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 policies.