President Bush on AIDS: More Questions Than Answers

Comment by John S. James

Summary: The president spoke on AIDS June 23 in Philadelphia. His comments looked great in headlines, but details raised major questions.

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On June 23, 2004, President Bush spoke on AIDS in Philadelphia, at the same African American church where he also spoke on July 4, 2003. A transcript of this year's talk is at http://www.whitehouse.gov/news/releases/2004/06/20040623-4.html -- along with a White House fact sheet, and a discussion led by Carol Thompson, White House Office of National AIDS Policy.

The high-profile attention to AIDS is welcome, and the announcements look generous when reduced to headlines. But they leave major questions unanswered. The quotations below are from the fact sheet, which listed four announcements the president made in his speech:

* "Immediate availability of $20 million in new funding to deliver life-saving drugs to the men and women in the United States living with HIV/AIDS who are waiting today for HIV-related medication;"

This is welcome if it will get treatment for some of the over 1,600 Americans now on waiting lists for antiretrovirals through the AIDS Drug Assistance Program (ADAP). But there is good information on the cost of meeting the need, and the $20 million promised is less than 20% of the emergency funding required to end the waiting lines for this fiscal year. So far at least 25 U.S. senators have signed a letter calling for a $217 million increase for fiscal year 2005, plus a $122 million emergency increase to end the waiting lines now through March 30, 2005 (when ADAP can use the 2005 funding).

Also, the $20 million is not new money but will come from some other health funding. As of late June we do not know what other program will be cut.

Another long-term problem is that the ADAP program is supposed to be supported jointly by the Federal government and the states. The new money will largely go to those states that have failed to do their part (since they tend to have the longest waiting lines), removing incentive for states to contribute. While the central concern is getting treatment to the individuals who need it, we also need plan for sustainability, not just looking good before the election.

* "Support for the reauthorization of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act based upon the principles of focusing Federal resources on life-extending care; ensuring flexibility to target resources to address areas of greatest need; and ensuring results;"

The focus on life-extending care means "such as anti-retroviral drugs, doctor visits, and lab tests" (quoted from the fact sheet). Does this mean that cost-effective services like case management will no longer be funded through Ryan White, and almost all of the money will go to pharmaceutical companies instead?

Also, Bush wants his Administration to control how Ryan White money is allocated among different parts of the country. But this Administration has politicized science probably more than any other in history. How do we know that the money will not be directed to reward political supporters even if their programs were not working? This is happening already with abstinence-only HIV prevention programs.

* "Second distribution of available funding for the focus countries of the Emergency Plan for AIDS Relief -- $500 million -- will soon be on its way to organizations working in the field to provide antiretroviral therapy, promote prevention, care for orphans, and build the health system capacity in Africa and the Caribbean;"

This sounds generous in the headlines, but this money was appropriated by Congress and should have been spent long ago. The main reason for the delay is that the Bush Administration largely rejected the Global Fund created by United Nations Secretary General Kofi Annan, and set up its own system instead -- allowing it to use AIDS funding to pressure countries on unrelated issues.

* "Vietnam as the 15th focus country in the Emergency Plan."

We have no information on the merits of directing funding to Vietnam instead of some other country. But clearly the announcement works as compassion PR; Bush said in his talk, "We're putting a history of bitterness behind us with Vietnam."

The president also mentioned condoms "when appropriate," while much more strongly emphasizing abstinence. We are hearing that on the ground, "where appropriate" means restricting condom programs to sex workers or other marginalized populations -- and that countries are being told not to ask for condoms when applying for U.S. HIV funding.

Related: Bangkok, WHO, TAC

* Bush did not mention that his administration recently stopped 28 researchers from the U.S. Centers for Disease Control from attending the International AIDS Conference in Bangkok in July, forcing the withdrawal of about 40 scientific papers, after pressure against the Conference from right-wing members of Congress -- or that his administration is demanding that the World Health Organization get political approval before inviting any U.S. government scientist to WHO scientific meetings.

* Possibly by coincidence, the president spoke one day before the global day of demonstrations to invest in heath not war, called by the Treatment Action Campaign (TAC) of South Africa for June 24. From the call:

"In January 2003, the Bush Administration promised $15 billion over the next five years to alleviate the HIV epidemic. This was cautiously welcomed by human rights and AIDS organizations. Yet the expenditure approved by the US Congress as part of this commitment for 2004 is only $2.4 billion. The total amount of US aid money for 2004 is $17.55 billion. Yet the military budget approved for 2004 is already $368.2 billion, an amount that does not reflect the $87 billion war supplemental requested by the Bush Administration. Much of this military budget is being used to fight the so-called War Against Terror and to sustain the occupation of Iraq. We acknowledge the threat of terrorism. However, the most important and widespread threats to global security are the ones exacerbated by poverty and lack of development: the HIV, malaria and tuberculosis epidemics, as well as malnutrition. Alleviating these problems together with promoting human rights and negotiating solutions to world problems through international institutions is the best way to ensure long-term global security."

The full text of TAC's call is at http://www.tac.org.za/HealthNotWar.htm By June 28, volunteers had compiled and circulated links to 125 news reports from around the world on the Health Not War demonstrations.

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