Report Card
President George W. Bush
Subject: AIDS
As the Bush Administration's Presidential Advisory
Council on HIV/AIDS (PACHA) convenes, national,
regional and local HIV/AIDS organizations have come
together and find that President George W. Bush and
his Administration are not making the grade in
providing the strong leadership, coordinated national
strategy and funding necessary to combat the AIDS
epidemic both at home and abroad. With 40 million
people in the world living with HIV, the AIDS epidemic
remains an urgent "national security issue"
that must be addressed at the highest levels of the
federal government.
We urge you to give priority consideration to three
items immediately:
- Your strong commitment
to increased funding for programs and services
that provide hope and health to people living with
HIV/AIDS at home and abroad;
- Rapid progress on the
appointments of health experts in critical
positions that are now vacant, especially those at
the Centers for Disease Control and Prevention,
Food and Drug Administration, Health Resources
Services Administration, and National Institutes
of Health; and
- A meeting between you,
key officials in your Administration, and AIDS
advocates regarding the many issues relating to
AIDS in the third decade.
Everyday in the United States 110 people are
infected with HIV, and 50 percent of those infected
are young people under the age of 24. While African
Americans and Latinos make up 31 percent of the U.S.
population, they account for an estimated 70 percent
of new HIV infections. AIDS is disproportionately
impacting women of color and men who have sex with
men, and increasingly impacting older Americans and
low-income persons. HIV is an issue of homeland
security.
The HIV/AIDS epidemic requires a comprehensive,
coordinated national strategy, adequate funding, and
strong leadership at the highest levels of government.
Numerous factors -- including toxic, complicated, and
expensive drug regimens; growing HIV and AIDS
caseloads at home and abroad; and the lack of
widespread, frank prevention programs -- require a
greater national commitment today than ever before.
The challenges faced by Americans -- those living
with HIV/AIDS, and the millions more who are affected
by this disease -- are opportunities for this
Administration to build on our nation's reputation for
leadership and resolve. As our nation invests in
protecting our borders from the threat of terrorist
attacks, this Administration must commit the same
vigor, leadership and resources to protect Americans
and other nations of the world from the terrors of the
AIDS epidemic.
Care
Funding
With preliminary reports from the
Centers for Disease Control and Prevention (CDC)
showing that the number of new AIDS cases increased in
the United States by 8 percent last year and medical
inflation reaching 11 percent, community-based AIDS
service organizations around the country face
significant challenges in their efforts to increase
access to comprehensive care with less funding. When
medical inflation is taken into consideration, flat
funding the Ryan White CARE Act programs, as twice
proposed by the Bush Administration, has the affect of
reducing or eliminating care and treatment to nearly
16,000 individuals currently receiving care under this
program. By not increasing funding for the CARE Act,
it is also estimated that 27,000 of the 40,000
individuals infected by HIV annually in the United
States will not be able to turn to federally-supported
care.
The Administration's budget provides no new funding
for the AIDS Drug Assistance Program (ADAP) while
thousands of low-income persons living with HIV are
waiting to access life-prolonging drugs through ADAP.
Despite the billions of dollars invested in developing
important AIDS drugs, escalating drug prices and no
additional federal investment will force states to
deny access to these essential drugs.
With states facing serious shortfalls in their
respective state Medicaid budgets, the Administration
has yet to show support for an increase in the federal
Medicaid contribution, forcing states t o reduce
coverage, services and prescription benefits. This
could threaten the care and treatment of the 30
percent of persons living with HIV/AIDS in the US
receiving essential medical services through Medicaid.
Leadership
The Administration has failed to
show any leadership in reforming Medicaid to ensure
that low-income individuals whose HIV disease has not
yet progressed to AIDS are eligible for the program so
that they can benefit from early treatment. The
Department of Health and Human Services has not led
efforts to expand services covered by Medicaid or
worked with states to reach eligible individuals and
enroll them in Medicaid.
Housing
Funding
President Bush has twice
requested modest increases for the Housing
Opportunities for People with AIDS (HOPWA) program.
The FY 2002 request allowed the Department of Housing
and Urban Development (HUD) to fund newly eligible
localities without major disruption to existing
programs, but still leaves thousands of people living
with HIV/AIDS homeless or marginally housed.
