What can Mitt Romney do for HIV/AIDS?

By JAMES DRISCOLL, Ph.D.  

What can Mitt Romney do for AIDS? In a word — plenty. As we approach the XIX International AIDS Conference opening in Washington July 22, Mitt Romney has so far said nothing about AIDS. Perhaps his advisers are reluctant to touch the subject. They shouldn’t be. George W. Bush learned early that AIDS holds opportunities for conservative activism; he then built the best AIDS record of any president.

The Bush record provides a fine example and starting place for Mitt Romney. Bush cleared regulatory hurdles to rapid HIV testing and reformed federal AIDS care programs. He launched PEPFAR, the President’s Emergency Plan for AIDS, which has become the most successful foreign aide initiative since the Marshall Plan. Bringing AIDS drug treatment to millions in Asia and Africa, PEPFAR has saved countless lives and earned America worldwide respect and good will.

However, many more lives can now be saved by improved use of PEPFAR resources. As president, Romney could focus the program more on antiretroviral drug treatment and less on administration. Program efficiencies, boosted by falling drug costs, could allow PEPFAR to treat many more patients with current funding.

Tariffs and taxes on medical products remain serious obstacles to combating AIDS and other killers throughout the developing world. More than 30 countries, including the U.S., have abolished tariffs on medical products. Nonetheless, in too many trade negotiations, medical products still have the same priority as balloons, boom boxes and rum. Everything is a trading chip, regardless of whether it is trifling or essential to human health. This must change.

Countries like India, China and Thailand, with chronic trade surpluses and large HIV epidemics, continue to impose trade barriers on medications for AIDS and other life-threatening diseases. Elimination of all taxes worldwide on vital medical products would be a great boon to world health. At the same time it would help reduce dangerous trade imbalances between the West and Asia, an important priority for the next president.

PEPFAR gave President Bush a chance to pursue a lofty international goal. President Romney will have a unique opportunity to advance America’s domestic AIDS goals.  Last year NIH’s 052 study, cited by Science as the top advance of 2011, proved that anti-retroviral treatment is 96 percent effective in preventing infection of HIV negative partners. We now know that widespread HIV testing and treatment can prevent the spread of AIDS.

However, more than 20 percent of HIV positives in America do not know their status. We must get them tested and into treatment. President Obama formulated a viable National AIDS Strategy, but he has neglected the hardest part, implementation. As a result, the AIDS virus continues to spread rapidly among many groups, especially gay men, Latinos and African-American women.

President Romney would need to re-prioritize AIDS funding in order to find savings and efficiencies to pay for more testing, linkage to care and AIDS drug treatment for many additional HIV patients. He can, thereby, reduce the rate of new infections and at last turn the tide against AIDS in America.

Keeping down AIDS regimen costs is essential to HIV treatment expansion given a troubled global economy and soaring deficits in every developed country. We must recognize that nearly all AIDS patients are poor people whose treatment hinges on some form of taxpayer funding. There is no true free market in AIDS drugs.

Presidential leadership will be crucial to negotiating agreements with pharmaceutical companies that allow us to treat many more HIV-positive Americans with current funding. The global AIDS drug market is $22 billion. A share of a market that size is a powerful incentive to continue development of new HIV drugs, though additional inducements would be helpful.

The next president needs to create effective tax, IP and regulatory avenues to speed private sector research on cures and better treatments for the big killers with the heaviest impact on healthcare budgets, like Alzheimer’s, cancer, diabetes, and HIV-AIDS. The best, the most humane, way to cut spiraling healthcare costs is to prevent, cure or effectively treat the most costly diseases.

Americans will want Romney to replace “Obamacare” with policies that deliver better healthcare at sustainable costs. However, silence and inaction by Romney on AIDS will make Obama shine by comparison. The XIX International AIDS conference offers Romney a choice opportunity to show America how and why he can do better.

Equally important, AIDS and the XIX Conference give him a chance to reach out to the constituencies who suffer most from AIDS and feel marginalized by the Republican Party — gays, Latinos and African Americans. Romney can thereby demonstrate the broad understanding and proactive leadership essential to serving as president of all Americans.

James Driscoll, Ph.D., is a longtime AIDS activist and was a member of the Presidential Advisory Council on HIV/AIDS under President George W. Bush.