By Tom Rosshirt — Originally published in Creators Syndicate on 20 June 2012

My brother Matt died of AIDS 26 years ago today, passing away in his bed in my parents' home in Houston.

It was a benighted time for people with AIDS. There were no antiretrovirals then. There was nothing much you could do for an AIDS patient but hold his hand. And many people still thought you could get AIDS by touching. My parents knew of individuals who'd been fired from their jobs for volunteering for AIDS organizations. That's how crazy the fear was.

As Matt was dying, we were befriended by a man named Lou Tesconi, a volunteer from the local AIDS organization. Lou came by to visit with Matt and to offer whatever service and kindness he could to my mom and dad.

Shortly after Matt died, Lou began studies to become a Catholic priest. Within the year, he was diagnosed with AIDS and kicked out of the seminary. Lou was a lawyer by training and temperament. He appealed the judgment to a Catholic bishop, who then asked Lou to found and head a ministry for people with AIDS. It was called Damien Ministries and was established in a poor part of Washington, D.C.

In early 1989, when the country was still very ignorant and fearful of AIDS, Lou got a call from the White House. First lady Barbara Bush was planning to visit Grandma's House, a home for infants with AIDS. It was one of the very first outings in her tenure as first lady, and Lou was asked to join a team of people to brief her privately before the event.

During the briefing, Lou told me later, he said: "Mrs Bush, it is a fantastic thing that you are holding these babies with AIDS. But the country sees them as innocent and the rest of us with AIDS as guilty. The whole suffering AIDS community needs a collective embrace from you today."

Lou thought he was speaking metaphorically. Apparently, Mrs Bush doesn't do metaphor. She stood up, walked over to Lou and gave him a big hug.

After the briefing, Mrs Bush took a tour of the facility as she talked to the press. She hugged, kissed and played with three little girls and then nailed the message: "You can hug and pick up babies and people who have ... HIV. ... There is a need for compassion."

At the news conference afterward, Lou stood by his point on Mrs Bush's visit: "I'm afraid that it may send a message that babies are innocent and can be helped," he said, "but that the rest of us aren't." He added: "I told her it would certainly help to get a collective hug from the first lady."

Then, again, this time in front of the cameras, Mrs Bush wrapped Lou up in a big embrace.

Mrs Bush wrote of this visit in her memoirs. She noted that "even then, people still thought that touching a person with the virus was dangerous." But she didn't give herself any credit for dealing a blow against stigma by embracing a gay man with AIDS in 1989.

Lou had a buzz from that hug that never went away.

In the fall of 1991, near Thanksgiving, I got a call from a friend that Lou had gone into the hospital again. He didn't have to tell me that it was for the last time. I called the White House and asked whether I could speak to the first lady's office. I was a nobody press secretary on the Hill. I didn't expect anyone in the White House to talk to me. Suddenly, I was speaking with the first lady's press secretary, Anna Perez, who had accompanied Mrs Bush to Grandma's House that day. I began to recount the events of two years before, and she saved me the time: "I remember Mr Tesconi," she said. I explained Lou's condition and said, "It would be so comforting for him to receive a letter from Mrs Bush."

A few days later, I went to see Lou in the hospital. As soon as he saw me, he reached beside his bed with a slow and shaky hand and pulled out a letter: "Look what I got," he said.

The letter was unflinching and full of love. She didn't duck the issue that Lou was dying. She used it as a pivot to say, "Well-done." At the bottom, in her own hand, she wrote to Lou that his life mattered, that he had made an impact.

That was a long time ago. But some things you don't forget — and shouldn't. In a time of ignorance, her wise touch eased the sting of exclusion for my friend and many others.

Thank you, Mrs Bush.

Tom Rosshirt was a national security speechwriter for President Bill Clinton and a foreign affairs spokesman for Vice President Al Gore.

Indigenous peoples the world over face exclusion and discrimination. High rates of addiction and mental illness increase their marginalization.

Among First Nations young people in Saskatchewan, Canada, suicide rates are five to seven times higher than among the general population. First Nations young people are more likely to end up in jail than to graduate from high school. Tuberculosis and HIV disproportionally affect First Nations peoples in Canada.

