An AIDS Free Generation?

considerations from a different lens

With World AIDS Day (December 01) fast approaching, here are some thoughts to consider for those of us who hope to see the much toted “AIDS free generation” become a reality. The ideas introduced here will form the basis of more detailed work soon to come.

My work in community based HIV research and training, as well as volunteering within segments of the HIV community has been an experience of substantial insight into what is, and isn’t working in the HIV policies of 2015. An experience that has occasionally been uplifting, though more often than not, one that has been intensely frustrating, as the same problems tend to occur over and over again. Mistakes across the board, from failed public health policy, to misguided ASO mandates, to ineffective HIV prevention models and outreach, not to mention the issue of inadequate treatment and support, both initially and ongoing of those infected. Success in managing the virus on a medical front (ie treatment), means very little if it only applies to those who have the resources to afford it, the structure to sustain adherence, and the benefit of a healthy supportive network to see them through the inevitable rough spots.

What has become clear via a litany of policy mistakes, is that if the goal is a two pronged approach that attempts to prevent infection and treat the infected, then our responses need to meet people where they are. Mentally, physically, culturally, and socially. That does not mean a one size fits all, happy happy, ra-ra campaign, it means tailoring your outreach to intentionally target the most vulnerable; the same ones that are usually never served, and often harmed, by public health policy. Those include sex workers, new immigrants, racialized minorities, trans men, trans women, victims of domestic abuse, homeless youth, first nations communities, incarcerated populations, and those marginalized due to poverty, substance issues, or mental health conditions.

It is shameful that with the vast wealth of knowledge, expertise, and technology in North America, we have largely failed these communities as it relates to HIV. Of course, the cruel irony is that these communities all have disproportionately high numbers of infected and at risk.

Yet, here’s the thing.

These insights are not in any way new. We have known them for a long time, yet have consistently failed to make a meaningful impact. This fact is a dangerous one for those in HIV leadership positions. Because it means confronting, thus shining a light on the failure of things like throwing condoms at people sans other messaging, shame and fear based prevention campaigns that never prove successful, punitive centered policies toward addiction, and the lack of psycho / social support structures for the newly diagnosed as well as long term survivors of HIV. To openly acknowledge these failures is key. Unlikely however, given almost three decades spent neglecting or ignoring them.

HIV has been a public health and human rights issue for well over thirty years. Is it not time that we take an honest, compassionate, and specifically targeted approach that realizes the historical, cultural, and socioeconomic realities of those at risk and infected, and then react accordingly, dealing with things as they actually are? That means dealing with stigma, dealing with drug addiction, with child sexual abuse, and with domestic violence. It means recognizing the links and interplay between HIV infection and racism, poverty, homelessness, mental illness, and the myriad other ways people are marginalized in our society. It means advancing realistic and creative prevention options that move beyond “a condom every time”. And it means ensuring those infected and at risk have access to adequate, affordable, culturally competent health care, with ongoing support to ensure they are retained in care.

If I have learned one thing as a researcher and educator in this field, and as a gay man with personal connections to HIV, it is this: The ability for this disease to be contained, will always be analogous to the potential one has to see their life having worth and meaning.

In 2015, despite all the talk of an AIDS free generation just around the corner, all evidence would suggest we are still several blocks away from that elusive corner.