The American health insurance companies are denying claims for any pain meds if you have HIV. Apparently HIV is not only harmless, it’s painless, too. Cigna is not who or what they say they are.

I am writing this on my phone, waiting for Gino to show up. He’s always late. HIV is killing him. He’s been on every antiretroviral known to man. These drugs do not work with everyone. Abacavir almost killed him.  He wasn’t breathing when I found him, and he was turning a ripe blue. They let me ride the ambulance with him. We were seconds from being too late.

I do not remember hearing the siren. The whole thing unfolded in my head while it was happening in my face. I could not hear a thing. Only muffled, disconnected fragments. Gino and I were no longer lovers.

We were friends.

I am not sure if one has any more value than the other.

When Gino called, it was quit late. I could not understand him. But I could hear the gasping.

The last time Gino called, he was beyond the grave.

He had been at an all night party and when he woke up on the floor, the other people still there were slipping away. Heroin and fentanyl will do that. It gets quite grim out there.

“You need to call 911,” I told him.

Frankly, I didn’t want to get involved. This had been a miserable party, and the drugs were brutal.

Gino was just not cut out to do sex work. He was suicidally depressed. But I had spent years attempting to extricate Gino from the egregious thing that was now his life.

I had remembered to grab the abacavir just before the ambulance arrived to take us to the ER. This dangerous drug was not unknown to them.

Gino was on a first name basis with everyone who worked in the ER, and the ambulance paramedics.

Do not ask me why he called me and not them. He was mainly incoherent on the phone.

I didn’t know the drug except by name. Abacavir has killed many people with HIV.

Abacavir can cause serious, life-threatening side effects. These include a serious allergic reaction, a buildup of lactic acid in the blood (lactic acidosis), and liver problems.

People who take abacavir may have a serious allergic reaction (hypersensitivity) that can cause death. Your risk of this allergic reaction is much higher if you have a gene variation called HLA-B*5701. Your health care provider can determine with a blood test if you have this gene variation. If you get a symptom from two or more of the following groups while taking abacavir, contact your health care provider right away to find out if you should stop taking abacavir.

Symptom: Fever

Symptom: Rash

Symptom: Nausea, vomiting, diarrhea, abdominal pain

Symptom: Exhaustion, aching

Symptom: You cannot breathe

Symptom: Buying clothes for funerals

Symtom: UNRELENTING PAIN

Today, you will be given you a Warning Card with a list of these symptoms. Carry this Warning Card with you at all times. If you stop abacavir because of an allergic reaction, never take abacavir or any other abacavir-containing medicine again. (The combination HIV medicines abacavir/lamivudine [brand name: Epzicom], abacavir/lamivudine/zidovudine [brand name: Trizivir], and abacavir/dolutegravir/lamivudine [brand name: Triumeq] also contain abacavir).

If you take abacavir or any other abacavir-containing medicine again after you have had an allergic reaction, within hours you may get life-threatening symptoms that may include very low blood pressure or death. If you stop abacavir for any other reason, even for a few days, and you are not allergic to abacavir, talk with your health care provider before taking it again. Taking abacavir again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction to it before. If your health care provider tells you that you can take abacavir again, start taking it when you are around medical help or people who can call a health care provider if you need one.

Contact your health care provider right away if you have any of the following symptoms that could be signs of lactic acidosis:

• Feeling very weak or tired
• Unusual (not normal) muscle pain
• Trouble breathing
• Stomach pain with nausea and vomiting
• Feeling cold, especially in your arms and legs
• Feeling dizzy or lightheaded 
• Fast or irregular heartbeat
• Contact your health care provider right away if you have any of the following symptoms that could be signs of liver problems:
  

• Yellowing of your skin or the whites of your eyes (jaundice)
• Dark-colored urine
• Light-colored bowel movements
• Loss of appetite for several days or longer
• Extreme nausea
• Pain, aching, or tenderness on the right side of your stomach area

It had been my turn to call Gino last night.

“Cigna is denying our claims for pain meds.”

“I can get marinol if you want any. Pro bono, baby. No charge. I owe you that. Meet me in the alley around 2am.”

My eyes to the sky. Gino was late.

Then. There. He. Was.

White as the dirt-pocked snow. Driven. Always driven.

The marinal was probably stolen.

“Let me know when you need more. How are the boys.”

“Not good.”

“What’s going on.”

“Besides living through the year from hell, HIV is beginning to feel like dragging a fifty pound ball and chain. Right now, we are all going through a bad spell of diverticulitis.”

Gino nods.

“That one is very nasty.”

“We have one bathroom, and we’re lucky to have that.”

“I’m trying not to laugh, Tim.”

“I’m in no mood for it.”

“You look terrible. Like a ghost.”

“Yeah, I look like you.”

“You always did.”

Many people still think I am Gino. I’m not.

“The marinol will help.”

“Thank you.”

“I can get fentanyl if you need it.”

There was a long silence between us.

I hugged him. He means well. But I would sooner die that go through that withdrawal again.

It would take about ten seconds for the lot of us to turn into addicted junkie ghosts just like the last time we did fentanyl. You may as well just hang yourself from a tree.

Never give that fucking opiate to a junkie who is sober and in recovery. Probably for the rest of his life. He will relapse then and there.

“I don’t allow needles anywhere near us.”

“I am now a Diabetes Darling.”

This is junk code for I have needles.

Gino will never change.

I know the day will sneak up on me when I am going to have to go shopping for another new black suit.

https://tim-barrus.format.com/about