Presidentís Advisory Panel Finally Convenes
The newly appointed Presidential Advisory Council on HIV/AIDS (PACHA) met for the first time under the Bush administration in Washington, D.C. in March.
President Bushs top health advisors were on hand for the meetings. Health and Human Services Secretary Tommy G. Thompson imparted to members that we are beginning a new chapter in the struggle against HIV. He stated that this isnt business as usual, but rather that the Office of National AIDS Policy is committed to developing effective tangible steps to arrest the advance of AIDS.
PACHA Council member Caya Lewis, a manager at the National Family Planning and Reproductive Health Association, argued that allocations for treatment programs do not correspond to the spread of the disease in the U.S. Lewis stated, I am deeply concerned about the lack of emphasis on prevention in this administration. Caya questioned the administrations commitment to curbing the increasing rates of infection within minority communities with flat funding for Ryan White programs.
Thompson proceded to defend the administrations decisions on AIDS policy, including flat funding for Ryan White programs and funding emphasis on abstinence-only programs, for fiscal year 2002-03. He said that given the costs associated with the war on terrorism and homeland security, AIDS advocates are fortunate that current funding levels were maintained for prevention and treatment, and for increases for research. You dont know how hard I had to fight to get flat funding, he informed the newly appointed Advisory Council. The priorities are the international war and homeland security.
The administrations allocation for prevention funding is disappointing because it appears to directly counter the efforts of the Centers for Disease Control (CDC) and Prevention to improve HIV prevention. Many critics have also denounced Bushs proposed budget as devastating for many HIV-infected people who do not qualify for Medicaid and have no private insurance to cover their medications.
Stuart Burden, a Council member and Levi-Strauss and Company executive, questioned the administrations pledge to the Global AIDS Fund. The U.S. has promised $500 million for the Fund, estimated to need $8-10 billion. There is a belief in the international community, given the size of our economy, that the United States has not done enough, Burden said. What more are you [Thompson] prepared to recommend? Thompson responded that no other country has re-committed to the Fund on the same level as the U.S. He noted that the U.S. pledge represents 25 percent of the total $2 billion in pledges, a tremendous and generous contribution. Thompson restated that the international war, homeland security, and domestic concerns were priorities for the Bush administration and therefore overrides the Fund.
Thompson informed the Council that his office has commissioned a management review of all federally funded HIV programs. He stated that the goal of the review is to make them more accountable, better coordinated and more efficient. These efforts have also raised concern among AIDS advocates who fear that this is simply the first step in the administrations plan to reduce HIV prevention programs or redirect money.
Dr. Joe ONeill, the acting director of the Office of HIV/AIDS Policy, is overseeing the review process of HIV programs and funding. ONeill stated that he only agreed to lead the process in order to honor successes and identify problems, in other words, to improve the governments efforts. I know theres a lot of concern this review will be either a whitewash or a witch-hunt, he said. I want to put your minds at rest. The interest here is in doing a better job. He emphasized the fact that he is not trying to damage any programs, but finding a way of doing a better job of providing services to people living with HIV.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, presented his agencys AIDS research for the Council. When asked about a possible AIDS vaccine, Dr. Fauci informed the members that an effective AIDS vaccine could be a decade or more away. Do I think in five years we are going to have a vaccine that is going to prevent AIDS? Probably not, he said. However, Fauci pointed out that some global health good could come out of the vaccine clinical trials that are currently being conducted. He explained that in developing nations with the highest rates of HIV infection an AIDS vaccine with moderate effectiveness would have a lasting impact.
...the Office of National AIDS Policy is committed to developing effective tangible steps to arrest the advance of AIDS.
Data on Mercks highly anticipated experimental vaccine was presented at the Retroviruses conference held in Seattle this past February. The vaccine is only in the first stage of safety testing and if successful it will be at least another five years (and probably longer) before the vaccine would reach the general public. Many experts are of the opinion that a vaccine is the only way to stop the AIDS epidemic, which has infected over 40 million people and caused some 20 million deaths worldwide.
Comments from President Bushs gay AIDS czar, Scott Evertz, drew mixed reviews from those in attendance. Whats the deal with him? In a scattered presentation, Evertz spoke briefly about the resolve of the Office of National AIDS Policy resolve to address HIV/AIDS, specifically in communities of color. Evertzs comments on efforts to reduce HIV infection rates (targeting National Testing Day), and engaging in early treatment for HIV infection, including reforming ADAP, Medicaid and Medicare regulations, drew praise from Council members. However, Evertz did not speak of specific policy initiatives. Although Evertz appears to be dedicated and committed to the work, his comments to the Council came across as being unprepared and not well thought out. Is this always the case? Evertz was also harshly criticized in an appearance in Atlanta in early March for his off-the-cuff remarks. One former board member of Atlanta Executive Network, a gay and lesbian business organization, stated that while he expected Evertz to deliver leadership, what he received was a stand-up routine.
