So, let's go back in time, to May of 2007. President Bush has just given a speech outlining his vision for the next five years of U.S. global AIDS efforts. In short, he said "we should keep doing what we're doing, not learn any lessons, keep pushing abstinence, and flat fund the program." This was on top of six and half years of wholesale neglect of the domestic AIDS crisis. In response, activists got together and developed a platform that laid out exactly what the next president would need to do to undo the harm of the Bush administration's AIDS plan, while continuing the parts that are doing good and saving lives.
We set out on a mission - to convince each of the candidates for office that they needed to support our plan, which included such novel ideas as promoting comprehensive sex education, advancing generic drug access and spending $50 billion over five years on AIDS around the world. While we made some progress, the fight against AIDS was overshadowed by other issues shaping the campaigns, such as the war, healthcare and the economy.
Then, a little over a year ago, several hundred people marched through the streets of Philadelphia to the doors of the Democratic debate, and demanded AIDS plans from each of the Democratic candidates for president. Shortly after, all eight candidates had released comprehensive plans to fight AIDS, including our current President-elect and Vice-President-elect. Their plans were modeled in large part on a platform many of us had been advocating for months.
Taking a look at Obama's AIDS plan (PDF) is like reading my policy wish list. He promises to leave behind ideology-driven debates over how to spend money, and instead put common sense and science first. He wants to end our funding of programs that only discuss abstinence and fidelity without a mention of condoms. He would no longer negotiate harmful trade deals that prioritize drug company profits over people's lives. And he wants to invest fully in the fight against global AIDS, both through bilateral programs and the multilateral Global Fund to Fight AIDS, TB, and Malaria.
Domestically, his plan is spot-on. He's calling for the development of a National AIDS Strategy, including expanding Medicaid to cover people with HIV, not just AIDS, and ending the federal ban on funding for syringe exchange. He recognizes that we must do more to confront the epidemic of HIV communities of color, especially amongst gay men and other men who have sex with men, and calls for action on this issue.
Unlike Bush's plan detailed in May of 2007, we won a plan from Obama that uses many of the real tools we have to fight the epidemic. In two months and two days, President Obama will become the 44th president of the United States. We have much to be hopeful for, but we also know that he is going to face incredible challenges to enact his visionary plan. In the midst of a financial crisis, programs aimed at the poorest people are easy to push aside for a few months or a few years. We need to let President-elect Obama know we support him, and we support him implementing his AIDS plan.
In two days, one thousand activists will do just this. People living with HIV, and allies, from across the country are coming to DC to rally behind Obama's AIDS plan, and call for him to take steps to implement it in his first 100 days in office. We'll be holding an "inauguration ceremony and parade," and will march to the White House and transition team offices.
The AIDS crisis, both domestically and globally, is not something that can be ignored any longer. No president has ever taken fighting AIDS, especially at home, seriously. We're on the verge of inaugurating the first person that not only can help us end the AIDS epidemic, but has the plan to do it, too. We're hopeful that he will really do what he says he's going to do. But we're also taking action, and rallying behind his plan, because we know that grassroots action is the only way we'll really end the AIDS epidemic.
]]>You can find out more information about our Inauguration and Rally at www.100daystofightaids.org.
The first six words are found in the sections on family planning, and have been discussed frequently on this blog. The President's Emergency Plan for AIDS Relief (PEPFAR) is currently able to provide funding for HIV counseling and testing in family planning settings. Many women enter the health care system through family planning clinics. It is critical that we ensure HIV prevention and treatment efforts are integrated with family planning clinics to reach the most number of women with HIV services. While it may seem innocuous, the phrase "supported by the United States Government" in the sections on linkages to family planning programs[1] may be a major step backward in efforts to prevent HIV infection. It is absolutely insane that the House PEPFAR legislation, by including six small words, could completely eliminate funding for HIV/family planning integration.
The last two words that may mean life or death for thousands of people are found in the section on training additional health workers to fight AIDS, TB and malaria. Over the past five years, dozens of reputable sources, from the World Health Organization to the Global AIDS Coordinator, have pointed out that the lack of trained health professionals represents the greatest obstacle to scaling up access to HIV treatment, prevention and care in Africa. The WHO recommends 2.3 health professionals per 1,000 country residents, but thirty-six African countries do not even meet this minimum standard. The reality is that we simply will not be able to reach any of the goals set by PEPFAR reauthorization, whether they are to treat one-third of people in need, or prevent millions of HIV infections, unless we train and retain more doctors, nurses and other health professionals.
The House PEPFAR legislation calls for training "at least 140,000 new health care professionals and workers for HIV prevention, care and treatment"[2]. They key here is the use of two words - and workers. Everyone knows it is costly and time-consuming to train new doctors and improve working conditions so those who are trained want to stay. By including "and workers" in the bill language, the House leadership has given the Global AIDS Coordinator an easy option for quickly and cheaply meeting the goal - give 139,999 people a two-day course on how to administer AIDS medication, or test someone for HIV, then pay them marginal wages for a few hours of work each week, and train one new doctor.
There is one big problem with this strategy. While community health workers are needed, we will not be able to meet our other goals unless we train doctors, nurses and other health professionals to provide care and treatment. Instead of taking the easy and cheap way out, we need to train 140,000 new health professionals, plus additional community health workers and paraprofessionals as needed.
So why are those eight words in the bill? Maybe it's because House leadership didn't want to stand up to far-right ideologues like the Family Research Council who praised the House bill for addressing "some, if not all, of the social responsibility concerns"? Maybe it's because fighting AIDS the right way is more expensive than doing it the easy way?
Millions of lives depend on whether this legislation passes, and House leaders should do everything they can to make sure the best possible bill, one that does not compromise on key issues and hamper our efforts to fight AIDS, is passed this year. Whatever their reason for including these eight words, there is still a chance to fix it with amendments before the bill becomes law and we have to deal with these words for five years.
[1] "supported by the United States Government"- Henry J. Hyde and Tom Lantos United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, p. 21, lines 13-14, p. 66, lines 1-5, p. 108, lines 1-5, p. 111, lines 8-16
[2] "and workers" - Henry J. Hyde and Tom Lantos United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, p. 52, line 2
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