A Statement of Recognition, Remembrance, Equity, and Renewed Commitment

WHEREAS, HIV/AIDS remains one of the most consequential public-health crises of the modern era, with approximately 41 million people worldwide living with HIV in 2025; and

WHEREAS, since the beginning of the HIV/AIDS epidemic, approximately 44.2 million people worldwide have died from AIDS-related illnesses, including approximately 570,000 people in 2025 alone; and

WHEREAS, despite extraordinary scientific advances, HIV remains a major global health challenge, with approximately 9 million people living with HIV worldwide still without antiretroviral treatment in 2025; and

WHEREAS, the HIV epidemic has never affected all communities equally, and Black and African American, Latino, Indigenous, and other communities of color have experienced disproportionate burdens of HIV in the United States, reflecting persistent inequities in access to health care, prevention, testing, treatment, economic resources, and other social determinants of health; and

WHEREAS, Black and African American communities in particular continue to experience a profoundly disproportionate burden of HIV in the United States, underscoring that progress against HIV must be measured not only by overall reductions in illness and death, but also by whether those advances reach communities that have historically faced some of the greatest barriers to care; and

WHEREAS, California continues to have one of the largest populations of people living with HIV in the United States, and Medi-Cal remains an essential source of health care for this community, with approximately 47% of California adults living with HIV enrolled in Medi-Cal in 2023; and

WHEREAS, gay and bisexual men experienced an extraordinary burden during the early years of the epidemic, particularly in San Francisco, where the landmark San Francisco Men's Health Study found HIV prevalence among participating gay and bisexual men had risen from approximately 23% in 1982 to 48.6% by the latter half of 1984, remaining at approximately 50% during subsequent study periods; and

WHEREAS, although advances in prevention and treatment have transformed HIV from an almost invariably fatal illness into a manageable chronic condition for people with access to effective treatment, HIV continues to disproportionately affect gay and bisexual men, and a 2021 San Francisco surveillance study found approximately 19% of participating men who have sex with men were living with HIV; and

WHEREAS, approximately 11,500 San Franciscans are living with HIV today, including many long-term survivors who have lived with HIV for decades and who continue to experience medical, psychological, relational, social, and economic consequences of an epidemic that has now spanned more than four decades; and

WHEREAS, San Francisco has suffered an extraordinary human loss from HIV/AIDS, with more than 22,000 deaths among people diagnosed with AIDS recorded in San Francisco since the beginning of the epidemic; and

WHEREAS, behind these statistics were individual human beings — partners, lovers, friends, family members, neighbors, patients, colleagues, caregivers, and members of chosen families — whose illnesses and deaths transformed San Francisco and its LGBTQ+ communities and left psychological and emotional consequences that continue across generations;

THE SAN FRANCISCO RESPONSE

WHEREAS, San Francisco became an international center of innovation in HIV/AIDS treatment and care, establishing pioneering dedicated AIDS services at San Francisco General Hospital and developing a compassionate and interdisciplinary system of medical, psychological, social, community, hospice, and home-based services that became known throughout the world as the San Francisco Model of HIV/AIDS care; and

WHEREAS, the San Francisco Model recognized that treating HIV/AIDS required caring for the whole person, bringing together physicians, nurses, psychiatrists, psychotherapists, social workers, case managers, addiction specialists, community organizations, volunteers, friends, partners, and chosen families in an unprecedented system of coordinated care that influenced HIV/AIDS treatment throughout the United States and internationally; and

WHEREAS, San Francisco's commitment during the earliest and most devastating years of the epidemic was extraordinary even by national standards, with historical accounts documenting a period when San Francisco was committing more resources to AIDS treatment and care than the federal government was committing nationally, despite San Francisco being a city of fewer than one million residents; and

WHEREAS, while the history of HIV/AIDS in San Francisco is inseparable from the devastating losses experienced by gay and bisexual men, the epidemic has always extended beyond any single population, affecting people across racial, ethnic, gender, and socioeconomic communities, including Black and African American, Latino, Indigenous, Asian and Pacific Islander communities and others whose experiences have not always received equal visibility in traditional accounts of the epidemic; and

