David Ernesto Munar

This is an open letter to President Barack Obama and the World AIDS Day panelists, including President George W. Bush, President Bill Clinton, Tanzanian President Jakaya Kikwete, California Rep. Barbara Lee, Florida Sen. Marco Rubio, Bono and Alicia Keys. The historic discussion will take place on World AIDS Day, Dec. 1, at George Washington University, and can be viewed from the (RED) website.

November 30, 2011

The President
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President and distinguished World AIDS Day panelists,

Thank you for agreeing to sit down at the table on this historic World AIDS Day and renewing your commitment to bringing an end to the HIV/AIDS pandemic.

Reflecting on 2011, we expect this year to be known as the moment that finally put to rest the treatment v. prevention debate. As we all surely know now -- treatment is prevention.

Looking to the future, it's time to retire another worn-out dichotomy: the global v. domestic response to AIDS. We need a unified commitment and a detailed plan for fighting the epidemic at home and abroad, vigorously working toward the AIDS-free generation so eloquently envisioned by Secretary of State Hillary Clinton last month.

We raise this point because we worry this World AIDS Day panel will focus largely on international issues. As you know, there are still over 1 million people in the United States with HIV. In several states, waiting lists for drug assistance are growing. Budgets are being cut.

Now is the time to recommit ourselves to the fight against AIDS here at home, or risk gains made in the past 30 years. Now is the time to articulate concrete steps the United States will take to make the bold vision of an AIDS-free generation a reality.

President Obama, you gave us hope with your unveiling of the National HIV/AIDS Strategy last year, the first of its kind. But now we need you to push this plan forward with detailed action. How will we fulfill its promise?

As you know, this is urgent. Between 2006 and 2009, the number of HIV infections among young gay/bisexual African-American men increased almost 50 percent -- the highest incidence increase of any at-risk group, according to the U.S. Centers for Disease Control and Prevention (CDC).

President Bush, it was you who marshaled national resources for the President's Emergency Plan for AIDS Relief (PEPFAR). The significance of that cannot be overstated. We must scale up the program in order to meet the United Nations goal of treating 15 million people worldwide by 2015.

And we must also ask ourselves, what have we learned from PEPFAR that we can use to address the epidemic domestically?

President Clinton, when you addressed delegates at the International AIDS Conference in Mexico City in 2008, you vowed to broaden the focus of the William J. Clinton Foundation's HIV/AIDS Initiative to also target AIDS in America. This came on the heels of CDC data showing a 40 percent increase in HIV infections in the United States.

Respectfully, we have seen too little come of your pledge. No one can question your foundation's commitment to HIV/AIDS globally, but it is time to bring the fight home.

Sen. Marco Rubio, as you well know, over 3,000 people in your state of Florida are currently on the AIDS Drug Assistance Program waiting list. We hope you're committed to changing that by fighting to provide those people with access to affordable medication.

Rep. Barbara Lee, you have been a lionhearted advocate for HIV/AIDS in this country. You were instrumental in eliminating the HIV travel and immigration ban and bringing the International AIDS Conference to Washington, D.C., in July. Please continue leading us in this fight, globally and at home.

And Bono, we commend you for your work through ONE and (RED). We hope you'll continue to use your celebrity to broker discourse on HIV/AIDS everywhere it resides, including the United States.

To all of you, we thank you for your passion and commitment.

With a greater allocation of resources for HIV prevention, care and treatment to meet the National HIV/AIDS Strategy targets, stalwart defense of the Affordable Care Act, and a renewed federal commitment to the Medicaid program, we can make enormous progress against HIV/AIDS.

Ending HIV/AIDS is a moral and humanitarian endeavor that matches our commitment to curb unnecessary future healthcare expenditures and increase our nation's productivity.

Let us stir our citizens to action! A reinvigorated and well-informed American public is necessary to ending AIDS globally and at home in the United States.

On this World AIDS Day, we implore you to pledge greater attention and support to move forward on efforts to end the AIDS epidemic worldwide.

Striving for an end to AIDS domestically is as important as our nation's commitments to rid the world of AIDS globally through an expanded commitment to PEPFAR; the Global Fund to Fight AIDS, Malaria, and Tuberculosis; and comprehensive prevention and treatment efforts.

