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The 96 Percent Campaign: How Obama Can Help End the AIDS Crisis

9:26 am in Uncategorized by RH Reality Check

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Written by Matthew Kavanagh & Dázon Dixon Diallo for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

President Obama has repeatedly stressed his administration’s commitment to science as one way to distinguish his leadership from that of his predecessor.  Right now that commitment is being put to the test on HIV and AIDS: if the President could do more to  end the crisis, would he?

A revolutionized response to the global AIDS crisis has just been made possible with the August publication of a US-funded study showing that antiretroviral AIDS medicines (ARVs) can cut the risk of HIV transmission from an infected to a non-infected partner  by 96 percent. Not only do AIDS drugs save lives—they are among the most powerfully effective prevention tools.

This double-benefit changes the equation in fighting AIDS at home and abroad and raises the question: Will the Obama administration respond?

That is why we are launching The 96% Campaign making clear the choice the President faces between action and inaction. AIDS treatment is not just science—it’s a reproductive, economic, and racial justice issue.

The Obama administration has had a decidedly mixed record on AIDS treatment. Now, the science and our communities are asking: Will he step up?

The President Can “Begin to End” AIDS

The fact that treatment of HIV-infected adults is also prevention gives us the wherewithal, even in the absence of an effective vaccine, to begin to control and ultimately end the AIDS pandemic.”

Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, NIH

The past few months have been heady for the science of HIV.  The biggest headlines came when the HIV Prevention Trials Network (HPTN) 052 study was halted after it showed clearly that when an HIV-positive person takes AIDS medicines as prescribed, their HIV-negative partners are protected—cutting risk of HIV transmission by 96 percent. That was followed by a study that AIDS drugs might also be able to protect HIV-negative people from acquiring the virus. And this has followed other recent evidence that medical male circumcision can cut infection rates dramatically and topical ARVs in a gel can reduce HIV transmission in women. These findings add to what we have long-known–that other efforts to expand access to male and female condoms, comprehensive sexuality education, syringe exchange programs, and harm reduction efforts with sex workers and other groups at high risk are also critical prevention strategies.

With proof that treatment is prevention, and with this basket of broader prevention options, scientists and economists have finally been able to show what few could before: models of how we end the AIDS crisis. Globally, the UNAIDS “investment framework” shows that investment in core high-impact interventions could save over 7 million lives while preventing over 12 million new infections by 2020 and also bending the cost curve of the epidemic.  Last month at the scientific advisory board for the President’s Emergency Plan for AIDS Relief (PEPFAR), data from the Centers for Disease Control showed that, in Kenya, dramatically scaling up ARVs and getting them to people earlier could reduce HIV incidence by 31 percent over five years and offset nearly 60 percent of the direct costs by keeping people alive.  And just today a study led by Harvard researchers shows that AIDS treatment pays for itself, and likely saves money, if you look at the economic impact of keeping parents alive for the sake of their kids and workers alive for their economies.

AIDS Treatment is a Reproductive Justice Issue and Many Lack Access

It is too easy, amidst the positive science, to lose sight of the real lives of real people living with HIV and the lives of their partners. The life-saving benefits of AIDS treatment have long been obvious. Today we see that a young woman in Sub-Saharan Africa is eight times as likely to be HIV-positive as a young man and gay men face similarly higher rates—so the question of who lives and who dies is also a profound question of gender and sexuality. At home, HIV is similarly inequitable along lines of race and sexuality.

For many in our community, the reality that ARVs prevent transmission is not news. For years people have worked to achieve “undetectable” viral loads to protect their partners and, in wealthy countries, ARVs have all-but eliminated the transmission of HIV from parents to babies.  People living with HIV have a right to fulfilling sexual lives and, if they choose, to parenthood—and ARVs are (one of several) prevention technologies to make that possible.

But decisions made by the Obama administration and other global leaders will dictate the extent to which these prevention strategies become available in the global South. Right now, for example, lack of funding to expand access to treatment means that while an HIV-positive pregnant woman in Africa might be able to access drugs while she is pregnant to prevent transmission from her to her newborn infant, her protection ends with giving birth, doing little for her own health and survival in the long term. And today, people living with HIV, seeking ARVs to help keep their partners HIV-negative, can’t access them unless they are much more advanced in AIDS progression and warrant scarce treatment slots.

