Read it (and weep) here.
The Republicans are looking to cut, among other things, 21 percent from the Department of Health and Human Services. Which means the National Institutes of Health will be cut by $6 billion dollars.
Ladies and gentlemen, kiss your NIH-funded AIDS cure goodbye if this happens. Even if Dr. Frieden and Dr. Fauci are all over HIV/AIDS, they can only do so much with so little.
Republican control of the U.S. government will be a dangerous thing to the health of people with HIV/AIDS worldwide.
Which is why I was stunned to see a group of AIDS activists attack President Obama at several key pre-election rallies in states like Massachusetts and Connecticut just prior to one of the most important mid-term elections of all time for people with HIV/AIDS. While I understand the dire need for their activism (and, as a woman living with HIV am likely to benefit if they are ultimately successful), I think the action was ill timed.
Let me be crystal clear: I agree with the message they were delivering--just not the timing and venue they chose.
See the video here.
In an effort to keep the majority of the states blue, Obama, his entourage, and even Bill Clinton, hit the road to campaign for democrats whose seats are at risk. And while the President stepped up to help vulnerable members of Congress, a vociferous group of AIDS activists (mainly students at Harvard and Yale University, including long-time global AIDS activist, and now Yale undergrad, Gregg Gonsalves) interrupted the action with cries for funding for global AIDS. This past Saturday, they could not be quieted at the rally in Bridgeport, CT. Ironically, they disrupted the support for Democratic Senate candidate Richard Blumenthal and incumbent Democratic Congressman Jim Himes. A Congressman, mind you, who co-sponsored the repeal of "Don't Ask, Don't Tell," who voted for the legalization of syringe exchange and who voted in favor of funding global AIDS.
In response to the protesters, the President said, "You've been appearing at every rally we've been doing. And we're funding global AIDS. And the other side is not. So I don't know why you think this is a useful strategy to take." The President added that it would be "hard to go move forward on all these initiatives...until we get the economy fixed, unless we can put people back to work, unless folks feel more confident about the future."
And, at the risk of sounding like a presidential suck-up, I must say, I agree. And I wondered: Why would AIDS activists choose the near-eves of critical mid-term elections to disrupt a pre-election rally if doing so could lessen the chances that the people most likely to support the fight against HIV will gain--or re-gain--their seats?
I am the first to agree with the points Gonsalves and his group made. I wrote an entire feature story in the July/August issue of POZ that went to the International AIDS Conference about the dire need to increase funding for both domestic and global AIDS. Gonsalves is right--not only about the massive number of deaths that will occur from inadequate AIDS funding, but also about the fact that our funding levels reflect broken promises on Obama's part.
But, to be realistic, we are in a recession the likes that no one (not even Obama on the campaign trail) could have seen coming three years ago when those promises were made. That doesn't mean it's okay to break them, or that we should stand silently when they are broken.
But it means that a critical first step in fixing the problem of low levels of funding for global AIDS has to be to support democratic control of government and ensure that the people best poised and most willing to help us maintain their political power. Do you think it's going to get better with Republicans? Then why would you do anything to undermine the Democrats? Even if they have yet to deliver all we hoped for, all they promised?
Part of the reason many of us in the HIV/AIDS community elected President Obama was his pledge to focus on HIV/AIDS and to allocate $50 billion to the global fight against HIV/AIDS via the President's Emergency Plan for AIDS Relief (PEPFAR)--thus upping the previous budget of $48 billion set by President George W. Bush by $2 billion. President Obama has not done this. Instead, he requested an additional $153 million for PEPFAR. Additionally, President Obama initially requested a $50 million decrease for the Global Fund to Fight TB, Malaria and HIV/AIDS, then, in response to activism and press coverage, increased the U.S. pledge. Still, our ultimate pledge was $2 billion short of our fair share based on our GNP. Given that other donations hinged on the levels of U.S. giving, the net effect was compounded. And many lives now hang in the balance.
