Many of the social and economic barriers that stand in the way of effective HIV prevention, treatment, support and care for people living with HIV are the same barriers that impede access to comprehensive sexual and reproductive health programs and services. In societies where cultural and gender norms tightly restrict the sexual and reproductive lives and choices of women and men, the risk for both unintended pregnancy and HIV infection is greatest.

I am part of the HIV support community at Positive Women's Network (PWN) in Vancouver, BC. Many of our members are of Aboriginal descent -- not a surprise, given that Aboriginal people are disproportionately affected by HIV. Stigma shadows discussions about sexual health, mental health and wellness, drug use, and definitely sex itself.

It is no coincidence that in countries and regions with high HIV/AIDS prevalence, women tend to have a lower position in society. But exactly what are the linkages between how women and girls are valued and their risk for HIV/AIDS? A significant factor is the ability to make choices. Women's lack of power relative to men gives them less bargaining power in negotiating the use of condoms to protect themselves. Poverty and lack of alternative options lead women to use survival strategies, including prostitution and exchange of sex for resources. To improve women's position in society and give them more control over their life choices, the perceived value of women and girls must change.

Hats off to the spin doctors who managed to turn this year's World AIDS Day into a global celebration. A mere 34 million people are living with HIV! ...

Recent advances in our understanding of HIV transmission, treatment, prevention and testing are changing the landscape of our response to HIV and generating a significant amount of optimism. The buzz at the International AIDS Conference this past July in Washington D.C. was that we may now be able to achieve an "AIDS-free generation."

Since 1996 we have developed better HIV medications and we live longer, fuller and healthier lives. People who are newly diagnosed and the young might not remember the endless funerals and whisperings about who was sick, who had committed suicide, or who had partied to death to escape the inevitable wasting and loss of personal strength and dignity. It's certainly a good thing that we have better medications, but the AIDS industry has become so dichotomized and disjointed that it is not recognizable from those early "grass roots" days, where everyday people did what they could with little resources and a whole lot of heart. The grass roots of HIV have withered and died.

World AIDS Day is time for both activism and reflection. As nurses, we know the benefit that modern health care has provided to people living with HIV, but we must ensure as technology advances, that we don't lose sight that a person lives with the virus, not the other way around.

Canada used to be a leader in supporting research to monitor HIV in key populations -- terrifically difficult because the activities that put them at risk are covert and illegal in many countries; surveillance can expose vulnerable populations to authorities and create risks for them. But Canada bowed out of supporting the HIV/AIDS Surveillance Project this year, just one more brick in a wall that is contributing to exclusion and marginalization of those most vulnerable to HIV infection. It's such a shame that our government has lost its vision of never leaving anyone behind.

You know what's not fun? AIDS. And you know what's even less fun than AIDS? People who have it, then have sex with you without telling. And you know what's the least fun of all? A bunch of stern newspaper editorials about the Supreme Court's recent decision that not disclosing that you suffer from AIDS before having sex can be legally permissible under certain circumstances.

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