Opinions
AIDS 2012: Measuring progress by lives saved
President Obama committed to the fight to create an AIDS-free generation
By DR. GRANT COLFAX & DR. ERIC GOOSBY
As the two people who worked as physicians in the early years of the HIV/AIDS epidemic before the miracle of antiretroviral drug (ARV) therapy, and who now have the honor of leading the domestic and global HIV/AIDS programs for the Obama administration, we look back in awe of the American leadership that has transformed the epidemic in the 22 years since the International AIDS Conference was last held on U.S. soil. As we remember the lives lost to this disease and commit to the vision of an AIDS-free generation, it’s worth reflecting on how U.S. leadership and U.S. investments to combat HIV/AIDS domestically and internationally are saving lives and turning the tide against the disease.
Here at home, we have more than tripled the life expectancy of people living with HIV/AIDS since 1993. More than half a million persons living with HIV receive care and treatment through the Ryan White program, established in 1990 and maintained with consistent bipartisan congressional support through four administrations. Successful prevention efforts have averted more than 350,000 new infections and mother-to-child transmission of HIV has dropped by more than 90 percent since the early 1990s. HIV prevention has also generated substantial economic benefits. A recent study estimated that HIV prevention efforts in the United States have saved $129.9 billion in medical costs.
In 2010, President Obama released the first-ever National HIV/AIDS Strategy, and he has made implementing the strategy a top priority by requesting increased funding for HIV treatment and care services every fiscal year. In Fiscal Year (FY) 2013, the president’s domestic budget for HIV/AIDS is $22.25 billion, including requesting a $40 million increase for the Centers for Disease Control and Prevention (CDC) HIV prevention efforts, and an additional $74 million to increase treatment and care services for our nation’s veterans living with HIV. The president has also increased federal investments for AIDS Drug Assistance Programs (ADAPs) to expand access to life-saving medications and assist states with ADAP waiting lists. A shared federal-state program, federal funding for ADAPs has increased every year of the Obama administration, rising from $815 million in FY 2009 to $933 million in FY 2012. In FY 2013, the president proposed a total of $1 billion for ADAPs, a $67 million increase above FY 2012. These steps have concrete results — ADAP waitlists have declined by 80 percent since September 2011, dropping from more than 9,000 to approximately 2,000 today, and the federal budget provides sufficient resources to end the waitlists once and for all, if states also step up and do their part.
In addition, people living with HIV have much to gain from the Affordable Care Act. People with HIV are more likely to be uninsured, are more likely to face barriers in accessing medical care, and often experience higher rates of stigma and discrimination than other groups. The Affordable Care Act seeks to expand Medicaid for the lowest income people; it strengthens and improves Medicare, and makes private insurance work better for all Americans, including people with HIV. The Act also prohibits discrimination on the basis of HIV status, bans lifetime limits on insurance coverage and is phasing out annual limits in coverage.
Globally and building on the strong foundation laid by President George W. Bush, the Obama administration has made unprecedented progress in the fight against AIDS. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has expanded its prevention, care and treatment programming, and now has significant investments in more than 80 countries in several regions worldwide. Since FY 2008, PEPFAR has increased the number of people supported on treatment by more than 2.1 million and the number of individuals receiving HIV testing and counseling by almost 19.9 million, supporting nearly four million people on treatment HIV testing and counseling for more than 40 million people in 2011 alone. And on World AIDS Day 2011, President Obama announced a new treatment goal of reaching six million people by the end of 2013.
Since taking office, President Obama has requested more than $26 billion in funding for global HIV/AIDS, including both bilateral U.S. government PEPFAR programs and our contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. In his FY 2013 Budget, the president fulfilled his historic commitment to request $4 billion over three years for the Global Fund. We are grateful for the bipartisan support that PEPFAR has received from Congress since its inception and the continued bipartisan support for the Global Fund.
In FY 2013, we made the decision to re-allocate resources from within PEPFAR and take an exceptional step at a unique moment to strengthen the Global Fund. Because of the interdependence of the two programs, strengthening the Global Fund now will also help ensure the success of PEPFAR; equally as important, U.S. contributions to multilateral institutions like the Global Fund allow us to leverage increased contributions from other countries. In recent months, new and existing donors, including Saudi Arabia, Japan, Germany and the Gates Foundation, have stepped up their contributions. We know that other donors are also planning to do the same.
The fact of the matter is that our achievements are continuing to grow rapidly. This is due to greater efficiencies borne of driving our programming with evidence of impact, the growing commitment of governments and citizens in the developing world, the reduced costs of treatment, and the growing impact of prevention. With our current budget request PEPFAR will meet the President’s World AIDS Day goals for treatment, care and prevention, including the dramatic increase in people supported on treatment from 4 to 6 million. Along with complementary efforts to strengthen the Global Fund, this will accelerate progress toward the goal of an AIDS-free generation.
