Sign-on letter to President Bush
re: Domestic AIDS Policies
June 20, 2003
The Honorable George W. Bush, President
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Mr. President:
As leaders of national, regional and local organizations committed to ending the human suffering caused by AIDS, we are appreciative of the focus you and your administration have placed on the global AIDS pandemic. We also recognize and applaud the work Secretary Thompson and the Health and Human Services (HHS) staff put into approving the new HIV rapid tests. Your recognition of the importance of fighting HIV/AIDS is to be commended.
However, we are deeply troubled by recent developments and federal policy changes in HIV prevention. The most recent actions by the Centers for Disease Control and Prevention (CDC) with regard to federal funding of locally-approved HIV prevention programs at the STOP AIDS Project in San Francisco are only the latest in a series of events which appear to prioritize political ideology over sound science and public health practices. The cumulative effect of these policy changes threatens to increase, not reduce HIV transmission rates, and jeopardizes the lives of thousands of men and women across the country who are at risk of HIV infection.
We simply cannot afford for HIV/AIDS to continue to be mired in political debate. Unfortunately, these recent actions seem to be not just isolated events but indicative of a growing and very troubling trend. Increasingly, federal agencies are making politically motivated decisions intent on dismantling or discrediting programs and funding initiatives targeted at those communities most at risk of infection: people of color and gay and bisexual men. This trend is not acceptable and works against not just the health and safety of at-risk groups, but the health and safety of all citizens. We need your leadership on this issue.
We have outlined our major concerns below:
Funding for Domestic HIV/AIDS Programs
The HIV epidemic is growing in America every day, while federal resources to fight it are not keeping pace. If the government does not fully fund federal AIDS programs, there is only one sure result: The American taxpayers will see both costs of treatment and the death toll rise dramatically. A recent study from the Emory University Rollins School of Public Health states that "failure to reduce new HIV infections in the United States by 50 percent in the next two years could cost the nation more than 18 billion dollars." For three years your Administration has recommended essentially flat funding for domestic AIDS treatment and prevention programs, ignoring the increasingly devastating toll this epidemic is taking on Americans.
HIV prevention has never been funded at the levels needed to meet the CDC's goals of halving HIV infections by 2005. When more people than ever before are living with HIV/AIDS, flat funding is simply not acceptable. Forty thousand Americans are newly infected with HIV every year, half of them under the age of 24. Further, the epidemic is hitting low-income communities of color hardest. Adequately addressing the epidemic now means recognizing long-existing health disparities and dealing with social mores in tandem with traditional HIV prevention. We must fully arrest this epidemic - and that requires a national commitment to both sound public health and compassion on a larger scale than we have seen in the twenty-two year history of AIDS.
The CDC's New Prevention Initiative
While we are supportive in general of the initiative's stated goals, we are extremely concerned that released drafts of these new guidelines signify a dangerous shift in health policy that will negatively impact efforts to prevent new infections and educate individuals about their risk for HIV infection. The initiative focuses almost entirely on HIV testing and prevention programs for HIV-positive people. By doing so, it shifts already inadequate resources away from other effective strategies (specifically health education and risk reduction) which are critical to keeping at-risk individuals uninfected. Community-based health education and risk reduction strategies have been under fire from a small number of elected officials and their staff members, despite overwhelming scientific data about the effectiveness and necessity of these efforts. Rising trends in new HIV infections are not in and of themselves signs of a failed effort as much as evidence that resources to halt the spread of HIV have been too meager.
As such, the new initiative fails to support targeted comprehensive prevention strategies for at-risk populations including people of color, especially women of color, as well as injection drug users, gay men, homeless individuals, and sex workers. These populations comprise the vast majority of new infections in our country each year and require comprehensive ongoing prevention interventions that reflect the reality of their lives. Community-based organizations, in collaboration with state and local health agencies, are uniquely positioned to deliver and target comprehensive prevention interventions to vulnerable populations. The CDC has set the goal of reaching 200,000 people in the U.S. who don't know their HIV status. With no guarantee that the CDC will support community-based interventions with these groups, we have little faith that such a goal is achievable. The CDC acknowledged years ago that hard-to-reach populations depend absolutely on well funded programs developed and implemented by community-based organizations.
We are further concerned that the recommendations for prenatal HIV testing policies will result in pregnant women being HIV-tested without their knowledge and explicit consent. Data demonstrate that states with so-called opt-out prenatal HIV testing policies have high percentages of pregnant women who do not know they have been HIV-tested. Medical ethics require that patients understand their examinations and treatment, especially concerning a disease as medically and socially serious as HIV/AIDS. Providing pregnant women with information about HIV and an opportunity to choose an HIV test is not an onerous burden upon medical providers.
Finally, we question the release of these draft guidelines without any coordinated efforts with other federal agencies that would indicate how programs already struggling to provide Americans with access to health care, including the AIDS Drug Assistance Programs, will meet the treatment, care and housing needs of newly identified HIV-positive people.
