The United States, a Leader in Efforts Against Global AIDS Epidemic, Is Failing to Address the Disease at Home, Says New Report

NEW YORK CITY—While an upcoming United Nations summit may cite U.S. leadership against the AIDS epidemic overseas, a new report released today shows that the U.S. is falling short on its commitments made at the UN five years ago to curb the disease at home.

The report, published by the Public Health Watch HIV/AIDS Monitoring Project of the Open Society Institute (OSI), provides the first comprehensive analysis of how the United States is responding to the domestic AIDS epidemic and calls on the U.S. government to step up prevention and treatment efforts.

Based on extensive consultation with experts and review of U.S. AIDS policy and outcomes, the report—HIV/AIDS Policy in the United States: Monitoring the UNGASS Declaration of Commitment on HIV/AIDS—reveals, among other findings, that:

• U.S. efforts against the disease are uncoordinated, with no national plan for comprehensive HIV prevention, treatment, and support.
• Half the people in the U.S. who need HIV treatment are not receiving it.
• The number of new HIV infections in the U.S.—40,000 a year—has not decreased in over a decade.
• HIV/AIDS continues to have a devastating impact on communities of color, gay men and men who have sex with men, injecting drug users, and the poor.

“America has no deficit of dedicated scientists, health care workers or prevention providers, but chronic rates of HIV incidence and inadequate access to care reveal a shocking level of systems failure,” said Chris Collins, the report’s author and Public Health Watch consultant. “This is not the fault of any one president or Congress, but an ongoing shared responsibility. Still, this report shows that the federal government is becoming even less responsive to the growing needs of those most affected by the epidemic here at home.”

At a press conference to release the report, Collins was joined by David Satcher, Former Surgeon General of the United States and Interim President, Morehouse School of Medicine; Judy Auerbach, Vice President for Public Policy of amfAR, the Foundation for AIDS Research; Pernessa Seele, Founder/ CEO of The Balm in Gilead; and Phill Wilson, Executive Director of the Black AIDS Institute; and Public Health Watch Project Director Rachel Guglielmo.

The report comes as the UN prepares for the May 31 opening of its High-Level Review Meeting on HIV/AIDS that will assess whether member states are living up to commitments made in 2001 at the UN General Assembly Special Session on HIV/AIDS.

“Five years after the United States committed to reach those most vulnerable to HIV, we still see huge racial and economic disparities in infection rates,” said Rachel Guglielmo. “Communities of color, especially African Americans, women, gay men, injecting drug users, and the poor continue to bear the greatest burden of this disease. African Americans account for half of new HIV infections in the U.S., despite being less than 13 percent of the national population, and AIDS is the leading cause of death for African-American women ages 24-34. These are not the signs of a strong national response to AIDS.”

The OSI report offers concrete recommendations for improving the U.S. response in HIV prevention and treatment to meet not only UN goals, but also those published by the U.S. Centers for Disease Control. These recommendations include:

Establish a national HIV/AIDS strategy that focuses on outcomes

• Create a coordinated national HIV/AIDS strategy across federal, state, and local agencies that addresses delivery of prevention, treatment, and other services and identifies clear roles, responsibilities and timelines to measure results. Systematically assess programming and policy and hold funders and agencies accountable on an ongoing basis.

Comprehensively address racial disparities in HIV/AIDS impact

• Launch a vigorous, federally managed effort to test, refine, and deliver innovative programming that improves outcomes for communities of color. Target services to those who are often not reached by the current health system.

Dedicate increased resources to proven-effective interventions

• Use proven tools such as frank sexual education and needle exchange to bring HIV incidence down; fund programs based on evidence of what works.
• Act on the proposals made by a distinguished Institute of Medicine panel in 2004 to broadly and equitably deliver quality HIV care. Focus on making Medicaid work for low-income people living with HIV/AIDS, in part by overturning cost-sharing schemes and benefit caps on services.
• Increase resources to meet the housing, mental health, and substance abuse prevention and treatment needs of people living with HIV/AIDS.
• Maintain commitment to a robust research effort to continue to discover ever more effective HIV prevention and treatment strategies.

“There are many proud successes in the U.S. response to AIDS globally, but when we look at outcomes here at home, it’s clear the country cannot afford to settle for such disappointing results” said Collins. “We must do better for our citizens.”

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