On Tuesday, Secretary Clinton delivered a strong and welcome speech on global HIV/AIDS. Referencing the potential of new, game-changing research on HIV prevention, she called for an “AIDS-free generation” and recommitted the U.S. government to doing its part. At a time of stagnating budgets and threats to foreign aid, her strong support for ramping up the fight was good news.
At the heart of the speech was a pitch for “combination prevention” that will include prevention of mother-to-child transmission, voluntary medical male circumcision, and treatment for HIV infection. All three have been proven to dramatically reduce the spread of AIDS. Clinton played up the cost effectiveness angle. I’d point out that all three also hit the sweet spot of left-right political support. Under the Bush Administration, Republicans led the call for an historic and dramatic expansion of treatment. Will they do it again?
Three items of note:
- Hello, Ellen. Ellen DeGeneres will be the new Special Envoy for Global AIDS Awareness. Presumably her job is to help the American people understand why we spend more than $6 billion a year on global HIV/AIDS – and why they should feel good about it.
- Clear support for the Global Fund. The U.S. is the single largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria and made its first multi-year commitment under Obama’s watch. This year the Fund has come under fire for corruption that its own auditors discovered and addressed. On this front, Clinton got it right: “Let’s remember, uncovering problems is exactly what transparency is supposed to do. It means the process is working. So let’s not put the Global Fund into some kind of catch-22. Go be transparent, go be accountable, and when you find problems, we’re going to take money away from you. Now, from day one, the United States Congress has insisted that our contributions to the Global Fund support accountable programs that produce measurable outcomes. And it’s been my experience that the American people are happy to support lifesaving programs if they know they really work. And this is how we show them.”
- Uganda, take note. Clinton notes that the U.S. will work to repeal “laws that make people criminals simply because of their sexual orientation.” This is good news. And lest we think “combination prevention” is too narrow, Clinton was careful to note that the three main interventions work in concert with an array of services, such as condom use and addressing gender-based violence.
What was missing?
- No new money and no new targets. It’s not surprising that Clinton wasn’t in a position to promise new money as the future of foreign aid is under active debate by the congressional “Super Committee” and others. While Clinton spoke of an expansion of those on treatment, it as yet unclear how much the U.S. will take on and how much it will ask of others.
- Only passing recognition of marginalized, at-risk populations. Sex workers, injection drug users (IDUs) and men who have sex with men (MSM) are disproportionately at risk of contracting HIV and far less likely to have access to prevention services and treatment. The promise of “treatment as prevention” is particularly hollow for members of these groups, as criminal laws and discrimination drive them into prison instead of clinics. Under Clinton, the State Department issued excellent guidance for programs addressing both MSM and IDUs but much more needs to be done to implement these policies. The U.S., for example, supports syringe exchange on paper, but has yet to fund a single syringe abroad to help a drug user avoid HIV infection.
- No mention of the International AIDS Conference. Washington, DC will host more than 25,000 people from around the world in July 2012 for the world’s largest public health conference on HIV/AIDS. It’s the first time the conference has been in the U.S. in 20 years and it falls a few months before the next Presidential election. The U.S. has a lot to be proud of on HIV/AIDS, but the potential for contracting budgets could turn a love-fest into a protest.
The Administration says that Clinton’s speech was the first in a series by high-level Administration officials. Let’s hope they keep pushing for the programs people deserve and a plan for an “AIDS-free generation” we can all embrace.
Read the full text of Clinton's speech: http://www.state.gov/secretary/rm/2011/11/176810.htm