But again, these choices must be understood in the context of the current economic climate. For the past year in particular AIDS activists all over the world have been fighting vehemently for increased funding levels--no small task in a major recession, when millions are out of work, at war, out of their homes or awash in oil, recovering from earthquakes, tsunamis and volcanic eruptions. And, while we scream about what isn't getting done and the promises that have been broken, we must also acknowledge what has been done and what promises have been kept. The AIDS Drug Assistance Program stateside got additional emergency funding (yes, it is not nearly enough and ADAP wait lists are nearing, or perhaps already past 4,000 people, but it was a sign of initial responsiveness to the problem); syringe exchange was legalized; the travel ban for people living with HIV entering the U.S. was lifted. The International AIDS Conference is coming to Washington, D.C. in 2012 and we have a National HIV/AIDS Strategy that many agree, if properly funded, can really impact AIDS in America. On the global front, no other nation has given as much in terms of absolute dollars as the U.S. has given and continues to give. (However, it should be noted that as a percent of our GNP, our level of support for the Global Fund compared to other countries' is low.)
Is it enough? Hell no. But no nation has what is needed. Even if we were to quadruple our effort, we'd still fall way short of the total need. And the problem is one that is not the United States' alone to solve.
All that being true, it does not remove the reality that under funding global AIDS will result in tens of millions of deaths. A point eloquently made in a letter addressed to President Obama, written collectively today by the collegiate activists to explain their activism of late, and at pre-election rallies in particular. (To read the letter in its entirety, scroll to the end of this entry.) The irony is that even a promise of $50 billion wouldn't come close to solving the problem. Yes, millions of lives would be saved. But we'd still lose millions even at that level.
Faced with such a conundrum--a dismal economy and an exponentially growing need for funding to fight HIV and keep people alive--the question, really, is how can we best work together, as a community and a government, to solve this problem? And what is the most effective way to communicate to the administration about what is needed? I am alive today in part because of activism like that led by Gonsalves; yet I also feel we must be strategic as a community about lobbying for better outcomes. To me, screaming at the man who is listening to us more than any other president in history on the topic of HIV/AIDS at the precise moment he is trying to get others who are willing to help us survive HIV/AIDS get elected seems, well, a little less than strategic.
I was at the White House this past summer when CEO and President of Housing Works Revered Charles King interrupted President Obama at the reception the president hosted for people in the HIV/AIDS community. I heard the gasps throughout the crowd when King, another who has arguably saved countless lives, perhaps, even mine, with his brand of in-your-face-AIDS-activism, yelled "Mr. President!" and then proceeded to ask about housing for people with HIV/AIDS until the president told him he would discuss the matter with him later. I would argue that King's point could have been made as effectively, and less disruptively, had King, for example, spoken to a member of the President's Advisory Council and asked them to relay his ask to the president in their pre-reception, face-to-face meeting with the president. Perhaps he did.
In my opinion, the incident cast an unnecessary sour mood over the event. By choosing a moment that was supposed to be a gesture of good faith support for our community as an opportunity to criticize the administration just felt inappropriate and counter productive. And, by focusing on a single aspect of the myriad cultural, structural and societal issues that put people at greater risk for HIV/AIDS, King ignored the larger and collective problems.
Don't get me wrong. I totally understand King's desire.
When access is limited and the stakes are so high, it's hard to resist screaming everything you want the administration to hear at the top of your lungs. And were they not listening, I would be yelling at them myself. But they are listening.
That is my point. If they listen, and still decide to do things we don't agree with, that is another matter. And we must relentlessly push for the needs of people who have no ability to advocate on their behalf. Something Gonsalves and King are legendary at doing. But given that they are listening and are trying to help, I just wonder whether the moments King and Gonsalves chose to make their points helped, or hurt, their efforts. Time will tell, I suppose. I would love to hear what you all think.
The Obama administration, certainly more than any other in history, is paying attention to us. They have re-opened the Office of National AIDS policy, staffed up the President's Advisory Council on HIV/AIDS and spent countless days touring the nation and reading through emails trying to put together a National HIV/AIDS Strategy to address as many of the keys issues as they can.
Some say none of this offsets the dearth of funding needed to keep people alive. That is true. A piece of paper and a strategy mean nothing if people are still contracting HIV, getting sick and dying. But they could prove to be a blueprint for a better way to fight HIV. The administration shared the process of creating the strategy with the community. I know hundreds of people who have consulted directly with the government. The Office of National AIDS Policy has shared their implementation plan for the strategy and claim they will share their operational plan that reflects feedback from all federal departments as soon as they can.
Have they given us everything we want? No. Not by a long shot. But the channels of communication are open and it seems they are willing to try to solve the problems with us. Which is why I was shocked by King's need to yell about his agenda in a room with hundreds of others who had arguably equally valid agendas who had found other ways to communicate them.
