October / November 2011
by Regan Hofmann
We need to ask the president to
step up his game on HIV/AIDS. President Barack Obama took a
leadership position on HIV/AIDS when he made the development of a
National HIV/AIDS Strategy for the United States a campaign promise. He
delivered on that promise, reinvigorating the Office of National AIDS
Policy, re-upping the President’s Advisory Council on HIV/AIDS (PACHA)
and ushering the National HIV/AIDS Strategy to life. It exists. Now we
ask: Will its implementation get funded, or will it remain merely a
promise on paper?
If President Obama can encourage Congress to
secure the money to fight AIDS abroad and at home at levels capable of
changing the course of the pandemic (which in today’s grim economy may
equate to defending current spending levels or at least, minimizing
cuts), he will do something no president has done before: jump-start the
end of AIDS. PEPFAR is already ahead of its pledge to put more than 4
million people on meds by 2014. We’d like to see President Obama ratchet
it up and officially pledge to put 6 million in care by 2013 as a “down
payment” toward achieving the United Nations’ goal of 15 million in
care by 2015.
Linking millions more with HIV to ARVs, coupled with being the first
president to reform health care, would secure President Obama’s place in
the humanitarian history books.
It would also make him a wildly popular guy at the International AIDS
Conference, scheduled for next July in Washington, DC. And being popular
is a very good thing for a man looking to get re-elected several months
We need to request that the first
lady publicly state that HIV/AIDS is the No. 1 cause of death for women
of childbearing age worldwide. Michelle Obama’s main
platform is fighting obesity. While it is a critical issue that needs
resolving, nothing kills more women ages 15 to 44 than HIV.
The Obama administration launched the U.S. government’s Global Health
Initiative (GHI); and GHI took PEPFAR under its umbrella. Since one of
the GHI’s underlying principles is to “implement a women- and
girl-centered approach” to health, and considering how profoundly HIV
undermines the health of women and girls, HIV should remain at the top
of the list of GHI’s concerns. The first lady could help ensure that
happens. While we’re asking, we’d also love to see the first lady and
her daughters Sasha and Malia help unfold the AIDS Quilt on the Mall in
July 2012 at the start of the International AIDS Conference—a conference
that the president and Congress helped bring home by lifting the ban on
people with HIV traveling into the United States.
The president and first lady were publicly tested for HIV when visiting
Kenya in 2006, and on her recent trip to South Africa in 2011, Michelle
Obama said, “You can be the generation that ends HIV/AIDS in our
time—the generation that fights not just the disease, but the stigma of
the disease, the generation that teaches the world that HIV is fully
preventable and treatable and should never be a source of
If there was ever a first couple that could embrace the end of AIDS as
part of their legacy, the Obamas are it.
We need to encourage conservative
Democrats and Republicans (yes, even Tea Partiers) to support AIDS
spending stateside—and overseas. Fighting AIDS has
historically been a bipartisan effort. Both sides of the aisle have seen
the value of America launching a global humanitarian relief effort
focused on AIDS via PEPFAR. The program built relationships between our
government and foreign governments, elevated health literacy around the
world and developed health infrastructure with and in other nations. In
turn, those accomplishments served as sound foreign policy and were good
for U.S. national security.
Regardless of what anyone thinks of the rest of his record, President
George W. Bush’s decision to start PEPFAR (and Congress’s approval to
fund it) saved millions of lives and made America many new friends
around the world. Bush II believed that because America could help end
the suffering of people with HIV/AIDS globally, it was our moral
imperative to do so. Was PEPFAR perfect under Bush II’s oversight? No.
Did it have questionable constrictions around certain populations like
sex workers and injection drug users? Yes. Does it happen to align with
some of the nations on which we are dependent for natural resources
(like oil)? Yes. Did it give the religious right a direct line into
vulnerable people in need of “conversion” in the developing world? Yes.
But it also proved that we could get lifesaving medications to people in
developing nations who need them and that they will take them as
prescribed, then get healthy, survive, parent their children and
contribute to the world’s economy.
I’d like to think that the current crop of Republicans could be
similarly moved to see the value of fighting HIV/AIDS both abroad—and at
home (because while Bush II set out to save the world from AIDS, he
forgot that the United States was part of the world). However, bearing
witness to Tea Party Republicans’ attitudes toward all disenfranchised
people, it’s reasonable to be deeply skeptical that Tea Party leadership
benevolent to people with HIV.
