By Matthew Williams
Radiant smiles accompanied the cloudless sky and sunshine above a white tent outside the Journey Pure addiction and treatment center. The rustling incomers roused David McKinney to his feet behind tables of condoms and lube, goodie bags and Gatorade drinks. McKinney offered a pen and clipboard, tempting passersby to complete a free HIV rapid test inside the tent to receive some health assurance — and a $15 gift card.
McKinney moved with a serene of sureness and self while celebrating the upcoming gay men’s HIV Awareness Day on Sept. 27, 2023. His vibrant auburn hair, flamingo-colored shirt, and motivation to enlighten others about sexual health came three months on the heels of the legalization of the distribution of HIV self-test kits. Kentucky’s House Bill 349 represented a rarity in the Bluegrass State, where lawmakers within the past year pushed through bills that target cross-dressing performers, transgenders and the LGBTQIA+ community.
At 35, McKinney embraces a life mission to host HIV/AIDS awareness testing events for college campuses and community events. But simply wanting to serve as an advocate and educator aren’t what define his dedication. The faded lymph node scars along the underside of his beard line testify to how HIV left its mark on him nearly three years ago.
“COVID about killed me a year before I got diagnosed,” said McKinney.
He contracted Coronavirus in 2020 but realized during a rough recovery that his body mysteriously began showing profound signs of his system fighting off various infections. Rashes began to appear on his arms, neck and chest. His lymph nodes became enlarged. He found himself knocking on death’s door while at 150 pounds lighter than he weighs today.
McKinney, although familiar with HIV’s impact on the queer community as someone who identifies as gay, didn’t get a lot of learning about HIV in the conservative environment of high school.
“I thought you’d be able to tell by looking at someone that they would have HIV,” said McKinney.
Taking an initiative to learn more on his own never happened.
Contraction of HIV through blood, semen, vaginal fluid, or breast milk could but does not always immediately lead to symptoms. The HIV virus in the individual’s blood will grow and transition through three stages without medical intervention.
• The first stage begins after contracting an acute HIV infection, when an individual may exhibit flu-like symptoms and can transmit the virus.
• The second stage, a chronic HIV infection, may last a decade or longer where HIV grows in the individual’s blood and weakens the immune system.
• The third stage, Acquired Immunodeficiency Syndrome (AIDS), comes as the most severe result when the individual becomes prone to other critical illnesses due to HIV having damaged the white blood cells all humans need to fight off diseases and infections.
On April 8, 2021, McKinney nervously awaited his HIV test results with his mother, his biggest supporter after “coming out” during his senior year of high school. She stood next to him as he discovered his diagnosis on the online MyChart service for patients.
“It was a double hit for both of us,” McKinney said.
McKinney’s CD4 levels were below 200 which put him at a stage three AIDS diagnosis.
Commonly referred to as CD4 cells in the health field, these white blood cells trigger the immune system to fight opportunistic infections. The “count” of someone’s CD4 cells is found through blood work. A normal CD4 count ranges between 500 and 1,500 which can be used as a basis for determining the progression of HIV in the patient.
His first thoughts turned to a scene of actor Tom Hanks dying of AIDS in a courtroom in the 1993 movie “Philadelphia.”
But McKinney found himself under the wings of Matthew 25, a regional nonprofit founded in 1996 with a mission to serve the HIV and AIDS community.
The Matthew 25 staff spent 45 minutes on a call to help calm his mother amid remembrance of the dramatized depiction of AIDS in the movie. By the following Monday, McKinney met with Matthew 25 staff to go over starting treatment with medication immediately.
“I had denied the possibility of me having HIV for so long,” McKinney said.
McKinney began a restorative health journey, a tough road for anyone who gets a positive HIV/AIDS diagnosis.
The Joint United Nations Programme (UNAIDS) global fact sheet for 2022 found 39 million people around the world living with HIV in 2022. Although new HIV infections have globally decreased by 59 percent since their peak in 1995, it serves as a stark reality that millions may not look like they are someone living with HIV but in fact are.
