World AIDS Day is Dec. 1, a day when we recognize the impact of HIV/AIDS in this country and around the world. It’s a day to think about all those who have been lost, but also to recognize the medical advances that have been achieved in the past 10 years.
Today, many people living with HIV are able to take one antiretroviral pill daily and stabilize their health. Newly infected people who are treated promptly can anticipate a normal lifespan.
That’s a great achievement; however, living with HIV can be much more complex, especially when you face challenges from mental health or substance use disorders, poverty and homelessness.
At the Spahr Center, where we help people living with HIV/AIDS access health care, stable housing, behavioral health treatment and other services, we know that these folks will need our services for some time to come.
There is a clear path, however, for ending this epidemic in the long term.
We have always known that prevention is the key and with new medical approaches to stopping transmission, the end of AIDS is in sight. By taking a daily pill, called PrEP, people vulnerable to HIV can effectively prevent it. Further, the Centers for Disease Control is convinced that people living with HIV/AIDS who take their medication as prescribed and keep the virus at an undetectable level “have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”
Therefore, widespread testing and linking people to HIV treatment is obvious.
Navigating vulnerable people around the many barriers to getting on PrEP and supporting them to continue the medication will help them from even acquiring HIV in the first place.
Traditional interventions such as limiting partners, regular condom use and providing safe injection supplies are also helping lower infection rates.
The Spahr Center has been promoting healthy sexuality and operating Marin County’s syringe access site for over 30 years. Now more than ever, our syringe-access site is crucial in light of the growing opioid epidemic in our community.
However, it is doubtful that these methods of prevention alone will get us to zero new infections.
It is important that we tackle the stigma that surrounds the behaviors that lead to new cases. HIV infection continues, especially among young men and most often among young men of color, at an alarming rate.
The internalized shame and stigma felt from society by young people regarding their behaviors continue to be an obstacle. Young people will always push boundaries and experiment with substances and sex.
Stigma continues to get in the way of effective harm reduction, especially when decision-making skills have not been well developed.
And shame surrounding their activities will prevent them from asking for the health screenings and treatment from providers.
Stigma often gets in the way with providers who may not ask about sexual health or needle sharing behaviors in their offices or exam rooms and thus miss an important opportunity.
But the impact of stigma and shame are the most important within the family. Having an understanding and supportive family is the greatest variable in the prevention equation.
This is as true for HIV prevention as it is for suicide prevention or binge drinking. Having a parent or parents who are open to listening and who can accept their child, even if they aren’t comfortable with their actions, will do more to end stigma and to ending this epidemic than any test or pill.
Talking and nonjudgmental love is the best prevention strategy we have. By reducing and hopefully ending stigma and shame, we can attain a world without new HIV infections and, in a generation, a world without HIV/AIDS.
Only then can we declare World AIDS Day to be a day of remembering, but also a day of true celebration.
Andy Fyne is the prevention and testing manager at the the Spahr Center in San Rafael.