International AIDS Funding Is Great, But Problem At Home

Armen Hareyan's picture
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Earlier this week, President Bush signed legislation that authorizes $48 billion over the next five years to be spent around the globe (and particularly in Africa) preventing the spread of HIV/AIDS and providing treatment to those infected. In addition, the money helps treat TB and malaryia, two of the diseases that cause the greatest complications to those infected with HIV/AIDS.

It’s a large and noble commitment from the American government. 1.7 million people are receiving anti-retroviral drugs today, compared with 50,000 in 2003. Along with other G8 nations, there is a commitment to treat 5 million people, and this is a big part of that.

I’m left to wonder, though, what about the estimated 1.2 million people living in the United States with HIV/AIDS. Is our government doing the same for them? It’s tough to tell what is spent domestically since state governments spend in addition to what the federal government allocates. But it is safe to say that as early as February, organizations were blasting the Bush administration for its meager support of Americans dealing with the same disease in the 2009 budget.

What’s alarming is that the government submitted a report to the World AIDS Conference this week that said there were 34,000 diagnoses in 2004 and 37,000 diagnoses in 2005. Previous estimates for 2006 were around 40,000. Today, the government admitted that it had grossly underestimated that number. In fact, there were around 56,000 people diagnosed in 2006 (and admitted that the 2004 and 2005 numbers were probably similar).

Further, while spending on treatment and research (about $22 billion at the federal level) has soared, spending on prevention is about $700 million - a number that is virtually unchanged since 2001. This is something hard to prevent, and perhaps it has grown less frightening given the effectiveness of drugs. We’re seeing people infected with HIV and AIDS live stronger and longer all the time which is great.

The problem is, as people live longer and healthier, the risks associated with HIV/AIDS get less attention and the prevention messages are harder to get through. And for all we know about HIV at this point, the only ways to prevent transmission rely entirely on human decision making in situations where judgment is often compromised.

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Needle exchange programs don’t exactly reinforce positive behavior. And for those with the greatest addiction and the greatest risk, the judgment decision of “should I use this needle or not” has to be completely obscured by the prospect of a fix. You don’t run down to the corner market and buy a clean needle, a bag of chips and a 40 and run back to score some smack. It just doesn’t work that way.

As for the majority of the rest of infections? Alcohol, Extacy (and goodness knows how many other drugs), lust, raging hormones and youthful invincibility combine to varying degrees. It’s a wicked combination that can overpower the threat of Chlamydia, Gonorrhea, Herpes, HIV, HPV (the virus that causes cervical cancer), warts, crabs, and pregnancy. It’s easy to see how it happens.

And I haven’t even mentioned the fact that most of us guys don’t like condoms to begin with. Changing behavior is hard. Changing behavior when some part of all of the above factor against you? Damn.

Given the cost of treating and caring for all the conditions, $700 million seems like a paltry investment in prevention. Granted, I’ve got no idea how to convince people to use condoms, especially given the social stigma against talking about sex. It’s not like we have celebrity spokespeople for safer sex. America’s “moral sensibilities” would never go for mainstream advertising. Can you hear the Puritans and Catholics howl?

When the moment of truth rolls around and people are about to hook up, be it in the alley, back seat, cheap motel, park, kitchen table, shower or bed, part of the decision has to have been made. Before the clothes start coming off, the condoms had to be bought (or picked up). The odds of someone putting the brakes on long enough to run down to the 7-11 for rubbers and lube are only marginally better than the junkie going to find the clean needle.

And for those that have the condoms but don’t use them? How do you communicate the risk/reward when the reward is - some would argue - a diminished experience and negative test results that come back negative. It’s a really dicey sociological/psychological challenge, and I don’t think $100 billion would solve the prevention problem entirely.

I guess it is kind of like wearing a seat belt. You don’t really pay the consequence for not doing it until it is too late. And while they’ve legislated seat belt use and only increased usage to 82%, you can’t exactly legislate condom usage considering it’s even less enforcable than the seatbelt law. There’s no annoying dinging sound and flashing red light when you go at it without a condom - and some say that both feel better. Officer friendly isn’t looking over your shoulder, ready to write a ticket, either (although it might be a fantasy for some).

The easy answer? There isn’t one. The best idea until there is a better one? Wrap it up.

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