by Matthew Kavanagh, Dázon Dixon Diallo - Oct 7, 2011 - RH Reality Check
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 [14] 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" [16]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 [17]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 [18] 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 [19] 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 [20]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 [21] 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" [22]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 [23] 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 [14] 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.
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