A New National Strategy?

You’ve probably heard that the White House Office of National AIDS Policy just issued the National HIV/AIDS Strategy for the United States. Like many similar documents, it’s full of lofty language about all the marvelous things the federal government might consider doing to address the HIV epidemic. Those of you with a cynical side might be tempted to roll your eyes and throw the document out the window after reading no further than the “Vision for the National HIV/AIDS Strategy” which functions as the plan’s preamble: “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.” Heck, all people with seasonal allergies will never have “unfettered access” to health care in America.

(And yes, we know the feds should have included a comma after “rare” and deleted the comma after “circumstance,” but apparently the budget crisis is so severe they couldn’t afford a copy of Elements of Style. But we digress.)

As idealistic (and admittedly laudable) as this “vision” is, it also sends a critical message to those working to end the HIV epidemic: stigma and discrimination must be defeated before we can claim to have conquered this disease. In a nutshell, that’s why AIDS Legal Council exists.

The document is also somewhat remarkable in its tone. It’s one of the few government-generated reports about HIV that bends over backwards to remind readers that people with HIV are “us,” not “them,” and furthermore that HIV is a national emergency whether or not you happen to know someone with HIV. The executive summary eloquently makes the case:

“Our national commitment to ending the HIV epidemic … cannot be tied only to our own perception of how closely HIV affects us personally. Just as we mobilize the country to support cancer prevention and research whether or not we believe that we are at high risk for cancer, or just as we support investments in public education whether or not we have children, success at fighting HIV calls on all Americans to help us sustain a long-term effort against HIV.”

We couldn’t have said it better ourselves. And we talk real good.

Perhaps the most surprising aspect of the document is the way it links ongoing stigma to the existence and enforcement of criminal HIV transmission laws. It begins by pointing out that public health policies depend upon the cooperation of affected populations, and that “people at high risk for HIV cannot be expected to, nor will they seek testing or treatment if they fear that it would result in adverse consequences of discrimination.” It goes on to say (and pardon us if we quote at length):

“At least 32 states have HIV-specific laws that criminalize behavior by people living with HIV. Some criminalize behavior like spitting and biting by people with HIV, and were initially enacted at a time when there was less knowledge about HIV’s transmissibility. Since it is now clear that spitting and biting do not pose significant risks for HIV transmission, many believe that it is unfair to single out people with HIV for engaging in these behaviors and should be dealt with in a consistent manner without consideration of HIV status. Some laws criminalize consensual sexual activity between adults on the basis that one of the individuals is a person with HIV who failed to disclose their status to their partner. CDC data and other studies, however, tell us that intentional HIV transmission is atypical and uncommon. A recent research study also found that HIV-specific laws do not influence the behavior of people living with HIV in those states where these laws exist. While we understand the intent behind such laws, they may not have the desired effect and they may make people less willing to disclose their status by making people feel at even greater risk of discrimination. In some cases, it may be appropriate for legislators to reconsider whether existing laws continue to further the public interest and public health.”

Talk about food for thought. And food for advocacy.

If you want to read the whole document, it’s here.

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