Letter from the editor.

DEAR READER

Salvage is an ugly word. Saying it by itself, one thinks of a large yard with rusting heaps of old appliances or dismantled cars that once had use and purpose in our modern world. Salvage can also refer to the rescue of a ship from a shipwreck, fire, or other destruction. So, how in the world could we have ever applied such a word to people living with HIV/AIDS? Perhaps it's the meaning of salvage as a verb--to save from loss or destruction. But is that any more appropriate?

Medical jargon is filled with examples of dehumanizing and insensitive terminology, created largely for purposes of convenience and, less convincingly, practicality. How many of us cringe when we hear about "cancer patients" or "AIDS patients" instead of "patients with cancer" or "people living with AIDS," as if one's disease defined a human being? Those are by far among some of the least offensive examples. Therefore, considerable burden or even stigma might be attached to the use of phrases like "salvage patients" or even "salvage therapy" to refer to the situation where cross-class viral drug resistance abounds and treatment options to suppress virus and restore immune function are in desperate need.

But given one of its meanings is synonymous with "rescue," the use of "salvage" might he justifiable. What are the alternatives? Highly antiretroviral treatment-experienced? Multi-drug resistant? Such lengthy or technical phrases do not impart the urgency associated with this condition. Language is a powerful tool, and the ability to express such a profound concept in just one word can be very effective.

The reality of patients who need salvage or rescue therapy has been apparent from the very early days of HIV therapy. These are patients who will experience disease progression and die unless something is done. With each enhancement in antiretroviral therapy over the past 15 years or so has come the acute reminder that this virus presents a formidable challenge and will not easily he subdued or eradicated. Salvage therapy represents our failures in HIV therapy thus far. Salvage patients remind us that we must not settle for anything short of a cure.

I write this letter in the midst of hearing about the loss of Charles Clifton, a colleague, a friend, and an inspiration. Charles was the Executive Director of Test Positive Aware Network (TPAN) in Chicago and Editor of its publications (www.tpan.com). He also served with me on the Steering Committee of the AIDS Treatment Activists Coalition (www.atac-usa.org). His presence in AIDS advocacy will be sorely missed; his humanity and service will not be forgotten. This issue is dedicated in Charles Clifton's memory. Farewell, Charles.

Very truly yours,

The Center for AIDS:

Hope & Remembrance Project

Thomas Gegeny, MS, ELS

Senior Editor