By Chris Collins (amfAR - Vice President and Director, Public Policy)
Last week on The Colbert Report, during an interview with National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, Stephen Colbert remarked about the AIDS epidemic, "I thought we were done with that one." The audience laughed at the joke, but Colbert's fictional character was speaking to the reality that AIDS is today much less present in the public mind.
A sense of urgency has been replaced with complacency, even though AIDS remains a devastating, and worsening, epidemic in the hardest hit communities in our country. Two salient facts: the rate of 56,000 annual new HIV infections has not fallen during the past decade, and at least one-third of Americans living with HIV/AIDS are not receiving lifesaving care.
The good news is that the Obama Administration has recently taken decisive steps to refocus efforts to tackle our domestic AIDS problem. In July 2010, the President released a National HIV/AIDS Strategy that sets ambitious goals by aiming to reduce HIV infection rates, increase access to AIDS treatment, and reduce the profound racial and other disparities that have been the signature of America's AIDS epidemic from the beginning.
On paper, at least, the response to AIDS in America already looks better. Whether improved outcomes actually materialize now depends on how the Strategy is implemented by federal, state, and local governments, as well as community and private providers. In many ways, however, the National HIV/AIDS Strategy is a challenge to the status quo, and its success depends on people's willingness to do business differently: to collaborate better, redistribute existing resources, find new money, and, in some cases, change what their agencies do.
Plans released by the White House this past February call for a whole list of smart, Strategy-related reforms. First, there are several proposals from the Centers for Disease Control and Prevention (CDC) for using funds more effectively.
Millions of HIV prevention dollars would be redirected from small-scale approaches to interventions with broader community impact. Funding formulas would be revised to put more resources where the epidemic is most severe. And the work of planning bodies would be reviewed to ensure they are allocating resources appropriately.
Each of these proposals presents challenges. For example, greater emphasis on community-level impact means many providers will need to reinvent how they approach HIV prevention. Planning groups and public health departments will need to reassess resource allocations to ensure that programs for groups at elevated risk of infection, including gay men (particularly African-American gay men), African American and Latina women, youth, and others, receive financing that is proportionate to their share of the epidemic.
Second, the Strategy places new emphasis on epicenters: the 12 jurisdictions that account for 44 percent of all people living with HIV/AIDS in the U.S. This "12 cities" approach could be a leading edge of health systems reform because it promises to support local planners in identifying gaps and then mapping out a more coordinated and effective response. But it's yet to be seen whether "12 cities" lives up to its potential or devolves into another set of rigid bureaucratic requirements.
To be successful, "12 cities" will need sustained funding, a new spirit of collaboration across multiple agencies, forceful federal leadership providing a clear vision of the initiative's core goals, and enough flexibility in funding and reporting to allow local and state planners to be creative.
Third, the Strategy lays the groundwork for a paradigm shift in HIV prevention. Research in the last several years has established that providing quality treatment to people living with HIV reduces the amount of virus in their system, making them less infectious. San Francisco and other cities are studying whether focusing on community viral load (the amount of HIV circulating in the community) can help track who is and is not benefiting from treatment, and eventually reduce new HIV infections through better treatment delivery. The early signs are promising, and the CDC has plans to help cities utilize this community-level prevention tool.
This new approach could be a game changer in the epidemic, but success depends on doing a much better job of reaching people who want and need HIV treatment, and finding the money to do that. It depends on more efficient health systems that can effectively link people to the care they need. And it means new roles for community-based providers, some of whom will be challenged to adjust their work to focus more on HIV testing, linkage to care, and support with treatment adherence. The new paradigm must not lead to divestment in critically important community-based services, but it will mean that, in some cases, those services will need to be transformed.
Finally, with a more strategic approach in place, there has never been a better case for dedicating new resources to the fight against AIDS. HIV prevention has been chronically underfunded since the beginning of America's epidemic, and thousands of Americans wait in line to benefit from the AIDS Drug Assistance Program (ADAP).
With states facing draconian cutbacks in public health, the federal financing role is more important than ever. Congress must pass the modest new domestic HIV investments proposed in the President's fiscal year 2012 budget request, and do better in areas like ADAP and housing. Congress also needs to enact a proposal by the White House to give Secretary of Health and Human Services Kathleen Sebelius authority to create a funding pool to promote the National HIV/AIDS Strategy goals. Without new resources, the promise of recent scientific breakthroughs, such as pills and microbicidal gels that prevent HIV infection, will remain unrealized.
