Before I address why we stood outside in the autumn chill for six hours to get four minutes of the President's attention, l need to clarify my role in the demonstration. I simply tagged along to a single event in a series of protests against the President that have been organized by Harvard and Dartmouth students, members of Act Up Philadelphia and Act Up New York over the past few months. As someone who has been to many protests over the past decades, I was drawn to this one because of who organized it: young people fiercely committed to the fight against AIDS and for social justice. As a relatively old-timer, I've often wondered where the next generation of AIDS activist will come from in the United States--well, they've arrived and boy, am I happy. I am studying biology here at Yale: if I could clone these students, I would, they are that good, that smart, that passionate about the need to get AIDS medicines to all who need them around the world.
The other day, I asked those who were in Bridgeport two Saturdays ago, why they came out, some for the first demonstration in their young lives. I wanted to share some of the answers:
From David Carel, Yale class of 2013:
After gaining a sense of how crucial PEPFAR is for rural southern Africa this summer, I feel an obligation to join the effort to help speak on behalf of millions who can't advocate for themselves. Through last week's rally and looking into the future, I hope to raise interest and awareness among students to pressure the US government on both sides of the aisle to step into its rightful role as a leader in the fight against HIV/AIDS around the world.
From Alyssa Yamamoto, Harvard class of 2012:
Growing up in sheltered suburbia, prep school and now an Ivy League college, I often find it difficult to shed the coinciding stigma of ungrounded idealism. But the fight against AIDS is a plausible reality and more importantly, a necessary element to lessening the endless, other injustices that strain our globalizing world today. I am in this movement because I believe in humanity's shared vulnerability. When I hear about the 2 million individuals who will die of AIDS this year because they don't have access to affordable treatment, I think of the pain that I felt when my own father passed away from pneumonia and multiply it by the millions. Every child, family member, or friend whom I can save from watching a loved one die from preventable circumstances keeps my passion for this cause inflamed.
From Jared Augenstein, an MPH student at the Yale School of Public Health:
I voted for Candidate Obama in 2008 in hopes that he would live up to his campaign slogan of change. While I am certainly proud of what he has achieved so far, he still must be held accountable for his campaign promises, especially when those promises directly affect the lives of millions of vulnerable individuals. We have been criticized as a group for choosing a "bad time" to protest, I didn't realize such a thing existed. The President of the United States must be held accountable for promises he made, no matter how inconvenient the timing is.
First of all, I wish I was as self-possessed and articulate as they are about what Alyssa calls "humanity's shared vulnerability" when I was their age. When I was in my early 20s, waiting on tables in Boston, I was worried about my own problems, my relationships, my own future--like most young people in Reagan's America the world revolved around me, even if my politics were liberal ones. Here at Yale, I see many students with a driving sense of careerism, a rabid pragmatism, which mirrors the narcissism of my own youth. This makes these young activists even more remarkable: they've been handed the keys to a bright future and their first impulse is to use it to make the lives of other people, rather than their own, better, to try to redress some of the inequities so apparent in the daily lives on these elite campuses.
Now onto the protest. Regan: you're wrong. President Obama has been willing to address some of the more egregious policies on AIDS that we've inherited from Administrations and Congresses past, but he hasn't stepped up on AIDS, or paid more than lip service to global health since he got in office. Don't get me wrong: I am a fan of the President and think he's had some remarkable accomplishments during his short tenure, but not on the AIDS epidemic.
The ban on needle exchange is gone, the ban on HIV+ travelers to the US is a thing of the past, but where it counts--putting your money where your mouth is--the President has failed miserably. He has flat-funded President's Emergency Plan for AIDS Relief and last year even asked for a $50M cut to the US' contribution to the Global Fund to Fight AIDS, TB and Malaria. At home, he's told us the new National AIDS Strategy is not about the money, while 4,000 Americans with AIDS sit on waiting lists for AIDS drugs, which he could fix with the wave of a pen and a tiny sum relative to the size of the federal budget.
I don't buy the idea that in a recession, we should simply be grateful we didn't receive outright cuts in AIDS funding. As AIDS researcher Julio Montaner, the President of the International AIDS Society and hardly an activist firebrand, said at the International AIDS Conference in Vienna this past summer:
World leaders "had absolutely no problem finding money on a moment's notice to bail out their corporate friends, the greedy Wall Street bankers, yet when it comes to global health the purse is always empty."
There is enough money sloshing around in DC, which could fund AIDS and global health priorities even in this economic climate.
What disturbs me even more is that we may not truly have an ally on HIV/AIDS in the White House. While so many Republicans nowadays are crazy-ass mother-fuckers, it isn't good enough that the President is sane and sympathetic to us in the most general sense. President Obama's chief advisor on global health is Dr. Ezekiel Emanuel, brother of his former chief of staff Rahm Emanuel, and a noted bioethicist at the National Institutes of Health, but without one lick of experience in the developing world or any clinical training on HIV, TB, malaria or any of the major diseases of the poor around the world. Dr. Emanuel wrote a piece in the Journal of the American Medical Association two years ago, where he advised the new Administration not to invest any more in AIDS treatment claiming that it wasn't cost-effective to provide AIDS drugs to people in Africa and that focusing on more basic interventions for maternal and child health should be the main new priorities for global health.
