Better than PEPFAR

Now that the President’s Emergency Plan For AIDS Relief has shown some results in global AIDS-fighting efforts, it is time for a similar program at home to address the pandemic at home, writes Dr. Robert Gallo, the scientist who led Amercian efforts to identify the virus leading to AIDS.

His call, in a Washington Post opinion piece today, echoes others, and the parallelism of compensating for long neglect with ambitious plans would seem to promise parallel results.

But we can do better than that. While PEPFAR seeks to fight the epidemic in developing nations by addressing the health and education deficits it has highlighted, we would do better here to seek answers to why this country has more people living with HIV and AIDS than any other developed country. And the result of such introspection should be more than the “inner city” PEPFAR that Gallo discusses.

Such introspection would be timely, in any case, leading as it would to a constructive look at where our health, education, criminal justice, and economic systems have fallen so short of what they should be as to feed an epidemic that flourishes wherever neglect and greed have coexisted.

Rather than duplicate a plan that has limited itself by imposing American ideology on others, with faith-based efforts leading to a contrived emphasis on abstinence from sex it might be an opportunity to see how much better we can do when we face facts.

And the facts are:

• “Education” programs promoting abstinence until marriage don’t work;
• Countries with federally funded needle exchange programs have limited their epidemics
• Rates of HIV and AIDS are as much as five times higher inside prisons and jails than outside, and yet programs addressing risks for infection including substance abuse and mental illness are scarce in prisons as are condoms and peer education. Also missing has been a serious look at what we have gained and what we have lost by locking up more people than any other country;
• There is a link between the epidemic and a housing boom that created homelessness.
• Discriminatory laws, as three states just passed banning same-sex marriage, feed the epidemic.

The epidemic at home has permeated not just our inner cities but our countryside and our suburbs. It is a mobile target, and we would do well as we seek solutions, to look at our entire society .