- September 24, 2013
Post submitted by by Dr. José M. Zuniga, President, International Association of Providers of AIDS Care (IAPAC)
The early history of HIV highlighted the importance of empowered affected communities as a central component of an effective response to an epidemic. The beginnings of HIV were strongly intertwined with community activism and involvement. Before HIV became a concern, the gay community in the United States had already mobilized around a civil rights agenda. When HIV emerged, therefore, there were established networks and structures which mobilized to understand and deal with what was happening in our community.
In clear contrast to draconian (and evil-hearted) attempts to isolate or quarantine HIV-positive people, there was growing recognition that effective responses to HIV strongly depended upon the participation of those most affected and most at risk. We witnessed affected communities help to strengthen responses, which reinforced the fact that the best way to ensure people are empowered and supported to protect themselves and others is by protecting their rights. New rights-based, health-focused civil society organizations also emerged, including the Gay Men’s Health Crisis in New York City, and they began to combat discrimination and stigma and advocate for the rights of people living with HIV/AIDS.
As we approach National Gay Men’s HIV/AIDS Awareness Day, I am reminded of this early history and how, building upon empowered communities, we have reached a point in the almost three-decade struggle against HIV in which I can say that the end of AIDS--more specifically, no more progression to symptomatic HIV--is in sight.
The secret weapon: testing more and earlier, and linking more people earlier to care, regardless of their HIV status. We have the means to do this through combination HIV prevention, using all methods at our disposal, including condoms and antiretroviral medications, to irreversibly change the course of the epidemic in our community. But it all starts with identifying those who test positive and providing them access to treatment, and identifying and offering preventive care to those who test negative.
The notion, though, that once-a-year testing will help us control the epidemic in our community must be supplanted by an approach that positions testing within the context of an accountability proposition binding one individual to another and, indeed, every individual to the community. This approach must also recognize the reality of human nature: although we must continue to educate about the means by which we can mitigate the risk of infection and transmission, we must embrace a new way of thinking about testing (more frequent; three to six times a year) and sort through the ways in which we integrate new prevention tools, including pre-exposure prophylaxis (PrEP), into our prevention toolkit.
Just as in the early 1980s, we must think of ourselves as responsible for the health and wellbeing of our community and, with prevention tools at hand, go back out into our community to promote a message of accountability – to ourselves and to each other. Let’s reclaim our community from the insidious human immunodeficiency virus, and perhaps a few years from now, when we reminisce about our community’s indomitable courage and unshakable resolve, we can refer to more recent history than that of the early 1980s.
Dr. Zuniga is President of the International Association of Providers of AIDS Care (IAPAC), which represents more than 20,000 clinical and non-clinical providers, including approximately 4,500 in the United States.