The Good the Bad and the Ugly: AIDS 2014

As with most things in life, the 20^th International AIDS Conference (IAC) and its associated events, were full of “highs,” but neither void of the “lows,” nor the “really lows” for that matter. Here I’ll recap the good, the bad, and the ugly of the 2014 Ecumenical Advocacy Alliance (EAA) Interfaith Preconference and International AIDS Conference based solely on my opinion as a three time participant of both events.

The Good

The Interfaith Preconference brought together the world’s foremost faith leaders in HIV and AIDS to address what most faith groups are reluctant to discuss: faith, stigma, sex, and HIV. The preconference had representation from the Jewish, Buddhist, Christian and Hindu communities but also offered a high level panel discussion in conjunction with the Catholic Preconference, which included the likes of Dr. Luiz Loures and Dr. Deborah Birx. To conclude the Interfaith Preconference, the EAA highlighted the voices of young adults for the first time in my history of attending, which is a move in the right direction for faith communities and the HIV and AIDS discussion in general.

The 20^th International AIDS Conference had its highlights as well. With headliners in the field of HIV medical research abound, the latest advances in the fight to end AIDS were brought to the stage; information presented publicly for the first time in some cases. Government dignitaries were present, most notably Bill Clinton who has been a regular at IAC and a faithful partner in the AIDS epidemic vis-à-vis The Clinton Foundation. He delivered a well scripted report of the work of the Foundation and subsequent progress in the quest to end AIDS, encouraging the international community to redouble its efforts in the fight as we are closer than we’ve ever been to getting to zero. By my assessment, there was far less science and far more social justice focus during AIDS 2014, which I see as a benefit to the majority of stakeholders in the AIDS epidemic: people living with HIV, and advocates – mostly people who are not medical science professionals. This shift in attention can be seen as the International AIDS Society’s (IAS) realization that we now have the science to treat HIV, and must concentrate more on treating people by reducing stigma, changing behaviors and altering attitudes. I was delighted to see workshops addressing gender based violence, criminalization of high risk populations, HIV in prisons, and even a workshop focused specifically on men who have sex with women (a joke was made that this was the first time a workshop was held for men who have sex with women given the high rate of HIV transmission among men who have sex with men (MSM) and subsequent increased attention). As a faith representative I was equally pleased to see 8 faith related workshops during the main conference, the most since my participation in 2010 and 2012, and if I had to guess, probably the most ever.

The Bad

Although the world’s foremost faith leaders in HIV response were present at the Interfaith Preconference, they were the same leaders who’ve been out front since my introduction to the faith and HIV arena. If this was your first experience at such a forum you left encouraged and excited about what you were hearing from the faith community, but if you’ve been doing the work for a while, you realize there have been few new voices added to the conversation over the years. The dialogue held before each IAC around faith and HIV creates the illusion that faith ambassadors around the world are truly stepping up as the preconference theme, “Stepping up in Faith” suggests, when in reality there is a minority of committed leaders consistently engaged in the work. This is no fault of the EAA or those who continue to be present, but a testament to how far we’ve come by faith, and how much farther we still have journey to fully integrate our churches, synagogues, temples, and mosques in the conversation on HIV, faith, sex, and stigma. Likewise, despite the efforts of the EAA to highlight the voices of young people in the closing plenary of the Interfaith Preconference, young voices are largely absent from the faith +HIV dialogue as are new voices. The Evangelical Lutheran Church in America (ELCA) has consistently been well represented during the preconference by its young adult delegation, often supplying the full complement of registrants under the age of 30. This year the Young Women’s Christian Association (YWCA) also had a substantial presence of young people, but 2 organizations out of the many in the world is a poor representation of the quarter of people living with HIV and AIDS in the world under the age of 30. Again this is not an issue for the EAA to solve, rather a deeper issue of the faith community’s need to engage youth and young adults more intentionally.