Reaching fragile communities such as indigenous peoples is therefore vital if the world is to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals.

The Know Your Status Forum raises awareness and spurs action to increase HIV and hepatitis C testing among indigenous communities in Saskatchewan. Speaking at the opening of the second annual meeting of the Know Your Status Forum in Saskatoon on 13 February, UNAIDS Executive Director Michel Sidibé called for a catch-up plan for indigenous communities and people left behind. Point-of-care HIV testing and harm reduction should be key parts of the catch-up plan, he said.

Mr Sidibé underscored UNAIDS’ commitment to working with the Government of Canada, communities and other partners to continue to bring the voices of indigenous people into decision-making. He also announced that UNAIDS will convene an expert meeting on indigenous communities and HIV at the United Nations Permanent Forum on Indigenous Issues.

Founded by the Saskatoon Tribal Council, the Ahtahkakoop Cree Nation, the Big River First Nation and the First Nations and Inuit Health Branch, the Know Your Status Forum aims to achieve the 90–90–90 targets among the First Nations people. The 90–90–90 targets are that, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

Before attending the Know Your Status Forum, Mr Sidibé visited the Saskatoon Tribal Council Health Centre, the One Arrow First Nation Reserve and the White Buffalo Youth Lodge. He met with health and community workers, young people and other community members and heard about the impact of intergenerational trauma being played out through a drug crisis and an epidemic of mental illness. 

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During a visit to Ottawa, Canada, from 29 November to 1 December, UNAIDS Executive Director Michel Sidibé discussed with government officials ways to strengthen collaboration with the Canadian Government and met with representatives of civil society.

Mr Sidibé visited the AIDS Committee of Ottawa to see first-hand how a frontline AIDS service organization is responding to the opioid crisis in Canada. At a round-table discussion with Canadian civil society organizations, the successes and challenges in the Canadian response to HIV were highlighted. During the discussion, Mr Sidibé stressed that a vibrant civil society was critical to scaling up responses towards universal access to HIV prevention, treatment, care and support.

Mr Sidibé also met Marie-Claude Bibeau, Minister of International Development and La Francophonie, and Diane Jacovella, Deputy Minister of International Development, who underlined the progress made in preventing new HIV infections and the important impact those efforts are having on women’s health, including the sexual and reproductive health and rights of women.

Mr Sidibé spoke with senior government officials during a town hall meeting on human rights-based approaches to health and how the response to HIV can be a catalyst for accelerating progress towards achieving the Sustainable Development Goals. He shared his vision and perspective on the opportunities towards ending AIDS and spoke about the recent reform of UNAIDS. The link between sexual and reproductive health and HIV was discussed, as was the need for greater efficiencies and reform in the global health architecture.

Mr Sidibé also met the Minister of Health, Ginette Petitpas Taylor, and the Minister of Indigenous Services, Jane Philpott, to discuss the HIV epidemic in Canada and to hear their perspectives on the current needs and challenges of the AIDS response in the country, especially among indigenous populations. It was highlighted that tuberculosis and hepatitis are major causes of death among indigenous people in Canada. They discussed how cooperation between UNAIDS and Canada could help in addressing the special needs of indigenous people.

The visit ended on World AIDS Day with the launch of a groundbreaking report on increasing male engagement in health services and with Mr Sidibé raising a flag on Parliament Hill with Ms Bibeau, Ms Petitpas Taylor and representatives of people living with HIV. 

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During a visit to Canada, on 28 November UNAIDS Executive Director Michel Sidibé met with members of the Government of Quebec, members of parliament and civil society at the National Assembly of Quebec.

In meetings with the Quebec Minister of Health, Gaétan Barrette, and the Deputy Minister for International Relations and the Francophonie, Jean-Stéphane Bernard, Mr Sidibé underlined that it is important that UNAIDS’ work be aligned with that of the Quebec Government and stressed the need to tailor the response to HIV in accordance with the needs of the country or region. He also spoke about the urgent need to make HIV prevention more effective and the importance of investing in HIV prevention and reducing the number of new HIV infections.

