World AIDS Day 2009- Think globally and act locally

This year’s theme for World AIDS Day is ‘Universal Access and Human Rights”. It is a cruel irony that the world is focusing on increasing access to treatment while California is considering reducing access due to budget woes. It is a cruel irony that as the world focuses on human rights as a fundamental component of addressing HIV/AIDS, in the United States, where men who have sex with men are still the majority of HIV/AIDS cases, gay men and lesbians are not afforded acknowledgement of our relationships and our families through the fundamental right to marry- a punch in the gut to the idea that t he United Sates is a paragon of human rights, Bush era torture notwithstanding. We must look globally at how to address the HIV/AIDS pandemic but it is incumbent upon us to act locally as well.

Let’s look at access first. In California there are draconian measures being considered in order to “balance the budget” on the backs of those who can least afford it. The California AIDS Drug Assistance Program (ADAP) program is on life support and we had better start to advocate that the program be fully funded now rather than after Governor Schwarzenegger releases his budget in mid January or it might be too late. Thanks to Project Inform and WORLD, San Franciscans are stepping up to the plate on World AIDS Day eve with a “Save ADAP” rally at San Francisco City Hall.

While I will advocate vociferously I am not hopeful. ADAP was spared in the last horrific round of budget cuts and I am not sure that our successes will be sustainable. Virtually every program for the poor, the disabled and the most vulnerable in California has been decimated and there are likely to be those who say that there is no such thing as a sacred cow including ADAP.

Unfortunately we are a nation that doesn’t look further than the next month or, at best, the next fiscal year. President Obama’s initiatives are proof of that. The president’s agenda is likely not to reap benefits for a few years down the road, but the American people demand immediate gratification, like spoiled children. His thoughtful, methodical approach to the problems we have and which he inherited could be politically perilous for the midterm election.

California’s destruction of social and health related programs will have dire effects and is cost ineffective in the long term. While I think that all of the cuts that have occurred to social and medical programs are unconscionable it is ADAP I know best. Plus this piece is about World AIDS Day ergo my focus on ADAP rather than other vital programs.

ADAP not only helps to reduce hospitalizations and other expensive healthcare by ensuring that people living with HIV/AIDS can maintain the best possible health, but by reducing the community viral load it is also a prevention intervention and thus the program helps keep down the number of Californians that might rely on ADAP and other programs in the future. That could save millions of dollars- let alone thousands of lives. Unfortunately the state doesn’t see the future beyond the next fiscal crisis and by having such a myopic view it solidifies our ongoing budget woes. We are a short sighted nation.

Second let’s address human rights. To my way of thinking addressing stigma is a significant part of addressing human rights. HIV stigma abounds in the United States. The communities most heavily impacted by HIV in the United States- African Americans- especially African American women, gay men, IV drug users and transgendered people are already stigmatized in this country. HIV/AIDS in the United States walks hand in hand with poverty and Americans are not terribly keen on admitting the level of poverty within our own boarders and being poor is stigmatized as well. HIV just adds to this stigma stew.

In every state where gay marriage has been put in front of the electorate, gay marriage has been defeated. Could prejudice of gays and lesbians be made clearer than this record of defeat? Where there is prejudice there is stigma. Prejudice and the resulting stigma thwart addressing the human rights of people living with HIV/AIDS.

I am not naïve enough to think that addressing gay marriage is the only way to help address the human rights of people living with HIV/AIDS in our nation. We need to address a host of social justice issues. And of course the human rights abuses that people in other parts of the world are profound. We are discussing gay marriage in our country, but in some parts of the world being gay can get one executed. There are also gross abuses of human rights throughout the world regarding women and ethnic minorities.

But I am a gay man with AIDS living in California. Many of us are barely holding our heads above water and too many Americans forget about the epidemic in our own country. In my home state, I am sad to say that California is more focused on low taxes than on saving lives even though it is clear that, thanks to Prop13 our tax base is completely out of whack. Without addressing societal inequities such as gay marriage and without adequate funding from Congress and state legislatures for care, treatment, social services and prevention services, our national epidemic will not abate.

It is a juggling act trying to address HIV/AIDS internationally and domestically, but we do not have a choice. President Obama has taken some important initial steps towards addressing our domestic epidemic by reinvigorating the White House Office of National AIDS Policy and charging that office with the development of the first ever National HIV/AIDS strategy for our nation. While I recognize that President Obama has an enormous amount on his plate and that the righting the wrongs of the Bush years will take an enormous amount of effort, those of us in the HIV/AIDS community must continue to push the president to do more. The president must insist on adequate funding for care, treatment, research and prevention from Congress and he must support the right for gay men and lesbians to marry as one step towards addressing the myriad of social justice issues concomitant with HIV/AIDS.

On this World AIDS Day, the AIDS community is asking President Obama to convene a summit of HIV + leaders in our country. While such a meeting would largely be symbolic, it would nevertheless be a power and eloquent statement for the leader of the free world to meet with a group of openly HIV + people.

We are waging a war on two fronts. There is much work to be done and there is no room for reducing our vigilance. HIV/AIDS is a worldwide problem and it is a national problem. Access to care and treatment and proven forms of prevention is a worldwide problem and it is a national problem. Addressing human rights as part of our fight against HIV/AIDS is a worldwide issue and a national issue.

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