It is possible one day that Stephen Colbert's comment about AIDS won't be a laugh line. We could be "done with this one" with a combination of smarter approaches, prudent new investments, and thoughtful application of new research findings. The President has called for a new direction in the domestic AIDS crisis. Now Congress, states, local communities and all of us must seize this opportunity and end the AIDS epidemic in America.
Chris Collins is vice president and director of public policy at amfAR, The Foundation for AIDS Research. His email is chris.collins@amfar.orgSean on:
I trying to understand the situation. but only that these information is not dealing with the coomunity in gerale it seems that the reacher study that done this is not really useing correct information concerning individual has over 30 years dealing with HIV/AIDS and we still have not understand this if we put all this information together it will all look the same pior look around you and tell yourself what have we accomplish in this situation this effect our community now we have individual that think by covening the situation that it will go alway not so fast we still here at the bottom trying to make for another day dealing with this averyday for the rest of our life
I agree that it is a top down plan where again the Federal Government is preaching to the choir and trying to understand HIV/AIDS without spending any time in the local community or rubbing elbows with a HIV person. These National talking points are good for some, but again the D.C insiders forgot to ask the local communities input and again thinking that their fine words will come to the streets in 12 major cities. Many ask for the Denver Principles (NMAC leadership for years) and This National Plan group0 to include a Cure for AIDS, action plan, Now. But all the Big AIDS INC so called leaders or High Paid Executive Directors (with health insurance) choose not to Ask for a Cure Action Plan for AIDS and HIV, instead more studies after studies and more studies. I think this will be the biggest blue ribbon document that looks good from the outside and have no substance on the inside. This young man Mr. Collins from AMFAR came from our Congress where he learned to double talk around ever issues for that is the politic way for D.C insiders, where one is always questing the truth and motivates of these politicians. Mr. Collin stepping into a National Policy Director for AMFAR is another sign that Congress, Government and our President is playing the Game of talking good and lacking zeal and vision for the millions of people globally that are in the community fighting each day for doctor, labs and a pill with hopes for a job to live a healthy and prospering journey. The Good New is that the community will over come and the federal will follow one way or a other. Get Real DC policy wonk come into the community, pray with the community and fine some zeal for the children of the future and stand up to Demand a Cure Agenda in resources and action and expand HIV prevention to fair and free access for Over the Counter Rapid Home Screening Kits, Over the Counter Affordable PREP, Over the Counter Microcopies and Over the Counter Clean Needles, while advocating with passion like your life and soul is on the line, for a Cure For AIDS. Wake UP,,, Have a great day, Smile, for even D.C beltway people are the Apple of God's eyes.
Well....what can we do? I was talking to a doctor about the virus 2 weeks ago and she shook her head. She said, "it's so difficult, it's such a hard virus to understand...". I just wonder how we will ever be able to find a way to destroy the darn thing completely. I want to have hope. But i do think that complacency has gone rampant. Will we ever get the energy back to fight this thing? It just scares me, like it scares everyone else. I'm at a loss sometimes.
hmm i kinda agree with the wingnuts on this one. @ 30 years into this epidemic, we need more of a radical vision than this. the 12 cities is a good idea but not enough.
@thanks frederick for getting real, we need that now.
does anyone feel good about knowing that while 1 gay white man has been CURED of HIV (the Berlin patient), yet millions of us still live with (and millions more have died of) this retrovirus?
we're not that far away from a cure. but lets face, if we don't demand it, it wont happen.
What I see missing from the National AIDS Strategy is getting the message out to the general public. If we are talking prevention efforts, doesn't it make sense to use those of us who are already HIV-positive to raise awareness, encourage testing and keeping one safe from contracting HIV? If we are talking about the complancency over the years, which is rampant, and trying to reduce infection rates, then maybe the strategy needs to look at utilizing loud and proud positive folks to get the message out that HIV/AIDS is still alive and well in the U.S. If I had known way back in the 1980's what I know today, perhaps I would have been more cautious in the past, and not be HIV-positive since 1989. PLWHA are the best spokespersons. Time to stand up and realize that folks! Just sayin...