Mr Sidibé also discussed Quebec’s AIDS response and visited Point de Repères, a community-based organization that advocates for harm reduction. He met with leaders from MIELS-Québec, a community-based organization working for more than 30 years with people living with HIV, and Ruban en Route, a not-for-profit organization providing prevention education programmes designed to reduce sexual risk behaviours.

During meetings with members of Quebec’s Parliament, including with Jacques Chagnon, President of the National Assembly and President of the Parliamentary Assembly of La Francophonie, Mr Sidibé emphasized the important role that parliamentarians play in the global response to HIV. He also stressed that parliamentarians are critical to advancing the vision of ending AIDS by 2030 through their leadership, advocacy role and ability to authorize and oversee spending on AIDS. 

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UNAIDS Executive Director Michel Sidibé met with students and staff during a visit to the Johns Hopkins Bloomberg School of Public Health in Baltimore, United States of America, on 15 September.

During an open dialogue in the school’s Sheldon Hall, Mr Sidibé and the Dean of the school, Michael Klag, joined with students, faculty, researchers, global health leaders and alumni to discuss global health, systems for health, leaving no one behind and social justice. Mr Sidibé expressed his concerns about the fragmented global health system and introduced his vision of systems for health that engage all relevant constituencies, including civil society, governments and scientists, and a global health financing institution that goes beyond HIV, tuberculosis and malaria. In addition, he said, there is an urgent need for an instrument for global health advocacy and accountability. 

The visit also saw Mr Sidibé meet with a group of Sommer Scholars to discuss their future contributions to global public health and with members of the Johns Hopkins University Center for AIDS Research.

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Fastening a seatbelt when driving, wearing a hard hat on a construction site and slapping on sunscreen when out in the sun all lessen potential harms from the risks being taken. This is how the Harm Reduction Action Center (HRAC), based on Colorado, United States of America, introduces the principles of harm reduction for drug use in a video entitled Harm Reduction 101.

The video—a stick-figure animation—explains that 47 000 people died from drug overdoses in the United States in 2014. According to StoptheClockColorado.org, every 9 hours and 24 minutes someone dies from a drug overdose in Colorado—such deaths are preventable with harm reduction. Harm reduction includes linking people to health services, giving people access to naloxone—a drug that reverses the effects of an opioid overdose—and making sterile needles and syringes available to prevent the spread of HIV and viral hepatitis.

“Harm reduction keeps people alive, that is the nature of the business we are in,” said Lisa Raville, Executive Director of HRAC, which has provided emergency and health services to injecting drug users in Colorado since 2002. HRAC offers sterile syringes, proper syringe disposal and access to HIV testing, as well as health education classes, street outreach and referrals to mental health and substance abuse treatment.

The video, Ms Raville explains, allows people to understand the framework and the logical next step, which is installing supervised injection facilities. The video notes that in the 102 supervised injection facilities across the world, there has yet to be a single fatal overdose.

Matt Slaby and the creative agency Luceo produced the video with the aim of making a complex issue accessible to all. “Harm reduction has struggled with normalization and has been misrepresented for decades, so we pointed to other things that have come to be the norm in our society, like seatbelts, designated drivers and hard hats,” Mr Slaby said.

“Our aim is to reduce the negative impact of years of archaic drug policy, because jailing and repression only drives drug use underground, increases overdoses and leads to the spread of HIV,” Mr Slaby added.

Millions of people who use drugs continue to be criminalized and marginalized in the United States and other countries. Despite this, levels of drug use have remained unchanged. However, countries that have moved away from punitive laws and policies against drug users and have increased investment in harm reduction have seen a drop in new HIV infections and improved health outcomes. These policies have lowered levels of drug-related crime and reduced pressure on the health-care and criminal justice systems.

Harm reduction is cost-effective. According to the Harm Reduction Coalition, the lifetime cost of medical care for each new HIV infection is more than US$ 400 000, but if the same amount of money was spent on needle–syringe exchange programmes at least 30 new HIV infections would be prevented.

UNAIDS believes that the world cannot continue to ignore the evidence. Michel Sidibé, UNAIDS Executive Director, said, “We must reduce the impact of HIV and other harms related to drug use and adopt a new course of action—to treat people who use drugs with dignity and respect and to provide them with equal access to health and social services.”

