World AIDS Day Compilation December 2nd 2013

Metro: World AIDS Day sets a hopeful goal http://www.metro.us/newyork/news/local/2013/12/03/a-faithful-world-aids- day/#sthash.4wW1wKKR.dpuf

Philly: Looking ahead to World AIDS Day 2014 and beyond http://www.philly.com/philly/blogs/public_health/Looking-ahead-to-World-AIDS-Day-2014-and- beyond-.html#wcZQYq6DzvoYwwSl.99

Wall Street Journal: Gates Foundation to Double Donation to Fight AIDS http://blogs.wsj.com/washwire/2013/12/02/gates-foundation-to-double-donation-to-fight-aids/

USA Today: Obama pledges up to $5 billion for global AIDS fund http://www.usatoday.com/story/news/politics/2013/12/02/obama-world-aids-day-2013/3804569/

AIDS.Gov: Celebrating a Decade of Progress Fighting Global HIV/AIDS http://blog.aids.gov/2013/12/celebrating-a-decade-of-progress-fighting-global- hivaids.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aids%2Fgov+%28 Blog.AIDS.gov%29#sthash.1UnveZss.dpuf

SF Gate: Big crowd marks World AIDS Day in Golden Gate Park http://www.sfgate.com/bayarea/article/Big-crowd-marks-World-AIDS-Day-in-Golden-Gate-Park- 5026213.php

The Herald-Sun: Church marks World AIDS Day with quilt http://www.heraldsun.com/news/showcase/x1219092103/Church-marks-World-AIDS-Day-with-quilt

Huffington Post: World AIDS Day, 2023 http://www.huffingtonpost.com/alicia-keys/keep-a-child-alive_b_4368210.html

HTVN: World AIDS Day Message http://www.hvtn.org/wad-kublin-2013-update.html

ABC News: World AIDS Day: Bono Looks Ahead to an AIDS-Free World http://abcnews.go.com/blogs/politics/2013/12/world-aids-day-bono-looks-ahead-to-an-aids-free- world-2/

The Grio: Living with HIV — a life worth living http://thegrio.com/2013/12/01/world-aids-day-living-with-hiv-a-life-worth-living/#s:unnamed

CNN: HIV no longer considered death sentence http://www.cnn.com/2013/12/01/health/hiv-today/?hpt=he_c1

Vancouver Sun: So close to a cure http://www.vancouversun.com/health/AIDS+close+cure/9230534/story.html

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CNN: Wrong time to reverse course on HIV/AIDS http://www.cnn.com/2013/12/01/health/world-aids-day/

Huffington Post: Striving for the AIDS End Game: Translating Research Promise Into Public Health Success http://www.huffingtonpost.com/anthony-s-fauci-md/world-aids-day_b_4351133.html

LA Times: AIDS fatigue: a dangerous diagnosis http://www.latimes.com/opinion/commentary/la-oe-greene-aids-research- 20131201,0,4207052.story#ixzz2m8VZInyB

The Globe and Mail: Can we imagine the end of AIDS? http://www.theglobeandmail.com/globe-debate/can-we-imagine-the-end-of-aids/article15676966/

The Lancet: Rights and wrongs http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962536-2/fulltext?rss=yes

New Yorker: What Young Gay Men Don’t Know About AIDS http://www.newyorker.com/online/blogs/comment/2013/11/what-gay-men-have-forgotten-about- aids.html

The News Tribune: We Can End AIDS Without a Cure http://www.thenewstribune.com/2013/12/01/2920628/we-can-end-aids-without-a-cure.html

CNN: Where to put the smart money to end AIDS http://www.cnn.com/2013/11/29/opinion/gates-world-aids-day/index.html

NEXT MAGAZINE: THE FUTURE OF HIV http://www.nextmagazine.com/content/future-hiv

Take Part: A Reason To Celebrate World AIDS Day, Anti-Retrovirals Are Amazing http://www.takepart.com/article/2013/11/25/world-aids-day

The Hill: We can beat HIV http://thehill.com/blogs/congress-blog/healthcare/191487-we-can-beat-hiv

US AID: 10 Years in the Making: Celebrating USAID’s Achievements Under PEPFAR http://blog.usaid.gov/2013/11/celebrating-usaids-achievements-under-pepfar/

Metro: World AIDS Day sets a hopeful goal Maja Lundager Pedersen December 3rd 2013

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In Times Square on Sunday, the chant of “end AIDS now” echoed as Housing Works, an organization that helps homeless and low-income New Yorkers living with HIV/AIDS, and nearly 1,000 supporters took to the streets to mark World AIDS Day.

This year’s commemoration had a faithful message.

“Seven years from today we gather again at this very place in a great day of celebration. In a day to say that we were there at the beginning of the end. To say to our loved ones who passed on that we kept the faith, we kept up the fight and AIDS did not win,” said Charles King, president and CEO of Housing Works, about his dreams for the future.

The rally demanded political action against the AIDS epidemic in New York through, among other initiatives, comprehensive prevention education and social justice.

“We need to get our political leaders all in on ending AIDS. This is completely doable. This is entirely by political will and targeting our resources where we know the epidemic lives to bring it to an end and that’s really about leadership,” said Daniel Tietz, executive director of AIDS Community Research Initiative of America, addressing his comments to Gov. Andrew Cuomo and Mayor-elect Bill de Blasio.

More than 1.1 million people are living with HIV in the United States; 130,000 of them are New Yorkers.

The theme for this year’s World AIDS Day was “Shared Responsibility: Strengthening Results for an AIDS- Free Generation,” and in a press release President Barack Obama declared, “If we channel our energy and compassion into science-based results, an AIDS-free generation is within our reach.”

Philly: Looking ahead to World AIDS Day 2014 and beyond Janet Golden December 3rd 2013

With Sunday's World AIDS Day, behind us, today is as good a day as any to think about the future and to embrace the World Bank’s “Development Goal 6”: “to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment and mitigation services for those affected by HIV and AIDS.“

Here in the United States, the Centers for Disease Control and Prevention (CDC) website Act Against AIDS has fact sheets and testing information available, as well as a reminder that over one million people in the United States are living with HIV. While there is no cure for HIV/AIDS there are drugs available to control the virus, and President Obama on Monday announced the $100 million funding of a new National Institutes of Health initiative to discover next-generation therapies. That’s the good news. The bad news is from the Morbidity and Mortality Weekly Report, the weekly epidemiological digest published by the CDC. It finds that rates of unprotected sex by men having sex with men have increased between 2005 and 2011.

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There’s a public health solution for that: harm reduction, a strategy that seeks to reduce the harm from a hard-to-stop behavior, most typically drug use, rather than stopping the behavior itself. reduction. The CDC report makes clear the steps that are needed: “Health-care providers and public health officials should work to ensure that 1) sexually active, HIV-negative MSM (men having sex with men) are tested for HIV at least annually (providers may recommend more frequent testing, for example every 3–6 months); 2) HIV-negative MSM who engage in unprotected sex receive risk-reduction interventions; and 3) HIV-positive MSM receive HIV care, treatment, and prevention services.”

In short, get tested, use condoms, and, if infected, get treatment.

Condoms. The word used to be something left out of polite discussion. Today it is something we have to talk about. Condoms can and do prevent infection. For more information see the CDC fact sheet on condoms. And better condoms may be coming soon. The Bill and Melinda Gates Foundation is supporting a Global Health Challenge to develop next generation of condoms and they even have a condom blog.with links to promising new products, such as Origami Condoms' female (video embedded below) and male condoms. Until that next generation arrives, you can access free, current generation male and female condoms from the Philadelphia Department of Public Health’s Take Control Philly program.

Another aspect of HIV prevention is needle exchange. Prevention Point Philadelphia runs a syringe exchange, as does the Camden Area Health Education Center. They also provide confidential HIV screening and counseling and provide other medical services. Despite scientific findings that needle exchange is a lifesaving, cost-effective means of preventing blood-borne diseases, a federal funding ban remains in place. The American Foundation for AIDS Research (AMFAR) along with many others, is working to end that ban and extend services. You can still celebrate World AIDS day in a meaningful way by signing their petition and contacting your representatives in Congress.

Wall Street Journal: Gates Foundation to Double Donation to Fight AIDS Thomas M. Burton December 2nd 2013

BETHESDA, Md. — Billionaire philanthropist Bill Gates said he plans to nearly double his foundation’s contribution to the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, to as much as $500 million. Coupled with matching grants from other donors, Mr. Gates and his foundation’s officials said this could mean a total $1.6 billion contribution to the Global Fund.

The new money follows management troubles and a leveling off in funding for the Global Fund amid difficulties in the economies of many nations that contribute to it. Mr. Gates, who also spoke of worldwide health milestones that have been achieved by various groups including the Global Fund and his own foundation, made his remarks in a round-table discussion with news reporters preceding a lecture he gave at the National Institutes of Health.

The co-founder of Microsoft Corp., now a trustee and co-chair of the Bill & Melinda Gates Foundation, Mr. Gates said the commitment of various groups to fight diseases has had a measurable positive impact on lowered infant mortality and disease deaths around the world. Yet he said one impediment in that fight is the U.S. mandated budget cuts, known as the sequester, or sequestration.

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The sequestration will force another $600 million reduction in federal funding for the NIH in January. The will cut the total $29.1 billion budget from 2013, which itself was slashed by the sequestration from a rate of nearly $32 billion a year ago. The sequestration was a mechanism created by congressional and White House negotiators to force strict cuts across the federal government when the two sides were unable to reach a more nuanced, negotiated budget level.

For the NIH, it means more limitations on what it can donate to medical research, both in the U.S. and abroad. The NIH currently funds about 40% of worldwide medical research and development outside the U.S., while the Gates Foundation pays for another 17%, according to Mr. Gates and NIH Director Francis Collins.

“Sequestration is a serious problem for the NIH in research,” said Mr. Gates. “It’s really a crisis where universities will have to look at their own infrastructure” and begin cutting back on their own research. Dr. Collins, in the roundtable discussion, agreed that sequestration “was the stupidest form of fiscal management.”

Mr. Gates said he is “deeply disappointed” in mandatory cuts in the NIH budget, since so many efforts against worldwide disease and malnutrition “are all long-term ventures,” the fruits of which won’t be seen for a while. Even so, he said, the Gates Foundation and other health groups have brought down the rate of infant death in recent decades from about 20 million annually to about 6.5 million now.

He said his goal is to lower that figure to below three million within 15 years, through vaccinating children worldwide and through efforts to reduce malaria, AIDS and rotavirus-caused diarrheal disease, among many others.

USA Today: Obama pledges up to $5 billion for global AIDS fund Aamer Madhani December 2nd , 2013

WASHINGTON — President Obama on Monday pledged up to $5 billion in U.S. money over the next three years to the pre-eminent global program to combat AIDS on the condition that the rest of the international community pitches in $10 billion.

Obama announced the pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria as the White House marked World AIDS Day. Donor communities are getting ready to begin meetings in Washington on Monday night to discuss the three-year replenishment cycle of the fund.

The 1-to-2 funding ratio is set by Congress, and Obama had already marked $1.65 billion for the Global Fund in his 2014 budget. But activists — including South Africa's Desmond Tutu — had been pushing Obama to make clear ahead of the conference that the United States stood ready to donate up to $5 billion to the fund for the next cycle.

"Don't leave our money on the table," said Obama, which was attended by several officials from other donor countries.

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Obama also announced that the National Institutes of Health (NIH) will invest $100 million in re- prioritized funding over the next three years to launch a new HIV cure initiative.

Recently, several individuals appear to have been cured of HIV through aggressive therapy but the methods "are too toxic or premature to apply beyond the research setting," according to the White House. But the White House, in announcing the NIH funding, believes that the research could provide clues to explore new possible treatments.

Obama was also facing calls by a bipartisan group of 40 lawmakers to use the conference and the 25th commemoration of World AIDS Day to announce a new goal for the U.S. government to double its support of treatment through anti-retroviral drugs by the end of his presidency through the President's Emergency Plan for AIDS Relief (PEPFAR). The program is credited with providing millions of Africans with anti-retroviral drugs since its establishment and led to 1 million babies globally being born HIV-free.

