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Advocates Urge Obama to Address HIV in the U.S.
What three things would you advise President Barack Obama to change now that would make a difference in HIV prevention and treatment in the United States?
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Pick an AIDS Czar!
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Cornelius Baker, National Policy Adviser, National Black Gay Men's Advocacy Coalition, Atlanta, Ga.
The first thing that I would advise President Obama is that we need a senior leadership person who will have crosscutting authority to ensure that agencies are not only coordinating and planning with each other, but that resources are being allocated appropriately to HIV services.
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The second thing that I would say to him is he has to be visible. What our communities have lacked for a long time now is a visibility in the United States that really can inspire our communities to believe that we can accomplish great things against the AIDS epidemic, and we need that. We need that from our commander-in-chief, but we also need that from our highest elected officials in this country.
Then, lastly, what I would say is that the president needs to believe and he needs to think boldly. If we're ever going to have a cure and a vaccine, it will require leadership that can envision an end to the HIV epidemic. So his national AIDS plan has to have that as its starting point, but we need to see that visionary leadership every day.
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Acknowledge Women's HIV Risk!
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Carrie Broadus, Executive Director, Women Alive, Los Angeles, Calif.
Advice for President Obama:
- Develop a better, parallel risk model for women at sexual risk for HIV stemming from data on social and cultural factors (i.e., race, history of violence or domestic abuse, education and income level, social network and geographic location), which more accurately predict women's risk and allow them to better assess their own level of risk.
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- Begin to differentiate between a woman's actual risk level and her knowledge of her risk level.
- Methodically revise the concept of prevention in women using realistic, data-driven strategies and methods.
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Coordinate Efforts Across Government Departments!
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Larry Bryant, Director of National Advocacy, Housing Works, Washington, D.C.
It's difficult to narrow it down to three things, but the idea that our president-to-be has endorsed a national AIDS strategy opens the door to having an open and honest discussion that goes towards the best solutions and best prevention methods down the road.
One, obviously, would be to have dedicated staff within his administration that are cross-pollinated from different departments: Health and Human Services, CDC [U.S. Centers for Disease Control and Prevention], Housing and Urban Development -- all the different related agencies that could provide input towards being able to direct resources to the primary needs of the communities most affected in the epidemic.
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Having that committee set up to work inclusively with the communities, the target population, and having HIV-positive people sitting as members of this committee to strategize best practices and best methods, I think that would be first and foremost.
Another step in that direction, once this committee, for lack of a better term, is set up, would be that within the strategy we would start laying out specific and tangible target outcomes. We don't hear often enough, if at all, specific goals set in decreasing infection rates.
We've had a lot of pomp and circumstance to alert the country -- as well as the world -- that there are actually 40 percent more infections in the United States than were originally counted. But we need to start putting some tangible goals out there that let us know we're going in the right direction in lowering infection rates and in targeting people who aren't in care, targeting people who are tested and keeping them in care.
As the plan is being set out, we should start to include those guideposts along the way. Otherwise how do we know we're going in the right direction? We keep dumping millions and millions of dollars into funding with no real measurable way of knowing whether or not we've been successful in what we're doing.
The third thing -- and this is kind of integrated in the first one -- is to make sure that we have an inclusive committee's input towards this strategy. We need an inclusive group of people to be part of this conversation -- a group that involves people of color, women, transgender communities, gay men, injection drug-using and other addiction-related communities, homeless communities -- so that we have all the different components in place as part of this one comprehensive national strategy to end the HIV epidemic.
In the past, I think we've had starts and stops, sporadic conversations happening in various communities at different times, but very rarely have we had an all-inclusive, comprehensive strategy that includes all parties.
If you ask me tomorrow I could probably say three other things, but I think those three would be steps towards creating that national AIDS strategy that President Obama has endorsed -- not just addressing the needs of today, but ending the epidemic once and for all.
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Sex Education Is HIV Prevention!
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Gwendolyn Carter, Prevention Outreach Coordinator, SisterLove, Inc., Atlanta, Ga.
First, I am completely for age-appropriate sex education or HIV education. I think it's important, definitely, in elementary schools. The way that the world is these days, children are starting younger; people are learning more, younger. Learning the correct way to go about things -- even sex and sexuality -- is very important. I think that that should be in place.
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I think that there should be more comprehensive HIV and STD [sexually transmitted disease] education and prevention models in place.
The national AIDS and HIV plan should be more comprehensive to include better prevention messages.