While tough budget decisions come with the job, President Obama has committed us to achieving more in the fight to create an AIDS-free generation in the U.S. and across the globe, and we’re succeeding. That continues the legacy of American leadership on HIV/AIDS that should make us all proud.
Dr. Grant Colfax is director of the Office of National AIDS Policy and Dr. Eric Goosby is the nation’s Global AIDS Coordinator.
Opinions
New research shows coming out is still risky
A time of profound psychological vulnerability
Coming out is often celebrated as a joyful milestone – a moment of truth, pride, and liberation. For many LGBTQ+ people, that’s exactly what it becomes. But new research I co-authored, published in the journal Pediatrics this month, shows that the period surrounding a young person’s first disclosure of their sexual identity is also a time of profound psychological vulnerability. It’s a fragile window we are not adequately protecting.
Using data from a national sample of lesbian, gay, and bisexual people, our study examined what happens in the years before and after someone comes out to a family member or a straight friend. We weren’t looking at broad lifetime trends or comparing LGBTQ+ youth to heterosexual peers. Instead, we looked within each person’s life. We wanted to understand how their own suicide risk changed around the moment they first disclosed who they are.
The results were unmistakable. In the year a person came out, their likelihood of having suicidal thoughts, developing a suicide plan, or attempting suicide increased sharply. Those increases were not small. Suicide planning rose by 10 to 12 percentage points. Suicide attempts increased by 6 percentage points. And the elevated risk didn’t fade quickly. It continued in the years that followed.
I want to be very clear about what these results mean: coming out itself is not the cause of suicidality. The act of disclosure does not harm young people. What harms them is the fear of rejection, the stress of navigating relationships that suddenly feel uncertain, and the emotional fallout when people they love respond with confusion, disapproval, or hostility.
In other words, young LGBTQ+ people are not inherently vulnerable. We make them vulnerable.
And this is happening even as our culture has grown more affirming, at least on the surface. One of the most surprising findings in our study was that younger generations showed larger increases in suicide risk around coming out compared to older generations. These are young people who grew up with marriage equality, LGBTQ+ celebrities, Pride flags in classrooms, and messaging that “it gets better.”
So why are they struggling more?
I think it’s, in part, because expectations have changed. When a young person grows up hearing that their community is increasingly accepted, they may expect support from family and friends. When that support does not come, or comes with hesitation, discomfort, or mixed messages, the disappointment is often devastating. Visibility without security can intensify vulnerability.
Compounding this vulnerability is the broader political environment. Over the last several years, LGBTQ+ youth have watched adults in positions of power debate their legitimacy, restrict their rights, and question their place in schools, sports, and even their own families. While our study did not analyze political factors directly, it is impossible to separate individual experiences from a climate that routinely targets LGBTQ+ young people in legislative hearings, news cycles, and social media.
When you’re 14 or 15 years old and deciding who to tell about your identity, the world around you matters.
But the most important takeaway from our study is this: support is important. The presence, or absence of family acceptance is typically one of the strongest predictors of whether young people thrive after coming out. Research consistently shows that when parents respond with love, curiosity, and affirmation, young people experience better mental health, stronger resilience, and lower suicide risk. When families reject their children, the consequences can be life-threatening.
Support doesn’t require perfect language or expertise. It requires listening. It requires pausing before reacting out of fear or unfamiliarity. It requires recognizing that a young person coming out is not asking you to change everything about your beliefs. They’re asking you to hold them through one of the most vulnerable moments of their life.
Schools, too, have an enormous role to play. LGBTQ+-inclusive curricula, student groups, and clear protections against harassment create safer environments for disclosure.
Health care settings must also do better. Providers should routinely screen for mental health needs among LGBTQ+ youth, especially around the time of identity disclosure, and offer culturally competent care.
And as a community, we need to tell a more honest story about coming out. Yes, it can be liberating. Yes, it can be beautiful. But it can also be terrifying. Instead of pretending it’s always a rainbow-filled rite of passage, we must acknowledge its risks and surround young people with the support they deserve.
Coming out should not be a crisis moment. It should not be a turning point toward despair. If anything, it should be the beginning of a young person’s journey toward authenticity and joy.
That future is possible. But it depends on all of us – parents, educators, clinicians, policymakers, and LGBTQ+ adults ourselves – committing to make acceptance a daily practice.
Young LGBTQ+ people are watching. And in the moment they need us most, they must not fall into silence or struggle alone.
Harry Barbee, Ph.D., is an assistant professor at the Johns Hopkins Bloomberg School of Public Health. Their research and teaching focus on LGBTQ+ health, aging, and public policy.
