World AIDS Day 2031: How We Could Outsmart HIV

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World AIDS Day 2031: How We Could Outsmart HIV

Brian Ackerman

In 2031, HIV will still be a reality. But if the Obama administration leads the world in promoting smart and evidence-based prevention education, it will be a disease everyone on the planet knows how to prevent.

The date is Dec. 1, 2031.  HIV/AIDS has ravaged the global population
for 50 years.  It is World AIDS Day again and I sit down in my
futuristic flying chair to draft a blog (an ancient form of personal
commentary that only middle-aged people have heard of).  The theme
of this year’s World AIDS Day is "Victory."  Here is my blog
from the future:

we made it.  50 years.  Millions of lives lost.  Millions
more chronically ill.  But we made
it.  The world has fought a 50 year battle with AIDS and finally,
with infection rates continuing their 22-year-long plummet around the
world, nearly universal access to antiretroviral therapy, and a sustainable
global healthcare infrastructure that
integrates prevention, treatment, and care services, we can claim victory. 
Many are saying "I can’t believe it."  But I can.  And
not only can I believe it, I would find it unacceptable to have it any
other way. 

this triumphant juncture in human history I think we must reflect on
the path we chose to take together to achieve this feat.  While
the AIDS epidemic began in 1981, before I was even born, the global
response to the disease took a dramatic turn 22 years ago, in 2009. 
Amidst a crisis in the world economy from which we have only recently
completely recovered, and amidst a massive power shift in Washington,
D.C., the United States charted a new course in the global response
with its five-year, $48 billion initiative to end the pandemic.

Obama Administration and 111
th Congress were
charged with calculating the sum of these parts: limited financial resources
+ an explosive global epidemic + donor fatigue for AIDS-specific funding
+ the largest generation of young people in human history (3 billion
people) accounting for 45 percent of new infections annually +
over two decades of data collection and a wealth of evidence-based,
best practice models for prevention, treatment, and care. 

Sex. Abortion. Parenthood. Power.

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many said the sum was in fact, a negative one, the U.S. government decided
that the knowledge we had about the AIDS epidemic, about how to prevent
it, about how to treat it, and about how to care for those affected
by it, was enough to outweigh the challenges of the other parts. 
And it could do such things because the U.S. government remembered that
it was good at defying the odds when it employed science, as was the
case with that trip to the moon back in 1969. 

what exactly did the U.S. government
do in 2009 that changed the course of human history and led us on a
path to victory over HIV/AIDS?  The list of specific actions could
fill a book, but fundamentally, what is now taught in history books
as the eight-year "War on Science," came to an end, and science
won!  The Office of the Global AIDS Coordinator
declared that with regards to prevention, it would fund only comprehensive,
medically accurate, and evidence-based programs
and emphasized that one of the only ways to outsmart HIV was to not
be afraid to address socially complex issues of sexuality and reproductive
health in a holistic and healthy manner. 
Congress amended PEPFAR reauthorizing legislation to eliminate the balanced
funding requirement for abstinence and be faithful programs and to fund
family planning programs within U.S. global AIDS funding. 

largest generation of young people (half the world’s population in
2009) were targeted in these programs
and like magic (but better, because it was science), a new generation
of sexually educated, informed, and responsible decision-makers
came of sexual and reproductive age.  Their new world became the
one in which we live today, where HIV is no less a reality, but it is
a reality that almost everyone on the planet knows how to prevent. 
Today, using prevention commodities such as male and
female condoms during sex is as common as putting on sunscreen before
spending a day at the beach or wearing our seatbelts when we fly our
futuristic cars (this comparison is particularly apt considering the
invention of multicolored seatbelts in 2015 that made them so much more
fun to wear!).  Even further, young people know how to negotiate
safe sex so they are empowered to protect themselves
(even if their partner is not as excited about multi-colored commodities). 

to this emphasis on evidence-based prevention programming, we were able
to finally catch up with the number of people newly living with HIV
and ensure their access to life-extending anti-retroviral therapy and
other holistic interventions. 
The emphasis on quality prevention programming did not detract from
treatment access, but in effect, amplified our ability to ensure that
a greater percentage of people living with HIV and AIDS could live long,
healthy lives. 

course the United States did not do this alone.  It joined a global
majority of donor countries and technical institutions that had been
saying the same thing for some time.  But it seems that the theme
of World AIDS Day 2008, "Leadership," must have really been effective. 
The United States dramatically enhanced its own
response to the pandemic in 2009 and led the way for a truly sustainable
and effective global response, so much so that I can sit here today
and claim victory over HIV along with the rest of the world. 
Looking back, the moon was pretty cool 80 years ago, but I don’t think
the world has ever claimed a win as big as this one.

we time warp back to the present.   

gross oversimplification of my blog from the future is intended neither
to "pit prevention against treatment," nor to place unreasonable
pressure on our incoming policy makers.  Rather, it outlines a
vision of what could be instead of what is, and highlights that we have
a choice as a country and as a world, instead of a dilemma.  It
is no secret that unprotected sex fuels AIDS.  Let’s choose to
utilize our limited resources as best as possible in the coming years,
and only fund comprehensive prevention programs to construct a world
in which access to HIV prevention information and commodities is universal,
so that universal access to treatment can also become a reality.   

expect nothing less from the incoming Administration and, like others,
believe it’s time. 

you are interested in sharing your thoughts about World AIDS Day, join
me for Advocates for Youth’s World AIDS Day Bog-a-thon, between
December 1-7, 2008 at