You cannot expect concrete results for your investments without a clear plan of action. So when the United States sets out to help a country tackle its AIDS epidemic, one of the first things we do is insist that a national AIDS plan is in place.
But over a quarter-century into the AIDS epidemic, we still don't apply that same logic here at home, and we have just the kind of results you would expect.
New HIV infections have remained at 40,000 a year for more than a decade — one new infection every 12 minutes. The outcomes in treatment are no better. The latest estimates are that only about half of Americans who have HIV are receiving appropriate medical care.
The stark racial disparities that characterize our country's AIDS epidemic are a continuing national shame. Half of all new HIV infections are among Black Americans, though Blacks represent only 13 percent of the population. And Black Americans who have HIV disease have not seen equal benefits from AIDS treatment. Between 2000 and 2004, deaths among Whites living with HIV declined 19 percent, compared to 7 percent for Black Americans. How can a country that spends $18 billion a year on its domestic AIDS epidemic tolerate such miserable outcomes for its own citizens?
There is no easy fix for America's AIDS epidemic, but we can make a start by refocusing our sights on improved outcomes and developing a comprehensive strategic plan to achieve them. A national AIDS plan would set targets for lowered HIV incidence and expanded access to HIV care and require the government to report annually on progress toward those goals. A strategic plan would force the public health establishment to clearly define the barriers to better outcomes and then outline specific steps to address those barriers.
A true national strategy will need the ongoing involvement of many sectors of society. And though a national plan must serve all Americans, it will need to focus its attention on the epidemic in Black communities. There can be no significant improvement in HIV/AIDS unless government programs better serve the needs of Black Americans.
A national AIDS strategy is no panacea. More important are increased resources for programs like the CARE Act and AIDS housing, along with removal of co-pays and benefit caps on Medicaid services. Expanded access to needle exchange programs, condoms in prisons and comprehensive sex education would reduce the number of new infections.
All these programs, and many others, deliver results every day and they need our support. But in addition to defending good programs we need to start demanding better outcomes. AIDS has become a devastating and chronic health affliction in our country, a disaster we could have avoided but still have the means to address with greater ingenuity and effectiveness, and with steadily improved results.
Chris Collins is author of the new report "HIV/AIDS Policy in the United States," published by the Public Health Watch project of the Open Society Institute.
