"This year marks the twentieth year that the world has been in engaged in the war against AIDS. However, the fight is far from over. Instead, this disease is spreading rapidly throughout the world. During this past year, political leaders from around the worldhave joined together to launch new global efforts against this deadly pandemic. In light of continuing escalation of the pandemic, the United Nations selected HIV/AIDS as the focus of this year's Special Session, making the pandemic a central topic in the UN Global agenda. Addressing HIV/AIDS in this context has increased global awareness of the disease on both social and political levels.

AIDS has claimed the lives of nearly 22 million people throughout the world. It is projected that the number of deaths caused by AIDS in the next ten years will be greater than the combined fatalities in all wars of the 20th century. In some countries today, the disease is spreading so rapidly and fiercely that more than one-third of their adult populations are infected with HIV.

While most developed countries like the US are not now experiencing such dramatic losses, it is crucial that all countries combine their resources to further combat this pandemic. Long ago, we realized that all people of every region, ethnicity, age, gender, and sexual orientation can be at risk for acquiring HIV/AIDS. Furthermore, it is increasingly evident that citizens in every nation are now affected by this disease, if not directly, then indirectly through the pandemics influence on the social and economic well-being of their global neighbors.

This year's theme for World AIDS Day - I Care… Do You? Youth and AIDS in the 21st Century - reflects the reality that HIV is reaching younger populations, here in the US and around the world. Already youth under 25 represent half of all new HIV throughout the world, and five young people are infected with HIV every minute. …

It will take concerted global efforts to provide the necessary resources, research, and educational programs to curb further spread of this disease. And yet, the world's best prevention and treatment techniques will not be fully effective until we first overcome the fear, denial, and stigma [that continues to be] associated with HIV/AIDS." ___________________________________________________________________________________

Twenty Years of AIDS: the Anguish and the Hope
Sermon by Rev. Danita Noland, December 9, 2001

In the summer of 1981, articles began appearing in newspapers announcing the mysterious and sudden appearance of two rare medical conditions, the skin cancer - Kaposi's Sarcoma, and a form of pneumonia - pneumocystis. Equally puzzling to medical experts was the fact that these illnesses were occurring in a specific population, that of young homosexual males. In August of that summer, The New York Times reported, "Two rare diseases have struck more than 100 homosexual men in the United States in recent months, killing almost half of them, and a medical study group has been formed to find out why, the Centers for Disease Control said today." After describing the symptoms of Kaposi's Sarcoma and pneumocystis, the article went on to say, "Nobody knows why homosexual men get [these] diseases… There may be a link to some previous infection, or the victims may have a problem with their immune systems. The diseases may be linked to their sexual lifestyle, drug use or some other environmental cause, although no evidence of those connections has been found." By the end of 1981, 159 people would die from AIDS-related illnesses.

In the year 2001, newspaper articles tell of a vastly different reality when reporting information about what is now known as HIV - Human Immunodeficiency Virus, in initial stages of infection, and AIDS - Acquired Immune Deficiency Syndrome, when opportunistic illnesses begin invading the body. In the December 2nd edition of The New York Times a headline reads, "Mandela Urges Access to Drugs to Fight AIDS". The article warns of the now global epidemic and future predictions, stating, "Today on World AIDS Day, China broadcast its first drama on AIDS… The world's most populous country was jolted into action after [new cases of] H.I.V infections surged 67.4% to 3,541, in the first half of 2001… The United Nations says China could have 10 million people with H.I.V. by 2010 unless it acts decisively… Marking the day in South Africa, where more people live with HIV or AIDS than in any other country, former President Nelson Mandela called for victims to be given access to drugs that fight the disease, [saying] 'Nothing threatens us more today than HIV/AIDS. AIDS is a scourge threatening to undo all the gains we made in our generations of struggle." The article concludes with this statement, "In 16 countries, more than 10% of people aged 15 to 49 are infected with HIV. Worldwide, more than 40 million people live with HIV or AIDS, including 4.5 million children. Twenty years after scientists in the United States reported first clinical evidence of the disease, there is no cure." In these last twenty years, 22 million lives have been cut short because of AIDS. In 1981, no one ever imagined that those first cases of unusual illnesses were the beginning of an incurable disease that would spread, reaching epidemic proportions first here in the United States and then throughout the world. The twenty-year story of AIDS is one of great sorrow and loss, of courage and dignity. It is a story that has transformed many aspects of our society, from the pharmaceutical industry and patients' rights in medical treatment, to how we talk to our children about sexuality. It is a story that has opened our eyes and changed our hearts, confronting Americans with their homophobia when HIV was initially considered a gay person's disease, bringing to our attention issues of economic injustice, racism, and sexism, with HIV disproportionately affecting women and people of color in this country and decimating entire countries of Sub-Saharan Africa. The story of AIDS has no end in sight with young people under the age of 25 accounting for half of all new infections and the much hoped for vaccine still not developed.

