II. HIV/AIDS Policy
Log Cabin
Republicans
Legislative Watch
Background Since taking control of Congress in 1994, the
Republican Majority has made HIV/AIDS policy a top legislative priority,
particularly the areas of treatment access, care, research, minority
community outreach and women and children with HIV/AIDS. The GOP has built
a solid record on AIDS policy, uniting conservative and centrist
Republicans behind sound policy goals, and bringing along most Democrats
including, on the issue of minority outreach, the Congressional Black
Caucus.
The major legislative programs have been the Ryan White CARE Act
authorization and appropriation and National Institutes of Health
appropriations, which the GOP Congress has funded at levels hundreds of
millions of dollars higher than Clinton budget requests since 1995. Along
with prevention funding for the Centers for Disease Control, these
programs are funded through annual Labor/HHS appropriations. Furthermore,
as a general principle, GOP AIDS policy has been governed by setting clear
priorities --- saving lives over saving bureaucracies, partnership with
Governors and state and local governments in building a broad coalition
with industry and HIV/AIDS patient advocates community, and doubling the
federal health research budget across the board. Since the GOP takeover,
the national AIDS death rate has plummeted by almost 70%.
These policies have been a success. We should stay the
course.
President Bush has embraced these principles, and LCR pledges to work
closely with Health and Human Services Secretary Tommy Thompson to
continue successful GOP AIDS policies.
A. Treatment and Care
-- The Ryan White CARE Act, reauthorized by the GOP Congress in
1996 and 2000, remains a top legislative priority. This is the anchor of
the federal HIV/AIDS response, providing necessary funds to state and
local authorities for patient access to vital treatment and care-related
services. Reforms made under the bipartisan 2000 Coburn-Waxman-Jeffords
reauthorization focused the Ryan White program even more on providing more
efficient delivery of life-saving HIV/AIDS drug treatments, HIV drug
regimen compliance education for patients and clinical personnel, viral
load testing, more equitable funding across all the states and territories
and greater accountability standards.
The AIDS Drug Assistance Program (ADAP) is a key element of Ryan
White. It is a program where federal funds are sent to state and
territorial governments to support patient access to life-saving HIV/AIDS
drug treatments when patients do not qualify for Medicaid and are
uninsured or underinsured. It is a major success story of the Republican
Party, particularly between Congress and GOP Governors who have added
state appropriations or designed effective programs to ensure the greatest
number of patients in need getting access to the drugs they need. ADAP
must continue to be a major appropriations priority each year.
-- Minority Outreach: Congress has also addressed a growing
problem of less efficient care and treatment access available to African
American patients in the Ryan White CARE Act system. A bipartisan
initiative, spearheaded by then-Rep. Tom Coburn (R-OK) and the
Congressional Black Caucus, was first passed in FY 1999 to target funding
for enhancing health care delivery in AIDS service organizations serving
African American communities, and increasing black enrollment in the ADAP
program. The program also targets dollars to prevention programs. This
effort has proven to be successful since its passage and should continue
to be supported.
-- Opposition to Drug Price Controls: Log Cabin Republicans
strongly opposes all forms of price controls on breakthrough drug
treatments, and has made this a major legislative and political priority
since the opening of our national office in 1993. Private industry has
been the driving force behind the life-saving breakthroughs in HIV/AIDS
treatments, and any form of government price controls, direct or indirect,
inhibits capital flowing to private research in the pharmaceutical
industry and the biotech industry. Price controls create an inherently
hostile environment for new and better treatments for fatal diseases, and
lead to less innovation, more deaths and greater suffering for patients.
LCR continues opposing all forms of price controls on breakthrough
drugs proposed by Democrats in Congress, and President Bush should veto
any legislation that contains price controls.
-- Opposition to Reimportation of Drug Treatments without Safety and
Quality Standards: Log Cabin Republicans has always sought to speed
drugs to needy patients, while at the same time insuring that those drugs
are safe and effective. Allowing for the reimportation of drugs through
third countries in order to reduce prices could easily result in
adulterated, mismeasured and unsafe drug therapies making their way into
the United States. This would pose a public health threat most seriously
to terminally ill patients, like those with HIV/AIDS, who rely on
effective and safe drug therapies to live.
LCR opposes reimportation of drugs into the United States without
strict quality and safety standards being applied in advance, and without
strong curbs on drugs not approved by the FDA, and without steps taken in
advance to prevent cross-border industries that adulterate or mismeasure
drugs and reimport them into the United States.
