Legislative Smoke and Mirrors

'And it's one, two, three'what are we fighting for?' 'Country Joe and the Fish Now that the invasion is complete and the occupation of Iraq has begun, is it just me, or does anyone else remember that the primary reason for bombing Iraq'at a cost of $95 billion, killing 2,400 Iraqi civilians, and putting 275,000 U.S. military personnel in harm's way'was that Saddam Hussein, the Iraqi dictator, supposedly had weapons of mass destruction and was an immediate threat to the United States? First we said Iraq had nuclear weapons. Then we said there were biological weapons. Yet to date no significant nuclear or biological weapons have been found, and there is no evidence to suggest that even if Iraq had weapons of mass destruction, it posed an immediate threat to the United States. Given Iraq's inability to deploy conventional weapons, it seems unlikely that it had the ability to launch any weapon from within its borders that could threaten U.S. territories or interests. On April 17 the Centers for Disease Control and Prevention announced a new initiative 'aimed at reducing the number of new infections caused by HIV.' There are approximately 40,000 new AIDS cases and 16,000 AIDS-related deaths reported each year in the United States. Given the changing demographics of the pandemic (more than half of new AIDS cases in the United States are among blacks, and about 30% are among women) and new technology available, it is appropriate to reevaluate our HIV prevention strategies. The CDC should be commended for finally responding to part of what advocacy groups have known and been saying for years'current prevention efforts are not effective enough. But I fear, just like 'Operation Iraqi Freedom' is about neither Iraq nor freedom, the 'Advancing HIV Prevention: New Strategies for a Changing Epidemic' initiative is neither about advancing HIV prevention nor about the changing epidemic. No one can disagree with Health and Human Services secretary Tommy G. Thompson when he says, 'The nature of this epidemic is changing, and it is time to expand our prevention strategies in order to more effectively reduce the number of HIV infections in the United States.' The stated goals of the new CDC initiative are (1) to reduce barriers to early diagnosis of HIV infection and (2) to increase access to quality medical care, treatment, and ongoing prevention services. While the initiative calls for expanded access to HIV testing at nonclinical sites, it also calls for the elimination of the requirement of both informed consent and pretest counseling, allowing doctors to perform procedures on patients without their knowledge as well as perform tests on people without counseling them on what the tests are and what the results mean. This will exacerbate the already suspicious environment in which some patients live and will increase barriers to early diagnosis. Furthermore, the initiative eliminates direct funding to community-level interventions. One of the goals of this initiative, as written in the official CDC statement, is 'preventing new infections by working with people diagnosed with HIV and their partners.' Yet this initiative was designed and announced without any formal consultation with representatives of people living with HIV or any public comment period. Unfortunately, rather than 'expand' our prevention strategies, the new initiative shifts and narrows them. Risk behavior occurs in a cultural and social context. Relying on individual interventions to the exclusion of comprehensive approaches only ignores the evidence demonstrated by effective HIV prevention efforts in other countries. Furthermore, efforts to address smoking, seat belt use, drunk driving, and other health behaviors clearly show that prevention efforts must target communities and social norms to be effective. In the end, the issue here is not whether the goals of this initiative are laudable or not. The issue is, Will the strategies discussed in this plan be effective in preventing new HIV infections? This plan boils down to expanding HIV testing by removing patient protections and privacy. While testing is an important component of any effort to end the HIV pandemic, an HIV test is not a cure. It is not treatment or care. An HIV test alone is not even prevention. Terje Anderson, the executive director of the National Association of People With AIDS, points out, 'While it is essential to increase knowledge of HIV status to support individual and community health, it is equally important that those who test positive have access to medical care and essential services.' The CDC is seeking to identify people living with HIV, while care and treatment services like the AIDS Drug Assistance Program and the Ryan White act are underfunded and the Bush administration is working to gut Medicaid eligibility for people with HIV. This initiative is not designed to expand comprehensive prevention efforts. It is not designed to get people with AIDS into care. It is designed to identify, isolate, and punish. Just like bombing a people into submission does not a democracy make, improving HIV test accessibility does not a prevention strategy make! 'And it's five, six, seven'open up the pearly gates, Well, there ain't no time to wonder why.' Wilson is director of the African-American HIV University, a two-year fellowship program, and founding director of the Black AIDS Institute.