Feeling my way as a new RBCer, I have been attempting to discern what readers find interesting of all of the varied content that is posted here. As part of that process I have been looking at the volume of comments per post, which led me to notice that the only post since I started blogging that got no comments at all was Harold Pollack’s words of praise for the new federal needle exchange funding guidelines. RBC readers are following the larger trend in this case: President Obama’s National HIV/AIDS strategy points out that the proportion of the U.S. public who considers HIV/AIDS the nation’s most urgent health problem has declined from 44% to only 6% over the past 15 years.
The costs of complacency about HIV/AIDS are substantial and well-known: Young people born before the greatest horrors of the epidemic do not bother to find out their HIV/AIDS status or to practice safer sex, funding and enthusiasm for prevention wanes, and the financial and human costs of caring for more infections pile up. Complacency also feeds cynicism in some quarters — which I believe does not take sufficient account of how the country has changed since the epidemic started — that most Americans just don’t care about any problem that primarily affects African-Americans, gay and bisexual men, and injection drug users.
Yet I see some benefits to the public’s ennui. Many of us who worked on the needle exchange guidelines about which Harold was so gracious were in a pre-emptive defensive crouch upon their release, in expectation of a culture war blowback. Mercifully, it did not materialize. The lack of press hysterics about AIDS such as we saw in the 1980s gave President Obama and his AIDS Policy team the chance to talk to the country with more nuance and accuracy about how the epidemic has evolved and what steps we need to take. And at a simply human level, the reduction in klieg lights and shouting matches makes it easier for everyone involved to think carefully rather than react viscerally when designing HIV/AIDS policy.
I give primary credit to President George W. Bush for helping end the culture war about HIV/AIDS. After a decade of hand painted “Thank God for AIDS” signs, President Bush showed how true Christians react to human suffering by creating PEPFAR. This remains the largest effort by any country in history to fight a single disease, and two of my Stanford colleagues recently calculated that it has already saved over a million lives. In one stroke, President Bush created humane policy and shattered the meme that there was something Christian about attacking people with AIDS.
President Obama also deserves some credit, although in a way that is less visible outside the beltway. One driver of press and political interest in AIDS over the years has been ongoing infighting between drug czars and AIDS czars. Both in the people he nominated and the tone that he set, President Obama ended the bickering and fostered collaboration in its place. Five years ago, the Vienna Declaration at the World AIDS Conference would have generated front page headlines and dueling quotes from “drug policy people” and “AIDS people”. But today, one reason it sank almost immediately into obscurity is that it’s hard to foment a fight between the AIDS and drug control communities when the White House Drug Policy Office and White House AIDS office are working side by side to lift the ban on needle exchange funding, to expand opiate substitution treatment within PEPFAR, and to help write each other’s national strategies.
All that may seem to be inside baseball seen through the biased eyes of someone who was very recently on the team, but I believe the level of collaboration President Obama has fostered across the AIDS and drug policy offices filters out more broadly through the country in the regular contacts between those two offices and Congress, activist groups, and other stakeholders.
Do these benefits of AIDS’ current low profile outweigh the costs? Absolutely not. In the short term, they have provided a window for good policy relatively free of culture war extremities (and the press and popular attention that it produces) but in the long term we need to find other ways to revive American interest in an epidemic that has claimed the lives of almost 600,000 of our fellow citizens, and millions more around the world.