Groups push national AIDS strategy
by Matthew S. Bajko
The United States could have a national strategy for combating AIDS by 2010 under a proposal numerous AIDS agencies are pushing President-elect Barack Obama to adopt. It would mark the first time the country had a coordinated policy in place to combat an epidemic that has ravaged the gay community, in particular, for 27 years.
Along with a national AIDS strategy, the groups are also urging Obama to resurrect the White House Office on National AIDS Policy and appoint a new "AIDS czar" to oversee the office. They also want to see the person be given budgetary authority over the more than $23 billion in federal money spent on HIV prevention and care for people living with HIV and AIDS.
The last person to oversee the office, Carol Thompson, stepped down in February 2006 and it has been vacant ever since. At least two names are being floated as a potential AIDS czar: Dr. Helene Gayle, who served as director of the Centers for Disease Control and Prevention's National Center for HIV, STD, and TB Prevention between 1995 and 2001; and Jesse Milan Jr., chairman of the Los Angeles-based Black AIDS Institute.
Both Gayle and Milan are African American and have extensive resumes in terms of combating HIV and AIDS. Gayle is now president and CEO of CARE, which focuses on poverty issues facing women throughout the world. A spokeswoman told the Bay Area Reporter that, "Dr. Gayle has not been inclined to speculate about appointments."
Gayle had served as a senior adviser for HIV/AIDS with the Bill and Melinda Gates Foundation and was the AIDS coordinator and chief of the HIV/AIDS Division for the U.S. Agency for International Development. She attained the rank of rear admiral (assistant Surgeon General) in the U.S. Public Health Service and serves on the boards of the Institute of Medicine and the Council on Foreign Relations.
The openly gay Milan, 52, who has been HIV-positive for 26 years, is vice president of the Altarum Institute, a nonprofit that focuses on health research. He also chairs the CDC Business and Labor Responds to AIDS Partners Board.
From 2002 until last year, he co-chaired the CDC's and the Health Resources and Services Administration's Advisory Committee on HIV and STD Prevention and Treatments, through which he pushed to see adoption of a national AIDS strategy. Since last spring he has served on the national committee working on developing such a document.
He told the Bay Area Reporter this week he would be happy to serve in any capacity in an Obama administration.
"I am always committed to national service and have been doing so at a volunteer level for a long time. I expect to be of service in the right capacity for me and for the country. Certainly, I am hoping to be asked to do something to move the HIV/AIDS agenda forward," said Milan, who married his partner of 20 years, William Roberts, in September at a ceremony inside Oakland City Hall presided over by Mayor Ron Dellums.
Besides having a national strategy on AIDS in place, what is also needed is someone who can coordinate between the various federal agencies which currently receive some type of AIDS funding, said Milan.
"We need to make sure our efforts in the states are supported by federal dollars that are consistent and appropriate. With almost 50 percent of HIV-positive people not yet in care and 20 percent of the people infected not knowing their status, the current system is not adequate enough to meet all those needs," he said. "Without a plan we will continue to be shooting in the dark, or shooting with hope, that all those people we need to find will come to our doors."
Obama endorsed a national AIDS strategy during his presidential campaign and his commitment to that is listed on his transition Web site. [See story, page 12]. AIDS groups expect he will name an AIDS czar sometime after he is sworn into office in January and will instruct that person to convene a national panel to begin crafting what the strategy will look like within his first months in office.
"We are talking to members of the transition team to get an appointment within his first 100 days," said Judith Auerbach, Ph.D., the San Francisco AIDS Foundation's deputy executive director for science and public policy. "Whether it is a czar or different model is not important as long as the person has authority to put in place the process for developing this strategy."
AIDS advocates are pressing the transition team and incoming Obama administration to quickly implement a number of changes. Among them are lifting the ban on federal funding of syringe exchange programs; defunding abstinence-only education programs; and fully funding prevention and treatment programs. A coalition calling itself the 100 Days to Fight AIDS led a march to the White House and the Obama transition team office in Chicago on November 20 to press seeing a national strategy adopted.
