White House's AIDS strategy refocuses attention on people most at risk

The federal government announced on Tuesday its plan to fight the AIDS epidemic by reallocating resources to the hardest-hit areas, adopting the most effective strategies and relying on evidence-based research. In unveiling its national strategy to reduce the rate of new infections and to better care for people who already have AIDS, the Obama administration made it clear its focus would be on efficiency, not extra spending.

“We can’t expect this to be solved with huge infusions of new resources,” said Kathleen Sebelius, the secretary of Health and Human Services.

That attitude has angered some AIDS advocates, who say spending on the domestic and international epidemic is insufficient. In recent days, supporters of the domestic AIDS Drug Assistance Program (ADAP) and the President’s Emergency Plan For AIDS Relief (PEPFAR) have been calling for more funding, with the nonprofit AIDS Healthcare Foundation even launching an ad campaign asking “Who’s Better on AIDS?” — President Obama or George W. Bush?

“This strategy is a day late and a dollar short: 15 months in the making, and the White House learned what people in the field have known for years,” said foundation President Michael Weinstein. “There is no funding, no ‘how to,’ no real leadership.”

Other advocates were more positive.

Nancy Mahon, director of the MAC AIDS Fund, said the Obama administration has been the most “scientifically grounded” in its approach to AIDS, for example by lifting the ban on people with HIV and AIDS entering the country.

“You can never downplay the importance of presidential leadership on any issue,” she said.

Overly critical advocates are letting the perfect be the enemy of the good, Mahon said. She also rejected as ill-founded the concerns of rural advocates who are worried that their scarce funding could be reallocated to areas with more prevalence of the disease, such as Washington D.C., or Manhattan’s Chelsea neighborhood.

“What we’ve had in this country is really a broken business model for approaching AIDS ... [where] we’re usually underfunding prevention and we’ve waited until people were infected,” she said. “What we’ve known for years is that AIDS is 100 percent preventable, but it’s not curable.”

Microsoft co-founder Bill Gates struck a similar message in a conference call Tuesday ahead of his participation in the International AIDS Conference in Vienna, Austria, next week. While not addressing the White House strategy per se, Gates said that AIDS groups have seen a “major challenge in terms of funding” because of the economic downturn. As a result, he said, “we need to apply new innovations to get even more out of every dollar of funding that is available.”

“There’s a real opportunity to drive efficiency,” Gates said, “and there’s a real opportunity for better spending on the prevention side to drive down the number of cases.”

The White House AIDS strategy provides a roadmap for government, businesses and local communities to reduce the number of new cases, increase access and quality of care for people living with HIV and reducing HIV-related health disparities.

Sebelius also announced Tuesday that $30 million from the healthcare reform law’s Prevention Fund will support AIDS prevention, surveillance and testing.