On the Hill

Two Days at the Capital give Insight into the World of the Public Sector and HIV

I have had the privilege to document some of the most effective models of providing HIV treatment and prevention around the world. I will soon be departing for Rwanda to cover Partners in Health’s famous model that addresses the HIV epidemic through development and working with local communities and the Rwandan government. The United States of America is responsible for much of the increased funds that support and foster the progress that has been made throughout the world in combating HIV. Both the public sector, through programs such as PEPFAR (The President’s Emergency Plan for AIDS Relief), and the private sector, such as the Clinton and Gates Foundations, have made great strides in addressing the vital components of treatment and prevention. However there is a startling rise that is calling our government officials to take a deeper look domestically and maybe learning from programs abroad.

The Washington Post ran an article covering a recent report, which in the words of government officials I ate dinner with, shocked the Hill. One would think the story was about an exposed affair or high level corruption charges but it was not – it centered on the alarming rise of HIV in Washington DC. When people think about an HIV epidemic and children infected during birth, their minds travel to “other” places, such as India and sub-Saharan Africa. However, the study reports DC in a “modern epidemic” and shows cases of infection through birth; something unthinkable in the states because of readily available drugs that can greatly reduce the transmission rate from mother to baby. Lastly, the report strongly emphasizes that there is a clear racial component to being HIV infected in DC – the subtitle reads “More than 80% of HIV Recent Cases were Among Black Residents”.

This Washington Post article on the rise in HIV infection was followed by a recent announcement by the CDC that "1 in 4 teen girls has at least one sexually transmitted disease". The core facts of the study show that there is a serious issue of sexually active teens who are at risk of dangerous consequences, such as infertility, cervical cancer, and HIV. Many factors play a role in the alarming figure. The taboo nature of discussing sex within families, schools, or churches, the inadequacy of many health education programs to cover the in depth issues of STDs and condom use, the sex drive of teens, and simple myths or misunderstanding create an arena where HIV and STDs can flourish.

Given these two reports that highlight HIV on the rise and the prevalence of sexually transmitted diseases, I posed a question to US Senator Tom Coburn of Oklahoma and Congresswoman Michele Bachmann of Minnesota if they would support universal sex education that approached the issues in an objective fact based scientific manner. Their responses spoke volumes. Coburn, an obstetrician by trade, acknowledged the reports as very serious and concerning. His response focused on the difficulty of presenting all the issues properly, such as that condoms do not always protect a person from HPV (the virus that causes cervical cancer) or herpes. Congresswoman Bachmann spoke of the role of family values and her strong support of science but did not delve into anything of substance. I attempted to push the issue and discuss the merits of empowering teens through teaching about transmission of STDs and the role of condoms in preventing HIV. However, her assertion that science has not shown condoms can completely prevent HIV transmission left me dumbfounded. Was she arguing that condoms do not have a 100% yield or did she simply not know her science; after all the CDC has hailed latex condoms as “highly effective when used consistently and correctly” for deterring HIV transmission.

The prevalence of STDs and the alarming fact that HIV cases are both rising in some cities and are heavily racially disproportionate depict the importance of the public and private sector to reassess how we address HIV and STD prevention. One non elected official spoke candidly how we can learn from the successes of the projects abroad and implement them here in the states. It caused me to think back to the various organizations that I have covered. Though differing in region, culture, and religion many of them maintained the approach that to affect change in a population you must start with the individual and community. Here the goal is the empowerment of the person through education and awareness and it is a concept that can find support in both the public and private sectors. Unless we expect our sex-sells culture to change or the biological sex drive of teenagers to disappear, then the answer for prevention has to be found in obtaining a level of understanding about STDs and the various methods of prevention, such as male and female condoms, abstinence, and faithful monogamous relationships. I would heed Senator Coburn’s advice on the challenges that sex education can present but I would assert that a comprehensive lesson plan can be achieved and should be achieved.