Words v. Action on World AIDS Day

Bush’s speech conflicts with other urgent priorities in Capitol Hill budget wrangling

Last week in his World AIDS Day address, President George W. Bush affirmed America’s commitment to fighting the worldwide epidemic with an unprecedented amount of resources. The occasion’s importance was reinforced by the presence of five cabinet secretaries—Defense’s Donald Rumsfeld, Condoleezza Rice from State, Labor’s Elaine Chao, Commerce’s Carlos Gutierrez, and Mike Leavitt from Health and Human Services.

However, according to those involved in the daily fight against HIV’s spread, a gulf exists between Bush’s words and the action necessary from both sides of the political aisle to adequately address the epidemic.

Bush might declare, “We’re determined to improve care for minorities and citizens in the greatest need,” but Congress early last month moved to reduce Medicaid’s budget by $10 billion, the very program meant to help those in the most need. The House version also increased the premiums and deductibles many people would pay for medical services, as well as allowing states more leeway on who qualifies for Medicaid benefits. The implication is that many of those who depend on Medicaid for treatment and HIV medication will find themselves unable to qualify for the government program or afford the out-of-pockets.

“Medicaid is our nation’s largest provider of HIV/AIDS treatment and care and Americans trimmed from the rolls will be forced to see care through Ryan White CARE act programs that are already overextended and under-funded,” said Joe Solmonese, president of the Human Rights Campaign, the nation’s largest LGBT advocacy group, in a statement.

The differences between the House and Senate versions still need to be reconciled in a conference committee before a continuing resolution to keep the federal government running ends on December 17.

The soaring deficit and looming spending for the Iraq war and hurricane relief have forced Congress into a serious wrangle over government priorities. Since September, only a handful of agencies have been granted their full 2006 funding. Most others have limped along with reduced budgets, or at 2005 levels, when instead more money is needed. This is the second time the appropriations bill covering Health and Human Services has languished in the House. An earlier version was found so objectionable after it came out of a House-Senate conference committee that the House membership refused to ratify it.

Beyond the Medicaid cuts, there has been a lack of movement on the most important cornerstone of public HIV/ AIDS treatment in the country, the Ryan White CARE Act. As part of the appropriations bill that also funds Medicaid, and the Departments of Labor and Health and Human Services, the CARE Act has been living on temporary resolutions since September when its five-year authorization expired.

Enacted in 1990 to cover those who do not qualify for Medicaid, Ryan White has had increasing demands put upon it as the epidemic has spread and the anti-retroviral boon ensured more people remained alive to draw on its resources. The program provides comprehensive services including primary and home health care, case management, substance abuse treatment, and nutritional and housing services. Also, through the AIDS Drug Assistance Program (ADAP), administered separately by each of the states, it provides HIV-related medications to those without access to such drugs, typically people with inadequate or no private insurance but earning too much to qualify for Medicaid.

The measure is nowhere near being robust enough to handle the nation’s HIV-positive population.

“It needs another 300 million alone in the ADAP part just to keep up with the number of people who could qualify for help,” said Bill Arnold, director of the Title II Community AIDS National Network. “This year it got only ten million dollars.”

Bush’s budget allocated an additional $25 million for ADAP. Congress cut that increase to ten million dollars. The other Ryan White initiatives were granted no increased funding.

“This amounts to cutting the program’s budget once you factor in the number of additional people enrolled, inflation and the rising cost of healthcare,” Arnold said.

Ryan White, unlike many other government programs also receives budgetary funding only every five years, making it unable to respond to increased needs on a yearly basis. With 40,000 new infections annually in the U.S,. this assures Ryan White will always operate at full capacity and still not reach everyone who needs it.

Bush mentioned in his speech “the correct use of condoms,” a subject on which his reticence had become a focus of criticism aimed at his administration’s response to the epidemic. This was a move of sorts beyond the abstinence-until-marriage programs the president has always touted.

For some that still was not enough.

“Congress and the administration have ignored sound science in dealing with HIV,” said Chris Labonte, the Human Rights Campaign’s legislative director. “Their heavy reliance on abstinence-only programs are failing to arm our kids with the information they need to lead healthy and safe lives. They continue to prohibit federal money from being used in needle-exchange programs that have been shown to reduce the spread of HIV, while at the same time reducing prevention programs in favor of abstinence.”

Labonte said that he expects Congress to finally agree on a 2006 budget before December 17 when the continuous resolution funding runs out.

This past year the administration proposed $39 million be allocated to abstinence-only sex education programs around the country as a way of reducing HIV transmission. In an embarrassing rebuke to the president, the House proposed only $1.8 million. The amount was finally upped to $11 million in a House-Senate conference, though that amount was later again voted down by the House. The final sum waits like other appropriations until an agreement is reached later this month.

The Centers for Disease Control and Prevention (CDC) will endure a cut of more than $500 million its 2006 budget, while abstinence programs have seen a four-fold increase in the past five years.

Bush’s speech was also notable for its positive use of the word “gay” and the credit given the gay community in fighting HIV. If anything, the domestic portion of his remarks was a major concession to America’s evolving attitude toward the disease and the LGBT community.

“We are fortunate that such designated funding exists for HIV, said Greg Smiley, director of public policy for the American Academy of HIV Medicine, the only organization in the U.S. that certifies HIV specialists. “Something that doesn’t exist for any other disease. At the same time, the level of attention has been waning. It might be because fatigue is setting in or people believe the new medicines have made the situation less dire.”

Even with the Medicaid cuts and flat-funding of Ryan White, the amount the U.S. spends annually combating HIV is unprecedented. The major problem seems to be neither anti-gay nor anti-AIDS sentiments among lawmakers, but simply one of practicality.

“George Bush does care about AIDS,” said Carl Schmid, federal affairs director for the Washington, D.C.-based AIDS Institute. “But there are so many other budget needs its getting harder and harder to get people to respond to what’s needed.”

“This isn’t just a Republican problem,” Schmid said. “It’s as difficult to get Democrats to bring up AIDS as well.”