Federal Update—February 15, 2005

• Bush Budget Under-Funds HIV/AIDS Fight
• Senate Takes Early Start on AIDS Legislation
• Two Federally Funded Studies Confirm Benefits of HIV Screening, Care Services
• Multi-drug resistant HIV discovered in New York City

Despite Rhetoric, Bush Budget Under-Funds HIV/AIDS Fight
FEB. 16, 2005--As communities across the country commemorated National Black HIV/AIDS Awareness Day last week, President George W. Bush released a proposed federal budget that, if approved by Congress, would slow the federal government's response to HIV/AIDS in America.

Just days earlier President Bush had spoken of the escalating HIV/AIDS crisis among African Americans and the need for HIV prevention and care services during his State of the Union address. To the chagrin of most AIDS advocates, the president's fiscal year (FY) 2006 budget does not match his rhetoric and contains no bold plans to address the epidemic. In fact, in most areas the president proposes scaling back efforts against HIV/AIDS.

A review of important federal activities and the president's FY06 budget follows.

PREVENTION
Despite enormous challenges curbing new HIV infections in America, the president is requesting $4 million less for domestic HIV prevention services funded through the Centers for Disease Control and Prevention (CDC). According to experts, a $386 million investment in science-based HIV prevention services could substantially decrease the 40,000 new infections that occur annually in the U.S. Failure to adequately invest in HIV prevention will result in a predicted 130,000 new infections by 2010 at an estimated healthcare cost of more than $18 billion.

CDC's budget for global health initiatives, including HIV/AIDS programs, would increase 4.2% to $306 million. Nonetheless, overall CDC funding would decrease 9%.

Meanwhile, the administration is requesting a $38 million increase for medically inaccurate abstinence-only programs, bringing the budget to $192.5 million—an increase of more than half since 2004. Abstinence-only programs do not include education about safer sex and HIV/AIDS transmission and have been proven ineffective in reducing sexual risk taking among young people.

The Minority AIDS Initiative (MAI), a cross-departmental appropriation designed to help communities of color respond to the epidemic, is slated for level funding in FY06. Prior to the budget announcement, AIDS advocates had hoped the president's State of the Union remarks signaled support for MAI expansion:

"Because HIV/AIDS brings suffering and fear into so many lives, I ask you to reauthorize the Ryan White Act to encourage prevention and provide care and treatment to the victims of that disease," President Bush said to the nation in his State of the Union address on February 2. "And as we update this important law, we must focus our efforts on fellow citizens with the highest rates of new cases: African-American men and women."

HOUSING
The Bush budget includes another deep funding cut—$14 million—for the Housing Opportunities for People with AIDS (HOPWA) program, which sustained a $13 million reduction this year. Funding at this amount would return the program's budget to pre-2001 levels, and result in a loss of housing for thousands of low-income, disabled people with AIDS across the country. Two more jurisdictions will become eligible for HOPWA assistance next year, bringing the total to 124. This reduction assures currently eligible jurisdictions, such as Chicago, of funding cuts again next year.

Big cities across the country have raised serious concerns with the proposal to eliminate the Community Development Block Grants (CDBG) program, which supports economic development, housing, environmental, and social services projects in blighted urban areas. Under the new proposal, 18 existing community and economic development programs from five cabinet departments, including CDBG, will be consolidated into a single program with new eligibility and accountability criteria. The Bush administration proposes to spend $3.7 billion on the new Commerce Department program, about $2 billion less than the total all 18 programs receive now.

HEALTHCARE & SOCIAL SERVICES
Without offering many specifics, the Bush budget calls for a $60 billion reduction in federal Medicaid dollars provided to states over the next decade. As part of the plan, the Centers for Medicaid and Medicare (CMS) would narrow how states raise matching Medicaid dollars, adjust long-term care rules, and lower reimbursement rates for medical providers and pharmacy services. Healthcare advocates expect CMS to unveil a more detailed proposal, describing a capped funding or block-grant initiative, in order to meet the President's savings goal.

Medicaid is the most important payer of AIDS care in America, covering more than half of all people with AIDS in the U.S. If the administration succeeds in decreasing federal Medicaid funding, states are likely to devise ways to reduce new enrollments and/or eliminate covered services—all changes that could be devastating to the health of low-income, uninsured people with HIV/AIDS. For the Ryan White CARE Act, President Bush is seeking only a $10 million increase, all of which goes to the beleaguered AIDS Drug Assistance Program (ADAP). His budget seeks no funding increases for the essential medical and social services that administer HIV medications and help keep clients in care. The CARE Act is under-funded by more than $500 million, half of which is necessary to provide equitable access to ADAP across the country.

