This was supposed to be a milestone year in the fight against AIDS. In 2001, the Centers for Disease Control and Prevention (CDC) announced that it intended to intensify its prevention programs in order to cut new HIV infections in half by 2005. Instead, the number has held steady at 40,000 a year since 1998. Just this June, the CDC announced that, for the first time since the 1980s, more than 1 million people in this country are living with HIV or AIDS. This number partly reflects the fact that, thanks to medical advances, more people are living longer with the disease, even though public treatment and care programs for HIV-positive individuals -- such as the Ryan White CARE Act and Medicaid -- are massively strained for funds.
But they also represent a huge step backward on an essential front: prevention. Activists fear that the Bush administration is more concerned with ideology than prevention -- and that it is using institutions like the CDC to discourage organizations from broadcasting prevention messages that go against the administration's conservative ideology.
The San Francisco-based Stop AIDS Project is a case in point. For years the organization, which works with gay and bisexual men at risk for HIV/AIDS, was considered the gold standard in HIV prevention. Stop AIDS began receiving federal funding from the CDC in 1992, according to spokesman Jason Riggs. A few years later, program staff and volunteers launched a number of projects that would become national program models for the CDC.
But in August 2002, after a decade of working with the CDC, Stop AIDS was hit with three successive audits, instigated by Indiana Congressman Mark Souder, who claimed that Stop AIDS was using federal funds to finance programs promoting sex. The organization passed each audit with flying colors, Riggs said, but still, in June 2003, the CDC informed Stop AIDS staff that they would have to end prevention workshops deemed too risqué or risk losing federal funding.
In the end, Riggs said, nothing came of the threats. Yet last summer, several of Stop AIDS' programs were ruled ineligible for federal funding because of a shift, initiated last year by the CDC, in the types of community prevention programs eligible for federal funds.
Known as "Advancing HIV Prevention," the guidelines redirect the federal prevention funding available to private community organizations away from groups working primarily on education and counseling and to community health clinics and organizations focused instead on HIV testing. Critics of the policy, like Terje Anderson, executive director of the National Association of People with AIDS, see the strategy as a way for the CDC to quietly defund the safe-sex education programs that have been controversial within the Bush administration.
"The ideology behind this strategy is all about individual choice, not the environment that shapes these choices," Anderson said. "It ignores how much this disease is about social context."
Dozens of organizations across the country lost funding, and many were forced to cut staff and programs. One of these, the Northern Virginia AIDS Ministry, now reaches 6,500 fewer young adults than before the CDC's decision, according to deputy director Andrew Oatman.