexico: The fear of living without HIV medication firsthand

It wasn't the fear of the virus that I had learned to accept and acknowledge, but the possibility that the only thing that stopped its advance in my veins might be missing.

Text and photos: Adrián Miranda

When they confirmed my HIV test was positive, the first thing I heard was, “You can have a normal life.” That phrase became a mantra, repeated ad nauseam for the next few weeks. Before every test, after every blood sample, someone would say, “You can have a normal life.” While I was biting my nails in a waiting room where no one looked me in the eye but everyone insisted, “You can have a normal life.” While a nurse asked me if I had been in a foreign prison, if I had drunk stagnant water, if I had ever had anal sex, and ended by announcing in a voice like a tired old infomercial that “You can have a normal life.” After two months, they handed me two bottles of medication and a pamphlet that flashed before my eyes, proclaiming that it wasn't the end of the world and “You can have a normal life.”

[READ ALSO: “AMLO: People with HIV are not ‘AIDS patients’ and we demand medication” ]

I always wanted to ask them what, exactly, a normal life meant. But at that time I was so catatonic and depressed that I invented a definition based on the certainties I had. The normal life of a middle-class kid in Mexico unfolds in endless lines to complete absurd procedures to obtain mysterious documents to finish impossible processes that will take sixty business days to get a response. You survive in an inadequate and rusty bureaucratic system that can deny you basic human needs because they lack authorization, because the supervisor is on spring break , because someone signed with black ink instead of blue, because their internet went down. You pepper every conversation with the negatives that you end up accepting as symptoms of a normal life. I can't afford it. They don't have it. They haven't received it. The system is down.

I've been living with HIV for two years now, and strangely enough, life feels normal. I receive care at the Mexican Social Security Institute (IMSS), and it's not unusual to spend my days in endless lines and navigating impossible procedures, intercepting doctors to get a prescription, chasing down superiors who just retired, or trying to understand how the lab lost my samples. Many people joke that at the IMSS they're convinced that time heals all wounds, which is why I've aged eons in the administration of my clinic, correcting typos that changed my age and blood type. Ultimately, that's normal life.

In 2019, a nationwide shortage of medications began. I learned about it after reading an online article: Andrés Manuel López Obrador confirmed it was real, that there were shortages in healthcare facilities, but “it was worse before; it’s just that now, with this plan to combat corruption in the purchase of medications, the issue is being brought to light, whereas before nothing was said.” This plan consisted of investigating pharmaceutical suppliers who monopolized the market, canceling business deals until they agreed on a fair price for medications. The AIDS Healthcare Foundation responded with an open letter refuting the information provided by AMLO and CENSIDA regarding the distribution of medications to the 97,000 HIV-positive patients served by the Ministry of Health, but so far no one has responded to the organization.

In July, my CD4 cell count had increased considerably thanks to my adherence to Truvada and Efavirenz therapy. The relief was short-lived when the pharmacy staff told me their efavirenz stock was depleted. I had a few pills left over, and I didn't worry too much during the three days it took for them to notify me that they had received more bottles. At my next appointment, I asked my doctor what would happen with the drug shortage. “I’m not sure,” he replied, “we haven’t been told anything about the supply for the rest of the year.” He then told me that, to maintain a normal life, I couldn’t miss a single day of medication, and I didn’t want to ask him how the hell I was supposed to continue the treatment if I didn’t know when I would receive it again.

The pills counted

Then normalcy merged with fear. It was no longer the fear of the virus, which I had learned to accept and acknowledge, but the possibility that the only thing stopping its advance in my veins might be gone. Every visit to the IMSS (Mexican Social Security Institute) gave me a knot in my stomach, expecting the worst, and I realized that the other patients felt the same. They still wouldn't look me in the eye, but they all wore the same nervous expression. Things didn't improve when the nurse on the ward couldn't schedule my appointment for the following month because "my schedule is full, and prescriptions can only be filled on Mondays and Fridays." I didn't want to tell her that I had enough pills for exactly one month, and that the whole prescription days thing sounded ridiculously stupid, because I wouldn't be able to explain what would happen if the treatment was interrupted. No one ever told me, and I stopped trusting Google diagnoses when it mistook my allergic reaction to bricks for pancreatic cancer.

In December, my CD4 cell count was almost normal, the latest results reaffirmed my serological status as “undetectable,” and at the pharmacy, they told me that all they needed now was Truvada. They gave me a phone number to call in the following days, and the only time I got through, their response was a curt “we don’t have it” before hanging up. The fear that had been gnawing at me in my trips turned to rage. Around that time, we had our first meeting of the Morelos Chapter of the Mexican Network of Positive Youth and Adolescents, and we agreed to file complaints with the National Human Rights Commission. I received several calls from the CNDH and the Clinical Excellence Coordination of the IMSS (Mexican Social Security Institute), asking if I had received the medications, stating that they were doing everything possible to guarantee the supply, and thanking me for the patience that had run out before the pills. We organized ourselves to get some bottles of antiretrovirals. For a week, I switched to Goltrec, a combination that caused me chronic fatigue and catastrophic nausea in the middle of the night.

