Do Black reps fight AIDS?

The fight against AIDS is fought on many fronts. Hand-to-disease combat takes place on medical battlefields. In these opening weeks of a new Congress and a new presidency, the key factors challenging AIDS lobbyists are all in play, set in motion by a number of events last year.

Most importantly, campaigning on a platform of inclusion and promising to provide more money and resources for the epidemic, Bill Clinton was elected president. President Clinton, in a pre-election speech, vowed to appoint an AIDS czar to lead the nation's efforts to prevent the spread of the disease and find a cure. In that same speech, Clinton also pledged support for huge funding increases that will likely be tougher to deliver. Before the election, AIDS activists, including Magic Johnson and Arthur Ashe, lambasted former President Bush's inability to lead forces against the disease. AIDS scientists became livid when notified that Congress approved $20 million for human trials of an experimental AIDS drug without approval from researchers at either the National Institutes of Health or the Food and Drug Administration. Finally, the Federal Centers for Disease Control redefined the symptoms of AIDS to include pulmonary tuberculosis (TB), invasive cancer of the cervix and recurrent bacterial pneumonia. The redefinition will double the number of AIDS cases reported and boost federal aid, which is based on case numbers.

In fiscal year 1992, Congress appropriated $4.4 billion for AIDS-related activities. Research spending was $1.19 billion (see Economic Perspectives, this issue).

These factors put pressure on Congress. Last October, when the 102nd Congress adjourned, lawmakers had authorized no new AIDS programs and, by federal overnment standards funding for treatment and research had increased only slightly. What Congress did do, however, was pass a fiscal 1993 spending bill that included over $2 billion for existing AIDS research and health and education programs. This was a slight increase over funding in 1992. President Bush signed the bill. While members of Congress said they provided as much funding as they could, given budget constraints, the groups charged that the funding was way too low to meet the need for health care for those suffering from the disease and for prevention programs.

To some African-American communities hardest hit by the epidemic, $2 billion seems like a small sum. Blacks are still dying in disproportionate numbers from AIDS (see chart), with deaths among black women growing fastest.

The question facing these communities as well as members of Congress is how much money is enough? If America is not spending enough and doing enough, where will the money come from at a time when the deficit is high and economic growth low? AIDS programs must compete for funding with scores of federal programs. And due to budget constraints, larger increases will be hard to come by.

The Black Caucus And AIDS

Are African-American legislators in the front ranks in the fight against AIDS? It depends who you speak to. Louis Stokes (D-Ohio), a member of the Congressional Black Caucus (CBC) and the House appropriations subcommittee that allocates AIDS funding and other health programs, states the, obvious when he says that in large measure, the answer to the AIDS problem is money. "It's going to take money. Right now, the budget commitments are very, very tight." Stokes adds that he hopes that this year's changes in budget rules under which Congress and the White House must operate will open new funding sources.

To understand the ramifications, a little background information is needed. In July 1992, the U.S. Centers for Disease Control's quarterly report listed more than 225,000 reported cases of AIDS in the United States and the territories. This was about 10,000 more cases than reported during the same period last year. Blacks comprised roughly 65,000, about 30%, of total cases. Black women equaled 12,835 victims; 70% of women with AIDS are black or Hispanic.

New York City continues to lead the nation with the most reported cases, at more than 40,000. From June 1981 to June 1992, 152,153 deaths were reported to be caused by AIDS.

In addition, the nation is seeing a resurgence of other infectious Aids-exploitative diseases. For example,there has been a steady increase in TB cases. Many new TB cases are also resistant to known methods of treatment.

Some activists say that despite the number of deaths and the problem's complexity, the federal government and the CBC still do not take the disease seriously. Belinda Rochelle, director of public policy education for the Washington, D.C.-based AIDS Action Council, argues that although both political parties addressed the issue in last fall's campaign, with tight budget constraints it is uncertain Congress will commit the dollars activists say is essential to meet current needs.

And minority communities in particular have been struck by budget cuts. In fiscal year 1991, $15 million was cut from prevention programs targeting blacks. Congress increased funding for prevention programs for fiscal year 1993, but activists say it is still unclear how much of the money would be targeted for black communities.

So what grade does the CBC receive? So far, it is an incomplete. For example, Anita D. Taylor, public policy director for the National Minority AIDS Council, says the CBC has been far more active on the issue than in the past. But she says most black lawmakers are still not actively involved in providing a response to the disease.

Just as important is the black community's response to the disease. With any issue, it is political pressure and the lure of needed votes that gets Congress' attention.

Some black members are less active, Taylor maintains, because their constituents do not push for action on AIDS. The black community, like the rest of the nation, long ignored the problem of AIDS. "They really respond to what's going on in their districts and what the priorities are," Taylor says.

There are exceptions. AIDS groups point to Stokes, Maxine Waters, (D-Calif.) and Eleanor Holmes Norton, (D-D.C.). To a lesser degree they cite Charles B. Rangel, (D-N.Y.), chairman of the House Select Narcotics Abuse and Control Committee. Rangel has a large number of AIDS-infected individuals in his district and deals with the issue primarily as it relates to drugs and treatment.

Stokes is seen as the most powerful black legislator on AIDS. He is the only black member of the House Subcommittee on Labor, Health and Human Services and Education. Thus, he is also the sole black lawmaker with the direct power to impact AIDS funding.

Rep. Waters has been outspoken on the issue and is currently drafting AIDS legislation. She plans to introduce a bill this year that would direct the president to come up with a national AIDS strategy. In addition, the measure would direct the appropriate agencies to implement some of the 30 recommendations proposed by the National Commission on AIDS. Waters says that while the commission was set up in 1989 to propose recommendations to Congress and the White House; to date, none of them have been implemented. She also hopes to focus legislation on expanding AIDS education efforts in black communities. Clinton has said he would support Waters' legislation. Five days before the election, Clinton vowed to push for implementation of the recommendations. "I want to dust off the reports ... and implement the recommendations as soon as possible," Clinton said.

The representative from South-Central Los Angeles says that after coming to Congress in 1991, she knew that the time and focus of members is determined by the committee they are appointed to serve on. But by function, few committees and subcommittees deal with health issues, Likewise, few CBC members have seats on those panels. This means blacks have little clout in pushing health-related bills. "I think there are people who care," Waters says. "They do what they can when the opportunity presents itself."

Last year, CBC members signed a letter drafted by Waters' office, urging Rep. William Natcher (D-Ky.), the chairman of the subcommittee that funds AIDS programs in the House, to support program increases. Stokes, a House member since 1969, agreed. "Members are on a variety of committees and subcommittees in Congress, and just a few committees have jurisdiction over these matters," he says. But because of this reality, much of "the caucus generally looks to me for leadership on health matters."

AIDS Action Council director Rochelle is not impressed. "On the whole, they [the CBC] are not an active body on HIV," she says. "They do nothing. They vote right, but they don't initiate anything. They don't even wear red ribbons." Rochelle says the Council and other groups try to encourage the CBC to become more active, but few take the initiative. "We've done everything we can to pull them in," she says.

Although Waters does not serve on a committee with jurisdiction over national health issues, Rochelle says she is involved lending her name, her face and her fervor to the issue. This activism leads Rochelle to conclude, "I think we have to face the fact that we have some black elected officials who treat underserved communities just as anyone else would--as throwaway communities."

They will not have that option much longer, The growing number of deaths and constituent pressure will soon force more CBC members to get involved in forging a new political consensus on AIDS.