Those of us who lived through the 1980s and the emergence of the AIDS epidemic can remember the horror, confusion, and awful prejudice around the disease. Social stigma prevented government action and interrupted healthcare delivery to patients, and countless preventable deaths occurred as activists pled and fought for their lives.
Looking back, that seems a lifetime ago, and both the scientific and social progress we have made since then have been truly monumental. But despite immense improvements, both HIV infections and the punishing stigma that accompany them persist. In much of the world, an HIV infection can still carry a death sentence, forcing the same lamentable inaction and delays in care.
This intractable stigma informs the themes for this year’s World AIDS Day from both the World Health Organization (WHO) and the United States Department of Health and Human Services (HHS). The WHO is encouraging individuals to “Take the rights path: My health, my right!,” a call to action emphasizing the essential, inalienable human right to healthcare and personal dignity. HHS has chosen “Collective Action: Sustain and Accelerate HIV Progress,” focusing on systemically addressing structural barriers to care and ensuring no communities are left behind.
Both organizations have set ambitious goals to end the AIDS epidemic by 2030, goals that just 20 years ago would have sounded all but impossible. UNAIDS, the United Nations Program on HIV/AIDS, has set targets called “95-95-95.”
By 2030, the goals are:
- 95% of people living with HIV know their status through better access to testing
- 95% of those who know their status are receiving treatment through better access to care
- 95% of those treated will be virally suppressed—defined as less than 200 copies of the virus per milliliter of blood—through consistent care
The HHS goals focus more narrowly on prevention of infection through a combination of care interventions and awareness initiatives:
- A 75% reduction in the number of new HIV infections by 2025
- At least a 90% reduction in new HIV infections by 2030
Reaching these goals would avoid an estimated 250,000 new infections. Currently, HHS estimates that there are 38,000 new diagnoses in the United States each year.
Thanks to innovative anti-retroviral therapies and emerging pre-exposure prophylaxis (PrEP) medications, which reduce the risk of transmission, these goals are attainable. But testing and medication are only effective if everyone who needs them can access them.
The communities disproportionately affected by HIV are also those historically subjected to the greatest social prejudices, the least outreach, and the most persistent disparities in healthcare access. In the United States, the last 2 years have seen a slight increase in new infections among some marginalized ethnic groups. HIV diagnoses have also risen in some underserved geographic areas. Overall, the percentage of people who know their HIV positive status has been virtually unchanged since 2017. Important gaps remain and there is much work left to be done.
We can all begin to do our part simply by refusing to accept that stigma and recognizing the basic human right to healthcare, regardless of disease status. If we speak frankly about HIV/AIDS, we can help ensure those directly affected by it feel they can openly and confidently pursue their right to live a healthy, boundless life.