On December 24th, the Mexican Social Security Institute (IMSS) issued a statement explaining that due to “the atypical situation that affected our inventories,” Truvada would be replaced by a new drug called Biktarvy, a regimen that combines previous treatments and causes fewer side effects. I ignored the idiotic instruction on the prescription pad and went to my doctor's office to ask about the new regimen. They did have it, but I needed to be evaluated to determine if I was a candidate to switch to Biktarvy. “Since it's a new-generation medication, not everyone is suitable. And we don't actually have enough to treat everyone; with what we receive, I can prescribe it to one hundred of the twelve hundred patients I have.” The other option was to continue the treatment I was on at the time; however, the doctor reminded me that Truvada would be discontinued, and the same would happen with Movitrem, a generic I only just learned existed. I agreed to the evaluation, but there were no needles or drops of blood involved. My doctor wrote me a prescription for biktarvy and reminded me that if I ran out, I'd have to face the consequences. Like any angry decision in a normal life.

We became public enemy number one

In January, AMLO addressed the issue of shortages again during his morning press conference. “There have been campaigns to talk about shortages, about a lack of medicine. They've talked about a lack of medicine for children with cancer, AIDS patients, all of that. We had to buy medicine abroad. We are suffering from a boycott by those who controlled this huge business.” The response on social media was swift. Several comments on YouTube demanded that the “PRI-PAN supporters” stop defaming the president and his work for those most in need. Others called for him to be awarded a Nobel Peace Prize. My favorite comment, which I saw on Facebook, read, “What about the AIDS patients? They're meddling where they shouldn't. The children with cancer aren't to blame for any of this.”

Someone less intelligent might read that kind of stuff and ruin their self-esteem. For me, that kind of thing is part of my normal life. When I came out of the closet, if I ever really was one, I discovered I'd left my Adidas sneakers, my fake interest in the Super Bowl, and most of my rights as a citizen inside. In seventy countries around the world, I'm considered a criminal, and in twelve of those, I could be sentenced to death for sleeping with another man. Ironically, I can only get married in thirty countries, and in twenty-eight, I could adopt a child. But laws don't mean much to normal life, and that's why I've never touched my boyfriend in the street: if some passerby decides that a kiss is enough to crack my skull or put a bullet in my ribs , in a matter of hours I'll be a candle in the middle of the asphalt or a new statistic in a tabloid, and the rest of the citizens with normal, decent lives will be convinced that I "was up to no good" and that I brought it on myself by living an abnormal and indecent life. With a bit of luck, the tabloid won't discover my serological status and print it in bold Arial 36, because then it wouldn't be a regrettable but understandable loss, but a civic example of disease control.

The thing is, it wasn't just an ordinary, decent citizen who called 180,000 people in Mexico "AIDS patients" in front of a packed room of reporters. It was the president of the republic who won the most votes in the history of democratic elections. A man with a decidedly leftist bent who has ignited ideological battles in every economic stratum. A man who has spent three decades of his political career proclaiming his contempt for monopolies and power elites and his devotion to the less fortunate. A man with such media influence that his followers sometimes seem more like a cult about to drink Kool-Aid. That is the person who is dismissing the most significant epidemic of the century with a disdainful gesture and a despicable adjective.

Living with HIV is a constant interrogation. In the school cafeteria, at Christmas dinner, in the heat of a drunken stupor, at any moment you can be bombarded with questions. Who infected you? When did they infect you? Why did they infect you? Why didn't you use a condom ? Why do you still use condoms? Can you eat chocolate? Can you drink vodka? Can you climb a mountain? What color is your blood? Do you have sores? Do you have skin lesions? Are you going bald prematurely? Do you have a will? Are you at peace with God? How much time do you have left? When will you tell your parents? When are you going to die? All the answers are rehearsed because other people's normal lives need them to let you into theirs. But no one should have to explain to the president of a nation the difference between a virus and a syndrome and a disease, the damage that words can inflict in a verbally deficient society, the dimension of a public health crisis caused by a bunch of AIDS patients who don't take their pills for three or four weeks.

"AIDS transmitted through homosexual contact"

Yesterday I read that a young man who was HIV-positive went to the Mexican Social Security Institute (IMSS) for a case of genital warts, and his medical summary stated that he had contracted AIDS through “homosexual transmission.” A few months ago, an HIV-negative friend wasn't allowed to donate blood because he's bisexual. A few years ago, my boyfriend was hospitalized after his HIV diagnosis, and they noted in his file that “the patient has engaged in various high-risk practices with numerous sexual partners.” In the secret orgies that the right-wingers exposed us for—the ones where we plotted the annihilation of Catholic marriage and fornicated between episodes of RuPaul's Drag Race—we all talk about these frequent occurrences like an old friend we have in common. We get angry, grind our teeth, and sigh with resignation because, well, it could be worse. They could have locked us up in a cell in Lecumberri Prison. They could have chemically castrated us in Dachau. They could have beaten us up in Greenwich Village. They could have stoned us in a Borneo town square. They could have left us to agonize, stained with Kaposi's sarcoma, in a hospital quarantine.

I keep wondering what a normal life means. I can't even remember the last time I felt real, someone who doesn't know the messed-up, broken, and overlooked things that make the world go round. When you don't know the mistakes made to keep the surface from shattering, you can feel moderately happy and moderately precious, like a background character in an Orwellian story where ignorance is strength. That's why I don't miss what I was like before the diagnosis. I never asked for the virus, the syndrome, or the disease, but I also didn't ask for the determination, the knowledge, or the curiosity. I've forgotten when it stopped being a mammalian struggle to save myself and became the certainty that I can turn a few screws, stop the world, and make it a little better; when I stopped feeling alone and found a bunch of people willing to stand on the edge of the abyss and scream at it with all their might.

Today I woke up with my boyfriend snoring in monosyllables, I greeted the virus floating in my veins, I scratched my cat's belly, I watched the apocalypse exploding on YouTube, I took my pills at nine o'clock, I wrote this last impossible paragraph, and I again told any hint of a normal life to go to hell.

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