Life in Northern Gaza is precarious enough without having to worry about AIDS. Airstrikes and ground raids are a constant threat that keep people from leaving their homes to find food. “We have to conserve,” said E.S., a 27-year-old who lives with his mother and younger brother in the Tel al-Hawa neighborhood in southwest Gaza City. “People are fighting each other to get the aid boxes.”
And then there’s the issue of medication.
“My doctor told me that the antiretrovirals have been consumed completely and there is nothing left in store,” said E.S., who is HIV-positive and agreed to speak with The Intercept using a pseudonym to avoid community stigma and targeting by the Israeli authorities.
He needs tenofovir, a common HIV medication, and lopinavir/ritonavir, a much more rarely prescribed one. At times, E.S. has had so little left that he dangerously began rationing his pills by skipping morning doses. “There are no more supplies coming in or there hasn’t been any supplies at all coming in to the south or to the north,” he typed in a direct message. While Israel has denied blocking medication, international aid groups like Glia have told The Intercept that HIV medication specifically has been blocked from entering the Gaza strip.
Without these medications, E.S. — who already uses a walker for mobility — would see his health deteriorate rapidly. Within a short span of time, he would begin to move even more slowly, and he might lose the ability to walk altogether. With soldiers mandating mass displacement and sniping Palestinians as they try to evacuate, this could mean a death sentence.
E.S.
As Israel’s war on Gaza rages around him, E.S. has spent most of his time at home with his two cats. While many of his neighbors moved south to Rafah, he stayed put with his brother and mother, who is a cancer survivor. His limited mobility, the result of a viral infection exacerbated by HIV, made leaving more dangerous than staying.
So they chose to stay north — despite warnings from the occupation military to evacuate. His home, while offering more protection than a tent, hasn’t exactly been safe: “I saw people get sniped right across the street from me. It was a family of five trying to cross the road after they were ordered to evacuate their building before it was bombed.” He said the parents died and the children survived.
E.S. used to get his medication from Al Rimal Martyrs Clinic, but it was evacuated and then reinhabited by displaced Palestinians.
“Now, with the genocide happening, I fear not only my health deteriorating, but also how my family will respond,” he wrote. For years, his family didn’t acknowledge his HIV status; now he worries that his condition will be a liability for them.
There is an added terror for Palestinians in Gaza who must hunt down vital medications. It’s especially hard for those few dozen looking for stigmatized HIV meds.
According to “HIV/AIDS in Palestine: A growing concern,” a 2020 article in the International Journal of Infectious Disease, there have only ever been about 100 cases of HIV officially documented by the Palestinian Ministry of Health. Still, the report found, “the Middle East and North Africa region is considered an area of increasing concern for HIV infection due to high mortality associated with AIDS” in general, and “Palestine (the West Bank and Gaza Strip) is part of this concern.”
This is because HIV incidence is slowly increasing, and untreated HIV-positive Palestinians are progressing toward cases of AIDS. Similar to HIV dynamics among Black queer men in the Mississippi Delta, in Palestine, “within a short time patients become susceptible to opportunistic infections, probably due to the late diagnosis and presentation of the cases.”
And as outbreaks in America and Greece have shown, without adequate testing and screening, even a few cases of HIV can rapidly increase.
As recently documented in Ukraine and Russia, wars have long exacerbated HIV transmission. In Gaza, the universal protocols needed to prevent blood-borne infections simply cannot be followed.
The Gaza Ministry of Health told The Intercept that it contacted HIV patients at the beginning of the war, urged them to visit specific health facilities, “and their treatments were dispensed for a period of 3 months.”
“Now, unfortunately, their treatments are not available,” the ministry added.
Bombings routinely cause Palestinians with no training (let alone latex gloves) to desperately try to save their wounded neighbors, hospitals lack water for washing hands or surfaces, and patients with gaping wounds are treated on blood-soaked floors.
With Gaza’s few hospitals targeted and largely destroyed — and with more than 1,000 of its health care workers killed and others detained — this is not an environment where any virus can be contained.
E.S. was born and raised in Gaza. He grew up Muslim but doesn’t practice the religion anymore. He describes himself in many ways: as someone who is very spiritual, with a deep connection to the divine. As an artist, with a focus on mixed-media work related to gender expression and Gaza. As someone who is HIV-positive. As Palestinian. As queer.
“I like ‘queerness,’ it kind of represents my wanting to be free and, like, fluid,” he wrote.
