A presidential administration run by Texas Gov. George W. Bush (R) could mean the end of the Office of National AIDS Policy and the President's Advisory Council on AIDS, an AIDS Policy & Law newsletter reports. These are just two of the ways in which a Bush presidency, as well as the changing makeup of Congress, could affect HIV/AIDS policy. According to AIDS Policy & Law, "Few expect Bush to renew" the advisory council, which issued its final report last month. The Office of National AIDS Policy might not survive even if Vice President Al Gore takes office, as one activist questioned whether it is still "needed any longer." Sandra Thurman, national AIDS policy director and special diplomatic envoy for AIDS assistance abroad, would not be retained in a Bush administration because she "is seen as too closely associated with President Clinton," the newsletter writes. Two departures that are "certain" under a Bush presidency are Surgeon General David Satcher and Timothy Westmoreland, director of Medicaid for the Health Care Financing Administration. Westmoreland has "worked on AIDS issues since the early days of the epidemic" and "sought to extend [Medicaid] to include people with HIV." Claude Earl Fox, head of the Health Resources and Services Administration, which oversees the Ryan White CARE Act, is "likely to depart, though not immediately." One possible nominee for either HHS secretary or surgeon general in a Bush administration, according to the newsletter, is Antonia Novello, who served as surgeon general for former President George Bush and is currently the state health commissioner in New York. One analyst told the newsletter, "She would be great for HIV/AIDS issues," though another said Novello's support for needle-exchange programs and her "outspokenness about how homophobia contributes to the spread of the epidemic" make her an unlikely choice.

Congressional Changes
In the House, Rep. John Porter (R-Ill.), who chaired the Labor/HHS subcommittee for appropriations that oversees spending on most HIV research, treatment and care programs is retiring at the end of this term. He also was a "strong advocate for increased funding at the NIH." Also departing is Rep. Tom Coburn (R-Okla.), thus leaving a "void in the House Republican ranks on HIV policy development." In co-sponsoring the reauthorization of the Ryan White CARE Act, Coburn "pressed for provisions that emphasized prevention, revised the funding formula for grants and gave states financial incentives to test newborns for HIV." Rumors have arisen that Coburn, a physician, may be appointed HHS secretary in a Bush administration, although a Coburn spokesperson called such speculation "premature" (AIDS Policy & Law, 11/24).