AIDS Prevention, Conservatively
This column was written by Alyson Zureick.
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.
"This shift seems to send a message that we'll only educate you after you're infected," Oatman said. "The CDC is under pressure to reduce infections, but the new guidelines have made it clear that young adults are not a priority even though their data shows that half of all new infections happen under the age of 25."
The CDC, however, argues that it needs to focus on those who are already infected in order to make progress against the disease.
"Today about a quarter of the people who are HIV-positive don't know that they are positive," CDC spokeswoman Jessica Frickey said. "We need to get them connected to the services and knowledge they need to deal with this disease if we want to see a decrease in new cases. This doesn't mean there has been any indication that the CDC prevention focus is going to change from its comprehensive approach."
The shift away from prevention education is of a piece with many pro-abstinence policy decisions made by the Bush administration. In the last four years, funding for abstinence programs has more than doubled, from $80 million in fiscal year 2001 to $168 million in FY2005, while HIV/AIDS treatment, care, and prevention programs have mostly been flat-funded. The CDC's condom Web site was edited to emphasize abstinence, and its site on effective educational programs was removed altogether.
More troublingly, in 2002 and 2003 several leading AIDS organizations faced repeated audits. Around the same time, 150 National Institutes of Health-funded researchers were placed on a "hit list" given to the House Committee on Energy and Commerce by a group called the Traditional Values Coalition. The coalition deemed the researchers' work on sexual behavior and HIV controversial.
And in June 2004, the CDC introduced new regulations that required groups receiving federal funding to submit all educational materials to review boards staffed by state and local health officials in addition to the prevention experts who currently review programs. While the policy has not yet gone into effect, its repercussions seem obvious.
"These guidelines could be very dangerous," Riggs said. "If you live in a conservative community, you will basically have duct tape on your mouth."
The abstinence focus is not the only obstacle, of course; the amount of money that goes to abstinence programs is only a fraction of the funds needed for comprehensive prevention, treatment, and care services. And HIV/AIDS programs are not the only ones strapped for funding; as Murray Penner, director of the care and treatment program at the National Alliance of State and Territorial AIDS Directors, points out, most public-health programs are in similar straits.
But it is significant that an administration that has heralded itself as an international leader in the fight against HIV/AIDS has done so much to undermine the cause at home. It has dramatically increased funding for abstinence-only education while flat-funding crucial prevention and treatment programs. It has harassed community organizations working on HIV prevention. And while right-wing attacks have not completely destroyed the bonds of cooperation between the CDC and community organizations (many community organizers are quick to point out the strains the CDC itself faces from a tight budget and an ideological administration), there is a sense of caution among advocates when they talk about CDC policies. In this environment, it is difficult for many of them to tell just where science ends and dogma begins.
"This administration is trying to reinforce a certain conservative ideology, and that is not an appropriate use of federal funds," Riggs said. "At the end of the day, they are putting peoples' lives at risk."
Alyson Zureick is a Prospect intern and a senior at Princeton University.
Reprinted with permission from The American Prospect, 5 Broad Street, Boston, MA 02109. All rights reserved