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Agenda for AIDS Advocacy Meeting with Secretary Hillary Clinton

I.

Introduction Peter Staley

Good afternoon, everyone. My name is Peter Staley, and I was diagnosed with AIDS-Related
Complex in 1985. With me are nineteen other AIDS activists, many of whom have been in this fight
for decades, and some who werent even born when this crisis began, but have joined the fight since.
We represent a coalition of over 70 AIDS organizations that came together to ask the current
candidates running for president for their help with this continuing health crisis.
AIDS is not over. 37 million infected worldwide. 2 million infected every year. 1.2 million die every
year. Annual infections in this country have fallen only slightly from the levels we hit in the 1990s.
The good news is that we now have the tools to dramatically change these numbers. We need our
next president to join us in committing to use those tools. All of us, regardless of how old were
getting, want to witness the end game. We want to be there when they finally discover a cure and a
vaccine. We want to end what has become the worst plague in human history.
So we thank Secretary Clinton for meeting with us today, for very publicly showing us that youre
with us in this fight. Well be pushing you during this meeting and in the months ahead. And well be
pushing all of the candidates that are trying to become our next HIV Commander in Chief. So
before we get all wonkish with a challenging policy discussion, I know Secretary Clinton would like
to set the stage with some opening remarks.
II.

Opening Remarks Secretary Hillary Clinton

Wonkish is a term of endearment to me. After acknowledging Peter Staleys long leadership in the
fight against AIDS and his efforts to arrange this meeting, she acknowledged other people in the
room and who they represent. She noted that it is jarring to realize that some in the room were not
even born when the AIDS crisis began and acknowledged former Ambassador Eric Goosby and his
leadership at OGAC when she was Secretary of State. Together we were able to position the
United States so that we can achieve the goal that I set of an AIDS Free Generation.
Clinton reviewed current HIV statistics, including men who have sex with men, people who inject
drugs, and, particularly women in sub-Saharan Africa, who represent some 60% of the Epidemic.
She spoke of the need to increase funding for research, the need to scale up use of PrEP and the
need to build on the current National HIV/AIDS Strategy, and called for repeal of all HIV
criminalization laws.
This issue matters deeply to me. We owe it to the people we lost to continue the fight against
AIDS. She closed by thanking everyone and expressed the desire that this be the beginning of a
productive conversation.
III.

HIV/AIDS in the United States Kenyon Farrow, Melanie Thompson (10 minutes)
A.
The current domestic land-scape
1.
Infection and mortality trends
2.
Access to care

B.

3.
Research funding
Goal of ending AIDS as an epidemic in the United States by 2025 - What will it take?
1.
Commit to getting below 12,000 new infections in 2025, by scaling up all the tools
available, including PrEP, TasP, nPEP, housing, syringe exchange, etc. Infection and mortality
trends.
2.
Commit to appoint a high level expert/stakeholder Task Force to develop a national EtE
blueprint with bolder and more ambitious targets than the existing NHAS, that would report back
within the first six months of the new administration;
3.
Commit to fight for full funding of the NHAS in order to implement that blueprint in
full; and
4.
Commit to Increased funding for HIV/AIDS research to make ending AIDS
sustainable.
5.
Fulfill the promise of HIV biomedical research by supporting annual budget increases for
the NIH of 10-15% per annum for eight years, and for corresponding increases in the NIH
HIV/AIDS research budget to ensure the development of better preventive and treatment
interventions, a vaccine, and a cure.

