An AIDS-Free Future Requires More Than Medicine

Ruth MessingerIn 1985, during the height of the AIDS crisis in New York City, I was elected to the New York City Council. Time and again, I felt heartbroken as my friends and constituents lost their lives to a deadly disease without a cure. Too frequently, they suffered the effects of ignorance, fear and hate.

Now, nearly 30 years later, advances in biomedical treatment have been stunning in their power to achieve an AIDS-free future. But the truth is that prejudice and fear are as persistent as HIV. Medicine alone cannot deliver the future we seek. Even as we celebrate the scientific discoveries and treatments that dramatically reduce HIV transmission and death, we should not delude ourselves into thinking that a biomedical solution can overcome the devastating effects of bigotry. If, as the United Nations agency UNAIDS urges, we wish to get to zero—zero discrimination, zero new infections, and zero deaths—we must take an integrated approach that combines biomedical treatment and an enduring commitment to human rights.

Without a doubt, medicine is working. As of September 30, 2013, the United States’ program, PEPFAR, is currently supporting life-saving antiretroviral treatment for 6.7 million men, women, and children worldwide. This exceeds President Obama’s 2011 World AIDS Day goal of 6 million people on treatment—a four-fold increase (from 1.7 million in 2008) since he took office. But, unfortunately, the World Health Organization predicts that 50 million people will need treatment for HIV by 2030. This means we face a tremendous uphill climb and must somehow identify between $22 and $24 billion—a truly ambitious financial target.

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Needle Exchange Programs Vital In Fight Against AIDS

In 1986, British Prime Minister Margaret Thatcher’s special cabinet committee on AIDS made a fundamentally important decision which changed the course of the emerging HIV epidemic in the UK. In spite of some vocal opposition, it decided there should be clean needle exchanges for injecting drug users (IDUs) to prevent the spread of HIV.

The opposition to that move has been echoed in the years that followed — not least in the United States. Government-financed needle exchanges would condone crime, the critics claimed. It would encourage drug use and give entirely the wrong message to the public.

The experience of the last quarter of century has disproved those fears. There is no question that needle exchanges and drug substitution have reduced HIV: only 2% of new infections in Britain now come through that route. The policy has neither encouraged drug taking nor crime. Similar reports come from other nations that have adopted this approach.
Tragically, not all nations have followed such a lead. Nearly half of the countries with epidemics concentrated among IDUs have no needle and syringe programs at all according to UNAIDS. The result is the further spread of HIV and an increasing death toll — only four of every 100 people who inject and are eligible for treatment get antiretroviral (ARV) drugs.

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