By Bob Roehr
President George W. Bush expanded his international AIDS initiative, added $20 million to ADAP, supported condoms while touting abstinence, and called for restructuring the Ryan White program that funds domestic services, all in a major address June 23.
The forum of an African American church in Philadelphia was chosen to guarantee a positive response to his message that contained large dollops of rhetoric on abstinence and faith-based programs.
The church has received a $1 million faith-based grant and its pastor has endorsed Bush's reelection. 'Now there's a heavenly payoff,' said Rev. Barry Lynn, executive director of Americans United for Separation of Church and State.
The President said, 'HIV/AIDS is a direct challenge to the compassion of our country, and to the welfare of not only our nation, but nations all across the globe. It's really one of the great challenges of our time ... . This isn't a minor tragedy. It's just not a blip in history. It is a great tragedy.'
Among those that Bush introduced was Dr. Joe O'Neill, the openly gay medical director of the international effort, the President's Emergency Plan for AIDS Relief (PEPFAR). Bush called him 'the architect of the global AIDS initiative … a deeply compassionate person and a man I'm proud to call friend.'
He announced release of the second round of funding, more than $500 million, for PEPFAR. Vietnam will become the 15th nation eligible to receive support. PEPFAR will spend $15 billion over five years and adding Vietnam means that the same amount of money will be spread across more countries.
Domestically, an additional $20 million is being released immediately to address waiting lists for state run AIDS Drug Assistance Programs (ADAP). Bush said that total federal funding for domestic HIV programs has increased 27% from 2001, to more than $17 billion in his proposed budget for next year.
The President also weighed in on reauthorization of the Ryan White Care Act. He said it was written years ago in an era when we were 'concerned largely with caring for the sick and dying, instead of helping AIDS patients lead longer and healthier lives.'
He wants to refocus program activities 'on life-extending care, such as antiretroviral drugs and doctor visits and lab tests [that were] just a dream 20 years ago,' and change 'a rigid geographic formula' that do not mirror the changing face of the epidemic.
Bush praised Uganda's ABC model of prevention—'Abstain, be faithful in marriage, and, when appropriate, use condoms'—as having cut their infection rate to 5% over 10 years. His positive mention of condoms was rare, though the majority of his prevention message focused on abstinence.
Drug addiction and needle sharing were mentioned, along with a plug for faith-based programs. But he avoided talking about federal support for needle-exchange programs.
It seems that the President touched just about every single group affected by HIV except one—gay and bisexual men—the group most affected by AIDS in the U.S.
Incredibly, gay and AIDS groups mirrored this silence on gays in their news releases reacting to the speech.
Cheryl Jacques, president of the Human Rights Campaign, chastised the President for his support of 'abstinence only until marriage education programs ... have been proven ineffective ... .'
Paul Volberding, chairman of the HIV Medical Association, called The President's focus on domestic HIV issues 'welcome and long overdue.' Singling out the ADAP increase, he said, 'We can only hope that these funds are not being reallocated from other federal health programs that provide services to medically needy populations.'
Log Cabin Republicans executive director Patrick Guerriero said the money for ADAP is 'a good first step … . This recognizes the seriousness of ADAP waiting lists and brings presidential leadership to bear. Now it is up to Congress and HHS to find ways to correct overall ADAP funding shortfalls.'
'This is a stop-gap measure,' said Gene Copello, executive director of the AIDS Institute. 'We still need $217 million to ensure that 136,000 low-income people have access to medications ... .'
'If you were on a waiting list as of June 23, you're in, if you weren't, you're out,' explained Murray Penner director of care and treatment programs at the National Alliance of State and Territorial AIDS Directors. Another ten states are on a watch list and soon may be initiating ADAP waiting lists. People subsequently added to existing waiting lists will not be covered.
It appears that rather than add money to the ADAP program, the Department of Health and Human Services is going to survey states with waiting lists, purchase drugs, and distribute them to the states, who will pass them on to patients. Penner said, 'It is going to be an administrative nightmare for the programs with higher numbers on waiting lists—all with no additional funding.'
Cynics have called it a band-aid approach by the administration to make the inconvenient problem of ADAP waiting lists—and potentially people dying while on those lists —go away until after election day.
Terje Anderson, executive director of the National Association of People With AIDS, is leery about refocusing the Ryan White programs on medical services. He pointed out that for many people living with AIDS, social services such as transportation and child care are essential to being able to visit the doctor and take full advantage of medical services, 'they are not icing on the cake.'
