AIDS Talk Ignores Gays

Imagine two senior HIV/AIDS administrators delivering prepared speeches on the President's Emergency Plan for AIDS Relief program that assists countries hardest hit by the epidemic and not uttering the word "gay," or even the more clinical term "men who have sex with men."

It would be disappointing but not surprising during the George W. Bush administration. It is disheartening when it is the Obama administration in 2012.

But that's what happened when Ambassador Eric Goosby, U.S. global AIDS coordinator, and Nils Daulaire, director of the Office of Global Affairs at the U.S. Department of Health and Human Services, delivered remarks this week.

The occasion was the July 10 unveiling in Washington, D.C. of the 278-page issue of the journal Health Affairs . It focuses on evaluations of PEPFAR, perhaps the only shining legacy of the Bush presidency.

Neither the speeches the two men gave nor the papers they contributed to the journal mentioned the group hardest hit by HIV on all continents.

It can't be out of ignorance. Goosby did his medical training at UCSF and has spent his career alternating between Washington and San Francisco dealing with HIV. He knows better.

Instead of a balanced discussion that included all of the major groups affected by the HIV epidemic, Goosby focused on advances made in prevention and treating women and children.

In the bad old days, say 25 years ago, they were the "innocent victims" of the disease while, to many, gay men were not so innocent, they had brought the infection on themselves. What progress has been made; from being demonized to being ignored, despite the fact that gay men were and remain disproportionately affected by HIV in nearly every country in the world.

Even while that six-hour briefing continued to roll on, a mile away at the National Press Club a handful of AIDS advocates tried to draw a little attention to the still-festering domestic AIDS situation ahead of the International AIDS Conference.

The Obama administration wants to believe that health reform in the shape of the surviving Affordable Care Act will take care of everything.

AIDS advocates hope it will help address many of their concerns, but major provisions won't take effect until 2014 and evaluating their effectiveness will take even longer. One still has to get from here to there, and even with expanded Medicaid coverage there will still be a need for HIV-specific support programs.

HIV in the U.S. remains "an epidemic of the marginalized ... of discrimination and neglect," said Cornelius Baker with the National Black Men's Advocacy Coalition. "It is still largely a disease of white, black, and Latino gay men who comprise more than a majority of the cases despite being only 2 percent of the American population."

The perception is that science has solved the problems, he said. "There is a low perception of risk," he noted, despite the fact that 50,000 new infections a year occur in the U.S. And while the problem continues to grow, funding for AIDS education continues to shrink.

"We have a population that is becoming increasingly ignorant about the epidemic," he added.

Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, said the goals of the national AIDS strategy, unveiled two years ago, "cannot be achieved without significant increases in funding for critical HIV/AIDS discretionary programs."

At least $190 million is needed for the AIDS Drug Assistance Program. Only 4 percent of total HIV domestic spending goes toward prevention, a number that would have to double "to make a big difference in the epidemic in the U.S.," Johns Hopkins University HIV researcher David Holtgrave told a congressional hearing in 2009.

Scofield called on Congress "to meet and exceed the president's budget" for HIV programs. But she fears the sequestration process of an automatic slashing of appropriations to non-defense spending that will take effect in January if Congress does not agree to specific substantial cuts toward balancing the budget.

Ronald Johnson, with AIDS United, called on all political and private actors "to end the acrimonious battles over healthcare reform and move toward full implementation" of the ACA.

The AIDS Healthcare Foundation continues to act independently of most other advocacy groups. It held a Washington news conference on July 9 chastising President Barack Obama for being "MIA - missing in action" for not having yet committed to speak at the International AIDS Conference set to open in the capital on July 22.

The group has criticized the administration for lagging on AIDS education, needle exchange, and other programs, as well as not devoting adequate resources to the epidemic. AHF spokesman Tom Myers said, "It may be better if the president not attend the conference if he is coming without any concrete proposals to fix these problems."

Earlier in the month White House staff met with a number of AIDS advocates about what Obama might say in a speech to the conference. A participant who did not want to be identified said the staff seemed to be more concerned with spin than with offering anything new.