Can advocates keep Congress focused on HIV?

Improving president’s budget proves harder now

By the time this issue of AIDS Alert goes to press, there may be an approved appropriations budget for federal HIV/AIDS funding, but it’s unlikely that many AIDS advocacy groups will be complaining about it, even if it falls far short of their desires. Lobbying for more HIV money has become a difficult job in these times of bioterrorism and emergency war budgets.

"We are concerned that bioterrorism and anthrax and other related things that are health issues don’t completely take our attention away from HIV/AIDS," says Mark Vogel, a spokesman for the HIV Medicine Association in Alexandria, VA, which is part of the Chicago-based Infectious Disease Society of America (IDSA).

Exactly a week before the Sept. 11, 2001, terrorist attacks in Washington, DC, and New York, the HIV Medicine Association sent out a media alert claiming that thousands of people with AIDS would lose their access to care due to the inadequacies of the fiscal year 2002 budget. A national "Call to Commitment Day" had been scheduled for Oct. 1, and the organization had been reasonably assured that such a campaign would receive extensive media coverage, given all of the renewed attention given to HIV/AIDS in the past year.

However, so much of the media’s and the nation’s focus and priorities changed on that Tuesday in September that AIDS lobbyists had to tone down their appeals and essentially lie low, waiting for a more opportune time to remind politicians that more than 450,000 people have died from AIDS in this country. "At first the AIDS advocacy groups were sensitive to the timing issue, but appropriations budget moved a lot faster than we thought it would," Vogel says.

Ironically, while AIDS groups took a wait-and-see approach, the House of Representatives on Oct. 11, 2001, passed its version of the Labor, Health and Human Services Appropriations bill, providing $112 million in increased funding for the Ryan White CARE Act. "It was Congress’ initiative to move it forward," Vogel says.

In mid-October, it was at times impossible to reach Senators and Representatives to talk about keeping increases in the final appropriations bill because the anthrax scare in Washington, DC, blocked the usual avenues of communication, including mail service, telephone, and e-mail.

"For the last week, all of the congressional offices have been closed, and they can’t get external e-mail hook-up because of security issues at remote facilities, so you can’t find people," says Tanya Ehrmann, director of public policy at AIDS Action in Washington, DC. Ehrmann’s comments came in mid-October, at a time when her own office had not received mail for two days because of the anthrax scare. "So we’re trying to schedule meetings and keep track of what’s happening, but it’s pretty hard when there are people in space suits going through buildings," Ehrmann adds.

Repercussions could be long-lasting

What AIDS advocacy groups are left with is a fear that even if the final 2002 appropriations are an improvement over the president’s proposal, there will be other and perhaps longer-lasting repercussions from America’s new war with regard to the HIV/AIDS epidemic. On the one hand, what will happen next year when the nation needs to pay for its anti-terrorism spending? "It’s hard to speculate on the 2003 budget because it depends on what happens with anthrax and the war, but if anything did happen, it would be across-the-board cuts that would include HIV/AIDS but wouldn’t necessarily be unique to it," Vogel predicts.

Ehrmann agrees. "We’re hearing a lot now that this year’s budget will be what it can be, and it will be okay, but next year will be really hard," she says. "Congress is so eager to be helpful by spending all of these resources on fighting bioterrorism, providing relief to the families in New York and Washington, and sustaining businesses in our economy," Ehrmann adds. "But when they come back next year, there will be questions about how to support all of these things without taking away from other programs."

Then there are the repercussions that might be cause for optimism. For example, it is possible that the nation’s focus on bioterrorism will lead to increased funding for public health departments, which could be a first step in rebuilding the public health infrastructure. This would benefit HIV/ AIDS issues, as well as preventing outbreaks of anthrax and smallpox, Ehrmann suggests.

"The IDSA’s position is that one of the best ways to prepare for a response to bioterrorism is to maintain the public health infrastructure," Vogel says, adding that he doubts the federal government will make any meaningful changes to boost health departments. "It doesn’t seem very likely," Vogel says. "The response so far has been more specific, such as stockpiling antibiotics for treating anthrax."

Patent laws might be weakened

Another repercussion could be a weakening of federal pharmaceutical patent laws through the precedent of the government strong-arming Bayer Corp. into lowering the price on its antibiotic ciprofloxacin (Cipro) from $1.77 per tablet to 95 cents per tablet sold to the federal government. The deal, arranged near the end of October, was a compromise that was expected to prevent the government from pushing Bayer to allow generic versions of its drug to be made, thus breaking its patent.

"The reason the Bush administration and Bayer are so unwilling to have Bayer’s patent broken on Cipro is because they know the impact it will have on the discussion about AIDS drugs," Ehrmann says. "They’re not going to be able to support maintaining HIV drug patent law over 25 million people around the world, whereas we have a limited number of people here who have been exposed to anthrax," Ehrmann adds.

That very issue was raised at the October IDSA conference in San Francisco, Vogel says. "One speaker said that in AIDS communities in other countries there has been a push for years to get generic drugs available, while it sounds like for a handful of anthrax cases in the last couple of weeks, we’re on the brink of getting generic ciprofloxacin," Vogel says.