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Anand Reddi Headshot

United States Domestic AIDS War Is Falling Apart

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Today we commemorate World AIDS Day. We watched the HIV virus devastate our country in the 1980s and then watched again when it devastated mothers and children in sub-Saharan Africa. We listened to our moral conscience to intervene and today as Americans we should be proud that our government is leading the fight to eradicate the AIDS pandemic globally. However, sadly and unbeknownst to many in the U.S., some of our fellow citizens are experiencing AIDS treatment rationing.

As of Nov. 17, 6,595 Americans in 12 states are on waiting lists for HIV drugs. Austerity measures enacted by the federal government have limited the ability of the AIDS Drug Assistance Program (ADAP) to provide the necessary funds to help state governments purchase HIV medications for their low-income citizens. ADAP serves over 150,000 individuals, accounting for roughly one-third of people on AIDS treatment in our country. However, ADAPs can no longer provide HIV treatment to all of the people who need it.

The problem just got worse. Since the Congressional supercommitee failed to agree on a deficit-reduction package, automatic funding cuts starting in 2013 will affect the 500,000 HIV-infected people currently receiving aid through the Ryan White HIV/AIDS Program. Ronald Johnson, vice president of policy and advocacy at AIDS United, said "automatic cuts would be devastating."

Delaying HIV treatment not only increases overall healthcare costs but also endangers the nation's public health. Immediate provision of HIV antiretrovirals leads to better treatment outcomes and fewer costly hospitalizations. Additionally, a recent study in the New England Journal of Medicine demonstrated that the provision of antiretroviral treatment to patients living with HIV reduces the risk of transmission to a partner by 96 percent.

How can the richest nation in the world and the largest provider of global AIDS funds neglect the needs of its own citizens? Where is our moral conscience to intervene?

Earlier in the month, Secretary of State Hillary Rodham Clinton declared the U.S. government's intent to create a new global health initiative called the "AIDS-free generation." Secretary Clinton outlined a bold plan to reduce new HIV-infections worldwide, including the eradication of pediatric HIV by 2015. The U.S. government contributes over 50% of the global funds for HIV prevention and treatment initiatives in resource-limited settings. We should celebrate that over 6.6 million people are receiving lifesaving HIV treatment worldwide due to the combined efforts of the U.S. funded Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and the President's Emergency Plan for AIDS Relief (PEPFAR).

But what about a U.S. "AIDS-free generation?"

On World AIDS Day, President Obama should issue an executive order that instructs the Secretary of Health and Human Services to ensure that every American has access to lifesaving HIV medications. Just as the Obama administration committed to boldly reduce new HIV-infections globally, President Obama should make the same pledge domestically.

Given the national tenor for deficit reduction it will not be easy. However there is strong bipartisan support in Congress for AIDS initiatives including a new Congressional HIV/AIDS caucus. We also have lessons from the developing world to reduce the cost of treating HIV. A recent study in the journal AIDS reports PEPFAR delivered HIV care and treatment, on average, for $880 per patient in Africa. Yet, in the U.S. total HIV per-patient costs exceed $20,000 per year. The federal government must not only allocate adequate funding but also work with both the pharmaceutical industry and domestic AIDS managed care organizations to reduce U.S. treatment and delivery costs.

Achieving universal access to HIV treatment is the moral imperative of our time. As a nation, we must insist that President Obama and the U.S. Congress adequately fund both domestic and global AIDS initiatives. As former President George W. Bush wrote on last year's World AIDS Day, "A thousand pressing issues come with each day. But there are only a few that you will want to talk about in retirement with your children. The continuing fight against AIDS is something for which America will be remembered."

The writer was a former J. William Fulbright Scholar assisting the PEPFAR-funded Sinikithemba HIV/AIDS clinic at McCord Hospital in Durban, South Africa. Currently, Mr. Reddi is at the University of Colorado School of Medicine.