At Conference, Sec’y Sebelius Confronts Urgency of HIV Prevention

by Kilian Melloy

EDGE Staff Reporter

Wednesday August 26, 2009

The U.S. Secretary of Health and Human Services addressed a convention of health experts who have convened in Atlanta for this year's National HIV Prevention Conference.

With more than 3,000 attendees expected at the Aug. 23-26 event, Secretary Kathleen Sebelius addressed an audience on the topic of renewing the fight against HIV/AIDS here in the United States, using proven techniques from a program initiated under George W. Bush to fight the disease in Africa.

Secretary Sebelius made her speech on Aug. 24, after being introduced by the new head of the Centers for Disease Control and Prevention (CDC), Dr. Thomas Frieden.

Secretary Sebelius told the crowd, "Six years ago, the United State announced the most ambitious plan to fight global HIV/AIDS in the history of the world. This plan combined a new level of focus, new funding, and a new commitment to using proven approaches."

Noting that the program, called PEPFAR, has been a "great success," Sebelius' speech went on to acknowledge that the fight here at home has "stalled."

"In 2006, more than 56,000 Americans were newly infected with HIV, a rate that has been stable over the past 10 years.

"Because HIV infection is fatal if not treated--and its transmission can be prevented with proven interventions--this isn't just a statistic. It's a tragedy," Sebelius continued.

"If the results aren't changing, our actions have to," the Secretary's address went on.

"That's why one of the first things President Obama did after he took office was to begin developing the first-ever National HIV/AIDS Strategy.

"This strategy will take a page from the successes of PEPFAR--a new level of focus, and a new commitment to proven approaches--and apply it to HIV/AIDS here in the US."

The address continued, with Sebelius noting that despite the quarter-century duration of the AIDS epidemic, Americans seem to have lost a sense of urgency about the disease.

"At a time when more Americans than ever are living with HIV/AIDS--an estimated 1.1 million--fewer Americans are worrying about it," the Secretary observed.

"We're at a turning point as a country," the Secretary went on. "Either we choose to get used to HIV/AIDS... to accept that it is a permanent feature of society... to be satisfied with lengthening lives instead of saving them.

"Or we decide to double our efforts and start bringing the number of new infections down. President Obama has chosen the second course, by calling on us to focus our efforts on reducing HIV incidence, getting all people living with HIV into care, and working to reduce HIV-related health disparities."

The Secretary said that among the new plan's initiatives is a new focus on concurrent health issues, such as substance abuse.

At the same time, research is going to continue into new treatments, the Secretary said.

And although critics have questioned the wisdom of continuing to fund efforts to create a cure or a vaccine against HIV, the Secretary indicated that a vaccine would still be pursued by researchers.

Critical services for those living with HIV/AIDS would also continue, the Secretary said, as would efforts at education and prevention.

"We're looking for opportunities to increase our effectiveness in all of these areas," Secretary Sebelius said.

"For example, we know that testing is one of the keys to stopping the spread of HIV/AIDS. We also know that it's a key to lengthening the lives of people living with HIV, since the earlier you learn your HIV status, the earlier you can start taking steps to protect your own health and reduce the risk that you will transmit HIV to others."

Secretary Sebelius said that HIV testing would be offered as part of routine health care. Testing would not be mandatory, however.

The Secretary also said that a new domestic focus would be brought to the Presidential Advisory Council on HIV and AIDS (PACHA).

"We hope this council will be a platform to share our plans and insights with the public health community and the broader public," Secretary Sebelius told the audience. "But we also hope that it will be a vehicle to carry your ideas back to us.

Secretary Sebelius also announced that the CDC had started a new program.

"Act Against AIDS is a $45 million investment over five years to let Americans know that the threat of HIV/AIDS isn't going away," the Secretary said.

"That effort will focus on underserved communities to include racial/ethnic minorities, women and gay and bisexual men."

Added Secretary Sebelius, "We're targeting our efforts at high-risk groups like African Americans.

