Thirty years ago, we didn’t know what caused
AIDS. There was no specific laboratory test to diagnose the condition. And
there was little that medicine could offer beyond struggling to treat the
myriad, and gruesome, infectious and malignant consequences resulting from the
profound immunodeficiency associated with this mysterious new disease. Is it
any wonder that fear and ignorance flourished in a climate of such profound
uncertainty?
But I can also report that that same climate
of uncertainty and dread also bred caring of the highest degree, strong-fisted
resolve and relentless action that has helped bring us to where we are today. True, our work toward finding a vaccine and a
functional cure for HIV has not concluded, but the prevention and treatment
options available to community and clinical providers in this fourth decade of
the epidemic could hardly have been imagined in the early 1980s. That’s the
good news. But there are also
reasons to be circumspect.
Increases in new HIV infections among young
gay men, along with recent HIV outbreaks among people who inject drugs remind
us that our victory over HIV/AIDS is not a given. Whether it’s HIV infection or
some other threat to our nation’s wellbeing, we must remember that achieving
health is a continual process, not a destination. Our experience with the
resurgence of tuberculosis in the U.S. in the latter part of the twentieth
century is a cautionary example of what happens when we let down our guard,
stepping back from public health efforts because we think that we’ve licked a
disease. We must be very careful to avoid that same pitfall when it comes to
our efforts to achieve an AIDS-free generation.
Caveats notwithstanding, all of us anticipate
that science will continue to bring to fruition potent new tools to advance our
work in HIV prevention, diagnosis and treatment. We trust that ongoing research
will continue to move forward, delivering positive results in the form of
vaginal and rectal microbicides, evidence-based operational strategies to
improve HIV care outcomes and that pinnacle of success, a vaccine that’s
effective in preventing the acquisition of HIV. But
at the same time that we put our faith in the ability of science and technology
to advance our fight against HIV/AIDS, it’s critical that we remember and act
upon those principles that have carried us forward from the earliest and
darkest days of the epidemic.
In our efforts to prevent HIV transmission and
improve the care of persons living with HIV we must keep foremost in mind that
we are not merely dealing with the interplay between a retrovirus and an
individual’s immune system; it’s a much more nuanced interaction. Understanding
and addressing the relevant social, economic and environmental circumstances of
our client’s lives is as important today as it was back in 1981. And
while as a nation we may have moved beyond the more blatant, headline-grabbing
forms of stigma and discrimination associated with HIV in that first decade of
the epidemic, we must continue to confront HIV-related stigma whenever and
wherever we encounter it.
Finally– and this is a lesson that we should never forget–we are stronger and
more effective when we can work together, building bridges across programs,
disciplines and perspectives. The fact that biomedical science has tremendously
advanced our ability to counter this epidemic should never be misinterpreted to
mean that other components of a comprehensive response to HIV/AIDS are no
longer necessary. Strong leadership, community mobilization, a shared vision of
success and an unwavering commitment to empowering our most vulnerable
populations must always be at the heart of our work to stop the HIV/AIDS
epidemic here in the U.S. and abroad.
Dr. Ronald Valdiserri
