Judging from the bold, daily headlines during the 19th International AIDS Conference, held in Washington, D.C. July 22-27, you might have thought the world finally woke up to the reality of the deadliest plague in modern history.
But then the thousands of journalists covering the conference went home. The spotlight was flicked off, again. And those who don't live with HIV on a daily basis -- in their own body, among their friends or family, in their awareness -- returned to their safe sand castles where dreadful things like AIDS happen only to others.
Unfortunately, not all of us enjoy those illusions of immortality. In the United States alone, the Centers for Disease Control and Prevention (CDC) estimate that by 2009, 1,129,127 Americans had been diagnosed with AIDS. More than 600,000 Americans had already died from AIDS by then. In 2010 alone, an estimated 47,129 more in this country were diagnosed as HIV-positive in the 40 states and five U.S. territories that report the diagnoses by name.
Worldwide, the Joint United Nations Programme on HIV/AIDS (UNAIDS) says that 60 million men, women and children have been infected with the human immunodeficiency virus since it was first identified in 1981. An estimated 30 million have died.
For all of us living with HIV infection -- Oct. 27 will mark seven years since my own diagnosis -- the question we face daily, hopefully more consciously and deliberately than most, is how shall we live, knowing as we do that we will most assuredly die one day? As a Danish youth program (ungegruppen) puts it in a simple, stark, striking postcard I picked up at the AIDS conference: Warrior or victim?
Hope with an asterisk
In one of the many speeches by "name" speakers, Secretary of State Hillary Clinton said, "We want the next Congress, the next secretary of state, and all of our partners here at home and around the world to have a clear picture of everything we've learned and a roadmap that shows what we will contribute to achieving an AIDS-free generation."
An AIDS-free generation is certainly a worthy goal. It's also a great sound bite. But even if tens of billions of additional dollars are allocated to address HIV/AIDS, even if the Republicans don't succeed in inflicting their Darwinian "survival of the fittest" upon the nation and the world, the question will continue to be what it has been for 31 years, since young American men first began to die horrifically from a then-new disease: Will we have the political will to end AIDS?
After all, it took three decades for the U.S. government finally to develop the National HIV/AIDS Strategy that the Obama administration released in 2010. Hundreds of thousands of Americans, tens of millions of people worldwide, died during the years America and the rest of the world diddled, arguing about how much to be involved.
It is certainly a remarkable achievement that the President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. government's global initiative and the largest health initiative in history, now provides antiretroviral medication to nearly 4 million people worldwide -- from fewer than 50,000 receiving the life-saving treatment at the time of the program's 2003 beginning.
As for scientific research aimed at treating and curing HIV, it's wonderful that, as National Institutes of Health director Francis Collins noted in a meeting prior to the AIDS conference, the U.S. has spent $50 billion on HIV research over the 30 years since the National Institutes of Health began to investigate it. Altogether, the world today spends about $17 billion a year on HIV prevention and treatment in the developing world.
But to put that large amount of money in perspective, consider this: In 2010, just 40 states, those that responded to a survey by the Vera Institute of Justice, spent $39 billion on prisons. And this: In 2012, the U.S. will spend $903 billion on defense just this year alone.
Relative to these figures, $50 billion over 30 years to address a plague that 30 years ago was already described as "the greatest health threat of our time," is a pittance. And a disgrace.
Even in the United States, CDC Director Thomas Frieden says that only 28 percent of HIV-positive people are getting effective treatment. An estimated one in five people infected with HIV don't know they are infected. Nearly 40 percent of those who have been diagnosed with HIV aren't linked to care, and 60 percent of those in care drop out.
One in four Americans with HIV have no health insurance and don't qualify because of their "pre-existing condition" -- meaning that, even though they likely can't afford insurance, they aren't quite poor enough for Medicaid or old enough for Medicare. Many rely on the federal-state AIDS Drug Assistance Program (ADAP) for their survival.
As of 2011, ADAP was providing drugs for more than 138,000 people, according to the National Alliance of State and Territorial AIDS Directors. The program is able to secure lower-price antiretroviral drugs for their clients, but the "discount" the pharmaceutical companies get away with charging in this country means American taxpayers still pay more than $11,000 for a year of HIV medication through the ADAP program that can cost them as little as $335 per year in developing countries served by the PEPFAR program.
This means that even in the U.S., for all the exciting talk about an "AIDS-free generation," only one-third of all people living with HIV are getting antiretroviral therapy. They are likely to transmit the virus to others and are at high risk for what are highly-preventable life-threatening illnesses, and death, from the advanced untreated form of HIV infection known as AIDS.
A marathon, not a sprint
On Friday night, winding down the last day of the AIDS conference, I enjoyed a late dinner at La Tomate, in Washington's Dupont Circle neighborhood. A TV screen over the bar showed the opening ceremonies of the Olympics. I was struck to think about the parallels and obvious differences between the international gathering that had just wrapped up, and the one just beginning in London.
In the spanking new Olympic stadium, thousands of athletes and thousands more spectators gathered to celebrate the beauty, grace and power of the human body tuned like a fine violin to its highest pitch of physical capability.
Inside Washington, D.C.'s Walter E. Washington Convention Center, men and women from every corner of the world assembled to share from their experience and learn from one another. Their shared goal wasn't gold medals or world records, but the long prayed-for end of a terrible plague that has broken bodies, shattered dreams and stolen hope.
If there was a common theme of the two global events, I expect the world's great athletes and those at the AIDS conference -- whether living with HIV themselves or working to prevent its spread and ease the suffering of those of us with the virus -- might all sum it up in that three-word question of the Danish youth: Warrior or victim?
How shall we live, knowing the time of youthful athletic prowess is brief, knowing, as HIV/AIDS reminds us, that life is fragile, precious and short? For me, in my life, with my time, I choose not to be a victim. Instead, I choose -- and will continue to urge others -- to join the band of warriors who work tirelessly to defend life. It alone is worth far more than gold.
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