At this weekend’s 32nd annual AIDS Walk, Boston Mayor Martin J. Walsh announced that Boston would become the 12th U.S. city to join the global campaign to end the transmission of HIV. By joining what’s known as the Fast-Track Cities Initiative, Boston has committed to taking the necessary steps to improve public health, enact social justice initiatives, and expand access to healthcare to ensure that by 2020 90 percent of city residents living with HIV are aware of their status; 90 percent of those diagnosed with HIV are treated with antiretroviral therapy; and 90 percent of those receiving antiretroviral treatment are virally suppressed.
The move is yet another example that in the Age of Trump democratic efforts to make the world a better place aren’t stopping, they’re going local. The Fast-Track Cities Initiative, like the newly formed U.S. Climate Alliance, which is made up of cities and states that intend to abide by terms of the Paris Climate Accord to reduce carbon emissions, is an example of local leadership doing what national leaders either can’t or won’t do.
Perhaps fittingly, the Fast-Track Cities Initiative was launched in Paris on World AIDS Day 2014. There, mayors from 27 cities in 50 countries signed the Paris Declaration on Fast-Track Cities committing to do what was necessary to end the transmission of HIV in their locales. The foundation of the Fast-Track Cities Initiative is to get more people tested for HIV and into treatment. It is clear by now that top-down approaches cannot accomplish this goal; knowledge of local communities combined with the credibility to influence them, is necessary.
Last year, the Massachusetts Getting To Zero Coalition, which is made up of 35 community-based organizations and health centers around Massachusetts, held 10 community forums and 10 working group meetings in every region of the state. By talking with people living with HIV/AIDS, healthcare providers, and local leaders in communities with high rates of HIV/AIDS, we learned a lot about what’s needed in cities around the state to end the transmission of HIV.
First and foremost is helping those who are living with HIV adhere to medical treatment plans. By taking medicine as prescribed, and lowering the amount of HIV in their blood to undetectable levels, it becomes next to impossible for someone with HIV to transmit the virus to another person. Second is prescribing pre-exposure prophylaxis (PrEP) to those who are at high risk of contracting HIV such as gay and bisexual men, transgender people, Black and Latina women, and people who use intravenous needles. (PrEP is an antiretroviral medication that if taken as prescribed is a safe and effective way to prevent HIV infection from taking hold if you are exposed to it.)
Given that nearly everyone living in Massachusetts has access to health insurance, it might sound relatively easy to make sure that those living with HIV are getting proper care, and those vulnerable to acquiring the virus are taking PrEP. But that assumes that every gay and bisexual man is not only out to their doctor but also comfortable about talking about their sexual activities with their medical provider. It assumes that people living with HIV who are also homeless have a place to store their HIV medicine. It assumes that people who are addicted to opioids and using needles are also getting tested regularly for HIV and will know immediately if they acquire the virus. It assumes that Black and Latino/a people have the same access to services as White people.
Of course, none of these things are true. Healthcare disparities based on race are still quite pronounced. Not all people who are gay, bisexual, or transgender are out to their doctors. Not all doctors are comfortable talking about sexual orientation or gender identity, much less sex, with their patients. People who are homeless rarely have access to lockers in which to store their belongings, never mind a place to keep medication that requires refrigeration. And unless those who use intravenous needles to inject drugs have access to a needle exchange program that also offers regular HIV testing, chances are they not getting tested and they do not know if they have acquired HIV.
Changing these factors takes tight coordination among local agencies, community-based service providers, and advocacy organizations. It takes a deep understanding of local communities with a city’s larger population and how to best work with them. It takes a willingness to enact sexual health education in local schools. None of these can occur without local leadership and commitment.
The phrase “think globally, act locally” grew out of the environmental movement of the 1970s and was shorthand for how individuals and local communities could have an impact on global issues. The emerging U.S. Climate Alliance is a striking example of the concept in action. But it also extends to needs in public health and social justice, and Boston’s commitment under Mayor Walsh’s leadership to join the Fast-Track Cities Initiative is a much-welcomed act that will eventually end AIDS.
Carl Sciortino is the executive director of AIDS Action Committee of Massachusetts.