Obama announced Monday that PEPFAR has now treated 6.7 million people — shattering the goal of reaching 6 million by the end of this year — but the president won't set a new PEPFAR target until early next year. HIV/AIDS activists criticized the decision to delay setting a new goal.

"PEPFAR's bold treatment targets have driven steep declines in rates of death and new infections worldwide—but the current targets have lapsed and we cannot wait months and months for a new goal," said Paul Davis, director of global campaigns for the activist group Health GAP.

Obama suggested that he wants to better coordinate goals set by PEPFAR and the Global Fund. The president also said he first sought to name a replacement for Ambassador Eric Goosby, who until October served as the U.S. Global AIDS coordinator tasked with administering PEPFAR, before setting a new target for the program.

"It's time for the world to come together to set new goals," Obama said. "Right now we are working hard to get a new leader in place at PEPFAR. And once we do, one of our first items of business will be convening a meeting early next year so the United States and our partners worldwide … can sit around one table and develop joint HIV prevention and treatment goals for the countries where we and the Global Fund do business."

AIDS.Gov: Celebrating a Decade of Progress Fighting Global HIV/AIDS Deborah Birx, MD December 2, 2013

This World AIDS Day, CDC and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) commemorate a decade of success in fighting global HIV/AIDS. Ten years ago, this modern-day plague was devastating the health and wellbeing of millions of individuals in communities across Africa and in other resource-poor countries around the world. Today, we celebrate the extraordinary progress we have made in reducing new HIV infections and providing life-saving care and treatment to those who are living with HIV/AIDS.

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With resources available through PEPFAR, we have provided antiretroviral drug treatment (ART) to millions and increased life expectancy rates in much of Africa. HIV infected patients have returned to the workforce, enabling them to provide for themselves, their families, and communities; and AIDS-related deaths are declining worldwide. In June, Secretary of State John Kerry announced the joyous news of the millionth baby born HIV-free thanks to life-saving PEPFAR-funded programs to prevent mother-to- child transmission (PMTCT) of HIV. New pediatric HIV infections have dropped by nearly 50% since PEPFAR began.

CDC contributions have played a critically important part in all of these accomplishments. Throughout the past decade, CDC has been advancing science and innovation, and making strategic investments to build the capacity of host countries to lead their own responses to the HIV/AIDS epidemic.

The next 10 years will be equally pivotal as CDC continues to implement proven biomedical interventions that will dramatically decrease the impact of HIV/AIDS, including PMTCT, ART to prevent new HIV infections, and voluntary medical male circumcision. CDC is assessing the impact of rapidly bringing these core prevention interventions to scale in countries with high HIV/AIDS burdens, while it continues to emphasize the importance of HIV testing and counseling as the gateway to all prevention and treatment interventions.

The theme for this World AIDS Day – Shared Responsibility: Strengthening Results for an AIDS-Free Generation – reflects the global commitment and collaboration needed to achieve this inspiring goal championed by President Barack Obama in his 2013 State of the Union Address. Creating an AIDS-free generation is possible only if all stakeholders share responsibility. CDC continues to work side-by-side with countries to build their technical and operational capacity for leading and sustaining their national responses. In addition, we work with a wide variety of partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria , to ensure complementary, coordinated programming that maximizes the impact of our collective investments.

While the accomplishments made in the fight against HIV/AIDS are impressive, there is still much work to be done. UNAIDS reported that 2.3 million people were newly infected with HIV in 2012, and an estimated 1.6 million people died from AIDS-related causes that same year. However, we know that we have reached a historic crossroads. Just a few years ago, many experts thought it was too late to turn the tide of the epidemic. Thankfully, by continuing to work together, what was once considered an impossible dream is now within our grasp.

SF Gate: Big crowd marks World AIDS Day in Golden Gate Park Meredith May December 2nd, 2013

More than 600 gathered to heal broken hearts and to urge against complacency in the ongoing fight against HIV and AIDS on Sunday, at the 20th observance of World AIDS Day at Golden Gate Park.

Among them was Mike Smith, the executive director of the AIDS Emergency Fund and co-founder of the Names Project AIDS Memorial Quilt, who comes every year to remember the friends whose names are engraved in the Circle of Friends monument in the park's National AIDS Memorial Grove.

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The memorial contains names of those who have died of the disease, as well as those who have dedicated their careers to fighting AIDS or have made financial donations to the grove.

Many who came Sunday had names of lovers, co-workers and friends etched in stone. Famous donors also appear: Robin Williams, Sharon Stone, Calvin Klein.

"It's important to come each year and reflect," Smith said.

The emergency fund he directs helps 2,000 San Franciscans living with HIV/AIDS stay out of poverty by assisting them with rent, utility bills and groceries.

"Too many young people today think HIV is an old man's disease," he said. "What they don't understand is that the drugs have terrible side effects. Most of the people I know who are now dying are of cancers at a premature age."

Just managing their health care keeps many in poverty, he said.

In keeping with World AIDS Day tradition, two people were honored with awards.

The 2014 National Leadership Recognition Award was given to Phill Wilson, a member of the Presidential Advisory Council on HIV/AIDS and founder of the Black AIDS Institute in Los Angeles.

Although black males make up just 1 in 500 men with HIV/AIDS in the United States, they account for 1 in 4 new HIV infections.

Wilson, who has been HIV-positive for more than 30 years, electrified the crowd with a rallying cry for national health care.

"We have the tools to end AIDS in the United States, but will we?" he said. "We are not going to get to the end of the AIDS epidemic unless we find a way to get health care to the 1.1 million Americans estimated to be living with HIV. Obamacare has got to work. We have got to make it work instead of wasting time arguing about a broken website."

The Local Unsung Hero Award was posthumously given to Franco Angelo Beneduce, an artistic producer who created the annual Light in the Grove event to commemorate loved ones, as well as the Folsom Street Fair's Magnitude after-hours dance party. Eight family members, several of whom flew in from Rhode Island, took the stage to receive his award.

After the ceremonies, organizers read a list of the newest names engraved on the Circle of Friends.

In the crowd was Kelly Rivera Hart, a San Francisco native who has been living with HIV for more than two decades. Medical side effects have given him a degenerative nerve disorder that gives him chronic numbness and tingling in his limbs.

"This disease isn't something you can just take a pill for and it's over," he said. "You have to worry about what the pills do to you."

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But coming to World AIDS Day is a form of spiritual healing for Rivera Hart.

"I feel supported seeing so many people here," he said. "When I pass on, and I'm doing everything I can to make that not happen for a long time, at least I know that I won't be forgotten."

The Herald-Sun: Church marks World AIDS Day with quilt Jamica Ashley December 1st 2013

The NAMES Project AIDS Memorial Quilt will be on display at Eno River Unitarian Universalist Fellowship all week. A complete schedule of display times is available at www.eruuf.org.

In observance of World AIDS Day, two 12x12 pieces of history hang in the sanctuary of the Eno River Unitarian Universalist Fellowship.

What began in the summer of 1987 as a way to memorialize those who lost their lives to AIDS, the NAMES Project AIDS Memorial Quilt has grown into the world’s largest community art project with more than 94,000 names on 1.3 million square feet of fabric.

“We decided that it was something that needed to be brought to the area,” said Joyce Heflin, fellowship member and coordinator of Interweave, the church’s group for LGBT affairs which is hosting the quilt. “It’s an epidemic still but it’s no longer a death sentence. We want to help people be aware.”

The two panels have been rented to the fellowship, Heflin explained, and one of them happens to contain a memorial to a Duke University undergraduate and law school graduate, Bill Pursley, who according to the quilt, died on Nov. 25, 1987 from AIDS (Acquired Immunodeficiency Syndrome).

Heflin added that the quilt is “so big now it can no longer be displayed in its entirety.”

The memorial quilt is comprised of more than 48,000 individual panels. The quilt was first displayed on Oct. 11, 1987 on the National Mall in Washington D.C. during the National March on Washington for Lesbian and Gay Rights.

It is estimated that half a million people visited the quilt that weekend. Since then, more than 14 million people have visited the quilt via displays around the world and raised more than $3 million for AIDS service organizations throughout North America.

To help start the weeklong display at the Fellowship, both Sunday services had time for reflection on the quilt.

Audience members were given the opportunity to reflect on how AIDS has affected their lives. One woman said that she lost two brothers to the disease less than four years apart, while another lost her ex-husband.

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Dr. Ross McKinney spoke at the 11:15 a.m. service, reflecting on an encounter he had in 2011 with a 17- year-old high school student who was born HIV (Human Immunodeficiency Virus) positive while he was a pediatrics infectious disease specialist.

“Most of us (doctors) felt that we offered more by being there than we were by treating them with the medicines we had to offer,” McKinney said. “In 1986, there was a three and a half year life expectancy for a child with HIV or AIDS. We hoped for the best but planned for the worse.”

McKinney explained that in the 80s, children born with AIDS or HIV could expect frequent hospital visits and a poor quality of life, which presented a specific obstacle.

“How should I balance the reality that I know with the hope that I want to feel,” he said.

McKinney said that had his patient in 2011 been one in 1986, “I would have considered it absolutely unbelievable, science fiction.”

“In my career, I’ve seen my hopes realized,” he explained. “What was once a death sentence is now the promise of a future. AIDS in America is a very different disease.”

The AIDS Memorial Quilt will be on display at Eno River Unitarian Universalist Fellowship through Saturday.

The fellowship will also host a film screening of “Common Threads: Stories from the Quilt” at 7 p.m. Wednesday in the Fellowship Hall.

Huffington Post: World AIDS Day, 2023 Alicia Keys December 1st, 2013

A few weeks ago you couldn't turn on the television without hearing echoes of President Kennedy's bold moon shot speech. Less than a decade later after it was delivered, an American flag was being planted in lunar sand.

Today marks the 26th Anniversary of World AIDS Day and we are still looking for our moon shot. Yes, there have been remarkable strides in the international response to HIV/AIDS. New infections are down by over 50 percent worldwide. Nearly 10 million people in poor countries are now receiving treatment that weren't just a decade ago. There's greater awareness and prevention, more effective treatment and more access to it -- especially in the West. But if we're focused as a nation, as a people, as a planet, we are at a far more powerful turning point -- the beginning of the end of AIDS.

We are on the cusp of ensuring everyone in the world living with HIV receives the treatment they need to survive. Science is showing signs this would control the pandemic once and for all. Someone fire up the rocket boosters, because this is possible and possible within the next decade. Treatment for everyone is a very reachable goal championed by leading HIV advocates, world leaders, global organizations, and dignitaries. Bill Gates, Hillary Clinton, Archbishop Tutu, Elton John, and many others have spoken eloquently on the specifics of how to see this dream realized.

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This is our moon shot.

To borrow and reimagine the words of President Kennedy: We choose to end AIDS. We choose to provide access to treatment to everyone in the world living with HIV by the end of this decade, not because it is easy, but because it is hard; because it will save millions of lives that for too long have been overlooked, cast aside, and forgotten; because it will help elevate a generation out of poverty, heartbreak and despair; because children regardless of race or geography deserve the opportunity to pursue their dreams; because it will prove that the collective hearts of humanity are more powerful than stigma, homophobia, and indifference; because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win.

There is much work yet to do, seven out of 10 children still don't have access to treatment. We need to turn that number around. I have seen the power of the on the ground programs of Keep a Child Alive, the organization I co-founded 10 years ago with Leigh Blake. As part of the international movement to expand access to treatment to those most in need, we have touched the lives of more than 300,000 children and adults affected by HIV in Africa and India. I am encouraged by the stories of young people like Aimee in Kigali, Rwanda, and Evelyn in Kampala, Uganda, who came to us as children, were initiated on antiretroviral treatment and provided compassionate care; they are still coming back, still taking their medicines, and now entering their teen years with a bright future ahead. Such a transformation seemed impossible just a decade ago.

Ten years ago under the previous administration both Republicans and Democrats championed the United States President's Emergency Plan for AIDS Relief (PEPFAR), which put nearly three million people on life saving treatment, mainly in Sub-Saharan Africa. During this decade one million babies globally that would have been infected have been born HIV-free, and the spread of HIV has slowed, even in the hardest hit countries. Congress recently voted to extend PEPFAR, which is remarkable, especially at this time when Republicans and Democrats can't seem to agree on anything. President Obama expanded this program and increased the number of people receiving HIV treatment to six million. (Mr. President, we understand your administration's goal is to once again double the number of people receiving treatment. We're counting on you...)

