July 13, 2010
My grandmother used to say, "If you fail to plan, you plan to fail." Today represents a new day in our country's nearly three-decade-long struggle against AIDS. For the first time, we finally have a national plan in place to guide our fight against the epidemic and to hold decision-makers accountable for results.
America has long required countries that receive foreign AIDS assistance to have a national strategy, but we have never had one. With no plan in place to mandate coordination between different government agencies or to ensure accountability, it is hardly surprising that we have an HIV/AIDS epidemic 40% worse than previously believed, with 1 in 5 Americans infected with HIV don't know they have the disease, half or more of people diagnosed with HIV are not receiving regular medical care, and HIV rates in some communities worst than those found in some of the poorest countries on the planet.
America can do better. We must do better. This new strategy represents an important step in that direction.
"The new strategy provides a promising opportunity for us to get real about the shortcomings in our national response to the epidemic. While the government has long funded intensive HIV prevention programs for individuals, we as a country have invested relatively meager amounts in efforts to affect community norms and values to promote risk reduction. At a time when AIDS deaths are largely preventable, the government has provided only minimal leadership in making knowledge of HIV serostatus an essential social norm in the most heavily affected communities. And even though the face of AIDS in America is typically Black or brown, most people with HIV are forced to seek medical care from health providers who neither look like them nor understand the challenges they face. The new strategy provides a blueprint for changing some of these realities, and it is an opportunity we must energetically grasp.
We salute President Obama for placing Black America front and center in his national HIV/AIDS strategy. AIDS in America today is a Black disease. Accounting for only about 13% of the national population, Black people make up half of all new HIV diagnoses. The AIDS death rate among Black males is eight times higher than for white males, while Black women are 19 times as likely to die as whites.
If the new AIDS strategy is to succeed, it has to work for Black people. In reporting results, the Obama administration needs specifically to report outcomes for Black people. Only if prevention and treatment programs work for Black America will we win our national fight against AIDS.
Unfortunately, the new strategy does not sufficiently address the issue of resources. Already, we are seeing many AIDS drug assistance programs impose caps or waiting lists for life-saving drugs. There are over 3000 people on ADAP waiting lists. This month, the President authorized a one-time funding increase for ADAP of $25 million, but this amount, while welcome, represents only about 7% of amounts needed this year alone to ensure the program's continued solvency.
At a time when we are largely losing the fight to prevent new infections, prevention programs currently account for only 3% of federal AIDS spending. To put available prevention weapons to effective use, experts estimate that annual prevention spending needs to increase from $750 million to $1.3 billion for at least each of the next five years. This new strategy offers a sound, evidence-based approach to better results, but it will be worth little more than the paper it is written on if we don't follow through with essential resources.
In difficult economic times, it is often necessary to make painful choices. As a country, though, we need to transition from AIDS "spending" to AIDS "investments." By investing in cost-effective AIDS programs, we are investing in America's families and helping young people remain productive contributors to society for future decades.
President Obama deserves our thanks and gratitude for making good on his campaign promise to launch a national AIDS strategy. But the new strategy is only a step, not an end in itself. Now the hard work begins. Leadership matters. The plan must be effectively implemented. This is where leadership matters. The new strategy has no chance of success without the President personally leading the charge. President Obama and the first lady must personally participate in advocating for the new strategy and communicating the strategy to the American people. Affected communities and people living with HIV must join with government, industry, and philanthropy to ensure the strategy's success. And we all need to hold ourselves accountable for sharply reducing the number of new HIV infections and AIDS deaths. Achieving these outcomes will be the ultimate test of this strategy's success.