Bay Area Reporter - February 26, 2009
Lisa Keen

Even the most veteran Washington observer could not glean from this speech what numbers might constitute "absolutely critical" or making "hard choices" on any particular budget item, much less health care matters, such as HIV. But groups working to prevent new infections and to care for people with HIV/AIDS are hopeful they will be better than they saw from the administration of President George W. Bush during the past eight years.

They are also aware that the Obama administration dropped an earmark in his $787 billion stimulus package last week that would have directed $400 million toward efforts to prevent HIV and sexually transmitted disease infections. It is still not clear whether the White House's AIDS policy coordinator has been dumped this month from the President's Domestic Policy Council. And what does it mean that his commitments include no mention of HIV under "Health Care" but are listed, instead, under "Support for the LGBT Community" on the White House Web site?

"President Obama's first priority has to be guiding the nation through the economic crisis it's facing, and his budget will reflect that necessity," said Human Rights Campaign President Joe Solmonese. He added that "the LGBT community has every right to expect that the budget will allocate much-needed support for HIV/AIDS treatment, prevention and research efforts." And HRC hopes to see an end to funding for Bush's abstinence-only educational programs.

As Chip Lewis, a spokesman for the Whitman-Walker Clinic in Washington, D.C., noted, federal funding through the Ryan White CARE Act has been "relatively flat funded" for the last eight years. Meanwhile, he said, "the number of people living with HIV has increased."

And Representative Henry Waxman (D-California), a longtime advocate for fighting the AIDS epidemic on all fronts, last September made the case for increased spending. At a hearing on HIV prevention, he noted that, in President Clinton's last month in office, there were 40,000 new HIV infections per year - down from 130,000 per year of the mid-1980s. But by 2006, midway through Bush's second term, the number of new infections topped 56,000 per year. Waxman acknowledged that the increased number was due to "improved counting methods," but said it still "tells us the epidemic in the United States is and has been growing faster than we thought."

Waxman noted that the budget for prevention efforts grew in the Clinton years and dropped under the Bush administration. Even the goal for decreasing the rate of new infections dropped under the Bush administration - from a goal of cutting it by 50 percent to cutting it by only 10 percent. Most importantly, he established that while the Bush administration had asked for only $752 million for HIV prevention, the "appropriately scaled-up" budget for fiscal year 2009 should have been $1.6 billion.

War of cliches

In his address Tuesday night before Congress and a national television audience, Obama acknowledged a reality about Washington, D.C. - "how quickly good intentions can turn into broken promises and wasteful spending." That's another way of saying "money is politics in Washington" - a principle dramatically illustrated in the debate over the stimulus package this month, when Republicans characterized funding for HIV and sexually transmitted disease prevention as $400 million for condoms. The earmark was suddenly gone.

Earnest Hopkins, a longtime AIDS activist in Washington and currently the director of federal affairs for the San Francisco AIDS Foundation, said AIDS organizations were "very excited" when they first saw the funds designated to HIV prevention. Then news reports began quoting House Minority Leader Representative John Boehner (R-Ohio), characterizing the money as "hundreds of millions of dollars on contraceptives."

The final package, signed February 13, includes $650 million for "prevention and wellness strategies."

"But there's no language to target it" to HIV or STDs, said Hopkins. "In our community, we are concerned," said Hopkins, that officials at Health and Human Services and the Centers for Disease Control and Prevention will interpret the stripping of the earmark as meaning no money for HIV prevention. Hopkins said AIDS groups are hoping for some "additional targeted language" in the president's overall federal budget.

As Obama said Tuesday night, the budget is a "vision for America - a blueprint for our future."

In his first federal budget proposal, Obama is expected to show a shift in priorities from the Bush years - from defense to domestic. That could mean significant improvements in such efforts as HIV prevention, which have, during the past eight years, seen less than half the funding that professionals say they need.

LGBT and AIDS groups have had numbers poised since the election. They are not getting what they wanted this week for the current year's (FY 09) budget, but Carl Schmid, director of federal affairs for the AIDS Institute, said the blame for that rests with Congress, not Obama. He's hoping to see more promising numbers from Obama's summary budget for FY 2010 and groups are focusing on specific numbers for the FY 2010 budget Obama will propose in April.

Confused yet? Washington's federal budget process is a mess - politically and otherwise. Congress has not yet approved the FY 09 budget - that governs spending for the fiscal year that has been under way for five months already. That could happen next week.

The FY 10 budget that Obama issues this week is but a "summary." Details - the real numbers - will come in April.

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