January 15, 2015

The Breakthrough that is yet to happen in HIV: Us/Them

Last week, Dr. Anthony Fauci from the National Institutes of Health wrote an editorial published in the Washington Post declaring no more excuses for why we should not be able to bring an end to the HIV/AIDS pandemic. In my mind, he is absolutely right – no more excuses. In fact, I think it’s been that way for nearly a decade, and only reinforced with the addition of PrEP and self-testing. What I think Fauci fundamentally misses is that one of the big barriers to the successful goal of ending the pandemic is the rigidity and even arrogance of the HIV/AIDS industry. 

Take, for example, the top-down model that Fauci writes from. There is a lot of “we/they” sentiment - as in "we need to get them into testing and treatment" - that reinforces stigma and creates cultural blindspots. He defaults back to the failed policy of targeting people for testing, rather than engaging in a comprehensive testing campaign that includes all of us, not “them.” He then goes on to gloss over the fact that, for many, having HIV or being at-risk for HIV is part of a syndemic that requires a more comprehensive, organic and creative approach. He merely says we have to give “careful attention to barriers such as poverty, substance abuse, and housing and food insecurity.” Where there is poverty, housing and food insecurity, and substance abuse, we need to align and work to end those things and give careful attention to HIV-testing and education. This, too, will be achieved when we see the world as a “we”, something, again, Fauci does little to nurture. 

So, yes, we are out of excuses. It is time for action, and we will be judged for how much institutional rigidity, turf wars, and greed have played in us not being more holistic, collaborative and engaging. We still are way under-utilizing self-testing (something Fauci completely ignores) for education, repeat testing and creative, empowering engagement. One of the barriers that needs to busted through is AIDS, Inc. itself, and its stranglehold on the national dialog, funding and policy.