WHEREAS, an honest remembrance of San Francisco's HIV/AIDS history therefore requires recognition not only of the communities whose experiences became most visible, but also of those whose illness, caregiving, advocacy, grief, survival, and contributions were too often underrecognized;

LESBIAN AND BISEXUAL WOMEN ANSWERED THE CALL

WHEREAS, during some of the darkest years of the epidemic, lesbian and bisexual women stepped forward to care for gay and bisexual men living with and dying from AIDS, including men who experienced rejection, abandonment, or isolation because of their sexual orientation or HIV status; and

WHEREAS, lesbian and bisexual women served as nurses, social workers, psychotherapists, caregivers, advocates, volunteers, friends, and chosen family, providing hands-on care, emotional support, hospice and bereavement assistance, organizing community services, and standing beside gay men during a period of profound illness, fear, stigma, discrimination, grief, and loss; and

WHEREAS, lesbian women played an especially important role in San Francisco's response through nursing and health advocacy, community organizing, caregiving, AIDS activism, blood drives, hospices, food programs, clinics, hospitals, and community organizations serving people with HIV/AIDS; and

WHEREAS, women organized blood drives to assist gay men with AIDS during a period when gay men themselves were prohibited from donating blood, while lesbian health professionals, activists, caregivers, and volunteers worked throughout San Francisco to provide care, dignity, advocacy, companionship, and support; and

WHEREAS, this extraordinary solidarity strengthened relationships among lesbian, gay, and bisexual communities and contributed to a broader sense of shared LGBTQ+ identity and chosen family, making the contributions of lesbian and bisexual women an essential and too often underrecognized chapter in the history of the response to HIV/AIDS;

HIV/AIDS AND MENTAL HEALTH

WHEREAS, HIV/AIDS brought not only devastating physical illness but profound psychological consequences, including grief and bereavement, trauma, survivor's guilt, stigma, discrimination, anxiety, depression, substance-use concerns,relationship difficulties, caregiver stress, social isolation, fear of illness and death, and the psychological consequences of witnessing partners, friends, patients, and entire social networks become ill and die; and

WHEREAS, the HIV-affected community consequently became a significant consumer of mental-health and psychosocial services in San Francisco, and mental-health care became an integral component of the City's response to AIDS, including psychotherapy, psychiatric treatment, substance-use services, bereavement counseling, support groups, case management, and other forms of emotional and social support; and

WHEREAS, the psychological burden of HIV can be compounded for people who simultaneously experience racism, poverty, unstable housing, inadequate insurance, discrimination, immigration-related barriers, or limited access to culturally responsive health and mental-health services, making equitable and culturally affirming care an essential component of an effective HIV response; and

WHEREAS, mental-health professionals responding to HIV must therefore recognize the intersecting experiences of race, ethnicity, sexual orientation, socioeconomic status, chronic illness, stigma, and other social conditions that shape how people experience HIV and whether they are able to obtain and remain connected to care;

GAYLESTA'S HISTORY AND ROLE

WHEREAS, Gaylesta was founded in 1987, during the height of the AIDS epidemic, became an unincorporated association in 1988 and a nonprofit organization in 1997, and has grown to include approximately 500 mental-health professionals dedicated to LGBTQ+-affirming mental-health care; and

WHEREAS, Gaylesta emerged within an LGBTQ+ community being profoundly transformed by HIV/AIDS, at a time when people urgently needed mental-health professionals who understood their sexuality, relationships, chosen families, grief, trauma, HIV-related stigma, discrimination, and lived experiences without pathologizing their identities; and

WHEREAS, throughout nearly four decades, Gaylesta therapists have provided psychotherapy and mental-health support to generations of LGBTQ+ people affected by HIV/AIDS, including people living with HIV, long-term survivors, partners, caregivers, grieving friends and family members, and communities profoundly shaped by the epidemic; and

