Let's Talk HIV: a PEPFAR for the United States

Last Tuesday, Secretary of State Hillary Clinton laid out an ambitious and groundbreaking U.S. action plan for an AIDS-free generation during a conference at the National Institutes for Health. Clinton also introduced daytime television host Ellen DeGeneres as the new special envoy for global AIDS awareness.

DeGeneres wasn't present at the press conference, which was streamed online November 8. But this public role for DeGeneres is still very significant as her "The Ellen DeGeneres Show" reaches millions of people every day, and DeGeneres herself has eight million Twitter followers and almost six million Facebook fans.

"I'm honored to have been chosen," DeGeneres said. "The fight against AIDS is something that has always been close to my heart, and I'm happy that I can use my platform to educate people and spread hope."

In another significant recent development, on November 3rd the U.S. Department of Health and Human Services (HHS) identified HIV as a critical health priority for the nation. Moving forward "persons living with HIV who know their serostatus" has now been added to the Healthy People 2020 initiative's list of Leading Health Indicators. The Healthy People 2020 program aims to improve U.S. public health by gathering data and increasing public awareness as well as by helping motivate and coordinate individuals, communities and policymakers.

Now getting back to Clinton's speech, for me the biggest takeaway is that this new commitment makes HIV/AIDS a domestic "policy priority" for the nation, even though it has for quite some time been a global leader in the fight against HIV/AIDS. This new mission is supported by $60 million in funding from the President's Emergency Plan for AIDS Relief (PEPFAR), the emergency global AIDS fund, to "rigorously measure the impact" of future HIV-related services.

Clinton stated that "creating an AIDS-free generation has never been a policy priority for the United States government -- until today." As advocates, we have been on the frontlines in pressuring to make this sea-change in U.S. policy. Now we need to finish the job.

Not long ago the Obama administration was calling global AIDS treatment unsustainable. After creative direct actions, demonstrations, emails, letters to the editor, and a ton of our work together, Secretary Clinton is making it U.S. policy to end AIDS. But I for one have learned over the years that pretty speeches are only as good as the final action they ultimately deliver!

Now we need to hear from President Obama as World AIDS Day approaches that he is ordering PEPFAR to reach a bold new ARV treatment target. The current plan to put four million on treatment by 2013 has already nearly been met and is clearly insufficient. Instead, we need to ask the President to double the pace of scale up -- and put millions more on treatment as a down payment to finally ending AIDS.

Although Clinton's speech was an important breakthrough, there are a number of issues that still need more clarity from my perspective. This new AIDS strategy must be targeted and tailored to the specific needs of communities most affected. To accomplish this, we must respectfully engage those communities.

All eyes now turn to America to lend support to reinforcing U.S. commitments, especially in the lead up to next July's International AIDS Conference in Washington, D.C. The conference returns to U.S. soil for the first time since 1990, bringing with it 20,000 delegates and the hopes and aspirations of millions.

So what's the bottom line as we move ahead? We must continue to raise our voices about why the United States has a moral and fiscal obligation to spend the money to stop AIDS, and that we are speaking about people who have value and matter; we need to put AIDS back in the spotlight and take it out of its silo, we must utilize existing health and faith-based infrastructures to deliver care; we need to make health care a human right that is equally offered to all; we must protect the human rights and dignity of people with HIV; we must focus our attention and scarce resources on where we know it works best; and we must zero in proven result-driven approaches that lead to more people getting educated, protected, tested, treated, and linked to care.

If we put forth needed financial and political resources between now and 2015 that will lead to the disease being controlled and, eventually, reversed. But any viable AIDS strategy must take into account the varying needs of disproportionately affected populations if it is going to effectively reduce HIV burden. Even the most promising evidence-based interventions cannot succeed if they neglect the social, legal, and structural barriers faced by those who suffer the most HIV burden.

Moreover, stigma, discrimination, and criminalization are still widespread and must be challenged without equivocation as that ultimately impacts the spread of HIV. While biomedical approaches may present useful new strategies in the fight against HIV, we cannot use them as an excuse to skirt the hard work of addressing intractable barriers that have prevented gay men and other key populations from accessing services since the beginning.

As I stated in my last post, we are now at a critical crossroads with respect to our work on HIV/AIDS. I would like to share a reflective statement from Chris Collins, a colleague from amfAR, which aptly encapsulates why it is still so very important that the United States take the lead in ending AIDS: "U.S.-funded science indicates the end of AIDS is now possible in our lifetime. Studies recently revealed that antiretroviral treatment for AIDS doubles as prevention. People with HIV on pills have a 96% reduction in odds of transferring the virus. If we significantly expand access to HIV treatment at home and abroad, we will save tens of millions of lives, slow, and eventually stop the spread of the virus, and preserve billions of taxpayer dollars.

"With the right strategic shifts in current resources and an influx of foreign aid from nations who stand to benefit from the end of AIDS, we could see HIV incidence and expenditures decline dramatically in as few as five years. Jump-starting the end of AIDS would be a terrific legacy for us all. Thus, in the final analysis scaling up our collective efforts means scaling up saving millions of lives."