"Today, African Americans make up just over a tenth of the population. But they account for nearly half of new HIV infections.

"One in 30 African-American women will be diagnosed in her lifetime. One in sixteen African-American men will be diagnosed with HIV.

"In 2005, the CDC reported that in five major cities, almost half of all African-American gay men were HIV-positive," the Secretary went on. "The situation is also dire for Latinos."

Sebelius invited the audience to think about the problem in a different way. "Imagine if it were half the straight white women in Atlanta. Wouldn't we be calling this a national emergency? Shouldn't we be?

"That's how we at HHS are treating it."

In order to make such new programs effective, Secretary Sebelius noted, apathy and ignorance have to be countered with education, and social stigmas must be eradicated.

"There are people who don't get tested because they're afraid they could get beaten up or lose their place to live if the test comes back positive," noted Secretary Sebelius.

"They don't pick up a flyer about treatment because they're afraid if they're seen with it, someone will make a judgment about their sexual orientation or their drug use.

"Because we care about all of our friends, families, and neighbors, we need to send a message that HIV/AIDS may be a serious condition, but we have the knowledge and tools to help people live successfully with this condition."

The Secretary also promised that the so-called "HIV Entry Ban" that bars foreign nationals from visiting or emigrating to the U.S., and which has come under sharp criticism, would finally and definitively be eliminated before year's end.

Although the ban, enacted in the 1980s, was struck down by legislation signed by then-President Bush before he left office, immigration regulations still present a bureaucratic hurdle to HIV+ individuals seeking to enter the United States.

This rule led to 60 Canadian individuals who intended to go to a June conference on HIV/AIDS in Washington, D.C., being barred entry.

Secretary Sebelius noted, "The more accepted people with HIV/AIDS feel, the more open they are about their HIV status. The more open people can be about their HIV status, the more likely other people are to get tested. The more likely people are to get tested, the slower the spread of HIV.

"It's a virtuous cycle and it starts with ending the stigma."

Secretary Sebelius also addressed health care reform in the context of providing care and prevention.

"The President's plan to expand coverage and improve our health insurance system has some clear benefits for Americans living with HIV/AIDS.

"For example, it would end insurance company discrimination based on preexisting conditions, which would give people more insurance options," Sebelius told the audience.

"It would also cap out-of-pocket expenses, which can quickly add up even for people living with HIV who have health insurance.

"Reform will be helpful for Medicare beneficiaries with AIDS. Right now, the high cost of HIV medications leaves people with HIV/AIDS with income too high for the low-income subsidy with thousands of dollars of out-of-pocket expenses--or potentially treatment interruptions if they cannot pay for their drugs.

"But as part of reform, we are working with the drug manufacturers to provide assistance to mitigate that coverage gap in the Medicare prescription drug program."

The Secretary then gave an indication as to just how serious the problem of new HIV infections is in the U.S.

"When you do the math on new HIV infections, it turns out that one American gets infected with HIV every nine and a half minutes.

"That means that since I started talking, another two Americans have acquired this fatal and totally preventable disease."

With that observation, Secretary Sebelius introduced a commercial created to promote the Act Against AIDS campaign, a spot titled "Nine and a Half Minutes."

The gathering will be the site of more than 700 presentations and an array of special sessions to address topics associated with the domestic spread of HIV/AIDS.

But of all the medical advances in the past quarter century, prevention may have done more than anything else to protect Americans, from comprehensive sex ed to condom distribution.

"It is estimated that prevention efforts have averted more than 350,000 HIV infections in the United States to date, and saved more than $125 billion in medical costs alone," reported Medical News Today in an Aug. 25 article.

Kilian Melloy serves as EDGE Media Network's Associate Arts Editor and Staff Contributor. His professional memberships include the National Lesbian & Gay Journalists Association, the Boston Online Film Critics Association, The Gay and Lesbian Entertainment Critics Association, and the Boston Theater Critics Association's Elliot Norton Awards Committee.