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I am honored that the White House chose to commemorate the 30th Anniversary of the HIV/AIDS pandemic with me and other openly HIV-positive organizers from across the country. We gathered recently with federal officials to reflect on the salient lessons learned and milestones marked in the fight against HIV/AIDS over the past three decades.
Reflecting on this solemn occasion stirs a mix of emotions.
In 30 years, HIV has caused tremendous loss and human suffering in every corner of the inhabited world. But it has also inspired heroic acts of kindness, generosity, and leadership. Looking back, we must laud the significant medical, political, and scientific advances achieved but also sustain a firm understanding of the unfinished work that lies ahead. With record numbers of people living with HIV and increasing numbers of new infections, we must reinvigorate efforts to provide people with and at risk for HIV/AIDS with the health and social services, housing, prevention, and human-rights protections they so desperately need and deserve. HIV knows no borders and neither should our compassion and actions.
Recognizing the rapid maturity of HIV medical, behavioral and social sciences, the U.S. Centers for Disease Control and Prevention now considers HIV a winnable battle. To truly win the future, the U.S. must not relent until we’ve won the fight against HIV/AIDS.
Thankfully, the U.S. is poised to make tremendous progress. For the first time, the U.S. has a comprehensive National HIV/AIDS Strategy, which President Obama unveiled in July 2010. The Strategy provides a thorough analysis of the HIV/AIDS epidemic in the U.S. and maps a pathway to decrease HIV infections, improve health outcomes for those of us living with HIV, and decrease HIV-related health disparities among the three groups most severely impacted: African Americans, Latinos, and men who have sex with other men. Winning the battle against HIV must start with realizing the measurable targets of the Strategy.
In 2010, Congress enacted and President Obama signed into law the Patient Protection and Affordable Care Act, which could quite literally reverse the epidemic’s spread once the law is fully implemented. From the very beginning, inadequate healthcare access, discrimination, and indifference sowed the seeds of today’s burgeoning epidemic. By eliminating healthcare insurance discrimination against those who desperately need it, expanding public and private sources of affordable insurance, and guaranteeing a minimum standard benefit, HIV care will become more readily accessible than ever before.
But the most significant portions of the law will not take effect until 2014, which is why our current safety-net systems—namely Medicaid, Medicare, and the Ryan White HIV Act—are so critically important. In over a dozen states, nearly 10,000 individuals with HIV languish on waiting lists for medications through their state’s overburdened AIDS Drug Assistance Programs, which desperately need an infusion of state and federal funds. Hundreds of thousands of other HIV-positive Americans remain unaware of their infection or have simply given up and are not seeking or receiving medical attention, at grave danger to themselves and others. Engaging and assisting these individuals will take valiant efforts but will also pay dividends to the nation by realizing future healthcare savings.
Even after federal health reform is fully implemented in 2014, the Ryan White program will be instrumental in providing wrap-around services not covered by healthcare insurance for low-income people with HIV. Moreover, a small number of people in the U.S. will remain ineligible for federal healthcare assistance that can only be met through Ryan White services.
U.S. leadership in response to global AIDS must also grow so that the poorest and most affected countries in the world benefit from the very best tools and knowledge available to control HIV. Our nation’s continued leadership in response to global AIDS—spearheaded by leadership from President George W. Bush who created and rapidly expanded the President’s Emergency Plan for AIDS Relief—will also ensure that the wealthy nations of the world sustain and grow their investments in stopping HIV/AIDS globally. Increasing investments in global AIDS is not just a moral and public health imperative but, as documented by the CIA, will help abate civil unrest and destabilization that can breed factions sympathetic to terrorism and threaten global security.
Earlier this year, groundbreaking, new evidence that antiretroviral therapy not only stabilizes HIV-positive people medically but also dramatically curbs new infections heightens the urgency to expand healthcare and testing access and wrap-around services, such as housing and case management, that are instrumental in successful and continuous medical engagement. Scaling access to medical care in an ethical and responsible way without losing focus on human rights and other pivotal strategies will be the basis for a successful and comprehensive anti-HIV approach moving forward.
It is worth underscoring that the battle against HIV/AIDS is waged daily in communities around the world by non-governmental organizations such as the AIDS Foundation of Chicago that keep urgency to the fight, demand accountability, and innovate creative, new ways to inspire individuals, institutions, and large public and private bureaucracies to do more against HIV, do it better, and continuously aim to achieve greater results.
Inspired by those of us living with HIV—who stand the most to gain or lose from society’s responses to this epidemic—the HIV/AIDS advocacy movement is by itself among the greater accomplishments of the history of the pandemic. We have changed the way affected community members are engaged in healthcare decision-making, awoken political awareness among the most disenfranchised segments of society, and shined a light on the symptoms and causes of structural inequities.
The fourth decade of HIV/AIDS will be marked by how well, or how poorly, societies around the world address such fundamental determinants of health as poverty, access to healthcare and prevention, housing, and basic human and civil rights needed for individuals and communities to thrive.
David Ernesto Munar is President/CEO of the AIDS Foundation of Chicago (AFC).