The Log Cabin Republicans (LCR) rightfully complain that this budget has come into being after two appropriations cycles wherein the Clinton Adminstration ignored the impact of life-saving AIDS treatments in the budget process.

The Republican Congress, says LCR, countered with a total of $169.5 million in emergency funding increases. Now the White House has released a budget request for Fiscal 1999 which includes a $100 million increase for the AIDS Drug Assistance Program (ADAP) in the Ryan White CARE Act.

"We applaud the White House finally addressing the breakthrough in AIDS treatments," said Richard Tafel, executive director of Log Cabin Republicans. "This is a step in the right direction, but these numbers fall short of the projected need from state AIDS directors. This shifts the burden of leadership back to Congress to close the gap."

The Human Rights Campaign (HRC) lauded the fact that President Clinton's budget proposal includes increases for programs that deal with people living with HIV and AIDS, but says it shortchanges essential prevention programs administered through the Centers for Disease Control and Prevention.

"The good news is that the president is asking for increases for care, housing, drugs and research in a budget that is balanced," Winnie Stachelberg, HRC's political director, said Monday.

"Unfortunately," she stated, " by calling for no increase for HIV prevention, we miss an opportunity because prevention is the only sure path we have right now to save lives."

State AIDS directors, who administer the ADAP program, have projected a need of $175 million above 1998 figures. With the President's $100 million increase request, LCR and allied organizations are looking at ways to come up with the additional $75 million that will be needed. Tafel argues that prioritizing saving lives over increased funding for the AIDS bureaucracy should guide the AIDS budget process.

"There is at least $46 million in proposed spending in the AIDS budget that can be moved into ADAP if we are going to prioritize saving lives over increasing non-medical related services," Tafel said. Tafel cited the $25 million proposed increase for Title I of Ryan White and the $21 million proposed increase in AIDS housing subsidies as unnecessary for Fiscal 1999, as both programs are already funded at record-high levels while ADAP, a life-saving program, is in a crisis.

"The AIDS priorities for this budget boil down to three words -- save lives first," Tafel said. The Human Rights Campaign insists that prevention is "the only sure path to saving lives."

Log Cabin points out, however, that the introduction of breakthrough AIDS drugs, protease inhibitors, caused an explosion of demand for ADAP funding around the country. Several state programs have been forced into limiting enrollment, putting patients on lotteries, dropping the new drugs from their formularies or shutting down altogether. In 1996, Congress appropriated $50 million in emergency spending for ADAP over the President's FY 1997 budget. The next year, with the ADAP crisis worsening, Clinton released a 1998 budget which flat-funded ADAP.

The Log Cabin Republicans say they have repeatedly called on the White House to reverse itself and to request an increase, but the Administration, they charge, refused. Instead, LCR testified before Congress in April 1997 and requested an increase. The Republican Congress approved a $118.5 million ADAP increase for 1998.

The Human Rights Campaign also stresses that among the most significant increases in the president's overall HIV/AIDS budget for fiscal 1999 is the 35 percent increase for the AIDS Drug Assistance Program, which enables people with HIV and AIDS to obtain new, life-prolonging drugs. A year ago, HRC admits, the president's budget asked for no increase in the ADAP program.

"We are heartened that the administration has heard the message of the HIV and AIDS community and is asking for a significant increase for these programs," Stachelberg noted. A report last July by the National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network, found that more than half of the 52 state ADAPs have had to impose limits on their programs because of inadequate federal funding.

Although the president's budget includes no increase for AIDS prevention programs at the CDC, it does earmark $5 million in new money for HIV prevention in minority communities as part of $80 million for a CDC program addressing racial inequities in health treatment.

"This is a good step, but small in light of the need," Stachelberg said.

"As the president's own HIV/AIDS advisory council indicated in a report card last year, this administration needs to exercise bolder leadership in HIV prevention efforts. We had hoped to see an indication of that leadership in the budget request and are still waiting for Health and Human Services Secretary Donna Shalala to allow some of those federal funds to be used for lifesaving needle exchange programs."

The president also requested a $21 million increase in the Housing Opportunities for People With AIDS program. This represents a 10 percent boost over fiscal 1998, when $204 million was appropriated for HOPWA. About 90 percent of these funds go directly to states and cities to provide housing for people with AIDS.

In the area of care, the president asked for a $165 million increase above the $1.2 billion appropriated last year. Of that increase, about $27 million would go to states under Title II of the Ryan White CARE Act, giving them the flexibility to earmark the funds for drugs. Title I of the CARE Act would receive an increase of about $25 million. Title I supports cities and counties hardest hit by the AIDS epidemic to fund primary medical care and essential support services like case management and transportation to and from the doctor. Title IIIB of Ryan White, which provides funds for direct services to people living with HIV and AIDS, would get an increase of $10 million, 13 percent above fiscal '98 levels.

"These increases are particularly welcome in light of the dramatic health improvements some people with HIV and AIDS have shown after taking the new drug combinations," Stachelberg said. "We continue, however, to call on the administration to find ways to allow more people with HIV to enroll in Medicaid. This more systemic approach is essential to provide early and comprehensive access to medical care for people with HIV."

The budget also calls for $1.7 billion for AIDS-specific research at the National Institutes of Health, an 8 percent increase over fiscal 1998.