Sparking Difficult Conversations as We Move Toward an AIDS-Free Generation

The International AIDS Conference (IAC) is consistently charged with emotion, energy and opinions. The conference this year in Washington, D.C., was no different. What was different was the great deal of optimism shared by activists, scientists, researchers and outreach specialists alike. This optimism was clearly fueled by a consistent message provided by several of the conference's distinguished speakers: We have the tools to dramatically curb the global HIV/AIDS epidemic! We know how to prevent babies from being born with HIV. We have the technology to drop viral loads. We have even seen the development of pre-exposure prophylaxis for preventing infection. But is the science really enough?

For all the intensity and excitement about our new tools and joint commitment to ending the epidemic, we continue to stumble in addressing the social and structural determinants that drive new infections. Most sessions at IAC covered the science. What was missing were candid and constructive conversations about why the science has not been enough for many of our most vulnerable populations, especially people of color and men who have sex with men.

Fear of being labeled a promoter of the universal "isms" (racism, ageism, heterosexism, etc.) prohibited what could have been fruitful dialogues throughout the duration of the conference. There was little to no space to say those things often left unsaid. The structural drivers of the epidemic are difficult to discuss honestly and openly, especially in a mixed crowd. To stop HIV transmission, we have to be open to talking about accessibility to sexual partners, how sexual decision making takes place and the social dynamics of race, age, gender expression, etc. Without creating a safe space to engage in a healthy dialogue about these sensitive matters, IAC fails to achieve its potential. This IAC resembled many other conferences before it -- with players keeping to their corners, respectfully exchanging smiles but unwilling to furrow brows or engage in challenging conversations.

Our inability to push ourselves into uncomfortable but necessary terrain hinders our ability to help people overcome their fear of testing and knowing their status, link newly diagnosed HIV-positive people to medical care and ensure that they consistently take their life-sustaining medication. New tools in the toolbox won't address these issues. Only by initiating and sustaining conversations on these issues, all over the world, will we begin to curb the structural drivers that allow HIV to spread. Only by confronting homophobia, racism, sexism and other social inequalities will we be able to fully implement our toolbox.

With so many eager to embrace the vision of an "AIDS-free generation," it seems imperative now more than ever before to push the boundaries of our discourse and have all players willing to meet at the table. We owe it to ourselves to be made uncomfortable and identify the truths that will guide our successful journey to zero new infections. With that, we have our eyes set on Melbourne in 2014, where the dialogues will surely continue and GMHC will lead the charge.