December 3, 2013

On March 24, 1987, the activist group AIDS Coalition to Unleash Power (ACT UP) gathered in front of Trinity Church on Wall Street in New York City for its first ever demonstration. The flyer advertising the event was crammed with damning facts (“AIDS is the biggest killer in New York City of young men and women”), indictments (“President Reagan, nobody is in charge!”) and the desperate rage of people who were done being ignored (“AIDS is everybody’s business now”).

Of course, ACT UP took to the streets precisely because, in the 1980s, AIDS wasn’t seen as everybody’s business. Before it was a global epidemic, many thought of AIDS as the problem of — and even (capital) punishment for — the already marginalized gay communities living in cities such as New York and San Francisco. As movingly chronicled in last year’s Oscar-nominated documentary “How to Survive a Plague,” it wasn’t until sick and dying activists, with literally nothing left to lose, raised hell that intransigent government agencies and drug companies were finally forced to act.

Thirty years later, as another World AIDS Day passes, there’s been an enormous amount of progress. According to UNAIDS, the number of new HIV infections has declined by one-third in the last 12 years. Since 2005, there’s been an almost 30 percent drop in AIDS-related deaths, and since 2001, new infections in children have fallen 52 percent, thanks to treatments that prevent mother-to-child transmission. Access to antiretroviral treatment around the world has increased exponentially.

Yet, sadly, as musician and activist Elton John reminds us in his book “Love Is the Cure: On Life, Loss and the End of AIDS,” the AIDS epidemic is far from over. As John persuasively argues, the same inequalities and stigmas that spread the disease in the 1980s prevent its eradication today.

AIDS continues to ravage the most ostracized groups in every society — gay communities, intravenous drug users, prostitutes, young people and minorities. And the people who are most socially marginalized are also the most economically marginalized. Thus, at a time of widening income disparities, inequality is the driving force behind new AIDS infections.

Today, thanks to medical advances, HIV is no longer an automatic death sentence. The latest treatments generally allow infected people to live long and healthy lives and make it highly unlikely that they will transmit the disease. It is therefore entirely possible to end AIDS once and for all.

The problem, John argues, is the stigmatization of those people living with HIV/AIDS and those communities most likely to contract it. Using examples from two decades of work through the Elton John AIDS Foundation, he illustrates how, in too many places around the world, the most vulnerable communities suffer from brutal discrimination, not to mention poverty, that prevents them from accessing the treatment and prevention they need.

We might think this is unique to the developing world. In a country like Uganda, for instance, where homosexuality is illegal, it is extremely difficult to bring awareness, prevention and treatment to gay men who fear coming out of the shadows.

But even in the United States, stigma and inequality perpetuate the disease. According to the CDC, almost half of all new infections in the United States are found in southern states, and they disproportionately affect African Americans. Bigotry becomes a vehicle for the disease as policymakers, uncomfortable with the reality of how AIDS is transmitted, pass shortsighted policies — from refusing to teach comprehensive sex education to preventing access to clean needles to criminalizing people living with HIV/AIDS — that perpetuate the stigma and make it even harder to reach those most at risk of contracting the disease.

Just as ACT UP once demanded that the government pay attention to what was happening to the gay community, today we must demand that it address the new fronts in the fight against AIDS. That means grappling with sensitive issues like needle exchange programs, sex trafficking and sex workers. It means going to where the disease is, no matter how uncomfortable or inconvenient.

We must also demand that the U.S. government build on its much-improved track record in this area and fully fund the fight against AIDS. As John argues, if we were to provide prevention and treatment for every person who needed it, we could eventually eradicate AIDS. According to a UNAIDSstudy, access to universal prevention and treatment would cost just an additional $5 to $7 billion per year until 2020 — a worthy investment to wipe out a plague.

When ACT UP took to the streets three decades ago, AIDS was a death sentence. Nobody knew what caused it and nobody knew how to treat it. Today, that is no longer the case. We have cutting-edge drugs that keep people alive. We have evidence-based models for prevention. We have global awareness of the epidemic.

What we lack is the political will and compassion to reach out to the most marginalized among us and make sure that they have equal access to prevention and care. Ending AIDS is no longer a matter of science — it’s a matter of justice.

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