July 18, 2012 | by Gregory Pappas
We cut red tape abroad, why not domestically?

Half of the people living with HIV in the United States reside in 12 cities and D.C. is one of them. Urban America continues to suffer high rates of HIV despite successes of antiretroviral treatment that can suppress the virus, decrease transmission, prevent progression to AIDS, and lower death rates.

HIV knows no boundaries; it does not discriminate. The global U.S. response known as the President’s Emergency Program for AIDS Relief (PEPFAR) succeeded by enhancing funding, coordinating government efforts and working across jurisdictions. Bold action cut across bureaucratic and government boundaries. Bureaucratic bottlenecks gave way to coordinated programs that delivered medications across boundaries and saved millions of lives. President Bush, President Obama and Congress should be congratulated for this success and we should now emulate the model in the U.S.

The highways that connect Washington, D.C., environs and Baltimore convey more than just traffic; they are also corridors for the transmission of diseases. We live in a fluid society where people from all over the region communicate and connect.  The corridor from Northern Virginia, through D.C. and up to Baltimore have become one social, economic and epidemiological unit. The urban epidemic among men who have sex with men, heterosexuals and intravenous drug users has intensified. In D.C., one in four minority gay and bisexual men are now HIV positive. HIV is spreading from center cities to the suburbs. HIV is spreading from the center cities to the suburbs.

A domestic PEPFAR would emphasize enhanced spending, promote regional data and plan and coordinate services regionally. A study by the CDC estimates that we need about $10 billion invested now to save $66 billion over the long term by averting infections and the medical costs that follow. Better coordination with the federal government will increase efficiencies. Our health departments are burdened with managing and reporting on upwards of a dozen federal grants with overlapping grant periods and duplicative requirements that could be greatly simplified if the federal government worked in a more coordinated fashion. PEPFAR cut the red tape abroad; we can do the same at home. Fighting the epidemic in the region can also be improved by better coordination of services. People living across the street from a clinic in a different state cannot use their government insurance there.

Washington, D.C., Baltimore and adjoining counties offer an historic opportunity for the federal government to apply the PEPFAR approach. The region has strong public health departments, nationally recognized medical facilities and global academic institutions. They form the foundation for what could become a coordinated response to the regional epidemic. We also have dedicated community residents, HIV-positive people and activists that are well poised to collaborate in a regional coordinated effort.

Let D.C. and Baltimore be a national example of coordination by funding a domestic PEPFAR model right here. Hold us accountable for results in reducing new HIV cases on a regional basis, ensuring people get quality care and providing critical data to document success. Gov. Martin O’Malley of Maryland and Mayor Vincent Gray of D.C. recently wrote President Obama urging him to address the regional nature of the HIV epidemic and help our jurisdictions work together by facilitating a necessary collaboration. The president can use the international stage of AIDS 2012 as the opportunity to announce a domestic PEPFAR for urban America starting in the Baltimore-Washington corridor. By this initiative, the leadership he brought with the National HIV/AIDS Strategy can take the next step in ending the domestic epidemic.

Dr. Gregory Pappas is senior deputy director of the D.C. Department of Health’s HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA).

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