The Global Fund replenishment meeting to be held next week in Washington is an opportunity to remind ourselves that we can't stop now. Let's be bold enough to imagine that in ten years -- 2023 -- all people living with HIV in the world will have access to life-saving antiretroviral treatment. No baby boy or girl will be infected with HIV. We have conquered AIDS. But this vision depends on how big of a commitment we, as nations, religious institutions, the private sector, individuals and communities, are willing to make to see this mission through.

Now is the time to build on our success and remain vigilant. We have a roadmap to end this epidemic and live in a world where ALL PEOPLE regardless of geography have access to life-saving medicine.

We can (and have) high-fived each other for our past achievements. Everyone who has marched, donated, rallied, lobbied, prayed, or searched for an end to AIDS can certainly feel good about how far we've come. I have seen the love in action first hand. But World AIDS Day was never meant to be a victory lap. It's a mile marker.

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World AIDS Day reminds us all of the role we have in ending this disease: We can encourage our representatives to expand funding for PEPFAR and the Global Fund. We can utilize the power of our social media platforms and networks to help keep HIV/AIDS on the forefront of minds by spreading awareness about the great work left to be done. We can support the many organizations doing good work to prevent HIV, support those living with HIV here in the US and around the world and to help reduce the stigma associated with the disease.

As President Kennedy said in the moon shot speech, "If this capsule history of our progress teaches us anything, it is that man, in his quest for knowledge and progress, is determined and cannot be deterred." The millions affected by HIV are counting on our generation's brave and bold determination.

HTVN: World AIDS Day Message Dr. James Kublin December 2nd , 2013

On this World AIDS Day, we are reminded of both how far we have come and how far we still need to go in the battle against HIV/AIDS. In The Dallas Buyers Club, a movie based on the real life experience of a man infected with HIV in the early 1980's, the main character is told by an emergency room physician that he is infected with HIV, has advanced AIDS, and has at most 30 days to live. What follows is a story of courage and determination that reminds us of what it meant to get a diagnosis of AIDS back in the days when there was only one approved drug for its treatment – AZT – and how short-lived a person's hopes might be. Today we have over 3 dozen drugs approved for treatment and AIDS, for most, has become a chronic but treatable disease. http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm11891 5.htm Not only are there more drugs available, but many more people infected with HIV are receiving anti- retroviral therapy (ART) thanks to PEPFAR and other programs committed to the scale-up of treatment around the world. UNAIDS reports that at the end of 2012, 9.7 million people in low- and middle-income countries were receiving lifesaving treatment. However, we also know that new infections outpace those who get into treatment, with about 2.3 million new infections in 2012. In the Republic of South Africa alone, there are over 1000 new infections per day, and worldwide 1.6 million people died of AIDS- related illness. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2013/november/2 0131120report/

So, with many new infections each year, we need lasting and efficient ways to keep ourselves safe from HIV and control this devastating pandemic. One tool that will surely make a big difference in saving lives and stopping the spread of the virus will be a safe and effective preventive vaccine, and the mission of the HIV Vaccine Trials Network (HVTN) is to develop such a vaccine for the world. The Network has conducted 59 research trials with over 15,000 volunteers, and we continue to learn more about HIV, the human immune system and how best to stimulate the body's own defenses against infection. The journey has been a long one, and as with all research there have been disappointments along the way. But with the active support of HIV prevention advocates and communities, study sponsors, vaccine developers and most vital of all, study volunteers, we will continue to work toward a future free of HIV. On this World AIDS Day 2013 we have much to be thankful for, but we must not lose sight of what must

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ABC News: World AIDS Day: Bono Looks Ahead to an AIDS-Free World Amber Kian December 1st, 2013

This week’s Sunday Spotlight gives the stage to U2 frontman Bono, who has been a leader in the global fight against AIDS for more than a decade. Helping “This Week” mark World AIDS Day, Bono sat down with ABC’s George Stephanopoulos to talk about the dramatic turnaround in the battle against a virus that has killed more than 25 million worldwide since 1981.

Antiretroviral drugs, once unaffordable to the majority of people affected by HIV/AIDS, are now significantly more accessible.

“They used to cost a fortune, you know, ten grand a year. It’s down to 40 cents a day for one pill,” Bono said. “I remember being in Malawi, in Lilongwe, where there was four to a bed, queuing up to be diagnosed. But the diagnosis was a death sentence because there was no treatment. They had the medication. But they couldn’t give it to them. They couldn’t afford it.”

Bono, who is co-founder of ONE and the (RED) Campaign, said a person’s ability to access antiretroviral drugs was an “accident of where you live.” Unequal accessibility to HIV/AIDS treatment, often exacerbated by political or corporate interests, made Bono “ready to put his life on the line” for the fight against HIV/AIDS.

“It actually really was an assault on my whole idea of equality. And so the charity bit went out the window for me. It became a justice issue,” he said. “We can’t have these technologies, simple, cheap and be denying them to others.”

But changes are happening now, he said. And though Bono recognizes there are still obstacles, he says there is an end in sight.

“There does seem to be the political will. The American people have said that this fight against HIV/AIDS, this tiny, little virus that’s wreaked so much havoc in so many people’s lives…they got it in their sights. They want to see it done. And that is so inspiring to me,” he said.

This year, Congress reauthorized PEPFAR, a program started by President George W. Bush, which has dedicated billions of dollars to the fight against AIDS.

“We argued with President Bush about setting up PEPFAR,” Bono said. “We thought, ‘Why not just stick with The Global Fund‘, which is the multilateral mechanism.”

But President Bush, Bono said, wanted a uniquely American organization so the government could “keep an eye on it” and do it “properly.”

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Political interests are coming together this Tuesday at The Global Fund’s Conference, which the U.S. government is hosting.

“Even though originally Republicans historically supported PEPFAR, and Democrats The Global Fund, that has changed,” Bono said. “This is incredible. This is what happens when people put their ego and political point-scoring away for a bigger purpose and they stop playing politics with the poor.”

These organizations are seeing great results – but Bono’s main concern is complacency.

“There’s a chance of having the first AIDS-free generation by 2015, 2016. We can see it. We could lose that if we lose the political will,” he said. “I would just say to people, ‘Hold on tight to this one.’”

The Grio: Living with HIV — a life worth living Maria Davis December 1st, 2013

On November 13, 2013, I celebrated my 54th birthday, and just a few days prior I recognized my 18th year of being diagnosed with HIV.

This year’s celebration with my two children, family and friends was a reminder of how truly blessed I am. Many of my friends have not been so lucky. Over the years, I’ve lost more than 20 of them to AIDS- related causes.

Not too long ago, I attended a close friend’s funeral and got to see so many people that I had not seen in a long time. As we celebrated my friend’s life that evening at a special dinner, I was greeted by so many. One memory still sticks in my mind of when two of my old girlfriends first saw me. One of them was frantically crying and she looked into my eyes and said, “They told me you were dead.” It shocked our other friend, but not me. I’ve heard this story many times throughout the years.

My story

I guess people have assumed I’d have died by now. Well, I am here and very much alive, still sharing my story and grateful for every minute that God allows me to be on this earth. Looking back on my life I am reminded how far medication has come. When I first heard about AIDS in the mid-eighties, I had a very vibrant modeling career and was not concerned with the disease, because at that time we thought that it only affected gay, white men. To my surprise, by the early nineties, we were now seeing the effects of HIV/AIDS in the African American community — especially among women and children.

By this time, I had transitioned out of modeling and was one of the first top female music industry promoters working with artists such as 50 Cent, Anthony Hamilton, Brandy, Monica, Usher and Jay Z. I was also featured on Jay Z’s very first successful album, Reasonable Doubt, on a song called “22 Two’s.”

Then in November of 1995, through testing for a life insurance policy, I found out that I had HIV. I still remember that day, November 6, like it was yesterday. The letter came and I wrote on it, “Not true! The Lord has much for me to do!!!”

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Living positively, despite challenges

Yes, there was much for me to do, and first was my long road to recovery mentally and physically. Living with AIDS has not been an easy journey.

It was only three years into my diagnosis that I developed full-blown AIDS. I continue to struggle with a very compromised immune system; peripheral neuropathy in both legs from my knees down to my feet; several battles with pneumonia; and I also suffer from Avascular necrosis, a degenerative disease in both my hips, which affects the way I walk.

In my earlier experiences when I was uneducated and living with AIDS — like so many others today — I thought AIDS was a death sentence. In 2009, I was introduced to amfAR, The Foundation for AIDS Research, through a friend who asked me to participated in a project she was working on called, Making AIDS History — a PSA campaign for amfAR that would share the stories of those living with HIV/AIDS.

I was later asked by amfAR to become one of the Making AIDS History Ambassadors.

A meaningful life through educating others

As an African-American woman, I was excited and honored and I accepted the call. I knew I would help so many, including the African-American community, which is still largely disproportionately affected by HIV/AIDS. “In 2010, African-Americans accounted for only 14% of the U.S. population, but 44% of new HIV infections,” according to a White House statement on HIV/AIDS in the black community.

While there is some hope on the horizon — for instance, reports state that HIV rates among most segments of our community are no longer increasing — there is still much work to be done to help prevent infections. Being an amfAR Making AIDS history Ambassador has allowed me the opportunity to educate and bring awareness to hundreds of thousands of people that may not know my story, but who are, or are likely to be impacted by the disease every day.

Today, on World AIDS Day and 18 years later, I can tell you that my life is so meaningful, and I do not take it for granted. My hope and dream is that in the African-American Community through amfAR’s research efforts, together, we will soon see an AIDS-free generation. I invite you to join in the battle of stopping the spread of HIV/AIDS and bringing the balm of human compassion to all those impacted by this disease.

CNN: HIV no longer considered death sentence Saundra Young December 1, 2013

(CNN) -- Justin Goforth was just a 26-year-old nursing student when he had unprotected sex with another man and, as a result, got the diagnosis that changed his life.

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"I started to feel like I had the flu -- aches, pains, chills, fever, swollen lymph nodes, that kind of thing -- and so I went to my doctor ... we did a viral load test, which was rare back then ... and he called me and said, you know, it came back (HIV) positive."

It was 1992. Goforth's doctor immediately sent him to the National Institutes of Health, where research was being done, but treatment options were, at the time, still few.

Patients were being treated with AZT, the first drug approved by the Food and Drug Administration in 1987 to treat HIV/AIDS in the United States -- by then known for its serious, even life-threatening side effects.

The reality of the diagnosis set in.

"I was so sick," Goforth says. "I was sitting silently and crying because of my circumstance ... and the nurse came over and was trying to console me, I believe, and said ... 'Because you were just infected, you may have, you know, six or eight years before you die.'

"I think she was trying to cheer me up," he says. "Didn't work very well, but that's just a good commentary on where we were at the time"

That was then, but what does it mean to have HIV today, after years of research and advances in treatment?

"It means likely you can have a normal lifespan and have a similar life to someone who does not have HIV," says Dr. Ray Martins, chief medical officer at Whitman-Walker Health in Washington, which provides health care services for the lesbian, gay, bisexual and transgender community.

"For people who had to deal with the medications and stuff from the '80s and '90s, it was a bit of a rough road there, so figuring out the virus and the medications that would work effectively with the least side effects, it took a while," Martins says. "But now we're at the point where we have three options for one pill, once-a-day regimens with very little side effects."

In 1981, when the virus was discovered, being HIV-positive was considered a death sentence. For most patients today, it's a chronic disease, much like diabetes or heart disease.

Goforth is a perfect example. He has been living with the disease for 21 years and today is a healthy 47- year-old.

Instead of the difficult treatment regimen he was on back then. which included some 40 pills five times a day with "horrific" side effects, he now takes five pills twice a day "with virtually no side effects," he says.

For the last 7½ years, Goforth, who is a registered nurse, has worked at Whitman-Walker in a variety of positions, including director of nursing and in case management.

