The Bay Area Reporter - July 17, 1999
Cynthia Laird

"I'm upset and I'll say it publicly," Harkin said. "In February 1997, Secretary Shalala acknowledged needle exchange programs are effective but did not certify they will not encourage use of illegal drugs." Such certification is required for federal funds to be used for needle exchange.

"Keep speaking out," Harkin told testifying witnesses, including Shindle, who often spoke about the need for needle exchange during her tenure as Miss America 1998.

San Francisco AIDS Foundation board member Lonnie Payne also testified that needle exchange is needed to slow the spread of HIV/AIDS. He told Harkin and fellow subcommittee members, Republican Senator Arlen Specter of Pennsylvania and Democratic California Senators Dianne Feinstein and Barbara Boxer, "I cannot leave without expressing my disappointment over the lack of federal support for needle exchange programs."

Cuts would be devastating

Specter, the subcommittee chair, said that members are looking at a 10 percent cut in AIDS funds, a notion that concerned many of the speakers. He pointed out that the government has substantially increased funding from $3.3 million in 1982 to about $4 billion today for all programs, including the Ryan White CARE Act and Centers for Disease Control and Prevention (CDC), and referred to a decline in the disease's morbidity that reduced reported AIDS-related deaths to 22,000 in 1996.

Volberding, a professor at the University of California, San Francisco, agreed there has been incredible progress made in fighting the disease, but said many patients are failing the drug therapies. Any funding cuts "would be truly disastrous," he added.

Boxer also commented on the irony that although treatments and drugs can help people live longer, many people can't access the medicine because of the healthcare system. "We've got to do more," she said.

San Francisco Mayor Willie Brown also praised advances in treating the disease, but warned that "San Francisco would be devastated, in particular, with any less in resources and has always been productive with the dollars we're using."

Brown told the subcommittee that new anti-HIV therapies are "marvelous techniques" that "must be generously and liberally supported."

Another irony is that life-extending therapies have actually increased the caseload for many AIDS organizations. Payne predicted that by fiscal year 2000-2001, the number of clients at SFAF would increase by 20 percent, and urged the subcommittee to resist pressure to cut back on federal HIV/AIDS funds.

Sasser, who appeared on MTV's The Real World and was the partner of the late Pedro Zamora, reminded the group that AIDS is not over; Sasser has been living with HIV since 1988.

Jeanne White provided the most emotional testimony when she tearfully recalled how her son, the late Ryan White, contracted HIV from infected blood products used to treat his hemophilia. As the family faced AIDS discrimination in the midwest, and found it necessary to fight a series of court battles so Ryan could attend school and live a normal life, Ms. White somewhat reluctantly took up the fight and confronted her own prejudices along the way.

"I did not want this role," she testified. "My life changed overnight. I started meeting a lot of people with AIDS and the more gay people I met, the more gay people I liked."

Boxer responded, "Your voice is bringing Ryan back."

Dellums's 'Marshall Plan'

Former East Bay Congressman Ron Dellums addressed the subcommittee and spoke at length on conditions in sub-Saharan Africa. Dellums, now president of Healthcare Management International, said the AIDS epidemic "dictates a major global response," and that 2.5 million people die in sub-Saharan Africa each year.

"How can the world stand by and do nothing?" Dellums asked. "We have to do something." He said the federal government needs to abandon the conspiracy of silence surrounding HIV/AIDS, move beyond a state of denial, and make a commitment to do something on a large scale. His proposal, an "AIDS Marshall Plan" was first announced last October. Dellums told the subcommittee that the name connotes "bigness."

"We need to take a leap of scale in resources," he said. "[AIDS] is no longer at the 'project level.'"

The AIDS Marshall Plan is a public-private partnership, Dellums said, and several hundred million dollars are needed to develop the plan that would focus on access to treatment and other issues around the world. He estimated that 80 to 90 percent of the AIDS cases worldwide are in third world countries, where the AIDS Marshall Plan would focus its efforts.

"What makes us think we're living in a cocoon here?" he asked. "All my life I've been a peace activist, and this is war."

Feinstein then asked Dellums what he considered the "biggest bang for the buck" that could effectively make a difference. Dellums replied that funding is needed in three key areas: education, prevention, and treatment.

"We need to do all three things, expand education, expand prevention, and also be committed to treat people," said Dellums.

Fauci, in an abbreviated presentation, said that India is the next epicenter for the epidemic and predicted it will "probably dwarf sub-Saharan Africa."

He impressed upon the subcommittee that there's a critical need for a HIV vaccine. "With all the good news there's sobering news," he said. "The drugs have a dramatic effect, but many people can't tolerate the side effects." Also, he warned, "People are starting to become complacent."

Other voices, same room

Feinstein, who was a San Francisco supervisor before becoming mayor in 1978, waxed nostalgic about returning to the Board of Supervisors Chambers in City Hall. "I haven't been back in this room since I left," she said, while sitting in the same spot she occupied as a supervisor.

Feinstein, who pointed out that San Francisco was one of the first cities in the country to spend public funds back in the early 1980s on what was then called "gay cancer," recalled that the city closed the gay bathhouses in 1984, and commented briefly on efforts locally by some gay men to reopen the baths.

"Recently, I was very pleased to see the public health commission rebuffed efforts of [reopening] bathhouses," Feinstein said. "Commercial establishments can't profit at such a human price."

Last month the city's Health Commission decided -- without a vote -- to leave the decision of allowing private spaces in commercial sex establishments to Health Director Dr. Mitch Katz. Katz has said he is opposed to changing the city's policy, although he has acknowledged that he has no scientific data to support his contention that reopening the bathhouses would increase the spread of HIV.
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