Sunday, January 31, 2010

Are we going to lose the fight against HIV?

It was with sadness and disappointment, but not surprise, to read the Wall Street Journal article published January 30 titled “War on AIDS Hangs in Balance as U.S. Curbs Help for Africa”. The gist of the article is this: “Seven years after the U.S. launched its widely hailed program to fight AIDS in the developing world, the battle is reaching a critical turning point. The growth in U.S. funding, which underwrites nearly half the world's AIDS relief, has slowed dramatically. At the same time, the number of people requiring treatment has skyrocketed.” The article goes on to point out that the global effort to prevent new infections has suffered some reversals due to a combination of factors such as complacency because of effective treatments, abstinence-only education, and testing that continues to suffer from the oppressive burdens of prejudice and homophobia.

As I sit and write this, it is a quiet Sunday afternoon and I am reflecting on, among other things:
• The radio program presently airing about being gay in Africa (in Namibia in particular), and how policies that outlaw homosexuality devastate HIV-prevention efforts. American Family Association radio host here in the US also thinks gays should be put in prison.
• The sermon at the National Cathedral this morning that talked about how Love, not our love, but God’s Love, is everywhere
• The Sunday forum at the Cathedral, with Congressman Tom Perriello (D-VA) talking about faith and politics. He mentioned how the financial bailout rewarded failure, and it had me thinking that when huge dollars are given to the big players in HIV/AIDS work (“AIDS, Inc”), are we not doing the same thing?
• In 2003, I pitched the idea to Senator Durbin that Illinois be the first state in the country to commit to getting all residents tested as part of the effort to get ahead of the HIV-transmission curve. He said “we can’t afford to do that”.
• This Wall Street Journal article, while certainly ringing an alarm that we all need to pay attention to, also perpetuates the misconception that “global HIV” is “Africa-only”. We are starting to see waiting lists for HIV-treatment in this country. If we cannot offer people who test positive some treatment options, we have lost a major selling point for testing. This is not an African truth, it’s a global truth that exists here as well.
• The two written comments to the WSj article include these comments: “This is a classic case of trying to fix problems in a retarded society using modern technology…AIDS isn’t the problem, it’s only one of the many symptoms…Until a people decide they want to join civilization, no amount of money will save them…” and “maybe what we are seeing is nature (gods) way of population control?”. Gotta love the compassion of ethno-centric Americans.

The nice thing about blogs vs. publications is that there is wiggle-room for venting, and that’s what the combination of the above drives me to. Are there no adults anywhere that can sit people down and say, ok, let’s be serious here: this is a deadly disease that is very treatable, preventable not curable, costly to treat, and the sooner we contain it, the cheaper the collective treatment costs will be. I’m not a public health expert, theologist, politician, financial whiz, prophet etc, but it just seems increasingly clear to me that we are a society that is trying to tinker with a system that needs a major overhaul. HIV/AIDS is both an example of this in action and an opportunity to learn what it takes to make a major overhaul. Funny thing is that this overhaul is not one of bricks and mortar, but of mindset. The image that comes to mind of our current state is this: the best mechanics in the world have been asked to work on the engine of an old car. They are all looking at the parts of the engine, talking about a new air filter, an oil change, perhaps some spark plugs. Then a kid walks by and points out to them that the car has rust, torn seats, no tires, smashed trunk, broken windows, and is basically beyond repair. By focusing on the engine, they did not see the big picture. That’s what we seem to have with HIV/AIDS work; no one in a position of authority seems to be willing to connect the dots. For example:
• The need for treatment will go up no matter what we do. Ideally, if we can quickly implement community-wide, compassionate, non-judgmental HIV-testing, the need will spike dramatically as we quickly decrease the collective “undiagnosed”, and then the needs for testing and will decrease over time. Under the current testing system, however, that tries to “cherry-pick” the most at-risk from society (basically the approach of the last 30 years), we will stay on the same course of ever-increasing needs for treatment.
• We cannot effectively stop the spread by saying everyone should be tested, and then focus on “them”.
• It is not possible to encourage the openness needed to have everyone know their status while condemning and judging the people most at-risk.

I could go on, and have for years. The point is, this WSJ article should be our wake-up call. I remember saying to a friend in Wheaton, IL, perhaps 4 years ago that the reason we were so insistent on community-wide testing in Wheaton is that’s where we were, we have to start where we are, and if we can’t do it here, is it realistic to expect places like Africa to take the lead? Most importantly, I felt then that if we do not implement a program like this locally, regionally, nationally, and internationally, we will see HIV become worse. I fear that that day has now come. We humans think we are so smart, but this simple virus has exposed a dark side of us that we need to overcome: greedy, arrogant, judgmental, afraid, and very short-sighted.

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