A long-awaited National HIV/AIDS Strategy document the White House released this week calls for devoting more funds and attention to HIV prevention programs that target four high-risk population groups, especially gay and bisexual men.
In unusually blunt language, the 45-page strategy document that took 15 months to prepare says state and federal AIDS prevention programs have so far failed to adequately target gay and bisexual men and transgender people.
“Given the starkness and the enduring nature of the disparate impact on gay and bisexual men, it is important to significantly reprioritize resources and attention on this community,” says the document. “The United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men.”
The document adds, “As with gay and bisexual men, transgender individuals are also at high risk for HIV infection. … Yet, historically, efforts targeting this specific population have been minimal.”
Other high-risk groups the strategy calls for targeting are blacks, Latinos and substance abusers.
The National HIV/AIDS Strategy and an accompanying 35-page Federal Implementation Plan call for reducing the overall number of new infections by at least 25 percent over the next five years; increasing access to medical care and “optimizing health outcomes” for people living with HIV; and reducing HIV-related health disparities.
“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination,” the implementation plan declares as its goal.
The strategy and implementation document were released Tuesday amid a flurry of activity at the White House, which included a morning briefing on the document for the media and AIDS activists. Among those conducting the briefing were Melody Barnes, director of the White House Domestic Policy Council; Kathleen Sebelius, secretary of the Department of Health & Human Services, and Jeff Crowley, the gay director of the White House Office of National AIDS Policy.
Later in the day, President Obama hosted a reception in the White House East Room for about 150 national and community activists working on HIV/AIDS issues.
“From activists, researchers, community leaders who’ve waged a battle against AIDS for so long, including many of you here in this room, we have learned what we can do to stop the spread of the disease,” Obama told the gathering.
“We’ve learned what we can do to extend the lives of people living with it. And we’ve been reminded of our obligations to one another — obligations that, like the virus itself, transcend barriers of race or station or sexual orientation or faith or nationality,” he said.
“So the question is not whether we know what to do, but whether we will do it, whether we will fulfill those obligations, whether we will marshal our resources and the political will to confront a tragedy that is preventable.”
The president was interrupted briefly during his remarks by a man in the audience who shouted, “Mr. President,” prompting Obama to promise to talk with him after finishing his speech at the reception.
“Let’s hold on, you can talk to me after — we’ll be able to talk after I speak,” Obama said. “That’s why I invited you here, right? So you don’t have to yell.”
The audience member was later identified as Charles King, president and CEO of Housing Works, a New York City-based AIDS group that sometimes organizes AIDS-related protests involving arrests spurred by civil disobedience.
After completing his remarks, the president walked to where King was standing and spoke with him as news photographers hovered over the two.
King could not be immediately reached and it was not clear what he and Obama said to each other. But his brief interruption of Obama’s speech drew attention to concerns raised by some AIDS activists that the National HIV/AIDS Strategy does not include a call for significant new funds to fight the AIDS epidemic.
At the White House briefing earlier in the day, Sebelius and Crowley announced that the Obama administration would allocate $30 million to implement the strategy from a disease prevention fund created by the Affordable Care Act. The act is one of two landmark bills that Congress passed earlier this year to put in place the president’s sweeping health insurance reform proposals.
Sebelius and Crowley also noted that the administration would arrange for a separate emergency supplemental appropriation of $25 million to fund the struggling AIDS Drug Assistance Program, which provides life-prolonging anti-retroviral drugs for low-income people with HIV/AIDS who lack health insurance.
AIDS activists have criticized the administration and Congress for declining so far to appropriate $126 million in emergency funds for ADAP this year, an amount that state AIDS office directors believe is needed to provide drugs for 2,300 people who are on ADAP waiting lists in at least a dozen states.
The AIDS Healthcare Foundation, which bills itself as the largest global AIDS organization providing medical care to people with HIV/AIDS, held a separate news conference in Washington on Tuesday to criticize the AIDS strategy document.
Michael Weinstein, the group’s president, called the proposed $30 million allocation for the National HIV/AIDS Strategy and the $25 million proposed for ADAP grossly inadequate. He also said that the strategy document contained few if any new ideas and would likely “collect dust at the Library of Congress.”
But officials with other national AIDS organizations did not share Weinstein’s assessment of the strategy, calling it an important first step and a first-of-its-kind effort to prioritize federal AIDS programs.
