GMHC (Gay Men’s Health Crisis): The first responder to HIV in the United States

July 14, 2011 in AIDS at 30

This entry is part of a new blog series about the 30th anniversary of the AIDS epidemic in America.  Submissions are invited from all AIDS United stakeholders, including Community Partnerships (and their grantee organizations), grantees, funders, Trustees, staff, advocates, Facebook and Twitter friends and followers, and anyone who has been impacted by HIV/AIDS who reads this blog.  For submission guidelines, email communications@aidsunited.org

by Janet Weinberg, Chief Operating Officer of GMHC

Fourth of July weekend 1981 looked like it was going to be another beautiful long weekend on

Fire Island Pines, much like the past two decades of weekends had looked like for some gay men. This weekend had a chilling change to it.  Lawrence Altman’s article in the New York Times had the following headline: Rare Cancer Seen in 41 Homosexuals. With these words, the party stopped at least for a moment. As men were quietly enjoying their weekend, some of them knew that their lives were about to be greatly altered.

Six gay men got together on August 11, 1981 in the living room of Larry Kramer’s home and the rest is history. GMHC had its humble beginnings.  Three of the men in that living room are no longer alive.

As you can see, the HIV/AIDS movement was built out of fear and the need to be empowered. The early programs at GMHC were started out of necessity. The first HIV hotline began with a phone and answering machine in the closet of Rodger McFarlane’s living room.   The hotline rang off the hook with terrified men asking questions and wondering where to find the most reliable information about the “gay cancer.” Rodger became the first paid Executive Director of GMHC. To this day terrified people call and write to GMHC’s helpline looking for the most reliable information they can get. Inquiries come from all over the world.

The next program to begin was called the Buddy Program. This program assigned a volunteer to a homebound person with what was then called Gay Related Immune Deficiency or GRID. Buddies would do everything from holding a dying person’s hand to washing their clothes, food shopping, and helping with phone calls. Why did we need buddies? The medical world was afraid of people with AIDS. They would gown up in outfits that were fit for space travel but not for dying people. There was no human element to the care. We were watching 20, 30, 40 and 50 year olds dying long before they reached the prime of their lives and their deaths were ignored.  As Rodger McFarlane said during a GMHC video about the 25th anniversary of HIV, “whole zip codes were redlined out of insurance and no one gave a shit.”  The buddies cared.  This program was so successful that it was replicated all over the country.

These early beginnings led to an agency that has changed as the disease has changed. Yes, breakthroughs allowed people to live much longer and regain their strength. But let us not forget that in the United States, according to the Kaiser Family Foundation as of June 2011, there are 8506 people on a wait list for access to drugs through the AIDS Drug Assistance Program (ADAP).   So who will live and who will die? Those who have access to medical care and drugs live. Those who are poor, undocumented or do not have access to care will die. Yes, in 2011 we have people dying of AIDS due to lack of access to medicine and care.

Currently, those most affected by HIV are black, white, and Latino MSM (men who have sex with men) and African American women. The most common denominator for all of these groups of people is poverty.   Recently, GMHC needed to find a new home after being in its Chelsea location for 15 years. We looked at about 40 properties and made offers to close to half a dozen of these possible new homes. Dr. Marjorie Hill, CEO, was taken aback when several of the representatives for these properties asked to come see where GMHC was housed. At first, she was delighted to show off GMHC’s services. She then realized that when real estate shopping, people do not ask how you currently live in order to decide whether or not they should accept you as a tenant. From this hard lesson we know that stigma continues to be a driver of the epidemic.

Today, GMHC is newly housed at 446 West 33 St. between 9th and 10th Ave., New York City. The most utilized programs include the hot meals program, mental health counseling, 12-step meetings, pharmacy services, legal services, benefits and entitlements assistance, housing assistance programs, workforce development, community outreach and prevention services.  Public Policy continues to fight bad legislation that passed in the 1980’s and early 1990’s and to fight for new legislation to protect people living with or affected by HIV 30 years after the start of this scourge.

Outcomes for those with access to care have changed over the 30 years. Outcomes for others have not changed one bit. Disparity continues to play a big role in HIV. Gay men and men and women of color are disproportionately affected.