- Back to Work Programs for People with HIV/AIDS: Because of the
advent of breakthrough HIV drug treatments, thousands of AIDS patients
previously living completely on disability are seeing such great
improvement in their health that they are able to return to work, but may
have difficulties in transitioning to private insurance from federal
treatment support without disruption in their complex drug regimen. In the
106th Congress, then-Rep. Rick Lazio (R-NY) sponsored the Work Incentives
Improvement Act which passed by a wide margin. It extends Medicaid
eligibility to people with disabilities (which includes people with AIDS)
for periods of 4 to 10 years after they return to work. The bill also
allowed states to find ways to extend Medicaid to those not considered
disabled under the federal definition but have medical problems that are
"reasonably expected" to become severely debilitating.
LCR supports efforts to assist people with HIV/AIDS to return to
work and transition to private health insurance in a way that ensures no
disruption to their treatment regimen.
B. Prevention
The Centers for Disease Control administer federal HIV/AIDS prevention
programs, funded annually. These programs are an important part of the
overall federal AIDS strategy. Prevention, like treatment and care, must
be a partnership between federal, state and local governments, with
flexibility allowed to local communities on how best to stop new HIV
infections. AIDS advocacy groups have criticized the Clinton
administration for not giving the same priority to prevention programs as
given treatment, care and research. The Clinton Administration joined the
GOP Congress in opposing federal funding or authorizing the HHS Secretary
to order any programs involving needle exchange to prevent HIV infection
among IV drug abusers. Republicans in Congress are divided on the efficacy
of needle exchange programs. Also, there are divisions among AIDS
advocates on the inclusion of abstinence education in HIV prevention
programs.
Also, the bi-partisan Coburn-CBC initiative to target funding to the
African American community includes important prevention-related funding.
LCR urges greater focus on building a successful HIV prevention
strategy at the federal level. The Bush administration and Congress should
expand HIV prevention programs in the coming years. Such programs may
include abstinence training, but not at the expense of a wider and
specific prevention education program that may or may not be targeted to
specific groups and communities.
-- Continued GOP Support for HIV/AIDS research at National
Institutes of Health: Since the GOP takeover of Congress, the
Republican Majority, led by Senator Arlen Specter (R-PA), chairman of the
Senate Labor/HHS appropriations subcommittee, and Rep. John Porter (R-IL),
chairman of the House Labor/HHS Subcommittee (who retired in 2000), have
made all health research funding at the National Institutes of Health a
major priority, pledging to double NIH funding by 2003. The success
stories in research on HIV/AIDS have been significant, and work is
underway on the discovery of an HIV vaccine.
LCR supports the continuation of GOP prioritization of NIH funding,
and urges the continued support of HIV/AIDS research programs, especially
the HIV vaccine development effort.
E. Global AIDS/AIDS in Africa
There have been huge breakthroughs in the advancement of HIV/AIDS drug
therapies in the past decade, directly resulting in dramatic reduction of
the AIDS death rate in the United States and many developed countries. But
breakthroughs in the area of science cannot guarantee immediate results
without the necessary health care infrastructure to deliver treatments to
those who need them to live. Without the existing health care
infrastructure in place in the United States, issues of access would be
virtually impossible to address. And such is the root cause of the
spiraling disaster in Africa and the developing world, where AIDS is
quickly growing beyond a health care issue to become a full-scale
geopolitical crisis.
The 1999 Annual Report by the United Nations Childrens' Fund (UNICEF)
found that the global death toll for HIV/AIDS stands at 14 million today,
with 11 million occurring in Africa alone. The World Health Organization
has labeled HIV/AIDS the world's "most deadly infectious disease," making
it the fourth leading cause of death in the world today.
In South Africa, 3.6 million citizens are HIV-positive, with 1,500 new
infections daily. The virus will have infected 20 percent of the South
African workforce by the end of this year. In Zimbabwe, 1 out of 5 adults
is HIV-positive, with a weekly death toll of 1,400 people from AIDS. Life
expectancy rates in Botswana, Malawi, Zimbabwe, Zambia and Swaziland have
dropped from 65 to 40 -- the lowest life expectancy rates in the world --
due to high HIV/AIDS mortality rates. And for the next generation,
1,800 babies are born HIV-positive every day in Africa, and HIV/AIDS alone
will double infant mortality rates in sub-Saharan Africa and triple child
mortality rates across the African continent. AIDS orphans in Africa will
number in the tens of millions by 2010.
Unless something is done to change the status quo, HIV/AIDS will reduce
by one-fourth the values of the economies of sub-Saharan African nations.
In Africa, the problem is much more complex, more deeply entrenched, and
cannot be solved by funding alone, nor by government-to-government plans
alone. A comprehensive solution must quickly address the lack of any
health care delivery infrastructure that can handle the
epidemic as it exists today in Africa, and must bring non-government
partners together in systems that will be minimally impacted by factors
such as politics, government inefficiency and corruption, which have
undermined anti-famine and other previous relief efforts in Africa.
