October / November 2011
by Regan Hofmann
5. THE CHURCH
We need the blessing of the church. The Roman
Catholic pope, Benedict XVI, has come closer to sanctioning the use of
condoms than any other papal leader. While we recognize it’s unlikely he
will ever get all the way there, we need to remind him that if he
could, it would create a paradigm shift in how we stop AIDS from
spreading. We don’t think God wants people to get HIV or die of AIDS. If
the pope is a conduit for God’s word, can’t he tell Catholics it’s OK
to save their lives and protect others? Denying that people have sex and
telling people the only way to protect themselves sexually is to
abstain from sex is killing them. This doesn’t seem very Christian, does
it? Helping keep the sick alive, however, does.
We need to leverage the global
network of faith-based organizations of all types to spread the good
word about HIV. We should work with churches of all
denominations to disseminate lifesaving information about HIV/AIDS
around the world. Faith-based organizations can play an enormously
pivotal role in the end of AIDS. They offer safe spaces, are led by
trusted elders and are visited by people from all socio-economic tiers
on a weekly, sometimes daily, basis.
Leveraging faith is a great way to reach people who do not intersect
with the health care system, and it’s a wonderful vehicle to deliver
messages of empowerment, health and tolerance.
There are far more churches in the world than medical centers. There is
also a greater chance of people confiding in their pastor, priest,
rabbi, iman or guru than coming clean with their medical doctor, nurse
or health care provider.
Tolerance—of gay people, sex workers, transgender people, injection drug
users and other marginalized populations—especially within houses of
worship is key to making it possible for those who need medical help to
get it. Can we get an “amen”?
We need to fight stigma,
discrimination and the criminalization of people with HIV.
Nothing is perhaps harder, or more critical, than removing
the very real emotional barriers to testing, linkage to care, retention
in care, adherence and disclosure.
It’s difficult enough to face a life-threatening illness. It’s that much
harder without the understanding, support and compassion of friends,
family, lovers and community. No one who has HIV did anything wrong.
There is no shame in having HIV. Those living with HIV who have come to
terms with their diagnosis can help newly diagnosed people accept their
serostatus and overcome the self- and societally inflicted stigma that
beats us down.
Everyone living with the virus needs to be educated and empowered to
know that there are many good laws protecting against HIV-related
discrimination. And we need to ensure that those laws are upheld, that
new ones are created as needed and that unjust laws (such as those
criminalizing people with HIV) are stricken off the books. And those of
us who suffer injustices need to have the courage to come forward and
prosecute those who commit the injustices.
We need to fight the increased
incidence and severity of criminalization of people with
HIV. The laws currently in place are sufficient to cover
the rare cases in which a person with HIV intentionally attempts to
infect another person. There is no need for AIDS-specific laws. They
backfire and present hurdles to individual and public health. Who would
want to get tested for HIV if knowing your status could mean you could
be falsely accused of non-disclosure and end up in prison?
Criminalization of HIV doesn’t protect anyone, but it does increase the
risks for everyone.
We need to fight racism in the
context of HIV/AIDS and the health disparities it creates.
Because of racism, marginalized populations get disproportionately
inadequate health care. No state and no nation should be allowed to
offer inequitable health care, or reduced access to people simply
because they don’t have as much money or political power as others. The
arguments must be clearly made on Capitol Hill that health care is a
human right—and everyone deserves equal human rights. Currently, African
Americans and Latinos are disproportionately impacted by HIV/AIDS in
the United States; they are nine and three times more likely,
respectively, to contract the virus than whites.
We need to fight homophobia in
the context of HIV. Homophobia is as dangerous as racism and similarly
impedes individual health and therefore public health. When
we allow large swaths of society to remain sick and when we drive
entire populations underground, we give up the opportunity to improve
the health of our nation as a whole—and that leaves everyone more
vulnerable. Because in the real world, people don’t stay in their
corners. People move around and interact. HIV doesn’t know your race,
ethnicity, gender, sexual orientation or socioeconomic status. It is a
biological agent that can move between any two people who engage in
certain activities, and those certain activities have never been the
exclusive domain of any one type of person. Sex and drug use seem to be
We will never end AIDS if LGBT people around the world don’t feel safe
coming forward to get educated about prevention, get tested for HIV and
get care if needed.
