Page 2 The Skanner May 10, 2017
Challenging People to Shape
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Opinion
Stay True to the National HIV/AIDS Strategy
By Judith Auerbach, Rob-
ert Bank, Chris Collins, JD
Davids, Rebecca Haag, David
Ernesto Munar, Dana van
Gorder, Phill Wilson and A.
Toni Young (Original Conve-
ners of Coalition for a Nation-
al AIDS Strategy)
T
en years ago, hundreds
of organizations and
individuals signed a pe-
tition calling on all pres-
idential candidates to create
a national AIDS strategy. We
knew the approach to HIV in
the U.S. had to change. If you
read about AIDS in the pa-
per, then it was likely about
the horrifying scale of the
global epidemic; the epidem-
ic at home had largely be-
come invisible. The national
HIV response we saw was a
patchwork: uncoordinated,
without clear goals, under-
invested where the challenge
was most acute, with inter-
ventions delivered well below
the scale necessary for im-
pact. And the science of HIV
prevention was changing dra-
matically without sufficient
efforts to put it into practice.
By the end of 2007, most
presidential candidates, in-
cluding John McCain, Hillary
Clinton and Barack Obama,
had accepted the challenge to
create a strategy. In June 2010,
President Obama issued the
first comprehensive Nation-
al HIV/AIDS Strategy for the
United States.
Five Things We Learned
From Implementation of the
National HIV/AIDS Strategy
1) A commitment to being
strategic provides political
cover to do tough things.
The Strategy itself was full
of smart analysis of the epi-
demic and laudable goals, but
its real impact came in how it
was used. With strong lead-
ership by Jeff Crowley, head
of the White House Office of
National AIDS Policy (ONAP),
and his deputy Greg Millett,
a series of epidemiologically
necessary but politically chal-
lenging policy innovations
were undertaken, each justi-
fied by the new Strategy.
This included:
• Increased investment in
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2) Changing the conversa-
tion is important, and it’s
just the first step.
The Strategy helped put
the domestic epidemic back
on the radar and galvanized
the AIDS services communi-
ty around a new approach to
tackling the epidemic focused
on epidemiologic impact. Be-
yond assuring the availability
of services, the focus shifted
to outcomes, and people asked
how a policy would lead to ac-
complishing the Strategy’s
prevention and treatment
House to own the Strategy
because we wanted the gov-
ernment to be responsible
for follow-through. But it all
started with the communi-
ty. And that meant that AIDS
service organizations were
ready to engage creatively
with the government when
the nation embarked on a
more outcomes-oriented ap-
proach full of hard choices.
As the Strategy said, “The job
... does not fall to the Federal
Government alone. ... Success
will require the commitment
of all parts of society[.]”
targets. Conversely, observ-
ing that an approach would
fail to advance the Strategy’s
goals was now a tool to fight
bad policy. Using the “care
continuum” as a framework
for assessing service deliv-
ery helped bring focus to the
Strategy goal of greater equi-
ty.
All of these were advanc-
es, but they only took us so
far. The Affordable Care Act
(ACA) -- which led to a marked
increase in Medicaid cover-
age among people living with
HIV -- as well as increased
investments in appropriate
services expanded access to
lifesaving and infection-pre-
venting measures.
4) It takes amazing science
and the commitment to de-
liver its results to everyone.
The outcomes of HIV/AIDS
research have been phenom-
enal, turning a deadly disease
into a chronic, manageable
condition in the space of a
couple decades. When we
were working on the strat-
egy effort, we had inklings
of the potential efficacy of
“treatment as prevention”
and pre-exposure prophy-
laxis (PrEP) to prevent both
transmission and acquisition
of HIV.
When rigorous, multi-site
clinical trials proved these ap-
proaches did work, it changed
what was considered possi-
ble, and scientific and policy
leaders in the U.S. and around
the world now said we had the
opportunity to “end AIDS.”
Soon, in places such as New
York and San Francisco, ac-
tivists, scientists and officials
took up the challenge.
3) It matters that the effort
grew from the community.
We wanted the White
Read the rest of this commentary at
TheSkanner.com
The science of HIV prevention
was changing dramatically with-
out sufficient efforts to put it into
practice
HIV prevention for gay
men, which had been seri-
ously under-financed rel-
ative to that population’s
share of the epidemic.
• A new, “high impact” ap-
proach to HIV preven-
tion
emphasizing
evi-
dence-based programming
at scale.
• Reallocation of funds to ar-
eas of the country most af-
fected by HIV.
• Streamlining of data re-
porting to track progress
more effectively.
A new emphasis was placed
on federal agency coordina-
tion that has shown some suc-
cess and remains a work in
progress, as well on the most
affected communities, which
are now at the leading edge of
Climate Change Is Creating Climate Refugees
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progress in the U.S. response.
ave you ever heard of
the Marshall Islands?
They are 1156 islands
that constitute a repub-
lic in the South Pacific. Major
battles during World War II
were contested on those is-
lands and, following the war,
nuclear tests were conduct-
ed on there, too, from which
there was significant radio-
active fallout. The capital city
is only three feet above sea
level.
I have never been to the
Marshall Islands, but during
the People’s Climate March
in Washington, D.C., on April
29, I met and interviewed a
woman from that republic.
She is a student in the United
States. She and I spoke on the
air (WPFW-FM, part of the
Pacifica Network) about what
the climate crisis means for
her people.
Climate change has a di-
rect impact on the future
of the Marshall Islands. At
three feet above sea level, the
Marshall Islands do not have
much room to maneuver.
With extreme environmental
Bill
Fletcher Jr.
The Global
African
changes, particularly with
damaging storms, the islands
have faced severe floods. She
described roads cut off as a
result of high water and the
inability of the people to leave
their homes.
“
what they needed to do to sur-
vive. And one route to sur-
vival will inevitably be migra-
tion unless there is some sort
of creative infrastructure
work that can preserve life in
the Marshall Islands.
And it is this matter of cli-
mate migration that is rare-
ly discussed in mainstream
circles. Certainly, the envi-
ronmental movement is ad-
dressing it, but in the 2016
U.S. elections, for instance, in
all of the xenophobic discus-
sions concerning immigra-
There is a global necessity to ad-
dress the future of islands that
may become submerged
My co-anchor — he great
sportswriter Dave Zirin —
and I asked, almost at the
same time, what did she think
would happen as sea levels
rose? What would the people
do?
In some respects, our ques-
tion may have seemed odd or
simplistic. The people of the
Marshall Islands would do
tion, there was no discussion
about the fact that island na-
tions across the planet will be
disappearing and that their
populations will need to mi-
grate somewhere.
The woman from the Mar-
shall Islands that Dave and I
interviewed wants to return
to her home. She is trying to
be optimistic about the future
of that island republic, but she
was clearly frightened by the
possibility that those islands
and their history will disap-
pear beneath the ocean waves
forever.
The debate concerning the
environment and the debates
around immigration must
be joined together. There is
a global necessity to address
the future of islands that may
become submerged. Many of
these islands were once—or
continue to be—possessions/
colonies of Europe, Japan and/
or the United States. In that
sense, there is a historic ob-
ligation that is owed to these
islanders by the so-called
“Global North.” The Global
North left many of these terri-
tories “underdeveloped”—to
borrow a phrase from the late
Walter Rodney—and now the
bill has come due. That means
that, in addition to assisting
in preventive measures, and
in addition to addressing cli-
mate change, immigration
policies must be changed, so
that space is created for these
climate refugees.