A large piece of tape covered Christopher Bates' mouth as he stepped to the podium of the 2009 National HIV Prevention Conference in Atlanta, and then dramatically ripped it off.
"It was eight years of budget cuts; eight years of abstinence only; eight years of condoms don't work; eight years of bad people do bad things so bad things happen to them; it was eight years of monogamy until marriage," said the director of HIV/AIDS policy at the Department of Health and Human Services. "But we made it."
The career government employee said the Obama administration is like a breath of fresh air. He called on those in the audience to "hold our feet to the fire" in responding to the domestic epidemic of HIV. Bates' remarks were filled with challenges, but few promises.
Jeff Crowley, director of the Office of National AIDS Policy at the White House, said he has begun work on developing a national HIV/AIDS strategy, due by the end of the year. He sees it not so much as a product but a process, "a national conversation that asks the question, where are we with the epidemic in 2009."
"The President's goals are reducing HIV incidence; getting all people living with HIV into care; and reducing HIV-related health disparities," Crowley said. The focus will be on those most affected by the epidemic, gay and bisexual men, and African Americans.
"I start with the idea that we are doing lots of things right. How can we sharpen our focus and do a better job?" He held the first of 14 scheduled town hall meetings in Atlanta toward that end.
"This is the moment we have been waiting for," said Kevin Fenton, director of AIDS programs at the Centers for Disease Control and Prevention ( CDC ) .
"A national plan should have measurable goals, measurable objectives, tied to resources. We have seen too many strategic plans which have been developed without any new resources or without looking critically at how we leverage existing resources to ensure that they are targeted to areas where they are most needed or we can have the greatest impact."
When pressed as to why he is optimistic that this planning exercise will be successful where others have failed, Fenton said at a news conference, this is the first plan that encompasses all federal agencies, not just CDC. He hopes that it will create excitement and draw new resources, while better coordination will create greater efficiencies.
"We shouldn't expect that there is lots of free money on the table, we understand that there are very serious federal budget deficits," cautioned Crowley, sounding like a Republican of yore. "But we also are not taking off the table new investments."
"Part of the opportunity with the strategy is to sharpen our case, come out with something that Congress and the American people can understand we are building on success, and if we make new investments, this is what they can expect to get from that."
Many states are cutting back their support for AIDS care and prevention. Crowley said the administration has directed economic stimulus money to Medicaid and community health centers "but there are limits to how much the federal government can respond…we just don't have the capacity to backfill all of the needs at the state and local level."
"Our progress towards ending the disease here in the US has stalled," Health and Human Services Secretary Kathleen Sebelius said later in the day. She is the first Secretary to speak at the prevention conference. She noted that complacency has set in among the American public about HIV and it has largely disappeared from the media.
But almost half of all African-American gay men were HIV-positive, according to a 2005 study conducted in five cities that Sebelius cited. "Imagine if it were half the straight white women in Atlanta. Wouldn't we be calling this a national emergency? Shouldn't we be?"
Sebelius said the Obama administration has chosen to redouble the domestic HIV effort. She announced that Helene Gayle has agreed to chair the Presidential Advisory Council on HIV/AIDS, which will be restructured to focus on domestic programs. Gayle has been a leader in the fight against AIDS at the CDC, the Gates Foundation, and now as president of the international relief group CARE.
The Secretary was not made available to the press at the event.
But even Obama supporters have to wonder, if the administration is was intent upon restoring the public visibility of HIV, why then on the same day as Sebelius' appearance at the conference did it also release a presidential advisory commission report on the H1N1 virus, the so-called swine flu?
The estimates of death within that report rightly made the front page of the Washington Post, USA Today, and television news. It was guaranteed to be the lead health story of the day and completely crowd out news coverage of HIV.
Delaying release of that report by a day or two would have left room for HIV coverage.
What is Crowley going to learn in his cavalcade of a 14 city "listening tour" that he hasn't already learned from his years of experience working with the epidemic, or his town hall meetings earlier this year at AIDSWatch and when he has traveled to cities like Philadelphia and Chicago?
What "new" things will make it into what he envisions as a 20-page strategy explaining things to the American people?
Or is it just a procedural exercise to defer grappling with the real issues of AIDS programs and funding?
While these representatives of the Obama administration hope that additional funding will be made available to them, there was no firm commitment, and a dampening of expectations that it would be. They all cautioned that the current economic climate was tough.
More troubling to some observers is that funding for HIV prevention was cut from the economic stimulus package this spring, along with money for family planning. They were the two areas that the administration readily conceded to Republican objections.
While participants at the prevention conference may have appreciated the change in atmosphere from the Bush to the Obama administrations, what beyond the atmosphere has changed?