-by Jake T. Snake
Tomorrow is a big day for those of us who work in AIDS service organizations and really anyone who cares about the issue. It is the one day a year that a large number of people pay attention for a few moments and ask us "So, how's it going?" That is a complex question. By and large well, I suppose, but I am worried. This disease that used to routinely kill people in 6-18 months has become a chronic, manageable illness. That is great news, but as with any change presents another set of difficulties. Taking care of people long term is expensive. The Director of the Center for Disease Control recently testified before Congress that each HIV infection cost approximately 1 million dollars in treatment and lost productivity. This is just dollars and cents and doesn't calculate the human cost of a chronic illness. Better treatments seem to have taken away some of the immediacy that people once felt about AIDS. I have recently heard intelligent sensible people talk about how they would try to practice safer sex, but hey! if they were infected the treatments were good and getting better and odds are they would live long enough for a cure to come along. Complacency has set in at all levels from individuals up to the federal government.
The Center for Disease Control announced this year that their previous estimates of 40,000 new infections annually in the United States were wrong and that the number is actually 56,000+. Here in lovely upstate New York we have our own epidemic that has quietly taken hold and spread. While people were justifiably concerned about the epidemic in New York City, upstate garnered enough people with AIDS that without any NYC cases upstate by itself would be the 5th highest state in the US in terms of number of AIDS cases. At our small shop the number of newly HIV+ people we have seen has doubled in one year and they are young, many in their early 20s. The bitter fruits of the abstinence only movement are beginning to ripen.
In the midst of this, the New York State legislature has cut funding to local HIV/AIDS organizations by 10% as a direct result of the crash in the financial sector. As Wall Street goes, so goes the New York State tax base and a portion of our funding. This at a time when the need for services is escalating, both prevention and care of those already HIV+. What seems to have been forgotten in the orgy of budget cutting is that HIV remains a communicable disease. While a man of my advanced years sometimes ponders the scary demons that may await, such as heart attacks, prostate cancer, alzheimer's etc. I know that if I go out tonight and have a fling there is no chance of me picking up a heart attack. I am hopeful that the administration of an African-American who knows the devestation this disease has wrought on the south side of Chicago would consider HIV/AIDS a priority.
Politically, several things conspire to put AIDS in a difficult place. 1.) Good treatment gives people the impression that the problem has been, if not solved, then at least dealt with adequately. AIDS can now be treated as merely a medical issue, but this is problematic given that it is still diproportionately striking African-American, Latino communities and men who have sex with men. Respecting and responding to cultural contexts with prevention messages isn't going to happen in a physician's office. They simply don't have the time. 2.) In the early days of the epidemic to garner attention and funding (and probably because at that point we believed it), we told people that everyone was at risk. History and time has proven us wrong. While it is possible for anyone to become HIV+ the epidemiology tells us that some groups just have better odds. It will probably not shock anyone that those most likely to become HIV+ are already disenfranchised because of race, gender or sexual orientation. 3.) Finally, people are just tired of AIDS and are on to the next issue du jour. We have had our 15 minutes I fear.
I can't seem to move on to the next thing. I live a haunted life and it is worst on December 1st. I remember all the wonderful people I knew who aren't with us anymore. I see their faces, I hear their voices and sometimes in the quiet moments I feel them next to me. They are with me always. I ponder the good they would have done, but could not and the myriad of ways the world has been lessened because of their communal loss. Tomorrow I will remind anyone who wishes to listen that AIDS has not gone away, remember all that we have lost and hope for a world without AIDS. As much as I love my work, I would willingly find something else to do for a living.
So here's my challenge to all of you, look in your local paper, website etc and go to a World AIDS Day event in your community. Take your friends, pass out condoms to the ones who won't come, start a conversation about safer sex, hell, call an AIDS organization and offer your house for a safer sex party. They are big fun. Oh! and practice safer sex in your own lives, of course. See you on December 1st!