Washington Blade - September 8, 2005
Lou Chibbaro Jr.

O'Neill was the last remaining Bush administration appointee in a high-level job who self-identified as gay. His departure has fueled speculation that he was forced to leave the administration for a variety of reasons, including opposition to gay presidential appointees by conservative religious groups and disagreements he reportedly had over the administration's controversial "abstinence-only" policies on HIV prevention.

In a statement released to the Blade, O'Neill said he completed his most recent assignment at the White House to help the president develop a set of principles for Congress' effort to reauthorize the Ryan White CARE Act, which provides federal AIDS funds to cities and states. "I began my federal service to people at risk for, and living with, HIV/AIDS in 1988," O'Neill said. "It is now time for me to spend more of my energy in the aspect of public health that I have always loved - medical practice."

He said the University of Maryland's Baltimore campus has just approved "staff privileges" for him and that he is applying to do studies for a master's degree in palliative medicine at the University of Cape Town's School of Medicine in South Africa. He said he also plans to provide "policy and technical support to several health related efforts around the world and here at home."

O'Neill did not comment on reports that his departure from the Bush administration may have been due to policy disagreements and instead praised the president's programs on AIDS.

"I will always be deeply grateful to President Bush for the unprecedented leadership he has provided on HIV/AIDS and for giving me a once-in-a-lifetime opportunity to serve people with HIV/AIDS around the world and at home," O'Neill said in his statement.

In discussing his own future, O'Neill said, "Most importantly, I am looking forward to having more time and energy to devote to my 20-year relationship with my partner. Without his love, understanding, humor and support, none of these accomplishments would have been possible."

White House spokesperson Maria Tamburri said O'Neill left the administration "to do other things," but said federal personnel rules prevented her from providing further details about his departure.

"We thank Dr. Joe O'Neill for his service," Tamburri said.

Bush has called O'Neill one of his most trusted advisers on AIDS issues during O'Neill's tenure as director of the White House Office of National AIDS Policy. Those holding that post have been called the White House AIDS "czar."

Hired by Clinton

In the 1980s, O'Neill worked as a physician specializing in the treatment of people with HIV and AIDS at Baltimore's Chase-Brexton Clinic. He has maintained a faculty appointment at Johns Hopkins University's School of Medicine.

O'Neill began his government service during the Clinton administration, where he served as associate administrator for HIV/AIDS in the Department of Health & Human Service's Health Resources & Services Administration. He later became director of the Ryan White CARE Act program for HRSA. In that capacity, O'Neill directed the Ryan White program's then annual budget of $1.7 billion and a staff that coordinated assistance to more than 500,000 people with HIV or AIDS each year.

In July 2002, Bush appointed O'Neill to replace gay Republican activist Scott Evertz as head of the White House AIDS office. The president transferred Evertz to the post of special assistant to then HHS Secretary Tommy Thompson in a move described by most White House observers as a demotion.

Evertz, a former official with Log Cabin Republicans, a gay GOP group, became an outspoken advocate for AIDS programs during his short tenure as director of the White House AIDS office. Evertz appeared before gay and AIDS groups and agreed to interviews with the gay press, developments that angered conservative religious groups.

Some White House observers speculated that Evertz's high visibility as a gay appointee made the White House uncomfortable and led to his ouster. Others speculated that Evertz, whose background was in politics rather than health care, did not have the skills and in-depth knowledge about AIDS policy issues to adequately head the nation's leading AIDS office.

When O'Neill entered the White House post, he shunned press interviews and kept a low profile, meeting privately with leaders of AIDS groups while avoiding the public limelight. Bush mentioned O'Neill in one of his State of the Union addresses, and introduced O'Neill at White House functions involving AIDS or health care issues. However, the president never publicly acknowledged that O'Neill was gay, keeping to a policy articulated by his first press secretary, Ari Fleisher, that the administration would never ask an appointee about his or her sexual orientation.

Focus on Africa

In August 2003, Bush named O'Neill as deputy coordinator and chief medical officer for the newly created Office of the Global AIDS Coordinator. Based on a reorganization plan to boost the administration's attention to AIDS in developing regions, such as Africa, the White House set up the global AIDS office within the State Department. It consisted, among other things, of staff and agencies pulled out of the U.S. Agency for International Development and HHS.

Its main task was to operate Bush's proposed $15 billion, five-year initiative to combat the AIDS epidemic in Africa and the Caribbean Basin, where nearly 20 million people - including women and children - were infected with HIV and were struggling to stay alive. A top priority was to help provide life-sustaining drugs to the infected populations.

At the president's request, O'Neill traveled to Africa and other Third World countries to promote the program. Although officials with a number of AIDS groups had praised O'Neill for his commitment to combating AIDS and his knowledge of the subject, some expressed concern when he spoke out in defense of Bush's controversial "abstinence-only" policies for HIV prevention, both in the U.S. and for the global AIDS initiative.

O'Neill also defended the Bush administration's initial opposition to providing lower cost, generic AIDS drugs as part of the U.S. assistance programs for Africa and other regions. The administration said the more expensive, name-brand drugs produced by U.S. pharmaceutical companies were approved by the Food & Drug Administration and thus were more reliable and safer than generic drugs, which often are produced in other countries, such as India. AIDS activists said the use of the more expensive drugs drained the budget of the global AIDS program and appeared to be aimed at benefiting the U.S. pharmaceutical industry.

Less than two years after his appointment to the global AIDS office, Bush transferred O'Neill back to the White House, in April of this year, in what was said to be a temporary appointment to help the administration revamp a domestic program - the Ryan White CARE Act. There was no official announcement of O'Neill's departure from the global AIDS office or his return to the White House.

His new White House assignment placed him in his old location at the White House AIDS office, but this time under Carol Thompson, who heads that office and who worked as his deputy when O'Neill directed the office. O'Neill's official title, according to the White House, was special assistant to White House domestic policy chief Claude Allen.

Sharon Ann Lynch, an official with Heath Gap, a New York City-based AIDS group that monitors international AIDS issues, said O'Neill's departure from the global AIDS office was viewed by AIDS group insiders as part of a "shakeup" at the State Department.

Lynch and Naina Dingra, an official with Advocates for Youth, a D.C. group that also monitors global AIDS issues, said O'Neill's departure from the global AIDS office came at a time when career staffers at the office, who had come from U.S. foreign service programs, were in a heated dispute with politically appointed staffers who came from HHS.

Much of the dispute centered around Bush administration proposals to place strings on U.S. global AIDS funds to force Third World countries to adopt abstinence-only programs in the area of HIV prevention. Other proposals called for cutting off funds for condom distribution in African countries such as Uganda, Lynch said.

"Many people viewed this as putting ideology and religion over science," said Lynch. "Joe was the administration's point person on this."

Lynch said she did not know whether O'Neill privately supported or opposed these controversial proposals. However, one source familiar with the administration, who spoke on condition of anonymity, out of concern over losing access to administration staffers, said O'Neill may have voiced opposition to these initiatives, prompting White House officials to view him as disloyal.

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