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.
| July 15, 2010; 11:19 AM ET
Categories: Gerson | Tags: Michael Gerson
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