Kenyon Farrow: HIV remains a public health emergency in America. We are asking for you to
commit to ending AIDS as an epidemic in the United States by 2025. With about a million persons
living with HIV in the US we had 44,000 new diagnoses in 2014, essentially unchanged over
decades.
70% were gay and bisexual men (transgender persons are not separately counted, and should
be)
2/3 were African-American or Hispanic/Latino
Survival is increasing but in 2013, there were still almost 17,000 deaths among people with
HIV. Almost half of people newly diagnosed with HIV already had AIDS.
Half of new diagnoses and nearly half of all deaths were in the South.
Melanie Thompson: Secretary Clinton, the South is far from an AIDS-free Generation. In Atlanta,
young black gay and bisexual men are getting HIV at rates comparable to some African nations, and
they are still dying from AIDS. We must be more aggressive to end this epidemic.
Mathematical modeling tells us we need to get below 12,000 new infections per year by 2025 to
bend the curve toward ending this epidemic. Thats almost a 400% reduction from where we
currently are, but it is both necessary and achievable, and we are asking you to commit to this goal.
This will require a commitment to scale up resources. Treatment is prevention, and access to care
and drug treatment varies widely across the country. Also we must scale up pre- and post -exposure
prophylaxis, syringe exchange, and access to housing, and other necessary services.
Kenyon: We are asking you to commit to appointing a high level expert/stakeholder Task Force to
develop a national End the Epidemic blueprint with bolder and more ambitious targets than the
existing NHAS that would report back within the first six months of the new administration.
Many local efforts are underway, but if we are going to make progress happen nationally, we will
need this taskforce to create a national blueprint, and to support this work, we are also asking you to
commit to fight for full funding of the NHAS in order to implement that blueprint in full.

Melanie: We ask that you commit to increasing both the HIV/AIDS research budget, and that of
NIH overall, by 10-15% per year for the next 8 years. The last 3 budgets for HIV research have
been flat, and the HIV 10% set-aside has been dropped. We are rapidly falling behind in our
treatment and prevention research, not to mention research on cure and a vaccine. We need your
commitment to change this.
Clinton: We are going to work to see how far we can go.
We need to expand Medicaid coverage. Otherwise we will be hard pressed to achieve these goals.
We will go through and prioritize your ask.
I am all on board for increasing NIH funds.
I wont make promises that I cant keep.
I will do everything I can to achieve an AIDS Free Generation.
We will work with you to lay out a path to do this.
Kathie Hiers: In speaking to the plight of people living with HIV/AIDS in the Deep South: 27%
of people diagnosed with AIDS die within five years of their diagnosis.
Clinton: Recalls Senate debate about shifting HIV funds from states like New York and California to
states like Alabama. As a Senator from New York, she argued against that shift and instead called for
adding more money to allow more money to flow to southern states. Calls efforts to cut funding and
stop expansion of Medicaid a national shame. Decries efforts to cut back funding for HIV and
health overall. Calls out states that have not expanded Medicaid as recalcitrant and obstructionist.
We must incentivize and force states to expand Medicaid.
IV.

HIV/AIDS Globally Morolake Odetoyinbo, Hilary McQuie


A.
The current global landscape
1.
Infection and mortality trends
2.
Access to medicine
B.
Goal of ending AIDS as a global epidemic by 2030 What will it take?
1. Commit to fight for an increase of $2 billion in PEPFAR funding in order to double the
number of people the US is maintaining on treatment.
2. Maintain US commitment to the US share of the cost of the Global Fund in order to double
the number of people on treatment globally.
3. Support trade and other policies that reduce monopoly strengthening barriers to medicines so that
people have access to medicines at an affordable price; and
4. Leverage other national and international resources to address the social and economic drivers of
the epidemic.

Morolake Odetoyinbo: PEPFAR saves lives. Noted the failure to increase PEPFAR funding over
the last three years is effectively a cut in funding, and called for a commitment to increase PEPFAR
funding annually to scale up to an annual increase of $2 billion increase by 2020. Also called for the
US to maintain its commitment to fund 1/3rd of the cost of the Global Fund budget as it scales up
to reach 2030 targets.
Clinton: I am a staunch supporter of PEPFAR.
We tripled the number of people on ARVs in four years.
This was partly due to my husbands contracts reducing the cost of drugs.