WHEREAS, LGBTQ+ people living with and affected by HIV are themselves extraordinarily diverse, and culturally responsive LGBTQ+-affirming mental-health care must recognize the experiences and needs of Black and African American, Latino, Indigenous, Asian and Pacific Islander, multiracial, immigrant, and other communities whose experiences exist at the intersections of multiple identities and social conditions; and

WHEREAS, Gaylesta and its members have helped sustain LGBTQ+-affirming clinical knowledge relevant to the HIV/AIDS experience, including expertise concerning grief and loss, trauma, chronic illness, stigma, sexuality, aging, relationships, substance use and recovery, chosen family, caregiving, resilience, and the psychological experiences of long-term survivors; and

WHEREAS, Gaylesta was born during an era in which LGBTQ+ people learned that community itself could become a form of survival — when friends became caregivers, neighbors became advocates, volunteers became lifelines, and chosen families cared for people who sometimes had nowhere else to turn;

DECADES OF EXTRAORDINARY PROGRESS

WHEREAS, more than four decades of scientific research, activism, public investment, medical innovation, community organizing, and compassionate care have produced extraordinary progress against HIV/AIDS, allowing millions of people with HIV to live long and healthy lives; and

WHEREAS, effective antiretroviral therapy can suppress HIV to an undetectable level, protecting the health of people living with HIV and preventing sexual transmission — the scientific principle known as Undetectable = Untransmittable (U=U); and

WHEREAS, the tremendous medical progress achieved against HIV/AIDS matters only if people can actually access and afford the treatment and services that allow them to live, thrive, and maintain viral suppression, and scientific breakthroughs cannot fulfill their promise when the people who need them are unable to obtain them; and

WHEREAS, many people living with HIV depend upon Medi-Cal, Medicaid, the Ryan White HIV/AIDS Program, and other publicly funded programs for access to lifesaving medications, medical treatment, mental-health care, and essential support services; and

WHEREAS, the progress achieved against HIV/AIDS therefore depends upon continuous access to medications, physicians, health insurance, mental-health services, prevention programs, testing, community organizations, and the public-health infrastructure that has taken decades to build; and

WHEREAS, progress against HIV cannot be considered complete while profound racial, economic, and geographic disparities remain, and the benefits of scientific advancement must reach every community affected by HIV;

A RENEWED THREAT TO THAT PROGRESS

WHEREAS, federal reductions in Medicaid spending enacted during the Trump Administration in 2025 threaten access to health care for millions of Americans, with the nonpartisan Congressional Budget Office estimating that the Medicaid provisions of the law will result in approximately 7.5 million additional people being uninsured by 2034; and

WHEREAS, these changes are of particular concern to people living with HIV because Medicaid is a critical source of health coverage for this population and approximately 47% of California adults living with HIV receive coverage through Medi-Cal; and

WHEREAS, reductions in Medicaid and other publicly funded health and social services do not fall equally across communities, and populations already experiencing economic and health-care inequities — including Black and African American, Latino, Indigenous, and other communities of color — may be particularly vulnerable to the consequences of losing insurance coverage, safety-net services, or continuous access to HIV treatment and mental-health care; and

WHEREAS, because communities experiencing disproportionate burdens of HIV are also among those that frequently depend upon Medicaid and other publicly funded health services, reductions in these programs risk not only reversing progress against HIV overall but also widening racial and economic disparities that decades of HIV advocacy and public-health work have sought to reduce; and

WHEREAS, protecting access to HIV treatment is therefore also a matter of health equity: no person's ability to remain healthy, maintain viral suppression, receive mental-health care, or benefit from decades of scientific progress should depend upon their race, ethnicity, income, insurance status, or ability to pay; and

WHEREAS, threats to health coverage and the social safety net are therefore not abstract political or budgetary questions for people living with HIV, but matters with potentially profound consequences for their health, dignity, independence, and lives; and

WHEREAS, loss or interruption of health coverage can jeopardize access to antiretroviral medications, medical monitoring, mental-health care, substance-use treatment, and other essential services, threatening both individual health and the public-health progress achieved during the past four decades;

