#Gaza
#Israel
#queer
#Medical
#War
#HIV

Forth Chapter

By June, the situation in which ES was living had deteriorated drastically. The borders had been closed for over a month. He wrote that the northern Gaza Strip was being starved: "We lack any humanitarian aid." He continued: "I can't remember the last time we had fresh fruit and vegetables, poultry, meat, or dairy products. Whatever processed canned food is left is being sold at much higher prices." People are running out of money, and there are no longer any banking services. "It feels like a never-ending vicious cycle," he wrote in the chatbox.

He also witnessed Israeli forces using quadcopters to attack civilians. "Once we were at the market, where a group of people were shot at, killing at least three people. It's horrifying, to say the least."

In July, ES asked his brother to travel to get more medication from a sibling's stash of his doctor's medicine. Although it was a great risk, he returned with enough to last ES until October. It was a relief to have more pills left, but he wrote, "When these run out, I WILL absolutely have to find another way to get them because, as far as I know, there are none left up north. And I don't know if they can send any more up north."

ES decided it would be best to ration his medication and skip doses. "I did that for a few days. But my doctor told me I couldn't do that under any circumstances. It's better to be cut off from the supply than to ration/share it or mix up the dose."

As the months passed, the stress became too much for ES. "I try to persevere, trust in my faith, and do my best to find a way out, even though working under pressure has never been easy for me. I've turned to certain organizations to get medicine to Gaza, but every door I knock on is closed. The only door that never closes is God's, and maybe by sharing my story, I can finally get the help I need."

On July 10, ES wrote: "It's been crazy here. The violent clashes have been extremely close. Everything has gone crazy in the last few days. " The raging conflict made it impossible to imagine when his dwindling supply of pills might be replenished.

In August, ES's original doctor stopped responding. "I hope nothing happened to him," he wrote. On September 15, ES wrote: "For the past ten months, I've been lucky. I had access to my HIV medication because I stayed in northern Gaza. But now I'm running out. I took the last doses available in the north," and he was told "no more shipments are arriving. There are no more medications for me."
Mylan brand blue pill box: Lopinavir/Ritonavir 200mg/50mg, 120 tablets
white pill box from Mylan: Emtricitabine/Tenofobir, 200 mg/300 mg, 30 tablets

At that point, Dr. Tarek Loubani, a Canadian emergency physician of Palestinian descent representing a medical organization called Glia, saw ES's story on Instagram and contacted him to help. Loubani has participated in more than 20 medical missions in Gaza since 2011 and continues to do so, despite being shot in 2018, which he downplays ("it was the cleanest shot possible").

On their first scheduled mission after the October 7 attack, Loubani's group brought various medications to prevent shortages, including 100,000 units of insulin. But when it came to HIV medication, the first problem Loubani encountered was that ES "takes a very, very, very specific medication that most people with HIV don't use."

Nevertheless, Glia did everything she could to obtain the medication, but was thwarted in several countries. "I thought we could simply buy it in Jordan, but in Jordan, access to the medication was absolutely forbidden to anyone who wasn't Jordanian."

"I don't have great news," Loubani wrote to ES in early October, along with a photo of three bottles of urgently needed lopinavar/ritonavir tablets that had been procured in Canada. "Everything is ready for entry in Jordan, but on Tuesday the entire team was denied entry. It has been postponed until October 22nd. If you know of anyone who will still be allowed in, I'll be happy to pass it on to them."

But when Glia transported a three-month supply of medicines to the Gaza border, the shipment was confiscated. Then Glia, along with some of the organization's medical volunteers, was barred from entering Gaza. The organization believes this was retaliation for her contribution to a New York Times essay published on October 9 under the headline "65 Doctors, Nurses and Paramedics: What We Saw in Gaza."

When contacted, the Israeli Coordination of Government Activities in the Territories (COGAT) responded that "Israel neither blocks nor restricts the import of medicines, including HIV medications, which can be imported without quantitative restrictions." COGAT did not directly address a question about whether Glia had been retaliated against for the Times article, but merely described an article about the suspension as "outdated" and said, "The organization's activities have been approved."

Loubani said Israel treated the medical supplies "basically like weapons depots" and accused the military of "burning down many of the medical depots it found." Loubani said the Israeli military was "stationing snipers in front of some depots." A pharmacist "ran and tried to get the medicine, was shot in the neck, and miraculously survived," Loubani said.

Then, in mid-October, ES's house was hit by a rocket. He, his brother, and his mother barely escaped with their lives. In his Instagram stories, he shared a picture of a damaged wall. ES said his brother had been sleeping next to it, but his cats, his constant companions, were found dead under rubble. In a video shared by ES, an emergency worker says, "Alhamdulillah, alhamdulillah," as she leads him out of his destroyed home, while he clings to his walker and wipes tears from his face.

