by Bob Roehr
The nation's leading AIDS organizations are calling on the incoming Obama administration to take strong action on the domestic epidemic during its first 100 days.
During the campaign, President-elect Obama "said he would focus on the domestic AIDS epidemic, initiate a national AIDS strategy, have prevention programs based on evidence, and would increase funding for HIV prevention, care and treatment, and research programs," said Carl Schmid, a lobbyist with The AIDS Institute.
He spoke during a Nov. 25 telephone news conference organized by "AIDS in America," an umbrellas coalition of more than a hundred organizations.
The group has submitted a list of actions to the Obama transmission team that the President can take without waiting for Congress. It also requested a meeting with that team to discuss the recommendations in greater detail. The team does not appear to have a surfeit of those with direct experience with HIV/AIDS.
"The cornerstone of what we are asking the administration to do is develop a national AIDS strategy," said Rebecca Haag, executive director of the AIDS Action Council. "It is astonishing to us that, more than 25 years into this epidemic, the U.S. has never set an overall plan and agenda with measurable outcomes, accountabilities and timetables to getting to those results."
This is something that the U.S. PEPFAR program requires of the foreign nations that it assists. The coalition wants a similar plan to be created for the U.S.
It is asking for leadership from the White House to pull together and coordinate the 17 federal agencies that have activities dealing with HIV. The Bush administration has let the "AIDS czar" office atrophy during the last few years.
The coalition believes that HIV prevention activities should be based upon evidence of effectiveness. There is ample evidence that syringe exchange programs reduce the spread of HIV and hepatitis. The Department of Health and Human Services should certify that fact. This is an important step toward allowing federal funds to be spent on those activities.
The Bush administration has based its prevention activities "on what is morally correct," said Haag. "There is tons of evidence that (abstinence only programs) are not effective." The organizations want funding for those programs shifted to activities with proven efficacy.
Haag is asking that Obama direct the Centers for Disease Control and Prevention "to really look at new prevention models that work, particularly in the most affected communities" – gay men of all hues and African American women, she said.
Christine Lubinski, with the HIV Medical Association, said in the early 1980s. the healthcare response to the AIDS epidemic "was a lens through which you could see all of the fragmentation in our healthcare system."
She is optimistic about the possibility of broad healthcare reform and wants to insure that it adequately addresses the special needs of persons living with HIV. "If it works for HIV/AIDS, it will work for all of us." But that is not guaranteed.
The majority of people living with HIV receive healthcare through Medicare and Medicaid. "Those safety net programs are not really responsive to the needs of people living with catastrophic chronic diseases like HIV," said Lubinski.
The greatest barrier is that they require a person to be disabled in order to gain access to them. But HIV treatment guidelines strongly urge the start of antiretroviral therapy before the onset of those conditions that define disability.
"Ironically, we are still in a situation where many people have to become disabled with the disease before they can get the care that they need to prevent them from getting AIDS to begin with," Lubinski said.
All of the research points to the desirability of starting therapy earlier to better preserve immune function and slow disease progression. Additionally, viral load is one of the most important factors in transmission of HIV and continued spread of the virus. Getting people into care earlier will contribute to prevention efforts.
The Ryan White CARE Act does fund programs that allow for early intervention, but it is inadequately funded. The program also is set to expire at the end of September 2009. The coalition is pushing for a three-year extension of the Act.
"Ryan White has always been designated as the payer of last resort," said Haag, "So, there is no reason to redesign Ryan White until those other systems (Medicare, Medicaid, an HIV strategic plan) are going to look like.
Next February, the President must submit to Congress, a budget for fiscal years 2010. "This will be a good signal of the Obama administration's commitment to the domestic HIV epidemic," said Schmid.
Prevention funding at the CDC has been flat or actually decreased over the last several years. A significant increase is long overdue. Ryan White programs also are underfunded as the number of people living with HIV continues to grow. The declining economy will mean that more people will be losing their job and health insurance and will seek help from this safety net programs.
The letter of recommendations to the transition team is available in pdf format at The AIDS Institute Web site, or directly at http://www.theaidsinstitute.org/downloads/AIDS%20in%20America%20-%20Letter%20and%20Document.pdf