We urge you to make a bold announcement about our nation's ability to begin to end this epidemic in our country, our communities and our world.

Respectfully yours,

David Ernesto Munar
President/CEO of the AIDS Foundation of Chicago

Follow David Ernesto Munar on Twitter: www.twitter.com/dmunar

I had the privilege of delivering opening remarks at US Conference on AIDS opening plenary session, which featured Jeff Crowley, Director of the White House Office of National AIDS Policy, and Health and Human Services Secretary Kathleen Sebelius. 

Good morning USCA.   And welcome to my hometown!  On behalf of the entire Host Committee, we are thrilled you're here and proud to let you know what Chicago is all about. 

Chicagoans are a roll-up-your-sleeves kinda people.   We don't buckle under extreme heat, arctic winds or snow.  You're in the City that Works - the City of Big Shoulders.   I hope the hearty character of Chicago rubs off on you this week because as AIDS advocates, we have some heavy lifting to do.  My friends, it's time to get our hands dirty.

Let's face it -- our best efforts against the epidemic are stuck in the mud.  The speed of new infections remains unchanged.   Too many people with HIV don't know it.  And among those of us who are aware of our diagnosis, too many are gripped by shame and fear to seek lifesaving services.  And disparities widen everyday among gay men, adolescents, women and trans folks. 

Sadly, what we see today is a growing viral underclass - their needs are far greater and more complex than just HIV.  The crisis is pronounced in communities of color, our poor neighborhoods, our jails and prisons and among those who roam the streets without a place to call home.

The great tragedy in all of this is that we now have the tools and scientific know-how to stop AIDS in its tracks.  Where once HIV was a certain death sentence, ending the pandemic is now technologically possible. 

With expanded medical care, essential services, and treatment - among other strategies such as the protection of human rights - we can save the lives of people with HIV and simultaneously reduce the risk of transmission - in some cases by as much as 96%.   Combined with other promising advances, a revolution of hope fighting AIDS has dawned.

But with our nation's uncertain political and economic climate, sustained progress is in peril. 

At stake is whether we march forward as a society to begin to end AIDS.  Or whether we face a diminished government response that squanders the many promises, the plans, the unrealized potential.

These are not hypothetical scenarios.  The fierce deficit-reduction debates in Washington threaten progress on AIDS. 

In just two week, the 12-person congressional Super Committee is tasked with recommending $1.5 trillion in federal cuts to the deficit.  In deliberating their task, nothing is off the table.  The super committee can propose deep funding cuts to invaluable AIDS and biomedical research activities, plus hundreds of other programs for the poor.  The committee can also recommend revenue increases, thereby reducing the impact on vital services. 

Failure by the committee to reach agreement--or failure by Congress to enact their recommendations--will trigger $1.2 trillion in automatic, across-the-board spending cuts.  These cuts will affect virtual every federal program we care about.

We need Super Committee members to carefully weigh their options and safeguard funding for the domestic and global AIDS fight.  Without expanded investments, the end of AIDS will not draw near - in fact, it will only fade farther away. 

Will the US strive for an AIDS-free generation as envisioned by Secretary of State Hillary Clinton in her powerful address at the National Institutes of Health?  Or will our policies condemn entire communities to generational HIV and other socio-economic woes?

From now until Thanksgiving, the six House members and six Senators who comprise the Super Committee are best poised to answer these questions.  We need your help to send these elected officials an unequivocal message: don't reduce the deficit on the backs of people affected by AIDS.  

Many groups have joined forces to mobilize a grassroots campaign.  This morning volunteers are circulating with petitions that need your signature.  Please sign one and return it to a volunteer and we'll make sure they get to the appropriate offices. 

But don't stop there and don't be lulled into any false sense of security.  You will need to mobilize your clients, your board members, your donors, your networks and media contacts like never before - ending AIDS is truly too important to fail.

And it doesn't end with the Super Committee. 

