Are we cany closer, truly?

I have been writing in parts about my Highs and Lows from the IAC and DC Trip.  And I will continue those, but today I’m going to deviate and think in text for a while about a few things that are churning in my head.   They are actually parts of a running theme throughout this experience It would seem. 

The questions I have are regarding personal responsibility.  Prevention and Harm Reduction.  Community involvement in HIV/AIDS Policy planning.  Leadership.  And Understanding of “where the people are.” 

Let’s think about a few of these things…

I mentioned that while we are making great strides in the Global South(Sub-Saharan Africa, India, other poorer developing nations) in terms of new transmission and treatment.  We have learned that male-circumcision reduces risk of heterosexual transmissions. ( I do not know the science behind this and have yet to catch-up on the research).  We know that we can now treat mothers for their HIV, and offer Cesarean Section Deliveries, to help reduce the risk of Mother-to-child transmission to less than 2% chance of transmission.  We know that adhering to meds make HIV+ people more likely to get to  high CD4 counts and Low Viral loads, and the lower the viral load the lower the risk of sexual transmission.  Even though there are problems with availability and access to medications for Developing Nations (due mostly to pharmaceutical company greed) we are making great strides in achieving a slow-down of the Virus in the Global South.

So then, this begs the question, Why can’t we slow down these new infections in the American South?

Now let me be clear. I am not, by any means, a believer in the “care for those at home first” mentality.  I will never complain about the amount of money we spend on Foreign Aide, unless I’m complaining that its not enough.  People are people, and if we have enough and they don’t have enough then we give them what we have extra. Period. My mom taught me that as a child, and it holds true for individuals, families and nations.

But I *DO* have to ask.  What is going on here? We are able to reduce transmission rates in sub-Saharan Africa, with cultural and language barriers by the dozen. But we can’t get the rate of new infections in D.C. to slow down even a little bit?  Rates are sky rocketing in Georgia, Tennessee and Mississippi! What is going on down there in the South?  Why are Young black Men contracting HIV at enormous rates? When young African men are living longer without becoming HIV+? 

I ask about this because I think we need a clarion call from strong leadership to start approaching things differently.   We’ve been saying to people for over 20 years now, “the only 100% method is abstinence from Sex and Drug, and the next best thing is to have safer sex using dental dams, condoms.”  Is this news to anyone? No, I don’t think it is.  I think most, most adults have heard this somewhere by now. (I of course, do not think that we should stop, even for a second, continuing to fund programs and schools to spread this information everywhere they can.  We can’t let a single child slip into adulthood without hearing this information many times!  But, let’s be honest about this.  We’ve been spreading that message already, and there are plenty of people who know better. I am one of them.  I am not going to put myself into the category of people to whom we need to do better outreach, or change our message. I am clearly not.  But If I know better, and I’ve had unprotected sex, made mistakes, or made bad choices, with my relatively well educated and culturally connected background, then how are we going to approach those other younger MSMs (Men who have sex with Men, because they don’t’ all identify as Gay.) And Men of color who are increasing their transmission rates still?  Telling them to use condoms is not working. What else can we do?

We talk a lot, I feel, about personal responsibility.  And I have to wonder what part this plays in the HIV world.  Luckily I have removed most of the acquaintances I have, from my life (or taught them to be more compassionate) that have the “they did it to themselves” attitude.  I don’t expect to hear anytime soon, from friends or loved ones, “well they were slutty and they got HIV, that’s their problem.”  I am sure there are still people like this in the world, but I have no patience for them.  As anyone who knows me knows, compassion above all things.  Do all things with love.  But let’s think about personal responsibility.  What does it mean in the Age of HIV? What does it mean in the age of Undetectable Viral Loads, and higher CD4 counts? I saw a pair of underwear for sale from a Canadian organization in DC that said “I Party. I Bareback. I’m Positive. I’m Responsible. “I thought about it for a moment.  What does it mean, Party? I mean I know what that means in NM, but the language is different everywhere. And what could that mean, being positive, bare backing (the act of having unprotected sex, typically anal sex between two men, without condoms. ) and still being responsible?  Isn’t that precisely what responsibility is, protecting others from becoming infected? This begs questions about, does responsibility mean simply disclosing your status?  *surely this is more than a pair of underwear that state your HIV+, I for one, at that point in time, don’t stop to read the underwear very often. (Though I am looking into buying a pair, because they were super cute and why not ?!?!  I don’t drink Jaeger, but I wear that T-Shirt)  Does being responsible mean having a conversation about the role sexually (bottom VS Top – This I won’t get into because My mom reads this blog) and what the risk factors are?  (Your risk is decidedly lower if you are a top, and your partner is the positive one, when the partner/bottom is undetectable viral load etc…) 

The bigger question this brings to mind for me is, where are we headed in terms of “ending AIDS?” 

We talk about Community Planning Groups. And we talk about an AIDS Free Generation.  As my friend Javier recently commented on my FB post, this “AIDS free Generation” seem to be the agenda of politicians and scientists, not of the community. 

So then my question is, how do we decide what the community wants? And who is this community? Should we be talking only to those who are positive, about what we need? That seems unfair as it is as much my battle as a negative person as it is the positive friends and loved ones of mine.  I mean I am just as concerned with making sure I do not become Positive, and protecting my other loved ones, as I am alleviating the virus and its accompanying struggles for those who are.

So I ask, what do we do now?

How do we tackle responsibility? How do we determine the agenda? Is treatment really the primary goal? What does access to treatment mean in a world of STIGMA and SHAME? Transportation issues, healthcare affordability issues. Disclosure issues. Counseling and understanding issues. 

What is the next step?

I came back from DC excited about the promise of an END to AIDS. I was hopeful that “The Last One” Panel would soon be sewn onto the Quilt and that I would be covered with tattooed AIDS Ribbons, and the war would be over. They would simply be badges of honor, or scars of battle for my work and the memory of my loved ones. But now that I have reflected upon it, I have to wonder. Are we any closer, truly than we were a decade ago? Two? In 1984?