AIDS Activism: Confusing Accountability With Personal Attacks

In the last year, AIDS activists have criticized President Obama and his former senior healthcare advisor Ezekiel J. Emanuel MD, PhD. AIDS advocates claimed that the Obama administration was de-emphasizing international AIDS treatment initiatives in favor of other global health priorities. In a commentary published in The Journal of the American Medical Association, Dr. Emanuel advocated funding maternal and child health initiatives at the expense of future funding increases for The President's Emergency Plan for AIDS Relief (PEPFAR).

There is evidence corroborating AIDS activists' claims:

"In 2008, the United States Congress authorized the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act providing $48 billion over 5 years ($9.6 billion/year) to PEPFAR. However, President Obama's $63 billion Global Health Initiative allocated $51 billion over 6 years ($8.5 billion/year) resulting in an overall decrease in PEPFAR funding while allocating $12 billion towards other global health initiatives including maternal and child health."

By not providing "new" money towards maternal and child health, President Obama had in de facto pitted HIV/AIDS against other global health objectives. In fact, several articles in the scientific literature argued policies that weakened HIV/AIDS treatment programs threatened to undermine, rather than support, maternal and child health in countries with high HIV/AIDS prevalence (AIDS and Science). Ultimately, as Sarah Leeper and I argued:

"Confronting illness in isolation -- whether by funding PEPFAR at the expense of programs that target maternal or child health or vice versa -- cannot be our way forward. We should be advocating for funding both PEPFAR and maternal and child health together instead of favoring one program over another."

As a result of the collaborative efforts of the AIDS advocacy community, the Obama administration directed additional funding towards PEPFAR's antiretroviral treatment scale-up in Uganda. Additionally, in October 2010 the Obama administration increased the U.S. contribution towards The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria to $4 billion (an increase of 38%). These results demonstrated that pragmatic advocacy by AIDS activists was a powerful instrument towards yielding accountability on HIV/AIDS funding.

Yet, despite focusing on global health policy issues, some AIDS activists have myopically lambasted Dr. Emanuel with personal attacks even after he left the Obama administration. AIDS activists in Los Angeles, castigated Dr. Emanuel. Their posters decreed: "Zeke, To People with AIDS 'Drop Dead'," and [Emanuel] "Not a friend of people with AIDS."

Surprisingly, the protesters chastised Dr. Emanuel despite the fact that he had left the Obama administration one week earlier. Since Dr. Emanuel was no longer in a position to influence U.S. global health policy, the protest was simply theatrical.

As an AIDS activist, I am distressed at these tactics. Do we actually believe that Dr. Emanuel wants "People with AIDS to drop dead" as some protesters declared? What happened to rational and civil discourse? Is engaging in libel attack an effective advocacy tool? Perhaps it garners headlines and press, but does it actually result in policy change? There is a clear distinction between issues based advocacy and vitriolic attacks against individuals. The disparaging polemics against Dr. Emanuel, by these rogue AIDS activists, endangers the credibility and legitimacy of our advocacy movement.

A constituency of nearly 40 million HIV-infected persons throughout the world deserves a pragmatic approach to advocacy. Global health policies and funding allocations require serious, thoughtful, and collegial debate. AIDS activists must aspire for responsible advocacy. We must demand accountability on issues, not personal attacks against individuals.

I hope as a community, AIDS activists will demand accountability while avoiding ad hominem attacks.

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Anand Reddi is an AIDS activist and researcher. In 2005, Reddi was a Fulbright Scholar assisting the Sinikithemba HIV/AIDS clinic at McCord Hospital in Durban, South Africa. Currently, Mr. Reddi is a medical student at the University of Colorado, School of Medicine.

 

Follow Anand Reddi on Twitter: www.twitter.com/reddianand

Comments

[TeeDUK]

02:38 PM on 03/12/2011

This post is lacking critical information. Exactly when and where was this protest? And most importantly, who organized it?