The main blemish on the face of the IAC was the host continent: Australia. While the city of Melbourne itself was a wonderful host, Australia was a difficult destination. It’s an expensive trip, and participation suffered as a result. But that’s out of Australia’s control, so no harm no fouls. What is within their government’s control is the process in which citizens of visiting countries may enter into Australia. The IAC normally averages an attendance upwards of 20,000 people, but this year’s registration fell well short of that number at only 12,000 participants. Again, the distance and cost of the trip was part to blame, but at a conference where African Nationals are sometimes the largest demographic present, the process under which African Nationals were required to undergo in order to be granted travel visas to Australia, was prohibitive. Anyone not an Australian citizen is required to have a visa to visit Australia. As a U.S. citizen, the process for me involved filling out an online application that took all of five minutes, resulting in instant approval of an electronic visa that did not require me to leave the comfort of my home to visit an Australian embassy. However, African Nationals interested in traveling to Australia had to go to Johannesburg, South Africa to receive their visas. If you are familiar with the continent of Africa, you understand that travel to Johannesburg isn’t logistically or economically feasible for citizens of countries outside of South Africa. Those African Nationals who might have had the means to travel to Joburg still had to deal with the high possibility of being denied a visa. Therefore many African Nationals who intended to attend AIDS 2014 were not able to do so due to a prohibitive process for entry into Australia. I spoke with many Australian citizens about this and they noted this to be a black eye for a country trying to shed its xenophobic reputation. The bright side: AIDS 2016 will be in Durban, South Africa where I anticipate a rebound in African and international participation.

The Ugly

The Interfaith Preconference also suffered from the challenges of journeying to Australia. What usually is a participation of 250 or more registrants, the Interfaith Preconference boasted a registration of roughly 100 people; but that wasn’t the main concern. Of those 100 or so participants, nearly all of them were of Christian faith; not very interfaith for an Interfaith Preconference. Nonetheless, between the preconference, interfaith worship service, and faith track during the main conference, we managed to hear from the Jewish, Buddhist, Christian, Islam, and Hindu communities either by direct representation or by proxy.

By far, the lowest moment of the IAC happened before the conference even began in the skies over the Ukraine/Russia conflict zone when flight MH17 was downed by a missile fired as a result of what’s believed to be mistaken identity. We quickly learned that many of the passengers on the plane were delegates headed to Melbourne for the IAC, including world renowned HIV expert and former IAS president, Joep Lange. Needless to say this sad and unfortunate event completely changed the tone of a conference that otherwise gathers every two years to celebrate life. The impact was felt right away during the opening ceremony that usually has the feel of an international party, but felt more like a memorial service as moments of silence, tributes, and solemn song were abundant. Many of the persons lost were not only colleagues of those present, but close friends of a lot of the keynote speakers. Throughout the week, each speaker appropriately honored their colleagues in their own special way, sometimes including personal photos with the victims in their presentations before sharing their research. While lives were lost to the lament of the AIDS community, years of knowledge in HIV and AIDS research was lost to the world. Ironically, Ukraine/Russian has the highest rate of new HIV infections in Eastern Europe and Central Asia, and the solution to their fast growing epidemic may have been lost in their blunder. To say the least, a grey cloud hovered over the Melbourne Exhibition Centre during the IAC, but the IAS did its best to honor the lives of those lost in a way they would be proud of; by carrying on with AIDS 2014 in spite of the tragedy, because the best way to honor them, is to continue the work they began.

El Fin

Doctors have a saying: “If there are no ups and downs in your life, it means you are dead.”

The 20^th International AIDS Conference and its associated events were not short of ups and downs, but life was present all around us, even in the wake of death; people LIVING with HIV, not dying. HIV and AIDS is no longer a death sentence, and even as many died trying to advance the work being done in the field, millions more will live as result of their sacrifice. AIDS 2014 was much more than a medical science conference; it was a gathering to celebrate humanity; a time to not just focus on HIV treatment, but people treatment; an opportunity to not just share the statistics, but to share the stories. AIDS 2014 was about “Stepping up in Faith” and “Stepping up the Pace,” leaving no one behind in the fight against AIDS. I look forward to continuing the good fight at AIDS 2016 in Durban, South Africa.

