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The newly appointed Presidential
Advisory Council on HIV/AIDS (PACHA) met for the first time
under the Bush administration in Washington, D.C. in March.
President Bush’s top health
advisors were on hand for the meetings. Health and Human Services
Secretary Tommy G. Thompson imparted to members that we are
“beginning a new chapter” in the struggle against HIV. He
stated that “this isn’t business as usual,” but rather that
the Office of National AIDS Policy is committed to “developing
effective tangible steps to arrest the advance of AIDS.”
PACHA Council member Caya
Lewis, a manager at the National Family Planning and Reproductive
Health Association, argued that allocations for treatment
programs do not correspond to the spread of the disease in
the U.S. Lewis stated, “I am deeply concerned about the lack
of emphasis on prevention in this administration.” Caya questioned
the administration’s commitment to curbing the increasing
rates of infection within minority communities with flat funding
for Ryan White programs.
Thompson proceded to defend
the administration’s decisions on AIDS policy, including flat
funding for Ryan White programs and funding emphasis on abstinence-only
programs, for fiscal year 2002-03. He said that given the
costs associated with the war on terrorism and homeland security,
AIDS advocates are fortunate that current funding levels were
maintained for prevention and treatment, and for increases
for research. “You don’t know how hard I had to fight to get
flat funding,” he informed the newly appointed Advisory Council.
“The priorities are the international war and homeland security.”
The administration’s allocation
for prevention funding is disappointing because it appears
to directly counter the efforts of the Centers for Disease
Control (CDC) and Prevention to improve HIV prevention. Many
critics have also denounced Bush’s proposed budget as devastating
for many HIV-infected people who do not qualify for Medicaid
and have no private insurance to cover their medications.
Stuart Burden, a Council
member and Levi-Strauss and Company executive, questioned
the administration’s pledge to the Global AIDS Fund. The U.S.
has promised $500 million for the Fund, estimated to need
$8-10 billion. “There is a belief in the international community,
given the size of our economy, that the United States has
not done enough,” Burden said. “What more are you [Thompson]
prepared to recommend?” Thompson responded that “no other
country has re-committed to the Fund” on the same level as
the U.S. He noted that the U.S. pledge represents 25 percent
of the total $2 billion in pledges, “a tremendous and generous
contribution.” Thompson restated that the international war,
homeland security, and domestic concerns were priorities for
the Bush administration and therefore overrides the Fund.
Thompson informed the Council
that his office has commissioned a management review of all
federally funded HIV programs. He stated that the goal of
the review is to make them “more accountable, better coordinated
and more efficient.” These efforts have also raised concern
among AIDS advocates who fear that this is simply the first
step in the administration’s plan to reduce HIV prevention
programs or redirect money.
Dr. Joe O’Neill, the acting
director of the Office of HIV/AIDS Policy, is overseeing the
review process of HIV programs and funding. O’Neill stated
that he only agreed to lead the process in order to “honor
successes and identify problems,” in other words, to improve
the government’s efforts. “I know there’s a lot of concern
this review will be either a whitewash or a witch-hunt,” he
said. “I want to put your minds at rest. The interest here
is in doing a better job.” He emphasized the fact that he
is not trying to damage any programs, but finding a way of
doing a better job of providing services to people living
with HIV.
Dr. Anthony Fauci, director
of the National Institute of Allergy and Infectious Diseases
at the National Institutes of Health, presented his agency’s
AIDS research for the Council. When asked about a possible
AIDS vaccine, Dr. Fauci informed the members that an effective
AIDS vaccine could be a decade or more away. “Do I think in
five years we are going to have a vaccine that is going to
prevent AIDS? Probably not,” he said. However, Fauci pointed
out that “some global health good” could come out of the vaccine
clinical trials that are currently being conducted. He explained
that in developing nations with the highest rates of HIV infection
an AIDS vaccine with moderate effectiveness would have a lasting
impact.
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Data on Merck’s highly anticipated
experimental vaccine was presented at the Retroviruses conference
held in Seattle this past February. The vaccine is only in
the first stage of safety testing and if successful it will
be at least another five years (and probably longer) before
the vaccine would reach the general public. Many experts are
of the opinion that a vaccine is the only way to stop the
AIDS epidemic, which has infected over 40 million people and
caused some 20 million deaths worldwide.
Comments from President Bush’s
gay AIDS czar, Scott Evertz, drew mixed reviews from those
in attendance. What’s the deal with him? In a scattered presentation,
Evertz spoke briefly about the resolve of the Office of National
AIDS Policy resolve to address HIV/AIDS, specifically in communities
of color. Evertz’s comments on efforts to reduce HIV infection
rates (targeting National Testing Day), and engaging in early
treatment for HIV infection, including reforming ADAP, Medicaid
and Medicare regulations, drew praise from Council members.
However, Evertz did not speak of specific policy initiatives.
Although Evertz appears to be dedicated and committed to the
work, his comments to the Council came across as being unprepared
and not well thought out. Is this always the case? Evertz
was also harshly criticized in an appearance in Atlanta in
early March for his off-the-cuff remarks. One former board
member of Atlanta Executive Network, a gay and lesbian business
organization, stated that while he expected Evertz to deliver
leadership, what he received was “a stand-up routine.”
