Reflecting on 30 years of AIDS triggers a flood of memories both personal and professional. Thinking about the first small mention in the New York Times of AIDS in June 1981, until now, it staggers the imagination how cataclysmic that news was. I remember telling my parents soon thereafter that there was a disease that had appeared that would change the world.
In the earliest days it seemed that somehow AIDS would pass. We hoped that after it had beaten its path of maximum destruction, it would blow out to sea like a deadly hurricane, or if it stayed, that a magic bullet would somehow be discovered that would tame it. As neither of these things happened, it has been a long, hard slog.
Romantic notions, borne of Hollywood celebrities adorned with red ribbons, or the Academy Award-winning performance of Tom Hanks as a person living and dying of AIDS in Philadelphia, have given way to a decades-long battle that is won and lost daily in bits and pieces. While the glamour may be gone, the problem of AIDS remains.
Thirty years of battling AIDS has left me older and, I trust, wiser. My basic impatience is tempered today by understanding how much we are still up against. AIDS intersects so many issues that are highly emotional -- sex, love, homosexuality, race, class, gender, addiction, religion, culture, power and politics -- to name a few. It was very naive to believe that society would rise above all of these issues in the face of a global health crisis. Yet the battle against this virus has been characterized by so much courage and determination. In many ways it has brought out the worst in our civilization, but also the best.
One thing is certain: AIDS has changed everything it has touched. Our attitudes regarding condoms and safer sex; global public health on our shrinking planet; speeding the process of drug approvals; sex education in schools, the Catholic Church's acceptance of condoms to protect against disease; needle exchange; patient activism; etc. From every major catastrophe the world experiences there is always a shift, and with AIDS, it has been bigger than most.
AIDS has gone in and out of public awareness. At certain times there is a lot of media attention; then other times, silence. The denial that there is a sexually transmitted disease out there that has already killed tens of millions and will kill millions more is profound. It is natural that we don't look at something that has gone on for thirty years as a crisis, just as it is difficult to get people to act as if pollution is a clear and present danger. A health threat that does not immediately affect you is somebody else's problem.
Today, AIDS is a crisis for the thirty three million people who are infected as well as for their families. AIDS is a crisis in sub-Saharan Africa, where double-digit infection rates are decimating entire generations. AIDS is a crisis for Eastern Europe, where infections are fueled by runaway IV drug use and extreme discrimination. AIDS is a crisis for the world because it does not respect geographic boundaries and tests our ability to fight infectious disease on a global level. The modern trends of jet travel and mass migration are here to stay, and they help fuel the spread of disease.
In addition, the system we have for fighting infectious disease is very antiquated. Different rules apply to every country and even different states. If we ran air traffic control this way, planes would be colliding in the sky every day.
All the grim AIDS statistics belie the amazing progress we have made in these three decades. We have taken AIDS from being a certain death sentence to being a chronic, manageable illness. We have seen successful HIV prevention campaigns that are reducing HIV prevalence in many places in the world today. There is hope on the horizon that we can bring AIDS under control in this decade. Science is on the brink of new discoveries about natural immunity found in some HIV patients that may hold the key to neutralizing the virus in those that are infected and in the uninfected alike.
AIDS remains today as it has been for thirty years: a moral litmus test. Society is at its best when it responds to this disease based on science and public health principles; it is at its worst when policies are determined by prejudice, superstition and ignorance. Sex is the basis from which all human life springs. Sexuality is one of the most powerful motivators of human behavior. Before 1981, we would never have anticipated that a killer sexually transmitted disease would afflict the world, but here we are in 2011.
We have fought a Herculean battle for thirty years. We have had many victories and defeats. The future is bright. We can conquer AIDS. The question always comes back to one of will. We now know what works and what doesn't. We know that it is critical to find the people who are HIV-positive and don't know it in order to break the chain of new infections. We know that only a fraction of people living with HIV in the world are currently receiving treatment. We know that universal access to condoms and science-based sex education will reduce new infections, but we have not yet summoned the necessary will to make these things happen universally.
The younger generation sees the world differently. They don't have the same prejudices. It is inevitable that they will change the way we deal with HIV and other sexually transmitted diseases. But the difference between waiting for their ideas to take hold, challenging those who cling to power and prejudice, is the fate of thirty-three million people currently infected, and the tens of millions more who will become positive at the current rate.
There is no better time as we mark thirty years of AIDS to recommit ourselves to saving as many of these thirty-three million lives as we can, and to ending AIDS. If we don't take a stand now, imagine how poorly history will judge us.
For me personally, AIDS has been both a nightmare without end and an amazing odyssey. I was there at the beginning, doing the best I could to help people die with dignity, and for the last fifteen years, to live well with HIV. The scope of my work has gone from local to global. AIDS Healthcare Foundation, the organization that I co-founded with Chris Brownlie, has grown into an enormous global institution that is testing millions and saving more than 160,000 lives in 26 countries. But as much as things have changed, the essential elements are the same -- love, compassion and fighting for what's right -- and always believing that this battle can be won.