Thirty July 4th weekends have occurred and the sun still glistens over the beautiful Pines beaches. The houses are still filled with gay men. But their landscape will never be the same again.   We are forever grateful to those six men who had the foresight to create GMHC. It is their shoulders that we stand upon 30 years later.

The National HIV/AIDS Strategy: Turning Point or More of the Same? It’s Our Choice!

July 13, 2011 in National HIV/AIDS Strategy

vignetta charlesby Vignetta Charles, Ph.D.,
Vice President of Programs & Evaluation

The launch of the National HIV/AIDS Strategy one year ago marked an historic opportunity and potential turning point for the epidemic in the United States.  For the first time, a U.S. President and his administration demonstrated a serious commitment to ending HIV/AIDS in the United States by bringing together government officials and HIV/AIDS community leaders to develop a clear, focused and achievable plan to reduce new infections and to ensure those living with and affected by HIV have access to life-saving prevention and care services. And we – the HIV community, the private sector, and public and private philanthropies have a key role to play in helping the federal government, with bi-partisan support, ensure its successful implementation.

AIDS United has taken this responsibility seriously.  In the year since the NHAS release, we have been at the forefront of cultivating significant public and private investments for our Access to Care (A2C) programs, which advance real-time implementation of the NHAS goal of Increasing Access to Care and Improving Health Outcomes for People Living with HIV.

Thanks to the millions of dollars invested by Bristol-Myers Squibb, the Social Innovation Fund (SIF)MAC AIDS Fund, the Elton John AIDS Foundation, the Ford Foundation, ViiV Healthcare,  Chevron, Walmart Foundation, Broadway Cares/Equity Fight AIDS, and Walgreens, AIDS United is able to support community-driven programs across the country that  help thousands of people living with living with HIV/AIDS from our country’s most vulnerable populations access  life-saving care and support services.  These investments represent the largest public and private collaboration to date to move the National HIV/AIDS Strategy forward.

Unfortunately, while we forge ahead building private sector support for community-based HIV/AIDS programs, Congressional battles over the federal debt threaten to severely cut funding for Medicare and Medicaid, and other federally-funded services that significantly impact people living with HIV/AIDS.  AIDS Drug Assistance Programs (ADAP) across the country continue to face funding crises, forcing waiting lists that total nearly 9,000 and counting.  Clearly we have to advocate for and protect these programs, and the people they serve.

And while we fight to protect and save federally-funded programs that help people living with HIV/AIDS, the National HIV/AIDS Strategy serves as a game-changing blueprint for helping to end HIV/AIDS in America.  The goals and outcomes of the NHAS are now ours to support, in the face of whatever is happening in the halls of Washington. We must continue to build partnerships that leverage new investments that are disbursed to the communities and populations in our country most affected by the epidemic. We must continue to advocate for sound HIV/AIDS policy that supports the implementation rather than slows, or worse, halts it.  We must continue working together – the HIV community and the private and philanthropic sectors – to fund and implement  innovative solutions that improve health outcomes and make achievable the goals of the National HIV/AIDS Strategy.

Without these essential partnerships, the National HIV/AIDS Strategy will remain only that – a strategy – and it will fail to be the historic turning point in the epidemic which will lead us to the  ultimate vision  – the end of the AIDS epidemic in America.

Why I Work in HIV

June 30, 2011 in AIDS at 30

This entry is part of a new blog series about the 30th anniversary of the AIDS epidemic in America.  Submissions are invited from all AIDS United stakeholders, including Community Partnerships (and their grantee organizations), grantees, funders, Trustees, staff, advocates, Facebook and Twitter friends and followers, and anyone who has been impacted by HIV/AIDS who reads this blog.  For submission guidelines, email communications@aidsunited.org

by Lauren Fayish, Program Associate

I wasn’t here for the early days of the epidemic. I didn’t lose a loved one to this disease and I never had any personal connection to this cause growing up. But after serving as an AmeriCorps member in the field of HIV/AIDS, I came to realize that my values were so strongly aligned with the fight to end the HIV epidemic that I now consider this work to be a deeply persona

l endeavor, and as I have come to learn, one which benefits all of us regardless of our HIV status.

