30 Years Is Enuf

This report by the Black AIDS Institute marks the 30th anniversary of the first official report on the emergence of the HIV/AIDS epidemic. Over three decades, AIDS has radically altered our world, reshaping entire regions of the world, changing people's relationship with their own sexuality, dramatically accelerating social and cultural change, and producing some of the most important scientific advances of the last century.

No single report can possibly address all the various ramifications of the epidemic's first 30 years, and this one certainly does not attempt to do so. Rather, this report aims to provide a degree of context to our understanding of the epidemic, using the 30th anniversary as an opportunity to reflect on what we have experienced and to understand both the challenges and the opportunities that will face us in the future.

The report, titled 30 Years is Enuf, includes the following:

• A brief historical overview of the first 30 years of AIDS, including a timeline of key events and a report card for the American presidents who have overseen our national response;
• Personal HIV-themed essays from 30 people under age 30 explore some of the ways that AIDS has affected both our world at large and our own individual lived experiences;
• Key findings from a consultation with several long-term survivors of HIV infection, sponsored by the Black AIDS Institute;
• Profiles of current and emerging leaders in Black America's response to AIDS, including leaders in government, traditional Black institutions, AIDS advocacy, and the media;
• Major new scientific advances that may hold the key to eventual efforts to end AIDS.

As a new decade in the AIDS fight dawns, prospects have never been brighter for an actual end to the epidemic. In 2010, a South African research team reported results from the first study to find that a vaginal microbicide was effective in reducing women's probability of becoming infected. Outcomes from a separate study also found that pre-exposure prophylaxis significantly reduces the risk that gay men will become infected, with especially strong protection seen in men who carefully adhere to the daily prophylactic regimen. In May 2011, it was announced that a federally-sponsored trial found that early antiretroviral therapy reduced the likelihood of HIV transmission by 96 percent in comparison to later initiation of treatment.

Altogether, these recent results suggest that it is reasonable -- indeed, imperative -- for us to begin thinking about an "end game" for AIDS, although it's equally critical that we acknowledge how many major opportunities we have failed to seize over the course of the epidemic.

Capturing the potential of these new prevention technologies will demand radically new ways of doing business. Closing racial and ethnic disparities in HIV-related health outcomes will demand major new investments in treatment literacy and advocacy programs in Black communities. Concerted efforts are also required to address the access barriers and other factors that impede favorable health outcomes in Black communities. And leadership will be critical to achieve substantially greater success in the AIDS response in Black America.

The Black AIDS Institute offers the following priority recommendations:

Build strong and durable treatment capacity in Black communities.

• Make major investments in HIV treatment science education in Black communities.
• Create a national network of AIDS treatment advocates in Black America.
• Establish a national network of HIV centers of excellence in Black communities.

Sustain and strengthen the national AIDS response to capitalize on historic new opportunities to end AIDS.

• Maintain and increase funding for AIDS.
• Take immediate steps to eliminate all AIDS Drug Assistance Program waiting lists.
• Ensure that AIDS funding follows the epidemic by targeting spending to those who need it.
• Fully implement the Affordable Care Act.
• Take immediate steps to introduce new prevention tools.
• Invest in operational research to inform implementation of innovative new programs to capture the potential of treatment-as-prevention.
• Continue and strengthen investments in HIV prevention and treatment research.

Create a single, comprehensive service continuum for HIV.

• Merge the federal response into a truly unified approach, integrating prevention and treatment with streamlined reporting a single locus for accountability.
• Planning for treatment and prevention services must be merged at the local level.
• Innovative operational funding and capacity-building support should encourage cross-fertilization of expertise and best practices among local service providers.
• Health care providers should be adequately reimbursed for a comprehensive array of prevention interventions, including HIV testing and counseling as well as diverse uses of antiretrovirals.
• Monitor HIV results.

Pursue innovative strategies to market and promote HIV testing and treatment.

• Undertake mass marketing campaigns to promote HIV testing and treatment.
• Mandate that all testing providers have strong and demonstrated links with HIV treatment settings.
• The offer of a voluntary, confidential HIV test should be made routine in a range of health, educational and service settings.

Ensure strong leadership on AIDS -- nationally, and especially within Black America.

• President Obama should deliver a major address specifically dedicated to the fight against AIDS.
• Every Black institution in the U.S. must develop and implement an AIDS strategy.
• Cultivate future AIDS leaders.