4 GAY PEOPLE'S CHRONICLE November 18, 2011

www.GayPeoplesChronicle.com

speakout

Don't retire the red ribbon just yet

by Robert Toth

Another World AIDS Day is here. In the October issue of Poz magazine, Regan Hoffman looked hopefully forward to the day of "retiring" the red AIDS ribbon.

"With enough money, political will and the right implementation plan, we can rewrite the ending of one of the worst stories ever told, so it is one of triumph not endless tragedy."

Hoffman writes of "securing the political and financial capital. . . necessary to permanently hinder HIV's forward progress."

Two weeks ago, Secretary of State Hillary Rodham Clinton said an "AIDS-free generation" is within our grasp.

However, due to a combined profound lack of foresight, anemic political will and infighting, there has been a world health failure in the fight against AIDS. The red AIDS ribbon has already been retired, faded and fallen into the shadows. We fail to see the tools we have and are not using. We fail to see how far we've come and how very, very far we have to go before we "retire" the red ribbon. Have we already forgotten the paths we bravely blazed and the struggles we endured?

Gay men and our compatriots started the ribbon-as-awareness campaign. We can take it back! We started with red; now's there's blue, pink and a host of equally important awareness ribbons and colors. We started the empowerment movement. Occupy Wall Street is "so 80s." Ever the trend-setters, gay men have already been there and done that. In the 1980s members of ACT UP, the AIDS Coalition to Unleash Power, chained their bodies to the stony edifice of Wall Street to raise awareness and rankle Big Pharma. We actually shut down trading! We fought the National Institutes for Health and the Centers for Disease Control for expanded access and fast-track approval of much-needed HIV meds.

We initiated the Patient Bill of Rights.

We were the first to actively work with our doctors as a partner in our own healthcare decisions. We were among the first to embrace positive visualization techniques in an effort to stay healthy. We continue to spend billions of dollars on herbal supplements, vitamins, minerals and a host of other non-traditional immune system supple-

ments.

Gay men, our lesbian sisters and friends were the angels at our bedsides and gravesides. We had a very real sense of community back then. I hesitate to say 'back in the good ol' days' because they were far from good. They were downright frightening. Gay men were dying. Handfuls of AZT, the only drug available at the time, had to be taken on a strict schedule even though it made you sick to your stomach.

The blotchy-skinned, frail main character in Philadelphia was based on reality. Only in Hollywood could Kaposi's sarcoma look so "pretty." I remember seeing a young man in his pajamas looking for his car during a blinding rainstorm, dementia having gripped his reality. Also gone are the panicstricken phone-calls for help to change a friend's partner's diaper.

With knowledge came power. Blessed gone are the days of being forced to gown up head to toe-mask, booties and all-when visiting an HIV-positive friend in the hospital. Gone are the days of seeing food trays left at a positive patient's biohazard-branded door and the days of dating as a game of chance. Taking a chance on dating a guy not knowing Monday if he'd be around for that Friday's movie matinee. (Yes, Virginia, that actually happened.)

These things sound old and cliche like something out of An Early Frost, Longtime Companion, Angels in America or And the Band Played On. Art imitated life and won a Tony award and a Pulitzer or two. Over one million Americans are currently

Treatment as prevention

Turning the tide in the AIDS epidemic

by Julie Patterson

We have reached a turning point in the AIDS epidemic.

In August, a milestone study showed that treating HIV patients with AIDS drugs makes them remarkably less infectious. Not only do AIDS drugs save lives, they are also some of the most effective tools for HIV prevention.

This randomized multinational trial of heterosexual couples where one partner had HIV and the other didn't-called HIV Prevention Trials Network 052-confirms a growing body of research and has inspired a new urgency for treatment of HIV. AIDS activists call this "treatment as prevention."

About half of the couples in the trial were randomly assigned so that the infected partner went on antiretroviral drugs right away. In the other couples, the infected partner waited to start treatment until later in the course of the disease, a standard practice in many countries. All participants were counseled on how to protect against HIV transmission and were given free condoms and other prevention services.

Comparing the two rates of infection, HIVpositive partners taking antiretroviral drugs were 96% less likely to pass on the virus.

Antiretroviral drugs don't cure AIDS, but merely keep it in check. So the pills must be taken every day for life. Still, treatment as prevention has a financial advantage: it is a secondary benefit to the primary purpose of improving an HIV-positive individual's health, quality of life, and lifespan.

