Bipartisan political support is central to the U.S. government’s domestic and international response to HIV/AIDS, and a special session devoted to this response was held at AIDS 2012 on Wednesday. Vivek Jain, an assistant professor of medicine in the UCSF Division of HIV/AIDS at San Francisco General Hospital and Trauma Center (SFGH), offered the following report on the session:
Former Senator and Majority Leader Bill Frist (R-TN) chaired a bipartisan panel of members of Congress on Wednesday July 25th to discuss the United States’ past and future role in supporting, shaping, and leading the global response to HIV. Senator Frist began by reviewing the history of U.S. engagement with its own domestic HIV epidemic, and then reviewed the development of bipartisan consensus around supporting a global scale-up in antiretroviral therapy and HIV care programs. He then began the panel by posing insightful questions to each member, asking them to reflect both on the past, how they became interested in HIV, and how they view the current debates in the U.S. Congress about the United States’ role moving forward, in light of the current economic climate.
Rep. Barbara Lee (D-CA) spoke first, reviewing key steps that occurred in congress in the 1980s and 1990s that led to precursor legislative packages that supported HIV services and treatment. She then spoke enthusiastically about her and others’ engagement with President George W. Bush as the PEPFAR legislation became reality. And she strongly reaffirmed the U.S. Government’s commitment to maintaining high level support for HIV/AIDS efforts domestically, including maintaining and expanding support for vulnerable populations, and globally, by continuing and expanding support for PEPFAR and other global activities.
Sen. Marco Rubio (R-FL), elected to the U.S. Senate in 2010, spoke next and reviewed his memories of first learning about HIV/AIDS growing up, remarking poignantly that it would have been unimaginable then to think we would now have effective treatments for the disease and are on the cusp of speaking about eliminating it. He noted that despite a current climate of political division, HIV remains an area where members have come together in strong bipartisan fashion to tackle key issues.
“This is something the country should be proud of, the amount of investment the American taxpayers have made in a time of significant fiscal constraints.” He went on to say, “we are going to be asked by future generations where we were when these things were happening,… And living in a nation with the resources to make a difference… so I think that should motivate us.” He then noted with resolve that despite all the progress, we must maintain a sustained response, saying “my biggest concern is that this is an issue that has lost focus because people now think there’s a way to treat it.” However, he said we have to maintain a push for innovation, develop new medications, guard against drug resistance, and generate what he called a “sustained response.”
Senator Frist then asked Senator Christopher Coons (R-DE) to reflect on his position as Chair of the Senate’s Foreign Relations Committee’s Subcommittee on African Affairs. He spoke about his earliest trips to Africa, commenting on how inspiring they have been in informing his views. He applauded the bipartisan leadership of congress, and of President George W. Bush, and specifically lauded his colleague Senator Rubio for their ongoing work together. He then called for ongoing commitment to the issues of HIV and pledged his continued support.
Next, Sen. Frist recalled one of his journeys to Africa with Sen. Mike Enzi (R-WY). Sen. Enzi reflected on this first trip, recalling visiting orphanages, hearing from clinicians how scarce antiretroviral therapy was, and visiting hospitals overrun by patients in need of therapy. He also recalled coming in contact with researchers who were studying the positive role that supporting patients’ transportation costs can be in helping them get access to therapy. He also reflected poignantly on lessons learned about prevention of mother to child transmission, and the incredible role antiretrovirals can have in both preventing transmission and allowing for breastfeeding to occur with greatly diminished risk of transmission.
“I wish that everyone in America could have the chance to go to Africa, particularly the young people, to see the conditions they’re living under,” Frist said, and he lauded Sen Enzi for his involvement in Africa. He made the case that if more members of Congress could see the tremendous progress that has been made by programs funded by U.S. taxpayers, the case for continued appropriations would only be made stronger and more easily. ”We need more members of Congress to be able to tell the story,” he said.
Sen. Frist then asked Sen. Rubio to frame the issue of HIV funding against the backdrop of the fiscal constraints that are dominating conversations in Washington, D.C. Sen. Rubio, noting the mismatch between public perceptions of how much the U.S. Government spends on foreign aid versus actual spending totals said, “we don’t have a debt because of foreign aid,” continuing that “if you zeroed out foreign aid, it would do nothing for the debt but it would be devastating not just for the world, but for America’s role in it.” He then went on to eloquently state that “the issue speaks to the core of who we are as a people, and one of the things I’m proudest of is this nation’s legacy of compassion. ” He continued, remarking that “this willingness of the American people to fund a program like this is testament to our legacy of compassion.” He also argued that supporting the eradication of AIDS is in the United States’ national interest, saying, “Prosperity around the world has always meant prosperity here in our country. This is about caring for folks who are going to die.”
Sen. Frist then asked Sen. Coons what it will take to sustain U.S. leadership in HIV/AIDS. Sen. Coons echoed Sen. Rubio’s remarks, noting current budgetary pressures. But he also called for continued investment to “innovate and cure our way out of this,” specifically calling for continued support of PEPAR, as well as increased funding towards HIV vaccine and cure research, and investment in how to best deliver the care that scientific evidence has proven can be effective.
As a physician and scientist, this was a rare opportunity for me to hear directly from highly articulate members of congress with direct background and knowledge in the HIV arena about their vision for the U.S. role in this fight. Despite the usual protest activity that sometimes occurs at political sessions at the IAC, it was encouraging to see this bipartisan group of members of our Congress articulate the very same issues we as clinicians and researchers are prioritizing, and encouraging to see the passion they have for preserving the United States’ lead role in this domestic and global battle.
Vivek Jain, MD, MAS, is an assistant professor of medicine in the UCSF Division of HIV/AIDS at San Francisco General Hospital and Trauma Center (SFGH).