in Analysis and Commentary

Over the past year or two it seems to me there have been more conversations on HIV/AIDS and its treatment and prevention than I’ve probably ever seen in my entire time as an LGBT advocate, writer and community member. Conversations on new treatment options, increasing access and affordable care, debates (and eventual praise for) PrEP. All of these conversations — mostly all good news — add up to a continuing increase in awareness and decreases in stigma. Today, on World AIDS Day, it’s a good time to pause and reflect on where we’ve been and where we’re going.

Since the beginning of the world AIDS epidemic in the 1980s, we’ve seen astonishing levels of progress. Life for those affected by HIV has changed dramatically. But we still have more progress to achieve.

New research this year has confirmed yet again that those with undetectable HIV viral loads are living healthier, fuller lives. Transmission risks for those who are undetectable are nearly zero.

In July, a study out of the University of North Carolina-Chapel Hill confirmed an earlier 2011 study that found zero risk of HIV transmission when those affected are on treatment and undetectable. Another study in 2014 also confirms the findings.

These results are encouraging. For HIV-positive people, it means fuller, healthier lives. It also has the great power and potential to decrease stigma, be that in work places, social spaces, schools, communities and, yes, in our beds.

Stigma — especially sexual stigma — has been a hot topic over the past couple years, too. Conversations around PrEP (pre-exposure prophylaxis) have fueled discussions on what it means for gay, bi and other men who have sex with men (MSM), in particular, to have healthier, more open, more affirming sexual relationships with each other. Fears of HIV transmission are decreasing as more and more poz individuals attain undetectable viral loads and negative men begin Truvada regimens.

But PrEP hasn’t been without controversy. Leading AIDS groups had at one time criticized PrEP, though later (possibly) endorsing its use. Among community members, debates have often turned ugly, with those taking PrEP accused of being “Truvada whores.” That kind of stigma launched a strong reaction by those who champion the ability of Truvada to help prevent new HIV infections. Even national LGBT organizations like the Human Rights Campaign jumped in, endorsing PrEP late last year.

Indeed, PrEP usage has increased. But not by much. New reports and estimates from the Centers for Disease Control and Prevention show that only about 21,000 people are taking PrEP. In reality, that’s 60 times lower than the 1.2 million people at the highest risks who should be taking the prevention drug. The CDC also says those at the highest risk include some 25 percent of the MSM population.

Clearly, there’s a long way to go on PrEP adoption. Better education and awareness among health professionals and medical providers is key. Too few know about the new breakthroughs and studies on undetectable risks and PrEP.

So, while we celebrate all the successes and progress we’ve attained since 1981, we still have to buckle down. We have to keep our conversations — like the many we’ve had over the past few years — focused on better treatment, more access, more affordable access and better prevention. While we do it, we must ensure we’re reaching those who are most vulnerable in our MSM and trans communities — men of color, trans women of color and low-income people.

We’re so close… so close to either a cure or a worldwide treatment option that effectively ends new HIV infections and makes life easier, more comfortable, more safe and more affirming for those who are already poz.

On this World AIDS Day, I encourage you to take a moment to learn more, get involved, get tested, inquire about PrEP, give a word of support or encouragement to others, throw your support behind organizations working on HIV/AIDS. In the end, small steps toward progress will culminate in big changes for all of us.

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