THE GLOBAL THREAT

WHEREAS, reductions and disruptions in United States foreign assistance have also placed HIV treatment, prevention, and community programs throughout the world at risk, particularly programs historically supported through the President's Emergency Plan for AIDS Relief (PEPFAR); and

WHEREAS, UNAIDS estimates that the permanent discontinuation of HIV treatment and prevention programs previously supported by PEPFAR could result in an additional 6.6 million HIV infections and 4.2 million AIDS-related deaths between 2025 and 2029; and

WHEREAS, these projections demonstrate that the extraordinary progress against HIV/AIDS is neither permanent nor inevitable and that withdrawing the resources that sustain prevention and treatment carries the risk of renewed transmission, preventable illness, and millions of preventable deaths; and

WHEREAS, globally, as in the United States, the burden of HIV and the consequences of reductions in health services fall especially heavily upon communities already experiencing poverty, discrimination, limited health-care infrastructure, stigma, and other structural barriers to prevention and treatment; and

WHEREAS, the history of AIDS has already taught us what happens when people living with HIV cannot obtain treatment, when governments fail to respond adequately, when stigma isolates people from care, and when communities are left without the resources necessary to protect their members; and

WHEREAS, we must not allow people to begin dying unnecessarily from AIDS again because the political commitment and financial resources necessary to sustain HIV treatment, prevention, mental-health care, and community support have been weakened or withdrawn;

SILENCE = DEATH

WHEREAS, we invoke one of the defining calls to action of the HIV/AIDS crisis: SILENCE = DEATH — a reminder that silence, complacency, stigma, and inaction have consequences, and that the progress achieved against HIV/AIDS was made possible because people living with HIV, activists, health-care professionals, mental-health professionals, caregivers, and communities refused to remain silent; and

WHEREAS, HIV remains a very real, present-day issue, and remembering the AIDS crisis requires more than honoring the past; it requires applying its lessons to the present — speaking out when access to care is threatened, standing with people living with HIV, protecting the systems that keep people healthy and alive, and refusing to allow silence or complacency to undo the progress for which so many people fought and so many lives were lost;

REMEMBRANCE, EQUITY, AND RESPONSIBILITY

WHEREAS, we reaffirm our unwavering support for people living with HIV today, long-term survivors, those who died during the HIV/AIDS epidemic, and the partners, families, friends, caregivers, clinicians, and chosen families who loved them, cared for them, survived their loss, and continue to carry their memories; and

WHEREAS, as we remember those lost to HIV/AIDS and stand with those living with HIV today, we recognize that remembrance must be inclusive — honoring people of every racial and ethnic community affected by the epidemic, including communities whose stories have too often received less recognition despite their profound experiences of illness, caregiving, activism, grief, resilience, and survival; and

WHEREAS, San Francisco knows perhaps better than any American city the human consequences of HIV/AIDS, but it also knows the extraordinary things that become possible when physicians, nurses, psychotherapists, social workers, activists, government, caregivers, volunteers, partners, friends, and communities stand together; and

WHEREAS, those who lived through the height of the AIDS epidemic carry both the memory of what was lost and the responsibility to protect the extraordinary medical, psychological, social, and human progress achieved through decades of activism, research, treatment, caregiving, and community solidarity; and

WHEREAS, our renewed commitment must include particular attention to communities experiencing disproportionate HIV burdens and barriers to care, including Black and African American, Latino, Indigenous, and other communities of color, while affirming the dignity and right to accessible, culturally responsive care of every person living with HIV; and

WHEREAS, now, more than at any time since the height of the HIV/AIDS epidemic, the mental-health community must stand together with people living with HIV, long-term survivors, physicians, nurses, social workers, advocates, caregivers, families, and community organizations to defend access to care, confront stigma and isolation, address inequities, support those whose health care is threatened, and ensure that no person living with HIV faces these challenges alone; and