Patients on antiretroviral medication are less infectious because the drugs sharply suppress the amount of HIV in the body, meaning people on treatment have less virus to transmit.

The hopeful results come 30 years after the disease was first identified in the U.S. Now, a combination of new and emerging

HIV prevention methods has convinced many leading AIDS experts that they can dramatically reduce new infections.

"Although it is still important to develop an HIV vaccine," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, "we have significant tools already at our disposal that can make a major impact on the trajectory of this epidemic.”

"Treatment as prevention" is an umbrella term describing various HIV prevention methods where the same antiretroviral drugs that are used in treatment of HIV are instead used to reduce the risk of passing HIV to others. Many people are familiar with this AIDS-drugs-as-prevention strategy's success in preventing mother-to-child transmission of HIV by providing these drugs to pregnant women who are HIV-positive.

In addition, HIV-negative people may also use antiretrovirals for prevention. Last year, a placebo-controlled study showed that a vaginal gel containing the AIDS drug tenofovir reduced the chance an HIV-negative woman would contract HIV by 39%. Among women who used it consistently, the gel more than halved the chance they would get infected. Further research is needed to approve a gel for general use. But work has already begun on more convenient products, such as vaginal rings that would dispense the virus-blocking drug for a month or more.

Also in this past year, several studies showed significant reductions in HIV transmission when HIV-negative people took AIDS drugs to protect themselves against HIVreductions ranging from 44% to 73%. This concept, known as pre-exposure prophylaxis or PrEP, is based on the principle that, if medication is in the bloodstream when some-

living with AIDS. That number is exponentially higher when it comes to those living with HIV. The death toll from AIDS is now over 500,000 Americans and probably more. We're dying of heart attacks, stroke, liver and kidney failure, even old age! These are complications of decades on life-saving Highly Active Anti-Retroviral Therapy.

Thirty years ago, a "cure for HIV" was touted as ten years away. Well, here we are thirty years later into this preventable pandemic and hundreds of thousands of Americans have died of AIDS. The AIDS Memorial Quilt has gotten so large it can no longer be fully displayed. Millions are HIV-infected but not diagnosed.

With advances in medicine, we are living longer with it. Where access to HIV antiretroviral medications is readily available, only a small percentage are on any HIV medication at all. Worldwide, over 33 million people are HIV-positive and about six million are in care.

In the United States we have an annual HIV infection rate of over 50,000. We have dwindling government resources funding the Ryan White C.A.R.E. Act and Title IX. There is a polarized and stagnant two-party system leading our increasingly fragile health care complex.

Now is not the time to even dream of retiring the red ribbon. The world must summon the political fortitude needed to eradicate new HIV infections. We must reengage our scientific minds and find an actual cure for HIV. We must ensure everyone testing positive for HIV has access to HIV medications. We must erase HIV stigma. Join a clinical trial. Give blood. Call your representative or senator for increased funding of the Ryan White Act and Title IX. Get tested, it's free and anonymous. Donate to your local AIDS service organization. Or simply start wearing a red ribbon again.

one is exposed to HIV, the virus will not be able to establish itself, and this will prevent the person from becoming HIV infected.

Clearly there is no magic bullet; it is the use of these emerging HIV prevention methods in combination-added to behavior change methods such as condom promotion and limiting one's sexual partners— that could finally end the epidemic.

Treatment as prevention has been around for a long time, but only in the last year has the evidence convinced a critical mass of AIDS scientists that it can play a major role in the combination approach to HIV prevention.

In the U.S., the National HIV/AIDS Strategy has been a significant step in the right direction, but it is not enough to counter the current, economy-driven lack of access to HIV care and treatment. Over a third of those living with HIV are not in AIDS care, even after being diagnosed.

Nearly 7,000 people in 12 states cannot afford to pay for AIDS medications and are now on waiting lists for help. While most of these are temporarily receiving medications through ad-hoc measures, these may fail and leave people without life-saving medications. In Ohio, our HIV Drug Assistance Program waiting list has recently been cleared, but activists fear it may return after the current fiscal year ends in March 2012.

It is time to pay attention to the science, translate it into real world HIV-prevention as part of a combination approach, and end the AIDS crisis. It starts with ensuring that our communities have what they need. Let's not wait.

Julie Patterson is director of capacity building at the AIDS Taskforce of Greater Cleveland.

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