"Based on the level of intelligence and thoughtfulness coming from his transition team, I am incredibly hopeful we will have a smart response to HIV within the next few years," said Randy Allgaier, an HIV-positive gay man who sits on several San Francisco HIV policy bodies and is a member of the committee developing the national AIDS plan.
Robert C. Gallo, the co-discoverer of the HIV virus, endorsed adoption of a national plan to combat AIDS in a November 16 column in the Washington Post.
"We must actively address the growing HIV/AIDS pandemic
He noted that the high rates of infection seen in America's poor neighborhoods are similar to those found in the developing world, where the President's Emergency Plan for AIDS Relief has allowed millions of people in Africa to begin treatment for HIV. Gallo called for a similar "plan for America's inner cities [that] would help to neutralize and diminish the number of people contracting HIV and the number dying of AIDS."
In addition to better serving U.S. residents, such a program also would be "sending a message to the world that America recognizes that it is not different from other countries and that we too have an HIV/AIDS pandemic," wrote Gallo.
Project Inform Executive Director Dana Van Gorder has spent the last eight months helping to hash out what a national AIDS strategy could look like. He co-chaired the committee that developed the framework document now being circulated online through the Web site http://www.nationalaidsstrategy.org/.
A draft copy of the nine-page document notes, "No plan requires the myriad federal agencies that have a role in addressing HIV/AIDS to coordinate their efforts in order to maximize outcomes, or holds federal agencies accountable for steady progress in reducing new infections and increasing rates of care and treatment for already infected individuals. A roadmap is urgently needed at the national level to better coordinate the work of federal, state, and local agencies and focus policy and programming on achieving improved outcomes."
Van Gorder said the steering committee and a lot of supporters of the strategy feel that the current response to the epidemic is not "sufficiently strategic."
"It is not focused and targeted on the very limited and specific set of things that could be done to have significant additional impact on the epidemic," he said. "Additionally, the response to the epidemic at an institutional level is not sufficiently well coordinated."
He said the national AIDS strategy document would be a "true public health blueprint for how you would end the epidemic."
The three overarching goals the document would call for are increasing the number of people who know they are HIV-positive, getting those people into treatment programs, and improving HIV prevention methods.
Van Gorder predicted the plan would call for shifting HIV prevention resources from behavioral approaches to biomedical approaches.
"Clearly, the Bush administration deserves a lot of credit for paying attention to the global epidemic over the last years. But virtually none has been paid to the domestic epidemic," he said.
While acknowledging there is "a massive federal fiscal crisis" that will hamper what the Obama administration will be able to do, Van Gorder expressed hope that more money can be found for HIV and AIDS programs.
"There is a hope that the Obama administration can work with us not only to increase resources but also make sure through strategy and other efforts we are using the money we have with the greatest impact," he said. "In HIV leadership of this country there is a nagging sense we are spending a certain amount of money without the kind of impact we should be seeing in terms of reducing HIV incidence."
AIDS advocates are hopeful that Obama will end the ideology-driven practices pursued over the last eight years by the Bush administration and allow public policy on HIV to be driven by science.
"It is time for us all to agree on what is really going to make a difference and to have money flowing only to those activities that are proven to be effective," said Van Gorder.
Perhaps most significantly for the LGBT community, the word "gay" would finally be able to come out of the closet during the Obama administration. Under Bush, conservative lawmakers in Congress targeted HIV prevention programs aimed at gay men and researchers expunged any reference to the LGBT community from their requests for funding.
"It has been a dismal atmosphere," said Allgaier. "President-elect Obama made a practice of saying gay in speeches in areas and venues that are not terribly receptive to hearing that word."
Auerbach said Obama's approach to HIV prevention would be "a sea change."
"We will see a real shift in that Mr. Obama is committed to evidence-based approaches and letting science be the basis for policy decisions," she said. "I think you will see more outspoken references to populations most vulnerable to HIV. That still is predominately gay men in America."
Milan agreed that LGBT Americans would see their lives improve under Obama.
"It is a new era where same-gender loving people will find new plateaus of respect from this country," he said. "We are part of it; we are here; and we will be accepting new positions of leadership more and more throughout this century."
Bob Roehr contributed reporting from Washington D.C. to this article.