While “Time to Act is Now,” boundaries, barriers and delineations that marginalize still stand between HIV service provision and need

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U.S. National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci at Tuesday’s White House World AIDS Day event

In its function as a source of inspiration, a World AIDS Day theme must be unambiguous and positive, and leave out nuances that might offend or discourage, with the result this year of  “The Time to Act is Now.” More upbeat than “Don’t stop now,” less daunting than “Try harder,” and more forgiving than “Better late than never,” this year’s theme, reiterated at a White House gathering of federal and local government agency representatives involved in HIV responses refers both to the science that this year validated the value of speeding responses, and the UNAIDS call to put that science to use on a fast track in the next four years.

Dr. Anthony Fauci, who has been responding to the HIV pandemic since its emergence, referred to his perspective piece with Dr. Hilary Marston that just appeared in the New England Journal of Medicine, “Ending the HIV-AIDS Pandemic — Follow the Science.

“There is no reason whatsoever not to end this,” he concluded, after reviewing the trials that have shown the value of immediate and continuous treatment in preventing illness, death and transmission. “The science has spoken. There can be no excuse for inaction.”

But this week of World AIDS Day also brought news from the field where the barriers still stand in the way of science. From Médecins Sans Frontières a new report, Empty Shelves, Come Back Tomorrow — ARV Stockouts Undermine Efforts to Fight HIV, describes the gaps in supply chains that disrupt lives, treatment and can fuel the spread of drug resistance in four countries that it notes represent many more. The report underscores the critical role of community involvement in program design that could then better reflect the realities of patients’ lives, and the impacts of treatment obstacles.

This week also brought (more) bad news from Zimbabwe, where members of populations often referred to as “key” in fighting HIV globally including sex workers, sexual minorities and people who inject drugs, face a particularly hostile policy environment, and where activists attending the International Conference on AIDS and STIs in Africa reported trouble entering the country, harrassment, and confiscation of their materials. Adding insult to injury, they reported, their existence — and issues — went unmentioned in UNAIDS leader Michel Sidibe’s conference address, although he has expressed support for those populations in less intimidating settings.

In addition, this week saw the release of a report from Health GAP and global partners showing that fewer than one in 10 people living with HIV live in a country where policy allows for treatment on demand for everyone upon diagnosis.

Speakers at the White House Tuesday acknowledged these obstacles and similar ones, across both domestic and global HIV responses, and the need to act now on addressing them. It was James Loduca of San Francisco AIDS Foundation who summed up the approach of empathy across all the borders that marginalize people and put science out of reach, with what might be a candidate for next year’s theme: “Shatter the margins.”

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