Commemorating the 25th anniversary of AIDS is bittersweet. The good news? More of us are living longer. The bad news? More of us lack access to health care. That some of us who were infected years ago have lived to toast the quarter-century mark is a triumph of many things, including science and our will to live. That there are so many newly infected—last year, more than 40,000 new infections in the United States alone—is an alarming reflection of how badly the world, particularly the U.S., is managing what we’re repeatedly told is a “manageable” disease.

Much of the problem with AIDS in America can be attributed to focus. Fortress America—a cold war expression for the U.S.’s myopic sphere of concern—could be used today to describe our view of the AIDS epidemic. Our government and media suggest that the problems we have with AIDS on our home soil differ from those plaguing sub-Saharan Africa, Russia, India, China and other countries. The truth is, the issues that contribute to the spread of AIDS abroad—willful disregard of proven prevention strategies, lack of access to prevention tools and treatment (especially in penal systems), poverty, homelessness, drug use, the sex trade—are similarly undermining our efforts to prevent HIV in America.

The United States shares similar barriers with the world when it comes to tasks like awareness and prevention. If we can’t talk about sex or the disease, how can we raise awareness? And if we can’t talk about sex, particularly with the next generation to become sexually active, how can we prevent HIV? And if we can’t vaccinate against things like HPV, administer PREP or PEP meds or distribute the facts of life—let alone condoms—without the religious right accusing us of encouraging sex among those who shouldn’t be having it, how can we protect against HIV?

America, the richest nation on earth, has recently pledged a larger sum of cash than ever before to battle AIDS beyond our borders ($15 billion by 2008). Yet we simultaneously cut the budgets of services set up to help those with HIV at home. Many Americans have no health insurance; 50% of the 1.1 million HIV positive Americans need assistance finding housing; Medicaid is being cut; ADAP budgets are being slashed; and, increasingly, people with HIV in America are being forced to choose between paying for food and medical care.

As we mark the 25th birthday of one of the worst epidemics the world has ever seen (25 million dead, 41 million currently infected, conservative projections of another 45 million dead or infected by 2010), many Americans are in a tizzy over bird flu, which has killed just over 100 people since it was discovered in 1997. I’m not suggesting avian flu couldn’t one day be devastating. I am suggesting, however, that we remain equally concerned about the 41 million of us (47% women; 53% men) currently living with HIV. Bird flu may be headed toward the global community. But AIDS, as those of us carrying the virus know—even if the rest of America doesn’t—has already descended upon us.