She attributed expansion as well to improved delivery system, and called on Ambassador Goosby to
comment.
Eric Goosby: It took an extraordinary effort to go from 1.9 million people on treatment to 6 million
in four years. Three things made this possible. It was partly due to the shift from brand name drugs
to generics. It was also due to improvements in the delivery system making it more efficient. Finally,
PEPFAR shifted from funding low impact prevention efforts to funding high impact efforts.
Example of low impact efforts would be the ABCs. Examples of high impact efforts to which
PEPFAR shifted resources are reducing mother to child transmission and focusing on high risk
populations such as sex workers. All of this is attributable to Secretary Clintons leadership.
Clinton: We will certainly try to build on what worked.
It has stagnated since we left, Im afraid. Wouldnt you say that is correct, Ambassador?
Goosby: Yes, thats correct.
Clinton: We need [recipient] governments to be more effective partners.
Cites Uganda as an example. It was the first PEPFAR country. But the government moved away
from being a good partner. Describes doing a visit to Uganda in hopes of shaming the government
to live up to its responsibilities. Describes a man who thought he was going to die, but was revived
with access to PEPFAR funded ARVs and proudly introduces Clinton to his two sons. But Uganda
has unfortunately gone backwards with new infections rising.
We need to get as much resources as we can, use those resources effectively, and hold
governments feet to the fire.
We need to hold the governments accountable just like we need to hold Alabama accountable.
Describes foreign governments removing their own funds from their health systems as PEPFAR
dollars flow in, and using that money on roads and other priorities instead of health.
Hilary McQuie: PEPFAR was able to achieve such tremendous success because it had unspent
money in the pipeline in addition to capitalizing on efficiencies. Now there is now money in the
pipeline and we have maxed out on savings through efficiencies. If we continue with flat funding,
we will miss a historic opportunity. We need to get 30 million people on treatment in order to turn
the tide.
Clinton: We will set out a plan, but we will need help to overcome efforts by Republicans to cut
back on AIDS funding.
We will continue to support the Global Fund.
We will set ambitious goals.
Obama is equally sympathetic to this effort but has had to fight Congress.
Hilary McQuie: It is hard to advocate for more money than the President puts into his own budget
proposal.

Clinton: President Obama has to be realistic about his proposals so that they are not dead on arrival.
He has to anticipate what he can get Congress to approve. It would help if we had a Democratic
Senate and then we could more effectively negotiate with the House. We should all be working for
that.
McQuie: Spoke to need to oppose the Trans Pacific Trade Agreement and the need to stop
supporting efforts by pharmaceuticals to put pressure on generic drug manufacturers.
HRC: I voted against CAFTA and am against the TPT agreement in part because it went too far to
protecting intellectual property. States she will not support any trade agreement that prevents
countries form getting the medications they need and acknowledges the pressure being placed on
generic manufacturers.
V.

Discrimination Against PLHIV/AIDS Cecilia Chung, Phill Wilson


A.
The current landscape of efforts and infrastructure
B.
What would a high profile effort to eliminate stigma look like?
1.
Thank you for your strong stand against HIV criminalization
2.
Commit to a high profile effort to eliminate stigma, and other forms of discrimination, and
violence directed against key/vulnerable populations including PLHIV, transgender
persons, gay and bisexual men, girls and women, sex workers, and people who use drugs.

Cecilia Chung: Thanked Clinton for her strong stand against HIV criminalization. Notes that high
risk populations including gay men, transgender people, sex workers, and people who have been
incarcerated still face stigma and discrimination. Calls for the next President to take a leadership role
that is empowering of these communities. Cites a recent Human Rights Council report that declares
that ending AIDS as an epidemic can not be achieved without full human rights for those most at
risk.
Phill Wilson: Thanked Clinton for being in the fight. Has been wondering what Bob Hattoy would
say if he were in the room today. Acknowledges that we have to tools to end AIDS as an epidemic,
but these tools will not be effective if people dont know how to use them, if they dont have access,
or if they face other barriers, particularly stigma. Describes the enhanced stigma faced by Black gay
men in the South who are living with HIV. Acknowledges Clintons public opposition to HIV
criminalization but cites other forms of criminalization that serve as barriers, including as an
example the possession of condoms as evidence of prostitution. Commends Attorney General
Lynch for fighting HIV stigma with her public stance against discrimination against transgender
people manifest in the new North Carolina bathroom law. Notes that we have never had a sitting
president participate in an anti-stigma campaign and calls on Clinton to commit to doing so.
Clinton: [Re: President leading an anti-stigma campaign] What a good idea! Phils point is very
real. Now that we have the tools, people have stopped talking about HIV.
The Presidents voice can make a difference. Cites speech she gave in Geneva as the Secretary of
State in which she declared, Gay rights are human rights.
Describes instructions she issued calling on US ambassadors around the world to march in Pride
parades and otherwise show open support for the LGBT community, and the blowback we