Most of us working on AIDS are strong proponents of health overall. Some of us old-timers were crying out for single-payer health care in the USA back in the 1980s and also realize that strong primary care is vital to the treatment of AIDS here and around the world. We also know that the kinds of traditional approaches to global health that prioritized cost-effectiveness in its most narrow sense ended up driving the field to set its sights to the lowest level of aspirations, which allowed maternal and child health to stagnate in Africa for decades, for the AIDS epidemic to explode across the continent while the world and its experts watched it happen.
As Paul Farmer and David Walton wrote in a piece in the Journal of Public Health Policy back in 2004, AIDS activists rescued the entire field of global health and gave the old-rallying cry of "health for all" a vitality it had lost in the years since primary care proponents launched the Alma-Ata Declaration in the 1978. We want to build on the success of AIDS to deliver better health care to people around the world. We started with AIDS because that's what brought us into activism, but it took only minutes working on AIDS to realize that the problems we faced were about providing health and other services to the poor more generally.
Dr. Emanuel and his patron, President Obama, represent a return to the past to the old ways of approaching global health, of "selective primary care," which is about public health on the cheap, giving poor people what poor people deserve, which certainly doesn't include "luxuries" like antiretroviral therapy. Many would say poor people around the world would be lucky to have just the basic of health interventions and I'd agree, but the way to expand access to primary health care isn't by going back to the old ways of the last century, but by building on the energy, momentum, innovations and successes of AIDS to achieve greater goals.
And it's not just me who is saying such things. Close to 40 global health leaders, including deans of major American and African medical and public health schools, wrote to President Obama last November, urging him to use AIDS as stepping stone to greater achievements in global health rather than seeing AIDS as an obstacle to these objectives. However, the President is not listening. Perhaps he's delegated global health to Dr. Emanuel and doesn't know what's going on. He does have bigger issues on his agenda, but after the demonstration in Bridgeport at the end of last month, the President no longer has plausible deniability on his side. His budget requests for AIDS now look like a change in philosophy, a move from the bipartisan support over the past decade of AIDS efforts overseas, and a return to failed global health policies of the past.
Yes, the Republicans are awful and I am not sure we can even count on those who were firm supporters of PEPFAR to stand up to their own party's blood-thirst for indiscriminate budget cutting. As the President likes to say, the Republicans have become the Party of No. In Bridgeport, he tried to hint that the Republicans were going to cut AIDS spending and that he was our chief supporter and we simply didn't understand this reality. But flat-lining PEPFAR and letting 4,000 Americans waste away on ADAP waiting lists is not leadership on AIDS unless leadership is defined downwards. If the Republicans are the Party of No and would be for us as well, the Democrats cannot simply be the political equivalent of a grammatical double-negative: the Party of Not No. We need affirmative leadership on AIDS. We need those 4,000 Americans on ADAP waiting lists freed from the terror of not knowing where their medications will come from, as they watch their CD4 counts decline. We need robust funding for PEPFAR, the Global Fund and the Global Health Initiative, which doesn't rob Peter to pay Paul or dumb-down our vision for global health.
To me, the demonstration in Bridgeport was long-overdue. The President hasn't stepped on AIDS domestically or internationally, where it counts in terms of the budget requests, and he's even off-track to reach the goals for the new Global Health Initiative at this point. I've worked with Republicans and Democrats over the past twenty years and I've protested leaders of both parties. While my own personal politics led me to vote for President Obama in 2008, my assessment of his accomplishments on AIDS and global health isn't ideological--show me results and commitment and I'll be happy. I am not happy now.
We're in for a rough time ahead. Giving our leaders, including President Obama, the benefit of the doubt, as people with AIDS across the world panic realizing that the promise of access to AIDS drugs had an expiration date attached to it, is not an option. We've heard it all before, back in the 1980s and 1990s, when the mainstream gay and lesbian groups chastised Act Up for getting in the face of local and national politicians and we're hearing it again from some in our community who scolded us last week for protesting at the wrong place and the wrong time. We should have waited for a more appropriate venue, challenged a more appropriate target. Well, "wait" has almost always meant "never". I leave you with a paragraph from Martin Luther King's Letter from a Birmingham Jail, which sums it all up to me:
I have just received a letter from a white brother in Texas. He writes: "All Christians know that the colored people will receive equal rights eventually, but it is possible that you are in too great a religious hurry. It has taken Christianity almost two thousand years to accomplish what it has. The teachings of Christ take time to come to earth." Such an attitude stems from a tragic misconception of time, from the strangely irrational notion that there is something in the very flow of time that will inevitably cure all ills. Actually, time itself is neutral; it can be used either destructively or constructively. More and more I feel that the people of ill will have used time much more effectively than have the people of good will. We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people. Human progress never rolls in on wheels of inevitability; it comes through the tireless efforts of men willing to be co workers with God, and without this hard work, time itself becomes an ally of the forces of social stagnation. We must use time creatively, in the knowledge that the time is always ripe to do right. Now is the time to make real the promise of democracy and transform our pending national elegy into a creative psalm of brotherhood. Now is the time to lift our national policy from the quicksand of racial injustice to the solid rock of human dignity.
Dr. King's words are those to live by. I feel lucky that the young people who protested last week, let me come along to their demonstration. I'd do it again, in a heartbeat, anytime they need another body on the line.
To read the blog entry by Regan Hofmann, POZ editor-in-chief, that prompted this response, click here.
To read Charles King's blog entry on the same subject, click here.