ES moved with his family from his damaged home to a friend's house, which they rent in another part of Gaza City. "I haven't been able to rest lately. It's been four days, but all my psyche needs is to return home and rest, and I can't," ES explained.

On October 26, ES was finally able to reconnect with his original doctor from the Ministry of Health in the south, who had good news: He was able to get more of his medication. One of the medications is intended for children. "So I have to take 2.5 tablets instead of the one I used to take."

On December 3, Loubani wrote: "Good news: Lopinavir/Ritonavir for 3 months finally arrived on Tuesday. Now we need to get it to Gaza City." Many people around the world helped make this happen because, as he put it, "HIV medication is important for everyone. It holds a special place in people's hearts."

HIV medications are important for everyone. They hold a special place in people's hearts.
IT

ES currently has a few months before he needs to worry again, and he says his mental health has improved significantly, but he still desperately hopes he can leave Gaza before he runs out of medication again.

"No matter how tirelessly Israel works to make things work for us who suffer in Palestine, the magic and power of God defy these efforts," says ES. "They are evident in these small acts of grace—the kindness of strangers who have expressed concern and offered help, and the miraculous arrival of my medication through a plan I could never have foreseen. These acts of grace keep us steadfast in Gaza."

By Afeef Nessouli and Steven W. Thrasher. Originally published on January 13, 2025. Translated from English and republished with permission from The Intercept, an award-winning nonprofit news organization dedicated to holding the powerful accountable through fearless, adversarial journalism. Sign up for The Intercept's newsletter.

https://magazin.hiv/magazin/krieg-und-hiv-queer-in-gaza/

#Gaza
#Israel
#queer
#Medical
#War
#HIV

Third Chapter

By the time ES's HIV infection was finally properly treated, "it was already very late." The disease had progressed to AIDS by then, as the number of his T cells—a type of white blood cell necessary to fight infection—was dangerously low. An MRI suggested that an opportunistic infection might have already spread to his brain.

By restarting his HIV medication, ES's condition eventually improved, and he was able to pull himself out of his deep depression. "I started figuring out how to get back into life. One of the first things I did was dress in bright colors instead of all black. I also created Instagram stories, mostly for myself, to save in the archive. But my father didn't like that and sensed I was 'going down that road again,' so he assumed I was communicating with someone online."

In early 2023, ES said his father continued to give him intimidating "pep talks." He threatened to kill him if he continued "acting like a faggot." The cost of his treatment also caused pressure, and ES said his father wouldn't let him forget this. Instead of prioritizing rehabilitation, ES threw himself into working as an English tutor seven days a week. The exhausting workload hampered his recovery. When he was diagnosed with neurosyphilis, his doctor said the physical complications would be temporary as long as he received proper physical therapy and rehabilitation. But because there were no facilities for these in Gaza, he planned to work hard for a year and save money to travel for treatment.

Months later, on a rare Saturday off from work, ES agreed to go swimming with his brother, his father, and his younger half-brother at a local pool. He was excited—he hadn't been swimming in a long time. The night before, he talked to his father about where they could get one of those "round, tire-like flotation devices," because with his disability, he said, "he wouldn't have a chance in the water without one." His father assured him they could buy one along the way.

But as he was making coffee around 6 a.m. the next morning, he began to see and hear an "unbelievable number of rockets being fired over the horizon. I knew immediately something was wrong. I had never seen anything like it. I rushed inside to wake my mother and brother and then called my father. We didn't even need to cancel our plans for the day—it was clear they were already canceled."

It was October 7, 2023. ES turned on the television and quickly realized that some people had managed to break the siege and enter Israeli territory. Before he could fully comprehend the repercussions, "it felt like breaking out of prison—literally," he said.

But then he was brought back down to earth. What initially seemed like a prison escape for Gaza eventually turned into an even harsher prison sentence.

Months of Israeli military violence in front of his home and the inadequate supply of food exacerbated his disability. The longer ES had to live without adequate rehabilitation or food, the more his mobility deteriorated.

And if the syphilis came back, "I don't think there are any doctors left who can help." He's running out of HIV medication, and he knows this could be his death sentence. He understands that at some point he'll have to start prioritizing his health over the fear of being outed. In one message, he wrote, "It remains painfully true that silence is death," echoing a phrase coined by the activist group ACT UP in the 1980s.

So he started connecting online with people he thought could help. Around the same time, a controversial story about a person who stopped taking their HIV medication under very different circumstances garnered attention on Instagram.

On December 1, 2023, playwright Victor I. Cazares had to rush to the airport to travel to his native Texas when his grandmother became ill. Cazares' artistic home at the time was the New York Theatre Workshop, where he was completing a two-year fellowship and teaching a class.