received from some countries. Acknowledges that her successor at the State Department has
continued this effort.
Here at home we have gone quiet [about HIV].
Not talking leaves people feeling isolated and alone. Isolation leaves people feeling stigmatized.
Lets work to do that [presidentially led campaign against stigma].
Describes pride she feels in having done a video for the It gets better campaign. People, mostly
gay men, come up to me and thank me for doing that, telling me how much it helped them.
We need to emphasize not only different populations [impacted by stigma], but also different
regions of the country [where stigma is more highly manifest]. She cites the example of a woman
she met in the South whose mother told her church that she was living with HIV, and the church
responded by kicking the woman out.
Phill: Cites CDC projection that 50% of Black MSM will become HIV+ during their lifetimes. Says
stigma is the driver of these infection rates. Ending the epidemic goes through the South.
Clinton: Affirms commitment to an anti-stigma campaign and her leadership on the issue as
President.
VI.
Campaign and Presidential Leadership on HIV/AIDS Dazon Dixon Diallo,
Guillermo Chacon
A.
Promoting the importance of ending the HIV/AIDS epidemic in the campaign.
1.
Appoint full time HIV advisor and move HIV into Health (not just LGBT)
immediately;
2.
Include HIV in speeches between now and the convention (and not just to LGBT
audiences);
3.
Include a policy statement on HIV that incorporates the recommendations in our consensus
paper in the campaign platform within the next 30 days and ensure that these
commitments are included in party platform (under health, not LGBT);
4.
Invite/Schedule an out HIV positive Speaker at Democratic Convention; and September
in the key state of Florida
B.
Civil society and the next President
1.
Leveraging domestic and international funds to strengthen civil society
2.
How else can the next President engage civil society?
3.
Leverage national and international and international support for civil society
organizations and networks that engage in advocacy and other activities on behalf of people
living with HIV/AIDS, and, where US funds are involved, domestically and
internationally, require that people living with HIV who are representative of the epidemic
are included in decision-making, implementation, and evaluation processes

C.

The Office of National AIDS Policy


1.
What are we doing well and what are the gaps?
2.
The National HIV/AIDS Strategy
a)
Empower ONAP with access and attention from the President; ONAPs
influence should reflect Presidential leadership in the fight against AIDS.
b)
Increase resources to assure more timely access to surveillance data while also
improving data quality.
c)
Address deficiencies in the Affordable Care Act that obstruct access to care and
HIV medications, use the power of CMS to induce all States to buy into Medicaid
expansion; and promote legislation that places the US territories such as Puerto Rico on
equal footing with regard to health insurance coverage as the States.

Dazon Dixon Diallo: Recalls pride she felt in Beijing when Clinton gave the speech declaring that
womens rights are human rights. Calls for Clinton to make AIDS a national campaign issue.
Suggests the following: A full time advisor on HIV, within the health focus rather than LGBT focus;
talk about AIDS in your speeches; invite an HIV+ speaker during prime time at the convention
(notes the last time this happened was during Bill Clintons campaigns, a point HRC quickly chimes
in on.), and other people who are positive or at risk at other points in the convention; an updated
policy statement on HIV/AIDS by the campaign within the next 30 days, that is informed by our
consensus document; the same kind of robust policy statement in the campaign platform; and her or
a top line surrogate speaker at USCA this September in Florida.
Guillermo Chacon: Thanked Clinton. Notes that leadership makes a difference. Calls for increased
engagement with civil society domestically and abroad and insuring that, in particular, inclusion of
people living with HIV/AIDS is done in a meaningful way. Calls for the next president to ensure
that everyone knows that ONAP is a priority and that it has her attention. Calls for significant
improvement in both data quality and timeliness so that it can meaningfully inform efforts the end
HIV as an epidemic. Calls for full implementation of the Affordable Care act with appropriate
reforms to expand access. In particular, notes the current circumstances in Puerto Rico and calls for
equalizing the participation of Puerto Rico and the territories to match the benefits received by the
states.
Clinton: What is happening in Puerto Rico right now is a disaster for Puerto Rico and for everyone
else. Discusses her awareness of the circumstances and frustration that the Puerto Rican
government has not yet been provided with a meaningful solution to their debt crisis.
Acknowledges that there is a terrible Medicaid disparity in Puerto Rico. Commits to follow up on
your suggestions, especially that we equalize Medicaid in the territories.
VII.

