Advocacy groups dismayed by lack of funding in president’s budget

Ryan White funding is flat-funded under proposal

The budget proposed by President George W. Bush for the various programs dealing with the domestic HIV/AIDS epidemic is a far cry from what AIDS advocacy groups say is needed — and from what is recommended by the National Organizations Responding to AIDS (NORA).

For example, the Bush administration proposes no increase in Ryan White CARE Program spending, requesting the same funding as last year ($1.808 billion). Since the epidemic has not slowed down and there is evidence of a rise in new infections, along with increases in the cost of providing care to HIV/AIDS patients, this proposal is a major disappointment, says Alexis Schuler, director of government affairs for AIDS Action in Washington, DC.

"For the first time in the history of the program, there is no proposed increase in funding, despite the increased cost of caring for people with AIDS and the increased need with new infections," Schuler says. "That’s very startling and profoundly disappointing."

NORA had recommended a $277 million increase in Ryan White funding, under the Department of Health and Human Services (HHS), for a total of $2.085 billion in fiscal year 2002. (To see FY 2001 budget request chart, click here.)

"I think it’s unconscionable that in the face of an expanding epidemic, particularly in communities of color, that the president’s budget doesn’t even recognize the need to provide sufficient funding to meet ongoing needs," says Javier G. Salazar, federal affairs manager of the National Minority AIDS Council of Washington, DC. "The two biggest problems we’re concerned about are the level-funding of the Ryan White programs and the Minority AIDS Initiative," Salazar says. "The Minority AIDS Initiative is the nation’s tool to address the lack of availability of quality services in communities of color."

Other parts of the budget causing distress were the small increases proposed for HIV prevention programs under the Centers of Disease Control and Prevention of Atlanta and decreases in funding for maternal and child health. The president’s budget also makes no specific request for funding to the Sexually Transmitted Disease Prevention Program or for the Department of Defense’s global HIV efforts and the Department of Labor’s HIV/AIDS Workplace Program.

"I will note that the budget calls for an increase in HIV prevention, but the increase is about 1%, which is below the inflation level and is below the 4% growth that Mr. Bush was proposing overall in domestic spending," says Ronald Johnson, associate executive director of the Gay Men’s Health Crisis in New York City.

The State Department’s global HIV/AIDS programs received one of the few budget boosts in the proposal, an increase from $315 million to $329 million. While AIDS advocates see this as a positive move, they also view it with skepticism in light of other HIV budget proposals.

"One thing that’s cause for concern and cynicism is that the budget for AIDS pits one community against another," Schuler says. "There is an increase — although not as much as we need — for international funding at the same time they are flat-funding domestic funding, and there’s an increase for research but flat-funding for treatment and prevention."

The proposal suggests funding the National Institutes of Health (NIH)’s research with an increase of $258 million for a total of $2.501 billion. While this is a generous proposal, it doesn’t resolve concerns over HIV care and prevention funding, says Jane Silver, MPH, vice president of public policy for the American Foundation for AIDS Research in Washington, DC. "We are obviously pleased about the increase in funding for the National Institutes of Health overall, but we continue to be concerned about the entire budget and the AIDS research budget," Silver says.

While the funding for AIDS research is a proposed 11.5% increase, it’s not enough, Silver says. "The recommendation of NORA is for 16.5% increase for NIH overall." A more technical concern about President Bush’s budget is that it is not a consolidated AIDS budget, as has been the case since 1993, Silver adds. "A consolidated budget for AIDS research means you know how much you’re spending on AIDS research at all institutes," Silver explains.

Without a consolidated budget providing guidance, it’s possible that research money could be subject to internal debates that pit one disease against another in effort to divide a smaller-than-desired pie. "We believe the scientists should make decisions about appropriate funding, and we should increase the pie and not pit diseases against each other," Silver adds.

Early in the new administration, AIDS advocates feared Bush would eliminate the White House Office of National AIDS Policy, sending a chilling signal about how committed he was to fighting the epidemic. Media attention and public criticism appear to have influenced the administration’s decision to maintain the agency and appoint long-time HIV/AIDS activist Scott Evertz, who also is openly gay, to the post of AIDS Czar.

While the decisions to continue operating the office and appoint Evertz have some symbolic merit, there is doubt regarding their true significance, AIDS advocates say. "We met with Scott Evertz last week, and his personal beliefs are right where the advocacy community is, and he knows prevention is important and he’s spoken out on this issue," Schuler says. "The question is whether he is going to have any authority at all, and I suspect he is not."

The Bush administration’s intent is suspect when one reads the fine print, Schuler explains. "I think there are a lot of smoke and mirrors here, and it’s all bait-and-switch," Schuler says. "We attended a Department of State briefing, and what they passed out was a one-page flier on the White House’s AIDS initiative to increase funding at HHS by 7%, but if you read the fine print, you see that two-thirds of that money is mandatory spending on Medicare and Medicaid."

While the administration’s goals for HIV/ AIDS prevention and care are laudable, AIDS advocates say they cannot be achieved under the current funding proposal. (See "Bush’s HIV/AIDS goals for prevention and care," in this issue.) For example, the budget proposal calls for the CDC to reduce the incidence of new HIV infections in the United States by 50% by 2005, but it allocates no additional money to cover the cost of meeting that goal.

"We’re concerned about all parts of the budget, including prevention, care, research, and international efforts, and we believe the goals are admirable, but it will take a far greater commitment of resources than we’ve seen so far," Silver says. "And this includes the efforts of the previous administration."

Although HIV/AIDS advocates express dismay at the proposed budget, some say they were not surprised, since the administration has said from the start that tax cuts are the top priority. "The overall message is we’re in a time of record surpluses, but we’re seeing a budget where you’d expect to see record deficits," Schuler says.

The important key will be what Congress does with this budget proposal. If past experience is an indicator, then it’s likely Congress will increase funding for HIV/AIDS prevention and care, Salazar says. "There are leaders in Congress, both Republican and Democrat, who know that increased funding is needed, and communities across the country need to address HIV," Salazar says.

HIV funding traditionally has done better under Congress than under the president, even with President Clinton, Johnson says. "We have allies on both sides of the aisle who are in tune with people living with AIDS, and we’re hopeful that we can increase the numbers as the budget goes through the legislative process in Congress," he says.

Without increases in HIV funding, it’s possible that the HIV infection rate will rise and the rates of AIDS illness and deaths will increase, Johnson says. "When you have a negative financial impact on those services, you either have to curtail the level of quality of services or curtail the number of people served, and it’s more likely you’ll have more people progressing to illness that wouldn’t have otherwise," Johnson says.