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Recommendations submitted by Treatment Action Group to President Barack Obama on ways to strengthen the struggle to end AIDS

Demonstrate Strong Domestic and Global Leadership

TAG urges President Obama to make fighting AIDS a national and global priority through personal involvement, public speeches, and swift action. His administration must act immediately to implement a comprehensive national AIDS strategy and preserve the successful PEPFAR (President’s Emergency Plan for AIDS Relief) program. The administration must be steadfast in its commitments to reducing HIV transmission, expanding testing and treatment, and protecting the civil and health rights of all individuals affected by HIV.

Put Research for HIV, TB, and Viral Hepatitis Back on Track

The U.S. National Institutes of Health (NIH) leads global research efforts against HIV and is the world’s largest government funder of research on HIV and related diseases, such as hepatitis B, hepatitis C, and tuberculosis (TB). In 2008 the NIH spent $2.9 billion on HIV research but only about $160 million on TB, the leading killer of people with HIV globally. Even less was spent on hepatitis B and C, two devastating viral infections among people with HIV in the United States. New resources must be committed to the scientific struggle against these diseases.

Funding for the NIH has stagnated during the past five years—a period during which biomedical inflation shrank the value of each research dollar by 20%. The funding drought has hurt all biomedical research, including AIDS research. This puts an entire generation of young scientists at risk of being unable to fulfill their ambitions to make the medical breakthroughs needed to develop better treatments, cures, and vaccines.

TAG recommends that the Obama administration commit to at least five years of 15% year-on-year growth of the overall NIH budget (for fiscal years 2010–2014) in order to regain the momentum achieved between 1998 and 2003, when the NIH budget doubled.

The administration should protect and support a strong Office of AIDS Research at the NIH to ensure that the nation’s investment in AIDS and AIDS-related research responds to scientific opportunities and is well-coordinated across the 27 NIH institutes and centers.

Our nation’s AIDS research enterprise must balance efforts to achieve the longterm goal of a cure and a vaccine for HIV with research efforts on shorter-term goals, such as better treatment and preventive interventions appropriate for a broad range of settings—including resource-poor developing countries. Intensified research is also needed to understand the impact that mass testing campaigns and earlier treatment could have on the transmission and prevalence of HIV worldwide. Despite the achievement of bringing antiretroviral therapy to over 3 million people with HIV who live in developing countries, 30 million others still lack treatment—and more than half of those do not know they have HIV. We still lack treatment regimens cheap enough, powerful enough, and safe enough to be taken for decades without the need for expensive monitoring to prevent the emergence of drug resistance or dangerous side effects.

Strengthen and Integrate Domestic HIV Prevention and Treatment

According to U.S. Centers for Disease Control statistics, in 2006 about 1.1 million Americans were living with HIV; 56,300 people became newly infected. In the same year, 37,852 people were diagnosed with AIDS and more than 14,000 people who had AIDS died. These stark numbers grimly illustrate that support for HIV prevention, testing, and treatment in this country remains insufficient.

The Obama administration must reverse the growing number of new HIV infections in the United States by implementing a fully funded and comprehensive HIV prevention plan as part of a national AIDS strategy. The prevention plan must include safer-sex education for all ages; distribution of condoms and other barrier methods to prevent sexual transmission; full funding for needle exchange, harm reduction, and addiction treatment programs for drug users; and continuing efforts to protect the nation’s blood and organ transplant supplies from HIV and other transmissible diseases.

HIV testing must become a routine and voluntary part of medical care; referrals to affordable treatment must be available wherever HIV testing is carried out. Tighter integration of prevention, testing, and treatment in this country will result in fewer new infections and fewer deaths among those who have HIV.

Special emphasis must be placed on reaching individuals disproportionately affected by HIV in the United States, especially African Americans, gay and bisexual men, Latinos and Latinas, drug users, and the incarcerated. HIV prevention and treatment services are critically lacking for prisoners, detainees, and others incarcerated in state and federal facilities. These services include provision of condoms, clean syringes, and harm reduction education; and care and treatment for HIV, viral hepatitis, and TB.

Strengthen Community Involvement in the Fight against AIDS

President Obama has said that real change comes from the bottom up. We urge the administration to increase support for community-based HIV prevention and service organizations that strengthen community responses to the epidemic—both in the United States and internationally—through mechanisms such as the Ryan White CARE Act and the PEPFAR program. Until there is a cure for AIDS and a vaccine for HIV, the best way to fight the epidemic is by strengthening communities with the information, resources, tools, and treatments they need to prevent HIV transmission and to guarantee the health and rights of all people living with HIV.

Support the Global Fund and Other Key International Organizations

The Obama administration must champion fully funding the Global Fund to Fight AIDS, Tuberculosis, and Malaria—currently facing a $5 billion gap between now and 2010—and keep its promise to contribute our nation’s full share of resources needed by the Fund. The administration should also strengthen its collaboration with the World Health Organization; support incoming leadership at UNAIDS; and join UNITAID, a multilateral funding mechanism established to purchase second-line HIV and TB drugs and diagnostics.

Support Reforms at the IMF

The Obama administration must support International Monetary Fund (IMF) reform of debt- and inflation-reduction policies that limit public sector spending for health and education in resource constrained countries. The administration should urge the IMF to improve transparency and access to information about its decision making and include a greater range of stakeholders in developing policies.

TAG is committed to working with the new administration to ensure that the health and human rights of all people are protected and upheld to the highest possible standards.

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