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He sees potentially thousands of patients each year, and has personally delivered the same news he got two decades ago to more than 200 patients. But he tells them living with HIV today means that you can be healthy, thrive and live a normal lifespan without complications.

"You can go to your doctor two, three times a year, get some tests done and make sure everything's on track, and then just live the rest of your life as you would," he says. "Follow your dreams ... have your career, your family, or whatever it is that you'd like to do with your life, and that is the truth of where we are."

Today's science, he said, supports that.

"We are at a place that we actually have the tools we need to stop the epidemic and then just get to a point where we're just taking care of the people who have HIV throughout their life," he says.

"But because of how horrible the first 10, 20 years of this (epidemic) was, we have collectively this culture of what it means to be infected and affected by HIV that still is this huge block, this huge barrier for people understanding that they can get into care and they can be OK and that it's not something to be afraid of."

About 1.1 million Americans live with HIV, according to the Centers for Disease Control and Prevention. But because of improved treatments, they're living longer and their quality of life is better.

"If a person is HIV infected today, it is important that they put themselves under the care of a physician experienced in caring for HIV-infected individuals," says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. "Depending on the stage of infection, it is highly likely that it will be recommended that the person begin antiretroviral therapy (ART)."

ART is a combination of at least three antiretroviral drugs that prevents the virus from replicating. It can also help reduce virus transmission.

Unlike years ago, when effective treatments were not available, HIV patients now benefit significantly from ART, Fauci says. "These drugs are highly effective in suppressing HIV replication and, if taken as directed, can result in the HIV-infected individual having an almost normal lifespan without experiencing serious illness related to their HIV infection."

And so, on this 25th World AIDS Day, Goforth has mixed emotions. It's a day that, in the past, has been incredibly sad and traumatic for him. Now, he says, he has tremendous hope.

"I see the freight train being slowed down so that we can turn it around," he says. "Even five, six years ago, I'm not sure that I could have said that I had the hope that that was going to happen, but I think we're at that point we're at a really historical moment with this."

Each November in advance of World AIDS Day, POZ, an award winning magazine started in 1994 to provide education and information for people living with and affected by the disease, names its "POZ 100" -- HIV-positive people who are unsung heroes in the fight against AIDS, and committed to ending the epidemic.

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This year, Goforth is on that list.

Vancouver Sun: So close to a cure Denise Ryan December 1st , 2013

Vancouver at centre of research as AIDS turned from deadly epidemic to manageable condition

From a crowded office at Vancouver’s St. Paul’s hospital, Dr. Julio Montaner likes to track his progress, and the progress of the disease that for 30 years has been the focus of his life.

Keeping track keeps him optimistic.

“I can always look back and say yesterday we were here and it was bad, but today we are here and it’s better. I can see over there, we are going in the direction of things getting better and better all the time.”

Looking at his graphs, the rising and falling lines, it’s possible to see the transformation of a deadly, out- of-control AIDS epidemic into an illness that can be low-grade, manageable or even eradicated.

Eradication is still a dream but, for the first time since the identification of the HIV virus in 1983, researchers are guardedly using the word “cure” as if it were no longer a fantasy but a scientific possibility. Recent reports of “functional cures” and controlled remissions have raised much hope.

In May, a story broke that a Mississippi toddler born HIV-infected had been “functionally cured” after being treated aggressively with anti-retroviral therapy immediately after birth.

A group of 14 patients in France, dubbed the Visconti cohort, were “functionally cured” after starting anti-retro viral drugs within 10 weeks of infection, much earlier than when the medication is usually given.

Participants in the study were able to become “post-treatment controllers,” their bodies capable of keeping the virus at bay after coming off treatment, possibly because the virus had been dealt with so early after primary infection.

There is reason for excitement.

Made in Vancouver

Montaner’s strategy of “treatment as prevention,” or “TasP”, is already dramatically reducing levels of new infections.

By aggressively seeking out and treating everyone who is HIV positive with highly active anti-retro viral therapy (HAART), individual viral loads (the level of HIV in the blood) are lowered, transmission drops and the progress of the disease in a community can effectively be curbed or halted.

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Montaner announced his research results at the 2006 International AIDS Conference in Toronto and international studies have since independently confirmed them.

“More people are living with the disease and less people getting infected,” said Montaner.

China, the United States, France and Brazil have adopted Montaner’s “treatment as prevention” strategy, which involves expanded testing in the general population, providing affordable or free HIV/AIDS medication, and creating support programs to encourage patients to keep taking them. (In Vancouver, Oak Tree Clinic is piloting an outreach program providing cellphones with free texting service to hard-to-reach women on the Downtown Eastside. Patients can easily ask for help if they need it, and case workers can check to see if they are staying on their drug regimen.)

Research shows that between 1995 and 2008, B.C. averted more cases of HIV than Ontario and Quebec combined and that the $15,600-a-year HAART treatment is much less than the cost of medical management of HIV infection, which averages $425,000 over a lifetime.

Although the cost of antiretroviral therapy drugs is heavily discounted for poor countries, the cost to middle-income countries such as Russia, Armenia and Malaysia is still prohibitive and only eight million of 15 million people who need the treatment are able to receive HAART in resource-limited countries.

Although TasP is endorsed by the World Health Organization guidelines, Canada lags. B.C. is the only province that has adopted the strategy, a situation Montaner has called “an embarrassment.”

Without political will, Montaner argues, an AIDS-free future remains a dream.

Montaner believes stigmas associated with sex, drugs and homosexuality still interfere with the federal government of Canada’s willingness to support the treatment as prevention program: “They have attached a value judgment to HIV that makes it very difficult to have a conversation. If it were breast cancer or a flu epidemic, it would be different.”

Cleaning out the hidden reservoirs of prejudice around the illness has been as difficult as rooting out the virus itself.

Montaner has grappled with the prejudice, discrimination and stigma of AIDS from the beginning.

When the Argentine-born respiratory specialist was a young post-doctoral fellow at St. Paul’s Hospital, reports started showing up about a new disease that was being identified in small groups of mostly young gay men.

“It was happening in California, it was happening on the East Coast and it was happening in Florida. We didn’t know if this was a real issue or some sort of mini-outbreak that was going to go away.”

He pauses.

“Little did I know that it was going to capture the rest of my life.”

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In the early months and years, Montaner and other specialists worked hands-on with patients arriving with unusual and devastating life-threatening illnesses: pneumocystis carinii pneumonia, skin rashes, weight loss, cytomegalovirus. Some had been turned away from other hospitals, and sent to St. Paul’s in taxis.

The concentrated streaming of AIDS patients to one Vancouver hospital created a pressurized environment that transformed the Catholic-run hospital, and gave rise to a unique opportunity for study and research.

“At first our staff resented the actions of the other hospitals. But it turned out to be a good thing. It further focused our resolve, our intent, our attention. So HIV became an area of intense focus for us and led to very dramatic discoveries,” said Montaner.

“It would be easy to write the history as if we were heroes and everyone else were villains. The truth is, we didn’t know what was happening. There was fear. There was concern. A lot of hesitation. For us it was a matter of urgency because it was something that was happening in our own midst. The epicentre of HIV-AIDS was in the West End. We couldn’t walk away from our neighbours.”

Facing down panic

John Ruedy, head of the department of medicine at St. Paul’s from 1978 to 1992, knew almost immediately he faced a growing emergency.

“There was panic throughout the institution, the nursing community, the administration,” he said. “No one knew how contagious this was. The majority of my staff were not very sympathetic to the issue, but there were outstanding exceptions.”

Among those were physician Alistair McLeod, respirologist Lindsay Lawson, nurse Irene Goldstone, hematologist Hilary Wass and gastroenterologist Linda Rabeneck, who formed the first AIDS care team.

The circumstances under which they worked — lack of funds, staff burnout, social stigma — were extreme and challenging. The hospital board was slow to apply for the funding they desperately needed, even as the numbers of patients were doubling every three months, Ruedy recalls.

“The board was very conservative. They didn’t want us to be known as an AIDS hospital.”

The fear was that other patients, the public, doctors, would not want to come to the hospital.

“It was the two nuns on the board that swayed everyone to go to the government and they came up with significant funding.”

When AZT, the first breakthrough drug, appeared in 1987, authorities were slow to approve it and even slower to fund it. Activists like Kevin Brown of the Vancouver Persons With AIDS coalition collected signatures, lobbied and led attention-grabbing protests. To the team at St. Paul’s, it was becoming clear the only way to widen access to drugs was through clinical trials. In 1989, Ruedy began to build the infrastructure of what would become the Canadian HIV Trials network.

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Ruedy tapped Montaner to become the head of the new AIDS research program. Montaner accepted.

“I was a department of one,” he recalls.

Montaner wasn’t alone for long. Dr. Michael O’Shaughnessy, who worked for Health Canada in Ottawa and was chairman for the National Advisory Committee on AIDS, moved to Vancouver to help found the B.C. Centre for Excellence in HIV-AIDS in 1992. At that time the stigma around the disease was so great, people would turn away from O’Shaughnessy at cocktail parties when he announced, cheerfully, that he worked with HIV.

“I could clear a room.”

He can reel off stories about literally coming to blows in the hallways of the federal Parliament buildings with bureaucrats trying to block the trickle of money allotted to AIDS research.

“There was a fight over resources. Other branches of government undermined the federal centre for AIDS. … They’ll deny it, but I was there,” said O’Shaughnessy.

Researchers met similar resistance from B.C.’s socially conservative government, O’Shaughnessy recalls.

A near riot had erupted in the legislature over the Vander Zalm government’s announcement that patients would have to pay for AZT themselves, The drug could cost $10,000 a year.

O’Shaughnessy shakes his head in disbelief.

“How can you afford to pay thousands of dollars for a drug when you are so sick you can’t leave your apartment?”

When he joined the B.C. Centre for Excellence, his mandate was “to develop a system to get drugs to the people who needed them — for free.”

The strategy was research: “By setting up a study to measure outcomes, they could give out the drugs for free. That’s how it started.”

Like the AIDS quilts stitched by parents and friends, the Centre for Excellence was, in a way, handmade.

O’Shaughnessy recalls chasing birds out of the sixth floor of St. Paul’s with Montaner, Ruedy, McLeod, Goldstone and Dr. Marty Schector.

“There was nobody on the sixth floor, it was empty and full of crap and garbage.”

In 1992, B.C.’s Social Credit government gave St. Paul’s $1.7 million to establish the B.C. Centre for Excellence in HIV-AIDS. By then, attitudes were changing even among the most rigid conservatives.

“They had families. They had sons,” said O’Shaughnessy. “Behind closed doors, this was affecting everybody.”

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Breakthrough

The year 1996 was, said O’Shaughnessy, “the watershed year.” Vancouver hosted the International AIDS conference where Montaner announced the dramatic results of his research: the triple drug therapy that could reduce the viral load in a patient’s blood, and the vital link between a reduced viral load and dramatically improved outcomes.

“The sense of excitement was absolutely palpable. It was incredible. Within months mortality, death rates and progression to AIDS among people taking triple therapy was down to nothing. This happened in Vancouver,” said Montaner.

It was a fantastic story, but Montaner knew continuous aggressive action would be required to curb the epidemic.

“We had a moral and ethical obligation to bring treatment to the people. We started very aggressive new initiatives to go into the Downtown Eastside to treat people that until then others felt could not be treated; injection drug users, for example.”

Then another miracle. As Montaner and researchers monitored the impact of treatment in the community they saw the rate of new infections coming down.

“It didn’t make sense,” said Montaner.

Wouldn’t more people living with HIV mean more transmission? Montaner realized that because the treatment made bodily fluids free of virus, infection rates were lowered in individuals and in the community.

“Treatment is prevention,” he said.

Lessons learned

“The lesson learned is don’t exclude people,” said O’Shaughnessy. “That’s what happened to gay men. Then we repeated it with addicts. Native women. Native men. Street youth. It was exclusion and marginalization that set up the epidemic and there is no doubt about that. No doubt at all.”

If exclusion and marginalization set up the epidemic, HIV-AIDS still functions as a kind of divining rod that detects social issues that need to be addressed, whether related to sexuality or socio-economic status.