"I had forgotten my HIV pills. The taxi was there, and I forgot them," Cazares recalled. But as Cazares sat on the plane, a vivid scene played out in his mind. "I imagined the Palestinians fleeing their homes and finding they had forgotten their medication or no longer had access to it. On top of that, it was World AIDS Day."

An idea took shape: "I won't take my medicine until the New York Theatre Workshop calls for a ceasefire." The company is known for its work on AIDS, such as the musical "Rent," but like many nonprofit organizations in the arts and other fields, it had remained silent about the rising death toll in Gaza.

I imagined Palestinians fleeing their homes and finding that they have forgotten their medication or no longer have access to it.
Victor I. Cazares

Cazares' pill strike, documented on his own Instagram account and the subject of a widely read story on Vulture, recalls a history of HIV medication refusal as a form of activism. In post-apartheid South Africa in 2002, Zackie Achmat, co-founder and activist of the Treatment Action Campaign, became known for his refusal to take antiretroviral medication until it was available to everyone.

Cazares told Vulture that they were prepared to refuse to take their medication until the New York Theatre Workshop called for a ceasefire, a ceasefire was reached, or they were hospitalized.

Then, "the night sweats started. I felt the pH of my skin change. It took about two months before I became noticeable."

"I started experiencing certain neurological symptoms. I started getting scared," Cazares recalled to The Intercept. Cazares had moments when she couldn't think clearly and felt troubled by the "faulty" thoughts and "paths my mind was taking." As a playwright, Cazares worried about what would happen if these symptoms worsened and she suffered permanent neurological damage.

After Cazares learned about ES and his attempts to obtain the medication they had voluntarily refused, they began to cry—and eventually to sob.

"It's not that I couldn't imagine a person like ES"; Cazares just hadn't known exactly who they were. In 14 years of living with HIV, "I've had nights where I was really scared, even though I had access to medication, and I can't imagine what that must be like for ES." Cazares noted how the "propaganda, pinkwashing," and stigma make people living with HIV "disappear."

Ultimately, the reason Cazares ended the strike after 125 days and resumed taking the medication was that she no longer believed the New York Theatre Workshop would speak out. Cazares came to this realization when the company mounted a production of the World War II-era play "Here There Are Blueberries," which she described as "a play about people who remain inactive during a genocide," and the New York Theatre Workshop still hadn't spoken out against the violence in Gaza.

When an HIV patient stops taking antiretroviral medication, "the virus can multiply very rapidly in the body," says Dr. Oni Blackstock, an HIV primary care physician and former deputy commissioner of the Bureau of HIV at the New York City Department of Health. The biggest hurdle in dealing with an otherwise treatable virus is when access to medical care is disrupted by racism, homelessness, or war. The second biggest challenge arises when the stigma surrounding treatment keeps patients away.

Although the time it takes for the effects of stopping antiretroviral medication to become noticeable varies, Blackstock said this could happen within a few weeks or days and has a lot to do with the person's baseline condition.

Given that ES had neurosyphilis, typically eats only one meal a day, and is trying to survive a genocide, his situation is already quite precarious. Even a brief interruption of his HIV medication could lead to a worsening of his neurological symptoms and mobility.

"HIV destroys CD4+ T cells, which protect us from infection. Without medication, the virus multiplies, producing more copies of itself, and the immune system weakens—leaving the person vulnerable to various types of infections and cancer," warned Blackstock. "Even minor infections can become serious." The risks in Gaza extend far beyond minor infections. Wounds from rubble and bombings are common, hepatitis A and cholera are rampant, and war zones are breeding grounds for antibiotic resistance.

Even polio, once eradicated, is back.

Compared to people living with HIV worldwide, what ES experiences is both universal—stigma has been a major barrier to his health—and place-specific due to the ongoing genocide in Gaza and the decades-long occupation of Palestine.

Around November 2023, the brother of ES's doctor gained access to the Health Department's infectious diseases warehouse in northern Gaza and brought the medicines ES needed to his own home. "He feared they would be destroyed if he left them at the clinic," ES said. He received a three-month supply—enough to buy him a bit of time.

For months, ES had avoided publicly asking for help, unwilling to acknowledge his dwindling supply while the Israeli military was killing his neighbors. It felt strange to ask for help while others were starving or orphaned. He also suspected that there was some chance the supply could somehow be replenished.

However, in March 2024, he began reaching out. (He reached out to Afeef, one of the co-authors of this story, because of his coverage of queer Arab stories on his Instagram page.) ES wrote: "I have about two months of HIV medication left. And I'm definitely looking for ways to get my medication."

It feels like a never-ending vicious circle.
IT