Around 1.2 million Americans currently have HIV, but nearly 13 percent of these individuals are unaware and have not been tested. The U.S. has seen a 12-percent decrease in new HIV infections — 32,100 cases in 2021 and 36,500 in 2017 with the South the region most impacted. The West region of the U.S. represented 21% of new HIV infections. The Midwest totaled 14%, the South 52% and the Northeast 14%.
AIDS was the top cause of death for American men between ages 25-44 in 1992, and by 1994, became the leading cause of death for all Americans within that age. It wasn’t until 1996 when the amount of AIDS diagnoses decreased after oral HIV tests and non-blood antibody tests became available.
AIDS-related deaths have globally decreased by 69 percent since its peak in 2004 and then has decreased by 51 percent since 2010. But just two years after McKinney received his AIDS diagnosis, 630,000 people were found to have died from AIDS-related illnesses in 2022.
Sarah Upchurch, a medical case manager with Mathew 25’s AIDS Services, sees clients with a similar story to McKinney’s as part of the tight-knit crew in Bowling Green, Kentucky. Upchurch links individuals to care for HIV. The Matthew 25 office in Bowling Green opened in January 2020.
It draws its name from the bible, Matthew Chapter 25:
“For I was hungry, and you gave me something to eat, I was thirsty, and you gave me something to drink, I was a stranger and you invited me in,
“I needed clothes, and you clothed me, I was sick, and you looked after me, I was in prison, and you came to visit me.”
“When people come to you with nothing, you provide them with what they need because we’re all human beings,” Upchurch said.
As a nurse case manager, discretion characterizes her relationships with patients. Most back-and-forth phone calls with clients always come with procedures to ensure confidentiality. For example, before calling clients, Upchurch always dials “Star 67,” so their number is blocked, which blocks Matthew 25’s number from being displayed on the client’s phone or records.
If any of the Matthew 25 staff crossed paths with a client in public, they have strict rules to not make contact unless a client initiates it.
It’s also important to Upchurch that the phones used at Matthew 25 handle more than just conversations about health.
“I’ve had plenty of clients that call me, and I can name (them), their pets, how many children they have, what’s going on in their lives, what’s going on in their jobs,” Upchurch said.
But her start in healthcare didn’t begin with such compassion.
Upchurch recalled experiencing a burnout in her career path while working in Nashville at a COVID intensive care unit. At the height of the pandemic in 2020, Upchurch was expected to shuffle patients in-and-out, “whether they were ready or not,” which made her realize she needed work that allowed her to experience the impact of helping others.
Toward the final months of 2020 and her final days at the hospital, Upchurch saw an ad about a position at Matthew 25, and she applied. Later that night at the hospital, a nursing tech warned her to be careful of a patient who recently received an AIDS diagnosis. Caring for him mostly in silence and seeing him through his downcast spirits affirmed to Upchurch that her calling was working in HIV healthcare.
“I knew I needed to work at Matthew 25 because nobody should feel like that — ever,” she said.
Upchurch’s healthcare encounters with all walks of life helped her destigmatize people living with HIV, the LGBTQ+ community and/or those who inject drugs.
The CEO and founder of Matthew 25, Cindy Burton, started the organization in 1996. She attended Zion United Church of Christ in Henderson, Kentucky, where some members of the congregation lived with HIV. This led her to helping these people three decades ago at a time when contracting HIV was seen as a death sentence.
Since 2001, Matthew 25 has accumulated $1.2 million in grants to provide specialized services to patients. Individuals who test positive for HIV are scheduled for an intake appointment, so a medical provider is aware of their medical history.
• As a starting point, the provider at the first appointment, checks the patient’s viral load and documents any major cardiovascular events. The viral load is found through blood tests, which search for the amount of HIV in the patient’s blood. With the results, the doctor or nurse practitioner can meet with the patient to answer questions and provide decisions for medical treatment. Tracking a patient’s viral load over time is an important part of the recovery process to ensure the HIV medicine is effective and that there aren’t any changes in the HIV infection.
• Within the following seven days, the patient will start antiretroviral therapy (ART) medicine taken every day to prevent HIV from multiplying and reducing it.