[Anand Reddi]

03:03 PM on 03/12/2011

The AIDS Healthcare Foundation organized this protest at UCLA on 1/14/11. Zeke Emanuel left the Obama administration on Jan 6.

https://picasaweb.google.com/aidshealthcare/AHFProtestsEzekielEmanuelAtUCLAOverObamaAIDSPolicies11411#

[Anand Reddi]

03:06 PM on 03/12/2011

The AIDS Healthcare Foundation organized this protest at UCLA on 1/14/11. Zeke Emanuel left the Obama administra­tion on Jan 6.

http://www.facebook.com/album.php?aid=326663&id=34661411150

[TeeDUK]

12:17 PM on 03/13/2011

Thanks, that was my guess as to who was behind it. I see AIDS Healthcare Foundation as a large HMO, not activists in any way. Their leadership has a long history of self-serving stupidity, e.g. settling with Abbott even though Norvir's price was not lowered: http://www.thebodypro.com/content/treat/art4872.html

[Kathan Amin]

05:05 PM on 03/10/2011

I think Mr. Reddi has laid out the problem not only with HIV/AIDS advocacy, but many other forms of advocacy in our nation. In these distressed times, people have turned to the blame game, and individual attacks that have resulted in little but negativity and debilitating political games. Positive change requires thoughtful debate and respectful discourse. The millions diagnosed with HIV/AIDS today and those that will be suffering in the future definitely deserve better forms of advocacy. Despite all that is said, I think it is important to remember that this is not the attitude of the majority of advocates, and its unfortunate that these immature efforts get more attention than those that have well thought out arguments.

[Anand Reddi]

06:42 PM on 03/10/2011

Thank you Kathan. I completely agree. These rogue AIDS activists in LA are not indicative of the majority of our movement. But, unfortunately, our movement is being typecast by these juvenile and reckless tactics. As I write above: "There is a clear distinction between issues based advocacy and vitriolic attacks against individuals. The disparaging polemics against Dr. Emanuel, by these rogue AIDS activists, endangers the credibility and legitimacy of our advocacy movement. "

[Sue Saltmarsh]

03:11 PM on 03/10/2011

I agree with Mr. Reddi that pragmatic protest is more productive. However, as one who has been flommoxed at the lies and vitriol that the RIght has been allowed to get away with - everything from signs depicting Obama as Hitler to Sarah Palin's recent dismissal of Kathy Griffin as a "50-year-old bully," I have to say that the usual liberal stance of "taking the high road" may allow for us to feel self-righteously smug, but it rarely leads to our side achieving our goals. Considering the massive amount of money and influence conservative forces have at their disposal, it doesn't seem unreasonable to me that we should get out of our New-Agey-love-everybody comfort zone occasionally and show that we can be street fighters. In this case, I believe it is an instance of misdirection, not inappropriate ire. Dr Emanuel was no longer in a positio to influence any funding. But somebody was. Where were the signs naming the Republicans who would rather cut funding to any HIV/AIDS program in the name of deficit-reduction than provide people with the prevention, testing, and care they need?

I believe we can learn a lesson from Wisconsin. The awe-inspiring protest of the people there will ultimately be a game-changer, no matter what laws the Republicans break along the way. As they chanted along with Michael Moore in Madison, "We have HAD it!" and it's about time! Go, Cheeseheads!

[Anand Reddi]

04:17 PM on 03/10/2011

Dear Ms. Saltmarsh, Thanks for your message. You make some interesting points, and I agree. Indeed, I often struggle with how can advocacy be best delivered. Diction and message is of course important, and unfortunately vitriolic attacks can garner, in some cases, more press. However, I think in this case, we saw over the summer how pragmatic, issues based advocacy, worked and can continue to work. I worry that credibility and legitimacy of our advocacy movement is being jeopardized by these rogue AIDS protests. Global HIV/AIDS funding is not a partisan issue. Liberals, Moderates, Conservatives/Evangelicals all agree that funding from the US is important. In my opinion, I think we can keep our government accountable, without the use of ad hominem attacks. There is old adage from Isfahan, Persia: Only the pigeons name-call, and the righteous pursue with strategy. We can protest and hold our government accountable without the dirty tactics used by those LA protesters. In the end they achieved absolutely nothing with their name-calling but tried to get 5 minutes of fame. Dr. Emanuel had already left the administration. It was a cheap attack and the vast of majority of AIDS activists disagree with those tactics.

