Jim: It feels like I should probably explain a little bit about why [Wyoming AIDS Walk] was so important and so necessary as well. Most of us, when we think about having a medical condition, oh, well, you can just go see the doctor for that, right? There are doctors everywhere. Well, that's not entirely true here in Wyoming. A lot of small communities don't have their own doctor or that have very limited medical resources. But when it comes to HIV and AIDS care—last count that I knew, we have a grand total of three doctors in the state who work with HIV patients. That number is up. At one point over the years, we had one single doctor in the state. So most everybody who is HIV positive in the state has to travel out of state for their care to see an infectious disease specialist or someone who has enough medical knowledge and enough specialized knowledge about HIV care and the special concerns that go along with that.

There are also a number of programs that folks can access. There are things like the Ryan White Care Act. There were folks here in Wyoming who were registered with the State Health Department, and were receiving some assistance through Ryan White funds or other state funds. Some of our folks that we worked with had insurance that helped cover some of those costs. 

But even when you have access to those kinds of programs through the state, or through insurance, there are a lot of extra costs that add up, the little things that can nickel and dime you. If you're having to travel out of state to go to your medical provider, you have to pay for gas. Wyoming is not a small state. It can take you all day to drive across that, across state lines. You are gonna have to spend some money on food when you're traveling, probably, or take a cooler with you, and then you gotta buy the groceries to go in it. You might have to pay for a hotel room. You might have insurance or Ryan White funds that could pay for your medications, but if there's a copay, those add up. And for HIV and AIDS medication, those costs—especially in the 2000 era—were astronomical. Some of those costs have come down since then because the drugs are now available in a generic form, some of them, but back then that wasn't really a possibility. That wasn't a thing. 

Ashley: Can you talk a little bit about how identity impacts access to care? 

Jim: Absolutely. In Wyoming, the state HIV and infectious disease prevention program—most programs like that involve surveillance programs. Not like Big Brother is watching you, but we're going to track the progress of the disease in our state, we're gonna look at the number of people, how many confirmed cases do we have? The data did show that a majority of the people in Wyoming who were known HIV cases and documented cases were MSM, men who have sex with men. They may not identify as gay or bisexual, but their behavior might mean that sometimes they engage in sexual acts with other men. 

That was definitely something that affected prevention work. I and some of the others were also on the HIV Materials Review Committee, where we looked at the prevention and education materials used and approved in the state of Wyoming. One of the things that we had to look at was the wording in some of those materials. We had to look at whether or not that was going to be off putting to somebody. 

Just the use of the term “men who have sex with men” is an example of that. Rather than saying gay or bisexual men—which some people might argue, well, if you're having sex with men sometimes, you're at least bisexual—but if somebody doesn't identify with that term and we are putting out HIV prevention materials that say gay and bisexual men, well, that's going to mean a whole lot of the men in this state who should be receiving that message are not going to pay attention to it because of the label associated there.

And so, a lot of the prevention efforts over the years became focused on addressing behaviors rather than identities. Certainly we saw a lot of stigma with anyone who is HIV positive, not just somebody who was gay or bisexual, or identified as part of any other particular identity or community. Anyone who was HIV positive was really subject to a possibility of stigma. Many people lost jobs. People didn't want their status to be known. They didn't want to even go in for a test because of what that might mean. 

And a lot of that has to do, I think, with the fact that we've got such a small population and we're dealing with small towns and rural communities. It's really hard for somebody living in Lusk, Wyoming, or Medicine Bow, or Kaycee—those small towns—to go to your hometown doctor, who may have been there and delivered you when you were born, to go and talk about sexual health, much less, “Hey, I need an HIV test.”

It really creates some barriers there for people accessing care, for people accessing information, or testing just to know what their status was. I think that the stigma is less than it used to be when we started this in 2001, but there's still very much stigma. And that I think affects care for everyone. The stereotype and the stigma that is associated with the disease, and the fact that it is seen as a gay disease, I think prevents heterosexual people from going and getting tested. It is really important that we talk about the disease, and talk about those stigmas, so that everyone can feel safe and comfortable going and getting a test so that you know what your whole status is, so that you know if you need to start taking some medication to address this, so that you can also take steps to not spread the disease.

We have treatments now that can help people get their viral load down to undetectable, where they have an almost zero chance of transmitting the disease through normal sexual contact. There's just so much that that stereotype and that bias prevents people from accessing care and support. And for no reason should anybody not be able to get health care because of who you are. That shouldn't be a thing. In this day and age, with our advances in technology, with our talk about society, we need to take care of one another. 

Ashley: Do you think that in Wyoming, there are any additionally unique problems regarding stigma or access to care or living with HIV AIDS? 

Jim: I think so. And I think, you know, I've kinda I've kind of touched on a lot of them so far. I think that some of the things that make it more challenging or unique are the lack of resources. The fact that we have fewer doctors, the fact that we don't have as many healthcare providers, period. If you are having any kind of opportunistic infection and you need medical care, you might have to travel farther to get that. And so that levels up that challenge and creates that extra barrier or that extra hurdle to jump. 

The stigma of your friends and neighbors, you know, creates some challenge there. Just the rural nature of the state, like I was talking about. Dental care, vision care, those sorts of things. We have fewer dentists, fewer eye doctors. It would be illegal for a business to refuse to serve someone because they were HIV positive—doesn't mean it doesn't happen. Doesn't mean that when you go into your local doctor's office, the nurse in the reception area doesn't make it real clear she is not happy to have you there. And I think also here in Wyoming, just a lack of knowledge and awareness. This is not something that we talk about a lot in all corners of the state. 

And in addition to what I've talked about already with meals and gas and things like that, there are other things that people don't think about that HIV and AIDS makes a special requirement of. We bought water purification systems—we bought something like 50 water purifiers one year—because one of the things that's important when you're taking some of those medications, some of those you have to take with water. And with the number of folks living in Wyoming in rural areas, it needs to be good clean water rather than something that might just come out of any old well. For a lot of people living with HIV or AIDS, the medications come with side effects. Oftentimes taking your pills with meals or with food was a way to make sure that that stayed down, so that you didn't get some of the really bad side effects that can come along with that.

And so it was little things and odds and ends. It was really necessary for us to raise some money for people, to cover those extra costs, the things that insurance or state assistance and federal assistance programs just don't cover to fill in those gaps. So that was really the driving force behind Wyoming AIDS Walk and why we created it.

Note: The transcript above has been condensed from its original audio recording to improve the flow and readability of the story.