AIDS is here to stay. At least for now…. It didn’t seem that way during the 1980s. As we learned more about HIV and its manifestations, the predominantly male and intervention-driven scientific world organized itself to find a solution within a decade or two. After all, the war against smallpox, polio and other infectious diseases had been won with medicines, vaccines and public health efforts. Well, here we are, way into the third decade, and despite the achievements, the pandemic continuous to grow. What lessons can we draw from the cumulative knowledge, organizational responses and manifestations of solidarity?

The first decade of AIDS was marked by fear, death and loss. AIDS was visible in the faces with Kaposi sarcoma and the wasting of the bodies. We feared the contagion, death, the loss of loved ones, the unknown. And among so much fear, we blamed others: the “4 Hs” (Haitians, hemophiliacs, homosexuals, heroin addicts), sex workers, … even monkeys. Conspiracy theories flourished to explain the origin of the virus: a biological weapon, a laboratory experiment gone wrong. But the first decade of AIDS gave birth to the very essence that made it a disease like no other. A powerful medical model was challenged by participation. A movement was created. Never again would patients be patient. AIDS forever changed the way health would be delivered.

The second decade of AIDS was marked by hope; hope for a treatment, a vaccine, a cure. Science took enormous strides. Antiretroviral therapies created miracles: the Lazarus effect, they called it. HIV became a chronic condition, not a death sentence. While a cure and a vaccine were still to be found, the benefits of the quest advanced all aspects of clinical care. The breath of fresh air that came with so many developments also fueled a stronger coalition. Communities began to take control and demand action. People living with HIV and AIDS showed their faces, let their voices be heard, and influenced program design and policy. Access to treatment became a unified call.

The ongoing third decade of AIDS has been marked by money. The unknown, stigmatized disease that nobody wanted to touch in the beginning of the pandemic came of age drawing the attention of global leaders. New public-private-partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria were created to unleash extraordinary levels of funding. The movement peaked with this expanded response but money did not buy a solution.

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