Washington Blade - May 23, 2003
Joe Crea

The AIDS bill recommends that 55 percent of the funds go to treatment programs in Africa while one-third will fund abstinence-based programs. The remaining funds would cover condom distribution programs aimed at promoting faithfulness, palliative care and programs assisting children who have lost one or both of their parents to AIDS-related causes. The bill also features a unique provision to teach feminism to African males.

On the same day, Republican leaders, eager to gain crucial Democratic votes for President Bush's plan to eliminate taxes on dividends, agreed to requests to provide $20 billion in relief to economically suffering state governments, half of which is earmarked for Medicaid.

"Any money that we are going to get is just fabulous," said Joanna Rinaldi, deputy director of the AIDS Health Project in San Francisco. "The question I don't know much about is whether or not there is a hidden trade-off. Is this going to take money away from my state's medical services? Will this be a net loss?"

Rinaldi said that the California state budget is in terrible shape and added that California's federally funded AIDS Drugs Assistance Program (ADAP) has, for the first time, introduced co-pays.

The House approved the United States Leadership Against HIV/AIDS Act of 2003 (HR 1298), sponsored by Rep. Henry Hyde (R-Ill.) and Rep. Tom Lantos (D-Calif.), which authorizes $3 billion a year for five years to international HIV/AIDS programs. The bill is modeled after the "ABC" HIV prevention model in Uganda -Abstinence, Be faithful, use Condoms -which has succeeded in lowering AIDS rates, according to sponsors of the bill.

"The bill establishes a pattern of American leadership that other wealthy nations, I believe, will follow," Rep. Hyde said in a statement. "It is my expectation that the House will accept the only Senate amendment to the bill that provides debt relief for poor nations, and that this vital legislation will be signed by the president within the next few weeks."

Republican officials said that President Bush is "eager" to sign the measure before the G8 summit in June, hoping to use the bill as leverage to acquire more international money for the initiative.

In a written statement, the Family Research Council said if it had not been for their leadership and that of Focus on the Family, the AIDS bill "would have been a complete disaster." FRC also criticized an amendment that Sen. Dianne Feinstein (D-Calif.) proposed seeking to remove the provision allowing one-third of the funds going to abstinence only programs. FRC called the amendment a "condom airlift" and said that Sen. Feinstein did not understand that abstinence is the only 100 percent effective mode of prevention.

Sen. Feinstein noted in a press release that the legislation should address "the whole prevention puzzle" and added that her amendment would have given "countries the tools necessary to design HIV prevention programs that meet the needs of their communities in order to further halt the spread" of AIDS.

Congresswoman Barbara Lee (D-Calif.) applauded the passage of the bill but had hoped that lawmakers had withdrawn the abstinence provision.

"We should be supporting a wide variety of prevention strategies instead of prioritizing one over the other," Lee said in a statement.

Republicans also defeated an amendment by Sen. Edward Kennedy (D-Mass.) requiring antiretroviral drugs, as outlined in the bill's treatment programs, be available at the lowest price.

Two other amendments were defeated. Sen. Richard Durbin (D-Ill.) sought to strengthen U.S. commitments to the U.N.'s Global Fund for treating and preventing AIDS, and Sen. Byron Dorgan (D-N.D.) sponsored an amendment that would have provided $250 million in food aid.

The only Democratic amendment approved was one submitted by Sen. Joseph Biden (D-Del.) that increased funding for debt relief.

Representatives for several AIDS service organizations declined to comment on the bill until President Bush signs it.

States get more funding On May 14, 220 U.S. AIDS service groups signed a letter to the Senate that urged support for new federal funding to state Medicaid programs. The letter notes that while the U.S. economy struggles, states have had to limit eligibility to Medicaid programs and cap prescription drug benefits. It added that for those with HIV/AIDS, "Medicaid serves as nothing less than a lifeline."

"Losing eligibility or critical covered services translates into emergency room visits, preventable hospitalizations and premature death," the letter stated.

In addition to the $10 billion allocated to state Medicaid programs, officials say that $6 billion in unrestricted grants will go to states and the remaining $4 billion will go to unrestricted grants to cities and counties.

The New York Times reported that Sen. Susan Collins (R-Maine) said that by eliminating the dividend tax, a move she supports, the states will be deprived of "at least $8 billion in tax revenue, thereby increasing their dependency on the federal government for future aid."

20% say secret AIDS vaccine exists: survey As legislators were crafting the AIDS bill in D.C., just down the road in nearby Bethesda, Md., researchers were busy readying trials for a new HIV vaccine amid concerns raised by a survey that suggests many Americans believe an AIDS vaccine already exists.

As human trials begin on a potential new HIV/AIDS vaccine, nearly half of all African Americans and a quarter of Latinos in the United States believe that a vaccine already exists and is being kept a secret, according to preliminary results from the survey, which also shows that 20 percent of the general population believes a vaccine has been developed.

The analysis, conducted by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, involved surveys of 3,500 people and three smaller surveys of communities most affected by HIV and AIDS: African Americans, Latinos and gays.

Matthew Murguia, director of program operations and scientific information at NIAID, said that his team is continuing to analyze data to determine the best ways for NIAID to target the most affected communities. According to Murguia, all vaccine trials sponsored by NIAID, must include minorities and women.

"We need to do a better job at getting our message into those communities," Murguia said, "because the vast number of those who are volunteering for the research don't mirror where the epidemic is. We want to be able to say to various communities that it worked in this population and that population, but we still need [minority] participants. It is a challenge and minorities have not traditionally offered to be such participants."

The HIV Vaccine Trials Network (HVTN) funded by NIAID has launched the ambitious human vaccine trials being conducted in both the United States and Botswana. Epimmune, a San Diego pharmaceutical company, developed the vaccine, called EP HIV-1090, from synthetically formed DNA.

According to officials at the HVTN, this DNA creates detailed proteins, similar to the ones found in HIV. These proteins allow the body to recognize actual HIV.

Murguia addressed a common concern about HIV vaccine trials - that they can give the virus to someone who is HIV-negative. Murguia said that there is no such risk with this trial. Epimmune officials buttressed Murguia's conclusion by stating that the vaccine allows the body to arrange a defense against the vaccine, with the hope that it will thwart real HIV, should the participant ever be exposed to the real virus.

Murguia said he and his team, along with more than 100 organizations, have launched a national HIV communication campaign designed to create a supportive environment for vaccine research.

"We are working to educate communities and leadership on the ongoing research and why it is important," Murguia said. "Many still think you can get HIV from the vaccine and many think you have to be HIV positive to participate in the trials. It's just the opposite. You need to be HIV negative."

HVTN said that the double-blinded trial, which will last 18 months, will use 42 volunteers, 36 of whom will receive the vaccine; the remaining six will receive a placebo. Once the trial concludes and the data is evaluated, HVTN will consider the vaccine for the next juncture of testing.

To date, "more than 12,000 men and women worldwide have come forward as volunteers for HIV vaccine research," according to a NIAID press release.

But for now, Murguia said the outreach effort to minorities remains daunting.

"Trust is something that is earned not given," Murguia said. "The legacy of the Tuskegee experiments and a historical mistrust of government and human rights issues are still factors."

The full analysis of the survey, completed in March 2003, is expected to be released by the end of summer 2003.

Joe Crea can be reached at jcrea@washblade.com.

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