E.S. grew up exploring sexuality with his classmates and neighbors. Many of them are married to women now, he explained. He also had unfortunate experiences that he didn’t consent to with some men.
E.S.
E.S. spent a year in the United States as an exchange student in high school. He applied to colleges there afterward but, while waitlisted, began his studies in Turkey in early 2014 as a scholarship student. It was then that he first felt symptoms which he worried might mean he had HIV. In the same year, he got a scholarship to study at an American college, and by the end of 2016, he moved to the Midwest, where he was first diagnosed with HIV and syphilis and treated with antiretroviral medication. Feeling he could no longer deal with his illness alone, he left the United States in 2019 and returned home to Gaza.
Gaza has been the love of his life, the beach most of all. “It’s the only place where I feel at peace with myself.”
But when he returned, E.S. didn’t know a single other queer person, let alone anyone else with HIV. When his parents found out about his HIV status, they told him it was his fault and they were worried it would bring shame to the family.
E.S. found it easier to avoid the subject, which meant he ran out of the medication he had been getting in the U.S. He didn’t know he could talk to the Ministry of Health to get more. His physical health deteriorated. “It was very complicated, because my mom was dealing with cancer,” he said. “She always justifies it by how there was so much happening. Because she was diagnosed with breast cancer and went through the treatment at around the same time.”
People newly infected with HIV might not feel anything, and they may appear asymptomatic for many years. But E.S. also had syphilis. The delayed treatment for that and for his HIV (which suppressed his immune system) allowed the syphilis to progress into neurosyphilis, which damaged his nervous system, left him with chronic pain, impeded his ability to walk, and thrust him into severe depression and anxiety.
He felt like he wasn’t in a position to advocate for himself to his parents to help him, because the subject of his sexuality and his HIV status and viral infection were already so taboo.
“For them it is just like, no, like the natural way to go about it is dick and pussy. And like, if it’s dick and dick, you will go to hell. And before you go to hell, you’re gonna destroy the reputation of our family.” His parents had gotten divorced a few years earlier. “‘If anyone knows about your HIV status, there’s gonna be an apocalypse that’s gonna just destroy the entire world.’ This is what they made me feel like.”
For years, E.S. suffered painfully without support. “I was complaining about pain in my legs. My dad would take me every month or so to the beach to lecture me and remind me to change my life.” When his father saw the infection was impeding his ability to walk, he took him to see a neurologist — but, according to E.S., told his son to lie about his condition. The neurologist couldn’t help E.S. without knowing the truth.
Eventually, in 2022, his father consulted with a close friend who was a doctor. This time, he confessed that his son was potentially dealing with a sexually transmitted disease.
“To my dad’s shock,” E.S. said, “the doctor friend sympathized with my case in complete understanding and advised my dad to urgently rush me to the infectious disease department to get me registered (anonymously) and have me put on antiretrovirals and other needed treatment.” E.S. believes that his dad’s friend saved his life.
His parents’ response to his condition strained their relationship. “I kind of blame my parents for my disability,” E.S. said “I should not blame them, because this is from God and I respect it. I accepted surrender to it.”
But he still carries so much love for them. “What you would expect is like a supportive family — that would be the most important thing for you. Or like a solid group of friends, chosen family. But I had no one.”
Still, he has seen signs of other seemingly queer people. In one voice note, E.S. described getting food at the market in Gaza City. He was with his mom, and there was “this guy that had short hair, and his outfit was fully coordinated. And he had, you know, these mini purses in the way the bags that would hang from your shoulder, like no man wears that in Gaza, at least. And the walk was a bit flamboyant.”
A few weeks later, he said he saw another two guys, who were “straight looking or dressed in a straight way, wearing caps. Arab guys in Gaza, they like to wear tight jeans. But these two guys, when I was walking, we locked eyes and I just felt it. These motherfuckers sleep together.”
E.S. says that there is an excitement to “clocking” other people in Gaza who might be queer. But it also brings with it other emotions. “I am just presuming their sexuality. I am presuming from how they walk fast or what they are wearing, but the biggest feeling I get is insecurity. What if that person perceives me? I’ve noticed them, so does that mean they are perceiving the queerness in me? So then, I feel this sense of shame and judgment or disapproval almost immediately.”
E.S. likes to express himself by bleaching his eyebrows. “When I was a baby I had blonde hair. It is pretty much a ritual at this point. I usually get shy and ask my mom to buy the products for me. It’s weird when I buy them myself.”
Any identity, aside from being a Palestinian surviving, is hard for him to prioritize right now.