The proposed 5 percent increase for HOPWA in FY
2003 is an improvement, however, the overall HUD
budget is flat-funded after accounting for renewal of
expiring Section 8 vouchers. Characterized as
increases, the renewal funds do not produce a single
new slot for eligible individuals or families. The
budget also flat funds other key programs for
low-income, homeless people with HIV/AIDS, including
Shelter Plus Care and Section 811.
Leadership
HUD Secretary Mel Martinez and
Deputy Secretary Roy Bernardi have publicly stated
their support for expansion of federal housing for
underserved, disabled populations, including
low-income people with HIV/AIDS. Unfortunately,
President Bush has largely ignored the federal
government's responsibility to provide housing support
for low-income, marginally housed working families and
homeless individuals, including many who are living
with HIV/AIDS.
Minority HIV/AIDS Initiative
Funding
An estimated 70 percent of all
new HIV infections are among African Americans and
Latinos, though they comprise only 31 percent of the
US population. Yet, for two consecutive years
President Bush has requested no new funds for the
Minority HIV/AIDS Initiative (MHAI). Officials at the
Department of Health and Human Services (HHS) have
undermined this critical initiative by failing to
follow "congressional intent" and AIDS
community efforts to target MHAI resources to
indigenous, minority, community-based organizations
within communities of color. As HIV infections and new
AIDS cases increasingly devastate communities of color
in the United States, Presidential inaction on the
domestic HIV/AIDS state of emergency in communities of
color is unconscionable.
Leadership
Despite promising statements from
HHS Secretary Tommy Thompson about the
Administration's commitment to eliminating health
disparities and improving health access for people of
color, he has not followed up that rhetoric with
action. President Bush has done nothing substantive to
support the MHAI. Indeed, the President himself has
yet to publicly acknowledge the AIDS crisis in
communities of color, which continues to
disproportionately impact women, gay men and youth.
Prevention
Funding
While the CDC has set a goal of
reducing HIV infections by 50 percent by 2005, the
Administration has failed to provide the resources to
the CDC and community-based organizations to achieve
such an important and necessary goal.
With the CDC's recent report that the number of HIV
infections in the United States is increasing, it is
irresponsible for the Administration not to make a
significant commitment to increasing the nation's
investment in HIV prevention. With half of all new
infections in young people under the age of 24, a
substantial influx of federal resources is necessary
to protect a generation from HIV that has never
experienced the real suffering and death associated
with AIDS. The federal government must invest
significantly more resources to enhance the quality
and scope of locally planned and targeted prevention
programs that respond to the particular needs of
populations at greatest risk for infection including
African Americans, Latinos and gay and bisexual men.
Leadership
In the past year, the Bush
Administration has actively undermined effective HIV
prevention programs. The Administration failed to
endorse and develop prevention policies and programs
based upon the findings of "The
Surgeon General's Call to Action to Promote Sexual
Health and Responsible Sexual Behavior." In
addition, the Administration has attacked
comprehensive, locally tailored HIV prevention
programs. The ultimate goals and scope of an
Administration-driven review of all HIV/AIDS programs,
including prevention programs, remains unclear and
undefined.
The public health community shares grave concern
over this Administration's strong and vocal support
for abstinence-only and abstinence-until-marriage
programs to the exclusion of comprehensive prevention
messages that include a discussion about and access to
contraceptives.
This Administration continues to support a federal
ban on harm reduction programs, including needle
exchange programs that have been affirmed by the
Institute of Medicine. President Bush has maintained
the Clinton Administration directive prohibiting the
use of federal funds to support needle exchange
programs and has endorsed a similar ban on the use of
District of Columbia funds in the Administration's FY
2002 and FY 2003 budgets.
Research
Funding
The National Institutes of Health
(NIH) is the backbone of the nation's AIDS research
initiative and President Bush's support for doubling
of the entire NIH budget is critical and supported.
However, allocation of these funds must be based on
scientific opportunity. The consolidated AIDS research
budget, which is required by law and provides for a
comprehensive AIDS research portfolio, must also be
included in the final NIH budget.
Leadership
President Bush has left the NIH,
the NIH's Office of AIDS Research and the Food and
Drug Administration (FDA) without leadership for over
a year while qualified candidates sit by. Both the NIH
positions are key to the success of the nation's
comprehensive AIDS research effort, including the
development of effective, better-tolerated treatments,
more evidence-based approaches to care and new
prevention strategies including vaccines and
microbicides. The FDA director is key to the
scientific review and marketing approval for new AIDS
drugs and treatments.
