When you think about the arc of the history of HIV, these are exciting times. In the U.S. and in countries throughout the world we have moved rapidly from the early dark days of the epidemic, when there was little we could do other than offer comfort and condoms. Today we have treatment, both for the care of individuals and the protection of entire communities, and an array of prevention strategies that give women, girls, men, and boys options about how best to protect themselves. There is new thinking and action around how best to control the epidemic and invest our resources for maximum impact. There is a sense of hope like I have not seen since the introduction of antiretrovirals (ARVs) in the 1990s.
It is so easy, and right, to get caught up in the euphoria surrounding the HIV “wins”— more people on treatment with better classes of drugs, pre-exposure prophylaxis(PReP) and the use of ARVs for treatment—and lose sight of the fact that many people still face daily challenges of living with HIV.
We should celebrate all that has been achieved, but never, ever lose sight of the fact that we have a long way to go. We continue to struggle with how to deal with co-infections, particularly tuberculosis and hepatitis C. We have treatments for both, as well as HIV, but achieving treatment success is complex and expensive and we find ourselves falling short of our goals.
There are long term survivors, and I count myself lucky to be one of them, who are facing challenges we never anticipated. There are people who have been paying a price for using some of the original drugs which undoubtedly saved our lives, but have long-term unknown and unintended consequences. It is a cautionary tale for all the new drugs which have simplified our lives with easier regimens and fewer pills but may also have hidden side-effects that only become apparent after long-term use. As more people live longer by successfully treating HIV with ARVs, age-related complications associated with the virus itself and/or the treatment is an increasingly important issue. Health and community support systems have to adapt to respond to these complexities. For all we know about preventing HIV, we don’t have it right. The recent HIV outbreak in Indiana makes clear that we still struggle to address the structural issues that prevent people at risk from accessing the right prevention tools, such as needle exchanges.
And let’s not forget stigma. We’ve come a long way, but we have so very far to go to eliminate HIV-related stigma and discrimination. As anyone living with HIV can most likely attest, stigma and fear are part of life and they shouldn’t be, not this late in the game. However, shaming and blaming happen all too often; we see this anew as PrEP is rolled out, with some being stigmatized—called “Truvada whores”—simply because they have chosen to use a highly effective method of HIV prevention to protect themselves. If we ever hope to conquer this disease and its health social impacts, we have to address stigma head on.
For me, World AIDS Day is a day to celebrate. Celebrate our history and our successes and celebrate the challenges and opportunities to make a difference that lie ahead. Please continue to join me and all of my colleagues at JSI in this celebration and journey.