I was 18 in 1981, just entering my adult years. While I am sure I must have heard the initial reports of this new disease, I don't remember being aware of AIDS for at least another couple of years. In college in a small town in Louisiana, it was during my sophomore year that I first remember conversations about what was then referred to as the gay disease, something that was happening to someone else, someplace else, in big cities. In the early 80's, having safe sex meant women were protecting themselves from unwanted pregnancies, usually by taking the birth control pill. Even though the CDC added female sexual partners of men with AIDS to the list of high risk categories which included intravenous drug users, homosexual men, and hemophiliacs, and over two thousand people had died by the end of 1983, most people in America did not believe they were at risk of contracting HIV - gay or straight. In 1985, the rate of infection in the U.S. reached its peak, with over 150,000 new cases of HIV being diagnosed, and the death toll began to rise. While most of America was still in denial about the spread of AIDS, the gay communities in San Francisco, Los Angeles, and New York City, were suffering huge losses which created a sense of urgency largely unfelt and unresponded to by the rest of the nation. It was only when AIDS spread beyond the gay community that America took seriously the threat of an epidemic. In 1985, AIDS was given a human face when beloved actor Rock Hudson became the first well-known person to announce he had AIDS. He died later that year. And Ryan White, a thirteen year old hemophiliac, received national attention when he was barred from school because he was HIV positive, having contracted the disease from a blood transfusion.

Fear and panic began to shape the public dialogue concerning AIDS as infection rates climbed. In 1986, it was suggested that people diagnosed with HIV should be quarantined or at least tattooed so others would know their status. But public-health authorities had a less hysterical response and began an educational campaign, telling Americans they could avoid infection by practicing safe sex and not sharing needles. Being bombarded with the message that AIDS equals death was a very strong motivator for people to change their behaviors, and many did. By 1990, the infection rate had dropped to 40,000 new cases a year.

During the first ten years, the battle against AIDS was mainly fought by the gay community. It became clear that homophobia and a condemnation of homosexuality by most religious institutions were influencing the nation's response to the epidemic. The government was slow to fund research that could lead to effective drug treatments and a vaccine. This led to the forming of gay activist groups and a new protest movement that brought about reductions in the cost of drug treatments and changes in the health care industry. One group, ACT UP - which stands for AIDS Coalition to Unleash Power, was especially effective in bringing about much needed changes. They staged die-ins and political funerals, carrying the bodies of their dead partners to the gates of the White House in wide-open caskets, waking up our nation's politicians who then began funding prevention programs. With AZT, an old cancer drug that had been around since the 60's, being the only treatment offered to AIDS patients. ACT UP demanded changes in pharmaceutical research procedures, reducing the ten-year process for getting FDA approval to one. ACT UP also rejected the model of research that used placebo-control groups, with half of the patients receiving only sugar pills, claiming this was cruel when experimental drugs were the only hope they had. Now, exceptions to this protocol are often granted.

AIDS united the gay community and gave birth to the gay rights movement, demanding fair and equal treatment in society. With courage and dignity, gays and lesbians came out of the closet, standing in solidarity with those infected with HIV. Americans were forced to recognize the validity of same sex couples when gay men demanded the right to be at the bedside of their dying companions. Religious communities began to re-examine their stands on homosexuality and their response to the AIDS crisis, which led many of them to become more compassionate and open to gays and lesbians over time.

As the 90's began, the infection rates of HIV in the United States had dropped dramatically, but the death rate was climbing. In 1990, nearly 30,000 people died of AIDS related illnesses, bringing the total to nearly 122,000. In 1992, AIDS became the leading cause of death in men between the ages of 25 and 44. The use of AZT and other similar drugs was proving to be ineffective in the long-term fight of the disease. By 1993, nearly 27,000 women were living with AIDS and over 6,000 had died from it. Our awareness also shifted to how AIDS was spreading throughout Sub-Saharan Africa, Asia, and South America, with an estimated 12 million people infected worldwide by AIDS, 4 million were women. In 1994, AIDS becomes the number one cause of death for all Americans between the ages 25 to 44, with 50,000 aids related deaths reported that year and the next.

