At Last

It is deceptively simple: a glossy white cover with gold letters, the seal of the President, and some words on paper.  But for many of us living with HIV and who have dedicated our lives to decreasing the number of new infections and supporting those who are positive, it is a powerful document.  This is the first time in nearly three decades that the United States, one of the leaders in HIV, has a national strategy to address the epidemic. For years I have been advising and helping countries and communities around the world build comprehensive HIV programs that hopefully address the greatest needs of those at risk for and living with this disease.  Yet as time went on, it became harder and harder, to the point of embarrassment, to explain why the U.S.—with its PEPFAR program and requirements that each country have a single national HIV plan—didn’t have one of its own. Now I don’t need to explain any longer.

There is a vision in this document, a vision that for me has a life. “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, social orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.” Powerful words.  Aspirational.  But also grounded in reality. This is not a lofty proclamation about ending HIV in our time.  That isn’t likely to happen.  What it says is that HIV should be rare, something of note. Most importantly for me, it makes clear that we should be striving to ensure that anyone living with HIV, anyone, should not have to live a life compromised in quality. I see myself and so many of the people I’ve known, here and no longer with us, in this statement. For my government to be plain, straightforward and direct, gives me hope.

There are those who say that the plan isn’t…fill in the blank.  Isn’t bold enough, isn’t sufficiently ambitious, that it omits critical factors and components. I disagree. Is it perfect?  Not likely; little in life is perfect. What it has is simplicity and direction.  The strategy has four major parts: (1) reduce new HIV infections; (2) increase access to care that leads to better health outcomes for people living with HIV; (3) reduce disparities and inequalities; and (4) coordinate better.  Each component has two or three steps required to achieve it.  And there are goals.  Real, measurable goals: lower the number of new infections by 25%; increase the number of newly diagnosed who get into to care quickly (from 65% to 85%); increase the percentage of people in Ryan White who remain in care and also have housing; and increase the proportion of gay and bisexual men, Blacks, and Latinos with undetectable virus.  All by 2015.  Ambitious, yet achievable, if we continue to focus on what we know works, look for new solutions, working a little harder and better at what we do.

On this World AIDS Day I encourage all of us to celebrate this achievement.Often in the HIV community we spend time, rightly so, on what is wrong and what could be better.  On this day, take a moment to celebrate this profound achievement. Read the strategy. We are all reflected in it. We all have a place.  It has given me new energy and I know that along with my colleagues at JSI and beyond, I am excited about the work and opportunities ahead.  Let’s get to it!

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