For me, the prevalence of HIV in the United States has shined a light on the injustices and the inequalities that lurk beneath the surface of our society. From a place of privilege, one never needs to acknowledge the disparities in our communities. An us against them mentality can make it easier to turn a blind eye to the shifting epidemic.  But when I look at the pattern of new infections and see how and where HIV is spreading, these injustices become clear. Not only is the epidemic in the U.S. highly concentrated in certain populations (men who have sex with men, communities of color), but in 2010, the CDC reported a clear link between HIV infection and poverty. A survey of 9,000 individuals living in high-poverty areas of 23 U.S. cities reported a HIV prevalence nearly 20 times the rate of HIV in the generalized heterosexual population in the U.S.. From my experience working in this field, it is clear that disparities in wealth, educational opportunities, social status, and access to medical care contribute to the spread of HIV. As a member of this community and this country, I find these realities unacceptable.
Despite the social injustices that the HIV epidemic has brought to my attention, I am grateful for the fact that this disease forces us to see our country at its worst and to strive to make it better.  HIV/AIDS requires us to address our inequalities. As a result of our efforts to stop the spread of the virus and to care for those infected, we have created solutions that make our society stronger and more equal.

  • Advocacy work in the field of HIV/AIDS has forged successful models for grassroots organizing which remind us that devoted citizens still have the power to make change in this country.  Advocates have been able overturn a ban on using federal funds for syringe exchange, remove the antiquated practice of denying HIV-positive individuals entrance into the U.S., and ensure that scientifically accurate sex-education is available in public schools.
  • Caring for those with HIV has led to the creation of holistic models of health care that are more patient-centered. HIV case management and the system of Ryan White clinics in the U.S. demonstrate the type of medical infrastructure that our country must consider as we move towards a medical home based health care model. Even now, as we work to improve access to care for PLWHA, we are informing policy-makers on how to improve the accessibility and utilization of health care for people managing chronic diseases and multiple health care needs.
  • Scientific research related to HIV/AIDS has led to advancements that translate beyond this field.  Prevention science has benefited from the interventions that have been developed to stop the spread of HIV. The devastating impacts of stigma on disease prevention, care and treatment are better understood.  And, the cost-effectiveness of HIV prevention and treatment investments lends credence to the need to transition our health care system from one that treats disease to one that prevents disease.

These advancements, among many others, exemplify how the tireless work to combat HIV/AIDS during the past 30 years has contributed to the well-being of the country that we all share.

In this field, our values of justice and equality have coalesced into a force that has won many battles, even if a cure still eludes us. The suffering and loss that this disease has inflicted on the world will never be erased, but we should not overlook the legacy of progress that has resulted from our 30 year battle against this epidemic. Although I wasn’t around for the start of this work, I am privileged to honor those who have lost their lives to the virus by carrying this work forward for the betterment of us all.

Finding a Way to Get Through This: My Story of Being Tested for HIV After Exposure

June 29, 2011 in Policy/Advocacy, Uncategorized

Jimmy Schneidewindby Jimmy Schneidewind, Public Policy Associate

The most difficult three months of my life were the three months I spent wondering if I was HIV positive. I suspect that similarly, they were also three of the most difficult months my family has ever endured. Though I had volunteered in numerous HIV testing clinics and had trained hundreds of HIV educators on the values of getting regularly tested for HIV, there was nothing that could have prepared me or my family for the stress, anxiety, and heartache that we felt when my own status was in doubt.  Nearly three years later, I can still recall with extraordinary vividness the thoughts and emotions that ran through me during those months, and the pain that I felt as I considered what the rest of my life would be like if I were to contract HIV at age 24.

I had been living in Mozambique, a Portuguese-speaking country found on the south-eastern most part of Africa, for 14 months when I was exposed to HIV. I lived in a small rural village called Nicoadala (pronounced: nick-wa-dah-la) where I worked as a consultant to a civil group of Mozambicans who were working in collaboration with an international non-governmental organization to build up the health infrastructure of the town. Overall, I was enjoying my experience, though I would often be consumed in my private time by feelings of isolation as the only American.

