San Francisco Chronicle - May 10, 2008
Sabin Russell, srussell@sfchronicle.com.

"You have to scale the money to the scope of the problem," Gerberding said during a forum hosted by Rep. Barbara Lee, D-Oakland, at a West Oakland community center.

The chief of the Atlanta-based federal agency responsible for controlling infectious disease acknowledged that, when it comes to HIV, "We have not succeeded in our prevention efforts."

Her call for more money comes even as the Bush administration, which appointed her to run the agency, is proposing a $1 million reduction - to $691 million - for HIV prevention and surveillance in the CDC budget request for the coming fiscal year.

Gerberding was received warmly by the mostly African American audience, but several speakers decried the years of flat or declining spending on AIDS prevention in the United States, even as the administration's spending on the epidemic overseas has soared.

"The pie is only so big right now," Gerberding said. "What we need is a bigger pie."

In testimony before Congress, Gerberding has often conceded that she wanted far more money for her agency than requested by her superiors in the administration. Last year, she said $7.2 billion was needed, but the CDC budget was cut to $5.9 billion.

The epidemic in the United States has been shifting from one that primarily affected gay white males to one where the majority of new infections are occurring among African Americans.

Among young people newly diagnosed between 2001 and 2005, for example, 61 percent were black, and 48 percent of infections among black men were linked to sex with other men.

The infection rate among African American men was seven times higher than that of white men in 2005, according to the CDC. African American women are being infected at 20 times the rate of white women in the United States.

As a result, although 13 percent of the U.S. population is black, African Americans make up half of those living with HIV infection.

In light of such figures, Lee said she is once again urging the federal government to declare a "national public health emergency," just as Alameda County declared HIV a health emergency 10 years ago.

"We need to make sure not only that resources are increased, but are targeted to where they are needed most," she said.

According to Robert Williams of the Center for AIDS Prevention Studies, the HIV prevention budget in Alameda County has been cut in half, to $800,000 from $1.6 million. "I think we are moving in the wrong direction," he said. "If it is, in fact, a state of emergency, then why aren't we acting like it's an emergency?"

George Lemp, director of the Universitywide AIDS Research Program at UC, said studies dating back to the early 1990s repeatedly showed that gay African American men were becoming infected with HIV at twice the rate of gay white men. Yet prevention programs were not reaching young black men.

"Our interventions are targeting the wrong people, in the wrong places, and at the wrong time of day," he said.

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