An AIDS-Free Generation?

By Sue Saltmarsh

I admit it – it’s hard to be the “child left behind” as my PA colleagues are all in Washington attending AIDS 2012. But perhaps I have the advantage of distance from what must surely be a consuming, exhilarating feeling of unity, shared struggle, and hope for the future. If I were there, much like at my first HIV/AIDS conference last year (USCA), I’m sure I would be swept up in the incredible energy of thousands of people from all over the country (and this time, the world) coming together synergistically to exchange information, ideas, and experiences that share the common theme of dedication to ending this disease. Perhaps for me, distance breeds objectivity, while at the same time, a certain level of re-dedication to my little “niche” in the fight.

As my colleagues attend sessions focusing on global policies and challenges and hear speeches about PEPFAR and the National HIV/AIDS Strategy (NHAS), and disparities in care and treatment both within our own country and between resource-poor and wealthier nations, I will be back here like a dog with a well-chewed bone asking how we are ever to arrive at Secretary Clinton’s “AIDS-free generation” when we can’t even provide care and treatment for the people we know are positive now, let alone those who have yet to find out that they are?

While this conference is one of the best reminders that the U.S. is just another country, no better off than most and worse off than others in terms of the fight against HIV, I admit that my particular drum is a nationalistic one. Unlike the Gates and Clinton Foundations, whose great work I applaud, I care more about what’s going on in my own country than in Africa or Europe. And unlike PEPFAR and the NHAS, my noise is not just about HIV/AIDS—it’s about every chronic, life-changing, if not threatening, disease or condition. As stated by AIDS activist David Barr, “…it is not enough to demand HIV treatment for a woman with AIDS in Alabama while her mother is dying of hypertension and her children suffer from asthma.”

We will not ever have an AIDS-free generation unless we finally have a profit-free healthcare system. We will not ever have a healthier, more productive, more unified country until everyone at risk for HIV, cancer, heart disease, Alzheimer’s or any other disease has equal access to prevention, screening, and treatment without having to choose between food and healthcare, housing or healthcare, child care or healthcare or the threat of medical bankruptcy.

It was David and his fellow activist Gregg Gonsalvez who started my engine in 2010 – their idea was to organize a massive demonstration on the opening day of AIDS 2012 to demand universal healthcare. But the day was already reserved by another organization, there was no community-wide enthusiasm for the idea, and David and Gregg soon moved on to other more pressing work. But my engine kept running and the Demonstration for Universal Healthcare (DUH) was born and grew and now, finally, the AIDS community is beginning to wake up to the inadequacies of our current healthcare policy (as well as the improbability of Congress funding its implementation) and others have begun asking the question I asked repeatedly at the 2011 USCA—when the ACA fails, what is our “Plan B?”

So I hope that someone from the U.S. is talking to someone from Canada, France, Germany, Cuba, or any of the other nations among the majority in the developed world that have some form of single-payer healthcare to help them in their fight against HIV. I hope that, unlike other segments of American society, the HIV advocates at AIDS 2012 have both open minds and the willingness to learn from the experiences of others. I hope that as Secretaries Clinton and Sebelius, Congresswoman Lee, and Drs. Havlir and Fenton speak at the conference, they will also ask questions, listen, and take the lessons they learn with them so that the goals of the NHAS and the words “AIDS-free generation” aren’t just empty rhetoric, but rather actual possibilities.

It’s a good thing, our willingness to help other countries through such policies as PEPFAR and the Global Fund to Fight AIDS, but as world AIDS leaders come to our country and are able to see for themselves the disparities that keep the rates of HIV incidence and prevalence in Washington, D.C. and the U.S. South at rates nearing those in the Sudan, shouldn’t we make sure our own people have access to the care and treatment they and their loved ones with diabetes, liver disease, and arthritis need?

HIV/AIDS had to become a devastating cause of death for hundreds of thousands before PEPFAR and other worldwide efforts to help were created. According to a report published in the American Journal of Public Health in 2009 there are an estimated 45,000 premature deaths in the U.S. per year due to lack of insurance. How many more will it take?