[U.S. President George W.] Bush had his ABCs, the Abstinence and Be faithful and wear Condoms model. That's all fine and good, but it's not necessarily realistic in my mind. I guess it's just not realistic because it's really something that's said. It's nothing that's really implemented. There need to be better implementation strategies.
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Fund Syringe Exchange!
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Allan Clear, Executive Director, Harm Reduction Coalition, New York City
- President Obama should work with Congress to remove the federal ban on the funding of syringe exchange programs.
- He should appoint a Director of National Drug Control Policy who bases drug policy in public health and not within a criminal/moral framework.
- Implement a national AIDS strategy
- Establish universal health care for all Americans.
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The HIV Epidemic Continues -- Pay Attention!
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Jim Curran, M.D., M.P.H., Co-Director, Emory Center for AIDS Research, Atlanta, Ga.; Former Head of CDC [U.S. Centers for Disease Control and Prevention]'s HIV/AIDS Task Force in the Early 1980s
The HIV efforts in the United States that preceded for 27 years, particularly the HIV prevention efforts, have stagnated over the past decade or so -- in part because of complacency. So I would encourage President Obama, first of all, to call attention to the extent of the ongoing HIV transmission in the U.S., with as many as 60,000 people per year becoming infected. Second of all, I would ask for a renewal of commitments to integrate HIV care and treatment and to pay attention to the ongoing epidemic. Thirdly, we need to look for innovation not only in HIV prevention, but also in HIV research and care.
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Develop a National AIDS Plan!
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Natasha Davis, Ed.D., M.P.H., Clinical Instructor of Public Health, Temple University, Philadelphia, Pa.
I would advise President Obama to develop a national HIV/AIDS plan for treatment and prevention in the U.S. I find it confusing as to how we could require other countries receiving financial assistance from the U.S. to develop a national strategy to address the epidemic when one is lacking in our own backyard.
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Now is the time to restore leadership around the world and I believe that President Obama will listen intently to individuals from across the country as he begins to address the tremendous challenges facing our nation.
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Bring PEPFAR to the Southern U.S.!
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Martin Delaney, Longtime HIV/AIDS Activist; Founding Director, Project Inform, San Francisco, Calif.
The first thing would be that I would want to see President Obama create something like a PEPFAR [U.S. President's Emergency Plan for AIDS Relief] program for the Eastern Seaboard and southeastern United States, where there's a horrible spread of HIV, coupled with people not getting into health care and not getting diagnosed even until they are in advanced disease. They're presenting at doctors' offices with cases of pneumocystis pneumonia and 150 T cells. That's just like 1986! That's unheard of in the gay white male community, but it's almost the norm in many of these places along the seaboard and in the southeastern United States.
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That would be the single most important thing he could do to affect the situation of HIV in the United States. Make that a number one priority.
Secondly, I think I'd like to make sure that he continues the existing programs overseas and widens them. The current PEPFAR programs have done terrific things, but they were somewhat hamstrung by some of the political baggage that they were forced to carry by the previous administration. I think Obama will be in a good position to lift that baggage off of it.
I think he needs to increase the NIH [National Institutes of Health] budget for research. But they also need to increase the budget for social science to really make some progress on prevention. The prevention area is one that I think has always been underfunded and is responsible for a lot of the problems we have today with the continuing epidemic. We need new ideas, new concepts and new efforts in prevention. Those would be the three on my list.
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Mandate Sex and Life-Skills Education, Wherever Services Are Given!
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Dazón Dixon Diallo, M.P.H., Founder and President, SisterLove, Inc., Atlanta, Ga.
If I could advise President Obama, three things I think that would immediately need to change in terms of HIV prevention as well as treatment are: One, that there be a federal mandate for comprehensive sex and life skills education that's age appropriate through all the ages; and that it be integrated into wherever there is service delivery, whether it be in the education system, in the public health system, in the overall health care delivery system or in the labor force. Whether I'm elderly and in an assisted living situation or whether I'm a teenager in public or private school, we should all be getting appropriate comprehensive information and education.
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Two is making sure that I vet and revise all policies to reflect the best of the science that we have with regard to HIV prevention, treatment and research, and remove the ideology and politics from it.
The other immediate thing that can be done is to ensure that we absolutely have our own U.S. plan with the appropriate funding and leadership necessary to address the urgency of HIV/AIDS at home as we do abroad; and to make sure that the efforts that we have abroad are also appropriate and devoid of the influence of ideology and politics and as much based in science as evidence and the lived experience of people living with HIV.