At home and abroad millions are still waiting for AIDS treatment. Globally 10 million people are, today, in need of treatment in low and middle-income countries.  Here in the United States—wealthiest nation in the world—our health system is failing people living with HIV as over a third of those living with HIV are not in AIDS care, many even after being diagnosed.  We can and must do far, far better; if we do, we can end the AIDS crisis.

Administration Steps Forward and Backward for AIDS Treatment

The Obama administration record on AIDS treatment has been decidedly mixed.

In the United States, the Administration’s “National HIV/AIDS Strategy” has been largely applauded, though implementation and funding has been slow. The administration’s signature legislative victory—the Affordable Care Act—would have many positive benefits. But today as the economy falters so too have people’s access to care and treatment, , especially in southern states.  Nothing demonstrates this more clearly than the nearly 10,000 people in a dozen states who cannot afford their AIDS drugs but are now on waiting lists for help. While most of these people are currently receiving medications though temporary and ad-hoc efforts, most of these will expire and leave people without life-saving medicines–a costly and dangerous prospect for maintaining health and prevention.

Globally, the administration has taken some good steps—making a 3-year pledge to the Global Fund and, through leadership from some in the State Department, scaling up ARV access despite budgets. But other signs show clear failures of leadership. White House officials have spoken of AIDS treatment as a “mortgage” they need to get out from under and said we need  “we can’t treat our way out of the HIV-AIDS epidemic.”Meanwhile, a close analysis shows that funding for treatment programs within U.S. global AIDS programs has actually decreased since the President came into office—limiting the potential to treat more people.

President Obama: Put Us On Track to End the AIDS Crisis…

I want the American people to be able to say, ‘this is a President and an Administration that admits when it makes mistakes and adapts itself to new information, that believes in making decisions based on facts and on science as opposed to what is politically expedient.’” –President Obama

We believe that he means what he says. So this is why we have launched the 96% Campaign to ask the President to pay attention to the science and pay attention to what people living with HIV need. Treatment is only one piece of the puzzle, but it is among the bedrock pieces.

With the 2012 International AIDS Conference coming to Washington, DC and tens of thousands of community members, experts, and media focused on the U.S. global AIDS response the world will be watching.  It is also the 30th year of AIDS and 10th anniversary of the groundbreaking United Nations General Assembly Special Session on AIDS which brought the world together to focus on the urgent need to scale up access to treatment.

We’re asking the President to act now to:

1) Tell PEPFAR administrators to immediately and dramatically scale up access to AIDS drugs under PEPFAR by 2013—to prevent and treat HIV and help galvanize the global AIDS fight.

2) Do everything in his power to ensure that PEPFAR, the Global Fund, and domestic AIDS programs get at least the funding you put in your budget—please remind Congress that ending the AIDS pandemic will not wait.

3) Fight for the expansion of Medicaid and expand the resources specifically needed to ensure that all those in the US in need of ARVs have access, including permanently ending state waiting lists.

We can end the AIDS crisis.  Let’s not wait.  Tell the President not to wait.

On Women & Girls HIV Awareness Day, Awareness Of, Action On Domestic Epidemic Still Lacking

6:33 am in Uncategorized by RH Reality Check

Written by Brook Kelly for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

On this Women and Girls HIV/AIDS Awareness Day 2010, we reflect back on the past year’s work around HIV/AIDS and women in the United States. The rate of HIV among women and girls has been steadily increasing over the years, with women of color the hardest hit.  HIV has now become the leading cause of death among Black women ages 25 to 34.

At the 2009 HIV/AIDS Prevention Conference in Atlanta, Secretary of Health and Human Services Kathleen Sebelius commented on the dramatic and disparate impact of the HIV epidemic on minority communities: "Today, African Americans make up just over one-tenth of the population. But they account for nearly half of new HIV infections. One in 30 African-American women will be diagnosed in her lifetime. One in sixteen African-American men will be diagnosed with HIV. The situation is also dire for Latinos. Think about that. Imagine if it were half the straight white women in Atlanta. Wouldn’t we be calling this a national emergency? Shouldn’t we be?"

The answer is, of course, yes we should be calling the HIV/AIDS crisis a national emergency.  

