Obama’s Not-So-Bold AIDS Czar Pick

We clearly now have two epidemics in this country: one white, one black. To pick a white gay man seems terribly 1996.

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Last week, the Obama administration tapped Georgetown University researcher Jeff Crowley to lead the Office of National AIDS Policy; the director is the president’s top AIDS adviser, acting as point person for Congress and coordinating work across federal agencies. Crowley’s a longtime AIDS advocate and a smart policy wonk, an all-around competent guy. He’s also a sadly underwhelming choice for the job.

The problem isn’t who Crowley is, but rather who he is not. His appointment is another in a series of staffing choices—from Timothy Geithner to Kathleen Sebeliusin which the president has made safe choices that reaffirm conventional wisdom at a time when we need radically new ideas.

Crowley earned his AIDS bona fides during the Clinton era, when he worked for the National Association for People With AIDS. That was a time when NAPWA was involved in some important heavy lifting on beltway AIDS policy. It played a crucial role in getting Washington to at least rhetorically recognize the rapidly widening gulf between the black and white epidemics, and to start directing money toward black-specific projects. Crowley was deeply involved in that important work.

He’s also a leading expert on the inner workings of the public health care system that the majority of black people living with HIV depend upon to stay alive—a system in disarray after the previous administration’s insistent neglect of its ballooning caseload.

So Crowley both understands the challenges of today’s epidemic and, importantly, sets about solving them from a community-based perspective. Many credible AIDS activists have roundly praised Obama for choosing him.

All of that said, by appointing Crowley, Obama has missed an opportunity to send a clear message about how he’ll deal with the two most pressing issues he faces when it comes to AIDS today—the epidemic’s gaping racial disparities and the fact that the vast AIDS bureaucracy is aching for a bold leader to radically redirect its myriad, often unfocused efforts.

As I’ve written about at length—most recently in the Black AIDS Institute’s annual State of AIDS in Black America report—we clearly now have two epidemics. There’s the one that looks like other Western epidemics—people living longer, infection rates falling—and there’s the black one. We account for roughly half of all people living with AIDS, half of those newly infected every year, and far more than half of both women and youth infected. Federal study after federal study has shown black gay and bisexual men to have infection rates on par with the hardest hit parts of the developing world.

With all of that as a backdrop, I hoped and expected Obama would appoint one of the many smart, talented black people working on AIDS inside and out of government. Many of us working on AIDS have been arguing for a decade or more that solutions to the black epidemic are necessarily going to be home-grown. Appointing someone rooted in the black community would have offered a strong message both to our community and to the AIDS world at-large that the administration understands that, too. I have no info about the selection process, so it’s possible the White House tried and failed, for whatever reason, to make such an appointment work. But to pick a white gay man seems terribly 1996.

Symbolism aside, what Obama most needed for this post was an old Washington hand who knows how to make the levers of government work. The president has vowed to draft—in his first year in office—the nation’s first overarching strategy for dealing with AIDS. We’ve never had one, shockingly, which means the couple billion dollars we spend each year on AIDS seeps out willy nilly. We insist anyone getting foreign aid for AIDS work have such a strategy, and Obama says it’s high time we get one, too. Kudos.

But both getting it written and, worse, getting it implemented is gonna require moving a few bureaucratic and political mountains. There are competing interests between federal agencies, across party lines, in the community versus the various health care industries with a stake. I’d hoped Obama would pick someone—black or white, gay or straight—with the contacts and experience necessary to crack skulls and make bold reforms a reality. Crowley’s great, but I doubt he’s that person. I hope he proves me wrong.