HIV Is At The Crossroads

The incoming President of the International AIDS Society, Dr. Linda-Gail Bekker has challenged the world. She has repeatedly stated: "It's not over till it's over. Let's urgently roll up our sleeves and get back to work. There is so much work to do!"
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When I was a young boy, I was an avid reader but only for particular types of books. For the most part, I primarily read biographies of intriguing American Civil Rights leaders or those of my favorite sports legends. Those types of biographies did not require much imagination. They just required one to go through a formulaic process with the author from their birth or at a pivotal time during the protagonist's life. Thereafter, we would travel through a piecemeal description of factual details and the impact of those details on the main character and their respective associates.

Sometime during middle school, I had my literary mind blown away. I read a different book style that I did not even know existed. It was about the Star Trek adventures. Science fiction had never crossed my mind as an interesting genre. But all the other boys in school were reading sci-fi so I figured that I would give it a shot. Now, the intergalactic battles and the people from distant planets honestly did nothing for me. What blew my mind was that this was a Reader's Choice book. Those books have storylines that habitually pause and adapt to the reader's choice of actions for the story's protagonist. For example in this Star Trek book, I could choose to have the Captain continue to battle Klingons in deep space or escape the battle by taking the Enterprise into Warp 5.

These pivotal choices happen throughout the storyline. For a passive reader being shuttled into the world of an active reader or the story commander if you will, it was quite an experience. Throughout our lived experiences, we can trace our life's trajectory mimic these books filled with pivotal moments that may ultimately change the main plot of our own biographies. And collectively, movements and communities similarly have crossroads that will forever change what is written in the history books.

In the HIV field, we have clearly reached that moment. Thirty-five years ago in July of 1981, awareness of the AIDS Epidemic became abundantly clear. During that time, ignorance, fear, political inaction, and civil disobedience became the norm until it eventually became taboo in some regions of the world to discriminate based on one's real or perceived HIV status. Those years were followed by massive investment in HIV research until we finally had protease inhibitors that could significantly control the virus originally presented at the Conference of Retroviruses and Infections (CROI) in 1996. And nearly twenty years later, definitive evidence was presented that we could now turn off the tap to new HIV infections by properly treating all those infected immediately as opposed to the standard of care of waiting for them to have declining health to begin antiretroviral medication. Around the same time, we learned that there is no direct evidence (aka nearly impossible) for a person who is living with HIV to transmit the virus when that person is taking their medication properly and it is suppressing the virus.

In past few years, optimal treatment regimens for HIV seem to be coming out every other day. And a drug that can prevent HIV infection has even been approved in several countries--but not all--around the world. There has been a commitment to engaging, addressing the needs of, and tailoring interventions for key populations who at-risk. At the International AIDS Conference occurring this week in Durban, South Africa, the world will receive updates on vaccine development; advancements on HIV antiretroviral treatment; and progress on prophylactic and treat-based injectables and implants. That all sounds great, yes? It does to me. But as in those Reader's Choice books, it is never that easy.

Currently, we are at the lowest level of donor funding for HIV care since 2010. Thirteen of the top fourteen donors have reduced support in the battle against HIV in the past year. That's an unacceptable reality. As someone who has dedicated his life to working in a field that has the ultimate goal of putting itself out of business, the lack of interest, desire, or motivation to support global End AIDS campaigns is disheartening to the say the least. We already know that when we scale up resources for accessing HIV-related healthcare to support key populations disproportionately impacted by HIV, i.e. gay/bisexual men, transwomen, drug users, and commercial sex workers, that all populations benefit.

The incoming President of the International AIDS Society, Dr. Linda-Gail Bekker has challenged the world. She has repeatedly stated: "It's not over till it's over. Let's urgently roll up our sleeves and get back to work. There is so much work to do!"

As many of my colleagues will attest while we search for the elusive HIV cure or vaccine, we have the tools to win nonetheless. We must come together and collectively choose to turn the page in the Reader's Choice book to End AIDS and reduce HIV and not the one that sends us back to the beginning. We can do this together.