After taking some critical time away from fighting HIV, Marco Benjamin last year became the director of public health at the Joseph H. Neal Health Collaborative in Columbia, South Carolina.

 

After living with HIV for 20 years, much of that time as an AIDS activist, Benjamin was at a crossroads. Decades of HIV activism had left him feeling burned out.

 

“I kind of thought I retired from HIV, so I spent some time on the beach in Puerto Rico,” says Benjamin, whose island roots run deep. “Then the Neal family called and explained it was time for me to come back to activism. They needed my help to run the organization as it needed to be done.”

 

Joseph H. Neal was a legendary South Carolina state lawmaker who died in 2017. He spearheaded the removal of the Confederate flag from the statehouse. He also had a decades-long track record fighting HIV. In 1993, he sponsored the bill to make HIV testing private and confidential in South Carolina. “After his death, the family opened up a nonprofit in his name, primarily to address HIV and rural health,” Benjamin says.

 

According to Benjamin, roughly 20,000 South Carolina residents are living with HIV, including 5,000 who are not in care. So what’s it like in a state that didn’t expand Medicaid and doesn’t fund HIV prevention tools like condoms or needle exchange?

 

“We are in a twilight zone here,” says Benjamin, a New York native, referring to South Carolina’s conservative leanings. “Some would say if you can’t beat them, you join them, right? So we made MAGA-style red caps. The hat doesn’t say, ‘Make America Great Again.’ It says, ‘Make Sex Safe Again.’”

 

Benjamin also uses South Carolina’s high diabetes rates as a point of entry for his health advocacy.

 

“We’re not leading with HIV; we’re leading with diabetes or hepatitis C,” Benjamin explains. “And while you’re here to test your blood sugar, can I test you for HIV as well? In the past few months, we’ve identified about 20 people with hepatitis C and got them on treatment.”

 

Benjamin notes a growing cohort of heterosexual patients engaging in their sexual health for the first time “because something’s itching, burning and/or dripping.”

 

And that highlights one of Benjamin’s current headaches: a nationwide shortage of Bicillin, a frontline treatment for syphilis. So, like many sexual health professionals before him, he’s forced to improvise.

 

“You can use doxycycline [to treat syphilis], but you have to take it for a month,” Benjamin says. “And when you’re on doxycycline, you cannot expose your skin to the sun. We’re in South Carolina. Hello, when is it not sunny here?”

 

Being forced to act on the fly all the time to navigate such headwinds is “exhausting.” That’s why Benjamin preaches the benefits of a short sabbatical for HIV activists looking to foster longevity in the fight.

 

“The war on HIV has not been won,” Benjamin explains. “And so I got a little break, and now I’m back, better than ever, stronger than ever, mentally better prepared. And more importantly, I’m in a place where I am needed, in a state where people need my help.”