Bill Arnold, the chairperson of the ADAP Working Group in Washington, D.C, told the Council that the AIDS Drug Assistance Program (ADAP) needs an $82 million emergency supplement to cover current shortages in the program. ADAPs accept some 600 new clients every month, and six or seven states now have waiting lists while others have unofficial waiting lists, Arnold said. States currently with waiting lists, client expenditure caps and/or drug access restrictions include Alabama, Georgia, North Carolina, Kentucky, South Dakota, Idaho, Wyoming, Maine and Texas.
Reports indicate that the southeastern region of the U.S. appears to be having the most difficulty with ADAP funding, with about 700 HIV/AIDS patients on several waiting lists to receive antiretroviral drugs. In addition, Arnold stated that these states have placed so many restrictions on who is eligible for anti-HIV meds through Medicaid that ADAPs have become the safety net for HIV positive individuals. AIDS groups in Florida have asked the legislature for an additional $5 million in ADAP funding. They say a drug waiting list in the state will be inevitable unless the state receives supplemental funding from the federal government. AIDS advocates remain hopeful that Congress will improve on the presidents budget, as it has in the past. However, even during the budget surpluses of the Clinton years, the final funding was regularly short of what AIDS groups said was needed.
In a surprise move, Hank McKinnell, head of the drug company Pfizer, Inc. and a Council member, announced that his company is freezing the price of Viracept, a leading protease inhibitor used for HIV therapy. Pfizer is the parent company of Agouron, the manufacturer of Viracept. We want all patients to have access to needed medicines, McKinnell said. AIDS activists have harshly criticized pharmaceutical companies in recent months for their pricing of AIDS drugs, the associated impact on state ADAP budgets and insurance premiums. In a move that will certainly place additional pressure on competitors, including industry leaders Bristol-Myers Squibb and GlaxoSmithKline, McKinnell promised that Pfizer would not raise the price of Viracept for two years.
The make-up of the Council has raised many eyebrows in the AIDS community. President Bushs decision to name former Oklahoma congressman Tom Coburn to co-chair the Presidential Advisory Council on HIV/AIDS created a firestorm among AIDS advocates. Co-chair Dr. Louis Sullivan was Secretary of Health and Human Services for the first Bush administration. Dr. Sullivan now serves as the President of Morehouse School of Medicine in Atlanta. While most are comfortable with the selection of Sullivan, Coburn is criticized for having difficulties separating his personal beliefs from proven science and public health policies.
Coburn is an obstetrician and gynecologist by profession. He also served as a Republican congressman from Oklahoma for six years until he retired in 2000. To his credit, Coburn was very instrumental in securing the reauthorization of AIDS treatment and research funding during his term in the House. He was the primary sponsor of legislation renewing the Ryan White CARE Act. However, Coburn maintains strong opposition to programs promoting condom use and safe sex. He advocates sexual abstinence and monogamy instead to reduce new HIV infections.
Coburn also opposes the distribution of clean syringes to injection drug users (IDUs) as a means to prevent the spread of HIV through contaminated needles. Despite evidence indicating that clean needles do not promote drug use and addiction, and do reduce the risk of HIV infection, Coburn maintains that clean-needle programs are an endorsement of further drug use. Under the Clinton administration, the PACHA advocated for clean needle programs in its reports.
In late January, Coburn issued statements stating that his personal views would not dictate the work of the Council, but he promised to challenge the national focus on condom use to prevent the spread of HIV. We have a prevention strategy thats failed, Coburn said in an earlier interview. Weve spent hundreds and hundreds and hundreds of millions of dollars and HIV infection is going up. AIDS activists counter that while rates of infection are rising among certain groups, primarily in communities of color, overall the 40,000 new infections reported each year in the U.S. are well down from the 150,000 at the height of the epidemic.
To the surprise of many, Coburn took a low-key position at this initial meeting. He urged members to work towards building a consensus on recommendations. He spoke of his visions of a day with no more HIV infections, no babies being born with HIV, and when all HIV positive individuals, including IDUs, would have available to them the treatments and services required.
President Clinton, Vice President Gore, and Health and Human Services Secretary Donna Shalala established PACHA in 1995. The Presidential Advisory Council on HIV/AIDS provides advice, information and recommendations to the Secretary regarding programs and policies intended to promote effective prevention of HIV disease, and advance research on HIV disease and AIDS. The role of the Council is solely advisory in nature.
Early in the Bush presidency there was concern that the Council would not be renewed. At one point the administration suggested that the Council, as well as the Office of National AIDS Policy were unnecessary. However, after much criticism, President Bush and Secretary Tommy G. Thompson renewed the Council´s charter in July 2001.
There are 35 advisory council members, an interesting mix of corporate executives, AIDS advocates and people living with HIV. Six members are returnees from the Clinton-era council. The members who served during the Clinton administration are Stuart Burden, Caya Lewis, Joseph Cristina, Ronald Dellums, Philip Burgess and Ingrid Duran.
A full list of PACHA members and affiliations are available online at www.pacha.gov, as are minutes from previous meetings.
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