AIDS Action Weekly Update
July 9, 2004
The subcommittee mark-up is the first opportunity for its members to comment on, and/or amend, the first draft of the Labor-HHS appropriations bill, which is known as the Chairman's mark. Representative Regula opened the markup by highlighting the legislation's key points. The appropriations amount to $142.5 billion in funding which will be distributed across 500 discretionary programs. This figure represents a 2% growth from the overall FY 2004 funding level. The bill provides a $2 billion increase for the Department of Education. In addition, the bill restores funding to the FY 2004 levels for job training and employment assistance programs run through the Department of Labor.
Many health programs are funded by these appropriations as well. According to the current text of the bill, the Centers for Disease Control and Prevention (CDC) will receive $101 million less than in FY 2004, but the resources for their emerging infectious disease efforts will be increased by $29 million. The National Institutes of Health (NIH) will be provided with $28.5 billion for FY 2005, a $727 million increase over last year. The appropriations expand community health centers, with funding totaling $1.8 billion.
Many of the programs contained in this appropriations bill directly impact people living with HIV. The Ryan White CARE Act funding will be increased by $35 million, totaling $2.1 billion. The bill will continue to fund the international HIV/AIDS, TB, and Malaria programs with $624 million. The bill also provides $110 million for the discretionary abstinence education program, an increase of $35 million over FY 2004. Representative Regula expressed his sentiments that given the resources available to the committee, this bill represents a "fair, balanced, non-partisan response" to the needs of the American people. Representative C.W. Bill Young (R-FL), chair of the full House Appropriations Committee, completed Regula's introduction by stating his strong desire to have the bill moved through the committee.
The Chairman then opened up the meeting for comments. Subcommittee Ranking Member David Obey (D-WI) delivered a rebuttal to Representative Regula's praise of the legislation. He expressed his strong disappointment with the bill and pointed out his criticisms. He accredited the bill's shortcomings to a budget crisis fueled by tax cuts for wealthy Americans. In terms of health care, Representative Obey believes the bill falls far short. He stated that the bill will terminate community access programs, cut health care programs in rural America, decrease funding for physician and dentist training, and grant the smallest increase in funding for the National Institutes of Health in 19 years. Obey lamented the fact that members of Congress are looking to expand their own health care benefits while 44 million Americans remain uninsured. These concerns are especially important to the HIV community, as this bill may further limit access to health care for those living with the disease.
After stating his arguments, Representative Obey introduced his own amendment to the bill. The Obey amendment would add $7.3 billion to health, labor, and education programs. The cost of these additions would be offset through a 30% reduction in the tax cuts received by people with annual incomes above $1 million. The amendment was debated, with Chairmen Regula and Young emphasizing that taxes and tax cuts are an issue outside the jurisdiction of the subcommittee. The amendment was put to a roll call vote and defeated by an 11-7 party line vote.
With no other comments or amendments presented, the subcommittee proceeded to vote on the bill. The subcommittee unanimously voted to send the FY 2005 appropriations to the full committee for further action, although many Democratic representatives voiced the need for additional revision at the full committee level.
Senator Frist characterized health disparity as a bi-partisan issue that is of great importance to the entire country. When a participant asked if Senator Frist's legislation would move through Congress or if the health disparity legislation introduced by Senator Daschle would have a hearing this year, Senator Frist's staff stated that movement on either bill is not likely. Nevertheless, it was noted that the introduction of these two bills has heightened awareness and discussion of health disparities across the country.
The conferees also heard from Deputy Secretary Claude Allen who informed the audience that he is focusing the Department of Health and Human Services (HHS) on the elimination of health disparities. The conference continued with presentations from Dr. John Ruffin, director of the National Center on Minority Health at NIH; Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention; Dr. Andrulis of SUNY Downstate Medical Center; Dr. Joseph Bentancourt, director of Multicultural Education, Harvard Medical School; Dr. Carolyn Clancy, director of Agency Healthcare Research and Quality, HHS; Dr. Harold Freeman of Ralph Lauren Center for Cancer Care and Prevention; and Dr. Louis Sullivan, chair of the President's Advisory Board for Historically Black Colleges, a co-Chair of PACHA and a former Secretary of Health and Human Services. Each of the speakers discussed the following topics: minority health research, preventative care, chronic disease management, cultural fluency, health care quality, and patient navigators.