We must help them see the light. The argument for finding the money to
end AIDS exists. We just have to make it compelling to
We need to support the HIV/AIDS
Caucus within Congress. As we go to print, the HIV/AIDS
Congressional Caucus has been strengthened. As founding co-chair of the
caucus, Barbara Lee (D–Calif.) is leading the charge to keep Congress
abreast of HIV/AIDS issues. To date, there are 50 members in the caucus,
including: caucus co-chairs Trent Franks (R–Ariz.) and Jim McDermott
(D–Wash.), as well as notable newcomer Jim Himes (D–Conn.) and AIDS
heroine Nancy Pelosi (D–Calif.). Currently, two new pieces of AIDS
legislation are on the Congressional table. They include: H.R. 1462, the
National Black Clergy for the Elimination of HIV/AIDS Act of 2011,
re-introduced by Charles Rangel (D–NY) and Senator Kirsten Gillibrand
(D–NY); and H.R. 2704, the Justice for the Unprotected against Sexually
Transmitted Infections among the Confined and Exposed (JUSTICE) Act
(introduced by Lee). Another bill, the Repeal HIV Discrimination Act, is
scheduled to be introduced by Lee in September. With the help of this
bipartisan caucus, we have a better shot at educating more members about
why these bills are essential and must be passed. Not to mention that
the caucus will be critical as we struggle to protect AIDS
We need to start an AIDS PAC. Washington, DC, is a transactional town.
If we expect members of the House of Representatives and Senate to go to
bat for us, we need to ensure they get re-elected. “PAC” stands for
political action committee and refers to a private group of people who
organize to elect political candidates or to advance certain issues
and/or legislation. A political committee is so named when the
organization receives donations, or makes them, in excess of $1,000 for
the purpose of influencing a federal election. In short, an AIDS PAC
allows us to put our money where our mouths are. We can ask, but money
We need to secure the money we
have and raise more soon to avoid needing a whole lot more
later. Almighty greenbacks, euros, yen, pesos, rands or
rupees. Call your dinero anything you want—we must defend our earmarks
and find more funding if we can. This is challenging during an economic
crisis. However, if we’ve learned anything from our current state of
economic affairs, it’s that ignoring problems in the short term ensures
they can reach catastrophic dimensions down the road.
As Anthony Fauci said at a meeting of the U.S. Mission to the United
Nations this summer, “Either you are going to pay a lot now [to end
AIDS] or an awful lot later on.” The piper will be paid one way or
another. We can either pay with cold, hard currency or with tens of
millions of lives.
Modeling conducted by Bernhard Schwartlander, MD, UNAIDS director for
evidence, strategy and results, shows that if we invest and maintain the
$46.5 billion needed over the next 10 years to make the United Nations’
universal access goal a reality, new HIV infections would be reduced by
12.2 million between 2011 and 2020, a cumulative 7.4 million deaths
from AIDS would be averted during that time and 29.4 million life years
would be gained. The $46.5 billion investment would pay for itself with
savings incurred from averted infections and their associated cost of
The more quickly we act, the better our long-term outcomes and the more
money we’ll save to apply to other problems at home and around the
We need to encourage the U.S.
government to remain a leader in global funding for HIV—in order to
encourage other countries to pony up. It was never the
United States’ intention to pick up the tab for ending AIDS. PEPFAR was
designed so that the countries we helped could eventually sustain their
own AIDS relief efforts. Our long-term strategy needs to shift the
monkey of paying almost entirely for AIDS off the backs of the U.S.
government and American tax payers and spread the enormous cost among
all those who will benefit from the demise of AIDS.
This isn’t happening. The Global Fund to Fight AIDS, Tuberculosis and
Malaria is essentially flat funded. Some nations are refusing to meet
their pledges (Italy, for example, is $192 million in arrears); some
have reduced their pledges; and some are paying far too little given
their relative wealth and dependency on the fund.
More of the G8 and G20 countries must be convinced to get some skin in
the AIDS game. The world needs to find a way to hold donor nations
accountable to their Global Fund commitments, and we must see an
increased investment in bilateral and multi-lateral aid. Affected
countries with big GNPs should be required (and pressured by in-country
advocacy efforts led by people with and affected by HIV) to dedicate
more resources to their own epidemics. The Global Fund’s policy review
process needs to be refined; we need to get more strategic about
HIV-related granting. All donors and affected countries should
reallocate their HIV portfolios to maximize impact and to ensure
investment in what we know works in any particular area or nation (for
example, male circumcision or prevention of mother-to-child transmission
in certain African nations).
We should encourage the United
States to demonstrate it is prepared to do what it expects other nations
to do: find the funds to provide health care for their citizens with
HIV. About 950,000 of the estimated 1.2 million Americans
living with HIV are not on antiretroviral medicines (ARVs) for a variety
of reasons. A good way to inspire other nations to contribute to the
global AIDS fight would certainly be providing care for our citizens. By
doing so, we could also show that when enough people are on ARVs
consistently and that when this expanded access is coupled with
awareness, testing and prevention efforts, AIDS can be wiped
The Affordable Care Act, a.k.a. health care reform, should address much
of the gap in access to care in the United States, but reform doesn’t
fully kick in until 2014, and even then, it won’t solve all of the
health care concerns of people living with the virus domestically.
So far, the president and Congress have released emergency funding to
meet the growing need of the AIDS Drug Assistance Program (ADAP). And
the pharmaceutical companies that manufacture the drugs have dropped
prices and increased funding for their Patient Drug Assistance Programs.
But the recent waves of emergency funding are not a long-term solution.
