Attacks on prevention work have increased

One researcher experienced in-depth federal audit

The HIV-prevention community could be forgiven for a little paranoia at the beginning of 2004. In recent years, they have experienced increased public political scrutiny and threats that funding will be pulled on projects aimed at reducing the transmission of HIV among men who have sex with men (MSM), injection drug users, and other high-risk groups.

HIV-prevention programs first came under fire in the fall of 2001. First, former Inspector General Janet Rehnquist investigated Centers for Disease Control and Prevention (CDC)-funded prevention programs at STOP AIDS Project Inc. of San Francisco and called the programs obscene.

Then Claude Allen, deputy secretary for the Department of Health and Human Services (HHS), was assigned to examine all HHS-funded HIV/ AIDS activities. And AIDS service organizations and others who receive CDC grants received letters reminding them to adhere to 1992 requirement for content of AIDS-related written materials.

Within months of this increased federal scrutiny and search for obscenity among HIV prevention work, a chilling effect was experienced by new applicants for CDC prevention grants.

For example, the South Dakota Department of Health in Pierre turned down grant applications for two MSM risk-reduction seminars to be conducted by the Sioux Empire Red Cross in Sioux Empire. It also turned down a proposal by The Center, a gay and lesbian counseling service, that had planned to use CDC funds to expand its HIV/AIDS peer education system.

According to South Dakota officials, the state’s secretary of health was concerned the Sioux Empire program might not meet with federal approval.

By early 2003, HIV-prevention researchers were hearing rumors about additional scrutiny of their own work, and this fear was confirmed July 10, 2003, when the U.S. House of Representatives held a floor debate on an amendment to the appropriations bill to fund the departments of Labor, Health and Human Services, and Education.

Researchers say the amendment was written to pull National Institutes of Health (NIH) funding from five ongoing research projects that some congressmen said they found repugnant. After the American Psychological Association of Washington, DC, and other behavioral science and public health organizations intervened, the amendment failed with a 210-212 vote.

The projects singled out by Rep. Patrick Toomey (R-PA) were:

Grant HD04368: Mechanisms Influencing Sexual Risk-Taking. This grant funded a study of emotions and moods that influence sexual risk-taking behavior.

Grant RD01HD039789: Spatial and Temporal Interrelationships between Human Population and the Environment. This grant, awarded to Michigan State University, funded a five-year project that examines interactions between human population and the environment in the Chinese Wolong Nature Reserve, which conserves endangered giant pandas.

Grant R03HD039206: Longitudinal Trends In The Sexual Behavior Of Older Men. This grant was awarded for the study of changes over time in a range of behavioral and cognitive factors associated with male sexual functioning and behavior.

Grant R01DA013896: HIV Risk Reduction Among Asian Women. This grant funded a study of drug use and HIV risk behaviors among Asian female commercial sex workers at massage parlors in San Francisco.

Grant R01MH065871: Health Survey of Two-Spirited Native Americans. This grant was awarded for the study of Native American gay, lesbian, bisexual, and transgender individuals, who are an understudied, but at risk for multiple psychological and health problems.

Also, at least one of the investigators singled out by Republican congressmen found that his research projects were scrutinized by several federal agencies from which he received funding.

Tooru Nemoto, PhD, an investigator and assistant professor at the University of California, San Francisco, who works at the Center for AIDS Prevention Studies in San Francisco and who conducted the research on Asian sex workers, was audited by members of each agency that funded his project, all of which were under HHS, says Cynthia Gomez, PhD, co-director of the Center for AIDS Prevention Studies.

"The outcome was that there was nothing out of order," she says. "But he did have to dedicate quite a bit of time going through the audit with the investigators."

The center has about 70 studies funded through HHS at any given time, and Nemoto’s study was the only one that was selected for an audit, Gomez adds. "His was the only one that went through that process, and it certainly had been targeted and identified as a research study that people disagreed with," she says.

Then came the latest assault on HIV-prevention research and other behavioral research when NIH director Elias Zerhouni, MD, was asked at an Oct. 2 House hearing for an explanation of the medical benefits of a list of 10 research projects, including the five that had been in Toomey’s amendment in July.

When NIH officials asked for a copy of the 10-study list, they were sent a list of more than 250 grants for research involving HIV, high-risk sexual behaviors, substance abuse, and MSM. While the original source of the list was left undetermined, there were reports that it originated within NIH at the instigation of a group called Traditional Values Coalition.

On the Traditional Values Coalition’s web site, it states, "For [more than] four years, we have been researching and studying the grant proposals that the National Institutes of Health have been giving to groups to study certain kinds of sexual behaviors. Now we have discovered that nearly $100 million has been given to study sexual habits and trends of different groups. These studies are awful and pornographic. Now we are lobbying our friends in the Congress to hold hearings so we can show everyone how the Homosexual Agenda gets millions of dollars to promote their lifestyle. We are on the front lines for you, and we are your voice here at the Capitol for Christian Values."

The ministry group’s web site also provides links to NIH research the group finds unacceptable, including the largest category of HIV-prevention research of every type, including HIV prevention among the general population, youths, gays and lesbians, injection drug users, etc. From a quick look at the web site’s listed grants, it would appear that the only prevention research to which it does not object are abstinence-only projects.

Rep. Henry A. Waxman (D-CA) wrote HHS Secretary Tommy G. Thompson Oct. 27, 2003, to protest the NIH list and to urge him to denounce scientific McCarthyism.

"This hit list appears to be part of a calculated effort to subvert science and scientists at NIH to a right-wing ideological agenda," Waxman said in the letter.

He also called for the NIH to stop contacting scientists on the list and asking them for further details and explanations about their studies when there already is plenty of information contained within the lengthy grant applications.

"This atmosphere of intimidation is unacceptable," Waxman wrote. "If past is any prelude, no amount of detail about grants involving sexuality or condom use will satisfy those who are ideologically opposed to such research.