Reflecting on the History of HIV/AIDS

Today is World AIDS Day. It is time for us to reflect on the history of the HIV virus and how it has affected and changed our lives over the past three decades. It is also a time to remember those that have died because ARVs were not available or accessible, HIV testing was not available or accessible, and communities were not fully aware and educated about HIV/AIDS and how to reduce their risk and/or protect themselves. We now have no excuse for those HIV-infected to not know their status or not have access to life-saving ARVs. However, the lack of access to testing and medications still exists.

People, even in high resource countries like the US, are still unaware of their HIV status. Recent data in the US has shown that 20% of Americans living with HIV are not aware that they are HIV-infected[1]. Still in many countries, we know what to do to save lives and avert infections but political will and stigma still hamper these efforts. World AIDS Day is time for us to reflect on what we as a global family can do onward towards achieving a generation where no child is born infected with HIV, and no one dies from HIV. As the UNAIDS World AIDS Campaign beckons us to do, we must "Close the Gap." From my own personal experience, I saw how care and treatment practices evolved to close the gap and be people-centered.

During the late 2000s as a medical resident at a large academic teaching institution, I often admitted and covered HIV infected patients and those with AIDS.  Though much progress had been made in terms of availably of HAART and prophylaxis for opportunistic infections, we still had a large cohort of patients that came in at the latter stages of the disease and others that presented with complications of opportunistic infections but did not know their HIV status. This period was also around the time that PEPFAR started. My initial clinical experience in treating HIV was mostly marred by seeing patients that were bed ridden, some with TB, cryptococcal meningitis, and toxoplasmosis, who at times were not empowered or educated about HIV and the importance of taking ARVs and other related medications.

A few years later I moved to another academic institution in a city with HIV rates that rivaled some countries in sub-Saharan Africa. The one difference at this institution was that people living with HIV were part of the staff providing care, and educating patients, their families and providers in the community.  The program put patients at the center. Each patient that entered into this program was assessed and asked questions not only about their health but also about their support system and knowledge and attitudes about HIV, and taking ARVs. This information served as the basis to help educate and empower patients to be an active partner and participant in their care. Back then, there was no catchy buzz word like "people-centered care." It was the care necessary to ensure that patients were adherent to taking their medications and making lifestyle choices to reduce their risk of harm to themselves and their loved ones.

I currently work as the HIV lead for the USAID ASSIST Project. Through our current HIV portfolio with USAID ASSIST, URC has been supporting the World AIDS Day theme and the UNAIDS Campaign. Our programs focus on addressing gaps in healthcare delivery that affect quality and safety of services; ASSIST partners with host country Ministries of Health, PEPFAR and other implementing partners; and through our projects and collaborations we are working to help achieve an AIDS Free generation, and to help close the gaps that exist in access, treatment, and stigma.

As we commemorate World AIDS Day for the 27th time, let us remember how far we have come in improving HIV/AIDS services and treatment but also take account of the barriers that still remain as we strive to achieve an AIDS-free generation.

December 01, 2014
Regions/ Countries