People who experience sexual assault in childhood or early adulthood typically do not acquire H.I.V. from the specific incident of abuse, although that does occur. Rather, according to the Centers for Disease Control and Prevention, those who have been sexually abused may be more likely to engage in riskier sexual behavior like exchanging sex for drugs and having unprotected sex with multiple partners, just as Mr. Van Ness described. These behaviors can serve as coping mechanisms or forms of self-medication. Women and men who have been sexually abused as children are also more likely to experience more sexual violations and may find it more difficult to negotiate sexual parameters in relationships, potentially increasing their risk of exposure to H.I.V. What we dismiss or judge as promiscuity is often pain in practice.
Second, Mr. Van Ness’s story reminds us that as the floor drops out from under us, we all need safety nets. He was fortunate to have a supportive family, financial resources to help him start anew and a professional network that recognized his talents and steered him to the right opportunities. Unfortunately, that kind of safety net isn’t available for everyone. In particular, people of color, women, poor people and those marginalized in many ways are much more likely to end up homeless, incarcerated, underserved by the health care system, or even dead than their white, male and wealthier counterparts.
Transgender people are especially vulnerable. The television drama POSE, which chronicles the lives of black and brown queer and transgender people in the New York ballroom community in the 1980s and 1990s depicts this powerfully. The characters’ struggles are compounded by the devastation of the early days of the AIDS epidemic as it killed people at an alarming rate because of slow intervention from the government, a lack of public compassion and no cure.
For those who don’t have access to resources, the H.I.V. safety net — which includes the Ryan White CARE Act, the Housing Opportunities for Persons with AIDS program, the AIDS Drug Assistance Program, and the Affordable Health Care Act, all of which help people remake their lives after an H.I.V. diagnosis by granting access to much-needed resources — is essential. Created by the early mobilization of AIDS activists, and now funded through public, private and nonprofit dollars, it is one of the most important and effective policy creations of the last several decades.
Mr. Van Ness’s story also has something to say to those who seek to defund and destroy Planned Parenthood. This organization helped to save his life by providing the information that he needed about his H.I.V. status. Four years after Mr. Van Ness tested positive, Austin, Ind. — a poor, predominately white, rural town located about 80 miles south of Indianapolis in a county that registered the highest per capita use of OxyContin in the state — saw one of the largest H.I.V. outbreaks in recent years. Among the many challenges thought to fuel the community’s epidemic was the lack of available H.I.V. testing locations: Scott County had closed its only H.IV.-testing clinic, a Planned Parenthood clinic, in 2013.