While taking a moment to recognize the strides that have been made to address the epidemic in recent years, President Clinton and the panelists were quick to exhort the audience and the U.S. not to be complacent about the challenges facing the domestic and global community. They stressed that the disease still requires concerted action and attention with panelists identifying a number of issues, including:

• Worldwide, more than half of people diagnosed with HIV still do not have access to treatment;
• HIV incidence rates are rising amongst some minority populations in the U.S., particularly African-American women;
• The lack of even rudimentary health-care systems in some poorer countries prevents people from accessing the treatment and medicines; and
• The importance of improving education both domestically and abroad to better address stigma and gender inequality while also providing the necessary information about safe sex practices.

Mr. Stephen Lewis, co-director of AIDS-Free World, moderated the discussion which, in addition to President Clinton and Dr. El-Sadr, featured panelists Ms. C. Virginia Fields, president and CEO of the National Black Leadership Commission on AIDS, and Mr. Kali Lindsey, senior director for federal policy for the Harlem United Community AIDS Center, Inc.  Columbia University president Dr. Lee Bollinger welcomed the attendees and distinguished panelists, and Dean Linda P. Fried of the Mailman School of Public Health offered closing remarks. 

A Global Epidemic That Also Hits Close to Home
“Despite the great progress we’ve made in our global fight to end HIV/AIDS, in recent years, the Centers for Disease Control has estimated that the crisis in the United States is worse than we previously thought, and the UN reports this year that the number of new HIV infections worldwide is more than double the number of those on treatment” - President Bill Clinton

All of the panelists joined President Clinton in noting that HIV/AIDS continues to rise in the United States with some segments of the population bearing the brunt far more so than others. They stressed that the country needs to do a better job of educating people, promoting needle exchange, expanding access to HIV testing, and ensuring access to treatment. Critical to any HIV intervention is the identification and understanding of the needs of at-risk populations like African Americans or men who have sex with men, so as to better target prevention and treatment initiatives. Prison populations, in particular, were cited as being a crucial group that has been long overlooked with regards to HIV prevention.

To address the serious toll that the epidemic exacts on communities worldwide, especially in poorer countries, panelists discussed the role that gender inequality plays, methods of preventing vertical transmission to children, and international funding of HIV prevention and treatment programs. 

As Mailman School Dean Linda Fried noted in her closing remarks, “The panel reflected the urgency of marrying knowledge and science with service and training.” 

Dean Fried also thanked the panelists for making passionate cases for access to healthcare; creation of health systems; holistic treatment of people and communities; and sophisticated investment in HIV prevention as being crucial to fighting the spread of HIV/AIDS.

World AIDS Day Symposium
The panel was part of a World AIDS Day symposium sponsored by ICAP. Entitled “HIV Scale-Up and Global Health Systems,” the symposium explored the rapid expansion of HIV/AIDS programs, and their impact on the health systems of resource-limited countries. Topics included leveraging HIV programs to support other chronic disease initiatives, the impact of HIV scale-up on women’s health and rights, and the future of HIV funding. Panelists from government, academia, the World Bank, UNICEF, and Rockefeller Foundation took part in the day-long event.

“It was fitting that this year’s World AIDS Day theme was ‘human rights and access to treatment’. The all-day symposium on HIV and Global Health Systems, as well as President Clinton’s panel, brought meaningful, substantive discussion to relevant issues such as the rights of women and children, the need to vigorously pursue scaling up of services, and the importance of reaching disenfranchised and underserved communities in the U.S. and globally," said Dr. El-Sadr, also Professor of Epidemiology and Medicine at Columbia University. "ICAP’s challenge in the coming year is to leverage its programs and its talented staff towards even greater and broader impact.”

Other symposium speakers included: Dr. Peter Berman, lead health economist at the World Bank; Dr. Mickey Chopra, chief of Health at UNICEF; Dr. Pamela Collins, director of the Office for Global Mental Health at the National Institutes of Mental Health; Dr. Mark Dybul, Georgetown University; Dr. Sherry Glied, Columbia University Mailman School of Public Health; Mr. Gregg Gonsalves, founder, International Treatment Preparedness Coalition; Ms. Lynn Freedman, Columbia University Mailman School of Public Health; Dr. Ariel Pablos-Mendez, managing director at the Rockefeller Foundation; Dr. Jeremy Shiffman, Syracuse University; Dr. Nandini Oomman, director, HIV/AIDS Monitor, Center for Global Development; and others. 

The symposium was partially supported by the Rockefeller Foundation.

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[Photo caption: Dr. Wafaa El-Sadr (right), director of Mailman School’s ICAP, with President Clinton on World AIDS Day.]