“It’s something just like you take a pill to treat diabetes — you take a pill to treat HIV,” Upchurch said.
• Checkups occur every four-to-six months to monitor the patient’s viral load and to ensure they’re not experiencing side effects. As the patient’s viral load rises and reaches normal levels, the patient will become undetectable and incapable of transmitting HIV to others.
McKinney is one of the 29.8 million people around the world who had access to antiretroviral therapy in 2022. Antiretroviral medicines have more than just the power to stop the replication of the virus in the blood. They are a modern-day elixir of life to those living with HIV/AIDS.
Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe are five countries that have achieved the “95-95-95” targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS), a United Nations effort to fight AIDS on a global scale.
In these five countries, 95 percent of those living with HIV know their status, 95 percent of those living with HIV have access to ART medicines, and 95 percent of those taking HIV treatments are suppressing the virus in their blood and preventing the risk of spreading HIV to others.
In the hands of every person living with HIV/AIDS, antiretroviral medicines can end AIDS as a global health threat.
“I tell people you know it seems daunting at first when you have all these appointments just all the time, but eventually you’re only having to come twice a year,” Upchurch said.
Matthew 25 also offers additional services to patients throughout Western Kentucky and Southern Indiana. Patients have access to medical and housing assistance, partner counseling, transportation and other resources such as mental health, dental and vision services
In 2022, Matthew 25 performed 2,053 HIV tests. Of those, 29 tested positive. And within the last few months, Matthew 25 started a PrEP medicine program to prevent new HIV infections.
The ever-evolving Gen Zers represent a target audience for Matthew 25’s work.
Matthew 25 uses their social media updates to deliver weekly bite-size nuggets of information on HIV and sexual health. Their inclusive approach, particularly toward providing acceptance and valuable information to the LGBTQIA+ community, serves as a powerful draw for the youth.
Matthew 25’s media also spotlight its staff, some of whom proudly identify as LGBTQIA+, which creates a space where the younger generations can feel support for their diverse identities in a way that isn’t just acknowledged but also is celebrated.
This inclusive stance sends a powerful message about the organization. Matthew 25 serves as a beacon for the younger generation seeking organizations that mirror their values and promote a culture of acceptance, Upchurch said.
Additionally, the organization shares updates on testing events and sweetens the deal by offering gift cards as incentives, encouraging community members to actively participate.
Advertisements have appeared for the medications Truvada or Descovy during television commercials. The Centers for Disease Control (CDC) found that taking PrEP pills decreased the possibility of contracting HIV through sex by 99%.
PrEP strengthens the defenses of CD4 cells. If HIV enters the individual’s body, the medicine prevents the virus from taking over healthy cells and multiplying. If HIV enters your body, it will be unable to breach the walls to gain access to the CD4 cells. Matthew 25 conducts kidney function tests before and during PrEP use to ensure the individual’s body is stable on the daily use of the medication.
Swan De’Leone accompanied McKinney on Matthew 25 awareness setups as a friend and a spokesperson for the PrEP program.
De’Leone met with Courtney Woolfork, the current Matthew 25 CEO, at a surprise party for a mutual friend in 2020. The comforting aura of De’Leone’s personality stood out as a great fit for a spokesperson. So he began working at Matthew 25 on March 27, 2023.
De’Leone advocated for use of the medicine, even for those who believe their lifestyle doesn’t pose risky behavior.
“I know when I’m in the heat of the moment, I don’t have the best judgment,” De’Leone said.
They know firsthand how situations can arise unexpectedly which allows being on PrEP to be one’s safety net.
“PrEP helps you protect yourself and allows you to go out and have fun.” De’Leone said.
Recent advancements in PrEP research showed the possibility for a more targeted use. Rather than daily ingestion, the individual would only have to take the pills for a short period during sexual activeness.
Women (who were assigned female sex at birth) represented 18 percent of the new HIV diagnoses in 2021. At 54 percent of the women, Black/African American represented the highest number of women affected, United Nations Programme reported.
