These Folks With HIV Discovered How to Live Outside the U.S. and Access Care Tim Murphy - TheBody
go to original December 7, 2021

Bob Doyle in Cuenca, Ecuador, where he moved from Palm Springs in 2019

By 2019, Bob Doyle had been living in the gay desert retirement mecca of Palm Springs, California, for about five years - and was not happy. Diagnosed with HIV in 1986, Doyle, 66, had moved there from Seattle partly because his income qualified him for California’s free-meds ADAP system, but not Washington state’s, and partly because of Palm Springs’ excellent network of health care and services for older folks living with HIV.

But he’d soon found that his modest Social Security income didn’t get him far in the increasingly posh community. “My car was 16 years old and falling apart,” he says, “and my rent was $1,000 for a studio in a ’50s-style motel building and was about to go up again.” Affordable-housing options he’d signed up for had waitlists of three to four years.

Moreover, Trump’s win in 2016 had left him demoralized about the direction of the U.S. “I was just so frustrated and disappointed,” he says, “feeling like so much of what we had fought for was going away very quickly.”

There was yet another factor in his discontent: “I’d always wanted to see what the rest of the world was like.” Via Facebook groups for English-speaking LGBT ex-pat retirees, he learned about Cuenca, a stunningly historic and LGBT-friendly city of about 660,000 nestled in the Andes mountains of southern Ecuador, with temperate weather to boot. If foreign retirees could show $400 (now $800) in monthly income and no criminal record, he learned, they could move there on a retiree visa and enjoy Ecuador’s solid health care system for about $80 a month, including HIV and other meds.

He did the paperwork and, armed with a year’s supply of HIV meds gifted to him from his Palm Springs doctor’s sample closet, made the leap, moving there in 2019. He now pays $450 for a three-bedroom, two-and-a-half-bath, fully furnished modern apartment including all utilities except internet. It’s so affordable that “I’m now able to put some money away.” He’s slowly learning Spanish and practices with cab drivers - half of whom, he says, have worked in New York or Boston. COVID has slowed his opportunities to get to know others from the area’s considerable LGBT ex-pat community, but he loves walking around the city, with its four scenic rivers running through it and a plethora of cultural institutions and markets teeming with art, crafts, and produce. “You can get a nice lunch here for less than three dollars,” he raves. “The cocoa and coffee [are] fantastic. I cook a lot more now than I did in the states.”

He has no plans of returning to the U.S. “I love it here,” he says. “I’m calmer.”

Pulling Off a Dream

Doyle is fulfilling a dream that many Americans share but few act on - living abroad. It’s a particularly rare thing for Americans living with HIV, who often are - or at least feel - tethered to where they live in order to get health care and meds through either their job or their state’s particular Medicaid or ADAP program. And in a country with a fractured health system like the U.S., where moving across a state line can make the difference between robust and weak health care, leaving the country completely usually entails a level of freedom and privilege unavailable to many of us. But for those who can do it, it can feel hugely freeing.

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