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Creating an AIDS-Free Generation

It's important that we examine our own combination prevention strategy, because what's effective in sub-Saharan Africa will not necessarily be effective in the U.S. There are four things we can do right now to create our own AIDS-free generation.
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On the evening Dec. 1, San Francisco City Hall will be bathed in red light in honor of World AIDS Day. It will be a fitting recognition of all we have lost and all we have yet to accomplish. I look forward to a future World AIDS Day when all the pictures captured of City Hall are historical images. For many in this country, that may seem like a day we will never realize -- a day without HIV/AIDS. We still have tremendous hurdles to overcome in communities across the United States. But now is the time for our country to ask: do we have the will and the wisdom to seize on a climate of tremendous opportunity to end this disease once and for all?

This week Secretary of State Hillary Clinton delivered a major speech on HIV/AIDS at the National Institutes of Health (NIH). She called on the United States and our allies to increase funding for HIV/AIDS prevention and treatment to "usher in an AIDS-free generation." It's a bold statement. But, as Clinton points out, "it is possible with the knowledge and interventions we have right now. And that is something we've never been able to say without qualification before."

Clinton asks the U.S. and the global community to step up use of "combination prevention." It is an idea that started conceptually in San Francisco and recognizes that HIV is a complex disease that cannot be fought with one approach alone. As Clinton explained, a global combination-prevention strategy should focus on three proven interventions: ending mother-to-child transmission through greater access to AIDS medications, expanding voluntary medical male circumcision to dramatically reduce female-to-male transmission, and scaling up treatment for people living with HIV/AIDS so that they do not pass along the virus to others.

I applaud Secretary Clinton for laying out a bold and ambitious plan for beginning the end of HIV worldwide. I commend her for refocusing attention on a pandemic that has killed 30 million people and still has 34 million people living with HIV. As we have seen in San Francisco over the past three decades, HIV must be fought on all fronts, and Clinton's strategy will be effective in tackling some of the most difficult challenges facing countries around the world.

Here in the United States, it is critically important that we closely examine what our own combination prevention strategy looks like, because we know that what's effective in sub-Saharan Africa will not necessarily be effective here at home. Building on Clinton's strategy, there are four things we can do right now in the United States to create our own AIDS-free generation through combination prevention.

First, as the secretary pointed out, we must scale up treatment for people living with HIV. A study published earlier this year by the NIH shows that HIV-positive people who are on treatment are 96 percent less likely to transmit the virus to their uninfected partners. Treatment as prevention works, and that's why San Francisco is dramatically expanding HIV testing to identify more people who are infected and get them into care as quickly as possible after their diagnosis. Currently, one in five people with HIV doesn't know he or she is infected, and one study suggests that newly infected people may account for as many as half of all new infections. Ramping up testing is good for the health of the individual, and it's good for the health of their entire community.

Second, the United States must continue to invest in new biomedical tools to stop the spread of HIV. Clinical trials are moving us closer to a day when women can use a microbicide gel to protect themselves from infection, and when HIV-negative people can take drugs currently used to treat HIV to prevent infection. We are at a unique moment scientifically in the epidemic, and now is not the time to stop the momentum of groundbreaking research.

Third, biomedical tools are only effective when used in conjunction with services that address root contributors to new HIV infections, like substance use, mental illness, homophobia, stigma, discrimination, homelessness, and poverty. When we address these issues through evidence-based interventions, such as our counseling and support groups for African Americans and Latinos here at San Francisco AIDS Foundation, we infuse our communities with culturally competent services that meet the distinct needs of people most vulnerable to HIV. But there is no question that gains in this area will be hard-won. Our country still faces gross health disparities related to HIV prevention and care; rates among young black men who have sex with men have increased sharply in recent years. This is unacceptable and must not be overlooked.

Finally, we must place a premium on collaboration. In this fiscally troubled environment it's important that government agencies and community providers work in symphony with each other to create seamless networks of care for people at risk for or living with HIV. At a time when science is making tremendous strides, we cannot allow people to fall through the cracks and lack access to care. In fact, President Obama mandates such innovative new partnerships in his National HIV/AIDS Strategy, and strategic collaborations will become even more vital in the years to come as we brace for potentially devastating cuts to HIV programs and services at all levels of government.

Just a few weeks from now, people all over San Francisco will gaze at City Hall on World AIDS Day to see that grand old building glowing in red. Among them will be colleagues, community partners, doctors, social workers, activists, educators, and others. Together we are the faces of combination prevention, because it will take all of us to stop this disease.

For us, World AIDS Day 2011 is not merely the final chapter in the narrative of this 30th-anniversary year. It is a time to look forward, to keep pushing the envelope, to redouble our efforts, to invest in our communities, to encourage new research, and to give care to people who need it most. Secretary Clinton has provided a roadmap, NIH has provided the tools, and now our elected officials must give us the resources to fight even harder. An AIDS-free generation truly is in sight. This will be our legacy.