December 1, 2023, marks the 35th anniversary of World AIDS Day (WAD), first commemorated in 1988. The theme for this year’s celebration is “Remember and commit,” a truly impactful theme because through remembrance, we acknowledge those who have lost their lives and those who have inspired us to get to where we are. We acknowledge the journey we have been on, and through commitment, we commit to a healthier future and ending the HIV epidemic.
In 1988, I was a medical student in Ibadan, Nigeria, buried in med school stuff and unaware of World AIDS Day. Ten years later, as a chief resident, a few months away from starting my ID fellowship, I celebrated WAD and have done that every year since 1998.
So, “Remember and commit.”
What do I remember?
I remember the first person living with HIV that I took care of in the Inpatient Service in 1995 and how many medications he was on.
I remember the first patient I had with cryptococcal meningitis and how many lumbar punctures he had in one admission—12.
I remember when HIV tests took over a week to confirm with Western blots and how thrilled we were when rapid tests became available.
I remember having patients describe side effects from their multiple HIV medications but committing to keep taking them to stay alive.
I remember the first time my patients were able to go from six pills twice a day to one pill a day to control and maintain HIV suppression.
I remember the first publication showing how HIV combination therapy changed the mortality curve.
I remember the first time one of my patients had a baby who was born HIV uninfected, and many more babies born uninfected in our clinic after that.
I remember the joy and excitement when a patient became undetectable after sometimes years of struggling with poorly tolerated medications.
I remember the first time one of my patients volunteered in the clinic to become one of our peer advocates and went on to recruit and lead peer advocates within the clinic.
I remember my first mentor in infectious diseases, who channeled brilliance with compassion.
I remember my infectious disease mentors spending hours counseling their patients and their families.
I remember patients I have lost to HIV from advanced HIV-related complications or non-HIV complications of cancer and heart disease.
I remember patients coming into my exam room many times, living with HIV for years and unable to disclose to family or friends and just doing it alone.
I remember the joy of celebrating new romances, marriages, and other milestones with my patients.
I remember patients’ excitement, volunteering to be a part of clinical trials to advance the therapy for HIV.
I remember the joy when my first patient with HIV was cured of his hepatitis C. I remember the joy of many, many patients cured after that.
I remember my joy when I first heard about the initial results of the PrEP studies and when PrEP was approved in 2012.
I remember the excitement from my patients as I shared information about upcoming new long-acting injectables for treatment and prevention.
I remember all the focus groups, town halls, and meetings as we came together across Illinois to write our Getting to Zero state plan.
I remember a time when we could not definitively tell a person that they could not transmit HIV sexually if undetectable and now celebrate the incredible, empowering message that is undetectable = untransmittable (U=U).
I remember my patients and their resilience, grit, and determination to survive and thrive despite hardships in their lives.
I also remember and know that there are disparities in PrEP use, HIV testing, care, and viral suppression, and that Black and brown people remain disproportionately impacted by HIV.
I remember that sexual health conversations are not happening in routine clinical settings, and with that, less than 40 percent of Americans have ever had an HIV test.
I remember that stigma remains a huge issue that impacts the quality of life for people living with HIV, impacts HIV testing, and threatens our ability to truly end the epidemic.
So, to the other aspect of the 2023 theme: Commit. What do I commit to?
I remain committed to being an advocate for people living with HIV and for those who would benefit from PrEP.
I remain committed to educating health care providers (seasoned, new, emerging) on the importance of these sexual health conversations and prioritizing quality-of-life conversations with people living with HIV.
I commit to fostering a sense of urgency among health care providers with a call to action during my interactions.
I commit to doing my part to ensure that as we develop innovative medications and therapies, we collaborate with impacted communities and do not widen existing disparities.
I commit to joining with advocates to protest policies that impact health and reproductive rights and further worsen disparities.
I commit to using my platform as a physician, advocate, medical director, author, and podcaster to inform and educate communities on the importance of HIV testing as a first step in the status-neutral care continuum.
I commit to discussing stigma and doing my part to engage individuals and communities to help eliminate stigma.
This is my pledge on World AIDS Day 2023.
How has HIV impacted you? What will you remember and commit to?
Toyin M. Falusi is an infectious disease physician.