FASTFAX is available by fax in the 215 and 610 area codes at no cost, or by mail anywhere for $20.00 per year, by calling 215-545-6868, and by E-mail by contacting and type the message SUBSCRIBE in the message section. Sources for some information in this issue include AIDS Action Council, Chicago Tribune, and Reuters.
House cuts Medicaid, threatens Ryan White funding
Clinton calls for vaccine in 10 years
"AIDS fraud" task force formed
Chicago AIDS Walk faces racial controversy
Gray to leave HIV Commission post
House cuts Medicaid, threatens Ryan White funding
The House of Representatives passed this week a budget resolution which includes $13.6 billion in Medicaid cuts over 5 years.
The resolution, based on the budget agreement between the Congressional Republican leadership and the Clinton Administration, was expected to pass the Senate by a large margin as this issue of fastfax went to press.
The resolution also cuts funding for what are called "health domestic discretionary programs," including Ryan White CARE Act-funded programs and AIDS research and housing programs. Pennsylvania Republican Arlen Specter has proposed an amendment restoring most of these cuts, which was expected to be acted on Thursday or Friday.
The budget agreement identified funding targets for cuts with some detail on how the cuts may be achieved. Through the resolution passed this week, the House and the Senate will instruct the authorizing and appropriating committees on how much savings they will need to identify, but not exactly how to achieve these savings. The funding levels included in the budget resolution are binding, but the authorizing and appropriations committees will have some significant latitude in determining how to fund specific programs and how to cut or modify others.
No legislation has been developed yet to map out the details of budget cuts to programs like Medicaid and Medicare. Because they are entitlement programs, the only way to get savings out of the program is to change the way the program works through legislation. The final legislation on Medicaid and Medicare will be included in a Budget Reconciliation bill which may be completed by the July 4 recess.
Although legislation has not yet been introduced laying out the details of the $13.6 billion in cuts to the Medicaid program, the AIDS Action Council, the major AIDS lobbying group in Washington, said it is concerned that the cuts will have a negative impact on health care access for people living with HIV/AIDS and other vulnerable populations.
A significant portion of the Medicaid cuts will most likely come from cuts to the Disproportionate Share Hospital (DSH) program, which assist hospitals that provide large volumes of care to uninsured and Medicaid populations. Some states have abused the DSH program by identifying hospitals as DSH hospitals even if they do not provide care to high volumes of people within these populations. Despite the abuses in the program, DSH funding has provided crucial support to hospitals, many of which provide safety-net care for people living with HIV/AIDS. AIDS Action said it is advocating targeting DSH cuts in a manner that will protect those hospitals that provide high levels of care, including uncompensated care, to low income and Medicaid populations.
"Across-the-board DSH cuts will allow further abuses in the program and undermine the ability of public hospitals to provide care to uninsured individuals, undocumented persons and Medicaid clients with HIV/AIDS," the group said.
In addition to the cuts in the DSH program, other state flexibility proposals are being considered as additional sources of Medicaid cost savings. "These flexibility proposals would compromise access and quality of care under Medicaid," AIDS Action said. Some of these proposals would allow Medicaid managed care plans to charge co-payments that would be too costly to individuals who require frequent usage of services and drugs like people living with HIV/AIDS; require individuals who are dually eligible for Medicaid and Medicare to enroll in managed care programs. Currently, these individuals have the option, but are not required to enroll in managed care plans. The majority of people with HIV/AIDS on the Medicare program are also eligible for Medicaid.
Other proposals would eliminate cost-based reimbursement for federally qualified health centers and rural health clinics. These community health centers provide a significant portion of AIDS care in Philadelphia. They have been historically reimbursed for the cost of the services they provide because of the complicated health care needs of the low income individuals and families they serve.
Clinton calls for vaccine in 10 years
Evoking the memory of John F. Kennedy's challenge to Americans to put a man on the moon in the 1960s, President Clinton has promised that the United States would find an AIDS vaccine within a decade.
In a commencement address at Morgan State University, Clinton announced that a special research center would be established at the National Institutes of Health to spur the effort.
"With the strides of recent years, it is no longer a question of whether we can develop an AIDS vaccine -- it is simply a question of when," Clinton said. "And it cannot come a day too soon."
Recalling President Kennedy's May 1961 commitment to send a manned flight to the moon by the end of the decade, Clinton said an AIDS vaccine should be the "first great triumph" of the 21st century.
"He gave us a goal of reaching the moon and we achieved it ahead of time," Clinton told graduates of the predominantly black college. "Today, let us look within and step up to the challenge of our time."
"Let us today set a new national goal for science in the age of biology. Today, let us commit ourselves to developing an AIDS vaccine within the next decade," he said.
Clinton said to help fulfill the goal a dedicated HIV vaccine research and development center would be established at the National Institutes of Health.
Sandy Thurman, director of the White House Office of AIDS policy, said the center would be fully operational within the next several months and initially involve 40 to 50 scientists. It will add about $17 million to AIDS spending, bringing the annual total to $150 million, she said.