Australian Places

Melbourne, Australia is a wonderful place to visit because it is convenient for people to get around. One place people should check out is the Victoria market because it is the cheapest place to buy things and have fun. Another place to see is the Eureka sky deck because it has amazing views of the whole city.

A View from Outside

by Karin L. Klingman, an infectious diseases physician, member of Lutheran GrACE, and Christ Lutheran Church, in Washington, DC.

I had the opportunity to spend some time with the ELCA Youth Delegation while I was attending AIDS 2014 in Melbourne for work. I was also involved with fund-raising and organizing the travel of 2 of the youths who were sent from the Metro DC synod—one was sponsored by the ELCA and one by donations from the DC area churches raised by Lutheran GrACE (a group of DC area church members who are working to end HIV stigma, and to make churches a more welcoming for HIV positive and HIV at-risk people). Both young men were great additions to the delegation. They are both volunteers at Youth Haven, a camp for HIV affected and infected children and families sponsored and run by Lutheran Social Services of the National Capital Area. 

The ELCA Youth Delegation was a thoughtful and eager group who wanted to learn and interact with almost everything that AIDS 2014 had to offer—the researchers, the policy makers, the drug company representatives, the community activists, and the NGO workers. The conference challenged all of us to rethink our priorities and our prejudices. It was a call to action. The conference theme was “Stepping up the Pace,” a call to redouble our efforts to end the AIDS pandemic. This is within our grasp—most experts agree with this assessment. Only it will, like solving all problems, take commitment. And the HIV community, from researchers to activists, to people living with the disease, see the wills of our governments and our communities, especially as reflected in funding support, flagging. As a researcher said at one meeting I attended, our leaders and societies “have moved on.” The window for solving HIV is narrow. Now is truly a “tipping point.” If we “bend the curve” now, we can end this sooner, rather than later—within a generation. If we wait, if we prevaricate, even 5 years, the disease will have spread too far to be easily bendable, curve-wise. 

The other “tag-line” at the conference was “No one left behind.” This concept recognizes that HIV incidence and prevalence are highest in marginalized populations in whatever society or country you are talking about. Only by addressing the epidemic in these populations will we succeed in ending this disease. The marginalized are stigmatized and vulnerable, and include drug users, sex workers, LGBT people, the poor, and minority groups, including indigenous populations and prisoners. HIV concentrates in these most vulnerable populations and people. Marginalization and stigmatization impedes access to diagnosis, treatment, and other resources making it hard to have an impact on the HIV epidemic in these populations. More than biomedical interventions need to be deployed in order to solve the HIV epidemic; we need to end discrimination, create opportunities for women, girls and others, and provide more primary and secondary education. The conference presenters in various sessions called us to become more inclusive of these ignored people. When I hear calm and rational biomedical scientists utter words and concepts like this, I marvel. 

Then I wonder, where is the church in this? Isn’t this the church’s mission, to bring everyone home to God, into experiencing a community of caring and love? Where are our hands in this part of God’s work and fulfilling his Word? With the church, HIV can be ended faster, and it could happen with more healing to individuals and societies. Without the church, the problem of HIV will still get solved, but it will take longer, require more resources, and more suffering will happen until we eventually get there. If the church wants to be relevant, we should heed this call to this mission. I think the youth delegates heard this call. I think they understand the urgency of this call. I think ending the HIV pandemic is a call they think the church should answer.

Ignorance and Misinformation Keeping HIV/AIDS Alive

Most people probably know that HIV can leads to AIDS, and that AIDS is something that can make you very sick. While there is currently no cure, there is medication that can fight the virus and allow those living with it to live healthy lives. HIV stands for Human Immunodeficiency Virus; it is a virus that affects the immune system by destroying immune system cells that help the body fight off bacteria and viruses. AIDS stands for Acquired Immune Deficiency syndrome which is classified when the virus destroys a certain number of immune system cells. There are common misperceptions about the way this disease is spread. HIV/AIDS is commonly spread through unprotected sexual intercourse, exchanging needles, and mother to child transmission during birth/breast feeding stage. HIV is not spread through “feces, nasal secretions, saliva, mucus, sweat, tears, urine, or vomit unless these are contaminated with blood.”

