A Proactive CDC “Just a Pipe Dream”

The history of AIDS activism in the U.S. has been a mix of great success and great failure. Activism forced presidents and congress to dramatically increase AIDS research funding, resulting in the life-saving treatments we have today. But when it came to preventing new infections, we’ve failed miserably. As I’ve written about before, we’ve never really focused as a nation on reducing the spread of HIV. Our efforts in this regard have always been half-assed.

Activists were partly to blame. In the early years, we focused mostly on “drugs into bodies” ? treatment activism. Besides, once it was confirmed that a virus was killing us, and everyone started attending weekly funerals, prevention kind of took care of itself. It was the birth of “safe sex” ? no government program needed ? and it worked dramatically to reduce HIV infections.

But once the funerals stopped, so did our collective fear-based response. In its place, we could have made a serious effort to prevent new infections using more traditional science-based disease prevention programs. There are dozens of community interventions that have been shown to reduce infections (the CDC currently lists 57 programs that it believes have worked), but we’ve never had the leadership or resources to implement a science-based national HIV prevention strategy.

President Obama is committed to launching a national strategy to fight the spread of HIV (at least he says he is, even on the White House website). But he’s got a problem. Such a strategy would largely be run by the CDC. In my adult lifetime, I’ve never witnessed proactive CDC leadership. They’re great at reacting to the latest outbreak of some scary bug we’ve never heard of before, but if that bug becomes entrenched and involves sex, the CDC gets very cold feet.

In short, they have never had an Anthony Fauci at the helm (the man behind our government’s AIDS research programs, and the driving force that created PEPFAR, saving millions of lives worldwide). Imagine what ambitious, science-driven leadership at the CDC could accomplish in the fight against HIV.

I’m imagining it now that Obama is president, especially since it was reported that Dr. Thomas R. Frieden, New York City?s health commissioner, was one of the candidates being considered to run the CDC. What a brilliant and exciting choice he would be.

Frieden is considered by many to be the most proactive, life-saving health commissioner in New York City’s history. He’s successfully pushed science-based policies, even when they had substantial political resistance. This was the guy that single-handedly banned cigarettes from enclosed work spaces in New York, including our bars, leading to a dramatic drop in smoking rates (and a measurable drop in smoking-related deaths). His HIV prevention efforts have included giving away millions of NYC-branded condoms, expanded needle exchange programs, and targeted HIV testing initiatives (the largest, called The Bronx Knows, was launched last year).

Sadly, according to the New York Times City Room Blog, a single but powerful New York-based AIDS organization has come out publicly against a possible Frieden appointment to head the CDC. Charles King, the president and chief executive of Housing Works, said in a statement:

Appointing Commissioner Frieden to the top post at the CDC would be a devastating blow to combating HIV/AIDS in the U.S. as well as other chronic illnesses that require complex public health solutions and involvement from local communities. Throughout his tenure as New York City Health Commissioner, Frieden has simultaneously employed an authoritarian, my-way-or-the-highway approach and an unabashed secretiveness undignified of a public servant. He has excluded AIDS groups wherever possible from having input into life-and-death AIDS funding, testing and care policymaking decisions.

I almost snotted out my morning tea when I read this, because as almost every New York City AIDS activist will tell you off the record, Housing Works only operates on one level ? “my-way-or-the-highway.”

Don’t get me wrong ? I’ve long admired Housing Works. They are very aggressive advocates for people living with HIV. But I also know they are very old-school, always-hate-The-Man activists. Obama-esque, they are not. The only health commissioner (or mayor) they will ever get along with would have to be Charles King himself, and even that honeymoon would be short.

Let’s hope Obama doesn’t make the same mistake he just made with the PEPFAR’s Mark Dybul (see the San Francisco Chronicle’s "A bad start on AIDS") ? listening to one or two loud naysayers that don’t, by a long shot, represent the consensus view, even among activists, of the man in question. Let’s hope the Obama folks read the responses in the City Room Blog from other New York-based AIDS organizations, advocates and researchers who sing Frieden’s praises. Let’s hope they pick up the phone and ask respected heavy-weights like amfAR’s Mathilde Krim what she thinks of about the possibility of Frieden running the CDC.

When it comes to HIV prevention efforts in this country, it’s time for change we can believe in.