On June 5, 2021, the world marked the 40th anniversary of the first reported cases of rare of immune deficiency in otherwise healthy young gay men in New York and San Francisco. There is no story in global health as transformative, awe-inspiring, and yet tragic as the AIDS pandemic. Within a few short years, AIDS was found on every continent, enveloping the world to become one of the most devastating pandemics in human history — causing untold human suffering, social disintegration, and economic destruction.
Over time, this deadly retrovirus embedded itself in society’s most oppressed populations — drug users, sex workers, sexual minorities, and the poorest of the poor — creating often-impenetrable sociopolitical and economic barriers to prevention and treatment. In the early days, the sociopolitical response was, at best, denial, ignorance, and silence — President Reagan did not utter the word “AIDS” in public until 1986. At worst, the response was social marginalization, discrimination, and punishment — blaming people for their own suffering and criminalizing them for their behavior. The fear, pain, and despair faced by persons living with AIDS and their loved ones cannot be overstated.
By 2010, UNAIDS announced a goal that was once unimaginable: Getting to Zero — Zero New Infections, Zero AIDS-related Deaths, and Zero Discrimination. But what exactly is the “zero” or “AIDS free,” world we were talking about? In 2020, 37.6 million people globally were living with HIV, with 1.5 million newly infected that year, and 690,000 deaths.
But even with the ongoing devastation, if we step back, it is impossible not to marvel at the technological advances that enabled global health leaders to say the unthinkable — that we may one day see the end of the scourge of AIDS. Antiretroviral medications have been a lifeline, with 27.4 million people accessing ARVs in 2020, even as the virus has evaded all our heroic attempts to develop an effective vaccine.
But beyond the scientific innovation, what was truly inspirational was the social mobilization for treatments and for dignity. From ACT UP and Lambda Legal Defense in the United States to the Treatment Action Campaign (TAC) in South Africa, courageous individuals and organizations have literally transformed the politics of AIDS — turning neglect and derision to empowerment and social action.
AIDS changed the world. It taught us a crucial lesson that must never be forgotten. If we invest in scientific ingenuity, and equitably deliver innovative therapeutics and vaccines, there is no boundary that the world cannot overcome. But the only way to overcome barriers to dignity, rights, and treatment access is through bottom-up social mobilization. No vast transformation in global health can occur without the activism of communities most affected and their civil society partners. As we face the immense human, social, and economic devastation of the COVID-19 pandemic, AIDS advocacy stands as a beacon of hope. The AIDS model could become, yet again, a powerful engine for the global public good.