Health Care Blog

White House Meeting on Black Men and HIV

The toll of the HIV epidemic among Black men in the United States is staggering.  CDC estimates that 1 in 16 Black men will become infected with HIV in their lifetime.  An estimated two-thirds of people living with HIV/AIDS in the Black community are men, and Black men in some U.S. cities have HIV rates as high as heavily impacted countries in Africa. According to CDC, Black gay and bisexual men are the most heavily impacted population in the Black community.  One study in five major U.S. cities found that as many as half of all Black gay men in these communities were living with HIV. Although not as heavily impacted, Black heterosexual men are also at high risk for HIV infection through heterosexual sex and injection drug use. 

On June 2, 2010, The Office of National AIDS Policy (ONAP) convened a meeting at the White House on Black Men and HIV.  The meeting included black men living with HIV, experts on HIV/AIDS, Federal, State, and local policymakers,  community-based service providers, representatives from foundations, and leaders from across the black community’s civil rights and faith organizations.  The purpose of the meeting was to raise awareness about the domestic HIV epidemic among Black men, discuss government and community responses to the epidemic, and promote a conversation among diverse elements of the Black community.  The meeting is part of a series of discussions that have been hosted by ONAP over the past year.  Past meetings have focused on HIV among women, youth, and other topics.

Part of the reason why it is so important to re-energize the dialogue is that frequently discussions of HIV among Black men have had the effect of casting blame without spreading knowledge of the factors that cause Black men to be at heightened risk. To move forward, we need the public to have a deeper understanding of the complex issues that contribute to infections, and we need a more concentrated focus on solutions for supporting Black men and the other communities who bear a heavy burden of responding to HIV.

The diversity of participants who attended the event was reflected in the diversity of opinion. Topics ranged from supporting faltering organizations engaged in HIV prevention work with Black men; HIV/AIDS awareness campaigns targeting Black men and education efforts at the Federal and community level; ongoing social pressures facing Black men; the role of the Black community and society at large in preventing HIV infection among Black gay and bisexual men, and how the HIV epidemic among Black men impacts Black women.  Please see the meeting agenda for more information on the speakers and meeting format. 

As a scientist who has spent the last 10 years addressing this topic while at the Centers for Disease Control and Prevention, I believe that this type of dialogue is essential to improving our country’s response to HIV/AIDS.  This conversation needs to continue, but more importantly, it needs to be followed by collective action to end the national tragedy such that future generations of Black men do not face HIV infection as a rite of passage.  (For more information about HIV, go to www.AIDS.gov )

Gregorio Millett is the Senior Policy Advisor for the Office of National AIDS Policy.
 

The Affordable Care Act and the Deficit

Cross-posted from the OMB blog.

CBO Director Doug Elmendorf recently gave a presentation on health costs and the fiscal outlook.  Doug concludes that the federal budget remains on an unsustainable course even after enactment of the Affordable Care Act, and I wholly agree with him. 
 
There should be no ambiguity about whether we face unsustainably large deficits over the medium- and long-term.  We do.  That is why the Administration’s Budget proposes significant additional deficit reduction and that is also why the President has formed a bi-partisan Fiscal Commission charged with recommending measures to achieve medium term fiscal sustainability and to meaningfully improve the long-run fiscal outlook.

The fact that more action must be taken on the deficit even after enactment of the Affordable Care Act, however, is a distinct question from whether the health legislation helps to improve our fiscal course — which it does. 

In particular, CBO estimates that the Act will reduce the deficit by more than $100 billion over the next ten years and more than $1 trillion in the ten years after that.  That’s more deficit reduction than has been enacted in over a decade.
 
Perhaps more importantly, the Act has the potential to fundamentally transform our health system into one that delivers better care at lower cost.  This potential isn’t fully captured in CBO’s numbers, and that’s appropriate.  CBO produces its estimates based on what has happened in the past, and we have never enacted such a fundamental transformation. 
 
The new law incorporates the most promising ideas from economists and leaders from  across the political spectrum to control health care costs.  As I have written before, this includes the vast majority of the options CBO itself suggested for reducing long-term health care cost growth.  And we now have a variety of new institutions that will be devoted to guiding policy toward higher-quality and lower-cost outcomes.
 
The bottom line is that we are on a long journey toward fiscal sustainability — but that should not diminish the importance and potential of the Affordable Care Act.

Peter R. Orszag is the Director of the Office of Management and Budget