Washington Blade - November 30, 2001
Eric Erickson

In the wake of the Sept. 11 terrorist attacks in the United States, the new buzzword is bioterrorism. The CDC has mounted the largest epidemiologic investigation in its more than 50-year history, larger even than in 1981 when its disease detectives first uncovered what would soon become AIDS among gay men.

The agency's efforts on bioterrorism brought President Bush to its Atlanta headquarters this month, the first visit by a sitting president, to boost morale and lend support to increased spending for the CDC.

But after first enduring criticism that the large federal agency didn't react quickly -- or publicly -- enough when the first anthrax cases surfaced last month, now CDC officials are facing a one-two punch over AIDS. Some conservative, religious groups are saying federally funded HIV prevention efforts should be ended, while some AIDS activists are concerned that resources turned over to bioterrorism efforts are short-changing the fight against AIDS. CDC officials said that while priorities of the agency have shifted since Sept. 11, the changes are temporary.

"It is important to say that most of CDC is continuing to work on our other critical health priorities, including HIV prevention," Dr. David Fleming, the agency's second-in-charge and deputy director of the CDC for science and public health, said in an interview Wednesday.

New priorities

Of the agency's nearly 8,000 employees, about 500 have been working on the outbreak of anthrax in the United States and in dozens of countries across the globe. Some of those employees and researchers have been reassigned from the CDC's National Center for HIV, STD & TB Prevention.

"There are a number of employees that have been detailed to this emergency," said Curtis Allen, health communications specialist with the CDC's bioterrorism unit. "Once the emergency passes, we will go back to our normal positions."

But with an end to the war on bioterrorism nowhere in sight, AIDS advocates are concerned about prevention efforts and research.

"We can't reduce our efforts in the fight against HIV and AIDS and tuberculosis and malaria and the other diseases that the CDC has traditionally focused on, and I don't think we will," said Sandy Thurman, a former AIDS czar for President Clinton who is now executive director of the International AIDS Trust in Washington, D.C., a new nonprofit AIDS service organization.

But Thurman added that the government doesn't have a choice but to refocus its efforts on bioterrorism.

The focus on anthrax and bioterrorism, though, may mean other branches of the CDC are suffering, Dr. Jeffrey Koplan, the agency's director, hinted during a conference call with reporters Tuesday.

"We've had lots of occupational safety and health people working on [bioterrorism], and yes, the things they were working on before are either going slower or are on hold until they can get back to them," Koplan said. "I think important public health urgent activities are ongoing, but not with the same level of staff support that they would have had before."

Despite repeated requests, Koplan was not available for an interview with Southern Voice, a newspaper owned by Window Media, the company that publishes this newspaper.

Fleming said that while the level of staff support may be lower for activities other than the bioterrorism efforts, it does not mean the level of importance of those other activities has also been lowered.

"Our goal is to try, within the context of our resources to continue to work on our critical priorities," Fleming said. "We're operating right now at emergency mode to respond. It's our intentions that as things calm down that people who have been temporarily detailed over here would return to the parts of the CDC that they are supposed to be working in."

Outside the refocused resources and shifted researchers inside the CDC, little has changed externally -- so far -- in the fight against AIDS, according to Thurman.

"In my day-to-day dealings with the CDC, nothing has changed," Thurman said. "I haven't been disturbed to date at the kind of work that we're doing in HIV and AIDS. In the midst of all of this, the work continues."

Increased funding

The anthrax effort comes just a year after the CDC received more than $180 million to fund bioterrorism efforts.

Since the outbreak of anthrax cases, the agency has received 10,000 anthrax false alarms, Koplan said. Agency scientists are working 18-hour days and offering assistance to a wide range of local, state and federal agencies and more than 60 other countries with concerns about anthrax, he said.

"The scope of the problem, with respect to needing to provide support to states and localities that were experiencing anthrax letters as well as any place in the country that was experiencing threats, was such that we did need to temporarily call some people from other parts of the agency to help staff our emergency operations," Fleming said. Since the terrorist attacks, some lawmakers have been lobbying to increase the

CDC's funding for improvements to decades-old equipment and cramped and crumbling quarters that have stymied its anthrax investigation.

Congress is considering a proposal that would add $1.5 billion to the CDC's 2002 budget for efforts in combating bioterrorism, more than six times the amount spent this year.

"What I think this is saying is we're looking forward in the future to be better prepared for additional bioterrorism events," Fleming said. "Dollars invested in bioterrorism will reap dividends, not only in our ability to respond to bioterrorism, but also in our ability to respond to other critical health issues."

Thurman said increased funding for bioterrorism shouldn't come at the expense of HIV/AIDS programs.

"Just because we ratchet up our activities on one hand doesn't mean we reduce our activities in another," Thurman said. "I think it means we have to go to Congress, we have to ask for increases in funding for CDC and not reduce our funding for HIV and other activities, but to get Congress to give CDC the money they need to increase their work in bioterrorism."

Conservative backlash

While Congress considers expanded funding for the CDC's war on bioterrorism, a group of anti-gay political action groups is calling on lawmakers to eliminate HIV prevention funding, arguing that tax money should be instead spent on fighting bioterrorism.

