Obama Criticized Over AIDS Policy

by Kilian Melloy
Wednesday Dec 9, 2009

There's one thing about the Bush administration that some gay activists miss: the previous administration's commitment to combating AIDS globally. For some, aspects of the Obama administration's Pepfar (President's Emergency Plan for AIDS Relief) program fall short by comparison.

The controversy arises, according to a Dec. 8 New York Times story, out of a new focus on preventing the transmission of HIV, which causes AIDS--as well as a perception that the administration is choosing to fight less expensive international health wars, targeting malaria and other health issues as the expense of concentrating on AIDS.

"I'm holding my nose as I say this, but I miss George W. Bush," AIDS activist Gregg Gonsalves told The New York Times. "On AIDS, he really stepped up. He did a tremendous thing. Now, to have this happen under Obama is really depressing."

"We're honoring our commitment, we're increasing our commitment, we will not veer from that commitment," countered Dr. Eric Goosby, the head of Pepfar under Obama, who insisted that the program would not shrink from getting HIV-positive people the treatment they need.

"This is the president's policy and the way he wants to approach it, and no individual counselor stands in his way," said Dr. Ezekiel J. Emanuel, an adviser to the Office of Management and Budget and the White house Chief of Staff Rahm Emanuel. Ezekiel Emanuel had been accused of wielding his influence as Rahm Emanuel's brother to pare back on the administration's commitment to people with AIDS.

However, the article noted, projections in the program's newly released Five Year Strategy show a slowdown in the number of people worldwide to be added to the program's roster of those provided with HIV-fighting medication. The projection shows that the goal is to have a total of four million people receiving medication by 2014--an increase of only 320,000 per year as opposed to the 500,000 new additions to the program per year over the last five years.

Though AIDS activists see this as a "betrayal," others say that the program's sharing out of resources to combat other health problems makes sense. Ezekiel Emanuel is one proponent of the modification in the program's focus; the article said he authored a paper titled U.S. Health Aid beyond Pepfar last November that advocated targeting "simple but more deadly diseases, such as respiratory and diarrheal illnesses," and saying that by doing so, "the U.S. government could save more lives--especially young lives--at substantially lower cost."

But the AIDS epidemic is only growing, the article said, with five new infections for every two HIV-positive people added to the program.

"It's a terrible dilemma," the chairman of New York University Medical School, Dr. Martin J. Blaser, told the Times. "Pneumonia and diarrhea are important, too, but one hates to take from one side of the pie to increase the other."

Earlier this year, the Obama administration chose Jeffrey S. Crowley to head up The Office of National AIDS Policy (ONAP), which advises the administration on HIV/AIDS issues and oversees federal policies. A Feb. 26 White House press release said that Crowley "is recognized and respected for his capacity to integrate public health research with political strategy to achieve policy changes."

Further, the release noted, "Crowley has spent the last fourteen years working to improve access to health and social services for people living with HIV/AIDS, people with physical and mental disabilities, low-income individuals, and other vulnerable populations."

The release said that the ONS "emphasizes prevention through wide-ranging education initiatives and also helps to coordinate the care and treatment of citizens with HIV/AIDS, " adding that, "The President has made a strong commitment to developing a national AIDS strategy, which will be a top priority for the Office of National AIDS Policy."

But even domestically, the administration has seen controversies related to containing and treating AIDS emerge. A new bill to repeal a ban on the use of federal funds for needle exchange programs might mean the difference between some needle exchange programs closing down or continuing to operate-- but a provision in the bill that would deny crucial funding to programs that operate within 1,000 feet of places where children might congregate (schools, parks, day care centers, pools, arcades, and the like) might ensure that even with the repeal, needle-exchange programs are unable to access federal funds.

Proponents of needle exchange programs say that the provision is the ban all over again, only swaddled in friendlier-looking clothing. "This 1,000-foot rule is simply instituting the ban in a different form," the executive director of the AIDS Action Council, Rebecca Haag, told the New York Times in a Nov. 8 article. "Clearly the intent of this rule is to nullify the lifting of the ban."

The article noted that the Centers for Disease Control and Prevention say that up to 20% of HIV cases stem from needle sharing. Moreover, the World Health Organization showed in a 2004 report that reductions in HIV cases of up to 18% accompanied the largest needle exchange programs.

But those programs operate on a thin financial margin, and as local governments trim their budgets, some of those programs--already hard-pressed to keep going--are on the verge of going under. Four of the nation's approximately 200 programs have ceased operations this year due to budgetary shortfalls. The new bill would allow federal funds to be used in the programs, but in most communities--especially small towns--the 1,000-foot rule would end up denying the very programs the bill is supposed to allow funds to reach.

But in densely packed urban centers, where about 70% of such programs operate, the bill's provision would prove just as problematic. The executive director of Manhattan's Lower East Side Harm Reduction Center, Raquel Algarin, told the Times, "I was thinking, 'A thousand feet, how much is that?' And then I found myself thinking, 'We'd probably be doing syringe exchange in the middle of the East River, and any exchange on the West Side would be in the Hudson River.' How do you work that out?"

One program, at the Harm Reduction Center of Southern Oregon in Roseburg, Ore., could be denied funds because of thirty-six inches: the program is located 997 feet from a local high school. "We could move a few feet down, but the building is more expensive at the other end," Ellis Poole, the program's executive director, told the New York Times. The additional rent that comes with those crucial additional feet of distance poses a major barrier to a program already desperately squeezed for cash: "I have to beg for money for computers. I have to ask people to come clean the carpet at no charge," said Poole.

The rule is cloaked in child-welfare rhetoric. "Let's protect these kids," proclaimed Jack Kingston, a Georgia Republican congressman. "They don't need to be playing kickball in the playground and seeing people lined up for needle exchange."

But the communities at large could better served by well-funded programs, say advocates, who point to the suite of services that come with needle exchange: HIV testing and other screening services, food banks, distribution of condoms, mental health services. The economic crisis may squeeze those services out along with needle exchange if the bill, which has passed both the House and the Senate subcommittee, passes in its current form.

The full Senate has yet to weigh in on the measure, and opponents--including AIDS prevention advocates and the National Association for the Advancement of Colored People (N.A.A.C.P.)--are bringing pressure to bear to get the 1,000-foot rule dropped.

Gay Men's Health Crisis, an organization working to combat the spread of HIV, released a report last August showing that the city's needle exchange programs are highly effective.

The city of San Francisco has worked to keep its needle exchange programs running even as it trims the budget of other services; the city's health department says that 10% of new HIV cases resulted not from needle use, but from sex with male intravenous drug users, adding a new, secondary dimension to needle sharing as a means of HIV transmission.

When Congress passed the new law last July, Speaker of the House Nancy Pelosi, who district includes San Francisco, hailed the bill's passage, saying, "Sound science is an essential component of good public health policy, and the scientific support for needle exchange could not be more clear. The Centers for Disease Control [and Prevention], the National Institutes for Health, the World Health Organization, and former Surgeon General David Satcher have all confirmed the scientific evidence in support of needle exchange programs. These initiatives are an effective public health intervention that reduces the number of new HIV infections without increasing the use of illegal drugs."

Kilian Melloy serves as EDGE Media Network's Assistant Arts Editor. He also reviews theater for WBUR. His professional memberships include the National Lesbian & Gay Journalists Association, the Boston Online Film Critics Association, The Gay and Lesbian Entertainment Critics Association, and the Boston Theater Critics Association's Elliot Norton Awards Committee.


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