When I met my friend Joseph in June 2000 at a writing program in Vermont, he had already been HIV+ for decades, Nearly everyone who was infected when he was, early in the days of the AIDS epidemic, had died. He would go out to the National Institute of Health in Bethesda every year so they could draw his blood as they searched for a cure.

Joseph was my best man at my wedding. (Mine, not Alex’s). He was handsome, charming, funny and talented, great company and a devoted friend. He was too sick to work full-time, and couldn’t risk losing his government healthcare by working part-time—the loss of those benefits would have been a death sentence for him. So he was always living precariously.

Joseph died just over a year ago. I think about him often. And I think about the ways we could better design our healthcare system, so that it doesn’t penalize those who can’t work much when they want to do the little they can.

Photo Credit: Shelagh Shapiro