Obama's New HIV Strategy: Slow Virus Spread, Increase Care

Although fewer people in the United States are dying of AIDS, the spread of HIV continues at the same rate, and certain high-risk populations are not getting enough attention or prevention, a report assembled by the Obama administration says.

The president has outlined goals and strategies in an ambitious plan to slash new infection rates and provide better care and education around the disease, according to a July 11 New York Times article.

"Approximately 56,000 people become infected each year, and more than 1.1 million Americans are living with H.I.V.," the new report notes, going on to declare a need for ""a more coordinated national response to the H.I.V. epidemic." The new domestic plan to combat HIV / AIDS will take a page from the efforts launched under former president George W. Bush, who upped efforts to combat the disease in Africa.

The report echoed a now-familiar lament that since the advent of drug regimens that successfully keep HIV in check, and prevent it from ravaging the immune system and leading to AIDS, a perception has grown up that contracting HIV is no longer a big deal. "Because H.I.V. is treatable, many people now think that it is no longer a public health emergency," the report says. But the urgency of keeping the spread of the disease in check is quite real: a significant number of HIV+ individuals do not know of their own status, and many people living with HIV do not receive the care they need. Both factors contribute to the stubborn persistence of the HIV transmission rate, which the administration wishes to see decline by one-fourth in the next five years.

Part of what the new initiative is designed to do is increase the number of HIV+ people who know that they are positive, so that they can take steps to maintain their own health and preserve the health of others. The new initiative seeks to reallocate available funds to places where they are most needed, and to step up efforts to reach out to men who have sex with men (MSMs), who make up around half of the people with HIV, and African Americans, who account for 46% of HIV+ individuals.

Part of the new initiative's strategy is to fight against stigma and discrimination, which can discourage testing, prevent people from getting adequate care, and drive up HIV transmission rates by driving the disease underground. "People living with H.I.V. may still face discrimination in many areas of life, including employment, housing, provision of health care services and access to public accommodations," notes the report.

The economic downturn and resulting loss of jobs--not to mention the fiscal strain that local governments have come under--has also contributed to the crisis, leaving HIV+ people without insurance and, in a growing number of instances, without a means of getting the medications they need. In a separate article from July 8, the Times reported that the secretary of health and human services had announced plans to provide additional federal funds--$25 million--to localities in need of money to provide for HIV+ people. Similar to the new national initiative, Secy. Kathleen Sibelius pledged to reallocate existing funding in order to address the needs of people living with the virus who have found themselves on waiting lists. The article said that 2,100 people living with HIV were on waiting lists across 11 states; only a few years ago, there were no waiting lists. Meantime, while some states have stopped adding new recipients to the aid programs, other sash-starved states have discontinued assistance for some people, the New York Times reported on June 30. One state, Louisiana, refused to maintain a waiting list: "It implies you're actually waiting on something. We don't want to give anyone false hope," the temporary head of the HIV / AIDS program there told the New York Times.

The infusion of emergency cash was welcome, but some questioned whether $25 million would get the job done. "It's a start. But it's definitely not enough," said Carl Schmid of the AIDS Institute. Advocates had lobbied for five times that much in emergency assistance, in addition to the $835 million that are already allocated to such programs. In total, the U.S. spends $19 billion annually to combat AIDS here at home.

Non-governmental groups are also working on the problem. Gay Men's Health Crisis (GMHC), a New York-based advocacy organization, released its own report, titled Gay Men and HIV: An Urgent Priority.

"New HIV diagnoses among MSM jumped 17% from 2005 to 2008," a July 12 GMHC press release reported, going on to quote GMHC's executive director, Dr. Marjorie Hill, who said, "The HIV/AIDS epidemic among gay men and other MSM necessitates a response that is multi-faceted and sustained for the long term.

"Our recommendations coincide with the White House Office of National AIDS Policy's (ONAP) impending release of our nation's first national HIV/AIDS strategy," added Hill. "We are pleased that throughout the development of the national HIV/AIDS strategy, ONAP has prioritized reducing disparities affecting gay men of all races."

"The report highlights GMHC's innovative social marketing campaigns, one of which is about to be launched through posters on subways, in local venues and on the Internet," the release said. " 'I Love My Boo' features black and Latino, young gay male couples expressing their love and care. The campaign directly challenges homophobia and encourages viewers to think critically about notions of love and what is possible in relationships."

Because racial minorities and the young are among the most vulnerable, the new report's recommendations include a call for accurate, fact-based sex education classes and safe schools measures, as well as for a reduction in anti-gay and anti-HIV stigma, which can lead to the abandonment of gay youth by their families.

Another vulnerable population are men in prison. The report also calls for efforts to scale back the rate of rape in prison, as well as implementing condom distribution among inmates.

A leading factor in HIV transmission, especially among GLBT youth, is substance abuse. The report calls for "culturally competent and gay-sensitive services for prevention and treatment of substance use," as well as more "HIV prevention messaging where gay men meet and socialize, making use of social networks and the Internet."

"This report solidifies GMHC's vision and leadership in prevention programs in the United States which are also duplicated throughout the world," Hill said. "Through our participatory approach, we actively create opportunities for community members to be involved as agents of change. We believe that solutions to HIV lie within communities."