American Journal of Public Health Commentary Addresses Current Domestic and International HIV/AIDS Challenges

The July issue of the American Journal of Public Health features a commentary on the challenges facing U.S. policymakers on the eve of the XIV International AIDS Conference. In the commentary, Jennifer Kates of the Kaiser Family Foundation; Richard Sorian, formerly of the Institute for Health Care Research and Policy at Georgetown University; Jeffrey Crowley of Georgetown's Institute for Health Care Research and Policy; and Todd Summers with Progressive Health Partners describe the domestic and international HIV/AIDS policy issues currently facing lawmakers and health officials. The domestic issues include the following:

• Reducing new HIV infections: To curb HIV infection, officials should craft culturally specific HIV prevention efforts, aim to reduce stigma, integrate prevention into clinical care settings, support needle-exchange efforts and continue to fund microbicide and vaccine research, the authors state.
• HIV testing: The authors write that to increase the number of people getting tested for HIV, policymakers should provide more information to the public, specifically to high-risk populations, about voluntary HIV counseling and testing. New HIV testing techniques, such as rapid testing, should also be used, and efforts to reduce stigma will help boost the number of people willing to undergo testing. The authors also endorse the Early Treatment for HIV Act (HR 2063), which would create a new state option to expand Medicaid coverage to HIV-positive low-income individuals before they develop AIDS.
• HIV among minorities: "There is a critical need to better understand where and why these disparities [in HIV infection] occur, what factors affect receptivity to prevention messages and health care access and whether public programs ... are adequately serving people of color," the commentary states.
• AIDS drug costs: As the cost of AIDS drugs continues to rise, policymakers must address a number of issues, including whether to implement strategies such as bulk purchasing, rebates and price caps, the commentary states.
• Research and development: Policymakers must examine the federal government's role in fostering research and development, the commentary states, adding that attention must also be given to the best way to distribute public funding for researh.

International AIDS Issues
The commentary also addressed several global AIDS issues, including:

• Foreign aid: It is important to assess the ways in which funding is allocated and how this funding is spent, according to the authors. For example, when the government considers that debt is "one of the major barriers facing developing nations' ability to respond" to the HIV/AIDS epidemic, it might decide that grants and debt relief are "more viable options" than loans, the authors write.
• Global Fund to Fight AIDS, Tuberculosis and Malaria: "The U.S. government has played a critical role in shaping decisions concerning the fund" and must provide continued leadership as the epidemic continues, the commentary states. The United States can provide leadership in the areas of mobilizing contributions, establishing staffing and clarifying the role of the fund in the context of other HIV/AIDS efforts, the authors write.
• Priorities for international efforts: "As the United States seeks to promote an integrated approach to the global pandemic, it will need to look at ways to foster public-private partnerships that support prevention and care, including the provision of antiretroviral therapies ... and research in developing countries," the commentary says.
• Access to treatment: The purchase of generic drugs, bulk purchasing, parallel importation, compulsory licensing and tiered pricing are all ways that policymakers can promote access to treatment.