Sean Philpott-Jones: Leadership. Commitment. Hype.
Today is World AIDS Day. It is, in fact, the 29th annual World AIDS Day, which is held every year on December 1st to honor the 35 million people who have died from the disease and to support the 40 million who currently live with HIV/AIDS. The theme for this year’s event, at least according to the US federal government? “Leadership. Commitment. Impact.” You’ll have to excuse me if I scoff openly at the audacity of that motto.
Let’s consider the leadership and commitment of our politicians in fighting HIV/AIDS. When AIDS was first identified in 1981, it was seen as a disease that primarily affected socially marginalized populations, notably gay men, injection drug users and immigrants from poor Caribbean countries like Haiti. As long as it was confined to those ‘undesirable’ groups, there was no need for upstanding American citizens to pay it much heed. Following the lead of then-President Ronald Reagan – who didn’t even mention the word ‘AIDS’ publicly until 1985, and then only sparingly -- politicians and other members of his conservative administration largely ignored the looming public health crisis.
American leadership failed when it was needed the most, by refusing to tackle the nascent AIDS crisis with measures like comprehensive education, blunt messaging and active promotion and widespread distribution of condoms. Had federal officials not been so afraid of ruffling conservative feathers, it is entirely possible that the HIV/AIDS epidemic might have be thwarted then and there.
This isn’t to say that there haven’t been a few times when our political leaders actually stepped up to the plate and contribute to the fight against HIV/AIDS. In 1988, despite opposition by the more conservative members of the Reagan Administration, then-Surgeon General Dr. C. Everett Koop mailed detailed information to every American household on the use of condoms to prevent the spread of HIV.
Similarly, in response to public pressure from celebrity advocates and radical activist groups, Reagan radically increased funding for AIDS research and established what would eventually be the first permanent advisory council on HIV/AIDS. Subsequent Administrations have increased funding and support for treatment and prevention efforts even more, including the establishment of the President’s Emergency Plan for AIDS Relief (PEPFAR), a global initiative spearheaded by George W. Bush that provides lifesaving antiretroviral treatment to millions of people living with HIV/AIDS in the hardest hit countries around the world.
That being said, political leaders at both the state and the federal level are more likely to stymie that promote efforts to prevent the spread of HIV/AIDS, most often for ideological reasons. Despite decades of research demonstrating that needle exchange programs greatly reduced rates of HIV transmission among injection drug users, for example, the use of federal funds to support these programs was largely banned until 2015. Opposition to federal support of needle exchange programs was largely based on the erroneous fear that they actively promote drug use among clients, in spite of evidence to the contrary. This decades ban likely lead to the otherwise preventable infection of thousands of drug users and their partners.
Under the leadership of Vice President-elect Mike Pence, Indiana legislators eliminated all state funding for Planned Parenthood because of their ideological opposition to abortion. As many who have been following the political wrangling over Planned Parenthood know, however, legal termination of pregnancy accounts to less than 3% of the total number of medical procedures and services offered by that organization. Rather than a place to get abortions, for many poor Americans Planned Parenthood is the only source for a variety of desperately needed health care services, family planning; pregnancy testing and prenatal care; screening for breast, cervical and testicular cancer; testing and treatment for sexually-transmitted diseases; and HIV testing and education. When Pence and his colleagues cut funding for Planned Parenthood in Indiana, five clinics were shuttered. This included one clinic that was the sole provider of HIV counseling and testing in Scott County. Soon after, that rural community saw a 16-fold increase in the number of new HIV infections.
Similar increases in the spread of HIV are likely to be seen nationally should newly emboldened conservative politicians make good on many of their campaign promises. During the recent campaign, now President-elect Donald Trump called for the complete elimination cut of all public funding for organizations like Planned Parenthood. Congressman Tom Price, Trump’s nominee for Secretary of Health and Human Services, is an ardent pro-life advocate who has championed those efforts. Representative Price has also called for a rollback of Medicaid, including eliminating support of programs that provide HIV-positive patients with low-cost access to care and treatment, and is a strong supporter of faith-based abstinence-only education programs that are widely known to be ineffective in educating teens and young adults about HIV/AIDS.
Support for HIV prevention and treatment efforts has been slipping for years, in part because of public fatigue and in part because of hype that new drug regimes have turned HIV/AIDS from a once deadly disease to a chronic condition that can be managed like diabetes or heart disease. AIDS is no longer seen as a serious public health crisis, explaining why both private and pubic funding for HIV/AIDS programs has been stagnant for almost a decade.
This problem is only going to get worse in the coming years, if the current political climate is any indication of where American priorities lie. Unless our newly-elected politicians show true leadership and commitment to the fight against HIV/AIDS – instead of their usual self-serving and ideologically-motivated efforts to promote themselves and enrich their donors -- I fear that the hard-won gains that we have made since HIV was first discovered will soon be lost.
A public health researcher and ethicist by training, Dr. Sean Philpott-Jones is Director of Research Ethics for the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of the Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.
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