UNAIDS calls for the global adoption of a people-centred, public health and human rights-based approach to drug use. Reducing the harms of drug use will contribute to the end of the AIDS epidemic and the achievement of the Sustainable Development Goals. 

HARM REDUCTION 101 from LUCEO on Vimeo.

The state of Georgia, the home to the Ponce de Leon Center in Atlanta, saw a 6% annual decline in new HIV infections between 2008 and 2014. The clinic treats more than 6000 people living with HIV. Marianne Swanson, a nurse at the clinic who is also living with HIV, told UNAIDS about the antiretroviral therapy that she and her clients take to stay healthy and to ensure that their loved ones stay HIV-free. Treatment for HIV is playing a major role in HIV prevention. New evidence released shows that annual new HIV infections in the United States of America fell by 18% between 2008 and 2014, but that not all groups are benefitting equally.

Nurse Marianne Swanson uses own experience of living w/#HIV to ensure best care for patients https://t.co/rQ0TB8SQVi via @atlantamagazine pic.twitter.com/aUjW9dTj4B

— Michel Sidibé (@MichelSidibe) February 8, 2017

The estimates were released by the United States Centers for Disease Control and Prevention (CDC) at the Conference on Retroviruses and Opportunistic Infections, taking place in Seattle, United States of America, from 13 to 16 February.

The CDC’s estimates show that while the number of new HIV infections among people who inject drugs fell by 56% from 2008 to 2014, there was no decline among men who have sex with men in the same period. The number of white and young men who have sex with men acquiring HIV dropped in the six-year timespan, but increases among other groups—most notably 25- to 34-year-old men who have sex with men, with a 35% increase—were responsible for the general flatlining of new infections among men who have sex with men in the country.

The drop in new HIV infections also varied by location, with states and districts showing drops of up to 10% annually, for example Washington, DC, while others experienced lower declines—for example Texas, with a 2% annual drop—or remained stable. No states showed increases in new HIV infections, however.

The CDC attributes the 18% decline from 2008 to 2014 in large part to the increased number of people living with HIV knowing their HIV status, accessing treatment and becoming virally suppressed—including the clients of the Ponce Center—as well as the success of past programmes for people who inject drugs and the increasing use of pre-exposure prophylaxis (PrEP). This shows the importance of the Fast-Track approach and its 90–90–90 targets for 2020 towards ending AIDS by 2030, whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

While the 18% reduction in new infections between 2008 and 2014 is very encouraging, additional tailored programmes are needed to achieve a 75% reduction by 2020, as set out in the 2016 Political Declaration on Ending AIDS.  

The variance in the decline in new HIV infections among different groups of people and in different states shows the importance of a location and population approach, in which programmes are focused on the people and places that will deliver the greatest impact. CDC’s High-Impact Prevention approach plans to scale-up prevention programmes through such a location and population response.

By scaling up prevention programmes and ensuring that more people stay HIV-free, the hope is that the need of clinics like the Ponce Center, and the thousands like it worldwide, to provide HIV treatment to people living with HIV will be much less in the future.

Each year, more than 6000 people are served by the Ponce de Leon Center in Atlanta, United States of America. For the past three decades the clinic has provided HIV care and services to men, women, adolescents and children living with HIV. Part of the Grady Health System, the Ponce Center is staffed by doctors and researchers from the leading research university in Atlanta, Emory University, and is considered one of the largest and most comprehensive HIV outpatient clinics in the country.

“The Ponce Center delivers comprehensive services to a vulnerable population in the heart of the United States HIV epidemic,” said Carlos del Rio, Professor of Global Health and Medicine and Co-Director of the Emory Center for AIDS Research.

Atlanta’s epidemic largely affects the most vulnerable populations, who not only live with HIV but also live in poverty and are un- or underinsured. Many of the people who come to the centre for care are already very sick, having lived with HIV for a number of years undiagnosed and untreated. Thirty-five years into the epidemic, persistent stigma still keeps many patients from accessing life-saving treatment.

In 2015, owing to late stage diagnosis and treatment of HIV, some 50% of people diagnosed at the clinic already had AIDS. More than 75% of patients at the centre have advanced, symptomatic HIV disease (less than 200 CD4 cells/mm³ and/or AIDS-defining symptomatology).

