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Eliminate the Leadership Deficit on HIV/AIDS

President Obama and GOP House Majority Talk of Austerity Spells Bad News for the Fight Against HIV/AIDS

January 27, 2011

With Capitol Hill's stark ideological differences on full display this month, some AIDS advocates are doubtful federal leaders will address the structural injustices driving the HIV epidemic in America.

"The nation's deficit is not just seen in red ink but revealed in a burgeoning HIV crisis that, unless confronted, will command an even greater share of costly services and lost productivity," said Julie Davids, lead organizer for the HIV Prevention Justice Alliance (HIV PJA) and National Mobilization Director for the AIDS Foundation of Chicago (AFC).

State of the Union

President Barack Obama's State of the Union address -- which included no explicit mention of HIV/AIDS -- made an impassioned case for nation-building in an increasingly competitive global marketplace. The President defended the Affordable Care Act in the wake of a U.S. House vote last week to repeal the new health insurance reform law. He called for increased investments in science, including biomedical research, and called for greater federal government efficiencies and transparency.

Considering that an estimated one in two HIV-positive individuals do not receive HIV-related medical care, protecting and fully implementing the health reform law is fundamental to diminishing the health inequities so prevalent in the domestic HIV epidemic. In addition, the focus on science, innovation, and enhanced federal coordination is needed to attain National HIV/AIDS Strategy targets. The HIV PJA applauds these White House priorities and urges President Obama to articulate explicit HIV-related goals related to health reform implementation and a streamlined federal bureaucracy consistent with the National HIV/AIDS Strategy.

Era of Austerity

Unfortunately, the President is also seeking a more prolonged ban on new federal discretionary spending, until at least the 2016 federal fiscal year. The ban on new spending would extend to all categories of the federal budget -- including important HIV services such as CDC prevention programming, the Ryan White CARE Act (including the AIDS Drug Assistance Program), and Housing Opportunities for Persons with AIDS (HOPWA). It also would stall or roll back efforts to address social disparities in broader access to housing, education and employment opportunities that further the poverty and inequity that fuels the HIV epidemic in our country. The ban would only exempt Homeland Security, Medicaid, Medicare, and Social Security categories. For the first time, the President supports nominal military spending reductions.

The President's zeal for spending austerity is outmatched only by House leadership plans to trim the federal budget to 2008 spending levels and adopt deeper reductions in subsequent years. In the line of fire are education, food, safety, prevention, housing, healthcare, and other essential services for millions of low-income Americans, including hundreds of thousands with and at risk for HIV/AIDS.

Yet in his State of the Union address, President Obama described the shortsightedness of draconian service cuts.

"Cutting the deficit by gutting our investments in innovation and education is like lightening an overloaded airplane by removing its engine. It may feel like you're flying high at first, but it won't take long before you'll feel the impact."

Do Not Resuscitate

Capped spending or deeper funding cuts will most certainly stall an economic recovery, needlessly prolonging the suffering of those most vulnerable to an economic downturn -- the nation's poor. Leading economists suggest that the federal government should sustain or expand its investments as a way to stimulate economic recovery and jobs creation. With near agreement on Capitol Hill to at least cap federal spending growth -- if not severely slash spending -- stalled economic conditions in the U.S. are likely to persist.

State governments are likely to be among the first to feel the pain of federal austerity as they contend with severe budget deficits, expiring stimulus grants, double-digit unemployment rates and depressed housing markets. In turn, state funding for non-profit organizations and AIDS-related services will decline even more.

Efforts to address the social drivers of HIV, expand proven prevention services, end AIDS Drug Assistance Program (ADAP) waiting lists, and link low-income people diagnosed with HIV/AIDS to needed care services will become increasingly harder as states undergo even more severe budget belt-tightening.

Under such an environment, meeting the goals of the National HIV/AIDS Strategy looks bleak.

Back to the Future

Most cynical are proponents of sweeping funding cuts that would harm millions of low-income Americans already struggling to survive. The push to cap spending at 2008 levels, for example, masks a deeper deficit in leadership. Dialing back spending will not also dial back important national metrics to 2008 levels. Where's the commensurate plan to:

  • Rollback unemployment to 2008 levels?
  • Rollback uninsured to 2008 levels?
  • Rollback AIDS drug wait lists (ADAP) to 2008 levels?
  • Return state-funded HIV prevention services to 2008 levels?

Without cogent plans to reach such aims, spending-cut proponents conspire to ensure the HIV epidemic and other forms of injustice continue to thrive.

The values held by the new House leadership are not difficult to decipher. Despite claims that the federal deficit has cycled out of control, the new GOP leadership was eager to extend Bush-era tax cuts to the wealthiest 1% of Americans and adopt legislation to repeal health insurance reform, despite ample evidence that both initiatives would add to the federal deficit. Moreover, new budget rules adopted by the House require lawmakers to identify a budgetary cut for any proposed increase; new revenue sources cannot be used as offsets. However, any proposed tax cut, which would reduce federal revenue, does not have to be offset with a spending reduction. In the parlance of Capitol Hill, this is called "cut as you go."

Where to Go From Here?

If federal leaders won't stand up for progress against the epidemic, HIV-affected people and our allies must. We will tell President Obama and members of Congress to end the leadership deficit.

We've lost too much ground in the past 30 years, and this is not the time to dial back the nation's HIV/AIDS response. Any cuts in federal spending will hurt hard-hit states and keep the economic, job loss, un-insurance and public health crises alive.

Rather than more civility, we need more honesty about the true impact of the proposals circulating on Capitol Hill. Poor people, people living with HIV/AIDS, people of color, LGBTQ people and other marginalized folk are bearing the brunt of the currently leadership deficit.

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This article was provided by HIV Prevention Justice Alliance. Visit HIV Prevention Justice Alliance's website to find out more about their activities and publications.
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