While attending seminary in 1996, I had the opportunity to go to Washington, D.C. and participate in the last display of the AIDS Memorial Quilt in its entirety. The AIDS Memorial Quilt was started by Cleve Jones in 1987. With over 1,000 deaths by this time in San Francisco alone, Jones was overwhelmed by grief and wanted to make the public understand what he and his friends were experiencing. He needed to find a way to express his unending grief as friends and loved ones continued to die. At demonstrations, Jones and his friends would carry placards with the names of their partners and friends written on them. After one march, they had taped all the cards to the wall of the San Francisco Federal Building and it reminded Jones of a patchwork quilt. Inspired by this image, Jones gathered a small group of people together in an empty storefront on Market Street, and in his words, they began "to take all our individual experiences, and stitch them together to make something that had strength and beauty". 3 x 6 foot Quilt panels were made for each person they knew that had died with AIDS. A group of 90 volunteers worked to display the quilt for the first time On October 11, 1987, on the National Mall in Washington, D.C., during the National March on Washington for Lesbian and Gay Rights. It covered a space larger than a football field and included 1,920 panels. Half a million people visited the Quilt that weekend. When I participated in 1996, 1200 volunteers were needed each day to unfold the 44,000 panels included in the display. The names of all who are represented in the quilt are read aloud each time the quilt is shown. I spent three days at the Memorial Quilt, helping to unfold the quilt each morning, and then pack it away again in the evening. Mike Smith, the director of the 1996 display wrote, "Those of us were more innocent then, believing that the nightmare would soon end, that the hate and bigotry would subside, and that the dying would cease so we could go back to our day jobs. Instead, we have watched in horror as the Quilt doubled in size, then doubled again, and again. And yet, again." By 1996, 40 of the original 90 volunteers had taken their place in the quilt. By 1996, at least 7 people that I had gone to high school with had died of AIDS. The quilt panels are arranged chronologically and geographically so areas are represented together and smaller displays can be arranged for cities and states. I was surprised to see the names of people I knew as I walked down the row that included Louisiana. Walking from the first panels made to the end, I noticed a distinct change in the creation of the panels. The first panels were very bare, often having only a first name and year of death printed on them. Slowly, the panels began telling more about the individual they represented, listing their hobbies, telling the stories of their lives, their accomplishments, and what their dreams had been. The most difficult panels to view were those for children. Some panels had been created by hospitals and orphanages where babies had been left, sometimes because their parents had died of AIDS when they were very young and sometimes because parents were unable to bear caring for a child who would soon die. Some of these panels would have 10 or 12 names on them. The Quilt is a unique memorial, a beautiful and uplifting response to tragedy and unbearable loss of human life.

In 1996, a new drug was developed, protease inhibitors. This drug, when used with a combinations of other drugs, in what is often referred to as the AIDS cocktail, brought about a remarkable change in the story of AIDS, offering hope and health to people with HIV for the first time since 1981. 1997 was the first year to see a decline in the number of AIDS related deaths in the US since the beginning of the epidemic. I did my chaplaincy training at San Francisco General Hospital in the summer of 1997. The program there focused on AIDS ministry. San Francisco General had been the first hospital to create an AIDS unit, recognizing the unique needs of these patients and the importance of addressing the impact AIDS had on their entire life. Many patients were estranged from their family because of being homosexual. Many were alone because their friends had already died of this disease. Medical costs for people with HIV and AIDS is financially devastating, and many were unable to work, forcing some to become homeless, worsening their already grim situation. The hospital staff tried to help the AIDS patients with all of these struggles. The chaplains I worked with that summer noticed a change in the work being done with the patients. A patient said to me one day, "for years, I have been struggling to face my approaching death. Now, I need to learn how to live again. My health is improving and now I am looking at years ahead of me instead of just months." The AIDS cocktail was successfully restoring health to people who had been deathly ill for years. White cell counts and T-cell counts were returning to near normal levels and opportunistic illnesses were being fought off by the body's own immune system. I got close to one patient, who was in the hospital for nearly the entire 10 weeks I worked there. Her name is Heidi. Heidi had been living with AIDS for 14 years. She was the first female her doctor had ever diagnosed with AIDS in the early 80's. Heidi told me her life story over the weeks as I visited her. She had gotten AIDS from a man she had dated who used intravenous-drugs. He had probably contracted AIDS from his drug dealer, who had mysteriously died of organ failure before HIV had been identified. She had stayed in relatively good health the first 10 years of having HIV. Four years earlier, Heidi had become pregnant with a man she had fallen in love with. He never contracted HIV although they did not always use protection. While pregnant Heidi had been encouraged to take AZT, to protect her unborn child, and like many who took this drug, quickly went from being healthy to having full blown AIDS. She nearly died before giving birth to a healthy baby girl, her T-cell count dropping drastically and she had never regained her health. Because of the unpredicted consequences of her taking AZT, Heidi feared any new drug that was offered. With her T-cell count and white blood cell count both down to single digits, the doctors told her she would soon die. Her only hope was to start the AIDS cocktail, which would probably be very beneficial since she had not taken other drugs along the way. Because she wanted to live as long as possible to watch her daughter grow up, at the end of the summer, Heidi agreed to start taking the new drugs. A year later when I went back to visit the chaplains at San Francisco General, I checked the data base on the computer, and Heidi was still registered as an outpatient. The summer I worked at the hospital, for the first time since the AIDS epidemic had started, an entire month went by without a single AIDS related death.