Although I was aware that I had been exposed to HIV, the notion that I might have contracted the virus was not one that immediately dawned on me, strangely enough. It started as a small seed of doubt and ultimately morphed into an overwhelming panic, the intensity of which was almost paralyzing. I think I was hoping to wake up one day and realize that it had not really happened or that I would eventually succeed in convincing myself that it wasn’t really as serious as other cases of HIV exposure. After a month, I was completely taken over by fear, and belatedly took the two kilometer walk from my house to the local hospital where I had encouraged hundreds of Mozambicans to get tested for HIV, but had never once been tested myself.

The only available HIV tests in Mozambique are rapid tests. This testing method returns results in about 20 minutes, however, there is usually a latency period of between six weeks to three months for the virus to become detectable in most peoples’ bodies. When the nurse took my blood (note that the vast majority of rapid tests in the United States use a mouth swab) and dripped it onto the rectangular testing area, I turned my head away, unable to watch as my results emerged. The irony was not lost on me that as a white, heterosexual, upper-middle class, college-educated, American male, from an overly-supportive two parent family, I was probably the least likely person on the planet, statistically, to become infected with HIV. And yet, there I was, half a world away from family and friends, waiting and wondering; scared.

Though my initial test results came out negative, I spent the next two months in a state of melancholy while I waited for the three month mark post-exposure when I could finally be sure of my status. I wondered if my family would accept me. I wondered which of my friends would still hug me. I wondered who would want to marry me, and how I would ever become a father. Who would love me if I had HIV? As I contemplated what life would be like if I had HIV, I remember feeling as stripped down to my fundamental core as I imagine a human can feel and thinking that these are the same fears that everyone has when they are uncertain about their health status.

The reasons why I was terrified to get my test results then are the same reasons why I choose to get tested now. The faces of people who I love and for whom I care deeply drift into my mind whenever I am waiting to get tested or awaiting my results: My parents, my brother, my aunts, uncles, cousins,  and my friends. I realize in those moments when I am most scared that my life is valuable primarily because of the love given to me by all those faces I see and my decision to get tested derives purpose from that realization.

When I called my parents to tell them that I knew for certain that I had been exposed to HIV, my mom spoke first, after a slight pause, and said, “Whatever the results are, we will find a way to get through this.” I will never forget that. In varying degrees, I am still afraid every time I go to get tested, but I think the fear is good because it is a reminder of why I now get tested regularly and what is truly important to me. I continue to get tested for HIV because I want to be proactive and responsible about my health; I find meaning in my testing because I recognize the love people have for me, and the love I have for myself.

Although this blog was written in recognition of National HIV Testing Day, June 27, it appears on our website and in our Weekly Update after the day as a reminder that it is important to get tested no matter what day it is. AIDS United encourages everyone to find out their HIV status by getting tested today and by making it a regular part of your health check-up routine. To learn more about National HIV Testing Day, please visit the National Association of People Living With AIDS (NAPWA) website. To find the testing site closest to you, please use this link.


Revitalizing HIV Education in the Workplace

June 27, 2011 in President's Message

by Mark Ishaug, President & CEO

Just a few weeks ago, we marked the 30th anniversary of the AIDS epidemic, and since that time we have been taking stock of what we have accomplished, how we have responded to challenges, and where we see the most promise in ending HIV/AIDS.

Today is National HIV Testing Day (NHTD), which gives us another important opportunity this month to recognize the impact of HIV/AIDS in America, and to educate ourselves about one of the most significant actions that we can take as individuals in the fight against the AIDS epidemic – getting an HIV test – so we can all know our status.

CDC estimates approximately 21 percent of the 1.3 million Americans living with HIV are unaware of their HIV status.  If we don’t know our status, we won’t connect to the life-saving care and treatment.  If we don’t know our status, we won’t take steps to prevent transmitting HIV to others.  If we don’t know our status, we won’t be able to end the HIV epidemic.  It’s that simple.

What may not be that simple though, is figuring out where to get more information on HIV/AIDS, and where to find confidential HIV testing   Especially if you live in a smaller community or rural area.

Levi Strauss & Co. came to us at AIDS United to help address this issue for their employees in the United States – many who live in smaller communities.  We worked with them to create an innovative partnership with local AIDS organizations. The goal: to help connect employees with the resources they need to manage HIV/AIDS at work and in their lives – even if they don’t live in a big city.

