2011 marks the 30th year of AIDS. "The View from Here" is a special year-long series to mark the anniversary. Advocates, doctors, researchers, politicians, philanthropists, educators, public health professionals, journalists and celebrities are answering the same set of questions each month.
This month, we feature two leaders by example: California State Senator Mark Leno and San Francisco Supervisor Scott Wiener. The openly gay public officials recently came to Magnet, our community health center in the heart of the Castro, to get free rapid HIV tests and remind gay and bisexual men of the importance of being tested for HIV every six months.
1. We’ve learned a lot in 30 years. What do we have yet to learn?
Wiener: Perhaps the biggest challenge we face is how to keep our community motivated to fight the disease, particularly in terms of prevention. Memories of the height of the epidemic fade, and young people weren't around then. As we get further from those early days, it becomes more and more challenging to ensure that people understand that the epidemic is not over, that the disease is preventable, and that we all have a responsibility to stop it in its tracks. We've yet to learn how to convey this continual sense of urgency over a prolonged period of time.
Leno: We need to continue to strive to better understand the irrational human dynamic that allows for the continued transmission of HIV. It is the unanswered question due to the complexities and depth of human nature. Although we have constructed a very successful care model in San Francisco that has been replicated around the world, we need to be ever more creative in finding ways to identify necessary funding, especially in these tough economic times. We can’t let lack of funding be an excuse to cut back on education, prevention, testing and health care provision.
Wiener: We also need to have a more sustainable system of access to care, both in this country and internationally. While the federal government has, at times, done very well in this regard, our state is back-sliding, and San Francisco is barely holding on. We need to have a better system of providing for everyone impacted by HIV/AIDS.
2. What was your deciding moment, when HIV/AIDS became an important issue in your life?
Leno: In 1984, my partner Doug’s 23-year-old brother became very ill. After months of continual weight loss, we began to fear that Stewart might be HIV positive and at imminent risk of AIDS. After a six-month battle, Stewart died in our home surrounded by loving and supportive family. It was at that time Doug and I realized we needed to be tested (an experience so different than it is today, having just been HIV rapid tested last week). We learned that Doug was positive and I was negative. He lived symptom-free until late 1989. Doug was diagnosed with AIDS in early 1990 and died on June 14th of that year. The epidemic had clearly reached our doorstep. My own involvement in fighting the epidemic has only increased since then.
Wiener: I came out in 1990, at 20 years old. Shortly after, I went out to the bars in Philadelphia with my lesbian cousin and her partner, both 15-20 years older than me. I didn't know any out gay men at the time and only knew lesbians. My cousin's partner said to me: "I wanted to bring some gay guys out with us, since you shouldn't just be hanging out with lesbians, but my gay guy friends are all dead." Suffice it to say that statement had a huge impact on me and showed me in stark terms what this disease had done to the community I was entering.
3. With ever-increasing public health issues to contend with, why should anyone still prioritize HIV/AIDS?
Wiener: Because people are still being infected and because we have a large and aging population of people living with HIV/AIDS. Until we minimize or eliminate new infections, we must focus on prevention. We can't keep letting our community, and particularly our young people, become positive. In addition, after 30 years of the epidemic, we have a large population of HIV-positive people in our community. We need to ensure that those living with the disease have access to health care, housing, and employment. That the disease is more manageable than it was 20 years ago doesn't mean that it stops being a priority. Particularly given that so many people living with HIV/AIDS are aging, with the additional challenges of being a senior citizen and HIV-positive, we cannot de-prioritize the services on which people depend.
Leno: We need to continue to prioritize HIV/AIDS until the virus is no longer with us. The “Until There is a Cure” theme and promotion still rings true today. With the virus ever present and a next generation coming of age every day, we must remain vigilant in our efforts to stop the spread of the virus. Every dollar invested in prevention and education pays inestimable dividends.
4. What keeps you up at night?
Leno: Nothing. Anything that might, I make sure keeps me up during the day.
Wiener: What currently keeps me up at night is the prospect of San Francisco losing $4 million in annual Ryan White Care Act money from Washington. We are at continual risk of losing that money, and we continue to receive it only because our hero, Nancy Pelosi, has kept it intact by sheer force of will. It appears we will be in good shape to keep this funding in the next fiscal year, but this is a constant question mark. It will be an incredible challenge to back-fill $4 million, or even a significant portion of it, locally if the money is lost.
5. Three decades into the epidemic, what gives you hope?
Wiener: After 30 years of HIV/AIDS, our community has not only survived, but thrived. When the epidemic hit, our federal government abandoned us, and we didn't even know what the disease was, let alone have effective diagnostic tests and treatments. Our community easily could have given up. But, we didn't. We fought, we raised money, we created a unique system of community based organizations to support those with the disease, we advocated, and we survived. If we made it through the early years, we can make it through anything. I'm an optimist by nature, and I'm particularly optimistic that I will live to see the end of this disease.
Leno: My hope is fueled daily by the strength, power, commitment, intelligence, dedication, passion and compassion of the many communities that make San Francisco unique. The San Francisco AIDS Foundation’s leadership, staff, volunteers, board of directors, and donor base keep the dream and the hope alive that we will prevail in our battle with this virus. The Foundation’s partnership and collaboration with the many community-based HIV/AIDS organizations remind us that the impossible is doable with the proper spirit and tenacity.
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