The Epidemic Continues

President Obama has said he and his administration are seeking input as he works on a national AIDS strategy, and the White House is holding a series of meeting to finalize the new plan.

This is, as much as anything else, a New York City problem. According to the city’s Department of Health, New York remains “the epicenter” of the H.I.V./AIDS epidemic. More than 100,000 New Yorkers are living with H.I.V., accounting for nearly one-tenth of the 1.1 million people living with the disease in the U.S.

According to the city’s H.I.V. Web site, “New York City has the highest AIDS case rate in the country, with more AIDS cases than Los Angeles, San Francisco, Miami, and Washington DC combined. HIV is the 3rd leading cause of death below age 65 in New York City.” 

In an understatement, the department adds, “More must be done.”

Despite a constant increase in the number of H.I.V. infections, Americans’ sense of urgency about H.I.V./AIDS has “fallen considerably,” according to an April 2009 Kaiser Family Foundation report. Many Americans still do not even realize that as many as one-third of H.I.V. infections result from drug abusers sharing used unsanitary needles, and the majority of cases are from unprotected sex. It’s an honest if indelicate statement to point out that most AIDS would be prevented if new and multiple partners used a condom.

The city’s goal, according to Mayor Bloomberg, is “to stop the spread of H.I.V. and other sexually transmitted infections” by “improving access to H.I.V. testing and condoms, and working to promote safer sexual behavior.”

But to be more than a concept, this requires money—not just city and state, but federal money—when all are in short supply. This is Mr. Obama’s challenge.

It’s a tough sell when the entire federal health bill’s budget is being criticized by the right. The city already receives the most federal AIDS support money in the nation—including $40 million a year in Ryan White funding, according to the Community Health Preventive Institute.

But to stop AIDS at its “epicenter,” the city needs help—in the hundreds of millions of dollars range, which can be a combination of federal, state, local and private-sector money.

Eight years ago, Sandy Thurman, the former AIDS czar in the Clinton White House, said, “The sobering truth is that this pandemic is far from over—in fact, it has just begun to unfold.” If only she hadn’t been so right. Thirty-three million people are now living with H.I.V. worldwide. Africa buries 4,400 killed by the disease every day.

Bill Clinton turned up the federal response to the H.I.V./AIDS epidemic, creating the country’s AIDS czar and the National Task Force on AIDS Drug Development, increasing funding and opposing AIDS-related discrimination. Through his post-presidential foundation, the Clinton H.I.V./AIDS initiative has provided medication to more than two million people living with the disease and reduced AIDS drug costs by an incredible 90 percent for children in the developing world.

This year, one million people around the world won’t receive treatment for AIDS, and 2.9 million H.I.V.-positive women won’t receive services to prevent mother-to-child transmission of the disease. We’ve cut polio by 99 percent throughout the world, and we can do the same with AIDS.

The administration must keep Mr. Obama’s repeated promise to fully fund the Global Fund to Fight AIDS—the administration did not request the $2.7 billion in funding for the Global Fund from Congress as the U.S. share of the support agreed to by the G-8. We must not forget the home front.

Weakening the fight against the H.I.V./AIDS pandemic is not trimming fat; it’s putting our country—and our world—at risk. Healthy markets depend on a healthy populace. 

Fighting the AIDS pandemic at home and abroad with prevention, education and treatment is the right choice for the economy and for the health of our citizens. The economic crisis isn’t helping the AIDS fight. As he develops his first H.I.V./AIDS strategy, making the case for additional funding is Mr. Obama’s latest dilemma.

Mr. Koch is a former three-term mayor of New York City and a former U.S. congressman. Mr. Weiner is a former spokesman for the White House Drug Policy Office and House Government Operations Committee and was a legislative assistant to Koch. Mr. Osserman is the president of the Dartmouth College Coalition for Progress.


The Epidemic Continues