For now, it’s primarily through gift cards, or friends willing to send me fiat, and take Monero. However, I am one of those people who will actually pay more for something if I can pay for it directly in Monero. As an example of this, I get fresh coffee beans from gratuitas.org because they run their business in Monero. It is way more expensive than buying coffee from the store, but I am willing to do it just because they accept Monero only. My phone bill and groceries are paid via gift cards to Instacart and my phone carriers gift cards and life insurance is paid through Fiat with a friend who accepts Monero and sends me Fiat.