In B.C., HAART is free. In Ontario and Quebec, it is funded through both public and private insurance and access across Canada may vary according to socio-economic status.

Treatment or Cure

For O’Shaughnessy, the toll was intensely personal.

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“My personal toll was my family. I was never there. Would I change it? I can’t. It was a good thing to do. I got a lot of knife wounds in the back, and lots of problems but I wouldn’t change it. We saved lives.”

He credits the activists.

“Gay men and addicts and natives and women were treated so poorly, but they said this isn’t right. And they changed things. They moved the agenda forward.”

If there is one lesson he has for young investigators and researchers: “When you think you know what you have to do, when your compass is telling you must do this, well damn it, just do it. Have the balls to do it.”

It’s personal for Montaner, too. From the start, he has been emotionally involved.

“When you deal day by day with patients that are so willing to take all the steps to deal with a disease that is so devastating, it’s a tremendous source of inspiration and energy and stamina.”

For Montaner, the battle to bring treatment to everyone, no matter their economic status, citizenship or lifestyle is both moral and ethical.

“All HIV does is bring the focus of light into the most needy populations so HIV forces us to deal with it,” he said, quoting Jonathan Mann, the late American physician whose efforts through the World Health Organization reframed the international AIDS crisis as a global human rights epidemic.

Montaner continues to be an outspoken advocate for those infected with HIV-AIDS around the world, and has called the Canadian government’s low funding of HIV-AIDS research, criminalization of intravenous drug users and lack of funding for global treatment “criminal neglect.”

And he’s nowhere near stopping.

“For HIV, you need to be very focused and you need to stay with it and you need to be able to bring people’s attention to it even when you are succeeding.”

Montaner can see the future, because he has seen the past. He was there when life expectancy after diagnosis was five to six months. A 20-year-old diagnosed today who receives and sticks to treatment can expect to live until age 73.

“What I can offer my children and the next generation is that if we continue to do what we’re doing, we can prevent morbidity, mortality and transmission by 90 per cent so it is a virtually AIDS-free world.”

CNN: Wrong time to reverse course on HIV/AIDS By Kevin Robert Frost and Sharon Stone December 1 2013

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(CNN) -- As we mark the 25th observance of World AIDS Day on December 1, we have a golden opportunity to begin to end the HIV/AIDS pandemic.

To start with, this has been an extraordinary year for HIV/AIDS research, with headline-grabbing breakthroughs that stand as undeniable evidence of progress toward a cure.

The first documented case of a child cured of HIV, reported in March, was followed in July by a report of two adult HIV patients no longer showing any signs of virus after undergoing stem-cell transplants and stopping antiretroviral treatment.

Much work lies ahead before these and other scientific advances can be parlayed into a broadly applicable cure that can be made available to the 35 million people living with HIV/AIDS worldwide.

But it is an irony bordering on tragedy that just as a cure for HIV/AIDS is beginning to seem like a realistic proposition, the belt-tightening measures of the age of austerity could halt our momentum, cripple our progress and dash our hopes for ending AIDS in our lifetime.

As a result of U.S. budget sequestration, the National Institutes of Health -- the engine of progress on AIDS research for 30 years -- will lose $229 million in AIDS research funding in the coming year.

This caps a dismal decade for AIDS and other biomedical research support: From 2003 to 2012, the NIH lost 22 of its purchasing power as a result of stagnant levels of funding.

This hammer blow to AIDS research funding will be accompanied by cuts to a range of other HIV/AIDS programs -- cuts that will have negligible effect on the federal deficit but will have real consequences for people living with HIV/AIDS in the United States and around the world.

Based on the latest available data, amfAR, The Foundation for AIDS Research, has estimated that reduced funding for the President's Emergency Plan for AIDS Relief (PEPFAR) alone could result in 228,000 fewer people receiving treatment for HIV. This could lead to as many as 52,000 AIDS-related deaths and could leave more than 100,000 children orphaned.

The Institute of Medicine has said that PEPFAR has been "globally transformative" and has "had major positive effects on the health and well-being of individual beneficiaries, on institutions and systems in partner countries, and the overall global response to AIDS."

Why, then, are we shortchanging a program that enjoys broad bipartisan and popular support, has done more than any other foreign policy initiative in recent years to burnish America's image abroad, and has already altered -- though not irreversibly -- the trajectory of the HIV/AIDS pandemic?

Nor will people living with HIV here in the United States be spared. amfAR also estimates that the sequester could cause about 15,000 Americans who need help paying for their medications to lose support from the AIDS Drug Assistance Program.

And more than 4,000 households could lose housing assistance as a result of cuts in the federally funded Housing Opportunities for People with AIDS program. All of these cuts will fall disproportionately on people of color.

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Just a few years ago, the notion of a cure for HIV was considered by many to be heretical. It was creating false hope. It wasn't technically feasible. It couldn't be done. That all changed with the first reports, in 2008, of Timothy Brown, the "Berlin patient."

While on treatment for HIV, Brown was diagnosed with leukemia. To treat the leukemia, he received a stem-cell transplant -- with a twist. His savvy German doctor deliberately sought, and found, a stem-cell donor from among a very small group of people born with a genetic mutation that renders them highly resistant to HIV infection. After the transplant, Brown was able to stop HIV treatment without experiencing a return of the disease.

Similarly, the idea of an "AIDS-free generation" today is tossed around with abandon. It wasn't always thus. But over 30 years, we have developed a raft of tools that enable us to effectively prevent and treat HIV infection. What's more, research has shown us conclusively that treatment is prevention. Putting people on antiretroviral drugs makes them less infectious and less likely to transmit the virus to others.

Combine a broader deployment of these tools with an expansion of programs such as PEPFAR and a sustained investment in research, and you have a trifecta: a winning combination that could achieve the conquest of the AIDS pandemic in the foreseeable future.

Backpedal on AIDS, and you'll pretty much guarantee that we'll be dealing with it for generations to come.

The opinions expressed are solely those of Kevin Robert Frost and Sharon Stone.

Huffington Post: Striving for the AIDS End Game: Translating Research Promise Into Public Health Success December 1 2013 Anthony S. Fauci, M.D.

Dec. 1, 2013 marks the 25th annual commemoration of World AIDS Day. In highlighting this day, partners in the fight against HIV/AIDS will champion bold goals, such as "ending AIDS" and "getting to zero." With the sober recognition that 35.3 million people are living with HIV/AIDS today, these goals may seem unattainable, perhaps even fanciful to some. Although they will, without a doubt, be difficult to achieve, they are the correct aspirational goals to set forth. Every biomedical discovery, public health program, community-based solution, and demonstration of political will should be focused toward the attainment of these ambitious goals. Through concerted, cooperative and sustained effort, we can strive toward an AIDS-free reality. In that pursuit, even if total elimination eludes us, at the very least much suffering will be averted and the health and economic well-being of people, families, communities and entire nations will be boosted.

We can reduce and move toward elimination of new infections with the expanded combination prevention "tool kit" that biomedical research and public health practices have provided. When HIV transmission was first understood, public health prevention messages were limited for the most part to promotion of condom usage and safe injection practices. Today, expectant HIV-infected mothers can virtually eliminate the risk of transmission to their newborns with proper use of antiretroviral

25 medications. In this regard, antiretroviral treatment lowers HIV burden to extremely low levels; among heterosexual partners in which one partner is infected and the other is not, early treatment of the infected partner has been shown to reduce the risk of HIV transmission to uninfected sexual partners by 96 percent. At-risk uninfected individuals can protect themselves from HIV infection using pre-exposure prophylaxis, whereby individuals take a daily antiretroviral therapy pill to prevent infection. Another strategy is built on the observation that circumcised men had lower rates of HIV than uncircumcised men, and clinical trials and real world studies of voluntary adult male medically-supervised circumcision have demonstrated a 50-75 percent reduction in the risk of infection among circumcised men that has been sustained over several years. These prevention tools, combined with public health programs that promote their acceptance and adherence can substantially reduce new infections. However, failure of these two latter factors often creates stumbling blocks in achieving maximal effectiveness.

The global AIDS community must better understand the social factors that drive individual acceptance of and adherence to prevention modalities and treatment. Specifically, in addition to a nuanced understanding of financial and cultural barriers to care, stigma and discrimination must be systematically addressed. For example, in certain settings in the United States, condoms are used by law enforcement officials as forensic evidence of commercial sex work, complicating promotion of safe sex. Around the world, homosexuality is illegal in 76 countries and highly stigmatized in many more. These egregious examples of institutional discrimination, and the individual discrimination that invariably accompanies it, must be eliminated.

Although existing prevention methods paired with stigma reduction can help reduce new infections, these gains must be sustained for generations to come. To accomplish this, an HIV vaccine remains an important tool. Vaccination offers the ability to prevent infection at the population level without reliance on continual adherence to interventions at the individual level. Thus, pursuit of a vaccine remains a top priority for the scientific and global health community. Following years of disappointments, a large clinical trial in Thailand showed a 31 percent reduction in infection among vaccinated people. This response was encouraging, but recent scientific advances indicate that more robust results may be possible. Specifically, new insights into broadly neutralizing antibodies that powerfully block HIV entry into cells and into more effective cellular immune responses have reinvigorated the quest for an HIV vaccine. With the promise of such advances and other prevention tools available today, the rate of new HIV cases can be dramatically reduced, and hopefully ultimately eliminated.

Even if incidence of new infections is dramatically reduced, the global AIDS response must continue to address the needs of the 35.3 million individuals living with HIV/AIDS around the world. A handful of recent cases have highlighted the possibility of "cure," or sustained remission, whereby patients can control or perhaps even eliminate HIV without daily drug therapy. Notwithstanding the possibility of therapy-free sustained remissions, disease progression can largely be stopped with existing antiretroviral drugs widely available today. In other words, by treating individuals, the global AIDS community can strive toward the elimination of AIDS morbidity and mortality. To do so, availability of effective antiretroviral therapy must be expanded in accordance with the World Health Organization's treatment guidelines, which will require bolstering of human and financial resources, paired with implementation expertise. Gaps must be closed in the care continuum from diagnosis, to entry into health care, to retention in care, and to initiation and maintenance of treatment. Issues related to access to and delivery of health care, as well as social, behavioral and economic factors (among others) need to be addressed as well. In addition, the long-term comorbidities of HIV infection, i.e., associated

26 diseases that are more frequent, premature, and/or serious in HIV-infected individuals, must be better understood and addressed.

Finally, to control this epidemic and strive toward its end, effective interventions must be paired with political will and economic resources. The President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis & Malaria, the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative and other programs have made remarkable strides in fighting HIV/AIDS by smartly investing dollars in targeted, proven interventions, and working with partners at the international, regional, national and local levels around the world. These programs save lives -- according to UNAIDS, from 1995 to 2012, antiretroviral therapy averted 6.6 million AIDS-related deaths worldwide, including 5.5 million deaths in low- and middle-income countries.

The collective efforts of health care practitioners, patients and researchers around the world have brought new promise to the decades-long fight against HIV/AIDS. By sustaining and accelerating this fight, and striving toward the "end of AIDS," lives can be saved and suffering averted for decades to come.

LA Times: AIDS fatigue: a dangerous diagnosis Warner C. Greene December 1st, 2013

I saw my first AIDS case in 1981, the year the disease was identified. And for most of the time since then, I've conducted laboratory research to better understand the precise mechanisms by which the virus HIV causes AIDS.

Lately, however, I've been equally worried about a related condition that is prevalent, persistent and threatens to bankrupt us. People in my world call it AIDS fatigue.

AIDS fatigue has several telltale symptoms. One is thinking that the AIDS crisis is under control. Another is believing that AIDS is someone else's problem, while still another is assuming that antiretroviral medications cure HIV/AIDS. All three notions, unfortunately, are false.

World AIDS Day on Sunday is a great opportunity to begin treating these malignant misconceptions, which we must do to address one of the most lethal pandemics ever to strike mankind. As a global community, we are not supplying — and may not even be able to afford to supply — enough of the lifesaving drugs required to prevent an HIV infection from progressing to AIDS for all the people who need them.

Our best option is to cure this disease — thereby eliminating the need to fund a lifetime of expensive medications for tens of millions of people — while also developing a vaccine to prevent new infections. And to do this, we must first treat AIDS fatigue with the only medicine known to address it: facts.

