World AIDS Day is recognized around the globe on December 1st of every year. This year marks 30 years since the beginning of the epidemic. Around the world, there were candlelight vigils, speeches, and red ribbons to honor those who were lost, those who have survived and those who now thrive despite living with this terrible infection.
This year, I had the extreme pleasure of being at University of California, San Francisco’s HIV Update conference. Not only is this a premier conference for yearly updates on the latest research and treatment guidelines, but the conference organizers generously provide The Ihangane Project a place to offer conference attendees access to our Rwandan crafts. It is a wonderful mix of dedicated medical professionals, many of whom have been leading the fight against the HIV epidemic since the beginning. We had the great fortune of listening to Dr. Paul Volberding, interviewed on stage by journalist Hank Plate, share his experiences during the early days in San Francisco. Several things struck me during his talk and documentary presentation. The first was a better understanding of the fear and trauma experienced by the communities hit hardest by the disease. There was uncertainty regarding the source of transmission for health care providers, as well as the terrible trauma of burying loved ones on a weekly basis. This type of extreme trauma leaves scars that are often not seen initially, but that can shift one’s consciousness for a lifetime. The other important take home point for me was the incredible collaborative response that occurred in San Francisco during this time. Some of the most effective aspects of the response occurred when the medical community (at all levels) responded together with the Gay community that was being affected. What an important lesson to recognize as we enter this era of rethinking how we organize our health care delivery systems around the world.
Dr. Volberding’s conversation with Hank Plante was followed by an eloquent presentation by Dr. Diane Havlir that was designed to instill optimism regarding the potential future (or end) of this epidemic. Indeed, our armamentarium of research-based approaches to prevention, diagnosis, and treatment of HIV inspires hope that we can dramatically turn the tide in the next decade. Dr. Havlir also emphasized that we MUST take the opportunity now. To wait may mean that we miss our chance at having a substantial impact on the direction of HIV/AIDS.
During this second presentation, my iPhone announced that I had received an email. It was our Rwandan partner, Dr. Ngirabega, who was responding to my recent email question to him: “will the Global Fund announcement to halt the next grant cycle affect Rwanda?” Sadly, his response at that moment was “Yes. The Global Fund has cancelled the round of grant funding that Rwanda was going to request for 2013. This will affect many activities, and we will have to find other ways to provide services.” What a devastating contrast between the possibilities projected on the screen in front of me via Power Point and Dr. Ngirabega’s email message.
I firmly believe that AIDS Exceptionalism, and the resulting AIDS Fatigue, has played a role in leading us to this day. We founded The Ihangane Project for exactly this reason. We believe that long term success in curbing this epidemic will come from strengthening comprehensive health care infrastructure, addressing health care provider overwhelm, improving overall quality of health care, and erasing the socioeconomic barriers to good health. AIDS is a symptom related to marginalized communities and economic poverty, and cannot be addressed in a silo. That said, the strong push for HIV-specific programs such as PEPFAR and the Global Fund happened in response to the huge disparity between HIV care for the Global North and the Global South. Hundreds of thousands of people would have died due to lack of access to life-saving medications, and thousands of infants would have become perinatally infected with HIV if was not for the disease-specific outreach of these entities. It is true- it is time to pull away from the AIDS Exceptionalism approach that has frustrated so many Global Health experts. But, we cannot eliminate the very fabric that has brought us to this place in the epidemic. We are actually at a point that we can talk about ELIMINATION of HIV transmission to infants born to HIV+ mothers. How can we allow the Global Fund, with its commitments to our global partners, to disintegrate?!
We should learn from the mistakes made here in the United States. Domestic AIDS Fatigue hit as soon as the economy began to decline. In California, for example, 100% of funding for HIV prevention was cut from the State Budget in 2009. Since this time, our small community of Santa Cruz has seen the number of new HIV infections and syphilis cases more than double. Of course, by now, most people know how to prevent HIV. Unfortunately, these extremely marginalized communities no longer hear the message that they are worthy of protection and HIV prevention. Is this the message we will offer for the Global Epidemic as well?
Learn more about the Global Fund cuts as bluntly described by Stephen Lewis at aidsfreeworld.org