ADAP shortfalls
Bill Arnold, the chairperson
of the ADAP Working Group in Washington, D.C, told the Council
that the AIDS Drug Assistance Program (ADAP) needs an $82
million emergency supplement to cover current shortages in
the program. ADAPs accept some 600 new clients every month,
and six or seven states now have waiting lists while others
have unofficial waiting lists, Arnold said. States currently
with waiting lists, client expenditure caps and/or drug access
restrictions include Alabama, Georgia, North Carolina, Kentucky,
South Dakota, Idaho, Wyoming, Maine and Texas.
Reports indicate that the
southeastern region of the U.S. appears to be having the most
difficulty with ADAP funding, with about 700 HIV/AIDS patients
on several waiting lists to receive antiretroviral drugs.
In addition, Arnold stated that these states have placed so
many restrictions on who is eligible for anti-HIV meds through
Medicaid that ADAPs have become the safety net for HIV positive
individuals. AIDS groups in Florida have asked the legislature
for an additional $5 million in ADAP funding. They say a drug
waiting list in the state will be inevitable unless the state
receives supplemental funding from the federal government.
AIDS advocates remain hopeful that Congress will improve on
the president’s budget, as it has in the past. However, even
during the budget surpluses of the Clinton years, the final
funding was regularly short of what AIDS groups said was needed.
In a surprise move, Hank
McKinnell, head of the drug company Pfizer, Inc. and a Council
member, announced that his company is freezing the price of
Viracept, a leading protease inhibitor used for HIV therapy.
Pfizer is the parent company of Agouron, the manufacturer
of Viracept. “We want all patients to have access to needed
medicines,” McKinnell said. AIDS activists have harshly criticized
pharmaceutical companies in recent months for their pricing
of AIDS drugs, the associated impact on state ADAP budgets
and insurance premiums. In a move that will certainly place
additional pressure on competitors, including industry leaders
Bristol-Myers Squibb and GlaxoSmithKline, McKinnell promised
that Pfizer would not raise the price of Viracept for two
years.
PACHA co-chairs
The make-up of the
Council has raised many eyebrows in the AIDS community. President
Bush’s decision to name former Oklahoma congressman Tom Coburn
to co-chair the Presidential Advisory Council on HIV/AIDS
created a firestorm among AIDS advocates. Co-chair Dr. Louis
Sullivan was Secretary of Health and Human Services for the
first Bush administration. Dr. Sullivan now serves as the
President of Morehouse School of Medicine in Atlanta. While
most are comfortable with the selection of Sullivan, Coburn
is criticized for having difficulties separating his personal
beliefs from proven science and public health policies.
Coburn is an obstetrician
and gynecologist by profession. He also served as a Republican
congressman from Oklahoma for six years until he retired in
2000. To his credit, Coburn was very instrumental in securing
the reauthorization of AIDS treatment and research funding
during his term in the House. He was the primary sponsor of
legislation renewing the Ryan White CARE Act. However, Coburn
maintains strong opposition to programs promoting condom use
and safe sex. He advocates sexual abstinence and monogamy
instead to reduce new HIV infections.
Coburn also opposes the distribution
of clean syringes to injection drug users (IDUs) as a means
to prevent the spread of HIV through contaminated needles.
Despite evidence indicating that clean needles do not promote
drug use and addiction, and do reduce the risk of HIV infection,
Coburn maintains that clean-needle programs are an endorsement
of further drug use. Under the Clinton administration, the
PACHA advocated for clean needle programs in its reports.
In late January, Coburn issued
statements stating that his personal views would not dictate
the work of the Council, but he promised to challenge the
national focus on condom use to prevent the spread of HIV.
“We have a prevention strategy that’s failed,” Coburn said
in an earlier interview. “We’ve spent hundreds and hundreds
and hundreds of millions of dollars and HIV infection is going
up.” AIDS activists counter that while rates of infection
are rising among certain groups, primarily in communities
of color, overall the 40,000 new infections reported each
year in the U.S. are well down from the 150,000 at the height
of the epidemic.
To the surprise of many,
Coburn took a low-key position at this initial meeting. He
urged members to work towards “building a consensus” on recommendations.
He spoke of his “visions” of a day with no more HIV infections,
no babies being born with HIV, and when all HIV positive individuals,
including IDUs, would have available to them the treatments
and services required.
President Clinton, Vice President
Gore, and Health and Human Services Secretary Donna Shalala
established PACHA in 1995. The Presidential Advisory Council
on HIV/AIDS provides advice, information and recommendations
to the Secretary regarding programs and policies intended
to promote effective prevention of HIV disease, and advance
research on HIV disease and AIDS. The role of the Council
is solely advisory in nature.
Early in the Bush presidency
there was concern that the Council would not be renewed. At
one point the administration suggested that the Council, as
well as the Office of National AIDS Policy were unnecessary.
However, after much criticism, President Bush and Secretary
Tommy G. Thompson renewed the Council´s charter in July 2001.
There are 35 advisory council
members, an interesting mix of corporate executives, AIDS
advocates and people living with HIV. Six members are returnees
from the Clinton-era council. The members who served during
the Clinton administration are Stuart Burden, Caya Lewis,
Joseph Cristina, Ronald Dellums, Philip Burgess and Ingrid
Duran.
A full list of PACHA members
and affiliations are available online at www.pacha.gov,
as are minutes from previous meetings.
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