As the HIV Human Rights Attorney for the U.S. Positive Women’s Network, the only national membership organization for HIV-positive women, I have seen tremendous gains in advancing HIV-positive women’s issues to the highest policy levels. I have heard HIV-positive women’s voices where before there was only silence: in the White House, in Congress, at the tables where decisions are made.  But I am also struck by the continued blindness to the deeper structural challenges faced by women and girls affected and infected with HIV in the United States, a blindness that makes progress toward stemming the epidemic virtually impossible.

For the first time, the Center for Disease Control (CDC) in its Women and Girls HIV/AIDS Awareness Day 2010 statement called for the promotion of women’s human rights as a key factor in reducing “the burden of the epidemic among women and girls,” here in the U.S. They addressed the most challenging structural barriers that women face in preventing HIV transmission and in caring for themselves when HIV-positive: not only our biological vulnerability as women to HIV, which can be alleviated through safer sex tools, but the crux of the issue: gender inequity; lack of financial autonomy; and sexual and domestic violence that prevents women from demanding the use of safer sex tools.

While the CDC has taken a giant step in recognizing that the HIV epidemic among women is a human rights issue, beyond increased testing, they have yet to offer solutions that account for the complex barriers to HIV prevention and treatment women face. Yet, the implementation of a human rights based solutions that take a holistic approach to HIV prevention and care is necessary not only abroad but here at home.

For the PWN, a human rights based approach means that:

  • Every woman has access to and education about high quality, culturally appropriate, accessible, and integrated HIV/AIDS and sexual and reproductive health services;

 

  • Every HIV-positive woman can exercise her right to decide whether and when to have a child and has access to the information and services necessary to make an informed and voluntary decision; every woman’s right to confidentiality and dignity be respected;

 

  • Stigmatizing laws and policies–like those that criminalize HIV transmission and exposure, or harm women in prostitution–are amended or repealed;

 

  • Every woman has access to safe, adequate housing and meaningful employment, opportunities;

 

  • HIV-positive women are meaningfully involved in all policy decisions affecting their lives; and

 

  • Laws and policies that intentionally, or unintentionally negatively affect the prevention, or care and treatment of women living with or affected by HIV are changed.

 

Although the meaningful inclusion of HIV-positive women’s voices on issues most affecting their lives has been slow coming we see that progress has been made – voices have been heard.  For the first time the U.S. is in the process of drafting our first National HIV/AIDS Strategy.

As of today, however, the newly formed President’s Advisory Council on HIV/AIDS, which will review and monitor the Strategy has no Black HIV-positive woman member despite the fact that Black women carry the greatest burden of the HIV epidemic; as of today our U.S. foreign policy on HIV has a more woman-centered approach to HIV prevention and care than our own domestic policy – the PEPFAR Five-year Plan calls for the integration of HIV and reproductive health services and care as a mandatory component of HIV prevention and treatment; as of today we are still not calling HIV/AIDS among women of color in the U.S. a national emergency.

On this National Women and Girls HIV/AIDS Awareness Day, I hope our leaders will begin to listen to the resounding voices of HIV-positive women in the U.S. who know that the best solutions to the epidemic only begin with increased testing but succeed with the recognition of and work towards realizing women’s human rights to health, dignity, and equality.

AIDS Advocates Question Healthcare and Spending Cuts

6:38 am in Uncategorized by RH Reality Check

Written by Diana Scholl. This article was originally published at HousingWorks.org and is published at RHRealityCheck.org with permission from the author. RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Many AIDS advocates are expressing concern about President Barack Obama’s commitment to combating the epidemic, on the heels of a State of the Union that downplayed the urgency of federal healthcare reform and proposed freezing much government discretionary spending.

While Obama pushed for the passage of healthcare reform, the ask was buried 31 minutes into his speech. That timing felt ominous, given that on Wednesday Nancy Pelosi suggested passing healthcare reform in pieces. There has been some talk of only passing the popular parts of healthcare reform, such as regulations on the private insurance industry. But AIDS advocates say that would be horrendous news for people with AIDS and other disenfranchised people.

"We’re not the popular provisions," said Robert Greenwald, executive director of the Treatment Access Expansion Project. "There’s no question that this comprehensive package is the best we’ve seen in 50 years. We need to remove barriers to Medicaid and Medicare. I don’t think many of those things will happen if what we just see is incremental reform."

Christine Campbell, Vice President for National Advocacy and Organizing at Housing Works agreed. "The majority of this bill takes us strides above where we are. Democrats and Republicans in Congress just need to do their jobs."