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Mass Imprisonment Impacts HIV Risk!
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Kenyon Farrow, Public Education Director, Queers for Economic Justice, New York City
The first thing I would do is actually create some kind of coordinated strategy. I've been a part of a group of people for the last year or so who've been pushing for a national AIDS strategy in the U.S., the way HIV/AIDS prevention, testing and care, and research in fact, function in these kind of silos with very little coordination. I think that's first of all, to adopt a coordinated national AIDS strategy.
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I think number two would be to scale up funding for prevention, testing and care in the U.S. All of those across the board are drastically under-funded. The CDC [ Centers for Disease Control and Prevention] itself has been flat-funded for about the last 10 years. If you're funded at the same rate given inflation, cost of living, so on and so forth, you basically are being de-funded. That's number two.
Then, number three, the other kind of easier things to do off the top are to end the ban on federal funding for syringe exchange programs, end federal support for abstinence-only sex education, and then adopt federal funding and guidelines for comprehensive sex education in the U.S. in our schools.
The other thing I would do is to really take a critical look at the impact of mass imprisonment in African-American communities as it relates to the impact that that has had on increased risk for HIV/AIDS. Meaning, both looking at what's happening inside of prisons, but also, I think more importantly, looking at just the destabilizing effect that mass imprisonment has had on Black communities in the U.S., which has increased people's vulnerability to contracting HIV. Those would be my top priorities. |
Declare HIV/AIDS a National Health Emergency!
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Ingrid Floyd, Executive Director, Iris House, New York City
If we look at, historically, where HIV has been and where we are now and consider that we still have staggering HIV rates -- especially in communities of color and among women -- I would definitely first challenge the Obama administration to declare that HIV/AIDS is a national health emergency in the United States.
With over 50,000 people becoming infected annually with a preventable disease, I think that President Obama should definitely declare this to be a health emergency so that there is widespread attention on how to prevent and how to treat HIV in all communities.
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This way physicians would then be required to test their patients as they come in as well as ensure that they are providing counseling for people who are HIV negative on how to remain negative.
When we look at other countries like Thailand that have declared HIV a national health emergency, we see dramatic decreases in the HIV rate, because the focus has come from a national level and from national leadership down to the people who are actually providing the services.
I would also ask President Obama to immediately increase the amount of funding that's put into HIV prevention to ensure that organizations doing prevention work who have effective methods have adequate funding and adequate resources.
We've just seen, with the Ryan White [CARE Act] changes of last year, that funding shifted away from HIV prevention. Most of it has shifted to the medicalization of HIV and funding for medical services. That's fine for people who have HIV, but it doesn't help HIV-negative people who we want to remain negative. So we definitely need an increase in funding for HIV prevention work.
We also need to continue to make sure that there is funding for supportive services and supportive programs. We know that these things help to reduce the spread of the disease. Programs such as those that help with housing, needle exchange programs, mental health programs and substance abuse programs have to continue to be funded at levels that ensure that people who are HIV infected as well as those people who are negative get the services that they need.
We know for sure, for example, that people who are in housing maintain treatment better than those people who are facing homelessness. We also know that when people have access to needle exchange programs, we've seen reductions in the rates of HIV infection through injection drug use.
We know these things work and we should definitely make sure that the Obama team understands how these programs work, how successful they've been, how things like housing and mental health play a role in preventing HIV so that they can then ensure that there is a focus on funding and maintaining programs that provide those services.
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Create an AIDS Commission That Truly Represents the U.S. Epidemic!
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Bambi Gaddist, Ph.D., Executive Director, South Carolina HIV/AIDS Council, Columbia, S.C.
- Draw attention to the HIV/AIDS pandemic in the United States; initiate team to create first National HIV/AIDS Plan.
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- Address dire state of HIV/AIDS funding; reduce priority of abstinence-only agenda as the sole solution to the nation's pandemic.
- Create an expanded Presidential Commission on AIDS that is geographically representative of the nation's epidemic (southern/rural communities), not just the larger MSAs within urban areas.
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Provide Universal Health Care!
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Joel Gallant, M.D., M.P.H., Associate Director, Johns Hopkins AIDS Service; Director, Garey Lambert Research Center, Baltimore, Md.