WHEREAS, Gaylesta was founded in 1987 at the height of the AIDS crisis, when the LGBTQ+ mental-health community was called upon to respond to an unprecedented epidemic, and nearly four decades later, as access to HIV care and the resources that sustain it again face serious threats, Gaylesta and the mental-health community are once again called upon to stand together;

NOW, THEREFORE

NOW, THEREFORE, BE IT RECOGNIZED, that Gaylesta has played an important and enduring role in HIV-related mental-health care in San Francisco and throughout the San Francisco Bay Area, connecting LGBTQ+ people with affirming mental-health professionals and contributing to the larger tradition of compassionate, culturally competent, community-based care that emerged during the AIDS crisis; and

BE IT FURTHER RECOGNIZED, that the history of this work belongs to a broad and diverse community of people living with HIV/AIDS, long-term survivors, gay and bisexual men, lesbian and bisexual women, Black and African American, Latino, Indigenous, Asian and Pacific Islander and other communities of color, physicians, nurses, psychotherapists, social workers, activists, caregivers, volunteers, partners, friends, families, and chosen families who responded to an unprecedented crisis with courage, compassion, advocacy, solidarity, and care; and

BE IT FURTHER RECOGNIZED, that Gaylesta continues this vital work today by supporting LGBTQ+-affirming clinicians, facilitating access to psychotherapy, strengthening professional knowledge and community connection, and helping ensure that people living with HIV, long-term survivors, and the broader LGBTQ+ community throughout San Francisco and the Bay Area continue to have access to knowledgeable, compassionate, affirming, and culturally responsive mental-health care; and

BE IT FURTHER RECOGNIZED, that Gaylesta and the broader mental-health community must approach this renewed commitment through the principles of inclusion and health equity, recognizing that HIV disproportionately affects some communities and that Black and African American, Latino, Indigenous, and other communities of color may face intersecting barriers to health insurance, medical treatment, mental-health services, housing, economic security, and culturally responsive care; and

BE IT FURTHER RECOGNIZED, that standing with people living with HIV means standing with the full diversity of the HIV community and ensuring that those who have historically experienced the greatest barriers to care are not the first to lose access when public resources are reduced; and

BE IT FURTHER RECOGNIZED, that at this renewed moment of uncertainty, Gaylesta and the broader mental-health community are called upon to honor the lessons of the AIDS epidemic by once again standing together with people living with HIV, defending access to health and mental-health care, supporting long-term survivors, opposing HIV-related stigma, discrimination, racism, and inequity, and strengthening the community networks that have sustained people with HIV for more than four decades; and

BE IT FURTHER RECOGNIZED, that medical breakthroughs alone are not enough; the promise of HIV treatment is fulfilled only when every person who needs that treatment can obtain it, afford it, remain connected to care, and receive the medical, psychological, and community support necessary not merely to survive, but to live and thrive; and

BE IT FINALLY RECOGNIZED, that the extraordinary progress made against HIV/AIDS must never be taken for granted; that the lives saved through treatment, prevention, research, activism, caregiving, and community solidarity represent one of the great public-health achievements of our time; and that we must not allow preventable illness, isolation, inequity, suffering, and death to return because the political will to sustain HIV/AIDS care has weakened.

Gaylesta was founded during the height of the AIDS crisis, when our community was called upon to care for one another, speak out, and act. Nearly forty years later, we remember those we lost, honor those who cared for them and those who continue to carry their memories, stand unequivocally with people living with HIV and long-term survivors today, and reaffirm our responsibility to protect the progress for which so many fought. We recognize that this responsibility includes ensuring that the benefits of four decades of scientific and medical progress reach every community affected by HIV, particularly those that have experienced disproportionate illness, loss, discrimination, economic inequality, and barriers to care.

The lesson of the AIDS crisis remains as urgent today as it was then: medical progress means little without access; health equity means ensuring that progress reaches those who have historically been left behind; community means caring for one another; and silence in the face of preventable suffering has consequences.

SILENCE = DEATH.

Written by:

Michael Halyard, LMFT, LPCC
www.sanfrancisco-psychotherapy.com
www.SFtherapy.com