What should we make of this year's World AIDS Day theme of "keep the promise," when it comes to the epidemic here at home?
Maybe it's meant as encouragement to the adolescents promising virginity in still-will-be-federally-funded-under-the-Democrats abstinence-only programs? Or maybe it's a message to Congress thanking them for not only sustaining the ab-only funding but for their promise of continued under-funding of treatment, support, prevention and research, even as more than one million people are living with HIV in our country? Or maybe it's the promise of the fast-tracked Trojan horse regulations – a promise made with the Bush adminstration's fingers crossed firmly behind its back to "ease" the ban on HIV-positive people seeking to travel to the US, which would actually ensure that HIV-positive visitors will forego any right to later application for legal status?
Or maybe it's the near-promise that we'll have news soon in the new year that the annual infection rate in the United States is significantly higher than the 40,000 estimate used for the past decade, with the new estimate rumored to be 25-50% more.
Wow, it's hard to pick.
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To get half-full for a moment, there is the promise of increasing support for a National AIDS Strategy.
You may have figured that the world's wealthiest nation, which also has the world's worst AIDS epidemic in a "developed" nation, would have a thought-through, coordinated, comprehensive plan to combat said epidemic.
But candidates Clinton, Edwards, Kucinich, Obama, Richardson have all now endorsed the call for a national plan, as have the major national AIDS groups in the nation and scads of local HIV organizations.
(And the Republican pack of contenders? Well, they all refused or ignored the AIDSVote candidate questionnaire compiled by a critical mass of US AIDS groups that highlights the national strategy ask.)
The need for coordination and strategy is perhaps most clear when it comes to HIV prevention. And the bi-annual National HIV Prevention Conference is happening December 2 – 5, right after World AIDS Day. With over 3000 people gathering, there's likely be a big buzz about that anticipated increase in US HIV incidence and what it may mean.
But CDC's staying moot about their new numbers, waiting to get the green light for publishing their findings in one of the well-recognized peer reviewed medical journals. They distributed a letter on Monday about its non-release of the data, asserting that "the HIV prevention needs and challenges in the United States are too great to allow misinformation to guide program decisions."
This statement rang hollow for a lot of AIDS community members, including Mark McLaurin of the National Black Gay Men's Advocacy Coalition and the New York State Black Gay Network, who was moved to remark,
It's bitterly ironic to hear that a government that is still funding abstinence-only-until-marriage programs that say you can get HIV through sweat and tears is asking us to wait for crucial information because they fear misinformation, yet somehow they are going to reduce the disparities that are decimating my community. All I want for this World AIDS Day is the truth.
The Prevention Justice Mobilization (PJM) will be a big presence at the conference, calling on all political leaders, public health officials and electoral candidates to adopt comprehensive strategies to confront the inequities at the root of the complex HIV/AIDS epidemic.
The highlight will be the Unity for HIV Prevention Justice Rally and March on Tuesday, which will literally spotlight HIV prevention in a vocal, flash-lit march led off with giant interlocking puzzle pieces that show the components of a truly comprehensive and effective HIV prevention policy.
The PJM and communities across the country are calling for a paradigm shift in understanding the epidemic: HIV transmission is a social condition that requires systemic change. For example, the current issue of AIDS and Behavior presents 18 peer-reviewed articles examining the role that homelessness and housing instability play in increasing HIV risk, and in worsening health outcomes for those already living with HIV. Other systemic issues include high rates of incarceration, lack of health care, unemployment and low wages, and stigma.
Prevention justice resonates with the real-life experiences of people with HIV and those in their communities, including Waheedah Shabazz-El of ACT UP Philadelphia, who explains:
When there's a cholera outbreak, you don't blame people for drinking bad water! You treat the people who contracted the disease, and then you clean the water supply. We need to do the same with HIV. We need to stop blaming people for their behaviors and do what is necessary to ensure that everyone with HIV gets the treatment they need and individuals get access to the best prevention information and strategies. But we also need to change the environmental factors, such as widespread incarceration, poverty and violence, that lead to disparities in disease.
But will it resonate with the incoming administration? It won't be easy to get this sea change through, but a comprehensive and accountable plan that acknowledges the root causes of the epidemic is only way we'll have a shot at keeping the promise of uprooting HIV/AIDS in our country.