Medication exists called Antiretroviral therapy (ARV) that “reduce the ‘viral load’” (HIV virus in your blood). An HIV positive person with a low viral load has about the same life expectancy as someone without the virus. This doesn’t mean the virus is gone, it’s just suppressed and the chances of passing it on to another person is greatly reduced. Sadly, in some parts of the world this medication is not available for the people who need it.

If there is medication that can help an HIV positive person live healthy, then why is it that people don’t get tested. The answer is due to the stigma surrounding HIV and AIDS “AIDS stigma has been further divided into the following three categories:

Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.
Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.
Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use. In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice, such as anti-homosexual/bisexual attitudes. There is also a perceived association between AIDS and all men who have sex with men, including sex between uninfected men. However, the dominant mode of spread worldwide for HIV remains heterosexual transmission.”

Religion also plays a huge part on the stigma associated around HIV/AIDS. Some churches condemn the use of condoms. Some believe HIV/AIDS is only acquired through infidelity. Some believe it only affects the gay population and that HIV is God’s way of ‘punishing them for their sexual behavior’. “Some religious organizations have claimed that prayer can cure HIV/AIDS. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths.

Cure research has picked up significantly in the last 20 years, however, as of today no cure for HIV/AIDS exists. In the meantime, if a person engages in safe sex and HIV testing it is possible to prevent them from acquiring HIV. If a person is HIV positive, it is no longer a death sentence, that person can go on to live a normal healthy life. All this information isn’t secret, it was obtainable through a basic Google search. I believe HIV/AIDS is beatable, ignorance on the other hand, I have my doubts.

R.Adkins

Sources:
Kripke C (1 August 2007). “Antiretroviral prophylaxis for occupational exposure to HIV.”. American family physician 76.
Herek GM, Capitanio JP (1999). “AIDS Stigma and sexual prejudice” (PDF). American Behavioral Scientist 42
Sharma, A.K. (2012). Population and society. New Delhi: Concept Pub. Co. p. 242
Sharma, A.K. (2012). Population and society. New Delhi: Concept Pub. Co. p. 242.
Herek, GM; Capitanio, JP; Widaman, KF (March 2002). “HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999″. American journal of public health 92
Church HIV prayer cure claims ’cause three deaths'”. BBC News. October 18, 2011
(http://www.thebody.com/content/art6114.html)

The Main Event

Attending the 2014 AIDS Conference was so amazing because I learned so much during the workshops and exploring the global village. One of the workshops I attended was titled: “Curing HIV.” It was exciting because there’s so much research behind medicine to reduce the infection of HIV and that makes me happy.

I liked the global village the most. There were so many organizations promoting information and other good things to end HIV/AIDS. This experience has changed my life and I’ll never forget it.

Out Front: A Call to Action for U.S. Churches in the HIV/AIDS Response

The closing plenary of the EAA Interfaith Preconference of the 20^th International AIDS Conference featured young adult voices in the fight against HIV from different contexts around the world. Panelists included a young woman from India who is living openly with HIV and a young man from Togo who is an actor and peer educator in the reduction of HIV in young men who have sex with men (MSM). I had the pleasure of joining them as a representative of the United States context where I talked about the tasks of the Christian Church in equipping ourselves for the HIV/AIDS journey beyond 2015.

If the Church is to remain relevant in the fight against HIV in the United States and in the world, the Church must improve its outreach to youth and young adults. It’s no secret that Millennials are all but absent from the Church, not because young people don’t believe in God or don’t desire a connection with something or Someone higher than themselves, but because the traditional Church has failed to reconcile its 2000 year old theology with the present day context and realities that Millennials struggle to navigate. The inclusion of youth and young adults in the Church not only is imperative for the survival of an aging institution, but it’s paramount in the Church’s efforts to end AIDS because HIV is reality for young people in the United States and in the world.