“Today, the Obama administration took a significant step forward in the domestic battle against HIV/AIDS,” said AIDS Action, a national AIDS advocacy group, in a statement.
The statement said that, if properly implemented, the strategy would become “the first truly effective, comprehensive national plan in response to the U.S. HIV/AIDS epidemic, now in its 30th year.”
Michael Ruppal, executive director of the AIDS Institute, another national advocacy group, praised the strategy as an “ambitious” effort to curtail the domestic U.S. AIDS epidemic.
“The strategy will serve as a meaningful roadmap to reduce the number of HIV infections in the U.S., provide care to those who need it, and help reduce the stigma and disparities often associated with HIV/AIDS,” Ruppal said.
But he added, “Now we must turn our collective energies to implementing it with the necessary leadership and resources to achieve its goals and provide results for people who are currently living with HIV/AIDS or may be affected in the future.”
Cornelius Baker, former executive director of D.C.’s Whitman-Walker Clinic and a member of Obama’s Presidential Advisory Council on HIV/AIDS, issued a statement in his role as an official with the National Black Gay Men’s Advocacy Coalition.
He said the coalition considers the National HIV/AIDS Strategy and its accompanying implementation plan “significant steps forward in our nation’s effort to end the HIV epidemic.”
“Black gay men represent one of the most highly impacted populations and suffer the greatest disproportionate burden of the disease,” Baker said. “The National HIV/AIDS Strategy represents a major advance in its recognition that black gay men must be a focal point of attention if the United States is to make progress in reversing the trends of the HIV epidemic.”
In addition to the strategy and implementation documents, Obama issued a separate presidential memorandum to the heads of more than a dozen executive branch departments and agencies, establishing goals and timetables for carrying out the strategy.
The Obama memorandum designates six departments and agencies as “lead agencies” for implementing the strategy. They include the Department of Health & Human Services; Department of Justice; Department of Labor; Department of Housing & Urban Development; Department of Veterans Affairs; and the Social Security Administration.
The White House Office of National AIDS Policy, in consultation with the Office of Management & Budget, is assigned the task of monitoring the progress of the strategy’s implementation and setting the administration’s priorities for the project, the memo says.
At the White House briefing Tuesday, Crowley acknowledged that the National HIV/AIDS Strategy doesn’t initially call for providing significant new funds in the fight against AIDS, although he and Sebelius noted that the administration is committed to continue its existing proposals for increases in the federal AIDS budget in fiscal year 2011 and future years. The two also said the expansion of health insurance coverage for people who currently can’t afford it under the Obama health care legislation passed by Congress will greatly boost treatment and care for people with HIV/AIDS between now and 2014.
Crowley said the economic downturn and other competing spending needs made it important for the strategy to focus on ways to better use existing resources.
“Gay and bisexual men have comprised the largest proportion of the HIV epidemic in the United States since the first cases were reported in the 1980s, and that has not changed,” says the strategy document. “They still comprise the greatest proportion of infections nationally.”
To further show why greater resources must immediately be shifted to HIV prevention programs aimed at gay and bisexual men, the strategy document lists these facts:
• gay and bisexual men of all races are the only group in the United States where the estimated number of new HIV infections is rising annually;
• they are 44 to 86 times more likely to become infected with HIV than other men, and 40 to 77 times more likely to become infected than women;
• approximately one-half of the 1.1 million persons living with HIV in the United States are gay and bisexual men, and they account for the majority (53 percent) of new HIV infections each year;
• and high rates of HIV among gay men are found not only in large urban areas. More than half of all AIDS cases diagnosed in the United States are among gay and bisexual men irrespective of town or city size.
Jose Zuniga, president of the International Association of Physicians in AIDS Care, praised the strategy document’s call for participation by non-government entities and individuals to help implement the strategy, saying more than 13,000 members of his group worldwide and more than 5,000 U.S. members “stand ready” join in the effort.
“[W]e have a ready army of seasoned advocates — public health experts, clinicians and allied healthcare and laypeople providers, AIDS service organizations, community and faith-based organizations, academic institutions, and professional associations — that can help to accelerate implementation and thus allow for more quickly achieving many of the National HIV/AIDS Strategy’s objectives,” he said.