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HEALTH: U.S. Lacks National Action Plan on AIDS

Juliana Lara Resende

UNITED NATIONS, Jun 2 2006 (IPS) - Even as the U.S. 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, D.C. 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, told IPS. “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 people in need of treatment are receiving it, according to a recent report by the Open Society’s Institute’s Public Health Watch programme.

“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 U.N. 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 U.S. has been focusing much more on treatment than on prevention, “which is not showing effective results”.

For example, abstinence-only-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 behaviour, 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 Wednesday.

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 U.S. 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,” Evertz told IPS.

“Clearly the epidemic in the U.S. 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 U.S. 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 U.S., 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 U.S. among men who have sex with men”.

According to news reports and delegates to the Jun. 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 U.S. – attempting to remove references to prevention measures that offend conservative religious groups from the text.

In particular, the U.S. 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 Thursday. More than 140 nations are participating in this week’s meeting.

Guglielmo told IPS “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.”

Rights groups have also complained that countries such as Syria, Egypt and Gabon are trying to block language on the empowerment of girls, any mention of harm reduction and any reference to vulnerable populations, such as sex workers, drug users, migrants and prison inmates.

According to Human Rights Watch, the refusal to recognise the human rights of girls and women and those most at risk of HIV infection is “threatening to derail this week’s United Nations meeting on AIDS”.

“Fifty thousand people will die this week while delegates debate any reference to vulnerable populations,” Joe Amon, director of the HIV/AIDS Programme at Human Rights Watch, said Wednesday. “Yet this vulnerability to HIV/AIDS is aggravated by the failure of global leaders to face facts, speak truths and protect rights.”

“U.S. (aid) dollars may do more harm than good” if they force activists on the ground to do “what the conditions demand, even when if it is non-evidence based, even if it is not right,” Beatrice Were, founder of the National Community of Women Living with AIDS in Uganda, told IPS.

UNAIDS says that the number of people living with HIV in the U.S. has now reached its highest level ever – 1.2 million – and it is estimated that 43,000 people were newly infected last year.

But the United States is hardly the only country falling short on its commitments. A report released this week by the International Council of AIDS Service Organisations indicates that many other developed countries have failed to deliver on the 2001 targets, including Canada and Ireland.

“We need to be able to protect the most vulnerable,” U.N. Secretary-General Kofi Annan stressed this week. “We will not succeed by burying our heads in the sand and pretending that these people do not exist.”