By the time doctors began properly treating E.S.’s HIV, “it was super late.” The disease had progressed to AIDS at that point, since the level of his T cells — a type of white blood cells necessary to ward off infections — were dangerously low. An MRI suggested an opportunistic infection might have already gotten to his brain.
By restarting HIV medication, E.S. eventually improved and got out of his deep depression. “I just started to figure out how to get back into life. One of the first things I did was start to wear colorful clothes instead of all black. I would also record Instagram stories, mostly for myself to be saved in the archive. But my dad didn’t like that and sensed I was ‘going down that path again’ and assumed I was communicating with some guy online.”
By early 2023, E.S. said his father would continue having intimidating “pep talks” with him. He threatened to kill him if he kept “acting like a faggot.” Another pressure was the cost of his treatment — something E.S. said his father would not let him forget. Instead of prioritizing rehabilitation, E.S. threw himself into work as an English tutor, working seven days a week. The grueling schedule hindered his recovery. When he was diagnosed with neurosyphilis, his doctor said the physical complications would be temporary if he received proper physical therapy and rehabilitation. But since such facilities didn’t exist in Gaza, he planned to work hard for a year and save money to travel for treatment.
Months later, with a rare Saturday off work, E.S. agreed to go swimming at a local pool with his brother, father, and little half-brother. He was excited — he hadn’t gone swimming in a long time. The night before, he talked to his dad about where they could get one of those “round, tire-like floaties” because, with his disability, he said he “wouldn’t stand a chance in the water without one.” His dad reassured him they could buy one on the way.
But as he made coffee the next morning at around 6 a.m., he began to see and hear a “whopping number of rockets being launched across the horizon. I instantly knew something was off. I had never seen anything like that before. I rushed inside to wake up my mom and brother, then called my dad. We didn’t even need to call off our plans for the day — it was clear they were already off.”
It was October 7, 2023. E.S. turned on the TV and quickly realized that people had managed to break the siege and enter the occupied territories. Before fully processing the implications, he said “it felt like breaking out of prison — quite literally.”
But then, reality set in. What at first seemed like a jailbreak for Gaza, eventually transformed into a more intense prison sentence.
Months of Israeli military violence occurring outside of his house and inadequate food exacerbated his disability. The longer E.S. went without proper rehabilitation or food, the more his mobility deteriorated.
And if the syphilis came back, “I don’t think there will be any doctors left to help.” E.S. has been running out of his HIV medication and knows it could be his death sentence. He understands he eventually must begin prioritizing his health over the fear of being outed. In one written message, he typed, “silence equals death remains painfully true,” evoking a phrase coined by the activist group ACT UP in the 1980s.
So he started reaching out to people online who he believed could help. Around the same time, a controversial story was getting attention on Instagram about someone going off HIV medications under very different circumstances.
On December 1, 2023, playwright Victor I. Cazares had to hastily leave for the airport to travel to their birth state of Texas when their grandmother became ill. Their “artistic home” at the time was the New York Theatre Workshop, where they’d completed a two-year fellowship and taught a class.
“I forgot my HIV pills. The cab was here, and I forgot them,” Cazares recalled. But as they sat on the plane, a vivid scene played out in their head. “I got the image of Palestinians fleeing their homes, and realizing, or forgetting, or not having access to their medicine. And it was World AIDS Day.”
An idea formed: “I am not going to take my medicine until the New York Theater Workshop calls for a ceasefire.” The company is well known for work about AIDS, like the hit musical “Rent,” but like many nonprofit organizations in the arts and other fields, it had stayed silent about the mounting death toll in Gaza.
Cazares’s pill strike, documented on their Instagram account and the subject of a widely read Vulture story, recalls a history of HIV medication refusal as a form of activism. In post-apartheid South Africa in 2002, Treatment Action Campaign co-founder and activist Zackie Achmat infamously refused to take antiretrovirals until such medications were widely available to everyone.
Cazares told Vulture they were prepared to refuse their meds until New York Theatre Workshop called for a ceasefire, there was a ceasefire, or they became hospitalized.
Then, “the night sweats began. I could feel the PH level in my skin changing. It took about two months for me to become detectable.”
“I started having these neurological symptoms. I got scared,” they recalled to The Intercept. Cazares had moments where they lost clarity in their thinking and became alarmed at the “faulty” thoughts and “pathways that my mind would go” down. As a playwright, Cazares became worried about what would happen if these symptoms grew worse and if they suffered from permanent neurological damage.
