Rachelle Johnson is a vice president of the Podesta Group, a Washington, DC−based firm that specializes in global public affairs. Ms. Johnson worked for many years as a staff member and senior legislative advisor on foreign policy and federal appropriations in the U.S. Senate. She was later awarded a Mike Mansfield Fellowship that enabled her to spend time in Japan, achieving an in-depth understanding of Japanese government policies in the areas of national security, trade, and foreign policy. Most recently, she served as the director of public policy and global affairs at the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria. She has worked extensively with advocacy community organizations such as the UN Foundation, amfAR, Results, and UNAIDS. The TREAT Asia Report asked Ms. Johnson for her views on the future of U.S. support for global health and HIV/AIDS programs.
TREAT Asia Report: What do you think is the biggest global health challenge facing the new U.S. administration?
Rachelle Johnson: The biggest challenge for the administration is understanding what global health means, and the effects of the government’s investments in the broad and interconnected global health programs that it administers. For HIV specifically, the biggest challenge is understanding the pandemic over time. Where have we come from? What is happening on the ground and what are the significant challenges that remain concerning access to prevention, testing, and treatment?
It is also important for the new administration to understand that many countries may not be allocating domestic financing at the level needed to provide and sustain treatment. In addition to pushing other countries to contribute domestically, the U.S. needs to maintain its investments so that people have access to treatment.
We need to make sure that HIV/AIDS gets its fair share of the allocation. We also need to explain why adequate funding for all scientific research has to be sustained—research needs to be continuous in order to achieve real results.
TREAT Asia Report: Investments in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) have enjoyed bipartisan support in the U.S. Congress, and have resulted in substantial improvements in health and many lives saved. Some partner countries are increasingly concerned about the possibility of funding cuts that could slow or even stop the scale-up of HIV treatment. What can they expect could change in terms of America’s short- and long-term support for PEPFAR and the Global Fund?
Johnson: PEPFAR has tremendous support from Congress, as members have seen the data showing its impressive results. But indications are that funding to many governmental programs will be cut, not only to those focused on global health and not only to PEPFAR. So countries will either have to contribute more domestically and/or they will have to communicate effectively why the U.S. government should still be investing in PEPFAR. That means quantifying specific outcomes, such as how many lives that could be saved won’t be saved without continued aid. Nations that are not yet able to take full ownership of their HIV efforts may need to indicate where investments from PEPFAR, as well as from the Global Fund and UNAIDS, can fill in the gaps.
TREAT Asia Report: The AIDS epidemic has highlighted the critical intersection between public health and human rights—especially the rights of vulnerable populations such as men who have sex with men, people who inject drugs, and sex workers. These groups are disproportionately affected in Asia’s concentrated epidemics. How can we ensure the prioritization of rights-based HIV policies at a time when resources are becoming even more limited?
Johnson: This continues to be a challenge, particularly in countries with certain customs and/or laws that result in denial of access to treatment or to healthcare in general. The question for us is how can the U.S. be a leader in having that conversation to really get countries to ensure access? Sometimes it is necessary to tell countries that to receive funding they need to take specific steps to make sure that men who have sex with men and other vulnerable populations are reached. And I think the Global Fund has been successful in tying certain rights-based conditions to its funding model.
TREAT Asia Report: Domestic and global research funded by the U.S. National Institutes of Health—which has supported amfAR’s TREAT Asia program—has been essential to guiding evidence-based treatment practices and policies, as well as driving our search for a cure. What should be our key messages to promote the value of scientific and medical research to policymakers and society in general?
The government needs to see how global health programming, including for HIV/AIDS, affects the lives of real people—we have to show the human face of the pandemic.
Johnson: Over the past year, particularly as a result of President Obama’s cancer moonshot initiative, Congress has come to see the NIH as vital to curing a range of diseases, top among them cancer and Alzheimer’s disease. This past cycle saw a huge increase in allocations to the NIH, including the Cures Act, which funds research for specific diseases. We need to make sure that HIV/AIDS gets its fair share of the allocation. We also need to explain why adequate funding for all scientific research has to be sustained—research needs to be continuous in order to achieve real results.
TREAT Asia Report: Is there anything else that you'd like to convey to our readers?
Johnson: My main thought as we move through to a new administration is that we all need to be more proactive, whether through Twitter or other types of communication, just to educate. And I think that's one of the key words. It's okay to educate and we don't have to be fearful and on the defensive. The government needs to see how global health programming, including for HIV/AIDS, affects the lives of real people—we have to show the human face of the pandemic.