Since the beginning of the epidemic, AIDS-related illnesses have killed 36 million people, a number equal to the entire population of Canada. UNAIDS estimated recently that the rate of new infections is finally slowing. This is an excellent trend, but it's important to remember that the epidemic will continue to expand in the absence of a cure. HIV infected an additional 2.3 million people in 2012 alone.

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Around the world, no one is spared. Today, nearly 1% of the adult population carries the HIV virus. It infects slightly more women than men, and more than 9% of those with the virus are children. But because more than 70% of new infections occur in sub-Saharan Africa, many Americans think of it as a distant problem. They don't seem to realize that the epidemic continues to strike close to home too.

In 2011, Los Angeles County reported 1,880 new HIV diagnoses, accounting for 38% of California's 4,950 HIV diagnoses reported in that year. And a full 43% of the 80,000 Angelenos who have contracted the virus since its discovery are now dead. Nationwide, meanwhile, the number of people living with HIV could increase as much as 38% between 2010 and 2020, costing an additional $128 billion to $237 billion in healthcare costs, according to the Centers for Disease Control and Prevention.

Indeed, those unmoved by the human suffering this disease causes might be interested to learn of the effect HIV/AIDS has on their pocketbooks. In 2010, the average U.S. lifetime HIV-treatment bill was calculated at $380,000 per person. That cost is borne by all of us through higher insurance rates and tax dollars.

Medications have saved millions of lives, but these drugs do not cure HIV/AIDS. And many who need them are not getting them. More than 20% of what the federal government spends on AIDS supports critical international programs such as the President's Emergency Plan for AIDS Relief. The program has been highly effective in battling the epidemic in Africa. But we still live in a world in which not all those who need treatment can get it, particularly in sub-Saharan Africa, where the pandemic is most widespread and money for treatment is scarce. For example, only 18% of HIV-positive pregnant women are being treated with crucially important antiretroviral drugs in Nigeria, home to the world's second- largest population of people with HIV.

All this points to the need for a cure. In addition to being a global cause for celebration, a cure for HIV/AIDS would eliminate the need to spend billions of dollars on lifelong, lifesaving treatments for the 35 million who are already infected.

Research to produce a vaccine or a cure isn't cheap, however. And with sequestration, government shutdowns and renewed fiscal constraints, research funds are increasingly difficult to come by. We have to remember that spending now — whether through increased government grants, insightful philanthropy or bold investments from pharmaceutical firms — will more than pay for itself down the road.

The scientific community has made tremendous strides against this disease. And a recent flurry of news reports — including stories about the so-called Berlin Patient, the Mississippi Baby, France's Visconti cohort and two Boston men whose viral load became undetectable after stem cell transplants — has given us renewed hope for a cure. But it will take a renewed commitment of research funds if we are deliver on that hope. We are unlikely to put an end to the disease if we allow AIDS fatigue to take hold.

The Globe and Mail: Can we imagine the end of AIDS? Mark Wainberg November 29th 2013

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The HIV-AIDS epidemic is unprecedented for a number of reasons.

First, who can remember another disease that arose as quickly as HIV did in the early 1980s to infect millions of people around the world, almost all of whom succumbed to their illnesses at a time when antiretroviral drugs were non-available?

Second, the development of safe and well-tolerated ARVs over the past 25 years has now resulted in a situation in which almost all of these people can aspire to live for many years, as HIV has been transformed into a chronic, manageable condition. Of course, many problems remain, not the least of which is that HIV continues to spread to millions more people each year. In addition, people who live in developing countries are often treated with inferior drugs and so are less likely to fully benefit from these treatment advances.

All this notwithstanding, there is now a widespread consensus that the only truly effective way to deal with the HIV epidemic over the long term will be to find a cure. Although global programs to provide ARVs to people in developing countries (who could not otherwise afford them) have been successful, they may well be unsustainable over the long term. Simply put, the total costs may well exceed hundreds of billions of dollars over the next decade, and many health-care economists have sounded the alarm that the West may not be able to provide this assistance unless the global economy improves. Anyway, it is no panacea for anyone to have to take drugs every day for a lifetime.

So far, at least, the quest for an effective HIV vaccine has fallen flat, despite valiant and insightful efforts by scientists around the world. But there is palpable optimism about potential curative strategies.

Among other considerations, we now possess a much fuller understanding of the problems involved and recognize that HIV has been able to establish itself in latent form in long-lived cellular reservoirs that cannot be easily targeted by currently available ARVs. This has resulted in a large number of novel concepts aimed at reactivating these reservoirs, so that latently infected cells may be effectively targeted by more traditional drugs. In almost all Western countries, public and private granting agencies have now established dedicated funding programs to seek a cure. And for the first time, a large critical mass of scientists is fully engaged in this effort.

Research is also flourishing in a number of related areas. For example, the success of current ARV usage in the treatment of HIV has provided benefits to both society and individuals. We now know that people who are successfully treated have vastly diminished viral loads in their bodies and, as a consequence, are far less likely to transmit HIV than they otherwise would have been. On a population level, it has been shown that ARV use has led to significant reductions in community viral load, which refers to the average viral burden in a community of infected individuals.

Efforts are in place to protect against new infections (through the use of ARVs administered on a prophylactic basis) to people who might be at risk, in programs referred to as pre-exposure prophylaxis (PrEP). Some studies suggest that PrEP may be able to protect up to half of individuals at risk from acquiring HIV, so long as they take their ARVs as prescribed.

A related area of research, called Treatment as Prevention (TasP), holds that the successful mass use of ARVs will lead to diminished viral loads across populations, greatly reducing or halting the transmission of new HIV infections. Although concerns have been expressed that the development of HIV drug

29 resistance and the transmission of drug-resistant viruses might thwart such efforts, the recent development of novel compounds that may not be as prone to drug resistance as earlier drugs may help to provide a solution to this problem.

We have more of a right to be optimistic today than at any time since the outbreak of the HIV epidemic.

The Lancet: Rights and wrongs Matthew Weait November 30th 2013

On the eve of World AIDS Day it is worth reflecting how a distinctive feature of the response to HIV and AIDS has been the contribution of those whose lives it has most affected. Running in parallel with the juggernaut of biomedical, pharmacological, and social scientific research, there has been a no less fervent effort on the part of people living with HIV to raise public consciousness about the disease, its prevention, and its treatment. Activist and civil society contributions can be traced back to the Denver Principles of 1983. These principles, formulated by a group of men who were willing—at a time of widespread fear and ignorance—to declare themselves publicly as “people with AIDS”, demanded treatment with a right to information, to participate fully in treatment decisions, and to be accorded legal protection from discrimination. It was a call to arms.

Among the first clinicians to recognise the importance of the Denver Principles was the late Jonathan Mann (1947—98). Speaking at the UN General Assembly, in 1987, Mann explained that AIDS comprised three “distinct yet intertwined” epidemics: one was infection, another was illness, and the third was the “social, cultural, economic and political reaction to AIDS”, which for him was “as central to the global AIDS challenge as the disease itself”.

Mann was a prophet, but even he might have been surprised at how firmly embedded the human- rights-based response would become in the policies and practices of organisations committed to combating both the disease and the continued stigma and discrimination associated with it. This response remains relevant because some governments and their functionaries continue to violate human rights for self-serving political and populist ends. Zoe Mavroudi's documentary, Ruins: Chronicle of an HIV Witch-Hunt, is a timely reminder of this pernicious practice.

Mavroudi tells the story of the arrest and non-consensual HIV testing of women in Athens in the run-up to the 2012 Greek elections. Against a visually arresting backdrop of graffiti-covered walls, classical statuary depicting ancient Greece's idealised female form, and naked, de-limbed mannequins in shops abandoned as a result of the economic crisis, she uses contemporary television news footage, interviews with doctors, lawyers, activists, academics, and some of the women arrested and their family members to produce an account of the events that is coruscating.

Ruins explores how the reimplementation of a historic legal regulation by the then Minister of Health, Andreas Loverdos, was used by the police to drag women from the streets on suspicion, but without proof, of being sex workers, to have them tested for HIV against their will in police stations. Health Regulation No GY/39A, originally drafted in 1940 but subsequently reworded, provides for mandatory physical examinations, isolation, and compulsory treatment for various diseases that pose a risk to

30 public health. It also prioritises particular groups for testing, such as sex workers, injecting drug users, and undocumented migrants from countries where the listed diseases are endemic. 30 women who tested positive in the 2012 police sweeps were detained in appalling conditions and their faces appeared in the media, in breach of commonly held standards of medical confidentiality. This is bitterly ironic given that Regulation 39A also states that international human rights law will be respected in its enforcement. Mavroudi records the suffering, bravery, and dignity of these women in this extraordinary film.

There was an understandable outcry, both from Greek civil society groups and others involved in HIV prevention, and from international human rights organisations. They argued that not only was the Greek Government's action a violation of the women's human rights, but put at risk complex and critical outreach work with key populations that was already jeopardised by reductions in state funding. After months of campaigning the women detained were either released without charge, or had the charges against them reduced, and in April, 2013, Regulation 39A was withdrawn. In July, however, it was reinstated by the Greek Government.

Ruins is an important reminder that human rights do not provide protection unless they are respected in practice, that respect for human rights is most critical for the most vulnerable, and that those who are in a position to speak out—whether that be lawyer, politician, scientist, or clinician—do not remain silent when confronted with evidence of their violation.

New Yorker: What Young Gay Men Don’t Know About AIDS Michael Specter November 30th 2013

I used to keep a picture on my desk, taken on Castro Street, in 1983, at the moment when it seemed as if gay life in San Francisco was ending forever. There were two men in the photograph: the first, tall and gaunt, was leaning over the other, who was in a wheelchair, tucking a blanket around what little was left of the wasted man. A friend had given me the picture just before I began covering the AIDS epidemic for the Washington Post, along with a message. “Don’t forget these people when you write this story,” he told me. “This is not about policies. It’s about being human.” My friend died a few months later—nearly three decades ago. I must have spent a thousand hours staring at that photograph during the years since then, enough time to memorize the deep sadness in the hollow black eyes of both men.

I have covered wars, before the epidemic began and since. They are all ugly and painful and unjust, but for me, nothing has matched the dread I felt while walking through the Castro, the Village, or Dupont Circle at the height of the AIDS epidemic. It could seem as if a neutron bomb had exploded: the buildings stood; cars were parked along the roadside; there were newsstands and shops and planes flying overhead. But the people on the street were dying. The Castro was lined with thirty-year-old men who walked, when they could, with canes or by leaning on the arms of their slightly healthier lovers and friends. Wheelchairs filled the sidewalks. San Francisco had become a city of cadavers.

In 2002, while writing a Profile of Larry Kramer, the dark prophet of the American AIDS epidemic, I spoke to Tony Kushner, who received a Pulitzer Prize for his brilliant play about that time, “Angels in America.” He told me what those days did to him. “I had just started coming out of the closet, and gay life had seemed so exciting,’’ he said. But by the time he had finished reading Kramer’s shocking article “1,112 and Counting,’’ which appeared in 1983 in the New York Native and demanded that gay men start to

31 take notice of the catastrophe they faced, Kushner realized that “we were confronted with a genuine plague. People were beginning to drop dead all around us, and we were pretending it was nothing too serious.”

Kramer and many other activists changed all that. Outrage and new medicines largely overcame denial and hatred. In the years that followed, the epidemic seemed to go away—though of course it never did, here or anywhere else. (By the end of this year, AIDS will have killed nearly forty million people—most of them in Africa.) And this week, in a powerful story in the Times, Donald McNeil pointed out that those most wretched days could return. “Federal health officials are reporting a sharp increase in unprotected sex among gay Americans,’’ he wrote, “a development that makes it harder to fight the AIDS epidemic.”

That is a genteel way to put it. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, was a bit more frank. “Unprotected anal intercourse is in a league of its own as far as risk is concerned,’’ he said. Three decades of data demonstrate the truth of that statement. If unprotected anal intercourse is rising among gay men—a trend noted not just in America but in much of the Western world—the rates of HIV infection will surely follow.

