“They did a couple of tests to make sure. They hugged me. I was just worried about my son. They tested him four times. He’s negative." Now the 26-year-old New Yorker and five-year-old Matthew live happily in the Bronx. Life wasn’t over at all.
She started triple-combination therapy immediately. Six weeks later, her viral load (the level of virus in her bloodstream) was undetectable, and it’s stayed that way. An undetectable viral load means that although the virus is always present, you do not have any symptoms, and you are very unlikely to transmit HIV to anyone else. Now she has normal T-cells, takes one pill a day, and gets tested twice a year. She knows the virus will not go away. She doesn’t know what the future holds. But at this moment, her HIV doesn’t rule her life.
“There’s such good medicine out there and people don’t have to die. I didn’t even have symptoms when they tested me. I have no damage to my body," she says.
Look at Fisher’s picture, the blazing smile, the pink hair. That is the face of HIV in 2015, with life-saving treatment. But there are too many other faces, faces we don’t see—Haitians wasting away on the Dominican border; women in Sangli or Kanpur or Imphal who are infected by their husbands and die without ever knowing what killed them.
This doesn’t have to be. On World AIDS Day, this coming Tuesday, the World Health Organization (WHO) will release new guidelines on HIV. They will officially recommend that everyone who tests positive be given antiretroviral medication right away. Solid research supports this policy in every possible way. It will save lives. It will prevent transmission. It will save millions of dollars in treatment, and millions of tears of sorrow and loss. And, if every country commits to it, it will end AIDS.
“The fact that while most people living with HIV in wealthy countries are being given the care they need immediately, while millions of people living with HIV in low and middle-income countries are still being told to go home and come back when they’re sicker is now scientifically, economically, and morally indefensible," says Jamila Headley of Health Global Access Project, an international organization advocating for universal access to affordable HIV treatment.
India has the world’s third largest HIV epidemic, after South Africa and Nigeria. In 2013, 2.1 million Indians were living with HIV. In the same year, approximately 130,000 people died from AIDS-related illnesses, according to AVERT, a portal which gives information and advice on HIV and AIDS. India officially follows WHO’s obsolete 2010 guidelines, which recommended antiretroviral therapy to people with CD4 counts (CD4 cells are T-cells in the blood that help fight infection) below 350. Of course, India being India, even this doesn’t happen.
I spoke with Manoj Pardesi, general secretary of the National Coalition of People Living with HIV in India. HIV-positive himself, he buys medication privately and does not depend on the government. But most don’t have that luxury. He told me about a 20-year-old man, born with HIV, who died just two days before our conversation. He died because the clinic was out of viral load testing kits. They couldn’t measure his CD4 count, so they denied him drugs, and now he’s dead.
“We proudly say that India is the pharmacy of the world, but people in India are not getting the treatment," says Pardesi bitterly.
This is not the way to do what we can and must: slay the dragon, end the epidemic.
When the world woke up to the horrifying reality of AIDS in the 1980s, a positive diagnosis meant you had to die. Now, you don’t have to die—but you still could, and many do, without access to medicine. That’s even worse, somehow. It’s also stupid, because there’s no earthly reason not to adopt these new guidelines, here where we have a proud tradition of manufacturing affordable drugs that have saved millions of lives worldwide.
“Today, you have access to treatment immediately upon diagnosis only if you happen to live in one of 13 countries (Argentina, Australia, Brazil, Britain, France, Maldives, Mexico, the Netherlands, Spain, South Korea, Thailand, Turkey, or the US)," says Headley. Otherwise, too bad. If you’re lucky, you’ll get treatment at some point, but that’s after you’ve been sick, possibly transmitted the virus, and been paisa-wise, rupee-foolish in terms of medical expenses.
I ask Fisher what it’s like to tell sexual partners about her HIV status. “Oh, guys don’t care because they just want to have sex," she says.
Think about it. If Fisher had lived in Russia, Nigeria or Botswana, she would not have received medication until her CD4 count dipped below 350, or possibly even 200. During that time, her body would have paid a price for harbouring HIV, some of those guys who didn’t care or thought she was “too pretty to have HIV" could have contracted it, and the grisly carousel of death and despair would have kept turning.
We have the science to prevent this. We have the tools. We have Fisher and her son, living proof that HIV does not have to be a death sentence or an uncontrollable force. Now we need some political will, from those at the highest levels who legislate health policy and control the money. Let’s hold our leaders accountable. Let’s get off the carousel. Let’s put AIDS in the history books where it belongs.
Sohaila Abdulali is a New York-based writer. She writes a fortnightly column on women in the 21st century.