[ColumbiaChemist]

07:57 AM on 03/10/2011

Its amazing how a handful of idiots with signs can completely destroy rational debate. Its beyond the pale that a discussion on how best to appropriate money to combat AIDS becomes a personal attack on a well-respected physician like Dr. Emmanuel. (This is just like how the "death panel" rumors started) Because of "protesters" like these, it's very difficult/impossible for our elected representatives and policy makers to even begin to discuss the controversial issues of our generation in a meaningful way. I commend Anand Reddi on calling shenanigans on these people, who are actually no different than the nut jobs who go around with racist signs of Obama, Truthers, or Birthers.

[Ranmal Samarasinghe]

03:50 PM on 03/09/2011

Agreed. Rational disagreement is fair and useful, whereas personal attacks are largely an ineffective means of advocacy at best, and highly counterproductive at worst.

[Anand Reddi]

04:11 PM on 03/09/2011

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[Anand Reddi]

12:51 PM on 03/10/2011

Absolutely. One can still craft an effective message, if not more powerful, by focusing on issues and not individuals. I hope the AIDS advocacy community will confront these rogue and irresponsible activists towards crafting a more issues based approach. The greatest practitioners of advocacy have never blurred the line between accountability and personal attack

[FOXP]

01:46 PM on 03/09/2011

I wish to congratulate Mr. Reddi for putting into words what a lot of us were thinking when we watched these protesters go overboard. Useful advocacy loses its legitimacy when it crosses the line from principle to personal attack. The leaders of any organization have a duty to represent their constituents effectively. If they cannot live up to this responsibility then they should make way for new leadership.

[Anand Reddi]

04:11 PM on 03/09/2011

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[Anand Reddi]

12:54 PM on 03/10/2011

Thanks Foxp. I appreciate your comments. I think you have nailed it... "The leaders of any organizati­on have a duty to represent their constituen­ts effectivel­y." The leaders of any movement hold ultimately responsibly to keep personal vendetta outside the purview of advocacy. As I wrote above: "There is a clear distinction between issues based advocacy and vitriolic attacks against individuals. The disparaging polemics against Dr. Emanuel, by these rogue AIDS activists, endangers the credibility and legitimacy of our advocacy movement. "

[Dr Martin Van Nostrand]

12:52 PM on 03/09/2011

Mr. Reddi what a refreshing article. As a juliard trained dermatologist, I have seen countless protests that have failed because the energy was not directed at the appropriate organization.
I do feel that HIV patients need more advocacy and there should be better ways at getting the message across than attacking an individual.

[Anand Reddi]

04:11 PM on 03/09/2011

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[Anand Reddi]

01:31 AM on 03/09/2011

I received an email from a friend critiquing my post. She writes: "Where policymakers with power are inflicting bad policies, with devastating effect, on poor people, it's okay to make it hit home a little. The bounds of decency don't require Robert's Rules during protests." and " Then the discussion becomes one activist vs. another activist regarding appropriate tactics, and decency, rather than what it should be about: policy issues at a critical time, and a time when the policymakers are finally being put on the defensive. "

So the question I have is what are appropriate tactics towards advocacy?

What is fair?

What is not fair?

What closes doors and backs people into corners?

[ColumbiaChemist]

08:09 AM on 03/10/2011

Pitchfork advocacy never works in cases of nuanced policy debate. It only serves to make the "advocates" look like an unruly mob lacking sound judgment. I think in cases like AIDs advocacy, HEalth Care, etc, the best way to promote an issue/idea is writing to your representatives and in forums like this.

[Anand Reddi]

12:57 PM on 03/10/2011

I agree ColumbiaChemist.

As I wrote above:
"As a result of the collaborative efforts of the AIDS advocacy community, the Obama administration directed additional funding towards PEPFAR's antiretroviral treatment scale-up in Uganda. Additionally, in October 2010 the Obama administration increased the U.S. contribution towards The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria to $4 billion (an increase of 38%)."

"These results demonstrated that pragmatic advocacy by AIDS activists was a powerful instrument towards yielding accountability on HIV/AIDS funding."

I can guarantee you these myopic protests in LA achieved nothing perpetuated ad hominem attacks

[Taylor Triolo]

12:06 AM on 03/09/2011

Excellent point, personal attacks distract us from the important issues at hand and devalue our arguments.

[Anand Reddi]

11:52 AM on 03/09/2011

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[Andreas Thyssen]

11:14 PM on 03/08/2011

It's refreshing to see a young scholar take such a pragmatic stance. Why is it that people in politics often lose sight of the end goal and make debate personal? If only we could get the boys in Washington to listen to Reddi's message!