Told about E.S. and his trials to obtain the kinds of medication he’d voluntarily refused, Cazares began to cry — then weep.
“It’s not that I couldn’t imagine a person like E.S”; they just hadn’t known exactly who they were. In Cazares’s 14 years with HIV, “I had nights where I was really scared, and I had access to meds, and I can’t imagine on top of everything else, what that must be like for E.S.” Cazares noted how the “propaganda, the pinkwashing” and stigma “vanishes” people living with HIV.
Ultimately, what made Cazares end the strike after 125 days and resume taking their medication was when they gave up believing the New York Theatre Workshop would speak out. They came to this realization as the company mounted a production of the World War II Nazi-era play “Here There Are Blueberries,” which Cazares described as “a play about people who do nothing during a genocide” — and New York Theatre Workshop still did not speak out against the violence in Gaza.
When an HIV-positive patient stops antiretrovirals, “the virus can replicate in their body very rapidly,” said Dr. Oni Blackstock, an HIV primary care physician and former assistant commissioner at the Bureau of HIV for the New York City Department of Health. The biggest barrier to managing an otherwise treatable virus, she said, is when access to care is disrupted by racism, homelessness, or war. The next greatest challenge is when the stigma of seeking treatment keeps patients away.
“While how long it takes to feel the effects of” antiretroviral discontinuation varies, Blackstock said, it can happen in “weeks or days” and has a lot to do with a patient’s “baseline” of health.
Given that E.S. has had neurosyphilis, is usually eating just one meal a day, and is trying to survive a genocide, he doesn’t have much of a baseline to begin with. Even a brief interruption to his HIV medication could make his neurological symptoms and mobility deteriorate.
“HIV destroys CD4+ T-cells that protect us from infection. Without medication, the virus increases, makes more copies of itself, and the immune system gets weaker — and then the person becomes vulnerable to different types of infections and cancers,” Blackstock warned. “Even minor infections can become threatening.” The risks in Gaza extend far beyond minor infections. Wounds from debris and bombings are common, Hepatitis A and cholera are rampant, and war zones breed antibiotic resistance.
Even polio, once eradicated, is back.
Compared to people living with HIV around the world, what E.S. is experiencing is both universal — stigma has been a huge barrier to his health — and geographically specific to the yearlong genocide in Gaza and the decadeslong occupation of Palestine.
Around November 2023, E.S.’s doctor’s brother got access to the infectious disease health department’s storage in northern Gaza, and moved the medication E.S. needed to his own home. “They feared they would be destroyed had they left them at the health clinic,” E.S. said. He received a three-month supply — enough to buy him a bit of time.
For months, E.S. had avoided asking for help publicly because he didn’t want to acknowledge his dwindling supply while the Israeli military killed his neighbors. It felt awkward to ask for help when others were starving or becoming orphaned. He also surmised that there was an outside chance the stock could get replenished somehow.
But in March 2024, he began to reach out. (He contacted Afeef, one of the co-writers on this story, because of his reporting on queer Arab stories on his Instagram page.) E.S. wrote, “I have about two months of HIV — medication. And I’m definitely on the lookout for possible ways to access my meds.”
“It feels like a forever loophole.”
By June, the situation where E.S. was living had gotten drastically worse. Borders had been closed for over a month. In his correspondence, he said that the Northern Gaza Strip was being starved: “We are lacking any humanitarian aid,” he wrote. “We haven’t had any fresh produce/poultry/meat/dairy products for as long as I could remember. Whatever canned processed food that is left is being sold at much higher prices.” People were running out of cash, and no banking services remained operational. “It feels like a forever loophole,” he typed into the chat box.
On top of all of this, he saw Israeli forces using quadcopters to attack civilians. “We were once at the market where a group of people were fired at, killing at least three people. It’s very terrifying to say the least.”
In July, E.S. asked his brother to make a trip to pick up more medication from the cache at the home of his doctor’s sibling. Although it was a big risk, he returned with enough to last E.S. until October. It was a relief that there were more pills left, but he wrote “after this runs out, I WILL ABSOLUTELY need to figure out another way to access them because there isn’t any left here up north as far as I know. And I don’t know if they will even be able to send more up north.”
E.S. decided the best course of action was to begin rationing his medication and skipping doses. “I did that for a couple of days. But my doctor told me that I can’t under any circumstances do that. It’s better to be cut off than to ration/split or mess around with the doses.”
