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World AIDS Day

11 years ago South Florida lost a true original. 
A cross between one of Charlie's Angels and a James Bond girl, with a little Latina oomph, Sexcilia became known as a headliner in drag shows at Warsaw, the Delano and the salsa club Starfish. Reynaldo Pagan Rivera, the 33-year-old who transformed himself into Sexcilia, died Jan. 14  2004 from complications of acquired immune deficiency syndrome. 
''She took drag into completely different dimensions,'' said longtime South Beach club promoter Maxwell Blandford.  "A lot of drag performers now want to look like real girls, want to sing typical dance songs. But there was nothing typical of Sexcilia.'' Though Sexcilia's signature disco-era fashions, exaggerated heels, curled eyelashes and black wigs often turned heads, it was his one-of-a-kind performances that were most unforgettable.

Sexcilia transformed herself into whomever he was impersonating: Eartha Kitt, Nancy Sinatra or Celia Cruz. ''When he was on stage all eyes were on him,'' said Elaine Lancaster, one of the world's most famous drag queens."He was all about making people laugh and liberating them from themselves."
While Sexcilia was a star to us, his family would not even claim the body and so it was up to his adopted family to lay him to rest.

Fast forward to today and the outlook is brighter. AIDS treatments were available back in 2004 but they had so many side effects they were sometimes as punishing as the disease itself. Instead of 20 pills a day a person living with HIV today might take one pill once a day and experience few if any side effects. Treatments are on the horizon that could be administered once a month, perhaps once every three months.

Treatment is Prevention

With effective treatment comes viral suppression. Viral suppression benefits both the individual and the society. It benefits the individual because the virus is no longer ravaging their body, and it benefits the society because it is highly unlikely that such a person could pass the virus on to someone else, even while engaging in high risk behavior. Treatment is prevention.

We have the tools we need, without any new scientific breakthroughs, to end the plague of HIV/AIDS in our lifetimes. What we lack is the will and resources to apply what we know to the problem. Some states got a massive boost in the fight this year with the Affordable Care Act's Medicaid expansion. But that expansion is being rejected in precisely the places it is needed most.
Kaiser Health News (KHN) reported last March on a study which estimated that “nearly 115,000 uninsured, low-income people living with HIV/AIDS would be eligible for Medicaid if all states adopted the expansion.” But it added, “Of these, nearly 60,000 live in states not moving forward with the Medicaid expansion.” The KHN story notes that “About 70 percent of the group living in states not expanding Medicaid earn too little to qualify for financial help to buy insurance in the marketplaces created by the health law.” 
If the moral argument for the need to extend health coverage to all those who want and need it doesn’t hold sway then perhaps the economic one will. The ACA mandates full federal financing of a state’s Medicaid expansion. Starting in 2017, that 100 percent federal match will gradually taper to and remain at 90 percent by 2020. Thus, the remaining 23 states that haven’t done so are leaving money on the table that could help thousands of people living with HIV/AIDS to get health coverage, care and treatment for “a big disease with a little name.”  Knowing that, it takes a special kind of callousness to continue to say no to those in need.

The Deep South is Ground Zero for HIV/AIDS 

States that refuse to expand Medicaid are turning away monies that were slated to deal with this epidemic and other pressing health emergencies. They are, in effect, asking us to fight this disease with one hand tied behind our backs. Resources that could be going to education and prevention are instead used to meet the basic needs of HIV positive people, like buying the drugs that keep them alive.

This would be a good time to give a crash course on the mathematical models of infectious disease transmission, but suffice it to say that an ounce of prevention is worth a pound of cure.

The new hotbed of HIV/AIDS is the deep south and it is painful irony that this is the exact same place where shortsighted and indifferent governors and legislatures are failing to use the tools at their disposal to address this epidemic. They are undoubtedly costing lives.


  1. Maybe sexcelia should have performed in a giant condom to teach the audiences what prevention is really about.

  2. Most people don't need to put the condom over their face. There are some exceptions.

  3. Do you think that Sexcelia would be alive today if he had received proper education about safe sexual practices?

    What about people who know but fail to follow safe sexual practices? What should/can we do about them?

  4. No, I don't think it was an absence of sex education that killed Sexceilia. Safe sex messages and free condoms were everywhere on South Beach in the 90s. At that point in time it was the drug culture that was responsible for lapses in judgement that lead to risky behavior.

    People blasted out of their minds on X, K, or G are more likely to forget the rubber.

    I knew him/her as a casual friend but I was out of the scene at the time she got sick so I can't say for sure. Obviously she wasn't taking her meds. Maybe they were too much for her.

    If everyone who was HIV positive was on effective treatment we would stop HIV transmission in its tracks. That means getting everyone tested and everyone who tests positive on treatment. Here in the first world we have the resources. But in the 3rd world thousands have died since I put this post up yesterday.


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