In a press release issued last week, the Washington, D.C.-based Traditional Values Coalition said, "[The CDC] has misspent tens of millions of dollars on outrageous and unnecessary homosexual boondoggles."

The coalition charged that CDC-funded programs in San Francisco involve the use of sex toys and work to boost "self-esteem for HIV-infected individuals." Calls to the Traditional Values Coalition seeking comment were not returned.

The conservative coalition is one of a handful of groups which signed an open letter to Tommy Thompson, secretary of Health & Human Services, criticizing HIV prevention and safe sex advertising campaigns directed toward gay men.

"With a flailing economy and threats to the public health, the CDC must direct funding toward its stated mission and primary responsibility: protecting the public health," according to the letter, also signed by the anti-gay Family Research Council and Focus on the Family.

Neither group returned calls seeking comment.

"The CDC should be directing funds to the war on terrorism and increased production of vaccines needed to fight anthrax, smallpox and other biological weapons," Ken Connor, the FRC's president, said in a prepared statement as Bush visited the CDC's headquarters Nov. 8.

"It should not be spending taxpayer dollars on billboards in St. Louis featuring homosexuals in provocative poses encouraging individuals to get tested for AIDS," Connor said in the statement.

"The CDC's own guidelines prohibit subsidizing AIDS prevention programs that promote or encourage sexual activity. Yet, the content of the aforementioned ad and several other CDC-sponsored campaigns do just that. This is an absolute waste of taxpayer dollars," he added.

Congress joins critics

At least three Republican lawmakers are also speaking out against CDC funding of HIV prevention programs.

U.S. Reps. Joseph Pitts (R-Pa.), John Shadegg (R-Ariz.) and Christopher Smith (R-N.J.) all signed a letter to Thompson, written by Pitts, saying "we have grown increasingly concerned about some of the activities that the CDC is funding and promoting -- activities that are highly controversial in nature, and funding that could be better used for our War on Terrorism."

The letter cited billboards and TV ads aimed at gay men in St. Louis and San Francisco, and programs surrounding reproductive health care and abortion.

"These examples raise many questions and clearly cross the line between promoting public health and political advocacy, and in some cases, actually undermine the CDC's mission of promoting healthy living," Pitts said in the letter.

A spokesperson for Pitts said he was unavailable for comment. Calls to the offices of Shadegg and Smith were not returned.

Thurman said the criticism of the CDC's prevention efforts is unfounded. "People like that take advantage of situations like this and I think that's just unconscionable behavior," Thurman said. "It is disturbing that these people would take advantage of a situation like this and push for that kind of examination of our current activity."

White House reassures

Despite the pressure from conservative groups and politicians to diminish CDC funding for HIV and AIDS programs, the White House has sought to reassure AIDS activists that HIV and AIDS won't evaporate from the radar screen of the Bush White House.

Scott Evertz, director of the White House Office of National AIDS Policy, recently visited New York City and told local AIDS service organizations that "nothing has changed around HIV/AIDS."

"The fact is, post-Sept. 11, we were supportive of an increase that Congress added to the Ryan White CARE Act of $112 million," Evertz said during his three-day trip. "So, even in the midst of post-Sept. 11, the administration is responding really positively to the continued need for HIV/AIDS care, treatment and prevention."

On Tuesday, Sen. Bill Frist (R-Tenn.) said he would co-chair a task force about AIDS with Sen. John Kerry (D-Mass.).

The Center for Strategic & International Studies, a Washington-based think tank, is organizing the task force, which will spend two years focusing on public policy issues related to the disease, according to the Associated Press.

Expert panels plan to study funding, education initiatives and infrastructure needs in combating the disease. The task force also will examine the role of the United States in the fight against AIDS.

Frist, a former heart and lung surgeon, has introduced several pieces of AIDS legislation.

Emphasis from the White House and lawmakers is what keeps many activists from worrying about the future of the CDC's HIV prevention programs, said Tony Braswell, executive director of AID.

"We're all watching Congress," Braswell said. "If this bioterrorism gets funding and they hire additional staff, I won't be concerned."

Thurman said she is more concerned that HIV keep the public's attention.

"HIV and AIDS, which had [consistently] been on the front page of the New York Times and the Washington Post, has sort of fallen off the radar screen. This [month] was the first time I've seen a front page news story in the New York Times on HIV and AIDS since Sept. 11," Thurman said.

The coverage detailed the growing crisis over AIDS in China, the world's most populous country.

"I'm glad that it's creeping back onto the front burner," she said. "Those of us who are activists in our communities and care about HIV and AIDS need to make sure that we encourage our papers and our reporters and our press and our members of Congress not to neglect the new challenges that we have, but not to forget the old ones as well."

Fleming said the bigger picture should not be overlooked: what the current refocusing on bioterrorism could mean for the future of public health and the CDC.

"I believe that there is an increasing awareness about the importance of our public health system, and not only for our ability to respond to bioterrorism, but also for our assuring our ability to respond to other critical health needs including HIV," Fleming said.

"And so we're optimistic that as a result of this new found awareness," he added, "that likely we'll see that the public health system actually is something that makes our society work better and that we can translate this event into a more broad support of our public health priorities." Inga Sorensen contributed to this report.

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