In part, the same reasons can be applied to the concept of price
controls and compulsory licensing. By forcing price controls and
compulsory licensing under current delivery conditions in Africa,
AIDS drug treatments are guaranteed to become another measure of the
privileged classes of African societies, where those favored by the
current delivery system will have marginally better access to treatments
while others less favored will continue to be denied. In short, advocates
of compulsory licensing and price controls as a remedy for the AIDS crisis
in Africa show a dangerous lack of understanding of the depth of the
real problem -- one of a missing health care infrastructure that must
be in place before any infusion of treatments can actually reach the
people who need them. Not only would price controls fail to address the
real problem, but they are destructive to global progress by
slowing and holding back continued drug research and development. We
cannot forget that every breakthrough therapy being used today was funded
and manufactured by the private sector, and would not have made it to
market as quickly or with such efficacy in an environment of price
controls.
Clearly, the best solution would be one which addresses the real
problems in delivering vital treatments to the people who need them, and
involves partnerships that can ensure a long term structural solution that
can grow largely independent of potential corruption or political
interference. LCR strongly backs the current international initiative
involving five pharmaceutical manufactures, five leading United Nations
agencies and governments of African nations to build health care delivery
infrastructures in order to curb the AIDS pandemic. The manufacturers have
guaranteed quality HIV/AIDS drug treatments priced appropriately, while
the U.N. agencies have pledged oversight and provisions to increase
international investment in infrastructure and technology. Participating
governments have pledged to ensure that the care and treatment gets
directly to the patients in need and that drugs, technology and funding
are not diverted from their primary purpose. This initiative is leading to
infrastructure development in Senegal and Uganda.
LCR strongly supports this international initiative, and urges
Congress and the Bush Administration to back its expansion across the
African continent.
Pharmaceuticals are only part of the larger need. Beyond the drugs
themselves, there is a tremendous lack of basic technology to track
casework and ensure proper treatment compliance patient-by-patient.
Computer and internet technology companies should join with academic
research and medical institutions to fill this glaring technological gap,
which is essential to effective HIV/AIDS treatment and is largely
non-existent in Africa. Also, much greater incentives should be available
for corporations of all kinds to directly fund independent U.S./African
academic partnerships to train more clinical personnel in Africa on the
basics of wide-scale HIV/AIDS casework.
Partnerships that involve private corporations (which have the
technology, resources and materials necessary), African academic and
medical institutions (which have the in-country scientific base of
knowledge in Africa), health care organizations and non-government relief
agencies (which have the field experience in Africa to understand the
needs and the obstacles) are needed to turn this tragedy around. And the
role of the U.S. government should not be to create, run and fund the
system -- which is a proven recipe for failure and inadequacy -- but to
create bold incentives in the form of tax relief and other inducements for
major U.S. corporations to take on larger scale projects like the
international U.N. initiative in Africa, in close consultation with health
care professionals in Africa and AIDS policy and health care delivery
experts in the United States.
In sum, LCR opposes compulsory licensing and all other forms of
price controls on HIV/AIDS drug therapies in the developing world,
and supports bold action by the United States and other nations to
forge international public/private partnerships to ensure the building
of adequate health care delivery infrastructures in AIDS-affected parts of
Africa and other nations as a necessary first step.
F. FDA Reforms
LCR was the only gay or AIDS advocacy organization to back bi-partisan
reform of the Food and Drug Administration's breakthrough drug approval
process in 1997. The reforms passed that year were a vital step forward in
ensuring greater access to life-saving treatments by terminally ill
patients without other options for survival. The FDA has had a history of
slow, bureaucratic approval processes that left many terminally ill
patients, including people with HIV/AIDS, without any legal treatment
options. Many people died who could have accessed safe, effective drugs
that were stuck in the approval pipeline.
The bi-partisan reforms, championed by Republicans in the House and
Senate, have significantly improved treatment access. Continued
implementation of the legislation should go on, and LCR supports the
appointment of pro-reform FDA Commissioners.
F. Retention of the White House Office of National AIDS Policy.
The White House Office of National AIDS Policy (known as the office of
the "AIDS czar") has become an important focal point of federal AIDS
policy since its creation early in President Clinton's first term. As the
AIDS epidemic has grown and changed, the Director of the Office of
National AIDS Policy has played the role of chief advocate for
administration priorities and accomplishments, bringing focus to problems
and solutions laid out by the administration in the HIV/AIDS field.
It will be a major asset to the Bush Administration, and we support the
Office's retention.
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