Policy Watch

The title of this column is the slogan from World AIDS Day 2006, and as we look to 2007 and a new Congress, a more appropriate slogan could not have been chosen. However, rather than keeping the promise, we are only slightly farther ahead than we were 1, 5, 10, or even 20 years ago and at some risk of going backward, as evinced by the sobering information made available through the World Health Organization (WHO) and the CDC.

First, the international perspective:

• According to the latest figures . . . an estimated 39.5 million people are living with HIV infection. There were 4.3 million new infections in 2006, with 2.8 million (65%) of these occurring in sub-Saharan Africa and important increases in Eastern Europe and Central Asia, where there are some indications that infection rates have risen by more than 50% since 2004. In 2006, 2.9 million people died of AIDS-related illnesses.

• New data suggest that where HIV prevention programmes have not been sustained and/or adapted as epidemics have changedÑinfection rates in some countries are staying the same or going back up.

• In North America and Western Europe, HIV prevention programmes have often not been sustained and the number of new infections has remained the same. Similarly in low- and middle-income countries, there are only a few examples of countries that have actually reduced new infections. And some countries that had showed earlier successes in reducing new infections, such as Uganda, have either slowed [the decline] or are now experiencing increasing infection rates.¹

• And in the United States, the October 23, 2006 issue of Advanced Data includes the following information:

• In 2002, . . . 13.5% of black college graduates were at increased risk for HIV, compared with 29.5% of blacks with less than a high school education. Overall, 12.7% of men and 10.0% of women (a total of 10.6 million persons aged 22 to 44 years) reported sexual or drug-related behaviors that placed them at increased risk for HIV.²

From a more personal perspective, a recent letter written by Rev Ted Karpf, an Episcopal priest on the staff of the WHO AIDS Programme:

• The Second Conference of Arab Christians and Muslims on AIDS. There were some 300 sheiks, mullahs, imams and Maronite, Greek Orthodox, and Coptic priests and evangelical pastors from the Arab world . . . gathered to form a confederation of theological and spiritual power to address the movement of the AIDS pandemic into their world, [to] make sense of this disease which . . . exploded myths of purity and invincibility. It is 1987 all over again and we are learning what to do, as what happened in the non-Arab world is not known or remembered. The response of [the] evocative and emotional [was] summarized by this observation from several mullahs and sheiks: "You say things that are difficult for us to hear, but you speak from the heart and shatter our notions of what Americans are all about. We disagree with you on some points and yet you speak to our hearts and there open our lives. You must come to us often to remind us of what we are to do and who we are."

As most readers of this column already know, the problem is not ignorance about what could be done to halt the spread of HIV infection and allow those infected to live productive lives. For some reason, we are unable to make the decision to actÑand sustain that decision long enough to make lasting differences. Although this will be read after the New Year begins, here is a list of New Year reminders that should be taken to Congress as it convenes.

First on the list is the renewal of the Ryan White Act, the subject of the previous Policy Watch (AIDS Reader. 2006;16:593-596). Without this, domestic HIV treatment programs will falter. Renewal of the act without adequate funding will be mere window dressing, however, so the word needs to go to appropriations committees as well as the authorizers.

Second, Congress must remember the interrelationships of programs and adequately support education, housing, jobs, and recreation not only for those struggling to live with HIV infection but also for those at greatest risk of acquiring it. A youngster going to a school without modern textbooks, cramming for standardized tests without being exposed to real teaching, without a safe place to live and play and with no hope of a meaningful adult work life is a time bomb of high-risk behavior and future infection.

Third, Congress must hold the Administration accountable for making policy decisions and appointments that do not fly in the face of science. As a country that was outraged by the South African denial of HIV information, it is even more outrageous that President Bush has nominated Eric Keroack to head the federal government's family planning office. Among other bizarre ideas, he has argued that abortion increases the risk of breast cancer, early abortion is most risky (the reverse of the facts), birth control is demeaning to women, and women who have sex with multiple partners alter their brain chemistry. Congress can use oversight hearings to push Department of Health and Human Services Secretary Michael Levitt to retract this appointment and look carefully at the leadership of all HIV-related units and programs.

Fourth, the funding for international HIV/AIDS work should be sustained and even increased. The distribution of funds should be matched to risk at least as much as to the shifting winds of our preferences for international "friendships" and should meet the same test of science we use–or should use–at home. And we should use our resources to be sure that a solid health infrastructure is built and maintained, rather than cobbling together short-term antiretroviral drug distribution programs that are not sustainable.

We made the promise to stop AIDS a long, long time ago. It is time now to keep the promise, internationally and domestically.

References:

References

1. World Health Organization. HIV/AIDS. Global AIDS epidemic continues to grow. Available at:

http://www.who.int/hiv/mediacentre/news62/en/index.html

. Accessed November 29, 2006.
2. Anderson JE, Mosher WD, Chandra A; National Center for HIV, STD, and TB Prevention, US Department of Health and Human Services, Centers for Disease Control and Prevention. Measuring HIV risk in the US population aged 15-44: results from Cycle 6 of the National Survey of Family Growth. Adv Data. 2006; 377:1-27. Available at:

http://www.cdc.gov/nchs/data/ad/ad377.pdf

. Accessed November 29, 2006.