“The goal of an AIDS-free generation may be ambitious, but it is possible with the knowledge and interventions we have right now. And that is something we’ve never been able to say without qualification before. Imagine what the world will look like when we succeed. Imagine AIDS wards that once were stretched far beyond their capacity becoming outpatient clinics caring for people with a manageable condition, children who might have been orphaned and then trafficked or recruited as child soldiers instead growing up with the hope of a better future, communities where despair once reigned filled instead with optimism, countries that can make the most of every single person’s God-given potential. That is the world that has always been at the core of American belief, and we have worked toward it in our own history. It’s the world I think we all would like to live in. An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” Secretary of State Hillary Rodham Clinton, Nov. 8, 2011, NIH in Bethesda, MD. Read her full remarks.
December 1st marks World AIDS Day. There are 33 million people living with HIV/AIDS around the world and 1.2 million of them are here in the United States. Our neighbors; our family; our friends; us.
Which brings me to last October, when the phone rang early one Sunday morning. It was former-patient- now-friend Carter, calling to say he was lost en route to my home. I stood, phone in hand, shaking awake and trying to remember the plan but there was none, he was “just in the neighborhood.” Ten minutes later he arrived, directing his partner Grahm to perfectly arrange no less than 8 large containers of colorful Chrysanthemums on my outside steps. He next produced a large pumpkin with a wry, painted face, sporting a pink and black striped hat. Last to arrive were the scare crow decorations- propped on wooden sticks with kind grins. In ten minutes, the house was transformed.
Though we corresponded, I had not seen Carter in a while. He stood so tall and so thin, now walking with a cane. With his expansive, warm grin and deep laugh, he shared the latest news. Carter had been taking combination antiretroviral medications for many years. He had lived into the era of scientific discovery and effective therapies. He was an accomplished musician, producer, web designer and more. When he recently turned 50, he proudly posted a picture of his AARP card on his Facebook page. Now he was coping with signs of liver failure and waiting for biopsy results.
I have mixed emotions when it comes to AIDS awareness days or walks that pop up annually on the calendar to spread information or raise money. No doubt these are important events but the idea of a single awareness day for something so complex and needing attention all the time, seems odd. I worked with others to establish needle exchange in our City; to make condoms available in city High Schools; and to establish the Partnership Comprehensive Care Practice, which today provides care for over 1,200 persons with HIV/AIDS in our region. As a member of the Philadelphia Board of Health, I am proud that today in our City, you can learn how to prevent STDs and have condoms mailed to you for free with an easy point and click.
Later this week, I will be in Charleston, South Carolina moderating an expert panel at the Fifth Annual National Conference On Health Disparities -- we will discuss what the field of public health can do to reduce health-related disparities. HIV is fueled signficantly by poverty and discrimination, so work aimed at reducing health disparities is the work of reducing HIV/AIDS (and so much more!). At our School, this week's Public Health Grand Rounds is entitled “Health Communication in Action: Promoting HIV Prevention in Sub-Saharan Africa.” How fitting that on World AIDS Day, we will hear about health communication in a part of the world where people bear the heaviest burden of HIV disease.
Carter left my house that Sunday morning, headed home to rest. On the kitchen table he left a card and in it he had written “Thanks for all you do, XO, Carter," in big, looping script. The man who had done so much for me and so many others over so many years was now saying goodbye. One week later the biopsy revealed liver cancer. He died in mid-November, when the Chrysanthemums were still in bloom. I am the one who is thankful for the privilege and experience of knowing you, Carter.
Living with HIV in the era of effective therapies, Carter lived longer than we once dreamed possible. Longer, but not nearly long enough. Secretary of State Hillary Clinton said that an AIDS-free generation is “possible with the knowledge and interventions we have right now.” Right now! We have long known how HIV is transmitted and how to prevent it. How it impacts impoverished nations. The complex role that behavior plays and the need for tailored, evidence-based, sustained interventions. Right now. What is it that each of us can do to ensure an AIDS-free generation? What are you doing?