Politicians urged to rise above prejudices and embrace HIV/AIDS prevention strategies. (Policy Update).

"But AIDS is a perfect illness because it is so alien to human nature and has as its function to destroy life in the most cruel and systematic way. Never before has such a formidable calamity affected mankind."

These words were written by the Cuban-born writer and revolutionary Reinaldo Arenas shortly before his death in 1990 from complications associated with AIDS. The words strike hard at the heart of the personal cost and devastation of HIV/AIDS.Yet, Arenas gained from his own personal account a fuller understanding of what it means for all humanity.

To this extent, HIV/AIDS knows no borders; it recognizes no class, gender, nationality, or race. Nor does it take into account the political realities that accompany its relentless attack. The challenge for policymakers, therefore, is to rise above the conventions of human society that the disease does not recognize.

PREVENTION AND ABSTINENCE

On the whole, politicians have found it difficult to embrace prevention strategies that fall outside their realm of comfort. For example, demonstrating the proper use of condoms and making available dean needles and bleach kits run against the grain of what most politicians feel is appropriate.

Yet, it is precisely these types of interventions--specifically targeted to populations with increased risk factors for HIV infection--that are culturally appropriate and seek to deal with the reality of the epidemic in America.

In this column, SIECUS recently reported on the increasingly intense scrutiny under which federally-supported HIV/AIDS prevention programs are operating. Audits of HIV/AIDS prevention funds are now commonplace.

In some sense, this is good news. These are federal tax dollars, and accountability is vital if funding is to continue. On the other hand, many advocates fear that the audits are politically motivated and designed to root out progressive prevention efforts that are anathema to the current Administration's goal to have abstinence-only-until-marriage programs as the centerpiece of the federally-funded prevention portfolio.

There is also a very clear trend within the Administration to name abstinence-only-until-marriage proponents to the groups who advise and recommend HIV/AIDS policy to the President.

For example, the Advisory Committee on HIV and STD Prevention of the U.S. Centers for Disease Control and Prevention (CDC) increasingly includes individuals who support abstinence-only-until-marriage programs. A recent appointee, Gale Grant, helped create such a program in the state of Virginia (with the support of Claude Allen, the Deputy Assistant Secretary of Health and Human Services).

In another instance, Scott Evertz, director of the White House Office of National AIDS Policy, was recently shifted to the U.S. Department of Health and Human Services and replaced by the more politic Dr. Joseph O'Neill. This shakeup was reportedly the result of Evertz's philosophical differences with the Administration.

THE BOTTOM LINE

The Bush Administration's approach to HIV/AIDS policy is profoundly affecting the bottom line of prevention efforts.

The Washington Post published an editorial on September 12 that was aptly titled "Retreat on AIDS." It began by describing the initial support of longtime critic Senator Jesse Helms (R-NC) to increase U.S. funding of international HIV prevention efforts to the tune of $500 million targeted for programs focusing on mother-to-child transmission of HIV/AIDS.

While advocates greeted the apparent conversion of the ultra-conservative Senator Helms with some degree of joy, they were critical of the fact that the funding was not enough and that, while needed, it skirted the fundamental issue of unprotected sex among heterosexuals, which is responsible for the spread of most of the AIDS cases in Africa.

The editorial went on to detail how--to dare--the federal government has not spent a single cent of this money and that Congress, in attempting to fund programs related to mother-to-child transmission, must cut funds for other programs. In other words, there is no new money for the much-heralded initiative--it must come from the funds of current programs.

An Administration's priorities are most clearly spelled out each year when the White House releases its budget blueprint for the coming fiscal year. For 2003, there is a chasm between President Bush's "wartime" budget blueprint and the one released by HIV/AIDS advocates through National Organizations Responding to AIDS (NORA), an umbrella organization of which SIECUS is a member.

The President's budget flat-funds every aspect of domestic HIV prevention, care, and treatment, including all interventions within the CDC and all programs receiving funds through the enormously popular Ryan White CARE Act. The only area that is designated to receive increased funds is research.

At press time, the appropriations process for fiscal year 2003 is in an unprecedented state of disarray The U.S. House of Representatives has all but given up on trying to bridge differences over spending priorities with the White House and with most conservative elements of the Republican Party.

It appears that most domestic funds for HIV/AIDS programs will come from the President's budget when conservatives force its introduction as the Republican bill--bypassing the House subcommittee that usually has responsibility for such appropriations. Thus, the current House bill flat-funds everything.

The U.S. Senate, on the other hand, has listened to recommendations made by NORA and other advocates and provided for increases in vitally needed programs. For example, the current Senate bill funds the Ryan White CARE Act at $2.07 billion, an increase of $116 million over fiscal year 2002. Domestic HIV/AIDS programs at the CDC also received an increase of $2.7 million, bringing the total to $691 million.

While these numbers do not meet the recommendations set forth by NORA or meet the needs of programs in communities across the country, they are a significant improvement over the numbers proposed by the Administration and those in the current House bill.

Tellingly, even though the President and his conservative allies in the U.S. Congress argue that the current war on terrorism and its accompanying domestic security concerns mean less spending on other domestic programs, there is an exception: both the President and conservative legislators are pushing for a $33 million increase in the Special Project of Regional and National Significance--Community-Based Abstinence Education (SPRANS-CBAE) program for fiscal year 2003.

CONCLUSION

Money talks. It spells out where the growth is foreseen in our country's prevention initiatives geared toward HIV/AIDS, other sexually transmitted diseases, and unintended pregnancy. The pre-eminence of abstinence-only-until-marriage funding speaks loud and clear.

In mid-September, individuals gathered in California for the annual U.S. Conference on AIDS. In an unfortunate replay of the heckling of Tommy Thompson, the U.S. Secretary of Health and Human Services, at the International Conference on AIDS in Barcelona this past summer, White House Advisor O'Neill was similarly booed and heckled in San Diego. O'Neill rose above the clatter, arguing for abstinence saying, "We have nor made a dent in the annual number of infections in years."

The arguments around the role of abstinence-only-until-marriage programs in the federal funding portfolio are sure to continue. Yet, even if these programs eventually demonstrate a delay in sexual activity, we know that they are statutorily prohibited from presenting young people with information on proper contraception for the day when they do become sexually active.

Such a strategy merely postpones the unfortunate and irresponsible fallout of a policy that keeps young people in the dark. And at risk for HIV/AIDS.

RELATED ARTICLE: HIV PREVENTION OBJECTIVES DECLARATION OF COMMITMENT ON HIV/AIDS

This is the Declaration of Commitment on HIV/AIDS voted by the United Nations (U.N.) Special Session on HIV/AIDS in June 2001.

* Ensure by 2005 access in all countries to a broad array of prevention programs

* Ensure by 2005 that at least 90 percent of young people (15 to 24)--and 95 percent of such people by 2010--have meaningful access to the information, education, and services needed to protect themselves from HIV infection

* Reduce by 2005 the rare of HIV infection among young people by 25 percent and reach this target globally by 2010

* Reduce the proportion of infants born with HIV by 20 percent by 2005 and by 50 percent by 2010

* Strengthen HIV prevention efforts by enacting or strengthening anti-discrimination and other human rights laws, by empowering women and by raking steps to reduce the vulnerability of key populations to HIV

For more information on the United Nations Special Session on HIV/AIDS go to www.un.org/ga/aids/coverage