Onward and Upward: Why the Fight Against HIV Must Continue

By Murray Penner December 1, 2016

As we join together on World AIDS Days to commemorate the lives of so many that have been impacted by the epidemic and look with hope as we envision an end to the HIV epidemic, I’m reminded of my own journey as a gay man growing up in the Midwest. For me, the early days of the epidemic were full of immense fear and uncertainty.
 
This is my 29th World AIDS Day. I was diagnosed with HIV over 2 years before the first global health day in 1988 and was told by the public health doctor who gave me my test results to prepare to die.  He told me to write a will, tell my family and friends about my diagnosis, and live my life to the fullest as I would be lucky if I lived 2 more years.  I did write my will and told my family and friends, BUT I refused to accept that the challenge ahead of me couldn’t be overcome. I’m obviously still here today and as I think back to the first World AIDS Day in 1988, I was scared, yet I was full of hope. Throughout the years following that, there have been many points in time where I felt these same conflicting emotions, including today.  And that’s why I will never give up on working to overcome the challenges we all face in ensuring health equity for everyone.
 
As a community and a movement, we’ve faced what seemed like insurmountable odds many times throughout our existence. But every time these odds have been stacked against us, we overcame them. We overcame a President in the early days of the HIV epidemic who would not say “AIDS” by implementing the Ryan White CARE Act and achieving an unprecedented response from our government. We overcame the lack of access to advances in treatment by achieving approval of early access to lifesaving treatments with more than 18 million people living with HIV today now being able to live healthy and productive lives. And we overcame so many other challenges to the point where we now envision that we can end new HIV infections and achieve an end to the epidemic.    
 
We find ourselves today once again at a crossroads at which we have found ourselves so many times before. As we prepare for a change in our nation’s leadership (and this will be the 6th President who has led our country since I was diagnosed in 1986), we again face much uncertainty and fear. I pledge my commitment, more than ever, to overcoming the unimaginable challenges that now seem to be in front of us. As I move into my second year leading NASTAD, I also pledge that we will join organizations, leaders, the community, and people living with HIV across the globe to achieve our vision of a world free of HIV.  We as a community know how to do this. We have done it before and we will do it again. So today, I invite you to join me in coming together to respond to the new challenges that we face. 
 
Key to confronting the challenges ahead of us is affirming the essential role of governmental public health in policies and programs that address the HIV and hepatitis epidemics, working in concert with communities and people living with HIV. To this end, NASTAD continues to work with health departments at the state and local level to accelerate the end of HIV and hepatitis.
 
Earlier this year, NASTAD launched the “Ready to End the HIV and Viral Hepatitis Epidemics” Chair’s Challenge that calls on U.S. health departments to accelerate the end of HIV and viral hepatitis in the U.S. As part of the challenge, we are working with health departments to determine the minimum program and policy building blocks that must be in place to support impactful HIV and hepatitis prevention and care programs, and assess where health departments land on the continuum of these minimum requirements. We also are developing a “report card” for health departments on core health department competencies. And we are prioritizing NASTAD’s technical assistance, including state-level policy activities, to achieve the greatest impact in modernizing health department programs and policies. Finally, we are working in coalition with other organizations and coalitions, including the Federal AIDS Policy Partnership, Act Now: End AIDS, and Fast Track Cities to ensure that health department and community efforts are coordinated, both domestically and globally. While there is much work to do with some very heavy lifting, I know that with enough patience, passion, strategy, activism, education, and resources, obstacles can be overcome and we can achieve the end of HIV.
 
We have at our disposal incredible scientific advancements that are propelling us forward in our vision of an end to the epidemic and that can help us end HIV stigma and discrimination. We now know definitively that HIV treatment works.  It works not only in keeping people living with HIV healthy and living long and productive lives, but also renders the risk of transmitting HIV to others nearly impossible when people living with HIV are virally suppressed and on effective treatment (this is truly “treatment as prevention”). And of course there’s PrEP, which has the potential, particularly combined with treatment as prevention, to end new HIV infections. These are incredible tools that we must harness and exploit.

And finally, we must keep our eye on the fact that our programs and services are only as good as they are able to rigorously challenge the seemingly insurmountable social and structural inequalities. To really bring an end to new HIV transmissions, we must reframe our public health approaches and interventions to include social justice action and intentionally deepen our understanding of the needs of our most vulnerable communities. That means removing discriminatory practices within our public health systems and boldly demonstrating through action that the lives of our most vulnerable brothers and sisters really matter. This is true now more than ever.

I’m inspired by so many of you.  As I was writing this, I started to name people who inspired me but I realized that was an impossible task. But I feel compelled to share that I’m inspired by so many of my fellow colleagues, my dear family and children, my friends (some of whom have recently been diagnosed and/or disclosed their status to me), and the many people I’ve loved and admired who were not as fortunate as me in surviving HIV. But mostly, I’m inspired by the hope that we have that we can truly end this epidemic.

So today on World AIDS Day, I look to the future with that hope. And while yes, I find myself again scared as we face many uncertainties, I will continue to be vigilant and remain strong and steadfast in this work. NASTAD will continue to be a strong advocate on behalf of governmental public health programs and a leader and partner in working with communities, organizations and people living with HIV and/or hepatitis. I invite you to join me in remembering our past and our purpose and looking to the future, forging ahead together -- governmental public health, people living with HIV and hepatitis, researchers, advocates, community members, organizations, and policymakers -- to bring an end to HIV and hepatitis.

Murray Penner is an HIV and hepatitis treatment and drug pricing expert who has been living with HIV since 1986. Murray is also the executive director at NASTAD. NASTAD is a non-profit association that represents public health officials who administer HIV and hepatitis health care, prevention, education and supportive service programs funded by state and federal governments in all 50 U.S. states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the U.S. Pacific Islands. NASTAD also supports partner governments in Africa, the Central America region, and the Caribbean region and on providing care and support to all who live with HIV and hepatitis.