Obama’s HIV/AIDS Strategy: Real Change or Pocket Change?

We welcome a guest post today from Jennifer Brier, author of Infectious Ideas: U.S. Political Responses to the AIDS Crisis. When the Obama administration announced a new HIV/AIDS strategy, we asked Brier to unpack the news and help give historical perspective to the new plan.–ellen

Reading President Obama’s new HIV/AIDS strategy, released on July 13, 2010, was alternately exciting and maddening for me as a historian of the global AIDS pandemic. It pleased me because it contained language that recognized the ways that structural inequalities shape the HIV/AIDS epidemic – ideas I had not seen in government-produced material about HIV/AIDS over the last ten years. But at the same time, the strategy disappointed me because it made no commitment to increasing resources to combat the HIV/AIDS epidemic in the United States.

In looking to the last thirty years of governmental responses to HIV/AIDS for comparable models that combined representations of HIV/AIDS as more than a medical condition and unwillingness (or inability) to devote proportional resources to implementing social and political solutions, curiously I was more drawn to the example of policies that emerged at the end of the Reagan administration than to anything produced in the Clinton administration or George W. Bush’s President’s Emergency Plan for AIDS Relief (PEPFAR) implemented in 2004.

With consistent and plentiful references to the needs of men who have sex with men, gay men and transgender people, Obama’s AIDS Strategy begins to acknowledge the realities of our sexual and gendered lives. Obama’s vision statement reads:

“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

The implication of the passage is that the government is prepared to provide for its citizens, particularly those who have historically had the least. But the document does not so much provide; instead it recognizes the intersections of identity categories, particularly race and sexuality. A striking example of this is in the discussion of HIV among African American men.

“Fighting HIV among African Americans is not mutually exclusive with fighting HIV among gay and bisexual men. Efforts to reduce HIV among Blacks must confront the epidemic among Black gay and bisexual men as forcefully as existing efforts to confront the epidemic among other groups.” (13)

Without pretense, the strategy marked with the presidential seal not only acknowledges the existence of black gay and bisexual men, but more important, suggests that these men, working along side gay men of all races, have a role to play in fighting the homophobia and racism that have been at the center of the HIV/AIDS epidemic since its inception.

That said, the representation of a range of people affected by and infected with HIV was not enough to counter my profound disappointment in the strategy’s refusal to devote more resources to the fight against AIDS.

“Access to HIV prevention is too limited: HIV prevention services have never been sufficient to reach all people at risk for HIV. Since Federal resources are limited and many States have reduced HIV prevention budgets in response to the economic downturn, we need to do a better job of evaluating and allocating existing resources based on their demonstrated health impact.” (7)

The more I thought about the historical antecedents to this document, in terms of its argument about AIDS and inequality as well as its position on resources, the more I returned to the projects funded by United States Agency for International Development (USAID) at the end of the Reagan administration and the beginning of the first Bush administration. Designed to arrest the spread of HIV/AIDS in the global South, USAID contracted with a range of public health providers, particularly academics from U.S. universities, to create local policy responses that dealt with AIDS in conjunction with poverty, reproductive health, and the effects of colonialism. Unlike most of the contemporaneous policies that dealt with HIV/AIDS in the United States, this work reflected the sexual realities that people in a range of postcolonial countries faced and it refused to simply blame “cultural difference” for why people contracted HIV.

These projects–perhaps because of their far-reaching goals–were chronically underfunded in ways that seem akin to the proposals made in the Obama strategy. More pointedly, as I argue in Infectious Ideas, it was because these projects were not provided with sufficient resources that the academics and public health workers who staffed them could do the kind of work they did. In the late 1980s, during a period of conservative ascendency, I saw this AIDS work as a place where progressive ideas about AIDS found voice, albeit a very soft one.

Hearing a similar position articulated by Obama’s HIV/AIDS advisors potentially suggests something similar. Not only do we see how far-reaching the conservative attack on state-funded universal health care has been (maybe this moment in history is best described as a period of conservative ascendancy as well), but we see also that Obama has been unwilling and unable to put money where his mouth is and in the process made change more difficult. Ultimately the HIV/AIDS strategy begs the question of how Obama will garner the necessary resources for ideas and policies that actually counter the conservatism of this era, particularly the seemingly relentless attack on the expansion of a health safety net.

Jennifer Brier is assistant professor of gender and women’s studies and history at the University of Illinois at Chicago.