As AIDS related deaths in the country have dropped to 20,000 a year, bringing the total here to nearly 450,000, people have begun to think less and less about HIV and the epidemic that continues worldwide. While the AIDS cocktail has been effective here, turning HIV into a disease you live with, instead of a disease you die from, the devastating effects of AIDS is affecting millions of people globally. Throughout the world, 36 million people are HIV positive. In many developing countries, the lack of effective drug treatments and access to health care allows for unrestrained progression of the disease. In Africa this year, there has already been 3.4 million new infections and 2.3 million deaths. In some areas of Sub-Saharan Africa, such as Botswana, over 35% of the adult population is currently infected with HIV. Zambia can not train teachers fast enough to replace those killed by AIDS. Within 10 years, there will be 40 million AIDS orphans in Africa. Without AIDS the life expectancy in this area would be 62, it is now 47. And in a report released November 28th of this year, it states that the number of HIV infections in Eastern Europe is rising faster than anywhere else in the world. Reported figures are largely underestimated but even so, the latest figures reveal there were more than 75,000 reported new infections in Russia by early November, a 15-fold increase in just three years. In some areas of the world where low infection rates are reported, such as India and China, the figures can be misleading. India's .7% translates in to 3.7 million people with HIV. Drug treatments alone are not the answer. Even if the medications were made available at cost - a step many nations are calling for. Many developing countries do not have the medical infrastructure to handle distribution and continued care that would be needed.

Even in the United States, there are some disturbing new trends in the AIDS story. With people's health initially improving, there is less motivation to practice safe sex. The actual rate of new infections each year has remained at 40,000 a year for the past decade. While I was working at San Francisco General in 1997, doctors were then expressing concern that the difficult regimen of taking the AIDS cocktail would not be strictly followed by many patients, which could then produce resistant strains of HIV, and these resistant strains would be passed on to new patients. This concern has become a reality with a study in February of 2001 stating an increase in the number of newly infected people who are infected with a drug resistant strain of HIV, with 14% of new cases reviewed now resistant. There is no treatment to offer these people. And we are now seeing that the cocktails have limited effectiveness and are so hard on the body that people can not take these drugs forever. While the overall number of new cases of AIDS in the US is staying the same each year, the populations being infected have changed. There has been an increase in both women and minorities, and especially minority women. African American and Hispanic women represent 81% of all AIDS cases among women, yet they account for only 25% of the female population in this country. Factors contributing to the increase of HIV in minority populations include poverty, substance abuse and the lack of health care. The increase of AIDS among our young people is a concern worldwide, and demands significant attention here. Young Americans between the ages of 13 and 25 are contracting HIV at the rate of 2 every hour. An estimated 250,000 young adults in this country are unaware that they have HIV.

We must demand that the research for a vaccine is fully funded if we hope to see this disease brought under control. A global economic disaster is looming ahead as countries' work populations are decimated and it will affect us all. There is hope in the fact that there are a few vaccines in the testing stages now. A study is being conducted on a group of Nairobi prostitutes who remain free of HIV despite years of constant exposure. Maybe scientist will learn how to create a vaccine that will encourage our immune systems to behave as theirs do. The creation of a vaccine is much more difficult than developing treatments and we are years away from having even a partially effective one. What we do know is that the AIDS epidemic will certainly continue and get worse before it gets better. We must continue to educate ourselves and our youth about the risks of HIV. We need to demand that health care be made available to everyone in this country, and that pharmaceutical companies be urged to cut the profits they make off of the drugs that are a matter of life or death for millions worldwide. We need to encourage the UN to come up with a global action plan and then devote all possible resources to funding it. If we get lucky with prevention, treatment, and a vaccine, by 2021, AIDS will be killing 5 million people a year. If we don't the death toll could be 12 million.