Yesterday, President Bush signed H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act, which will fund PEPFAR, the the global AIDS program that may be Bush’s most positive legacy. This second iteration of PEPFAR bears significant flaws in the area of prevention, and troubling caps that could limit how many people receive treatment. But it represents significant progress against the daunting global epidemic, thanks in part to the political will generated through grassroots pressure.

Yet the domestic epidemic continues unabated. This week, the Black AIDS Institute published Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic, which notes that more Black Americans are infected with HIV than the total populations of people living with HIV in seven of the 15 countries served by PEPFAR. In fact, if our nation’s own capitol city were a country, Washington DC would be noted for having the 11th highest HIV prevalence in the world.

The real dollar levels of HIV prevention funding during the Bush years have shrunk even as the epidemic has grown. And, as it turns out, that epidemic may be growing faster than previously thought.

On Sunday, at the bi-annual International AIDS Conference in Mexico City, CDC will announce a new, higher estimate on the rate of new HIV infection in the United States (check out AIDS2008.com, the activist conference blog to get a taste on what else is happening there). In keeping with rumors swirling for many months, the new estimate will raise the annual infection rate from 40,000 to 56,000 – a drastic, almost 50% increase that’s even more striking in the context of the now-discarded CDC of decreasing infections by 50%.

The new estimate is based on data from one year – 2006. We don’t know whether this higher rate of new infections is going up or is stable, and won’t know for one or two more years -- but we do know it is too high, most notably among African Americans, Latino/as, and gay men of all races.

Will the candidates use this opportunity to issue a bold call for action against the HIV/AIDS epidemic in our country? Neither candidate has highlighted the domestic HIV epidemic in the post-primary season, and McCain doesn’t even have an HIV/AIDS platform.

At that International AIDS Conference next week, global collaboration on HIV will be impeded by the distinct absence of the vast majority of U.S. scientists and public health officials, thanks to the efforts of “Dr. No,” Senator Tom Coburn of Oklahoma, who has been the leader of a virtual travel ban for federal
employees who should be at this work-focused gathering.

Known as "Dr. No" for his dogged work to stall and block bills in Congress, the Oklahoma Republican has pushed for warning labels on condoms, is a leading force in the anti-prostitution pledge blocking effective HIV prevention efforts with sex workers, and is responsible for PEPFAR’s ongoing ideological barriers to effective HIV prevention as well as new funding limitations that will reduce the number of people with HIV accessing lifesaving treatment.

Guess what?

On the campaign trail, McCain has referred to Coburn as the person whose advice he seeks on HIV/AIDS issues, and Sen. Obama has cited his work with Coburn as an example of cross-party collaboration.

A week after the AIDS conference, Senators McCain and Obama will speak at the Saddleback Church, a megachurch led by evangelical pastor Rick Warren and his wife Kay, who have taken an unusually strong stance on faith involvement in the global epidemic. Will the candidates take this opportunity to distance themselves from Coburn by calling out for progressive action against the domestic epidemic? Will they vow to institute a national AIDS strategy, which we request from PEPFAR recipient countries but lack for ourselves? What about swapping the federal funding of misleading and biased abstinence-only programs with the long-standing ban on syringe exchange funding?

The bottom line is that the HIV epidemic in the US continues to spread, and at a rate greater than was previously thought. The real measure of political leaders and the American people is if this bad news spurs good action – the establishment of a comprehensive and accountable national AIDS strategy that will eliminate barriers to effective prevention, generate adequate resources, and hold the government accountable for ending this epidemic.