As the months passed, the stress was becoming too much to bear for E.S. “I’m trying to hold on, relying on my faith and doing my best to figure a way out, even though working under pressure has never been easy for me. I’ve reached out to organizations to try and get medication into Gaza, but every door I knock on gets shut. 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, E.S. wrote, “it’s been crazy here. Violent clashing has been super close. It’s been going insane the past couple of days 😞.” The raging conflict made it impossible to imagine when his dwindling pill supply could be replenished.
By August, E.S.’s original doctor stopped answering him. “Hope nothing bad happened to him,” he wrote. On September 15, E.S. wrote, “For the past ten months, I was lucky. I had access to my HIV medication because I stayed in the north of Gaza. But now, I’m running out. I took the last doses in the north,” and he’d been told “there are no more supplies coming in. No more meds for me.”
E.S.
By then, Dr. Tarek Loubani, a Palestinian Canadian emergency physician representing a medical organization called Glia, had seen E.S.’s story on Instagram and reached out to help. Loubani has been on more than 20 medical rotations to Gaza since 2011, and continues to go, even though he was shot in 2018, a fact he downplays (“it was the cleanest shot possible”).
On its first scheduled mission after the October 7 attack, Loubani’s group brought various medications in anticipation of shortages, including 100,000 units of insulin. But when it came to HIV medication, Loubani said that the first problem he ran into was that E.S. uses “a very, very, very special medication, such that most people with HIV don’t use this medication.”
Still, Glia did everything it could to procure the medications, only to be stymied in multiple countries. “I thought we could just buy it in Jordan, but in Jordan the medication was absolutely forbidden to access for anyone who wasn’t Jordanian.”
“Some not so great news,” Loubani wrote to E.S in early October, along with a photo of three bottles of the desperately needed lopinavar/ritonavir pills procured in Canada. “Everything is ready to enter in Jordan, but the entire team was denied entry on Tuesday. They’ve been rescheduled for 22 October. 😢😢If you know anybody else entering, happy to give it to them.”
But when Glia transported a three-month supply of meds to the Gaza border, the shipment was confiscated. Then, Glia was banned from entering Gaza, along with several of its medical volunteers. The organization believes it was in retaliation for their participation in a New York Times essay published on October 9 called “65 Doctors, Nurses and Paramedics: What We Saw in Gaza.”
Asked for a response, the Israeli agency for the Coordination of Government Activities in the Territories replied that “Israel neither blocks nor limits the entry of medications, including those for HIV, which can be brought in without quantitative restrictions.” COGAT did not directly address a question about whether Glia had been retaliated against for the Times essay, merely describing an article about its suspension as “outdated” and saying “the organization’s activities have been approved.”
Loubani said Israel has treated the medical caches “basically like weapons depots,” and alleged that the military “burned many of the medication warehouses that they found.” Loubani said the Israeli military “would station a sniper outside some of the depots.” One pharmacist “made a run for it, tried to get the medication and got shot in the neck, and miraculously survived,” Loubani said.
Then in mid-October, E.S.’s home was struck with a missile. He, his brother, and mother barely survived. On his Instagram stories, he shared a picture of a blown-out wall. His brother had been sleeping against it, E.S. said. But his constant feline companions were found dead under rubble. In one video that E.S. shared, a female emergency worker says “Alhamdulillah, alhamdulillah” as she guides him out of his destroyed house as he wipes his teary eyes with his walker in front of him.
E.S. moved with his family from his damaged home to a friend’s place they are renting in another part of Gaza City. “I haven’t had any rest lately. It’s been 4 days but all my psyche needs is to go back home and rest but I can’t do that,” E.S. explained.
On October 26, E.S. finally reconnected with his original doctor from the Ministry of Health in the south, who had good news: He had secured more of his medication. One of the medications is made for children, “So I have to take 2.5 pills instead of the one pill I used to take.”
On December 3, Loubani messaged: “Good news, 3 months of Lopinavir/Ritonavir finally entered on Tuesday. Now we have to get it to Gaza City.” Many people around the world worked to make this happen because, as he put it: “Everybody cares about HIV medication. It occupies a special place in people’s hearts.”
For now, E.S. has a few months before having to worry again, and he says that his mental health has vastly improved but still desperately hopes he can evacuate Gaza before running out of medication again.
“No matter how tirelessly Israel works to ensure that nothing works for us who are suffering in Palestine, the magic and power of God defy those efforts,” E.S. said. “It’s in the small mercies — the kindness of strangers who expressed concern and offered help, and the miraculous arrival of my medication through a plan I could never have foreseen. These acts of grace are what keep us steadfast in Gaza.”