"We've had some breakthroughs in research, and so now we are looking at seizing this moment" to begin a focused effort, Thurman said.
Clinton said also that at a summit in Denver in June, he will ask leaders of the world's other big industrial nations to support the AIDS vaccine initiative. The summit will bring together leaders of the United States, Britain, France, Germany, Italy, Canada, Japan and Russia.
"I will enlist other nations to join us in a worldwide effort to find a vaccine to stop one of the world's greatest killers," Clinton said.
Clinton also challenged the U.S. pharmaceutical industry to increase their investment in AIDS-related research. An AIDS vaccine should be part of the U.S. industry's "basic mission," he said.
While applauding Clinton's announcement, the lobbying group AIDS Action said that it "comes on the heels of a budget agreement which offers no priority for biomedical or behavioral research, and the myriad other health care and social services programs that keep tens of thousands of people affected by HIV and AIDS alive and healthy."
ACT UP spokesman Wayne Turner was also critical, noting that the goal of finding a vaccine was not backed up with a commitment of new spending.
"This is a sham and a hoax for Clinton to compare himself to Kennedy and then put no money behind it," Turner said in a telephone interview with Reuters Newsmedia. "Clinton proposed a Manhattan Project to cure AIDS in 1992. If he had started that Manhattan Project back then, we'd be well on our way to a cure now."
Meanwhile, citing the dangers of mixing politics with science, the National Vaccine Information Center (NVIC) says the Clinton Administration is playing politics by issuing his AIDS vaccine call. The 15-year old consumer advocate organization points to the existing annual commitment of 150 million dollars in federal monies to AIDS vaccine research and the creation of a new AIDS vaccine research center at NIH, together with President Clinton's highly publicized call on drug companies to get an AIDS vaccine on the market within a specific period of time, as "a recipe for disaster where government scientists and drug companies are pressured to 'fix' a problem with a solution more based on good politics than good science," according to NVIC co- founder and president Barbara Loe Fisher.
Suggesting that President Clinton's advisors in the Department of Health and Human Services may have failed to completely inform the President about the biological impediments and dangers associated with injecting DNA from HIV into humans via a generic vaccine, NVIC's Fisher added, "America and the world cannot afford to make a mistake on this one. There is a real danger of creating greater harm with an AIDS vaccine that is rushed to market in a vacuum of scientific knowledge than the harm we are already experiencing with AIDS in its current form."
The organization recently called on the Department of Health and Human Services to release information to the public about the contamination of early polio vaccines with monkey viruses. Following an NIH conference in February at which independent U.S. and European scientists presented evidence suggesting contaminated polio vaccines rushed to market in the 1950's may be contributing to the development of brain, bone and lung cancers in adults and children, NVIC asked the Food and Drug Administration to release government records pertaining to the contaminated polio vaccines using rhesus and African green monkey tissues for production.
Of particular interest, notes NVIC, are records relating to the contamination of early polio vaccines with simian immunodeficiency virus (SIV), which is a monkey virus genetically linked to human immunodeficiency virus (HIV ) and AIDS. Some scientists have suggested that HIV -1 is a genetic monkey-human hybrid.
"President Kennedy's national challenge to put a man on the moon within 10 years is not the same as the challenge of developing a safe and effective AIDS vaccine that will not compromise the genetic integrity of humans. While we strongly support scientific research, particularly into the biological mechanism at the cellular and molecular levels of vaccine induced immunity as well as vaccine induced injury and death, we do not support the politicization of the search for a scientifically and socially responsible solution to AIDS.
Setting an artificial deadline for coming up with a solution doesn't foster a reasoned search for that solution," said Fisher.
"AIDS fraud" task force formed
Representatives of local AIDS groups, the state Attorney General's office, and the federal Food and Drug Administration have formed AIDS Health Fraud Task Force to help people with HIV protect themselves against health products or treatments that could be dangerous to them.
The group formed in response to "false or unproven" claims which are associated with treatments which promise to "cure" HIV disease. "These so-called cures usually cost the consumer hundreds of dollars, for therapies that could hurt or even kill them," said Paul Gray, We The People's representative to the group.
The FDA has helped to establish similar groups in Florida and Arizona to educate people living with HIV/AIDS on how to evaluate the claims of products and treatments.
Gray said that the new group will conduct educational workshops and conferences and run media campaigns to raise awareness of approved and non-approved treatments.
Also serving on the committee are Virginia McComb of Philadelphia Community Health Alternatives; Robb Richards of BEBASHI; Kevin Green of the AIDS Activities Coordinating Office; Theresa Holmes and Diana Kola of the FDA, and John Kelly, of the Pennsylvania Attorney General's office.
Chicago AIDS Walk faces racial controversy
by Terry Wilson
(c.) Chicago Tribune
For nearly two years, the Kupona Network operated on the South Side of Chicago as a shell of its former self. Once a respected African American-run agency that set the standard for AIDS services in the black community, it was crippled by multiple leadership changes and poor management.
