The Washington Blade - December 3, 1999
Rhonda Smith

"The budget passed by Congress once again short-changed HIV prevention and jeopardizes the health of a new generation of young Americans," said Daniel Zingale, executive director of AIDS Action, a membership organization that represents people with HIV/AIDS and 3,200 organizations nationwide that provide AIDS services. "The abandonment of a new generation of young people to the ravages of HIV is a national disgrace. Where President Clinton has taken every step to protect our kids from smoking and gun violence, he stands silent as they fall victim to the deadliest virus of modern times."

Jean-Michel Brevelle, associate policy director for the National Association of People with AIDS, a nonprofit AIDS education and advocacy organization, echoed Zingale.

"Considering how difficult this appropriations process was, the fact that we did see increases across the board for every federal HIV/AIDS program is a significant achievement," he said. "We are still concerned, however, that the investment in prevention dollars, especially, does not meet the needs."

Congress and the president did agree, however, to an $80 million increase in funding for an AIDS initiative developed in 1998 to assist racial and ethnic minority communities nationwide in expanding related AIDS awareness and care efforts. Federal funds appropriated in fiscal year 1999 for the Minority AIDS Initiative initially totaled $156 million. In fiscal year 2000, appropriations for this effort amount to $245 million.

Sandra Thurman, director of the White House Office of National AIDS Policy, could not be reached Wednesday to comment, but she issued a statement in late November that said she was "thrilled with the strong funding increases achieved across the board in our efforts to address the AIDS epidemic both here and across the globe."

In fiscal year 2000, which runs from Oct. 1, 1999, to Sept. 30, 2000, ThurmanÆs office said federal appropriations to the CDC for HIV/AIDS prevention programs will be $730 million, a $73 million (11 percent) increase over the FY99 amount of $657.8 million.

AIDS Action and similar organizations have projected that $848 million in federal funds is needed to adequately address HIV prevention efforts nationwide.

In the FY2000 budget package, the total amount of federal funds appropriated for the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 is $1.594 billion, which represents a $183.7 million (13 percent) increase over the FY1999 funding level.

The omnibus budget package, which the House and Senate approved on Nov. 19, also includes a 15 percent increase for overall research, including AIDS research, at the National Institutes of Health. The Office of National AIDS Policy issued a statement that said a preliminary estimate indicates AIDS research funding to the NIH will include an increase of $224 million for a total of $2.024 billion. The NIH will determine the final allocation.

In addition, a separate bill approved for fiscal year 2000 includes $7 million more in funds for the Housing Opportunities for People with AIDS Program over the fiscal year 1999 level.

The budget package also includes full funding for ClintonÆs $100 million global AIDS initiative.

In addition, it includes an increase in HIV-related federal funds to the Substance Abuse and Mental Health Services Administration. That agency will receive an additional $29 million, bringing its fiscal year 2000 appropriations amount for substance abuse services targeting those at highest risk for HIV infection to $122 million. This represents a 31 percent increase over the fiscal year 1999 level, according to the Office of National AIDS Policy.

On World AIDS Day, Wednesday, Dec. 1, the CDC issued an Update on the Status of HIV Prevention that indicated the estimated annual rate of HIV infections -- 40,000 per year -- has remained roughly stable since the mid-1990s. CDC officials said, however, that recent outbreaks of gonorrhea and other sexually transmitted diseases could be signs of potential future increases in HIV infections.

The CDC also released statistics this month that indicate the number of AIDS cases as well as deaths from AIDS-related complications have been declining since 1996. But the report also shows the number of people living with AIDS is steadily increasing, they said, due to advances in medical treatment that have led to fewer AIDS-related deaths.

"The U.S. is at a turning point in the HIV epidemic," CDC officials said in the HIV Prevention report. "An increased focus on HIV prevention could pay tremendous dividends. Conversely, continued complacency could reverse progress and result in the first increases in infection rates in over a decade."

CDC officials noted that, while the United States was able to achieve significant decreases in HIV infection rates in past years, preventing HIV infections has grown increasingly complex. They said advances in HIV/AIDS treatment has been one factor complicating HIV prevention.

"Evidence suggests that news of the treatment success has led to resurgent complacency among some communities, while longer survival rates for people with HIV and AIDS means the population of infected individuals is growing ever larger," they said.

CDC officials also said in the report that at least half of new HIV infections are among people aged 25 and younger, "with the majority of infections occurring among young gay men infected sexually and young women infected heterosexually."

CDC officials also noted that Gay men have made significant strides in reducing high-risk behavior and HIV infection rates in their community, but they remain at very high risk of HIV infection and continue to make up 60 percent of all HIV infections among men in the U.S.

In the Gay community, they said, rates of infection are particularly high among black and Latino Gay men. The report said some Gay men have resumed risky behavior in part because they believe that HIV infection is not as serious as it once was because of new medical treatments.

Among African Americans, CDC officials said the rate of AIDS deaths and AIDS incidence is 10 times higher than among white people. Half of all HIV infections, AIDS cases, and AIDS deaths are among African Americans, who represent 13 percent of the U.S. population.

Latinos, who represent 11.5 percent of the U.S. population, are believed to account for 20 percent of new HIV infections and AIDS cases, CDC officials said. They also said that, in some cities, such as Chicago, groups of Latinos are at extremely high risk, with rates of HIV infection and related diseases comparable to those seen among black people.

Injection drug users, their partners, and their children account for 36 percent of all AIDS cases ever reported in the United States, CDC officials said. They also noted that there is growing evidence that HIV infection rates among this population are declining due in part to aggressive prevention programs.

CDC officials concluded that the next generation of prevention strategies must increase the number of people who learn early that they are HIV positive, "when the potential for transmission and the need for care, treatment, and prevention services are greatest."

"Researchers believe with existing knowledge, sustained prevention for populations currently at risk, and substantially increased efforts to reach individuals unaware of their infection with testing and prevention services," the report said, "U.S. infections could be nearly eliminated in four years."
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