[Editor's note:] This is guest post is by William McColl. William D. McColl, Esq., the Political Director of AIDS Action, has worked on HIV/AIDS, alcohol and other drug treatment, and criminal justice reform issues for nearly 15 years. He holds a law degree from the University of Maryland School of Law, a master's in International Relations from Troy State University and bachelor's in Political Science from the University of Michigan.
HIV/AIDS advocates, were left aghast by the President's budget which was released on February 4th. My own organization expressed outrage here.
Now, after steadying our heart palpitations, I suspect that HIV/AIDS advocates in the nation's capital are tempted to brush the budget away. After all, it's Bush's last, and leadership in Congress told us that it's D.O.A. They likely won't pass a final appropriations bill until after the elections or even the inauguration. Given the massive healthcare program cuts no Congress, much less a Democratic one, would follow Bush's lead. However, before we tune the dial to radio ignore, consider this.
First, HIV epidemic basic facts: 1) people living with HIV are living longer, healthier lives (due to increasing outreach and new medications' effectiveness) and 2) the infection rate has been holding steady or increasing for 10 years. Sadly, the Centers for Disease Control and Prevention (CDC) will be releasing new figures showing that they have consistently underestimated the rate of new infections by 50% or more annually. That means more people are living with the disease, and we need to be increasingly dedicated to preventing it. This budget does precisely the opposite.
One problem is that this budget tries to reset the base of expectations for what can and should be accomplished. The Ryan White CARE Act (which funds treatment of people living with HIV/AIDS) was truly flat-funded for the first time ever. Normally, the CARE Act, even in times of cutbacks, has received additional funding for either the AIDS Drug Assistance Program (ADAP) or for other individual programs of at least $70 million (although many parts of the CARE Act have seen actual declines due to annual across-the-board cuts known as rescissions).
For the first time ever, this year there are proposed cuts of $8 million to Title I (also called Part A) which funds urban areas that have been hard hit by the HIV epidemic. AIDS Education and Training Centers had a proposed cut of $5 million. Concurrently, there would be a gain of $14 million to Title II (Part B) programs which funds states. In short, this funding precedence of "robbing Peter to pay Paul" undermines infrastructure and training. Given the reality of an expensive war and an ongoing recession there will be considerable temptation for the next administration (Democratic or Republican) to play similar budget games. Now is the time to call this strategy out and get our opposition on the record early.
However, the really shocking part of the budget is in HIV prevention. The CDC may now be calculating that there are as many as 60,000 new cases of HIV per year. However, instead of responding to HIV by adopting proven prevention strategies, the President has adopted ideological and ineffective abstinence-only programs and supplemented that failure by banning the use of federal funding for syringe exchange. Most importantly, in this age of increasing HIV infection, the total budget for prevention spending is $692 million which they then cut by a symbolic $1 million. Look, $692 million is unforgivably low before cuts. They even cut the relatively non-controversial funding of prevention for viral hepatitis by $800,000. Our lack of a real prevention effort is completely unacceptable.
We could go on. HIV/AIDS Research? Flat funded. Medicare and Medicaid which also fund HIV/AIDS treatment? Cuts of hundreds of billions of dollars. All this goes to say that we don't do public health in the United States. We don't use science; we barely treat and we won't prevent.
We need to do more than respond with clucking tongues. We need to make it plain to Congress and the next President that this is an inadequate response to a 100% preventable, infectious, deadly, incurable and slowly growing disease. We must escape from the low expectations set by this and previous budgets. Even going back to the "standard" increases of previous years is insufficient to meet the U.S.'s treatment, prevention and research needs.
To that end, AIDS Action and numerous other organizations are focusing on the creation of a new "big idea." We want the country to commit to fully combating this disease. First by creating a National AIDS Strategy that will lay out achievable goals and create real accountability for the federal agencies tasked with fighting HIV/AIDS. Then the real work begins. We must fund that strategy at levels to execute it successfully. Currently, both Democratic candidates have agreed to create such a strategy. We urge people to ask Senator McCain to do so as well.
And now, let's bury this final Bush budget. On to a new strategy and on to the appropriations battle where we intend to reset Congress's sights a lot higher.