People with AIDS in the United States are poorer than the general population and also less likely to have adequate health care. Forty-five percent of people with HIV/AIDS in the United States have incomes under $10,000 a year, and 50 percent lack regular medical coverage. The situation is even more dire for people with hepatitis C, who aren’t co-infected don’t have access to the Ryan White CARE Act safety net.

Campbell and AIDS advocates are recommending the House pass the Senate version of the bill, as imperfect as it is. The Senate bill doesn’t include a public option so people who purchase healthcare must go through an insurance company. The Senate version also includes a provision to appease anti-abortion supporters that would require people to purchase specific abortion-only coverage separately from their regular premiums.

Gregg Gonsalves, a longtime AIDS activist who has been critical of Obama’s policies, said that even though he thinks there are parts of the Senate healthcare reform bill that "stink", he thinks it should still be passed.

"The bill is terrible compared to what it could be but it’s better than nothing basically," Gonsalves said. "I think they should pass this with a reconciliation fix."

Gonsalves expressed concerned with Obama’s commitment to the issue. "He said we can’t give up healthcare now. But he’s taken the backseat."

The HIV Healthcare Access Group sent a letter to House leadership calling on them to pass healthcare reform that includes a largely federally funded expansion of Medicaid to low income individuals; an exchange or regulated marketplace for the uninsured and the under-insured to purchase health insurance; generous subsidies to make coverage affordable for those who need it; stricter regulations that govern the private market preventing discrimination; an investment in reorienting our health system to focus on prevention and public health and critical measures to address primary care and public health medical workforce shortages.

Discretionary spending

Another problematic part of Obama’s agenda was his call for a three-year freeze in spending that wasn’t related to national security, Medicare, Medicaid, and Social Security. A freeze could impact housing, federal aid, health care and other programs essential to poor people with HIV/AIDS, and other disenfranchised people.

"This is a hare-brained idea," Gonsalves said. "Obama’s throwing a bone at Kent Conrad on the backs of poor people."

Although Obama mentioned global AIDS in his State of the Union Address in the context of U.S.‘s global commitment, he has already essentially flatfunded global AIDS spending, even though Congress authorized $50 billion for PEPFAR over five years.

A rally was organized by Health GAP Wednesday near the White House calling on Obama to rethink this proposal, as well as a Campaign to End AIDS-organized phone zap of the White House.

After some listserv chatter questioning whether a protest was necessary, Housing Works President and CEO Charles King defended the "preemptive strike," saying, "The truth is that the Obama administration is already not delivering on global AIDS and we have no idea whatsoever what their intentions are on the domestic front. They have done a good job of collecting information and making people feel like they have been heard. We still don’t know that they have been really listening, and we probably won’t know until the budget is out."

Although some advocates speculated there may be some efforts to shield HIV/AIDS programs from some of the cuts, broader hits to the social services will be devastating both to people with HIV as well.

"There may be some efforts to carve out HIV from the freeze," said David Munar, vice president for policy and communications at AIDS Foundation of Chicago. "But any cuts to health and human services programs, be it Head Start or cuts to the CDC budget, will be harmful for people with HIV."

Strengthening PEPFAR: A Plan for Immediate Action

8:47 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson for RHRealityCheck.org – Information, commentary and community for reproductive health and justice.

On January 20, President Obama will inherit many challenges, among them the global AIDS epidemic. He will also inherit the President’s Emergency Plan for AIDS Relief (PEPFAR), a program often cited as the hallmark of the Bush Administration’s otherwise contested international legacy, providing anti-retroviral therapy to an estimated 2 million people worldwide in its first five years.

For Obama, PEPFAR presents both opportunities and challenges. On one hand, the 2008 bill authorizes spending of up to $48 billion from 2009 through 2013, allowing dramatic increases in funding for treatment and care, orphans and vulnerable children and youth, and prevention of maternal-to-child transmission, among other programs.

On the other, several controversial policies originally supported by the Bush Administration remain in place and unless fully addressed will continue to undermine efforts to stop the spread of HIV, by denying critical services to the most vulnerable, blocking effective integration of health services, and failing to effectively address the social and economic roots of this pandemic.

The good news is: Some of these problems are remarkably easy to change at little if any cost. Read the rest of this entry →