The first thing -- and this is a pipe dream because I know it can't happen immediately -- what we need is health care for everybody. Then we wouldn't have to worry about Ryan White funding and ADAP [AIDS Drug Assistance Program] funding and inequalities from state to state in what people with HIV get.
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If everybody had health care, then all this other nonsense would go away. I guess my first priority would be universal health care so that we don't have to focus on specific diseases and specific locations and things like that.
I realize that's going to be a huge undertaking and not likely to happen in the first few days of his administration, but I really think that we as a country are seriously lagging behind the rest of the civilized world in not providing this to our people.
The only good thing I can say about George Bush was his attention to global HIV/AIDS. Having been in Uganda recently where I was writing prescriptions for drugs that were paid for by PEPFAR [ U.S. President's Emergency Plan for AIDS Relief], I was very grateful for that program even if there are flaws in it.
I would very much like to see President Obama continue PEPFAR funding or increase it, but to eliminate the stipulations about abstinence-based programs and the issues about censoring countries for what they say about AIDS prevention and putting so much of a focus on abstinence, using that money to further expand the treatment being offered through those programs.
But I would also point out that we in the United States have a pretty serious problem as well. If you look at Washington, D.C. as an example, the prevalence of HIV in that city is such that they would qualify for PEPFAR funding if they were an independent country. That's pretty scary and we don't have an AIDS policy with any clarity in this country.
I would really like to see PEPFAR or something like it expanded into the United States and to develop a comprehensive AIDS policy for our own country. Again, some of that wouldn't be necessary if we had universal health care, but unfortunately it is necessary the way things are currently, where we have so many people who are uninsured in our country.
That's three things: AIDS policy, continuation and expansion of PEPFAR and universal health care.
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Promote Partnerships Between Government and Nonprofit Organizations!
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Marjorie Hill, Executive Director, Gay Men's Health Crisis (GMHC), New York City
When he was a candidate, President Obama made a commitment to support the National AIDS Strategy. He has reiterated that commitment as recently as today [December 1, 2008], in a World AIDS Day statement. The United States requires foreign countries to put together a national coordinated plan, something that 20 years into the epidemic, the United States does not require of itself. The National AIDS Strategy would in fact mean that we would have that plan, have that coordination, and could really look at what are best practices and how to reach the most affected communities. I am very optimistic that President Obama will follow through on this commitment.
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What's the most important aspect of that proposed National AIDS Strategy?
I think that part of it is making an assessment of what we do, what works, and how to really promote intra-governmental coordination: Ryan White, CDC [U.S. Centers for Disease Control and Prevention], HUD [U.S. Department of Housing and Urban Development], the Veterans Administration -- which is the largest provider of HIV care in the country -- all of those programs need to coordinate care, but there could also be partnerships with the not-for-profit and foundation world.
We have many foundations, such as MAC AIDS Fund, that provide support, but do they provide the support where there's the greatest need? Or are they just providing support to whoever writes the best grants? While I want that money and GMHC [Gay Men's Heath Crisis] needs that money and the Black AIDS Institute needs that money, are there other groups or other programs that need it more?
The National AIDS Strategy should help assess what the national priorities are and what our roadmap will be for getting there.
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Eliminate Health Disparities!
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Bethsheba Johnson, Clinical Coordinator, Luck Care Center, Chicago, Ill.
The three things that I would advise President Obama to change immediately to make a difference to HIV prevention and treatment in the U.S. would be, first, to develop and implement his proposed national HIV strategy that guarantees treatment and care for all people with HIV in the United States, which includes housing, which is so pertinent to the lives of our HIV-positive people.
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I also think he should end the federal ban on funding for syringe exchange -- other countries have done very well with that. Plus he should redirect abstinence-only-until-marriage sex education funding to the real world. I go into elementary schools and talk to fifth and sixth and seventh graders about things, and this abstinence-only thing is not working. We need to really direct it towards what's going on. I don't condone sex among kids, but I definitely want to talk about things that are real. I think he should do that and he'll be on the right track.
Accurate programs are really necessary, also, to prevent and treat HIV and to eliminate those health disparities that we see and to provide people living in the United States with some kind of health care plan. Because if we don't have access, we are not going to eliminate HIV in this country. If we don't eliminate health disparities, poverty, the lack of education, we're never going to get at HIV either. It's a multifactorial process. It's a multifactorial problem.
