Reflections on World AIDS Day

An AIDS Free Generation—Do we have the right strategy? 

By Cynthia Carey-Grant

For the past 26 years World AIDS Day has been observed to raise awareness about the AIDS pandemic caused by the spread of the HIV virus. But after 26 years, how informed is the general public really about the current status of the epidemic? And most importantly, with everything we know about HIV and the incredible breakthroughs in treatment options available, why are so many people and communities so disproportionately impacted and the stigma still so strong?
This year, the theme is Focus, Partner, Achieve: An AIDS-free Generation–to highlight the need for governments, health officials, AIDS Service Organizations, healthcare providers and individuals to join in addressing HIV prevention and treatment. It portrays a message of hope and possibility for an end to the epidemic. But how are we to get there if we don’t address social determinants such as poverty, violence, racism, homophobia, etc. that intersects with and feeds the epidemic, or the misguided policies that hamper real and effective prevention partnerships?
For over three decades, we have been accumulating data and analyzing prevention and treatment research and interventions. We’ve all heard the numbers. We have the cold, hard facts and they remain incomprehensible. Let’s examine a few of these facts:
  • Today, over 35 million people worldwide are living with HIV. That is about the same number of people who have died from AIDS between 1981 and 2012. Since the beginning of the epidemic, around 78 million people have been infected with HIV. There are around two million deaths worldwide from AIDS each year, of which about 270,000 are children.
  • Sub-Saharan African remains most severely affected, with nearly one in every 20 adults are living with HIV and accounting for nearly 71% of the people living with HIV worldwide.
  • The United States continues to lag behind on the global HIV care continuum and our country has the highest AIDS-related death rate among the wealthier nations of the world.
  • There are approximately 1.2 million people living with HIV in the United States, of which 63% are not getting treatment. That is approximately the same percentage as in the low-and middle-income countries.
I would expect one of the most powerful and richest nations in the world to be doing better. Statistics and numbers, while powerful, only tell part of the story. How HIV affects individual lives and communities is as diverse and unique as the many peoples and cultures of the world. As a woman, I know from personal experience that the idea of “one size fits all” is false and misleading. And yet the US National HIV and AIDS strategy attempts to do just that. When it comes to achieving the goal of an AIDS free generation, what is needed are tailored strategies that appropriately fit those who are disproportionately impacted within their identified communities. Let’s look at what this means for black women in the U.S.:
  • Women make up 20% of the new HIV infections in the U.S.
  • The number of HIV positive women has tripled since 1985.
  • 84% of new HIV infections among women are from heterosexual contact.
  • African American women are 4 times more likely to become HIV positive than white women.
  • An estimated 1 in 32 African American women will be diagnosed with HIV infection in their lifetime.
  • The greatest risk of HIV infection for heterosexual African American women is from unprotected sex with a male partner.
Logic tells us that any national or local strategy should specifically address the unique needs of black women if it is to be successful. Black women want women-centered health services that address HIV prevention and treatment as a social justice issue. That means addressing HIV as it relates to women’s real lives, including the prevailing stigmatizations that keeps some women from seeking care and staying in care, and other social determinants that impact HIV positive women and their families, including lack of affordable housing, jobs, and food security.
The same analogy applies to the inclusion and empowerment of young people whom, without their buy-in and leadership, the promise of an AIDS Free Generation becomes hollow. Not enough youth are included at the policy and program development tables where strategies affecting them are designed. Unfortunately, this is true even at community-based organizations on the ground like WORLD. Their cry, “Nothing about us without us” resonates as truth that demands accountability. And we at WORLD intend to respond, “Yes, you are right. We must do better.” We often here, “Our youth are our future” and nowhere is this more applicable then in our goal of an AIDS Free Generation. We literally cannot do it without them.
It’s not enough to posit, “We may not be where we ought to be, but Thank God we aren’t where we used to be”. We need to speak up and act up again for justice. We need to actively support and call for greater resources and funding that addresses the reality of those living with and affected by HIV. We need greater public awareness around HIV prevention and treatment, and that requires full inclusion of those people directly impacted and on the front lines. It was the power of outrageous action fueled by love and compassion that turned the tide of the HIV epidemic once before. Quite possibly, the path to an AIDS Free Generation may lie in the lessons learned from the past signified by the motto, “Silence equals Death.” It’s time to Focus, Partner, and Achieve…again.

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