by Amelia Thomson-DeVeaux
President Obama’s new strategies have a way of taking on epic proportions, even when their proposals are actually pretty modest (inadvertent pun – no, not that kind of “modest proposal”). Such is the case with the new National HIV/AIDS Strategy (NHAS), which was unveiled today. The NHAS is the product of a 15-month fact-finding mission, in which members of the Office of National AIDS Policy (ONAP – so many acronyms, so little time!) criss-crossed the country, holding community forums and meeting with experts to discuss the proper way to implement the first national strategy on AIDS (I know – it’s staggeringly difficult to believe that after 30 years, this is the first national effort to combat the disease). Its three-fold mission, to reduce the number of people infected with HIV, to increase access to care, and to curtail HIV-related health disparities, is both ambitious and bizarrely limited.
Although the strategy (you can read the report here) is centered around the admirable goal of reallocating and re-targeting resources and funding that have been used ineffectively or incorrectly, the near-omission of any mention of comprehensive sex education (or teens and young adults generally) is downright puzzling, considering the fact that young people between the ages of 13 and 29 comprise a quarter of new infections. The report also does its best to disguise the fact that although the strategy will be dedicated to making sure that the $19 billion currently allocated for domestic HIV/AIDS programs is used more efficiently, there won’t be new money coming in.
There are some very good elements to the strategy, particularly the emphasis on the stigma that keeps some from seeking HIV testing and treatment. Similarly hopeful is the acknowledgment that there are serious discrepancies in the ways that different demographics receive treatment: HIV-positive women are less likely to access therapy than HIV-positive men, services are far less accessible for people living in rural areas than cities, and HIV-positive African-Americans and Latinos are more likely to die sooner after a diagnosis than HIV-positive whites, to name just a few inequities. If the NHAS can tackle even these two issues, then it will make some far-reaching gains. But as a national strategy, it’s lacking in the scope necessary to deal with the epidemic.
The report mentions the devastating fact that a third of young people hold serious misperceptions about how HIV is transmitted, but doesn’t dwell it, giving cursory lip service to the need for adequate sex education. Comprehensive sex education is never mentioned, and even more surprisingly, youth are also absent, despite disturbing new evidence from the CDC that revealed that over half of HIV-infected adolescents do not know their infection status. It’s shortsighted, to say the least, to neglect youth education, especially when the infection rate remains static.
But Obama has drawn the most fire for neglecting to allocate more resources, or to set more ambitious goals. Critics have pointed out, rightly, that state health budgets are being slashed daily, and that funds for AIDS programs are often the first to go – this is on top of the fact that there wasn’t very much money for these programs to begin with. Housing Works was swift to condemn the strategy in dramatic terms; its CEO, Charles King, said yesterday, “The president’s plan is so flawed that it might actually represent a step backwards in combating HIV and AIDS in the United States.” King’s main complaint was the president’s goal of reducing annual HIV infections by 25 percent over the next five years, which King said was both too modest and insufficiently funded.
I think it’s unfair to dismiss the NHAS in such sweeping terms; although it is limited, it also represents a hopeful step forward, even if that step is more symbolic than anything else. And certainly, if Obama can reduce inefficiency and inequity in the way that current AIDS resources are allocated, that will make a difference in the epidemic, to which Americans seem to have become curiously inured. Could Obama have done more, in creating this strategy? Absolutely. But the best thing to do right now is not to tear the NHAS apart (or at least, not completely), but rather to carefully watch its progress – while acknowledging that there is still a hell of a lot to be done.
Photo from Flickr.