While I agree with the U.S. assisting with the global HIV epidemic and malaria and TB [tuberculosis] through donations to The Global Fund [to Fight AIDS, Tuberculosis and Malaria], the World Bank and PEPFAR [ U.S. President's Emergency Plan for AIDS Relief], which I know President Obama has supported, as someone who's volunteered time working in other countries -- in Ethiopia, South Africa and South America -- [I see that] at home we are experiencing shrinking Ryan White dollars and shrinking Congressional Black Caucus dollars. We need more funding in the United States to take care of the problems here in the United States. Unless we have the leadership to increase the funding for this problem in the U.S., we are going to begin to look like South Africa.
They currently say now that there were 54,200 new infections in 2006, which, personally, I think is an underestimation of the real rates of infection. We really need to increase the funding to put this in check. We definitely need funding for the research into microbicides and antiretroviral medications and vaccines, even though we've had such failure in developing a vaccine for HIV. That's what I would say to President Obama.
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Develop a Comprehensive National AIDS Strategy!
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Jeff Johnson, Journalist, Activist and Host, BET (Black Entertainment Television)'s The Truth, New York City
The first thing he needs to do is take a step back and say we need a national AIDS strategy. I think it's got to be comprehensive. It's not good enough to just try to target one issue. There's got to be a comprehensive strategy in dealing with how we are educating about HIV, how we are talking about HIV, how we are funding programs, how we are dealing with prescription drugs. And this is domestically.
Over the last eight years, we've done a great job of engaging the continent of Africa, but an awful job of engaging our own communities. So I think that that to me is the first and only thing that needs to happen. And as result of that, we'll begin to see some specific strategies.
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What do you think is the most important aspect?
I think that's like saying that the pawn is more important than the knight. On the chessboard, every piece is equally important. If you effectively use each piece, then you checkmate the king on the other side. We can't spend too much time focusing on one piece on the board, but how do we use the pieces on the board to checkmate this pandemic called HIV/AIDS?
I think it's dangerous to say this is the one area we have to start, this is the one thing we need to do, because there are too many things that are cyclical and too many things that are connected. That's why the strategy needs to be comprehensive.
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Promote Condom Use!
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William Johnson, M.D., Medical Director, Luck Care Center; President, Southside Health Association, Chicago, Ill.
To make a difference for HIV treatment in [the] U.S., I would advise President Obama:
- Number one, there needs to be a lot more promotion of condom use: How to use condoms. When to use condoms. Why it's important to use condoms. Stop being so afraid of condoms! You see more commercials about alcohol and cars, all kind of things, but there's hardly any advertisement on condoms. We need to have more surrounding condom use and condoms, and how important that is. I think that coming from the President, I think that would help especially with some of our younger men and their responsibility surrounding that. I think that's one thing.
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- Number two -- funding. We need a lot more funding to combat HIV, particularly in Southeast United States, in our inner city areas. There's a growth of HIV providers in these areas where there are large amounts of HIV-infected people, as well as just infrastructure for social services and medications and medical treatments. I think we need a lot more money. I was reading an article the other day where one doctor suggested a PEPFAR [U.S. President's Emergency Plan for AIDS Relief] program for inner cities of [the] United States. I agree with that wholeheartedly. You need a big effort to do that.
We need to allow the agencies and clinics that are already providing HIV care to help them increase their infrastructure as well as use more of federal funding for operations costs, so that these clinics can remain open and do the jobs that they do, particularly clinics like mine, which have a hard time with day-to-day operation costs and finding the money. That's something that I think would be very helpful right away if he can do that. That's two.
- Third thing -- President Obama just needs to highlight the problem in the United States. I think our current administration really highlights the HIV crisis in other countries, particularly in Africa and Asia, but really says hardly anything or pays as much attention to what's going on here in the United States. So that needs to be done. I guess that takes you back from number two as well, but those are the three things.
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Help People Get Educated About Their Bodies!
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NaShawn Kearse, Actor, Brooklyn, N.Y.
I'm wondering if it's possible to open centers in the inner cities where people can go and sit down and be taught what to do to correctly protect themselves and be responsible with their bodies. And also, to open research places to find cures for the disease; and open clinics where people can get tested so that they know beforehand so it can help alleviate more people getting infected with HIV/AIDS.
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Forget Abstinence-Only -- Promote HIV Prevention That Works!
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Mark King, Author and Longtime HIV/AIDS Activist, Atlanta, Ga.
