Bush Administration AIDS Policies Continue
to Fall Short
March 1, 2005
By Gene C. Gerard
In the president's State of the Union address this year, he pledged
again to fight the growing HIV/AIDS epidemic. Mr. Bush asked Congress
to reauthorize the Ryan White CARE Act "to encourage prevention
and provide care and treatment" for those infected with the
disease. He also stated that "we must focus our efforts on
fellow citizens with the highest rates of new cases: African-American
men and women." But when his 2006 budget proposal was released
two weeks later, a very different picture emerged.
The Minority AIDS Initiative, a program targeting blacks and Hispanics
for prevention and treatment, and the CARE Act, received no new
funding. The budget cuts $14 million from the Housing Opportunities
for People With AIDS program, which provides housing subsidies for
low-income people with HIV/AIDS. Experts have complained that the
homeless and those in unstable home environments are often unable
to obtain medical care and are the first to die from AIDS.
The Centers for Disease Control Division of HIV/AIDS Prevention
was cut by $4 million. The budget also cuts $45 billion over ten
years from Medicaid. Yet Medicaid is the single largest provider
of medical care to those with HIV/AIDS. Annually, this federal program
provides $5.6 billion in medical services to those with the disease.
Mark Isaac, vice president of the Elizabeth Glaser Pediatric AIDS
Foundation, noted that as a result "programs can expect more
patients and longer waiting lines. As we know, waiting just a few
months for treatment ... can literally mean the difference between
life and death."
This is simply a continuation of Bush administration AIDS policies
that fall short. In his 2003 State of the Union address, Mr. Bush
boldly stated, "I ask the Congress to commit $15 billion over
the next five years, including nearly $10 billion in new money,
to turn the tide against AIDS in the most afflicted nations of Africa
and the Caribbean." But within a week, his administration was
forced to restate its position, announcing that this proposed funding
would not go to Africa and the Caribbean only, but rather was the
total international budget. Mr. Bush was strongly advised to funnel
the new money into The Global Fund.
The Global Fund was established in 2001 to pool funds from many
nations, organizations, and religious institutions to fight AIDS
more effectively. But much like his go-it-alone policy in foreign
affairs, Mr. Bush has opted only to give $1 billion to the fund,
and the rest is delivered to 15 nations separately, with little
coordination. Additionally, a stipulation requires that the total
U.S. contribution to the fund can never exceed 33 percent of the
total, since the U.S. economy is one-third of the global economy.
But contributions are calculated on the U.S. government's fiscal
year, which ends in September.
Most other governments operate on a calendar year basis. This
has created significant problems for the disbursement of funds.
Last year, $547 million was allocated to the Global Fund. In October,
since other governments still had three months to donate their portions,
the U.S. contribution exceeded the 33 percent threshold. Consequently,
the Bush administration withheld $88 million from the fund. This
left many programs unfunded, which could have prevented 100,000
new cases of HIV and treated 25,000 AIDS patients.
The go-it-alone policy of the administration was also obvious
during the last World AIDS Conference. Shortly before the international
conference was convened, the administration announced it would send
only one-quarter as many experts as had been sent the previous year,
in an effort to save money.
Dozens of scholarly presentations were withdrawn, and meetings
to train Third World AIDS researchers and encourage international
collaboration were cancelled. Workshops on sustainable HIV/AIDS
treatments and a conference on using the Internet to promote HIV-prevention
were cancelled. A presentation to advise Third World scientists
on how to apply for grants from the U.S. was cancelled. Peter Piot
of the United Nations AIDS program noted that the lack of participation
negatively affected the conference because "The largest group
in the world in terms of AIDS expertise comes from the U.S."
The administration's policy on international AIDS prevention also
misses the mark. A requirement mandates that one-third of the funds
spent on prevention programs, approximately $130 million, can only
promote abstinence before marriage, and cannot support condom usage.
Randall Tobias, U.S. Ambassador for AIDS Coordination, echoed this
in a speech he gave before visiting Africa when he said, "Statistics
show that condoms really have not been effective." Given that
2.3 million Africans die annually as a result of AIDS, this was
scientifically flawed and morally reprehensible. And it prompted
Ugandan President Yoweri Museveni to deem condoms "inappropriate
for Ugandans," despite his country having one of the highest
rates of HIV infection in the world.
This policy has caused many African countries receiving U.S. funds
to discontinue distributing condoms to the general public and only
supplying certain demographic groups. Two U.S. contractors that
previously distributed condoms to young people are now only promoting
abstinence programs. And an AIDS education magazine popular with
young Ugandans that previously advocated abstinence and condom usage,
now does not even reference safe sex. However, a study just released
by Texas A&M University concluded that teenagers who are only exposed
to abstinence programs become more sexually active.
The Bush administration has requested $3.2 billion in the 2006
budget for domestic and international AIDS programs. This represents
merely 0.14 percent of the total American budget, and equals only
seven percent of the budget for the Defense Department. Speaking
of those afflicted with AIDS, President Bush said, "There are
no second-class citizens in the human race. I carry this commitment
in my soul. "It's unfortunate that this is not evident in his