US lacks national action plan on AIDS

Even as the US tries to water down new global HIV/AIDS targets at a high-level United Nations meeting on the pandemic, it has also fallen short on commitments made five years ago to address HIV/AIDS at home, experts and civil society groups are charging. "There are sub-Saharan Africa-like levels [of the disease] in some parts of Washington, DC for the same reasons that the disease is spread in sub-Saharan Africa," the former director of the White House Office of National AIDS Policy in 2001-2002, Scott Evertz, said. "In many parts of New York, like Harlem and the Bronx, the situation is also alarming." The number of new HIV infections in the United States has been stuck at about 40,000 a year for over a decade, and only half of those needing treatment are receiving it, according to a recent report by the Open Society's Institute's Public Health Watch program. "We don't have comprehensive sexual education, we don't have a national plan to address the issue–which is one of the recommendations set five years ago [in the 2001 Declaration of Commitment that emerged from the last UN AIDS meeting]–and we're pursuing a prevention effort that is not working," Rachel Guglielmo, project director of Public Health Watch, said in an interview. "There is a lack of coordination in providing prevention, treatment and care," she added, stressing that the US has been focusing much more on treatment than on prevention, "which is not showing effective results." For example, abstinence-until-marriage campaigns, which the George W. Bush administration has aggressively promoted both at home and abroad, are viewed by many scientists as morally problematic "by withholding information [about condoms] and promoting questionable and inaccurate opinions," according to a recent article in the Journal of Adolescent Health. And the effectiveness of such policies may "come to zero" when one talks about converting good intentions into real-world behavior, explained John Santelli, a doctor and professor at the Mailman School of Public Health at New York's Columbia University at a briefing convened by Advocates for Youth. The 2001 Declaration of Commitment established concrete, time-bound goals for improving the global AIDS response, including ensuring that 90 percent of young people were well-informed about how to prevent HIV/AIDS by 2005. However, according to the 2006 UNAIDS report on the epidemic, less than 50 percent of young people have an adequate understanding of the disease. In one survey of 18 countries, the percentage of youth who correctly identified ways to prevent HIV transmission was just 20 percent among girls and 33 percent among boys. Evertz noted that "in US school curriculums there is already a movement towards abstinence-only education, and I think we will see the effects of that in the future." Minority groups, including African-Americans, gay men and men who have sex with men, and poor and injecting drug users, still bear the greatest burden of the epidemic, according to the UNAIDS report. "The federal health care system just does not adequately deal with the numbers of significant illness in those communities," said Evertz. "Clearly the epidemic in the US has moved in terms of whom it is affecting most, and it is actually African-American women who really represent one of the most economically disadvantaged groups in our society," he said. "It is just a matter of time for the disease to become a disease of poverty in the US as well," he added. Although African-Americans are only 13 percent of the population, they account for half of all new HIV infections in the US, says Public Health Watch, and AIDS is now the leading cause of death for African-American women ages 24-34. "This is not a sign of a strong national response to AIDS," Guglielmo said. Evertz said that among men who have sex with men, "The rate among them has thankfully leveled off and gone down in some places." But UNAIDS warns that "evidence continues to emerge of resurgent epidemics in the US among men who have sex with men." According to news reports and delegates to the June 1-3 meeting, the draft version of the international declaration on AIDS being debated this week would step back from setting specific targets for coming years, with certain governments–led by the US–attempting to remove references to prevention measures that offend conservative religious groups from the text. In particular, the US is opposing strategies that include condom distribution and needle exchanges, and references to prostitutes, drug users and homosexuals. Washington also tried to block a substantial increase in new funding, as recommended by UNAIDS, for prevention and treatment, but was overridden by other summit delegates recently. More than 140 nations are participating in this week's meeting. Guglielmo said "We can't promote accountability unless we have clear benchmarks and targets that can be monitored in the long-term. It's a way of distancing [themselves] from their responsibilities." UNAIDS says that the number of people living with HIV in the US has now reached its highest level ever–1.2 million–and it is estimated that 43,000 people were newly infected last year.