The first thing I would ask President Obama to do is to get rid of, once and for all, abstinence-based education. It has crippled the efforts of organizations and the CDC [U.S. Centers for Disease Control and Prevention] -- all of us -- to talk frankly about HIV transmission and prevention. Abstinence-based education is a failure and we need to move on and we need to get back to the basics of how HIV is transmitted and how you can prevent it.
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Secondly, needle exchange. It is vital that the federal government fund needle exchange programs. To get back on that wagon and be able to do that would be a great leap forward.
Finally, President Obama could set an example of how important it is that the black community speaks about AIDS and stops living in the denial that has contributed to HIV infection rates among African Americans.
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Fund Underfunded Initiatives!
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U.S. Congresswoman Barbara Lee (D-CA), Representative, Ninth Congressional District, East Bay, Calif.
We have all looked at what we've been doing over the last 10 years and we're at the point now where we believe that a National AIDS Strategy should be put together, just as we've worked on the international front with the president's initiative called PEPFAR [U.S. President's Emergency Plan for AIDS Relief]. I personally think we need a domestic PEPFAR.
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I think you're going to see many of us continue to work, as we have been working in the past, to make sure that we have this domestic PEPFAR as a policy. Also, as a member of the House Appropriations Committee, I will work to make sure we fully fund the Ryan White CARE Act, our Minority AIDS Initiative and all those other initiatives that haven't really been funded up until this point. So we have quite a bit of work to do and many, many challenges, but we know that these challenges present historic opportunities.
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Guidelines for Getting Services Shouldn't "Keep Recipients Down"!
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Marilyn A. Moering, M.P.H., Executive Director, Building Bridges, Inc., Jackson, Miss.
- More money for HIV prevention activities that don't necessarily fit into an evidence-based intervention but that are culturally appropriate and specific to the issues of the targeted population.
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- Make secondary HIV prevention a mandated part of treatment and care for persons testing positive for HIV in order to teach them how to live positive with HIV.
- Guidelines for receiving services need to be revised. For example, for a person to receive Medicaid or other services they have to be indigent, which means it keeps persons living with HIV "down." If they try to get a job or do better, then their benefits are cut off.
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Fund Grassroots Organizations!
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Nyrobi Moss, Sexual Health Educator and Trainer, SisterLove, Inc., Atlanta, Ga.
The first thing that I would say is the allocation of more funding to grassroots organizations that are doing work in HIV prevention and in treatment.
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The second thing I would say is more comprehensive sexual health education for our children that goes beyond the bounds or the cloak of abstinence. Because it's proven that most of our children are not abstinent and so we need to give them the information that they need in order to make informed decisions.
The third thing that I would say is more allocation of funding for programs that directly affect people living with HIV/AIDS in terms of governmental programs that assist them with not only medication, but their lifestyles. The financial crunch that the entire United States is in right now tends to affect people living with HIV directly because of having to get meds and treatment and care.
The allocation of funds to those types of programs would be the first thing I would change.
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Address Factors That Lead to HIV Infection!
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Heidi Nass, Treatment Educator and Advocate, Madison, Wis.
The thing that I would like to see -- which would be the first time we've ever seen this -- is what I imagine any one of us who care about the HIV epidemic and are fighting it and living in it would like to see: a national AIDS strategy with measurable goals and a plan for getting ahead of the HIV epidemic. It's inexcusable, given our stature as the wealthiest country on the planet, that we're not more out in front of this epidemic.
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I think that it all boils down to a more authentic engagement around the issues in the epidemic -- all of the factors that lead to HIV infection and create epidemics. In terms of preventing new infections, that means a much more honest and authentic conversation about condoms than the notion that "wear a condom" is good enough, because it's not. It doesn't work for at least half of the population of women, who often can't control condom use and don't wear condoms themselves.
We need more prevention tools, but we also have to come clean about the notion that not a soul on this planet is going to wear a condom for every sex act in their entire adult life. It's not going to happen, so we really need to stop pretending that it is and acknowledge that. We need to give people the tools they need to reduce their harm and do what's within their control to improve their lives, protect other people and protect themselves. We have to stop pretending that "wear a condom" is our answer.
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Recognize Necessity of Mental Health Services!
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Paul Plate, Executive Director, Positive Impact, Atlanta, Ga.
There are a couple of things that I can think of to advise President Obama. First one would be, regarding prevention: We have been told that the message needs to be about abstinence and we understand how important that is to some populations. However, in our prevention work and in our mental health work, we think it's shortsighted and needs to be part of a larger message about how to not be put in a position where you're exposed to HIV or where you are potentially exposing someone else.
