The Washington Blade Online - Friday, September 18, 1998
Rhonda Smith

A preliminary proposal that the U.S. Health and Human Services Department is developing calls for shifting between $35 million and $45 million of Ryan White AIDS funds for the current fiscal year to AIDS programs specifically designed to assist racial and ethnic minorities. The proposal is HHS's response to an urgent call from the Congressional Black Caucus in May that HHS Secretary Donna Shalala declare AIDS among African Americans a "public health emergency" so that more federal funds could be funneled to AIDS programs designed to help that population.

Details about the proposal were expected to be discussed Thursday, Sept. 17, after the Blade's deadline at the Caucus's national "town hall" meeting on AIDS at the Washington Convention Center. U.S. Rep. Maxine Waters (D-Calif.), the chair of the Congressional Black Caucus (CBC), said after a speech Tuesday, Sept. 15, that Shalala is expected to make a formal announcement about the proposal in 30 days.

Neither HHS officials nor Waters would discuss the proposal with the Blade, which obtained a copy of the preliminary document, dated July 30, from a source involved in the negotiations.

Waters did discuss aspects of the proposal during a speech this week in Washington, D.C., at an African American Leadership Summit on AIDS, sponsored by the 600-member National Black Caucus of State Legislators. During the speech, Waters said that HHS officials have offered to allocate $30 million in AIDS funds by the end of 1998 to community-based groups in black communities nationwide that already are addressing this problem. More funds would be made available in 1999, she said, and the bulk of it would be for AIDS education, prevention, and treatment programs aimed at African Americans.

At the same time, Waters said HHS officials and the 39-member Congressional Black Caucus disagree over how much money is needed to address the epidemic. The Caucus is requesting that between $90 million and $250 million in federal support be made available, Waters said.

"This makes people shiver," Waters said, "but we've got them responding."

Waters said the CBC suggested that HHS officials declare AIDS a public health emergency among African Americans to sound a national alarm about the epidemic and to create interest in developing new policies that more adequately address the problem.

"There's resistance. [HHS officials] basically have some problems declaring this type of public health emergency because it requires money," she said. "They think that targeting resources means we're going to talk about taking money away from other communities. Nobody wants to talk about race-based solutions."

In the HHS proposal draft obtained by the Blade, it states: "The Department is committed to developing and implementing a comprehensive response that both maximizes the effectiveness of existing programs to serve racial and ethnic minority communities confronting HIV/AIDS, as well as developing new and innovative strategies that target assistance to address specific needs."

This initial proposal, as well as a subsequent one that various AIDS activists said they have seen, is apparently HHS's formal response to a May 15 letter from Waters in which she requested that AIDS among African Americans be declared a "public health emergency." In a June 10 letter responding to Waters, Shalala promised to come up with "a detailed strategy" that involves developing policies that could be implemented immediately, as well as ones that would require more long-term planning. But in the letter last June, Shalala did not specifically address Waters's request for her to declare AIDS among African Americans a public health emergency.

National AIDS lobbyists who are familiar with the HHS-CBC negotiations said the black Caucus should renew its initial call that AIDS among African Americans to be declared a "state of emergency." This designation would more adequately reflect the scope and seriousness of the problem in black communities across the country, they said. It also reflects the strategy that Dr. Beny J. Primm, the director of the New York-based Addiction Research and Treatment Corp., proposed in April.

"People originally said they wanted the president to declare a 'state of emergency,' and that's something we shouldn't forget," said A. Cornelius Baker, executive director of the National Association of People With AIDS in Washington, D.C. "That goes beyond a 'public health emergency.'"

Government officials can declare a "state of emergency" when there are urgent and immediate needs for assistance in alleviating conditions that pose a serious threat to the health and welfare of communities. Under the federal Public Health Services Act, the HHS secretary can declare a "public health emergency" if he or she consults with directors in various HHS divisions and determines such a major step is necessary. The law stipulates that the HHS secretary can respond to "public health emergencies" by "making grants and entering into contracts and conducting and supporting investigations into the cause, treatment, or prevention of a disease or disorder."

The law also stipulates that a "Public Health Emergency Fund" be established. Currently, there is no money in this fund. Laurie Boeder, an HHS spokesperson, said Congress previously authorized $45 million for the fund and in 1987, then HHS Secretary Otis Bowen directed HHS officials to disperse $30 million from this fund to pay for AZT medication for people with AIDS nationwide who could not afford to pay for the prescription drug. (Boeder was unable to confirm whether there was $15 million still in the fund or whether Congress authorized $45 million but appropriated only $30 million.) She also said that before any similar action could take place again, Congress would have to vote on whether to appropriate additional AIDS dollars for the Public Health Emergency Fund and if so, in which specific budget fiscal year this should occur.

NAPWA's Baker, who is HIV-positive, said that he would like to see President Clinton declare AIDS among African Americans a "state of emergency" and approach Congress about getting federal funds to address this problem.

