International Conference Sheds Light on U.S. AIDS Crisis
Carey L. Biron
“When people think of AIDS today, most probably don’t realise that AIDS is still really in a crisis mode in (the United States),” Carl Schmid, the deputy executive director of the AIDS Institute, based in Washington, told journalists on Tuesday.
“The fact is, this country has more people living with HIV/AIDS than ever before – nearly 1.2 million people. Nearly 20 percent of those, some 200,000, don’t even know they are infected.”
Each year, the U.S. experiences 50,000 new cases of infection.
In late July, some 25,000 scientists, practitioners and activists are expected to gather here to attend the biannual international AIDS conference. The premier meeting of its kind, the event will mark the first time in more than two decades that the conference has been held in the United States.
According to Diane Havlir, a co-chair of the AIDS 2012 conference, speaking in Washington at one of several events on Tuesday, “It’s … significant (the conference) is back in the United States … it’s going to be an opportunity for us to highlight what’s happening with AIDS in the United States.”
Havlir participated in a panel discussion at which a pre-conference pronouncement, dubbed the Washington D.C. Declaration, was unveiled.
The conference is only able to take place because President Barack Obama, in 2009, rolled back the country’s longstanding ban on HIV-positive travellers entering the U.S. For many, that contentious policy highlighted a troubling discrepancy between U.S. scientific and advocacy achievements versus its public health policy, a gap that remains visible in startlingly high infection numbers.
Of those U.S. citizens who do know that they’re infected with HIV, only half are on medications, according to Schmid. Still more worrying, between 1995 and 2009 the public perception of the importance of HIV/AIDS declined massively – from 44 to just six percent, according to the respected Kaiser Family Foundation.
Today, Schmid notes, 40 percent of new HIV infections in the United States are among those under 29 years old.
Not only are the majority of new cases young, but they’re also primarily gay and African-American, thus sharpening the trend of AIDS as an epidemic of marginalisation.
“Of 50,000 new reports each year, this is still largely a disease of white, black and Latino gay men, who comprise a majority of the cases despite being only two percent of the population,” A. Cornelius Baker, a national policy advisor with the National Black Gay Men’s Advocacy Coalition, said in Washington on Tuesday.
This discrepancy can be put down to several factors, including lingering racial bias, sexual stigma, and the United States’ notoriously regressive health-care system.
Baker points to a “very significant lack of progress in civil rights” for gay people in the United States today. “Against that backdrop,” he says, “it’s very difficult to learn your sexuality in a way that protects your health.”
Dangerous domestic policy
Such a situation at home inevitably undercuts the United States’ international AIDS leadership.
While parts of Washington’s international AIDS policy have been highly contentious, former president George W. Bush is widely lauded for his pledge to commit 15 billion dollars over five years, starting in 2003, to fight the virus worldwide.
According to public-health officials, the unprecedented size of this fund – known as the President’s Emergency Plan for AIDS Relief, or PEPFAR – has led directly to significant and quantifiable reductions in AIDS-related deaths, particularly in Africa.
Yet while PEPFAR has since 2003 required any country receiving funding to have a comprehensive national AIDS policy in place, the United States only followed suit in 2010, at the behest of President Obama.
Even now, the U.S. Congress has remained obstinate on allocating the significant increases in funding that advocates say are necessary to consolidate gains and achieve official goals.
“We have to acknowledge that federal funding is not keeping pace with needs and, in some instances, is falling woefully behind,” Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, said on Tuesday.
Scofield notes that prevention currently constitutes a meagre four percent of the overall AIDS budget.
“The national strategy provides an excellent blueprint for ending the epidemic,” she says, “but the goals of the strategy cannot be achieved without significant increases in funding for critical discretionary programmes.”
Great promise ahead?
New scientific advances, coupled with President Obama’s reforms of the country’s health-care system – recently approved by the U.S. Supreme Court – are now allowing cautious optimism that something of a paradigm shift could be on the horizon in the U.S., echoing discussions across the globe.
“Through increasing access to proper, high-quality care and treatment, and combining it with comprehensive HIV-prevention programmes, we can move towards ending the HIV epidemic and achieving an AIDS-free generation,” Ronald Johnson, an advocate with AIDS United, said in Washington on Tuesday.
Johnson called on all levels of the U.S. government and private sector “to end the acrimonious and all-too-often political battles over health-care reform and to move toward full implementation of the Affordable Care Act,” referring to President Obama’s signature but extremely divisive reform bill.
The act would not only extend coverage to millions of low-income citizens, but would also force insurance companies to accept those with pre-existing conditions – both of overwhelming importance in stemming the ongoing U.S. epidemic.
Cornelius Baker points out that, in the absence of universal health coverage, AIDS-related programmes in the United States have been mere stopgap measures.
“The difference is startling in places that have well-advanced health-care systems,” Baker says. “You have fewer people who don’t know their status; once they get screened, they get into care and their survival rates are much better.”
He continues: “That’s the great promise that’s ahead of us, which can help us change the course of the HIV epidemic. And we shouldn’t think about that system as something different – it’s fundamental to the future of having a healthier America.”