AIDS Action staff will continue to monitor all of the health disparities legislation as it develops in Congress both this session and in the 109th Congress, and we will work to keep the disparity issues in HIV central to the legislation.
During the meeting, the Speaker announced the legislative calendar for the remainder of the 108th Congress. The issues to be covered are as follows: permanency of the tax cuts, Medicare, Transportation Reauthorization, and the Energy bill. According to the Speaker, all 13 appropriation bills will be completed on the House side before the August recess and will be ready for Senate consideration no later than the first week of September. Though the conversation did not focus on HIV, AIDS Action took the opportunity to present to Speaker Hastert's Outreach Coordinator Charles Chamberlain a copy of the Connecting to Care: Addressing Unmet Need workbook. The workbook offers examples of activities used by community-based service agencies to successfully bring HIV positive individuals who are aware of their infection into medical care.
AIDS Action will follow up with the Speaker's office after its staff has had an opportunity to review the document. This meeting provided an excellent opportunity for AIDS Action to talk with the Speaker of the House on the important work being done in the United States to address the domestic HIV epidemic.
A Mother's Promise the World Must Keep is a coalition campaign intended to remind community and government leaders, as well as the general public, about the importance of the Cairo Consensus on its 10th anniversary and to evaluate the progress made thus far. AIDS Action and National Organizations Responding to AIDS coalition (NORA) are among the over 40 health, human rights, environmental, and women's rights organizations cosponsoring the campaign.
The Cairo Consensus is a broad-based document that touches on many issues relating to public health, sustainable development, and population concerns. Among the principles discussed are in the document are the recognition of universal human rights; the empowerment and education of women and girls; access to reproductive health and family planning services; environmental conservation and sustainability; ending poverty; the rights of migrants and refugees; and the impact of HIV -- especially among women, young people, and families. As a whole, the document stresses the importance of nations working together to adequately address global concerns. It also calls on both the developed and developing world to devote resources to meeting these goals.
At the luncheon, several speakers addressed the audience on the importance of this anniversary. The first speaker, Gloria Feldt, president of Planned Parenthood Federation of America, started off by thanking the Members of Congress who have supported the campaign for their efforts to preserve women's rights and global health. She emphasized the importance of the Cairo promises in meeting the needs of countless individuals around the world who suffer because they lack access to, and information about, reproductive health care.
Ms. Feldt's opening comments were followed by remarks from several Members of Congress. Representative Joseph Crowley (D-NY) noted that he had recently returned from Puerto Rico, where he was part of a delegation attending the biannual meeting of the Economic Commission for Latin America and the Caribbean (ECLAC). One of the main topics of this meeting was the Cairo Consensus. He observed that in 1994, the U.S. was one of the lead advocates for the Cairo document; now, however, the Bush Administration does not support its goals. Representative Crowley stated, "It was disheartening in Puerto Rico to feel as if everyone was against the US. We are no longer the leader, but sadly stand alone."
Representative Betty McCollum (D-MN) observed that the U.S. government needs to reconfirm its commitment to the Cairo Consensus, and noted that it can only do this by working together. She spoke specifically about HIV and how the virus is intensifying the challenges that many women without access to family planning already face. "We need to give them opportunity of control with family planning," she stressed. "Women need control over their reproductive health." Next, Representative Nita Lowey (D-NY) spoke about the need for condom distribution and access to medically accurate contraceptive information within President Bush's global AIDS initiative. She also spoke about the unique barriers that many women face in protecting themselves and their health, including legal, economic, and financial challenges.
Representative Jim Moran (D-VA) emphasized the plight of children in developing countries who are suffering because their parents' lack access to family planning and information. "Abstinence is not an option in the third world [and] pregnancy is [often] not a blessed event," he pointed out. He finished his short speech by stating that it is the U.S. government's duty as a "first-world nation" to set aside political differences and recognize that the future of the world is at stake. Representative Carolyn Maloney (D-NY) commented on the politics of global reproductive health, accusing the current administration of being hypocritical in its enforcement of the Global Gag Rule, which prevents family planning organizations from providing any information on abortion and abortion-related services. Representative Maloney framed this as a civil liberties issue, asking, "How can we enforce policy action on another country when it's illegal to perform the same action in our own nation?"
