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Obama's HIV/AIDS strategy: sound, but not sufficient

Earlier this week, President Obama announced a comprehensive national HIV/AIDS strategy. It is needed. America’s domestic AIDS problem has dropped from the headlines since the early days of fear and controversy -- both of which were calmed by a better understanding of transmission and the development effective treatments. But more than a million Americans are living with HIV/AIDS, and infection rates on their current course will increase this number over time. AIDS is on the advance in America and, as I’ve written, the demographics of the disease are changing -- becoming more prevalent among the poor, minorities and women.

The administration’s strategy summarizes the best current thinking on AIDS in America. But the president’s announcement was attended with some unnecessary rhetorical fuzziness. “Fighting HIV/AIDS in America and around the world will require more than just fighting the virus,” he said. “It will require a broader effort to make life more just and equitable.” Hopefully, we can make some progress reducing the rate of new HIV infections before the arrival of the peaceable kingdom.

Obama also gave us more of a framework than a plan. Little gets accomplished in government without the alignment of authority, resources and responsibility. The President’s Emergency Plan for AIDS Relief (PEPFAR) succeeded internationally with a simple theory: put someone in charge, give them the resources they need, and hold them personally accountable for outcomes. By this measure, the new domestic AIDS strategy raises more questions than it answers. The report comes out of the National AIDS Policy Council at the White House, which does not have direct, government-wide authority over this issue. The new resources dedicated to the effort -- $30 million -- are minimal. And if the targets in the strategy are not met, it is not clear that anyone is held directly responsible.

The goals of this strategy, though, are worthy: reduce new infections by 25 percent over the next five years, increase the percentage of the infected who know their status, increase the percentage of those who get quickly from diagnosis into care.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes for Health, points to several positive elements of the new AIDS strategy (which he helped to produce), beginning with its realism about the current nature of the crisis. “It is important to avoid stigmatizing any group,” Fauci told me, “but we can’t act like HIV is an equal opportunity disease.” While African Americans comprise about 12 to 13 percent of the U.S. population, they account for nearly 50 percent of new HIV infections. And about half of new infections are found among men who have sex with men. The strategy, Fauci says, “takes the sugar coating away” – allowing public health officials to focus on the greatest needs.

Fauci also welcomes the strategy’s emphasis on linking HIV testing to care. He recounts the recent case of a District man who arrived at NIH with an advanced case of AIDS. The man had been tested and diagnosed three years before, but had never received care for his condition. “We not only need aggressive testing,” says Fauci, “we need aggressive efforts to make sure we don’t let people fall between the cracks.”

This new AIDS strategy is sound. Still, it is not a substitute for a strong, well-funded presidential initiative to combat AIDS in America -- which is the next, logical step.

By Michael Gerson  | July 15, 2010; 11:19 AM ET
Categories:  Gerson  | Tags:  Michael Gerson  
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Does this new plan have increasing the waiting lists for HIV drugs. Hopefully, there will be a cure within the next three of four years. Only problem is that it will take 10 to 15 years to put it into public use under the current medical system. I am so happy for the drug companies as they move to other area where more money can be made. Isn't capitalism wonderful.

Posted by: artg | July 15, 2010 12:31 PM | Report abuse

who cares what Bush's pimp has to say?

Posted by: turningfool | July 15, 2010 12:32 PM | Report abuse

President Obama should be commended in his efforts in fighting HIV and AIDS. It is important that we focus on both the treatment and the prevention of AIDS, particularly focusing on methods that have been conclusively proven to work.

I am worried that the White House will adopt the position that circumcision is effective HIV prevention. Recently, promoters of circumcision have been trying very hard to use trials in Africa to promote circumcision as HIV prevention policy, and I hope that the White House has enough sense to consider some important realities.

In America, for example, 80% of men are already circumcised from birth. The rates of infant circumcision are dropping, but at large, the population remains circumcised. These rates are at their highest in the east coast, where cities such as Philadelphia and Washington DC rival HIV hotspots in South Africa. In the 1980s, when the AIDS epidemic first hit, the rate of circumcised men in America was at 90%. One needs to question how something that never worked here in our own country is suddenly going to wonders in Africa.

In other countries, the "protection" remains to be seen as well. AIDS is a rising problem in Israel, where the majority of the male population is already circumcised. On Wednesday, July 7th, just last week, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims (in other words CIRCUMCISED).

In his strategy to tackle AIDS, our president would do best to dismiss a "prevention method" that is being shown by reality to fail. Promoting circumcision is a waste of money, when condoms and education have been proven to be far more effective. Reports in Africa are saying that HIV rates are falling, and that this is due to a change in behavior, such as more condom use, and having less sexual partners.

Ultimately, whether or not one is at risk for HIV transmission depends entirely on behavior, and not whether or not one has been circumcised. It is my sincerest hope that in your efforts to stem HIV transmission, that our president concentrate on methods that have been conclusively proven to work. In these hard economic times, promoting and subsidizing radical surgical procedure with dubious benefits is a waste of money that could be better spent on condoms, education and awareness.

Posted by: kogejoe | July 16, 2010 4:56 AM | Report abuse

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