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Clinton continued, offering points on how the United States is working to counter those situations, to ”Turn the Tide” – the conference theme – in the fight against HIV/AIDS. She announced three new efforts to reach key populations: $15 million for research to identify specific interventions that are the most effective for at-risk populations; $20 million to support country-led plans to expand HIV services; and $2 million to help civil society groups that do outreach in those communities.
Among the smaller panels that same Monday, one focused on young American gay men of color. Looking at those who provide health services to this ”YMSM” population, Dr. Ron Stall, professor and chair of the Department of Behavioral and Community Health at the University of Pittsburgh, said those providers must adopt a more holistic approach to treating young gay men of color, rather than focusing on HIV and STDs alone.
”Scientists are just obsessed with the area between the knee and the navel when it comes to gay men,” Stall said, citing a study showing that the more psychological/emotional health problems a person has, the more likely it is he will engage in high-risk sex, leading to greater HIV prevalence.
Monday also saw some debate over the newly approved pre-exposure prophylaxis (PrEP) treatment, Truvada, at another panel. Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS, argued in favor of “treatment as prevention” through antiretrovirals, while Kenneth Mayer, medical research director and co-chair of Boston’s Fenway Institute, countered that more research needs to be done before the medical community endorses pre-exposure prophylaxis. Audience members – on both sides of the issue – also spoke passionately.
”We need to do this without any further delay,” Montaner insisted. Mayer, however, spoke of unknown effects of such therapies in healthy individuals with normal CD4, or T-cell, counts. He mentioned the possibility of resistance to the medications over time among people with normal CD4 counts as a possible side effect, particularly in cases where adherence is lax.
Mayer and Sean Strub, founder and advisory editor of Poz magazine, also warned that while linking people with care is an admirable goal, public health officials may use antiretrovirals as a crutch of sorts, recommending it for all people regardless of the nature of their serostatus, instead of basing their recommendations on science. Strub, as well as some audience members, also raised questions about the ethical issues that accompany scientific advances such as antiretrovirals.
Tuesday saw another march through D.C. streets, the We Can End AIDS Mobilization for Economic Justice and Human Rights. Inside the convention center, meanwhile, one panel focused on challenges faced specifically by the transgender community in fighting HIV/AIDS.
JoAnne Keatley, director of the University of California, San Francisco (UCSF) Center of Excellence for Transgender Health, covered several of the factors contributing to transgender people’s higher risk of acquiring HIV. For example, she said, transgender people face relatively greater degrees of discrimination in employment, housing and health care, as well as marginalization, or, in some countries, criminalization of people who do not conform to gender norms.
Marcela Romero, a Colombian-born transgender activist, said that governments are complicit in the challenges faced by transgender communities. Marginalization and a lack of resources to address health and well-being contribute to a higher incidence of HIV and sexually transmitted infections, and lower life expectancy among transgender people.
“A person without an identity ceases to exist,” Romero said of governments who ignore transgender citizens.
Tuesday evening, Whitman-Walker Health marked a sad anniversary: 29 years since D.C.’s first community meeting about HIV/AIDS, April 4, 1983, held at the Lisner Auditorium at George Washington University. These nearly three decades later, the fight has certainly evolved.
The audience members at ”Return to Lisner” heard from Jeanne White-Ginder, the mother of the late Ryan White, a teenage hemophiliac and AIDS activist in the early days of the epidemic for whom the nation’s largest federally funded program to treat people with HIV/AIDS is named.
”I think there’s miracles happening all the time,” she said.
As the conference continues through Friday, July 27, conference attendees will continue to share their data and dialogue, in the ongoing hunt for those miracles – as well as straightforward scientific and social advances – to turn the tide toward a future without AIDS.
Will O’Bryan contributed to this report.