In 2014, HIV and AIDS is a reality for 1 in 4 young person’s age 13-24; expand the age range to 29 and the number increases to 1 in 3. Young people are at particularly high risk of HIV infection for a number of reasons including but not limited to: sexual discovery, drug and alcohol experimentation, unprotected sex, and lack of sex education. The equation of immature sexuality under the influence of state altering substances with insufficient education on how to protect one’s self = increased susceptibility to HIV infection. The Church can be and should be a first responder in addressing these challenges in the development of young people, however the Church cannot minister to or intercede on the behalf of a generation of people it does not have access to. So, if the Christian Church is to continue to have a foothold in the fight against HIV/AIDS in the United States and in the world, the Church much address its antiquated presence in the present day context of youth and young adults, especially as it relates to sex and sexuality.

Sex and sexuality have long been taboo topics within the Church, yet both are inextricably linked to HIV/AIDS. Therefore the Church must engage in healthy dialogue about sex and sexuality if it is to endure in the HIV and AIDS journey beyond 2015. The Rev. James B. Nelson explains in his book ‘Between Two Gardens’ that, “Sexuality and spirituality are inseparable elements of full personhood…” One cannot exist without the other and qualify as the wholeness of the body of Christ. Sexuality is a gift from God. Likewise one cannot discuss HIV and AIDS without discussing sex and sexuality because both/and make up the wholeness of the epidemic. The gift of HIV to the Church is that it has forced us to deal with the deafening silence on sex and sexuality in communities of faith. If HIV was cured today, the Church would still be mute on sex and sexuality, tomorrow. The Church must utilize this opportunity that HIV has given, to discuss the theology of homosexuality, for example, by studying the history of our religious texts, understanding the context under which the text was written and the people the text was written for; then use that bible study to inform conversations around homosexuality in today’s context. Such dialogue allows the Church to equip the next generation of theologians for the HIV and AIDS journey beyond 2015.

The Church would then be in a better position to minister to the demographic most affected and infected by HIV in the U.S.: men who have sex with men, specifically young MSM of color. Many mainline denominations in the States have a long standing history in delivering HIV services internationally, however domestic provisions have been few and far between. Black Churches in particular have been limited in the HIV/AIDS domestic response largely due to stigma and lack of resources. Unfortunately, the few inclusive Black led faith based HIV/AIDS capacity building organizations that had resources have been shut out for the next 5 years, as no Black led ASO or CBO was funded by the Centers for Disease Control for the next cycle. Considering the rate of HIV infection among Black Americans, and understanding the importance of cultural competency when providing services to a target population, Black Churches and faith based organizations are left to depend on each other for assistance. If the Church is to maintain a meaningful presence in the HIV response, it must truly become “Church;” collaborating and participating in ecumenical resource sharing that recognizes the value in community healing, and ignores the differences in denominational doctrine.

Someday HIV will be eradicated in the United States and in the world, and the question will be asked: Where was the Church in all of this? Will they say we were failing to reach youth who desperately needed guidance and grace? Will they say we were too busy arguing over how God feels about homosexuality, while millions of people died? Will the story be that we had all the resources and skills necessary to reach those most impacted by the disease, but failed to work together as one Holy Communion? Or will they say people of faith were there from the beginning to end? I choose the latter. The end of AIDS is in front of us, and I believe the faith community will be a key role player in its finale; so long as we can leave behind our collective differences, and get behind our united front: life, and life abundantly. End AIDS.

Snapshots!

Stepping Up in Faith. We as faith communities are crucial in reaching the end of AIDS.

These guys are golden.

Inspiring women from YWCAs around the globe.

Stephanie, the photographer!

Just a quick (chilly!) walk from our hotel to the Convention Centre. Laughing keeps the cold away.

We made it!!

The ELCA Young Adult Cohort with Karin from Lutheran Grace.

The ELCA young adult cohort with our ELCA colleagues Rebecca Duerst and Chandran Martin. So great to make connections!

Opening plenary session with a few of our closest friends.

The lives lost on flight MH17 were memorialized and celebrated often through the week.

We laugh and we cry…the best ways to create friendships!

Melbourne all lit up!

TOO excited to eat Nando’s — something we both ate often as YAGM in South Africa.

