In the early 1980s I encountered my first HIV patient as a young medical student in Los Angeles. He was a man in his 20s sick with fever and swollen lymph nodes.

I felt humbled and saddened in the face of a terrifying new disease we didn’t understand and didn’t know how to treat. He succumbed to AIDS not long after, becoming one of the millions whose lives have been cut short by the epidemic.

Today, when I train new healthcare providers at the Valleywise Community Health Center - McDowell, it’s hard to convey how awful those days were during the early years of the HIV/AIDS epidemic in the United States. There are books, plays and movies that try to portray the era, but if you didn’t live through it, it’s difficult to impart the misery and despair we all felt – providers and patients alike.

Thankfully, HIV is no longer a death sentence. There is still no cure, but newer antiretroviral drugs have made HIV a survivable condition treatable with a single daily pill. And if one medication doesn’t work or causes side effects, there are many other options.

What’s more, preventive medicine is available for those at risk for contracting HIV. Approval in the past decade, pre-exposure prophylaxis, or PreP, has dramatically changed the prevention landscape for HIV.

Yet the more things change, some things sadly remain the same in HIV transmission.

Today, Maricopa County is one of 48 counties across the United States with the highest rates of new infections. More than 11,000 individuals in Maricopa County are living with HIV.

Many of those newly infected, particularly younger LGBTQ patients, don’t know about the utter horror of the early days, and simply don’t view HIV as a big deal. To those in their teens, 20s and 30s, the early 1980s is outside of their lifetimes. Further, many heterosexual patients still think of HIV as a gay disease rather than a STD that anyone can get.

Furthermore, 40 years after the first HIV/AIDS in the US, we’re still dealing with shame and stigma. Unfortunately, an infection that any of us can encounter is still perceived by some as a scarlet letter, rather than simply the luck of the draw that intimacy can bring. Only through open dialog about risk, testing, PrEP and staying on treatment can we be safe from HIV.

When I counsel patients today, it’s a much different conversation than in the 1990s when I treated HIV patients at the LA County Medical Center. Back then, it was reassurance about fighting a terminal disease; today’s it’s optimism about a long and full life –if a patient takes their medication every day.

I remember a home visit with a very ill young man in the early 90s who looked at the full moon outside the window and remarked, “I don’t think I’m going to live to see the next moon.” A month later I smelled every bloom in the hospital rose garden on my way into the hugs that greeted me in the clinic the day after attending his death at home.

It’s just one of the many stories of loss and coping that those of us impacted by the AIDS pandemic carry in our hearts forever.

Going forward, however, we can reduce and prevent new infections in Maricopa County through education around safer sex , the use of PreP and helping HIV+ patients stay in care with suppression of their viral infection. At Valleywise Health, we treat more than 4,000 patients living with HIV, and provide testing and PrEP to those at risk for acquiring the infection.

It’s important to recognize the 40th anniversary of the first AIDS cases in the US and appreciate that now a days NO one needs to get infected with HIV. For our HIV+ patients, the history begins when they get their HIV diagnosis - and that’s when we’ll be there to offer understanding and support, for many decades to come. For those not yet infected we implore you to reach out to use so we can help you stay HIV uninfected.

About the author

Ann Khalsa, MD, has worked in the field of HIV medicine since 1986. From 2006-2010 she was the Medical Director at the Centro de Salud Familiar La Fe HIV/AIDS C.A.R.E. Center in El Paso Texas which cares for over 1000 patients living on the US-Mexico Border. She held a clinical appointment as an Assistant Professor of Family Medicine at the Texas Tech University Health Science Center and also served as the Clinical Director at the Texas-Oklahoma AIDS Education and Training Center Local Performance Site in El Paso Texas. For the fifteen years prior to that she worked at the University of Southern California in Los Angeles as an Associate Professor of Clinical Family Medicine at the USC Keck School of Medicine where she also she served as the Director of Clinical AIDS Training for the Pacific AIDS Education and Training Center at USC, and chairperson for part of the medical school curriculum. During that time she cared for over 1000 patients at the LA County Rand Schrader and Maternal-Child AIDS clinics, and trained over 1000 local and international physicians in the care of HIV patients. She started off in the HIV field by doing four years of AIDS policy work through the Public Health Commission of the American Academy of Family Practice during medical school and residency.