And, it's why I was shocked to see the group of AIDS activists confront the president in the midst of him fighting, arguably, for our lives.
There's a saying that if you whip a horse that's running as fast as it can it will slow down. I wonder what it must feel like to the president to know he's shown commitment to fighting domestic HIV/AIDS and is trying to continue our commitment to support the fight against global HIV/AIDS in one of the most challenging economic times in our nation's history, to invite people living with HIV/AIDS to the White House repeatedly to consult directly with your staff--and then be heckled. Especially to be heckled while he is trying to ensure that the very people who will fund the implementation of the National HIV/AIDS Strategy, PEPFAR and The Global Fund get elected to office.
I bet it doesn't feel great. As someone who has witnessed, firsthand, the efforts this administration has made to be receptive to the HIV/AIDS community, I find the actions of those who disrupted the pre-election rallies detrimental at best. At worst, they reflect badly on a community that has done a good job in respectfully, effectively and collectively expressing their needs to people who are all ears, especially when you're not screaming at them while they are fighting for your life.
The Obama administration has a lot to face and will need to make some serious financial commitments if they are really to have a chance at ending the HIV/AIDS pandemic. And they will have to keep their promises if they want to keep our support.
I believe they are committed to meaningfully trying to address the disease. But in order to do so, they need to retain political power.
Which is where you come in.
Tuesday--tomorrow--is it. If you want a fighting chance at survival, get out and vote.
Your life--and those of millions of others--is riding on it.
(Below, the activists' letter to President Obama)
1 November 2010
President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Mr. President,
As the November elections will soon draw to a close, we thought now would an appropriate time to respond to your criticisms of our current demonstrations. Many have called these actions "disrespectful" and "untimely". We assure you that as devoted supporters, volunteers, organizers, and students, we respect both you and the project of change you have brought to the United States. Because of this, we will continue to strive to show this respect by placing our concerns in as reasonable of terms as possible.
First, let us tell you who we are and why we are demonstrating. We are a coalition of AIDS activists from Connecticut, New Hampshire, Massachusetts, Philadelphia, and New York. We have come together because of our common commitment to combat a grave injustice. As Martin Luther King has said and you have echoed, "An injustice anywhere is a threat to justice everywhere". It is against the injustice of global AIDS that we are fighting.
You have consistently challenged our actions, and you recently said, "I don't know why you think this is a useful strategy to take". It is regrettable that your rallies have been consistently disrupted, but what is more regrettable is that this administration is not doing more for the millions around the world that are still dying of a treatable illness.
During your 2008 campaign, we spoke on several occasions with you and other Democratic leaders to encourage you to build upon the PEPFAR program. To our tremendous joy, in a debate among the Democratic candidates for President, you promised the world $50 billion in the fight against AIDS and we cheered that promise. However, soon after your election we realized that the budgets you submitted to Congress virtually flat-funded the President's Emergency Plan for AIDS Relief, slowing the growth of AIDS treatment and other interventions. This resulted in devastating consequences for millions of men, women and children around the world.
These are the victims of your broken promise, the effects of which are most evident in your recent budget requests to Congress. Last year you asked for only $153 million in new funding for PEPFAR in your request, bringing the program's allocation to $6.9 billion. That is far below the additional $1 billion per year you promised in 2008 when you were running for President and it is the smallest increase since PEPFAR was established in 2003.
The $2 billion difference between fully funding PEFPAR and your budget requests would have meant:
- 1.3 million more people could receive treatment for HIV/AIDS,
- 3.9 million more women could receive services to prevent mother-to-child transmission of HIV, and
- 36 million more people could access programs to prevent sexual transmission of HIV.
Members of your Administration have made it clear that they see core components of the response to HIV, particularly antiretroviral treatment, as unsustainable and not cost-effective. Thus, instead of building on the successes in the fight against AIDS, your new Global Health Initiative (GHI) has targeted proposed, new allocations of funding towards other diseases, conditions and interventions (which, themselves are not even on track to be realized), while efforts on AIDS have been sidelined. This move has been criticized by close to 40 deans of public health and medical schools, global health leaders including Dr. Paul Farmer of Harvard University, Dr. Jim Kim of Dartmouth University, and Sophie Delaunay of the Nobel Prize winning Doctors without Borders, in a letter to you last November. In November 2009, Doctors without Borders also issued a report, Punishing Success: Early Signs of a Retreat from Commitment to HIV/AIDS Care and Treatment, which documented your Administration's regressive policies on HIV/AIDS, describing what is happening in the field to their patients and to those who come to seek care from PEPFAR programs in the countries in which the organization is working.
