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Today is the 1st December 2014. World AIDS Day. 1,208 days since I was diagnosed – on another, slightly sunnier, Monday morning… 

This is my fourth World AIDS Day as a positive person, and each year its purpose becomes more and more clear to me.

The problem is we live in a world of such disparity, and a single ‘World AIDS Day’ tries to do too much. How can in one single day can you possibly cover:

  • Remembering the 38,000,000 people who’ve died from HIV related causes – 1,500,000 of them this year alone.
  • Reaching out to the 35,000,000 people who’re still living with HIV
  • Discuss the disparity of care between somewhere like the UK and places like Sierra Leone, or indeed Russia.
  • Challenge the differing attitudes across the world
  • Promote testing and safer sex.

It’s simply too big a task for a single day.

UK HIV Treatment Cascade 2011 - click to enlarge.
UK HIV Treatment Cascade 2011 – click to enlarge.

Here in the UK we’re relatively lucky. We’ve got 108,000 people living with HIV here (26,000, or 25%, of those are undiagnosed). Of those diagnosed 95% are retained in care, 84% of those are on treatment and 76% of those have an undetectable viral load. (data taken from 2011 PHE Treatment Cascade – see pic).

That’s amazing. 58% of people with HIV in the UK have undetectable viral loads – something which makes them (as studies have shown) essentially non-infectious.

Now I understand that ‘being undetectable’ isn’t the be all and end all, but for me as a positive person knowing that I have the virus under control and that I no longer pose a risk to my negative fiancé goes a long way to making me feel like whole person again. It keeps my threadbare sanity together that little bit more.

Unfortunately not everyone in the world is as lucky as we are here in the UK with our excellent state provided (for now) healthcare and free medication. Even in countries considered a beacon of democracy and modernity, like the US, things aren’t as rosy.

US Treatment Cascade (Source ARLP) - click to enlarge
US Treatment Cascade (Source ARLP) – click to enlarge

In the USA where not everyone has access to, or the ability to pay for, health insurance HIV testing and HIV treatment can simply be out of their price range, with even some of the older medications costing more than a whole month’s minimum wage. How do you justify spending $800 on one bottle of pills when you’ve got rent to pay, children to feed and clothe? This is why their Treatment Cascade (source ARLP) fares far worse than ours – with only 37% retained in care, and just 25% with an undetectable load.

If a country like America, the “leaders of the free world”, can’t look after its own people how can we expect countries with much worse financial situations and much higher levels of stigma to succeed? It’s not just areas like Subsaharan Africa either. Ukraine and Russia, for example, are facing rocketing infection rates and at the same time shortages of medication (often referred to as ‘stock-outs’) due to corruption and lack of funding. No, one day isn’t going to cut it.

HIV has dropped off the agenda in far too many countries, popping up when there’s some sensationalist story they can get their teeth into – or when the government releases the latest figures. With 2,500,000 people being diagnosed every year it’s something we need to be talking about every day, not just when December 1st rolls around.

The 2014 World AIDS Day theme is ‘Getting to Zero’, the only way we’re going to do that is change attitudes towards HIV, to get more people tested and more people treated. If only as it was as simple as it sounded.

Tom Hayes
(@PositiveLad on Twitter)

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