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November 18, 2011

‘We really do have the means to end the epidemic’

In early-November, in a gathering I attended in Chicago, a researcher made a statement that I was not sure I’d ever hear: “We really do now have the means to end the HIV/AIDS epidemic.”

The declaration was made at the U.S. Conference on AIDS, and the point was that, short of a cure, with early diagnosis and aggressive treatment, we have at least arrived at a stalemate with HIV. This is a profound milestone, three decades after the first diagnoses among gay men in the U.S.

In addition to news about breakthroughs in prevention technology, updates confirmed that one-pill-a-day treatment is increasingly common, and that with good treatment, a person with HIV could expect to live as long as an HIV-negative person. We all realized that a revolution had taken place, a revolution that came about because of the hard work of an army of scientists and activists and people with AIDS. Good cause to celebrate, indeed.

There is also growing awareness among the directors of America’s leading AIDS service organizations that moving from science to implementation to achieve the “new possible” in HIV and AIDS care will require continuing structural changes to facilitate better access to health care, sustainable treatment, support services for those struggling with mental illness and addiction, counseling support for medication adherence and safer sex, and more. We also believe that providing that care and those services must continue to be linked to ensuring the rights and dignity not only of people with HIV, but of still-too-often marginalized communities disproportionately impacted by AIDS, such as gay and bisexual men, or injection drug users.

In other words, we all recognized that much has changed, which is good; but much remains the same.

The work ahead will be carried out in a starkly different landscape than the recent past. Simply put, AIDS service organizations will have to restructure and re-tool to address the evolving epidemic, at a time when resources are thin, and unlikely to improve anytime soon. This fact was evident in the number of ASOs facing significant funding challenges, and contemplating mergers, alliances, and even closures because of those challenges. No one at the conference disagreed with this stark forecast: failure to adapt—especially linking services to medical care—means that individual organizations are at high risk going out of business and thus losing or disrupting services to local people with HIV or AIDS.

Here in Ohio, there have been numerous examples of strategic alliances and mergers. Over the past few months, AIDS Resource Center Ohio, the Columbus AIDS Task Force and the Ohio AIDS Coalition recently completed mergers. With nine offices, we provide testing, prevention, linkage to medical care, and other direct services to two-thirds of Ohio; and patient advocacy and education for the entire state. These moves have been thoughtful and intentional, designed to enhance our capacity to serve and survive in troubled times. 

Much has changed, but not everything—and there is much more work yet to do. Remarkably, frustratingly, in the U.S. the majority of new infections occur among gay and bisexual men. This reality cannot be separated from stigma and the lack of human and civil rights for LGBT people—rights which, study after study has concluded, are absolutely essential if we’re going to win the fight against HIV.

As a gay man who has spent most of my adult life living under the shadow of HIV, and who has lost too many loved ones to AIDS, this last point is particularly important to me. No one should forget that we live in a state that does little to affirm the rights and identities of LGBT people—a state where it is still legal, in many cases, to openly discriminate against LGBT people in employment, housing, and other areas of life. The inequality and disparity faced by gay and bisexual men extends to HIV as well.

This past summer, ARC Ohio and other AIDS organizations around the state issued a policy brief documenting an unacceptable reality: While two-thirds of Ohio’s HIV cases are among men who have sex with men, only one-third of Ohio’s HIV prevention resources go to efforts intended to reach gay and bisexual men, those most at risk for HIV.

The pain of losing so many in the LGBT community over the years is only amplified by the pain of realizing that, despite those losses, inequality and disparities still exist. There is much work yet to do, and all of Ohio’s major AIDS organizations, joined by Equality Ohio, have protested, with one voice, that the continuing disparity is intolerable.

But perhaps the most important work to do now is to dream again, with renewed vision; to re-energize our efforts, especially among the LGBT community, knowing that the means to end this epidemic are at hand. Fatigue and complacency must give way to new resolve and vigor: A world without AIDS seems possible, within our grasp. The tools are at our disposal; we can give people with HIV or AIDS their lives back, make new infections a rare thing, and embrace human and civil rights for all.

We are all leading the fight.

Bill Hardy is the president and chief executive officer of the AIDS Resource Center Ohio.










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