[Anand Reddi]

11:52 AM on 03/09/2011

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[aaron shupp]

05:39 PM on 03/08/2011

Mr. Reddi makes an excellent point regarding the political struggles surrounding the allocation of research funding for not only global health concerns, but many other important social, environmental, economic, and political issues. Many activists are passionate about their individual causes, but too frequently they lose sight of the big picture. In the case of battling the global HIV/AIDS epidemic, one must not be too quick to ignore the importance of addressing other critical health burdens in the world. Thus, an activist is well advised to consider a reallocation of funding in light of the United States' full-spectrum approach to global health. I agree with Mr. Reddi that denouncing Dr. Emanuel contributes little to improving global health or the HIV/AIDS epidemic. Instead, it would be refreshing to see our many special interest groups for various diseases/causes combine their efforts to convince Americans to dedicate more of our resources to appropriate and responsible research and interventions verified by peer-reviewed data in the area of global health. Public money is a limited resource. There is no need to have a personal smear campaign to decide how it gets allocated. Let the data and a broad perspective drive our decisions.

[Anand Reddi]

08:40 PM on 03/08/2011

I enjoyed reading your post, aaron schupp. I think you raise some great points.

A few points that I think you might be interested in:

1. "Polices that de-emphasize PEPFAR threaten to undermine, rather than support, maternal and child health in countries with high HIV/AIDS prevalence. A recent article in AIDS reported that in the five countries with the highest adult HIV prevalence worldwide, HIV is the leading cause of mortality in children under the age of five. A recent study in The Lancet estimated that in the absence of HIV, there would have been a 17.9% reduction in maternal mortality in 2008 suggesting the importance of providing HIV treatment to women." (http://www.huffingtonpost.com/anand-reddi/united-states-global-heal_b_654002.html)

2. I agree that "public money is limited," and while the US government should contribute I agree that now is the time to think about alternative funding sources for international AIDS Treatment.

Two ideas:
1. A Financial speculation Tax (Reddi, The Washington Post, http://www.washingtonpost.com/wp-dyn/content/article/2011/01/19/AR2011011906414.html)

2. Involving businesses, particularly those international companies involved in sub-Saharan Africa, to fund HIV treatment programs for their employees. Many companies have created HIV treatment programs including AngloAmerican and Chevron for their workers and communities. (Zygocki and Tedstrom, The Huffington Post, http://www.huffingtonpost.com/rhonda-i-zygocki/fighting-hivaids-all-hand_b_790176.html)

[Anand Reddi]

01:00 PM on 03/10/2011

I add another article from AIDS describing potential involvement of corporations in providing antiretroviral treatment.

http://www.ncbi.nlm.nih.gov/pubmed/17666965
AIDS. 2007 Jul;21 Suppl 3:S79-84.
Business and HIV/AIDS: the case of Anglo American.
Brink B, Pienaar J.
Anglo American South Africa, 44 Main St, Johannesburg, 2001, South Africa.

[Professor Frink]

05:06 PM on 03/08/2011

Sir,

This is a well thought out piece on the frivolousness of attacks on poorly understood decisions. I sincerely wish that this attitude of patient and investigative reservation were more prevalent in our often impetuous political environment.

[Anand Reddi]

08:44 PM on 03/08/2011

I agree. We need a reset on political discourse in this country. Innovation comes from the intersection of disagreements. Personal attacks distracts distract from the isues

[Matt Leroue]

04:58 PM on 03/08/2011

Agreed. These sorts of attacks are unproductive and tend to take away power from the AIDS community. Civilized discourse is necessary for proper advocacy. Wonderful article.

[Anand Reddi]

08:47 PM on 03/08/2011

I appreciate your comments

[sarnelly]

04:57 PM on 03/08/2011

I think this is part of a larger problem that is plaguing the United States. All too often grandstanding half-truths are given preference to honest, civil and productive discourse at the expense of progress.

[Anand Reddi]

08:46 PM on 03/08/2011

completely agree, sarnelly.

[Rosemary Reidy]

04:05 PM on 03/08/2011

excellent article with an important message to remember!

[Anand Reddi]

11:52 AM on 03/09/2011

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