What Will It Take to End AIDS?

At the San Francisco AIDS Foundation's Leadership Recognition Dinner this year, the agency posed a provocative question to its longtime supporters and allies: "What Will It Take to End AIDS?" 

In my new role as incoming executive director, the question seemed overwhelming at first. Like many others of us who have been working to manage and end this epidemic over the past 24 years, I had a difficult time conceiving of an actual end to HIV/AIDS. Can we truly make this a reality?

As I reflected on it more, I realized that we do in fact have the means available to us now to end the epidemic, if only we could harness the resources and human will to make this a reality. What is needed is the courage to reexamine our historic approaches to the epidemic, the discipline to pursue a deeper analysis of causes of risk behavior, the willingness to creatively develop new approaches focusing on root causes, and the strength to challenge ourselves and our leaders to take on this task.

We already have the tools necessary to significantly reduce new cases of HIV infection. We could, for example, reduce as many as 30% of the 750--1,000 new infections in San Francisco by aggressively confronting the crystal methamphetamine epidemic.

For our prevention efforts to succeed, we must be sure that those who are most at risk of acquiring HIV can imagine life as more fulfilling without having HIV. That means understanding the context of HIV risk in particular communities, including depression, substance abuse, stigma, distrust of health care providers, post-traumatic stress due to multiple deaths and losses among gay men, and a horizon of meaning that seems to dissolve when you are no longer young.

Today, we certainly have effective treatments available that can keep many HIV positive people healthy. Existing treatments provided to everyone who needs them could significantly extend life expectancy for people with HIV. To make them universally available, we must confront the barriers posed by the lack of health insurance coverage for vulnerable populations and disparities in health outcomes based on race and income.

In our own city, the delayed and lower rate of antiretroviral use among African Americans results in reduced life expectancy. San Francisco can and must address this sad fact. As Dr. Martin Luther King said, "Of all forms of inequality, injustice in health care is the most shocking and inhumane."

To bring an end to the epidemic we will also need to oppose a government that:

• seeks to deny the generative, playful and life-giving dimension of sex by demanding abstinence;
• rejects needle exchange, despite overwhelming scientific evidence supporting it;
• conducts witch hunts on HIV prevention programs;
• tampers with research findings to fit the rhetorical goals of the Administration; and
• starves our systems of care to pay for war and the redistribution of wealth through deficit-growing tax cuts.

There is much work that can and must be done with the current Administration in Washington to end the epidemic. The President's support for reauthorization of the Ryan White CARE Act is a good start. We must look for other ways to find common ground with the current Congress and Administration as we renew our commitment to ending the epidemic. But we will continue to fight efforts to undermine sound science, public health and the fundamental human rights of people at risk of HIV infection and those living with HIV/AIDS.

Given our national and global pandemic, I believe we must reflect upon what our collective and individual wealth is for, if not to eliminate unnecessary human suffering.

I decided that I wanted to lead the San Francisco AIDS Foundation because it has committed itself not just to limiting the damage caused by this grave epidemic, but because it is searching for the true means of ending AIDS and the human suffering caused by it. What more valuable service could an organization provide to this community, our nation and the global effort than to keep an unflinching focus on ending the epidemic?