Letter-to-the-Editor
Candidates should pledge to nominate LGBTQ judge to Supreme Court
Presidential, Senate hopefuls need to go on the record
As soon as the final votes are cast and counted and verified after the November 2026 elections are over, the 2028 presidential cycle will begin in earnest. Polls, financial aid requests, and volunteer opportunities ad infinitum will flood the public and personal media. There will be more issues than candidates in both parties. The rending of garments and mudslinging will be both interesting and maybe even amusing as citizens will watch how candidates react to each and every issue of the day.
There is one particular item that I am hoping each candidate will be asked whether in private or in public. If a Supreme Court vacancy occurs in your potential administration, will you nominate an open and qualified LGBTQ to join the remaining eight?
Other interest groups on both sides have made similar demands over the years and have had them honored. Is it not time that our voices are raised as well? There are several already sitting judges on both state and federal benches that have either been elected statewide or approved by the U.S. Senate.
Our communities are being utilized and abused on judicial menus. Enough already! Challenge each and every candidate, regardless of their party with our honest question and see if honest answers are given. By the way … no harm in asking the one-third of the U.S. Senate candidates too who will be on ballots. Looking forward to any candidate tap dancing!
Opinions
2026 elections will bring major changes to D.C. government
Mayor’s office, multiple Council seats up for grabs
Next year will be a banner year for elections in D.C. The mayor announced she will not run. Two Council members, Anita Bonds, At-large, and Brianne Nadeau, Ward 1, have announced they will not run. Waiting for Del. Norton to do the same, but even if she doesn’t, there will be a real race for that office.
So far, Robert White, Council member at-large, and Brooke Pinto, Council member Ward 2, are among a host of others, who have announced. If one of these Council members should win, there would be a special election for their seat. If Kenyon McDuffie, Council member at-large, announces for mayor as a Democrat, which he is expected to do, he will have to resign his seat on the Council as he fills one of the non-Democratic seats there. Janeese George, Ward 4 Council member, announced she is running for mayor. Should she win, there would be a special election for her seat. Another special election could happen if Trayon White, Ward 8, is convicted of his alleged crimes, when he is brought to trial in January. Both the Council chair, and attorney general, have announced they are seeking reelection, along with a host of other offices that will be on the ballot.
Many of the races could look like the one in Ward 1 where at least six people have already announced. They include three members of the LGBTQ community. It seems the current leader in that race is Jackie Reyes Yanes, a Latina activist, not a member of the LGBTQ community, who worked for Mayor Fenty as head of the Latino Affairs Office, and for Mayor Bowser as head of the Office of Community Affairs. About eight, including the two Council members, have already announced they are running for the delegate seat.
I am often asked by candidates for an endorsement. The reason being my years as a community, LGBTQ, and Democratic, activist; and my ability to endorse in my column in the Washington Blade. The only candidate I endorsed so far is Phil Mendelson, for Council chair. While he and I don’t always agree on everything, he’s a staunch supporter of the LGBTQ community, a rational person, and we need someone with a steady hand if there really are six new Council members, out of the 13.
When candidates call, they realize I am a policy wonk. My unsolicited advice to all candidates is: Do more than talk in generalities, be specific and honest as to what you think you can do, if elected. Candidates running for a legislative office, should talk about what bills they will support, and then what new ones they will introduce. What are the first three things you will focus on for your constituents, if elected. If you are running against an incumbent, what do you think you can do differently than the person you hope to replace? For any new policies and programs you propose, if there is a cost, let constituents know how you intend to pay for them. Take the time to learn the city budget, and how money is currently being spent. The more information you have at your fingertips, the smarter you sound, and voters respect that, at least many do. If you are running for mayor, you need to develop a full platform, covering all the issues the city will face, something I have helped a number of previous mayors do. The next mayor will continue to have to deal with the felon in the White House. He/she/they will have to ensure he doesn’t try to eliminate home rule. The next mayor will have to understand how to walk a similar tightrope Mayor Bowser has balanced so effectively.
Currently, the District provides lots of public money to candidates. If you decide to take it, know the details. The city makes it too easy to get. But while it is available, take advantage of it. One new variable in this election is the implementation of rank-choice voting. It will impact how you campaign. If you attack another candidate, you may not be the second, or even third, choice, of their strongest supporters.
Each candidate needs a website. Aside from asking for donations and volunteers, it should have a robust issues section, biography, endorsements, and news. One example I share with candidates is my friend Zach Wahls’s website. He is running for United States Senate from Iowa. It is a comprehensive site, easy to navigate, with concise language, and great pictures. One thing to remember is that D.C. is overwhelmingly Democratic. Chances are the winner of the Democratic primary will win the general election.
Potential candidates should read the DCBOE calendar. Petitions will be available at the Board of Elections on Jan. 23, with the primary on June 16th, and general election on Nov. 3. So, ready, set, go!
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
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