"The President has to lead an effort to implement a national plan that is responsive to this epidemic among African Americans and, some would argue, for the entire nation," he said, "and that is absent right now."

Baker said he fears that having AIDS declared a "public health emergency" among African Americans would limit the federal response to this problem to HHS officials, who are developing a national strategy. He noted that Shalala failed earlier this year to convince Clinton to support and make federal funds available for needle exchange programs, which many believe would reduce the spread of HIV among African Americans and Latinos, in particular. Because of this, Baker said that Shalala might not be able to garner the federal support needed to effectively tackle AIDS among African Americans.

Daniel Zingale, executive director of AIDS Action, said that during recent closed-door meetings that he attended, HHS and some members of the Congressional Black Caucus appeared to agree that AIDS is a public health problem that should be treated as an emergency. But the two sides disagree "on the semantics around a state of emergency."

"The CBC is still emphasizing the importance of declaring a state of emergency, while HHS is arguing that the state of emergency implies a short-term crisis," he said. "My own view is that they should, in fact, declare a state of emergency and emphasize it as an ongoing crisis, rather than a short-term one."

Zingale also said that the July 30 HHS proposal reflects a critical need for $100 million more in Ryan White AIDS funds for prevention and education programs. Currently, about $625 million in federal funds are available for HIV prevention and education programs nationwide.

In addition to making funds for HIV prevention programs more of a priority for racial and ethnic minorities, Zingale said the federal government's Medicaid policy must be revised so individuals eligible for this type of public health assistance have earlier access to protease inhibitors and other drug therapies.

"If you're serious about closing the gap between blacks and whites when it comes to AIDS, you have to change the Medicaid rule that says a person must have full-blown AIDS before they can be eligible for access to AIDS-preventing drugs," he said. "And you have to get out of the way of local communities in removing HIV-tainted needles from the streets. And [the July 30 proposal] does neither of those things."

Baker noted that he has concerns about where the $35 million to $45 million mentioned in the preliminary HHS proposal would come from -- federal AIDS funds that already exist or new funds that congressmembers would have to appropriate?

He and Zingale said they would be opposed to shifting federal HIV/AIDS funds from one population still struggling with the epidemic to another.

"We don't want to get in a situation where we're taking money from one group with AIDS to give to another group," Baker said, "when the issue is getting more money to serve all of our needs."

The source who provided the Blade with the July 30 proposal said HHS officials and Caucus members have refused to discuss their negotiations publicly because they do not want to create an "us-against-them" atmosphere in which various communities are pitted against each other for federal funds.

During her speech Tuesday, Waters said that the actions that have proven successful for the white Gay community in fighting AIDS might not necessarily work in the black community.

"But we've got to forge ways to do it in the same way they did," she said. "They got education and prevention going among white Gays that paid off, and we've got to find ways."

She later said, "I know we've got friends [working on this issue] who are not African American who will do the right thing, it's just not enough of them."

Waters also said that black community leaders and AIDS advocates must become more aware of how AIDS funds are allocated in each region "from the time the money hits the state until it gets to the lowest planning committee."

"Don't let any planning committee that African Americans are not on review proposals," she said.

In addition, Waters said that African Americans and others must stop criticizing black religious leaders, many of whom have come under fire for not responding quicker when AIDS was first identified as a threat to communities of color 15 years ago.

"To keep beating ministers over the head about this is unrealistic," she said. "Stop running ministers away from this issue. Ask them to help you, and let them design ways to help you."

Finally, Waters told the state lawmakers that black community members must begin talking about AIDS in a new way "and forget about being embarrassed."

The July 30 proposal from HHS officials highlights strategies in three broad categories that the CBC identified as areas of concern: technical assistance and infrastructure support, access to prevention and health care services, and building stronger linkages to community care for inmates soon to be released from prisons or jails. Waters said the CBC would like more programs developed that involve testing jail and prison inmates and making sure that those who need access to treatment have it.

Racial and ethnic minorities together account for more than 54 percent of the total AIDS cases reported since the beginning of the epidemic, according to recent HHS statistics. In 1997, the fastest-growing proportion of new AIDS cases was reported among women of color. African American and Latina women accounted for 80 percent of new AIDS cases reported among women. Today, 63 percent of new AIDS cases among children under 13 are among African Americans, and 23 percent are among Latinos.

"We need additional resources," said Miguelina Maldonado, director of government relations and policy at the National Minority AIDS Council. "And we need to have the resources directed toward where the epidemic is doing the most harm."

"We need to develop both HIV care and prevention capacity in ethnic and racial minority communities," she added, "and emphasis should be placed on the African American community first."

Maldonado said the National Minority AIDS Council and the CBC hope to agree on what levels of funding are needed for AIDS programs directed to racial and ethnic minority communities and to lobby Congress to adopt those numbers for FY 2000.

Baker said that certain AIDS strategies must focus solely on the African American community because that population is being disproportionately devastated by HIV/AIDS.

"But it does become problematic to somehow suggest that we're taking care of everybody except white Gay men," he added. "Every community has some level of emergency."
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