Interfaith worship service.

Interfaith worship. So beautiful and necessary!

Waiting waiting waiting to see President Bill Clinton address the conference!

Smile, Bill!

Rev. Phumzile Mabizela of South Africa. Living openly positive, and passionately calling communities of faith to act out loud in the fight against AIDS!

Rev. Phumzile Mabizela with the amazing Christine. Her wisdom just pours…

Social media takes teamwork. Sharing the story is so important!

Conversations facilitated in the “Faith Zone.” So many great, challenging questions about what we are up to in this world!

So inspired by both of these passionate leaders.

Oh, hey Steph!

Adventurous, hilarious, and thoughtful —- you just never know what Elishua will do next. What a joy it is to be in his genuine loving presence. He will see and change this world!

Courageous, sensitive, motivated, and going to do great things. Richard’s big heart will lead him to inspired action.  I know that I am following his lead.

Nothing says decompressing long days of sessions like a night at the Night Market and Silent Disco!

Sillies.

And we still have one day left!!

Many thanks again to those who are lifting us up in prayer now, and will continue to support us through our various journeys of fighting for social justice and loving all of God’s people.

Catching Up: Reflections from Kenya to NYC

Attending the International AIDS conference takes me back many years to the days of my youth. I was trained to become a peer educator on HIV/AIDS and Behavior Change in my Church. However, challenges and complexities of HIV/AIDS demanded a more comprehensive approach to poverty related issues. This epidemic has touched every family in Kenya. The church had no choice but to respond.

Those days, fear and stigma were so high no one dared to come out. We trained other youth and slowly came up with a team in each congregation that was dedicated to raising awareness about voluntary counseling, testing and prevention.

We have come far. Today, churches are at the center of the HIV/AIDS response. While HIV continues to affect families and communities, there are now many congregants who have come up openly about their status and are examples of people living positively with HIV in Kenya.

We still have far to go. It is hard to be here because I am reminded of David, the first person who ever dared to disclose his status during a Sunday service in my congregation. He dedicated his life raising awareness and advocating. He lived with the virus for almost 20 years. I am also reminded that despite my many years of peer education, close family members have died of AIDS; they discovered their status too late. I have sometimes blamed myself for failing to do enough. My reality though is that many of my relatives have no access to healthcare and others live far away from clinics that can do the diagnosis and offer lifesaving ARVs. Others are afraid of being stigmatized.

It is good to be here because it reminds me of the work that still needs to be done to fight stigma and discrimination, gender inequality and the many other social drivers of the disease. I am currently living in New York. During the day, I am surrounded by the UN, and affluence that Manhattan brings. One can almost be forgiven for forgetting about HIV/AIDS. In the evening, in the Bronx, surrounded by ordinary daily life – I still do not see the face of HIV, maybe because I do not know my neighbors, but I see glimpses of poverty and the burden of race, and racial discrimination.

The silence on HIV/AIDS in my little world is very loud. The US statistics are very loud. I keep asking myself why the silence? Is it ignorance? Is it indifference?

The reality is divorced from the response. Is it because of who is most affected?

The theme of the AIDS conference is Stepping up the Pace. A lot is being said about who is left behind. Who is missing? Who is not feeling welcomed in our communities’ response?  And in our pews? Is our theology one that empowers the discriminated and excluded?

So, I am here again (this is my third AIDS conference, I have been co- leading delegations of young adults for the last three conferences). I have many questions. I am here to educate myself; to catch up with the rest of the movement; the science (that is promising and challenged, as the search for a vaccine and cure intensifies). I am here to remember those we have lost to AIDS. I am here to celebrate the many that are living positively with HIV, to be in solidarity, to remind myself of my own vulnerability, to re-energize, to continue being hopeful that we will get to the three zeroes, and that an AIDS free generation is possible. I am here to celebrate life and dreams.