We must fight for fully implemented and fully funded health care reform.  Fight to protect Medicaid and Medicare; fight to end ADAP waiting lists; and fight to secure an extension for Ryan White.  We need evidence-based prevention services funded across the country, legal reform to confront stigma-producing criminalization laws, and increases for global AIDS programs, including PEPFAR and the Global Fund. 

This will require much more of us.  Put plainly, if you're not actively advocating on an array of these issues, you're simply not on board with the goal of ending AIDS.

I think many of us in this room identify with the rallying cry of Occupy Wall Street.  Somehow I suspect we all here are among the 99%. 

Not to confuse matters, but I also invite you to be part of an equally power movement aimed at promoting the 96%.  News this year that treatment is prevention is a clarion call to raise our voices powerfully - and even obnoxiously if we have to - so our ethical and moral message for immediate AIDS action is heard loud and clear. 

We are compelled to court a path to begin to end AIDS, because the science is lighting the way.  It's the humane, just, and righteous thing to do.  It even makes good economic sense.  We will not turn our backs on those whose lives depend on our advocacy.  We will rally, agitate, educate, campaign, and yes, even vote our conscience.

In 2011 and 2012, our country faces several deciding moments about the values we hold dear as Americans.  And for HIV/AIDS, the stakes could not be higher.  This all reminded me of a favorite poem, A Dream Deferred by Langston Hughes:

What happens to a dream deferred?

Does it dry up
like a raisin in the sun?
Or fester like a sore--
And then run?
Does it stink like rotten meat?
Or crust and sugar over--
like a syrupy sweet?

Maybe it just sags
like a heavy load.

Or does it explode?

Ending AIDS must not be our dream deferred, and with your help we can mobilize even greater support for the 96%. 

Enjoy your time here in Chicago.  Thank you!

The groups urge policymakers to protect people with HIV/AIDS and other vulnerable populations through an equitable approach that balances revenue increases and spending reductions.

The stakes in this debate could not be higher for people with HIV/AIDS. Recent research findings from the National Institutes of Health show that effective HIV treatment not only saves the life of the individual with HIV but also significantly reduces HIV transmission. The proposed deep cuts to health care programs, including Medicaid and Medicare, would come at a time when the nation should be doubling efforts to improve HIV prevention and diagnosis and access to HIV care in order to pave the way for long-term savings and an end to the HIV pandemic.

Massive health care cuts will cost us more over the long-term when it comes to HIV disease. We now have the tools to keep people with HIV healthy and make real headway in curbing new HIV infections, but cuts of the size being considered will cripple our ability to put science into practice. Serious cuts to Medicaid would undermine implementation of health reform and make it impossible to achieve the worthy goals of the Administration's National HIV/AIDS Strategy.

We are at a pivotal time in the battle against HIV disease. Our country and people with HIV/AIDS cannot afford significant health care cuts. Congress and the President must consider the impact of their decisions on people with HIV/AIDS and other vulnerable populations now and for years to come.

CONTACT:
David Ernesto Munar
AIDS Foundation of Chicago
312-334-0933
773-814-5606
DMunar@aidschicago.org 
 
CONTACT:
Cub Barrett
amfAR
847-571-0609
cub.barrett@amfar.org

CONTACT:
John Heys
HIVMA
703-299-0412 (office)
703-915-0458 (cell)
jheys@idsociety.org

###

In a sad twist of irony, the White House proposal to rollback critical health benefits, essential to the control of HIV/AIDS, is emerging on the one-year anniversary of the National HIV/AIDS Strategy, unveiled by President Obama in July 2010.

The Center on Budget and Policy Priorities reports that the White House is considering deep federal funding cuts for state Medicaid programs, a proposal that could have an immediate, chilling effect on efforts to meet the benchmark goals described in the National HIV/AIDS Strategy. Moreover, it would render the federal health reform law virtually meaningless for millions of low-income Americans.

Medicaid expansion for all low-income Americans, regardless of their health status, is the centerpiece of the health reform law championed by President Obama in 2010. Without full funding from the federal government to help states finance Medicaid expansion, low-income individuals -- including hundreds of thousands with and at risk for HIV -- will struggle to gain access to adequate healthcare services from bankrupt Medicaid programs, which will be unable to make up the shortfall in reduced federal funding.