Starting today Levi Strauss & Co. employees around the country will have access to HIV/AIDS education, testing and care in a new effort called HIVConnect. From our perspective at AIDS United, this effort revitalizes the HIV/AIDS in the Workplace effort in the U.S. – an effort that Levi’s® helped pioneer in the earliest days of the epidemic.

Together with local AIDS organizations and AIDS United partners, the company will train employees in workplaces around the country. This will ensure their colleagues can learn more about HIV/AIDS to fight stigma and discrimination, and protect themselves.  And, most importantly, employees can connect to trusted organizations, ready to meet their needs, no matter where they are.  HIVConnect stands to provide important – and potentially life-saving – information to thousands of Levi’s employees in the U.S. about HIV/AIDS, many of whom might have never had the opportunity or the motivation to seek these resources otherwise.

This is exactly the kind of leadership and initiative we need to be seeing in many, many more American companies.  A revitalization of the workplace HIV/AIDS effort is needed in the U.S. particularly when HIV resources are tight.  And ending AIDS requires we work across sectors to improve access to much needed services.   We are so proud to be working with a company like Levi’s that shares our vision of the end of AIDS in America, and that invests in the well-being of its employees.

This June, AIDS United stands with Levi’s and hundreds of HIV/AIDS organizations around the country in proclaiming that 30 years of this epidemic is enough.  We must work even harder to bring about a new anniversary to actually celebrate: The End of HIV/AIDS.  HIV/AIDS is a winnable battle and you can help us win.  Take the test. Know your status.  Take control of your life.  Be well!

To read more about HIVConnect, click here to read “Unzipped,” the Levi Strauss & Co. blog

Just a few weeks ago, we marked the 30th anniversary of the AIDS epidemic, and since that time we have been taking stock of what we have accomplished, how we have responded to challenges, and where we see the most promise in ending HIV/AIDS.

Today is National HIV Testing Day (NHTD), which gives us another important opportunity this month to recognize the impact of HIV/AIDS in America, and to educate ourselves about one of the most significant actions that we can take as individuals in the fight against the AIDS epidemic – getting an HIV test – so we can all know our status.

Today, CDC estimates approximately 21 percent of the 1.3 million Americans living with HIV are unaware of their HIV status. If we don’t know our status, we won’t connect to the life-saving care and treatment. If we don’t know our status, we won’t take steps to prevent transmitting HIV to others. If we don’t know our status, we won’t be able to end the HIV epidemic. It’s that simple.

What may not be that simple though, is figuring out where to get more information on HIV/AIDS, and where to find confidential HIV testing Especially if you live in a smaller community or rural area.

Levi Strauss & Co. came to us at AIDS United to help address this issue for their employees in the United States – many who live in smaller communities. We worked with them to create an innovative partnership with local AIDS organizations. The goal: to help connect employees with the resources they need to manage HIV/AIDS at work and in their lives – even if they don’t live in a big city.

Starting today Levi Strauss & Co. employees around the country will have access to HIV/AIDS education, testing and care in a new effort called HIVConnect. From our perspective at AIDS United, this effort revitalizes the HIV/AIDS in the Workplace effort in the U.S. – an effort that Levi’s® helped pioneer in the earliest days of the epidemic.

Together with local AIDS organizations and AIDS United partners, the company will train employees in workplaces around the country. This will ensure their colleagues can learn more about HIV/AIDS to fight stigma and discrimination, and protect themselves. And, most importantly, employees can connect to trusted organizations, ready to meet their needs, no matter where they are. HIVConnect stands to provide important – and potentially life-saving – information to thousands of Levi’s employees in the U.S. about HIV/AIDS, many of whom might have never had the opportunity or the motivation to seek these resources otherwise.

This is exactly the kind of leadership and initiative we need to be seeing in many, many more American companies. A revitalization of the workplace HIV/AIDS effort is needed in the U.S. particularl

Just a few weeks ago, we marked the 30th anniversary of the AIDS epidemic, and since that time we have been taking stock of what we have accomplished, how we have responded to challenges, and where we see the most promise in ending HIV/AIDS.

Today is National HIV Testing Day (NHTD), which gives us another important opportunity this month to recognize the impact of HIV/AIDS in America, and to educate ourselves about one of the most significant actions that we can take as individuals in the fight against the AIDS epidemic – getting an HIV test – so we can all know our status.

