I feel sorry for our children and grandchildren. We’ve left a mess. When there is no middle ground, the struggle becomes a fight for dominance. The winner gets to decide who and what is legal. It may start with abortion, but they also have their sights on who gets to marry, affirmative action, and maybe even a re-examination of the Affordable Care Act. This is a battle for the soul of America.

The world is exploding in too many ways. The leaked Supreme Court decision on abortion feels like another point of no return, the first of many legal precedents this court wants to overturn. HIV sits at the intersection of these “red meat” issues. It’s all interconnected. In my experience, the people who hate abortion also hate gay marriage, also hate affirmative action and definitely hate people living with HIV/AIDS. They want a mythical world where everyone knows their place and they sit at the top of the pyramid. The problem is that we’re not going back. Once you’ve tasted freedom, it’s hard to accept the yoke of oppression.

The world is heading towards a reckoning. After Trump, flipping the Supreme Court, COVID, Black Lives Matter, climate change, immigration, the election, Jan 6th, wildfires, gun violence, police killing Black men, record number of murders, Asian violence, don’t say gay, withdraw from Afghanistan, inflation, gas prices, BA2 variants, one million Americans dead from COVID, and a war in Ukraine, we get a leaked copy of a Supreme Court decision that has the court stepping into the culture wars.

How does the fight to end the HIV epidemic get balanced against a world that is falling apart? I wish I knew. To state the obvious, too many problems have created too many angry people. And there is no roadmap forward. At NMAC we do our best to navigate what sometimes feels impossible. How do you hold all this crazy?

In the past our struggle for justice and equity could be scientifically supported by articles such as the one in the American Journal of Managed Care that showed the difference in lifetime risk for getting HIV based on race and gender.

Lifetime Risk for HIV*

*AJMC on 4/13/22, used CDC data to document the lifetime risk for HIV. The article did not have data on people with transgender experience.


Females: 1 in 75

Males: 1 in 27


Females: 1 in 287

Males: 1 in 50

Native Hawaiian/Pacific Islander:

Females: 1 in 611

Males: 1 in 89

American Indian/Alaska Native:

Females: 1 in 435

Males: 1 in 116


Females: 1 in 874

Males: 1 in 171


Females: 1 in 1,298

Males: 1 in 187

With the advent of “fake” news, science takes a back seat to religion, dogma, and personal entitlement. COVID laid bare the reality that too many Americans don’t trust the government or science. The January 6th insurrection is a testament to the big lie. Given all these contradictions, it’s easy to understand the ambivalence in our communities.

Putin’s failure in Ukraine was a surprise and gives me hope. Given the optics of money, power, and military might, the war should have been a slam dunk. What we’ve learned is that reality can bite you in the ass. The war has shown the world that Russia is mostly smoke and mirrors. This might be a turning point for the underdog. With all the military power of Russia, Ukraine is fighting back and, from some perspectives, winning, if anyone really wins in war. With a coalition of support from the western world, they are not alone. It’s going to take a similar coalition to fight the leaked Supreme Court brief. Our shared understanding of oppression is what should bring women, LGBTQ, and people of color together. Ending the HIV epidemic in America is emblematic of our overall fight for justice and equality. Our work is part of a larger effort for the soul of America. We’re not just ending HIV; we are also holding up the communities hardest hit by the virus.

Yours in the Struggle,

Paul Kawata

A Proud Underdog