Why is this happening? Put at least some of it down to human nature. Why do people refuse to vaccinate their children against measles or whooping cough? In many cases, because they have never seen measles and have no idea what it might do. (For perspective, more than a hundred and fifty thousand people died of measles in the developing world last year.) HIV is far more dangerous than measles, but also much more complicated. HIV is tied up with sex, a basic human need, but also with desire, shame, discrimination, and fear. What twenty-year-old man, enjoying his first moments of sexual adventure, is going to be scared because, ten years before he was born, people like me saw gay men writhe and vomit and die on the streets where he now stands? For a while, in the nineties, gay men were scared, and the statistics showed it. They used condoms regularly, and tested themselves to see if they were infected. Many still do, but others began to weary long ago of the sexual and emotional straitjacket. A drug like crystal meth (which erases inhibitions and greatly enhances sexual pleasure), while addictive and attractive, also presented an obvious and immediate drawback: it caused a condition known as “crystal dick”—no erection, no sex. Then people began to combine crystal with Viagra, and a new surge of infections began.

Can we halt this epidemic once again? Of course, or at least the dangers can be greatly reduced. But of the more than a million Americans who are infected with HIV (there are fifty thousand new cases a year), many have no decent health care, and nearly a third are not even aware they are infected. Racism, homophobia, and poverty continue to drive much of the epidemic. Minorities have the highest infection levels and are least likely to have access to satisfactory medical attention or drug treatments. Obamacare will help, but how fast or how well, nobody yet knows. This should be repulsive to us all; those people need education immediately, but there is little public funding available to teach young gay African-American men how to have sex with each other safely. That’s the society we seem to have become.

The only appropriate conclusion here is to listen, again, to Larry Kramer’s warning. What was true in 1983 may well become true again. “If this article doesn’t scare the shit out of you,’’ he wrote in “1,112 and Counting,” “we are in real trouble. If this article doesn’t rouse you to anger, fury, rage and action, gay men have no future on this earth. Our continued existence depends on just how angry you can get… Unless we fight for our lives we shall die.”

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The News Tribune: We Can End AIDS Without a Cure Hugh Ryan November 29th 2013

This Dec. 1, as we mark yet another World AIDS Day without a cure, a vaccine, or an intelligently interdependent global response to the crisis, I’d like to propose a thought experiment based on a radical—yet commonsense—proposition: We can end AIDS without a cure for AIDS.

After all, we have learned ways to prevent transmission between mother and child, discovered drugs that bring the viral load down to undetectable levels, and placed a critical understanding of sexual health in the hands of (some of) those who need it most. With proper funding and political will, these advantages can be replicated in every population, in every country, in every corner of the globe. Incurable is not unbeatable—as we already know from polio and smallpox.

So why haven’t we beaten AIDS? Clearly, it’s not because we don’t need to. In the United States alone, an estimated 1.2 million people are living with HIV. Globally, it’s around 35.3 million people. For one reason or another—because they are black or brown, gay or transgender, drug users or sex workers, and overwhelmingly because they are poor and disenfranchised—the life-or-death needs of these people do not dictate global policy or move world markets. Because AIDS has from its very beginning been a disease of the marginalized, we have allowed it to spread like a weed through the cracks in our society. Inaction, more than transmission, is at issue here. HIV causes AIDS, yes, but the AIDS crisis is caused by stigma, oppression, discrimination, and apathy. The virus is not our biggest enemy—we are.

And here, the thought experiment begins.

Currently, the popular understanding of HIV/AIDS is that it is a disease that affects certain “high-risk groups”: gay men, for instance, or black women. To be sure, rates of infection among these groups are disproportionately high, as any number of depressing statistics show. According to recent figures from the Centers for Disease Control, approximately 30,000 men who have sex with men (MSMs) contracted HIV in 2010—up a significant 12 percent from 2008. While infection rates among black women seem to have fallen recently, they are still 20 times higher than those of white women. Such strong correlations between racial or sexual identities and infection rates suggest that this model is informative, that it is an accurate way to understand the AIDS crisis.

But these statistics conceal as much as they seem to reveal. In three distinct ways, the “risk group” approach to conceptualizing HIV actually impedes efforts to end the crisis. First, it pathologizes all people within a broad category, regardless of their actual sero-status or real likelihood of contracting HIV. Under this simplistic rubric, all gay men or black women or injection drug users are treated as likely sources of infection.

Second, this approach diminishes our ability to properly understand and target the real vectors for the disease by hiding them inside nearly useless categories. After all, there is nothing inherent to being a black woman that makes one more likely to contract HIV. It is the social position of black womanhood in our society that puts these women at risk, not their identities.

Third, by leading us to believe that these broad groupings have some causal relationship to HIV infection, this model limits our understanding of the crisis to our local context. Because we are actually

33 dealing with correlation, not causation, these groupings do not have the same relationship to HIV in other places. Efforts to work globally—or even in different communities in America—will always be hampered by our own preconceived notions of who is and is not at risk.

But what if we flipped the lens? What if we focused more on marginalization (and its real-world effects) and less on identities? What if we understood AIDS not as a disease affecting certain types of people, but rather, as a disease that affects those living at the intersection of a constellation of conditions, such as poverty, lack of access to education, inadequate health care, stigmatized sexual practices, drug and alcohol abuse (legal or illegal), and political disenfranchisement?

This would not only reduce the stigmatization of identity groups with high rates of HIV infection, it would also allow us to tailor our health remedies to those who really are most at-risk. For example, in a further breakdown of that statistic regarding rates of infection among MSMs, the CDC notes that the numbers of new infections among white and black MSMs were almost identical—despite the fact that non-Latino whites represent 63 percent of the U.S. population and blacks only 12 percent. Additionally, the greatest number of infections was seen in the youngest age group. Again and again, it is those who sit at the intersection of marginalized identities—those with the least social capital and political agency—who are most at risk. We must discard generic categorical bromides in favor of health remedies targeted to their specific needs.

Further, this way of understanding the crisis would turn our attention away from prevention models based solely on behavioral change, which studies have shown are often difficult to enact in real life. Though it is tempting to isolate a single action or inaction that could stem the tide of infection, in truth, we are complex social animals whose behaviors arise from our specific circumstances and experiences. Thus, without broader contextual shifts, our actions tend to be change resistant.

For example, behavioral models routinely admonish young women with little education, no access to health care, and a cultural lack of sexual agency to make difficult decisions in highly sexual situations. In an (oversimplified) metaphor, it’s like telling someone to use a condom every time they have sex— without considering where they will get the condom, who their partners are, how they will negotiate safer sex acts, what the word sex means to them, and so on. A more successful (and, to be blunt, fair) approach would be to ensure that these women are empowered to enter these situations with adequate support, knowledge, and decision-making agency—things marginalized groups often lack. This requires HIV prevention efforts that also work to create political power for marginalized groups; address issues of poverty and social justice; help individuals find or prepare for meaningful employment, housing, and health care; address mental health issues—efforts, in effect, that address a client’s life circumstances as a whole. Many, many on-the-ground service providers already work in this kind of model. But this is a long and slow process, which requires support from an informed populace and a government that sees the vital connection between civil rights, community empowerment, and HIV/AIDS.

By focusing on marginalization, not identity or behavior, we could begin to address the root causes of inequality that leave certain members of our society more at risk for experiencing any negative life or health outcome, AIDS included.

If we can stop AIDS and have chosen not to, the hard truth is that it is because certain lives don’t seem worth saving: They would cost too much, or have brought it upon themselves, or aren’t our concern, or

34 don’t even exist in our worldview. And this is what needs to change. Until we see every life as equal, we will never end AIDS.

CNN: Where to put the smart money to end AIDS Bill Gates November 29th 2013

(CNN) -- A decade ago, over 1 million people in Zambia were living with HIV.

Only 143 of them were receiving treatment. The average cost of that treatment was more than $10,000 per year. Being infected with HIV in Zambia was akin to a death sentence. When I visited Zambia in 2012, the picture had changed. Eighty percent of Zambians living with HIV now had access to treatment. I met Florence Daka, a mother of four, who received anti-retroviral treatment five years ago to prevent her from passing the virus to her baby while she was pregnant. Florence now takes medicine that allows her to work full time and care for her children. It costs about 50 cents per day.

On World AIDS Day, December 1, we have an opportunity to make Florence's story a reality for more families by supporting an organization that is helping developing countries respond to three of the world's biggest health challenges -- the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since it was founded in 2002, the Global Fund has been a leader in the world's successful response to HIV/AIDS, TB and malaria. All told, its efforts have saved nearly 9 million lives. The Global Fund also plays a key role in helping developing countries change the course of these three epidemics.

For example, when people have early access to HIV testing and treatment, they not only save their own lives but they dramatically reduce their chances of infecting others. Moreover, a simple preventive procedure like voluntary medical male circumcision lowers a man's chance of acquiring HIV -- and potentially transmitting it to his partner -- by about 60%. Overall, effective prevention and treatment programs have helped reduce new HIV infections by a third since 2001.

That last number is crucial, because preventing new HIV infections is absolutely essential to ending AIDS. Developing a vaccine to prevent HIV remains critical, and scientific researchers are achieving exciting breakthroughs. In the meantime, we need to develop new technologies that women can use to protect themselves. Condoms are a great way to prevent the spread of HIV, but they require the cooperation of both partners.

Even if a vaccine or a revolutionary new prevention method were discovered tomorrow, our work wouldn't be over -- because they won't end AIDS if they don't reach people at risk. That is what the Global Fund has been so successful at doing for the past decade: delivering the best tools available to the people who need them most.

The Global Fund doesn't just provide money for pills and other health products. It channels its resources into training new generations of doctors, nurses, and health care workers. It helps developing countries

35 build stronger health systems. This approach guarantees that the money donors invest in the Global Fund has a long-term impact on overall health and quality of life in dozens of countries. Put simply: The Global Fund isn't just one of the kindest things people have ever done for each other -- it's also one of the smartest investments the world has ever made.

On Monday and Tuesday, leaders from around the world will meet in Washington for the Global Fund's fourth pledge conference, called the Global Fund Replenishment, to raise the necessary funding for the next three years.

The gathering is a reminder that the Global Fund was founded by the world to address an urgent need. We still need the entire world's support to continue the incredible progress we've made. This World AIDS Day, we need governments, private donors, NGOs, activists and leaders to reaffirm their commitment to an organization that has helped change the course of three epidemics.

NEXT MAGAZINE: THE FUTURE OF HIV Will Pulos November 27, 2013

In the climax of Joseph Pintauro’s play Raft of the Medusa, a homeless woman with a dirty syringe attacks a reporter infiltrating an AIDS support group session. To the writer’s horror, the angry woman screams that it was her intent to infect him with the virus to punish him for secretly taping the sessions for an article. Later, she reveals that the syringe was clean, and the other, awestruck members of the group ask the reporter what it feels like to experience a miraculous “cure” to the ravishing disease. Since scientific research on HIV/AIDS began in the early ’80s, the Holy Grail has always been a cure. After more than three decades of dealing with the disease, that lofty goal still seems frustratingly distant, but the future isn’t completely dark. In recent years, the world has seen promising progress on the medical front in the war against HIV/AIDS.

One breakthrough you may remember from earlier this year was the case of two HIV-positive men treated in Boston who showed no sign of the virus nine months after receiving bone-marrow transplants. Their cases follow that of “Berlin Patient” Timothy Ray Brown, who was effectively “cured” of the disease in 2007 after undergoing a stem-cell transplant operation. The difference in the Boston cases was that, in an encouraging development, the bone-marrow donors lacked an extremely rare genetic mutation that was thought necessary for the operation to succeed.

“These findings clearly provide important new information that might alter the current thinking about HIV and gene therapy,” announced amfAR CEO Kevin Robert Frost at the time. “While stem-cell transplantation is not a viable option for people with HIV on a broad scale because of its costs and complexity, these new cases could lead us to new approaches to treating, and ultimately even eradicating, HIV.”

When it comes to a vaccine for HIV/AIDS, there are many challenges to be faced before one can be achieved. HIV is highly mutable and highly variable, and can easily evade most functions of the body’s immune system. Furthermore, most vaccines protect against exposure to a virus from the gastrointestinal system or respiratory tract, rather than the genitals or blood sharing. As if that weren’t enough, animal models aren’t suitable enough to test possible HIV/AIDS vaccines on.