I am excited because we have an amazing delegation of young people who are attending the AIDS conference for the first time. Their energy and hunger to learn, but also their leadership is infectious. I am privileged to learn from other fellow ELCA and LWF colleagues. It is also affirming to be part of the faith community and hence am mingling and getting to know efforts of other faith communities. I am also keeping an open mind and mingling with groups of people who challenge me because they are “different” from me. I am listening to their stories and understanding their rage at us people of faith because we are still struggling to be inclusive and accepting of all God’s people, the way they are.

The call to all faith communities is to be inclusive and reach out to all, including the key populations; to show love, compassion and join others in stepping up the pace. We are called to be outraged by the lack of urgency in scaling up treatment to all people still waiting to get on life saving treatment. High prices for drugs, patent fights and putting profits first all contribute negatively to the fight against HIV/AIDS. We are also called to examine what we are doing, or not doing at all, in our communities.

Above all, I am here to cry, laugh and build networks and friendships that go beyond the conference. I am reminded everyday how beautiful the world can be if we all can be our sisters’ and brothers’ keepers.

So, look around you, join the movement of care, support and advocacy. You are needed now more than ever!

How the West Was Lost

The 20^th International AIDS Conference (IAC) is the largest gathering of clinicians, scientists, activists, advocates, journalists, government officials, and people living with HIV in the world, to address the global pandemic of AIDS.

Historically, this event has been heavily attended by African Nationals, with registration of African Nationals sometimes accounting for half of the total participation at the IAC; and rightfully so. Africa accounts for 25 million of the 35 million people living with HIV, equaling 71% of the epidemic worldwide. With 10% of the world’s population, 20% of the world’s overall health burden, but only 3% of the world’s healthcare providers, Africa is heavily burdened by malaria (#1 most deadly disease in Africa), tuberculosis, and HIV/AIDS with an inadequate supply of care to address this massive burden. As one result, Sub-Saharan Africa accounts for 8 of the top 10 countries in the world with the highest number of people living with HIV.

India ranks 3^rd, which probably isn’t hard to believe considering AIDS is largely a disease of poverty, with 30 million of the 35 million people infected globally being of low to middle income countries as are India and Africa. What you may, however, find hard to believe is that the United States ranks 9^th in the world in number of person’s living with HIV; the only high income country to make the top 10. When we think about disparity of any kind within the global village, the narrative almost always lies in the gap between the “haves” of the global north and west and “have not’s” of the global south. Thusly, it’s natural to never consider the United States in discussions associated to poverty, disease, civil unrest and any other social ill when compared to the rest of the world. Unfortunately the HIV epidemic in the United States is not one we can afford to lose in the midst of the larger global pandemic, or for that matter – in the midst of the largest gathering for HIV and AIDS in the world, the IAC.

An estimated 1.3 million people are living with HIV/AIDS in the U.S. with approximately 50,000 new infections and 18,000 AIDS related deaths annually, totaling ~619,500 deaths since the beginning of the HIV/AIDS epidemic in the early 80’s. Injection Drug Users (IDUs) account for 8% of new cases of HIV infection and 16% of people living with HIV in the U.S., but primary transmission remains to be through sexual intercourse, predominately among men who have sex with men (MSM) at 63% of new infections and nearly half of all persons living with HIV. Furthermore, HIV not only affects MSMs at an alarmingly disproportionate rate, but new infections are overwhelmingly among blacks who make up 44% of all new infections and people living with HIV/AIDS while only accounting for 13% of the total U.S. population.

Much has changed since the discovery of AIDS in 5 White homosexual men in the summer of 1981. The face of HIV in America is now Black America. The Black AIDS Institute reports that if Black America were its own country, it would rank 16^th in the world in HIV/AIDS cases, ahead of Ethiopia, Haiti, and Botswana – a country that once had the highest prevalence of HIV on earth. This largely explains the United States’ position in the world as a leader in the number of people living with HIV. 4 key factors contribute to the epidemic among Black Americans:

1. High prevalence of HIV: Blacks are more likely to be exposed to the virus because of the existing heavy burden of HIV in the Black community where intra-racial partnering is the highest among ethnic groups (Blacks are more likely to partner with other Blacks)
2. High prevalence of Sexually Transmitted Infections (STIs): Blacks are more likely to be infected with other sexually transmitted diseases which increases the susceptibility of HIV transmission.
3. Stigma: There is an innate distrust of the healthcare system among Blacks (Tuskegee Experiment) limiting the interactions between Blacks and access to HIV prevention, testing, diagnosis and treatment. Homophobia is pervasive in the Black community where MSM are 51% of new infections among blacks and 73% of new infections in black men, stigmatizing a key population from knowing their status and seeking treatment.
4. Social determinants: High rates of poverty, lack of access to healthcare, racial discrimination, incarceration, and illiteracy persist in Black America and drive a raging epidemic throughout the American African diaspora.

How then was the West lost? The United States has been a leader in funding the fight against HIV globally, but has failed to take care of home first, before saving the rest of the world. One of the badges being distributed by activist groups at AIDS 2014 reads, “Save us from the savior;” in this case the United States. We are at a critical tipping point in the fight against HIV and AIDS worldwide, but whether or not the momentum tips backward or forward, hinges upon our ability to leave no one behind as stated by the IAC sub-theme. That also goes for the millions of people living with HIV/AIDS in the United States.

Words of wisdom from a flight attendant: “Secure your own oxygen mask first before assisting others.” Words to live, and die by.

let me tell you a story…

This 20th International AIDS Conference is far more complex than I expected it would be. It’s been overwhelming to take it all in, and it’s my challenge now to chew it up and spit it back out with meaning. Coming into the week, I knew I had a lot to learn. I knew that my familiar context was far removed from the event that I was headed to. But I had no idea just how narrow my perspective of HIV/AIDS was. I swear I’m not just being dramatic when I say that my mind has been blown.

My capacity to understand scientific lingo has been exceeded.

The little I learned in nursing school about the mechanism and action of retroviruses has felt like not nearly enough.

My limits of extending compassion to every child of God have been pushed.

And probably most difficultly, I have realized that I need not see myself so far removed from the fight against HIV/AIDS.

This is big stuff. And if I can be honest…I am both thrilled and frightened to be mixed up in it. The assumption I made that, ‘my familiar context is far removed from where I was headed’ remains true. My eyes have been opened to the complexities of the disease; I have felt drowned in the statistics and research findings; I cannot relate on a personal level to the experiences of people living with HIV…I was far removed.

But emerging through each of the facts that feel far away and the statistics that are difficult to wrap my mind around — are the statements like the ones I (loosely) quote below:

“I could tell you the facts, but I’d rather tell you the story.”

“I have no Power Point presentation, because I will be speaking from my heart.”

“Any person can present numbers, you must combine story telling with vidid insight.”

“We have been great at presenting the statistics, but not collecting the emotions.”

“We will be the first to be locked out of heaven if we judge them, just because we don’t understand.”

These are the soundbits that have shot right past the facts, and have drawn me in closer to the humanness of the virus. I got a small, personal glimpse of HIV/AIDS during my time serving with Young Adults in Global Mission in South Africa. But I have realized that there is much more to the story. This conference gives voice to some of the groups who are most affected by HIV, and are also most discriminated against by society. Sex workers, same-sex loving couples, people who inject drugs, transgender, and women in poverty have powerfully shared their stories; and all seem to agree that they just want to be heard and treated with dignity.

The science is rolling forward and the pharmaceutical companies have the capacity to create enough treatment, and (maybe it’s embarrassing to admit I have only this week learned that) a CURE IS POSSIBLE AND ON ITS WAY. But in order to get to the end of this, we must listen to the stories of those who are left behind. We must advocate for those who are seen as less-than. We must follow the lead of individuals who are affected, not always those with the power.

As the ELCA, we state that we are “Marked with the cross of Christ forever, claimed, gathered and sent for the sake of the world.” So, what can we do to speak up for the sake of those who don’t have a voice? What would it look like to live up to our claim that “all are welcome at our tables?”

AIDS is not only a biomedical issue, but is an issue of human-rights and social justice. I hope that you are just as thrilled and frightened as I am to realize that as a church, we better see ourselves mixed up in this.