The AIDS community applauds the President in
announcing in his FY 2003 budget a long-awaited
increase at NIH on microbicides, women and HIV, and
HIV prevention. The AIDS community eagerly awaits the
opportunity to work with the Administration in
identifying the direction of such research and
resources.
While the AIDS community recognizes the president's
efforts in coordinating the federal government's AIDS
vaccine research, it stands concerned that the
transfer of the Department of Defense's (DOD) entire
HIV research program to the NIH may compromise the
flexibility and uniqueness of the DOD program.
Global Programs
Funding
Although the United States was
first to pledge funds to the Global Fund to Fight
AIDS, Tuberculosis and Malaria, the initial $200
million pledge was meager compared to the $7 to $10
billion needed annually to address the global
pandemic. The US contribution sent a poor message to
other countries, and as a result contributions have
been far less than expected. United Nation's
Secretary-General Kofi Annan has called for the United
States to contribute $1 billion to the fund. The Bush
Administration must make sure that our global response
to HIV/AIDS does not come at the expense of other
critical international or domestic health programs.
Unfortunately, President Bush's FY 2003 budget
includes less than $900 million for international
HIV/AIDS programs, including only $200 million for the
global fund. The United States remains on the bottom
of the list of developed nations when considering our
international foreign aid contribution as compared to
total gross domestic product.
Leadership
The Administration's leadership
on global AIDS issues has been mixed. Secretary of
State Colin Powell deserves great credit for making
global AIDS issues a priority and delivering important
public statements about the pandemic's devastating
consequences and the need to speak frankly about
condom use. We applaud the Administration for
recognizing the importance of HIV/AIDS at USAID by
elevating the HIV/AIDS division to an office and
increasing its budget and staff resources. The
Administration's role in ensuring that
non-governmental organizations (NGOs) are funded by
the global fund is also noteworthy. In contrast, some
in the Administration have questioned the ability to
provide treatment in the developing world and have
attempted to limit developing countries' ability to
manufacture their own versions of HIV treatments or
import cheaper generic versions. By re-instating a
policy that prohibits NGOs that provide comprehensive
family planning services from receiving US funds,
President Bush weakens HIV prevention efforts abroad.
Executive Office of the President
Leadership
After a strong public outcry, the
Administration decided to keep the Office of National
AIDS Policy (ONAP) and subsequently named Scott Evertz,
an openly gay man, to serve as ONAP's director. While
Mr. Evertz has been visible in the HIV/AIDS community,
it remains unclear how much influence and authority
ONAP has on the development and support of sound
HIV/AIDS policies within this Administration and the
White House. We also stand concerned that the
community has not been given the opportunity to have
an open dialogue with key policy staff at the White
House Office of Domestic Policy and the Office of
Management and Budget to discuss the Administration's
comprehensive HIV and AIDS strategy, or lack thereof.
The mission and clear commitment of the White House
Task Force on HIV/AIDS, jointly chaired by Secretaries
Powell and Thompson, to develop a coordinated and
comprehensive strategy for addressing HIV/AIDS in the
United States and internationally remain unclear and
undefined. While the Task Force provides a promising
forum for the formation of the Bush Administration's
HIV/AIDS policies across agencies, it has truly been
underutilized to date.
We stand concerned that a number of key
appointments important to HIV/AIDS programs have not
been made by the Administration including the Surgeon
General, the Director of the CDC's National Center for
HIV, STD and TB Prevention, the Director of the CDC's
Division of HIV/AIDS Prevention, and the Director of
the Office of HIV and AIDS Policy within HHS.
While the HIV/AIDS community commends the
Administration for retaining the Presidential Advisory
Council on HIV/AIDS (PACHA), we are concerned that a
number of individuals appointed to the council have
public track records of supporting HIV/AIDS policies
that are at odds with science, public health experts,
people living with HIV/AIDS and community-based
providers and have made statements viewed as
homophobic and discrediting sound, proven HIV
prevention strategies.
Ryan Clary
Community Organizing Program Manager
Project Inform
205 13th Street #2001
San Francisco, CA 94103
415-558-8669, x224
415-558-0684 fax
tan@projectinform.org
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