At the White House all speakers -- Valerie Jarrett, Secretary Sebilius, PEPFAR's Eric Goosby, and NIAID AIDS supremo Tony Fauci -- expressed obvious relief that the election was over and that ACA implementation could proceed. Agreeing but broadening the point, a diverse and motivated group of community representatives spoke for young black women, young black gay men, Latinos, researchers, and providers. They cautioned that ACA implementation would not cover the needed housing, mental health, and other essential services required to deliver high quality HIV services.
It was good to be among a group of people committed to ending AIDS. But no one from the administration mentioned drug users. The ban on federal funding of needle exchange continues. No one mentioned the urgent upcoming need to reauthorize PEPFAR or the Ryan White Care Act, which will provide vital services, especially in states which decline to provide full HIV coverage under the ACA, and to provide community support, housing, and other services unlikely to be covered by insurance exchanges.
In the United States, only 25 percent of the 1.2 million HIV positive people are on effective ART with an undetectable viral load. Only 33 percent are retained in care. Only 82 percent even know their HIV status -- a number that's much lower among young people with the virus.
We can do much better. In nine years, Massachusetts has brought down its HIV infection and AIDS death rates by over 50 percent. Hospital costs dropped steeply over the same period.
On my way out of the gathering I ran into CDC Director Tom Frieden, who helped lead New York's successful response to the HIV-associated, drug-resistant tuberculosis outbreak in the 1990s. I told him that with TB rates at a historic low in the United States, we were in danger of making the same mistakes which led to its outbreak in 1989 -- excessive funding cuts, stockouts of first- and second-line TB drugs, inadequate political attention, funding and support. "TB is close to my heart," he said. "You need to put it higher up on your agenda," I replied.
Each year Obama has been president, he's cut funding to the CDC and to the TB program.
It's well past time for the administration to hold its own HIV/AIDS strategy to the same high standards that it expects from the scores of countries that have benefited from American generosity, and from their own increasing investments, to turn back the HIV pandemic in this decade.