Today, CDC estimates approximately 21 percent of the 1.3 million Americans living with HIV are unaware of their HIV status.  If we don’t know our status, we won’t connect to the life-saving care and treatment.  If we don’t know our status, we won’t take steps to prevent transmitting HIV to others.  If we don’t know our status, we won’t be able to end the HIV epidemic.  It’s that simple.

What may not be that simple though, is figuring out where to get more information on HIV/AIDS, and where to find confidential HIV testing   Especially if you live in a smaller community or rural area.

Levi Strauss & Co. came to us at AIDS United to help address this issue for their employees in the United States – many who live in smaller communities.  We worked with them to create an innovative partnership with local AIDS organizations. The goal: to help connect employees with the resources they need to manage HIV/AIDS at work and in their lives – even if they don’t live in a big city.

Starting today Levi Strauss & Co. employees around the country will have access to HIV/AIDS education, testing and care in a new effort called HIVConnect. From our perspective at AIDS United, this effort revitalizes the HIV/AIDS in the Workplace effort in the U.S. – an effort that Levi’s® helped pioneer in the earliest days of the epidemic.

Together with local AIDS organizations and AIDS United partners, the company will train employees in workplaces around the country. This will ensure their colleagues can learn more about HIV/AIDS to fight stigma and discrimination, and protect themselves.  And, most importantly, employees can connect to trusted organizations, ready to meet their needs, no matter where they are.  HIVConnect stands to provide important – and potentially life-saving – information to thousands of Levi’s employees in the U.S. about HIV/AIDS, many of whom might have never had the opportunity or the motivation to seek these resources otherwise.

This is exactly the kind of leadership and initiative we need to be seeing in many, many more American companies.  A revitalization of the workplace HIV/AIDS effort is needed in the U.S. particularly when HIV resources are tight.  And ending AIDS requires we work across sectors to improve access to much needed services.   We are so proud to be working with a company like Levi’s that shares our vision of the end of AIDS in America, and that invests in the well-being of its employees.

This June, AIDS United stands with Levi’s and hundreds of HIV/AIDS organizations around the country in proclaiming that 30 years of this epidemic is enough.  We must work even harder to bring about a new anniversary to actually celebrate: The End of HIV/AIDS.  HIV/AIDS is a winnable battle and you can help us win.  Take the test. Know your status.  Take control of your life.  Be well!

To read more about HIVConnect, click here to read “Unzipped,” the Levi Strauss & Co. blog

y when HIV resources are tight. And ending AIDS requires we work across sectors to improve access to much needed services. We are so proud to be working with a company like Levi’s that shares our vision of the end of AIDS in America, and that invests in the well-being of its employees.

This June, AIDS United stands with Levi’s and hundreds of HIV/AIDS organizations around the country in proclaiming that 30 years of this epidemic is enough. We must work even harder to bring about a new anniversary to actually celebrate: The End of HIV/AIDS. HIV/AIDS is a winnable battle and you can help us win. Take the test. Know your status. Take control of your life. Be well!

To read more about HIVConnect, click here to read “Unzipped,” the Levi Strauss & Co. blog

Winning the Battle Against HIV/AIDS

June 24, 2011 in AIDS at 30

by David Ernesto Munar, President/CEO of the AIDS Foundation of Chicago (AFC)

I am honored that the White House chose to commemorate the 30th Anniversary of the HIV/AIDS pandemic with me and other openly HIV-positive organizers from across the country. We gathered recently with federal officials to reflect on the salient lessons learned and milestones marked in the fight against HIV/AIDS over the past three decades.

Reflecting on this solemn occasion stirs a mix of emotions.

In 30 years, HIV has caused tremendous loss and human suffering in every corner of the inhabited world. But it has also inspired heroic acts of kindness, generosity, and leadership. Looking back, we must laud the significant medical, political, and scientific advances achieved but also sustain a firm understanding of the unfinished work that lies ahead. With record numbers of people living with HIV and increasing numbers of new infections, we must reinvigorate efforts to provide people with and at risk for HIV/AIDS with the health and social services, housing, prevention, and human-rights protections they so desperately need and deserve. HIV knows no borders and neither should our compassion and actions.

