Domestic AIDS programs got none of the necessary increases in funding when the U.S. Senate voted on the appropriations bill Sept. 10. It marked the end of broad bipartisan support for AIDS programs in general and ADAP programs in particular that had survived for more than a decade.
Sen. Charles Schumer, D-NY, offered an amendment to the House/Labor Health and Human Services appropriations bill that would have added $214.8 million to the AIDS Drug Assistance Program (ADAP). It was ruled out of order by the chair because it would exceed discretionary spending caps already set by the Senate. A motion to overrule the chair was defeated by a largely party line vote, 44-53.
Sen. Richard Durbin, D-Ill., offered an amendment to increase funding for international AIDS efforts, and that was defeated in a similar manner.
'The crisis started building two years ago and now is in full bloom,' said Jules Levin, executive director of the National AIDS Treatment Advocacy Project. 'ADAP has been underfunded and states have been unable to continue providing access to HIV treatment at the same levels as before.'
Many states have made it harder to qualify for the program; cut back on the number of drugs that are covered or have delayed adding newly approved drugs; or have established waiting lists. Recently three HIV-positive people died while on an ADAP waiting list in West Virginia and estimates are that 1,200 people will be on those lists by the end of the year.
Terje Anderson, executive director of the National Association of People With AIDS (NAPWA), said the Senate has heard this from their constituents 'but refuses to increase ADAP and Ryan White CARE Act funding by even the $100 million that the President proposed.' He was 'extremely disappointed.'
David Munar, associate director of the AIDS Foundation of Chicago, lamented, 'The Senate is honestly considering giving the Bush Administration an additional $87 billion for a questionable war and foreign occupation, but can't seem to find a way to make $400 million available to care for its own citizens in need.'
AIDS advocates hold out a small glimmer of hope that they will be able to get at least some of the necessary money when the House and Senate meet in conference to resolve differences between the two versions of the appropriations bill.
On the other side of the Capitol, three ranking Democrats in the U.S. House of Representatives have written the Bush administration protesting changes in the way that HIV prevention materials are reviewed by the Centers for Disease Control and Prevention (CDC) prior to their use.
Those changes have 'caused concerns among state HIV/AIDS directors,' wrote Dem Leader Nancy Pelosi (Calif.), Depty. Leader Steny Hoyer (Md.), and Henry Waxman (Calif.), the ranking member of the Committee to Sec. of Health and Human Services Tommy Thompson in their letter.
Under guidelines established in 1992, local Program Review Panels screen materials for appropriateness for the targeted audience. They also must make sure that they comply with federal law that requires that they are not 'designed to promote or encourage, directly, homosexual or heterosexual activity or intravenous substance abuse'; point out the harmful effects of such activities; and the benefits of abstaining from all of them.
The authors say CDC has added a layer of bureaucracy by requiring 'a certification that accountable state or local health officials independently review' the materials. The terminology of the requirement is not defined and the CDC is offering no funds for the added burden, at a time when most states face a severe budget crunch.
They asked Thompson to reconsider the changes and 'to make any future changes only after thorough analysis and full consultation with the stakeholder groups and Congress.' They requested answers to three questions dealing with the need for such changes by Sept. 25.