Q&A (5 Minutes)

Vanessa Johnson: Expresses appreciation for Clintons comments on civil society, but asks: How
do you intend to ensure the meaningful involvement of networks of people living with HIV/AIDS
both here in the United States and around the world?

Clinton: You are the experts. We cant do this without your input. Says she will ask John and
Maya to develop a plan to involve all of you in the efforts [to address HIV/AIDS] both in the
campaign and in her administration.
Bobby Tolbert: Encouraged by Clintons commitment to continue dialogue with the coalition. Also
thinks it is critical that Clinton recognize the drivers of HIV, including poverty and homelessness.
Talks about the new wave of injection drug use plaguing various parts of the country, citing Detroit
as an example, and calls for a full lift of the ban on use of federal dollars for syringe exchange.
Clinton: Thank you.
Ernest Hopkins: Describes success San Francisco has had in reducing new transmissions of HIV,
but notes that there are different outcomes in the interventions the coalition there is using based on
peoples income, sexual orientation and gender identity. He notes that, while the Affordable Care
Act has expanded the number of people who have access to health insurance, many of the plans
have put in place discriminatory drug pricing schemes and other barriers that make access to
appropriate care difficult for people living with HIV, because they dont want this population in
their plans. Discusses the need to fix the Affordable Care Act as well as the continued critical
important role played by discretionary federal programs that serve people living with HIV who
would otherwise go without getting their needs met. Keep the discretionary programs, and fix the
Affordable Care Act so that it works for everyone.
Clinton: I am defending the Affordable Care Act because I believe it would be a grave error to start
over. But I am also proposing ways to improve it. Describes proposed improvements to include a
cap on drug costs. Suggests something like a cap of $250 that any enrollee would be compelled to
pay out of pocket in total monthly for drugs. Stop predatory pricing. Cites examples of that,
condemns pharmaceuticals for buying drugs just to raise their prices when they made no investment
in research and development that, in many cases, was invested long ago. We are going to tackle
that. We are also going to get control on the price paid by Medicare and Medicaid. We are going to
expand their negotiating power. We need to look at the impact on drug pricing on people with
chronic disease. Cites a man with HIV in New Hampshire who came to her worried that actions by
Turing were going to make it impossible for him to afford the drugs he needs. We need to get out
early and hard on these issues. We need to take a 360 degree look at how we can improve the
Affordable Care Act from the perspective of people who ae poor to those who can now afford to
purchase insurance.
Eric Sawyer: Speaks to the central role of Ryan White and the Affordable Care Act combined to
address barriers experienced by both those with limited resources and those without resources. Also
speaks to the growing recognition of the need to address social determinants of health both for
people living with HIV and those at risk. Is hopeful that the commitment demonstrated by Clinton
as Secretary will continue should she be elected president.
Clinton: Speaks to the need to continue to grow and defend the HIV discretionary programs like
Ryan White. Describes a three hour drive as Secretary to visit a PEPFAR-funded program outside of
Pretoria as a demonstration of her personal commitment to addressing HIV.
Peter Staley: Thanks Clinton for taking the time to meet with us and for her commitment to making
AIDS a priority.

Clinton: I want to thank all of you. If it were not for your voices [over the years] we would be
facing even more challenging terrain. We have to move forward on all fronts. John Podesta will
follow with all of you to build a realistic, achievable and bold plan.
Michael Rajner: Presents Clinton with a letter of invitation from NMAC to speak at the USCA.
Mentions that we are still hoping to meet with Bernie Sanders and Donald Trump.
Clinton: Accepts letter. Expresses interest in what comes from be meeting with Trump on his plans
for HIV because, whatever it is, It will be huge!
Meeting adjourns followed by photo op.