Gregg Gonsalves, director of treatment and prevention advocacy at the Gay Men’s Health Crisis, contacted Tufts Magazine recently, not to tell us he was going to the International AIDS Conference—although we would have considered that newsworthy. Instead, he hoped to draw attention to the ongoing work of Tufts alumni, such as Sue Simon and Karyn Kaplan (see main story on page 35), who are fighting on behalf of people around the world who need HIV treatment.

“One thing that links Tufts alums doing AIDS work is that we were in New York or in other U.S. cities in the 1980s and watched as HIV cut a path of devastation through our lives,” says Gonsalves, a member of the Class of 1985. “We saw many of our friends die. We know what it means to attend several funerals a week. Karyn, Sue, and I have been part of the AIDS movement for a long time. As our colleagues in the developing world started asking for our assistance, we heard our own voices reflected back to us; we could easily identify with the holocaust that they were facing and all decided to take action.”

In addition to Kaplan, Gonsalves and Simon (among many other Tufts alumni) are responding to those voices—voices that now resound in a worldwide plea for help. According to the World Health Organization, some six million people living in the developing world are in urgent need of HIV treatment. The number receiving that treatment is only about seven percent, or some 400,000 individuals.

Advocating for improved access to health care on the international level, says Gonsalves, is essentially a struggle for justice. “Why should somebody in Malawi or Sri Lanka have less a right to life than I do?” And he prods his listener to imagine what would happen if nothing were done. “There are 40 million people infected with HIV right now who are going to die without treatment unless things change,” he says. “Their deaths will be a cataclysmic event not only for their families and friends, but for their communities, countries, and continents.”

Gonsalves has worked on behalf of people with HIV since 1990, first as a member of ACT UP (AIDS Coalition to Unleash Power)/Boston and then with ACT UP/NY. He co-founded the Treatment Action Group (TAG) in 1992. In 1995, he found out that he himself was HIV+. Now with the Gay Men’s Health Crisis in New York, he works on access to treatment issues for people with HIV/AIDS in the developing world as well as on HIV prevention and AIDS research issues in the U.S. Over the past few years, he and his colleagues in the AIDS advocacy movement have been instrumental in pushing down the price of drugs, setting the stage for wider access to treatment for poor people around the world.

Last fall the World Health Organization announced that the lack of access to HIV therapy was a global public health emergency and committed its resources to treating three million people in the developing world with antiretroviral therapy by 2005. “For years, people said the drugs were too expensive and treatment too complicated for poor countries,” says Gonsalves, “but from Haiti to Brazil, from Thailand to Malawi, we are now seeing programs that are successfully treating HIV infection and offering millions of people a new lease on life.”

Sue Simon, J84, who works in New York as associate director of the International Harm Reduction Development Program (IHRD) in New York, has seen firsthand how people living with HIV are also victims of ill-placed policies and attitudes. She recalls how a man living with HIV in Belgrade, Serbia, whispered to her his greatest fear: If his condition became known, he would lose his job, his apartment, and, worst of all, be abandoned by his friend’s and family.

The anecdote is only one of many that she uses to illustrate what she sees throughout Eastern Europe, Central Asia, and the former Soviet Union. She works closely with more than 200 projects in 23 countries on initiatives targeting injecting drug users that encompass a needle-exchange component as well as projects relating to sex workers, street kids, HIV prevention in prisons, harm reduction needs among ethnic minorities, and methadone treatment.

Amidst spiraling HIV infection rates, she says, “conflict, poverty, dislocation, and hopelessness have created a tinderbox in which the AIDS epidemic has moved quickly and with devastating consequences.” In Russia and Ukraine alone, the number of people infected by HIV in the past five years has increased by more than 500 percent; Eastern Europe as a whole now has the highest growth rate of HIV/AIDS in the world.

The good news is that harm reduction, which emphasizes a pragmatic and humanistic approach to diminishing the social and physical concerns associated with drug use, has achieved a foothold in almost every country in the region. “The burgeoning activist movement in the region has never been stronger,” says Simon. “Drug users and people living with HIV/AIDS are spearheading self-help, treatment, and advocacy efforts in record numbers. Services are more holistic, encompassing medical, mental health, and social care. The harm-reduction and human-rights communities have made important linkages in the fight against draconian drug policies. The Global Fund has awarded unprecedented funding to 16 countries in the region to help prevent and treat HIV and TB. I find hope in the tremendous leadership and commitment of service providers and advocates, working under the most difficult of circumstances, who care deeply about their communities.”