Around the world, 1.3 million were newly infected with HIV a year later in 2022. Similar to Black/African American women in the U.S. Children, adolescent girls, and young women in sub-Saharan Africa faced a great risk of acquiring HIV. Every week in 2022, adolescent girls and young women in sub-Saharan Africa, aged 15–24 years, represented 3100 of the 4000 globally who were newly infected, United Nations Programme reported.
HIV originated in Central Africa, initially a simian immunodeficiency virus in chimpanzees that mutated into HIV once contracted by humans. Studies show 20.8 million people who were found to be living with HIV in eastern and southern Africa in 2022. There were 4.8 million found in western and central Africa. These are countries where people continue to have to fight for their human rights which has a direct impact on their health resources and progress against the virus, United Nations Programme reported.
With the help of Matthew 25’s services, McKinney got a new lease on life more than nine months ago.
“I no longer have an AIDS diagnosis,” McKinney said.
After taking antiretroviral therapy medicine (ART), his CD4 levels rose above 200 which reverted his Stage 3 AIDS diagnosis to an HIV diagnosis.
McKinney reflected on his renewed positive outlook and on his life decisions.
A large part of that is a supportive circle of people.
McKinney took a leave of absence from his Starbucks job after his diagnosis in 2020 for six months to rebuild his immune system and overall confidence.
The six months allowed him to focus on getting his life back on track and overcoming the initial emotional turmoil. McKinney encountered moments where he questioned how he contracted HIV and battled the guilt that came with possibly transferring the virus to others.
McKinney started a regimen of meditation and yoga every morning as he continued to process the changes to his life. He came to the realization that he and any past sexual partners took that chance.
“It takes two to make that decision, so I can’t take all that guilt on myself,” McKinney said. “From the moment that I had processed everything, I thought, this isn’t anything to be ashamed of.”
Now, McKinney is in an open relationship with a male partner also living with HIV. His current vaccinations and boosters help ensure his protection against other illnesses. He uses his HIV status as a learning opportunity, to inform potential partners on his dating profiles and to educate curious strangers in passing conversations.
Finding a life balance after starting back to work proved difficult, but at the very least, McKinney monitors his eating habits and prioritizes staying hydrated.
But McKinney knows the impact others might experience without the privilege of support.
The six months McKinney took off work to start his health journey speaks to the new lifestyle people diagnosed with HIV/AIDS must acclimate themselves to. They begin a daily HIV regimen that includes taking a minimum of three HIV medication drugs from at least two drug classes. In 1996, researchers found that combining medicines to treat HIV was advantageous to preventing mutation of the virus in the individual’s body and strengthening the efficiency of the treatment long-term.
There are six classes of drugs used in antiretroviral therapy: NRTIs, NNRTIs, Protease Inhibitors, Fusion Inhibitors, CCR5 Antagonist, Integrase Inhibitors, Post-Attachment Inhibitors, and Pharmacokinetic Enhancers. There are various combinations possible in a patient’s HIV regimen depending on what stage they’re HIV is in.
But with taking a HIV regimen comes a critical responsibility to take the medication appropriately and at their designated times to reduce resistance and cross-resistance. This could mean one must integrate reminder alarms, pillboxes, and whatever means necessary to keep a strict regimen. A person who may not find themselves with McKinney’s allotment of time to adjust may struggle with keeping up their HIV regimen due to a busy work schedule, side effects of medicine, fear of making others aware, pill dysphagia and more.
McKinney found solace during those six months in a state of mind where patients are recommended to “plant themselves” to make the commitment more seamless.
McKinney hopes to find and help these people through Matthew 25. He inspires individuals to reach out to the nearest clinic and to find support from the Ryan White HIV/AIDS funded program.
Ryan White was 13 when diagnosed with AIDS after a blood transfusion in December 1984. The Kokomo, Indiana, teen lived for five years and died in 1990 after receiving a diagnosis of six months to live.
“HIV doesn’t discriminate, but we have come so far medically,” McKinney said. McKinney’s flare for bringing awareness shines bright.
“For anybody who’s HIV positive, learn about your disease, what that process looks like over time because it affects everybody differently,” he said. “Stay on top of it and fight for yourself. Advocating for yourself as an HIV positive person is extremely important.”