Mixed Response to AIDS Strategy

Making good on a promise President Barack Obama made on the 2008 campaign trail, the White House on Tuesday unveiled the much-anticipated National HIV/AIDS Strategy.

Melody Barnes, director of the White House domestic policy council, told advocates and reporters that 30 years had passed since the epidemic first hit the nation and 20 years had elapsed since the Ryan White CARE Act was first passed by Congress, yet 56,000 people still contract HIV every year in the U.S. and a new person is infected every 9.5 minutes.

"At this important marker in our history, we think it is imperative that we refocus our attention on the issue of HIV and AIDS and what we have to do in the United Sates to address this issue appropriately," said Barnes.

The plan will be fueled by $30 million that the Department of Health is redirecting from the newly passed health care bill's prevention fund in order to accomplish three goals: reducing the number of new infections, increasing access to care and creating better health outcomes for people living with AIDS, and reducing HIV-related health disparities among different groups of people.

While health advocates welcomed the new domestic emphasis on the issue and hoped it would produce better coordination among the nation's agencies and advocacy organizations, many worried that the effort wasn't ambitious enough and was being underfunded from the outset.

One of the main goals of the strategy is to reduce new infections by 25% by 2015. But Christine Campbell, vice president of advocacy for the New York-based group Housing Works said the goal would take new infections from about 56,300 per year today to 42,225, which wouldn't even match the 40,000 per year infection rate the country stood at three years ago, according to the Centers for Disease Control and Prevention.

"So we really don't believe it's an ambitious enough target for us to go back to where we were three years ago," said Campbell.

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Watch Health and Human Services Secretary Kathleen Sebelius discussing the new strategy.

But Jeff Crowley, director of the Office of National AIDS Policy, defended the target as "very aggressive" while taking questions at the afternoon briefing.

"We went through a very serious process and we're trying to be honest about what we think is achievable," he said.

Advocates uniformly welcomed the emphasis on prevention among groups at higher risk for contracting the disease.

"We really applaud the administration for refocusing the need to address the domestic AIDS epidemic, including the communities most impacted by it," said Carl Schmid, deputy executive director of the AIDS Institute, a Washington-based advocacy organization.

As the plan stated, "Not every person or group has an equal chance of becoming infected with HIV. Yet, for many years, too much of our nation's response has been conducted as though everyone is equally at risk for HIV infection."

According to an outline of the strategy, gay and bisexual men make up approximately 2% of the U.S. population, but the Centers for Disease Control estimates that they account for 53% of new infections. White gay men make up the greatest number of new infections, but black and Latino gay men are infected at higher rates.

While African-American men and women are only 13% of the population, they represent 46% of people living with HIV. Still, among blacks, gay and bisexual men face the highest risk for HIV infection, followed by women and straight men.

According to the CDC, Latino men are diagnosed with AIDS at three times the rate of white men, and Latina women are diagnosed at five times that of white women. But again, gay and bisexual men make up the greatest proportion of HIV cases among Latinos.

But Schmid pointed out that more research needs to be done about why gay men engage in activities that put themselves at risk for HIV. And although he was initially encouraged by the plan's return to evidence-based and age-appropriate sex education in class rooms after the Bush administration funded abstinence-only programs for youth, Schmid was disappointed by the implementation outlined in the National HIV/AIDS Strategy.

"The Department of Education is not even mentioned in the whole document," he said. "I don't see how that element is going to be implemented so we're going to have to continue to push them on that."

Many groups also continue to blast the administration for the level at which it intends to fund AIDS Drug Assistance Programs, saying $25 million barely covers the current need in many states let alone the shortages going forward. ADAP is a joint federal-state program that provides AIDS drugs for about 165,000 low-income Americans.

Ged Kenslea, communications director for the AIDS Healthcare Foundation, referenced reports of people dying for lack of access to their medications.

"As of July, there were 2,200 people on waiting lists -- that $25 million [the administration allocated] is basically what it costs to care for those 2,200 people. So that money is already out the window," he said.

Based on the shortage of funds, Kenslea said the administration would be forced to pull funds from some states in order to put money into other states.

"What they need to do is they need to appropriate more funding," he said, adding that the program really needs about $126 million to be sustainable.

President Obama addressed HIV/AIDS activists later at the White House East Room.

"In the beginning, of course, it was known as the 'gay disease.' A disease surrounded by fear and misunderstanding. A disease we were too slow to confront and too slow to turn back," he said.

But the president said much had been learned in the intervening years about the transmission and prevention of HIV/AIDS.

"The question is not whether we know what to do, but whether we will do it," Obama said.

That sentiment was shared by many community advocates.

"Now the issue is, we need to start implementing the plan," said the AIDS Institute's Schmid. "We need continued leadership. We need the resources to do all these things."