The remarks from Members of Congress were followed by brief comments from some of the event's cosponsors. Carmen Barroso, regional director of the International Planned Parenthood Federation, Western Hemisphere Region, spoke of the "absurdity" of U.S. policies on international reproductive rights. Steve Mills, the director for International Programs for the Sierra Club also spoke, focusing primarily on population as an environmental issue. "Women need to be able to control the size of their family," he said. In addition, Mr. Mills echoed an impression that many other presenters articulated, stating that in 1994 the U.S. was a leader in family planning and reproductive rights, but now it's "turning back the clock on success."
Anu Kumar, executive vice president from Ipas, spoke movingly about the many women who are suffering as a consequence of the Global Gag Rule. "The U.S. has a moral obligation to make a difference and to change legal abortions into safe abortions. The socially marginalized, poor, and young women are suffering, and the U.S. has the tools to protect them."
The last speaker of the afternoon was William Smith, the director of public policy for the Sexuality Information and Education Council of the United States (SIECUS), who emphasized the importance the Cairo Consensus provisions that specifically deal with young people. Commenting on the U.S. government's actions since 1998, he claimed that instead of spending much needed dollars on reproductive health and education programs, the U.S. has "poured millions of dollars into wasteful [abstinence-only] programs." He concluded his speech by asserting that the young people rely on the promises that have been made; therefore they must be kept.
To learn more about A Mother's Promise campaign, visit www.amotherspromise.org.
The report notes that the number of HIV cases has risen in every region of the world, totaling 35 million, and despite recent infusions of funding, the global response has only half of what is needed -- and it is not always effectively utilized. As a result, efforts are not keeping apace with the growing pandemic. Last year, a record five million people were infected with HIV, and three million died from HIV related illnesses.
The following are among the report's findings:
Sub-Saharan Africa alone -- home to just over 10% of the world's population -- accounts for almost two-thirds of all people living with HIV. According to the UNAIDS report, HIV prevalence rates in this region have remained stable, due to a rise in deaths related to HIV and a continued increase in new infections. Meanwhile, the epidemics in Asia and Eastern Europe are expanding rapidly. According to a New York Times article on Wednesday, July 7, Dr. Peter Piot, the head of UNAIDS, said, "One out of every four new infections is occurring in Asia today and the fastest growing epidemic is happening in Eastern Europe."
Just as some regions are greatly affected by HIV, some populations are as well. Notably, reveals the report, "Women are increasingly at great risk of infection." They account for nearly 50% of HIV positive people worldwide and "bear the brunt of the epidemic." It further mentions that as a result of illness, women and girls are "more likely to bear the brunt of the impact of the epidemic; they are most likely to take care of sick people; to lose jobs, income, and schooling ... and to face stigma and discrimination." The report determines, "There is an urgent need to address the many factors that contribute to women's vulnerability."
Youth are another population at high risk, accounting for nearly half of all new HIV infections, and the report calls for the establishment of "protective environment" -- regular schooling and access to health and support services -- so that young people can play "their vital part in combating the epidemic."
Currently, only 7% of the people who need antiretroviral treatment in developing countries have access to ARVs. The report cautions that "Programmes must be sustainable to prevent the development of drug-resistant strains of the virus." In addition, it will be necessary to scale up prevention programs, which currently reach only one in five people at risk for HIV infection. In low- and middle- income countries in 2003, only one in ten pregnant women were offered services for preventing vertical transmission. In high-income countries, "treatment has been a much higher priority than prevention and, as a result, there have been rises in HIV transmission for the first time in a decade."
To read the 2004 UNAIDS report of the global AIDS epidemic, link to www.unaids.org/bangkok2004/report.html and to review the New York Times article, link to www.nytimes.com/aponline/international/AP-Worldwide-AIDS.html.
According to Pfizer, almost half of this uninsured population postpones seeking care because of cost. They forego preventive care and, consequently, are more likely to be diagnosed with medical conditions at a later stage when treatment is often more expensive and outcomes less favorable. Nearly 40 percent report not being able to afford the medicines prescribed for them, and about 20 percent rely on hospital emergency rooms for their main source of medical care, it further noted. Moreover, caring for the uninsured imposes an enormous financial burden on America's health care system. Uninsured Americans received approximately $35 billion in uncompensated care in 2001, and the number of uninsured has risen by two million since 2001.