The White House contends that its proposal for a "blended rate" of Medicaid financing for states is far superior to GOP plans to give states a fixed block grant to cover all their low-income healthcare needs, no matter how extensive. While indisputably better than the draconian GOP proposal, a blended rate would likely shortchange states of billions in Medicaid financing that they otherwise would receive under a fully implemented health reform law beginning in 2014. Faced with reduced federal funding, most cash-strapped states will have no choice but to ration healthcare services and further erode already dangerously low provider reimbursement rates.

While this approach may help the federal government balance its budget short-term, the reality for low-income people living with HIV/AIDS will be delayed doctor's visits, deferred treatment and, eventually, costly emergency medical interventions. Scenarios like these will surely continue to drive unsustainable growth in health care costs in the U.S.

The new threat to Medicaid comes on the heels of a new policy by the U.S. Centers for Medicare and Medicaid (CMS) to make it easier on states to qualify for enhanced federal matching funds to expand coverage for low-income people with HIV. The proposal, announced as a letter to state Medicaid directors, eases requirements on states seeking to expand HIV coverage ahead of fully implemented health reform provisions in 2014. If adopted, the "blended rate" proposal would severely undermine any efforts to persuade states to expand Medicaid coverage for HIV-positive people ahead of 2014, and would jeopardize efforts to cover them thereafter.

The CMS policy, announced scarcely a month ago, is among the Obama administration's most significant accomplishment of the first year of the National HIV/AIDS Strategy. However, White House efforts to adopt a "blended rate" for federal Medicaid financing could render the CMS policy completely moot.

Moreover, deep funding cuts in discretionary spending could make it impossible for congressional appropriators and the White House to fund the National HIV/AIDS Strategy at levels needed to meet its goals. Already, the government's AIDS Drug Assistance Program (ADAP) -- a critical safety-net for HIV-positive people with no other means to afford their lifesaving HIV medications -- is facing severe service reduction in over a dozen states. More than 8,500 people are currently on ADAP waiting lists across the country. Public health researchers estimate that some 80,000 HIV-positive people clinically indicated to initiate HIV treatments have yet to do so, in part because of barriers to healthcare access.

The White House National HIV/AIDS Strategy underscores the importance of increased healthcare access in order to turn the tide against HIV/AIDS. The five-year Strategy aims to reduce annual HIV infections, increase the number of HIV-positive people who gain access to high-quality continuous care, and alleviate the disproportionate impact of HIV in three severely affected groups: African Americans, Latinos, and men who have sex with men (MSM). Instrumental to the White House plan are efforts to increase the number of HIV-positive people who receive HIV testing and are linked to high-quality, continuous medical care with housing and other needed services.


To underscore the relevance of healthcare access for HIV-fighting efforts, the Strategy seeks to ensure that 20 percent of all HIV-positive African Americans, Latinos, and gay/bi men achieve maximum viral suppression (known as "undetectable viral load") by 2015. The goal was crafted in recognition of evidence demonstrating that reductions in "community viral load" reduce rates of HIV transmission.

The results of a US-funded clinical trial go even further in demonstrating the significant benefit of HIV treatments in stopping the spread of HIV. Earlier this year, study investigators unveiled the game-changing finding that adherence to antiretroviral medications can reduce the risk of heterosexual HIV transmission by as much as 96 percent. So compelling were these and other research findings based on medical interventions, that Dr. Anthony Fauci, the government's leading AIDS researcher at the National Institutes of Health, wrote in a recent Science editorial that the prospect of dramatically controlling the HIV/AIDS pandemic is now scientifically within reach and will depend largely on the will of donor nations and philanthropic institutions around the world to prioritize treatment access.

On July 13, 2010, President Obama unveiled the National HIV/AIDS Strategy to much fanfare at an East Room briefing for AIDS advocates, dignitaries and federal officials. In his remarks he said: "So the question is not whether we know what to do, but whether we will do it.  Whether we will fulfill those obligations; whether we will marshal our resources and the political will to confront a tragedy that is preventable."  

Let's hope the president's words were not in vain. 

Follow David Ernesto Munar on Twitter: www.twitter.com/dmunar