Bay Area Reporter - September 18, 2008
Bob Roehr

Top officials at the Centers for Disease Control and Prevention offered the "professional judgment budget" in testimony before a September 16 hearing of the House Committee on Oversight and Government Reform, chaired by Representative Henry Waxman (D-California).

"CDC could greatly expand its efforts, increasing coverage and impact, and could provide leadership to an effective U.S. response to the epidemic at home," read the report submitted by CDC Director Dr. Julie Gerberding.

The enhanced funding was projected to reduce by 50 percent the number of people who do not know their HIV status, and over 12 years, cut the number of new infections in half. Given the lifetime cost of treating a person with HIV, preventing just 4,800 new infections over five years, would recoup all of the additional costs of the program.

"Not only do we need to expand what we know can work, we've got to find new things. The research for new tools is a very important part of it," she said.

"AIDS is a social disease as much as it is a viral disease. ... If we don't address the underpinnings of the problem [poverty, stigma, and homophobia] we are never going to be able to get where we need to be as a nation," Gerberding said in concluding her testimony.

Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, said the NIH HIV research budget has been essentially flat for the last five years, at about $2.9 billion. Even with the low rate of inflation, that translates into "a 12 to 14 percent decrease over five years."

In his "professional judgment," the NIH "could well spend about $3.5 billion" on HIV research; roughly a 20 percent increase.

The oversight hearing was the first ever on HIV prevention in the United States. The impetus was a 40 percent increase in the estimated number of new infections in the country, to 56,300 a year, released by the CDC in August.

Politics

"The new figures are a stark reminder that the HIV epidemic is far from over and that we must take new and urgent steps to strengthen our national HIV prevention efforts," said Waxman in opening the hearing.

He had asked the CDC to "prepare a budget that reflects not what the White House wanted but rather the agency's professional scientific judgment of what it would take to fully implement HIV prevention in the United States."

"The administration asked for less than half" of what the CDC thinks is necessary, said Waxman.

Representative Chris Shays (R-Connecticut) tried to blunt the edge of Waxman's attack. Gerberding, Fauci, and CDC's head of HIV activities Kevin Fenton all said they have never felt any political pressure from the Bush administration with regard to the needs assessment or budget on HIV issues. They also acknowledged that spending figures are set within the context of the total federal budget.

Shays concluded, "This was a budget which was agreed to by a Democratic Congress, and suggested by a Republican president. It is a bipartisan budget. In the end we have to work together."

Implicit in his statement was that Congress could have increased the HIV prevention budget above the president's request at any time. It had done so for the AIDS Drug Assistance Program under the Bush and Clinton administrations, but it chose not to do so with prevention.

Representative Maxine Waters (D-California) has been a longtime supporter of a more vigorous federal role in the fight against AIDS. She worked to create the 1998 Minority AIDS Initiative. Funding for the program is stagnant. And 10 years later, "I don't get the sense that you really feel this is a crisis," she told the panel of government officials.

Second panel

Social networks are an important factor in HIV transmission, said Ada Adimora, a researcher at the University of North Carolina School of Medicine. That is particularly true of the concentration and segregation of poverty within the black community that contributes to the spread of HIV. She spoke on the second panel of the hearing.

The relative scarcity of Africa American men, "due to high mortality and incarceration," destabilizes marriage and increases the likelihood of the remaining men having multiple female partners, Adimora said. She said focusing solely on the individual will not be sufficient to rein in new HIV infections; social forces need to be considered as well.

George Ayala, an adviser to AIDS Project Los Angeles, said stigma and discrimination "continue to undermine HIV prevention efforts in communities of color." Despite the fact that gay men are the hardest hit in the epidemic, "Only four of the CDC's 49 recommended evidence-based interventions specifically target gay men. And only one of them is designed to address the needs of gay men of color."

He argued for a comprehensive national HIV prevention plan for the U.S., something the nation demands of other countries that it helps through the international President's Emergency Plan for AIDS Relief program.

Frank Oldham, executive director of the National Association of People With AIDS, said stigma and homophobia continue to play a disproportionate role in fueling the epidemic. He pointed out that there are 12 different types of HIV awareness days in the U.S., but none that address gay men, who are the bulk of the caseload.

Reactions

"HIV prevention activities have waited many years to speak in the proactive rather than to be in a position of defensiveness," said Ayala in welcoming the hearing. However, he was disappointed that no other members of the committee stayed to engage the second panel of speakers.

"Two key points were made over and over again about prevention that works - about poverty and homophobia, homo hatred - as barriers to prevention for gay men of all colors," said Oldham. "AIDS has never left the gay community."

HIV consultant Marsha Martin said the hearing was "helpful ... but it's a little late. I'm happy that Congresswoman Waters said we were at the same place 10 years ago. Why isn't there a sense of outrage? Why we continuing to talk like there isn't a crisis here in the community."

"Obviously, it was not of sufficient interest for a majority of Democrats or Republicans to show up. The focused attention we would have liked to have seen from the Congress was not apparent," said Earnest Hopkins, with the San Francisco AIDS Foundation.

He thought it important that the need for increased funding was now on the table, and that CDC's Fenton, who is openly gay, corrected some of the misperceptions that women are a larger part of the domestic epidemic; it is still largely gay men.

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