Dr. Khalsa is certified as an HIV Specialist through the American Academy of HIV Medicine, has served on the national Board of Directors, the Academy’s Core Curriculum Committee to develop its “Fundamentals of HIV Medicine” self-study guide, and has authored chapters on Health Maintenance and antiretroviral therapy for treatment-experienced patients. She served on the Texas Steering Committee for the HRSA HIV/AIDS Bureau-National Quality Center Cross-Part Quality Management Collaborative, as well as on the Quality Management Committee of the Ryan White Title II Administrative Agency for the West Texas Health Service Delivery Area. She lectures on HIV-related topics to providers and patients alike, in both English and Spanish throughout the country and internationally.

She is board certified by the American Board of Family Practice, was awarded the US-Mexico Border HIV Hero Award in 2008, is a recipient of the Mead Johnson Award for Graduate Education in Family Practice, and a member of the Alpha Omega Alpha Medical Honor Society. Dr. Khalsa obtained her undergraduate degree from Pitzer College in Claremont California with honors in Psychobiology, and her medical degree from USC. She did her residency training at San Bernardino County Medical Center in California, holds master’s degrees in Biochemistry and Medical Education, and completed a Fellowship in Leadership Development at USC.

Photo courtesy of Michael Feinstein.

Michael Feinstein

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I think it’s fair to say we all want that #fitlife, especially with Spring around the corner — as well as Gaypril on the way. Whether it’s pool season yet or not, everyone would choose to look fit over not looking fit, if they could have it with a snap of their fingers. OK, the vast majority of us would.

If you’ve met me, or have been reading my articles, you know that I live, sleep, eat and breathe fitness; it’s my heart and soul. That being said, I’m here to tell you that the concept of “fitness” is oftentimes tragically misunderstood.

Before you get too aggressive with your goal for pool season, let’s dive a bit deeper into what fitness means on the inside versus what it looks like on the outside, and common misconceptions around this concept.

1. Beware of the cultural pitfalls and misleading information around fitness.

Most of the bodies you see in the media are probably not real, they just look very convincing. As a trainer who also moonlights as a photographer and Photoshop wizard, I’m telling you that it is incredibly easy to alter pictures in materially misleading ways. Once you know the tricks of the trade, the imposters are easily spotted. But that’s not what this is about.

The point is: to the untrained eye, it can be devastatingly defeating to see such impossible standards. It seems as though the cultural pressure to look a certain way, to look perfect, has spread all the way from runway models to fitness novices with the help of smartphone apps.

The truth is that we fitness models look that cut, and that lean for only a couple days at a time. That’s it! In many cases, months or even close to a year of training, dieting and programming all go into looking like that for ONE day. Let that sink in for a second. Day to day, I am less cut, less tan and much flatter muscularly than what you see in some of my pictures. That’s just the nature of the beast. So, when you have a bad day on the scale, in the mirror or in any other scenario, remember that we’re all human and that the most legitimate photos you’re comparing yourself against were from someone’s very best day. That should help to keep things in perspective.

2. Most people want the results, without actually doing the work.

Fitness is not six pack abs, it’s not superficial, it is not temporary and it’s not an isolated phase in your life. Further, fitness is not something you do for someone else, do to spite someone else or even to impress someone else.

Fitness is confidence, toughness, dedication, coordination, power, balance, speed, strength (both literally and figuratively) and persistence in the face of all obstacles. This includes control over your attitude, your mood, your sleep, your schedule, your diet and other aspects of your life. This means getting that workout in when you least feel like it.

It’s not easy, and it’s definitely a grind that has good and bad days. You must show up and keep working on the days you’re tired, stressed, rushed, defeated, doubtful, afraid and so on. The days you actually have to overcome something instead of just checking your workout off your to-do list are the days you have the greatest opportunity to really make progress, push your body and see the most improvement.

3. Fitness is really an internal mindset. The external physique is the fringe benefit.

I’ve said this time and time again, and it might sound strange coming from such an aesthetic-focused trainer, but you are not your body. Your body is a tool, it’s a means to an end, to express your internal mindset, belief system, discipline and dedication to your workout program. Your physique will come and go. Your strength will come and go. Your abilities will wax and wane depending on what you’re training for at the time.

The outside will, and should, be always changing, but the inside is what we’re really after here. Good trainers want to train you to believe in yourself when sh*t gets hard. We want to train you to be resilient in the face of injury, obstacles and other setbacks. We want you to set ambitious goals and shoot for the moon because you can get there with smart programming and relentless will (do yourself a favor and ditch the crash diets and the photo editing software).

So, as you make your spring preparations for swimsuit season, try focusing on developing a sterling, unshakeable internal character and the muscles will come along the way, this I promise you.

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