As we wait for health care reform, we must ask the president and
Congress to continue to preserve AIDS funding. We need to ensure states
are pulling their load and that they are using their funds most
efficiently. And we need to ask our community to make some difficult
choices and to make the money we already have work harder.
The depth and breadth of the president’s commitment to HIV/AIDS will be
challenged as recommendations for discretionary and entitlement budget
cuts land on his desk. The U.S. political system is not structured to
reward long-term planning and decision making on the part of
politicians. Many politicians have no choice but to cater to their
largest donors short term to secure re-election. This is true, even for
the president of the United States. And the Supreme Court’s ruling that
private corporations could give unlimited funds to politicians made it
more challenging for elected officials to support what’s good for the
public, the nation and the world, as opposed to what’s good for the
special interests of their biggest backers. That’s not conspiracy,
that’s the way the system currently operates.
This means the president is in a pickle. If he fails to get re-elected,
it is possible (and likely) that Republicans will
abolish his legacy of health care reform. That means people with HIV
will be in deep trouble since the majority of us rely on entitlement
programs like Medicaid, Medicare and the Ryan White CARE Act for meds.
But in order to get re-elected, the president may have to make some
budget cuts that could prove disastrous short- (and possibly long-) term
for many disenfranchised people—including many people living with
HIV/AIDS. We need to help him understand that this short-term thinking
will kill people, cost more money long-term—and backfire when it comes
to Election Day.
We need to engage the private
sector to help raise new money for HIV/AIDS. Corporations
could play a hugely important role in bringing in-kind services and
resources to the fight against HIV/AIDS. There are myriad ways
multi-national corporations can leverage the reach, resources and the
power of their brands to capture people’s attention and link them to
lifesaving care. Corporations can deliver information or tools for
health, leverage connections and media platforms or underwrite
micro-lending programs to help people with HIV secure jobs, incomes and
We also need innovative financing solutions that allow the general
public to make micro-contributions to the AIDS cause. A prime example is
“Massive Good”—a program launched by the Millennium Foundation for
Innovative Finance for Health. Massive Good utilizes a global network of
travel agencies to allow travelers to add two dollars to hotel or
flight reservations. The money is passed to UNITAID, which buys AIDS
in bulk and helps get them to those in need. Another example is
AIDS United’s recently launched “Make It Grow” campaign that also
solicits micro-donations from individuals—donations that are matched
dollar-for-dollar by Social Innovation Fund federal government grants.
That program also supports access to AIDS meds for those who can’t
We need to broaden our
fund-raising appeals beyond the usual suspects when it comes to
targeting philanthropic foundations. The Bill &
Melinda Gates Foundation, the Elton John AIDS Foundation, the Ford
Foundation, the MAC AIDS Fund and others have contributed gigantic
amounts of cash to the AIDS fight. But we must solicit new
philanthropists and charitable foundations, directing our pitches at
foundations beyond those that focus on funding health care. We need help
with policy, advocacy, media, technology and education. And, our
message should be that those who invest today in the fight against AIDS
have a chance to end suffering on a biblical scale. And who doesn’t want
to be a hero of epic proportion?
We need to whip up Wall Street.
We should re-engage the investment community and convince
the big money crowd that substantial investments in AIDS research
science now could not only make investors richer but also secure them a
legendary place in history for fast-tracking the cure and a vaccine.
There is no longer a rationale for the existence of the “Valley of
Death” (as the gap between funds needed to develop basic science and
funds needed to bring drugs to market is known). Indeed, eliminating the
Valley of Death is likely to save tens of millions of lives—while
potentially generating billions of dollars.
We need to address the pricing
issue of AIDS drugs to allow more people access to lifesaving care.
The 27.3 million people not in care represent a potentially
huge global expansion market for HIV drugs—a market that could bring
billions to the for-profit drug companies, even if they reduced their
prices. The trouble so far is that no one has been able to guarantee a
payer for that market. We need to find a way to make it more profitable
for pharmaceutical companies to get the drugs to more people—people who
can’t pay for them themselves. It’s a conundrum.
If the cost burden for universal access to care falls solely onto
governments (particularly the U.S. government) and the for-profit
companies that manufacture the pills, then these entities don’t have a
significant economic incentive to encourage more global expansion to
We need a more sophisticated strategy for asking pharmaceutical
companies to reduce their drug costs. Just because their products happen
to provide humanitarian relief does not, apparently, mean that pharma
is obligated to manufacture or distribute them at lower prices. There
needs to be a financial incentive. We need innovative financing
solutions that tap fresh sources of money, and we need more support from
the G8 and G20 countries, the private sector and citizens of the world.
If we could gather a pool of cash in order to make universal access
feasible, we could go to the table with pharmaceutical companies and
negotiate for more compassionate pricing.
Advocates for the AIDS Drug Assistance Program (ADAP) have shown that a
model exists for lowering drug costs in order to get more pills to more
people and grow profits. The Clinton Health Access Initiative and the
work being done to engage pharmaceutical companies in international
patent pools will prove key to ending AIDS.
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