Local Community-Based HIV Prevention Does Not Mean "One Size Fits All"
Since the beginning of the AIDS epidemic in the U.S., community-based responses have been critical to successes in prevention, care and treatment. While the government remained silent, our communities led the way by creating culturally relevant programs and media campaigns targeted to individuals and communities at risk for and living with HIV. These successful programs dramatically reduced HIV infection rates and prevented tens of thousands of HIV infections. Recent spikes in HIV infection rates require communities to produce more innovative, culturally-relevant messages targeted to specific at-risk populations.
The recent actions of the CDC with regard to the STOP AIDS Project are a prime example of an organization creating culturally relevant programming. While the work that STOP AIDS does may be, at times, controversial to some people, they are working to build innovative, culturally competent, scientifically-based and effective prevention interventions that address the realities of HIV risk and prevention for a particular community at high risk of infection. Multiple and invasive government program reviews and financial audits have shown that they have complied with the requirements for review and approval of their materials. The CDC itself in February reported that they were using current, effective models as the basis for their work. STOP AIDS continues to be singled out for attention based solely on the politically-motivated demands of conservative Congressional idealogues. This has extended far beyond reasonable oversight or accountability and become nothing more than harassment.
This kind of relentless and intrusive engagement between the CDC and a grantee sets a troubling precedent. The chilling impact this has had on community-based prevention efforts across the country is unacceptable. The law governing the federal funds at issue here forbids their use "to provide education or information designed to promote or encourage, directly, homosexual or heterosexual activity." It is clear that these programs are designed not to promote sexual activity, but instead are designed to promote the adoption of behaviors that lower the risk of HIV transmission. The efforts that STOP AIDS is engaged in are completely consistent with both the spirit and the letter of the law. While these programs may make some people uncomfortable, STOP AIDS is doing what is necessary and appropriate to save lives in a community at imminent risk.
The regulations enforcing Section 2500 of the Public Health Service Act require agencies such as the STOP AIDS Project to direct their activities towards those most at risk. In their case, that means targeting gay men who are already sexually active, and whose sexual behavior puts them at high risk for becoming infected with or transmitting HIV. An abstinence-only message offered to this and other populations that are made up of sexually active people is of extremely limited use. In particular, the strategy of abstaining until marriage is even less useful to gay men, the majority population impacted by HIV infections, who are forbidden from entering into legally recognized unions.
AIDS is a public health crisis, not a political campaign. We ask you and your agency officials to work with community-based HIV/AIDS prevention organizations, and refrain from stonewalling those whose HIV prevention philosophies do not match the most conservative political ideologies. We ask you to call on Congress to do the same.
Condoms, Abstinence, and Information
While your Administration may prefer to educate Americans about sexually transmitted diseases through an abstinence-only policy, current science continues to demonstrate that comprehensive HIV prevention - including but not limited to abstinence - is the most effective way to help reduce new infections.
We continue to be troubled that sound public health information is being measured against a political standard and not by science. We refer to the fact that information about condoms and condom efficacy virtually disappeared from the CDC web site for more than a year. Scientific studies have proven numerous times that condoms work and public health experts continue to advise that condoms should be a part of a comprehensive approach to HIV and STD prevention.
While the best protection against STDs, including HIV, is to abstain from sex or remain monogamous with an uninfected partner, it is also critical to ensure that sexually active individuals have information about condoms. In addition, comprehensive school health education - including encouraging teens to delay sexual activity and providing them with appropriate, scientifically accurate information on the effectiveness of condoms - is critical.
Teens are among those most likely to have multiple sex partners and engage in unprotected sex, and therefore are at highest behavioral risk for acquiring most STDs. Further, extensive research indicates that comprehensive school health education programs that include information on condom use do not encourage teens to initiate sex at an earlier age or engage in more frequent sex if they are already sexually active.
Potential Censorship at NIH and Other Federal Agencies
Published reports and communication with researchers at the National Institutes of Health and other federally-funded research institutions has led us to be extremely concerned about the potential of censorship in science. The heart of public health policy must be dictated by science, not partisanship. When researchers are discouraged, intimidated or threatened by federal agencies because of the perceived controversial subjects of their work, the scientific progress of our nation and the health of its citizens are compromised.
In particular, when HIV/AIDS researchers are implicitly or explicitly discouraged from doing research that includes any mention of gay or bisexual men, or sexual behavior between men that may put them at risk for HIV transmission, there is a clear censorship of potentially life-saving information that could help a community still devastated by the AIDS epidemic and new infections. We call on the Administration to protect science from such dangerous politics.
Mr. President, your Administration has the responsibility to support sound public health and science-based HIV prevention models and programs that allow all Americans to benefit from research and public health policy without regard to the divisive politics of a few politicians. We call on you to halt the regressive policies of censorship and intimidation-both regulatory and informal-that put American lives at risk.
We ask for a timely response from your office regarding these concerns.
Sincerely,
William E. Arnold
TII CANN - Title II Community AIDS National Network
1775 "T" Street, NW
Washington, DC 20009
Mark Harrington, Executive Director
Treatment Action Group
611 Broadway, Ste. 608
New York, NY 10012
A. Cornelius Baker, Executive Director
Whitman-Walker Clinic
1407 S Street, N.W.
Washington, DC 20009
cc: Cabinet Members
All Members of Congress
Democratic Candidates for President
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