Written by Helen Cornman, Senior Prevention Officer, JSI

On Monday, July 23rd, Ambassador Eric Goosby, Director of the Office of Global AIDS Program, began his speech at the World Bank Debate held during the AIDS 2012 international conference, by discussing his motivators for working in HIV. As I listened to Ambassador Goosby remember how many times he needed to tell a lover, friend, and family member that their loved one had passed needlessly due to lack of medication, I began to question what motivates us all. I began to ponder the path that all of us have taken to live and work within a world of HIV.

AIDS 2012 has awakened in me a motivation that is inspired by hope of what may be achieved, awe at the rapidly emerging science, trepidation of the challenges that lie ahead, and a sense of frustration at the stigma that still binds us from moving forward. I am motivated that we have grown from 5.2 million people living with HIV and AIDS (PLHIV) accessing treatment in 2009 to 8 million (1.7 million of those living in South Africa alone) PLHIV now accessing treatment in 2012. I am inspired by the new Clinton Health Access Initiative report that an average cost of $200 for treating PLHIV for one year at health facility level in low- and lower-middle income countries is four times less than previously thought. In sub-Saharan Africa an estimated 2 million fewer people died of AIDS-related causes in 2009 than died in 2004. Globally, 30% of people living with HIV are over 50, while it is predicted that by 2020 more than half of PLHIV will be over the age of 50.  This became palpable to me by the comment of a close friend and colleague to another HIV positive friend, “did we ever think we would be standing here talking about your woes with osteoporosis—here is to growing old.”

I am motivated by the call to eliminate MTCT by 2015 and that today 57% of women living with HIV have access to ARVs for prevention of mother to child transmission—an increase of nearly 14% since last year. We are already seeing the results of this increased access as South Africa has gone from a rate of 8 percent in mother to child transmission in 2008 to 2.1 percent in 2012. And yet the fact that in sub-Saharan Africa, 2 out of 3 (67%) of those becoming infected are girls gives me pause at the progress we are making among our future generation of women.

I am inspired by all of the emerging science on new prevention technologies with the AIDS Vaccine Advocacy Coalition reporting that male circumcision alone has the potential to avert more than 3.4 million new infections if scaled up to 80% of adolescents and adult men in five years. And yet I agree with the rapporteur who said human rights cannot be trampled upon in the rush to find a cure or to end the epidemic.

I was hopeful when Senator Marco Rubio (R-FL), a member of the Senate Foreign Relations Committee, remarked that foreign aid is not going to zero out the debt, but rather is less than one percent of our overall spending and is saving millions of lives.

I was pleased to see the plethora of discussions surrounding structural determinants that continue to drive the epidemic including poverty, gender inequity, violence, homophobia, and criminalization. And yet I find myself questioning how far we have come in terms of human rights and HIV. The fact that 50% of all countries criminalize sex work and HIV and many countries still criminalize men who have sex men should remind us of how far we still have to go. The conference has driven home to me the importance of addressing stigma and discrimination until all PLHIV can access care and support, and until no one feels ashamed or lives in fear that others will not approve of their choices. This same type of discrimination caused the violent beating and murder of two young sex workers where I was working in Guatemala City in 1996. When I began to inquire into their death, my boss–one of the most well-known infectious disease doctors in Central America–asked me if I wanted to go home on a plane or in a coffin. When I responded on a plane, he looked at me in the eye and said “then stop asking questions.” In that moment, I knew at times this work is larger than life, that at times we cannot move mountains, and must truly accept when we must board the plane with some haunting and mostly incredibly fulfilling memories. When we can only hold someone in their last moments, offer a family solace in knowing that her young gay son was loved by many, that their daughter who they truly loved was not morally bankrupt for working in the oldest profession, and that drug use is a disease that must be treated with compassion and hard work—not criminalization.

It is in those moments that I am motivated by so many who stand up against this virus and show the world that they can live a life filled with dreams and hopes. It is then that I remember that I am a professional and woman who cares deeply for all those infected and affected by HIV. It is then that I believe that the results of HPTN 052 prevention trials will not become a distant dream but a reality for all.  It is then that I am truly motivated to stand against criminalization of drug users, sex workers, and men who have sex with men. It is in that moment that I hold my children and truly believe that they will live to see an AIDS Free Generation.