"We are providing choice, simplicity and expanded access to help Americans get the medicines they need," Pfizer Chairman and Chief Executive Hank McKinnell explained in the press release. "Because we all know that millions of Americans can't afford health insurance, we are making an unprecedented commitment to help these hard-working people gain access to prescription medicines. We understand the need for action to help people who can't afford medicines or insurance, and that is why we are pleased that this initiative is receiving such widespread support from political leaders, our health care partners and the business community," he said. Among the initiative's supporters are Tommy Thompson Secretary of Health and Human Services and Senators Hillary Rodham Clinton (D-NY), Rick Santorum (R-PA), Jon S. Corzine (D-NJ), and Orrin Hatch (R-UT).
"Never before has a pharmaceutical company moved to provide Americans with greater access to their products," AIDS Action's Executive Director Marsha Martin, DSW stated on Tuesday, July 7. "Pfizer, and its CEO, Dr. Hank McKinnell are to be commended for their leadership, commitment, and actions taken today." She continued, "Through this innovative program, many people living with HIV and AIDS will be able to purchase lifesaving prescription medicines at significant cost savings."
Key elements of the new initiative, as noted in the press release, are as follows:
To read Pfizer's press release, link to www.pfizer.com/are/news_releases/2004pr/mn_2004_0707.html; to read select quotations from endorsing individuals and organizations, link to www.pfizer.com/are/news_releases/2004pr/mn_2004_0707_endorsements.html.
The New York Times article also included personal stories of several gay homeless youth. It described how for these young men each day consists of a struggle for food and shelter. It pointed out, for instance, that roughly two dozen beds are reserved specifically for homeless GLBT youths in New York each night, which leaves hundreds or more gay youth to find shelter on their own. As a result, many turn to survival sex to try and meet their basic needs, as they have few legal means by which they can earn enough money for food and shelter. This puts them at risk for HIV. "You've got to do what you've got to do to survive," one young man recently diagnosed with HIV explained in the article.
One of the personal stories described in the article is that of Brian Murray, a 22 year-old gay man living with HIV. As the article recounted, Mr. Murray had been both physically and sexually abused as a child, and had eventually been placed into foster care. When he was 21, however, he "aged out" of the foster care system. Murray described how that very night -- on his birthday -- his foster care caseworker drove him to a homeless shelter, gave him his bags, and wished him luck.
According to the Times article, most national estimates show that about half of all homeless youth in America are GLBT. Many have been forced to leave their homes when their parents discovered their sexual orientations. It is a problem that is putting a growing number of GLBT youth at risk for HIV, in addition to violence, depression, substance use, and hunger, the Times added. Carl Siciliano, who runs the largest shelter in New York specific for GLBT youth, remarked in the article, "The streets of New York will eventually consume them. If it doesn't kill them, there's no way to reverse the damage it has caused."
To read the article on which this news brief is based, link to www.nytimes.com/2004/06/27/nyregion/27homeless.html. To learn more about homeless youth, link to the National Coalition for the Homeless at www.nationalhomeless.org. More information about HIV positive youth can be found on the Web site for Advocates for Youth, which is www.advocatesforyouth.org.
The Institute will be headed by George Ayala, Ph.D., a nationally recognized expert on HIV prevention who will work at GMHC and APLA, with the staffs of both agencies, and comes to this position with much success in his current work at APLA and on several projects of national significance.
AIDS Project Los Angeles and the Gay Men's Health Crisis, two of the oldest HIV service and advocacy organizations in the United States, are members of AIDS Action.
In addition, the conference program will include a special series of open-house forums called "Meet the Leaders." The sessions will assemble leaders from national and local governments, industry, science, entertainment, and media to answer specific questions about the current efforts against the pandemic and changes leadership can effect to improve the global response. The public can submit questions for the series by e-mailing firstname.lastname@example.org. Each question will be read and considered for use in the Meet the Leaders sessions.
Some of the leaders who are scheduled to attend the sessions are listed below:
To learn more about the conference and its online coverage, link to www.aids2004.org/.
This article was provided by AIDS Action Council. It is a part of the publication AIDS Action Weekly Update.