We need to stop talking about HIV
in terms of “risk factors.” We must reframe the way we
describe who may be at risk for HIV. While acknowledging that certain
groups are at higher risk than others (for example MSM, African
Americans, injection drug users, etc.) we must change the misperception
that only people at high risk for HIV can contract the virus. The fact
is, anyone who has ever had unprotected sex, received a blood product or
an organ or shared injection drug equipment may have been exposed to
HIV and should be tested.
Doctors should no longer use risk-sorted behavior to determine whether
or not someone may have been exposed to HIV. Most people should be
tested at least once. Some people should be tested regularly.
We need to take HIV/AIDS out of
its silo and “normalize” the virus/disease. The very thing
that helped HIV get emergency funding in the early days is impeding our
ability to end the pandemic: AIDS exceptionalism.
We need to mainstream AIDS care. As more people living with HIV globally
are tested and diagnosed, we’re going to need a lot more medical care
workers. And, most people don’t get diagnosed with HIV in an infectious
disease specialist’s office. They discover their status in community
health centers, emergency rooms, at the OB/GYN and in other medical
settings. We need a better system for linking people to HIV-specific
care and retaining them in it. But we also need the general health care
system to be better equipped to handle HIV.
Every doctor needs to know how to test for, deliver a diagnosis of and
offer basic treatment for HIV. And we need to educate nurses too since
in many nations around the world, nurses administer the lion’s share of
We need to make testing guidelines clear, make testing more affordable
and consider an over-the-counter HIV test. Guidelines that don’t align
are confusing to doctors and present an “out” for them to HIV testing.
Currently, the Prevention Task Force and the CDC guidelines don’t align.
We need to fix this.
7. THE CURE
We need to support a research
agenda that could fast-track a cure and a vaccine. We must
invest heavily in the science that looks so promising at this moment. We
are closer than we’ve ever been. According to Kevin Frost, CEO of
amfAR, an investment of $100 million in the current cure research could
help usher in a cure within five to 10 years. Françoise Barré-Sinoussi,
PhD, who co-discovered HIV, is leading a global consortium of people
with HIV and scientists to fast-track a cure; amfAR has a new
collaborative consortium (ARCHE) hunting for the cure; and the NIH
recently made a five-year, $70 million pledge. What we now know about
broadly neutralizing antibodies, CCR5 inhibitors, HIV reservoirs and so
much more makes this the time in AIDS research when careers are made,
Nobel Prizes are won and the course of history is changed.
To sum it all up, AIDS needs a modern elevator speech—a compelling
statement any of us could blurt out if we found ourselves, say,
face-to-face with the president of the United States or any other world
leader. We should all be able to answer the question: Why must the world
Inspired by what Chris Collins, vice president and director of public
policy at amfAR, told us he’d say if he found himself in an elevator
with the president, we suggest the following: “Mr. President,
U.S.-funded science indicates the end of AIDS is now possible in our
lifetime. Studies recently revealed that antiretroviral treatment for
AIDS doubles as prevention. People with HIV on pills have a 96 percent
reduction in odds of transferring the virus. If we significantly expand
access to HIV treatment at home and abroad, we will save tens
of millions of lives, slow and eventually stop the spread of
the virus, and preserve billions of federal/taypayer dollars. With the
right strategic shifts in current resources and an influx of foreign aid
from nations who stand to benefit from the end of AIDS, we could see
HIV incidence and expenditures decline dramatically in as few as five
years. Jump-starting the end of AIDS is a terrific legacy for your
administration. Scaling up treatment means scaling up saving
Or, more simply put, the answer to why the world must end AIDS is,
“Because we can.”
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