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Getting to Zero: What Stands in the Way?

November 15, 2012

Getting to Zero: What Stands in the Way?

For the second year in a row, the theme for World AIDS Day is "Getting to Zero" -- a daunting call to action that HIV/AIDS leaders have taken on as a goal to tackle within a decade. For World AIDS Day 2011, we asked people living with HIV/AIDS and advocates to share what steps they thought were needed to reach zero new HIV cases, zero deaths and zero HIV-related discrimination. This year we're turning the tables: After several decades of awareness, education and research, what factors keep this reality out of the world's grasp?

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Nelson Vergel

Nelson Vergel

Program for Wellness Restoration, Houston; Diagnosed in 1986

More than 65 percent of new infections come from people who infect others and do not know their own status. Stigma drives denial, so many people are afraid to get tested and if they test positive, many are afraid to seek care due to fears of disclosure. Young age also makes people feel invincible, so they do not think they can get HIV. Social pressures on women in some countries make it difficult for them to protect themselves. And condom-free sex feels good and does not require money to buy a condom. I seriously doubt that we can dramatically decrease infection rates. That is why we need a cure or a preventive vaccine.

Michelle Lopez

Michelle Lopez

Brooklyn, N.Y.; Diagnosed in 1991

We are struggling to really address the issues surrounding stigma and discrimination. We as a people need to accept people for who they are, and be nonjudgmental, and not use someone's status to define who they are. We should be able to allow people to be who they are, and embrace people for who they are. We are still very far away from zero, because we are not doing those things. We are still very far away from getting to zero new infections. We have to be able to allow the gay man to be who he is; we have to be able to allow the gay youth to be who they are; we have to be able to allow a person who is an immigrant, because that's the population that I identify with, I'm an immigrant, and I've been living in the U.S. for the last 29 years. Eventually, I do want to go back to my island in the Caribbean, Trinidad. The Caribbean is at least 15 to 20 years behind the progress we have made today in the United States as far as HIV. So, globally, if we want to impact the stop of this disease, we have to be able to address these social issues, and stop sweeping these issues under the rug, because it's uncomfortable for some people to talk about it. We are way far away, and until we start addressing those things in a realistic manner, we are zero. We are zero on stopping these new infections.

Walker Tisdale

Walker Tisdale

Fulton County Department of Health and Wellness, Atlanta

Globally, I think it's a combination of barriers. Sometimes it's a lack of political will to devote the resources to combat this incurable illness. Sometimes it's combined with lack of individual will to be committed to prevention, to personal responsibility. Sometimes it is also a lack of passing down what we have learned from one generation to the next. And so, we can't afford to be complacent at all.

Jason Panda

Jason Panda

b condoms, New York City

A cure. The only way to get to zero is to make sure it's not happening anymore. Once we develop a vaccine, people will get it like chicken pox: You get vaccinated for it while you're a kid, thus you won't be exposed to it when you're a little bit older. If we're talking about really getting down to zero, I think prevention is always going to be part of it. But part of a comprehensive preventive approach is actually developing a vaccine so that we can no longer pass it person-to-person.

Christopher Ervin

Christopher Ervin

Aniz, Inc., Atlanta

The biggest barrier to getting to zero HIV infections globally will be the willingness to address those factors that presently put people at risk for HIV and will continue to put people at risk despite the advances in prevention and treatment. As the United States and the world experience another historic moment, come World AIDS Day there will still be economic uncertainty throughout the world that will hinder the research community's rapid development of the treatments we have envisioned, and limit the access for those living with HIV/AIDS to such treatments. These economic challenges will also affect prevention programs, so difficult decisions will be made on where to best target limited resources at the risk of causing unintended HIV incidence increases in communities left behind. Finally, we have begun to recognize housing, education, mental health/addiction treatment, and jobs are effective tools in the prevention and treatment of HIV/AIDS. However, throughout the world, we have yet to hear global leaders demonstrate sustainable commitments to provide these basic human needs to all.

Savannah Hornback

Savannah Hornback

NYSDOH Prevention Planning Group and Community Healthcare Network, New York City

There are individuals that are not at the decision-making table around HIV, from populations that are under-recognized and underfunded. Also, lack of funding, of course, and lack of health care coverage. One of the big ones is individuals who are positive and don't know their status.

Sherrie Burch

Sherrie Burch

Community Counseling Center of Southern Nevada, Las Vegas

The stigma of the disease. That it's only the bad people that get it. People don't disclose because of fear for their life, or fear for their jobs, fear of rejection, loss of money also. And, as far as globally, you've got people who are out in areas without access to HIV care or information that might not even know they're at risk.

Reggie Smith

Reggie Smith

Atlanta; Diagnosed in 1984

Well, I believe the biggest barrier to getting to zero, or getting back "home" like Dorothy wanted so desperately to do in The Wizard of Oz, is us not believing in ourselves, and in the inevitability of a cure for HIV.  It would also be a big deal to have an effective vaginal microbicide for people who refuse to or are unable to safely use condoms.  That way they would be empowered to protect themselves and the world from HIV transmission.  We are getting closer to zero, but these barriers don't help.




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