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Advocates push national HIV agenda for 1st 100 days
A surge of optimism
The demand for attention to the domestic HIV crisis has been pent-up for so long that within two days of the presidential election, a group of dozens of HIV/AIDS organizations sent the Obama-Biden transition team a letter requesting major changes to the how the domestic epidemic is handled.
Calling themselves "AIDS in America," the group called for renewed leadership and a comprehensive and adequately-funded response to the domestic epidemic, according to the Nov. 6, 2008, letter sent to John Podesta, Valerie Jarrett, and Peter Rouse, co-chairs of the Obama-Biden Transition Project.
Among the group's request for the first 100 days of Barack Obama's presidential term was a call for the development of a National AIDS Strategy for the U.S. Its goals would be to lower HIV incidence, increase access to HIV care, and reduce racial disparities in the epidemic, and integrate HIV with other programs at the local level, including programs targeting tuberculosis, sexually-transmitted diseases, and viral hepatitis. (See chart with some goals from AIDS in America.)
"It's pretty clear to us that the United States over 25 years into this epidemic has never set an accountable agenda for epidemic with a specific time table for getting results," says Rebecca Haag, executive director of AIDS Action Council in Washington, DC. Haag was as co-signer of the Nov. 6 letter and spoke at a December, 2008, teleconference on the impact of the Obama administration.
AIDS in America is asking Obama to appoint a panel that would deliver in his first year as president a national AIDS plan, Haag says.
The group is calling for a PEPFAR-like program that would have a plan with measurable outcomes and strategies to fix the problems, Haag adds.
"It's shameful for all of us to realize that in Washington, DC, the HIV infection rates are worse than in many sub-Saharan countries," Haag says.
AIDS groups are optimistic, says Carl Schmid, director of federal affairs for The AIDS Institute in Washington, DC. Schmid also spoke at the teleconference.
"While Obama ran for president, he said he's focus on the domestic AIDS epidemic and initiate a national AIDS strategy and have programs based on evidence and increased funding for HIV prevention and care and treatment," Schmid says.
"We are optimistic that we will see progress in the epidemic with Obama and his administration," Schmid says.
Another reason for the optimism is because of Obama's emphasis on national health care reform.
"In the early 1980s, there were many who argued that the health care response to the AIDS epidemic was a lens through which you could see all the fragmentation of our health care system," says Christine Lubinski, vice president for global health at the Infectious Diseases Society of America (IDSA).
"So obviously, we're very excited about the potential for health care reform," Lubinski says. "We represent a community that is very poor with multiple health care needs, so if a health care plan works for people with HIV/AIDS, it will work for all of us."
While no one expects national health care reform to occur overnight, there is some short-term action that could help stem the epidemic.
For example, the Obama administration could heed the overwhelming scientific evidence that needle exchange is a good prevention approach and lift the ban on federal funding for needle exchange programs, Haag suggests.
Also, since the Obama administration will focus on evidenced-based interventions, then it might mean an end to abstinence-only programs that result in people engaging in riskier sex because they're unaware of safer alternatives, Haag adds.
"We want the Centers for Disease Control and Prevention (CDC) to look at new prevention models that work in the most-affected communities, particularly looking at gay men of color and new prevention for African American women," Haag says.
The Bush administration did not apply a lot of the evidence-based methodology to HIV prevention strategies by promoting abstinence-only and banning funding for needle exchanges, Haag notes.
At a congressional hearing in September, it was announced that 2,000 organizations were waiting to be educated on the CDC's DEBI list of approved HIV prevention interventions, and they're not receiving the training because of a lack of funding, Schmid says.
"The CDC has 49 approved interventions in its compendium, and that compendium was not updated for the first seven years," he adds. "So hopefully with the Obama administration we will see more interventions and more research."
The new president also will have an opportunity to send a strong message about his commitment to fighting the domestic epidemic by increasing funding for HIV prevention and care programs in his first budget.
"Obama will have to propose a budget for fiscal year 2010, and it will come out in early February," Schmid says. "I think this will be a good signal of the Obama administration's commitment to the epidemic if he calls for increases in funding for prevention, the CDC, and for Ryan White Care Act programs."
Last year the Ryan White program was cut by $3.5 million, and this year the Congress is calling for a zero increase, despite large numbers of people infected by HIV/AIDS in our own country, Schmid says.
"People are living longer, so they need their health care and drugs much longer," Schmid says. "In addition, we have people being infected at a much higher rate, and they need treatment and medical costs and drug costs are increasing."