2011 US Conference on AIDS
November 10, 2011
Thank you, Daniel, for that introduction. It’s great to be back with all of you again.
I want to start by thanking the National Minority AIDS Council for hosting this conference and for your decades of leadership. I also want to thank the AIDS service providers here today for the life-saving work you do every day. And I want to thank all the other advocates, care providers, and policymakers who’ve come here to talk about how we can move forward together in our fight against HIV/AIDS.
Before I begin, I want to say a few words about our departing Director of the Office of National AIDS Policy, Jeff Crowley. Over the last three years, Jeff has been the leader of an effort to bring new energy and new direction to the federal government’s AIDS policies.
When this Administration came into office, our domestic HIV/AIDS strategy was basically to keep doing what we were doing. We weren’t adapting fast enough, agencies and programs weren’t working together well enough, and we had lost some of the urgency we had in the 90s. What the President and Jeff have done – with help from folks from across the Administration and the community – is take us off cruise control, create a new roadmap, and push down on the accelerator.
The result is that we have more momentum behind our domestic HIV/AIDS efforts today than we‘ve had for nearly a decade. And no one deserves more credit for that than Jeff. So thank you, Jeff.
But while we will miss Jeff a great deal, we are also going to make sure that momentum continues. And that starts with carrying out the National HIV/AIDS Strategy he helped craft with the input of many in this room.
Last year, when I spoke to this audience, the Strategy had just been introduced. Working with communities across the country, we had developed a plan that was guided by the latest science, that was focused on where we could make the biggest difference, and that set ambitious but achievable goals. But it was just a plan.
Today, I’m proud to say that those words are being turned into actions. I see it every day in the federal government where our HIV/AIDS efforts have kicked into a higher gear. But what’s even more heartening is to see the states, communities and organizations around the country that are embracing the strategy, including right here in Illinois where they’ve drafted their own statewide strategy aligned with our national efforts.
One of the areas where we’ve made the most progress is targeting our investments so they will make the biggest impact. That means supporting interventions that are proven to have a high payoff like HIV testing, prevention with positives, and condom distribution. It also means putting more resources into the communities with the highest risk.
There is no group of Americans or area of the country that hasn’t been touched by HIV/AIDS. But when gay men make up just a few percent of the population and more than half of all new infections, we need to pay attention. And when African-American women are 15 times more likely to have HIV/AIDS than white women, we need to take that into account. That’s why we’re zeroing in on the communities most affected by HIV/AIDS through efforts like the Minority AIDS Initiative and others across our department.
It’s also why we’re changing the way we allocate HIV/AIDS funding. In the past, the CDC distributed funds based on allocations made in the early years of the HIV epidemic. Under the new approach, we’ll hand out awards based on the current HIV burden, which measures the need today.
I know that this change is challenging for some areas, especially those that will see fewer resources. But this Administration believes that if we want to do more than fight HIV/AIDS to a stalemate – if we want to see new infections actually going down instead of holding steady – then we need to make sure that resources are provided to the areas with the greatest need.
With that said, we also understand that many of you are already stretching to make every dollar count, especially in the last few years. That’s why this Administration has made it a top priority to strengthen funding for HIV/AIDS.
For roughly a decade before the President came into office, HIV prevention funding had been flat. Since President Obama has come into office, that funding has gone up every year – including a $30 million increase last year, even as the overall CDC budget faced significant cuts.
We have also acted aggressively to address the serious problem of state waiting lists for the AIDS Drug Assistance Program or ADAP. In the summer of 2010 when waiting lists first became an acute issue, I took the emergency step of transferring $25 million from other essential programs to support ADAP. Then, because a great need still remained, we followed this up by fighting for a $50 million increase in ADAP funding last year. And the President has requested another $50 million increase for ADAP in his budget. We know these steps alone won’t make waiting lists go away, which is why we’ve also taken additional steps, from successfully calling on drug companies to step up their assistance to providing technical assistance to states.
At a time when the budget situation has forced us to make many cuts we didn’t want to make, we are increasing funding for HIV/AIDS because we know these programs keep people alive. In the last two years, the President has made it clear that life-saving prevention and treatment is not the place to cut corners, and he will continue fighting to make sure these programs get the funding they need.
We believe that this formula – additional resources for HIV/AIDS and a new strategy that helps us get the most out of these resources – has put us on the road to ending HIV/AIDS. But I want to stress again that we can’t do it without you. That’s why Jeff, our Assistant Secretary for Health Dr. Howard Koh, and others have been traveling around the country to talk about how states and communities can get on board. This is a national strategy, not a government strategy, and it will only work if all of us get behind it.