The message needs to be more about mental health issues that are related to how we make decisions, about what we do with our lives that may affect prevention. Abstinence is only part of a larger message. It's not as effective when it's not combined with some other issues.
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The second thing I can think of is that mental health is a critically important service that is needed by people with HIV. It is not an ancillary service. It is one that's critical for helping people to change how they think and feel and behave. It's important in terms of their primary health care, how they make decisions about taking medications and their ability to take medications. It's important for their being able to maintain housing. There are just so many levels.
It is critical to understand the relevance and importance of mental health as a viable and necessary component of any of the care that we provide for people with HIV.
The third thing I can think of is the importance of organic community-based agencies that complement a public health system. In this country, we tend to go back to the public health system the way it was, the way it always has been. It's the organic and community-based organizations that provide a richness of possibilities, changes to systems that are archaic, and creative new ideas and responsiveness to people that are not necessarily seen in a public health system. The complementary nature of the relationship between the two systems is really critical.
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Get People Active in Their Wellness -- and Reduce Costs!
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Rev. Guy Pujol, D.Min., Executive Director, AIDS Alliance for Faith and Health, Atlanta, Ga.
- Adopt (and then follow) a national AIDS strategy. The U.S. does not have a national AIDS strategy (even though it requires one of other countries that receive international AIDS funding from the U.S.). The U.S. needs a national AIDS strategy that can drive a more coordinated, accountable and outcomes-oriented response to the domestic HIV epidemic.
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- Pass legislation for true universal health care. Guaranteed access to health insurance and prescription medications would dramatically reduce the financial burden of government-funded medical care for persons living with HIV/AIDS, and would give people living with HIV/AIDS assurance and confidence in their medical care and would allow them to be more active and involved in their own health care. Ultimately, this proactive approach would reduce medical costs and hospitalizations, and improve the person's overall health, wellness and quality of life.
- Re-create the White House Office of National AIDS Policy and appoint a qualified director ("AIDS Czar") who would advise President Obama and oversee and advocate for the issues above. (P.S. I should be that director!)
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Educate Everyone About HIV/AIDS!
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Philip Rafshoon, Owner, Outwrite Bookstore and Coffee House, Atlanta, Ga.
That's pretty much a no-brainer because there are three really important things that were so mishandled before. Number one is education. Make sure that everybody who possibly could be gets educated on what AIDS is about, how to prevent it and how to treat it.
Two is needle exchange programs. They should be made available.
Three is education about HIV prevention. It is the most important thing -- and access to condoms.
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Learn Your Sexual Footprint!
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Sheryl Lee Ralph, Actor, Performer, Longtime HIV/AIDS Activist
One, it's not going to take just the government alone. It's going to take people. It's going to take charitable organizations. It's going to take foundations. It's going to take institutions. It's going to take corporate people to get involved solidly on this disease.
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The kinds of programs that we have like PEPFAR [U.S. President's Emergency Plan for AIDS Relief] -- the kinds of programs that we export to other parts of the world -- we need the same kind and quality of programs right here in America.
We need the development of new medication around this disease. We need people to take personal responsibility, find their voice and speak up about this disease. And we need people to take HIV testing seriously. Visit testtogether.org and do what you need to do. Learn your sexual footprint.
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Focus on HIV Prevention!
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Sandy Thurman, Faculty, Rollins School of Public Health, Atlanta, Ga.; Former "AIDS Czar" Under Former U.S. President Bill Clinton
First of all, I don't know how much difference this will actually make in HIV prevention and treatment, but I would ask President Obama to get the Secretary of Health and Human Services to sign the waiver that allows people with HIV/AIDS to come into the United States and out of the United States freely, so we can finally have an international AIDS conference in the United States after all these years.
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Secondly, I would advise President Barack Obama to focus on the domestic epidemic again and focus on prevention. We're losing so much ground and we really need to focus on prevention and hardest-hit communities. I think that's very, very important.
The other thing would be to look at increasing the work that we're doing overseas, but in addition to providing drugs to people living with HIV, to focus again on prevention. We can't treat our way out of this disease.
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Increase Funding to All HIV Research Areas!
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Loreen Willenberg, Executive Director, Zephyr Foundation, Sacramento, Calif.
