July 9, 2009

We Are the Ones We've Been Waiting For: AIDS Advocacy in the Obama Era

Now, let’s take that last point and couple it with what I said about offering ARV’s.  Imagine what would happen if we were offering housing or rental assistance to every single HIV+ person who needed it, and offering every single person who is HIV+ access to ARV’s.  Just with those two structural interventions, plus one other, you could bring the epidemic to a screeching halt even before we had a vaccine or a cure.  Why, because the vast majority of people who go on ARV’s before their immune systems are destroyed and are reasonably adherent…not perfectly, just reasonably…the viral load is reduced to an undetectable level.

What does that mean?  Well, it means that particularly in sexual interactions, even without condoms, it becomes very difficult to transmit the virus.  We would have dramatically reduced the viral pool, making reliance on changing individual behaviors in moments of passion and ecstasy, whether natural or chemically induced, no longer the principle vehicle for preventing transmission.  Couple that with clean needles for IV drug users, Medicaid or insurance-funded hormones for transgender folk, and treatment for HIV+ pregnant women, particularly at time of delivery, and we would have cut off just about every means of viral transmission.  Now that is prevention that follows science! 

But don’t expect it from this Administration, because we will have spent so much money on war in Afghanistan and its neighbors, bailing out the banks, saving Chrysler and General Motors, and tinkering with health care reform, that ending AIDS will just be too expensive and looking at the life-time costs of infections averted will seem too remote and hypothetical.

By the way, earlier I said there was one more piece to the equation.  That’s ending stigma.  As you all probably know, the CDC and a number of states have recommended or adopted policies and legislation calling for universal testing, and to make that more likely, the lifting of laws that require informed consent to be tested.  As David Holtgrave at Johns Hopkins University has pointed out, in a study the CDC paid him to do, “what a colossal waste of resources.”  Sorry, my paraphrase!  We know that the epidemic has really dug its way into certain marginalized populations.  Talking about a generalized epidemic is good public relations, but it just isn’t true.  Even in the District of Columbia, the epidemic is overwhelmingly African American and/or gay.  And among African Americans, it is men who have sex with men, IV drug users, and their sexual partners.  Hello?

Want to get more people tested?  End stigma.  And I am not just talking about stigma about HIV.  I am talking about homophobia.  I am talking about stigma about drug use.  I am talking about our prudishness about SEX!  How many women in American go every year faithfully putting their feet in the stirrups for their annual pap smear without ever being told that it’s a test for a sexually transmitted disease, much less being asked by the gynecologist about their sex life or having it suggested that they should have an anal pap smear too, because some 50 percent of American women have had anal sex, and that’s not counting finger play.  Hey, guys, I’m not just talking to the gay men now, you ever had anyone stick a finger in your ass?  Did anyone ever suggest to you that you might ought to have an anal pap smear for HPV, which just happens to be a precursor to rectal cancer in men and women?

I’ve got no problem with universal HIV testing every year or six months if the insurance companies want to pay for it, but how about if we just trained medical professionals to have honest conversations with their patients about sex and drug use and then offered the test where indicated?  We could then use the money we save the insurance companies to make universal offerings of voluntary testing not just in prison, but in pre-arraignment detention centers, in mental health programs, in shelters for homeless people, in low income communities with high addiction rates and to men who are hooking up with other men.  You get my drift.

The point is this:  We know what we need to do to end the AIDS pandemic both here in the United States and around the globe.  It’s not rocket science.  It’s common sense.  The reason we are not doing it is not a lack of resources.  It is, plain and simple, we are not doing it because we lack the political will.  And that lack of political will is driven by in principal part by homophobia, racism and sexism, coupled with stigma against IV drugs and users, fueled by a misguided fifty-year old war on drugs and on people who use drugs...except alcohol and cigarettes, which are good drugs because we can levy heavy taxes on them and people keep on drinking and smoking.

My friends, President Obama isn’t going to change this.  At his very best, his is just going to manage at the margins, unless we do something big.  And all of our outreach and prevention efforts are going to be like trying to empty the ocean with a sand bucket unless we take seriously our responsibility to build a new and reenergized AIDS activist movement that demands what we need to at long last bring this epidemic to an end. 

Some of you are perhaps too young to remember, but here in the home of one of the few remaining active chapters of ACT UP, you should know that nothing that is available for prevention, services, or treatment came about because some politician woke up one morning and said I have a great idea that I am going to put into law today.  Everything we have, we owe to brave men and women fighting for their lives, who took to the streets with creativity and flair, going to jail time and time again in non-violent acts of civil disobedience, marching, going on the hill, getting in the face of the news media and anyone else who had influence to demand that our government address that which was killing us.

We desperately need that very same kind of activism today.  We need new leaders to rise up, new voices to join the chorus… whether eloquent and rude…to demand, loud and clear, real health care reform that includes access to on-going primary care for every person living in this country.  We need to demand universal access and offering of ARV’s to every single person who is infected with HIV.  We need to demand HIV services, not allocated as a formula based on geography, but as an entitlement of every person who is infected.  We need to demand housing, not just for every person living with the virus, but as a basic human right, as recognized in the Declaration of Human Rights decades ago.  We need to demand an end of sexism that allows the President to boast that a women’s health issue is a lower priority.  We need to demand an end to homophobia that leads this Administration to actually argue against equal justice for Queer folk.  And we need to demand an end to racism that is really at the core of the war on drugs that has now destroyed more Black families through incarceration than were destroyed in this country through slavery.  And finally, we need to demand that we treat AIDS outside the United States with the very same level of commitment to human life and dignity as we treat it here at home.

Let me conclude by quoting Barack Obama, candidate for president of the United States:  “I’m asking you to believe,” he said.  “Not just in my ability to bring about real change in Washington…I’m asking you to believe in yours.”

“We are the ones we’ve been waiting for.  We are the change that we seek….We are the hope of the future; the answer to the cynics who tell us our house must stand divided; that we cannot come together; that we cannot remake this world as it should be.

Because we know what we have seen and what we believe - that what began as a whisper has now swelled to a chorus that cannot be ignored; that will not be deterred; that will ring out across this land as a hymn that will heal this nation, repair this world, and make this time different than all the rest - Yes. We. Can.”

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Dr. Paul Bellman, New York, 2009-07-14 10:17:33
Charles King's passionate and intelligent advocacy for better treatment, prevention and care for HIV positive persons gets right to the heart of the matter. As a physician I agree wholeheartedly with his vision and share his impatience with the current pace of change. I hope to be part of the grassroots activism he calls us to join that fights against stigma and fights for access to treatment and housing for every HIV positive person.

Frederick Wright, Tampa, 2009-07-14 09:03:22
Mr. King words are quite eloquent in his thoughts and words. However, I feel confident that most of his clients that he services in Housing Works would not understand his communication and therefore very limited in communicating to his base. I think it is most fascinating to me that folks in New York City or within POZ ( People of OZ) live in a complete fantasy land to think the world revolves around HIV/AIDS funding or Gay Marriages. Wake up and unite and stop attacking Obama.