RESEARCH
The National Institutes of Health is slated for a less than 1% funding increase, which will slow research toward an effective vaccine, microbicide, and cure.

Senate Takes Early Start on AIDS Legislation
The AIDS Foundation of Chicago (AFC) applauds the introduction of the Early Treatment for HIV Act (ETHA) by Senators Gordon Smith (R-OR) and Hillary Rodham Clinton (D-NY). The bill would provide states financial incentives to cover low-income and uninsured people with HIV in their Medicaid programs. The program remedies a significant flaw in Medicaid’s current structure – a requirement that people with HIV become disabled before Medicaid will cover the very medications that would prevent an HIV-related disability. The bill, S.311, already has 27 co-sponsors. Staff to Senator Dick Durbin confirmed his intention to co-sponsor the bill again this year. AFC is also reaching out to Senator Barack Obama for his support.

AFC’s partner in microbicide advocacy, the Global Campaign for Microbicides, reported that Senator Obama has agreed to introduce the Microbicide Development Act with Senator Jon Corzine (D-NJ), and others in early March. The bill will focus, streamline, and speed the research and development of microbicides for the prevention of HIV and other STDs, coordinating this work across the National Institutes of Health, the CDC, and the United States Agency for International Development.

Two Federally Funded Studies Confirm Benefits of HIV Screening, Care Services
Federal officials announced the results of two federally funded studies that recommend broader HIV screening and the offer of voluntary counseling, when applicable, for virtually all populations in the U.S. The studies confirm that if HIV-positive people know their status and access HIV-related medical care early, it may substantially prolong and improve their lives.

The study results support passage of the Early Treatment to HIV Act (ETHA), recently introduced by Senators Gordon Smith (R-OR) and Hillary Rodham Clinton (D-NY). ETHA would allow states to cover uninsured people with HIV in their Medicaid programs, before they become is matched with expanded HIV medical access for the uninsured in order to reach the benefits projected in these studies.

Researchers used computer models to measure the cost-benefits of voluntary HIV screening (not testing) in high, medium, and low seroprevalence populations. The underlying assumption in both studies was that those identified as HIV-positive after screening and voluntary testing would be able to access HIV-related medical care and treatments.

These studies recommend routine HIV screening, which includes HIV counseling, risk assessment, and the offer of voluntary HIV testing. HIV counseling and risk assessment are critical and should be performed with all people before an offer of HIV testing. The studies found that routine screening (i.e. every 1 to 3 years depending on risk factors) would be especially cost effective in high and medium seroprevalence populations, and one-time screening would likely be cost effective in low seroprevalence populations. The authors were careful to note that the models used did not measure other benefits of screening, such as risk reduction as a result of prevention education. Nor did it measure other costs, including increased clinical staff needed for HIV counseling, psychosocial support, and increased demand on programs such as the AIDS Drug Assistance Program, other Ryan White CARE Act services, and Medicaid.

The authors caution that testing should remain voluntary—not mandatory—and that issues such as community norms, stigma, and confidentiality be carefully considered in the operation of HIV screening programs. For more information, read the full article.

Multi-drug resistant HIV discovered in New York City
On Friday, February 11, 2005, the New York City Department of Health and Mental Hygiene, with support from the CDC and the Aaron Diamond AIDS Research Center, released partial results of a preliminary investigation of a single and rare case of HIV apparently resistant to three of the four classes of drugs used to treat HIV infection. Many scientists (including co-discoverer of HIV Dr. Robert Gallo and Cornell Medical School’s Dr. John Moore) reacted with caution to the news. While acknowledging that this rare case warrants thorough investigation and explanation, they stressed that there are many questions still to be answered and it is premature to announce the emergence of a “supervirus.”

New infections by drug-resistant strains of HIV are not a new phenomenon. This particular case is unusual in that the person’s virus is apparently concurrently resistant to many anti-HIV drugs. However, two cases of rapidly-progressing virus resistant to three classes of HIV drugs were documented by Dr. Julio Montaner in Vancouver in 2001, without a public health crisis in its wake. AFC will continue to monitor news about this issue as it becomes available.

For more information and commentary visit:
AIDSMap
Community HIV/AIDS Mobilization Project
Project Inform
San Fransisco AIDS Foundation

Federal Legislative News Archive