On July 13, 2010, the Obama administration released the National HIV/AIDS Strategy (NHAS) for the United States. The NHAS is the culmination of work and advocacy by people living with HIV, their advocates, AIDS service organizations, federal and state agency representatives, and corporate representatives, such as pharmaceutical companies, with a stake in the plan. The NHAS is organized into four areas of focus: 1) Reducing New HIV Infections; 2) Increasing Access to Care and Improving Health Outcomes for People Living with HIV; 3) Reducing HIV-Related Disparities and Health Inequities; and 4) Achieving a More Coordinated National Response to the HIV Epidemic, which looks to a more coordinated response to the three priority issues around which the report is organized.
The NHAS addressed multiple issues in which CHLP took a leading interest: criminalization of HIV, stepped-up enforcement of existing civil rights laws, expanded access to legal services, prisoners' health and prevention rights, gender issues, and informed consent. Most of these issues are addressed in greater detail in the NHAS section on reducing disparities.
The NHAS statement on the problem and public health consequences of HIV criminalization is very good and should be a significant boon to anti-criminalization advocacy in the U.S. and elsewhere. The NHAS maintains that many state HIV-specific criminal laws reflect long-outdated misperceptions of HIV's modes and relative risks of transmission.
The NHAS also recognizes more generally the importance of addressing widespread public ignorance about HIV transmission risks, a central aspect of HIV-related criminal prosecutions. Points such as these are encouraging evidence of the Obama Administration's understanding of the problem of stigma and its intent to address it.
Considering the mix of invisibility and coercion many women with HIV encounter in matters of prevention, treatment, pregnancy and reproductive choice, the silence of the NHAS on these points is disappointing. And in view of the State Department's repeated assurances that the Obama administration is "committed" to U.S. ratification of the CEDAW Treaty (the Convention on the Elimination of All Forms of Discrimination Against Women), the NHAS would have been a great place to connect the dots.
There also is no mention of the increasingly important role of informed consent in an era of rapidly expanding recommendations for the use of antiretroviral therapies earlier and more often for treatment and prevention.
Overall, there are elements of the NHAS that are encouraging and those that are a real disappointment, with the latter bearing more on what is missing than on what is said. That noted, the NHAS represents the first meaningful official U.S. government statement on the issue of criminalization and the role of civil rights in addressing the HIV epidemic.