Recognizing the rapid maturity of HIV medical, behavioral and social sciences, the U.S. Centers for Disease Control and Prevention now considers HIV a winnable battle. To truly win the future, the U.S. must not relent until we’ve won the fight against HIV/AIDS.

Thankfully, the U.S. is poised to make tremendous progress. For the first time, the U.S. has a comprehensive National HIV/AIDS Strategy, which President Obama unveiled in July 2010. The Strategy provides a thorough analysis of the HIV/AIDS epidemic in the U.S. and maps a pathway to decrease HIV infections, improve health outcomes for those of us living with HIV, and decrease HIV-related health disparities among the three groups most severely impacted: African Americans, Latinos, and men who have sex with other men. Winning the battle against HIV must start with realizing the measurable targets of the Strategy.

In 2010, Congress enacted and President Obama signed into law the Patient Protection and Affordable Care Act, which could quite literally reverse the epidemic’s spread once the law is fully implemented.  From the very beginning, inadequate healthcare access, discrimination, and indifference sowed the seeds of today’s burgeoning epidemic. By eliminating healthcare insurance discrimination against those who desperately need it, expanding public and private sources of affordable insurance, and guaranteeing a minimum standard benefit, HIV care will become more readily accessible than ever before.

But the most significant portions of the law will not take effect until 2014, which is why our current safety-net systems—namely Medicaid, Medicare, and the Ryan White HIV Act—are so critically important.  In over a dozen states, nearly 10,000 individuals with HIV languish on waiting lists for medications through their state’s overburdened AIDS Drug Assistance Programs, which desperately need an infusion of state and federal funds. Hundreds of thousands of other HIV-positive Americans remain unaware of their infection or have simply given up and are not seeking or receiving medical attention, at grave danger to themselves and others. Engaging and assisting these individuals will take valiant efforts but will also pay dividends to the nation by realizing future healthcare savings.

Even after federal health reform is fully implemented in 2014, the Ryan White program will be instrumental in providing wrap-around services not covered by healthcare insurance for low-income people with HIV. Moreover, a small number of people in the U.S. will remain ineligible for federal healthcare assistance that can only be met through Ryan White services.

U.S. leadership in response to global AIDS must also grow so that the poorest and most affected countries in the world benefit from the very best tools and knowledge available to control HIV. Our nation’s continued leadership in response to global AIDS—spearheaded by leadership from President George W. Bush who created and rapidly expanded the President’s Emergency Plan for AIDS Relief—will also ensure that the wealthy nations of the world sustain and grow their investments in stopping HIV/AIDS globally. Increasing investments in global AIDS is not just a moral and public health imperative but, as documented by the CIA, will help abate civil unrest and destabilization that can breed factions sympathetic to terrorism and threaten global security.

Earlier this year, groundbreaking, new evidence that antiretroviral therapy not only stabilizes HIV-positive people medically but also dramatically curbs new infections heightens the urgency to expand healthcare and testing access and wrap-around services, such as housing and case management, that are instrumental in successful and continuous medical engagement. Scaling access to medical care in an ethical and responsible way without losing focus on human rights and other pivotal strategies will be the basis for a successful and comprehensive anti-HIV approach moving forward.

It is worth underscoring that the battle against HIV/AIDS is waged daily in communities around the world by non-governmental organizations such as the AIDS Foundation of Chicago that keep urgency to the fight, demand accountability, and innovate creative, new ways to inspire individuals, institutions, and large public and private bureaucracies to do more against HIV, do it better, and continuously aim to achieve greater results.

Inspired by those of us living with HIV—who stand the most to gain or lose from society’s responses to this epidemic—the HIV/AIDS advocacy movement is by itself among the greater accomplishments of the history of the pandemic. We have changed the way affected community members are engaged in healthcare decision-making, awoken political awareness among the most disenfranchised segments of society, and shined a light on the symptoms and causes of structural inequities.

The fourth decade of HIV/AIDS will be marked by how well, or how poorly, societies around the world address such fundamental determinants of health as poverty, access to healthcare and prevention, housing, and basic human and civil rights needed for individuals and communities to thrive.