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Traveler's Notes: AIDS Advocacy in the Age of Obama

January 2009

Sometimes you do your best thinking on the beach.

So it was a week after the election as I retreated from the 24-hour news cycle to relax with family in Cartagena, Colombia.

Known as the Heroic City, Cartagena readied for its annual independence parades and festivals as I arrived. The laid-back rhythms of this Caribbean colonial port helped soothe my accumulated stress. On a healthy diet of seafood and sun, I gained a renewed perspective about the significance of this transformative period in American history.

"Is he as impressive as he seems?" I was asked frequently. In this predominately multi-racial society where racism nonetheless prevails, President-elect Barack Obama inspires both a sense of pride and enormous awe in the resiliency of the American spirit.

For those of us affected by HIV/AIDS, Obama's ambitious AIDS plan portends a better future. Could our aspirations be dashed, however, under the weight of AIDS complacency and competing priorities?

AIDS advocates have good reason to be cautious. As the U.S. deployed unprecedented assistance to combat the global HIV/AIDS pandemic, the Administration of President George W. Bush blocked lifesaving and science-based HIV prevention, divested from community-based HIV organizations, and allowed the domestic epidemic to grow without a commensurate expansion in services.

The global AIDS response, while commendable, nonetheless neglected proven harm reduction approaches, undermined access to condoms and family planning, and failed to empower women, girls, and gay/bisexual men in the fight against HIV/AIDS.

I harbor resentment that no amount of caravans, protests, facts, or organizing succeeded in dampening the Bush Administration's (and its allies') powerful and ideologically based resistance to sound HIV/AIDS policies.

After these past eight years, I'm practically programmed to be disappointed.

So I gathered with my mix of emotions -- and North American newspapers -- in the quiet moments of my Colombian vacation to recalibrate my thinking about our movement's next strategies and approaches.

No doubt, our advocacy must continue. In these difficult economic times, more not less HIV/AIDS community mobilization is warranted.

But with Barack Obama at the helm, a new dance begins in which the subject of our requests is at least an interested participant. Like the courtship dances that celebrate Colombia's rich folklore, so must we finesse a new engagement with the executive branch that balances pressure with persuasion.

Like any good partner, AIDS advocates will need to be attuned listeners. As Obama prepares to assume power, the first priorities he plans to address are of deep importance to our constituents. Plans to reverse the slumping economy, create new jobs, stabilize housing markets, and fix the nation's fragmented healthcare system run to the core of structural forces exacerbating HIV/AIDS in the U.S.

Economic recovery policies must help improve the lives of people in poverty and those struggling against housing instability/homelessness, hunger, substance use, and mass incarcerations -- all factors contributing to HIV transmission and poor health outcomes among HIV positive people.

A living wage for all -- including those disabled by HIV/AIDS -- promotes dignity and worth, qualities necessary to help individuals get back on their feet. Without fundamental healthcare reform, greater progress preventing, diagnosing, and treating HIV simply cannot be achieved.

We must work hard to insert ourselves into the public and political discourse framing these issues and make sure decision-makers understand the important implications to the fight against HIV/AIDS. And, to pick up another dancing metaphor, we must prepare to lead and not just follow.

Top legislative priorities must include efforts to expand needle exchange (and the entire HIV prevention portfolio, in fact), achieve HIV-specific Medicare and Medicaid reforms, and increase appropriations for domestic and global AIDS programs. We must set ambitious goals and hold members of Congress and the White House accountable for moving our agenda forward.

Efforts to develop a National AIDS Strategy, a top Obama priority, must begin immediately, with the President-elect naming a diverse group of federal officials, HIV experts, and community representatives -- inclusive of people openly living with HIV/AIDS -- to a federal panel charged with writing the plan. The process should set ambitious goals in HIV prevention, care, research, and civil/human rights protections and detail specific activities and accountability mechanisms to actually achieve them.

Finally, the theme of change is one I hope AIDS community leaders embrace. Nearly 30 years into the HIV/AIDS epidemic, it's time for us to look critically at our movement's institutions and structures and devise ways to gain greater efficiency, coordination, and impact.

It's not enough to ask federal departments and agencies to adopt new, results-oriented approaches and greater coordination if we ourselves cannot strive to do the same. Barack Obama's impressive use of online organizing and disciplined messaging were instrumental to his electoral success. While dozens of AIDS organizations have varying degrees of online organizing capacity, the lack of coordination (and adequate coverage in every state) too often contributes to a cacophony of messages and messengers that depletes our national impact and effectiveness.

For AIDS advocacy at home and abroad, commitments to shepherd in change and hope are exactly what we need. We have a big agenda ahead and it's time to get started: puyá el burro -- as they say.

David Ernesto Munar is Vice President for Policy and Communications at the AIDS Foundation of Chicago and Chairman of the National Association of People with AIDS. As a member of CHAMP's Prevention Justice Mobilization campaign, he blogged for from the 2008 International AIDS Conference in Mexico City.

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This article was provided by Community HIV/AIDS Mobilization Project. It is a part of the publication HHS Watch.
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