Our country has an official national AIDS strategy for the first time since the HIV epidemic emerged. Our hope is that this strategy will guide the nation's response to the HIV epidemic and that the days of politics determining the government's response to HIV will be over.
It is the "first official national strategy" because nearly 30 years ago when our nation was in homophobic denial, together our communities launched an unprecedented response to a public health emergency. In the face of indifference and hostility at the federal level, it was networks of individuals in many communities along with concerned physicians and local public health officials who created – ad hoc – our country's national AIDS strategy. Together we built an infrastructure of care, advocated for treatments and research, shared information, and developed tools for prevention. The strength, courage, caring, pain, and hope for the future of those activists and advocates were the cornerstones of that ad hoc national AIDS strategy. The first official national AIDS strategy released by the White House Tuesday, July 13 is a result of that continuing legacy and the efforts of several advocates who had the foresight to approach President Barack Obama during the campaign.
In May 2009, the Stop AIDS Project contributed to these ongoing efforts by taking the lead in helping to create a town hall forum attended my more than 200 people and co-sponsored by Project Inform, API Wellness Center, the San Francisco AIDS Foundation, and several other groups. The Office of National AIDS Policy replicated this town hall model across the country to help maximize community-level input. Many of the recommendations by community members and advocates from these town halls are reflected in the strategy, including recognition of housing needs, expansion of access to services for marginalized communities, and focused research on transgender populations and communities of color.
The strategy contains a commitment to innovation, establishment of pilot programs based on community models, and acknowledgment of the need for more holistic approaches to health. The strategy includes recognition of stigma and discrimination as barriers to prevention services, treatment, and care. Breaking from abstinence-only education, this strategy encourages baseline education for all Americans pointing out that the percentage of Americans with misperceptions about HIV/AIDS has not improved since 1987.
We are encouraged by the strategy's expansion of care and treatment access with a renewed focus on programs such as the AIDS Drug Assistance Program, providing lifesaving medications to people with HIV. We are also encouraged by the endorsement of a combination approach to HIV prevention, which has been a hallmark of HIV prevention strategies and innovations in San Francisco. The plan states, "One of the hardest lessons of the HIV/AIDS epidemic is that there is no 'magic bullet' ... our prevention efforts have been hampered by not deploying overlapping, combination approaches to HIV prevention." A combination approach to prevention takes into consideration individual needs; medical innovations, such as pursuing vaccines; and environmental factors, from stigma and discrimination to providing free condoms in bars.
This national AIDS strategy is comprehensive and encouraging in its commitment to communities affected by HIV. We applaud the White House for concentrating efforts on those hardest hit by the epidemic and the acknowledgement that stigma and discrimination are a major factor in health disparities. However, advocates across the country are expressing concern that the plan is not fully funded and therefore the expansion of services, care and treatment will not be realized.
Perhaps most striking is the president's call for a national engagement in the strategy. It is not just a call to those communities most impacted directly by HIV. Rather, it is a call to the country to engage. A call to governments at every level, to businesses, and to each American to do their part in creating a world where HIV is rare and those of us with HIV have the care and support we need. It's a call many of us have been waiting 30 years to hear.
Inasmuch as we have the right to dedicate this national AIDS strategy to anyone, we dedicate it to those we've lost to AIDS, to those early heroes who stood up nearly alone, to those who built on their legacy, to those who are a part of this even though they are not directly affected, to the advocates and activists who had the foresight to push and push for the creation of this strategy, and for those who hear this new call.
The authors are the executive director, program director, and deputy director, respectively, at the Stop AIDS Project.