We, along with a vast majority of leaders in global health, see no contradiction in supporting AIDS treatment, as well as efforts to combat maternal and child mortality and to strengthen health systems--we have been advocates for a broad based response to global health long before you took office.
The dichotomy between horizontal and vertical approaches to health is a false one. We know that health systems need breadth and focus: an investment in infrastructure, personnel and basic primary care services, and a keen eye towards priority diseases, which cause the vast burden of morbidity and mortality in developing countries. This diagonal approach has been articulated by experts, such as the former Health Minister of Mexico and the current Dean of the Harvard School of Public Health Dr. Julio Frenk, and many others. Finally, most experts have recognized that the AIDS response has been a key catalyst for the expansion of interest and investment in a broad range of other areas of health and development, enlarging the scope of what was previously thought possible and feasible to accomplish in Africa and elsewhere in the developing world.
What we do not support is the pitting of AIDS against other diseases, of narrowly conceived notions of cost-effectiveness as the primary metric by which to make decisions on global health financing. Your Administration is "punishing success," and promoting a vision, which will weaken the response to the global AIDS pandemic and will be bad for global health overall. While we hold you ultimately responsible for your Administration's policies, the vision underlying the GHI has been most clearly articulated by Dr. Ezekiel Emanuel of White House's Office and Management and Budget. Dr. Emanuel has had a long, distinguished career in bioethics, but he has admitted that his clinical training and practical experience do not include the treatment of diseases of the poor or efforts on health system strengthening in developing countries. Yet, he seems to be leading your Administration's work in this area, while blatantly ignoring the counsel of experts with decades of field experience and expertise on infectious and chronic disease in developing countries, on health systems and program management in resource-poor settings.
We want to negotiate; this has been our objective all along. Our colleagues from other organizations have met with members of your staff, including Dr. Emanuel, Dr. Eric Goosby and Ms. Gayle Smith, numerous times to discuss these issues, but our concerns have been rebuffed on each occasion. We have been left with no other option than to engage in direct action. We will continue to protest at campaign stops, fundraisers, town hall meetings, and other events until the Administration's policies change. Furthermore, the International AIDS Conference is in 2012 in Washington, DC. There will be a march, as there usually is at these large gatherings. Whether or not that march of 20,000+ people will criticize your Administration's efforts on AIDS or praise them, is entirely up to you.
You promised you would increase bilateral programs by at least $1 billion a year and fully fund the Global Fund. What we demand from you then is at least a $1 billion increase in your PEPFAR request and an $800,000,000 increase in your Global Fund request for the 2012 fiscal year. This funding must not be drawn from other foreign aid programs or other global health programs. Only once these demands are met will we cease our demonstrations.
We want to work with you. We are your supporters. However, the fight against AIDS is too important to give you uncritical allegiance or remain silent when the lives of millions of people are at stake over the direction of your policies. When you and the First Lady came onto the stage in Grant Park on Election Night in 2008, we believed we were entering a new era borne on the audacity of hope and a renewal of American political leadership at home and abroad. We need you to lead on HIV/AIDS, for the sake of millions of people with HIV all around the world and to set an example, which other Presidents and Prime Ministers can follow. We still have great hopes for your Presidency and the kind of America you are trying to build. But now, words must now be matched with deeds, as there is no one who can change the trajectory of the epidemic more dramatically than you can at this moment in history.
Scott Gregg, Krishna Prabhu and Marguerite Thorp--Harvard College, Cambridge, MA
Matthew Basilico--Harvard Medical School, Boston, MA
Luke Messac--University of Pennsylvania Medical School, Philadelphia, PA
David Carel and Gregg Gonsalves--Yale College, New Haven, CT
Jared Augenstein and Nicholas DeVito --Yale University School of Public Health, New Haven, CT
Jacob Izenberg--Yale University School of Medicine, New Haven, CT
Liana Chase and Cameron Nutt--Dartmouth College, Hanover, NH
Gloria Prusakowski, Max Ray and Amanda Coliani--Act Up Philadelphia, PA
Johnny Guaylupo--Act Up New York, NY
To read Gregg Gonsalves' blog entry in response to this blog entry, click here.
To read Charles King's blog entry in response to this blog entry, click here.