In addition to breaking down the barriers that keep people from accessing the clinic sooner for earlier diagnosis, the Ponce Center is focused on how to make it easier for people to continue life-long HIV treatment.

The clinic provides comprehensive co-located services ranging from financial counselling and nutrition to acute care and chemotherapy. Providers take an integrated approach for people who may face multiple issues, including substance use and mental health issues. One of the key components is helping patients find the right combination of medicines with the fewest side-effects.

“Social capital is about having someone who can support the patient through their diagnosis and treatment. The patients who have no one else in their corner really do struggle and that is where the personal approach at the Ponce Center comes in,” said Wendy Armstrong, Professor of Medicine at Emory University and Medical Director of the Grady Infectious Disease Center.

Helping people manage their HIV also means supporting patients as they stabilize their lives, which is why the centre encourages close ties between patients and staff. The personal attention helps to support the logistics of treatment and encourages people to keep their medical appointments. Many people who access the clinic have also volunteered to take part in research studies to improve care.

“I am grateful for the tireless work of the staff to provide people-centred care at the Ponce Centre,” said Michel Sidibé, Executive Director of UNAIDS. “This best practice approach is saving lives.”

The Ponce Centre provides a unique service to the thousands of people living with HIV in Atlanta as well as important research data and information, helping the United States to advance global efforts to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals. 

During a two-day visit to Atlanta, United States of America, UNAIDS Executive Director Michel Sidibé visited the Emergency Operations Center of the United States Centers for Disease Control and Prevention (CDC) and interacted with CDC staff during a town hall meeting.

He also spoke on leadership in the global AIDS response with students and faculty at a special session at the Rollins School of Public Health moderated by Carlos del Rio, Hubert Professor and Chair of the Department of Global Health at the Rollins School of Public Health and Professor of Medicine in the Division of Infectious Diseases at Emory University School of Medicine.

In honour of the inauguration of the 20th President of Emory University, Claire Sterk, the first woman President of the University and a renowned public health and HIV researcher, the university held an academic symposium entitled Health Challenges and Bold Opportunities. Speaking alongside Deborah Bruner, Associate Director for Mentorship, Education and Training at the Winship Cancer Institute, Professor in the Nell Hodgson Woodruff School of Nursing and Professor of Radiation Oncology in Emory University School of Medicine, and Elaine Walker, Director of the Development and Mental Health Research Program of Emory University, Mr Sidibé provided an overview of what is needed to end the AIDS epidemic as a public health threat within the framework of the Sustainable Development Goals.

At the close of the symposium, Ms Sterk awarded Mr Sidibé the Emory President’s Medal in recognition of his work as a “passionate champion for health and humanity”, which he accepted on behalf of all people working to end the AIDS epidemic. Past laureates of the President’s medal include President Jimmy Carter, the Dalai Lama, Congressman John Lewis, global health hero William Foege and civil rights activist Rosa Parks.

While in Atlanta, Mr Sidibé also visited the Ponce de Leon Center, one of the largest HIV clinics in the United States of America, serving more than 6000 people annually. Mr Sidibé spoke with staff about the unique challenges of delivering quality HIV care and treatment to people with late stage diagnosis of HIV. Thirty-five years into the epidemic, patients still face high levels of stigma, which can delay and keep people from accessing life-saving treatment.  

Mr Sidibé concluded his visit to Atlanta with a meeting at the Carter Center to explore how UNAIDS and the Carter Center can best leverage combined expertise and knowledge for the greatest impact in areas where the work of the two organizations converges.

On the International Day of the Girl Child, 11 October, Together for Girls and its partners, including the Government of the United States of America, the Government of Canada, five United Nations agencies, including UNAIDS, and several private sector organizations cohosted an event entitled 72 Hours and Counting: Why Every Hour Matters for Post-Rape Care. Panellists at the event called for increased domestic and global programming to address violence against girls.

Every Hour Matters is a new global advocacy campaign designed to raise awareness of the need to ensure that people have timely access to comprehensive services after rape and of the need for such health services to be made available in all communities. Every Hour Matters was launched in 2016 by Together for Girls, a public–private partnership focused on ending violence against children, particularly sexual violence against girls.

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