LGBT POV

On Friday, December 4 at 9:30 a.m. ET, (6:30 a.m. PST) the Kaiser Family Foundation is hosting a live webcast of a town hall-style discussion with Ambassador Eric Goosby, the U.S. Global AIDS Coordinator.

The expressed purpose is to explore the recently announced five-year strategy for the President’s Emergency Plan for AIDS Relief (PEPFAR). A KFF press release says:

“Ambassador Goosby will discuss the strategy, including how it fits into the larger U.S. Global Health Initiative, announced last May, and take questions from the audience in an hour-long session moderated by Jen Kates, vice president and director of HIV Policy at the Kaiser Family Foundation. Registration is required to attend the event in person in Washington, D.C.”

But Webcast viewers may submit questions for Ambassador Goosby anytime before 5 p.m. ET (2:00PST)  TODAY to ask@kff.org.

The webcast can be viewed here: kff.org/globalhealth/gh120409video.cfm. KFF will subsequently post a podcast, transcript and an archived version of the webcast.

As Kerry Eleveld from The Advocate reported Tuesday, Goosby was asked about the situation in Uganda, where a “Kill the Gays” bill (as Rachel Maddow, who has been covering this extensively, terms it) is now being considered. The bill not only criminalizes homosexuality but punishes gay sex with sentences that include life imprisonment and possibly, the death penalty. Andy Towle at Towleroad reports Thursday that the bill is likely to pass.

On Dec. 1, World AIDS Day, the European Union took a strong stance against the Anti-Homosexuality Bill 2009, as UK Gay News reported.

In an opinion piece in the Los Angeles Times Nov. 20, James Kirchick, an assistant editor of the New Republic and a contributing writer to the Advocate, called for the US and Goodsby to withhold PEPFAR funding from Uganda to kill the “Kill the Gays” bill.

According to Newsweek, Uganda received $287 million in PEPFAR funding last year. But, in an interview with Newsweek, Goosby said he would not intervene:

I’m very concerned about any decision that any country—including our own—would make to target a group that’s in the population, and that’s always been in the population, by excluding them from a service or passes legislation that criminalizes their behavior. Every time you do that, you push the behavior underground. It never works. Rather than minimizing the spread of the virus, it actually amplifies it.

The U.S. policy is trying to work with governments to say exactly that. I think I would do more harm than good by connecting our resources to respond to the epidemic to making them dependent on a behavior that they’re not willing to engage in on their own. My role is to be supportive and helpful to the patients who need these services. It is not to tell a country how to put forward their legislation. But I will engage them in conversation around my concern and knowledge of what this is going to do to that population, and our ability to stop the movement of the virus into the general population.

Newsweek concludes:

So, for all those who hoped that PEPFAR funding might be used as a hammer to pressure the Ugandan powers-that-be to abandon their crusade: no dice. The Obama era is the dialogue era; don’t pick fights, but persuade through elegant theses. That said, since the moral argument clearly hasn’t convinced the Ugandan authorities of the errors of their ways, one can only hope that Goosby’s public-health argument will.

The Advocate’s Eleveld got a similar response, reporting that Goosby “declined to say how the administration would respond if the bill passes.” But Secretary of State Hillary Clinton said on Monday:

“We have to stand against any efforts to marginalize and criminalize and penalize members of the LGBT community worldwide.”

Perhaps Secretary Clinton and Ambassador Goosby should read Samatha Powers’ “Bystanders to Genocide” article in the Atlantic Monthly, September 2001:

“In March of 1998, on a visit to Rwanda, President Clinton issued what would later be known as the “Clinton apology,” which was actually a carefully hedged acknowledgment. He spoke to the crowd assembled on the tarmac at Kigali Airport: “We come here today partly in recognition of the fact that we in the United States and the world community did not do as much as we could have and should have done to try to limit what occurred” in Rwanda.”

You might remember that Powers was on candidate Barack Obama’s senior foreign policy team until she was forced to resign after calling candidate Hillary Clinton a “monster.” But nonetheless, surely people in the State Department who supervise Goosby can concur that preventing a genocide is better than apologizing later for not doing anything to stop it.

Clearly Goosby needs to be pressed. Eleveld reported:

“Goosby had intimated in an interview last week that it was not his role “to tell a country how to put forward their legislation.”

The Advocate asked Goosby, “As you know, there’s a bill pending in Uganda — have you considered what you will do if that bill passes and, more generally, how you will be working with some African countries that harbor homophobic attitudes and target gays?”

Goosby responded, “We have a similar evolution in our country — we’ve had legislation that was put up every year during the early days of Ryan White that anything promoting ‘homosexual behavior’ was considered unacceptable and anything that did fall into that very large category was — attempts were made to not have those funded within the Ryan White context, things that promoted homosexual behavior.

“We’re familiar with that type of mind-set, and from a public health perspective it has no place in trying to engage and curtail movement of the virus into the population.

“Our collective experience globally in every country, both in developing and in resource-poor settings, has shown that every time your target a population in a negative way and put restraints and constrictions on their ability to reveal themselves to the society, to the community, you push that behavior further underground. When you push it further underground, individuals always come in later to care — later stage of the disease — and continue in that period off their antiretrovirals to participate in high-risk behaviors that further spreads the virus through that community.

“Our hope would be to — in a collegial and respectful way — to work with our colleagues in a country who are in policy-making decision places to understand that relationship, to understand the science of how the virus moves through populations and how you need, as the public health responsible entity, to position yourself in front of each of those expanding waves of seroconversion. And until you do that, that remains a conduit for the virus to reenter the general, not high-risk behavior population.

“So our hope is, is that the science will lead the way and that that dialogue can stay on that level and that the governments that are involved will realize that it’s in their interest and the interest of the larger population for them to develop strategies that address these populations.”

Here is Goosby’s official biography:

Term of Appointment: 06/23/2009 to present

Ambassador Eric Goosby serves as the United States Global AIDS Coordinator, leading all U.S. Government international HIV/AIDS efforts. In this role, Ambassador Goosby oversees implementation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), as well as U.S. Government engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Ambassador Goosby served as CEO and Chief Medical Officer of Pangaea Global AIDS Foundation from 2001 to June 2009. At present, he is also Professor of Clinical Medicine at the University of California, San Francisco. Ambassador Goosby has played a key role in the development and implementation of HIV/AIDS national treatment scale-up plans in South Africa, Rwanda, China, and Ukraine. He focuses his expertise on the scale-up of sustainable HIV/AIDS treatment capacity, including the delivery of HIV antiretroviral drugs, within existing healthcare systems. Ambassador Goosby has extensive international experience in the development of treatment guidelines for use of antiretroviral therapies, clinical mentoring and training of health professionals, and the design and implementation of local models of care for HIV/AIDS. He has worked closely with international partners on the development of successful HIV/AIDS treatment and treatment-based prevention strategies for high-risk populations.

Ambassador Goosby has over 25 years of experience with HIV/AIDS, ranging from his early years treating patients at San Francisco General Hospital when AIDS first emerged, to engagement at the highest level of policy leadership. As the first Director of the Ryan White Care Act at the U.S. Department of Health and Human Services, Ambassador Goosby helped develop HIV/AIDS delivery systems in the United States.

During the Clinton Administration, he served as Deputy Director of the White House National AIDS Policy Office and Director of the Office of HIV/AIDS Policy of the U.S. Department of Health and Human Services. Ambassador Goosby has longstanding working relationships with leading multilateral organizations, including UNAIDS, the Global Fund and the World Health Organization.

June 23, 2009