As we work to implement this strategy, we’re building on a foundation laid by last year’s health care law, which dramatically expands access to coverage for people with HIV/AIDS. For years, we had a health insurance market in which insurers made profits by trying to avoid sick people. This was great for insurance companies, but it was terrible for the people with the greatest health needs, including those with HIV/AIDS. In effect, the people who needed health insurance the most were the ones shut out of the market.
This wasn’t right, and the health care law is bringing these days to an end. Today, insurers can no longer deny coverage to children because of a pre-existing condition, and adults with pre-existing conditions have new, more affordable insurance options. And in 2014, insurers will no longer be able turn anyone away because of their health status. That means people with HIV/AIDS will always have somewhere to go for coverage.
We’ve also established a long overdue Patient’s Bill of Rights that bans the worst insurance abuses. Insurers are no longer allowed to put a lifetime cap on your benefits or cut your coverage when you get sick because of an error on a form. Some of you may have seen a report last year about an insurance company that was using a computer program to search the applications of anyone who was recently diagnosed with HIV, looking for any excuse to cancel their coverage. Now, that practice is gone for good.
Under the health care law, we’re also expanding Medicaid so that it will be available to many more Americans with HIV/AIDS, including adults without children. And we’ve told states that they can now offer people coverage through Medicaid as soon as they get their HIV diagnosis, instead of waiting until they develop AIDS. Given what we know about how effective treatment can be at delaying the onset of AIDS, this is a critical change, and we hope states will take advantage of it.
Finally, the health care law provides long overdue relief from prescription drug costs for Medicare beneficiaries. Because AIDS drugs are so expensive, beneficiaries with HIV/AIDS often quickly hit the prescription drug coverage gap. Now, when they do, they’ll get a 50 percent discount on their brand-name drugs. And if ADAP covers their medicines, those payments will count towards moving beneficiaries through the donut hole, so they don’t get stuck there.
What these reforms mean is that far more Americans with HIV/AIDS will be able to get coverage they can count on through Medicaid or the private insurance market. We will still need ADAP and the Ryan White program to fill in the gaps in our health insurance system – and this Administration supports the reauthorization of Ryan White. But once we fully implement the health care law, those gaps will be small cracks, not gaping holes, which means there will be less strain on the safety net and more people with HIV/AIDS will get life-saving medications.
That’s good news because in the last year, researchers have demonstrated just how important treatment can be. Not only can it save the lives of the people receiving it, but it also turns out to be one of our best tools for preventing transmission. When treatment is started early, NIH researchers found that it can reduce the risk of transmission by 96 percent. That’s an incredible finding, and it’s part of the reason why Secretary Clinton argued earlier this week that we have the opportunity for the first time to usher in an AIDS-free generation.
She was speaking about America’s efforts around the world, but policy changes and advances in research have given us that same opportunity right here in the US too. The question we should all be asking ourselves today is: what will we do with this opportunity? In the coming years, will we watch 50,000 new infections a year become the new normal? Or will we begin to bring those numbers down once again? Will we allow the incidence of HIV in young gay men to keep rising? Or will we reverse this tragic trend? Will we watch HIV/AIDS recede even further from the national spotlight? Or will we spark a national movement to end this disease once and for all?
It’s up to us to decide how we answer these questions. And it’s important to realize that even the progress we’ve made so far is not guaranteed. For every step forward we’ve taken in the last two years, there are those in Washington who want to take two steps back.
In the last year, Republicans in Congress have put forward a budget that would make deep cuts in to the part of the budget that contains the Ryan White Program, ADAP, and NIH research. They would repeal the health care law and tell insurance companies to dust off their denial of coverage slips. They would replace Medicare’s guaranteed benefits with a voucher. And instead of expanding Medicaid, they would cut it in half by 2030. If you think the safety net is straining now, just imagine how big those holes will get if all these cuts go into effect.
This is not a shy group. You are not afraid to make your voices heard in your communities. Thirty years ago, when people in the White House would not even say the word AIDS, you forced our country to acknowledge and confront the disease. When we were losing thousands of friends and family members because they could not afford treatment that could save their lives, you fought to make sure they could get it. When research budgets came under attack, you made sure we continued to invest in the studies that have produced more than 30 licensed drugs to treat HIV/AIDS and brought us closer to a vaccine.
Today, we need you to raise your voices in your communities again. We need you to remind the nation, as you have so many times before, that when we talk about these programs, we are not just talking about numbers in a budget spreadsheet. We are talking about the lives of our friends and family members – the lives of those living with AIDS who need medications to survive, the lives of those we could save from a lifetime of disease with the right prevention, and the lives of those future Americans who could be part of that AIDS-free generation if we seize the opportunity in front of us.
This is a pivotal moment. For 30 years, this community has fought to get to where we are today – with proven prevention strategies, effective treatments, better access to coverage, and a strong commitment from the federal government. Now, we all need to work together to make the most of it.