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Bush on AIDS: More Questions Than Answers |
Summary: The president spoke on AIDS June 23 in Philadelphia. His comments looked great in headlines, but details raised major questions.
This is welcome if it will get treatment for some of the over 1,600 Americans now on waiting lists for antiretrovirals through the AIDS Drug Assistance Program (ADAP). But there is good information on the cost of meeting the need, and the $20 million promised is less than 20% of the emergency funding required to end the waiting lines for this fiscal year. So far at least 25 U.S. senators have signed a letter calling for a $217 million increase for fiscal year 2005, plus a $122 million emergency increase to end the waiting lines now through March 30, 2005 (when ADAP can use the 2005 funding). Also, the $20 million is not new money but will come from some other health funding. As of late June we do not know what other program will be cut. Another long-term problem is that the ADAP program is supposed to be supported jointly by the Federal government and the states. The new money will largely go to those states that have failed to do their part (since they tend to have the longest waiting lines), removing incentive for states to contribute. While the central concern is getting treatment to the individuals who need it, we also need plan for sustainability, not just looking good before the election.
The focus on life-extending care means "such as anti-retroviral drugs, doctor visits, and lab tests" (quoted from the fact sheet). Does this mean that cost-effective services like case management will no longer be funded through Ryan White, and almost all of the money will go to pharmaceutical companies instead? Also, Bush wants his Administration to control how Ryan White money is allocated among different parts of the country. But this Administration has politicized science probably more than any other in history. How do we know that the money will not be directed to reward political supporters even if their programs were not working? This is happening already with abstinence-only HIV prevention programs.
This sounds generous in the headlines, but this money was appropriated by Congress and should have been spent long ago. The main reason for the delay is that the Bush Administration largely rejected the Global Fund created by the United Nations, and set up its own system instead -- allowing it to use AIDS funding to pressure countries on unrelated issues.
We have no information on the merits of directing funding to Vietnam instead of some other country. But clearly the announcement works as compassion PR; Bush said in his talk, "We're putting a history of bitterness behind us with Vietnam." The president also mentioned condoms "when appropriate," while much more strongly emphasizing abstinence. We are hearing that on the ground, "where appropriate" means restricting condom programs to sex workers or other marginalized populations -- and that countries are being told not to ask for condoms when applying for U.S. HIV funding. AIDS Treatment News Subscription and Editorial Office: 1233 Locust St., 5th floor Philadelphia, PA 19107 Phone: 800/TREAT-1-2 toll-free, or 215-546-3776 Fax: 215-985-4952 (email is preferred) Email: aidsnews@aidsnews.org Useful AIDS links: http://www.aidsnews.org Editor and Publisher: John S. James Reader Services: Allison Dinsmore Statement of Purpose: AIDS Treatment News reports on experimental and standard treatments, especially those available now. We interview physicians, scientists, other health professionals, and persons with AIDS or HIV; we also collect information from meetings and conferences, medical journals, and computer databases. Long-term survivors have usually tried many different treatments, and found combinations that work for them. AIDS TREATMENT NEWS does not recommend particular therapies, but seeks to increase the options available. AIDS Treatment News is published 12 times per year, and print copies are sent by first class mail. Articles are available at http://www.aidsnews.org To subscribe, you can call 800-TREAT-1-2 or 215-546-3776:
ISSN # 1052-4207 Copyright 2004 by John S. James |
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George W. Bush's commitment to his pledge to fight AIDS has come under scrutiny