Secretary of State Hillary Clinton’s speech at the National Institutes of Health in November, calling for an “AIDS-free generation,” is admirable.
She was correct to note that we have the medical tools we need to achieve the goal. Since 1996, combination antiviral medication has been available which, when properly taken, can render HIV infection a chronic, manageable condition often likened to diabetes.
But what Secretary Clinton neglected to mention is that we still lack the thing we have lacked since AIDS was first recognized in 1981, the key ingredient to letting us effectively contain — and ultimately end — the AIDS epidemic: political will.
Simply put, AIDS has never been treated with the urgency and commitment that a deadly global plague warrants. There has never been a truly concerted, all-out effort to make sure everyone who is at risk for HIV is tested, and everyone who tests positive is treated — even though studies confirm that treatment reduces someone’s infectiousness by 96 percent. Treating those with the virus is the surest way to stop it from spreading.
But Daniel C Montoya, with the National Minority AIDS Council, pointed out at the recent U.S. Conference on AIDS in Chicago that only 19 percent of people living with HIV in the U.S. are on treatment and have undetectable viral loads, the optimal goal of medically managed HIV infection and the only way to reduce their infectiousness.
Other advocates at the Chicago meeting pointed out the impossibility of ending AIDS even in the U.S. so long as an estimated one in five of those infected with HIV do not know their HIV status and so many learn they are infected only after their immune system has been damaged.
Even among those known to be HIV-positive and needing medication, 6,411 Americans as of November were on waiting lists for the federal-state AIDS Drug Assistance Program that pays for the costly medication needed to treat HIV.
Dr. Julio Montaner, of the Columbia Center for Excellence on HIV/AIDS, called for “a second PEPFAR for the Americas,” referring to the President’s Emergency Plan for AIDS Relief, which pays for prevention programs and the medical care of hundreds of thousands of people with HIV in developing countries. He said it is unacceptable that the U.S. pays for medications for citizens of other countries even as thousands of HIV-positive Americans determined to need medication wait in terror as the deadly microbe is allowed to inflict its harm on their immune systems.
Making HIV testing a routine part of medical care, and easily accessible in other settings would increase the percentage of those who know their HIV status. The District of Columbia actually offers HIV testing at two motor vehicle offices so customers can get tested while they wait to renew their registration.
Political leaders must put our money where their mouths are, and put the power of their office and use the bully pulpits of their positions to launch and lead an all-out effort to provide universal, routine HIV testing, and guaranteed treatment for all who need it.
Until they can muster the political will that should be commensurate with a pandemic still killing millions each year, Secretary Clinton’s laudable – and achievable – goal of an “AIDS-free generation” will be remembered as just another speech in the 30th year of a plague we all thought would be over by the end of the 1980s, at the latest.
And until the United States practices the adage “charity begins at home” by caring properly for its own HIV-positive citizens, the loudest admonitions to other nations to chip into the global anti-AIDS effort will be drowned out by the gong clang of hypocrisy.
John-Manuel Andriote, author of Victory Deferred: How AIDS Changed Gay Life in America, has reported on HIV/AIDS since 1986. Distributed by Healthy Living News