What Is President Obama’s Track Record on HIV/AIDS?

Starting Sunday, more than 20,000 HIV researchers and activists will gather in Washington, D.C. for the first international AIDS conference to take place in the country in 22 years.

Heavy hitters like former Presidents Bill Clinton and George W. Bush and Secretary of State Hillary Clinton are slated to speak, but President Obama — who lifted the travel ban that made the conference possible — won’t be attending, a fact that has incensed some AIDS advocacy groups. (He plans to tape a short video message for the attendees, and host a private event for conference attendees at the White House tonight.)

But activists’ anger at Obama isn’t just about the conference. Some critics charge that the president has not sustained the same levels of commitment to fighting the AIDS epidemic as his predecessor.

In 2003, President Bush shocked the world in his State of the Union address when he announced a program that would commit an unprecedented $15 billion to fight the global AIDS epidemic for the next five years. Despite controversial political and financial conditions attached to the funding, AIDS activists say the program, known as PEPFAR, the President’s Emergency Plan for AIDS Relief, has had a crucial impact abroad.

The plan acknowledges the disparity between infection rates in black and white America, and focuses resources on the 12 cities with the highest incidents of AIDS: New York, Philadelphia, Baltimore, Washington D.C., Atlanta, Miami, San Juan (Puerto Rico), Dallas, Houston, Chicago, Los Angeles and San Francisco.

Also in 2010, the president pledged $4 billion over three years to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the first multi-year commitment to the organization. The next year, the president pledged to give antiretroviral drugs to 1.5 million pregnant women with HIV around the world, distribute more than 1 billion condoms and support 4.7 million male circumcisions, which has been found to reduce female-to-male transmission by 60 percent. (Read more about why critics suggest that last goal may have been set too high.)

But advocacy groups point out that some of the $4 billion for the Global Fund is coming at the expense of PEPFAR funding, and note that the administration has cut $214 million from the program in its proposed 2013 budget.

In December 2011, the president announced a plan to redirect $50 million in public health funds towards increasing access to life-saving medications at home, including $35 million to state AIDS drugs assistance programs and $15 million to the Ryan White program, which provides services to people without sufficient health care coverage.

While it hails the strong domestic policies introduced by the president, the Global AIDS Alliance calls out the administration for inadequately funding them:

President Obama introduced the watershed National HIV/AIDS Strategy — a collaborative roadmap for policymakers and private groups to reduce HIV infections, bolster treatment and decrease HIV-related health disparities. But the Administration has severely underfunded AIDS Drug Assistance Programs (ADAP) for the poor, with more than 2,500 people now on waiting lists for medication.

An estimated one-third [PDF] of Americans diagnosed with HIV aren’t receiving any kind of treatment, according to government data, many of them because they can’t afford it.

Federal funding for HIV/AIDS increased by $5 billion since 2008, with $22.25 billion budgeted for domestic programs this year, according to a report [PDF] from the Kaiser Family Foundation. The majority of those funds — $15.6 billion — are for health care and treatment services.  The Obama administration released millions in emergency funding to bolster HIV programs, including $40 million in 2011 and an additional $35 million to be distributed this summer to ease the burden on AIDS Drugs Assistance Program (ADAP). But the waiting lists for care are still high.

Earlier this year, Ambassador Eric Goosby, the U.S. Global AIDS Coordinator, defended the administration’s AIDS funding, emphasizing that “even in a challenging budget environment with strict budget caps, the administration has continued to make this work a priority.”

The administration’s defenders also point to the Medicaid expansion under the Affordable Care Act, which will soon prevent private insurance companies from denying coverage to those living with HIV as a pre-existing condition.

And earlier this week, the White House also released a statement defending the president’s record, saying the administration “has increased overall funding to combat HIV/AIDS to record levels.”

Beyond funding, another source of discontent for activists involves an Obama campaign pledge to lift a federal ban on funding for needle-exchange programs to prevent needle sharing that could transmit HIV and other infections.

Study after study has shown that needle-exchange programs do not increase drug use, and both the World Health Organization and the American Medical Association have said the programs work to help reduce the spread of HIV.

The ban was lifted in 2009, but was reinstated in a federal spending bill in December 2011. According to the San Francisco Chronicle, needle exchange became a casualty of contentious budget negotiations:

Republican leaders initially demanded wholesale concessions from Obama as the price of approval, including elimination of funding for the new federal health care and bank-regulation laws and a ban on federal regulation of greenhouse gases. They settled Dec. 15 for a more modest agreement that included … a renewal of the prohibition on federal spending for needle exchanges.

Some AIDS advocacy groups charged that the administration has reneged on the promise out of political pressure and a fear of looking soft on drugs.  “The omnibus spending bill was the product of a tough negotiation, and the bill provides increased funding to implement health reform and Wall Street reform,” an Obama administration official told Kaiser Health News at the time. “But to reach a compromise, we had to accept certain provisions that we oppose, and this is one of them.”

But some AIDS advocacy groups aren’t hopeful.

“The president’s failure at this late date to commit to attending the conference unfortunately speaks volumes about this administration’s commitment to the AIDS epidemic,” Tom Myers, the AIDS Healthcare Foundation’s (AHF) chief of public affairs and general counsel said in a teleconference Monday emphasizing the budget cuts. “This commitment has been lukewarm at best.”

“If he’s coming without any concrete proposals to fix these problems, he added, “AHF suggests that it may be better if the president not attend.”