If somehow you have gotten through the last 30 years without HIV/AIDS impacting your life, kudos to you. For the rest of us, it's been different. My sister-in-law, Susan, whose wry grin pushed through a determined exterior, who could get in and out of a grocery store like nobody's business and who raised two great kids on her own waiting tables at that Greek place on Michigan Avenue, comes into my heart and head almost daily even 22 years after she died. Her giggle isn't so far away to hear, even this long gone.
Because many of us have felt 30 years of impact and made huge strides against the onslaught of HIV/AIDS, Toronto's Mayor Rob Ford's proposed cuts to funding to HIV/AIDS prevention and services has provoked outrage. It is hard to believe that our governments are actually proposing public health cuts.
Make no mistake, these cuts are in favour of Ford's massive reallocation of city resources to things like consulting firms (KPMG), removing successful infrastructure (streetcars and bike lanes), breaking contracts (Transit City), and rejecting free nurses from the province. Ford is drawing a line in the sand. Increased infections and death lie on one side of that line (the side we're on) and our public wealth handed over to the private sector is on the other side. Maybe Ford has not been touched by HIV/AIDS. If that's the case, I am glad for him. I am. But many, many infections and deaths have been prevented because of 30 years of increased education, research, access to medicines and destigmatization. HIV/AIDS is a public health issue.
Last Friday, AIDS ACTION NOW! hosted a die-in in Toronto. A seven foot tall grim reaper and mournful clarinetist solemnly marched into Toronto City Hall's rotunda. There, we 'died' on the floor. After a minute or so, we were resurrected with chants of "Stop the cuts! AIDS action now!" Councillors Carroll and Wong Tam held the doors for us as we made our way back outside where we died again on the pavement. We drew chalk outlines around our "dead" bodies in memory of all of those, like Susan, whom we have lost. And, in honour of all of those who we could lose due to Ford's proposed cuts.
The cuts matter at the individual, municipal, provincial and national level. Two people helped me to connect the dots: Paul Sutton of the Regional HIV/AIDS Connection in London, Ontario and Richard Elliott of the Canadian HIV/AIDS Legal Network. Paul told me:
"How things are being conducted here (in Toronto) really gives us a demonstration of impacts and consequences that are going to be seen around the country. Specifically in terms of the HIV work that I do, a lot of it is built in, around and out of the infrastructures that have developed in doing HIV work here." If cuts are made in Toronto, "then that is going to have ripple repercussions, not just through the province, but around the country as a whole...."
Across the board, Paul argued, Ford's proposals represent "a general lack of perception about what is actually happening here and what Toronto means to itself and to the rest of us who relate to it." While HIV/AIDS can be a chronic condition, it is manageable only "with the right conditions." That means education, medicine and support.
Richard made the connection that resisting the cuts is critical because it is more costly "down the road" -- an economic impact that Ford doesn't seem to understand. More fundamentally, though, "It is the right thing to do."
Harkening me back to what Paul said about 'the right conditions' for health, Richard asserted the following:
"People are made vulnerable. And this is a city that has the resources and the infrastructure to reduce that vulnerability, to support people with the services that they need that make for a good quality of life. And there's no reason we can't provide that and we should. I think it's particularly troubling that we're talking about scaling back on programs that we know actually work including addressing HIV that is linked to injection drug use, for example. It's a major public health issue for the city... why wouldn't we want to invest in those things when we can at a very affordable price?"
We all have a stake in the public health, Richard asserted. "That's why it's called 'public' health."
We have a self-interest in an altruistic approach. If we want less transmission of HIV and Hepatitis C, then we have to invest in programs and services demonstrated to work, Richard explained.
I pressed him to make the connection between the proposed cuts and the increased criminalization of HIV transmission at the federal and provincial levels.
"The idea of cutting HIV prevention services at a municipal level, like Toronto's," he said, "is damaging per se. But the damage that it does is heightened by the context in which it's happening. And the context in Canada is that we're seeing ever more attention focused on punitive responses to dealing with HIV, including this vast over-criminalization of people with HIV, that makes HIV out to be this, you know, horrible imminent threat that's lurking to get everybody at any moment and so we need to crack down and be tough. We're throwing out the window reason when it comes to responding to HIV by saying that the response is to criminalize people with HIV no matter what kind of risk that they pose or not pose to other people for transmitting the virus. And, at the same time we're cutting the services that actually are shown to be effective in HIV prevention. So the shift is completely backwards." Richard continued to say that arguably, HIV prevention efforts and efforts to make sure that people can get access to the services they need will be undermined by "applying federal, criminal law to people or as here in Toronto cutting, or proposing to cut, services that are actually shown to work and be good value for money."
It is shocking how, across the board, a mayor who jigged into office on the arguably false claim that gravy was drowning the city has become an out-of-control spender on consultants, broken contracts, dismantling effective infrastructure to the tune of more than half of the budget deficit he claims we must amend. And now, at the expense of public health.