Treatment Issues: Newsletter of Experimental AIDS Therapies - Volume 16, Number 12, December 2002
Gregg Gonsalves

As the New Year begins, it's time to take stock of where we've been and where we're going. Around the world, only a fraction of the people who need AIDS treatment get it and the virus continues to spread like wildfire in Asia, Eastern Europe, and Africa. In the United States, 13 state AIDS Drug Assistance Programs (ADAPs) have already closed enrollment to new clients or limited access to antiretroviral treatments. Adding expensive new drugs like T-20 or treatments for hepatitis C are out of the question for most ADAPs.

Meanwhile, the extreme right wing within the Bush Administration continues to play politics with HIV prevention, pushing abstinence-only prevention programs — despite evidence that suggests these kinds of efforts are ineffective — and questioning the worth of condoms, despite data that confirms their central role in protecting people against HIV.

Soon, Congress, working with Draconian budget caps, the prospect of more tax cuts, and a war in Iraq, will have nothing to spend on domestic discretionary programs, including those for HIV/AIDS. Nor will there be room for any real investment in international efforts to combat the epidemic. Additionally, the doubling of the NIH budget has come to an end, forcing some hard choices about the future of AIDS research.

As Irish poet William Butler Yeats wrote 80 years ago, "the best lack all conviction, while the worst are full of passionate intensity." Since the advent of highly active antiretroviral therapy (HAART) in the late 1990s, we've seen a waning of AIDS activism here in the United States. It seems as if many of the activists who fought for the programs and policies that we rely on today — if they survived to see the drugs — considered their work done and moved on. And although many new-generation AIDS activists have focused their energies on vital international work, one wonders if and when we'll see resurgence in the activism needed here at home.

The passionate intensity of the Right is bent on destroying all we have worked for during the past twenty years, yet people with AIDS and their advocates in the U.S. seem strangely silent. Have gay men in New York City and around the country forgotten what it was like in the 1980s? Or have they decided, now that they've got HAART and health insurance, and now that the epidemic has moved into African-American and Latino communities, that HIV is not their problem? Are there still some leaders in the African-American and Latino communities practicing denial about the swath of destruction that HIV has unleashed in their communities?

A few of our readers here at GMHC Treatment Issues have complained that the newsletter has gotten "too political" over the past couple of years. I happen to like our focus on treatment information, policy and advocacy—it eloquently reflects the challenges and opportunities of the next decade of the pandemic. In counterpoint, I would maintain that a few of our readers have gotten "too complacent" since HAART came on the scene.

Today, I can ask: where were you when your state's ADAP program closed? Where were you when "just say no" abstinence-only programs were instituted as the only HIV prevention efforts in your teenager's high school? Soon, I'll be able to ask: where were you when public funding for AIDS programs began to slide backwards? Where were you when your local AIDS service organization started cutting back services to those most in need due to lack of funding from individuals and foundations? Where were you when the number of people in the world infected by HIV — where, for the majority, AIDS remains a death sentence — hit 70 million?

So, it's a New Year. Time to make your resolution. Pick up a pen and write to the President, your members of Congress, your governor, and your mayor. Check in with your local AIDS organization to see what needs to be done, and then get to work. If every subscriber to Treatment Issues did this, thousands of calls and letters would flow to Washington, D.C., to the people who make the decisions that affect our lives.

Yeats concluded his poem by asking, "what rough beast, its hour come round at last, slouches towards Bethlehem to be born?" Those of us living with AIDS don't need to ask; this terrible creature lives in our bodies, swirling in our blood, and it links our fate to all people with HIV, whether they are a subway ride away or a world apart.

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