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HIV policy should be lauded

BY DI EDITORIAL BOARD | JULY 28, 2010 7:20 AM

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With one in 17 Iowans living with HIV/AIDS on the waiting list for life-saving drugs — and state officials predicting these grim statistics to worsen: 2009 repeated 2007's record number of new HIV infections — President Obama's new strategy is just what we, as a state, need.

While Iowa still has a relatively low number of HIV cases, contributing only 0.3 percent of the nation's number, recent increases concern public-health officials. Particularly unnerving is the jump in infections among African Americans, men who have sex with men, and Latinos.

The DI Editorial Board, therefore, was pleased when the Obama administration unveiled a national HIV/AIDS strategy on July 13. The new strategy has a three-pronged set of goals: "Reduce the number of people who become infected with HIV; increase access to care and optimize health outcomes for people with HIV; and reduce HIV-related health disparities." All of these are of course, laudable, but the proposed implementations are even more interesting; they involve direct collaboration with at-risk communities and improved protections to those who have the virus.

In many ways, this is the approach to HIV/AIDS we've been looking for, an approach that focuses on the human needs of those caught up in the epidemic. It takes a solid first step toward a coordinated response to the continuing crisis, and we hope that its small budget will not limit its effectiveness.

Randy Mayer, the chief of the Bureau of HIV, STD, and Hepatitis at the Iowa Department of Public Health, said he is "cautiously optimistic" about the new strategy: "It's great that we have a national strategy. In many ways, it lines up with the steps we have already taken in Iowa."

One provision we throw our support behind is the fight against HIV/AIDS-related discrimination. The Obama administration's strategy advises that inquiries be launched into improving enforcement of the Americans with Disabilities Act, which explicitly includes people with HIV, symptomatic or not. The DI Editorial Board feels that continued disenfranchisement of HIV-positive individuals only marginalizes them further and hinders the open communication necessary to curb the spread of the virus.

Obama's AIDS strategy is daring, to say the least. Along with the matters already discussed, it mandates effectiveness evaluations every five years, community input into prevention plans, job assistance, and new Medicaid waivers allowing pre-disabled people access to antiretrovirals they might not be able to afford otherwise — relieving the overburdened AIDS Drug Assistance Program.

The requested federal budget for the next fiscal year allots $27.2 billion to fund new antiretroviral research, new statistics on HIV prevalence in underserved demographics, free HIV testing for substance abuse patients, and greater mental-health services for those in communities hard-hit by the epidemic.

Many of the measures in the national strategy are simply bureaucratic changes or calls for greater communication. These can be undertaken for cheap or free — they're just shifts in how agencies communicate on local, state, and federal levels. But somewhere along the line, money will come into play. The national strategy is couched in the idea that shifts in funding focus will allow for the suggested provisions and that funding will be allocated to areas and communities with the most need.

Which brings us to our one concern with Obama's HIV/AIDS initiative: that these excellent strategies won't quite reach Iowa. Iowa may have a small number of cases, but the recent increase in diagnoses demonstrates a real need for inclusion in the national plan.

"If you allocate public funding by geographic area, low-incidence states don't seem to be winners," Mayer said.

The DI Editorial Board hopes that positive effects of the new national strategy don't pass Iowa by.


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