The organization's final gasp came last month, when it withdrew from the board of AIDS Walk Chicago, forfeiting the potential to reap tens of thousands of dollars in contributions from the annual end-of-summer fundraiser.
Now, as planning builds for this year's walk, Kupona's departure has plunged the fundraiser into racial controversy. Black gay and lesbian activists have charged that without Kupona or another minority-run agency on its board, AIDS Walk is not adequately equipped to respond to the needs in the African-American community, where city statistics show AIDS is, by far, spreading most rapidly.
Members of the Chicago Black Lesbians and Gays advocacy group met last week with AIDS Walk board members to try to resolve the debate.
Organizations on the AIDS Walk board -- which now total 12 -- have in the past received about three-fourths of the money raised each year, with the rest going toward administrative costs and to the AIDS Foundation of Chicago.
This year, organizers hope to raise $2 million through corporate contributions and pledges when thousands of volunteers walk 6.2 miles along the lakefront.
But without the involvement of Kupona, which was the only minority-run organization on the board, no black agency is in place to receive a substantial cut of the money. Currently, only one black sits on the AIDS Walk board, a woman representing the Cook County HIV Primary Care Center.
Chicago Black Lesbians and Gays is demanding that Kupona's position be filled by another community-based agency run by minorities.
So far, AIDS Walk board members have not committed to the group's demand. They have agreed, however, to allocate the full share of funds Kupona would have been eligible to earn -- more than $70,000, if the goal is reached -- to HIV/AIDS services in minority communities, said Debbie Hinde, secretary of the AIDS Walk Chicago board.
At the meeting, the board's member agencies also agreed to split only half of the money raised, allowing AIDS Walk to donate a larger share of its proceeds to the AIDS Foundation, which grants funds to agencies, with an emphasis on those serving minorities.
About 17 percent of this year's total -- $340,000, if the goal is met -- will go to the foundation, Hinde said. Last year, AIDS Walk donated $200,000 to the foundation.
"We do feel very strongly that the AIDS Walk should benefit communities of color," Hinde said. "We're committed that there will be services across the city for all people. It's the right thing to do."
Black activists who attended the meeting generally were pleased with the discussion. But they noted there is no guarantee the additional money to the AIDS Foundation will wind up in minority communities.
And leaders still insisted that minority representation on the board is essential.
"People of color need to be intricately involved in decision-making and in the structure and allocation of funds," said Renae Ogletree, co-chair of Chicago Black Lesbians and Gays. "We don't want to affect the ability of the AIDS Walk to raise money for the disease. But if the money is not going to be targeted to the community affected by the disease, we don't care."
At the heart of the debate over control and allocation of resources is the disease's increasing affliction among blacks. The most recent AIDS Surveillance Report compiled by the Chicago Department of Public Health shows that since 1992, more than half of all city AIDS cases have occurred among African-Americans.
"Since 1990, blacks have had the highest rate," according to the report, published earlier this year. "In 1995, the increasing rate for Hispanic people caught up with the declining rate for white people, at around 40 per 100,000 population. Both of these rates are still less than half of the black rate."
For years, Kupona essentially was the only community-based agency combating the AIDS epidemic in black neighborhoods. The group was founded in 1986. Its effectiveness was credited, in part, to its mostly black staff, which many HIV-positive blacks said made them feel comfortable.
At its peak, Kupona ran a residence for people with AIDS and provided case management to help clients get social services.
But the agency poorly weathered several management changes which created internal turmoil. Last year, it suspended services for five months as it changed hands for at least the third time.
Kupona fulfilled a minimal number of obligations to AIDS Walk last year and ended up taking in only $200 in proceeds, while board agencies that met their full obligations, which included raising funds and providing volunteers to promote the walk, each netted more than $70,000.
Nearly all the service providers that founded AIDS Walk in 1989 are located on the North Side, though at least one, Stop AIDS, has satellite offices on the South and West Sides, where the majority of the city's black residents and many Hispanics live. Even the North Side agencies serve a substantial number of African-Americans.
Even so, the demographic shift of the disease requires that more services and resources be rooted in black communities, advocates say.
"The face of this epidemic has changed," said Betty Smith, executive director and founder of the South Side Help Center. "In all fairness, they should open [the AIDS Walk board] up to another organization serving people of color."
Gray to leave HIV Commission post
Sonia Hunt-Gray, manager of the Philadelphia HIV Commission since its founding early last year, announced Wednesday that she will resign from the post in early June.
Gray was responsible for managing the Commission's oversight of over $10 million in federal funding for AIDS services awarded to the Philadelphia region through the Ryan White CARE Act. She was appointed to the post by Jesse Milan, then director of the city's AIDS Activities Coordinating Office (AACO), who himself resigned last February.
Commission members, meeting Wednesday, have asked the city health department to appoint an "interim" manager of the Commission while a national search is conducted for Gray's replacement.
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