Washington Blade - November 23, 2001
Eric Erickson

In response to an inspector general's report, HHS Secretary Tommy Thompson has ordered a review of all CDC AIDS prevention grants. (AP photo)

ATLANTA -- A report from the federal government criticizes nearly $700,000 in funding and two provocative AIDS prevention programs in San Francisco and is prompting a larger review of all AIDS programs funded through the Centers for Disease Control & Prevention.

AIDS activists defended the two programs -- "Booty Call" and "Great Sex" by the Stop AIDS Project in San Francisco -- as needing to be explicit to get across their message.

"This may not be true for gay and bisexual men across the country, but for gay and bisexual men in San Francisco, using sexually explicit language, talking about rimming and fisting and fucking are appropriate language," said Steve Gibson, co-executive director of the Stop AIDS Project.

But the programs were also approved by a local review panel in San Francisco, said Gibson; obtaining such approval is a requirement under guidelines for federal funds.

Michael Cover, spokesperson for Whitman-Walker Clinic, an AIDS service organization in Washington, D.C., said the inspector general's audit of AIDS-prevention programs would be "a critical debate" for similar organizations nationwide.

"This debate tends to be politicized very easily, and we've got to remember that targeted HIV prevention is effective and HIV-prevention programs save lives," he said. "That's the bottom line."

The programs in San Francisco "could be construed as `encouraging, directly à sexual activity' and as `obscene,' and thus not in compliance with CDC guidelines," said Janet Rehnquist, inspector general of the Department of Health & Human Services.

Rehnquist's extensive audit of HIV prevention programs at Stop AIDS Project has prompted Tommy Thompson, secretary of Health & Human Services, to order a review of all AIDS-prevention grants; his office will separately review all HIV/AIDS programs run by his department, including a much larger program for treatment of low-income victims of the disease.

Rehnquist's report, obtained by the Associated Press and first reported Nov. 15, reviewed $698,000 in AIDS-prevention funding to the Stop AIDS Project by the Atlanta-based Centers for Disease Control & Prevention.

The CDC's guidelines for prevention programs state the material used cannot promote sexual activity or intravenous substance abuse, and cannot be obscene under standards set forth by the Supreme Court in 1973 in Miller v. California. Rehnquist's report also stated that "the Project did not subject its workshop materials to a local review panel, contrary to CDC guidelines."

Gibson said the programs questioned in Rehnquist's report were submitted and approved by the San Francisco Department of Public Health's materials review panel.

"The federal guidance says that since community standards vary across the country, that it's up to a local review panel to decide if the materials are in compliance with that restriction," Gibson said.

Whitman-Walker's Cover noted the importance of the local review panel process to determine what is most effective in different communities. In Washington, the HIV/AIDS Administration in the D.C. Department of Health reviews proposals by AIDS service organizations before awarding them CDC funds.

"The Clinic has always had a position where we've had to make sure we're well within any guidelines because of our location in the nation's capital," Cover said. "We are very visible to policymakers and have a responsibility to our communities.

"We've got to keep concentrating on providing quality, appropriate, targeted HIV-prevention while remaining within the law," he added. Bill Hall, spokesperson for HHS, said the department would offer neither further information nor interviews, other than letters written by Rehnquist and Thompson.

A CDC spokesperson was unclear on whether the agency knew how the Stop AIDS Project was planning to use the $698,000 in grants.

"CDC sometimes doesn't even see the material because it's really not logical for someone at the federal level to be deciding what's appropriate in San Francisco and what's appropriate in some other cities or communities," said Lisa Swenarski, senior public affairs specialist at the CDC.

Steven Tierney, director of HIV prevention with the San Francisco Department of Public Health, could not be reached for comment.

U.S. Rep. Mark Souder (R-Ind.), chairperson of the House Subcommittee on Criminal Justice, prompted the investigation.

Souder could not be reached for comment by press time.

Roland Foster, a subcommittee staff member, said AIDS agencies should not expect federal funds if they cannot follow government guidelines.

"During the same period when we've significantly increased prevention funding, we've never decreased the number of new infections," Foster said. "There has to be some question if the money we're investing continues to increase and the number of infections never drops from year to year. Isn't it about time we look at how we're spending our money to see whether or not we're investing it wisely?"

Rehnquist said in her report that investigators did not attend the workshops, but instead reviewed transcripts and training materials.

The grants for the Stop AIDS Project did not specifically fund the two workshops cited in Rehnquist's report; instead the money was pooled with other funds for the agency, Gibson said.

Stop AIDS Project, which Gibson said enjoys a strong relationship with the CDC, is one of about 90 AIDS agencies across the country that receive funds directly from the CDC, which is in part why Rehnquist said the review was conducted. A complete list of the agencies was not immediately available from the CDC.

In her report, Rehnquist also took issue with accounting methods used by Stop AIDS, which do not differentiate between programs funded through federal dollars and programs funded locally.

The CDC has never asked Stop AIDS Project to change its accounting system, but if any changes come as a result of Rehnquist's report, it will be in the way the agency tracks funds, Gibson said.

Swenarksi said that the CDC has never specifically asked Stop AIDS to record which funds are paying for various programs, but said that is a requirement for grantees to do so.

"I'm not sure what the consequence of it would be," Swenarksi said. "I'm sure we would work with them to work something out."

Gibson said the report was prompted by politics, not health concerns.

"Talking openly and honestly about gay sexuality is being viewed as promoting the homosexual agenda, and that needs to stop, according to their tactics," Gibson said. "We know that doing good and effective community-based prevention with gay and bisexual men means you need to talk openly and honestly in a language that people use to develop strategies to reduce the risk of transmitting the virus. That's being spun as promoting the homosexual agenda." Cover said he could not comment on the HIV-prevention programs that critics contend are inappropriate.

"I can say that when you're working with specific populations, it's important to use language and programming that's appropriate for that population," he said.

"I believe HIV-prevention programs can be specific to populations in ways that are positive and that reinforce sexual identity and affirm gay men's sexuality."

The Clinic offers HIV-prevention outreach programs primarily aimed at women, young gay men, and African American and Latino communities. Cover said that in the last few years Whitman-Walker Clinic has not offered many HIV-prevention and education seminars and workshops like those being scrutinized. Rhonda Smith contributed to this report.

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