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But against the odds, a number of promising vaccine trials are happening all over the world. PxRD, the HIV Prevention Research and Development Database, currently follows over 25 vaccine trials progressing at different paces internationally. One of the most important trials so far was a U.S. military HIV research trial that concluded in 2009. Referred to as RV144, the study combined two separate vaccines (the ALVAC vaccine and the AIDSVAX B/E vaccine) and effectively lowered the rate of infection by 31 percent. However, another equally promising study, HVTN-505, which included over 2,500 participants, was abruptly stopped in April of this year, after researchers discovered that the vaccine was ineffective.

Another organization working towards developing a vaccine is the Abzyme Research Foundation, founded by Zachary Barnett. The group is currently working on raising funds to study an E-vaccine developed by Dr. Sudhir Paul. It involves chemically supercharged molecules that will hopefully act as an effective antibody against HIV’s most necessary protein.

“I was infected by a boyfriend in 2008. I started volunteering for Dr. Paul because I found his work and goals incredibly inspiring,” says Barnett. “Currently we are very busy filing with the FDA for permission to test the E-vaccine in humans, starting commercial manufacturing, and negotiating a trial site. Ideally, we would like to start human trials at the end of next year.”

Because of the difficulty in developing an HIV vaccine, some medical researchers are turning their efforts to other methods of prevention. The International Rectal Microbicide Advocates is a coalition of over 1,000 scientists and policymakers from six continents that formed in 2005 to create a safe and effective rectal microbicide for those who engage in anal intercourse.

“This could be a gel, a lubricant, a douche—that would have anti-HIV properties and provide protection against HIV, either with condoms or in the absence of condoms,” explains IRMA’s Jim Pickett. “Overall, condom use is not universally acceptable. Human beings don’t like to use condoms. If people did like using them we wouldn’t have a global pandemic with two million new infections every year. We need new ways to prevent HIV infection, and we need a bigger tool box, using ways people like to use.” Recently, the Microbicide Trials Network launched MTN-017, the world’s first Phase II trial of a rectal microbicide. The major trial launched both in and outside the United States is just one step away from discovering whether or not the technique would be effective on a wider scale. Last month’s Scientific American may have argued that it could take scientists a decade to bring a potentially effective HIV vaccine to the market for mass distribution, but promising developments are emerging across the field every month. A few weeks ago, scientists announced that they had finally determined the first atomic-level structure of HIV’s “envelope” protein, a major breakthrough. The protein has served as a main challenge to many vaccine trials in the past. If such discoveries and incrementally successful trials continue, perhaps it won’t be long until we, too, look a man in the eyes and ask how it feels to be “cured.”

Take Part: A Reason To Celebrate World AIDS Day, Anti-Retrovirals Are Amazing Christina Hoag November 29th 2013

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We could end the HIV/AIDS crisis that has killed more than 25 million people. Really.

Anti-retroviral treatment is well known as the wonder drug that keeps people with AIDS alive, but now more attention is turning to another use for the medication: It blocks the virus from being transmitted.

With a vaccine still some years away, HIV/AIDS advocates say the key to containing the epidemic is broadening the use of anti-retrovirals to prevent transmission, as well as to prevent sickness.

Known as “treatment as prevention,” the concept involves getting HIV-positive people on anti- retrovirals as soon as possible, even if they are still healthy and have no AIDS symptoms.

It represents a radical departure from what has been the traditional treatment strategy of administering the drugs only to people who are either already ill or with dangerously low immunity levels.

“It’s changing the way we look at AIDS,” said Mitchell Warren, executive director of AVAC (AIDS Vaccine Advocacy Coalition), an advocacy organization based in New York. “It’s the superhighway to an AIDS- free generation.”

The study sparked calls to widen testing and treatment. United Nations AIDS now recommends treatment as prevention as a way to halt the growth of the AIDS epidemic, which affects some 34 million people globally.Treatment as prevention grew out of a 2011 study that found anti-retrovirals, which stop the virus from replicating in the body, are 96 percent effective in blocking HIV transmission.

UNAIDS has set a goal of increasing drug access to 15 million people across the globe, up from 9.7 million currently, by 2015. That’s still a long way from ideal—the Geneva-based agency estimates that 25.9 million people need the drugs.

The World Health Organization has also revamped its AIDS policy guidelines. In June, the agency recommended that HIV-positive people start anti-retrovirals much sooner than it previously recommended—before their immunity drops.

Countries are increasingly starting to follow suit. Over the past two years, treatment as prevention has become a main component in the anti-AIDS battle in the United States, China, and British Columbia, Canada. More recently, Brazil and France said in October they were adopting treatment as prevention as their official AIDS policy.

But advocates warn that treatment as prevention is not a panacea. For the full preventive effect, a maximum number of people need to get tested and then, if HIV positive, commit to lifelong, daily medication. Neither factor is as easy as it sounds.

Some people are reluctant to get tested for fear of discrimination or simply denial. Sticking to treatment is another issue. A U.N. report found only a quarter of HIV-positive Americans adhere to anti-retroviral therapy.

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Diane Havlir, director of the AIDS Research Institute at the University of California, San Francisco, said people with HIV need more information about the consequences of not taking anti-retrovirals even when they feel well, as with people who take blood pressure or cholesterol medicine.“What is it that creates that gap? We don’t know, but it reinforces the notion that it’s great to embrace treatment as prevention but not oversimplify it,” said Jeremiah Johnson, HIV prevention research and policy coordinator at the Treatment Action Group, a New York–based advocacy organization. “A reduction in a clinical trial isn’t necessarily how it’s going to translate in the real world.”

“It can be difficult for people,” she said. “There’s stigma all over the world.”

The concept also faces a struggle in gaining traction among the highest-risk populations that are also the hardest to reach—IV drug users, sex workers, and men who have sex with men.

In San Francisco, where anti-retroviral drugs have been recommended to anyone who tested positive since before the 2011 study, the city has had success in offering HIV services at community organizations that serve at-risk populations.

These include syringe exchange programs, clinics that treat sex workers, and organizations that serve gay men, said Susan Philip, director of disease prevention and control for the city's Department of Public Health.

The crucial factor is providing social services to stabilize people’s lives so they can deal with their health issues and a routine of pill taking, she noted.

Despite the obstacles, advocates say the time is right—and not just because it is World AIDS Day on Sunday—to expand anti-retroviral access exponentially.

Generics have brought prices down drastically, and the Affordable Care Act mandates insurance coverage for people with preexisting conditions such as HIV. The drugs themselves are more convenient—down to one or two pills a day from a handful, and they have fewer side effects.

Advocates stress that anti-retrovirals are only one weapon in the anti-AIDS arsenal while a vaccine or cure is being developed. Other preventive measures continue to be recommended, including condoms and the drug tenofvir, which is taken by HIV-negative people as a prophylaxis against being infected.

“It’s way too soon to declare victory in the fight against AIDS, but we’re at a tipping point,” said Warren of AVAC. “But we just can’t tip backwards.”

The Hill: We can beat HIV Myron S. Cohen, MD November 26th 2013

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HIV is a fierce opponent. Since its appearance three decades ago it has killed 35 million people, and in the process, decimated many countries’ most productive generations, further compromising efforts to stop it. Yet in recent years we have increasingly begun to win this fight by uniting policy and science.

For three years we have known with certainty that early treatment of HIV dramatically reduces transmission of the virus. This means that we are on the right track. If we continue to accelerate our fight against HIV, and do it better than ever before, we can win this fight.

Now, in a remarkable show of wise bipartisan support, on November 19 the U.S. Congress reauthorized the President’s Emergency Plan for AIDS Relief and the U.S. investment in the Global Fund to Fight AIDS, Tuberculosis and Malaria by passing legislation to extend the program’s authorization. This decision will save millions of lives and is a terrific example of the U.S. engaging in “health diplomacy.”

But it is only one, vitally necessary step. The week before 40 U.S. legislators urged the president to double the number of people currently supported on treatment through PEPFAR. If he heeds that advice, science, united with policy, will continue to gain on HIV.

The development of the first antiretroviral drug in 1987 and continued improvement in treatment is one of the great accomplishments of the 21st century. More than 10,000,000 are already receiving treatment. But everyone with HIV infection needs treatment, and sooner rather than later. Today, an early diagnosis of HIV means taking just one pill a day, a pill that can provide a person with excellent health, a normal life span and a drastically reduced chance of transmitting the virus to someone else. By keeping people healthy and reducing new infections, early treatment of HIV proves to be a great investment. In some places-such as the South African province of Kwa-Zulu Natal-the increased availability of antiretroviral therapy has reduced the incidence of new infections quite dramatically, and almost certainly because infected people become less contagious. Treatment of HIV now (rather than later) saves health care costs by keeping people feeling healthy. And healthy people are more productive, which can have a positive effect on the economies of countries where HIV infection is common.

Remarkable progress in HIV research and care has led to the call for an AIDS-free generation. The cover of The Economist magazine speculated about “The End of AIDS.” But these are aspirations, not promises. History tells us that when we are making progress against an infectious disease, we must not relax. For HIV we must redouble our efforts in every regard: to get more people treated as quickly as possible, to make a vaccine, and to find a cure.

US AID: 10 Years in the Making: Celebrating USAID’s Achievements Under PEPFAR Goli Fassihian 11/22/2013

USAID is observing World AIDS Day this year by celebrating ten years of our HIV and AIDS work under PEPFAR.

In less than two short weeks, the global health community will unite to commemorate the fight against AIDS. The United States, foreign governments, civil society, local communities and many others dedicated to reaching an AIDS-free generation will mobilize around the world to celebrate the incredible achievements that have been made since the epidemic was first identified over 30 years ago.

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We’ve come a long way in the last three decades: unexplained immune system failure and a race to identify the cause in the early 1980s; life-sustaining therapy introduced in the mid-1990s; a landmark foreign assistance initiative in 2003 that brought treatment to millions of people who had no access before; and a groundbreaking study in 2011 showing that healthy people living with HIV on antiretrovirals can limit transmission by 96 percent. The worldview of the HIV pandemic has changed dramatically in our lifetime.

The Building Local Capacity Project has reached 57,223 orphans and vulnerable children (OCV) and caregivers with child health services in southern Africa. Photo credit: Management Sciences for Health Our work is not over. As Secretary of State John Kerry said during a speech earlier this year, “As progress continues, we will gradually evolve as our fight against this disease evolves, and that is going to happen both by necessity and by design. Achieving an AIDS-free generation is a shared responsibility and it is going to be a shared accomplishment.”

Some of the most monumental achievements in combating HIV and AIDS have occurred in the past 10 years with the creation of two unprecedented global health programs – the Global Fund Against AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR was, and continues to be, ambitious, visionary, and far-reaching. Through access to antiretroviral treatment, it has literally brought people living with HIV back from the brink of death and enabled them to live long and healthy lives.

It’s been ten years since the United States Leadership Against HIV/AIDS Tuberculosis, and Malaria Act of 2003 was passed into law, creating PEPFAR. And today, we can confidently say that the program has saved millions of lives and delivered hope to communities where it was so desperately needed. As a key implementing agency, USAID has contributed significantly to these remarkable achievements. Through programs that prevent mother-to-child transmission, offer voluntary medical male circumcision and improve condom use, to those that reduce gender-based violence and risky behaviors for select populations; through our commitment to deliver effective treatments and care for the most vulnerable – especially orphans and other affected children – to our support for the development of an HIV vaccine, USAID has played a significant role in changing the face of the pandemic around the world.

In the 10 days leading up to World AIDS Day - through a digital campaign called 10 for 10 (PDF) – USAID will share stories from the last decade that touch on the various ways the agency has contributed to one of the most successful foreign assistance programs ever created. This campaign will culminate in the launch of “Gift’s Last Ten Years” – an animated video that tells the story of our work through the eyes of a fictional 10-year old southern African girl.

AIDS used to be a disease that everyone feared and discussed only in private. Today, there is a global sense of optimism that did not seem possible at the beginning of this century. What a difference a decade makes – we’re proud to have played our part.

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