Treatment Issues: Newsletter of Experimental AIDS Therapies - Volume 17, Number 1, January 2003
Gregg Gonsalves

Well, the President's budget for the coming fiscal year arrived on Capitol Hill at the beginning of February and except for an unexpected spasm of largesse for global AIDS efforts, the news looks bleak for domestic HIV programs, as well as Medicaid, which provides healthcare to thousands of people with HIV/AIDS.

While reports from the 10th Annual Retroviruses Conference in Boston warned that 25 states that track HIV cases are reporting an increase in new diagnoses, the Bush Administration offers flat funding for the Centers for Disease Control and Prevention's domestic prevention programs. While scientists at the CDC have announced a goal of cutting new infections in half by 2005, they're getting no help from 1600 Pennsylvania Avenue, except cries of "Just Say No!" (to sex, to drugs, to condoms, to clean needles) from the arch-conservatives that seem to be dominating White House policy making in this area.

AIDS treatment activists have been pushing hard for additional funding for state AIDS Drug Assistance Programs, as thirteen ADAPs have already either limited access to antiretroviral treatments or closed enrollment to new clients. Let's pray that T-20, the new fusion inhibitor from Roche, doesn't break the ADAP bank when it receives FDA marketing approval and the price is announced, but don't count on states being able to afford it if you're an ADAP client with few therapeutic choices left. By the way, ADAP was the lucky sibling among the family of other Ryan White programs: the rest of them are looking at flat funding or even a slight decrease in funding.

Medicaid is the principal source of government funding for HIV/AIDS care and treatment in the United States, covering 40% of people with HIV and 55% of people with AIDS. While state Medicaid programs are reeling from the deepening recession and require immediate fiscal relief, the Administration isn't offering additional funding to states and, over time, is looking to cap the program. Capping Medicaid would severely diminish the program's capacity to respond to the HIV epidemic.

So, the future is grim for people with HIV/AIDS in the United States. While the President is practically rabid about involving the country in a multi-billion dollar assault on Iraq and cutting taxes for the wealthiest of Americans, he's hacking away at programs that serve the poor and the sick and is racking up huge deficits that will curtail social spending for years to come. I exhorted TI readers to get involved in AIDS advocacy last month based on the fiasco that was 2002 for people with HIV living under Bush Jr. The coming year looks no better.

Last Saturday, I participated in a demonstration against the coming war in Iraq on a truly frigid day in New York City. I was joined by about 200,000 others from all over the Northeast. Perhaps, activism is coming back from the deep freeze and people are beginning to wake up to the insanity of what's happening around them.

The AIDS community slumbered through the late 1990s and the grassroots strength and policy expertise that it had built up over the previous decade-and-a-half has withered and disbursed. We need to rebuild our grassroots capacity by making a new commitment to community organizing within our diverse AIDS community and by building new partnerships with others working on behalf of the poor, the sick and disabled, and "vulnerable" populations, including prisoners, drug users and sex workers. We need to be able to rally thousands to action to undo the damage of the past three years and it's going to take a lot of time, effort and resources to do this.

We've also got to confront the "brain-drain" from AIDS policy work. While there are still some great people working on public policy in AIDS, we've lost far too many others to industry, consulting firms or academia. Recruiting new, smart and practical policy "wonks," while trying to re-engage the alumni who were responsible for many of the advances during the first two decades of the epidemic, needs to be another priority for us all.

Growing a stronger grassroots movement and public policy apparatus is a recipe for success — it's been used effectively by political parties to drive their agendas through Congress or their candidates into the White House.

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