Friday, October 21, 2005

Bush's Funny Numbers

HIV/AIDS Domestic Allocation and President George W. Bush:
Lives Hanging in the Balance

The media and the Whitehouse praise President George W. Bush for his efforts on the domestic front to combat the HIV/AIDS epidemic. But, then I pulled out my books. Globally, says the Carnegie Council on Ethics and International Affairs, developed countries have an obligation on historical grounds to provide monetarily for other countries. Both President Bush and former President Clinton make seemingly large global commitments to the cause; however, the domestic numbers for the current President are misleading.

Current government officials don't help to clarify either. Vice President Cheney publicly admitted in his debate with former Sen. John Edwards in the 2000 presidential race that he knew nothing of the epidemic's effect on African Americans, especially women. And, Bush's pledge, first mentioned publicly in his 2003 State of the Union address, along with Health and Human Services Secretary Leavitt's label of HIV/AIDS as a "top priority," upon Bush's recommendation to extend the Ryan White Care Act (RWCA) earlier this summer, have not yet become reality.

According to the Black AIDS Institute, the RWCA increased yearly under Clinton, and has decreased with Bush, with the President increasing international aid, and decreasing domestic aid. They claim, in accordance with Bush's 2003 pledge to increase global spending by $15 billion by 2008, the 2005 budget recommendations by the President did call for an increase in RWCA funding, but most was international and 75% went to "core medical services"—a concept not defined, posits editor Kai Wright. In addition, they demonstrate, the budget indirectly cuts many related services like transportation, prescriptions drugs, and food banks that are critical to people living with HIV/AIDS.

Johns Hopkins University AIDS Service says the RWCA, originally passed 8.18.90 by Congress is "designed to improve the quality and availability of care for persons with HIV/AIDS and their families," and that the Act is separated into four titles based on metropolitan rates, individual need, and medical support available. The Bush Administration and the Republican National Committee claim "The President's continued commitment to combating HIV/AIDS domestically is reinforced in his budget for FY 2005 with $17.1 billion in funding for domestic AIDS research, care, prevention, and treatment—an increase of 27% since 2001." But this is very misleading.

In comparison with his predecessor, Bush has done an exceedingly bad job of leveling domestic HIV/AIDS funding. Being a discretionary item, by law, the RWCA must be re-evaluated and extended every five years, with yearly caps on spending, according to the Henry J. Kaiser Foundation. While Bush requested 19.8 billion for domestic and global funding for 2005, that is less than a 1% of the total federal budget, and only a 7% increase since 2004. Other entitlement social programs like Medicaid (the largest health coverage option of people living with HIV/AIDS), Medicare, Social Security Disability Insurance, and Supplemental Security Income received 51% of the funds or $10.1 billion, and 49% was discretionary.

Increase in funding is not novel, and should not be applauded, yet analyzed critically. My calculations, comparing the Clinton and Bush Administrations in their domestic commitment to Title II (HIV Care) of the RWCA, which allocates funds to extend and save the lives of HIV infected persons, suggest Clinton, on average increased HIV Care funding by 30.9% and total RWCA funding by 24%. Bush, on average, increased HIV Care by 5.7% since 2001, and total RWCA spending by 3.5%. The 27% he and the GOP account for, is the total of percent increase in total RWCA funding since 2001, not the average per year. For Clinton, that figure is 191.7%. (HRSA, Dept. of Health and Human Services RWCA Appropriations History: FY 1991 to FY 2005).

Bush has improved in other areas, however. The FDA approved Viread for HIV-1 infection in 2001, a new rapid HIV test kit in 2002, a new therapy, Aptivus, for HIV patients with advanced disease in June 2005, and just this month the first pediatric generic drug for U.S. marketing. Still, Bush Administration problems, with the commissioner of the FDA, Lester M. Crawford, resigning this month, may affect the FDA's implementation of these new policies.

With Katrina, Rita, and Iraq, it's doubtful to expect Bush to make significant changes in his appropriations of the RWCA or sustaining HIV + citizens' lives. Not only does his less than 1% of the federal budget allocation of HIV/AIDS funding severely under-estimate the scope of the epidemic, but it leaves lives in the balance.

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