The biggest political sex scandal doesn’t involve Roy Moore. It involves our government aiding and abetting HIV transmission, killing more Americans than died in battle in all wars since the Revolutionary War.
President Trump has called Washington a swamp, whose moral, fiscal, and ethical corruption has contaminated our nation. There’s no greater example than government’s failure to eliminate AIDS. With another World AIDS Day behind us, infections have remained stubbornly steady at roughly 40,000 new cases a year for decades.
In addition to the human toll, that means we’re accruing about $20 billion in future HIV treatment costs annually. The $34 billion AIDS budget accounts for over 1 percent of all federal tax receipts. This week, we’ve heard many Democrats talk in frightening terms about the potential $1 trillion impact over the next ten years of the tax reform package. Yet, we’re on the path to spending almost $500 billion on AIDS over the next 10 years unless we do something now. Where’s the outrage over failed HIV prevention?
Testing virtually eliminated HIV transfusion transmission. The testing of pregnant women for HIV dramatically reduced mother-to-unborn-child transmission. Yet we have failed to make testing widely accessible so that people can test themselves and partners before having sex — the most common way HIV is transmitted.
Blame the Swamp. For decades, government promoted a politically palatable HIV prevention message: Abstinence, being faithful, and, for those living dangerously, condoms as “safe sex.” The government aggressively promoted condoms, aware of their limitations both in terms of people’s willingness to use them and their known high failure rate for protecting even from pregnancy (only 2 percent if used perfectly, but 18 percent under real-world conditions). At the same time, government went out of its way to limit the one thing that would definitely stop the spread of HIV: testing.
The Swamp’s victory over testing began in 1983, before a specific HIV test was available. A scientist at the Centers for Disease Control noticed an 88 percent correlation in detecting infection by testing for hepatitis B. He proposed testing and donor screening to protect the blood supply.
But the CDC didn’t follow his recommendation after opposition from blood banks, who didn’t want to pay for testing, and AIDS activists who feared it threatened their civil rights. The result: By 1985, when the first specific HIV test was approved and testing donated blood began, almost half of hemophiliacs had been infected with HIV. It took until 1989 before Gay Men's Health Crisis, then the largest AIDS advocacy group, dropped its opposition to wider testing.
The most sensible approach to preventing HIV is giving people a highly effective, low cost, user-friendly test that can be used in the privacy of their home. In 1987, a company I founded (later acquired by Johnson & Johnson and no longer in business today) submitted an approval application to the Food and Drug Administration for the first home HIV test. But activists strongly opposed home tests at the time.
Over many years, I met with activists and calmed their fears, but the most powerful opponents would not be swayed. Clinics and laboratories, who feared competition, lobbied against approval. FDA responded by banning the acceptance of home HIV test applications, even though our application demonstrated a test was safe and effective, and contained survey data, later confirmed by CDC, showing a third of Americans who wanted to get tested would only get tested using a home HIV test.
The Swamp's victory over common sense in this area was complete until 2012, when FDA dropped its outright ban. In the meantime, almost two million Americans had been infected with HIV, and over a trillion dollars had been spent on AIDS.
Sadly, other countries banned home tests, believing the FDA’s ban was based on science, even as over 70 million people worldwide became infected. After the U.S. ban ended, countries like Australia, the UK and South Africa lifted their bans as well. Yet most European countries, including Germany, Spain, and Italy, still have bans on home AIDS testing.
In 2006, the CDC recommended that every American 13-64 get tested. But it’s not happening. For less than half of government’s $900 million prevention budget, which funds an inefficient network of brick and mortar testing facilities, a public-private partnership could develop and distribute a user-friendly, highly effective, low cost (less than a dollar) rapid HIV test to every adult.
From Apple to Abbott and P&G, America has some of the most capable companies in the world. President Trump should seek their help. For almost four decades, the Washington swamp has acted against the interests of the American people, thwarting a sound approach to HIV prevention. It’s time for a president who understands the role of government in ensuring domestic tranquility, promoting general welfare, and providing a common defense… and will act against infection.
Elliott Millenson was founder and CEO of the Johnson & Johnson company that developed the world’s first home HIV test.
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