MASON: AIDS Reform leadership needed

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By Abner Mason

COMMENTARY:

This December will mark the last World AIDS Day under this administration, but it will also mark the beginning of an "Enlightenment Period" addressing how best to cure this worldwide epidemic - the next president must take a reformation approach.

I briefed Sen. John McCain on the HIV/AIDS epidemic earlier this year. Given his interest in foreign policy, I expected him to appreciate the importance of U.S. leadership in the global fight against HIV, but I was surprised by his understanding of the domestic challenge we face. He asked insightful questions and it was clear he understood we were losing the fight against HIV here at home.

I made the case for presidential leadership in the domestic fight against HIV and we agreed that we needed to change the way we were doing things.

About 30 percent of those infected don't know it, so they are disproportionately fueling the increase in new infections. Despite spending $23.3 billion in the last fiscal year to fight HIV/AIDS in America, we have made little progress. Even with new and better drugs, we will not be able to treat our way out of this epidemic - we are losing the fight against HIV in America.

Here are the three reasons we have failed to make progress against HIV/AIDS in the United States and what the new president, Mr. McCain or Barack Obama, should do to achieve better results.

(1) We need a national AIDS strategy with clear and achievable goals against which budget and funding decisions can be made. It's hard to believe the United States has been operating for years without a strategy, especially since the United States requires other countries to have such a plan in place before we will provide them with funding as part of the President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. government's highly successful international AIDS program. A national AIDS strategy would require input and broad agreement from government, civil society, private sector and people living with HIV. Once the national strategy has been developed, yearly program funding decisions are based on the national strategy and not on politics or ideology.

(2) The second priority for the U.S. government is to make someone accountable for implementing the strategy. The PEPFAR program should again be used as an example. After major inter-agency battles over turf, money and power, a new position - U.S. global AIDS coordinator - was created to carry out and be held accountable for the PEPFAR program. This consolidation of responsibility and accountability has been crucial to the PEPFAR program's success. When there is no one to hold accountable for failure, there is likewise no one working to ensure success.

(3) The other reason our domestic efforts have met with such failure is that we have focused too much of our time and energy on the government's response. I am not saying the government does not have a major role to play in fighting the domestic HIV/AIDS epidemic. However, even when the government lives up to its obligations, it will not be enough. The HIV virus is spread by voluntary, individual, usually private behavior.

All Americans need to accept the individual responsibility we each have for our own behavior, but for people most at risk for becoming infected or infecting others there is little margin for error. Individual behavior change is the only answer.

Recent statistics from the Centers for Disease Control paint a dismal picture. There are more than 56,000 new infections in the United States each year, about 40 percent higher than previously thought. Those newly infected are disproportionately minority and low income, which makes them dependent on government health care. To make matters worse, they are disproportionately concentrated in Southern states, which are financially least capable of meeting the escalating costs of HIV treatment, now about $12,000 annually per person.

Americans need a reformer president to successfully lead and combat the global fight against HIV/AIDS, its long past time we applied what we know works to the fight here at home. Let's hope our new president makes the necessary changes as soon as possible.

Abner Mason is executive director of AIDS Responsibility Project. He also was a Bush appointee to the Presidential Advisory Council on HIV/AIDS.