In regard to prevention strategy: First, I believe that President Obama could and should promote scientific and evidence-based curriculum in all educational institutions on HIV/AIDS. Obviously, eliminating any moral ideology as a prevention message would be beneficial. Connect those messages to the facts. Also, eliminate any abstinence-only funding qualifiers to available federal prevention education grants.
Secondly, develop, implement and maintain through realistic funding stream a comprehensive program to support the CDC'S [U.S. Centers for Disease Control and Prevention] recommendations on universal HIV testing in order to increase the number of citizens who know their HIV status.
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Also, create those cooperations between federal, state and local medical service delivery systems to streamline the HIV testing process itself, inclusive of funding for and implementation of on-site counseling programs.
Also, restructure existing reimbursement policies with insurers -- programs like Medicaid, Medicare, etc. -- to remove those barriers to testing.
On HIV treatment strategies, I believe that the new administration needs to increase funding for scientific research on all levels on HIV/AIDS, meaning treatment, prevention and vaccine research. And they need to develop and fund those programs to provide incentives and mentoring of new young research scientists in the field of HIV/AIDS research.
Also, they need to implement a comprehensive review and restructuring of ADAP -- AIDS Drug Assistance Programs -- and Medicare part D to eliminate those donut holes and the unnecessary red tape that contributes to waiting lists, caps and barriers to access life-saving treatment.
Finally they need to continue to advocate for and develop pricing controls with pharmaceutical companies for HIV medicines and establish a policy to regulate the reasonable and fair reimbursement for medications and doctor's visits by health insurance companies.
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Fund HIV Prevention -- It Works!
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Andrea Williams, Community Health Worker, Brooklyn Plaza Medical Center, Brooklyn, N.Y.; Real-Life Inspiration for 2007 Film Life Support Starring Queen Latifah
President Obama needs to educate himself and find out that HIV is an epidemic here [in the United States]. We have a war here that we need to fight.
We need more prevention money. Prevention does work. We can't document it, but it can work. I know. I've been out there in the streets. It works.
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Get People Into Care!
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Phill Wilson, Founder and Executive Director, Black AIDS Institute, Los Angeles, Calif.
The first thing the new president really needs to do is invest in a national AIDS strategy. Now, when the U.S. invests in aid to foreign countries around HIV, we require that they have a national AIDS strategy. Yet, we don't have a national AIDS strategy in this country, and as my grandmother used to say, "When you fail to plan, you plan to fail." We have a hodgepodge collection of programs and agencies that work at cross-purposes, so we need to develop an AIDS strategy.
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The second thing: We need to talk about developing a domestic PEPFAR [U.S. President's Emergency Plan for AIDS Relief] program. We've seen huge successes in PEPFAR across the globe and we need to take some of those lessons learned across the globe and apply them here in this country.
We need to increase our investment in HIV prevention. We're currently spending around $600,000 a year on HIV prevention. Experts say we should be spending around $1.2 billion a year. Now we just made an investment of $48 billion a year in PEPFAR to fight AIDS overseas. And don't get me started on what we're spending in Iraq every day. At least we could make a minimum commitment in HIV prevention in this country.
We also need to figure out how to get people into care and treatment. In the richest country in the world, it's absolutely outrageous that we have people living with AIDS who don't have access to proper care and treatment.
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Lift the Travel Ban for People With HIV!
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Jorge Zepeda, Manager of Latino Programs, San Francisco AIDS Foundation, San Francisco, Calif.
One thing that we have witnessed is that needle exchange is a great prevention strategy. I would advise President Obama to work in public policy that facilitates needle exchange in places that don't have it, because we know that that strategy really impacts HIV prevention.
The other recommendation would be to lift the travel restriction for HIV-positive individuals that live outside of the States. How would this move impact prevention and treatment? Because then we could host International AIDS Conferences and other conferences; and we could enrich our knowledge on HIV prevention and also share our knowledge of treatment.
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The other immediate action that we need to take is to provide national access to HIV testing for uninsured and underinsured individuals -- to develop public policy around insurance companies paying for HIV testing.
Testing and the infrastructure you need to provide testing have a cost and some agencies, mainly community-based organizations, don't have enough resources for that.
I think the resources for community-based organizations should be increased. Also, the resources for outreach to communities that are not being outreached to, like the immigrant community should be increased. And we need to create policies that assist agencies in covering the cost of having HIV testing. Those would be my recommendations to Obama.
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Do you think Obama should make a commitment to a National AIDS Strategy? Here's how you can remind him.
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